Background:Post-earthquake engineering and epidemiologic assessments are important for the development of injury prevention strategies. This paper describes mortality and its relationship to building collapse patterns and initial medical responses following the 1992 earthquake in Erzincan, Turkey.Methods:The study consisted of: 1) background data collection and review; 2) design and implementation of a field survey; and 3) site inspection of building collapse patterns. The survey included: 1) national (n = 11) and local (n = 17) officials; 2) medical and search and rescue (SAR) workers (n = 38); and 3) a geographically stratified random sample of lay survivors (n = 105). The survey instruments were designed to gather information regarding location, injuries, initial actions and prior training of survivors and responders, and the location, injuries, and management of dead and dying victims. A case-control design was constructed to assess the relationship between mortality, location, and building collapse pattern.Results:There was extensive structural damage throughout the region, especially in the city where mid-rise, unreinforced masonry buildings (MUMBs) incorporating a “soft” first floor design (large store windows for commercial use) and one story adobe structures were most vulnerable to collapse. Of 526 people who died in the city, 87% (n = 456) were indoors at the time of the earthquake. Of these, 92% (n = 418) died in MUMBs. Of 54 witnessed deaths, 55% (n = 28) of victims died slowly, the majority of whom (n = 26) were pinned or trapped (p <0.05). Of 42 MUMB occupants identified through the survey, those who died (n = 25) were more likely to have been occupying the ground floor when compared with survivors (n = 28) (p <0.01). Official medical and search and rescue responders arrived after most deaths had occurred. Prior first-aid or rescue training of lay, uninjured survivors was associated with a higher likelihood of rescuing and resuscitating others (p <0.001).Conclusion:During an earthquake, MUMBs with soft ground floor construction are highly lethal, especially for occupants on the ground floor, suggesting that this building type is inappropriate for areas of seismic risk. The vulnerability of MUMBs appears due to a lack of lateral force resistance as a result of the use of glass store fiont windows and the absence of shear walls. The prevalence of this building type in earthquake-prone regions needs to be investigated further. A large portion of victims dying in an earthquake die slowly at the scene of injury. Prior public first-aid and rescue training programs increase participation in rescue efforts in major earthquakes and may improve survival.

The commonly encountered cardiovascular effects of intravenous indigo carmine administration is transient alpha-receptor stimulation, namely increased total peripheral resistance, diastolic and systolic blood pressure, and central venous pressure with decreased cardiac output, stroke volume and heart rate. These usually cause no problems and frequently go undetected unless the patient is monitored closely during that brief interval. However, significant problems occur occasionally and its use is not totally without risks.

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The "TUR syndrome" is a well described complication of transurethral resection of the prostate (TURP). 1"2 The symptomatology is believed to be due to intravascular absorption of bladder irrigation fluid, which may then result in acute water hltoxication. Dilution'al hyponatremia and hypoosmolarity are thought to be the underlying mechanisms for the symptom complex which can include agitation, confusion, nausea, vomiting, coma, and possibly death. Absorption can occur not only through open prostatic venous sinuses, but via other routes, such as surgically created defects in the prostatic capsule or perforations of the bladder. 3'4 Such occurrences can allow significant volumes of irrigation solution to bc sequestered in the perivesical at~d retroperitoneal spaces.t,5'6 We describe a case in which a patient developed the gradual onset of severe hyponatremia over a period of several hours after a TURP complicated by bladder perforation and intraperitoneal extravasation of irrigation fluid. This demonstrates a rare variant of the "TUR syndrome," in which the time course for pathophysiologieal changes seems to he considerably prolonged. Appropriate diagnosis and intervention by the anaesthetist is important to prevent unnecessary morbidity and mortality in this situation. Case reportA 63-year-old 70 kg man underwent TURP. His history included insulin dependent diabetes mellitus treated with daily split doses of lente insulin. His spot blood glucose values were less than 11.1 mmol.L-t for several days preoperatively. Other medications included indomethacin and amitriptyline. He received no preoperative intravenous fluid therapy. Other preoperative laboratory values included: sodium 141 mmol. L-t, potassium 3.9 mmol' L-i, blood urea nitrogen 5.6 mmol' L-~, creatinine 239 p, mol ' L-t, and haemoglobin 94 g-L-t. His pre-anaesthetic arterial blood pressure was 130/70mmHg, with a pulse rate of 100 beats/rain. Preoperative medications included meperidine 50 mg and promethazine 25 mg IM, and lente insulin 25 units SC (half of usual morning dose).Intravenous therapy with five per cent dextrose in lactated Ringer's solution was initiated. Spinal anaesthesia with tetracaine 12 mg in hyperbaric dextrose solution was successfully performed with a 22g needle at the L2-L3 interspace. Anaesthesia up to the Tto dennatome was obtained without significant change in blood pressure or pulse rate, After 15 minutes of resection the patient complained of bilateral shoulder and neck pain. At this time it was noted that the arterial blood pressure had decreased to 90/60 mmHg, with a pulse rate of 92. The anaesthetist examined the patient and discovered that he had a tensely distended, non-tender abdomen. No CAN J ANAESTH 1987 / 34:2 f pp 193-5