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ELECTRIC SHOCK TREATMENT FOR SNAKE BITE
1022
(Western diamondback rattlesnake) venom in 3 ml saline, and given equivalent injections of Agkistrodon piscovorus (Cottonmouth moccasin) venom. 20 min after the injection, two dogs from both groups were given five electric shocks of 1-3 s duration at 5-10 s intervals from a stun gun, described by
atrox
three were leukostoma
Pain score (visual analogue) in infusion (arrows).
patient given pamidronate by
assessed by a visual analogue scale. Another infusion was given 7 days later and the pain intensity continued to decrease. However, 2 weeks after the second infusion the pain intensity started increasing again. On further cycles of pamidronate every 2 to 3 weeks his pain was controlled (figure). The doses of opioids and non-steroid anti-inflammatory drugs were kept constant during the visual analogue assessment. Serum calcium levels also remained normal during the assessment of pamidronate. Then increasing neurological signs of spinal cord involvement developed, with excruciating bladder spasms and urinary tract infection, and he died 16 weeks after being started on pamidronate. Pamidronate, by osteoclast inhibition, decreases osteolysis and permits bone healing. Studies have shown beneficial effects in lowering hypercalcaemia due to malignancy, 1-3 and in reducing symptoms from Paget’s disease. Some patients with bone metastases from breast carcinoma have also experienced pain reduction with the use of pamidronate.4 Our experience suggests that pamidronate can reduce pain due to bone metastases from prostatic carcinoma. Department of Medical Oncology, St Bartholomew’s Hospital, London EC1A 7BE; and Homerton Hospital, London E9
T. MASUD M. L. SLEVIN
1. Sleeboom
HP, Bijvoet OLM, van Oosterom AT, Gleed JH, O’Riordan JLH. Comparison of intravenous (3-amino-1-hydroxypropylidine)-1,1-bisphosphonate and volume repletion in tumour-induced hypercalcaemia. Lancet 1983; ii: 239-43. 2. Coleman RE, Rubens RD. 3(amino-1,1-hydroxpropylidene) bisphosphonate (APD) for hypercalcaemia of breast cancer. Br J Cancer 1987; 56: 465-69. 3. Cantwell BMJ, Harris AL. Effect of single high dose infusions of aminohydroxypropylidene diphosphonate on hypercalcaemia caused by cancer Br Med J 1987; 294: 467-69. RE, et al. 3 (amino-1,1-hydroxypropylidene) bisphosphonate (APD) for the treatment of bone metastases from breast cancer. ECCO meeting (Madrid, November, 1987); abstr. 5. Morton AR, Cantrill JA, Craig AE, Howell A, Davies M, Anderson DC. Single dose versus daily intravenous ammohydroxypropylidene bisphosphonate (APD) for the hypercalcaemia of malignancy. Br Med J 1988; 296: 811-14.
4. Coleman
Guderian et al. Contraction of the affected muscle was felt and observed as the shocks were applied. One animal from each group was a control. Blood samples were taken at regular intervals over the subsequent 36 h. All four dogs given shocks and the two controls had typical signs and progression of severe, untreated pit viper envenomation. There were no differences in discomfort or mobility of the test dogs or controls. At 36 h post-envenomation, all six dogs were moribund and were killed. Pathology reports on specimens taken from the envenomation sites showed severe necrotising suppurative and acute haemorrhagic cellulitis and myositis. Although our research continues, these findings suggest that the use of electric shock as a recommended treatment for venomous snake bite is at best premature. Whether electric shock is a viable field treatment or should be added to the incredible number of folklore cures for snake bite bears further examination.
University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
RH, Mackenzie CD, Williams JF. High voltage shock treatment for snake 1986; ii: 229. Kroegel C, Meyer zum Buschenfelde K-H. Biological basis for high-voltage-shock treatment for snakebite. Lancet 1986; ii: 1335.
1 Guderian
bite. Lancet
2.
ERYTHROMYCIN RESISTANCE IN GROUP A STREPTOCOCCI of
SiR,—Dr Spencer and colleagues (Jan 21, p 168) report that 97% p-haemolytic streptococci group A in the UK are susceptible to
erythromycin. There are similar reports from the United States.’ Only one major outbreak of erythromycin-resistant group A streptococci has been reported, from Japan.2 In 1988 we found an increase in erythromycin resistance among group A streptococci isolated from throat cultures in the Turku area in Finland (table). In January only 2% of the strains were resistant to erythromycin. By June 16% of group A streptococci were so resistant. The frequency of resistant strains remained over 10% for six months thereafter, decreasing to 4-7% by November// December. All strains were susceptible to penicillin. Susceptibility tests were primarily done by disc diffusion (ROSCO, Taastrup) with ’Iso-Sensitest Agar’ (Oxoid, Basingstoke) supplemented with 5% defibrinated sheep blood agar. About one-third of the resistant isolates, collected consecutively from September, were confirmed to be resistant (minimum inhibitory concentration [MIC] over 16 ug/ml) by MIC plate dilution (Mueller-Hinton agar supplemented with 5% defibrinated sheep blood) as well. Resistant strains were susceptible to clindamycin, which suggests an inducible type of erythromycin resistance. OUTBREAK OF ERYTHROMYCIN-RESISTANT STREPTOCOCCUS PYOGENES IN
ELECTRIC SHOCK TREATMENT FOR SNAKE BITE
SIR,-Popular American outdoor-sports journals have introduced to the public high voltage and low amperage direct current shock (20-25 kV at less than 1 mA) as a field treatment for poisonous snake bites (Outdoor Life June, 1987, and June, 1988; Backpacker, March, 1989). These articles cite the report by Guderian et all on the excellent results they achieved after the application of shocks directly to the bite. Kroegel and Meyer zum Büschenfelde2 proposed that such shocks may influence the hydrogen bonds of the venom enzymes and reduce various ions that are necessary cofactors for these enzymes. We have studied the efficacy of the shock treatment. Six 13-35 kg dogs received simulated snake bites in the thigh. Three dogs had an injection (into tensor fasciae latae) of 30 mg desiccated Crotalus
CLIFFORD C. SNYDER RICHARD T. MURDOCK GEORGE L. WHITE JR JOHN R. KUITU
1988 IN TURKU AREA
(Western diamondback rattlesnake) venom in 3 ml saline, and given equivalent injections of Agkistrodon piscovorus (Cottonmouth moccasin) venom. 20 min after the injection, two dogs from both groups were given five electric shocks of 1-3 s duration at 5-10 s intervals from a stun gun, described by
atrox
three were leukostoma
Pain score (visual analogue) in infusion (arrows).
patient given pamidronate by
assessed by a visual analogue scale. Another infusion was given 7 days later and the pain intensity continued to decrease. However, 2 weeks after the second infusion the pain intensity started increasing again. On further cycles of pamidronate every 2 to 3 weeks his pain was controlled (figure). The doses of opioids and non-steroid anti-inflammatory drugs were kept constant during the visual analogue assessment. Serum calcium levels also remained normal during the assessment of pamidronate. Then increasing neurological signs of spinal cord involvement developed, with excruciating bladder spasms and urinary tract infection, and he died 16 weeks after being started on pamidronate. Pamidronate, by osteoclast inhibition, decreases osteolysis and permits bone healing. Studies have shown beneficial effects in lowering hypercalcaemia due to malignancy, 1-3 and in reducing symptoms from Paget’s disease. Some patients with bone metastases from breast carcinoma have also experienced pain reduction with the use of pamidronate.4 Our experience suggests that pamidronate can reduce pain due to bone metastases from prostatic carcinoma. Department of Medical Oncology, St Bartholomew’s Hospital, London EC1A 7BE; and Homerton Hospital, London E9
T. MASUD M. L. SLEVIN
1. Sleeboom
HP, Bijvoet OLM, van Oosterom AT, Gleed JH, O’Riordan JLH. Comparison of intravenous (3-amino-1-hydroxypropylidine)-1,1-bisphosphonate and volume repletion in tumour-induced hypercalcaemia. Lancet 1983; ii: 239-43. 2. Coleman RE, Rubens RD. 3(amino-1,1-hydroxpropylidene) bisphosphonate (APD) for hypercalcaemia of breast cancer. Br J Cancer 1987; 56: 465-69. 3. Cantwell BMJ, Harris AL. Effect of single high dose infusions of aminohydroxypropylidene diphosphonate on hypercalcaemia caused by cancer Br Med J 1987; 294: 467-69. RE, et al. 3 (amino-1,1-hydroxypropylidene) bisphosphonate (APD) for the treatment of bone metastases from breast cancer. ECCO meeting (Madrid, November, 1987); abstr. 5. Morton AR, Cantrill JA, Craig AE, Howell A, Davies M, Anderson DC. Single dose versus daily intravenous ammohydroxypropylidene bisphosphonate (APD) for the hypercalcaemia of malignancy. Br Med J 1988; 296: 811-14.
4. Coleman
Guderian et al. Contraction of the affected muscle was felt and observed as the shocks were applied. One animal from each group was a control. Blood samples were taken at regular intervals over the subsequent 36 h. All four dogs given shocks and the two controls had typical signs and progression of severe, untreated pit viper envenomation. There were no differences in discomfort or mobility of the test dogs or controls. At 36 h post-envenomation, all six dogs were moribund and were killed. Pathology reports on specimens taken from the envenomation sites showed severe necrotising suppurative and acute haemorrhagic cellulitis and myositis. Although our research continues, these findings suggest that the use of electric shock as a recommended treatment for venomous snake bite is at best premature. Whether electric shock is a viable field treatment or should be added to the incredible number of folklore cures for snake bite bears further examination.
University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
RH, Mackenzie CD, Williams JF. High voltage shock treatment for snake 1986; ii: 229. Kroegel C, Meyer zum Buschenfelde K-H. Biological basis for high-voltage-shock treatment for snakebite. Lancet 1986; ii: 1335.
1 Guderian
bite. Lancet
2.
ERYTHROMYCIN RESISTANCE IN GROUP A STREPTOCOCCI of
SiR,—Dr Spencer and colleagues (Jan 21, p 168) report that 97% p-haemolytic streptococci group A in the UK are susceptible to
erythromycin. There are similar reports from the United States.’ Only one major outbreak of erythromycin-resistant group A streptococci has been reported, from Japan.2 In 1988 we found an increase in erythromycin resistance among group A streptococci isolated from throat cultures in the Turku area in Finland (table). In January only 2% of the strains were resistant to erythromycin. By June 16% of group A streptococci were so resistant. The frequency of resistant strains remained over 10% for six months thereafter, decreasing to 4-7% by November// December. All strains were susceptible to penicillin. Susceptibility tests were primarily done by disc diffusion (ROSCO, Taastrup) with ’Iso-Sensitest Agar’ (Oxoid, Basingstoke) supplemented with 5% defibrinated sheep blood agar. About one-third of the resistant isolates, collected consecutively from September, were confirmed to be resistant (minimum inhibitory concentration [MIC] over 16 ug/ml) by MIC plate dilution (Mueller-Hinton agar supplemented with 5% defibrinated sheep blood) as well. Resistant strains were susceptible to clindamycin, which suggests an inducible type of erythromycin resistance. OUTBREAK OF ERYTHROMYCIN-RESISTANT STREPTOCOCCUS PYOGENES IN
ELECTRIC SHOCK TREATMENT FOR SNAKE BITE
SIR,-Popular American outdoor-sports journals have introduced to the public high voltage and low amperage direct current shock (20-25 kV at less than 1 mA) as a field treatment for poisonous snake bites (Outdoor Life June, 1987, and June, 1988; Backpacker, March, 1989). These articles cite the report by Guderian et all on the excellent results they achieved after the application of shocks directly to the bite. Kroegel and Meyer zum Büschenfelde2 proposed that such shocks may influence the hydrogen bonds of the venom enzymes and reduce various ions that are necessary cofactors for these enzymes. We have studied the efficacy of the shock treatment. Six 13-35 kg dogs received simulated snake bites in the thigh. Three dogs had an injection (into tensor fasciae latae) of 30 mg desiccated Crotalus
CLIFFORD C. SNYDER RICHARD T. MURDOCK GEORGE L. WHITE JR JOHN R. KUITU
1988 IN TURKU AREA