Cases reported "Bites and Stings"

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1/20. The medusa stage of the coronate scyphomedusa Linuche unguiculata ('thimble jellyfish') can cause seabather's eruption.

    adult Linuche unguiculata medusae cause seabather's eruption just like that animal's larval form. This observation explains the wide seasonal incidence and the fact that lesions can appear on exposed skin.
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2/20. Skin and soft tissue artifacts due to postmortem damage caused by rodents.

    Five cases of postmortem bite-injuries inflicted by rodents are presented (five males between 41 and 89 years; three cases caused by mice, one case by rats, one case of possible mixed rodent activity by rats and mice). The study presents a spectrum of phenomenological aspects of postmortem artifacts due to rodent activity to fresh skin and soft tissue: the majority of the injuries have a circular appearance. The wound margins are finely serrated with irregular edges and circumscribed 1-2 mm intervals within, partly showing protruding indentations up to 5 mm. Distinct parallel cutaneous lacerations deriving from the biting action of the upper and lower pairs of the rodents incisors are diagnostic for tooth marks of rodent origin but cannot always be found. No claw-induced damage can be found in the skin beyond the wound margins. Areas involved in the present study were: exposed and unprotected parts of the body, such as eyelids, nose and mouth (representing moist parts of the face); and the back of the hands. Postmortem rodent activity may occasionally be expected on clothed and therefore protected parts of the body. The phenomenon of postmortem rodent activity to human bodies can be found indoors especially under circumstances of low socioeconomic settings; outdoors this finding is particularly observed among fatalities among homeless people.
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3/20. Delayed cutaneous reaction to jellyfish.

    A 57-year-old woman presented with a widespread papulonodular eruption. The dermatitis had appeared about 1 week after her return from a trip to the Red Sea, where she had come into contact with a shoal of unidentified jellyfish; however, that contact had not been followed by cutaneous lesions and/or symptoms. The patient also stated that she had had previous contacts with jellyfish during other trips to exotic seaside resorts. The dermatitis was characterized by papulonodular lesions, round or oval in shape, of a few millimeters in diameter, with a color ranging from pink to red to brown, and with a smooth and regular surface. The lesions were grouped in an apparently random fashion (Fig. 1) or arranged linearly (Fig. 2). The patient complained of pruritus and burning. Histopathologic examination showed the presence of some necrotic keratinocytes; in the upper and mid dermis, edema and a predominantly perivascular and periadnexal lymphohistiocytic infiltrate, with numerous neutrophils and eosinophils, were observed (Fig. 3). The patient was treated with hydroxyzine (37.5 mg/day) and hydrocortisone butyrate, which resulted in the rapid disappearance of the symptoms; however, the cutaneous lesions persisted for about 3 weeks.
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4/20. Analysis of tooth marks in a homicide case. Observations by means of visual description, stereo-photography, scanning electron microscopy and stereometric graphic plotting.

    In 1957 a woman was murdered in Oslo. Her left breast exhibited tooth marks. A man was arrested and sentenced to life imprisonment partly because of the dental evidence. He never admitted guilt and filed a petition for retrial. The present author was appointed as new dental expert. The material consisted of the fixed breast, models of the bite mark and models of the teeth of the convict, and several photographs. By means of visual examination, a magnifying glass, a lens stereoscope and a stereomicroscope characteristic details were noted. Stereoscopic picture pairs were taken, the material was studied by means of scanning electron microscopy and a stereometricgraphic plotting method permitting the outline of the tooth mark or the biting edge of a tooth to be registered in great detail in all three dimensions in the form of a contour map. This method has not previously been applied in the analysis of tooth marks in human skin. These examinations revealed no discrepancies but showed many corresponding characteristic features between the tooth marks and the teeth of the convict, resulting in the conclusion that it is highly probable that the tooth marks in the breast were made by the teeth of the convict.
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5/20. A case of jellyfish sting.

    Jellyfish sting may result in a wide range of symptoms from common erythematous urticarial eruptions to the rare box-jelly induced acute respiratory failure. In taiwan, with the increasing frequency of international travel, cases of jellyfish sting to foreigners are on the rise. We report a case of jellyfish sting with the rare presentation of painless contact dermatitis. A 38-y-o man accidentally stepped on a sea urchin with his right foot during scuba diving in a beach in thailand. Traditional therapy with vinegar was applied on the lesion. However, when he returned to taiwan, erythematous patches on the left thigh with linear radiations to the leg were discovered. The skin lesions had bizzare shapes and showed progressive change. No pain or numbness was noticed. Jellyfish stingwas suspected, topical medications were applied, and the patient recovered without complication. Jellyfish stings usually result in a painful erythematous eruption. In this case, though the lesion involved a large surface, there was no pain. delayed diagnosis of jellyfish sting was due to the atypical presentation and the physician's unfamiliarity to the Thai jellyfish sting. awareness to the wide spectrum of jellyfish sting symptoms should be promoted.
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6/20. A report of canine tooth syndrome.

    The authors describe the case of a 5-year-old girl traumatized from a dog bite to the superior aspect of the orbit in the right eye. The dog's canine tooth penetrated deep into the posterior orbit and severed the attachment of the superior oblique muscle from the globe posterior to the trochlea. The management and clinical course of the patient are described and photographs documenting the initial ocular damage and postoperative course are provided. In addition, the entity known as 'canine tooth syndrome' is reviewed.
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7/20. Toxic shock syndrome in an adult male secondary to puncture wound.

    The finding of toxic shock syndrome (TSS) is a rare, potentially fatal illness that physicians often associate with young, menstruating females. However, TSS is not exclusively a disease of females. We report the unusual case of an adult male patient who presented to the Emergency Department at Ruby Memorial Hospital in Morgantown with toxic shock syndrome secondary from a fish tooth suffered while trout fishing. The diagnostic features of TSS and treatment are also discussed in this article.
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8/20. Severe delayed cutaneous reaction due to Mediterranean jellyfish (Rhopilema nomadica) envenomation.

    During summer, mediterranean sea waters are invaded by a species of jellyfish designated as Rhopilema nomadica. Their tentacles contain numerous nematocysts loaded with a toxin that causes envenomation, usually expressed as immediate appearance of redness, burning sensation and papulovesicular eruption in the affected skin. We report a lady with a severe delayed reaction due to jellyfish envenomation that developed 2 days after contact with jellyfish tentacles.
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9/20. Dental follicle infection following a dog bite.

    Animal bite wounds and their subsequent infection are relatively common. incidence rates for dog bites are significantly higher among children aged 0-9 years, especially among boys. Although bite wounds may initially look innocuous, they frequently lead to serious infection with a potential for life-threatening complications. The microbiology of dog bite wounds is usually polymicrobial, typically including anaerobes, staphylococcus aureus and Pasteurella species. A case is described of a 22-month-old boy who, subsequent to a dog bite over the left maxilla, suffered infection of the dental follicle of the primary maxillary canine with pasteurella multocida. The infection proved difficult to treat, requiring several attempts at incision and drainage of the abscess together with systemic antibiotics, and resulted in the eventual loss of the tooth.
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10/20. Prolonged urinary incontinence and biliary dyskinesia following abdominal contact with jellyfish tentacles.

    A 16-year-old girl was seriously stung on her abdomen by a jellyfish as she jumped on her small surfboard. She and her mother identified the animal from photographs as Chrysaora fuscescens. Within several minutes the girl developed a massive abdominal cutaneous eruption composed of hundreds of punctuate erythematous papules and macules, which persisted for 5 to 7 days. Persistent urinary incontinence and biliary dyskinesia appeared over the following night. It is theorized that a systemic uptake of venom occurred percutaneously after contact of the jellyfish tentacles with her abdominal skin. The result was an injury to the urinary and biliary bladders. This is the first case report of such sequellae after topical contact with a marine animal. The causal relationship of these abnormalities with the sting is suggested by their temporal association. The gallbladder disorder required surgical intervention, but spontaneous resolution of the urinary bladder dysfunction occurred within 20 months.
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