Envenomation by the brown recluse spider (loxoscelism) is classically associated with a necrotic ulcer. Systemic manifestations occur in a minority of cases, but are generally mild and self-limited. The hematologic complications of brown recluse spider bite range from mild hemolysis to fulminant intravascular hemolysis with or without evidence of disseminated intravascular coagulation. Intravascular hemolysis is a rare but occasionally lethal complication of brown recluse spider envenomation. This article presents two cases of severe hemolysis associated with loxoscelism occurring in two young women in Memphis, Tennessee. The second documented death in an adult from severe hemolysis due to a brown recluse spider bite is reported. A review of the literature emphasizing the pathogenic mechanisms of spider bite hemolysis is also included.
Children without an auditory brainstem evoked response can benefit from an auditory-oral hearing habilitation program. This study focuses on 31 such children enrolled at the Houston School for Deaf Children. Eleven had excellent auditory-oral skills, with language ability equal to normal-hearing children of a similar age, and speech easily intelligible to a familiar listener. A statistically significant factor associated with success was hearing acuity at 250 Hz. Other important factors included age at enrollment at the school, duration of enrollment, degree of parental support, and absence of middle ear disease.
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