Objective.—Encounters with alligators are increasing in the United States. Both severe injuries and fatalities can occur from an alligator attack. This study provides information on alligator attacks reported in the United States as well as infections that are commonly associated with alligator bites.

Methods.—In order to collect information on the number of alligator bites, nuisance calls, and estimated alligator population of each state, calls were made to wildlife offices in all southern US states, and an online search for lay press articles was performed. Detailed information was available from Florida and is presented regarding the types of injuries and the activities of the victims at the time of the injuries.

Results.—From 1948 to August 1, 2004, 376 injuries and 15 deaths have been reported in the United States as a result of encounters with alligators. The number of nuisance calls as well as the alligator population is increasing.

Conclusions.—As the human population encroaches on the habitat of alligators, attacks and nuisance complaints increase. A uniform reporting system among states should be developed to obtain more complete information on alligator encounters.

Objective.—To describe the incidence and types of injury and illness treated during a multiday recreational bicycling tour.

Methods.—In July 2001, 2100 bicyclists rode 520 miles from Minneapolis, MN, to Chicago, IL, during the 2001 Heartland AIDS Ride. A volunteer medical staff provided medical care along the route. All patient encounters were recorded in an injury and illness log. Information from the log was used to describe the incidence and types of injury and illness treated during the event.

Results.—A total of 2100 riders participated, with 244 patient encounters recorded. The 2 most common reasons for requiring medical care were dehydration (35%) and orthopedic injuries (27%). Forty patients were transferred to the hospital and 7 required admission.

Conclusions.—Individuals charged with providing medical care for recreational bicycling events should be prepared to treat a wide variety of injuries and illnesses. In this and other studies, dehydration, heat illness, and overuse injuries were the most common reasons to require medical care. The results of this study suggest that implementation of prevention strategies before and during bicycling events may significantly reduce the requirement for on-site medical care.

This article describes a case of leptospirosis in a man who returned from caving in Sarawak, Malaysia, and includes a discussion of epidemiology, pathophysiology, diagnosis, prevention, and treatment. The patient presented with symptoms of leptospirosis, which was confirmed by microhemagglutination titers. He became infected despite taking doxycycline daily for malaria prophylaxis. Leptospirosis is an important consideration in any returned traveler with fever. The spirochete spreads from animals to humans via water. Caving in tropical endemic zones may increase exposure risk due to the combination of multiple skin abrasions with immersions. Water in caves may increase infection risk because of increased water pH. Standard prophylaxis may be inadequate in cases of high-risk exposures.

Objective.—To quantify awareness of altitude sickness in a sample of trekkers in Nepal and identify strategies for increasing knowledge in that population.

Methods.—Sixty-five high-altitude trekkers were surveyed. Demographic data were gathered. Respondents were asked about their experience in high-altitude environments, and they answered clinical-vignette questions designed to test their abilities to recognize and identify treatments for common symptoms of altitude sickness. An altitude-awareness score was generated by tabulating correct answers to questions. Scores were correlated with demographic data.

Results.—Respondents who scored highest (n = 8) had significantly more experience in high-altitude environments, averaging 5 to 10 years (P < .05), and achieved higher average altitudes on their treks of 5171 m (P < .05) than did low scorers. Respondents with low scores (n = 17) trekked to an average altitude of 4138 m. Seventy-three percent wanted to learn more about altitude sickness, 30% said they would prefer to learn from the Internet, and 27% said they would ask a doctor.

Conclusion.—This study suggests that a large population of at-risk high-altitude travelers may be relatively naïve to the dangers of altitude sickness. Overall, respondents were interested in learning more about altitude sickness. Physicians and the Internet are the most attractive sources of information for this population.

Objective.—As competition climbing becomes increasingly popular, younger climbers are entering the sport, and some are among the top-level athletes. This early start combined with intensive training methods can lead to radiographic changes in the fingers and even osteoarthrosis. Since 1994, we have been observing an increasing number of nontraumatic epiphyseal fractures in young athletes.

Methods.—Twenty-four cases of young climbers with nontraumatic epiphyseal fractures of the finger middle joints are presented.

Results.—The average age of the climbers was 14.5 (±0.9) years; 23 were boys, and 1 was a girl. Eight (33%) fractures were in an early stage, whereas in 16 (67%) a longer time interval elapsed between the onset of symptoms and the presentation for evaluation. All radiographs showed an epiphyseal fracture of the dorsal base of the middle phalanx of the finger; 20 patients presented a Salter-Harris III fracture and 4 presented a Salter-Harris II epiphysiolysis. An acute injury was not evident in any of the patients. All fractures were thus fatigue fractures caused by repetitive stress.

Conclusions.—Chronic finger pain in young and intensively training climbers must be carefully evaluated, and radiographic studies need to be performed. The risk of epiphyseal injuries must be minimized by eliminating intensive power training in the schedules of athletes of this age.

Crocodilians represent one of the oldest constant animal lineages on the planet, in no small part due to their formidable array of predatory adaptations. As both human and crocodilian populations expand, they increasingly encroach on each others' territories, bringing morbidity and mortality to both populations. In this article, the medical and herpetologic literature pertaining to injuries caused by crocodilians is reviewed, and the patterns of saltwater crocodile attacks in Australia from 1971 to 2004 are analyzed. In this review, we examine the features of crocodilians that contribute to explaining their evolutionary success, as well as the potential hazard they pose to humans. Only by understanding their capabilities is it possible to mitigate the potential threat to life and limb.

The plasma of monkeys envenomated with tiger snake (Notechis scutatus) venom was monitored by radioimmunoassay for both crude venom and a neurotoxin. When the injected limb was immobilised and a pressure of 55 mm Hg applied to the injection site, only very low levels of circulating venom or neurotoxin were detectable. In practical terms, venom movement can be effectively delayed for long periods by the application of a firm crepe bandage to the length of the bitten limb combined with immobilisation by a splint. Pressure alone or immobilisation alone did not delay venom movement.