Finger Burns Caused By Concentrated Hydrofluoric Acid, Treated With Intra-arterial Calcium Gluconate Infusion: Case Report [queimadura Digital Por ácido Fluorídrico Concentrado Tratada Com Infusão Intra-arterial De Gluconato De Cálcio: Relato De Caso]

Context: Hydrofluoric acid (HF) is widely used in industry and at home. Severe lesions can occur after contact with highly concentrated solutions, leading to tissue necrosis and bone destruction. Specific treatment is based on neutralization of fluoride ions with calcium or magnesium solutions. Case report: A 41-year-old male was seen at the emergency department 35 minutes after skin contact with 70% HF, showing whitened swollen lesions on the middle and fourth fingers of his right hand with severe pain starting immediately after contact. 2.5% calcium gluconate ointment was applied. Twenty-four hours later, the patient was still in severe pain and the lesions had worsened. Considering the high concentration of the solution, early start of severe pain, lesion characteristics and impossibility of administering calcium gluconate subcutaneously because of the lesion location, the radial artery was catheterized and 2% calcium gluconate was administered via infusion pump for 36 hours, until the pain subsided. No adverse effects were seen during the procedure. Ten days later, the lesions were stable, without bone abnormalities on X-rays. Six months later, a complete recovery was seen. Conclusions: Intra-arterial calcium gluconate might be considered for finger burns caused by concentrated HF. Complete recovery of wounded fingers can be achieved with this technique even if started 24 hours after the exposure. However, controlled clinical trials are needed to confirm the effectiveness and safety of this intervention.1276379381Anderson, W.J., Anderson, J.R., Hydrofluoric acid burns of the hand: Mechanism of injury and treatment (1988) J Hand Surg Am, 13 (1), pp. 52-57Sheridan, R.L., Ryan, C.M., Quinby Jr., W.C., Blair, J., Tompkins, R.G., Burke, J.F., Emergency management of major hydrofluoric acid exposures (1995) Burns, 21 (1), pp. 62-64Lin, T.M., Tsai, C.C., Lin, S.D., Lai, C.S., Continuous intra-arterial infusion therapy in hydrofluoric acid burns (2000) J Occup Environ Med, 42 (9), pp. 892-897Roblin, I., Urban, M., Flicoteau, D., Martin, C., Pradeau, D., Topical treatment of experimental hydrofluoric acid skin burns by 2.5% calcium gluconate (2006) J Burn Care Res, 27 (6), pp. 889-894Vance, M.V., Curry, S.C., Kunkel, D.B., Ryan, P.J., Ruggeri, S.B., Digital hydrofluoric acid burns: Treatment with intraarterial calcium infusion (1986) Ann Emerg Med, 15 (8), pp. 890-896Graudins, A., Burns, M.J., Aaron, C.K., Regional intravenous infusion of calcium gluconate for hydrofluoric acid burns of the upper extremity (1997) Ann Emerg Med, 30 (5), pp. 604-60

Neuroanatomical abnormalities in first-episode psychosis across independent samples: a multi-centre mega-analysis

Abstract Background Neuroanatomical abnormalities in first-episode psychosis (FEP) tend to be subtle and widespread. The vast majority of previous studies have used small samples, and therefore may have been underpowered. In addition, most studies have examined participants at a single research site, and therefore the results may be specific to the local sample investigated. Consequently, the findings reported in the existing literature are highly heterogeneous. This study aimed to overcome these issues by testing for neuroanatomical abnormalities in individuals with FEP that are expressed consistently across several independent samples. Methods Structural Magnetic Resonance Imaging data were acquired from a total of 572 FEP and 502 age and gender comparable healthy controls at five sites. Voxel-based morphometry was used to investigate differences in grey matter volume (GMV) between the two groups. Statistical inferences were made at p < 0.05 after family-wise error correction for multiple comparisons. Results FEP showed a widespread pattern of decreased GMV in fronto-temporal, insular and occipital regions bilaterally; these decreases were not dependent on anti-psychotic medication. The region with the most pronounced decrease – gyrus rectus – was negatively correlated with the severity of positive and negative symptoms. Conclusions This study identified a consistent pattern of fronto-temporal, insular and occipital abnormalities in five independent FEP samples; furthermore, the extent of these alterations is dependent on the severity of symptoms and duration of illness. This provides evidence for reliable neuroanatomical alternations in FEP, expressed above and beyond site-related differences in anti-psychotic medication, scanning parameters and recruitment criteria