Fracture and dislocation of major joints may be caused by the forceful tonic muscular contractions of seizure activity. A 77-year-old man who was found dead in bed with no sign of external trauma had bilateral central fracture dislocations of the femoral head through the acetabular floor with fatal pelvic hemorrhage and extensive pulmonary fat and bone marrow embolism. He had epilepsy, but the last seizure was 6 years earlier, and he had long discontinued medication. The fractures were attributed to a new unwitnessed seizure. This is the twentieth case of central fracture dislocation of the hip since 1970, when better anesthesia eliminated convulsive therapy-induced fractures. The authors review these 20 cases. Seizures followed inflammation, infarction or neoplasia of the brain, eclampsia, metabolic or iatrogenic causes, or epilepsy (6 cases, 2 of which had no prior seizures for 5 years). There were 11 men (mean age, 64 years) and 9 women (mean age, 47 years). Fractures were unilateral in 13 and bilateral in 7. Additional fractures (in vertebrae, shoulders, or femur) were present in eight. Only eight had prior bone disease. Local symptoms led to diagnosis in most, but two were identified incidentally on imaging. The current patient was the only one to die suddenly, but six other patients presented with shock and three died (one of whom had injuries that led to a suspicion of manslaughter). Central fracture-dislocation of the hip is a rare and little known consequence of seizures, with strong potential for misdiagnosis and lethal complications.
Dear Sir:In the clinical laboratory, many workers spend prolonged periods at microscopy, but there is little appreciation of the range and severity of the work-related problems that may ensue. We administered a questionnaire to assess the magnitude of occupational problems associated with microscope use in the pathology laboratory.Laboratory personnel in Ireland were interviewed through an anonymized questionnaire. Ethical approval for the study was obtained from the St. James's and Federation of Dublin Voluntary Hospitals Ethics Committee. There were 62 respondents with equal numbers of males and females. The response rate was approximately 40%. Personnel were predominately histopathologists or cytopathologists working at consultant level. The majority were less than 50 years of age. Table 1 is a summary of the main results.This study reports a high incidence of visual and musculoskeletal problems (some serious) in the pathology laboratory associated with microscopy use. Three quarters reported episodic musculoskeletal problems involving predominately the neck, back, and shoulder and 20% noted repetitive strain injuries. More than half of those affected required some therapy and 5% had taken sick leave. Visual problems, predominately eye fatigue, were indicated by more than half the respondents. Interestingly quite a significant number of respondents who performed routine microscopy less than the median number of hours per week (20.5h) still reported quite a high incidence of either occupationally associated visual or musculoskeletal problems (39% and 26%, respectively). As expected, there was an increase in the reported visual and musculoskeletal problems once the median number of hours is exceeded (71% and 55%, respectively). Furthermore, the number of years working with a microscope did not have a major impact on the type of occupational injury sustained: Those respondents who worked less than the median number of years (14.5 years) reported a high incidence of either visual or musculoskeletal problems (65% and 32%, respectively) as did those who worked above the median number of years (45% and 42%, respectively).Microscopists should be aware for the potential for work-related illness. Previous studies, involving cytotechnologists and part-time microscopists, have reported similar high rates of neck, shoulder and back pain, eye strain, or headache as a result of working long hours with a conventional light microscope, and related these to the use of non-ergonomic workstations [1][2][3]. It is interesting that there is little fall in the number reporting occupational injuries compared with the older studies. Although specifics on microscope types was not assessed in the questionnaire, it is likely that newer generation microscopes were in use
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