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Sample records for acute chest syndrome

  1. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome

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    Soldati Gino

    2008-04-01

    Full Text Available Abstract Background Differential diagnosis between acute cardiogenic pulmonary edema (APE and acute lung injury/acute respiratory distress syndrome (ALI/ARDS may often be difficult. We evaluated the ability of chest sonography in the identification of characteristic pleuropulmonary signs useful in the diagnosis of ALI/ARDS and APE. Methods Chest sonography was performed on admission to the intensive care unit in 58 consecutive patients affected by ALI/ARDS or by acute pulmonary edema (APE. Results Ultrasound examination was focalised on finding in the two groups the presence of: 1 alveolar-interstitial syndrome (AIS 2 pleural lines abnormalities 3 absence or reduction of "gliding" sign 4 "spared areas" 5 consolidations 6 pleural effusion 7 "lung pulse". AIS was found in 100% of patients with ALI/ARDS and in 100% of patients with APE (p = ns. Pleural line abnormalities were observed in 100% of patients with ALI/ARDS and in 25% of patients with APE (p All signs, except the presence of AIS, presented a statistically significant difference in presentation between the two syndromes resulting specific for the ultrasonographic characterization of ALI/ARDS. Conclusion Pleuroparenchimal patterns in ALI/ARDS do find a characterization through ultrasonographic lung scan. In the critically ill the ultrasound demonstration of a dyshomogeneous AIS with spared areas, pleural line modifications and lung consolidations is strongly predictive, in an early phase, of non-cardiogenic pulmonary edema.

  2. Acute chest pain fast track at the emergency department: who was misdiagnosed for acute coronary syndrome?

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    Prachanukool, Thidathit; Aramvanitch, Kasamon; Sawanyawisuth, Kittisak; Sitthichanbuncha, Yuwares

    2016-01-01

    Background Acute coronary syndrome (ACS) is a commonly treated disease in the emergency department (ED). Acute chest pain is a common presenting symptom of ACS. Acute chest pain fast track (ACPFT) is a triage to cover patients presenting with chest pain with the aims of early detection and treatment for ACS. This study aimed to assess the quality of the ACPFT with the aim of improving the quality of care for ACS patients. Methods This study was conducted at the ED in Mahidol University, Bangkok, Thailand. The inclusion criterion was patients presenting with acute chest pain at the ED. We retrospectively reviewed the medical records of all eligible patients. The primary outcomes of this study were to determine time from door to electrocardiogram and time from door to treatment (coronary angiogram with percutaneous coronary intervention or thrombolytic therapy in the case of ST elevation myocardial infarction). The outcome was compared between those who were in and not in the ACPFT. Results During the study period, there were 616 eligible patients who were divided into ACPFT (n=352 patients; 57.1%) and non-ACPFT (n=264 patients; 42.9%) groups. In the ACPFT group (n=352), 315 patients (89.5%) received an electrocardiogram within 10 minutes. The final diagnosis of ACS was made in 80 patients (22.7%) in the ACPFT group and 13 patients (4.9%) in the non-ACPFT group (P-value <0.01). After adjustment using multivariate logistic regression analysis, only epigastric pain was independently associated with being in the ACPFT group (adjusted odds ratio of 0.11; 95% confidence interval of 0.02, 0.56). Conclusion The ACPFT at the ED facilitated the prompt work-ups and intervention for ACS. PMID:27980438

  3. Elevated troponin levels and typical chest pain: Is always acute coronary syndrome?

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    Altug Osken

    2016-01-01

    Full Text Available Aortic dissection is a fatal disease that must be considered in the differential diagnosis of chest pain. If the diagnosis cannot be made in early period, mortality is very high. Here, we present a case of aortic dissection, clinically mimicking acute coronary syndrome.

  4. Acute chest pain fast track at the emergency department: who was misdiagnosed for acute coronary syndrome?

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    Prachanukool T

    2016-12-01

    Full Text Available Thidathit Prachanukool,1 Kasamon Aramvanitch,1 Kittisak Sawanyawisuth,2–4 Yuwares Sitthichanbuncha1 1Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, 2Department of Medicine, Faculty of Medicine, 3Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH, 4Internal medicine research group, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand Background: Acute coronary syndrome (ACS is a commonly treated disease in the emergency department (ED. Acute chest pain is a common presenting symptom of ACS. Acute chest pain fast track (ACPFT is a triage to cover patients presenting with chest pain with the aims of early detection and treatment for ACS. This study aimed to assess the quality of the ACPFT with the aim of improving the quality of care for ACS patients. Methods: This study was conducted at the ED in Mahidol University, Bangkok, Thailand. The inclusion criterion was patients presenting with acute chest pain at the ED. We retrospectively reviewed the medical records of all eligible patients. The primary outcomes of this study were to determine time from door to electrocardiogram and time from door to treatment (coronary angiogram with percutaneous coronary intervention or thrombolytic therapy in the case of ST elevation myocardial infarction. The outcome was compared between those who were in and not in the ACPFT. Results: During the study period, there were 616 eligible patients who were divided into ACPFT (n=352 patients; 57.1% and non-ACPFT (n=264 patients; 42.9% groups. In the ACPFT group (n=352, 315 patients (89.5% received an electrocardiogram within 10 minutes. The final diagnosis of ACS was made in 80 patients (22.7% in the ACPFT group and 13 patients (4.9% in the non-ACPFT group (P-value <0.01. After adjustment using multivariate logistic regression analysis, only epigastric pain was independently associated with being in the ACPFT group (adjusted

  5. Chest X ray changes in severe acute respiratory syndrome cases after discontinuation of glucocorticosteroids treatment

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    姚婉贞; 陈亚红; 张立强; 王筱宏; 孙永昌; 孙威; 韩江莉; 张福春; 郑亚安; 孙伯章; 贺蓓; 赵鸣武

    2004-01-01

    @@ Severe acute respiratory syndrome (SARS) is a disease identified in Asia, North America and Europe. The drugs for treatment and prevention of and vaccine for the disease are in research.1,2 There is still no agreement on glucocorticosteroid treatment of SARS. In treatment of SARS patients with glucocorticosteroids, we found 5 cases whose chest X ray changes were different from what the literature reported.

  6. Severe acute respiratory syndrome (SARS): chest radiographic features in children

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    Babyn, Paul S.; Gahunia, Harpal K.; Manson, David [Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario (Canada); Chu, Winnie C.W.; Metreweli, Constantine [Prince of Wales Hospital, Shatin (China); Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong (China); Tsou, Ian Y.Y.; Wansaicheong, Gervais K.L.; Chee, Thomas S.G.; Kaw, Gregory J.L. [Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng (Singapore); Allen, Upton; Bitnun, Ari; Read, Stanley [Division of Infectious Diseases, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario (Canada); Cheng, Frankie W.T.; Fok, Tai-Fai; Hon, Ellis K.L.; Li, Albert M.; Ng, Pak-Cheung [Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong, SAR (China); Chiu, Man-Chun; Leung, Chi-Wai [Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Lai King Hill Road, Lai Chi Kok, Hong Kong, SAR (China); Khong, Pek L. [Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, SAR (China); Stringer, David A.

    2004-01-01

    We abstracted data (n=62) on the radiologic appearance and course of SARS in pediatric patients with suspect (n=25) or probable (n=37) SARS, diagnosed in five hospital sites located in three cities: Toronto, Singapore, and Hong Kong. Available chest radiographs and thoracic CTs were reviewed for the presence of the following radiographic findings: airspace disease, air bronchograms, airways inflammation and peribronchial thickening, interstitial disease, pleural effusion, and hilar adenopathy. A total of 62 patients (suspect=25, probable=37) were evaluated for SARS. Patient ages ranged from 5.5 months to 17 years and 11.5 months (average, 6 years and 10 months) with a female-to-male ratio of 32:30. Forty-one patients (66.1%) were in close contact with other probable, suspect, or quarantined cases; 10 patients (16.1%) had recently traveled to WHO-designated affected areas within 10 days; and 7 patients (11.2%) were transferred from other hospitals that had SARS patients. Three patients, who did not have close/hospital contact or travel history to affected areas, were classified as SARS cases based on their clinical signs and symptoms and on the fact that they were living in an endemic area. The most prominent clinical presentations were fever, with a temperature over 38 C (100%), cough (62.9%), rhinorrhea (22.6%), myalgia (17.7%), chills (14.5%), and headache (11.3%). Other findings included sore throat (9.7%), gastrointestinal symptoms (9.7%), rigor (8.1%), and lethargy (6.5%). In general, fever and cough were the most common clinical presentations amongst younger pediatric SARS cases (age<10 years), whereas, in addition to these symptoms, headache, myalgia, sore throat, chills, and/or rigor were common in older patients (age{>=}10 years). The chest radiographs of 35.5% of patients were normal. The most prominent radiological findings that were observed in the remaining patients were areas of consolidation (45.2%), often peripheral with multifocal lesions in 22

  7. Acute chest syndrome of sickle cell disease: radiographic and clinical analysis of 70 cases

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    Martin, L. [Department of Radiology, Children`s Hospital, 300 Longwood Avenue, Boston, MA 02115 (United States); Buonomo, C. [Department of Radiology, Children`s Hospital, 300 Longwood Avenue, Boston, MA 02115 (United States)

    1997-08-01

    Background. Acute chest syndrome (ACS) is a pulmonary illness with fever, chest pain, leukocytosis and new pulmonary opacity in a patient with sickle cell disease. It is a common reason for hospitalization in sickle cell patients, and a significant cause of mortality. The etiology of ACS is unclear. Lung or bone infarction and infection, among other possible causes, have been proposed. Objective. We reviewed the chest radiographs and medical records of 41 patients with 70 episodes of ACS and correlated the clinical and radiographic courses in an attempt to better characterize and understand the syndrome. Results. In 87 % of episodes, no identifiable etiology of ACS was found. This group of patients had a median age of 14 years and showed dramatic clinical and radiographic improvement within 24 h of therapy. In the remainder of episodes (13 %), an identifiable etiology was found, usually bacterial pneumonia. These patients were younger than the group without an identifiable etiology (median age 2 years) and had a prolonged radiographic course of illness. Conclusion. The chest radiographs of children with ACS without an identifiable etiology have an extremely typical appearance and evolution. Only in cases which do not have this typical pattern should infection be suspected as the underlying cause. (orig.). With 3 figs.

  8. A case of catastrophic antiphospholipid syndrome, which presented an acute interstitial pneumonia-like image on chest CT scan.

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    Kameda, Tomohiro; Dobashi, Hiroaki; Susaki, Kentaro; Danjo, Junichi; Nakashima, Shusaku; Shimada, Hiromi; Izumikawa, Miharu; Takeuchi, Yohei; Mitsunaka, Hiroki; Bandoh, Shuji; Imataki, Osamu; Nose, Masato; Matsunaga, Takuya

    2015-01-01

    We report the case of catastrophic antiphospholipid syndrome (CAPS) complicated with mixed connective tissue disease (MCTD). A female patient was diagnosed with acute interstitial pneumonia (AIP) with MCTD by chest CT scan. Corticosteroid therapy was refractory for lung involvement, and she died due to acute respiratory failure. The autopsy revealed that AIP was compatible with lung involvement of CAPS. We therefore suggest that chest CT might reveal AIP-like findings in CAPS patients whose condition is complicated with pulmonary manifestations.

  9. [Pulmonary contusion and acute respiratory distress syndrome (ARDS) as complications of blunt chest trauma].

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    Michalska, Agata; Jurczyk, Agnieszka P; Machała, Waldemar; Szram, Stefan; Berent, Jarosław

    2009-01-01

    Blunt chest traumas are common nowadays due to development of motor transport. They are associated with high mortality rates because of serious injuries of internal organs. The mechanisms of injuries are complex and may cause damages ranging from small ones, such as bruises or abrasions, to life-threatening trauma. Among typical injuries there are rib fractures, sternal fractures, pneumothorax, hemothorax, diaphragm lacerations, pulmonary contusions, cardiac tamponade, cardiac rupture and many others. The authors of the article would like to emphasize the pathophysiology and diagnostic difficulties in such blunt chest trauma complications as pulmonary contusions and acute respiratory distress syndrome, for which no causal treatment is available and only early diagnosis and administration of symptomatic treatment may increase the patients' chances to survive. In Forensic Medicine Department, Medical University of Łódź, an opinion was issued on a case which illustrates the clinical problem.

  10. Pulmonary contusion and acute respiratory distress syndrome (ARDS) as complications of blunt chest trauma

    National Research Council Canada - National Science Library

    Michalska, Agata; Jurczyk, Agnieszka P; Machała, Waldemar; Szram, Stefan; Berent, Jarosław

    2009-01-01

    .... The authors of the article would like to emphasize the pathophysiology and diagnostic difficulties in such blunt chest trauma complications as pulmonary contusions and acute respiratory distress...

  11. The Characteristics and Dynamic Changes of X-Ray Chest Film in 50 Patients with Severe Acute Respiratory Syndrome

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    马俊义; 李智岗; 赵增毅; 孙武装; 王颖

    2003-01-01

    @@ Severe acute respiratory syndrome (SARS) is a new acute infectious disease which quickly spreads and develops, resulting in high mortality. Since there lacks any diagnostic method with high specificity and sensitivity, the X-ray chest film becomes an important measure for diagnosis for SARS. Therefore, to understand the characteristics of X-ray chest film in SARS patients and get to know the rule of its dynamic changes is meaningful for SARS diagnosing, treating and prognosing. The characteristics and dynamic changes of chest film in 50 SARS patients in Hebei Province were analysed by the authors and reported as follows.

  12. Interpretation of chest radiographs in both cancer and other critical care patients with acute respiratory distress syndrome

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    Sema Yilmaz

    2013-04-01

    Full Text Available Acute respiratory distress syndrome is a clinical, pathophysiological and radiographic pattern that has signs of pulmonary edema occur without elevated pulmonary venous pressures. Clinical presentation and progression of acute respiratory distress syndrome are followed by frequently ordered portable chest X-ray in critically ill patients. We evaluated chest radiographs of ten cancer and other six critical care pediatric patients. The parenchymal imaging of lung in patients with cancer was reported the same as that of other critically ill children despite underlying pathophysiological variations in our investigation. [Cukurova Med J 2013; 38(2.000: 270-273

  13. Asthma is a risk factor for acute chest syndrome and cerebral vascular accidents in children with sickle cell disease

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    Scott Paul J

    2005-01-01

    Full Text Available Abstract Background Asthma and sickle cell disease are common conditions that both may result in pulmonary complications. We hypothesized that children with sickle cell disease with concomitant asthma have an increased incidence of vaso-occlusive crises that are complicated by episodes of acute chest syndrome. Methods A 5-year retrospective chart analysis was performed investigating 48 children ages 3–18 years with asthma and sickle cell disease and 48 children with sickle cell disease alone. Children were matched for age, gender, and type of sickle cell defect. Hospital admissions were recorded for acute chest syndrome, cerebral vascular accident, vaso-occlusive pain crises, and blood transfusions (total, exchange and chronic. Mann-Whitney test and Chi square analysis were used to assess differences between the groups. Results Children with sickle cell disease and asthma had significantly more episodes of acute chest syndrome (p = 0.03 and cerebral vascular accidents (p = 0.05 compared to children with sickle cell disease without asthma. As expected, these children received more total blood transfusions (p = 0.01 and chronic transfusions (p = 0.04. Admissions for vasoocclusive pain crises and exchange transfusions were not statistically different between cases and controls. SS disease is more severe than SC disease. Conclusions Children with concomitant asthma and sickle cell disease have increased episodes of acute chest syndrome, cerebral vascular accidents and the need for blood transfusions. Whether aggressive asthma therapy can reduce these complications in this subset of children is unknown and requires further studies.

  14. Acute Chest Syndrome in Sickle Cell Disease Patients Post Caesarean Delivery

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    YM Zhang

    2016-02-01

    Full Text Available Sickle cell disease (SCD is the most common inherited disease worldwide and is associated with anaemia and intermittent painful crisis. Pregnant women who are affected are known to have increased maternal and fetal mortality and morbidity. Acute chest syndrome (ACS is an uncommon but serious complication in pregnant women with SCD that can lead to death. We present two cases of patients with SCD, both of whom had severe ACS within 24 hours post Caesarean section. By accurate diagnosis and appropriate management by a multidisciplinary team, both mothers and fetuses had excellent outcomes. It is suggested that prompt recognition of ACS in a pregnant woman with SCD and collaborative medical and obstetric management are essential to optimize maternal and fetal outcomes.

  15. Computed Tomography Diagnosis of Nonspecific Acute Chest Pain in the Emergency Department: From Typical Acute Coronary Syndrome to Various Unusual Mimics.

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    Yoo, Seung Min; Chun, Eun Ju; Lee, Hwa Yeon; Min, Daniel; White, Charles S

    2017-01-01

    It is a challenging task for emergency department physicians to establish a precise and rapid diagnosis based only on clinical and laboratory findings in patients who present with nonspecific acute chest pain. In this circumstance, CT angiography can provide important clues to the diagnosis. To provide a rapid diagnosis of acute coronary syndrome (ACS) and its various mimics, the physician should enumerate each possible cause of acute chest pain on the basis of an objective assessment of pretest probability. On the basis of clinical suspicion, the appropriate CT protocol should then be performed. Moreover, radiologists should be familiar with typical CT findings of ACS and its various mimics to assist the emergency department physician in diagnosing patients with nonspecific acute chest pain. This review article presents an overview on choosing an appropriate CT protocol in patients with nonspecific acute chest pain and provides specific CT findings of ACS and various mimics of ACS.

  16. Acute chest syndrome after laparoscopic splenectomy in children with sickle cell disease: operative time dependent?

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    Bonnard, A; Masmoudi, M; Boimond, B; Capito, C; Holvoet, L; Skhiri, A; El Ghoneimi, A

    2014-11-01

    Laparoscopic splenectomy remains a technically demanding procedure. On patients with sickle cell disease (SCD), a post operative acute chest syndrome (ACS) can occur. The aim of the study was to look for predictive factors of post operative ACS. It's a retrospective study on patients with SCD, who underwent a laparoscopic splenectomy in Robert Debré hospital, Paris, France, between March 2008 and December 2013. Diagnosis of ACS was done if the patient developed hypoxemia associated with fever above 38.5 °C and an infiltrate on chest x ray during the post operative course. Pre-, post- and operative factors were studied. Descriptive statistics were compared using the Mann-Whitney test or the exact Fisher test. A p inferior to 0.05 was considered as significant. 52 patients with SCD underwent a laparoscopic splenectomy. Twelve patients presented a post operative ACS (23%) (mean age at surgery 4 years old) while forty did not (mean age 5.25 years old). Neither previous episode of ACS nor any factors reflecting SCD severity were significant. The shorter the operative time was, the greater the risk of developing an ACS (p post operative management, in the absence of predictive factors for ACS, should be carefully followed in a high dependency unit at least for 48 h for all patients.

  17. Triple-rule-out CT angiography for evaluation of acute chest pain and possible acute coronary syndrome.

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    Halpern, Ethan J

    2009-08-01

    Triple-rule-out (TRO) computed tomographic (CT) angiography can provide a cost-effective evaluation of the coronary arteries, aorta, pulmonary arteries, and adjacent intrathoracic structures for the patient with acute chest pain. TRO CT is most appropriate for the patient who is judged to be at low to intermediate risk for acute coronary syndrome (ACS) and whose symptoms may also be attributed to acute pathologic conditions of the aorta or pulmonary arteries. Although a regular cardiac rhythm remains an important factor in coronary CT image quality, newer CT scanners with 64 or more detector rows afford rapid electrocardiographically (ECG) gated imaging to provide high-quality TRO CT studies in patients with a heart rate of up to 80 beats per minute. Injection of iodinated contrast material ( 300 HU) and in the pulmonary arteries (> 200 HU). To limit radiation exposure, the TRO CT examination does not include the entire chest but is constrained to incorporate the aortic arch down through the heart. Scanning parameters, including prospective ECG tube current modulation and prospective ECG gating with the "step-and-shoot" technique, are tailored to reduce radiation exposure (optimally, 5-9 mSv). When performed with appropriate attention to timing and technique, TRO CT provides coronary image quality equal to that of dedicated coronary CT angiography and pulmonary arterial images that are free of motion artifact related to cardiac pulsation. In an appropriately selected emergency department patient population, TRO CT can safely eliminate the need for further diagnostic testing in over 75% of patients.

  18. Diagnostic values of chest pain history, ECG, troponin and clinical gestalt in patients with chest pain and potential acute coronary syndrome assessed in the emergency department.

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    Mokhtari, Arash; Dryver, Eric; Söderholm, Martin; Ekelund, Ulf

    2015-01-01

    In the assessment of chest pain patients with suspected acute coronary syndrome (ACS) in the emergency department (ED), physicians rely on global diagnostic impressions ('gestalt'). The aim of this study was to determine the diagnostic value of the ED physician's overall assessment of ACS likelihood, and the values of the main diagnostic modalities underlying this assessment, namely the chest pain history, the ECG and the initial troponin result. 1,151 consecutive ED chest pain patients were prospectively included. The ED physician's interpretation of the chest pain history, the ECG, and the global likelihood of ACS were recorded on special forms. The discharge diagnoses were retrieved from the medical records. A chart review was carried out to determine whether patients with a non-ACS diagnosis at the index visit had ACS or suffered cardiac death within 30 days. The gestalt was better than its components both at ruling in ("Obvious ACS", LR 29) and at ruling out ("No Suspicion of ACS", LR 0.01) ACS. In the "Strong suspicion of ACS" group, 60% of the patients did not have ACS. A positive TnT (LR 24.9) and an ischemic ECG (LR 8.3) were strong predictors of ACS and seemed superior to pain history for ruling in ACS. In patients with a normal TnT and non-ischemic ECG, chest pain history typical of AMI was not a significant predictor of AMI (LR 1.9) while pain history typical of unstable angina (UA) was a moderate predictor of UA (LR 4.7). Clinical gestalt was better than its components both at ruling in and at ruling out ACS, but overestimated the likelihood of ACS when cases were assessed as strong suspicion of ACS. Among the components of the gestalt, TnT and ECG were superior to the chest pain history for ruling in ACS, while pain history was superior for ruling out ACS.

  19. Clinician gestalt estimate of pretest probability for acute coronary syndrome and pulmonary embolism in patients with chest pain and dyspnea.

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    Kline, Jeffrey A; Stubblefield, William B

    2014-03-01

    Pretest probability helps guide diagnostic testing for patients with suspected acute coronary syndrome and pulmonary embolism. Pretest probability derived from the clinician's unstructured gestalt estimate is easier and more readily available than methods that require computation. We compare the diagnostic accuracy of physician gestalt estimate for the pretest probability of acute coronary syndrome and pulmonary embolism with a validated, computerized method. This was a secondary analysis of a prospectively collected, multicenter study. Patients (N=840) had chest pain, dyspnea, nondiagnostic ECGs, and no obvious diagnosis. Clinician gestalt pretest probability for both acute coronary syndrome and pulmonary embolism was assessed by visual analog scale and from the method of attribute matching using a Web-based computer program. Patients were followed for outcomes at 90 days. Clinicians had significantly higher estimates than attribute matching for both acute coronary syndrome (17% versus 4%; Psyndrome (r(2)=0.15) and pulmonary embolism (r(2)=0.06). Areas under the receiver operating characteristic curve were lower for clinician estimate compared with the computerized method for acute coronary syndrome: 0.64 (95% confidence interval [CI] 0.51 to 0.77) for clinician gestalt versus 0.78 (95% CI 0.71 to 0.85) for attribute matching. For pulmonary embolism, these values were 0.81 (95% CI 0.79 to 0.92) for clinician gestalt and 0.84 (95% CI 0.76 to 0.93) for attribute matching. Compared with a validated machine-based method, clinicians consistently overestimated pretest probability but on receiver operating curve analysis were as accurate for pulmonary embolism but not acute coronary syndrome. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  20. Pulmonary Thromboembolism in a Child with Sickle Cell Hemoglobin D Disease in the Setting of Acute Chest Syndrome

    OpenAIRE

    Hazel Villanueva; Sandeepkumar Kuril; Jennifer Krajewski; Aziza Sedrak

    2013-01-01

    Introduction. Sickle cell hemoglobin D disease (HbSD) is a rare variant of sickle cell disease (SCD). Incidence of pulmonary thromboembolism (PE) and deep venous thrombosis (DVT) in children with HbSD is unknown. PE and DVT are known complications of SCD in adults but have not been reported in the literature in children with HbSD. Case Report. We are reporting a case of a 12-year-old boy with HbSD with acute chest syndrome (ACS) complicated by complete thrombosis of the branch of the right pu...

  1. The Role of Inspiratory Muscle Training in Sickle Cell Anemia Related Pulmonary Damage due to Recurrent Acute Chest Syndrome Attacks

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    Burcu Camcıoğlu

    2015-01-01

    Full Text Available Background. The sickling of red blood cells causes a constellation of musculoskeletal, cardiovascular, and pulmonary manifestations. A 32-year-old gentleman with sickle cell anemia (SCA had been suffering from recurrent acute chest syndrome (ACS. Aim. To examine the effects of inspiratory muscle training (IMT on pulmonary functions, respiratory and peripheral muscle strength, functional exercise capacity, and quality of life in this patient with SCA. Methods. Functional exercise capacity was evaluated using six-minute walk test, respiratory muscle strength using mouth pressure device, hand grip strength using hand-held dynamometer, pain using Visual Analogue Scale, fatigue using Fatigue Severity Scale, dyspnea using Modified Medical Research Council Scale, and health related quality of life using European Organization for Research and Treatment of Cancer QOL measurement. Results. A significant improvement has been demonstrated in respiratory muscle strength, functional exercise capacity, pain, fatigue, dyspnea, and quality of life. There was no admission to emergency department due to acute chest syndrome in the following 12 months after commencing regular erythrocytapheresis. Conclusion. This is the first report demonstrating the beneficial effects of inspiratory muscle training on functional exercise capacity, respiratory muscle strength, pain, fatigue, dyspnea, and quality of life in a patient with recurrent ACS.

  2. A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome

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    Chun-Peng MA; Xiao WANG; Qing-Sheng WANG; Xiao-Li LIU; Xiao-Nan HE; Shao-Ping NIE

    2016-01-01

    ObjectiveTo validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percu-taneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diag-nosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 byχ2 for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0–2), intermediate risk (score 3–4), and high risk (score 5–10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

  3. Reversible posterior leukoencephalopathy syndrome and silent cerebral infarcts are associated with severe acute chest syndrome in children with sickle cell disease.

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    Henderson, Jessica N; Noetzel, Michael J; McKinstry, Robert C; White, Desiree A; Armstrong, Melissa; DeBaun, Michael R

    2003-01-15

    Patients with severe acute chest syndrome (ACS) requiring endotracheal intubation and erythrocytopheresis are at increased risk for neurologic morbidity. This study examines patients with sickle cell disease who developed severe episodes of ACS, leading to endotracheal intubation, ventilatory support for respiratory failure, and erythrocytapheresis. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) studies, a neurologic examination by a pediatric neurologist, and cognitive testing were done in all patients. Five consecutive patients, aged 3 to 9 years, were identified with severe ACS. All patients developed neurologic complications resulting from ACS episodes, including seizures (n = 2), silent cerebral infarcts (n = 3), cerebral hemorrhage (n = 2), and reversible posterior leukoencephalopathy syndrome (n = 3). Children with severe ACS should have a magnetic resonance image of the brain, neurologic examination by a neurologist, and cognitive testing to detect the presence of neurologic morbidity.

  4. Pulmonary thromboembolism in a child with sickle cell hemoglobin d disease in the setting of acute chest syndrome.

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    Villanueva, Hazel; Kuril, Sandeepkumar; Krajewski, Jennifer; Sedrak, Aziza

    2013-01-01

    Introduction. Sickle cell hemoglobin D disease (HbSD) is a rare variant of sickle cell disease (SCD). Incidence of pulmonary thromboembolism (PE) and deep venous thrombosis (DVT) in children with HbSD is unknown. PE and DVT are known complications of SCD in adults but have not been reported in the literature in children with HbSD. Case Report. We are reporting a case of a 12-year-old boy with HbSD with acute chest syndrome (ACS) complicated by complete thrombosis of the branch of the right pulmonary artery and multiple small pulmonary artery emboli seen on computed tomography (CT) pulmonary angiogram and thrombosis of the right brachial vein seen on Doppler ultrasound. Our patient responded to treatment with anticoagulant therapy. Conclusion. There are no cases reported in children with HbSD disease presenting as ACS with pulmonary thromboembolism. We suggest that PE should be suspected in patients presenting with ACS who do not show improvement with standard management. CT pulmonary angiogram should be utilized for early diagnosis and appropriate management as there is no current protocol for management of PE/DVT in pediatric patients with SCD.

  5. Hashimoto's thyroiditis and acute chest syndrome revealing sickle cell anemia in a 32 years female patient.

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    Igala, Marielle; Nsame, Daniela; Ova, Jennie Dorothée Guelongo Okouango; Cherkaoui, Siham; Oukkach, Bouchra; Quessar, Asmae

    2015-01-01

    Sickle cell anemia results from a single amino acid substitution in the gene encoding the β-globin subunit. Polymerization of deoxygenated sickle hemoglobin leads to decreased deformability of red blood cells. Hashimoto's thyroiditis is a common thyroid disease now recognized as an auto-immune thyroid disorder, it is usually thought to be haemolytic autoimmune anemia. We report the case of a 32 years old women admitted for chest pain and haemolysis anemia in which Hashimoto's thyroiditis and sickle cell anemia were found. In our observation the patient is a young woman whose examination did not show signs of goitre but the analysis of thyroid function tests performed before an auto-immune hemolytic anemia (confirmed by a high level of unconjugated bilirubin and a Coombs test positive for IgG) has found thyroid stimulating hormone (TSH) and positive thyroid antibody at rates in excess of 4.5 times their normal value. In the same period, as the hemolytic anemia, and before the atypical chest pain and anguish they generated in the patient, the search for hemoglobinopathies was made despite the absence of a family history of haematological disease or painful attacks in childhood. Patient electrophoresis's led to research similar cases in the family. The mother was the first to be analyzed with ultimately diagnosed with sickle cell trait have previously been ignored. This case would be a form with few symptoms because the patient does not describe painful crises in childhood or adolescence.

  6. Diagnostic contributions of cardiac magnetic resonance imaging in patients presenting with elevated troponin, acute chest pain syndrome and unobstructed coronary arteries.

    Science.gov (United States)

    Leurent, Guillaume; Langella, Bernard; Fougerou, Claire; Lentz, Pierre-Axel; Larralde, Antoine; Bedossa, Marc; Boulmier, Dominique; Le Breton, Hervé

    2011-03-01

    Myocardial infarction with unobstructed coronary artery disease represents a serious diagnostic challenge. The role of cardiac magnetic resonance in the management of cardiomyopathies is increasing. We examined the diagnostic contributions of cardiac magnetic resonance in patients presenting with acute chest pain syndrome, elevated serum cardiac troponin concentrations and no significant coronary artery stenoses. Over a 3-year period, 107 consecutive patients (mean age 43.5 years; 62% men) presented to our institution with acute onset of chest pain, elevated serum troponin concentration and unobstructed coronary arteries, and underwent 3-tesla cardiac magnetic resonance at a mean delay of 6.9 days. A diagnosis was made based on: wall motion abnormalities and pericardial effusion on cine mode; myocardial oedema on T2-weighted imaging; abnormalities on first-pass perfusion imaging; and late gadolinium enhancement on T1-weighted imaging. Cardiac magnetic resonance was normal in 10.3% of patients and contributed a diagnosis in 89.7%, including myocarditis in 59.9%, stress cardiomyopathy (takotsubo syndrome) in 14% and myocardial infarction in 15.8%. Patients with normal cardiac magnetic resonance had a significantly lower mean peak troponin concentration (2.6ng/mL) than patients with diagnostic cardiac magnetic resonance (9.7ng/mL; P=0.01). Cardiac magnetic resonance contributed a diagnosis in nearly 90% of patients presenting with acute chest pain, elevated serum troponin and unobstructed coronary arteries. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  7. Chiropractic Treatment vs Self-Management in Patients With Acute Chest Pain: A Randomized Controlled Trial of Patients Without Acute Coronary Syndrome

    DEFF Research Database (Denmark)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner;

    2012-01-01

    OBJECTIVE: The musculoskeletal system is a common but often overlooked cause of chest pain. The purpose of the present study is to evaluate the relative effectiveness of 2 treatment approaches for acute musculoskeletal chest pain: (1) chiropractic treatment that included spinal manipulation and (2......) self-management as an example of minimal intervention. METHODS: In a nonblinded, randomized, controlled trial set at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were...... included. After a baseline evaluation, patients with musculoskeletal chest pain were randomized to 4 weeks of chiropractic treatment or self-management, with posttreatment questionnaire follow-up 4 and 12 weeks later. Primary outcome measures were numeric change in pain intensity (11-point box numerical...

  8. Acute Pancreatitis Concomitant Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Okay Abacı

    2013-03-01

    Full Text Available Acute pancreatitis is an inflammatory syndrome with unpredictable progression to systemic inflammation and multi-organ dysfunction. As in our case rarely, acute pancreatitis can be presented with the coexistance of acute coronary syndrome. To prevent a misdiagnosis of acute situation presented with chest or abdominal pain, physicians must be aware for coexisting pathophysiologies and take into account the differential diagnosis of all life-threatening causes such as cardiac ischemia or acute abdominal situations.

  9. Chest pain unit (CPU) in the management of low to intermediate risk acute coronary syndrome: a tertiary hospital experience from New Zealand.

    Science.gov (United States)

    Mazhar, J; Killion, B; Liang, M; Lee, M; Devlin, G

    2013-02-01

    A chest pain unit (CPU) for management of patients with chest pain at low to intermediate risk for acute coronary syndrome (ACS) appears safe and cost-effective. We report our experience with a CPU from March 2005 to July 2009. Prospective audit of patients presenting with chest pain suggestive of ACS but no high risk features and managed using a CPU, which included; serial cardiac troponins and electrocardiography and exercise tolerance test (ETT) if indicated. Outcomes assessed included three-month readmission rate and one year mortality. 2358 patients were managed according to the CPU. Mean age 56 years (17-96 years), 59% men and median stay of 22h (IQR 17-26h). 1933 (82%) were diagnosed as non-cardiac chest pain. 1741 (74%) patients had an ETT. Median time from triage to ETT was 21h (IQR 16-24h). 64 (2.7%) were readmitted within three months. The majority of readmissions, 39 (61%) were for a non-cardiac cause. Twenty patients (1%) were readmitted with ACS. There was no cardiac death after one year of being discharged as non-cardiac chest pain. This study confirms that a CPU with high usage of predischarge ETT is a safe and effective way of excluding ACS in patients without high risk features in a New Zealand setting. Copyright © 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  10. 29. Triple rule out versus standard coronary computed tomography angiography in evaluation of acute chest pain syndrome.

    Directory of Open Access Journals (Sweden)

    O. smettei

    2016-07-01

    Full Text Available Acute chest pain (ACP in emergency department represents a health care challenge. Triple-rule-out (TRO Computed Tomography Angiography (CTA can provide an evaluation of the coronary arteries, aorta,Pulmonary arteries, and chest structures in one scan. The aim of our work was to evaluate the diagnostic yield of TRO versus cardiac CTA in patients with ACP, In addition to compare the image quality, contrast material and radiation doses of TRO with standard CTA.We hypothesized that TRO CTA has a comparable diagnostic yield to standard coronary CTA, in addition to its ability to add extra diagnostic information. Prospective analysis of 134 TRO CTA data, to assess the presence of coronary artery disease(CAD, Aortic dissection, pulmonary embolism and other chest pathology. Then retrospectively to compare the results with 132 standard CTA. Normal coronaries or non-significant CAD was seen in 97 (72.9% patients, 19 (14.2% had moderate or significant CAD, two (1.5% had aortic dissection, three (2.2% had a pulmonary embolism, 61% had other findings. The image quality score and noise were comparable between the standard and TRO CTA (2.8 ± 0.6 vs 2.96 ± 0.6, P = 0.28 and (30.5 ± 10.6 vs 28.4 ± 1, P = 0.1 respectively. The effective radiation dose was significantly lower in the standard compared to the TRO CTA using prospective (4.4 ± 1.7 vs. 5.1 ± 0.5 mSv = 0.008 and (11.9 vs. 18.3 ± 5 msv, P = 0.0001 for retrospective gating protocols. The contrast dose was lower with standard protocol (83 ± 5 vs 102 ± 9 ml. p = 0.001. TRO CTA is a valid tool for diagnosis of CAD and can provide accurate detection of non-coronary pathology, but it was associated with higher radiation and contrast doses compared to the standard CTA.

  11. HLA DRB1*130101-DQB1*060101 haplotype is associated with acute chest syndrome in sickle cell anemia patients.

    Science.gov (United States)

    Mahdi, N; Al-Subaie, A M; Al-Ola, K; Al-Irhayim, A Q; Ali, M E; Al-Irhayim, Z; Almawi, W Y

    2009-03-01

    We investigated the association of human leukocyte antigens (HLA) class II alleles and haplotypes with the pathogenesis of acute chest syndrome (ACS) in 186 sickle cell anemia (SCA) patients, of whom 58 had documented ACS (new pulmonary infiltrate, fever, and other associated clinical events) and 128 with a negative history of ACS, serving as controls. HLA DRB1* and -DQB1* genotyping was performed by polymerase chain reaction-sequence-specific priming. Of the DRB1* and DQB1* alleles analyzed, only DRB1*130101 (Pc haplotype was more prevalent among ACS patients (P = 0.018), thus conferring disease susceptibility. Specific HLA alleles and haplotypes may influence ACS risk in SCA patients, and specific HLA genotypes may be useful markers for identifying high-risk SCA ACS patients.

  12. Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Henzler, Thomas, E-mail: thomas.henzler@medma.uni-heidelberg.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Gruettner, Joachim, E-mail: joachim.gruettner@umm.de [Emergency Department, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Meyer, Mathias, E-mail: mr.meyer.mathias@gmail.com [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Rothhaar, Baerbel, E-mail: baerbel.rothhaar@umm.de [Business Development – Medical Controlling, University Medical Center, Mannheim (Germany); Apfaltrer, Paul, E-mail: Paul.Apfaltrer@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Metzger, Franz, E-mail: franz.metzger@umm.de [Business Development – Medical Controlling, University Medical Center, Mannheim (Germany); Borggrefe, Martin, E-mail: martin.borggrefe@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoenberg, Stefan O., E-mail: stefan.schoenberg@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); and others

    2013-01-15

    Objective: To evaluate the economic impact of integrating coronary CT angiography (cCTA) or whole chest “triple-rule-out” CTA (TRO-CTA) in the work-up of patients with acute chest pain. Materials and methods: 100 consecutive emergency department patients with acute chest pain and an intermediate cardiac risk for ACS underwent cCTA or TRO-CTA (cCTA group). Diagnostic performance, rate and length of hospitalization, hospital costs, hospital reimbursement and hospital profit were analyzed. All findings were compared to those of 100 different patients with acute chest pain that were evaluated with a standard of care (SOC) diagnostic algorithm (SOC group) that did not include cCTA. Diagnostic performance (“safety”) of both algorithms was defined as the absence of major adverse cardiac events (MACE) over a 90-day follow-up period. Results: In the cCTA group 60/100 patients were safely discharged at the same day. 19/100 patients were hospitalized due to significant coronary stenosis on cCTA, which was confirmed by invasive coronary catheterization (ICC) in 17/19 patients. Relevant non-coronary disease that led to hospitalization were found in 21 patients of the cCTA group. In the SOC group all patients were hospitalized. 87 of these hospitalized patients underwent ICC for exclusion of coronary artery stenosis. A significant coronary artery stenosis was found in only 25 of these patients. Within the cCTA group no patient suffered from MACE over the 90-day follow-up period. In the SOC group 2 patients were rehospitalized during the 90-day follow-up period due to recurrent chest pain and 1 patient because of a pseudoaneurym of the left femoral artery after ICC. The median hospital costs per patient were significantly lower in the cCTA group than in the SOC group (428.9€ vs. 1575.0€, p < 0.001). The median reimbursement of the cCTA group was less compared to the SOC group (589.8€ vs. 2412.1€, p < 0.001) and patients in the cCTA group gained less profit than

  13. Pulmonary ultrasound and pulse oximetry versus chest radiography and arterial blood gas analysis for the diagnosis of acute respiratory distress syndrome: a pilot study.

    Science.gov (United States)

    Bass, Cameron M; Sajed, Dana R; Adedipe, Adeyinka A; West, T Eoin

    2015-07-21

    In low-resource settings it is not always possible to acquire the information required to diagnose acute respiratory distress syndrome (ARDS). Ultrasound and pulse oximetry, however, may be available in these settings. This study was designed to test whether pulmonary ultrasound and pulse oximetry could be used in place of traditional radiographic and oxygenation evaluation for ARDS. This study was a prospective, single-center study in the ICU of Harborview Medical Center, a referral hospital in Seattle, Washington, USA. Bedside pulmonary ultrasound was performed on ICU patients receiving invasive mechanical ventilation. Pulse oximetric oxygen saturation (SpO2), partial pressure of oxygen (PaO2), fraction of inspired oxygen (FiO2), provider diagnoses, and chest radiograph closest to time of ultrasound were recorded or interpreted. One hundred and twenty three ultrasound assessments were performed on 77 consecutively enrolled patients with respiratory failure. Oxygenation and radiographic criteria for ARDS were met in 35 assessments. Where SpO2 ≤ 97%, the Spearman rank correlation coefficient between SpO2/FiO2 and PaO2/FiO2 was 0.83, p arterial blood gas testing and chest radiography are not readily available.

  14. Sickle cell disease patients in eastern province of Saudi Arabia suffer less severe acute chest syndrome than patients with African haplotypes

    Directory of Open Access Journals (Sweden)

    Alabdulaali M

    2007-01-01

    Full Text Available Background and Objectives : Genetic studies suggest that the sickle cell mutation has arisen on at least four separate occasions in Africa and as a fifth independent mutation in the Eastern Province of Saudi Arabia or India. The pathophysiology of sickle cell disease (SCD is essentially similar in these different areas although the frequency and severity of complications may vary between areas. The aim of this study was to evaluate the prevalence and outcome of acute chest syndrome (ACS in SCD patients from Eastern province of Saudi Arabia in comparison with patients with African haplotypes. Materials and Methods : This was a retrospective study involving 317 SCD patients who were two years or older, admitted to King Fahad Hospital Hofuf between January-May 2003 for different etiologies. Twenty six patients presented with different causes of ACS; 11 patients presented with different pathologies other than ACS, but had past history of ACS; 280 patients presented with different pathologies and never presented with ACS. Clinical features, CBC, Hb-electrophoresis, G6PD activity, cultures, chest X-ray, arterial oxygen saturation, blood transfusion rates and outcome were studied. Univariate and multiple regression analysis were carried out to evaluate influence on ACS. Comparison between SCD patients with ACS from this study and from Eastern province of Saudi Arabia to patients with African haplotypes were carried out, using data reported in the literature. Results : During the period of this study, 37 patients with new or previous episodes of ACS were studied (accounting for 11.67% of admitted SCD patients. Most of the patients with ACS had only one episode, but five patients (13.51% had had episodes or more. One patient died giving an in-hospital mortality rate of 1/26 (3.85%. Comparison of recurrence of ACS and mortality between SCD patients in Eastern province of Saudi Arabia to that of patients with African haplotype showed that recurrence is

  15. Chest wall syndrome among primary care patients: a cohort study

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    Verdon François

    2007-09-01

    Full Text Available Abstract Background The epidemiology of chest pain differs strongly between outpatient and emergency settings. In general practice, the most frequent cause is the chest wall pain. However, there is a lack of information about the characteristics of this syndrome. The aims of the study are to describe the clinical aspects of chest wall syndrome (CWS. Methods Prospective, observational, cohort study of patients attending 58 private practices over a five-week period from March to May 2001 with undifferentiated chest pain. During a one-year follow-up, questionnaires including detailed history and physical exam, were filled out at initial consultation, 3 and 12 months. The outcomes were: clinical characteristics associated with the CWS diagnosis and clinical evolution of the syndrome. Results Among 24 620 consultations, we observed 672 cases of chest pain and 300 (44.6% patients had a diagnosis of chest wall syndrome. It affected all ages with a sex ratio of 1:1. History and sensibility to palpation were the keys for diagnosis. Pain was generally moderate, well localised, continuous or intermittent over a number of hours to days or weeks, and amplified by position or movement. The pain however, may be acute. Eighty-eight patients were affected at several painful sites, and 210 patients at a single site, most frequently in the midline or a left-sided site. Pain was a cause of anxiety and cardiac concern, especially when acute. CWS coexisted with coronary disease in 19 and neoplasm in 6. Outcome at one year was favourable even though CWS recurred in half of patients. Conclusion CWS is common and benign, but leads to anxiety and recurred frequently. Because the majority of chest wall pain is left-sided, the possibility of coexistence with coronary disease needs careful consideration.

  16. Effect of automated red cell exchanges on oxygen saturation on-air, blood parameters and length of hospitalization in sickle cell disease patients with acute chest syndrome

    Directory of Open Access Journals (Sweden)

    John C Aneke

    2016-01-01

    Full Text Available Background: Red cell exchanges (RCEs lead to improvement in tissue oxygenation and reduction in inflammatory markers in sickle cell disease (SCD patients who present with acute chest syndrome (ACS. The aim of this study is to evaluate the effects of automated-RCE (auto-RCE on oxygen saturation (SpO 2 on-air, blood counts, the time to correct the parameters and length of hospitalization after the exchange in SCD patients presenting with ACS. Subjects and Methods: This was 2 years study involving five SCD patients; the time for SpO 2 on air to increase to ≥95% and chest symptoms to resolve, postprocedure, as well as the length of in-patient hospitalization was recorded. All data were entered into Statistical Package for Social Sciences Version 20.0 (SPSS Inc., Chicago, IL, USA computer software for analyses. Results: The study involved 4 (80% hemoglobin (Hb SS and 1 (20% HbSC patients. The median time of SpO 2 recovery was 24 h, ranging from 6 to 96 h. About 60% (3/5 of patients achieved optimal SpO 2 within 24 h post-RCE, while discharge from intensive care unit was 24 h after auto-RCE in one patient. The Hb concentration was significantly higher, while the total white cell and absolute neutrophil counts were significantly lower at the time of resolution of symptoms, compared to before auto-RCE (P < 0.05. The average post auto-red cell transfusion symptoms duration was 105.6 (24-240 h while mean inpatient stay was 244.8 (144-456 h. Conclusion: Auto-RCE could reverse hypoxia in ACS within 24 h.

  17. High-risk Plaque Detected on Coronary Computed Tomography Angiography Predicts Acute Coronary Syndrome Independent of Significant Stenosis in Patients with Acute Chest Pain – Results from ROMICAT II Trial

    Science.gov (United States)

    Puchner, Stefan B.; Liu, Ting; Mayrhofer, Thomas; Truong, Quynh A.; Lee, Hang; Fleg, Jerome L.; Nagurney, John T.; Udelson, James E.; Hoffmann, Udo; Ferencik, Maros

    2014-01-01

    Background To determine whether high-risk plaque as detected by coronary computed tomography angiography (CTA) permits improved early diagnosis of acute coronary syndrome (ACS) independent to the presence of significant CAD in acute chest pain patients. Objectives The primary aim was to determine whether high-risk plaque features, as detected by CTA in the emergency department, may improve diagnostic certainty of ACS independent and incremental to the presence of significant CAD and clinical risk assessment in patients with acute chest pain but without objective evidence of myocardial ischemia or myocardial infarction. Methods We included patients randomized to the CCTA arm of ROMICAT II trial. Readers assessed coronary CTA qualitatively for the presence of non-obstructive CAD (1-49% stenosis), significant CAD (≥50% or ≥70% stenosis), and the presence of at least 1 of the high-risk plaque features (positive remodeling, low coronary CTA with diagnostic image quality (mean age 53.9±8.0 years, 52.8% men) had ACS (7.8%; MI n=5, UAP n=32)]. CAD was present in 262 (55.5%) patients [non-obstructive CAD 217 (46.0%) patients, significant CAD with ≥50% stenosis 45 (9.5%) patients]. High-risk plaques were more frequent in patients with ACS and remained a significant predictor of ACS (OR 8.9, 95% CI 1.8-43.3, p=0.006) after adjusting for ≥50% stenosis (OR 38.6, 95% CI 14.2-104.7, pstenosis. Conclusions In patients presenting to the ED with acute chest pain but negative initial electrocardiogram and troponin, presence of high-risk plaque on coronary CTA increases the likelihood of ACS independent of significant CAD and clinical risk assessment (age, gender, and number of cardiovascular risk factors). PMID:25125300

  18. Serial multiple biomarkers in the assessment of suspected acute coronary syndrome: multiple infarct markers in chest pain (MIMIC) study.

    Science.gov (United States)

    Macdonald, Stephen P J; Nagree, Yusuf; Fatovich, Daniel M; Phillips, Michael; Brown, Simon G A

    2013-02-01

    To evaluate the accuracy of a 2-h serial multiple biomarker (SMB) protocol for exclusion of myocardial infarction (MI) in the Emergency Department. A prospective, multicentre, observational study enrolled patients undergoing evaluation for possible MI. Blood samples at presentation and 2 h later were analysed for myoglobin, creatinine kinase-MB, troponin-I and B-natriuretic peptide. Thrombolysis in Myocardial Infarction (TIMI) score and National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (NHF/CSANZ) guideline for acute coronary syndrome were used to determine clinical risk. Primary outcome was MI diagnosed at index presentation. Secondary outcome was composite of all-cause mortality, MI and previously unplanned coronary revascularisation within 30 days. 1758 patients were recruited. 168 (11%) of 1501 with data sufficient for analysis had MI, and 223 (14%) of 1620 had a secondary outcome. SMB sensitivity and specificity were 0.90 (95% CI 0.84 to 0.94) and 0.41 (95% CI 0.39 to 0.44) for MI. For 30-day outcome, SMB sensitivity and specificity were 0.84 (95% CI 0.78 to 0.88) and 0.41 (95% CI 0.39 to 0.44), compared with standard 8-12 h troponin sensitivity and specificity of 0.79 (95% CI 0.73 to 0.84) and 0.96 (95% CI 0.95 to 0.97). Combined with risk scores, SMB had sensitivity and specificity for MI of 0.99 (0.96 to 1.00) and 0.11 (95% CI 0.09 to 0.12) for TIMI score 0, compared with 0.98 (95% CI 0.94 to 0.99) and 0.31 (95% CI 0.29 to 0.34) for NHF/CSANZ low/intermediate risk groups. SMB alone is not sufficiently sensitive to exclude MI. Combined with risk scoring, SMB appears to identify patients at lower risk. This requires prospective validation.

  19. Acute chest syndrome is associated with single nucleotide polymorphism-defined beta globin cluster haplotype in children with sickle cell anaemia.

    Science.gov (United States)

    Bean, Christopher J; Boulet, Sheree L; Yang, Genyan; Payne, Amanda B; Ghaji, Nafisa; Pyle, Meredith E; Hooper, W Craig; Bhatnagar, Pallav; Keefer, Jeffrey; Barron-Casella, Emily A; Casella, James F; Debaun, Michael R

    2013-10-01

    Genetic diversity at the human β-globin locus has been implicated as a modifier of sickle cell anaemia (SCA) severity. However, haplotypes defined by restriction fragment length polymorphism sites across the β-globin locus have not been consistently associated with clinical phenotypes. To define the genetic structure at the β-globin locus more thoroughly, we performed high-density single nucleotide polymorphism (SNP) mapping in 820 children who were homozygous for the sickle cell mutation (HbSS). Genotyping results revealed very high linkage disequilibrium across a large region spanning the locus control region and the HBB (β-globin gene) cluster. We identified three predominant haplotypes accounting for 96% of the β(S) -carrying chromosomes in this population that could be distinguished using a minimal set of common SNPs. Consistent with previous studies, fetal haemoglobin level was significantly associated with β(S) -haplotypes. After controlling for covariates, an association was detected between haplotype and rate of hospitalization for acute chest syndrome (ACS) (incidence rate ratio 0·51, 95% confidence interval 0·29-0·89) but not incidence rate of vaso-occlusive pain or presence of silent cerebral infarct (SCI). Our results suggest that these SNP-defined β(S) -haplotypes may be associated with ACS, but not pain or SCI in a study population of children with SCA.

  20. Quick identification of acute chest pain patients study (QICS)

    NARCIS (Netherlands)

    Willemsen, Hendrik M.; de Jong, Gonda; Tio, Rene A.; Nieuwland, Wybe; Kema, Ido P.; van der Horst, Iwan C. C.; Oudkerk, Mattijs; Zijlstra, Felix

    2009-01-01

    Background: Patients with acute chest pain are often referred to the emergency ward and extensively investigated. Investigations are costly and could induce unnecessary complications, especially with invasive diagnostics. Nevertheless, chest pain patients have high mortalities. Fast identification o

  1. Chest radiographic findings in acute paraquat poisoning

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    Na, Gyeong Gyun; Lee, Mi Sook; Kim, Hee Jun; Sun, In O [Presbyterian Medical Center, Jeonju (Korea, Republic of)

    2016-01-15

    To describe the chest radiographic findings of acute paraquat poisoning. 691 patients visited the emergency department of our hospital between January 2006 and October 2012 for paraquat poisoning. Of these 691, we identified 56 patients whose initial chest radiographs were normal but who developed radiographic abnormalities within one week. We evaluated their radiographic findings and the differences in imaging features based on mortality. The most common finding was diffuse consolidation (29/56, 52%), followed by consolidation with linear and nodular opacities (18/56, 32%), and combined consolidation and pneumomediastinum (7/56, 13%). Pleural effusion was noted in 17 patients (30%). The two survivors (4%) showed peripheral consolidations, while the 54 patients (96%) who died demonstrated bilateral (42/54, 78%) or unilateral (12/54, 22%) diffuse consolidations. Rapidly progressing diffuse pulmonary consolidation was observed within one week on follow-up radiographs after paraquat ingestion in the deceased, but the survivors demonstrated peripheral consolidation.

  2. Psychiatric syndromes associated with atypical chest pain

    Directory of Open Access Journals (Sweden)

    Nikolić Gordana

    2010-01-01

    Full Text Available Background/Aim. Chest pain often indicates coronary disease, but in 25% of patients there is no evidence of ischemic heart disease using standard diagnostic tests. Beside that, cardiologic examinations are repeated several times for months. If other medical causes could not be found, there is a possibility that chest pain is a symptom of psychiatric disorder. The aim of this study was to determine the presence of psychiatric syndromes, increased somatization, anxiety, stress life events exposure and characteristic of chest pain expression in persons with atypical chest pain and coronary patients, as well as to define predictive parameters for atypical chest pain. Method. We compared 30 patients with atypical chest pain (E group to 30 coronary patients (K group, after cardiological and psychiatric evaluation. We have applied: Mini International Neuropsychiatric Interview (MINI, The Symptom Checklist 90-R (SCL-90 R, Beck Anxiety Inventory (BAI, Holms-Rahe Scale of stress life events (H-R, Questionnaire for pain expression Pain-O-Meter (POM. Significant differences between groups and predictive value of the parameters for atypical chest pain were determined. Results. The E group participants compared to the group K were younger (33.4 ± 5.4 : 48.3 ± 6,4 years, p < 0.001, had a moderate anxiety level (20.4 ± 11.9 : 9.6 ± 3.8, p < 0.001, panic and somatiform disorders were present in the half of the E group, as well as eleveted somatization score (SOM ≥ 63 -50% : 10%, p < 0.01 and a higher H-R score level (102.0 ± 52.2 : 46.5 ± 55.0, p < 0.001. Pain was mild, accompanied with panic. The half of the E group subjects had somatoform and panic disorders. Conclusion. Somatoform and panic disorders are associated with atypical chest pain. Pain expression is mild, accompained with panic. Predictive factors for atypical chest pain are: age under 40, anxiety level > 20, somatization ≥ 63, presence of panic and somatoform disorders, H-R score > 102

  3. Atherosclerotic plaque burden in cocaine users with acute chest pain : Analysis by coronary computed tomography angiography

    NARCIS (Netherlands)

    Ebersberger, Ullrich; Sudarski, Sonja; Schoepf, U. Joseph; Bamberg, Fabian; Tricarico, Francesco; Apfaltrer, Paul; Blanke, Philipp; Schindler, Andreas; Makowski, Marcus R.; Headden, Gary F.; Leber, Alexander W.; Hoffmann, Ellen; Vliegenthart, Rozemarijn

    2013-01-01

    Chest pain associated with cocaine use represents an increasing problem in the emergency department (ED). Cocaine use has been linked to the acute coronary syndrome (ACS) and acute myocardial infarction (AMI). We used coronary computed tomography angiography (cCTA) to evaluate the prevalence, severi

  4. Pulmonary ultrasound and pulse oximetry versus chest radiography and arterial blood gas analysis for the diagnosis of acute respiratory distress syndrome: a pilot study

    OpenAIRE

    Bass, Cameron M.; Sajed, Dana R.; Adedipe, Adeyinka A.; West, T Eoin

    2015-01-01

    Introduction In low-resource settings it is not always possible to acquire the information required to diagnose acute respiratory distress syndrome (ARDS). Ultrasound and pulse oximetry, however, may be available in these settings. This study was designed to test whether pulmonary ultrasound and pulse oximetry could be used in place of traditional radiographic and oxygenation evaluation for ARDS. Methods This study was a prospective, single-center study in the ICU of Harborview Medical Center...

  5. Acute posteroinferior wall myocardial infarction secondary to football chest trauma.

    Science.gov (United States)

    Espinosa, R; Badui, E; Castaño, R; Madrid, R

    1985-12-01

    Myocardial infarction secondary to nonpenetrating chest trauma is rare. We present the case of a sportsman who developed an acute transmural posteroinferior wall myocardial infarction due to chest trauma by a football. The angiographic study revealed total obstruction of the proximal right coronary artery.

  6. Chest physical therapy in acute viral bronchiolitis: an updated review.

    Science.gov (United States)

    Postiaux, Guy; Zwaenepoel, Bruno; Louis, Jacques

    2013-09-01

    We describe the various therapies for infant acute viral bronchiolitis and the contradictory results obtained with chest physical therapy. The treatment target is bronchial obstruction, which is a multifactorial phenomenon that includes edema, bronchoconstriction, and increased mucus production, with a clinical grading defined as severe, moderate, or mild. Chest physical therapy is revisited in its various modalities, according to preliminary scoring of the disease.

  7. Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain

    DEFF Research Database (Denmark)

    Lyngbæk, Stig; Andersson, Charlotte; Marott, Jacob L

    2013-01-01

    Plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict mortality in several clinical settings, but the long-term prognostic importance of suPAR in chest pain patients admitted on suspicion of non-ST-segment elevation acute coronary syndrome (NSTEACS) is uncertain....

  8. Tricuspid regurgitant velocity elevation in a three-year old child with sickle cell anemia and recurrent acute chest syndromes reversed not by hydroxyurea but by bone marrow transplantation

    Directory of Open Access Journals (Sweden)

    Raffaella Colombatti

    2011-09-01

    Full Text Available Elevated Tricuspid Regurgitant Velocity (TRV has been related to higher mortality in adults and to hemolysis, lower oxygen saturation during 6-minute walk test and acute chest syndrome (ACS in children with sickle cell disease (SCD. Hydroxyurea (HU has reduced TRV value in children and adults. We describe a three year old HbSS child with recurrent ACS, hypoperfusion of the left lung, mild hemolysis and persistent TRV elevation. TRV did not normalize after HU, despite improvement in clinical conditions and in baseline laboratory parameters related to hemolysis and blood viscosity, but normalized after bone marrow transplantation (BMT. Our experience suggests that in young patients, TRV reduction can be a positive concomitant effect of BMT.

  9. Acute fatal chest pain: optimized procedure in emergency department.

    Science.gov (United States)

    Yang, Yang; Zhang, Wei; Peng, Ming; Tong, Lianying; Lin, Shouyu

    2013-01-01

    To explore the diagnostic procedure of acute fatal chest pain in emergency department (ED) in order to decrease the misdiagnosis rate and shorten the definite time to diagnosis. The ultimate aim is to rescue the patients timely and effectively. Three hundreds and two patients (56.9 ± 11.8 Years, 72% men) complained with acute chest pain and chest distress presenting to our ED were recruited. They were divided into two groups according to visiting time (Group I: from October 2010 to March 2011, Group II: from October 2011 to March 2012). The misdiagnosis rate, definite time for diagnosis and medical expense were analyzed. Patients of Group I were diagnosed by initial doctors who made their diagnosis according to personal experience in outpatient service or rescue room in ED. While patients of Group II were all admitted to rescue room and were diagnosed and rescued according to the acute chest pain screening flow-process diagram. Differences inter-group was compared. The misdiagnosis rate of fatal chest pain in Group I and Group II was 6.8% and 0% respectively, and there was statistic difference (P=0.000). The definite time to diagnosis was 65.3 min and 40.1 min in control and Group II respectively, the difference had statistic significance (P=0.000). And the mean cost for treatment was 787.5/124.5 ¥/$ and 905.5/143.2 ¥/$ respectively, and there was statistic difference too (P=0.012). Treating emergency patients with acute chest pain according to the acute chest pain screening flow-process diagram in rescue room will decrease misdiagnosis apparently, and it can also shorten the definite time to correct diagnosis. It has a remarkable positive role in rescuing patients with acute chest pain timely and effectively.

  10. Radiological chest manifestations in diffuse infiltrative lymphocytosis syndrome (DILS

    Directory of Open Access Journals (Sweden)

    F Ismail

    2011-06-01

    Full Text Available This report focuses on the radiological manifestations of diffuse interstitial lymphocytosis syndrome (DILS in the chest. Awareness of this entity and early diagnosis by radiologists will enable timeous intervention by clinicians.

  11. Chest pain characteristics and gender in the early diagnosis of acute myocardial infarction.

    Science.gov (United States)

    Arora, Garima; Bittner, Vera

    2015-02-01

    Acute myocardial infarction is one of the leading causes of cardiovascular disease mortality in both men and women. Chest pain, which is often described as chest pressure, tightness, or a squeezing sensation, is the most frequent symptom in patients presenting with acute myocardial infarction. Although the diagnosis of acute myocardial infarction is often based on typical changes on a surface electrocardiogram and on changes in cardiac biomarkers, there is a need to better recognize and understand the impact of sex on symptoms among patients presenting with acute coronary syndrome or acute myocardial infarction. We briefly review the pathophysiology of ischemic symptoms, discuss potential mechanisms for variation in ischemic symptoms by sex, and summarize recent publications that have addressed sex differences in ischemic symptoms.

  12. Quick identification of acute chest pain patients study (QICS

    Directory of Open Access Journals (Sweden)

    van der Horst Iwan CC

    2009-06-01

    Full Text Available Abstract Background Patients with acute chest pain are often referred to the emergency ward and extensively investigated. Investigations are costly and could induce unnecessary complications, especially with invasive diagnostics. Nevertheless, chest pain patients have high mortalities. Fast identification of high-risk patients is crucial. Therefore several strategies have been developed including specific symptoms, signs, laboratory measurements, and imaging. Methods/Design The Quick Identification of acute Chest pain Study (QICS will investigate whether a combined use of specific symptoms and signs, electrocardiography, routine and new laboratory measures, adjunctive imaging including electron beam (EBT computed tomography (CT and contrast multislice CT (MSCT will have a high diagnostic yield for patients with acute chest pain. All patients will be investigated according a standardized protocol in the Emergency Department. Serum and plasma will be frozen for future analysis for a wide range of biomarkers at a later time point. The primary endpoint is the safe recognition of low-risk chest pain patients directly at presentation. Secondary endpoint is the identification of a wide range of sensitive predictive clinical markers, chemical biomarkers and radiological markers in acute chest pain patients. Chemical biomarkers will be compared to quantitative CT measurements of coronary atherosclerosis as a surrogate endpoint. Chemical biomarkers will also be compared in head to head comparison and for their additional value. Discussion This will be a very extensive investigation of a wide range of risk predictors in acute chest pain patients. New reliable fast and cheap diagnostic algorithm resulting from the test results might improve chest pain patients' prognosis, and reduce unnecessary costs and diagnostic complications.

  13. Non ST-elevation acute coronary syndrome

    OpenAIRE

    Sarkees, Michael L; Bavry, Anthony A.

    2010-01-01

    Non ST-elevation acute coronary syndrome (NSTE-ACS, here defined as unstable angina and non ST-elevation MI) is characterised by episodes of chest pain at rest or with minimal exertion, which increase in frequency or severity, often with dynamic ECG changes.

  14. Exercise echocardiography and multidetector computed tomography for the evaluation of acute chest pain.

    Science.gov (United States)

    Mas-Stachurska, Aleksandra; Miró, Oscar; Sitges, Marta; de Caralt, Teresa M; Perea, Rosario J; López, Beatriz; Sánchez, Miquel; Paré, Carles; Bosch, Xavier; Ortiz-Pérez, José T

    2015-01-01

    Up to 4% of patients with acute chest pain, normal electrocardiogram, and negative troponins present major adverse cardiac events as a result of undiagnosed acute coronary syndrome. Our aim was to compare the diagnostic performance of multidetector computed tomography and exercise echocardiography in patients with a low-to-intermediate probability of coronary artery disease. We prospectively included 69 patients with acute chest pain, normal electrocardiogram, and negative troponins who underwent coronary tomography angiography and exercise echocardiography. Patients with coronary stenosis ≥ 50% or Agatston calcium score ≥ 400 on coronary tomography angiography or positive exercise echocardiography, or with inconclusive results, were admitted to rule out acute coronary syndrome. An acute coronary syndrome was confirmed in 17 patients (24.6%). This was lower than the suspected 42% based on coronary tomography angiography (P<.05) and not significantly different than the suspected 29% based on the results of exercise echocardiography (P=.56). Exercise echocardiography was normal in up to 37% of patients with pathological findings on coronary tomography angiography. The latter technique provided a higher sensitivity (100% vs 82.3%; P=.21) but lower specificity (76.9% vs 88.4%; P=.12) than exercise echocardiography for the diagnosis of acute coronary syndrome, although without reaching statistical significance. Increasing the stenosis cutoff point to 70% increased the specificity of coronary tomography angiography to 88.4%, while maintaining high sensitivity. Coronary tomography angiography offers a valid alternative to exercise echocardiography for the diagnosis of acute coronary syndrome among patients with low-to-intermediate probability of coronary artery disease. A combination of both techniques could improve the diagnosis of acute coronary syndrome. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  15. The early risk stratification of the patients with acute chest pain

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:This investigation was designed to stratify patients with acute chest pain based on their symptoms,electrocardiogram (ECG),cardiac injury markers and the number of accompanying traditional risk factors(smoking,obesity,hyperlipemia,hypertension,diabetes),and to assess the effect of the above factors to obtain a risk stratification for patients with chest pain.Methods:We identified 139 patients with acute chest pain,including 45 myocardiac infarction patients,65 unstable angina patients and 29 chest pain patients without identified acute coronary syndrome(ACS)admitted to our Coronary Heart Center during December 2004 to February 2005.All patients accepted coronary angiography.All data was collected using questionnaires.Based on reported symptom,electrocardiogram (ECG),cardiac injury markers and the number of the accompanying traditional risk factors,we stratified all patients into four groups:Group l,patients with acute chest pain,ECG changes and abnormal cardiac injury biomarkers.Group 2,patients with acute chest pain and ECG changes(without abnormal cardiac injury biomarkers).Group 3,patients with acute chest pain,normal ECG,normal cardiac injury biomarkers and>2 traditional risk factors.Group 4,patients with acute chest pain,normal ECG and normal cardiac injury biomarkers.but only≤2 traditional risk factors.From this data we examined the difference of ACS incidence in the four groups.Results:After stratification the ACS incidence of the grouped patients in turn was 100%,84%,69.6%and 53.3%.The combination of early phase ECG and cardiac injury markers identified 70.9% patients with ACS(the specificity being 90.7%).The mortality of group 3 was higher compared with group 4(69.6% vs 53.3%),however the P value was more than 0.05 and didn't show significant statistical difference.The correlation analysis found the number of the traditional risk factors had a significant positive correlation(r=0.202,P=0.044)with the number of stenosis being more than 50% of

  16. Retrospective Evaluation of Two Fast-track Strategies to Rule Out Acute Coronary Syndrome in a Real-life Chest Pain Population

    DEFF Research Database (Denmark)

    Schønemann-Lund, Martin; Schoos, Mikkel Malby; Iversen, Kasper

    2015-01-01

    BACKGROUND: The European Society of Cardiology (ESC) guideline on non-ST-elevation acute coronary syndrome (N-STE ACS) proposed a new ACS rule-out protocol. OBJECTIVES: To evaluate this new tool, which uses diagnostic levels of high-sensitivity troponin T (hs-TnT; > 14 ng/L) in a slightly modified......, and symptom status at 6-9 h. Protocol 2: a single blood sample of hs-TnT. The primary endpoint was a discharge diagnosis of ACS by blinded adjudication. Secondary endpoints were ACS re-admission days and 1-year mortality. RESULTS: Protocol 1 classified 434/534 (81%) patients, with 27.9% being ruled out...... predictive value of 94.1% (88.2-97.6%) and 90.8% (81.9-96.2%), respectively. Both protocols correctly ruled in 2/3 patients with ACS re-admission days and 55/56 1-year fatalities. CONCLUSION: The present study confirms the diagnostic value of a modified version of the ESC rule-out protocol (Protocol 1...

  17. Slipping Rib Syndrome as Persistent Abdominal and Chest Pain.

    Science.gov (United States)

    Bolaños-Vergaray, Juan Javier; de la Gala García, Francisco; Obaya Rebollar, Juan Carlos; Bové Alvarez, Maria

    2015-11-01

    Slipping rib syndrome is an overlooked cause of persistent abdominal or chest pain. The etiology of this syndrome is not well understood, but the characteristic pain is from hypermobility of the false ribs. Although it is a diagnosis of exclusion, misdiagnosis may lead to an excessive workup. A simple clinical examination via the hooking maneuver is the most significant feature of its diagnosis. We describe the case of a 41-year-old woman with slipping rib syndrome.

  18. Fisioterapia respiratória em crianças com doença falciforme e síndrome torácica aguda Respiratory therapy in children with sickle cell disease and acute chest syndrome

    Directory of Open Access Journals (Sweden)

    Sandro Valter Hostyn

    2011-12-01

    Full Text Available OBJETIVO: Realizar uma revisão sistemática da literatura médica para identificar as técnicas de fisioterapia respiratória aplicadas em crianças com doença falciforme e síndrome torácica aguda, bem como descrever seu nível de evidência e recomendação. FONTES DE DADOS: Revisão bibliográfica nos bancos de dados Medline, Lilacs, SciELO e Cochrane no período de 1995 e 2009, com os descritores: "doença falciforme", "síndrome torácica aguda", "fisioterapia", "criança", "inspirometria de incentivo", em português e inglês, excluindo-se os estudos de revisão. Os artigos foram classificados por nível de evidência. SÍNTESE DOS DADOS: Foram encontrados cinco artigos; destes, três utilizaram a inspirometria de incentivo e observaram que ela evita as complicações pulmonares associadas à síndrome torácica aguda (nível de evidência II, II e IV, um deles (evidência II comparou a inspirometria de incentivo com o dispositivo de pressão expiratória, sem diferenças entre ambos. Um artigo utilizou uma rotina de cuidados, incluindo a inspirometria de incentivo (evidência V, e observou redução do tempo de internação hospitalar e do uso de medicação oral para dor. Outro estudo com a ventilação não invasiva para crianças com desconforto respiratório e com incapacidade de realizar a inspirometria de incentivo relatou melhora da oxigenação e do desconforto respiratório (nível de evidência V. CONCLUSÕES: As técnicas de fisioterapia respiratória com dispositivos de inspirometria de incentivo, de pressão expiratória e a ventilação não invasiva podem ser aplicadas em crianças com doença falciforme e síndrome torácica aguda; o nível de recomendação é C.OBJECTIVE: To systematically review the medical literature to identify chest physiotherapy techniques applied to children with sickle cell disease and acute chest syndrome, and to report their level of evidence and recommendation. DATA SOURCE: A bibliographic

  19. Acute Radiation Syndrome

    Science.gov (United States)

    ... Matters Information on Specific Types of Emergencies Acute Radiation Syndrome (ARS): A Fact Sheet for the Public ... is called the radiation dose. People exposed to radiation will get ARS only if: The radiation dose ...

  20. Acute heart failure syndrome

    African Journals Online (AJOL)

    tandfonline.com/ ... When heart failure develops gradually, there is time for the compensatory ... of this can be seen in acute brain injury, some forms of takotsubo syndrome or .... reduce blood pressure in cases presenting with elevated blood pressure.

  1. Fulminant myocarditis mimicking acute coronary syndrome = Miocarditis fulminante, simuladora de síndrome coronario agudo

    National Research Council Canada - National Science Library

    Senior, Juan Manuel; Muñoz Ortiz, Édison

    2014-01-01

    Fulminant myocarditis mimicking acute coronary syndrome We report the case of a 48 year-old man with chest pain and history of coronary and autoimmune diseases, who developed acute heart failure and hemodynamic collapse...

  2. Acute aortic and mitral valve regurgitation following blunt chest trauma.

    Science.gov (United States)

    Bernabeu, Eduardo; Mestres, Carlos A; Loma-Osorio, Pablo; Josa, Miguel

    2004-03-01

    Traumatic rupture of intracardiac structures is an uncommon phenomenon although there are a number of reports with regards to rupture of the tricuspid, mitral and aortic valves. We report the case of a 25-year-old patient who presented with acute aortic and mitral valve regurgitation of traumatic origin. Both lesions were seen separated by 2 weeks. Pathophysiology is reviewed. The combination of both aortic and mitral lesions following blunt chest trauma is almost exceptional.

  3. Effect of metoprolol on chest pain in acute myocardial infarction.

    OpenAIRE

    Herlitz, J; Hjalmarson, A.; Holmberg, S.; Pennert, K; Swedberg, K; Vedin, A; Waagstein, F; Waldenström, A; Wedel, H.; Wilhelmsen, L

    1984-01-01

    A total of 1395 patients aged 40 to 74 years were included in a double blind trial with the beta 1 selective blocker metoprolol in suspected acute myocardial infarction. Metoprolol was given intravenously (15 mg) as soon as possible after admission to hospital followed by 200 mg daily for three months. A placebo was given in the same manner. The severity of chest pain in the acute phase was calculated by recording the number of injections of analgesics given and the time from the start of bli...

  4. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Runza, G. [Department of Radiology, University of Palermo (Italy)], E-mail: grunza@sirm.org; La Grutta, L.; Alaimo, V. [Department of Radiology, University of Palermo (Italy); Evola, S. [Department of Cardiology, University of Palermo (Italy); Lo Re, F.; Bartolotta, T.V. [Department of Radiology, University of Palermo (Italy); Cademartiri, F. [Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam (Netherlands); Department of Radiology and Cardiology, Cardiovascular CT Unit, University Hospital, Parma (Italy); Midiri, M. [Department of Radiology, University of Palermo (Italy)

    2007-10-15

    Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation.

  5. Acute chest pain: The role of MR imaging and MR angiography

    Energy Technology Data Exchange (ETDEWEB)

    Hunold, Peter, E-mail: peter.hunold@uk-sh.de [Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck (Germany); Bischoff, Peter, E-mail: peter.bischoff@uk-sh.de [Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck (Germany); Barkhausen, Jörg, E-mail: joerg.barkhausen@uk-sh.de [Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck (Germany); Vogt, Florian M., E-mail: florian.vogt@uk-sh.de [Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck (Germany)

    2012-12-15

    MR imaging (MRI) and MR angiography (MRA) have gained a high level of diagnostic accuracy in cardiovascular disease. MRI in cardiac disease has been established as the non-invasive standard of reference in many pathologies. However, in acute chest pain the situation is somewhat special since many of the patients presenting in the emergency department suffer from potentially life-threatening disease including acute coronary syndrome, pulmonary embolism, and acute aortic syndrome. Those patients need a fast and definitive evaluation under continuous monitoring of vital parameters. Due to those requirements MRI seems to be less suitable compared to X-ray coronary angiography and multislice computed tomography angiography (CTA). However, MRI allows for a comprehensive assessment of all clinically stable patients providing unique information on the cardiovascular system including ischemia, inflammation and function. Furthermore, MRI and MRA are considered the method of choice in patients with contraindications to CTA and for regular follow-up in known aortic disease. This review addresses specific features of MRI and MRA for different cardiovascular conditions presenting with acute chest pain.

  6. Acute chest pain in a patient with a non-strangulated hiatal hernia

    Institute of Scientific and Technical Information of China (English)

    Alexander John Scumpia; Megan Elizabeth Dekok; Daniel Michael Aronovich; Gurpaul Bajwa; Randy Barros; Randy Katz; Jordan Ditchek

    2015-01-01

    Acute chest pain resulting in spontaneous idiopathic hemomediastinum is a rare, potentially life-threatening occurrence. Acute chest pain is a common chief complaint of patients, accounting for 2.4%-6% of adult emergency room visits. The clinician’s differential diagnoses for acute chest pain rarely include complications of hiatal hernias. An 83-year-old male presented with acute chest pain and was emergently diagnosed with hemomediastinum secondary to spontaneous gastric mesenteric vessel rupture due to a non-strangulated hiatal hernia after physical exertion.

  7. Stiff Person Syndrome Masquerading as Acute Coronary Syndrome.

    Science.gov (United States)

    Sharma, Ashish; Soe, Myat Han; Singh, Jagdeep; Newsome, Scott D

    2016-01-01

    Stiff person syndrome (SPS) is a rare neuroimmunological disorder characterized by severe progressive muscle stiffness in axial and lower extremity musculature with superimposed painful muscle spasms. Although chest pain is a common reason for SPS patients presenting to the emergency room, this disorder is overlooked and not part of the differential diagnosis of chest pain. Herein, we report on a middle age male presenting with classic symptoms of SPS; however, due to the rarity of this disease, he was initially thought to have acute coronary syndrome. Clinicians should consider the diagnosis of SPS in patients with fluctuating muscle spasms in the torso and/or extremities in the setting of repeated hospitalizations without subsequent symptom relief.

  8. Imaging strategies for acute chest pain in the emergency department

    NARCIS (Netherlands)

    A. Dedic (Admir); T.S.S. Genders (Tessa); K. Nieman (Koen); M.G.M. Hunink (Myriam)

    2013-01-01

    textabstractOBJECTIVE. Echocardiography, radionuclide myocardial perfusion imaging (MPI), and coronary CT angiography (CTA) are the three main imaging techniques used in the emergency department for the diagnosis of acute coronary syndrome (ACS). The purpose of this article is to quantitatively

  9. Chest wall reconstruction in a patient with Cantrell syndrome.

    Science.gov (United States)

    Mitsukawa, Nobuyuki; Yasunaga, Hiroshi; Tananari, Yoshifumi

    2009-06-01

    Cantrell syndrome is a very rare congenital anomaly with up to five features: a midline, upper abdominal wall abnormality, lower sternal defect, anterior diaphragmatic defect, diaphragmatic pericardial defect, and congenital abnormalities of the heart. This report describes our experience of performing a reconstruction of a chest wall defect in a Cantrell syndrome case with herniation of the heart. The patient was a 1-month-old female infant who received surgical patch repair of a ventricular septal defect (VSD) and atrial septal defect (ASD) at the Department of Cardiac Surgery. Subsequently, the patient underwent reconstruction at the second-stage surgery. A rhomboid skin flap with an inferior pedicle was used to close the defect. In this process the flap, including portions of the rectus abdominis muscles, was elevated and transferred into the defect. The sectioned ends of the divided pectoralis major muscles were sutured together to simultaneously reconstruct the muscles. It has been 2 years since the surgery, and the defect is covered with normal skin, and the protrusion of the heart from the chest wall and the externally visible pulsation have been resolved. The progress has been very good functionally and cosmetically.

  10. Acute compartment syndrome.

    Science.gov (United States)

    Via, Alessio Giai; Oliva, Francesco; Spoliti, Marco; Maffulli, Nicola

    2015-01-01

    acute compartment syndrome (ACS) is one of the few true emergencies in orthopedics and traumatology. It is a painful condition caused by the increase interstitial pressure (intracompart-mental pressure - ICP) within a closed osteofascial compartment which impair local circulation. It occurs most often in the legs, but it can affects also the arms, hands, feet, and buttocks. It usually develops after a severe injury such as fractures or crush injury, but it can also occurs after a relatively minor injury and it may be iatrogenic. Uncommon causes of ACS have been also described, that suggest surgeons to pay great attention to this serious complication. Diagnosing ACS is difficult in clinical practice, even among expert surgeons. Currently, the diagnosis is made on the basis of physical examination and repeated ICP measures. ICP higher than 30 mmHg of diastolic blood pressure is significant of compartment syndrome. Once diagnosis is made, fasciotomy to release the affected compartment should be performed as early as possible because delayed decompression would lead to irreversible ischemic damage to muscles and peripheral nerves. acute compartment syndrome is a surgical emergency. There is still little consensus among authors about diagnosis and treatment of these serious condition, in particular about the ICP at which fasciotomy is absolutely indicated and the timing of wound closure. New investigations are needed in order to improve diagnosis and treatment of ACS.

  11. Progress and perspectives in pediatric acute respiratory distress syndrome.

    Science.gov (United States)

    Rotta, Alexandre Tellechea; Piva, Jefferson Pedro; Andreolio, Cinara; de Carvalho, Werther Brunow; Garcia, Pedro Celiny Ramos

    2015-01-01

    Acute respiratory distress syndrome is a disease of acute onset characterized by hypoxemia and infiltrates on chest radiographs that affects both adults and children of all ages. It is an important cause of respiratory failure in pediatric intensive care units and is associated with significant morbidity and mortality. Nevertheless, until recently, the definitions and diagnostic criteria for acute respiratory distress syndrome have focused on the adult population. In this article, we review the evolution of the definition of acute respiratory distress syndrome over nearly five decades, with a special focus on the new pediatric definition. We also discuss recommendations for the implementation of mechanical ventilation strategies in the treatment of acute respiratory distress syndrome in children and the use of adjuvant therapies.

  12. [Acute coronary syndrome -- 2012].

    Science.gov (United States)

    Becker, Dávid; Merkely, Béla

    2012-12-23

    The acute coronary syndrome is the most severe form of coronary artery disease. It is an immediate threat of life and the mortality rate can be high without proper therapy and patient management. Based on the first ECG, two different forms can be distinguished: acute coronary syndrome with and without ST elevation. Besides adequate medication, management of these patients is an essential part of treatment. In case of ST elevation, coronarography and percutaneous coronary intervention is needed in general, within 24 hours from the onset of symptoms. When ST elevation is not detected on the ECG, individual ischemic risk factors and predictable mortality of the patient may define the necessity and the date of the invasive examination. The Hungarian hemodynamic laboratory network covers almost the whole country and, therefore, practically each patient may receive a state-of-the-art therapy. Although indicators of cardiovascular diseases are still prominent, the mortality rate of myocardial Infarction is decreasing in Hungary due to the well-organized invasive care.

  13. Acute chest pain:what about the time before visiting to the physician?

    Institute of Scientific and Technical Information of China (English)

    Beuy Joob; Viroj Wiwanitkit

    2013-01-01

    Acute chest pain is an important medical complaint that needs proper management.The acute myocardial infarction, which is an emergency condition primarily presented with chest pain.The important concerns in management are early diagnosis and prompt treatment.An important factor determining the success of treatment is the time before visiting to the physicians.In this report, the authors summarize on the time before visiting to the physicians.It can be seen that the health education to general people on the danger of acute chest pain is required.

  14. LECTURES ON ACUPUNCTURE Part Ⅰ Clinical Acupuncture Lecture Twenty-Four "XIONGBI" (CHEST PAIN) SYNDROME

    Institute of Scientific and Technical Information of China (English)

    Dong Hongying; Guo Ling; Shang Xiukui

    2001-01-01

    @@ "Xiongbi" chest (or precordial) pain with stuffiness, or chest pain syndrome is referred to choking pain in the chest due to stagnation of chest -yang, failure of qi and blood in warming and nourishing the local meridians. It is usually caused by stagnation of dampness and phlegm in the interior, or by insufficiency of qi and blood stasis, leading to impeded flow of qi and blood in the heart vessels. Its pathological characteristics are deficiency (chest-yang) in origin and excess (i. e., qi stagnation) in superficiality. The therapeutic principles are promoting blood circulation to remove blood stasis, getting rid of blockage and dredging the passages of yang-qi.

  15. Chest physiotherapy in children with acute bacterial pneumonia

    OpenAIRE

    2015-01-01

    Background: Pneumonia is the single leading cause of death in children younger than 5 years of age. Chest physiotherapy is often prescribed as an additional therapy in children with pneumonia. Different chest physiotherapy techniques are available that aim to improve airway clearance, gas exchange and reduce the work of breathing. However, it is unclear if these techniques are effective in this population.Objective: The present review aimed to determine the efficacy of different chest physiot...

  16. Homer syndrome after thoracoscopic apicectomy for spontaneous pneumothorax as a complication of chest tube placement.

    Science.gov (United States)

    Piccoli, Micaela; Golinelli, Marco; Colli, Giovanni; Mullineris, Barbara; Melotti, Gianluigi

    2007-01-01

    We describe a case of Horner syndrome occurring secondary only to the high insertion of a chest tube after video-thoracoscopic apicectomy for spontaneous pneumothorax. Because all other causes could be ruled out, the Authors assume that the lesion to the sympathetic nerve fibres was caused by pressure exerted by the tip of the chest tube. Horner syndrome due to this cause can easily be avoided. The tip of the chest tube should be kept at the level of, or below, the third posterior rib, unless the clinical situation dictates otherwise. This cause of Horner syndrome must be taken into account because, if recognized and treated promptly, it can be fully resolved.

  17. Neuroleptic-induced acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Francisco Garcia Soriano

    Full Text Available CONTEXT: A case of neuroleptic malignant syndrome and acute respiratory distress syndrome is presented and discussed with emphasis on the role of muscle relaxation, creatine kinase, and respiratory function tests. CASE REPORT: A 41-year-old man presented right otalgia and peripheral facial paralysis. A computed tomography scan of the skull showed a hyperdense area, 2 cm in diameter, in the pathway of the anterior intercommunicating cerebral artery. Preoperative examination revealed: pH 7.4, PaCO2 40 torr, PaO2 80 torr (room air, Hb 13.8 g/dl, blood urea nitrogen 3.2 mmol/l, and creatinine 90 mmol/l. The chest x-ray was normal. The patient had not eaten during the 12-hour period prior to anesthesia induction. Intravenous halothane, fentanyl 0.5 mg and droperidol 25 mg were used for anesthesia. After the first six hours, the PaO2 was 65 torr (normal PaCO2 with FiO2 50% (PaO2/FiO2 130, and remained at this level until the end of the operation 4 hours later, maintaining PaCO2 at 35 torr. A thrombosed aneurysm was detected and resected, and the ends of the artery were closed with clips. No vasospasm was present. This case illustrates that neuroleptic drugs can cause neuroleptic malignant syndrome associated with acute respiratory distress syndrome. Neuroleptic malignant syndrome is a disease that is difficult to diagnose. Acute respiratory distress syndrome is another manifestation of neuroleptic malignant syndrome that has not been recognized in previous reports: it may be produced by neuroleptic drugs independent of the manifestation of neuroleptic malignant syndrome. Some considerations regarding the cause and effect relationship between acute respiratory distress syndrome and neuroleptic drugs are discussed. Intensive care unit physicians should consider the possibility that patients receiving neuroleptic drugs could develop respiratory failure in the absence of other factors that might explain the syndrome.

  18. Acute coronary syndrome

    Science.gov (United States)

    ... infarction - ACS; Unstable angina - ACS; Accelerating angina - ACS; Angina - unstable-ACS; Progressive angina ... a blood clot, treat high blood pressure or angina, relieve chest pain, and stabilize your heart. Angioplasty . This procedure ...

  19. Depression following acute coronary syndrome

    DEFF Research Database (Denmark)

    Joergensen, Terese Sara Hoej; Maartensson, Solvej; Ibfelt, Else Helene;

    2016-01-01

    PURPOSE: Depression is common following acute coronary syndrome, and thus, it is important to provide knowledge to improve prevention and detection of depression in this patient group. The objectives of this study were to examine: (1) whether indicators of stressors and coping resources were risk...... factors for developing depression early and later after an acute coronary syndrome and (2) whether prior depression modified these associations. METHODS: The study was a register-based cohort study, which includes 87,118 patients with a first time diagnosis of acute coronary syndrome during the period.......8 % developed a recurrent depression. Most patient characteristics (demographic factors, socioeconomic status, psychosocial factors, health-related behavioural factors, somatic comorbidities, and severity of acute coronary syndrome) were significantly associated with increased HRs for both early and later...

  20. Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries.

    Science.gov (United States)

    Emrich, T; Emrich, K; Abegunewardene, N; Oberholzer, K; Dueber, C; Muenzel, T; Kreitner, K-F

    2015-05-01

    To assess the diagnostic value of cardiac MRI (CMR) in patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram. This study included a total of 125 patients treated in the chest pain unit during a 39-month period. Each included patient underwent MRI within a median of 3 days after cardiac catheterization. The MRI protocol comprised cine, oedema-sensitive and late gadolinium-enhancement imaging. The standard of reference was a consensus diagnosis based on clinical follow-up and the synopsis of all clinical, laboratory and imaging data. MRI revealed a multitude of diagnoses, including ischaemic cardiomyopathy (CM), dilated CM, myocarditis, Takotsubo CM, hypertensive heart disease, hypertrophic CM, cardiac amyloidosis and non-compaction CM. MRI-based diagnoses were the same as the final reference diagnoses in 113/125 patients (90%), with the two diagnoses differing in only 12/125 patients. In two patients, no final diagnosis could be established. CMR performed early after the onset of symptoms revealed a broad spectrum of diseases. CMR delivered a correct final diagnosis in 90% of patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram. Diagnosing patients with acute coronary syndrome but unobstructed coronary arteries remains a challenge for cardiologists. CMR performed early after catheterization reveals a broad spectrum of diseases with only a simple and quick examination protocol, and there is a high concordance between MRI-based diagnoses and final reference diagnoses.

  1. Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Carmen Sílvia Valente Barbas

    2012-01-01

    Full Text Available This paper, based on relevant literature articles and the authors' clinical experience, presents a goal-oriented respiratory management for critically ill patients with acute respiratory distress syndrome (ARDS that can help improve clinicians' ability to care for these patients. Early recognition of ARDS modified risk factors and avoidance of aggravating factors during hospital stay such as nonprotective mechanical ventilation, multiple blood products transfusions, positive fluid balance, ventilator-associated pneumonia, and gastric aspiration can help decrease its incidence. An early extensive clinical, laboratory, and imaging evaluation of “at risk patients” allows a correct diagnosis of ARDS, assessment of comorbidities, and calculation of prognostic indices, so that a careful treatment can be planned. Rapid administration of antibiotics and resuscitative measures in case of sepsis and septic shock associated with protective ventilatory strategies and early short-term paralysis associated with differential ventilatory techniques (recruitment maneuvers with adequate positive end-expiratory pressure titration, prone position, and new extracorporeal membrane oxygenation techniques in severe ARDS can help improve its prognosis. Revaluation of ARDS patients on the third day of evolution (Sequential Organ Failure Assessment (SOFA, biomarkers and response to infection therapy allows changes in the initial treatment plans and can help decrease ARDS mortality.

  2. Chest physiotherapy in children with acute bacterial pneumonia

    Directory of Open Access Journals (Sweden)

    Lieselotte Corten

    2015-04-01

    Full Text Available Background: Pneumonia is the single leading cause of death in children younger than 5 years of age. Chest physiotherapy is often prescribed as an additional therapy in children with pneumonia. Different chest physiotherapy techniques are available that aim to improve airway clearance, gas exchange and reduce the work of breathing. However, it is unclear if these techniques are effective in this population.Objective: The present review aimed to determine the efficacy of different chest physiotherapy techniques compared with no physiotherapy or other chest physiotherapy treatments in hospitalised children with bacterial pneumonia.Method: Six electronic databases (PubMed, Medline, Cochrane Library, PEDro, CINAHL and Africa-wide information, clinicaltrials.gov and pactr.org were searched for eligible studies.Results: Two randomised controlled trials and one ongoing study were identified. Neither completed trial reported differences between the control and intervention groups, although one study reported a longer duration of coughing (p = 0.04 and rhonchi (p = 0.03 in the intervention group.Conclusion: Because of the limited number of included articles and different presentations of outcome measures, we could not reject or accept chest physiotherapy as either an effective or harmful treatment option in this population.

  3. ACR Appropriateness Criteria(®) acute nonspecific chest pain-low probability of coronary artery disease.

    Science.gov (United States)

    Hoffmann, Udo; Venkatesh, Vikram; White, Richard D; Woodard, Pamela K; Carr, J Jeffrey; Dorbala, Sharmila; Earls, James P; Jacobs, Jill E; Mammen, Leena; Martin, Edward T; Ryan, Thomas; White, Charles S

    2012-10-01

    This document outlines the usefulness of available diagnostic imaging for patients without known coronary artery disease and at low probability for having coronary artery disease who do not present with classic signs, symptoms, or electrocardiographic abnormalities indicating acute coronary syndrome but rather with nonspecific chest pain leading to a differential diagnosis, including pulmonary, gastrointestinal, or musculoskeletal pathologies. A number of imaging modalities are available to evaluate the broad spectrum of possible pathologies in these patients, such as chest radiography, multidetector CT, MRI, ventilation-perfusion scans, cardiac perfusion scintigraphy, transesophageal and transthoracic echocardiography, PET, spine and rib radiography, barium esophageal and upper gastrointestinal studies, and abdominal ultrasound. It is considered appropriate to start the assessment of these patients with a low-cost, low-risk diagnostic test such as a chest x-ray. Contrast-enhanced gated cardiac and ungated thoracic multidetector CT as well as transthoracic echocardiography are also usually considered as appropriate in the evaluation of these patients as a second step if necessary. A number of rest and stress single-photon emission CT myocardial perfusion imaging, ventilation-perfusion scanning, aortic and chest MR angiographic, and more specific x-ray and abdominal examinations may be appropriate as a third layer of testing, whereas MRI of the heart or coronary arteries and invasive testing such as transesophageal echocardiography or selective coronary angiography are not considered appropriate in these patients. Given the low risk of these patients, it is mandated to minimize radiation exposure as much as possible using advanced and appropriate testing protocols. The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review

  4. Part Ⅱ The Typical Cases of Chest Pain Syndrome

    Institute of Scientific and Technical Information of China (English)

    Pan Xingfang; Shang Xiaohong

    2001-01-01

    @@ Case 1 Mr Wang, 47 years old. His first visit was on May 7th, 1995. Chief complaints: At the treatment time,chest distress and pain had attacked again and again for six years and worsened for ten days.

  5. Chest radiography in acute traumatic rupture of the thoracic aorta

    Energy Technology Data Exchange (ETDEWEB)

    Heystraten, F.M.; Rosenbusch, G.; Kingma, L.M.; Lacquet, L.K.; Boo, T. de; Lemmens, W.A.

    Of 123 patients who had suffered blunt trauma to the chest traumatic aortic rupture was eventually confirmed in 61 and absent in 62 patients. The chest radiographs of these patients were examined for 15 signs reported in the literature as being associated with traumatic aortic rupture. Although many individual signs were significantly more frequent in the aortic rupture group they were not useful in differentiating between patients with and those without rupture of the aorta. By using discriminant analysis combining 2 or 3 signs, patients were classified as having aortic rupture or not. The best discrimination between the two groups was obtained using the combined signs of a widened paratracheal stripe, and opacified pulmonary window, a widened right paraspinal interface and a displaced nasogastric tube.

  6. Lung ultrasound and chest x-ray for detecting pneumonia in an acute geriatric ward

    OpenAIRE

    2016-01-01

    Abstract Background: Our aim was to compare the accuracy of lung ultrasound (LUS) and standard chest x-ray (CXR) for diagnosing pneumonia in older patients with acute respiratory symptoms (dyspnea, cough, hemoptysis, and atypical chest pain) admitted to an acute-care geriatric ward. Methods: We enrolled 169 (80 M, 89 F) multimorbid patients aged 83.0 ± 9.2 years from January 1 to October 31, 2015. Each participant underwent CXR and bedside LUS within 6 hours from ward admission. LUS was perfo...

  7. Acute fatal coronary artery dissection following exercise-related blunt chest trauma.

    Science.gov (United States)

    Barbesier, Marie; Boval, Catherine; Desfeux, Jacques; Lebreton, Catherine; Léonetti, Georges; Piercecchi, Marie-Dominique

    2015-01-01

    Coronary artery injury such as acute coronary dissection is an uncommon and potentially life-threatening complication after blunt chest trauma. The authors report an unusual autopsy case of a 43-year-old healthy man who suddenly collapsed after receiving a punch to the chest during the practice of kung fu. The occurrence of the punch was supported by the presence of one recent contusion on the left lateral chest area at the external examination and by areas of hemorrhage next to the left lateral intercostal spaces at the internal examination. The histological examination revealed the presence of an acute dissection of the proximal segment of the left anterior descending coronary artery. Only few cases of coronary artery dissection have been reported due to trauma during sports activities such as rugby and soccer games, but never during the practice of martial arts, sports usually considered as safe and responsible for only minor trauma.

  8. Chest HRCT findings in acute transformation of adult T-cell lymphoma/leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Fumito; Sato, Haruka; Omeri, Ahmad Khalid; Ono, Asami; Tokuyama, Kouhei; Ando, Yumiko; Matsumoto, Akira; Mori, Hiromu [Oita University Faculty of Medicine, Department of Radiology, Yufu, Oita (Japan); Ogata, Masao; Kohno, Kazuhiro; Takano, Kuniko [Oita University Faculty of Medicine, Department of Medical Oncology and Hematology, Yufu, Oita (Japan)

    2015-06-01

    To assess chest high-resolution computed tomography (HRCT) findings in patients with acute transformation of adult T cell leukaemia/lymphoma (ATLL). We retrospectively identified 72 consecutive patients at our institution with ATLL between October 2000 and March 2014. The cases included acute type (n = 20), lymphoma type (n = 21), smouldering type (n = 24) and chronic type (n = 7). Sixteen (7 men, 9 women; aged 36-85 years, mean 63.3 years) of 31 patients (24 with smouldering and seven with chronic type; 51.6 %) developed acute transformation of ATLL, and had undergone chest HRCT examinations. Parenchymal abnormalities, enlarged lymph nodes, pericardial effusion, pleural effusion and skin lesions were evaluated on HRCT. Chest HRCT of 15 of the 16 patients showed abnormal findings, including ground-glass opacity (GGO) (n = 8), consolidation (n = 5), interlobular septal thickening (n = 5) and nodules (n = 5). Pleural effusion was found in five patients, lymph node enlargement in 10 patients and multiple skin thickening in two patients. Almost all patients with acute transformation of ATLL had abnormal findings on chest HRCT, which consisted mainly of lymph node enlargement, GGO, interlobular septal thickening, nodules and bilateral pleural effusions. (orig.)

  9. Think twice – Diagnostic delay in a patient with acute chest pain

    DEFF Research Database (Denmark)

    Bang, Caecilie Larsen; Porsbjerg, Celeste

    2016-01-01

    Heart involvement is the most critical and potentially lethal systemic manifestation in eosinophilic granulomatosis with polyangiitis (EGPA). We present a case of acute chest pain in a 58-year-old male with severe asthma, which regressed after sublingual administration of nitroglycerine. At the t...

  10. Unilateral chest wall anomaly in a patient with Gardner' s syndrome: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Song, Eun Hee; Lee, So Yeon; Park, Hee Jin; Kwon, Heon Ju; Kim, Mi Sung; Park, Hae Won; Kwang, Hyon Joo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Hye Jin [Dept. of Radiology, Eulji General Hospital, Eulji University School of Medicine, Seoul (Korea, Republic of)

    2014-05-15

    Gardner syndrome is a familial disease consisting of colonic polyposis, osteomas, and soft tissue tumors. We describe unilateral chest wall anomaly in a 32-year-old man with Gardner syndrome. A chest radiograph showed asymmetric hypertrophy of the right seventh to tenth ribs. CT images showed increased size of the medullary portions of these lesions, but relatively normal thickness of the cortex. Intercostal muscles along the right seventh to tenth ribs were hypertrophied as compared with the contralateral ribs. Both lungs were clear but the volume of right lung showed slightly smaller than left one.

  11. Nuclear cardiology in acute coronary syndromes

    Energy Technology Data Exchange (ETDEWEB)

    Bulow, H.; Schwaiger, M. [Nuclearmedizinische Klinik und Poliklinik Technische Universitat Munchen, Munich (Germany)

    2005-03-01

    Acute coronary syndromes are a frequent manifestation of a coronary artery disease, usually being associated with chest pain and presenting as a medical emergency. Since a considerable number of patients with chest pain, however, have a non cardiac etiology of trier pain, properly triaging these patients represents a diagnostic challenge for physicians in the emergency department. As the available diagnostic procedures have limited accuracy, many different diagnostic strategies have been evaluated. Among these, radionuclide myocardial perfusion imaging (MPI) at rest or in combination with stress procedures has been investigated in many trails. MPI has been proven to be useful, especially in a patient population with a low to intermediate probability of an ischemic event. Perfusion scintigraphy has a high sensitivity in the detection of myocardial infarction and reveals an excellent negative predictive value, allowing a safe discharge strategy of patients with a negative scan result. Moreover, it enables risk stratification and provides incremental and independent prognostic information regarding short to long term future cardiac adverse events. Several cost effectiveness studies have shown that perfusion imaging leads to lower overall direct costs, mainly by a reduction of unnecessary hospital admissions and diagnostic angiograms, without worsening of the clinical outcome of these patients. As a possible study endpoint, myocardial perfusion imaging in the acute setting enables the quantification of salvaged myocardium and therefore the evaluation of treatment efficacy. Besides perfusion agents, several infarcts avid radiopharmaceuticals have been developed, which in part show promising results. However, larger randomized trials evaluating these tracers in clinical settings are needed to warrant routine clinical application.

  12. Think twice - Diagnostic delay in a patient with acute chest pain.

    Science.gov (United States)

    Bang, Cæcilie Larsen; Porsbjerg, Celeste Michala

    2016-01-01

    Heart involvement is the most critical and potentially lethal systemic manifestation in eosinophilic granulomatosis with polyangiitis (EGPA). We present a case of acute chest pain in a 58-year-old male with severe asthma, which regressed after sublingual administration of nitroglycerine. At the time of hospital admission, there were non-specific ST-changes on the ecg, coronary enzymes were increased, and the patient was concluded to have a non-ST-elevation myocardial infarction, and treated as such. A subacute cardiac catheterization showed no signs of significant coronary stenosis. During the next days, there was increasing pain and reduced strength in both feet. Paraclinical imaging and neurological examinations could not explain the symptoms, and physiotherapy was initiated. At the time, no connection to patient's diagnosis of severe asthma was made. The patient was seen in the respiratory outpatient clinic for a routine check-up, three weeks after the initial hospital admission. At this point, there was increasing pain in both legs and the patient had difficulty walking and experienced increasing dyspnea. Blood eosinophils were elevated (12.7 × 10(9)/L), and an acute HRCT scan showed bilateral peribronchial infiltrates with ground glass opacification and small noduli. A diagnosis of EGPA was established, and administration of systemic glucocorticoids was initiated. A year and a half later, there is still reduced strength and sensory loss. This case illustrates that it is important to consider alternative diagnoses in patients with atypical symptoms and a low risk profile. Heart involvement is the most critical and potentially lethal systemic manifestation in eosinophilic granulomatosis with polyangiitis (EGPA, formerly known as Churg-Strauss syndrome), which makes a quick diagnosis and prompt initiation of correct treatment imperative.

  13. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge.

    Science.gov (United States)

    Mahler, Simon A; Riley, Robert F; Hiestand, Brian C; Russell, Gregory B; Hoekstra, James W; Lefebvre, Cedric W; Nicks, Bret A; Cline, David M; Askew, Kim L; Elliott, Stephanie B; Herrington, David M; Burke, Gregory L; Miller, Chadwick D

    2015-03-01

    The HEART Pathway is a decision aid designed to identify emergency department patients with acute chest pain for early discharge. No randomized trials have compared the HEART Pathway with usual care. Adult emergency department patients with symptoms related to acute coronary syndrome without ST-elevation on ECG (n=282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, emergency department providers used the HEART score, a validated decision aid, and troponin measures at 0 and 3 hours to identify patients for early discharge. Usual care was based on American College of Cardiology/American Heart Association guidelines. The primary outcome, objective cardiac testing (stress testing or angiography), and secondary outcomes, index length of stay, early discharge, and major adverse cardiac events (death, myocardial infarction, or coronary revascularization), were assessed at 30 days by phone interview and record review. Participants had a mean age of 53 years, 16% had previous myocardial infarction, and 6% (95% confidence interval, 3.6%-9.5%) had major adverse cardiac events within 30 days of randomization. Compared with usual care, use of the HEART Pathway decreased objective cardiac testing at 30 days by 12.1% (68.8% versus 56.7%; P=0.048) and length of stay by 12 hours (9.9 versus 21.9 hours; P=0.013) and increased early discharges by 21.3% (39.7% versus 18.4%; P<0.001). No patients identified for early discharge had major adverse cardiac events within 30 days. The HEART Pathway reduces objective cardiac testing during 30 days, shortens length of stay, and increases early discharges. These important efficiency gains occurred without any patients identified for early discharge suffering MACE at 30 days. URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01665521. © 2015 American Heart Association, Inc.

  14. [A case of acute coronary syndrome following the use of parenteral penicillin: Kounis syndrome].

    Science.gov (United States)

    Tok, Derya; Ozcan, Fırat; Sentürk, Bihter; Gölbaşı, Zehra

    2012-10-01

    Kounis syndrome refers to the concurrence of acute coronary events and allergic or hypersensitivity reactions. In this report, we describe the case of a male patient, in whom acute ST-segment elevation and myocardial infarction developed immediately after injection of depot penicillin, and we discuss the Kounis syndrome. A 52-year-old male patient had chest pain, hypotension and ST-elevation on leads DI and aVL of electrocardiography 30 minutes after intramuscular penicillin injection due to cryptic tonsillitis. Kounis syndrome was considered as a possible diagnosis according to the presentation. Histamine and tryptase levels were not studied due to the delay on arrival to the emergency department. The patient promptly underwent coronary angiography, which revealed only diffuse plaques in all main coronary arteries without any obstructive lesion. We found only increased immunoglobulin (Ig) E, which is associated with the syndrome. With this report, we remind clinicians to consider Kounis syndrome in patients who are subjected to allergenic substances and demonstrate acute chest pain.

  15. Long-Term Clinical Impact of Coronary CT Angiography in Patients With Recent Acute-Onset Chest Pain

    DEFF Research Database (Denmark)

    Linde, Jesper J; Hove, Jens D; Sørgaard, Mathias

    2015-01-01

    was a composite of cardiac death, myocardial infarction (MI), hospitalization for unstable angina pectoris (UAP), late symptom-driven revascularizations, and readmission for chest pain. RESULTS: We randomized 299 patients to coronary CTA-guided strategy and 301 to standard care. After inclusion, 24 patients......OBJECTIVES: The aim of the CATCH (CArdiac cT in the treatment of acute CHest pain) trial was to investigate the long-term clinical impact of a coronary computed tomographic angiography (CTA)-guided treatment strategy in patients with recent acute-onset chest pain compared to standard care....... BACKGROUND: The prognostic implications of a coronary CTA-guided treatment strategy have not been compared in a randomized fashion to standard care in patients referred for acute-onset chest pain. METHODS: Patients with acute chest pain but normal electrocardiograms and troponin values were randomized...

  16. The effect of streptokinase on chest pain in acute myocardial infarction

    DEFF Research Database (Denmark)

    Christensen, J H; Sørensen, H T; Rasmussen, S E;

    1991-01-01

    Treatment with intravenous streptokinase is known to restore blood flow to the ischaemic myocardium in patients with acute myocardial infarction. However, little is known about its effect on chest pain. In a retrospective cohort study, 76 patients treated with streptokinase were compared to 76...... patients not treated with streptokinase. All patients had acute myocardial infarction and less than 6 h of cardiac symptoms. Patients treated with streptokinase had a significantly lower need for nicomorphine (median 20 mg) than patients not treated with streptokinase (median 41 mg). Correspondingly......, the median duration (3.5 h) of pain was reduced significantly in patients treated with streptokinase compared to patients not treated (24 h). We conclude that intravenous streptokinase given in the acute phase of myocardial infarction is effective in reducing the duration of cardiac chest pain....

  17. Acute radiation syndrome and chronic radiation syndrome.

    Science.gov (United States)

    Grammaticos, Philip; Giannoula, Evanthia; Fountos, George P

    2013-01-01

    Acute radiation syndrome (ARS) or sickness or poisoning or toxicity is induced after a whole body exposure of men to high doses of radiation between 1-12Gy. First symptoms are from the gastrointestinal system, which together with bone marrow are the most sensitive parts of our body. Chronic radiation syndrome (CRS) may be induced by smaller than 1Gy radiation doses or after a mild form of ARS. Prophylaxis and treatment suggestions are described. In cases of ARS, a large part of the exposed population after proper medical care may survive, while without medical care this part of the population will be lost. Prophylaxis may also save another part of the population.

  18. Chest Pain

    Directory of Open Access Journals (Sweden)

    Samad Shams-Vahdati

    2014-03-01

    Full Text Available Introduction: Acute chest pain is an important and frequently occurring symptom in patients. Chest pain is often a sign of ischemic heart disease. Associated findings of electrocardiograph (ECG are rather heterogeneous, and traditional cardiac biomarkers such as Creatine Kinase-MB (CK-MB suffer from low cardiac specificity and sensitivity. In this study cost effectiveness of cardiac biomarkers single quantitative measurement was examined.Methods: The present descriptive-analytic study conducted on patients who were asked for troponin I and CK-MB. All patients who referred to Emergency unit of Tabriz Imam Reza educational-medical center during January 2012 to July the 2013 were included in study. All patients included in the study were documented in terms of age, sex, working shift of referring, main complaint of patient, symptoms in referring, ECG findings, and results of troponin I and CK-MB tests.Results: In this study, 2900 patients were studied including 1440 (49.7% males and 1460 (50.3% females. Mean age of patients was 62.91 (SD=14.36. Of all patients 1880 (64.8% of patients referred during 8 a.m. to 8 p.m. and 1020 (35.2% patients were referred during 8 p.m. to 8 a.m. The sensitivity of cardiac biomarkers’ test in diagnosing Acute Coronary Syndrome (ACS disease was calculated as 44.8% and its specificity was 86.6%. For diagnosing Acute Myocardial Infarction (AMI, sensitivity of cardiac biomarkers’ test was 72.2% and its specificity was 86%. None of patients who were finally underwent unstable angina diagnosis showed increase in cardiac enzymes.Conclusion: In conclusion, cardiac biomarkers can be used for screening acute chest pains, also cost effectiveness of cardiac biomarkers, appropriate specificity and sensitivity can guarantee their usefulness in emergency room.

  19. Chest associated to motor physiotherapy improves cardiovascular variables in newborns with respiratory distress syndrome

    OpenAIRE

    2011-01-01

    Abstract Background We aimed to evaluate the effects of chest and motor physiotherapy treatment on hemodynamic variables in preterm newborns with respiratory distress syndrome. Methods We evaluated heart rate (HR), respiratory rate (RR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP), temperature and oxygen saturation (SO2%) in 44 newborns with re...

  20. A prospective study of the HEART scores' value in diagnosing acute coronary syndrome in the chest pain center%前瞻性研究心脏评分在胸痛中心对急性冠脉综合征的诊断价值

    Institute of Scientific and Technical Information of China (English)

    王旭; 聂绍平; 曾哲淳

    2015-01-01

    Objective To study the value of HEART scores in predicting the risk of getting acute coronary syndrome in patients with chest pain and assessing the prognosis in order to elucidate the validity of the HEART scores.Methods A total of 1 200 patients with chest pain were continuously observed and followed up,and their HEART scores were calculated.The survival rates were calculated with Kaplan-Meier method and AUROC (area under ROC curve) was used to determine the accuracy of this methods.The HEART scores were compared with TIMI and GRACE scores.Results Low HEART scores (0-3) were found in 34.5% of the patients and MACE (major adverse cardiac event) occurred in 1.4% of them.The patients with intermediate HEART scores (4-6) accounted for 50.7% patients,and MACE was diagnosed in 22.2% of them.High HEART scores (7-10) were found in 14.85% patients,and MACE occurred in 60.7% of them.There was significant difference among these three groups (Log rank P < 0.01).The AUROC of HEART score was 0.83 (95% CI:0.80-0.85,P <0.01),being significantly higher than the GRACE scores (0.76) and TIMI scores (0.72).Conclusions The HEART score is applicable for predicting the risk of getting acute coronary syndrome of chest pain patients in emergency department and the prognosis.%目的 应用心脏评分(HEART)评价急诊胸痛患者中发生急性冠脉综合征的危险程度并判断其预后,以证明其应用的有效性.方法 连续观察急诊胸痛患者1 200例,分别计算各自HEART评分并进行长期随访,Kaplan-Meier法用以计算生存率,ROC曲线下面积观察该方法的准确性,并与TIMI和GRACE评分进行比较.结果 34.5%的患者为低分组(HEART评分0~3),MACE事件发生率为1.4%;50.7%为中分组(4~6),MACE事件发生率为22.2%;14.8%为高分组(7~10),MACE事件发生率为60.7%;3组比较差异具有统计学意义(Log-rank,P<0.01);心脏评分ROC曲线分析结果显示,曲线下面积(AUC) =0.83[95% CI:0.80 ~0

  1. Acute chest pain: a purely clinical problem or a question for radiology; Der akute Thoraxschmerz, ein rein klinisches Problem oder radiologische Fragestellung

    Energy Technology Data Exchange (ETDEWEB)

    Loewe, C. [Medizinische Universitaet Wien, Klinische Abteilung fuer Kardiovaskulaere und Interventionelle Radiologie, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)

    2008-05-15

    Acute chest pain represents a very common clinical occurrence and at the same time poses a severe diagnostic dilemma. It can be due to an acute life-threatening event such as acute cardiac infarct, or a relatively harmless condition of pain and illness (e.g. vertebrogenic pain) under the main symptom category of acute chest pain. This often unclear symptomatic, behind which there can always be a life-threatening disease leads to an exaggerated grouping of patients into emergency cases and to an increased number of inpatients for observation. The diagnosis of acute coronary syndrome with no initial ECG changes typical for ischemia is especially problematic. The availability of modern multidetector computed tomography is becoming increasingly more important for radiologists in the diagnosis and clarification of acute chest pain. In this article the clinical difficulties and radiology options for the diagnosis of patients with acute chest pain will be presented and possible future algorithms for diagnosis will be discussed. (orig.) [German] Der akute Thoraxschmerz repraesentiert ein sehr haeufiges klinisches Beschwerdebild und gleichzeitig ein grosses diagnostisches Dilemma, koennen sich doch sowohl lebensbedrohliche akute Ereignisse (wie der akute Herzinfarkt) als auch mehr oder weniger harmlose Schmerzzustaende und Erkrankungen (wie vertebrogene Schmerzen) unter dem Leitsymptom 'akuter Thoraxschmerz' praesentieren. Diese oft nicht eindeutige Symptomatik, hinter der immer auch ein lebensbedrohliches Krankheitsbild stecken kann, fuehrt zu einer Uebertriagierung der Patienten in Notaufnahmen und zu einer grossen Anzahl an stationaeren 'Absicherungsaufnahmen'. Besonders die Diagnose eines akuten Koronarsyndroms (AKS) bei initial fehlenden ischaemietypischen EKG-Veraenderungen stellt eine spezielle Problematik dar. Durch die Verfuegbarkeit moderner ultraschneller Multidetektorcomputertomographen (MDCT) spielt der Radiologe in der Diagnostik und

  2. Acute Respiratory Distress Syndrome Caused by Leukemic Infiltration of the Lung

    Directory of Open Access Journals (Sweden)

    Yao-Kuang Wu

    2008-05-01

    Full Text Available Respiratory distress syndrome resulting from leukemic pulmonary infiltrates is seldom diagnosed antemortem. Two 60- and 80-year-old women presented with general malaise, progressive shortness of breath, and hyperleukocytosis, which progressed to acute respiratory distress syndrome (ARDS after admission. Acute leukemia with pulmonary infection was initially diagnosed, but subsequent examinations including open lung biopsy revealed leukemic pulmonary infiltrates without infection. In one case, the clinical condition and chest radiography improved initially after combination therapy with chemotherapy for leukemia and aggressive pulmonary support. However, new pulmonary infiltration on chest radiography and hypoxemia recurred, which was consistent with acute lysis pneumopathy. Despite aggressive treatment, both patients died due to rapidly deteriorating condition. Leukemic pulmonary involvement should be considered in acute leukemia patients with non-infectious diffusive lung infiltration, especially in acute leukemia with a high blast count.

  3. Pathogenesis of Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    A. M. Golubev

    2012-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is a common complication of many diseases. Its polyetiological pattern determines the specific features of lung morphological changes and the clinical course of ARDS. Objective: to analyze the pathogenesis of ARDS in the context of the general pathological processes underlying its development. Material and methods. More than 200 lungs from the people who had died from severe concomitant injury or ARDS-complicated pneumonia were investigated. More than 150 rat experiments simulated various types of lung injury: ventilator-induced lung injury with different ventilation parameters; reperfusion injuries (systemic circulation blockade due to 12-minute vascular fascicle ligation, followed by the recovery of cardiac performance and breathing; microcirculatory disorder (injection of a thromboplastin solution into the jugular vein; blood loss; betaine-pepsin aspiration; and closed chest injury. Different parts of the right and left lungs were histologically examined 1 and 3 hours and 1 and 3 days after initiation of the experiment. Lung pieces were fixed in 10% neutral formalin solution and embedded in paraffin. Histological sections were stained with hematoxylin and eosin and using the van Gieson and Weigert procedures; the Schiff test was used. Results. The influence of aggression factors (trauma, blood loss, aspiration, infection, etc. results in damage to the lung and particularly air-blood barrier structures (endothelium, alveolar epithelium, their basement membrane. In turn the alteration of cellular and extracellular structures is followed by the increased permeability of hemomicrocirculatory bed vessels, leading to the development of non-cardiogenic (interstitial, alveolar pulmonary edema that is a central component in the pathogenesis of ARDS. Conclusion. The diagnosis of the early manifestations of ARDS must account for the nature of an aggression factor, the signs confirming the alteration of the lung

  4. Chest radiographic findings in patients with acute pulmonary embolism: observations from the PIOPED Study.

    Science.gov (United States)

    Worsley, D F; Alavi, A; Aronchick, J M; Chen, J T; Greenspan, R H; Ravin, C E

    1993-10-01

    To determine the sensitivity, specificity, and positive and negative predictive values of chest radiographic findings in patients suspected of having acute pulmonary embolism (PE). Chest radiographs of 1,063 patients with suspected PE were reviewed. PE was confirmed angiographically in 383 patients and excluded in 680 patients. The chest radiograph was interpreted as normal in only 12% of patients with PE. The most common chest radiographic finding in patients with PE was atelectasis and/or parenchymal areas of increased opacity; however, the prevalence was not significantly different from that in patients without PE. Oligemia (the Westermark sign), prominent central pulmonary artery (the Fleischner sign), pleural-based area of increased opacity (the Hampton hump), vascular redistribution, pleural effusion, elevated diaphragm, and enlarged hilum were also poor predictors of PE. Although chest radiographs are essential in the investigation of suspected PE, their main value is to exclude diagnoses that clinically mimic PE and to aid in the interpretation of the ventilation-perfusion scan.

  5. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    Energy Technology Data Exchange (ETDEWEB)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Rochitte, Carlos Eduardo, E-mail: rochitte@cardiol.br [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Instituto do Coração - InCor - HCFMUSP, São Paulo, SP (Brazil)

    2013-12-15

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies.

  6. Severe acute respiratory syndrome (SARS)

    Science.gov (United States)

    ... include: Arterial blood tests Blood clotting tests Blood chemistry tests Chest x-ray or chest CT scan ... The death rate from SARS was 9 to 12% of those diagnosed. In people over age 65, the death ...

  7. Patients and acute coronary syndrome - Prehospital delay and mental and emotional delaying responses - a qualitative study

    DEFF Research Database (Denmark)

    Lorentzen, Vibeke; Larsen, Birte Hedegaard

    2016-01-01

    . A phenomenological design inspired by Steinar Kvale provided the methodological foundation. 15 women and 15 men with a first-time diagnosis of Acute Coronary Syndrome were interviewed 48-72 hours after admission. On symptom debut, the participants’ strategies were to «wait and see» and «let me be». Chest pains were...

  8. Bilateral acute lupus pneumonitis in a case of rhupus syndrome

    Directory of Open Access Journals (Sweden)

    Supriya Sarkar

    2012-01-01

    Full Text Available Rhupus syndrome, the overlap of rheumatoid arthritis (RA and systemic lupus erythematosus (SLE, is an extremely uncommon condition. Organ damages found due to SLE are usually mild in rhupus. Lupus pneumonitis in rhupus syndrome has not been reported worldwide. We are reporting a 23-year-old female with bilateral symmetric erosive arthritis, oral ulcer, alopecia, polyserositis, anemia, leucopenia, positive RA-factor, anti nuclear antibody (ANA and anti ds-DNA. She presented with acute onset dyspnea, high fever, chest pain, tachycardia, tachypnea, hypoxia and respiratory alkalosis. High resolution computed tomography (HRCT-thorax showed bilateral, basal consolidation with air bronchogram. Repeated sputum and single broncho alveolar lavage (BAL fluid examination revealed no organism or Hemosiderin-laden macrophage. The diagnosis of rhupus was confirmed by combined manifestations of RA and SLE, and the diagnosis of acute lupus pneumonitis was established by clinico-radiological picture and by excluding other possibilities.

  9. Bilateral acute lupus pneumonitis in a case of rhupus syndrome.

    Science.gov (United States)

    Sarkar, Supriya; Saha, Kaushik

    2012-07-01

    Rhupus syndrome, the overlap of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), is an extremely uncommon condition. Organ damages found due to SLE are usually mild in rhupus. Lupus pneumonitis in rhupus syndrome has not been reported worldwide. We are reporting a 23-year-old female with bilateral symmetric erosive arthritis, oral ulcer, alopecia, polyserositis, anemia, leucopenia, positive RA-factor, anti nuclear antibody (ANA) and anti ds-DNA. She presented with acute onset dyspnea, high fever, chest pain, tachycardia, tachypnea, hypoxia and respiratory alkalosis. High resolution computed tomography (HRCT)-thorax showed bilateral, basal consolidation with air bronchogram. Repeated sputum and single broncho alveolar lavage (BAL) fluid examination revealed no organism or Hemosiderin-laden macrophage. The diagnosis of rhupus was confirmed by combined manifestations of RA and SLE, and the diagnosis of acute lupus pneumonitis was established by clinico-radiological picture and by excluding other possibilities.

  10. Acute arthritis as initial presentation of sarcoidosis: Significance of chest X-ray

    Directory of Open Access Journals (Sweden)

    Muhammed Emin Akkoyunlu

    2012-03-01

    Full Text Available Sarcoidosis is a multisystem granulomatous disease thatpredominantly affects the lungs. It usually presents withfatigue and respiratory findings. The rate of arthritis insarcoidosis is 15-25%. Arthritis as initial manifestation ofsarcoidosis has been reported rarely in the literature. Inpresent paper we highlighted the importance of sarcoidosisand conventional chest X-ray in differential diagnosisof acute arthritis. J Clin Exp Invest 2012; 3(1: 102-104

  11. Troponin elevation in conditions other than acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Tanindi A

    2011-09-01

    Full Text Available Asli Tanindi, Mustafa CemriGazi University Faculty of Medicine, Department of Cardiology, Ankara, TurkeyAbstract: Acute coronary syndromes comprise a large spectrum of clinical conditions ranging from unstable angina pectoris to acute ST-elevation myocardial infarction. Chest pain is usually the major symptom of atherosclerotic heart disease; however, it may be challenging to diagnose correctly, especially in the emergency department, because of the ambiguous way that pain is characterized by some patients. Cardiac troponins are sensitive and specific biomarkers used in the diagnosis of myocardial infarction that are released into the bloodstream when cardiac myocytes are damaged by acute ischemia or any other mechanism. They are the cornerstone for the diagnosis, risk assessment, prognosis, and determination of antithrombotic and revascularization strategies. However, troponin elevation indicates the presence, not the mechanism, of myocardial injury. There are many clinical conditions other than myocardial infarction that cause troponin elevation; thus, the physician should be aware of the wide spectrum of disease states that may result in troponin elevation and have a clear understanding of the related pathophysiology to effectively make a differential diagnosis. This review focuses on causes of troponin elevation other than acute coronary syndromes.Keywords: cardiac troponin, troponin elevation without acute coronary syndrome, differential diagnosis

  12. Acute respiratory distress syndrome.

    Science.gov (United States)

    Wilkins, Pamela A; Seahorn, Thomas

    2004-04-01

    all species that we work with? What do we define as acute onset? Most human ARDS cases occur while patients are in hospital being treated for other problems, whereas many of our patients present already in respiratory distress. If we are unable to ventilate patients for economic or practical reasons, what do we use as the equivalent of the Pao2/Flo, ratio'? Reliance on the pathologist is not reasonable, because many disease processes can look similar to ARDS under the microscope. If anything, ALI and ARDS are clinical diagnoses. It is time for veterinarians to reach a consensus on the definition for ALI and ARDS in our patients. Only when we have a consensus of definition can rational prospective clinical trials of therapies be designed.

  13. Dual-source computed tomography in patients with acute chest pain: feasibility and image quality

    Energy Technology Data Exchange (ETDEWEB)

    Schertler, Thomas; Scheffel, Hans; Frauenfelder, Thomas; Desbiolles, Lotus; Leschka, Sebastian; Stolzmann, Paul; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Department of Medical Radiology, Institute of Diagnostic Radiology, Zurich (Switzerland); Seifert, Burkhardt [University of Zurich, Department of Biostatistics, Zurich (Switzerland); Flohr, Thomas G. [Computed Tomography CTE PA, Siemens Medical Solutions, Forchheim (Germany)

    2007-12-15

    The aim of this study was to determine the feasibility and image quality of dual-source computed tomography angiography (DSCTA) in patients with acute chest pain for the assessment of the lung, thoracic aorta, and for pulmonary and coronary arteries. Sixty consecutive patients (32 female, 28 male, mean age 58.1{+-}16.3 years) with acute chest pain underwent contrast-enhanced electrocardiography-gated DSCTA without prior beta-blocker administration. Vessel attenuation of different thoracic vascular territories was measured, and image quality was semi-quantitatively analyzed by two independent readers. Image quality of the thoracic aorta was diagnostic in all 60 patients, image quality of pulmonary arteries was diagnostic in 59, and image quality of coronary arteries was diagnostic in 58 patients. Pairwise intraindividual comparisons of attenuation values were small and ranged between 1{+-}6 HU comparing right and left coronary artery and 56{+-}9 HU comparing the pulmonary trunk and left ventricle. Mean attenuation was 291{+-}65 HU in the ascending aorta, 334{+-}93 HU in the pulmonary trunk, and 285{+-}66 HU and 268{+-}67 HU in the right and left coronary artery, respectively. DSCTA is feasible and provides diagnostic image quality of the thoracic aorta, pulmonary and coronary arteries in patients with acute chest pain. (orig.)

  14. Effect of analgesia on the changes in respiratory parameters in blunt chest injury with multiple rib fractures

    National Research Council Canada - National Science Library

    Eyo Ekpe; Catherine Eyo

    2017-01-01

    Background: Blunt chest injury with multiple rib fractures can result in such complications as pneumonia, atelectasis, bronchiectasis, empyema thoracis, acute respiratory distress syndrome, and prolonged...

  15. Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease.

    Science.gov (United States)

    das Virgens, Cláudio Marcelo Bittencourt; Lemos, Laudenor; Noya-Rabelo, Márcia; Carvalhal, Manuela Campelo; Cerqueira Junior, Antônio Maurício Dos Santos; Lopes, Fernanda Oliveira de Andrade; de Sá, Nicole Cruz; Suerdieck, Jéssica Gonzalez; de Souza, Thiago Menezes Barbosa; Correia, Vitor Calixto de Almeida; Sodré, Gabriella Sant'Ana; da Silva, André Barcelos; Alexandre, Felipe Kalil Beirão; Ferreira, Felipe Rodrigues Marques; Correia, Luís Cláudio Lemos

    2017-03-26

    To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease (CAD) in patients with acute chest pain. We studied individuals who were consecutively admitted to our Chest Pain Unit. At admission, investigators performed a standardized interview and recorded 14 chest pain features. Based on these features, a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability, both numerically and categorically. As the reference standard for testing the accuracy of gestalt, angiography was required to rule-in CAD, while either angiography or non-invasive test could be used to rule-out. In order to assess reproducibility, a second cardiologist did the same procedure. In a sample of 330 patients, the prevalence of obstructive CAD was 48%. Gestalt's numerical probability was associated with CAD, but the area under the curve of 0.61 (95%CI: 0.55-0.67) indicated low level of accuracy. Accordingly, categorical definition of typical chest pain had a sensitivity of 48% (95%CI: 40%-55%) and specificity of 66% (95%CI: 59%-73%), yielding a negligible positive likelihood ratio of 1.4 (95%CI: 0.65-2.0) and negative likelihood ratio of 0.79 (95%CI: 0.62-1.02). Agreement between the two cardiologists was poor in the numerical classification (95% limits of agreement = -71% to 51%) and categorical definition of typical pain (Kappa = 0.29; 95%CI: 0.21-0.37). Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.

  16. [A case of postcardiac injury syndrome with repeated pleuritis after blunt chest trauma].

    Science.gov (United States)

    Namba, Ryoichi; Yamamoto, Yusuke; Nawa, Takeshi; Endo, Katuyuki

    2009-12-01

    A 59-year-old man suffered blunt injury to the left chest during a fall in August 2004. He had 5 repeated episodes of back and left chest pain in three years since August 2005. Since these symptoms were accompanied by left pleural effusion and serum inflammatory reaction, the tentative diagnosis was pleuritis. Although examinations of pleural effusion showed exudation with marked augmentation of inflammatory cells, there were no findings that suggested the cause of repetitive pleuritis. All symptoms were relieved within one or two weeks following administration of non-steroid anti-inflammatory drugs. Surgical thoracoscopy was carried out to investigate the cause of repeated pleuritis, and an acquired deficit of the left pericardium was noted. We considered this case to be postcardiac injury syndrome causing repeated pleuritis following blunt chest injury.

  17. Pharm GKB: Acute coronary syndrome [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available iew Alternate Names: Synonym ACS - Acute coronary syndrome PharmGKB Accession Id: PA165108401 External Vocabularies MeSH: Acute... Coronary Syndrome (D054058) SnoMedCT: Acute coronary syndrome (394659003) UMLS: C0948089 (C0948089) MedDRA: Acute... coronary syndrome (10051592) NDFRT: Acute Coronary Synd...reductase inhibitors No related diseases are available Publications related to Acute coronary syndrome: 164 ..., Race, and Mortality Among Clopidogrel Treated Patients Following Acute Myocardial Infarction. Circulation.

  18. Nitrofurantoin-induced acute respiratory distress syndrome during pregnancy: A case report

    Directory of Open Access Journals (Sweden)

    Sherif S. Wahba

    2014-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is a rarely seen complication with nitrfurantoin. We report improvement of a parturient who was admitted to our hospital’s obstetrical unit with life threatening nitrofurantoin-induced acute respiratory failure. She had been taking nitrofurantoin for one week for urinary tract infection (UTI. Her chest radiography showed bilateral parenchymal infiltrates of the lung. The patient responded well to nitrofurantoin discontinuation and methylprednisolone infusion 1 mg/kg/day.

  19. [Chest pain].

    Science.gov (United States)

    Horn, Benedikt

    2015-01-01

    Chest pain in ambulatory setting is predominantly not heart-associated. Most patients suffer from muskuloskeletal or functional (psychogenic) chest pain. Differential diagnosis covers aortic dissection, rib-fracture, shingles, GERD, Tietze-Syndrome, pulmonary embolism, pleuritis, pneumothorax, pleurodynia and metastatic disease. In most cases history, symptoms and signs allow a clinical diagnosis of high pretest-probability.

  20. Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk profile. Part 1: Impact on patient management

    Energy Technology Data Exchange (ETDEWEB)

    Gruettner, Joachim, E-mail: joachim.gruettner@umm.de [Emergency Department, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Fink, Christian, E-mail: Christian.Fink@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Walter, Thomas, E-mail: thomas.walter@umm.de [Emergency Department, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Meyer, Mathias, E-mail: mr.meyer.mathias@gmail.com [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Apfaltrer, Paul, E-mail: Paul.Apfaltrer@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260 (United States); Saur, Joachim, E-mail: joachim.saur@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Sueselbeck, Tim, E-mail: tim.sueselbeck@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Traunwieser, Dominik, E-mail: dominik.traunwieser@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Takx, Richard, E-mail: richard.takx@gmail.com [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260 (United States); and others

    2013-01-15

    Objective: To evaluate the impact of coronary CT angiography (coronary CTA) or “triple-rule-out” CT angiography (TRO-CTA) on patient management in the work-up of patients with acute chest pain and an intermediate cardiac risk profile. Materials and methods: 100 patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome (ACS) underwent coronary CTA or TRO-CTA for the evaluation of chest pain. Patients with a high and low cardiac risk profile were not included in this study. All patients with significant coronary stenosis >50% on coronary CTA underwent invasive coronary catheterization (ICC). Important other pathological findings were recorded. All patients had a 90-day follow-up period for major adverse cardiac events (MACE). Results: Based on a negative coronary CTA 60 of 100 patients were discharged on the same day. None of the discharged patients showed MACE during the 90-day follow-up. Coronary CTA revealed a coronary stenosis >50% in 19 of 100 patients. ICC confirmed significant coronary stenosis in 17/19 patients. Among the 17 true positive patients, 9 underwent percutaneous coronary intervention with stent implantation, 7 were received intensified medical therapy, and 1 patient underwent coronary artery bypass surgery. A TRO-CTA protocol was performed in 36/100 patients due to elevated D-dimer levels. Pulmonary embolism was present in 5 patients, pleural effusion of unknown etiology in 3 patients, severe right ventricular dysfunction with pericardial effusion in 1 patient, and an incidental bronchial carcinoma was diagnosed in 1 patient. Conclusion: Coronary CTA and TRO-CTA allow a rapid and safe discharge in the majority of patients presenting with acute chest pain and an intermediate risk for ACS while at the same time identifies those with significant coronary artery stenosis.

  1. Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk profile. Part 1: impact on patient management.

    Science.gov (United States)

    Gruettner, Joachim; Fink, Christian; Walter, Thomas; Meyer, Mathias; Apfaltrer, Paul; Schoepf, U Joseph; Saur, Joachim; Sueselbeck, Tim; Traunwieser, Dominik; Takx, Richard; Kralev, Stefan; Borggrefe, Martin; Schoenberg, Stefan O; Henzler, Thomas

    2013-01-01

    To evaluate the impact of coronary CT angiography (coronary CTA) or "triple-rule-out" CT angiography (TRO-CTA) on patient management in the work-up of patients with acute chest pain and an intermediate cardiac risk profile. 100 patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome (ACS) underwent coronary CTA or TRO-CTA for the evaluation of chest pain. Patients with a high and low cardiac risk profile were not included in this study. All patients with significant coronary stenosis >50% on coronary CTA underwent invasive coronary catheterization (ICC). Important other pathological findings were recorded. All patients had a 90-day follow-up period for major adverse cardiac events (MACE). Based on a negative coronary CTA 60 of 100 patients were discharged on the same day. None of the discharged patients showed MACE during the 90-day follow-up. Coronary CTA revealed a coronary stenosis >50% in 19 of 100 patients. ICC confirmed significant coronary stenosis in 17/19 patients. Among the 17 true positive patients, 9 underwent percutaneous coronary intervention with stent implantation, 7 were received intensified medical therapy, and 1 patient underwent coronary artery bypass surgery. A TRO-CTA protocol was performed in 36/100 patients due to elevated d-dimer levels. Pulmonary embolism was present in 5 patients, pleural effusion of unknown etiology in 3 patients, severe right ventricular dysfunction with pericardial effusion in 1 patient, and an incidental bronchial carcinoma was diagnosed in 1 patient. Coronary CTA and TRO-CTA allow a rapid and safe discharge in the majority of patients presenting with acute chest pain and an intermediate risk for ACS while at the same time identifies those with significant coronary artery stenosis. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  2. Acute compartment syndrome caused by uncontrolled hypothyroidism.

    Science.gov (United States)

    Modi, Anar; Amin, Hari; Salzman, Matthew; Morgan, Farah

    2017-06-01

    Acute compartment syndrome is increased tissue pressure exceeding perfusion pressure in a closed compartment resulting in nerve and muscle ischemia. Common precipitating causes are crush injuries, burns, substance abuse, osseous or vascular limb trauma. This is a case of 42year old female with history of hypothyroidism who presented to emergency room with acute onset of severe pain and swelling in right lower extremity. Physical examination was concerning for acute compartment syndrome of right leg which was confirmed by demonstration of elevated compartmental pressures. No precipitating causes were readily identified. Further laboratory testing revealed uncontrolled hypothyroidism. Management included emergent fasciotomy and initiating thyroid hormone replacement. This case represents a rare association between acute compartment syndrome and uncontrolled hypothyroidism. We also discuss the pathogenesis of compartment syndrome in hypothyroid patients and emphasize the importance of evaluating for less common causes, particularly in setting of non-traumatic compartment syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. CPDX (Chest Pain Diagnostic) - A Decision Support System for the Management of Acute Chest Pain Version 3.0. Programmer’s Manual

    Science.gov (United States)

    1989-10-23

    hyperventilation syndrome; e) psychoneurotic disorder; and f) digastric lesions ( cholelithiasis , peptic ulcer, etc.) a) Musculoskeletal pain and the pain...pain such as gastritis, peptic ulcer, pancreatitis, and cholelithiasis may occasionally ccsnplain of chest pain. In most of these disorders, the...under lew power (to select a suitable area for viewing) then under high pewer. Only slides with rare or no epithelial cells should be accepted for

  4. The Role of Bedside Troponin T Test for Identification of High Risk Patients With Acute Chest Pain

    Institute of Scientific and Technical Information of China (English)

    Guo xiaobi; Feng Jianzhan; Guo Hengshan

    2005-01-01

    Objectives Evaluation of patients with acute chest pain when they admitted is time-consuming. We prospectively investigated the role of bedside troponin T test for predicting the risk of death and acute heart failure of patients with acute chest pain. Methods and Results 502 consecutive patients with chest pain for less than 24 hours were determined by troponin T test at bedside and quantitative troponin I test in lab. For bedside troponin T tests, there were 160 patients in positive and 323 in negative. During 30 days of followed-up. Myocardial infarction evolved in 139 patients among 160 patients in positive troponin T test, only 7 patients in negative one. Acute heart failure occurred in 51 patients among the positive group, but 37 occurred it at negative group.The odds ratio of acute heart failure of positive group vs.negative group was 3.6. Patients died 39 in positive group, 15 in negative group, the all-cause death odds ratio of positive group vs. negative group was 6.7; 31patients died with cardiac event in positive group, 5 in negative group only. Conclusions Bedside Troponin T test is a powerful and independent predictor of death and acute heart failure for patients with acute chest pain.

  5. Diagnosis of Acute Coronary Syndrome with a Support Vector Machine.

    Science.gov (United States)

    Berikol, Göksu Bozdereli; Yildiz, Oktay; Özcan, I Türkay

    2016-04-01

    Acute coronary syndrome (ACS) is a serious condition arising from an imbalance of supply and demand to meet myocardium's metabolic needs. Patients typically present with retrosternal chest pain radiating to neck and left arm. Electrocardiography (ECG) and laboratory tests are used indiagnosis. However in emergency departments, there are some difficulties for physicians to decide whether hospitalizing, following up or discharging the patient. The aim of the study is to diagnose ACS and helping the physician with his decisionto discharge or to hospitalizevia machine learning techniques such as support vector machine (SVM) by using patient data including age, sex, risk factors, and cardiac enzymes (CK-MB, Troponin I) of patients presenting to emergency department with chest pain. Clinical, laboratory, and imaging data of 228 patients presenting to emergency department with chest pain were reviewedand the performance of support vector machine. Four different methods (Support vector machine (SVM), Artificial neural network (ANN), Naïve Bayes and Logistic Regression) were tested and the results of SVM which has the highest accuracy is reported. Among 228 patients aged 19 to 91 years who were included in the study, 99 (43.4 %) were qualified as ACS, while 129 (56.5 %) had no ACS. The classification model using SVM attained a 99.13 % classification success. The present study showed a 99.13 % classification success for ACS diagnosis attained by Support Vector Machine. This study showed that machine learning techniques may help emergency department staff make decisions by rapidly producing relevant data.

  6. Haemolytic Uraemic Syndrome Following Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Sinha A

    2005-07-01

    Full Text Available CONTEXT: Haemolytic uraemic syndrome is a common cause of renal failure in children but it is a rare condition in adults. Acute pancreatitis in adult as a cause of haemolytic uraemic syndrome is very rare. CASE REPORT: A 19-year-old male presented with symptom and signs suggestive of acute pancreatitis which was confirmed as his serum amylase was significantly raised. Within three days of admission he developed acute renal failure with evidence of haemolytic anaemia and thrombocytopenia. A clinical diagnosis of haemolytic uraemic syndrome was made and he was treated with plasma exchange. He made a complete recovery. CONCLUSION: Renal failure in a patient with acute pancreatitis is rarely due to haemolytic uraemic syndrome. But it is important to consider this differential diagnosis so that early treatment can be instituted to prevent mortality.

  7. Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain

    DEFF Research Database (Denmark)

    Linde, Jesper James; Kofoed, Klaus Fuglsang; Sørgaard, Mathias;

    2013-01-01

    In patients admitted on suspicion of acute coronary syndrome, with normal electrocardiogram and troponines, we evaluated the clinical impact of a Coronary CT angiography (CCTA)-strategy on referral rate for invasive coronary angiography (ICA), detection of significant coronary stenoses (positive...

  8. central hospital with acute coronary syndrome

    African Journals Online (AJOL)

    consecutivement admi a l'Hopital Central d'Aseer avec le diag- nostic d'un syndrome ... Unit of Aseer Central Hospital with the diagnosis of acute coro- nary syndrome for 14 .... action: consumer information processing. In: G] IDZ K, Lewis.

  9. [Acute coronary syndrome suspicion in patient with left coronary artery arising from right coronary sinus].

    Science.gov (United States)

    Kern, Adam; Górny, Jerzy; Rzeszowski, Bartłomiej; Witkowska, Ewa; Wasilewski, Grzegorz

    2013-01-01

    We present a case of 73 year-old patient who underwent coronary angiography due to suspicion of acute coronary syndrome without persistent ST segment elevation. The angiographic result showed no lesions that could cause recurrent chest pain,but it also revealed a seldom coronary artery abnormality - left coronary artery arising from right coronary sinus. Performed computed tomography of the chest confirmed the result of the coronarography. But apart from that it found the signs of neoplastic disease which was probably responsible for clinical presentation.

  10. [Often an orthopedic problem can manifest as chest pain. Cervical vertebrae syndrome mimics myocardial infarct].

    Science.gov (United States)

    Fromm, B

    2002-04-25

    Up to 20% of all patients with pectoral symptoms have an underlying orthopedic problem. The most common orthopedic conditions that may mimic chest pain radiating into the left arm include slipped disc, cervicothoracic tension syndrome, blockage of intervertebral or rib joints, and intercostal neuralgia. Less common causes of such pain are arthrosis of the shoulder, spondylocystitis, osteoporotic fractures or tumors of the bone. Management is oriented to the underlying cause, and treatment extends from physiotherapeutic measures (rest, heat treatment) via medication (non-steroidal anti-inflammatory drugs, myotonolytic agents) to operative interventions.

  11. Acute myocarditis associated with novel Middle east respiratory syndrome coronavirus.

    Science.gov (United States)

    Alhogbani, Tariq

    2016-01-01

    The novel Middle east respiratory syndrome coronavirus (MeRS-CoV) has been identified as a cause of pneumonia; however, it has not been reported as a cause of acute myocarditis. A 60-year-old man presented with pneumonia and congestive heart failure. On the first day of admission, he was found to have an elevated troponin-l level and severe global left ventricular systolic dysfunction on echo-cardiography. The serum creatinine level was found mildly elevated. Chest radiography revealed in the lower lung fields accentuated bronchovascular lung markings and multiple small patchy opacities. Laboratory tests were negative for viruses known to cause myocarditis. Sputum sample was positive for MeRS-CoV. Cardiovascular magnetic resonance revealed evidence of acute myocarditis. the patient had all criteria specified by the international Consensus Group on CMR in Myocarditis that make a clinical suspicion for acute myocarditis. this was the first case that demonstrated that MeRS-CoV may cause acute myocarditis and acute-onset heart failure.

  12. FINDINGS OF CHEST RADIOGRAPH AND SPIRAL COMPUTED TOMOGRAPHY IN SWYER-JAMES SYNDROME

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To evaluate the value of X-ray and spiral computed tomography (SCT) in the diagnosis of SwyerJames syndrome (SJS).Methods A total of 28 patients, 12 males and 16 females, were studied retrospectively. Ages ranged from 11 to 57 years, the mean age was 32 years. All patients underwent inspiratory chest X-ray films, 5 with expiratory chest films and 1 with bronchogram. Furthermore, inspiratory and expiratory SCT scans were performed. The SCT findings were analyzed and compared with X-ray films.Results SCT demonstrated 56 lobes with hyperlucency and diminished vascularity. The size of 51 lobes were smaller and 5 were normal. X-ray films showed that hyperlucency was only in 29 lobes, in which 19 lobes were smallsized and the other 10 lobes normal. There were 56 lobes with air-trapping on expiratory SCT scans, but only 5 lobes with air-trapping on expiratory X-ray films. Bronchogram in 1 case demonstrated bronchiectasis and bronchiolitis obliterans. SCT showed 24 patients with bronchiectasis, 9 patients with tuberculosis, 10 patients with bronchiolitis, and 2 with segmental collapse. Conclusion SCT scan is superior to chest radiography in the diagnosis and differential diagnosis of SJS.

  13. Clinical features of probable severe acute respiratory syndrome in Beijing

    Institute of Scientific and Technical Information of China (English)

    Hai-Ying Lu; Xiao-Yuan Xu; Yu Lei; Yang-Feng Wu; Bo-Wen Chen; Feng Xiao; Gao-Qiang Xie; De-Min Han

    2005-01-01

    AIM: To summarize clinical features of probable severe acute respiratory syndrome (SARS) in Beijing.METHODS: Retrospective cases involving 801 patients admitted to hospitals in Beijing between March and June 2003, with a diagnosis of probable SARS, moderate type.The series of clinical manifestation, laboratory and radiograph data obtained from 801 cases were analyzed. RESULTS: One to three days after the onset of SARS, the major clinical symptoms were fever (in 88.14% of patients), fatigue, headache, myalgia, arthralgia (25-36%), etc. The counts of WBC (in 22.56% of patients) lymphocyte (70.25%)and CD3, CD4, CD8 positive T cells (70%) decreased. From 4-7 d, the unspecific symptoms became weak; however, the rates of low respiratory tract symptoms, such as cough (24.18%), sputum production (14.26%), chest distress (21.04%) and shortness of breath (9.23%) increased, so did the abnormal rates on chest radiograph or CT. The low counts of WBC, lymphocyte and CD3, CD4, CD8 positiveT cells touched bottom. From 8 to 16 d, the patients presented progressive cough (29.96%), sputum production (13.09%), chest distress (29.96%) and shortness of breath (35.34%). All patients had infiltrates on chest radiograph or CT, some even with multi-infiltrates. Two weeks later, patients' respiratory symptoms started to alleviate, the infiltrates on the lung began to absorb gradually, the counts of WBC, lymphocyte and CD3, CD4, CD8 positive T cells were restored to normality.CONCLUSION: The data reported here provide evidence that the course of SARS could be divided into four stages, namely the initial stage, progressive stage, fastigium and convalescent stage.

  14. CPDX (Chest Pain Diagnostic Program) - A Decision Support System for the Management of Acute Chest Pain (User’s Manual)

    Science.gov (United States)

    1988-02-25

    result of poor disk quality, disk age, heavy use, electrical "glitches" in the power supply, or other events that subject a disk to strong physical or...psychoneurotic disorder; g) epigastric lesions ( cholelithiasis , peptic ulcer, etc.). Musculoskeletal pain and costochrondritis denote muscle, rib, or cartilage...ulcer, pancreatitis, and cholelithiasis may occasionally be confused with chest pain disorders. In most of these disorders, the abdominal exam is

  15. A rare cause of acute coronary syndrome: Kounis syndrome.

    Science.gov (United States)

    Almeida, João; Ferreira, Sara; Malheiro, Joana; Fonseca, Paulo; Caeiro, Daniel; Dias, Adelaide; Ribeiro, José; Gama, Vasco

    2016-12-01

    Kounis syndrome is an acute coronary syndrome in the context of a hypersensitivity reaction. The main pathophysiological mechanism appears to be coronary vasospasm. We report the case of a patient with a history of allergy to quinolones, who was given ciprofloxacin before an elective surgical procedure and during drug administration developed symptoms and electrocardiographic changes suggestive of ST-segment elevation acute coronary syndrome. The drug was suspended and coronary angiography excluded epicardial coronary disease. Two hours after withdrawal of the drug the symptoms and ST elevation had resolved completely.

  16. Usefulness of diastolic color kinesis imaging at rest in the diagnosis of acute coronary syndrome.

    Science.gov (United States)

    Odo, Takafumi; Muro, Takashi; Odo, Kyoko; Kikuda, Kenji; Tamimoto, Ayako; Najima, Chiyo; Sakaino, Naritsugu; Yoshiyama, Minoru

    2009-04-01

    The authors report two cases of acute coronary syndrome diagnosed by diastolic color kinesis imaging (CKI), an echocardiographic technique facilitating regional left ventricular wall motion analysis. Although both patients had experienced chest pain within the previous several days, the pain had remitted prior to visiting the clinic. In addition, neither electrocardiography nor routine echocardiography revealed ischemic changes. However, diastolic CKI clearly showed regional diastolic asynchrony of the left ventricle. Coronary angiography revealed significant stenosis compatible with the region of diastolic asynchrony observed on diastolic CKI. The patients underwent successful coronary revascularization, and diastolic asynchrony disappeared after revascularization. These findings suggest that diastolic CKI is useful for the diagnosis of acute coronary syndrome, even at rest and in the absence of chest pain.

  17. Cardiorenal Syndrome in Acute Heart Failure Syndromes

    Directory of Open Access Journals (Sweden)

    Mohammad Sarraf

    2011-01-01

    Full Text Available Impaired cardiac function leads to activation of the neurohumoral axis, sodium and water retention, congestion and ultimately impaired kidney function. This sequence of events has been termed the Cardiorenal Syndrome. This is different from the increase in cardiovascular complications which occur with primary kidney disease, that is, the so-called Renocardiac Syndrome. The present review discusses the pathogenesis of the Cardiorenal Syndrome followed by the benefits and potential deleterious effects of pharmacological agents that have been used in this setting. The agents discussed are diuretics, aquaretics, natriuretic peptides, vasodilators, inotropes and adenosine α1 receptor antagonists. The potential role of ultrafiltration is also briefly discussed.

  18. Pathobiology of acute respiratory distress syndrome.

    Science.gov (United States)

    Sapru, Anil; Flori, Heidi; Quasney, Michael W; Dahmer, Mary K

    2015-06-01

    The unique characteristics of pulmonary circulation and alveolar-epithelial capillary-endothelial barrier allow for maintenance of the air-filled, fluid-free status of the alveoli essential for facilitating gas exchange, maintaining alveolar stability, and defending the lung against inhaled pathogens. The hallmark of pathophysiology in acute respiratory distress syndrome is the loss of the alveolar capillary permeability barrier and the presence of protein-rich edema fluid in the alveoli. This alteration in permeability and accumulation of fluid in the alveoli accompanies damage to the lung epithelium and vascular endothelium along with dysregulated inflammation and inappropriate activity of leukocytes and platelets. In addition, there is uncontrolled activation of coagulation along with suppression of fibrinolysis and loss of surfactant. These pathophysiological changes result in the clinical manifestations of acute respiratory distress syndrome, which include hypoxemia, radiographic opacities, decreased functional residual capacity, increased physiologic deadspace, and decreased lung compliance. Resolution of acute respiratory distress syndrome involves the migration of cells to the site of injury and re-establishment of the epithelium and endothelium with or without the development of fibrosis. Most of the data related to acute respiratory distress syndrome, however, originate from studies in adults or in mature animals with very few studies performed in children or juvenile animals. The lack of studies in children is particularly problematic because the lungs and immune system are still developing during childhood and consequently the pathophysiology of pediatric acute respiratory distress syndrome may differ in significant ways from that seen in acute respiratory distress syndrome in adults. This article describes what is known of the pathophysiologic processes of pediatric acute respiratory distress syndrome as we know it today while also presenting the much

  19. Coronary ectasia in a man on breast cancer therapy presenting with acute coronary syndrome

    OpenAIRE

    2016-01-01

    Limited data exist on the association between breast cancer treatments and coronary artery disease anatomy, particularly in males. We describe an unusual case of diffuse coronary ectasia in a man with breast cancer presenting with acute coronary syndrome (ACS). A 66-year-old man with breast cancer on paclitaxel, tamoxifen, and carboplatin chemotherapy regimen, presents with new onset chest pain. Electrocardiogram reveals anterolateral ST-segment depressions and elevated troponin I level. Emer...

  20. Chest physiotherapy is not clinically indicated for infants receiving outpatient care for acute wheezing episodes.

    Science.gov (United States)

    Castro-Rodriguez, Jose A; Silva, Rodrigo; Tapia, Patricio; Salinas, Pamela; Tellez, Alvaro; Leisewitz, Thomas; Sanchez, Ignacio

    2014-05-01

    To evaluate the effectiveness of chest physiotherapy (CPT), which provides slow and long expiratory flow and assisted cough techniques, in infants receiving outpatient care for acute wheezing episodes. Forty-eight infants with moderate acute wheezing episodes were randomised to receive either salbutamol MDI with CPT (n = 25) or without CPT (n = 23). The clinical score and SpO2 levels were recorded, before and after treatment, in a blinded design. The primary outcome was discharge after the first hour of treatment: clinical score ≤5/12 and SpO2 ≥ 93%. Secondary outcomes were the number of admissions to hospital after the second hour, use of oral corticosteroid bursts and admissions to hospital on day seven. There were no differences between children with and without CPT in discharge rate (92% vs. 87%), clinical score (median [IQR]: 2.8 [2.2-3.3] vs. 3.4 [2.8-4.1]) and SpO2 = (96.4 [95.7-97.1] vs. 96.0 [94.9-96.5]) after the first hour of treatment or in the number of hospital admissions after the second hour. No differences were observed at days seven and 28 following treatment. There was no evidence of clinical benefits from these specific CPT techniques for infants receiving outpatient care for acute wheezing episodes. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  1. A randomized clinical trial of chiropractic treatment and self-management in patients with acute musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner;

    2012-01-01

    We have previously reported short-term follow-up from a pragmatic randomized clinical trial comparing 2 treatments for acute musculoskeletal chest pain: (1) chiropractic treatment and (2) self-management. Results indicated a positive effect in favor of the chiropractic treatment after 4 and 12...

  2. Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

    Energy Technology Data Exchange (ETDEWEB)

    Nahum, E.; Ben-Ari, J.; Schonfeld, T. [Pediatric Intensive Care Unit, Schneider Children' s Medical Center of Israel, Petah Tiqva (Israel); Horev, G. [Dept. of Diagnostic Radiology, Schneider Children' s Medical Center of Israel, Petah Tiqva (Israel); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel)

    2001-06-01

    A 3{sup 1}/{sub 2}-year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

  3. Combination Chemotherapy in Treating Young Patients With Down Syndrome and Acute Myeloid Leukemia or Myelodysplastic Syndromes

    Science.gov (United States)

    2017-02-07

    Childhood Acute Basophilic Leukemia; Childhood Acute Eosinophilic Leukemia; Childhood Acute Erythroleukemia (M6); Childhood Acute Megakaryocytic Leukemia (M7); Childhood Acute Minimally Differentiated Myeloid Leukemia (M0); Childhood Acute Monoblastic Leukemia (M5a); Childhood Acute Monocytic Leukemia (M5b); Childhood Acute Myeloblastic Leukemia With Maturation (M2); Childhood Acute Myeloblastic Leukemia Without Maturation (M1); Childhood Acute Myelomonocytic Leukemia (M4); Childhood Myelodysplastic Syndromes; de Novo Myelodysplastic Syndromes; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndromes; Untreated Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies

  4. Effectiveness of chest physiotherapy in infants hospitalized with acute bronchiolitis: a multicenter, randomized, controlled trial.

    Directory of Open Access Journals (Sweden)

    Vincent Gajdos

    2010-09-01

    Full Text Available Acute bronchiolitis treatment in children and infants is largely supportive, but chest physiotherapy is routinely performed in some countries. In France, national guidelines recommend a specific type of physiotherapy combining the increased exhalation technique (IET and assisted cough (AC. Our objective was to evaluate the efficacy of chest physiotherapy (IET + AC in previously healthy infants hospitalized for a first episode of acute bronchiolitis.We conducted a multicenter, randomized, outcome assessor-blind and parent-blind trial in seven French pediatric departments. We recruited 496 infants hospitalized for first-episode acute bronchiolitis between October 2004 and January 2008. Patients were randomly allocated to receive from physiotherapists three times a day, either IET + AC (intervention group, n=246 or nasal suction (NS, control group, n=250. Only physiotherapists were aware of the allocation group of the infant. The primary outcome was time to recovery, defined as 8 hours without oxygen supplementation associated with minimal or no chest recession, and ingesting more than two-thirds of daily food requirements. Secondary outcomes were intensive care unit admissions, artificial ventilation, antibiotic treatment, description of side effects during procedures, and parental perception of comfort. Statistical analysis was performed on an intent-to-treat basis. Median time to recovery was 2.31 days, (95% confidence interval [CI] 1.97-2.73 for the control group and 2.02 days (95% CI 1.96-2.34 for the intervention group, indicating no significant effect of physiotherapy (hazard ratio [HR]=1.09, 95% CI 0.91-1.31, p=0.33. No treatment by age interaction was found (p=0.97. Frequency of vomiting and transient respiratory destabilization was higher in the IET + AC group during the procedure (relative risk [RR]=10.2, 95% CI 1.3-78.8, p=0.005 and RR=5.4, 95% CI 1.6-18.4, p=0.002, respectively. No difference between groups in bradycardia with or

  5. Acute respiratory distress syndrome assessment after traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Shahrooz Kazemi

    2016-01-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is one of the most important complications associated with traumatic brain injury (TBI. ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors. Methods: This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013 done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis. Results: In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH 48 (60% and Subdural hemorrhage (SDH was Next Level with 39 (48% Correlation between Glasgow Coma Scale (GCS and Respiratory Distress Syndrome (ARDS were significantly decreased (P< 0.0001. The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009 [(2.3±4.6 vs (4.02±7.07]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%. Conclusion: Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis

  6. Percutaneous transluminal coronary angioplasty in acute ischemic syndromes

    NARCIS (Netherlands)

    H. Suryapranata (Haryanto)

    1988-01-01

    textabstractAcute myocardial ischemic syndromes are apparently related to the underlying pathophysiology leading to the clinical instability. Depending on the completeness and the duration of blood deprivation, different clinical syndromes result, such as sudden death, acute transmural infarction, n

  7. Role of the chest pain center in treatment of patients with acute ST-elevated myocardial infarction

    Directory of Open Access Journals (Sweden)

    Hai DONG

    2016-06-01

    Full Text Available Objective  To evaluate the role of establishment of the chest pain center in the treatment of patients with acute ST-elevated myocardial infarction (STEMI. Methods  Referring to the international association of chest pain centers, the chest pain center was established in the hospital the authors served, and the corresponding management system and treatment process were worked out. A total of 576 patients with acute STEMI, admitted after the establishment of the chest pain center (May 2015 Mar. 2016, were recruited as the observation group, and 512 STEMI patients admitted before the establishment of the chest pain center ( Jan. -Dec. 2014 were enrolled as control group. Patients in observation group were treated in the chest pain center, and those in control group received conventional treatment. The general situation, basic diseases, the finishing time of the first ECG and the completed number of ECG within 10 minutes, the success rate of stent implantation in percutaneous coronary intervention (PCI, the time of door-to balloon expansion (D2B, the length of hospital stay and in-hospital mortality were compared between the two groups. Results  No significant difference existed between the two groups in the species composition of diseases, age and sex. The average finishing time of the first ECG was shorter in observation group than in control group (P=0.001, the success rate of stent implantation in PCI was higher in observation group than in control group, but without statistical significance (P=0.222. The time of D2B and of hospital stay was shorter in observation group than in control group (P0.05. Conclusion  The establishment of the chest pain center may effectively shorten the rescue time for patients with STEMI, improve the efficiency of treatment and shorten the length of hospital stay, and is worthy of further clinical promotion. DOI: 10.11855/j.issn.0577-7402.2016.06.04

  8. Gender inequality in acute coronary syndrome patients at Omdurman Teaching Hospital, Sudan

    Directory of Open Access Journals (Sweden)

    Hyder O Mirghani

    2016-01-01

    Full Text Available Background: Gender differences among patients with the acute coronary syndrome is still being debated, no research has been done on gender inequality among coronary syndrome patients in Sudan. Objectives: To study gender differences in presentation, management, and outcomes of acute coronary syndrome in Sudan. Subjects and Methods: This cross-sectional descriptive longitudinal study was conducted in Omdurman Teaching Hospital between July 2014 and August 2015. Patients were invited to sign a written informed consent form, were interviewed and examined by a physician, and then followed during their hospital stay. Information collected includes coronary risk factors, vital signs, echocardiography findings, arrhythmias, heart failure, cardiogenic shock, and death. The Ethical Committee of Omdurman Teaching Hospital approved the research. Results: A total of 197 consecutive acute coronary syndrome patients were included, 43.1% were females. A significant statistical difference was evident between males and females regarding the type of acute coronary syndrome, its presentation, and time of presentation to the hospital, smoking, and receipt of thrombolysis (P 0.05. Conclusion: Women were less likely to receive thrombolytic therapy, present with chest pain, and diagnosed with ST-segment elevation myocardial infarction. No gender differences were found in acute coronary syndrome risk factors apart from smoking, which was more common in males, and there were no differences between males and females as regards in-hospital complications.

  9. Pharm GKB: Severe Acute Respiratory Syndrome [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available y syndrome PharmGKB Accession Id: PA136400566 External Vocabularies MeSH: Severe Acute Respiratory Syndrome ...Publications related to Severe Acute Respiratory Syndrome: 1 view legend The following icons indicate that d...et al. Common Searches Search Medline Plus Search CTD Pharm GKB: Severe Acute Respiratory Syndrome ... ...(D045169) SnoMedCT: Severe acute respiratory syndrome (398447004) UMLS: C1175175 (C1175175) MedDRA: SARS (10061986) NDFRT: Severe Acu...te Respiratory Syndrome [Disease/Finding] (N0000010956)

  10. Birt-Hogg-Dube syndrome prospectively detected by review of chest computed tomography scans

    Science.gov (United States)

    Park, Hye Jung; Park, Chul Hwan; Lee, Sang Eun; Lee, Geun Dong; Byun, Min Kwang; Lee, Sungsoo; Lee, Kyung-A; Kim, Tae Hoon; Kim, Seong Han; Yang, Seo Yeon; Kim, Hyung Jung; Ahn, Chul Min

    2017-01-01

    Purpose Birt-Hogg-Dube syndrome (BHD) is a rare disorder caused by mutations in the gene that encodes folliculin (FLCN) and is inherited in an autosomal dominant manner. BHD is commonly accompanied by fibrofolliculomas, renal tumors, multiple pulmonary cysts, and spontaneous pneumothorax. The aim of this study was to detect BHD prospectively in patients undergoing chest computed tomography (CT) scans and to evaluate further the characteristics of BHD in Korea. Methods We prospectively checked and reviewed the chest CT scans obtained for 10,883 patients at Gangnam Severance Hospital, Seoul, Korea, from June 1, 2015 to May 31, 2016. Seventeen patients met the study inclusion criteria and underwent screening for FLCN mutation to confirm BHD. We analyzed the characteristics of the patients confirmed to have BHD and those for a further 6 patients who had previously been described in Korea. Results Six (0.06%) of the 10,883 patients reviewed were diagnosed with BHD. There was no difference in demographic or clinical features between the patients with BHD (n = 6) and those without BHD (n = 11). Pneumothorax was present in 50% of the patients with BHD but typical skin and renal lesions were absent. The maximum size of the cysts in the BHD group (median 39.4 mm; interquartile range [IQR] 11.4 mm) was significantly larger than that in the non-BHD group (median 15.8 mm; IQR 7.8 mm; P = 0.001). Variable morphology was seen in 100.0% of the cysts in the BHD group but in only 18.2% of the cysts in the non-BHD group (P = 0.002). Nine (95%) of the total of 12 Korean patients with BHD had experienced pneumothorax. Typical skin and renal lesions were present in 20.0% of patients with BHD. Conclusions Our findings suggest that BHD can be detected if chest CT scans are read in detail. PMID:28151982

  11. Primary Sjogren’s Syndrome Presenting as Acute Interstitial Pneumonitis/Hamman-Rich Syndrome

    Directory of Open Access Journals (Sweden)

    Abidullah Khan

    2016-01-01

    Full Text Available A previously well, 45-year-old Pakistani lady was admitted to the medical unit on-call of Khyber Teaching Hospital (KTH Peshawar with a 5-day history of fever, productive cough with copious mucoid sputum, dyspnea, and pleuritic chest pain. She also complained of dry eyes, mouth, and vagina. Her chest X-ray showed diffuse alveolar shadowing and arterial gas analysis confirmed type 1 respiratory failure. Over the next few days, she deteriorated rapidly making an urgent transfer to the medical intensive care unit (MICU necessary, where she was mechanically ventilated. An HRCT followed by bronchoscopic biopsies made a diagnosis of acute interstitial pneumonitis (AIP, formerly known as Hamman-Rich syndrome. She also turned out to be positive for both anti-SS-A/Ro and anti-SS-B/La antibodies along with a positive Schirmer’s test and lower lip biopsy. She received intravenous steroids and supportive care. The patient had a complete recovery after approximately three weeks’ stay in the hospital with lung function returning back to normal. This is most probably the first ever case of primary Sjogren syndrome (pSjS presenting as AIP, recovering completely in less than a month time.

  12. Primary Sjogren's Syndrome Presenting as Acute Interstitial Pneumonitis/Hamman-Rich Syndrome

    Science.gov (United States)

    Humayun, Mohammad; Haider, Iqbal; Ayub, Maimoona; Shah, Zakir; Ajmal, Fahad

    2016-01-01

    A previously well, 45-year-old Pakistani lady was admitted to the medical unit on-call of Khyber Teaching Hospital (KTH) Peshawar with a 5-day history of fever, productive cough with copious mucoid sputum, dyspnea, and pleuritic chest pain. She also complained of dry eyes, mouth, and vagina. Her chest X-ray showed diffuse alveolar shadowing and arterial gas analysis confirmed type 1 respiratory failure. Over the next few days, she deteriorated rapidly making an urgent transfer to the medical intensive care unit (MICU) necessary, where she was mechanically ventilated. An HRCT followed by bronchoscopic biopsies made a diagnosis of acute interstitial pneumonitis (AIP), formerly known as Hamman-Rich syndrome. She also turned out to be positive for both anti-SS-A/Ro and anti-SS-B/La antibodies along with a positive Schirmer's test and lower lip biopsy. She received intravenous steroids and supportive care. The patient had a complete recovery after approximately three weeks' stay in the hospital with lung function returning back to normal. This is most probably the first ever case of primary Sjogren syndrome (pSjS) presenting as AIP, recovering completely in less than a month time. PMID:27818685

  13. Raised D-dimer levels in acute sickle cell crisis and their correlation with chest X-ray abnormalities

    Directory of Open Access Journals (Sweden)

    Hassan, Imad S. A.

    2010-01-01

    Full Text Available Objective: Quantitation of D-dimer level during a sickling crisis and its correlation with other clinical abnormalities. Design: Prospective longitudinal study. Setting: Armed Forces Hospital, Southern Region, Kingdom of Saudi Arabia. Patients: Adult patients (12 years and older admitted acutely with a sickle cell crisis who consent to taking part in the study. Candidates may re-participate if they are readmitted with a further acute painful crisis. Results: 36 patients with homozygous sickle cell disease consented to take part in the study. D-dimer levels were raised in 31 (68.9% of 45 episodes of painful crisis of whom 13 had an abnormal chest X-ray. Of those with a normal chest X-ray only one patient had a raised D-dimer level: sensitivity of 92.3%, specificity 40.6%, positive predictive value 38.7% and negative predictive value of 92.9% for an abnormal chest X-ray. Conclusion: D-dimer levels are frequently raised during an acute painful crisis. A normal level has a high negative predictive value for an abnormal chest X-ray.

  14. An Unusual Presentation of Adult Tethered Cord Syndrome Associated with Severe Chest and Upper Back Pain

    Directory of Open Access Journals (Sweden)

    Shotaro Kanda

    2015-01-01

    Full Text Available Adult tethered cord syndrome (ATCS is a rare entity that usually presents with multiple neurological symptoms, including lower extremity pain, backache, lower extremity muscle weakness, and bowel/bladder disturbances. Prompt surgical treatment is often necessary to avoid permanent sequelae. We report a 63-year-old man with sudden-onset severe right chest and upper back pain, followed by urinary retention. His initial workup included computed tomography of the abdomen and pelvis, which showed a presacral mass. His symptom-driven neurological workup focused on the cervical and thoracic spine, the results of which were normal. Pelvic radiographs and magnetic resonance imaging of the lumbosacral spine showed spina bifida occulta, meningocele, and presacral masses consistent with a teratomatous tumor. His symptoms, except for urinary retention, improved dramatically with surgical treatment. The excised specimen contained a teratomatous lesion plus an organized hematoma. Hematoma formation was suspected as the trigger of his sudden-onset right chest and upper back pain.

  15. Cardiac risk factors and risk scores vs cardiac computed tomography angiography: a prospective cohort study for triage of ED patients with acute chest pain.

    Science.gov (United States)

    Halpern, Ethan J; Deutsch, Jacob P; Hannaway, Maria M; Estepa, Adrian T; Kenia, Anand S; Neuburger, Kenneth J; Levin, David C

    2013-10-01

    The objective of the study is to evaluate cardiac risk factors and risk scores for prediction of coronary artery disease (CAD) and adverse outcomes in an emergency department (ED) population judged to be at low to intermediate risk for acute coronary syndrome. Informed consent was obtained from consecutive ED patients who presented with chest pain and were evaluated with coronary computed tomography angiography (cCTA). Cardiac risk factors, clinical presentation, electrocardiogram, and laboratory studies were recorded; the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores were tabulated. Coronary computed tomography angiography findings were rated on a 6-level plaque burden scale and classified for significant CAD (stenosis ≥50%). Adverse cardiovascular outcomes were recorded at 30 days. Among 250 patients evaluated by cCTA, 143 (57%) had no CAD, 64 (26%) demonstrated minimal plaque (70% stenosis). Six patients developed adverse cardiovascular outcomes. Among traditional cardiac risk factors, only age (older) and sex (male) were significant independent predictors of CAD. Correlation with CAD was poor for the TIMI (r = 0.12) and GRACE (r = 0.09-0.23) scores. The TIMI and GRACE scores were not useful to predict adverse outcomes. Coronary computed tomography angiography identified severe CAD in all subjects with adverse outcomes. Among ED patients who present with chest pain judged to be at low to intermediate risk for acute coronary syndrome, traditional risk factors are not useful to stratify risk for CAD and adverse outcomes. Coronary computed tomography angiography is an excellent predictor of CAD and outcome. © 2013.

  16. Complex regional pain syndrome with associated chest wall dystonia: a case report

    Directory of Open Access Journals (Sweden)

    Schwartzman Robert J

    2011-09-01

    Full Text Available Abstract Patients with complex regional pain syndrome (CRPS often suffer from an array of associated movement disorders, including dystonia of an affected limb. We present a case of a patient with long standing CRPS after a brachial plexus injury, who after displaying several features of the movement disorder previously, developed painful dystonia of chest wall musculature. Detailed neurologic examination found palpable sustained contractions of the pectoral and intercostal muscles in addition to surface allodynia. Needle electromyography of the intercostal and paraspinal muscles supported the diagnosis of dystonia. In addition, pulmonary function testing showed both restrictive and obstructive features in the absence of a clear cardiopulmonary etiology. Treatment was initiated with intrathecal baclofen and the patient had symptomatic relief and improvement of dystonia. This case illustrates a novel form of the movement disorder associated with CRPS with response to intrathecal baclofen treatment.

  17. Development and validation of a clinical prediction rule for chest wall syndrome in primary care

    Directory of Open Access Journals (Sweden)

    Ronga Alexandre

    2012-08-01

    Full Text Available Abstract Background Chest wall syndrome (CWS, the main cause of chest pain in primary care practice, is most often an exclusion diagnosis. We developed and evaluated a clinical prediction rule for CWS. Methods Data from a multicenter clinical cohort of consecutive primary care patients with chest pain were used (59 general practitioners, 672 patients. A final diagnosis was determined after 12 months of follow-up. We used the literature and bivariate analyses to identify candidate predictors, and multivariate logistic regression was used to develop a clinical prediction rule for CWS. We used data from a German cohort (n = 1212 for external validation. Results From bivariate analyses, we identified six variables characterizing CWS: thoracic pain (neither retrosternal nor oppressive, stabbing, well localized pain, no history of coronary heart disease, absence of general practitioner’s concern, and pain reproducible by palpation. This last variable accounted for 2 points in the clinical prediction rule, the others for 1 point each; the total score ranged from 0 to 7 points. The area under the receiver operating characteristic (ROC curve was 0.80 (95% confidence interval 0.76-0.83 in the derivation cohort (specificity: 89%; sensitivity: 45%; cut-off set at 6 points. Among all patients presenting CWS (n = 284, 71% (n = 201 had a pain reproducible by palpation and 45% (n = 127 were correctly diagnosed. For a subset (n = 43 of these correctly classified CWS patients, 65 additional investigations (30 electrocardiograms, 16 thoracic radiographies, 10 laboratory tests, eight specialist referrals, one thoracic computed tomography had been performed to achieve diagnosis. False positives (n = 41 included three patients with stable angina (1.8% of all positives. External validation revealed the ROC curve to be 0.76 (95% confidence interval 0.73-0.79 with a sensitivity of 22% and a specificity of 93%. Conclusions This CWS score offers

  18. Risk model for suspected acute coronary syndrome is of limited value in an emergency department

    DEFF Research Database (Denmark)

    Mogensen, Christian Backer; Christiansen, Maja; Jørgensen, Jess Bjerre

    2015-01-01

    INTRODUCTION: Among patients with acute chest pain, acute coronary syndrome (ACS) is seen only in a minority of the patients, which raises the question, whether it is possible to separate a group with a high risk of ACS for admission to a cardiac care unit (CCU) from those with a low risk who would...... be treated at an emergency department (ED). The aim of this study was to describe a risk stratification model for a Danish context. METHODS: This was a historic prospective cohort study of patients with suspicion of ACS. The patient was defined as a low-risk patient and admitted to the ED if: 1...

  19. Acute coronary syndromes in the community

    NARCIS (Netherlands)

    S.M. Manemann (Sheila M.); Y. Gerber (Yariv); A.M. Chamberlain (Alanna); S.M. Dunlay (Shannon); M.R. Bell (Malcolm); A.S. Jaffe (Allan); S.A. Weston (Susan); J.M. Killian (Jill); J.A. Kors (Jan); V.L. Roger (Véronique Lee)

    2015-01-01

    textabstractObjectives To measure the incidence of acute coronary syndrome (ACS), defined as first-ever myocardial infarction (MI) or unstable angina (UA); evaluate recent temporal trends; and determine whether survival after ACS has changed over time and differs by type. Patients and Methods This w

  20. Acute cardiac failure in neuroleptic malignant syndrome.

    LENUS (Irish Health Repository)

    Sparrow, Patrick

    2012-02-03

    We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignant syndrome in a 35-year-old woman following treatment with thioridazine and lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process.

  1. Medic - Chest Pain: A Decision Support Program for the Management of Acute Chest Pain (User’s Manual)

    Science.gov (United States)

    1989-10-05

    disk age, heavy use, electrical "glitches" in the power supply, or other events that subject a disk to strong physi cal or electromagnetic forces. 5...syndrome; e) psychoneurotic disorder and; f) epigastric lesions ( cholelithiasis , peptic ulcer, etc. ). a) Musculoskeletal pain and the pain of...their complaint. f) Patients with disorders that present with epigastric pain such as gastritis, peptic ulcer, pancreatitis, and cholelithiasis may

  2. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.

    Science.gov (United States)

    Roqué i Figuls, Marta; Giné-Garriga, Maria; Granados Rugeles, Claudia; Perrotta, Carla; Vilaró, Jordi

    2016-02-01

    This Cochrane review was first published in 2005 and updated in 2007, 2012 and now 2015. Acute bronchiolitis is the leading cause of medical emergencies during winter in children younger than two years of age. Chest physiotherapy is sometimes used to assist infants in the clearance of secretions in order to decrease ventilatory effort. To determine the efficacy of chest physiotherapy in infants aged less than 24 months old with acute bronchiolitis. A secondary objective was to determine the efficacy of different techniques of chest physiotherapy (for example, vibration and percussion and passive forced exhalation). We searched CENTRAL (2015, Issue 9) (accessed 8 July 2015), MEDLINE (1966 to July 2015), MEDLINE in-process and other non-indexed citations (July 2015), EMBASE (1990 to July 2015), CINAHL (1982 to July 2015), LILACS (1985 to July 2015), Web of Science (1985 to July 2015) and Pedro (1929 to July 2015). Randomised controlled trials (RCTs) in which chest physiotherapy was compared against no intervention or against another type of physiotherapy in bronchiolitis patients younger than 24 months of age. Two review authors independently extracted data. Primary outcomes were change in the severity status of bronchiolitis and time to recovery. Secondary outcomes were respiratory parameters, duration of oxygen supplementation, length of hospital stay, use of bronchodilators and steroids, adverse events and parents' impression of physiotherapy benefit. No pooling of data was possible. We included 12 RCTs (1249 participants), three more than the previous Cochrane review, comparing physiotherapy with no intervention. Five trials (246 participants) evaluated conventional techniques (vibration and percussion plus postural drainage), and seven trials (1003 participants) evaluated passive flow-oriented expiratory techniques: slow passive expiratory techniques in four trials, and forced passive expiratory techniques in three trials.Conventional techniques failed to show a

  3. Chest pain: a time for concern?

    Science.gov (United States)

    King, Joan E; Magdic, Kathy S

    2014-01-01

    When a patient complains of chest pain, the first priority is to establish whether the situation is life threatening. Life-threatening differential diagnoses that clinicians must consider include acute coronary syndrome, cardiac tamponade, pulmonary embolus, aortic dissection, and tension pneumothorax. Nonthreatening causes of chest pain that should be considered include spontaneous pneumothorax, pleural effusion, pneumonia, valvular diseases, gastric reflux, and costochondritis. The challenge for clinicians is not to be limited by "satisfaction of search" and fail to consider important differential diagnoses. The challenge, however, can be met by developing a systematic method to assess chest pain that will lead to the appropriate diagnosis and appropriate treatment plan.

  4. Prevalence and Overlap of Noncardiac Conditions in the Evaluation of Low-risk Acute Chest Pain Patients

    Science.gov (United States)

    Al-Ani, Mohammad; Winchester, David E.

    2017-01-01

    Background When patients present to the emergency department with a complaint concerning for heart disease, this often becomes the primary focus of their evaluation. While patients with noncardiac causes of chest pain outnumber those with cardiac causes, noncardiac etiologies are frequently overlooked. We investigated symptoms and noncardiac conditions in a cohort of patients with chest pain at low risk of cardiac disease. Methods We analyzed data from a prospective registry of patients who were evaluated in our chest pain evaluation center. Registry participants completed standardized and validated instruments for depression (by Patient Health Questionnaire PHQ-9), anxiety (by Generalized Anxiety Disorder GAD-7), and Gastroesophageal Reflux Disorder (GERD; by GERD Symptom Frequency Questionnaire). Chest pain characteristics were recorded; severity was reported on a 10-point scale. Results A total of 195 patients were included in the investigation. Using the instruments noted above, the prevalence of depression was 34%, anxiety was 30%, and GERD was 44%, each of at least moderate severity. 32.5% of patients had 2 or more conditions. The median for the severity of angina was 7/10 and the number of episodes over the preceding week was 2, respectively. Severity of angina was associated with PHQ-9 (r = 0.238; P tobacco, diabetes mellitus, hypertension, or hyperlipidemia. Conclusion In our cohort of low-risk acute chest pain patients, depression, anxiety, and GERD were common, substantial overlap was observed. The severity of these noncardiac causes of chest pain causes correlated with the self-reported severity and frequency of angina, but weakly. These conditions should be part of a comprehensive plan of care for chest pain management. PMID:26214812

  5. Arginine methylation dysfunction increased risk of acute coronary syndrome in coronary artery disease population

    Science.gov (United States)

    Zhang, Shengyu; Zhang, Shuyang; Wang, Hongyun; Wu, Wei; Ye, Yicong

    2017-01-01

    Abstract The plasma levels of asymmetric dimethylarginine (ADMA) had been proved to be an independent cardiovascular risk factor. Few studies involved the entire arginine methylation dysfunction. This study was designed to investigate whether arginine methylation dysfunction is associated with acute coronary syndrome risk in coronary artery disease population. In total 298 patients undergoing coronary angiography because of chest pain with the diagnosis of stable angina pectoris or acute coronary syndrome from February 2013 to June 2014 were included. Plasma levels of free arginine, citrulline, ornithine, and the methylated form of arginine, ADMA, and symmetric dimethylarginine (SDMA) were measured with high-performance liquid chromatography coupled with tandem mass spectrometry. We examined the relationship between arginine metabolism-related amino acids or arginine methylation index (AMI, defined as ratio of [arginine + citrulline + ornithine]/[ADMA + SDMA]) and acute coronary events. We found that plasma ADMA levels were similar in the stable angina pectoris group and the acute coronary syndrome group (P = 0.88); the AMI differed significantly between 2 groups (P angina and acute coronary syndrome patients; AMI might be an independent risk factor of acute coronary events in coronary artery disease population. PMID:28207514

  6. Two patients with TAFRO syndrome exhibiting strikingly similar anterior mediastinal lesions with predominantly fat attenuation on chest computed tomography.

    Science.gov (United States)

    Ozawa, Yoko; Yamamoto, Hiroshi; Yasuo, Masanori; Takahashi, Hidekazu; Tateishi, Kazunari; Ushiki, Atsuhito; Kawakami, Satoshi; Fujinaga, Yasunari; Asaka, Shiho; Sano, Kenji; Takayama, Hiroshi; Imamura, Hiroshi; Hanaoka, Masayuki

    2017-03-01

    We herein report on two middle-aged men with TAFRO (thrombocytopenia, anasarca, fever, reticulin fibrosis or renal failure, and organomegaly) syndrome, a unique clinicopathological variant of multicentric Castleman׳s disease recently proposed in Japan. Strikingly similar anterior mediastinal fat swellings with soft tissue density were observed in the patients on chest computed tomography. In TAFRO syndrome, bilateral pleural effusion and slight lymph node swelling are common in the thoracic region; however, anterior mediastinal lesions have not been previously observed. Although the mechanisms of anterior mediastinal lesions have not been defined, these lesions seem to have a close relationship with TAFRO syndrome.

  7. Risk stratification in chest pain patients

    NARCIS (Netherlands)

    Poldervaart, J.M.

    2016-01-01

    Yearly, a total of approximately 200,000 patients in The Netherlands present to the emergency department with chest pain. Only 20% of these patients will have an acute coronary syndrome (ACS), and need prompt admission and treatment. However, differentiating between ACS and other, mostly

  8. Sheehan syndrome: acute presentation with severe headache.

    Science.gov (United States)

    Hale, B; Habib, A S

    2014-11-01

    Postpartum headache is a common occurrence with a broad differential diagnosis. Sheehan syndrome, or postpartum pituitary necrosis, is not typically recognized as a cause of postpartum headache. We present a case of Sheehan syndrome that initially presented as severe headache after vaginal delivery complicated by retained placenta and postpartum hemorrhage. The patient was discharged home on postpartum day three but continued to have headaches and returned to hospital on postpartum day six with severe headache, failure to lactate, edema, dizziness, fatigue, nausea and vomiting. Cranial magnetic resonance imaging revealed pituitary infarction consistent with Sheehan syndrome. We discuss the differential diagnosis for postpartum headache, the pathophysiological features of Sheehan syndrome and headache as an atypical acute presentation.

  9. Dress syndrome with sepsis, acute respiratory distress syndrome and pneumomediastinum

    Directory of Open Access Journals (Sweden)

    Prabhas Prasun Giri

    2011-01-01

    Full Text Available Drug rash with eosinophilia and systemic symptoms (DRESS syndrome reflects a serious hypersensitivity reaction to drugs, and is characterized by skin rash, fever, lymph node enlargement, and internal organ involvement. So far, numerous drugs such as sulfonamides, phenobarbital, sulfasalazine, carbamazepine, and phenytoin have been reported to cause DRESS syndrome. We report a case of a 10-year-old girl who developed clinical manifestations of fever, rash, lymphadenopathy, hypereosinophilia, and visceral involvement (hepatitis and pneumonitis after taking phenobarbital for seizures, with subsequent development of sepsis, acute respiratory distress syndrome (ARDS and spontaneous air leak syndrome (pnemothorax and pneumomediastinum. She was put on steroids and various antibiotics and was ventilated, but ultimately succumbed to sepsis and pulmonary complications.

  10. Acute intestinal pseudo-obstruction (Ogilvie's syndrome: A case report

    Directory of Open Access Journals (Sweden)

    Navas Nadukkandiyil, MD

    2014-12-01

    Full Text Available Acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, is an acute clinical condition with clinical and radiological features of an acute large bowel obstruction in the absence of any mechanical cause. Patients presenting with Ogilvie's syndrome usually have underlying medical and surgical conditions predisposing them to the syndrome. In this article, we describe an elderly patient who presented with acute colonic pseudo-obstruction without any apparent cause.

  11. Acute renal failure in neuroleptic malignant syndrome.

    Science.gov (United States)

    Nishioka, Yoshiaki; Miyazaki, Masanobu; Kubo, Susumu; Ozono, Yoshiyuki; Harada, Takashi; Kohno, Shigeru

    2002-07-01

    We report a patient with neuroleptic malignant syndrome (NMS) who developed acute renal failure and was successfully treated by hemodialysis. A 60-year-old man with a 26-year history of schizophrenia had been treated with thioridazine and sulpiride. He was admitted to our hospital for muscular rigidity and oliguria. After the diagnosis of NMS with acute renal failure was established, thioridazine and sulpiride were discontinued and hemodialysis was instituted. Renal function gradually improved and hemodialysis was discontinued after 17th treatment. We also reviewed 57 cases of NMS with acute renal failure reported in the literature. To our knowledge, 26 years is the longest latency between initiation of neuroleptic drug treatment and onset of NMS. Our review of reported NMS cases with acute renal failure identified those risks for poor prognosis as high level of BUN, age and female gender.

  12. Acute Abdominal Pain Secondary to Chilaiditi Syndrome

    Directory of Open Access Journals (Sweden)

    David Kang

    2013-01-01

    Full Text Available Chilaiditi syndrome is a rare condition occurring in 0.025% to 0.28% of the population. In these patients, the colon is displaced and caught between the liver and the right hemidiaphragm. Patients' symptoms can range from asymptomatic to acute intermittent bowel obstruction. Diagnosis is best achieved with CT imaging. Identification of Chilaiditi syndrome is clinically significant as it can lead to many significant complications such as volvulus, perforation, and bowel obstruction. If the patient is symptomatic, treatment is usually conservative. Surgery is rarely indicated with indications including ischemia and failure of resolution with conservative management.

  13. ATRA (all-trans-retinoic acid) syndrome in acute promyelocytic leukemia: clinical and radiologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Keon Ha; Goo, Jin Mo; Im, Jung Gi; Chung, Myung Jin; Do, Kyung Hyun; Park, Seon Yang [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Seo, Joon Beom [Gachon Univ. Medical School, Gil Medical Center, Seoul (Korea, Republic of)

    2001-03-01

    To describe the clinical and radiologic findings of all-trans-retinoic acid (ATRA) syndrome in acute promyelocytic leukemia. Among 21 patients with acute promyelocytic leukemia who were treated with all-trans-retinoic acid between 1995 and 1998, we retrospectively evaluated the cases of four with ATRA syndrome. Two were male and two were female, and their mean age was 58 years. The clinical and radiologic findings of chest radiography (n=4) and HRCT (n=1) were analyzed. Between seven and 13 days after ATRA treatment, dry cough, dyspnea and high fever developed in all patients. The WBC count in peripheral blood was significantly higher [2.9-25.3(mean, 10.8)-fold] than before ATRA treatment, and in all patients, chest radiography revealed ill-defined consolidation and pleural effusion. Kerley's B line (n=3) and hilar enlargement (n=3) were also seen, and in one patient, HRCT demonstrated septal line thickening. Among four patients treated with prednisolone and Ara-C, three recovered and one died. In acute promyelocytic patients treated with all-trans-retinoic acid, radiologic findings of ill-de-fined consolidation, pleural effusion, hilar prominence and Kerley's B line may suggest ATRA syndrome. The early diagnosis of this will improve the patients' prognosis.

  14. Acute exertional anterior compartment syndrome in an adolescent female.

    Science.gov (United States)

    Fehlandt, A; Micheli, L

    1995-01-01

    Acute compartment syndromes usually occur as a complication of major trauma. While the chronic exertional anterior tibial compartment syndrome is well described in the sports medicine literature, reports of acute tibial compartment syndromes due to physical exertion, or repetitive microtrauma, are rare. The case of an adolescent female who developed an acute anterior compartment syndrome from running in a soccer game is described in this report. Failure to recognize the onset of an acute exertional compartment syndrome may lead to treatment delay and serious complications. Whereas the chronic exertional anterior compartment syndrome is characterized by pain that diminishes with the cessation of exercise, the onset of the acute exertional anterior compartment syndrome is heralded by pain that continues, or increases, after exercise has stopped. Compartment pressure measurement confirms the clinical diagnosis and helps guide treatment. True compartment syndromes require urgent fasciotomy.

  15. Pleural effusions in patients with acute leukemia and myelodysplastic syndrome.

    Science.gov (United States)

    Faiz, Saadia A; Bashoura, Lara; Lei, Xiudong; Sampat, Keeran R; Brown, Tiffany C; Eapen, George A; Morice, Rodolfo C; Ferrajoli, Alessandra; Jimenez, Carlos A

    2013-02-01

    Pleural effusions are rarely observed in patients with acute myelogenous leukemia (AML), acute lymphocytic leukemia (ALL) and myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN). Therefore the underlying etiology of pleural effusions and the efficacy and safety of pleural procedures in this population has not been well studied. In a retrospective review of cases from 1997 to 2007, we identified 111 patients with acute leukemia or MDS/MPN who underwent pleural procedures. Clinical characteristics were reviewed, and survival outcomes were estimated by Kaplan-Meier methods. A total of 270 pleural procedures were performed in 111 patients (69 AML, 27 ALL, 15 MDS/MPN). The main indications for pleural procedures were possible infection (49%) and respiratory symptoms (48%), and concomitant clinical symptoms included fever (34%), dyspnea (74%), chest pain (24%) and cough (37%). Most patients had active disease (61%). The most frequent etiology of pleural effusions was infection (47%), followed by malignancy (36%). Severe thrombocytopenia (platelet count < 20 × 10(3)/µL) was present in 43% of the procedures, yet the procedural complication rate was only 1.9%. Multivariate analysis revealed that older age, AML, MDS/MPN and active disease status were associated with a shorter median overall survival. Infection and malignant involvement are the most common causes of pleural effusion in patients with acute leukemia or MDS. After optimizing platelet count and coagulopathy, thoracentesis may be performed safely and with high diagnostic yield in this population. Survival in these patients is determined by the response to treatment of the hematologic malignancy.

  16. A Multivariate Model for Prediction of Obstructive Coronary Disease in Patients with Acute Chest Pain: Development and Validation

    Directory of Open Access Journals (Sweden)

    Luis Cláudio Lemos Correia

    Full Text Available Abstract Background: Currently, there is no validated multivariate model to predict probability of obstructive coronary disease in patients with acute chest pain. Objective: To develop and validate a multivariate model to predict coronary artery disease (CAD based on variables assessed at admission to the coronary care unit (CCU due to acute chest pain. Methods: A total of 470 patients were studied, 370 utilized as the derivation sample and the subsequent 100 patients as the validation sample. As the reference standard, angiography was required to rule in CAD (stenosis ≥ 70%, while either angiography or a negative noninvasive test could be used to rule it out. As predictors, 13 baseline variables related to medical history, 14 characteristics of chest discomfort, and eight variables from physical examination or laboratory tests were tested. Results: The prevalence of CAD was 48%. By logistic regression, six variables remained independent predictors of CAD: age, male gender, relief with nitrate, signs of heart failure, positive electrocardiogram, and troponin. The area under the curve (AUC of this final model was 0.80 (95% confidence interval [95%CI] = 0.75 - 0.84 in the derivation sample and 0.86 (95%CI = 0.79 - 0.93 in the validation sample. Hosmer-Lemeshow's test indicated good calibration in both samples (p = 0.98 and p = 0.23, respectively. Compared with a basic model containing electrocardiogram and troponin, the full model provided an AUC increment of 0.07 in both derivation (p = 0.0002 and validation (p = 0.039 samples. Integrated discrimination improvement was 0.09 in both derivation (p < 0.001 and validation (p < 0.0015 samples. Conclusion: A multivariate model was derived and validated as an accurate tool for estimating the pretest probability of CAD in patients with acute chest pain.

  17. SECONDARY MITOCHONDRIAL DYSFUNCTION IN ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    Y. A. Vasyuk

    2015-12-01

    Full Text Available So-called “metabolic” direction has been developing intensively during last decades. Its aim is the theoretical and practical analysis of the role of metabolic disorders in initiation and progression of many diseases. The pathogenic peculiarities of acute coronary syndrome (ACS which result in developing of secondary mitochondrial dysfunction are considered as a subject of this review. The methods of laboratory diagnosis of mitochondrial dysfunction and possibilities of its pharmaceutical correction in patients with ACS are reviewed.

  18. Microalbuminuria and C-reactive protein as a predictor of coronary artery disease in patients of acute chest pain.

    Science.gov (United States)

    Sharma, Smita; Ghalaut, Veena Singh; Dixit, Ramakant; Kumar, Sanjeev; George, P Jacob

    2013-03-01

    Microalbuminuria is a risk factor for cardiovascular disease. It is gaining importance as a marker of atherogenic milieu and indicates the target organ damage and can be a valuable tool in screening and identification of patients with cardiovascular disease. Markers of inflammation, such as C-reactive protein (CRP), were found to be related to cardiovascular disease (CVD) events in patients with chest pain. In addition, recent studies have shown that, in the case of atherosclerosis, increased levels of CRP, reflects inflammatory condition of vessel wall. In the present study, CRP and microalbuminuria were estimated in patients of acute chest pain. The patients were divided into two study groups (gp-1 patients of chest pain with CVD and gp-2 patients of chest pain of causes other than CVD) along with one healthy control group. It was found that microalbuminuria was higher in CVD patients (RR = 6.250,95% CI 2.346-16.45,P microalbuminuria were also higher in gp-1 (CVD) patients as compared to other two groups. Therefore, CRP and microalbuminuria can be used as important biomarkers in screening CVD.

  19. Gerstmann'S syndrome in acute stroke patients.

    Science.gov (United States)

    Zukic, Sanela; Mrkonjic, Zamir; Sinanovic, Osman; Vidovic, Mirjana; Kojic, Biljana

    2012-12-01

    Gerstmann in 1924. observed in a few patients a concomitant impairment in discriminating their own fingers, writing by hand, distinguishing left from right and performing calculations. He claimed that this tetrad of symptoms constituted a syndromal entity, assigned it to a lesion of the dominant parietal lobe. Since than, Gerstmann`s syndrome (GS) was enigma for neuropsychologists. The aim of this study was to analyze frequency and clinical features of GS among acute stroke patients. We prospectively analyzed 194 acute stroke patients (average age 65±11.06 years, male 113 (58.2%), female 81 (41.8%) hospitalized at department of Neurology, University Clinical Center tuzla, during the six mounths in 2010. For clinical assessment of agraphia, alexia and acalculia we used Minessota test for differential diagnosis of aphasia's. Among these acute stroke patients, 59 (30.40%) had alexia, agraphia and acalculia or different combinations of these disorders. two patients (3.4%) had agraphia and acalculia associated with other part of tetrad of GS: fi nger agnosia and left-right disorientation. they both where men, right handed, and cranial computed tomography scan showed ischemic lesion in the left parietal and left temporoparietal lobe. Gerstmann`s syndrome is rare clinical entity, and has the high value in localization and the lesion is mainly localized to angular gyrus of the dominant hemisphere.

  20. [Acute renal failure in neuroleptic malignant syndrome].

    Science.gov (United States)

    Wagner, G; Rónai, L

    1995-10-01

    The neuroleptic malignant syndrome is characterized by hyperpyrexia, muscle rigidity, extrapyramidal motion disorder, vegetative symptoms and mental disorientation. This group of symptoms develops abruptly and may lead to serious complications. One of these complications is the acute renal failure. Permanent muscle rigidity causes the damage of muscle cells which result in myoglobinaemia, myoglobinuria and elevations in muscle related creatine phosphokinase. The authors report the case of a young man who underwent neuroleptic medication because of hebephrenia. During the medication the following symptoms were developed: extrapyramidal symptoms, restlessness, muscle rigidity, high fever. These symptoms eventually lead to acute renal failure caused by rhabdomyolysis (characteristic urine finding, significant elevations in serum creatine phosphokinase). With regards to the neuroleptic malignant syndrome dantrolenum and bromocriptin treatment were applied with the discontinuation of neuroleptic medication. As a part of the complex therapy a massive volumen-supplementing and alkalizing treatment was used but haemodialysis had also become necessary. During the above mentioned treatment symptoms referring to the neuroleptic malignant syndrome resolved and the acute renal failure was cured. The case report calls attention to a specific group of symptoms and the possibilities for prevention and treatment. The above case report is the first observation in Hungary.

  1. Acute Compartment Syndrome of the Leg.

    Science.gov (United States)

    Konda, Sanjit R; Kester, Benjamin S; Fisher, Nina; Behery, Omar A; Crespo, Alexander M; Egol, Kenneth A

    2017-08-01

    Acute compartment syndrome (ACS) is well known among orthopaedic surgeons. The timely diagnosis and management of ACS is crucial to avoiding its sequelae, including renal failure, ischemic contractures, and limb loss. Despite its relative importance, ACS poses a challenge to many residents and clinicians as diagnosis relies largely on clinical judgment. Timely diagnosis and thorough compartment release are essential to optimizing outcomes in ACS. This video highlights a clinical case in which compartment syndrome of the leg was considered, diagnosed, and surgically managed. This video will present the indications for compartment release and a video-guided demonstration of compartment checks using an arterial line transducer, a 4-compartment fasciotomy with 2 incisions, and temporizing vessel loop closure. Compartment syndrome can be a devastating complication of common fractures. It is essential that orthopaedic practitioners understand the immediacy of intervention. We have a responsibility to provide timely, accurate diagnosis along with expedient surgical management.

  2. Delayed Presentation of Acute Gluteal Compartment Syndrome.

    Science.gov (United States)

    Tasch, James J; Misodi, Emmanuel O

    2016-07-19

    BACKGROUND Acute gluteal compartment syndrome is a rare condition that usually results from prolonged immobilization following a traumatic event, conventionally involving the presence of compounding factors such as alcohol or opioid intoxication. If delay in medical treatment is prolonged, severe rhabdomyolysis may ensue, leading to acute renal failure and potentially death. CASE REPORT We report the case of a 23-year-old male with a recent history of incarceration and recreational drug use, who presented with reports of severe right-sided buttock pain and profound right-sided neurological loss following a questionable history involving prolonged immobilization after a fall from a standing position. The patient required an emergent gluteal fasciotomy immediately upon admission and required temporary hemodialysis. After an extended hospital stay, he ultimately recovered with only mild deficits in muscular strength in the right lower extremity. CONCLUSIONS This report demonstrates the importance of early recognition of gluteal compartment syndrome to prevent morbidity and mortality. Compartment syndrome presents in many unique ways, and healthcare practitioners must have a keen diagnostic sense to allow for early surgical intervention. Proper wick catheter measurements should be utilized more frequently, instead of relying on clinical symptomatology such as loss of peripheral pulses for diagnosis of compartment syndrome.

  3. The surgical stabilization of multiple rib fractures using titanium elastic nail in blunt chest trauma with acute respiratory failure.

    Science.gov (United States)

    Tarng, Yih-Wen; Liu, Yuan-Yuarn; Huang, Fong-Dee; Lin, Hsing-Lin; Wu, Tzu-Chin; Chou, Yi-Pin

    2016-01-01

    Blunt chest injuries are usually combined with multiple rib fractures and severe lung contusions. This can occasionally induce acute respiratory failure and prolong ventilations. In order to reduce the periods of ventilator dependency, we propose a less invasive method of fixing multiple rib fractures. Since October 2009, we have developed a new method to fix fractured ribs caused by blunt trauma. Rib fixations were performed using 2.0- or 2.5-mm intramedullary titanium elastic nails (TEN), with the help of video-assisted thoracoscopic surgery (VATS) and minimal thoracic incisions. All the patients' demographics and postoperative data were collected. From January 2010 to December 2012, a total of 65 patients presenting with multiple rib fractures resulting in acute respiratory failure were included in the study. Twelve patients received the new surgical fixation. Rib fixations were performed at an average of 4 days after trauma. Patients were successfully weaned off ventilators after an average of 3 days. The average length of stay in the hospital and the intensive care unit (ICU) was shorter for the patients with fixation than for nonsurgical patients. All twelve patients returned to normal daily activities and work. In the reconstruction of an injured chest wall, the VATS with TENs fixation in multiple rib fractures is feasible. This method is also effective in decreasing the length of the surgical wound. Because the structure of the chest cage is protected, the period of mechanical ventilation is shortened and the length of stay in the hospital and the ICU can be reduced.

  4. Use of resting myocardial scintigraphy during chest pain to exclude diagnosis of acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Barbirato, Gustavo Borges; Azevedo, Jader Cunha de; Felix, Renata Christian Martins; Correa, Patricia Lavatori; Volschan, Andre; Viegas, Monica; Pimenta, Lucia; Dohmann, Hans Fernando Rocha; Mesquita, Evandro Tinoco; Mesquita, Claudio Tinoco [Centro de Estudos do Hospital Pro-Cardiaco (Procep), Rio de Janeiro, RJ (Brazil)

    2009-04-15

    Background: Images of myocardial perfusion taken during an episode of chest pain have been used for patients in the emergency department. Objective: To evaluate the operating characteristics of {sup 99m}Tc-Tetrofosmin scintigraphy during an episode of chest pain to exclude the diagnosis of cute myocardial infarction. Methods: One hundred and eight patients admitted with chest pain, or up to four hours after the end of symptoms and non diagnostic electrocardiogram, underwent resting scintigraphy and measurement of troponin I concentrations. Patients with a history of myocardial infarction (MI) were not excluded (24 patients). Troponin I concentrations were determined at admission and 6 hours later. Nuclear physicians performed a blind analysis of the images, and myocardial infarction was confirmed whenever troponin I level increase was three times that of the control. Results: Resting perfusion image was abnormal in all 6 patients with MI. Only 1 patient had a normal image and increased troponin levels. Fifty-five patients had positive images without MI, and 46 patients had normal images and troponin levels. The prevalence of the disease was 6.5%. The sensitivity and specificity of the resting images during an episode of chest pain to diagnose MI was 85.7% and 45.5%, respectively. The negative predictive value was 97.7%. Conclusion: Patients undergoing chest pain protocol with SPECT showed an excellent negative predictive value to exclude diagnosis of myocardial infarction. These results suggest that resting perfusion image is an important tool at the chest pain unit. (author)

  5. Gender bias in acute coronary syndromes.

    Science.gov (United States)

    Bugiardini, Raffaele; Estrada, Jose L Navarro; Nikus, Kjell; Hall, Alistair S; Manfrini, Olivia

    2010-03-01

    The major aim of this review was to ascertain whether effective evidence-based treatments for acute coronary syndromes (ACS) are underutilized in women in various geographic areas compared with men. The focus of our review was the relative use of effective treatments in patients with coronary angiographic evidence of obstructive coronary disease, defined as a lumen stenosis >50% of the adjacent non-diseased arterial diameter. We searched MEDLINE, and the Cochrane Database between January 1998 and May 2008. Only a few of the published clinical registries on ACS provide data on treatments dichotomized by confirmed coronary angiographic disease. Consequently, we also accessed individual patient-level data from 3 established ACS registries: the Finnish TACOS (Tampere Acute COronary Syndrome), the British EMMACE 2 (Evaluation of Methods and Management of Acute Coronary Events) and the Argentine PACS-ITALSIA (Prognosis in Acute Coronary Syndromes and the ITALian hospital Sindrome Isquemico Agudo). Despite presenting with higher risk characteristics and having higher in-hospital and 6 months risk of death, women with ACS and obstructive coronary artery disease were apparently treated less aggressively with secondary preventive drugs than were men, being less likely to receive aspirin, beta-blockers and statins at discharge. Overall, coronary revascularization appears to be performed in a similar proportion of women and men - once angiography has been performed and the coronary anatomy is known. However, substantial geographic variation exists in the relative rate of coronary angiography in men and women. In United Kingdom coronary revascularization tends to be done less frequently in women. Our study, therefore, demonstrates a gender bias in the delivery of secondary drug treatments for ACS, even for patients with documented significant coronary disease.

  6. The absence of coronary artery calcification does not rule out the presence of significant coronary artery disease in Asian patients with acute chest pain.

    Science.gov (United States)

    Yoon, Yeonyee E; Chang, Sung-A; Choi, Sang-Ii; Chun, Eun-Ju; Cho, Young-Seok; Youn, Tae-Jin; Chung, Woo-Young; Chae, In-Ho; Choi, Dong-Joo; Chang, Hyuk-Jae

    2012-02-01

    The absence of coronary artery calcification (CAC) has been used to as an indication to rule out significant coronary artery disease (CAD). However, diagnostic usefulness of 'zero calcium score criteria' as a decision-making strategy to rule out significant CAD as the etiology of acute chest pain has not been studied in depth, especially in Asian ethnicity. We prospectively enrolled 136 Korean patients (58% men, 56 ± 13 years) who presented to the emergency department (ED) with acute chest pain and non-diagnostic ECG. All patients underwent 64-slice CT for calcium scoring and coronary CT angiography (cCTA). We investigated the association of CAC with the presence of ≥50% CAD on cCTA and with a final diagnosis of an acute coronary syndrome (ACS). Ninety-two patients out of 136 (68%) did not show detectable CAC, and 14 out of these 92 without CAC (15%) had ≥50% CAD on cCTA. Sensitivity, specificity, positive predictive value and negative predictive value of zero calcium score criteria for the detection of ≥50% CAD were 0.66 (95% confidence interval, 0.50-0.80), 0.83 (0.74-0.90), 0.64 (0.48-0.77), 0.85 (0.75-0.91), respectively. Patients who had ≥50% CAD without detectable CAC were younger (P = 0.001), and had a higher prevalence of smoking (P = 0.048) as compared to patients with a degree of CAC. Most of the patients with ≥50% CAD of non-calcified plaque were younger than 60 years of age (79%, 11/14), however, 3 of them were older than 60 years of age. Forty-five patients (33%) were subsequently diagnosed as having ACS, and 38% (17/45) of them had no CAC. Zero calcium score did not necessarily guarantee the absence of significant CAD, even in patients older than 60 years, in Asian ethnicity presenting to the ED with chest pain.

  7. Acute respiratory failure following ovarian hyperstimulation syndrome

    Directory of Open Access Journals (Sweden)

    Antonello Nicolini

    2013-03-01

    Full Text Available Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6 ovarian hyperstimulation syndrome who presented ascites, bilateral pleural effusion and severe respiratory failure treated with non-invasive ventilation. The patient was admitted to the intensive care unit because of severe respiratory failure, ascites, and bilateral pleural effusion due to ovarian hyperstimulation syndrome. Treatment included non-invasive ventilation and three thoracentesis procedures, plus the administration of albumin, colloid solutions and high-dose furosemid. Severe form of ovarian hyperstimulation syndrome is observed in 0.5-5% of the women treated, and intensive care may be required for management of thromboembolic complications, renal failure and severe respiratory failure. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and, in more severe cases, assisted ventilation. To our knowledge, there have been only two studies in English language medical literature that describe severe respiratory failure treated with non

  8. Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

    Directory of Open Access Journals (Sweden)

    Parag Chevli

    2014-09-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50 and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset of chest pain and was admitted for the treatment of acute coronary syndrome. The coronary angiography showed dissection of the left anterior descending artery. The patient underwent successful percutaneous transluminal coronary angioplasty and stent placement.

  9. [Chest pains in the dental environment].

    Science.gov (United States)

    Garfunkel, A; Galili, D; Findler, M; Zusman, S P; Malamed, S F; Elad, S; Kaufman, E

    2002-01-01

    Chest pain does not necessarily indicate cardiac disease. The most common causes of acute chest pain encountered in dental situations include hyperventilation, pulmonary embolism, angina pectoris and myocardial infarction. Stress and fear often cause rapid breathing or hyperventilation. This usually occurs in young adults and although the hyperventilating patient often complains of chest pain, this is rarely a manifestation of cardiac disease. Pulmonary embolism usually indicates the occlusion of a pulmonary artery causing severe chest pain. The primary clinical manifestation of angina pectoris is chest pain. Although most instances of anginal pain are easily terminated, the dentist must always consider the possibility that the supposed anginal attack is actually a sign of acute myocardial infarction (AMI). AMI is a clinical syndrome caused by a deficient coronary arterial blood supply to a region of myocardium that results in cellular death. There is a high incidence of mortality among AMI with death often occurring within 2 hours of the onset of signs and symptoms. The initial clinical manifestations of all types of chest pain can be similar. Therefore the dentist must develop proficiency in constituting a differential diagnosis and an efficient management protocol. As in most medical situations prevention is the most powerful tool. However, if chest pains do occur, measures such as airway management, oxygen supplementation, coronary artery dilation, analgesis and in extreme cases, cardiopulmonary resuscitation and evacuation to the emergency room, may be necessary.

  10. Significance of an index of insulin resistance on admission in non-diabetic patients with acute coronary syndromes

    OpenAIRE

    Stubbs, P.; Alaghband-Zadeh, J; Laycock, J.; Collinson, P.; Carter, G.; Noble, M.

    1999-01-01

    BACKGROUND—Insulin resistance is associated with ischaemic heart disease and has been proposed as a risk factor for subsequent myocardial infarction.
AIM—To investigate the potential use of a recently proposed insulin resistance index in identifying insulin resistance in patients admitted with an acute coronary syndrome.
METHODS—Single centre study of 441 non-diabetic patients admitted with chest pain to a coronary care unit and followed prospectively for a median of three years for outcome. ...

  11. Examination of musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Brunse, Mads Hostrup; Stochkendahl, Mette Jensen; Vach, Werner

    2010-01-01

    Chest pain may be caused by joint and muscle dysfunction of the neck and thorax (termed musculoskeletal chest pain). The objectives of this study were (1) to determine inter-observer reliability of the diagnosis 'musculoskeletal chest pain' in patients with acute chest pain of non-cardiac origin...

  12. Pulmonary and extrapulmonary acute respiratory distress syndrome: myth or reality?

    Science.gov (United States)

    Rocco, Patricia R M; Pelosi, Paolo

    2008-02-01

    The pathogenesis of acute respiratory distress syndrome has been explained by the presence of a direct (pulmonary) or indirect (extrapulmonary) insult to the lung parenchyma. Evidence indicates that the pathophysiology of acute respiratory distress syndrome may differ according to the type of the insult. This article presents a brief overview of the differences between pulmonary and extrapulmonary acute respiratory distress syndrome, and discusses the interactions between lung functional, morphological aspects, and response to different therapies, both in experimental models and in patients with acute respiratory distress syndrome. Many researchers recognize that experimental pulmonary and extrapulmonary acute respiratory distress syndrome are not identical when considering morpho-functional aspects, the response to positive end-expiratory pressure and recruitment manoeuvre, prone position and other adjunctive therapies. Contradictory results have been reported in different clinical studies, however, which may be attributed to the difficulty of classifying acute respiratory distress syndrome in one or the other category, and being confident of the onset, the phase and the severity of acute respiratory distress syndrome in all patients. Heterogeneous acute respiratory distress syndrome patients are still considered to suffer from one syndrome, and are treated in the same way. Understanding the range of different pathways that lead to pulmonary dysfunction makes it possible to better target clinical treatment.

  13. ACUTE RESPIRATORY DISTRESS SYNDROME IN PREGNANCY

    Directory of Open Access Journals (Sweden)

    Madhumala

    2015-04-01

    Full Text Available Acute respiratory distress syndrome (ARDS is a clinical syndrome of severe dyspnea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure. ARDS occurs in pregnancy and may have unique causes. Overall mortality for both the mother and the fetus is high and significant morbidity can persist even after initial recovery. ARDS is associated with obstetric causes such as amniotic fluid embolism, preeclampsia, septic abortion, and retained products of conception or non - obstetr ic causes that include sepsis, aspiration pneumonitis, influenza pneumonia, blood transfusions, and trauma. Here is a 24 years old female admitted with 7months of amenorrhea, who presented with respiratory failure, she was intubated and ventilated for 47da ys. She recovered, and a live baby was delivered. She was discharged after 73days.

  14. Prone positioning in acute respiratory distress syndrome.

    Science.gov (United States)

    Gibson, Kristy; Dufault, Marlene; Bergeron, Kathy

    2015-08-12

    Acute respiratory distress syndrome (ARDS) is a condition with a high morbidity and mortality rate, and treatment is often long and costly. Prone positioning is a rarely used intervention for patients with this syndrome, although research suggests it may be effective. A literature search was undertaken to examine the effects of prone positioning on oxygenation, morbidity and mortality in patients with ARDS. It revealed that prone positioning, when used with low tidal volume ventilation over an extended period, may reduce mortality rates in selected patients with severe ARDS. The selection of patients with severe ARDS for prone positioning should be done on a case-by-case basis to maximise benefits and minimise complications. Further research is required on the use of prone positioning in patients with severe ARDS to support or disclaim the therapy's use in practice, and to compare confounding variables such as ideal prone duration and mechanical versus manual pronation.

  15. Melatonin Does Not Affect Oxidative/Inflammatory Biomarkers in a Closed-Chest Porcine Model of Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Halladin, Natalie L.; Ekelof, Sarah; Jensen, Svend Eggert

    2014-01-01

    Aim: To test whether melatonin reduces oxidative and inflammatory biomarkers in a closed-chest porcine model of acute myocardial infarction. Materials and Methods: Twenty pigs were randomized to receive a total dosage of 200 mg (0.4 mg/ml) of melatonin, or placebo immediately prior to reperfusion....... There was an increase in hs-TnT, but no significant difference between the melatonin-treated and placebo-treated groups. There were no significant differences in development of any of the circulating plasma markers between the two groups. Conclusion: Melatonin treatment did not result in reduction of inflammatory...

  16. [Acute carpal tunnel syndrome in a patient with Marfan syndrome].

    Science.gov (United States)

    Franke, J; Wenzel, W; Rehfuss, D; Keiner, H P; Manncke, K

    2008-05-01

    Acute carpal tunnel syndrome (ACTS) is rare and is mostly the result of fractures of the distal radius or the carpal bones. This paper gives the first report of an ACTS following contusion of the wrist as the result of an extensive haematoma of the flexor tendon sheath, which did not appear until 50 hours after the injury was sustained but then developed rapidly. The patient suffers from Marfan syndrome. This disease is associated with pathologic changes to the major vessels, and especially the aorta, and of the smaller peripheral vessels. It is assumed that the haematoma arose from an aneurysm of such a small vessel. The treatment of choice in ACTS is emergency incision of the carpal tunnel.

  17. Lung Morphological Changes in Closed Chest Injury (an experimental study

    Directory of Open Access Journals (Sweden)

    A. M. Golubev

    2012-01-01

    Full Text Available Objective: to study lung morphological changes in a closed chest injury model in laboratory animals. Material and methods. Experiments were carried out in 30 male albino nonbred rats weighing 350—380 g. Closed chest injury was simulated, by exposing the chest of anesthetized rats to a 300-g metal cylinder falling from a height of 30 cm. The observation periods were 1, 3, 6, and 24 hours. Results. The signs of evident perivenular edema that was uncharas-teristic to acute respiratory distress syndrome induced by other causes are an important peculiarity of lung morphological changes in this experimental model of closed chest injury. Conclusion. The experimental studies clarified the pattern of lung morphological changes in the early period after closed chest injury. Key words: closed chest injury, pulmonary edema.

  18. Clinical Profile & Risk Factors in Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    P Yadav, D Joseph, P Joshi, P Sakhi, RK Jha, J Gupta

    2010-12-01

    Full Text Available Coronary Artery Disease (CAD is becoming a major cause of morbidity & mortality burden in the developing world. Indians have been associated with a more severe form of CAD that has its onset at a younger age group with a male predominance. A prospective study was carried out to identify the risk factors and to know the emerging clinical profile in acute coronary syndrome (ACS including S T elevation & Non S T elevation myocardial infarction. We enrolled 200 consecutive patients with typical ECG changes & clinical history, admitted in emergency department from January 2009 to December 2009. A predefined Performa was completed in every patient with a detailed clinical history, physical examinations, and investigation studies. The clinical history revealed information about age, gender, risk factors, and modes of presentation and duration of symptoms. The details of physical examination including anthropometric data, vital signs and complete systemic evaluation were recorded. The regions of infarction and rhythm disturbances were also documented. Our study showed a significant male predominance with mean age being 56 years. Tobacco was identified as major risk factors (65% & obesity (BMI more than 25 is least common risk factor (13%.Patients had typical chest pain (94% and ECG showed anterior wall changes in54%. Forty percent patients developed complications, majority being arrhythmias (60% and least common is mechanical complication (2.5% Thus we conclude that ACS is more common in adult male with tobacco being major risk factors in our population.

  19. Acute respiratory distress syndrome (ARDS): HRCT findings in survivors

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jung Im; Park, Seog Hee; Lee, Jae Mun; Song, Jeong Sup; Lee, Kyo Young [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-08-01

    The purpose of this report is to describe the high-resolution computed tomography (HRCT) findings of the lung in survivors of acute respiratory distress syndrome (ARDS). Among eleven patients who survived ARDS for one year, chest radiography and HRCT revealed pulmonary fibrosis in four. Causes of ARDS included pneumonia during pregnancy, near drowning, pneumonia during liver cirrhosis, and postoperative sepsis. Thoracoscopic biopsy and histopathologic correlation were available in one patient. HRCT showed diffuse interlobular septal thickening, ground glass opacity, parenchymal distortion, and traction bronchiectasis. Fuzzy centrilobular nodules were seen in two patients and one patient had multiple, large bullae in the left hemithorax. In all patients, lesions affected the upper and anterior zones of the lung more prominently. The distribution of pulmonary fibrosis was characteristic and reflected the pathogenesis of lung injury; fibrosis was largely due to hyperoxia caused by ventilator care. In one patient, histopathologic correlation showed that imaging findings were accounted for by thickening of the alveolar septum along with infiltration of chronic inflammatory cells and fibrosis. Fuzzy centrilobular nodules corresponded with bronchiolitis.

  20. Acute Coronary Syndrome- Conservative vs Invasive Treatment

    Institute of Scientific and Technical Information of China (English)

    LIM; Yean Teng

    2001-01-01

    @@atients with Acute Coronary Syndrome (ACS)are a clinical continuum-with patients presenting with unstable angina on one end, with patients with ST elevation myocardial infarction (STEMI) at the other end of the spectrum. In between are those with non- ST elevation myocardial infarction (NSTEMI) The pathophysiology is similar in these patients, namely isruption and fissuring of an atheromatous plaque,leading to enhanced platelet activation and local vasohyperactivity, with reduced flow and thrombus formation. While medical experts have reached consensus in the management of STEMI patients (thrombolysis nd / or percutaneous coronary intervention), optimalmanagement of patients with UA/NSTEMI remainsunclear.

  1. [Acute intermittent porphyria and inappropriate ADH syndrome].

    Science.gov (United States)

    Tébar, M T; Aguilera, L

    2010-05-01

    A 44-year-old woman complained of abdominal pain of 4 days' duration accompanied by vomiting and painful urination. The admitting physician noted neurologic signs consistent with axonal polyneuropathy and hyponatremia. In the absence of other explanations for the syndrome, SIADH was diagnosed. Because of the nonspecific nature of the observations, the patient was assessed by various specialists and admitted to the anesthetic recovery unit due to worsening of neurologic signs and suspicion of acute intermittent porphyria. The diagnosis was confirmed by laboratory findings of elevated d-aminolevulinic acid and porphobilinogen levels and normal stool porphyrins. The patient improved with intravenous hematin infused over 4 days.

  2. Acute Coronary Syndrome and ST Segment Monitoring.

    Science.gov (United States)

    Carey, Mary G

    2016-09-01

    Acute coronary syndrome (ACS) is caused by a critical obstruction of a coronary artery because of atherosclerotic coronary artery disease. Three specific conditions are included: ST elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina. The ST segment on the electrocardiogram is a sensitive and specific marker of myocardial ischemia and infarction; however, ST segment deviation is regional not global, thus the ECG lead must be placed over the affected region of the myocardium. This article describes ACS and infarction and the use of ST segment monitoring to detect these conditions.

  3. Acute compartment syndrome of forearm and hand

    Science.gov (United States)

    Chandraprakasam, T.; Kumar, R. Ashok

    2011-01-01

    The diagnosis and treatment of the acute compartment syndrome is of paramount importance. Unless the viscious cycle is intervened at an appropriately early time it will result in irreversible damage leading to disability. In this review article we are discussing the basic pathophysiological process through which the various aetiological factors causing increased compartmental pressure lead to the progressive death of muscles and nerves. We also discuss the various clinical features that aid in the diagnosis and the role of intracompartmental pressure measurements. Finally we hope to ascertain the basic principles and the surgical techniques for treating this condition effectively. PMID:22022031

  4. Imaging of non-cardiac, non-traumatic causes of acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Kienzl, Daniela, E-mail: daniela.kienzl@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Prosch, Helmut; Töpker, Michael; Herold, Christian [Department of Radiology, Medical University of Vienna (Austria)

    2012-12-15

    Non-traumatic chest pain is a common symptom in patients who present in the emergency department. From a clinical point of view, it is important to differentiate cardiac chest pain from non-cardiac chest pain (NCCP). Among the plethora of potential causes of NCCP, life-threatening diseases, such as aortic dissection, pulmonary embolism, tension pneumothorax, and esophageal rupture, must be differentiated from non-life threatening causes. The majority of NCCP, however, is reported to be benign in nature. The presentation of pain plays an important role in narrowing the differential diagnosis and initiating further diagnostic management and treatment. As the benign causes tend to recur, and may lead to patient anxiety and great costs, a meticulous evaluation of the patient is necessary to diagnose the underlying disorder or disease.

  5. Impact of 64-slice coronary CT on the management of patients presenting with acute chest pain: results of a prospective two-centre study

    Energy Technology Data Exchange (ETDEWEB)

    Christiaens, Luc [Departement d' imagerie Cardiovasculaire, Assistance Publique- Hopitaux de Paris, Hopital Lariboisiere, Paris (France); CHU de Poitiers, Departement de Cardiologie, Poitiers (France); Duchat, Florent; Boudiaf, Mourad; Fargeaudou, Yann; Ledref, Olivier; Soyer, Philippe [Departement d' imagerie Cardiovasculaire, Assistance Publique- Hopitaux de Paris, Hopital Lariboisiere, Paris (France); Tasu, Jean-Pierre [CHU de Poitiers, Departement de Radiologie, Poitiers (France); Sirol, Marc [Departement d' imagerie Cardiovasculaire, Assistance Publique- Hopitaux de Paris, Hopital Lariboisiere, Paris (France); INSERM UFR U942, Insuffisance Cardiaque et Biomarqueurs, Universite Paris 7 - Denis Diderot, Hopital Lariboisiere, Paris (France); Universite Paris VII - Denis Diderot, Assistance Publique - Hopitaux de Paris, Service de Radiologie Vasculaire, Hopital Lariboisiere, Paris (France)

    2012-05-15

    Our two-centre prospective study evaluates the usefulness of 64-slice coronary computed tomography (CCT) to rule out significant coronary artery stenosis in patients admitted in emergency departments (ED) for acute coronary syndromes (ACS) with low-to-intermediate risk score. Patients (175) admitted for acute chest pain (ACP), unmodified electrocardiogram and first troponin measurement within normal ranges were included. A second troponin measurement and a 64-slice CCT within 24 h were performed. Major adverse cardiac events (MACE) were recorded during follow-up (6 months {+-} 2). 64-slice CCT was either normal or showed non-significant coronary stenosis in the majority of patients (78%). 64-slice CCT depicted significant stenosis (>50% diameter) in 22% of patient whereas initial clinical and biological evaluation was reassuring. For negative CCTs, elevated troponin at second measurement did not modify the strategy or treatment of patients. No MACEs were noted during follow up. In 12% of patients CCT identified unsuspected non-coronary abnormalities. Our study confirms 64-slice CCT utility to rule out significant coronary artery stenosis in 8/10 patients admitted in ED with ACP or ACS with low-to-intermediate risk score. Early discharge with a negative 64-slice CCT is associated with very low risk of cardiac events at 6 months. (orig.)

  6. Chinese herbal medicine for severe acute respiratory syndrome

    DEFF Research Database (Denmark)

    Liu, Jianping; Manheimer, Eric; Shi, Yi

    2004-01-01

    To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically.......To review randomized controlled trials (RCTs) evaluating the effects of Chinese herbal medicine for treating severe acute respiratory syndrome (SARS) systematically....

  7. Rivaroxaban in patients with a recent acute coronary syndrome

    DEFF Research Database (Denmark)

    Mega, Jessica L; Braunwald, Eugene; Wiviott, Stephen D

    2012-01-01

    Acute coronary syndromes arise from coronary atherosclerosis with superimposed thrombosis. Since factor Xa plays a central role in thrombosis, the inhibition of factor Xa with low-dose rivaroxaban might improve cardiovascular outcomes in patients with a recent acute coronary syndrome....

  8. Rivaroxaban in patients with a recent acute coronary syndrome.

    NARCIS (Netherlands)

    Mega, J.L.; Braunwald, E.; Wiviott, S.D.; Bassand, J.P.; Bhatt, D.L.; Bode, C.; Burton, P.; Cohen, M.; Cook-Bruns, N.; Fox, K.A.; Goto, S.; Murphy, S.A.; Plotnikov, A.N.; Schneider, D.; Sun, X.; Verheugt, F.W.A.; Gibson, C.M.

    2012-01-01

    BACKGROUND: Acute coronary syndromes arise from coronary atherosclerosis with superimposed thrombosis. Since factor Xa plays a central role in thrombosis, the inhibition of factor Xa with low-dose rivaroxaban might improve cardiovascular outcomes in patients with a recent acute coronary syndrome. ME

  9. The role of inflammatory stress in acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    沈成兴; 陈灏珠; 葛均波

    2004-01-01

    Objective To summarize current understanding of the roles of anti-inflammatory and proinflammatory mechanisms in the development of atherosclerosis and acute coronary syndrome and to postulate the novel concept of inflammation stress as the most important factor triggering acute coronary syndrome. Moreover, markers of inflammation stress and ways to block involved pathways are elucidated.Data sources A literature search (MEDLINE 1997 to 2002) was performed using the key words "inflammation and cardiovascular disease". Relevant book chapters were also reviewed.Study selection Well-controlled, prospective landmark studies and review articles on inflammation and acute coronary syndrome were selected.Data extraction Data and conclusions from the selected articles providing solid evidence to elucidate the mechanisms of inflammation and acute coronary syndrome were extracted and interpreted in the light of our own clinical and basic research.Data synthesis Inflammation is closely linked to atherosclerosis and acute coronary syndrome. Chronic and long-lasting inflammation stress, present both systemically or in the vascular walls, can trigger acute coronary syndrome.Conclusions Inflammation stress plays an important role in the process of acute coronary syndrome. Drugs which can modulate the balance of pro- and anti-inflammatory processes and attenuate inflammation stress, such as angiotensin-converting enzyme (ACE) inhibitors/angiotensin Ⅱ receptor blockers, statins, and cytokine antagonists may play active roles in the prevention and treatment of acute coronary syndrome when used in addition to conventional therapies (glycoprotein Ⅱb/Ⅲa receptor antagonists, mechanical intervention strategies, etc).

  10. Continuous glucose monitoring in acute coronary syndrome.

    Science.gov (United States)

    Rodríguez-Quintanilla, Karina Alejandra; Lavalle-González, Fernando Javier; Mancillas-Adame, Leonardo Guadalupe; Zapata-Garrido, Alfonso Javier; Villarreal-Pérez, Jesús Zacarías; Tamez-Pérez, Héctor Eloy

    2013-01-01

    Diabetes mellitus is an independent risk factor for cardiovascular disease. To compare the efficacy of devices for continuous glucose monitoring and capillary glucose monitoring in hospitalized patients with acute coronary syndrome using the following parameters: time to achieve normoglycemia, period of time in normoglycemia, and episodes of hypoglycemia. We performed a pilot, non-randomized, unblinded clinical trial that included 16 patients with acute coronary artery syndrome, a capillary or venous blood glucose ≥ 140 mg/dl, and treatment with a continuous infusion of fast acting human insulin. These patients were randomized into 2 groups: a conventional group, in which capillary measurement and recording as well as insulin adjustment were made every 4h, and an intervention group, in which measurement and recording as well as insulin adjustment were made every hour with a subcutaneous continuous monitoring system. Student's t-test was applied for mean differences and the X(2) test for qualitative variables. We observed a statistically significant difference in the mean time for achieving normoglycemia, favoring the conventional group with a P = 0.02. Continuous monitoring systems are as useful as capillary monitoring for achieving normoglycemia. Copyright © 2012 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  11. [Clinico-diagnostic evaluation of acute delirious syndromes in schizophrenia].

    Science.gov (United States)

    Panteleeva, G P

    1989-01-01

    Psychopathologic and nosologic issues of acute paranoid and Kandinsky-Clerambault syndromes are discussed on the background of clinical studies of 225 schizophrenic patients with these syndromes being initial manifestations. The data on the syndromes typology, clinical value and prognosis of acute delirious disorders are presented. These are shown to be not confined to progredient schizophrenia, including its paranoid form. Rather, they can manifest a course of the disease unspecific for schizophrenia, the so-called schizophrenic reactions and phasic states thus reflecting the course of latent schizophrenia. A differentiated approach to clinical and psychopathological analysis of acute delirious syndromes in schizophrenia is essential for adequate choice of medicosocial measures and epidemiologic investigations.

  12. Acute renal failure: A rare presentation of Sheehan's syndrome.

    Science.gov (United States)

    Bhat, Manzoor A; Laway, Bashir A; Allaqaband, Faheem A; Kotwal, Suman K; Wani, Imtiyaz A; Banday, Khursheed A

    2012-03-01

    Sheehan's syndrome occurs as a result of ischemic pituitary necrosis secondary to severe postpartum bleeding. It is one of the most common causes of hypopituitarism, characterized by variable clinical presentation. Acute kidney injury occurs rarely in Sheehan's syndrome and most of the cases have been found to be precipitated by rhabdomyolysis. We here present a case of Sheehan's syndrome with acute kidney injury where theprecipitating cause was chronic hypocortisolemia. We believe this is the first reported case of Sheehan's syndrome in which acute kidney injury was precipitated by adrenal insufficiency.

  13. Acute esophageal necrosis: a rare syndrome.

    Science.gov (United States)

    Gurvits, Grigoriy E; Shapsis, Alexander; Lau, Nancy; Gualtieri, Nicholas; Robilotti, James G

    2007-01-01

    Acute esophageal necrosis, which presents as a black esophagus on endoscopy, is a rare disorder that is poorly described in the medical literature. In this study, we analyze all cases reported to date to define risk factors, clinical presentation, endoscopic features, histologic appearance, treatment, complications, outcome and etiopathogenesis of the disease and to describe a distinct medical syndrome and propose a staging system. We searched Medline and PubMed from January 1965 to February 2006 for English-language articles using the key words "acute esophageal necrosis," "necrotizing esophagitis," and "black esophagus." A total of 88 patients were reported in the literature during the 40 years, 70 men and 16 women with an average age of 67 years. Patients were generally admitted for gastrointestinal bleeding and cardiovascular event/shock. Patients presented with hematemesis and melena in more than 70% of the cases. Upper endoscopy showed black, diffusely necrotic esophageal mucosa predominantly affecting the distal third of the organ. Necrosis was confirmed histologically in most cases. Complications included strictures or stenoses, mediastinitis/abscesses, and perforations. Overall mortality was 31.8%. This study provides a structured approach to identifying risk factors, diagnosis, and pathogenesis of the acute esophageal necrosis. Risk factors include age, male sex, cardiovascular disease, hemodynamic compromise, gastric outlet obstruction, alcohol ingestion, malnutrition, diabetes, renal insufficiency, hypoxemia, hypercoagulable state, and trauma. Mechanism of damage is usually multifactorial secondary to ischemic compromise, acute gastric outlet obstruction, and malnutrition. Overall, acute esophageal necrosis should be viewed as a poor prognostic factor, associated with high mortality from the underlying clinical disease.

  14. Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

    DEFF Research Database (Denmark)

    Afshari, Arash; Brok, Jesper; Møller, Ann

    2010-01-01

    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far.......Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical conditions that are associated with high mortality and morbidity. Aerosolized prostacyclin has been used to improve oxygenation despite the limited evidence available so far....

  15. Unveiling The Hidden Eagle: Acute Parotitis-Induced Eagle Syndrome

    OpenAIRE

    Nitipong Permpalung; Promporn Suksaranjit; Daych Chongnarungsin; Hyman, Charles L.

    2014-01-01

    Context: A cervicofacial pain and foreign body sensation in pharynx associated with styloid process elongation is called Eagle syndrome. Typically, this syndrome is provoked by tonsillectomy or trauma. We report the first case of acute parotitis-induced Eagle syndrome. Case Report: A 65-year-old woman presented with right facial pain. CT scan of neck revealed asymmetric enhancement of the right parotid gland compatible with acute parotitis. All inflammation was resolved with antibiotics. Howe...

  16. Acute Respiratory Distress Syndrome after Early Successful Primary Percutaneous Coronary Intervention Therapy in Acute Myocardial Infarction: A Case Report

    Directory of Open Access Journals (Sweden)

    Ho-Ming Su

    2005-02-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterized by acute-onset dyspnea, diffuse bilateral pulmonary infiltration, low pulmonary capillary wedge pressure (PCWP, and an arterial oxygen tension/ inspired oxygen fraction (PaO2/FiO2 ratio of less than 200 mmHg. Acute myocardial infarction (AMI, whether complicated by circulatory arrest, cardiogenic shock, and hypotension or not, was reported as an etiologic factor in the development of ARDS in the prethrombolytic era. In the thrombolytic era, two cases of AMI complicated with ARDS have been reported. ARDS in these two patients resulted from anaphylactic reaction to the thrombolytic agent and not from the hemodynamic consequences of AMI. Development of ARDS during the AMI period has not been reported after early successful primary percutaneous coronary intervention (PCI. Herein, we report a 61-year-old male patient with persistent chest pain who was diagnosed with Killip II anterior ST-segment elevation AMI. He was treated successfully with primary PCI 2.5 hours after the onset of chest pain. Unfortunately, on the third hospital day, acuteonset dyspnea (respiratory rate, 33 beats/min, fever (38.5°C, leukocytosis (white blood cell count, 18,360/μL, and diffuse bilateral pulmonary infiltration were noted. ARDS was diagnosed from the low PCWP (8 mmHg and a PaO2/FiO2 of less than 200 mmHg (160 mmHg. No usual causes of ARDS such as infection, aspiration, trauma, shock, or drug reactions were noted. We assumed that, in this particular patient, the systemic inflammatory response syndrome frequently induced by AMI might have caused this episode of ARDS. This may imply that AMI itself is a possible etiology of ARDS.

  17. Medical management of the acute radiation syndrome.

    Science.gov (United States)

    López, Mario; Martín, Margarita

    2011-07-13

    The acute radiation syndrome (ARS) occurs after whole-body or significant partial-body irradiation (typically at a dose of >1 Gy). ARS can involve the hematopoietic, cutaneous, gastrointestinal and the neurovascular organ systems either individually or in combination. There is a correlation between the severity of clinical signs and symptoms of ARS and radiation dose. Radiation induced multi-organ failure (MOF) describes the progressive dysfunction of two or more organ systems over time. Radiation combined injury (RCI) is defined as radiation injury combined with blunt or penetrating trauma, burns, blast, or infection. The classic syndromes are: hematopoietic (doses >2-3 Gy), gastrointestinal (doses 5-12 Gy) and cerebrovascular syndrome (doses 10-20 Gy). There is no possibility to survive after doses >10-12 Gy. The Phases of ARS are-prodromal: 0-2 days from exposure, latent: 2-20 days, and manifest illness: 21-60 days from exposure. Granulocyte-colony stimulating factor (G-CSF) at a dose of 5 μg/kg body weight per day subcutaneously has been recommended as treatment of neutropenia, and antibiotics, antiviral and antifungal agents for prevention or treatment of infections. If taken within the first hours of contamination, stable iodine in the form of nonradioactive potassium iodide (KI) saturates iodine binding sites within the thyroid and inhibits incorporation of radioiodines into the gland. Finally, if severe aplasia persists under cytokines for more than 14 days, the possibility of a hematopoietic stem cell (HSC) transplantation should be evaluated. This review will focus on the clinical aspects of the ARS, using the European triage system (METREPOL) to evaluate the severity of radiation injury, and scoring groups of patients for the general and specific management of the syndrome.

  18. Subclinical nephritic syndrome in children cohabiting with pediatric patients, Presenting acute nephritic syndrome

    OpenAIRE

    Guerrero-Tinoco Gustavo Adolfo; Julio-Barrios Emil

    2012-01-01

    Introduction: subclinical nephritic syndrome is the presence of hematuria, hypocomplementemiaand/or proteinuria without the presence of signs and/or symptoms.Objective: to determine the incidence of subclinical nephritic syndrome in childrenliving with pediatric patients diagnosed with acute nephritic syndrome.Methods: family visit to identify children living together in the two previous months, with pediatric patients hospitalized with acute nephritic syndrome, at Hospital InfantilNapoleon F...

  19. Subclinical nephritic syndrome in children cohabiting with pediatric patients, Presenting acute nephritic syndrome

    OpenAIRE

    Guerrero-Tinoco Gustavo Adolfo; Julio-Barrios Emil

    2012-01-01

    Introduction: subclinical nephritic syndrome is the presence of hematuria, hypocomplementemiaand/or proteinuria without the presence of signs and/or symptoms.Objective: to determine the incidence of subclinical nephritic syndrome in childrenliving with pediatric patients diagnosed with acute nephritic syndrome.Methods: family visit to identify children living together in the two previous months, with pediatric patients hospitalized with acute nephritic syndrome, at Hospital InfantilNapoleon F...

  20. [Despite medication, overdrive pacing is required to stabilize the electrical storm associated with acute coronary syndrome: a case report].

    Science.gov (United States)

    Umeda, Masanobu; Morimoto, Atsushi; Yokoyama, Kaori; Tateishi, Emi; Makino, Kanako; Yamamoto, Kazuo; Nakagawa, Yoko; Fukuhara, Shinya; Takase, Eiji

    2007-10-01

    A 75-year-old female complained of severe chest pain and was emergently admitted to our hospital because of anterior acute myocardial infarction. Emergent coronary angiography was performed and revealed occlusion in segment 7, so a stent was implanted. Lidocaine, carvedilol, amiodarone, magnesium, and nifekalant were administered successively because non-sustained ventricular tachycardia (NSVT) frequently appeared like an electrical storm. After nifekalant administration, QTc was significantly prolonged and torsades de pointes was induced. Overdrive pacing was performed and finally the NSVT was completely controlled. If fatal arrhythmias such as NSVT show resistance to medication, overdrive pacing should be considered to stabilize the arrhythmia associated with acute coronary syndrome.

  1. Severe acute respiratory syndrome (SARS) in a paediatric cluster in Singapore

    Energy Technology Data Exchange (ETDEWEB)

    Tsou, Ian Y.; Kaw, Gregory J.; Chee, Thomas S. [Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore (Singapore); Loh, Lik Eng; Chan, Irene [Department of Paediatric Medicine, KK Women' s and Children' s Hospital, 100 Bukit Timah Road, 229899, Singapore (Singapore)

    2004-01-01

    Severe acute respiratory syndrome (SARS) is a major infectious disease pandemic that occurred in early 2003, and one of the diagnostic criteria is the presence of chest radiographic findings. To describe the radiographic features of SARS in a cluster of affected children. The chest radiographs of four related children ranging in age from 18 months to 9 years diagnosed as having SARS were reviewed for the presence of air-space shadowing, air bronchograms, peribronchial thickening, interstitial disease, pleural effusion, pneumothorax, hilar lymphadenopathy and mediastinal widening. Ill-defined air-space shadowing was the common finding in all the children. The distribution was unifocal or multifocal. No other findings were seen on the radiographs. None of the children developed radiographic findings consistent with acute respiratory distress syndrome. All four children showed significant resolution of the radiographic findings 4-6 days after the initial radiograph. Early recognition of these features is important in implementing isolation and containment measures to prevent the spread of infection. SARS in children appears to manifest as a milder form of the disease as compared to adults. (orig.)

  2. Ipilimumab and Decitabine in Treating Patients With Relapsed or Refractory Myelodysplastic Syndrome or Acute Myeloid Leukemia

    Science.gov (United States)

    2016-09-12

    Chimerism; Hematopoietic Cell Transplantation Recipient; Previously Treated Myelodysplastic Syndrome; RAEB-1; RAEB-2; Recurrent Adult Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Untreated Adult Acute Myeloid Leukemia

  3. Severity of Acute Respiratory Distress Syndrome in haematology patients: long-term impact and early predictive factors.

    Science.gov (United States)

    Lagier, D; Platon, L; Chow-Chine, L; Sannini, A; Bisbal, M; Brun, J-P; Blache, J-L; Faucher, M; Mokart, D

    2016-09-01

    Severe forms of acute respiratory distress syndrome in patients with haematological diseases expose clinicians to specific medical and ethical considerations. We prospectively followed 143 patients with haematological malignancies, and whose lungs were mechanically ventilated for more than 24 h, over a 5-y period. We sought to identify prognostic factors of long-term outcome, and in particular to evaluate the impact of the severity of acute respiratory distress syndrome in these patients. A secondary objective was to identify the early (first 48 h from ICU admission) predictive factors for acute respiratory distress syndrome severity. An evolutive haematological disease (HR 1.71; 95% CI 1.13-2.58), moderate to severe acute respiratory distress syndrome (HR 1.81; 95% CI 1.13-2.69) and need for renal replacement therapy (HR 2.24; 95% CI 1.52-3.31) were associated with long-term mortality. Resolution of neutropaenia during ICU stay (HR 0.63; 95% CI 0.42-0.94) and early microbiological documentation (HR 0.62; 95% CI 0.42-0.91) were associated with survival. The extent of pulmonary infiltration observed on the first chest X-ray and the diagnosis of invasive fungal infection were the most relevant early predictive factors of the severity of acute respiratory distress syndrome. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

  4. Simple pulmonary eosinophilia (loeffler's syndrome): chest radiographic and CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Kyung Jae; Lee, Kyung Soo; Kim, Tae Sung; Chung, Man Pyo; Choi, Dong Chull; Kwon, O Jung [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2000-01-01

    The purpose of our study is to describe the chest radiographic and CT findings of simple pulmonary eosinophilia. Twenty-six patients with simple pulmonary eosinophilia underwent chest radiography and CT scanning; the results were analyzed retrospectively by two chest radiologists, focusing on the patterns and distribution of the parenchymal abnormalities. The chest radiographs were normal in eight patients (31%), while among the remaining 18 patients, they showed subtle opacity (n=3D9), nodules (n=3D8), consolidation (n=3D2), and mass (n=3D1). Follow-up chest radiographs (m=3D18) demonstrated complete (n=3D16) or partial (n=3D1) resolution of parenchymal lesions or migratory lesions (n=3D1). On CT, nodule(s) (n=3D19) were most commonly seen, followed by ground-glass opacity (n=3D16), consolidation (n=3D3), and mass (n=3D1). A peripheral halo surrounding a nodule or an area of consolidation was seen in 18 patients. The nodules(s) (n=3D19) were subpleural (n=3D13) or random (=3D6). Areas of ground-glass opacity (n=3D16) were subpleural (n=3D13), random (n=3D2), or central (n=3D1). All lesions were patchy rather than diffuse. Follow-up CT in nine patients showed complete (n=3D7) or partial (n=3D2) resolution of parenchymal lesions. Chest radiographs of patients with simple pulmonary eosinophilia often reveal no abnormality. The most common finding is subtle opacity or nodule(s), while CT reveals transient nodule(s) with a surrounding halo or transient areas of ground glass opacity. (author)

  5. Acute coronary syndromes in patients with HIV

    Science.gov (United States)

    Seecheran, Valmiki K.; Giddings, Stanley L.

    2017-01-01

    Highly active antiretroviral treatment (HAART) has considerably increased the life expectancy of patients infected with HIV. Coronary artery disease is a leading cause of mortality in patients infected with HIV. This is primarily attributed to their increased survival, HAART-induced metabolic derangements, and to HIV itself. The pathophysiology of atherosclerosis in HIV is both multifactorial and complex – involving direct endothelial injury and dysfunction, hypercoagulability, and a significant contribution from traditional cardiac risk factors. The advent of HAART has since heralded a remarkable improvement in outcomes, but at the expense of other unforeseen issues. It is thus of paramount importance to swiftly recognize and manage acute coronary syndromes in HIV-infected patients to attenuate adverse complications, which should translate into improved clinical outcomes. PMID:27845996

  6. Nuclear Cardiology in Acute Coronary Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Paeng, Jin Chul; Lee, Dong Soo [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2009-06-15

    Nuclear myocardial perfusion imaging is very effective in the evaluation of patients with suspicious acute coronary syndrome (ACS), for adequate diagnosis and treatment. There have been many clinical evidences to support the efficacy and cost-effectiveness. In addition, many authoritative guidelines support the utility of myocardial perfusion imaging in ACS with an appropriate diagnostic protocol. However, with the development of other cardiac imaging modalities, the choice of modality for the diagnosis of suspicious ACS now depends on the availability of each modality in each institute. Newly developed imaging technologies, especially including molecular imaging, are expected to have great potential not only for diagnosis but also for primary, secondary, and tertiary prevention of ACS.

  7. Activated protein C in the treatment of acute lung injury and acute respiratory distress syndrome

    NARCIS (Netherlands)

    A.D. Cornet; G.P. van Nieuw Amerongen; A. Beishuizen; M.J. Schultz; A.R.J. Girbes; A.B.J. Groeneveld

    2009-01-01

    Background: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) frequently necessitate mechanical ventilation in the intensive care unit. The syndromes have a high mortality rate and there is at present no treatment specifically directed at the underlying pathogenesis. Central in

  8. Acute Respiratory Distress Syndrome in Obstetric Patients

    Directory of Open Access Journals (Sweden)

    S. V. Galushka

    2007-01-01

    Full Text Available Objective: to define the specific features of the course of acute respiratory distress syndrome (ARDS in puer-peras with a complicated postpartum period. Subjects and methods. Sixty-seven puerperas with ARDS were examined. Group 1 included 27 puerperas with postpartum ARDS; Group 2 comprised 10 puerperas who had been treated in an intensive care and died; Group 3 consisted of nonobstetric patients with ARDS of various genesis (a control group. Results. In obstetric patients, the baseline oxygenation index was significantly lower than that in the control group. However, Group 1 patients showed a rapid increase in PaO2/FiO2 on days 3—4 of treatment. In the control group, the changes occurred later — on days 5—6. The baseline alveolar-arterial oxygen difference was significantly higher in the obstetric patients than that in the controls. In Group 1, AaDpO2 drastically decreased on days 3—4, which took place in parallel with an increase in the oxygenation index. At the beginning of the study, pulmonary shunting was high in the group of survivors, deceased, and controls. In Group 1, the shunting decreased on days 3—4 whereas in the control group this index normalized later — only by days 6—7. In Group 1, compliance remained lower throughout the observation, but on day 7 there was a significant difference in this index between the deceased, survivors, and controls. Conclusion. Thus, more severe baseline pulmonary gas exchange abnormalities are observed in obstetric patients than in general surgical and traumatological patients; the oxygenation index, alveolar-arterial oxygen difference, and pulmonary shunting index more rapidly change in patients with severe obstetric disease in its favorable course than in general surgical and traumatological patients; throughout the observation, thoracopulmonary compliance was less in obstetric patients than in the controls. Key words: acute respiratory distress syndrome, puerperium.

  9. Unveiling the hidden eagle: Acute parotitis-induced eagle syndrome

    Directory of Open Access Journals (Sweden)

    Nitipong Permpalung

    2014-01-01

    Full Text Available Context: A cervicofacial pain and foreign body sensation in pharynx associated with styloid process elongation is called Eagle syndrome. Typically, this syndrome is provoked by tonsillectomy or trauma. We report the first case of acute parotitis-induced Eagle syndrome. Case Report: A 65-year-old woman presented with right facial pain. CT scan of neck revealed asymmetric enhancement of the right parotid gland compatible with acute parotitis. All inflammation was resolved with antibiotics. However, the patient complained of pain in right mandibular region out of proportion to inflammation. Review CT found to have an asymmetrically long right styloid process measures. The diagnosis of acute parotitis-induced Eagle syndrome was established. Conclusion: Physicians should have a high index of suspicion for Eagle syndrome in patients with atypical neck pain and elongated styloid process since another significant manifestation of Eagle syndrome is carotid artery compression leading to recurrent syncope or stroke.

  10. Preventing acute renal failure is crucial during acute tumor lysis syndrome

    Directory of Open Access Journals (Sweden)

    Darmon Michael

    2007-01-01

    Full Text Available Tumour Lysis syndrome (TLS is characterized by the massive destruction of tumoral cells and the release in the extracellular space of their content. While TLS may occur spontaneously before treatment, it usually develops shortly after the initiation of cytotoxic chemotherapy. These metabolites can overwhelm the homeostatic mechanisms and cause hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia. Moreover, TLS may lead to an acute renal failure (ARF. In addition to the hospital mortality induced by the acute renal failure itself, development of an ARF may preclude optimal cancer treatment. Therefore, prevention of the acute renal failure during acute tumor lysis syndrome is mandatory. The objective of this review is to describe pathophysiological mechanisms leading to acute tumor lysis syndrome, clinical and biological consequences of this syndrome and to provide up-to-date guidelines to ensure prevention and prompt management of this syndrome.

  11. Acute Respiratory Distress: from syndrome to disease.

    Science.gov (United States)

    Cardinal-Fernández, P; Correger, E; Villanueva, J; Rios, F

    2016-04-01

    The acute respiratory distress syndrome (ARDS) is currently one of the most important critical entities given its high incidence, rate of mortality, long-term sequelae and non-specific pharmacological treatment. The histological hallmark of ARDS is diffuse alveolar damage (DAD). Approximately 50% of ARDS patients present DAD, the rest is made up of a heterogeneous group of histological patterns, many of which correspond to a well-recognized disease. For that reason, if these patterns could be diagnosed, patients could benefit from a treatment. Recently, the effect of DAD in clinical and analytical evolution of ARDS has been demonstrated, so the classical approach to ARDS as an entity defined solely by clinical, radiological and gasometrical variables should be reconsidered. This narrative review aims to examine the need to evolve from the concept of ARDS as a syndrome to ARDS as a specific disease. So we have raised 4 critical questions: a) What is a disease?; b) what is DAD?; c) how is DAD considered according to ARDS definition?, and d) what is the relationship between ARDS and DAD? Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  12. Acute respiratory distress syndrome: epidemiology and management approaches

    Directory of Open Access Journals (Sweden)

    Walkey AJ

    2012-07-01

    Full Text Available Allan J Walkey,1 Ross Summer,1 Vu Ho,1 Philip Alkana21The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; 2Asthma Research Center, Brigham and Women's Hospital, Boston, MA, USAAbstract: Acute lung injury and the more severe acute respiratory distress syndrome represent a spectrum of lung disease characterized by the sudden onset of inflammatory pulmonary edema secondary to myriad local or systemic insults. The present article provides a review of current evidence in the epidemiology and treatment of acute lung injury and acute respiratory distress syndrome, with a focus on significant knowledge gaps that may be addressed through epidemiologic methods.Keywords: acute lung injury, acute respiratory distress syndrome, review, epidemiology

  13. ANALYSIS OF PRE-HOSPITAL TREATMENT OF ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    O. V. Reshetko

    2015-12-01

    Full Text Available Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina in 2001 and 2006.Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI or unstable angina (UA in 2001 and 2006.Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

  14. ANALYSIS OF PRE-HOSPITAL TREATMENT OF ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    O. V. Reshetko

    2007-01-01

    Full Text Available Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina in 2001 and 2006.Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI or unstable angina (UA in 2001 and 2006.Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

  15. Klinefelter syndrome and acute basophilic leukaemia--case report.

    Science.gov (United States)

    Ljubić, Nives; Lang, Nada; Skelin, Ika Kardum; Lasan, Ruzica; Dominis, Mara; Perković, Leila; Zupanić-Krmek, Dubraka; Grgurević-Batinica, Anita

    2010-06-01

    Patients with 47, XXY karyotype (Klinefelter syndrome) appear to have increased risk of developing cancer, especially male breast cancer, germ cell tumours and non Hodgkin lymphomas, but rarely acute myeloid leukaemia. We report a patient with acute basophilic leukaemia with 47, XXY karyotype in both the tumour and constitutional cells. Acute basophilic leukaemia is very rare disease comprising less than 1% of all acute myeloid leukaemias. Morphological characteristic of leukaemic blast cells is moderately basophilic cytoplasm containing a variable number of coarse basophilic granules. The most characteristic cytochemical reaction is metachromatic positivity with toluidine blue. Blast are myeloperoxidase negative. Also leukemic blasts express myeloid and monocyte markers. There is no consistent chromosomal abnormality identified in this leukaemia. This is the first reported case of acute basophilic leukaemia in patient with Klinefelter syndrome. In this article the medical history of the patient is given and the possible connection between Klinefelter syndrome and acute myeloid leukaemia is discussed.

  16. Acute respiratory distress syndrome following cutaneous exposure to Lysol: a case report.

    Science.gov (United States)

    Liu, Y Y; Lu, C C; Perng, R P

    1999-12-01

    Lysol (mixed cresols) is a brand of popular detergent commonly used to disinfect toilets and floors in Taiwan. We report a patient with acute respiratory failure immediately following chemical burns caused by skin contact with Lysol solution. On admission, chest radiography showed bilateral diffuse pulmonary infiltrates and an arterial blood gas analysis disclosed hypoxemia refractory to a high concentration of oxygen by inhalation. Under the impression of acute respiratory distress syndrome, our patient was admitted to the intensive care unit for respiratory care. Poor clinical improvement was noted, despite aggressive respiratory therapy. High-dose steroid therapy (hydrocortisone 30 mg/kg/day) was administered from the seventh day after mechanical ventilation began and the ratio of arterial partial pressure of oxygen to fractional concentration of oxygen in inspired gas improved thereafter. The amount of steroid was gradually tapered to the maintenance dose and the patient was successfully weaned from the ventilator after a 93-day course of mechanical ventilation.

  17. A Case of Acute Aortic Dissection Type B Associated with Cushing's Syndrome

    Science.gov (United States)

    Petramala, Luigi; Cotesta, Dario; Sapienza, Paolo; Zinnamosca, Laura; Moroni, Enrico; di Marzio, Luca; De Toma, Giorgio; Letizia, Claudio

    2009-01-01

    We report a case of a 63-year-old man, with a previous history of hypertension and glucose intolerance associated troncular obesity that was emergently admitted to our Institution for evaluation of a severe, constant posterior chest pain which radiated anteriorly and dyspnoea with a suspected diagnosis of acute aortic dissection. A CT scan of thorax and abdomen demonstrated a dissection starting just below left succlavian artery and extending downward to the left renal artery, involving the celiac tripod and superior mesenteric artery. The dissection was classified as Stanford B, De Bakey III. Moreover, CT scan of abdomen revealed incidentally a left adrenal tumor of 25 mm of diameter. An emergent prosthetic graft was placed just below the origin of the left succlavian artery up-to the diaphragmatic hiatus. Furthermore, a diagnostic evaluation of the mass revealed an increase of cortisol production, and a diagnosis of Cushing's syndrome was done and the patient underwent an adrenalectomy via laparotomic approach. We report an association of acute aortic dissection of acute aortic dissection type B associated to Cushing's syndrome. Keywords Cushing's syndrome; Adrenocortical adenoma; Aortic dissection type B PMID:22505966

  18. Prone ventilation in acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Claude Guérin

    2014-06-01

    Full Text Available Prone positioning has been used for many years in patients with acute lung injury (ALI/acute respiratory distress syndrome (ARDS, with no clear benefit for patient outcome. Meta-analyses have suggested better survival in patients with an arterial oxygen tension (PaO2/inspiratory oxygen fraction (FIO2 ratio <100 mmHg. A recent randomised controlled trial was performed in ARDS patients after a 12–24 h stabilisation period and severity criteria (PaO2/FIO2 <150 mmHg at a positive end-expiratory pressure ≥5 cmH2O. This trial has demonstrated a significant reduction in mortality from 32.8% in the supine group to 16% in the prone group (p<0.001. The reasons for this dramatic effect are not clear but probably involves a reduction in ventilator-induced lung injury due to prone positioning, for which there is ample evidence in experimental and clinical studies. The aims of this article are to discuss: the rationale of prone positioning in patients with ALI/ARDS; the evidence of its use based on trial analysis; and the limitations of its use as well as the current place of prone positioning in the management of patients with ALI/ARDS. From the currently available data, prone positioning should be used as a first-line therapy in patients with severe ALI/ARDS.

  19. Acute encephalitis syndrome following scrub typhus infection

    Directory of Open Access Journals (Sweden)

    Ayan Kar

    2014-01-01

    Full Text Available Objective: The aim was to find the incidence of acute encephalitis syndrome (AES secondary to scrub infection and to observe the clinical, biochemical, radiological profile, and outcomes in these patients. Materials and Methods: A total of 20 consecutive patients of AES were evaluated for scrub infection using scrub typhus immunoglobulin M enzyme linked immuno-sorbant assay positivity along with the presence or absence of an eschar. Clinical profile, routine laboratory tests, cerebrospinal fluid (CSF analysis, and neuroimaging were analyzed. Patients were treated with doxycycline and followed-up. Results: Among 20 consecutive patients with AES, 6 (30% were due to scrub infection. They presented with acute onset fever, altered sensorium, seizures. "Eschar" was seen in 50% of patients. CSF done in two of them was similar to consistent with viral meningitis. Magnetic resonance imaging brain revealed cerebral edema, bright lesions in the putamen and the thalamus on T2-weighted and fluid-attenuated inversion recovery sequences. Renal involvement was seen in all patients. All patients responded well to oral doxycycline. Conclusion: AES is not an uncommon neurological presentation following scrub typhus infection. It should be suspected in all patients with fever, altered sensorium, and renal involvement. Oral doxycycline should be started as early as possible for better outcomes.

  20. Acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women.

    Science.gov (United States)

    Muniz de Souza, Helga; Rocha, Taciano; Campos, Shirley Lima; Brandão, Daniella Cunha; Fink, James B; Aliverti, Andrea; de Andrade, Armele Dornelas

    2016-06-15

    It is not completely described how aging affect ventilatory kinematics and what are the mechanisms adopted by the elderly population to overcome these structural modifications. Given this, the aim was to evaluate the acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women. Variables assessed included: tidal volume (Vt), total chest wall volume (Vcw), pulmonary rib cage (Vrcp%), abdominal rib cage (Vrca%) and abdominal compartment (Vab%) relative contributions to tidal volume. These variables were assessed during quiet breathing, maximal inspiratory pressure maneuver (MIP), and moderate inspiratory resistance (MIR; i.e., 40% of MIP). 22 young women (age: 23.9 ± 2.5 years) and 22 elderly women (age: 68.2 ± 5.0 years) participated to this study. It was possible to show that during quiet breathing, Vab% was predominant in elderly (pelderly (p=0.249). When MIP was imposed, both groups presented a predominance of Vrcp%. In conclusion, there are differences in abdominal kinematics between young and elderly women during different inspiratory efforts. In elderly, during moderate inspiratory resistance, the pattern is beneficial, deep, and slow. Although, during maximal inspiratory resistance, the ventilatory pattern seems to predict imminent muscle fatigue.

  1. Throat infection, neck and chest pain and cardiac response: a persistent infection-related clinical syndrome.

    Science.gov (United States)

    Zhou, Changqing; Fu, Xiangning; Yan, Jiangtao; Fan, Qiao; Li, Zhuoya; Cianflone, Katherine; Wang, Daowen

    2009-02-01

    Dizziness, chest discomfort, chest depression and dyspnea are a group of symptoms that are common complaints in clinical practice. Patients with these symptoms are usually informed that while neurosis consequent to coronary heart disease is excluded nonetheless they remain unhealthy with no rational explanation or treatment. 165 cases of these symptoms and 85 control subjects were reviewed and underwent further medical history inquiry, routine EKG test and cardiac ultrasound examination. Thirty-five patients received coronary artery angiography to exclude coronary heart disease. Serum myocardial autoantibodies against beta(1)-adrenoceptor, alpha-myosin heavy chain, M(2)-muscarinic receptor and adenine-nucleotide translocator were tested, and inflammatory cytokines and high sensitivity C-reaction protein were measured and lymphocyte subclass was assayed by flow cytometry. All patients had a complex of four symptoms or tetralogy: (1) persistent throat or upper respiratory tract infection, (2) neck pain, (3) chest pain and (4) chest depression or dyspnea, some of them with anxiety. Anti-myocardial autoantibodies (AMCAs) were present in all patients vs. 8% in controls. TNF-alpha, IL-1 and IL-6 were significantly higher in patients than in controls (Prib cartilage inflammation, symptoms of cardiac depression and dyspnea with or without anxiety.

  2. High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: A systematic review and cost-effectiveness analysis

    NARCIS (Netherlands)

    M. Westwood (Marie); T. van Asselt (Thea); B.L.T. Ramaekers (Bram); P. Whiting (Penny); P. Thokala (Praveen); M.A. Joore (Manuela); N. Armstrong (Nigel); J. Ross (Janine); J.L. Severens (Hans); J. Kleijnen (Jos)

    2015-01-01

    textabstractBackground The primary indication for this assessment is the early rule-out of acute myocardial infarction (AMI) in people presenting with acute chest pain and suspected, but not confirmed, non-ST segment elevation myocardial infarction (NSTEMI). Cardiac troponins (cTns) I and T are used

  3. Relationship between coronary artery ectasia, cocaine abuse and acute coronary syndromes

    Institute of Scientific and Technical Information of China (English)

    Gregory Dendramis; Claudia Paleologo; Davide Piraino; Pasquale Assennato

    2016-01-01

    Coronary artery ectasia(CAE)often represents a coronary angiography finding casually detected or following the occurrence of an acute coronary syndrome.The pathogenetic role of cocaine abuse in the genesis of CAE is still little known and very few data are available in literature.We describe a case of a 31-year-old male cocaine user admitted to our department for typical acute chest pain.Coronary angiography showed diffuse coronary ectasia with slow flows and without hemodynamically significant stenosis.An increasing of matrix metalloproteinases values and a reduction of their tissue inhibitors was showed both during hospitalization and at one month after discharge.This case report emphasizes the close relationship between cocaine abuse,CAE and acute coronary syndromes in patients without hemodynamically significant coronary stenosis.As reported by Satran et al,cocaine abuse should be considered an important risk factor for CAE and these patients appear to be at increased risk of angina and acute myocardial infarct.Further studies that can strengthen this hypothesis would be useful to deepen and better analyze this interesting association.

  4. Cardiovascular Conditions in the Observation Unit: Beyond Chest Pain.

    Science.gov (United States)

    Gaddy, Jeremiah D; Davenport, Kathleen T P; Hiestand, Brian C

    2017-08-01

    The first emergency department observation units (EDOUs) focused on chest pain and potential acute coronary syndromes. However, most EDOUs now cover multiple other conditions that lend themselves to protocolized, aggressive diagnostic and therapeutic regimens. In this article, the authors discuss the management of 4 cardiovascular conditions that have been successfully deployed in EDOUs around the country. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Ventricular Tachycardia and Resembling Acute Coronary Syndrome During Pheochromocytoma Crisis

    Science.gov (United States)

    Li, Shi-jun; Wang, Tao; Wang, Lin; Pang, Zhan-qi; Ma, Ben; Li, Ya-wen; Yang, Jian; Dong, He

    2016-01-01

    Abstract Pheochromocytomas are neuroendocrine tumors, and its cardiac involvement may include transient myocardial dysfunction, acute coronary syndrome (ACS), and even ventricular arrhythmias. A patient was referred for evaluation of stuttering chest pain, and his electrocardiogram showed T-wave inversion over leads V1 to V4. Coronary angiography showed 90% stenosis in the mid-left anterior descending coronary artery (LAD), which was stented. Five days later, the patient had ventricular tachycardia, and severe hypertension, remarkable blood pressure fluctuation between 224/76 and 70/50 mm Hg. The patient felt abdominal pain and his abdominal ultrasound showed suspicious right adrenal gland tumor. Enhanced computed tomography of adrenal gland conformed that there was a tumor in right adrenal gland accompanied by an upset level of aldosterone. The tumor was removed by laparoscope, and the pathological examination showed pheochromocytoma. After the surgery, the blood pressure turned normal gradually. There was no T-wave inversion in lead V1-V4. Our case illustrates a rare pheochromocytoma presentation with a VT and resembling ACS. In our case, the serious stenosis in the mid of LAD could be explained by worsen the clinical course of myocardial ischemia or severe coronary vasospasm by the excessive amounts of catecholamines released from the tumor. Coronary vasospasm was possible because he had no classic coronary risk factors (e.g. family history and smoking habit, essential hypertension, hyperglycemia and abnormal serum lipoprotein, high body mass index). Thus, pheochromocytoma was missed until he revealed the association of his symptoms with abdominalgia. As phaeochromocytomas that present with cardiovascular complications can be fatal, it is necessary to screen for the disease when patients present with symptoms indicating catecholamine excess. PMID:27057898

  6. A review of pulmonary coagulopathy in acute lung injury, acute respiratory distress syndrome and pneumonia

    NARCIS (Netherlands)

    Nieuwenhuizen, Laurens; de Groot, Philip G.; Grutters, Jan C.; Biesma, Douwe H.

    2009-01-01

    Enhanced bronchoalveolar coagulation is a hallmark of many acute inflammatory lung diseases such as acute lung injury, acute respiratory distress syndrome and pneumonia. Intervention with natural anticoagulants in these diseases has therefore become a topic of interest. Recently, new data on the rol

  7. Hypersensitivity Reaction and Acute Respiratory Distress Syndrome in Pyrethroid Poisoning and Role of Steroid Therapy

    Directory of Open Access Journals (Sweden)

    Jisa George

    2015-06-01

    Full Text Available Background: Pyrethroids are generally of low toxicity to humans, but in suicidal poisonings which are usually associated with ingestion of high doses, they lead to severe systemic effects. Case Report: A 30-year old woman presented to emergency department with a history of intentional ingestion of about 15 mL of prallethrin around 3 days earlier. She complained of shortness of breath along with chest pain for the last 2 days. She reported no vomiting or stomach pain prior to presentation to hospital. On chest auscultation, breath sounds were mildly decreased in bilateral infrascapular areas with generalized crepitation. Arterial blood gas analysis revealed respiratory alkalosis. Chest X ray and computed tomography of thorax revealed widespread confluent areas of consolidation with interlobular septal thickening involving bilateral parahilar regions suggestive of acute respiratory distress syndrome (ARDS. The patient did not respond to broad spectrum antibiotic coverage, diuretics and oxygen inhalation. Intravenous methylprednisolone (2 mg/kg/day divided 6 hourly was started and slowly tapered off during the next days. The patient discharged after 3 weeks in good health. Discussion: As pyrethroids can affect sodium channels, the osmotic gradient of alveolar epithelium probably disrupts and therefore, alveolar infiltrations gradually spread over lungs. In addition, there is a possibility of hypersensitivity reactions to pyrethroids, which can cause progressive inflammation and involve respiratory tract in severe cases. Conclusion: Pyrethroid poisoning can lead to ARDS. Steroid therapy may help such patients tide over the pulmonary crisis.

  8. The Effectiveness of Non-ECG-Gated Contrast-Enhanced Computed Tomography for the Diagnosis of Non-ST Segment Elevation Acute Coronary Syndrome.

    Science.gov (United States)

    Watanabe, Tomomi; Furuse, Yoshiyuki; Ohta, Yasutoshi; Kato, Masahiko; Ogawa, Toshihide; Yamamoto, Kazuhiro

    2016-09-28

    Non-ST segment elevation acute coronary syndrome (NSTE-ACS) can be difficult to diagnose accurately, especially in the hyper-acute phase. Non-ECG-gated contrast-enhanced computed tomography (non-ECG-gated CE-CT) has been used in many institutions for screening acute chest pain. Although early defects (EDs) observed in non-ECG-gated CE-CT have been reported as a sign of acute myocardial ischemia, the precise diagnostic value of this sign for acute coronary syndrome has not been fully elucidated. We investigated the usefulness of non-ECG-gated CE-CT for the diagnosis of NSTE-ACS. We retrospectively reviewed 556 patients who were hospitalized for acute-onset chest pain and who underwent emergent coronary angiography. Non-ECG-gated CE-CT was performed in 23 of these patients. Two readers independently analyzed CT images using a 5-point scale. Of the 23 patients, 13 were diagnosed with NSTE-ACS. The remaining 10 patients were diagnosed with other conditions. The sensitivity, specificity, positive predictive value, and negative predictive value, respectively, of EDs on non-ECG-gated CE-CT to detect NSTE-ACS were 84.6%, 90%, 91.7%, and 81.8%. The identification of EDs was consistent between the two readers. Non-ECG-gated CE-CT may be useful not only to triage patients with chest pain by ruling out other conditions, but also to accurately diagnose NSTE-ACS.

  9. Impact of copeptin on diagnosis of acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Zeinab H. El Sayed

    2014-07-01

    Conclusion: In suspected acute coronary syndrome, determination of copeptin and cardiac troponin I provides a remarkable negative predictive value, which aids in early and safe ruling out of myocardial infarction.

  10. LEUKOCYTOSIS AND RETINOIC ACID SYNDROME IN PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA TREATED WITH ARSENIC TRIOXIDE

    Institute of Scientific and Technical Information of China (English)

    Bo Jin; Ke-zuo Hou; Yun-peng Liu; Ping Yu

    2006-01-01

    Objective To study the incidence of leukocytosis and retinoic acid (RA) syndrome in newly diagnosed and relapsed acute promyelocytic leukemia (APL) patients treated with arsenic trioxide (ATO).Methods Thirty patients with newly diagnosed or relapsed APL received ATO for remission induction at the dose of 10 mg/d. RA syndrome was defined when patient was with one or more of the following signs or symptoms: fever,dyspnea, serous cavity effusion, muscular pain, pulmonary infiltration, weight gain, or pulmonary infiltration on chest X-ray.Results Twenty-three (77%) patients achieved complete remission, mean time to remission was 37.1 days. Leukocytosis was observed in 14 (47%) patients, mean time to leukocytosis was 12.7 days, median baseline leukocyte count for patients with leukocytosis was 3.1 × 109/L, which was higher than that for patients who did not develop leukocytosis (2.6×109/L, z=-2.635, P=0.008). No other cytotoxic therapy was administered, and the leukocytosis resolved in all cases. The RA syndrome was observed in 9(30%) patients, mean time to diagnose of RA syndrome was 13.9 days, median baseline leukocyte count for patients with RA syndrome was 3.6×109/L, which was higher than that for patients who did not develop RA syndrome (2.6 × 109/L, z=-1.909, P=0.046). No patient died of RA syndrome.Conclusion Leukocytosis and RA syndrome are associated with ATO and baseline leukocyte count respectively,and there is distinct link between leukocytosis and RA syndrome.

  11. Chest MRI

    Science.gov (United States)

    Nuclear magnetic resonance - chest; Magnetic resonance imaging - chest; NMR - chest; MRI of the thorax; Thoracic MRI ... healthy enough to filter the contrast. During the MRI, the person who operates the machine will watch ...

  12. Acute aortic syndromes: Role of multi-detector row CT

    Energy Technology Data Exchange (ETDEWEB)

    Salvolini, Luca; Renda, Pietro [Department of Radiology, University ' Politecnica delle Marche' , Ancona (Italy); Fiore, Davide [Department of Radiology, University of Padova, Padova (Italy); Scaglione, Mariano [Emergency and Trauma CT Section, Department of Radiology, Cardarelli Hospital, Naples (Italy); Piccoli, GianPiero [Cardiosurgery Division, Ospedali Riuniti ' Torrette-Lancisi-Salesi' , Ancona (Italy); Giovagnoni, Andrea [Department of Radiology, University ' Politecnica delle Marche' , Ancona (Italy)], E-mail: a.giovagnoni@univpm.it

    2008-03-15

    Acute thoracic aortic syndromes encompass a spectrum of emergencies including aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and aneurysm rupture. All these life-threatening conditions require prompt diagnosis and appropriate management. To date multi-detector row Computed Tomography represents a valuable diagnostic tool especially in the emergency setting. This paper focus on the use of multi-detector row Computed Tomography in the evaluation of acute thoracic aortic syndromes and illustrates the key imaging findings related to each disease.

  13. Takotsubo syndrome after mitral valve replacement for acute endocarditis.

    Science.gov (United States)

    Gariboldi, Vlad; Jop, Bertrand; Grisoli, Dominique; Jaussaud, Nicolas; Kerbaul, François; Collart, Frédéric

    2011-03-01

    Takotsubo syndrome is characterized by transient and acute left ventricular dysfunction and apical ballooning, with electrocardiographic abnormalities, but without coronary disease. We report a case of Takotsubo syndrome occurring after emergent mitral valve replacement for acute infective endocarditis. The patient is a 66-year-old woman who regained complete recovery of left ventricular function. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  14. A Case with Repeated Recurrent Acute Coronary Syndrome due to Pseudoephedrine Use: Kounis Syndrome

    Directory of Open Access Journals (Sweden)

    Metin Çeliker

    2014-01-01

    Full Text Available Allergic reaction-associated acute coronary syndrome picture is defined as Kounis syndrome. Although drug use is the most common cause of allergic reaction, foods and environmental factors may also play a role in the etiology. Herein, a case with acute coronary syndrome that developed two times at 8-month interval due to pseudoephedrine use for upper respiratory tract infection is presented.

  15. Side effects of using nitrates to treat heart failure and the acute coronary syndromes, unstable angina and acute myocardial infarction.

    Science.gov (United States)

    Thadani, Udho; Ripley, Toni L

    2007-07-01

    Nitrates are potent venous dilators and anti-ischemic agents. They are widely used for the relief of chest pain and pulmonary congestion in patients with acute coronary syndromes and heart failure. Nitrates, however, do not reduce mortality in patients with acute coronary syndromes. Combination of nitrates and hydralazine when given in addition to beta-blockers and angiotensin-converting enzyme (ACE) inhibitors reduce mortality and heart failure hospitalizations in patients with heart failure due to left ventricular systolic dysfunction who are of African-American origin. Side effects during nitrate therapy are common but are less well described in the literature compared with the reported side effects in patients with stable angina pectoris. The reported incidence of side effects varies highly among different studies and among various disease states. Headache is the most commonly reported side effect with an incidence of 12% in acute heart failure, 41-73% in chronic heart failure, 3-19% in unstable angina and 2-26% in acute myocardial infarction. The reported incidence of hypotension also differs: 5-10% in acute heart failure, 20% in chronic heart failure, 9% in unstable angina and < 1-48% in acute myocardial infarction, with the incidence being much higher with concomitant nitrate therapy plus angiotensin-converting enzyme inhibitors. Reported incidence of dizziness is as low as 1% in patients with acute myocardial infarction to as high as 29% in patients with heart failure. Severe headaches and/or symptomatic hypotension may necessitate discontinuation of nitrate therapy. Severe life threatening hypotension or even death may occur when nitrates are used in patients with acute inferior myocardial infarction associated with right ventricular dysfunction or infarction, or with concomitant use of phosphodiesterase-5 inhibitors or N-acetylcysteine. Despite the disturbing observational reports in the literature that continuous and prolonged use of nitrates may lead to

  16. Meteorological factors and the time of onset of chest pain in acute myocardial infarction

    Science.gov (United States)

    Thompson, David R.; Pohl, Jurgen E.; Tse, Yiu-Yu S.; Hiorns, Robert W.

    1996-09-01

    Analysis of the time of onset of chest pain in 2254 patients with a myocardial infarction admitted to a coronary care unit in Leicester during a 10-year period shows an association with temperature and humidity. During both the most cold and humid times of the year, the relationship is a strong one. A generalized linear model with a log link was used to fit the data and the backward elimination selection procedure suggested a humid, cold day might help to trigger the occurrence of myocardial infarction. In addition, cold weather was found to have a stronger effect on the male population while those men aged between 50 and 70 years were more sensitive to the effect of high humidity.

  17. Acute respiratory distress syndrome: the Berlin Definition.

    Science.gov (United States)

    Ranieri, V Marco; Rubenfeld, Gordon D; Thompson, B Taylor; Ferguson, Niall D; Caldwell, Ellen; Fan, Eddy; Camporota, Luigi; Slutsky, Arthur S

    2012-06-20

    The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.

  18. SICK SINUS SYNDROME IN PATIENTS WITH ACUTE CEREBROVASCULAR ACCIDENTS

    Directory of Open Access Journals (Sweden)

    E. K. Kazakova

    2015-01-01

    Full Text Available The article presents a clinical case of 2 patients with heart arrhythmias of the sick sinus syndrome type, who were implanted electriccardiac pacemakers in the acute period of cerebrovascular accidents. There were no cardiac complaints in the clinical manifestation, however, a comprehensive assessment confirmed the diagnosis of sick sinus syndrome.

  19. Abdominal compartment syndrome in acute pancreatitis: a systematic review

    NARCIS (Netherlands)

    Brunschot, S. van; Schut, A.J.; Bouwense, S.A.W.; Besselink, M.G.; Bakker, O.J.; Goor, H. van; Hofker, S.; Gooszen, H.G.; Boermeester, M.A.; Santvoort, H.C. van

    2014-01-01

    Abdominal compartment syndrome (ACS) is a lethal complication of acute pancreatitis. We performed a systematic review to assess the treatment and outcome of these patients.A systematic literature search for cohorts of patients with acute pancreatitis and ACS was performed. The main outcomes were num

  20. Abdominal Compartment Syndrome in Acute Pancreatitis : A Systematic Review

    NARCIS (Netherlands)

    van Brunschot, Sandra; Schut, Anne Julia; Bouwense, Stefan A.; Besselink, Marc G.; Bakker, Olaf J.; van Goor, Harry; Hofker, Hendrik; Gooszen, Hein G.; Boermeester, Marja A.; van Santvoort, Hjalmar C.

    2014-01-01

    Abdominal compartment syndrome (ACS) is a lethal complication of acute pancreatitis. We performed a systematic review to assess the treatment and outcome of these patients. A systematic literature search for cohorts of patients with acute pancreatitis and ACS was performed. The main outcomes were nu

  1. Takotsubo cardiomyopathy is an acute cardiac syndrome induced by stress

    DEFF Research Database (Denmark)

    Fuchs, Annette Maria; Bang, Lia E; Holmvang, Lene

    2016-01-01

    Takotsubo cardiomyopathy (TTC) is an acute cardiac syndrome, characterized by transient left ventricular dysfunction often following a stressful event in post-menopausal women. Symptoms are indistinguishable from myocardial infarction. However, TTC patients do not have a culprit lesion on acute...

  2. Acute carpal tunnel syndrome caused by peritendinitis calcarea. Case report.

    Science.gov (United States)

    Boström, L; Svartengren, G

    1993-01-01

    Two women presented with similar symptoms of acute pain in the hand that was diagnosed as acute carpal tunnel syndrome caused by peritendinitis calcarea. Radiological examinations in both cases showed calcifications in the carpal tunnel. Both patients were operated on immediately and the median nerve was decompressed. Both were completely relieved of pain after operation and hand function returned to normal.

  3. Abdominal Compartment Syndrome in Acute Pancreatitis : A Systematic Review

    NARCIS (Netherlands)

    van Brunschot, Sandra; Schut, Anne Julia; Bouwense, Stefan A.; Besselink, Marc G.; Bakker, Olaf J.; Goor ,van Harry; Hofker, Hendrik; Gooszen, Hein G.; Boermeester, Marja A.; van Santvoort, Hjalmar C.

    Abdominal compartment syndrome (ACS) is a lethal complication of acute pancreatitis. We performed a systematic review to assess the treatment and outcome of these patients. A systematic literature search for cohorts of patients with acute pancreatitis and ACS was performed. The main outcomes were

  4. Abdominal compartment syndrome in acute pancreatitis: a systematic review

    NARCIS (Netherlands)

    Brunschot, S. van; Schut, A.J.; Bouwense, S.A.W.; Besselink, M.G.; Bakker, O.J.; Goor, H. van; Hofker, S.; Gooszen, H.G.; Boermeester, M.A.; Santvoort, H.C. van

    2014-01-01

    Abdominal compartment syndrome (ACS) is a lethal complication of acute pancreatitis. We performed a systematic review to assess the treatment and outcome of these patients.A systematic literature search for cohorts of patients with acute pancreatitis and ACS was performed. The main outcomes were

  5. Acute respiratory distress syndrome in an alpaca cria

    Science.gov (United States)

    Simpson, Katharine M.; Streeter, Robert N.; Genova, Suzanne G.

    2011-01-01

    A 7-hour-old alpaca was presented for lethargy and depression. The cria responded favorably to initial treatment but developed acute-onset dyspnea 48 hours later. Acute respiratory distress syndrome was diagnosed by thoracic imaging and blood gas analysis. The cria was successfully treated with corticosteroids and discharged from the hospital. PMID:22210945

  6. The value of clinical and laboratory diagnostics for chest pain patients at the emergency department

    NARCIS (Netherlands)

    Jellema, Laurens-Jan C.; Backus, Barbra E.; Six, A. Jacob; Braam, Richard; Groenemeijer, Bjorn; van der Zaag-Loonen, Hester J.; Tio, Rene; van Suijlen, Jeroen D. E.

    2014-01-01

    Background: The focus during the diagnostic process for patients with acute chest pain is to discriminate patients who can be safely discharged from those who are at risk for an acute coronary syndrome (ACS). In this study the diagnostic value of the clinical examination is compared with laboratory

  7. Possibilities for exposure reduction in computed tomography examination of acute chest pain; Moeglichkeiten der Dosisreduktion bei CT-Untersuchungen des akuten Thoraxschmerzes

    Energy Technology Data Exchange (ETDEWEB)

    Becker, H.C. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany)

    2012-10-15

    Electrocardiogram-gated (ECG) computed tomography (CT) investigations can be accompanied by high amounts of radiation exposure. This is particularly true for the investigation of patients with unclear and acute chest pain. The common approach in patients with acute chest pain is standard spiral CT of the chest. The chest pain or triple-rule-out CT protocol is a relatively new ECG-gated protocol of the entire chest. This article reviews and discusses different techniques for the CT investigation of patients with acute chest pain. By applying the appropriate scan technique, the radiation exposure for an ECG-gated protocol must not necessarily be higher than a standard chest CT scan Aortic pathologies are far better depicted by ECG-gated scan protocols and depending on the heart rate coronary artery disease can also be detected at the same time. The use of ECG-triggered scans will not support the diagnostics of the pulmonary arteries. However, in unspecific chest pain an ECG-triggered scan protocol can provide information on the differential diagnosis. (orig.) [German] EKG-getriggerte CT-Untersuchungen koennen mit einer relativ hohen Strahlenexposition einhergehen. Dies gilt im besonderen Masse fuer die Untersuchung des gesamten Thorax bei Patienten mit unklarem akutem Thoraxschmerz. Bisher wurden Untersuchungen bei Patienten mit akutem Thoraxschmerz in Spiraltechnik ohne EKG-Triggerung durchgefuehrt. Das ''Chest-pain-'' oder ''Triple-rule-out''-Protokoll ist ein neues EKG-getriggertes Untersuchungsprotokoll des gesamten Thorax. Im vorliegenden Artikel werden verschiedene Techniken zur CT-Untersuchung von Patienten mit akutem Thoraxschmerz vorgestellt und besprochen. Mit der richtigen Untersuchungstechnik muss die Strahlenexposition fuer ein EKG-getriggertes Untersuchungsprotokoll nicht hoeher sein als eine Standarduntersuchung ohne EKG. Mit einem EKG-getriggerten Untersuchungsprotokoll laesst sich die Aorta in Hinblick auf

  8. Acute Charles Bonnet Syndrome following Hughes procedure.

    Science.gov (United States)

    Wilson, Michelle E; Pointdujour-Lim, Renelle; Lally, Sara; Shields, Carol L; Rabinowitz, Michael P

    2016-10-01

    A 69-year-old male experienced monocular formed visual hallucinations after occlusion of the right eye following resection of eyelid basal cell carcinoma and reconstruction with a Hughes procedure (tarsoconjunctival flap). His symptoms included recurrent, well-defined, organized, complex, formed images of small children playing in the snow. These visual phenomena occurred only in the occluded eye, began several hours after surgery, and recurred intermittently several times daily for 4 days, lasting several minutes with each occurrence. The patient retained insight into the false nature of the images throughout the duration of his symptoms, and the hallucinations resolved spontaneously while the flap was still in place. To our knowledge, this is the first reported case of Charles Bonnet Syndrome (CBS) following a Hughes procedure in a patient with normal visual acuity in the non-occluded fellow eye. Unlike other reported cases of acute onset CBS following transient monocular occlusion, hallucinations in the occluded eye remitted prior to restoration of vision in the occluded eye. Ophthalmologists should be aware of the potential for CBS following even transient monocular occlusion and should consider warning patients about its potential to occur.

  9. [Kinetic therapy for acute respiratory distress syndrome].

    Science.gov (United States)

    Chechenin, M G; Voevodin, S V; Pronichev, E Iu; Shuliveĭstrov, Iu V

    2004-01-01

    The authors evaluated the clinical and physiological effects of kinetic therapy (KT) in the treatment of acute respiratory distress syndrome (ARDS). Forty-six patients with ARDS underwent successive postural positioning in accordance with two regimens: 1) lateral, prone, contralateral, supine positions; 2) prone, lateral, contralateral, supine positions. The criterion for changing each position was the change in monitoring indices: SpO2, PaO2, and thoracopulmonary compliance (C). KT was performed until a respirator was withdrawn from the patient. In 25 patients, each maneuver of positioning was made during 30-minute propofol sedation. The control group included 24 patients with ARDS who received neither KT nor propofol sedation. KT caused a decrease in Vd/Vt, Qs/Qt and an increase in PaO2/FiO2 and C was more intensive, as compared with the control group. The duration of the patient's prone position was 3.2-0.7 hours and that of the supine position was 3.4-0.8 hours. The right and left lateral positions lasted 1.1-0.2 and 1.3-0.2 hours, respectively. KT regimen 1 was found to be more effective than KT regimen 2. Propofol sedation enhanced the efficiency of KT. The latter reduced death rates in patients with ARDS.

  10. Pathogenesis of severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ding-mei; LU Jia-hai; ZHONG Nan-shan

    2008-01-01

    Severe acute respiratory syndrome (SARS) first emerged in Guangdong province,China in November2002.During the following 3 months,it spread rapidly across the world,resulting in approximately 800 deaths.In 2004,subsequent sporadic cases emerged in Singapore and China.A novel coronavims,SARS-CoV,was identified as the etiological agent of SARS.1,2 This virus belongs to a family of large,positive,single-stranded RNA viruses.Nevertheless,genomic characterization shows that the SARS-CoV is only moderately related to other known coronaviruses.3 In contrast with previously described coronaviruses,SARS-CoV infection typically causes severe symptoms related to the lower respiratory tract.The SARS-CoV genome includes 14 putative open reading frames encoding 28 potential proteins,and the functions of many of these proteins are not known.4 A number of complete and partial autopsies of SARS patients have been reported since the first outbreak in 2003.The predominant pathological finding in these cases was diffuse alveolar damage (DAD).This severe pulmonary injury of SARS patients is caused both by direct viral effects and immunopathogenetic factors.5 Many important aspects of the pathogenesis of SARS have not yet been fully clarified.In this article,we summarize the most important mechanisms involved in the complex pathogenesis of SARS,including clinical characters,host and receptors,immune system response and genetic factors.

  11. Pathological study on severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    郎振为; 张立洁; 张世杰; 孟忻; 李俊强; 宋晨朝; 孙琳; 周育森

    2003-01-01

    Objective To study the pathological characteristics of severe acute respiratory syndrome (SARS) and its relationship to clinical manifestation. Methods Tissue specimens from 3 autopsies of probable SARS cases were studied by microscope, and the clinical data was reviewed.Results The typical pathological changes of lungs were diffuse hemorrhaging on the surface. A combination of serous, fibrinous and hemorrhagic inflammation was seen in most of the pulmonary alveoli with the engorgement of capillaries and detection of micro-thrombosis in some of these capillaries. Pulmonary alveoli thickened with interstitial mononuclear inflammatory infiltrates, suffered diffuse alveolar damage, experienced desquamation of pneumocytes and had hyaline-membrane formation, fibrinoid materials, and erythrocytes in alveolar spaces. There were thromboembolisms in some bronchial arteries. Furthermore, hemorrhagic necrosis was also evident in lymph nodes and spleen with the attenuation of lymphocytes. Other atypical pathological changes, such as hydropic degeneration, fatty degeneration, interstitial cell proliferation and lesions having existed before hospitalization were observed in the liver, heart, kidney and pancreas.Conclusion Severe damage to the pulmonary and immunological systems is responsible for the clinical features of SARS and may lead to the death of patients.

  12. Clinical presentation and chiropractic treatment of Tietze syndrome: A 34-year-old female with left-sided chest pain.

    Science.gov (United States)

    Gijsbers, Eefje; Knaap, Simone F C

    2011-03-01

    The purpose of this case report is to describe the clinical presentation and chiropractic management of Tietze syndrome. A 34-year-old woman presented with unexplained left-sided chest pain. Electrocardiogram and radiographs were taken at a medical emergency department to rule out cardiovascular and pulmonary causes, and pain medication did not relieve her pain. Physical examination showed tenderness on palpation and swelling of the second and third chondrosternal joints, as well as thoracic joint dysfunction. Heart and lung pathology was ruled out, and chondrosternal joint swelling was present, Tietze syndrome was diagnosed. A treatment plan aimed at restoring normal thoracic and rib joint movement and decreasing inflammation of the chondrosternal joints resulted in lower pain levels. Treatment consisted of diversified high-velocity, low-amplitude chiropractic manipulation; activator technique; and cryotherapy. Chiropractic management of Tietze syndrome was successful in reducing pain levels in this patient's case. Copyright © 2011 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  13. [A case of miliary tuberculosis presenting with acute resiratory distress syndrome].

    Science.gov (United States)

    Nojima, Daisuke; Ozaki, Shinji; Fujii, Yasuhiro; Wada, Sae; Ono, Katsuichiro; Fujimoto, Nobukazu; Gemba, Kenichi; Kishimoto, Takumi

    2009-03-01

    An 87-year-old woman was admitted because of high fever, progressive dyspnea and abnormal shadows on chest roentgenogram. Laboratory investigation on admission demonstrated a normal white cell count with neutrophilia (4000/microl, 90.5% neutrophils), an erythrocyte sedimentation rate of 10 mm/h and C-reactive protein value of 9.0mg/dl. Roentgenogram and computed tomographic scan of the chest shows bilateral infiltration and diffuse ground glass opacity, indicating acute respiratory distress syndrome (ARDS), but disseminated nodules, indicating miliary tuberculosis, were not found. Blood gas analysis demonstrated severe hypoxemia (PaO2 43.2Torr with 6L/ min oxygen). Based on the diagnosis of acute pneumonia and ARDS, intravenous administration of sivelestat sodium hydrate (100 mg/day), and continuous infusion of hydrocortisone (200 mg/day) were started. PaO2/FiO2 ratio improved but X-ray findings showed no improvement and a blood test revealed pancytopenia. Bone marrow biopsy revealed necrotizing epithelioid granuloma and acid-fast bacilli. A polymerase chain reaction (PCR) test detected Mycobacterium tuberculosis. Mycobacterium tuberculosis was also detected in sputum and urine. Therefore, we diagnosed miliary tuberculosis and transferred the patient to an infectious disease hospital. Miliary tuberculosis complicated with ARDS is relatively rare and the prognosis is extremely poor. Miliary tuberculosis should be kept in mind as a cause of ARDS.

  14. [Acute hemorrhagic leukoencephalitis in a woman with Goodpasture syndrome].

    Science.gov (United States)

    Konstantinov, G S

    1997-01-01

    A case of acute leukoencephalitis in a 17-year-old female with Goodpasture syndrome is described. Acute leukoencephalitis is a rare inflammatory-degenerative disease (practically not studied so far) affecting the brain white matter. The disease develops acutely as a rule after respiratory viral infection and has a fatal exitus. Multiple hemorrhages in the brain white matter with demyelinization and axons death are observed histologically.

  15. Current thinking about acute compartment syndrome of the lower extremity

    Science.gov (United States)

    Shadgan, Babak; Menon, Matthew; Sanders, David; Berry, Gregg; Martin, Claude; Duffy, Paul; Stephen, David; O’Brien, Peter J.

    2010-01-01

    Acute compartment syndrome of the lower extremity is a clinical condition that, although uncommon, is seen fairly regularly in modern orthopedic practice. The pathophysiology of the disorder has been extensively described and is well known to physicians who care for patients with musculoskeletal injuries. The diagnosis, however, is often difficult to make. In this article, we review the clinical risk factors of acute compartment syndrome of the lower extremity, identify the current concepts of diagnosis and discuss appropriate treatment plans. We also describe the Canadian medicolegal environment in regard to compartment syndrome of the lower extremity. PMID:20858378

  16. An unusual cause of intraoperative acute superior vena cava syndrome

    Directory of Open Access Journals (Sweden)

    Adam W Amundson

    2013-01-01

    Full Text Available Acute intraoperative superior vena cava (SVC syndrome is an exceedingly rare complication in the cardiac surgical population. We describe the case of a 71-year-old female undergoing multi-vessel coronary artery bypass grafting who developed acute intraoperative SVC syndrome following internal thoracic artery harvest retractor placement. Her symptoms included severe plethora, facial engorgement and scleral edema, which was associated with hypotension and severe elevation of central venous pressure. Transesophageal echocardiography was crucial in the diagnosis, management, and optimal retractor placement ensuring adequate SVC flow. Potential causes of intraoperative SVC syndrome are reviewed as well as management options.

  17. Acute Respiratory Distress Syndrome (ARDS) from Endemic Influenza A/H1N1: Prehospital Management.

    Science.gov (United States)

    Salihefendic, Nizama; Zildzic, Muharem; Ahmetagic, Sead

    2015-02-01

    Acute respiratory distress syndrome (ARDS) is a form of acute life threatening respiratory failure. In daily practice there is difficulty in diagnostic and therapeutic management of Acute respiratory distress syndrome (ARDS). We observed delay in diagnostic and therapeutic procedures in patients with clinical signs for the presence of severe respiratory disorders. Finding timely evidence of the presence the clinical signs of threatening ARDS and underlying diseases like influenza A/H1N1 during prehospital period in early stage of disease it is possible introduce early adequate treatment: high flow oxygen, fluid replacement and pharmacological and antiviral therapy. This measure can reduce high mortality in patients who develop ARDS. It is important to improve diagnostic criteria for a precise definition of ARDS and transfer it in practice of emergency and family medicine, microbiology, intensive care units, hospital departments of infectious and respiratory diseases. In this article we underlined the key elements of the new definition of ARDS, diagnostic criteria and the importance of early diagnosis in prehospital period following clinical feature and course (a presence of severe dyspnea) by adding chest x-ray and laboratory investigations.

  18. Predictors of image quality of coronary computed tomography in the acute care setting of patients with chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Bamberg, Fabian; Abbara, Suhny; Schlett, Christopher L.; Cury, Ricardo C.; Truong, Quynh A.; Rogers, Ian S. [Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Nagurney, John T. [Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Brady, Thomas J. [Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Hoffmann, Udo [Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)], E-mail: uhoffmann@partners.org

    2010-04-15

    Objective: We aimed to determine predictors of image quality in consecutive patients who underwent coronary computed tomography (CT) for the evaluation of acute chest pain. Method and materials: We prospectively enrolled patients who presented with chest pain to the emergency department. All subjects underwent contrast-enhanced 64-slice coronary multi-detector CT. Two experienced readers determined overall image quality on a per-patient basis and the prevalence and characteristics of non-evaluable coronary segments on a per-segment basis. Results: Among 378 subjects (143 women, age: 52.9 {+-} 11.8 years), 345 (91%) had acceptable overall image quality, while 33 (9%) had poor image quality or were unreadable. In adjusted analysis, patients with diabetes, hypertension and a higher heart rate during the scan were more likely to have exams graded as poor or unreadable (odds ratio [OR]: 2.94, p = 0.02; OR: 2.62, p = 0.03; OR: 1.43, p = 0.02; respectively). Of 6253 coronary segments, 257 (4%) were non-evaluable, most due to severe calcification in combination with motion (35%). The presence of non-evaluable coronary segments was associated with age (OR: 1.08 annually, 95%-confidence interval [CI]: 1.05-1.12, p < 0.001), baseline heart rate (OR: 1.35 per 10 beats/min, 95%-CI: 1.11-1.67, p = 0.003), diabetes, hypertension, and history of coronary artery disease (OR: 4.43, 95%-CI: 1.93-10.17, p < 0.001; OR: 2.27, 95-CI: 1.01-4.73, p = 0.03; OR: 5.12, 95%-CI: 2.0-13.06, p < 0.001; respectively). Conclusion: Coronary CT permits acceptable image quality in more than 90% of patients with chest pain. Patients with multiple risk factors are more likely to have impaired image quality or non-evaluable coronary segments. These patients may require careful patient preparation and optimization of CT scanning protocols.

  19. A Case of Acute Atraumatic Compartment Syndrome of the Thigh.

    Science.gov (United States)

    Gutfraynd, Alexander; Philpott, Sheila

    2016-09-01

    In the absence of trauma, compartment syndrome of the thigh is rare. Several case reports have described compartment syndrome in the presence of trauma, comorbid medical conditions, and acute muscle overuse. Very few reports have demonstrated an acute onset of atraumatic thigh compartment syndrome. A 24-year-old man presented to the Emergency Department (ED) with a painful and swollen left thigh immediately after a night of dancing at a concert. He was found to have an elevated intracompartmental quadriceps pressure of 45 mm Hg in the ED, which led to his transfer to the operating room for an emergent fasciotomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although acute, atraumatic compartment syndrome of the thigh is a rare entity, failure to diagnose it promptly can lead to muscle necrosis, permanent neurologic deficits, and amputation. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Acute interstitial pneumonia (AIP): relationship to Hamman-Rich syndrome, diffuse alveolar damage (DAD), and acute respiratory distress syndrome (ARDS).

    Science.gov (United States)

    Mukhopadhyay, Sanjay; Parambil, Joseph G

    2012-10-01

    Acute interstitial pneumonia (AIP) is a term used for an idiopathic form of acute lung injury characterized clinically by acute respiratory failure with bilateral lung infiltrates and histologically by diffuse alveolar damage (DAD), a combination of findings previously known as the Hamman-Rich syndrome. This review aims to clarify the diagnostic criteria of AIP, its relationship with DAD and acute respiratory distress syndrome (ARDS), key etiologies that need to be excluded before making the diagnosis, and the salient clinical features. Cases that meet clinical and pathologic criteria for AIP overlap substantially with those that fulfill clinical criteria for ARDS. The main differences between AIP and ARDS are that AIP requires a histologic diagnosis of DAD and exclusion of known etiologies. AIP should also be distinguished from "acute exacerbation of IPF," a condition in which acute lung injury (usually DAD) supervenes on underlying usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF).

  1. Acute chest pain in emergency room. Preliminary findings with 40-64-slice CT ECG-gated of the whole chest.

    Science.gov (United States)

    Coche, E

    2007-01-01

    ECG-gated MDCT of the entire chest represents the latest technical advance in the diagnostic work-up of atypical chest pain. The authors report their preliminary experience with the use of 40 and 64-slice CT in the emergency room and recommend to study only patients with moderate likelihood of coronary artery disease. ECG-gated MDCT of the entire chest will be preferentially performed on 64-slice MDCT rather than 40-slice MDCT because it enable to reduce the scan time (18 seconds versus 28 seconds acquisition time), the volume of contrast medium (82 mL + 15 mL versus 97 mL + 15 mL of highly concentrated contrast agent for a patient of 70 kgs) and radiation exposure (17 mSv versus 19 mSv). Approximately 1500 to 2000 of images are produced and need to be analysed on a dedicated workstation by a radiologist expert in cardiac and thoracic disorders. At the present time, only a few studies exist in the literature showing some promising results but further large clinical studies are needed before to implement such sophisticated protocol in emergency room.

  2. Acute coronary syndromes: an old age problem

    Institute of Scientific and Technical Information of China (English)

    Alexander D Simms; Philip D Batin; John Kurian; Nigel Durham; Christopher P Gale

    2012-01-01

    The increasing population in older age will lead to greater numbers of them presenting with acute coronary syndromes (ACS). This has implications on global healthcare resources and necessitates better management and selection for evidenced-based therapies. The elderly are a high risk group with more significant treatment benefits than younger ACS. Nevertheless, age related inequalities in ACS care are recognised and persist. This discrepancy in care, to some extent, is explained by the higher frequency of atypical and delayed presentations in the elderly, and less diagnostic electrocardiograms at presentation, potentiating a delay in ACS diagnosis. Under estimation of mortality risk in the elderly due to limited consideration for physiological frailty, co-morbidity, cognitive/psychological impairment and physical disability, less input by cardiology specialists and lack of randomised, controlled trials data to guide management in the elderly may further confound the inequality of care. While these inequalities exist, there remains a substantial opportunity to improve age related ACS outcomes. The selection of elderly patients for specific therapies and medication regimens are unanswered. There is a growing need for randomised, controlled trial data to be more representative of the population and enroll those of advanced age with co-morbidity. A lack of reporting of adverse events, such as renal impairment post coronary angiography, in the elderly further limit risk benefit decisions. Substantial improvements in care of elderly ACS patients are required and should be advocated. Ultimately, these improvements are likely to lead to better outcomes post ACS. However, the improvement in outcome is not infinite and will be limited by non-modifiable factors of age-related risk.

  3. Simvastatin in the acute respiratory distress syndrome.

    Science.gov (United States)

    McAuley, Daniel F; Laffey, John G; O'Kane, Cecilia M; Perkins, Gavin D; Mullan, Brian; Trinder, T John; Johnston, Paul; Hopkins, Philip A; Johnston, Andrew J; McDowell, Cliona; McNally, Christine

    2014-10-30

    Studies in animals and in vitro and phase 2 studies in humans suggest that statins may be beneficial in the treatment of the acute respiratory distress syndrome (ARDS). This study tested the hypothesis that treatment with simvastatin would improve clinical outcomes in patients with ARDS. In this multicenter, double-blind clinical trial, we randomly assigned (in a 1:1 ratio) patients with an onset of ARDS within the previous 48 hours to receive enteral simvastatin at a dose of 80 mg or placebo once daily for a maximum of 28 days. The primary outcome was the number of ventilator-free days to day 28. Secondary outcomes included the number of days free of nonpulmonary organ failure to day 28, mortality at 28 days, and safety. The study recruited 540 patients, with 259 patients assigned to simvastatin and 281 to placebo. The groups were well matched with respect to demographic and baseline physiological variables. There was no significant difference between the study groups in the mean (±SD) number of ventilator-free days (12.6±9.9 with simvastatin and 11.5±10.4 with placebo, P=0.21) or days free of nonpulmonary organ failure (19.4±11.1 and 17.8±11.7, respectively; P=0.11) or in mortality at 28 days (22.0% and 26.8%, respectively; P=0.23). There was no significant difference between the two groups in the incidence of serious adverse events related to the study drug. Simvastatin therapy, although safe and associated with minimal adverse effects, did not improve clinical outcomes in patients with ARDS. (Funded by the U.K. National Institute for Health Research Efficacy and Mechanism Evaluation Programme and others; HARP-2 Current Controlled Trials number, ISRCTN88244364.).

  4. BMS-214662 in Treating Patients With Acute Leukemia, Myelodysplastic Syndrome, or Chronic Myeloid Leukemia

    Science.gov (United States)

    2013-01-22

    Adult Acute Promyelocytic Leukemia (M3); Blastic Phase Chronic Myelogenous Leukemia; Childhood Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Relapsing Chronic Myelogenous Leukemia

  5. 'The Right Ventricle in Acute Respiratory Distress Syndrome'.

    Science.gov (United States)

    Zochios, Vasileios; Parhar, Ken; Tunnicliffe, William; Roscoe, Andrew; Gao, Fang

    2017-03-03

    Acute respiratory distress syndrome is associated with poor clinical outcomes with a pooled mortality rate of approximately 40% despite best standards of care. Current therapeutic strategies are based upon improving oxygenation and pulmonary compliance while minimizing ventilator induced lung injury. It has been demonstrated that relative hypoxemia can be well tolerated and improvements in oxygenation do not necessarily translate into survival benefit. Cardiac failure, in particular right ventricular dysfunction, is commonly encountered in moderate to severe acute respiratory distress syndrome and is reported to be one of the major determinants of mortality. The prevalence rate of echocardiographically evident right ventricular dysfunction in acute respiratory distress syndrome varies across studies ranging from 22% to 50%. Although there is no definitive causal relationship between right ventricular dysfunction and mortality, severe right ventricular dysfunction is associated with increased mortality. Factors that can adversely affect right ventricular function include hypoxic pulmonary vasoconstriction, hypercapnia, and invasive ventilation with high driving pressure. It might be expected that early diagnosis of right ventricular dysfunction would be of benefit however, echocardiography markers (qualitative and quantitative) used to prospectively evaluate the right ventricle in acute respiratory distress syndrome have not been tested in adequately powered studies. In this review we examine the prognostic implications and pathophysiology of right ventricular dysfunction in acute respiratory distress syndrome and discuss available diagnostic modalities and treatment options. We aim to identify gaps in knowledge and directions for future research that could potentially improve clinical outcomes in this patient population.

  6. Focused ultrasound examination of the chest on patients admitted with acute signs of respiratory problems

    DEFF Research Database (Denmark)

    Riishede, M; Laursen, C B; Teglbjærg, L S

    2016-01-01

    INTRODUCTION: Patients with acute respiratory problems poses a diagnostic challenge because similar symptoms can be caused by various pathological conditions. Focused ultrasound examination (f-US) of the heart and lungs has proven to increase the diagnostic accuracy in these patients. In this pro......INTRODUCTION: Patients with acute respiratory problems poses a diagnostic challenge because similar symptoms can be caused by various pathological conditions. Focused ultrasound examination (f-US) of the heart and lungs has proven to increase the diagnostic accuracy in these patients...... presumptive diagnosis at 4 hours from admission. METHODS AND ANALYSIS: This is a semiblinded randomised prospective study. 288 patients will be included and randomised into the control or intervention group. All patients receive a standard diagnostic evaluation by the EP to assess the primary presumptive....... As standard for correct diagnosis, we perform a blinded journal audit after discharge. As primary analysis, we use the intention-to-treat analysis. CONCLUSIONS: This study is the first multicentre trial in EDs to investigate whether f-US, in the hands of the EP, increases the proportion of correct diagnosis...

  7. Pitfalls in Suspected Acute Aortic Syndrome: Impact of Appropriate and If Required Repeated Imaging

    Directory of Open Access Journals (Sweden)

    C. Meier

    2015-01-01

    Full Text Available The incidence of acute aortic syndrome is low, but the spontaneous course is often life-threatening. Adequate ECG-gated imaging is fundamental within the diagnostic workup. We here report a case of a 53-year-old man presenting with atypical chest pain, slight increase of D dimers at admission, and extended diameter of the ascending aorta accompanied by mild aortic regurgitation. Interpretation of an initial contrast-enhanced computed tomography was false negative due to inadequate gating and motion artifacts, thereby judging a tiny contrast signal in the left anterior quadrant of the ascending aorta as a pseudointimal flap. By hazard, cardiac magnetic resonance imaging demonstrated an ulcer-like lesion superior to the aortic root, leading to aortic surgery at the last moment. As sensitivity of imaging is not 100%, this example underlines that second imaging studies might be necessary if the first imaging is negative, but the clinical suspicion still remains high.

  8. Analysis of high risk factors related to acute respiratory distress syndrome following severe thoracoabdominal injuries

    Institute of Scientific and Technical Information of China (English)

    ZHENG Guo-shou; BAI Xiang-jun; ZHAN Cheng-ye

    2007-01-01

    Objective: To investigate the high risk factors related to acute respiratory distress syndrome ( ARDS ) following serious thoracoabdominal injuries.Methods: The clinical data of 282 patients with serious thoracoabdominal injuries were retrospectively studied. Univariate and Cox multivariate regression analysis were used to determine the risk factors related to ARDS following serious thoracoabdominal injuries.Results: The incidence of ARDS was 31.9% (90/282) in patients with serious thoracoabdominal injuries.The mortality caused by ARDS was 37.8% (34/90). The univariate analysis and multivariate analysis demonstrated that the clinical conditions such as elder age, shock,dyspnea, abnormal arterial blood gas, hemopneumothorax,pulmonary contusion, flail chest, coexisting pulmonary diseases, multiple abdominal injury and high ISS score were the independent high risk factors related to ARDS.Conclusion: There are many high risk factors related to ARDS following severe thoracoabdominal injuries, which should be detected early and treated timely to decrease the incidence and mortality of ARDS.

  9. Residents' performance in the interpretation of on-call "triple-rule-out" CT studies in patients with acute chest pain.

    Science.gov (United States)

    Garrett, K Gabriel; De Cecco, Carlo N; Schoepf, U Joseph; Silverman, Justin R; Krazinski, Aleksander W; Geyer, Lucas L; Lewis, Alex J; Headden, Gary F; Ravenel, James G; Suranyi, Pal; Meinel, Felix G

    2014-07-01

    To evaluate the performance of radiology residents in the interpretation of on-call, emergency "triple-rule-out" (TRO) computed tomographic (CT) studies in patients with acute chest pain. The study was institutional review board-approved and Health Insurance Portability and Accountability Act compliant. Data from 617 on-call TRO studies were analyzed. Dedicated software enables subspecialty attendings to grade discrepancies in interpretation between preliminary trainee reports and their final interpretation as "unlikely to be significant" (minor discrepancies) or "likely to be significant" for patient management (major discrepancies). The frequency of minor, major and all discrepancies in resident's TRO interpretations was compared to 609 emergent non-electrocardiography (ECG)-synchronized chest CT studies using Pearson χ(2) test. Minor discrepancies occurred more often in the TRO group (9.1% vs. 3.9%, P TRO group most commonly resulted from missed extrathoracic findings with missed liver lesions being the most frequent. Major discrepancies mostly encompassed cardiac and extracardiac vascular findings but did not result in unnecessary interventions, significant immediate changes in management, or adverse patient outcomes. On-call resident interpretation of TRO CT studies in patients with acute chest pain is congruent with final subspecialty attending interpretation in the overwhelming majority of cases. The rate of discrepancies likely to affect patient management in this domain is not different from emergent non-ECG-synchronized chest CT. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  10. Epidemiology of acute lung injury and acute respiratory distress syndrome in The Netherlands : A survey

    NARCIS (Netherlands)

    Wind, Jan; Versteegt, Jens; Twisk, Jos; van der Werf, Tjip S.; Bindels, Alexander J. G. H.; Spijkstra, Jan-Jaap; Girbes, Armand R. J.; Groeneveld, A. B. Johan

    2007-01-01

    Background: The characteristics, incidence and risk factors for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) may depend on definitions and geography. Methods: A prospective, 3-day point-prevalence study was performed by a survey of all intensive care units (ICU) in the Neth

  11. Pericardial tear as a consequence of cardiopulmonary resuscitation (CPR) involving chest compression: a report of two postmortem cases of acute type A aortic dissection with hemopericardium.

    Science.gov (United States)

    Okuda, Takahisa; Takanari, Hiroki; Shiotani, Seiji; Hayakawa, Hideyuki; Ohno, Youkichi; Fowler, David R

    2015-05-01

    We present two cases of a pericardial tear as a consequence of cardiopulmonary resuscitation involving chest compressions in fatal acute type A aortic dissection (AoD) with hemopericardium. For each case, postmortem computed tomography revealed a hematoma in the false lumen of the ascending aorta with a slight hemopericardium and a large left hemothorax, as well as focal pericardial dimpling and discontinuity around the left ventricle. At autopsy, we confirmed a convex lens-shape gaping pericardial tear at the left posterolateral site of the pericardium and a massive volume of bloody fluid in the left thoracic cavity. It has been hypothesized that the pericardium ruptured due to chest compressions during resuscitation in these cases of acute type A AoD with hemopericardium and that intrapericardial blood leakage through the pericardial tear resulted in a hemothorax. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Hypertriglyceridemic acute pancreatitis in a patient with Sheehan's syndrome

    Institute of Scientific and Technical Information of China (English)

    Wei-Zhong Zhang; Jue-Xing Xie; Jie Shen; Feng Lin

    2006-01-01

    BACKGROUND:There is no report on case of severe acute hyperlipidemic pancreatitis after treatment of Sheehan's syndrome. METHODS: A 32-year-old female patient was diagnosed as having acute hyperlipidemic pancreatitis after treatment of Sheehan's syndrome, and treated with diet and lipid-lowering agents in early stage. RESULTS: Abdominal pain and fever of the patient resolved within a few days. She was subjected to diet and oral lipid-lowering therapy on the 4th day after admission. The disease did not recur during the follow-up for more than one year. CONCLUSIONS: Estrogen replacement therapy should be prescribed for Sheehan's syndrome. The serum level of triglyceride should be monitored and treatment should be given to prevent severe acute pancreatitis. Lipid-lowering therapy in early stage is the key step towards a complete recovery.

  13. Gerstmann's syndrome following an acute herpes simplex encephalitis.

    Science.gov (United States)

    Ilchevsky, S; Boev, I; Kazakova, T

    1998-01-01

    The authors present a rare clinical case of a woman who developed Gerstmann's syndrome following an acute Herpes simplex viral encephalitis. Clinical observation and laboratory evaluation were performed during the acute phase of the disease. After that the follow-up continued for one-year period. The localization of the pathologic process was determined by computerized tomography, conducted periodically. The characteristics of the clinical picture are interpreted in the context of the contemporary concepts of the topical diagnosis of Gerstmann's syndrome. The possibility of a sudden onset of acute Herpes simplex viral encephalitis without a preceding febrile-intoxication syndrome is worth noting. Conclusions are drawn stressing the need of an early etiologic treatment and the importance of the rehabilitation activities during the convalescence period.

  14. High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people eith acute chest pain: a systematic review and cost-effectiveness analysis

    NARCIS (Netherlands)

    M. Westwood (Marie); T. van Asselt (Thea); B. Ramaekers (Bram); P. Whiting (Penny); P. Tokala (Praveen); M.A. Joore (Manuela); N. Armstrong (Nigel); J. Ross (Janine); J.L. Severens (Hans); J. Kleijnen (Jos)

    2015-01-01

    textabstractBackground: Early diagnosis of acute myocardial infarction (AMI) can ensure quick and effective treatment but only 20% of adults with emergency admissions for chest pain have an AMI. High-sensitivity cardiac troponin (hs-cTn) assays may allow rapid rule-out of AMI and avoidance of unnece

  15. Cost-effectiveness of high-sensitive troponin assays for the early rule-out or diagnosis of acute myocardial infarction (AMI) in people with acute chest pain : A nice diagnostic assessment

    NARCIS (Netherlands)

    Ramaekers, B.L.T.; Armstrong, N.; Joore, M.A.; Westwood, M.; Whiting, P.; Thokala, P.; Ross, J.; Kleijnen, J.; Severens, J.; Van Asselt, A.

    2014-01-01

    Objectives: To assess cost-effectiveness of high sensitivity troponin (hs-cTn) assays for the management of adults presenting with acute chest pain at the emergency department. Methods: An economic model was constructed to estimate lifetime costs and QALYs of five hs-cTn strategies (differing accord

  16. High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain : a systematic review and cost-effectiveness analysis

    NARCIS (Netherlands)

    Westwood, Marie; van Asselt, Thea; Ramaekers, Bram; Whiting, Penny; Thokala, Praveen; Joore, Manuela; Armstrong, Nigel; Ross, Janine; Severens, Johan; Kleijnen, Jos

    2015-01-01

    BACKGROUND: Early diagnosis of acute myocardial infarction (AMI) can ensure quick and effective treatment but only 20% of adults with emergency admissions for chest pain have an AMI. High-sensitivity cardiac troponin (hs-cTn) assays may allow rapid rule-out of AMI and avoidance of unnecessary hospit

  17. Admission insulin resistance index in nondiabetic patients with acute coronary syndrome ( clinical and angiographic features

    Directory of Open Access Journals (Sweden)

    Wael Refaie

    2013-01-01

    Conclusion Elevated AIRI can predict coronary artery events in nondiabetic patients with acute chest pain. Multiple coronary vessel involvement is common in such cases and suitable planned invasive therapeutic strategies have to be considered.

  18. Admission insulin resistance index in non diabetic patients with acute coronary syndrome; clinical and angiographic features

    Directory of Open Access Journals (Sweden)

    Wael Refaie

    2013-12-01

    Conclusion: Elevated AIRI can predict coronary artery events in non diabetic patients with acute chest pain. Multiple coronary vessel involvement is common in such cases and suitable planned invasive therapeutic strategies have to be considered.

  19. Tachyarrhythmias, bradyarrhythmias and acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Trappe Hans-Joachim

    2010-01-01

    Full Text Available The incidence of bradyarrhythmias in patients with acute coronary syndrome (ACS is 0.3% to 18%. It is caused by sinus node dysfunction (SND, high-degree atrioventricular (AV block, or bundle branch blocks. SND presents as sinus bradycardia or sinus arrest. First-degree AV block occurs in 4% to 13% of patients with ACS and is caused by rhythm disturbances in the atrium, AV node, bundle of His, or the Tawara system. First- or second-degree AV block is seen very frequently within 24 h of the beginning of ACS; these arrhythmias are frequently transient and usually disappear after 72 h. Third-degree AV blocks are also frequently transient in patients with infero-posterior myocardial infarction (MI and permanent in anterior MI patients. Left anterior fascicular block occurs in 5% of ACS; left posterior fascicular block is observed less frequently (incidence < 0.5%. Complete bundle branch block is present in 10% to 15% of ACS patients; right bundle branch block is more common (2/3 than left bundle branch block (1/3. In patients with bradyarrhythmia, intravenous (IV atropine (1-3 mg is helpful in 70% to 80% of ACS patients and will lead to an increased heart rate. The need for pacemaker stimulation (PS is different in patients with inferior MI (IMI and anterior MI (AMI. Whereas bradyarrhythmias are frequently transient in patients with IMI and therefore do not need permanent PS, there is usually a need for permanent PS in patients with AMI. In these patients bradyarrhythmias are mainly caused by septal necrosis. In patients with ACS and ventricular arrhythmias (VTA amiodarone is the drug of choice; this drug is highly effective even in patients with defibrillation-resistant out-of-hospital cardiac arrest. There is general agreement that defibrillation and advanced life support is essential and is the treatment of choice for patients with ventricular flutter/fibrillation. If defibrillation is not available in patients with cardiac arrest due to VTA

  20. Acute pediatric leg compartment syndrome in chronic myeloid leukemia.

    Science.gov (United States)

    Cohen, Eric; Truntzer, Jeremy; Trunzter, Jeremy; Klinge, Steve; Schwartz, Kevin; Schiller, Jonathan

    2014-11-01

    Acute compartment syndrome is an orthopedic surgical emergency and may result in devastating complications in the setting of delayed or missed diagnosis. Compartment syndrome has a variety of causes, including posttraumatic or postoperative swelling, external compression, burns, bleeding disorders, and ischemia-reperfusion injury. Rare cases of pediatric acute compartment syndrome in the setting of acute myeloid leukemia and, even less commonly, chronic myeloid leukemia have been reported. The authors report the first known case of pediatric acute compartment syndrome in a patient without a previously known diagnosis of chronic myeloid leukemia. On initial examination, an 11-year-old boy presented with a 2-week history of progressive left calf pain and swelling after playing soccer. Magnetic resonance imaging scan showed a hematoma in the left superficial posterior compartment. The patient had unrelenting pain, intermittent lateral foot parethesias, and inability to bear weight. Subsequently, he was diagnosed with acute compartment syndrome and underwent fasciotomy and evacuation of a hematoma. Laboratory results showed an abnormal white blood cell count of 440×10(9)/L (normal, 4.4-11×10(9)) and international normalized ratio of 1.3 (normal, 0.8-1.2). Further testing included the BCR-ABL1 fusion gene located on the Philadelphia chromosome, leading to a diagnosis of chronic myeloid leukemia. Monotherapy with imatinib mesylate (Gleevec) was initiated. This report adds another unique case to the growing literature on compartment syndrome in the pediatric population and reinforces the need to consider compartment syndrome, even in unlikely clinical scenarios. Copyright 2014, SLACK Incorporated.

  1. Pediatric acute respiratory distress syndrome: Host factors in Down syndrome and the general population

    NARCIS (Netherlands)

    M. Bruijn

    2013-01-01

    We find that Down syndrome is an important risk factor for developing acute respiratory distress syndrome (ARDS) in children, but the reason why remains to be elucidated. In addition, we find several differences between adult and pediatric ARDS. The association between C-reactive protein (CRP) level

  2. Performance and efficacy of 320-row computed tomography coronary angiography in patients presenting with acute chest pain: results from a clinical registry.

    Science.gov (United States)

    van Velzen, J E; de Graaf, F R; Kroft, L J; de Roos, A; Reiber, J H C; Bax, J J; Jukema, J W; Schuijf, J D; Schalij, M J; van der Wall, E E

    2012-04-01

    The purpose of this study was to evaluate the performance of 320-row computed tomography angiography (CTA) in the identification of significant coronary artery disease (CAD) in patients presenting with acute chest pain and to examine the relation to outcome during follow-up. A total of 106 patients with acute chest pain underwent CTA to evaluate presence of CAD. Each CTA was classified as: normal, non-significant CAD (unstable angina requiring revascularization. Among the 106 patients, 23 patients (22%) had a normal CTA, 19 patients (18%) had non-significant CAD on CTA, 59 patients (55%) had significant CAD on CTA, and 5 patients (5%) had non-diagnostic image quality. In total, 16 patients (15%) were immediately discharged after normal CTA and 90 patients (85%) underwent invasive coronary angiography. Sensitivity, specificity, and positive and negative predictive values to detect significant CAD on CTA were 100, 87, 93, and 100%, respectively. During mean follow-up of 13.7 months, no cardiovascular events occurred in patients with a normal CTA examination. In patients with non-significant CAD on CTA, no cardiac death or myocardial infarctions occurred and only 1 patient underwent revascularization due to unstable angina. In patients presenting with acute chest pain, an excellent clinical performance for the non-invasive assessment of significant CAD was demonstrated using CTA. Importantly, normal or non-significant CAD on CTA predicted a low rate of adverse cardiovascular events and favorable outcome during follow-up.

  3. State-of-the-Art Evaluation of Emergency Department Patients Presenting With Potential Acute Coronary Syndromes.

    Science.gov (United States)

    Hollander, Judd E; Than, Martin; Mueller, Christian

    2016-08-16

    It is well established that clinicians cannot use clinical judgment alone to determine whether an individual patient who presents to the emergency department has an acute coronary syndrome. The history and physical examination do not distinguish sufficiently between the many conditions that can cause acute chest pain syndromes. Cardiac risk factors do not have sufficient discriminatory ability in symptomatic patients presenting to the emergency department. Most patients with non-ST-segment-elevation myocardial infarction do not present with electrocardiographic evidence of active ischemia. The improvement in cardiac troponin assays, especially in conjunction with well-validated clinical decision algorithms, now enables the clinician to rapidly exclude myocardial infarction. In patients in whom unstable angina remains a concern or there is a desire to evaluate for underlying coronary artery disease, coronary computed tomography angiography can be used in the emergency department. Once a process that took ≥24 hours, computed tomography angiography now can rapidly exclude myocardial infarction and coronary artery disease in patients in the emergency department. © 2016 American Heart Association, Inc.

  4. MELAS syndrome presenting as an acute surgical abdomen.

    Science.gov (United States)

    Dindyal, S; Mistry, K; Angamuthu, N; Smith, G; Hilton, D; Arumugam, P; Mathew, J

    2014-01-01

    MELAS (mitochondrial cytopathy, encephalomyopathy, lactic acidosis and stroke-like episodes) is a syndrome in which signs and symptoms of gastrointestinal disease are uncommon if not rare. We describe the case of a young woman who presented as an acute surgical emergency, diagnosed as toxic megacolon necessitating an emergency total colectomy. MELAS syndrome was suspected postoperatively owing to persistent lactic acidosis and neurological symptoms. The diagnosis was later confirmed with histological and genetic studies. This case highlights the difficulties in diagnosing MELAS because of its unpredictable presentation and clinical course. We therefore recommend a high index of suspicion in cases of an acute surgical abdomen with additional neurological features or raised lactate.

  5. Acute coronary syndrome among older patients: a review.

    Science.gov (United States)

    Veerasamy, Murugapathy; Edwards, Richard; Ford, Gary; Kirkwood, Tom; Newton, Julia; Jones, Dave; Kunadian, Vijay

    2015-01-01

    Ischemic heart disease is the leading cause of mortality worldwide. Due to advances in medicine in the past few decades, life expectancy has increased resulting in an aging population in developed and developing countries. Acute coronary syndrome causes greater morbidity and mortality in this group of older patients, which appears to be due to age-related comorbidities. This review examines the incidence and prevalence of acute coronary syndrome among older patients, examines current treatment strategies, and evaluates the predictors of adverse outcomes. In particular, the impact of frailty on outcomes and the need for frailty assessment in developing future research and management strategies among older patients are discussed.

  6. The threat of severe acute respiratory syndrome (SARS).

    Science.gov (United States)

    Kissoon, N

    2003-06-01

    Severe acute respiratory syndrome (SARS) is a recently recognized infectious disease associated with severe morbidity and mortality. It presents with non-specific signs and symptoms and because no definitive laboratory test is readily available, it poses a great risk to healthcare workers as well as difficulty in quarantine. The global response has been coordinated and enthusiastic in trying to understand and control this disease. Severe acute respiratory syndrome poses a threat to the Caribbean because of easy and convenient travel and the vibrant tourist industry.

  7. Acute fulminant invasive fungal sinusitis with cavernous sinus syndrome.

    Science.gov (United States)

    Chi, Tzu-Hang; Chen, Hsien-Shen; Yuan, Chien-Han; Su, Feng-Ming

    2014-11-01

    Acute fulminant invasive fungal sinusitis is most commonly found in immunocompromised patients with conditions such as diabetes mellitus, malignancies and acquired immune deficiency syndrome. The most common pathogens are Aspergillus and Mucoraceae and the sinus most frequently involved is the maxillary sinus. Fever, rhinorrhea, facial pain, headache, and diplopia are common presenting symptoms. Complications of this infection include intracranial and / or intraorbital spread of the infection; the prognosis is poor. Here, a rare case of acute fulminant invasive fungal sinusitis with cavernous sinus syndrome is reported.

  8. GERSTMANN’S SYNDROME IN ACUTE STROKE PATIENTS

    OpenAIRE

    Zukic, Sanela; MRKONJIC Zamir; Sinanovic, Osman; Vidovic, Mirjana; Kojic, Biljana

    2012-01-01

    Objective: Gerstmann in 1924. observed in a few patients a concomitant impairment in discriminating their own fingers, writing by hand, distinguishing left from right and performing calculations. He claimed that this tetrad of symptoms constituted a syndromal entity, assigned it to a lesion of the dominant parietal lobe. Since than, Gerstmann`s syndrome (GS) was enigma for neuropsychologists. The aim of this study was to analyze frequency and clinical features of GS among acute stroke patient...

  9. Idiopathic Atypical Haemolytic Uraemic Syndrome presenting with acute dystonia

    LENUS (Irish Health Repository)

    Maduemem, Rizwan K E

    2017-09-01

    Hemolytic Uremic Syndrome (HUS), a triad of microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury. The atypical HUS (aHUS) results from over activation of complement system with formation of micro thrombi and damage to endothelial cells resulting in renal impairment in 50 % and death in 25 %, commonly in untreated patients. We report an intriguing case of aHUS presenting with acute onset of movement disorder and fluctuating delirium.

  10. A Clinical Decision Rule to Identify Emergency Department Patients at Low Risk for Acute Coronary Syndrome Who Do Not Need Objective Coronary Artery Disease Testing: The No Objective Testing Rule.

    Science.gov (United States)

    Greenslade, Jaimi H; Parsonage, William; Than, Martin; Scott, Adam; Aldous, Sally; Pickering, John W; Hammett, Christopher J; Cullen, Louise

    2016-04-01

    We derive a clinical decision rule for ongoing investigation of patients who present to the emergency department (ED) with chest pain. The rule identifies patients who are at low risk of acute coronary syndrome and could be discharged without further cardiac testing. This was a prospective observational study of 2,396 patients who presented to 2 EDs with chest pain suggestive of acute coronary syndrome and had normal troponin and ECG results 2 hours after presentation. Research nurses collected clinical data on presentation, and the primary endpoint was diagnosis of acute coronary syndrome within 30 days of presentation to the ED. Logistic regression analyses were conducted on 50 bootstrapped samples to identify predictors of acute coronary syndrome. A rule was derived and diagnostic accuracy statistics were computed. Acute coronary syndrome was diagnosed in 126 (5.3%) patients. Regression analyses identified the following predictors of acute coronary syndrome: cardiac risk factors, age, sex, previous myocardial infarction, or coronary artery disease and nitrate use. A rule was derived that identified 753 low-risk patients (31.4%), with sensitivity 97.6% (95% confidence interval [CI] 93.2% to 99.5%), negative predictive value 99.6% (95% CI 98.8% to 99.9%), specificity 33.0% (95% CI 31.1% to 35.0%), and positive predictive value 7.5% (95% CI 6.3% to 8.9%) for acute coronary syndrome. This was referred to as the no objective testing rule. We have derived a clinical decision rule for chest pain patients with negative early cardiac biomarker and ECG testing results that identifies 31% at low risk and who may not require objective testing for coronary artery disease. A prospective trial is required to confirm these findings. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  11. TCM Therapeutic Strategy on Acute Lung Injury Caused by Infectious Atypical Pneumonia and Acute Respiratory Distress Syndrome

    Institute of Scientific and Technical Information of China (English)

    唐光华

    2003-01-01

    @@ Infectious atypical pneumonia (IAP) is also called severe acute respiratory syndrome (SARS) by WHO. In its development, around 20% of SARS can develop into the stage of acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), active and effective treatment of it constitutes the important basis for lowering mortality and reducing secondary pulmonary function impairment and pulmonary fibrosis.

  12. Depression masquerading as chest pain in a patient with Wolff Parkinson White syndrome

    Science.gov (United States)

    Madabushi, Rajashree; Agarwal, Anil; Gautam, Sujeet K S; Khuba, Sandeep

    2016-01-01

    Wolff Parkinson White (WPW) syndrome is a condition in which there is an aberrant conduction pathway between the atria and ventricles, resulting in tachycardia. A 42-year-old patient, who was treated for WPW syndrome previously, presented with chronic somatic pain. With her cardiac condition in mind, she was thoroughly worked up for a recurrence of disease. As part of routine screening of all patients at our pain clinic, she was found to have severe depression as per the Patient Health Questionnaire–9 (PHQ–9) criteria. After ruling out sinister causes, she was treated for depression using oral Duloxetine and counselling. This led to resolution of symptoms, and improved her mood and functional capability. This case highlights the use of psychological screening tools and diligent examination in scenarios as confusing as the one presented here. Addressing the psychological aspects of pain and adopting a holistic approach are as important as treatment of the primary pathology. PMID:27738505

  13. A retrospective study of 78 patients with severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    肖正伦; 黎毅敏; 陈荣昌; 李时悦; 钟淑卿; 钟南山

    2003-01-01

    Objective To summarize the clinical features of severe acute respiratory syndrome (SARS) and to discuss diagnosis and management of the disease.Methods A retrospective study was conducted on 78 cases of SARS referred to the Guangzhou Institute of Respiratory Diseases (GIRD) between December 22, 2002 and near the end of March 2003. Items reviewed cover all data concerning clinical manifestations, laboratory investigation and radiology.Results The patients in the study consisted of 42 males and 36 females, aged 20 -75 yrs (mean age 37. 5 +11.6 yrs), including 44 affected health-care professionals. Clinical symptoms seen in the group were fever (100. 0%), cough (88. 5%), and dyspnea (79. 5%). There were 12 cases (15. 3%) with WBCs <4.0×109/L, 49 cases (62. 8%) ranging between (4. 0 -10. 0) ×109/L and 17 cases (21.8%) over 10. 0 × 109/L. The average was(7. 58 ±4. 96) × 109/L, with 0.75 ±0. 14 (neutrophil) and 0.18 ±0.11 (lymphocyte). Chest films and CT scanning revealed changes related to pneumonia. The transmission of the disease was likely via close contact with contagious droplets.The prevalences of acute lung injury (ALI, in 37cases ) and acute respiratory distress syndrome (ARDS, 21 out of 37 cases ) were considerably high among the patients. Seven patients who developed ARDS complicated with multiple organs dysfunction syndrome (MODS) died.Conclusions A history of close contact, fever, sign of pneumonia by X-ray and normal-to-lowered WBC counts are favorable for the diagnosis of SARS. Recognition of All as the important index for critical SARS and comprehensive supportive management are of paramount in decreasing the mortality of the disease.

  14. Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods.

    Science.gov (United States)

    Bellone, A; Lascioli, R; Raschi, S; Guzzi, L; Adone, R

    2000-05-01

    To compare the short-term effects of postural drainage (PD), oscillating positive expiratory pressure (using the FLUTTER device), and expiration with the glottis open in the lateral posture (ELTGOL) on oxygen saturation, pulmonary function, and sputum production in patients with an acute exacerbation of chronic bronchitis. A prospective, randomized study. A clinical ward. Ten patients with chronic bronchitis exacerbation received PD, FLUTTER, and ELTGOL by the same respiratory therapist at about the same time of day on separate days and in random order. Oxygen saturation and pulmonary function were measured before, immediately after, and 15 minutes and 1 hour after each treatment. Improvement in sputum production was measured by total sputum wet weight immediately after and for 1 hour after treatment. PD consisted of positioning the patients in a posture that allows bronchial drainage by gravity. FLUTTER is a device that is claimed to combine oscillating positive expiratory pressure with oscillations of the airflow. ELTGOL is an airway clearance technique that uses lateral posture and different lung volumes to control expiratory flow rate to avoid airway compression. The total time spent for treatments was 30 minutes. All techniques were well tolerated, and oxygen saturation and pulmonary function did not change significantly during and after treatments. Thirty minutes after the beginning of treatment, sputum production increased significantly with all techniques, but during the 1 hour after the end of treatment, it was significantly larger with FLUTTER (from 15.0 +/- 8.6g to 19.0 +/- 9.3g, p ELTGOL (from 17.0 +/- 7.0g to 20.6 +/- 6.9g, p ELTGOL techniques were more effective in prolonging secretion removal in chronic bronchitis exacerbation than was the PD method.

  15. Agranulocytosis and acute coronary syndrom in apathetic hyperthyreoidism

    Directory of Open Access Journals (Sweden)

    Ivović Miomira

    2003-01-01

    disorder in hyperthyroidism but paroxysmal tachycardia and atrial fibrillation are not rare. This can be explained by increased heart rate, cardiac output, blood volume, coronary artery flow and peripheral oxygen consumption in thyreotoxicosis [9]. Patients with coronary arteriosclerosis can develop angina pectoris during thyreotoxic stage, which can be explained by imbalance between cardiac demand and supply. Myocardial damage is often in thyrotoxic patients with chronic hart failure, together with myocardial infarction in patients without coronary disease [2,6]. Congestive heart failure and atrial fibrillation are relatively resistant to digitalis treatment because of high metabolic turn over of medication and excessive myocardial irritability in hyperthyro-idism [6]. Cardiovascular and myopathic manifestations predominate in older hyperthyroid patients (over 60 years and some of them can have only few symptoms of hyperthyroidism [1-3]. Thyrotoxic state characterized by fatigue, apathy, extreme weakness, low-grade fever and sometimes congestive heart failure are designated as apathetic hyperthyroidism. Such patients have small goiters, mild tachycardia and often cool and dry skin with few eye signs [6]. Patients with subclinical hyperthyroidism are at increased risk for atrial fibrillation [9]. Unstable angina and non-Q myocardial infarction (non ST elevation are acute manifestation of coronary artery disease. The acute coronary syndrome of unstable angina, non-Q myocardial infarction and Q-wave myocardial infarction have atherosclerotic lesions of the coronary arteries as a common pathogenic substrate. Errosions or ruptures of unstable atherosclerotic plaque triggered pathophysiologic processes, resulted in thrombus formation at the site of arterial injury. This leads to abrupt reduction or cessation through the affected vessel. Clinical manifestations of unstable angina and non-Q myocardial infarction are similar and diagnosis of non-Q myocardial infarction is made on

  16. Treatment of 336 cases of chest trauma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jing; CHU Xiang-yang; LIU Yi; WANG Yun-xi

    2012-01-01

    Objective: To summarize the clinical features,diagnosis and treatment of chest trauma.Methods: A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011.Results:Out of all cases,325 were cured,accounting for 96.7%; 11 died,accounting for 3.3%.Among the dead cases,one died of hemorrhagic shock,three of acute respiratory distress syndrome,three of multiple organ failure,and four of severe multiple traumas.Conclusions:(1) For patients with severe chest trauma,early emergency treatment is crucial to save life.(2) Open thoracic surgery is needed for acute cardiac tamponade,intrapulmonary vascular injuries,progressive intrathoracic bleeding,lung laceration,tracheal breakage,and diaphragmatic injury.In addition,operative timing and method should be well chosen.(3) Pulmonary contusion is one of common complications in chest trauma,for which the combination of strong anti-infection therapy and mechanical ventilation is an effective treatment strategy.

  17. Treatment of 336 cases of chest trauma

    Directory of Open Access Journals (Sweden)

    ZHANG Jing

    2012-06-01

    Full Text Available 【Abstract】Objective: To summarize the clinical features, diagnosis and treatment of chest trauma. Methods: A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011. Results: Out of all cases, 325 were cured, accounting for 96.7%; 11 died, accounting for 3.3%. Among the dead cases, one died of hemorrhagic shock, three of acute respi-ratory distress syndrome, three of multiple organ failure, and four of severe multiple traumas. Conclusions: (1 For patients with severe chest trauma, early emergency treatment is crucial to save life. (2 Open thoracic surgery is needed for acute cardiac tamponade, intrapulmonary vascular injuries, progressive intrathoracic bleeding, lung laceration, tracheal breakage, and diaphrag-matic injury. In addition, operative timing and method should be well chosen. (3 Pulmonary contusion is one of common complications in chest trauma, for which the com-bination of strong anti-infection therapy and mechanical ventilation is an effective treatment strategy. Key words: Thoracic injuries; Thoracotomy; Emer-gency treatment

  18. Risk stratifying the acute coronary syndrome patient: a focus on treatable risk.

    Science.gov (United States)

    Steinhubl, Steven R

    2007-01-01

    Providing the optimal treatment for patients who present to the emergency room with chest pains or suspected acute coronary syndrome (ACS) remains a dilemma for many practitioners due to subjectivity, delayed diagnoses, and widely variable mechanisms with similar clinical presentations. In treating patients with chest pain but no obvious electrocardiogram changes, practitioners frequently utilize the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines. The guidelines group possible ACS patients together as unstable angina/non-ST-segment elevation myocardial infarction (NSTEMI) and recommend that treatment be based on level of risk. The challenge for practitioners is discriminating between "risk" and "treatable risk." Evaluation of troponin levels can help identify patients with possible ACS who are at high risk of death and MI, and guide early decision making. Available data indicate that in the troponin-negative patient, routine interventions such as unfractionated heparin, glycoprotein IIb/IIIa receptor antagonists, and invasive approaches have no benefit in terms of reducing death and MI. Although the ACC/AHA Guidelines combine patients with unstable angina and NSTEMI, it is essential to evaluate troponin status in order to optimize patient outcomes and safety in the treatment of suspected ACS.

  19. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

    Directory of Open Access Journals (Sweden)

    Yuwares Sittichanbuncha

    2015-01-01

    Full Text Available Background. To differentiate acute coronary syndrome (ACS from other causes in patients presenting with chest pain at the emergency department (ED is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0% were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval were 4.220 (1.445, 12.327, 3.333 (1.040, 10.684, and 12.539 (3.876, 40.567, respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  20. An online tool for nurse triage to evaluate risk for acute coronary syndrome at emergency department.

    Science.gov (United States)

    Sittichanbuncha, Yuwares; Sanpha-Asa, Patchaya; Thongkrau, Theerayut; Keeratikasikorn, Chaiyapon; Aekphachaisawat, Noppadol; Sawanyawisuth, Kittisak

    2015-01-01

    Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  1. Acute compartment syndrome of the forearm caused by calcific tendinitis of the distal biceps.

    Science.gov (United States)

    Garayoa, Santiago Amillo; Romero-Muñoz, Luis M; Pons-Villanueva, Juan

    2010-12-01

    Acute compartment syndrome of the forearm requires immediate treatment to avoid damage of the soft tissues and a poor functional outcome for the forearm. Muscular and bone lesions are the main causes of acute compartment syndromes. We report a case of acute compartment syndrome of the forearm caused by a calcific tendinitis of the distal biceps.

  2. Acute Cubital Tunnel Syndrome Secondary to Anconeus Epitrochlearis Muscle

    Directory of Open Access Journals (Sweden)

    Ying-Kan Law

    2015-12-01

    Full Text Available Cubital tunnel syndrome is the most common type of ulnar nerve entrapment that usually associates with chronic sensory and motor symptoms. Having anconeus epitrochlearis muscle is an uncommon cause of cubital tunnel syndrome. In this paper, the author introduces a case of cubital tunnel syndrome due to anconeus epitrochlearis muscle presenting with acute sensory, motor, and sympathetic symptoms. For such cases, there has been much controversy over the choices of surgical treatment, which can be excision of the muscle alone or together with ulnar nerve anterior transposition.

  3. C-reactive protein as a predictor of adverse outcome in patients with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    A S Sheikh

    2012-01-01

    Full Text Available Background and Objectives: The acute-phase reactant C-reactive protein (CRP has been shown to reflect systemic and vascular inflammation and to predict future cardiovascular events. The objective of this study was to evaluate the prognostic value of CRP in predicting cardiovascular outcome in patients presenting with acute coronary syndromes. Patients and Methods: This prospective, single-centered study was carried out by the Department of Pathology in collaboration with the Department of Cardiology, Bolan Medical College Complex Quetta, Balochistan, Pakistan from January 2009 to December 2009. We studied 963 consecutive patients presenting with chest pain to Accident and Emergency Department. Patients were divided into four groups. Group-1 comprised patients with unstable angina; group-2 included patients with acute ST elevation myocardial infarction (STEMI; group-3 comprised patients with Non-ST elevation myocardial infarction (Non-STEMI and group-4 was the control group. All four groups were followed-up for 90 days for occurrence of cardiovascular events. Results: The CRP was elevated (>3 mg/L among 27.6% patients in Group-1; 70.9% in group- 2; 77.9% in group-3 and 5.3% in the control group. Among cases with elevated CRP, 92.1% had a cardiac event compared to 34.3% among patients with CRP £3 mg/L (P < 0.0001. The mortality was significantly higher (P < 0.0001 in group-2 (8.9% and group-3 (11.9% as compared to group-1 (2.1%. There was no cardiac event or mortality in Group-4. Conclusions: Elevated CRP is a predictor of adverse outcome in patients with acute coronary syndromes and helps in identifying patients who may be at risk of cardiovascular complications.

  4. Acute cauda equina syndrome secondary to a lumbar synovial cyst.

    Science.gov (United States)

    Muir, Jeffery J; Pingree, Matthew J; Moeschler, Susan M

    2012-01-01

    Cauda equina syndrome is a well described state of neurologic compromise due to lumbosacral root compression. In most cases, it is due to a herniated disc, tumor, infection, or hematoma. We report a case of rapid lumbar synovial cyst expansion leading to acute cauda equina syndrome and compare it to similar cases in the literature. The patient is a 49-year-old woman with a history of chronic low back pain who developed cauda equina syndrome. Serial lumbar magnetic resonance imaging studies demonstrated a significant increase in the size of a lumbar synovial cyst over a 2 week interval. After an unsuccessful attempt to relieve her acute symptoms with computed tomography-guided cyst aspiration, an L4-5 posterior spinal decompression with excision of the synovial cyst was performed. Postoperatively the patient's perineal numbness, bladder incontinence, and associated pain complaints resolved. The only residual symptom at one month follow-up was continued numbness in the right lower limb in an L5 distribution. This report adds to 6 other well described similar cases found in the literature by illustrating several important points. First, a lumbar synovial cyst is a rare but possible cause of acute cauda equina syndrome. Second, magnetic resonance imaging is the test of choice to diagnose and characterize lumbar synovial cysts; serial imaging can detect fluctuations in cyst size. Third, percutaneous treatment of lumbar synovial cysts is variable in efficacy and proved to be unsuccessful in our patient. Finally, surgical management has shown high success rates for symptomatic cysts. Specifically, in the setting of acute cauda equina syndrome secondary to a lumbar synovial cyst, urgent surgical decompression has led to resolution of neurologic symptoms in most reported cases. A lumbar synovial cyst is an uncommon cause of acute cauda equina syndrome. Prompt diagnosis and treatment may lead to reduced morbidity associated with this condition.

  5. A mimicry of an acute coronary syndrome.

    Science.gov (United States)

    Teo, Bervin

    2009-01-01

    A 79-year-old woman was out in the garden having lunch on a hot summer day. She developed stabbing chest pains, more severe on her left side, associated with radiation down her left arm. Severity was 7 out of 10. There was no relief of pain with glyceryl trinitrate spray. Risk factors for ischaemic heart disease include hyperlipidaemia, being an ex-smoker (40 years), no history of diabetes or hypertension. There was a family history of her father having a myocardial infarction at the age of 54. Echocardiogram (ECG) revealed widespread deep symmetrical T-wave inversion in the chest leads and lateral limb leads. The patient's serum creatine kinase level was 180 IU/litre (normal range 30-135), troponin I level was 6.56 g/litre (normal range 0-0.10), D-dimer was negative and random serum cholesterol level was 5.3 mmol/litre (3.8-5.2). Significant coronary stenoses were excluded. A left ventriculogram revealed a hyperkinetic base and a dyskinetic apical region of the left ventricle. Echocardiography showed normal valves, basal septal hypertrophy and a dilated akinetic apex, with the region of akinesia spanning more than the arterial territory. Takotsubo cardiomyopathy. Treatment with aspirin, angiotensin-converting enzyme (ACE) inhibitor, β blocker and a statin.

  6. Takotsubo triggered by acute myocardial infarction:a common but overlooked syndrome?

    Institute of Scientific and Technical Information of China (English)

    Björn Redfors; Truls Rmunddal; Yangzhen Shao; Elmir Omerovic

    2014-01-01

    Takotsubo cardiomyopathy (TCM) is an acute cardiac syndrome characterized by extensive, but potentially reversible, left ventricular dysfunction in the absence of an explanatory coronary obstruction. Thus, TCM is distinct from coronary artery disease (CAD) and acute myocardial infarction (AMI). However, substantial evidence for co-existing CAD in some TCM patients exist. Herein, we take this associa-tion one step further and present a case in which the patient simultaneously suffered from AMI and TCM, and in which we believe that a primary coronary event triggered TCM. An 88-year-old female presented with chest pain. Echocardiography revealed apical akinesia with hypercontractile bases. An occluded diagonal branch with suspected acute plaque rupture was identified on the angiogram, but could not explain the extent of akinesia. Cardiac function recovered completely. Thus, this patient adhered to current diagnostic criteria for TCM. TCM is a well-known complication for other conditions associated with somatic stress. It is therefore intuitive to assume that AMI, which also associates with somatic stress and elevated catecholamine, can cause TCM. Our case illustrates that TCM and AMI may occur simulta-neously. Although causality cannot be conclusively inferred from this association, the somatic stress associated with AMI may have caused TCM in this patient.

  7. Guillain-Barre Syndrome Presenting as Acute Abdomen

    Directory of Open Access Journals (Sweden)

    Faruk incecik

    2015-09-01

    Full Text Available Guillain-Barr and eacute; syndrome (GBS is the most common cause of acute flaccid paralysis in childhood. Symmetric weakness, headache, respiratory symptom, neuropathic pain, muscle pain, paresthesia, and facial palsy were the most common clinical presentations. We report 13-year-old boy with GBS who presented with acute abdominal pain. This is the first report, to our knowledge, first presented of acute abdomen of a pediatric patient with GBS. [Cukurova Med J 2015; 40(3.000: 601-603

  8. [Acute compartment syndrome following snake bite].

    Science.gov (United States)

    Wagner, H E; Barbier, P; Frey, H P; Janggen, F M; Rothen, H U

    1986-04-01

    The experience with snake bites, causing local complications is discussed. Whenever systemic envenomation occurs, antivenin is the treatment of choice. Tissue necroses are treated by early debridement and a possible closed compartment syndrome demands the open fasciotomy.

  9. ACUTE RESPIRATORY DISTRESS SYNDROME DAN ACUTE PNEUMONIA PADA NEAR DROWNING:SEBUAH LAPORAN KASUS

    Directory of Open Access Journals (Sweden)

    Michelle Prinka Adyana

    2014-02-01

    Full Text Available Near drowning is a condition in which the victim survived the first 24 hours. The WorldHealth Organization (WHO , recorded worldwide in 2000 there were 400,000 incidentdrowned accidentally . That is, this figure ranks second only to traffic accidents.Aspiration pneumonia is a complication of near drwoning which occurred in 80 % ofcases of near drowning, while 50 % of patients sink into acute respiratory distresssyndrome ( ARDS . This case report discusses the acute respiratory distress syndromeand acute pneumonia in near drowning 24 years old , who had drowned at the beach for± 15 minutes , the chest x - ray obtained pulmonary edema dd / lung pnuemonia therepneuomothorax . Examination of multislice spiral computed tomography ( MSCT bilateral pneumothorax Thorax obtained major and minor fisuura right and left majorfissure , pneumomediastinum , pulmonary pneumonia contusio / suspected aspirationpneumonia , emphysema subcutis . In intensive care patients conducted for 9 days andreturn to akitivitas everyday

  10. Coronary CT angiography for acute chest pain triage: Techniques for radiation exposure reduction; 128 vs. 64 multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Goitein, Orly; Eshet, Yael; Konen, Eli (Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel Aviv Univ., Tel Aviv (Israel)), email: orly.goitein@sheba.health.gov.il; Matetzky, Shlomi (Heart Inst., Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel Aviv Univ., Tel Aviv (Israel)); Goitein, David (Surgery C, Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel Aviv Univ., Tel Aviv (Israel)); Hamdan, Ashraf; Di Segni, Elio (Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel Aviv Univ., Tel Aviv (Israel); Heart Inst., Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel Aviv Univ., Tel Aviv (Israel))

    2011-10-15

    Background. Coronary CT angiography (CCTA) is used daily in acute chest pain triage, although exposing patients to significant radiation dosage. CCTA using prospective ECG gating (PG CCTA) enables significant radiation reduction Purpose. To determine whether the routine use of 128 vs. 64 multidetector CT (MDCT) can increase the proportion of patients scanned using PG CCTA technique, lowering radiation exposure, without decreasing image quality. Material and Methods. The study comprised 232 patients, 116 consecutive patients scanned using 128 MDCT (mean age 49 years, 79 men, BMI 28) and 116 consecutive patients (mean age 50 years, 75 men, BMI 28) which were scanned using 64 MDCT. PG CCTA was performed whenever technically permissible by each type of scanner: 64 MDCT = stable heart rate (HR) <60/min and weight <110 kg; 128 MDCT = stable HR < 70/min and weight <140 kg. All coronary segments were evaluated for image quality using a visual scale of 1-5. An estimated radiation dose was recorded. Results. PC CCTA was performed in 84% and 49% of the 128 and 64 MDCT groups, respectively (P < 0.0001). Average image quality score were 4.6 +- 0.3 and 4.7 +- 0.1 for the 128 and 64 MDCT, respectively (P = 0.08). The mean radiation dose exposure was 6.2 +- 4.8 mSv and 10.4 +- 7.5 mSv for the 128 and 64 MDCT, respectively (P = 0.008). Conclusion. The 128 MDCT scanner enables utilization of PG CCTA technique in a greater proportion of patients, thereby decreasing the related radiation significantly, without hampering image quality

  11. Decitabine in Treating Patients With Myelodysplastic Syndromes or Acute Myeloid Leukemia

    Science.gov (United States)

    2013-09-27

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Atypical Chronic Myeloid Leukemia, BCR-ABL1 Negative; de Novo Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndromes; Untreated Adult Acute Myeloid Leukemia

  12. [Rhabdomyolysis with acute renal failure and malignant neuroleptic syndrome].

    Science.gov (United States)

    Kleinknecht, D; Parent, A; Blot, P; Bochereau, G; Lallement, P Y; Pourriat, J L

    1982-01-01

    Seven episodes of rhabdomyolysis with acute renal failure (ARF) have been observed in 6 patients treated with various short-acting tranquilizers and antidepressants. Clinical features usually included severe hyperthermia, diffuse hypertonicity with or without coma, circulatory failure or unstable blood pressure, and often acute respiratory failure. Serum CPK were always elevated. The type of ARF was prerenal failure without oliguria in 5/7 episodes, and acute tubular necrosis in 2/7 episodes, requiring hemodialyses in one patient. Three patients died. In any case, the tranquilizers and antidepressants responsible for this syndrome were stopped, and electrolyte disorders and acidosis were corrected. Associated acute circulatory failure, septicemia and/or acute hepatic failure required prompt therapy, and artificial ventilation was required in 4 instances. The further use of phenothiazines, butyrophenones, sulpiride and their derivatives should be avoided in any patient having developed such an accident, whose pathophysiology is similar to that described in malignant hyperthermia of various origin.

  13. SYNDROME X IN ACUTE CORONARY SYNDROME PATIENTS- A TERTIARY CARE CENTER STUDY

    Directory of Open Access Journals (Sweden)

    Yogendra

    2015-12-01

    Full Text Available Metabolic Syndrome (MS or insulin resistance syndrome is commonly defined as a group of risk factors or abnormalities associated with insulin resistance that markedly increased risk for both coronary heart disease and diabetes. Cardiovascular disease and all-cause mortality, even in the absence of baseline CVD and diabetes. Early identification, treatment and prevention of the metabolic syndrome present a major challenge for health care professionals facing an epidemic of overweight and sedentary lifestyle. AIMS AND OBJECTIVES To study the prevalence of metabolic syndrome in pts. with Acute Coronary Syndrome (ACS and its effect on hospital outcomes. MATERIALS AND METHODS Observational study in 55 cases (28 cases and 27 controls was conducted in Dr. BRAMH, Raipur and each patient was assessed with detailed clinical history and was also assessed for parameters of MS. The cases and controls were also followed up during their hospital stay for the presence of or development of heart failure, arrhythmias, shock and death. Chi square and ‘t’ test were used to analyse obtained data. RESULTS AND CONCLUSIONS In the present study sex ratio amongst the cases was (M:F 1.15:1 and 2.6:1 in controls. Maximum patients were between the ages of 50-60. Non-ST elevation MI was more common in patients with metabolic syndrome and they presented late to the hospital for treatment. Hypertension and fasting hyperglycemia are the most prevalent components of metabolic syndrome in patients of acute coronary syndrome. Our Study also suggests that hypertriglyceridemia is the most common lipid abnormality in patients of acute coronary syndrome. An increase in the incidence of heart failure was observed in patients with metabolic syndrome Cardiogenic shock is seen with increased frequency in patients with metabolic syndrome. Case fatalities were seen with equal frequency in both the groups, hence metabolic syndrome is not associated with increased case fatality while

  14. Acute calcifying tendonitis--an unusual cause of carpal tunnel syndrome.

    Science.gov (United States)

    Din, R; Giannikas, K; El-Hadidi, M

    2001-03-01

    We report a rare case of acute calcifying tendinitis resulting in acute carpal tunnel syndrome. Acute medical staff should be aware of this condition and the importance of early referral to avoid long term median nerve neuropathy.

  15. Severe Acute Respiratory Syndrome (SARS) Prevention in Taiwan

    Science.gov (United States)

    Liu, Hsueh-Erh

    2004-01-01

    Severe Acute Respiratory Syndrome (SARS) is a newly identified respiratory disease that threatened Taiwan between April 14 and July 5, 2003. Chang Gung University experienced various SARS-related episodes, such as the postponement of classes for 7 days, the reporting of probable SARS cases, and the isolation of students under Level A and B…

  16. [Acute coronary syndrome in women below 60 years of age

    NARCIS (Netherlands)

    Maas, A.H.E.M.; Lagro-Janssen, T.; Boer, M.J. de

    2011-01-01

    Women below 60 years of age with acute coronary syndrome (ACS) have higher in-hospital and 1-year mortality rates than similarly aged men, despite the lower prevalence of obstructive coronary artery disease. When ACS occurs, gender differences in symptom presentation result in later recognition by

  17. The severe acute respiratory syndrome epidemic in mainland China dissected

    NARCIS (Netherlands)

    W.C. Cao (Wu Chun); S.J. de Vlas (Sake); J.H. Richardus (Jan Hendrik)

    2011-01-01

    textabstractThis paper provides a review of a recently published series of studies that give a detailed and comprehensive documentation of the severe acute respiratory syndrome (SARS) epidemic in mainland China, which severely struck the country in the spring of 2003. The epidemic spanned a large ge

  18. Apixaban with antiplatelet therapy after acute coronary syndrome

    NARCIS (Netherlands)

    Alexander, J.H.; Lopes, R.D.; James, S.; Kilaru, R.; He, Y.; Mohan, P.; Bhatt, D.L.; Goodman, S.; Verheugt, F.W.A.; Flather, M.; Huber, K.; Liaw, D.; Husted, S.E.; Lopez-Sendon, J.; Caterina, R. de; Jansky, P.; Darius, H.; Vinereanu, D.; Cornel, J.H.; Cools, F.; Atar, D.; Leiva-Pons, J.L.; Keltai, M.; Ogawa, H.; Pais, P.; Parkhomenko, A.; Ruzyllo, W.; Diaz, R.; White, H.; Ruda, M.; Geraldes, M.; Lawrence, J.; Harrington, R.A.; Wallentin, L.

    2011-01-01

    BACKGROUND: Apixaban, an oral, direct factor Xa inhibitor, may reduce the risk of recurrent ischemic events when added to antiplatelet therapy after an acute coronary syndrome. METHODS: We conducted a randomized, double-blind, placebo-controlled clinical trial comparing apixaban, at a dose of 5 mg t

  19. Platelets and white blood cells in acute coronary syndromes

    NARCIS (Netherlands)

    Smit, Jaap Jan Johannes

    2008-01-01

    In this thesis, we have studied the role of leukocytes and platelets as methods to measure platelets aggregation, in the clinical management of presenting with acute coronary syndromes. We have tried to incidence and to identify predictors of adverse cardiac events with function tests or inflammator

  20. Acute lymphoblastic leukemia in children with Down syndrome

    DEFF Research Database (Denmark)

    Buitenkamp, Trudy D; Izraeli, Shai; Zimmermann, Martin

    2014-01-01

    Children with Down syndrome (DS) have an increased risk of B-cell precursor (BCP) acute lymphoblastic leukemia (ALL). The prognostic factors and outcome of DS-ALL patients treated in contemporary protocols are uncertain. We studied 653 DS-ALL patients enrolled in 16 international trials from 1995...

  1. Overview of emerging pharmacologic agents for acute heart failure syndromes

    NARCIS (Netherlands)

    De Luca, Leonardo; Mebazaa, Alexandre; Filippatos, Gerasimos; Parissis, John T.; Bohm, Michael; Voors, Adriaan A.; Nieminen, Markku; Zannad, Faiez; Rhodes, Andrew; El-Banayosy, Ali; Dickstein, Kenneth; Gheorghiade, Mihai

    2008-01-01

    Background: Several therapies commonly used for the treatment of acute heart failure syndromes (AHFS) present some well-known limitations and have been associated with an early increase in the risk of death. There is, therefore, an unmet need for new pharmacologic agents for the early management of

  2. Blastomyces gilchristii as Cause of Fatal Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Dalcin, Daniel; Rothstein, Aaron; Spinato, Joanna; Escott, Nicholas; Kus, Julianne V

    2016-02-01

    Since the 2013 description of Blastomyces gilchristii, research describing the virulence or clinical outcome of B. gilchristii infection has been lacking. We report molecular evidence of B. gilchristii as an etiologic agent of fatal acute respiratory distress syndrome. B. gilchristii infection was confirmed by PCR and sequence analysis.

  3. Apixaban with antiplatelet therapy after acute coronary syndrome

    NARCIS (Netherlands)

    Alexander, J.H.; Lopes, R.D.; James, S.; Kilaru, R.; He, Y.; Mohan, P.; Bhatt, D.L.; Goodman, S.; Verheugt, F.W.A.; Flather, M.; Huber, K.; Liaw, D.; Husted, S.E.; Lopez-Sendon, J.; Caterina, R. de; Jansky, P.; Darius, H.; Vinereanu, D.; Cornel, J.H.; Cools, F.; Atar, D.; Leiva-Pons, J.L.; Keltai, M.; Ogawa, H.; Pais, P.; Parkhomenko, A.; Ruzyllo, W.; Diaz, R.; White, H.; Ruda, M.; Geraldes, M.; Lawrence, J.; Harrington, R.A.; Wallentin, L.

    2011-01-01

    BACKGROUND: Apixaban, an oral, direct factor Xa inhibitor, may reduce the risk of recurrent ischemic events when added to antiplatelet therapy after an acute coronary syndrome. METHODS: We conducted a randomized, double-blind, placebo-controlled clinical trial comparing apixaban, at a dose of 5 mg

  4. Assessment of Malpractice Claims Associated With Acute Compartment Syndrome.

    Science.gov (United States)

    DePasse, John Mason; Sargent, Rachel; Fantry, Amanda J; Bokshan, Steven L; Palumbo, Mark A; Daniels, Alan H

    2017-06-01

    Because acute compartment syndrome is one of the few limb-threatening and life-threatening orthopaedic conditions and is difficult to diagnose, it is a frequent source of litigation. Understanding the factors that lead to plaintiff verdicts and higher indemnity payments may improve patient care by identifying common pitfalls. The VerdictSearch legal claims database was queried for the term "compartment syndrome." After 46 cases were excluded for missing information or irrelevancy, 139 cases were reviewed. The effects of plaintiff demographics, mechanism of injury, and complications were assessed. Of 139 cases, 37 (27%) were settled, 69 (50%) resulted in a defendant ruling, and 33 (24%) resulted in a plaintiff ruling. Juries were more likely to rule in favor of juvenile plaintiffs than adult patients (P = 0.002) and female plaintiffs than male plaintiffs (P = 0.008), but indemnity payments were not affected by the age or sex of the plaintiff. Plaintiffs who experienced acute compartment syndrome as a complication of surgery were more likely to win their suit and receive higher awards (P compartment syndrome if the patient was a woman or child or if acute compartment syndrome developed as a complication of a surgical procedure.

  5. Elucidating the molecular physiopathology of acute respiratory distress syndrome in severe acute respiratory syndrome patients.

    Science.gov (United States)

    Kong, Say Li; Chui, Paul; Lim, Bing; Salto-Tellez, Manuel

    2009-11-01

    Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury. It is a response to various diseases of variable etiology, including SARS-CoV infection. To date, a comprehensive study of the genomic physiopathology of ARDS (and SARS) is lacking, primarily due to the difficulty of finding suitable materials to study the disease process at a tissue level (instead of blood, sputa or swaps). Hereby we attempt to provide such study by analyzing autopsy lung samples from patient who died of SARS and showed different degrees of severity of the pulmonary involvement. We performed real-time quantitative PCR analysis of 107 genes with functional roles in inflammation, coagulation, fibrosis and apoptosis; some key genes were confirmed at a protein expression level by immunohistochemistry and correlated to the degree of morphological severity present in the individual samples analyzed. Significant expression levels were identified for ANPEP (a receptor for CoV), as well as inhibition of the STAT1 pathway, IFNs production and CXCL10 (a T-cell recruiter). Other genes unassociated to date with ARDS/SARS include C1Qb, C5R1, CASP3, CASP9, CD14, CD68, FGF7, HLA-DRA, IGF1, IRF3, MALAT-1, MSR1, NFIL3, SLPI, USP33, CLC, GBP1 and TAC1. As a result, we proposed to therapeutically target some of these genes with compounds such as ANPEP inhibitors, SLPI and dexamethasone. Ultimately, this study may serve as a model for future, tissue-based analyses of fibroinflammatory conditions affecting the lung.

  6. Acute Aortic Syndromes: Update in Current Medical Management.

    Science.gov (United States)

    Morris, Jacqueline H; Mix, Doran; Cameron, Scott J

    2017-04-01

    Advances in medical therapy and non-surgical percutaneous options to manage the specter of acute aortic syndromes have improved both patient morbidity and mortality. There are key features in the patient history and initial exam which physicians should be attuned to in order to diagnose acute aortic syndromes such as aortic dissection, penetrating aortic ulcer, and intramural hematoma. Once recognized, early initiation of the appropriate pharmacologic therapy is important, and further appreciating the limitations of such therapy before considering a surgical approach is critical to improve patient outcomes. For the undifferentiated patient with acute aortic dissection presenting to facilities who do not routinely manage this condition, adding pharmacologic agents in the correct sequence assures the best chance for a satisfactory outcome.

  7. [Prevalence of metabolic syndrome and its components in patients with acute coronary syndrome].

    Science.gov (United States)

    Jover, Ana; Corbella, Emili; Muñoz, Anna; Millán, Jesús; Pintó, Xavier; Mangas, Alipio; Zúñiga, Manuel; Pedro-Botet, Juan; Hernández-Mijares, Antonio

    2011-07-01

    A large proportion of patients with coronary disease have metabolic syndrome, although the frequency and association of its different components are not well understood. The aim of this study was to determine the prevalence of metabolic syndrome and the combination of its components in a Spanish cohort of patients with acute coronary syndrome. Clinical histories of 574 inpatients with acute coronary syndrome in 6 tertiary hospitals were reviewed and the presence of metabolic syndrome and its components determined by applying Adult Treatment Panel III criteria. In a second step, the components of the metabolic syndrome were analyzed, excluding those patients with diabetes mellitus. The metabolic syndrome was present in 50.9% of patients and was more frequent in women than in men (66.3% vs. 47.3%; P<.001). The most prevalent component was carbohydrate metabolism disorder (85.3%), followed by low high-density lipoprotein cholesterol (HDLc) levels (80.5%). In nondiabetic patients, 34.6% had metabolic syndrome and the most prevalent component was low HDLc levels (86%), followed by high blood pressure and hypertriglyceridemia and, in fourth place, impaired fasting serum glucose levels. The metabolic syndrome has a high prevalence in patients with an acute coronary syndrome, especially in women. The most frequent components are hyperglycemia and low HDLc levels. After excluding diabetic patients, the most prevalent diagnostic criterion of metabolic syndrome was low HDLc levels. Full English text available from: www.revespcardiol.org. Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  8. Acute lung injury and the acute respiratory distress syndrome in the injured patient

    Directory of Open Access Journals (Sweden)

    Bakowitz Magdalena

    2012-08-01

    Full Text Available Abstract Acute lung injury and acute respiratory distress syndrome are clinical entities of multi-factorial origin frequently seen in traumatically injured patients requiring intensive care. We performed an unsystematic search using PubMed and the Cochrane Database of Systematic Reviews up to January 2012. The purpose of this article is to review recent evidence for the pathophysiology and the management of acute lung injury/acute respiratory distress syndrome in the critically injured patient. Lung protective ventilation remains the most beneficial therapy. Future trials should compare intervention groups to controls receiving lung protective ventilation, and focus on relevant outcome measures such as duration of mechanical ventilation, length of intensive care unit stay, and mortality.

  9. The role of levosimendan in acute heart failure complicating acute coronary syndrome

    DEFF Research Database (Denmark)

    Nieminen, Markku S; Buerke, Michael; Cohen-Solál, Alain

    2016-01-01

    Acute heart failure and/or cardiogenic shock are frequently triggered by ischemic coronary events. Yet, there is a paucity of randomized data on the management of patients with heart failure complicating acute coronary syndrome, as acute coronary syndrome and cardiogenic shock have frequently been...... defined as exclusion criteria in trials and registries. As a consequence, guideline recommendations are mostly driven by observational studies, even though these patients have a particularly poor prognosis compared to heart failure patients without signs of coronary artery disease. In acute heart failure......, and especially in cardiogenic shock related to ischemic conditions, vasopressors and inotropes are used. However, both pathophysiological considerations and available clinical data suggest that these treatments may have disadvantageous effects. The inodilator levosimendan offers potential benefits due to a range...

  10. Patients ≥ 75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome

    Science.gov (United States)

    Wong, Vincent; Farah, Ahmed; von Korn, Hubertus; Memisevic, Nedim; Richter, Stefan; Tukhiashvili, Ketevan; Lauer, Bernward; Ohlow, Marc-Alexander

    2015-01-01

    Objective Absence of significant epicardial coronary artery disease (CAD) in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to analyse the clinical characteristics and outcome of such patients with advanced age. Methods We retrospectively analysed 4,311 patients with acute onset of chest pain plus necrosis marker elevation. Two hundred and seventy two patients without CAD on angiogram (6.3%) were identified. Out of them, 50 (1.2%) patients ≥ 75 years (Group I) were compared with (1) 222 acute coronary syndrome (ACS) patients without CAD on angiogram angina, and re-hospitalisation) was more frequent in Group I and II patients compared to Group III patients (64.9%, 66.7%, and 41.6%, respectively; P < 0.0001). Conclusions ACS in patients ≥ 75 years without CAD is very infrequent, associated with a (1) similar outcome compared to ACS patients < 75 years without CAD, and (2) significant better outcome compared to NSTEMI patients ≥ 75 years. PMID:25678899

  11. Heyde syndrome in a 71-year-old man who underwent chest radiotherapy at young age

    Directory of Open Access Journals (Sweden)

    V.M. Santos

    2013-08-01

    Full Text Available We report the case of a 71-year-old man with diagnosis of aortic valve stenosis for ten years, who came to hospital because of breathlessness during the previous two months and recent low intestinal hemorrhage. On admission, laboratory tests and upper gastrointestinal endoscopy and colonoscopy revealed anemia and bleeding cecal angiodysplasia. The echocardiography study showed a severe aortic stenosis. Classical Heyde syndrome is described as the association of aortic stenosis, bleeding gastrointestinal angiodysplasia and secondary anemia. The antecedent of mediastinal radiotherapy for treatment of Hodgkin´s disease during his youth, and eventual late cardiac adverse effects that may include aortic or mitral valve disturbances are highlighted. Electrocoagulation with argonium was performed on the sites of active bleeding during the colonoscopy. In sequence, surgical replacement by bioprothesis was done on the aortic valve. The patient remains asymptomatic, under long-term outpatient surveillance, with normal control evaluations. The aim of this case study is to emphasize difficulties related to diagnosis, and to highlight the role of endoscopy and imaging studies to confirm a hypothesis of this underestimated condition.

  12. Acute radiation syndrome caused by accidental radiation exposure - therapeutic principles

    Directory of Open Access Journals (Sweden)

    Dörr Harald

    2011-11-01

    Full Text Available Abstract Fortunately radiation accidents are infrequent occurrences, but since they have the potential of large scale events like the nuclear accidents of Chernobyl and Fukushima, preparatory planning of the medical management of radiation accident victims is very important. Radiation accidents can result in different types of radiation exposure for which the diagnostic and therapeutic measures, as well as the outcomes, differ. The clinical course of acute radiation syndrome depends on the absorbed radiation dose and its distribution. Multi-organ-involvement and multi-organ-failure need be taken into account. The most vulnerable organ system to radiation exposure is the hematopoietic system. In addition to hematopoietic syndrome, radiation induced damage to the skin plays an important role in diagnostics and the treatment of radiation accident victims. The most important therapeutic principles with special reference to hematopoietic syndrome and cutaneous radiation syndrome are reviewed.

  13. Prone position in patients with acute respiratory distress syndrome

    Science.gov (United States)

    Setten, Mariano; Plotnikow, Gustavo Adrián; Accoce, Matías

    2016-01-01

    Acute respiratory distress syndrome occupies a great deal of attention in intensive care units. Despite ample knowledge of the physiopathology of this syndrome, the focus in intensive care units consists mostly of life-supporting treatment and avoidance of the side effects of invasive treatments. Although great advances in mechanical ventilation have occurred in the past 20 years, with a significant impact on mortality, the incidence continues to be high. Patients with acute respiratory distress syndrome, especially the most severe cases, often present with refractory hypoxemia due to shunt, which can require additional treatments beyond mechanical ventilation, among which is mechanical ventilation in the prone position. This method, first recommended to improve oxygenation in 1974, can be easily implemented in any intensive care unit with trained personnel. Prone position has extremely robust bibliographic support. Various randomized clinical studies have demonstrated the effect of prone decubitus on the oxygenation of patients with acute respiratory distress syndrome measured in terms of the PaO2/FiO2 ratio, including its effects on increasing patient survival. The members of the Respiratory Therapists Committee of the Sociedad Argentina de Terapia Intensiva performed a narrative review with the objective of discovering the available evidence related to the implementation of prone position, changes produced in the respiratory system due to the application of this maneuver, and its impact on mortality. Finally, guidelines are suggested for decision-making. PMID:27925054

  14. [Hepatic retransplant and acute Budd Chiari syndrome. Case report].

    Science.gov (United States)

    Savio-López, Andrés M; Lara-Molina, Evelin E; Soliva-Domínguez, Ramón; Capo-Jorge, José A; Gala-López, Boris; González-Castillo, Fernando

    2005-01-01

    Hepatic retransplant constitutes 10-20% of all orthotopic hepatic transplants. The piggy-back technique was used in hepatectomy with conservation of the retrohepatic vena cava. A side-to-side cavo-cavostomy technique is described in the case of hepatic congestion or acute Budd Chiari syndrome post-transplant. This is an extremely serious condition and can result in death. We present the first case of hepatic retransplant performed in Hospital Hermanos Ameijeiras in a patient who received who received his first transplant due to non-resectable hepatocarcinoma and who required retransplant due to acute rejection and graft dysfunction. During retransplant, the Belghiti side-to-side anastomosis technique was used to resolve the acute Budd Chiari syndrome that presented itself. Post-surgical evolution at 18 months was satisfactory without evidence of complications of the graft. Acute Budd Chiari syndrome post-transplant can satisfactorily be resolved with the Belghiti technique, although it is preferable to take prophylactic measures to avoid it.

  15. Treosulfan, Fludarabine Phosphate, and Total-Body Irradiation Before Donor Stem Cell Transplant in Treating Patients With High-Risk Acute Myeloid Leukemia, Myelodysplastic Syndrome, Acute Lymphoblastic Leukemia

    Science.gov (United States)

    2013-10-29

    Accelerated Phase Chronic Myelogenous Leukemia; Adult Acute Lymphoblastic Leukemia in Remission; Adult Acute Myeloid Leukemia in Remission; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Blastic Phase Chronic Myelogenous Leukemia; Childhood Acute Lymphoblastic Leukemia in Remission; Childhood Acute Myeloid Leukemia in Remission; Childhood Chronic Myelogenous Leukemia; Childhood Myelodysplastic Syndromes; Chronic Myelomonocytic Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Secondary Myelodysplastic Syndromes; Untreated Adult Acute Lymphoblastic Leukemia; Untreated Childhood Acute Lymphoblastic Leukemia

  16. Characteristics of pulmonary cysts in Birt-Hogg-Dube syndrome: Thin-section CT findings of the chest in 12 patients

    Energy Technology Data Exchange (ETDEWEB)

    Tobino, Kazunori, E-mail: tobino@juntendo.ac.jp [Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421 (Japan); Gunji, Yoko [Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421 (Japan); Kurihara, Masatoshi [Pneumothorax Center, Nissan Tamagawa Hospital, 4-8-1 Seta, Setagaya-Ku, Tokyo 158-0095 (Japan); The Study Group of Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-Ku, Tokyo 158-0095 (Japan); Kunogi, Makiko; Koike, Kengo [Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421 (Japan); Tomiyama, Noriyuki [Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 (Japan); Johkoh, Takeshi [Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Kurumazuka 3-1, Itami, Hyogo 664-0872 (Japan); Kodama, Yuzo [Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421 (Japan); Iwakami, Shin-ichiro [Department of Respiratory Medicine, Juntendo University, Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka 410-2295 (Japan); Kikkawa, Mika [Biochemical Research Center, Division of Proteomics and Biomolecular Sciences, Juntendo University, Graduate School of Medicine, Bunkyo-Ku, Tokyo (Japan); Takahashi, Kazuhisa [Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421 (Japan); Seyama, Kuniaki [Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421 (Japan); Study Group of Pneumothorax and Cystic Lung Diseases, 4-8-1 Seta, Setagaya-Ku, Tokyo 158-0095 (Japan)

    2011-03-15

    Purpose: To describe in detail the characteristic chest computed tomography (CT) findings of Birt-Hogg-Dube (BHD) syndrome. Materials and methods: Thin-section chest CT scans of consecutive 12 patients with genetically diagnosed BHD syndrome were retrospectively evaluated by two observers, especially about the characteristics (distribution, number, size, shape and relation to pleura) of pulmonary cysts. Interobserver agreement in the identification of abnormalities on the CT images was achieved using the {kappa} statistic, and the degree of interobserver correlation for the characterization of pulmonary cysts was assessed using the Spearman rank correlation coefficient. Results: Multiple pulmonary cysts were seen in all patients. The number of cysts in each patient was various (range, 29-407), and cysts of various sizes (from a few mm to 2 cm or more) were seen in all patient. 76.6% (mean) of cysts were irregular-shaped, and 40.5% (mean) of cysts were located along the pleura. The mean extent score of cysts was 13% of the whole lung, and the distribution of cysts was predominantly in the lower medial zone. Finally, cysts abutting or including the proximal portions of lower pulmonary arteries or veins were also seen in all patients. Conclusion: Multiple, irregular-shaped cysts of various sizes with lower medial lung zone predominance are characteristic CT findings of BHD syndrome. Cysts abutting or including the proximal portions of lower pulmonary arteries or veins may also exist in this syndrome in a high probability.

  17. Thin-section chest CT findings of primary Sjoegren's syndrome: correlation with pulmonary function

    Energy Technology Data Exchange (ETDEWEB)

    Taouli, Bachir; Mourey, Isabelle [Department of Radiology, Universite Pierre et Marie Curie, Paris (France); Brauner, Michel W.; Lemouchi, Djamel [Department of Radiology, Universite Paris XIII, Bobigny (France); Grenier, Philippe A. [Department of Radiology, Universite Pierre et Marie Curie, Paris (France); Institut National de la Sante et de la Recherche Medicale, Universite Pierre et Marie Curie, Paris (France)

    2002-06-01

    The purpose of this study was to describe thin-section CT findings of lung involvement in patients with primary Sjoegren's syndrome (PSS), and to correlate them with pulmonary function tests (PFT). The chest thin-section CT examinations of 35 patients with proven diagnosis of PSS and respiratory symptoms were retrospectively assessed by two observers, in a first step independently with interobserver evaluation, and in a second step in consensus. The extent of the most frequent CT findings was scored. Correlation was made with PFT in 31 of these patients. Three main CT patterns were identified with good interobserver agreement (kappa coefficient 0.71): 19 of 35 (54%) large and/or small airways disease; 7 of 35 (20%) interstitial lung fibrosis (ILF); and 5 of 35 (14%) suggestive of lymphocytic interstitial pneumonia (LIP). The CT scans were normal in 2 patients (6%) and showed only dilatation of pulmonary vessels due to pulmonary arterial hypertension in two others (6%). Airway disease patients had predominantly obstructive profiles (mean FEV{sub 1}/FVC ratio 69.7{+-}12.7%, mean MEF{sub 25} 50.1{+-}22.9%), whereas patients with ILF and LIP had predominantly restrictive profiles and/or a decreased diffusing lung capacity (mean TLC 87.0{+-}26.0 and 64.6{+-}18.6%, mean DL{sub CO} 57.4{+-}21.2 and 52.0{+-}8.0%). Significant correlation (p<0.01) was found between the scores of ground-glass attenuation and TLC (r=-0.84) and DL{sub CO} (r=-0.70) and between the score of air trapping and FEV1 (r=-1.0). In patients with PSS and respiratory symptoms, thin-section CT may provide characterization of lung involvement which correlates with pulmonary function. (orig.)

  18. Black esophagus: Acute esophageal necrosis syndrome

    Institute of Scientific and Technical Information of China (English)

    Grigoriy; E; Gurvits

    2010-01-01

    Acute esophageal necrosis (AEN), commonly referred to as "black esophagus", is a rare clinical entity arising from a combination of ischemic insult seen in hemodynamic compromise and low-flow states, corrosive injury from gastric contents in the setting of esophago-gastroparesis and gastric outlet obstruction, and decreased function of mucosal barrier systems and reparative mechanisms present in malnourished and debilitated physical states. AEN may arise in the setting of multiorgan dysfunction, hypoperfusi...

  19. Donor Umbilical Cord Blood Transplant With or Without Ex-vivo Expanded Cord Blood Progenitor Cells in Treating Patients With Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, Chronic Myelogenous Leukemia, or Myelodysplastic Syndromes

    Science.gov (United States)

    2017-09-14

    Acute Biphenotypic Leukemia; Acute Erythroid Leukemia; Acute Lymphoblastic Leukemia in Remission; Acute Megakaryoblastic Leukemia; Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome; Acute Myeloid Leukemia in Remission; Blasts Under 10 Percent of Bone Marrow Nucleated Cells; Chronic Myelogenous Leukemia, BCR-ABL1 Positive; Mixed Phenotype Acute Leukemia; Myelodysplastic Syndrome; Myelodysplastic Syndrome With Excess Blasts; Pancytopenia; Refractory Anemia; Secondary Acute Myeloid Leukemia

  20. Human Rabies with Initial Manifestations that Mimic Acute Brachial Neuritis and Guillain-Barré Syndrome.

    Science.gov (United States)

    Mader, Edward C; Maury, Joaquin S; Santana-Gould, Lenay; Craver, Randall D; El-Abassi, Rima; Segura-Palacios, Enrique; Sumner, Austin J

    2012-01-01

    Human rabies can be overlooked in places where this disease is now rare. Its diagnosis is further confused by a negative history of exposure (cryptogenic rabies), by a Guillain-Barré syndrome (GBS) type of presentation, or by symptoms indicating another diagnosis, eg, acute brachial neuritis (ABN). A 19-year-old Mexican, with no past health problems, presented with a two-day history of left shoulder, arm, and chest pain. He arrived in Louisiana from Mexico five days prior to admission. Of particular importance is the absence of a history of rabies exposure and immunization. On admission, the patient had quadriparesis, areflexia, and elevated protein in the cerebrospinal fluid, prompting a diagnosis of GBS. However, emerging neurological deficits pointed towards acute encephalitis. Rabies was suspected on hospital day 11 after common causes of encephalitis (eg, arboviruses) have been excluded. The patient tested positive for rabies IgM and IgG. He died 17 days after admission. Negri bodies were detected in the patient's brain and rabies virus antigen typing identified the vampire bat as the source of infection. Rabies should be suspected in every patient with a rapidly evolving GBS-like illness-even if there is no history of exposure and no evidence of encephalitis on presentation. The patient's ABN-like symptoms may be equivalent to the pain experienced by rabies victims near the inoculation site.

  1. Estimating the incidence of the acute coronary syndrome

    DEFF Research Database (Denmark)

    Nielsen, Kirsten M.; Foldspang, Anders; Larsen, Mogens L.

    2007-01-01

    of identification and control of the cohort under observation, (iii) inconsistencies in the use of diagnostic criteria, and (iv) missing data. We aimed to measure directly the incidence of the entire spectrum of the acute coronary syndrome (ACS), consisting of unstable angina pectoris, MI and sudden cardiac death......BACKGROUND: Estimates of incidence are crucial to the planning of public health measures, but most studies of incidence of, for example, acute myocardial infarction (MI) are troubled by methodological problems such as; (i) selection biases of the patients being included for study, (ii) lack...

  2. Early Treatment of Severe Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Przybysz, Thomas M; Heffner, Alan C

    2016-02-01

    Acute respiratory distress syndrome (ARDS) is defined by acute diffuse inflammatory lung injury invoked by a variety of systemic or pulmonary insults. Despite medical progress in management, mortality remains 27% to 45%. Patients with ARDS should be managed with low tidal volume ventilation. Permissive hypercapnea is well tolerated. Conservative fluid strategy can reduce ventilator and hospital days in patients without shock. Prone positioning and neuromuscular blockers reduce mortality in some patients. Early management of ARDS is relevant to emergency medicine. Identifying ARDS patients who should be transferred to an extracorporeal membrane oxygenation center is an important task for emergency providers.

  3. Acute Respiratory Distress Syndrome Complicating Strongyloides stercoralis Hyperinfection

    Directory of Open Access Journals (Sweden)

    Ming-Ju Tsai

    2011-03-01

    Full Text Available Strongyloidiasis is endemic in tropic and subtropic areas, but is currently seldom encountered in developed area like Taiwan. We present an elder man with acute respiratory distress syndrome complicating Strongyloides stercoralis hyperinfection. There was no significant clue initially for diagnosing this patient as having S. stercoralis hyperinfection. Neither peripheral eosinophilia nor significant hemoptysis was noted. Bronchoscopy played a critical role to define the unexpected cause of his progressive pulmonary infiltrates. The correct diagnosis was soon made by recognition of the worm in bronchioloalveolar lavage cytology, and specific treatment was initiated promptly. For a septic patient with progressive pulmonary infiltrates, bronchoscopic studies including cytology may be necessary for defining the cause. Hyperinfection strongyloidiasis should be considered as a cause of acute respiratory distress syndrome in immunocompromised patient, especially with the presence of chronic gastrointestinal symptoms.

  4. Acute Compartment Syndrome of the Limbs: Current Concepts and Management

    Science.gov (United States)

    Mabvuure, Nigel Tapiwa; Malahias, Marco; Hindocha, Sandip; Khan, Wasim; Juma, Ali

    2012-01-01

    Acute compartment syndrome (ACS) of the limb refers to a constellation of symptoms, which occur following a rise in the pressure inside a limb muscle compartment. A failure or delay in recognising ACS almost invariably results in adverse outcomes for patients. Unrecognised ACS can leave patients with nonviable limbs requiring amputation and can also be life–threatening. Several clinical features indicate ACS. Where diagnosis is unclear there are several techniques for measuring intracompartmental pressure described in this review. As early diagnosis and fasciotomy are known to be the best determinants of good outcomes, it is important that surgeons are aware of the features that make this diagnosis likely. This clinical review discusses current knowledge on the relevant clinical anatomy, aetiology, pathophysiology, risk factors, clinical features, diagnostic procedures and management of an acute presentation of compartment syndrome. PMID:23248724

  5. FLAIL CHEST

    Directory of Open Access Journals (Sweden)

    Anton Crnjac

    2003-12-01

    Full Text Available Background. Major thoracic trauma is consistent with high mortality rate because of associated injuries of vital thoracic organs and dangerous complications. The flail chest occurs after disruption of the skeletal continuity of chest wall and demands because of its pathophysiological complexity rapid and accurate diagnosis and treatment.Conclusions. Basic pathophysiological mechanism of the flail chest is respiratory distress, which is provoked by pulmonary contusions and paradoxical chest wall motion. The treatment should be pointed to improvement and support of respiratory functions and include aggressive pain control, pulmonary physiotherapy and selective mechanical ventilation. Views about operative fixation of the flail chest are still controversial. Neither mortality rate neither long-term disability are improved after operative fixation.

  6. Acute toxic neuropathy mimicking guillain barre syndrome

    Directory of Open Access Journals (Sweden)

    Muhammed Jasim Abdul Jalal

    2015-01-01

    Full Text Available Case: A 30 year old male presented with numbness of palms and soles followed by weakness of upper limbs and lower limbs of 5 days duration, which was ascending and progressive. Three months back he was treated for oral and genital ulcers with oral steroids. His ulcers improved and shifted to indigenous medication. His clinical examination showed polyneuropathy. CSF study did not show albuminocytological dissociation. Nerve conduction study showed demyelinating polyneuropathy. His blood samples and the ayurvedic drug samples were sent for toxicological analysis. Inference: Acute toxic neuropathy - Arsenic

  7. Plasma Lactate Dehydrogenase Levels Predict Mortality in Acute Aortic Syndromes

    OpenAIRE

    Morello, Fulvio; Ravetti, Anna; Nazerian, Peiman; Liedl, Giovanni; Veglio, Maria Grazia; Battista, Stefania; Vanni, Simone; Pivetta, Emanuele; Montrucchio, Giuseppe; Mengozzi, Giulio; Rinaldi, Mauro; Moiraghi, Corrado; Lupia, Enrico

    2016-01-01

    Abstract In acute aortic syndromes (AAS), organ malperfusion represents a key event impacting both on diagnosis and outcome. Increased levels of plasma lactate dehydrogenase (LDH), a biomarker of malperfusion, have been reported in AAS, but the performance of LDH for the diagnosis of AAS and the relation of LDH with outcome in AAS have not been evaluated so far. This was a bi-centric prospective diagnostic accuracy study and a cohort outcome study. From 2008 to 2014, patients from 2 Emergency...

  8. Severe acute respiratory syndrome (SARS) in Hong Kong.

    Science.gov (United States)

    Tsang, Kenneth W; Mok, Thomas Y; Wong, Poon C; Ooi, Gaik C

    2003-09-01

    Severe acute respiratory syndrome (SARS) is a recently recognized and highly contagious pneumonic illness, caused by a novel coronavirus. While developments in diagnostic, clinical and other aspects of SARS research are well underway, there is still great difficulty for frontline clinicians as validated rapid diagnostic tests or effective treatment regimens are lacking. This article attempts to summarize some of the recent developments in this newly recognized condition from the Asia Pacific perspective.

  9. Statins as first-line therapy for acute coronary syndrome?

    OpenAIRE

    Ostadal, Petr

    2012-01-01

    It has repeatedly been shown that statins decrease morbidity and mortality in patients with atherosclerosis, thus supporting their use for the primary and secondary prevention of ischemic heart disease. Different pathological pathways that are triggered in the setting of acute coronary syndrome (ACS), such as endothelial dysfunction, activation of inflammatory and coagulation cascades, and thrombus formation, are known to be inhibited by statins, thereby justifying the use of these agents in ...

  10. Acute respiratory distress syndrome associated with severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Shiho; Sagara; Yasuo; Horie; Yumiko; Anezaki; Hideaki; Miyazawa; Masahiro; Iizuka

    2010-01-01

    Various extraintestinal manifestations including pulmonary abnormalities have been reported in patients with ulcerative colitis. Acute respiratory distress syndrome (ARDS) is a serious and fatal pulmonary manifestation. We have experienced a 67-year-old male patient with ARDS associated with a severe type of ulcerative colitis (UC). Severe dyspnea symptoms occurred during the treatment of UC in a previous hospital and the patient was transferred to our hospital on June 27, 2007. Both blood and sputa culture...

  11. Tropical pyomyositis presenting as sepsis with acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    Siddalingana Gouda TG; H Manjunath Hande; Weena Stanley; Ragini Bargur

    2011-01-01

    Tropical pyomyositis is an underdiagnosed condition. We reported a35 year old male farmer, who presented with septicemia and acute respiratory distress syndrome due to pyomyositis involving the paraspinal muscles. Culture of the pus grew methicillin sensitiveStaphylococcus aureus, and the patient recovered after surgical drainage and antibiotic treatment. Diagnostic delays can be avoided if tropical pyomyositis is considered as a differential diagnosis in patients with septicemia.

  12. Acute Compartment Syndrome of the Thigh in Combat Casualties

    Science.gov (United States)

    2013-03-01

    clinical signs and symptoms alone (27, 28). These signs include pain out of proportion, weakness and passive pain on stretch of the muscles in the...spasm/ cramping /weakness). Thirty-three percent (5/15) have pruritis. Twenty-seven percent (4/15) have symptomatic fascial herniations. Twenty...thigh. J. Orthop. Trauma 16:436–438, 2002. 6. Rooser, B., Bengtson, S., Hagglund, G. Acute compartment syndrome from anterior thigh muscle contusion: a

  13. Prevalence of Burnout Syndrome in patients admitted with acute coronary syndrome.

    Science.gov (United States)

    Prosdócimo, Ana Cláudia Giaxa; Lucina, Luciane Boreki; Marcia, Olandoski; Jobs, Priscila Megda João; Schio, Nicolle Amboni; Baldanzi, Fernanda Fachin; Costantini, Costantino Ortiz; Benevides-Pereira, Ana Maria Teresa; Guarita-Souza, Luiz Cesar; Faria-Neto, José Rocha

    2015-03-01

    Burnout Syndrome is the extreme emotional response to chronic occupational stress, manifesting as physical and mental exhaustion. Although associated with higher prevalence of cardiovascular risk factors, no study so far has evaluated whether the Burnout Syndrome could be a prevalent factor in non-elderly individuals active in the labor market, admitted for acute coronary syndrome (ACS). To evaluate the prevalence of the Burnout Syndrome in non-elderly, economically active patients, hospitalized with ACS. Cross-sectional study conducted in a tertiary and private cardiology center, with economically active patients aged Burnout Syndrome was evaluated with the Burnout Syndrome Inventory (BSI), which assesses workplace conditions and four dimensions that characterize the syndrome: emotional exhaustion (EE), emotional distancing (EmD), dehumanization (De) and professional fulfillment (PF). The Lipp's Stress Symptoms Inventory for Adults (LSSI) was applied to evaluate global stress. Of 830 patients evaluated with suspected ACS, 170 met the study criteria, 90% of which were men, overall average age was 52 years, and 40.5% had an average income above 11 minimum wages. The prevalence of the Burnout Syndrome was 4.1%. When we evaluated each dimension individually, we found high EE in 34.7%, high De in 52.4%, high EDi in 30.6%, and low PF in 5.9%. The overall prevalence of stress was 87.5%. We found a low prevalence of Burnout Syndrome in an economically active, non-elderly population among patients admitted for ACS in a tertiary and private hospital.

  14. Respiratory Therapy for Acute Respiratory Distress Syndrome in Cardiosurgical Patients

    Directory of Open Access Journals (Sweden)

    T. V. Zagorodnyaya

    2005-01-01

    Full Text Available The purpose of the present investigation was to improve the outcomes of intensive care in patients with acute respiratory distress syndrome after cardiac surgery under extracorporeal circulation.Materials and methods. Respiratory therapy was analyzed in 43 patients with acute respiratory distress syndrome after surgery under extracorporeal circulation. According to the procedure of artificial ventilation (AV, the patients were divided into 2 groups: 1 those who had undergone routine tracheal intubation (n=23 AND 2 THOSE who had received noninvasive intubation through a nasal mask (n=20. The respiratory parameters, blood gas composition, central hemodynamic parameters, respiratory support time, and the pattern of complications were analyzed.Results. Noninvasive artificial ventilation permits one to make the patients active in earlier periods and take a spontaneous breath, recovers the respiratory index earlier, reduces the level of positive end-expiratory pressure, the frequency of infectious complications of the tracheobronchial tree, and length of stay in an intensive care unit as compared with endotracheal AV.Conclusion. The findings suggest that noninvasive AV is highly effective and yields better results of treatment in patients with acute respiratory distress syndrome.

  15. Duration of dual antiplatelet therapy in acute coronary syndrome

    Science.gov (United States)

    Wilson, Simon John; Newby, David E; Dawson, Dana; Irving, John; Berry, Colin

    2017-01-01

    Despite a large volume of evidence supporting the use of dual antiplatelet therapy in patients with acute coronary syndrome, there remains major uncertainty regarding the optimal duration of therapy. Clinical trials have varied markedly in the duration of therapy, both across and within trials. Recent systematic reviews and meta-analyses suggest that shorter durations of dual antiplatelet therapy are superior because the avoidance of atherothrombotic events is counterbalanced by the greater risks of excess major bleeding with apparent increases in all-cause mortality with longer durations. These findings did not show significant heterogeneity according to whether patients had stable or unstable coronary heart disease. Moreover, the potential hazards and benefits may differ when applied to the general broad population of patients encountered in everyday clinical practice who have markedly higher bleeding and atherothrombotic event rates. Clinicians lack definitive information regarding the duration of therapy in patients with acute coronary syndrome and risk scores do not appear to be sufficiently robust to address these concerns. We believe that there is a pressing need to undertake a broad inclusive safety trial of shorter durations of therapy in real world populations of patients with acute coronary syndrome. The clinical evidence would further inform future research into strategies for personalised medicine. PMID:28249994

  16. Nephrotic Syndrome and Acute Renal Failure Apparently Induced by Sunitinib

    Directory of Open Access Journals (Sweden)

    Ying-Shou Chen

    2009-10-01

    Full Text Available We report a case of nephrotic syndrome and acute renal failure apparently induced by sunitinib. A 67-year-old man with a history of metastatic renal cell carcinoma presented with progressive kidney dysfunction with proteinuria, general edema, and body weight gain of 21 kg after undergoing 3 weeks of sunitinib therapy. The patient had taken no other over-the-counter medications, and all other possible causes of nephrotic syndrome were excluded. The Naranjo Adverse Drug Reaction Probability Scale score for this event was 6, indicating a high probability that the observed presentations were associated with use of the drug. However, despite the discontinuation of sunitinib, his condition deteriorated, and hemodialysis was initiated for respiratory distress. A renal biopsy was performed, which revealed ischemic acute tubular necrosis with minimal change nephropathy. In conclusion, nephrologists and oncologists should be aware that nephrotic syndrome with ischemic acute tubular necrosis is a possible adverse effect of sunitinib. For early diagnosis of this condition and to avoid renal damage, we recommend differential diagnosis of serum creatinine and proteinuria in patients undergoing sunitinib therapy.

  17. Marfan syndrome with acute abdomen: a case report

    Directory of Open Access Journals (Sweden)

    Beyazit Zencirci

    2010-11-01

    Full Text Available Beyazit ZencirciKahramanmaras Sutcu Imam University Medical Faculty, Department of Anesthesiology and Reanimation Kahramanmaras, TurkeyIntroduction: Marfan syndrome is an autosomal dominant connective tissue disorder characterized by a combination of clinical manifestations in different organ systems. Patients with Marfan syndrome (MFS whose lifetimes are extended may be encountered as acute abdomen (appendicitis cases apart from the obligatory reasons and emergencies arising naturally out of their disease, as in the case reported.Case presentation: In a 28-year-old Turkish male, arachnodactyly, pectus excavatum, kyphoscoliosis and, according to pulmonary roentgenogram, a density increase in the left apical field were detected. In addition, according to the echocardiographic examination, Ebstein’s anomaly, mitral valve prolapse, pulmonary hypertension, and inferior deficiency of mitral, aorta, and tricuspid valves were present. The patient was planned to be operated on with the prediagnosis of acute abdomen.Conclusion: Taking into consideration the pathologies that may accompany MFS and the probable future complications, the patients must be closely monitored during anesthesia applications and required measures should be taken beforehand.Keywords: Marfan syndrome, acute abdomen

  18. Network analysis reveals distinct clinical syndromes underlying acute mountain sickness.

    Directory of Open Access Journals (Sweden)

    David P Hall

    Full Text Available Acute mountain sickness (AMS is a common problem among visitors at high altitude, and may progress to life-threatening pulmonary and cerebral oedema in a minority of cases. International consensus defines AMS as a constellation of subjective, non-specific symptoms. Specifically, headache, sleep disturbance, fatigue and dizziness are given equal diagnostic weighting. Different pathophysiological mechanisms are now thought to underlie headache and sleep disturbance during acute exposure to high altitude. Hence, these symptoms may not belong together as a single syndrome. Using a novel visual analogue scale (VAS, we sought to undertake a systematic exploration of the symptomatology of AMS using an unbiased, data-driven approach originally designed for analysis of gene expression. Symptom scores were collected from 292 subjects during 1110 subject-days at altitudes between 3650 m and 5200 m on Apex expeditions to Bolivia and Kilimanjaro. Three distinct patterns of symptoms were consistently identified. Although fatigue is a ubiquitous finding, sleep disturbance and headache are each commonly reported without the other. The commonest pattern of symptoms was sleep disturbance and fatigue, with little or no headache. In subjects reporting severe headache, 40% did not report sleep disturbance. Sleep disturbance correlates poorly with other symptoms of AMS (Mean Spearman correlation 0.25. These results challenge the accepted paradigm that AMS is a single disease process and describe at least two distinct syndromes following acute ascent to high altitude. This approach to analysing symptom patterns has potential utility in other clinical syndromes.

  19. Inter-observer agreement in interpreting chest X-rays on children with acute lower respiratory tract infections and concurrent wheezing.

    Science.gov (United States)

    Bada, Carlos; Carreazo, Nilton Yhuri; Chalco, Juan Pablo; Huicho, Luis

    2007-05-03

    Many children with acute lower respiratory tract infections (ALRI) present to the emergency ward with concurrent wheezing. A chest x-ray is often requested to rule out pneumonia. We assessed inter-observer agreement in interpreting x-rays on such children. DESIGNS AND SETTING: Prospective consecutive case study at Instituto de Salud del Niño, Lima, Peru. Chest x-rays were obtained from eligible children younger than two years old with ALRI and concurrent wheezing who were seen in the emergency ward of a nationwide pediatric referral hospital. The x-rays were read independently by three different pediatric residents who were aware only that the children had a respiratory infection. All the children had received inhaled beta-adrenergic agonists before undergoing chest x-rays. Lobar and complicated pneumonia cases were excluded from the study. Two hundred x-rays were read. The overall kappa index was 0.2. The highest individual kappa values for specific x-ray findings ranged from 0.26 to 0.34 for rib horizontalization and from 0.14 to 0.31 for alveolar infiltrate. Inter-observer variation was intermediate for alveolar infiltrate (kappa 0.14 to 0.21) and for air bronchogram (kappa 0.13 to 0.23). Reinforcement of the bronchovascular network (kappa 0.10 to 0.16) and air trapping (kappa 0.05 to 0.20) had the lowest agreement. There was poor inter-observer agreement for chest x-ray interpretation on children with ALRI and concurrent wheezing seen at the emergency ward. This may preclude reliable diagnosing of pneumonia in settings where residents make management decisions regarding sick children. The effects of training on inter-observer variation need further studies.

  20. Inter-observer agreement in interpreting chest X-rays on children with acute lower respiratory tract infections and concurrent wheezing

    Directory of Open Access Journals (Sweden)

    Carlos Bada

    Full Text Available CONTEXT AND OBJECTIVE: Many children with acute lower respiratory tract infections (ALRI present to the emergency ward with concurrent wheezing. A chest x-ray is often requested to rule out pneumonia. We assessed inter-observer agreement in interpreting x-rays on such children. DESIGNS AND SETTING: Prospective consecutive case study at Instituto de Salud del Niño, Lima, Peru. METHODS: Chest x-rays were obtained from eligible children younger than two years old with ALRI and concurrent wheezing who were seen in the emergency ward of a nationwide pediatric referral hospital. The x-rays were read independently by three different pediatric residents who were aware only that the children had a respiratory infection. All the children had received inhaled beta-adrenergic agonists before undergoing chest x-rays. Lobar and complicated pneumonia cases were excluded from the study. RESULTS: Two hundred x-rays were read. The overall kappa index was 0.2. The highest individual kappa values for specific x-ray findings ranged from 0.26 to 0.34 for rib horizontalization and from 0.14 to 0.31 for alveolar infiltrate. Inter-observer variation was intermediate for alveolar infiltrate (kappa 0.14 to 0.21 and for air bronchogram (kappa 0.13 to 0.23. Reinforcement of the bronchovascular network (kappa 0.10 to 0.16 and air trapping (kappa 0.05 to 0.20 had the lowest agreement. CONCLUSIONS: There was poor inter-observer agreement for chest x-ray interpretation on children with ALRI and concurrent wheezing seen at the emergency ward. This may preclude reliable diagnosing of pneumonia in settings where residents make management decisions regarding sick children. The effects of training on inter-observer variation need further studies.

  1. Desmoid tumor in Gardner's Syndrome presented as acute abdomen

    Directory of Open Access Journals (Sweden)

    Rizos Spiros

    2006-03-01

    Full Text Available Abstract Background Gardner's syndrome can occasionally be complicated with intra-abdominal desmoid tumor. These tumors usually remain asymptomatic but can exhibit symptoms due to intestinal, vascular and ureteral compression and obstruction. Case presentation A rare case of a 41-year-old male patient with Gardner's syndrome complicated with intra-abdominal desmoid tumor, which first presented as acute abdomen, is presented. Conclusion Extra-abdominal manifestations of Gardner's syndrome along with a palpable abdominal mass would raise suspicion for the presence of a desmoid tumor in the majority of cases. In life-threatening cases, surgical treatment should be considered as a palliative approach, though the extent of excision remains debatable

  2. Coronary CT Angiography Versus Standard Emergency Department Evaluation for Acute Chest Pain and Diabetic Patients: Is There Benefit With Early Coronary CT Angiography? Results of the Randomized Comparative Effectiveness ROMICAT II Trial.

    Science.gov (United States)

    Truong, Quynh A; Schulman-Marcus, Joshua; Zakroysky, Pearl; Chou, Eric T; Nagurney, John T; Fleg, Jerome L; Schoenfeld, David A; Udelson, James E; Hoffmann, Udo; Woodard, Pamela K

    2016-03-22

    Cardiac computed tomography angiography (CCTA) reduces emergency department length of stay compared with standard evaluation in patients with low- and intermediate-risk acute chest pain. Whether diabetic patients have similar benefits is unknown. In this prespecified analysis of the Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT II) multicenter trial, we randomized 1000 patients (17% diabetic) with symptoms suggestive of acute coronary syndrome to CCTA or standard evaluation. The rate of acute coronary syndrome was 8% in both diabetic and nondiabetic patients (P=1.0). Length of stay was unaffected by the CCTA strategy for diabetic patients (23.9 versus 27.2 hours, P=0.86) but was reduced for nondiabetic patients compared with standard evaluation (8.4 versus 26.5 hours, Pemergency department discharge in both groups (each P≤0.0001, P interaction=0.27). No difference in hospital admissions was seen between the 2 strategies in diabetic and nondiabetic patients (P interaction=0.09). Both groups had more downstream testing and higher radiation doses with CCTA, but these were highest in diabetic patients (all P interaction≤0.04). Diabetic patients had fewer normal CCTAs than nondiabetic patients (32% versus 50%, P=0.003) and similar normalcy rates with standard evaluation (P=0.70). Notably, 66% of diabetic patients had no or mild stenosis by CCTA with short length of stay comparable to that of nondiabetic patients (P=0.34), whereas those with >50% stenosis had a high prevalence of acute coronary syndrome, invasive coronary angiography, and revascularization. Knowledge of coronary anatomy with CCTA is beneficial for diabetic patients and can discriminate between lower risk patients with no or little coronary artery disease who can be discharged immediately and higher risk patients with moderate to severe disease who warrant further workup. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01084239. © 2016 The Authors

  3. Post poliomyelitis syndrome: A rare sequel of acute poliomyelitis.

    Science.gov (United States)

    Abrar, Anam; Ahmad, Arsalan

    2015-03-01

    Post poliomyelitis syndrome (PPS) is a rare sequel of acute poliomyelitis, usually seen 30-40 years after an acute episode. It is characterized by new muscle weakness seen in survivors of acute poliomyelitis. We describe a rare case of a 50 year old man; with a previous history of poliomyelitis in right lower limb who now presented with complaints of progressive left lower limb weakness for past two years. The diagnosis was made on the basis of clinical suspicion and EMG findings. PPS is not a well recognized disease in Pakistan and due to the lack of documentation; its true prevalence is not known. Though, over the years, cases of Poliomyelitis have decreased worldwide, however, PPS still remains a constant challenge for the physicians. This report highlights the impact of the disease on the quality of life of patients suffering from PPS and emphasis on the need for new therapeutic approach.

  4. Hemorrhagic Fever with Renal Syndrome Associated with Acute Pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Edmond Puca; Arben Pilaca; Pellumb Pipero; Dhimiter Kraja; Entela Y Puca

    2012-01-01

    Hemorrhagic fever with renal syndrome (HFRS) is a systemic infectious disease caused by Hantaviruses and characterized by fevers,bleeding tendencies,gastrointestinal symptoms and renal failure.It encompasses a broad spectrum of clinical presentations,ranging from unapparent or mild illnesses to fulminant hemorrhagic processes.Among the various complications of HFRS,acute pancreatitis is a rare find.In this report,based on clinical data,laboratory and radiologic examination findings,we describe a clinical case,with HFRS from Dobrava virus,associated with acute pancreatitis.The patient was successfully treated by supportive management.Clinicians should be alert to the possibility of HFRS when examining patients with epidemiological data and symptoms of acute pancreatitis.

  5. Acute adrenal insufficiency due to primary antiphospholipid antibody syndrome

    Directory of Open Access Journals (Sweden)

    Kishore Kumar Behera

    2013-01-01

    Full Text Available Introduction: We report a case of acute adrenal insufficiency (AAI in a patient with antiphospholipid syndrome (APS. Case Report: A 44-year-old female patient presented to us with acute abdominal pain associated with recurrent vomiting and giddiness. On examination, her blood pressure was 80/50 mm Hg. Systemic examination was normal. Further evaluation revealed hypocortisolemia with elevated plasma adrenocorticotropin hormone indicative of primary adrenal insufficiency. Her abdominal computed tomography scan showed features of evolving bilateral adrenal infarction. Etiological work-up revealed prolonged activated thromboplastin time, which didn′t correct with normal plasma, her anti-cardiolipin antibody and lupus anticoagulant were also positive. She was diagnosed to have APS with adrenal insufficiency and she was started on intravenous steroids and heparin infusion. Conclusion: AAI due to the APS can present with acute abdominal pain followed by hypotension. A high index of suspicion is needed to make the correct diagnosis and to initiate appropriate treatment.

  6. Management of acute coronary syndromes with fondaparinux

    Directory of Open Access Journals (Sweden)

    Harm Wienbergen

    2007-07-01

    Full Text Available Harm Wienbergen, Uwe ZeymerHerzzentrum Ludwigshafen, Medizinische Klinik B, GermanyAbstract: Fondaparinux is the first selective inhibitor of the coagulation factor Xa which is commercially avaliable for clinical use. It has been approved for the prevention of venous thromboembolism in patients undergoing orthopedic surgery and for the initial therapy of venous thromboembolism. In randomized clinical trials the value of fondaparinux in the treatment of ST-elevation myocardial infarction (STEMI has been investigated. The PENTALYSE study showed that fondaparinux was at least as effective and safe as unfractionated heparin in 333 patients with STEMI undergoing fibrinolysis with t-PA. In the recent large OASIS-6 trial with 12,092 patients the treatment with 2.5 mg fondaparinux daily significantly reduced death and reinfarctions until day 30 compared with guideline recommended usual care and compared with unfractionated heparin (9.7% vs 11.2%, p = 0.008 without increasing major bleedings (1.0% vs 1.3%, p = 0.13. This advantage was predominantly seen in the subgroups of patients with fibrinolysis and without early reperfusion therapy. However, in the subgroup of primary percutaneous coronary interventions (PCIs no clinical benefit of fondaparinux was found, but there were more catheter thrombosis and acute thrombotic complications. In summary, fondaparinux is a new antithrombin that is an efficient, safe, and easy to use in treatment for STEMI patients, particularly those not undergoing primary PCI.Keywords: selective factor Xa inhibition, fondaparinux, acute ST-elevation myocardial infarction, antithrombin therapy

  7. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults

    DEFF Research Database (Denmark)

    Afshari, Arash; Brok, Jesper; Møller, Ann

    2010-01-01

    Acute hypoxaemic respiratory failure (AHRF), defined as acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), are critical conditions. AHRF results from a number of systemic conditions and is associated with high mortality and morbidity in all ages. Inhaled nitric oxide (INO) ha...

  8. Associated Factors of Acute Chest Syndrome in Children with Sickle Cell Disease in French Guiana

    Directory of Open Access Journals (Sweden)

    Narcisse Elenga

    2014-01-01

    Full Text Available A matched case-control study was performed in order to identify some associated factors for ACS or to confirm the published data. Controls were children hospitalized during the same period for pain crisis who did not develop an ACS during hospitalization. Between January 2006 and October 2010, there were 24 episodes of ACS distributed among 19 patients (8 girls and 11 boys. The median age was 7.5 years (range: 3 to 17 years for the cases and 7 years (range: 3–18 years for the controls. Four cases and 11 controls were treated with hydroxyurea (HU. In 75% of the cases, the ACS had arisen 24–72 hours following admission. The independent factors associated with ACS were average Hb rate 3 (OR = 5.44, 95% CI = 3.59–8.21, and P=0.003, average length of hospitalization >7 days (OR = 3.69, 95% CI = 3.59–8.21, and P=0.003, and a pathological transthoracic echocardiography (TTE (OR = 13.77, 95% CI = 2.07–91.46, and P=0.003. Although the retrospective design and small sample size are weaknesses of the present study, these results are consistent with those of previous studies and allowed identifying associated factors such as a pathological TTE.

  9. Message concerning Severe Acute Respiratory Syndrome ("SARS")

    CERN Multimedia

    2003-01-01

    IMPORTANT REMINDER If you have just come back from one of the regions identified by the WHO as being infected with SARS, it is essential to monitor your state of health for ten days after your return. The syndrome manifests itself in the rapid onset of a high fever combined with respiratory problems (coughing, breathlessness, breathing difficulty). Should these signs appear, you must contact the CERN Medical Service as quickly as possible on number 73802 or 73186 during normal working hours, and the fire brigade at all other times on number 74444, indicating that you have just returned from one of the WHO-identified areas with recent local transmission.China: Beijing, Hong Kong (Special Administrative Region), Guangdong Province, Inner Mongolia, Shanxi Province, Tianjin ProvinceTaiwan:TaipeiMoreover, until further notice the CERN Management requests that all trips to these various regions of the world be reduced to a strict minimum and then only with the consent of the Division Leader concerned. Anyone comin...

  10. CT Manifestations of Lung Changes and Complications in Patients with Severe Acute Respiratory Syndrome

    Institute of Scientific and Technical Information of China (English)

    张雪哲; 王武; 卢延; 黄振国; 洪闻; 尚燕宁; 任安

    2003-01-01

    Objective:To investigate the role of CT scanning in diagnosing severe acute respiratory syndrome(SARS). Methods: One hundred and twelve times of spiral CT scanning, 106 times on the chest with standard pulmonary and mediastinal window, 5 on the brain and once on the abdomen, were performed in 82 patients (37 males and 45 females) of SARS. Results: Bilateral shadows showed in 66 patients (80.48%) and unilateral shadow in 16 (19.52%). The lung CT findings were sub-pleural focal consolidation in 26 patients (31.70%), flaky cloudy opacity in 53 (64.63%), large area consolidation in 9 (10.97%), ground-glass blurry shadow in 31 (37.80%), alveolar substantive shadow in 14 (17.07%) and interstitial changes in 16 (19.51%). The pulmonary CT signs of SARS were relatively characterized by: (1) The lesions tending to multiply occur, mostly to be bilaterally distributed and commonly involved in the lower lung field. (2) The lung shadows mostly showed as sub-pleural focal consolidation, flaky cloudy shadow, large area consolidation, ground-glass blurry shadow, and often accompanied with signs of broncho-inflation. (3) Having opacified nodular shadows in the alveolar cavities. (4) Rapid progressions or changes on the size, amount, and distribution of the lesions likely to be found in dynamic observation of chest X-ray and CT scanning, i.e., markedly dynamic changes found within 24 to 48 hrs. Lesions with these characteristics may be recognized as pulmonary changes possibly induced by SARS. Complications were found in 6 patients (7.31%), including tuberculosis of lung and brain accompanied with pneumomediastinum in one patient, secondary infection of lung in 2, pneumothorax in 1, pulmonary fungus in 1, and pyothorax in 1.Conclusion: CT scanning is a sensitive method for diagnosis of SARS, by which more accurate assessment of the abnormal changes of lung and occurrence of complications in SARS patients can be made.

  11. A Comparison of Acute Respiratory Distress Syndrome Outcomes Between Military and Civilian Burn Patients

    Science.gov (United States)

    2015-03-01

    MILITARY MEDICINE, 180, 3:56, 2015 A Comparison of Acute Respiratory Distress Syndrome Outcomes Between Military and Civilian Burn Patients J Alan...Chung, MC USA*‡ ABSTRACT Background: The objective of this report was to compare the prevalence of acute respiratory distress syndrome (ARDS) and...Development of acute respiratory distress syndrome (ARDS) is a common complication of burn injury and is associated with poor outcomes. Previous reports using

  12. Increased wave reflection and ejection duration in women with chest pain and nonobstructive coronary artery disease: ancillary study from the Women's Ischemia Syndrome Evaluation.

    Science.gov (United States)

    Nichols, Wilmer W; Denardo, Scott J; Johnson, B Delia; Sharaf, Barry L; Bairey Merz, C Noel; Pepine, Carl J

    2013-07-01

    Wave reflections augment central aortic SBP and increase systolic pressure time integral (SPTI) thereby increasing left ventricular (LV) afterload and myocardial oxygen (MVO2) demand. When increased, such changes may contribute to myocardial ischemia and angina pectoris, especially when aortic diastolic time is decreased and myocardial perfusion pressure jeopardized. Accordingly, we examined pulse wave reflection characteristics and diastolic timing in a subgroup of women with chest pain (Women's Ischemia Syndrome Evaluation, WISE) and no obstructive coronary artery disease (CAD). Radial artery BP waveforms were recorded by applanation tonometry, and aortic BP waveforms derived. Data from WISE participants were compared with data from asymptomatic women (reference group) without chest pain matched for age, height, BMI, mean arterial BP, and heart rate. Compared with the reference group, WISE participants had higher aortic SBP and pulse BP and ejection duration. These differences were associated with increased augmentation index and reflected pressure wave systolic duration. These modifications in wave reflection characteristics were associated with increased SPTI and wasted LV energy (Ew) and a decrease in pulse pressure amplification, myocardial viability ratio, and diastolic pressure time fraction. WISE participants with no obstructive CAD have changes in systolic wave reflections and diastolic timing that increase LV afterload, MVO2 demand, and Ew with the potential to reduce coronary artery perfusion. These alterations in cardiovascular function contribute to an undesirable mismatch in the MVO2 supply/demand that promotes ischemia and chest pain and may contribute to, or increase the severity of, future adverse cardiovascular events.

  13. Pulmonary pathology of acute respiratory distress syndrome.

    Science.gov (United States)

    Tomashefski, J F

    2000-09-01

    Lung morphology in ARDS reflects the rapid evolution from interstitial and alveolar edema to end-stage fibrosis consequent to injury of the alveolocapillary unit. This morphologic progression, termed diffuse alveolar damage, has been subdivided into sequentially occurring exudative, proliferative, and fibrotic phases. Pulmonary lesions correlate with the phase of alveolar damage rather than its specific cause. The pathologic features are consistent with the effects of a host of injurious stimuli and the complex interaction of inflammatory mediators on alveolar epithelial and capillary endothelial cells. Although ARDS frequently culminates in "interstitial" fibrosis, the organization of intraluminal exudate dominates the histologic picture in the proliferative phase and establishes the framework for subsequent fibrous remodeling of the lung. Involvement of the pulmonary vasculature is an important aspect of ARDS, from the initial phase of edema to the terminal stage of intractable pulmonary hypertension. Vascular lesions include thrombotic, fibroproliferative, and obliterative changes that, like the parenchymal lesions, correlate with the temporal phase of DAD. Although ARDS is characterized by extensive bilateral lung involvement, alveolar damage can also affect the lung in a localized fashion. RAD is associated with the same clinical risk factors as DAD, suggesting that there is a spectrum in the extent of lung involvement and disease severity in patients at risk for ARDS. The factors that govern which patients will develop the fulminant syndrome are poorly understood. It must be re-emphasized that the lung is stereotyped in its response to injury and, consequently, descriptive, or even quantitative, studies of lung morphology can only provide clues regarding the initiating factors and pathogenetic mechanisms of ARDS. Progress in understanding the pathogenesis of ARDS and development of rational approaches to therapy will ultimately depend on careful clinical and

  14. Gender-specific issues in the management of patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-feng

    2008-01-01

    @@ Acute coronary syndrome (ACS) represents a continuum of acute myocardial ischemia including non-ST-elevation myocardial infarction and unstable angina, synonymous with non-ST-elevation ACS (NSTE-ACS),and ST-elevation myocardial infarction (STEMI).

  15. Acute myeloid leukaemia after treatment for acute lymphoblastic leukaemia in girl with Bloom syndrome.

    Science.gov (United States)

    Adams, Madeleine; Jenney, Meriel; Lazarou, Laz; White, Rhian; Birdsall, Sanda; Staab, Timo; Schindler, Detlev; Meyer, Stefan

    2013-09-18

    Bloom syndrome (BS) is an inherited genomic instability disorder caused by disruption of the BLM helicase and confers an extreme cancer predisposition. Here we report on a girl with BS who developed acute lymphoblastic leukaemia (ALL) at age nine, and treatment-related acute myeloid leukaemia (t-AML) aged 12. She was compound heterozygous for the novel BLM frameshift deletion c.1624delG and the previously described c.3415C>T nonsense mutation. Two haematological malignancies in a child with BS imply a fundamental role for BLM for normal haematopoiesis, in particular in the presence of genotoxic stress.

  16. Prone positioning ventilation for treatment of acute lung injury and acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    LAN Mei-juan; HE Xiao-di

    2009-01-01

    Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care work-ers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxy-genation without use of expensive, invasive and experimen-tal procedures.

  17. Acute lung injury and acute respiratory distress syndrome: experimental and clinical investigations

    Institute of Scientific and Technical Information of China (English)

    Hsing I Chen

    2011-01-01

    Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) can be associated with various disorders.Recent investigation has involved clinical studies in collaboration with clinical investigators and pathologists on the pathogenetic mechanisms of ALl or ARDS caused by various disorders.This literature review includes a brief historical retrospective of ALI/ARDS, the neurogenic pulmonary edema due to head injury, the long-term experimental studies and clinical investigations from our laboratory, the detrimental role of NO, the risk factors, and the possible pathogenetic mechanisms as well as therapeutic regimen for ALI/ARDS.

  18. Low-dose CT for quantitative analysis in acute respiratory distress syndrome

    National Research Council Canada - National Science Library

    Vecchi, Vittoria; Langer, Thomas; Bellomi, Massimo; Rampinelli, Cristiano; Chung, Kevin K; Cancio, Leopoldo C; Gattinoni, Luciano; Batchinsky, Andriy I

    2013-01-01

    The clinical use of serial quantitative computed tomography (CT) to characterize lung disease and guide the optimization of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS...

  19. [Chest trauma].

    Science.gov (United States)

    Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

    2011-01-01

    Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe.

  20. The use of the biomarker “copeptin” for the diagnosis of acute chest pain in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Elisa Conti

    2011-09-01

    Full Text Available The aim of the study is to assess if copeptin, in combination with negative troponin, is able to accelerate the rule-out of AMI in patients with chest pain. The study was retrospectively conducted on three groups of patients selected according to their discharge diagnoses: patients with non-ST elevation myocardial infarction (NSTEMI, non-cardiac chest pain (NCCP, unstable angina (UA. Comparing the levels of copeptin, we found that the diagnosis of AMI is associated more often with copeptin positive values (> 14 pmol/l than the diagnosis of NCCP and UA. However, about a quarter of our patients in which the combination of copeptin and troponin in the first blood sample was negative, the final diagnosis was AMI. According to our results, the combination of the two negative markers does not allow a safe rule out of AMI at time zero.

  1. Myocardial perfusion 320-row multidetector computed tomography-guided treatment strategy for the clinical management of patients with recent acute-onset chest pain: Design of the CArdiac cT in the treatment of acute CHest pain (CATCH)-2 randomized controlled trial.

    Science.gov (United States)

    Sørgaard, Mathias; Linde, Jesper J; Hove, Jens D; Petersen, Jan R; Jørgensen, Tem B S; Abdulla, Jawdat; Heitmann, Merete; Kragelund, Charlotte; Hansen, Thomas Fritz; Udholm, Patricia M; Pihl, Christian; Kühl, J Tobias; Engstrøm, Thomas; Jensen, Jan Skov; Høfsten, Dan E; Kelbæk, Henning; Kofoed, Klaus F

    2016-09-01

    Patients admitted with chest pain are a diagnostic challenge because the majority does not have coronary artery disease (CAD). Assessment of CAD with coronary computed tomography angiography (CCTA) is safe, cost-effective, and accurate, albeit with a modest specificity. Stress myocardial computed tomography perfusion (CTP) has been shown to increase the specificity when added to CCTA, without lowering the sensitivity. This article describes the design of a randomized controlled trial, CATCH-2, comparing a clinical diagnostic management strategy of CCTA alone against CCTA in combination with CTP. Patients with acute-onset chest pain older than 50 years and with at least one cardiovascular risk factor for CAD are being prospectively enrolled to this study from 6 different clinical sites since October 2013. A total of 600 patients will be included. Patients are randomized 1:1 to clinical management based on CCTA or on CCTA in combination with CTP, determining the need for further testing with invasive coronary angiography including measurement of the fractional flow reserve in vessels with coronary artery lesions. Patients are scanned with a 320-row multidetector computed tomography scanner. Decisions to revascularize the patients are taken by the invasive cardiologist independently of the study allocation. The primary end point is the frequency of revascularization. Secondary end points of clinical outcome are also recorded. The CATCH-2 will determine whether CCTA in combination with CTP is diagnostically superior to CCTA alone in the management of patients with acute-onset chest pain. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Acute bag-valve breathing maneuvers plus manual chest compression is safe during stable septic shock: a randomized clinical trial.

    Science.gov (United States)

    Blattner, Clarissa Netto; Santos, Rafael Saldanha Dos; Dias, Fernando Suparregui; Dias, Alexandre Simões; Mestriner, Régis Gemerasca; Vieira, Silvia Regina Rios

    2017-01-01

    To evaluate the effects of bag-valve breathing maneuvers combined with standard manual chest compression techniques on safety, hemodynamics and oxygenation in stable septic shock patients. A parallel, assessor-blinded, randomized trial of two groups. A computer-generated list of random numbers was prepared by an independent researcher to allocate treatments. The Intensive Care Unit at Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul. Fifty-two subjects were assessed for eligibility, and 32 were included. All included subjects (n = 32) received the allocated intervention (n = 19 for the Experimental Group and n = 13 for the Control Group). Twenty minutes of bag-valve breathing maneuvers combined with manual chest compression techniques (Experimental Group) or chest compression, as routinely used at our intensive care unit (Control Group). Follow-up was performed immediately after and at 30 minutes after the intervention. Mean artery pressure. All included subjects completed the trial (N = 32). We found no relevant effects on mean artery pressure (p = 0.17), heart rate (p = 0.50) or mean pulmonary artery pressure (p = 0.89) after adjusting for subject age and weight. Both groups were identical regarding oxygen consumption after the data adjustment (p = 0.84). Peripheral oxygen saturation tended to increase over time in both groups (p = 0.05), and there was no significant association between cardiac output and venous oxygen saturation (p = 0.813). No clinical deterioration was observed. A single session of bag-valve breathing maneuvers combined with manual chest compression is hemodynamically safe for stable septic-shocked subjects over the short-term.

  3. Indicación de la fisioterapia respiratoria convencional en la bronquiolitis aguda Indications of conventional chest physiotherapy in acute bronchiolitis

    Directory of Open Access Journals (Sweden)

    Liliana Bohé

    2004-06-01

    Full Text Available Los objetivos de este trabajo fueron evaluar la utilidad de la fisioterapia respiratoria convencional en el tratamiento de la bronquiolitis aguda y determinar su influencia sobre los días de hospitalización. Se realizó un ensayo clínico controlado aleatorizado, donde se incluyeron dieciseis pacientes con bronquiolitis que fueron tratados dos veces al día con fisioterapia torácica y se compararon con dieciséis pacientes control, con la misma patología, quienes recibían sólo aspiración nasofaríngea. El grupo de tratamiento presentó un promedio en el score clínico de dificultad respiratoria al ingreso de 5.56 (± 1.96 y al alta 3.25 (± 1.27. El grupo control presentó un score de 5.75 (± 1.61 y 3.12 (± 1.30, p=0.77 y p=0.76 respectivamente. Respecto al promedio en los días de hospitalización fue de 4.00 (± 2.00 en el grupo de tratamiento y de 3.87 (± 1,30 para el grupo control, p=0.84. Concluimos que la fisioterapia respiratoria no aporta beneficio en su uso rutinario en el manejo de la broquiolitis aguda ni acorta los días de hospitalización.To evaluate the benefits of conventional chest physiotherapy in acute bronchiolitis, 32 patients were allocated in a randomized controlled trial, 16 were given twice daily chest physiotherapy compared with 16 controls who were not given chest physiotherapy. The treatment group showed a mean clinical score for respiratory disability at admission of 5.56 (± 1.96, and 3.25 (± 1.27 when discharged. The control group presented a score of 5.75 (± 1.61 and 3.12 (± 1.30, p=0.77 and p=0.76 respectively. The mean length of illness in hospital in the treatment group was 4.00 (± 2.00 vs 3.87 (± 1.30 in the control group, p=0.84. Chest physiotherapy does not produce clinically important benefits in the treatment of acute bronchiolitis.

  4. Radial Versus Femoral Access for Acute Coronary Syndromes.

    Science.gov (United States)

    Routledge, Helen; Sastry, Sanjay

    2015-12-01

    The feasibility and safety of transradial coronary intervention was demonstrated soon after the description of the transfemoral approach, despite which the use of the femoral artery still dominates in acute coronary syndrome intervention. The advantages of using the radial artery are virtual elimination of access site complications and an important reduction in bleeding, both of which are of utmost importance to the patient with myocardial infarction. Randomised controlled trials have now documented what seems inherent; that transradial intervention should bring with it an advantage in terms of morbidity and mortality in this cohort. The potential disadvantages in terms of speed of procedure and radiation exposure are negated by operator experience. Registries have illustrated that conversion on a large scale from the femoral to the transradial approach is safe and saves lives, most convincingly so in acute coronary syndrome intervention. This review discusses the potential benefits and risks of the alternative access sites in acute patients and explores how these are borne out in the published data.

  5. IMMUNO-INFLAMATORY RESPONSES IN ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    R. G. Oganov

    2007-01-01

    Full Text Available Aim. To determine the role of immuno-inflammatory responses in the development of acute coronary syndrome (ACS.Material and methods. 93 patients with acute coronary syndrome (ACS, including 60 patients with unstable angina (UA and 33 patients with acute myocardial infarction (AMI were involved in the study. Comparison group included 83 patients with stable angina and control group - 25 healthy persons. The diagnosis of ischemic heart disease (IHD was verified on the basis of clinical and instrumental data. For assessment of immuno-inflammatory responses levels of C-reactive protein (CRP, pro-inflammatory (interleukins [IL-1β, IL-6], tumor necrosis factor [TNF-α] and anti-inflammatory (IL-4, IL-10 cytokines we determined by ELISA method.Results. There were high levels of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α, high CRP level and low levels of anti-inflammatory IL-4, IL-10 cytokines in UA and AMI patients. Insignificant immunological shifts were found in stable angina patients.Conclusion. Destabilization in the IHD course is characterized with more active immuno-inflammatory responses. Activity of these reactions is associated with ACS severity.

  6. IMMUNO-INFLAMATORY RESPONSES IN ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    R. G. Oganov

    2015-12-01

    Full Text Available Aim. To determine the role of immuno-inflammatory responses in the development of acute coronary syndrome (ACS.Material and methods. 93 patients with acute coronary syndrome (ACS, including 60 patients with unstable angina (UA and 33 patients with acute myocardial infarction (AMI were involved in the study. Comparison group included 83 patients with stable angina and control group - 25 healthy persons. The diagnosis of ischemic heart disease (IHD was verified on the basis of clinical and instrumental data. For assessment of immuno-inflammatory responses levels of C-reactive protein (CRP, pro-inflammatory (interleukins [IL-1β, IL-6], tumor necrosis factor [TNF-α] and anti-inflammatory (IL-4, IL-10 cytokines we determined by ELISA method.Results. There were high levels of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α, high CRP level and low levels of anti-inflammatory IL-4, IL-10 cytokines in UA and AMI patients. Insignificant immunological shifts were found in stable angina patients.Conclusion. Destabilization in the IHD course is characterized with more active immuno-inflammatory responses. Activity of these reactions is associated with ACS severity.

  7. Ivabradine in acute coronary syndromes: Protection beyond heart rate lowering.

    Science.gov (United States)

    Niccoli, Giampaolo; Borovac, Josip Anđelo; Vetrugno, Vincenzo; Camici, Paolo G; Crea, Filippo

    2017-02-22

    Ivabradine is a heart rate reducing agent that exhibits anti-ischemic effects through the inhibition of funny electrical current in the sinus node resulting in heart rate reduction, thus enabling longer diastolic perfusion time, and reduced myocardial oxygen consumption without detrimental changes in arterial blood pressure, coronary vasomotion, and ventricular contractility. The current guideline-based clinical use of Ivabradine is reserved for patients with stable angina pectoris who cannot tolerate or whose symptoms are inadequately controlled with beta blockers. In patients with chronic heart failure and reduced ejection fraction, Ivabradine has demonstrated beneficial effects in improving clinical outcomes when added to conventional therapy. However, the role of Ivabradine in acute coronary syndromes has not been established. Based on the results from some relevant preclinical studies and a limited amount of clinical data that were reported recently, the role of Ivabradine in acute ischemic events warrants further investigation. The aim of this review is to provide an overview of the available literature on the potential role of Ivabradine in the clinical context of acute coronary syndromes.

  8. SB-715992 in Treating Patients With Acute Leukemia, Chronic Myelogenous Leukemia, or Advanced Myelodysplastic Syndromes

    Science.gov (United States)

    2013-01-10

    Acute Undifferentiated Leukemia; Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Acute Promyelocytic Leukemia (M3); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Blastic Phase Chronic Myelogenous Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Relapsing Chronic Myelogenous Leukemia; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndromes; Untreated Adult Acute Myeloid Leukemia

  9. Stress induced cardiomyopathy presenting as acute coronary syndrome: Tako-Tsubo in Mercogliano, Southern Italy

    Directory of Open Access Journals (Sweden)

    Salemme L

    2007-10-01

    Full Text Available Abstract Background Tako-tsubo syndrome (TTS in its typical (apical and atypical (non-apical forms is being increasingly recognized in the West owing to early systematic coronary angiography in acute coronary syndromes (ACS. Aim of the study To assess the incidence, the clinical characteristics and the outcome of TTS in a single high volume cath lab in Southern Italy over the last 6 years. Methods Among 1674 consecutive patients (pts referred to our coronary care units in the last 6 years (2001–2006 for ACS we selected 6 (0.5% pts (6 women; age 57 ± 6 years who fulfilled the following 4 criteria: 1 transient left ventricular wall motion abnormalities resulting in ballooning at contrast ventricolographic or echocardiographic evaluation; 2 normal coronary artery on coronary angiography performed 5 ± 9 hours from hospitalization; 3 new electrocardiographic ischemic-like abnormalities (either ST-segment elevation or T-wave inversion and 4 emotional or physical trigger event. Results At admission all pts had presumptive diagnosis of ACS and ECG revealed ST elevation in 3 (50% and T wave inversion with QT elongation in 3 (50%. In the acute phase cardiogenic shock occurred in 2 (33% and heart failure in 1(16%. Presenting symptoms were chest pain in 6 (100%, dyspnoea in 2 (33% and lipotimia in 1 (16%. At echocardiographic-ventricolographic assessment, the mechanical dysfunction (ballooning was apical in all 6 pts ("classic" TTS. In all patients wall motion abnormalities completely reversed within 4.5 ± 1.5 days. The region of initial recovery was the anterior and lateral wall in 4 cases and the lateral wall in 2 cases. Ejection fraction was 35 ± 8% in the acute phase and increased progressively at discharge (55 ± 6% and at 41 ± 20 months follow-up (60 ± 4%, p Conclusion Classic TTS is a frequent serendipitous diagnosis after coronary angiography showed "surprisingly" normal findings in a clinical setting mimicking an ACS. Despite its long

  10. Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II.

    Science.gov (United States)

    Sostman, H Dirk; Miniati, Massimo; Gottschalk, Alexander; Matta, Fadi; Stein, Paul D; Pistolesi, Massimo

    2008-11-01

    We used the archived Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) data and images to test the hypothesis that reading perfusion scans with chest radiographs but without ventilation scans, and categorizing the perfusion scan as "pulmonary embolism (PE) present" or "PE absent," can result in clinically useful sensitivity and specificity in most patients. Patients recruited into PIOPED II were eligible for the present study if they had a CT angiography (CTA) or digital subtraction angiography (DSA) diagnosis, an interpretable perfusion scan and chest radiographs, and a Wells' score. Four readers reinterpreted the perfusion scans and chest radiographs of eligible patients. Two readers used the modified PIOPED II criteria and 2 used the Prospective Investigative Study of Pulmonary Embolism Diagnosis (PISAPED) criteria. The chest radiographs were read as "normal/near normal," "abnormal," or "nondiagnostic," and the perfusion scans were read as "PE present," "PE absent," or "nondiagnostic." The primary analysis used a composite reference standard: the PIOPED II DSA result or, if there was no definitive DSA result, CTA results that were concordant with the Wells' score as defined in PIOPED II (CTA positive and Wells' score > 2, or CTA negative and Wells' score PIOPED II criteria, the sensitivity of a "PE present" perfusion scan was 84.9% (95% confidence interval [CI], 80.1%-88.8%), and the specificity of "PE absent" was 92.7% (95% CI, 91.1%-94.1%), excluding "nondiagnostic" results, which occurred in 20.6% (95% CI, 18.8%-22.5%). Using PISAPED criteria, the sensitivity of a "PE present" perfusion scan was 80.4% (95% CI, 75.9%-84.3%) and the specificity of "PE absent" was 96.6% (95% CI, 95.5%-97.4%), whereas the proportion of patients with "nondiagnostic" scans was 0% (95% CI, 0.0%-0.2%). Perfusion scintigraphy combined with chest radiography can provide diagnostic accuracy similar to both CTA and ventilation-perfusion scintigraphy, at lower cost

  11. Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore.

    Science.gov (United States)

    Tripathi, Mukesh; Pandey, Mamta; Nepal, Bharat; Rai, Hari; Bhattarai, Balkrishna

    2009-09-01

    Mechanical ventilation with positive end expiratory pressure (PEEP) is associated with unequal aeration of lungs in acute respiratory distress syndrome (ARDS) patients. Therefore, patients may develop asymmetric atelectasis and postural hypoxemia during lateral positioning. To validate proposed lung infiltration score (LIS) based on chest x-ray to predict postural hypoxemia and lateralization of skin sores in ARDS patients. University hospital ICU. Prospective, observational study of consecutive patients. Sixteen adult patients of both genders on mechanical ventilation with PEEP for 24 to pressure sore grading was noted within a week of ICU stay. Nonparametric Bland and Altman correlation analysis, ANOVA and Student t test. Arterial oxygenation (PaO2/FiO2 = 313 +/- 145.6) was significantly (P or =3 between two lungs. The LIS mapping on chest x-ray was useful to differentiate between asymmetric lung disease and postural hypoxemia in ICU patients, which predisposed patients to early skin sore changes on higher LIS side.

  12. Diagnosis and management of acute coronary syndrome

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    Baker Hamilton

    2013-09-01

    La prévalence des maladies cardiovasculaires connaît une croissance rapide dans les pays en développement, entraînant une incidence croissante du syndrome coronarien aigu (SCA. Les modalités de diagnostic et de traitement de cette maladie continuent d’évoluer, et il convient de tenir compte des ressources locales lors de la réalisation d’un diagnostic et la détermination des options thérapeutiques. Cet article constitue un guide à la prise en charge du SCA fondé sur l’expérience, et fournit des recommandations spécifiques destinées aux médecins hospitaliers travaillant dans les pays à bas et moyen revenu. Le diagnostic du SCA, y compris les SCA sans élévation du ST et avec élévation du ST, se concentre sur la stratification du risque, la vigilance relative aux manifestations subtiles ou atypiques, et la prise en considération d’autres causes des douleurs poitrinaires. Le processus de diagnostic implique l’évaluation des facteurs de risque, la connaissance des antécédents médicaux défavorables et les conclusions de l’examen physique (des variantes étant susceptibles d’exister dans les différentes populations, ainsi que l’utilisation de tests de diagnostic appropriés. Il est recommandé d’utiliser de l’aspirine à titre de traitement initial, parallèlement à un antiagrégant plaquettaire supplémentaire. Le prasugrel est préféré au clopidogrel si le patient présente un SCA avec élévation du ST et qu’une intervention coronaire percutanée (ICP est prévue. La bivalidurine devrait être le premier choix pour éviter la coagulation dans les SCA avec élévation du ST, suivie de l’enoxaparine (qui ne nécessite pas de perfusion, puis d’héparine non fractionnée. Pour les patients présentant un SCA sans élévation du ST et en cas de risque de saignement accru, le fondaparinux devrait être envisagé à la place de l’énoxaparine. Les patients souffrant de dyspnée, présentant des signes d

  13. Clinical diagnostic approach to severe acute respiratory syndrome: an institution's experience

    Institute of Scientific and Technical Information of China (English)

    孙永昌; 姚婉贞; 王筱宏; 贺蓓; 赵鸣武; 孙伯章; 山耘; 郑亚安; 张福春; 孙威

    2003-01-01

    Objective To analyze diagnostic approach to severe acute respiratory syndrome (SARS) according to the diagnostic criteria issued by the Ministry of Health of China (MHC). Methods The clinical data and the diagnostic results of 108 cases of SARS were retrospectively reviewed according to the MHC criteria. Results There were 55 men and 53 women, with a median age of 34.5 years (range, 12-78 years). The interval between their first visit and clinical diagnosis was 3 days (range, 0-14 days). The diagnosis was made at the first visit in 7 (6.5%, 7/108) cases with a history of exposure to SARS patients and infiltrates on chest radiograph. Eighty-nine (82.4%) and 12 (11.1%) patients were categorized as probable cases and suspected cases respectively at their first visit and a clinical diagnosis of SARS was made subsequently. The interval between first visit and reaching the final diagnosis was 1-3 days in 72 (66.7%) cases and 4 days in 29 (26.9%) cases. The final diagnosis was made in 0-14 days (median, 2 days) for those (n=59, 54.6%) with a history of close contact with SARS patients and 2-8 days (median, 3 days) for those (n=49, 45.4%) living in Beijing but without such a history (P=0.03). The chest radiograph was interpreted as unremarkable in 26 (24.1%) cases at their first visit, and the diagnosis was made in 4 days (range 2-8 days), which was significantly longer compared with other cases (P<0.001). In patients without a history of close contact with SARS patients, all the five criteria were met after combination antibiotic therapy had failed. Conclusions A chest radiograph without infiltrates at the early stage of SARS is an important factor responsible for delayed diagnosis. In patients without a history of close contact with SARS cases, antibiotic effect was a major factor influencing doctors' diagnosis.

  14. Acute tubulointerstitial nephritis following intravenous immunoglobulin therapy in a male infant with minimal-change nephrotic syndrome.

    Science.gov (United States)

    Tanaka, H; Waga, S; Tateyama, T; Sugimoto, K; Kakizaki, Y; Yokoyama, M

    1999-10-01

    A boy aged 4 years with nephrotic syndrome (NS) was referred to our hospital because of the third relapse of NS. Hypogammaglobulinemia associated with massive proteinuria was observed at the presentation. Residual urinary tract infection required intravenous piperacillin and immunoglobulin therapy (IVIG). Soon after IVIG, he complained of high fever with chills, bilateral knee joint pain, dry cough and chest discomfort. Although he did not develop renal insufficiency, a transient increase in the urinary beta2-microglobulin and decrease in the serum complement hemolytic activity were observed. These clinical manifestations spontaneously ceased. A percutaneous renal biopsy for his NS performed 19 days after the episode of allergic reaction revealed tubulointerstitial nephritis (TIN) with marked eosinophil infiltrates. Glomeruli showed minor glomerular abnormalities. Renal complications associated with IVIG treatment have been reported to date, however, acute TIN has rarely been seen.

  15. Yttrium Y 90 Anti-CD45 Monoclonal Antibody BC8 Followed by Donor Stem Cell Transplant in Treating Patients With High-Risk Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, or Myelodysplastic Syndrome

    Science.gov (United States)

    2016-09-29

    Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome; Chronic Myelomonocytic Leukemia; Previously Treated Myelodysplastic Syndrome; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Secondary Acute Myeloid Leukemia

  16. Prediction of acute coronary syndromes by urinary proteome analysis

    Science.gov (United States)

    Htun, Nay M.; Magliano, Dianna J.; Zhang, Zhen-Yu; Lyons, Jasmine; Petit, Thibault; Nkuipou-Kenfack, Esther; Ramirez-Torres, Adela; von zur Muhlen, Constantin; Maahs, David; Schanstra, Joost P.; Pontillo, Claudia; Pejchinovski, Martin; Snell-Bergeon, Janet K.; Delles, Christian; Mischak, Harald; Staessen, Jan A.; Shaw, Jonathan E.

    2017-01-01

    Identification of individuals who are at risk of suffering from acute coronary syndromes (ACS) may allow to introduce preventative measures. We aimed to identify ACS-related urinary peptides, that combined as a pattern can be used as prognostic biomarker. Proteomic data of 252 individuals enrolled in four prospective studies from Australia, Europe and North America were analyzed. 126 of these had suffered from ACS within a period of up to 5 years post urine sampling (cases). Proteomic analysis of 84 cases and 84 matched controls resulted in the discovery of 75 ACS-related urinary peptides. Combining these to a peptide pattern, we established a prognostic biomarker named Acute Coronary Syndrome Predictor 75 (ACSP75). ACSP75 demonstrated reasonable prognostic discrimination (c-statistic = 0.664), which was similar to Framingham risk scoring (c-statistics = 0.644) in a validation cohort of 42 cases and 42 controls. However, generating by a composite algorithm named Acute Coronary Syndrome Composite Predictor (ACSCP), combining the biomarker pattern ACSP75 with the previously established urinary proteomic biomarker CAD238 characterizing coronary artery disease as the underlying aetiology, and age as a risk factor, further improved discrimination (c-statistic = 0.751) resulting in an added prognostic value over Framingham risk scoring expressed by an integrated discrimination improvement of 0.273 ± 0.048 (P < 0.0001) and net reclassification improvement of 0.405 ± 0.113 (P = 0.0007). In conclusion, we demonstrate that urinary peptide biomarkers have the potential to predict future ACS events in asymptomatic patients. Further large scale studies are warranted to determine the role of urinary biomarkers in clinical practice. PMID:28273075

  17. [Organ damage and cardiorenal syndrome in acute heart failure].

    Science.gov (United States)

    Casado Cerrada, Jesús; Pérez Calvo, Juan Ignacio

    2014-03-01

    Heart failure is a complex syndrome that affects almost all organs and systems of the body. Signs and symptoms of organ dysfunction, in particular kidney dysfunction, may be accentuated or become evident for the first time during acute decompensation of heart failure. Cardiorenal syndrome has been defined as the simultaneous dysfunction of both the heart and the kidney, regardless of which of the two organs may have suffered the initial damage and regardless also of their previous functional status. Research into the mechanisms regulating the complex relationship between the two organs is prompting the search for new biomarkers to help physicians detect renal damage in subclinical stages. Hence, a preventive approach to renal dysfunction may be adopted in the clinical setting in the near future. This article provides a general overview of cardiorenal syndrome and an update of the physiopathological mechanisms involved. Special emphasis is placed on the role of visceral congestion as an emergent mechanism in this syndrome. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  18. Acute Phase Hyperglycemia among Patients Hospitalized with Acute Coronary Syndrome: Prevalence and Prognostic Significance

    Directory of Open Access Journals (Sweden)

    Hameed Laftah Wanoose

    2011-03-01

    Full Text Available AbstractObjectives: Regardless of diabetes status, hyperglycemia on arrival for patients presenting with acute coronary syndrome, has been associated with adverse outcomes including death. The aim of this study is to look at the frequency and prognostic significance of acute phase hyperglycemia among patients attending the coronary care unit with acute coronary syndrome over the in-hospital admission days.Methods: The study included 287 consecutive patients in the Al- Faiha Hospital in Basrah (Southern Iraq during a one year period from December 2007 to November 2008. Patients were divided into two groups with respect to admission plasma glucose level regardless of their diabetes status (those with admission plasma glucose of <140 mg/dl (7.8 mmol/L and those equal to or more than that. Acute phase hyperglycemia was defined as a non-fasting glucose level equal to or above 140 mg/dl (7.8 mmol/L regardless of past history of diabetes.Results: Sixty one point seven percent (177 of patients were admitted with plasma glucose of ≥140 mg/dl (7.8 mmol/L. There were no differences were found between both groups regarding the mean age, qualification, and smoking status, but males were predominant in both groups. A family history of diabetes, and hypertension, were more frequent in patients with plasma glucose of ≥140 mg/dl (7.8 mmol/L. There were no differences between the two groups regarding past history of ischemic heart disease, stroke, lipid profile, troponin-I levels or type of acute coronary syndrome. Again heart failure was more common in the admission acute phase hyperglycemia group, but there was no difference regarding arrhythmia, stroke, or death. Using logistic regression with heart failure as the dependent variable we found that only the admission acute phase hyperglycemia (OR=2.1344, 95�0CI=1.0282-4.4307; p=0.0419 was independently associated with heart failure. While male gender, family history of diabetes mellitus, hypertension and

  19. Current perspectives for management of acute respiratory insufficiency in premature infants with acute respiratory syndrome.

    Science.gov (United States)

    Chen, Peng; Zhang, Ying; Li, Long-Yun

    2014-09-01

    Current perspectives for management of acute respiratory insufficiency in premature infants with acute respiratory syndrome and the pathology of acute respiratory insufficiency in the preterm infant, including the current therapy modalities on disposition are presented. Since the therapeutical challenge and primary clinical goal are to normalize ventilation ratio and lung perfusion, when respiratory insufficiency occurs, it is very important to introduce the respiratory support as soon possible, in order to reduce development of pulmonary cyanosis and edema, and intrapulmonary or intracardial shunts. A characteristic respiratory instability that reflects through fluctuations in gas exchange and ventilation is often present in premature infants. Adapting the respiratory support on a continuous basis to the infant's needs is challenging and not always effective. Although a large number of ventilation strategies for the neonate are available, there is a need for additional consensus on management of acute respiratory distress syndrome in pediatric population lately redefined by Berlin definition criteria, in order to efficiently apply various modes of respiratory support in daily pediatrician clinical use.

  20. Elevation of troponin values in differential diagnosis of chest pain in view of pulmonary thromboembolism.

    Science.gov (United States)

    Vucić, Rada; Knezević, Slavko; Lazić, Zorica; Andrejić, Olivera; Dincić, Dragan; Irić-Cupić, Violeta; Zdravković, Vladimir

    2012-10-01

    Acute coronary syndrome, as unstable form of ischaemic heart disease, beside clinical presentation and electrocardiographic abnormalities, is characterized by increased value of troponin one of cardiospecific enzimes. Although troponin is a high specific and sensitive indicator of acute coronary syndrome, any heart muscle injury may induce its increasing, so there are some other diseases with the increased troponin value. We presented a female patient with chest pain, admitted because of suspicioun of acute coronary syndrome. Performed coronarography excluded ischemic heart disease. Considering symtomatology, electrocardiographic abnormalities, increased troponin and D-dimer values, as well as echocardiography finding we considered pulmonary embolism as a differential diagnosis, which was confirmed by pulmoangiography. Isolated increased troponin values are not enough for diagnosis of acute coronary syndrome.

  1. Clinical correlation between myeloperoxidase and acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Jie Wang; Yanwei Xing; Changsheng Ma; Shihong Li; Zhizhong Li; Yonghong Gao; Yibing Nong

    2007-01-01

    Objective To study whether myeloperoxidase (MPO) can provide prognostic information in patients with acute coronary syndromes (ACS). Methods The study population consisted of 274 consecutive patients with ACS. All patients underwent coronary angiography which showed significant coronary artery disease and blood samples were collected at admission. Follow-ups were scheduled at 1, 3, and 6 months.The end point included cardiac death, acute myocardial infarction (MI), percutaneous or surgical revascularization. Results Patients with elevated MPO serum levels (MPO ≥ 72.2 AUU/L) were more likely to have diabetics and had a history of coronary events. Kaplan-Meier event rate curves with accumulative incidence of end point at 6-month follow-up in the MPO ≥ 72.2 AUU/L group was significantly higher than in MPO<72.2 AUU/L group. Conclusions MPO may be a powerful predictor of adverse outcome in patients with ACS.

  2. Neuroleptic Malignant Syndrome Associated with Refractory Acute Disseminated Encephalomyelitis

    Directory of Open Access Journals (Sweden)

    Silvia R. Delgado

    2016-04-01

    Full Text Available We present the case of a young man who was transferred to our hospital with worsening acute disseminated encephalomyelitis (ADEM despite treatment with intravenous methylprednisolone, intravenous immunoglobulin and plasma exchange. He developed neuroleptic malignant syndrome (NMS without the use of dopamine-modulating drugs. His progressive clinical improvement started after treatment with intravenous cyclophosphamide and methylprednisolone. In our patient, acute demyelination with severe bilateral inflammation of the basal ganglia could have caused a state of central dopamine depletion, creating proper conditions for the development of NMS. Significant clinical improvement of our case after treatment with intravenous cyclophosphamide and steroids provides further evidence for a possible role of the inflammatory lesions in the pathogenesis of NMS in association with ADEM.

  3. [Acute respiratory distress syndrome: a review of the Berlin definition].

    Science.gov (United States)

    de Luis Cabezón, N; Sánchez Castro, I; Bengoetxea Uriarte, U X; Rodrigo Casanova, M P; García Peña, J M; Aguilera Celorrio, L

    2014-01-01

    Acute Respiratory Distress Syndrome (ARDS) is due to many causes. The absence of a universal definition up until now has led to a series of practical problems for a definitive diagnosis. The incidences of ARDS and Acute Lung Injury (ALI) vary widely in the current literature. The American-European Consensus Conference definition has been applied since its publication in 1994 and has helped to improve knowledge about ARDS. However, 18 years later, in 2011, the European Intensive Medicine Society, requested a team of international experts to meet in Berlin to review the ARDS definition. The purpose of the Berlin definition is not to use it as a prognostic tool, but to improve coherence between research and clinical practice.

  4. [Corticosteroid administration for acute respiratory distress syndrome : therapeutic option?].

    Science.gov (United States)

    Möhnle, P; Briegel, J

    2012-04-01

    Despite a number of clinical trials there is still controversy about the role of corticosteroid therapy in acute respiratory distress syndrome (ARDS). In addition recent meta-analyses differed markedly in the conclusions. This review is intended to provide a short practical guide for the clinician. Based on the available literature, high-dose and pre-emptive administration of corticosteroids is hazardous and not indicated. A low-dose corticosteroid regime given for 4 weeks may potentially be helpful and can be considered in acute or unresolved ARDS in less than 14 days after onset of ARDS, if a close infection surveillance program is available, if neuromuscular blockade can be avoided and if a stepwise dose reduction of corticosteroids is performed. The total daily dose at the beginning of treatment should not exceed 2 mg/kg body weight (BW) methylprednisolone.

  5. Clinically Diagnosed Acute Diverticulitis in Outpatients: Misdiagnosis in Patients with Irritable Bowel Syndrome.

    Science.gov (United States)

    Longstreth, George F; Tieu, Ryan S

    2016-02-01

    Physicians often diagnose diverticulitis and prescribe antibiotics in outpatients with abdominal pain and tenderness without other evidence. We investigated the misattribution of irritable bowel syndrome (IBS) symptoms to diverticulitis in outpatients. In patients diagnosed with diverticulitis and dispensed antibiotics in an integrated healthcare system, we retrospectively compared 15,846 outpatients managed without computed tomography (CT) versus 3750 emergency department/inpatients who had CT. We assessed demographics and past history, including 17 symptom-based somatic and 11 mental disorders and three somatic-mental comorbidity pairs (dyads) coded over 3 years and seven drug classes dispensed over 1 year before diagnosis. Univariate analysis showed small intergroup demographic differences. Outpatients had increases in prior diverticulitis, including outpatient-managed episodes, total somatic diagnoses (p Hispanic white race/ethnicity, less Charlson comorbidity, diverticulitis history, IBS, chest pain, dyspepsia, fibromyalgia, low back pain, migraine, acute reaction to stress, and antispasmodic and anxiolytic dispensing and negatively associated with non-dependent drug abuse and opioid dispensing (p ≤ .0226). Multiple types of indirect and concordant evidence suggest misattribution of IBS pain to diverticulitis and unnecessary antibiotic therapy in outpatients.

  6. Acute Respiratory Distress Syndrome after the Use of Gadolinium Contrast Media.

    Science.gov (United States)

    Park, Jihye; Byun, Il Hwan; Park, Kyung Hee; Lee, Jae-Hyun; Nam, Eun Ji; Park, Jung-Won

    2015-07-01

    Acute respiratory distress syndrome (ARDS) is a medical emergency that threatens life. To this day, ARDS is very rarely reported by iodine contrast media, and there is no reported case of ARDS induced by gadolinium contrast media. Here, we present a case with ARDS after the use of gadobutrol (Gadovist) as a magnetic resonance imaging (MRI) contrast medium. A 26 years old female without any medical history, including allergic diseases and without current use of drugs, visited the emergency room for abdominal pain. Her abdominopelvic computed tomography with iodine contrast media showed a right ovarian cyst and possible infective colitis. Eighty-three hours later, she underwent pelvis MRI after injection of 7.5 mL (0.1 mL/kg body weight) of gadobutrol (Gadovist) to evaluate the ovarian cyst. She soon presented respiratory difficulty, edema of the lips, nausea, and vomiting, and we could hear wheezing upon auscultation. She was treated with dexamethasone, epinephrine, and norepinephrine. Her chest X-ray showed bilateral central bat-wing consolidative appearance. Managed with mechanical ventilation, she was extubated 3 days later and discharged without complications.

  7. A case of lung cancer associated with acute respiratory distress syndrome after thoracic radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Enoki, Masafumi; Tojima, Hirokazu [Tokyo Rosai Hospital (Japan)

    1996-12-01

    A 73-year-old man presented with dyspnea, cough, fever, appetite loss and stridor due to bronchial stenosis. Fiber-optic bronchoscopy revealed an endobronchial lesion in the right main bronchus and biopsy specimens showed poorly differentiated squamous cell carcinoma. The clinical stage of lung cancer was IIIB (T4N2M0). The patient received 60 Gy in 30 fractions over 43 days to a field including the right hilum and mediastinum. The tumor decreased in size and stenosis of the bronchus disappeared. A week after completion of radiation the patient began to have high grade fever and dyspnea, and progressive hypoxia developed. A chest radiograph showed diffuse bilateral interstitial infiltrates. Despite mechanical ventilation with PEEP and the administration of steroids, he died of respiratory failure three weeks after completion of radiation. Necropsy specimens obtained from the left lung revealed massive deposition of fibrin in the alveolar airspaces associated with hyaline membranes and hyperplasia of type II cells indicating diffuse alveolar damage. The patient had mild pulmonary fibrosis on a CT scan taken before the start of radiotherapy. We conclude that care should be taken if the case has pulmonary fibrosis because radiation therapy can precipitate severe radiation pneumonitis and acute respiratory distress syndrome in such cases. (author)

  8. Acute venous thrombosis as complication and clue to diagnose a SAPHO syndrome case. A case report.

    Science.gov (United States)

    Rosero, A; Ruano, R; Martin, M; Hidalgo, C; Garcia-Talavera, J

    2013-01-01

    This report concerns a male adult admitted for sternal and left arm pain, who was diagnosed and treated for acute deep venous thrombosis in the left subclavian and axillary veins. X-ray and a hybrid single photon emission tomography and computed tomography (SPECT-CT) scintigraphy scan revealed high intensity uptake in both sternoclavicular joints, which corresponded to hyperostosis, thereby suggesting a SAPHO syndrome. Upon reviewing the patient's medical history, we found dermatological pustulosis disease and an intermittent sternal chest pain untreated since 10 years ago. In the biochemical study we found erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) elevation, hyperglobulinemia, and mild anaemia. Initial treatment included nonsteroidal anti-inflammatory drugs (NSAIDs) with low response, which then changed to methotrexate, sulfasalazine, and prednisone. The patient's pain was controlled almost completely in 10 months. A control bone scan revealed a marked decrease in intensity of bone deposits according to clinical response. To our knowledge, there are only a few cases of SAPHO and thrombosis and none are followed up with a bone SPECT-CT scan.

  9. [Pathogenesis and target therapy of acute respiratory distress syndrome].

    Science.gov (United States)

    Moroz, V V; Vlasenko, A V; Golubev, A M

    2014-01-01

    The paper summarizes results of experimental studies and clinical observations of the pathogenesis and effectiveness of respiratory, non-respiratory and pharmacological treatment methods for acute respiratory distress syndrome caused by direct and indirect damaging factors. The article deals with differences and peculiarities of morphological changes and lung functional disorders, clinical, laboratory and instrumental signs of various origins in ARDS and justifies necessity of differential diagnosis and differential treatment of ARDS, depending on the reasons for its development. Furthermore the article discusses an algorithm for differential diagnosis and differential treatment for ARDS caused by direct and indirect damaging factors.

  10. Control dynamics of severe acute respiratory syndrome transmission

    Institute of Scientific and Technical Information of China (English)

    WANG Haiying; RONG Feng; KE Fujiu; BAI Yilong

    2003-01-01

    Severe acute respiratory syndrome (SARS) is a serious disease with many puzzling features. We present a simple, dynamic model to assess the epidemic potential of SARS and the effectiveness of control measures. With this model, we analysed the SARS epidemic data in Beijing. The data fitting gives the basic case reproduction number of 2.16 leading to the outbreak, and the variation of the effective reproduction number reflecting the control effect. Noticeably, our study shows that the response time and the strength of control measures have significant effects on the scale of the outbreak and the lasting time of the epidemic.

  11. Digestive system manifestations in patients with severe acute respiratory syndrome

    Institute of Scientific and Technical Information of China (English)

    詹俊; 陈为宪; 李楚强; 伍卫; 李建军; 江山平; 王景峰; 曾志勇; 黄子通; 黄洪章

    2003-01-01

    Objective To explore digestive system manifestations in patients with severe acute respiratory syndrome (SARS).Method The clinical data of 96 cases with SARS admitted into our hospital from February 6, 2003 to March 28, 2003 were retrospectively analyzed.Results Among the 96 cases, 26 cases (27%) had diarrhea, 17 (18%) had nausea, 6 (6%) had vomiting, 16 (17%) had bellyache, and 8 (8%) had ALT elevation.Conclusions Patients with SARS may have digestive system manifestations; diarrhea is the most common symptom.

  12. Acute compartment syndrome of the thigh in a rugby player

    Science.gov (United States)

    Smith, Richard David James; Rust-March, Holly; Kluzek, Stefan

    2015-01-01

    In the absence of obvious trauma, diagnosis of acute compartment syndrome (ACS) of the thigh can easily be delayed, as disproportional pain is not always present. We present a case of ACS of the anterior right thigh compartment in a healthy, semiprofessional rugby player with normal coagulation, who sustained a seemingly innocuous blow during a rugby match. Following early surgical fasciotomy, he returned to his preinjury playing standards within 12 months. Our literature review suggests that high muscle mass, young, athletic males participating in a contact sport are mostly at risk of developing ACS of the thigh. PMID:26250368

  13. Acute Compartment Syndrome in Orthopedics: Causes, Diagnosis, and Management

    Science.gov (United States)

    Raza, Hasnain; Mahapatra, Anant

    2015-01-01

    Almost all orthopaedic surgeons come across acute compartment syndrome (ACS) in their clinical practice. Diagnosis of ACS mostly relies on clinical findings. If the diagnosis is missed and left untreated, it can lead to serious consequences which can endanger limb and life of the patient and also risk the clinician to face lawsuits. This review article highlights the characteristic features of ACS which will help an orthopaedic surgeon to understand the pathophysiology, natural history, high risk patients, diagnosis, and surgical management of the condition. PMID:25688303

  14. [Clinico-psychopathologic varieties of the acute Kandinsky-Clerambault syndrome in schizophrenia].

    Science.gov (United States)

    Dikaia, V I

    1985-01-01

    Acute cases of the Kandinsky-Clerambault syndrome first manifested in adulthood were studied in schizophrenic patients. On the basis of the clinical mechanisms of the development of psychosis and the specific features of acute delirious disturbances in the structure of psychosis 3 clinical variants of the acute syndrome of psychic automatism were identified: developing according to the type of reaction in the structure of acute paranoid (the first variant), according to the regularities of endogenic paroxysm in the picture of acute sensory delirium (the second variant) and according to the mechanism of exacerbation of chronic delirium entering the structure of acute interpretative delirium (the third variant).

  15. Prevalence of Burnout Syndrome in Patients Admitted with Acute Coronary Syndrome

    Directory of Open Access Journals (Sweden)

    Ana Cláudia Giaxa Prosdócimo

    2015-03-01

    Full Text Available Background: Burnout Syndrome is the extreme emotional response to chronic occupational stress, manifesting as physical and mental exhaustion. Although associated with higher prevalence of cardiovascular risk factors, no study so far has evaluated whether the Burnout Syndrome could be a prevalent factor in non-elderly individuals active in the labor market, admitted for acute coronary syndrome (ACS. Objective: To evaluate the prevalence of the Burnout Syndrome in non-elderly, economically active patients, hospitalized with ACS. Methods: Cross-sectional study conducted in a tertiary and private cardiology center, with economically active patients aged <65 years, hospitalized with diagnosis of ACS. The Burnout Syndrome was evaluated with the Burnout Syndrome Inventory (BSI, which assesses workplace conditions and four dimensions that characterize the syndrome: emotional exhaustion (EE, emotional distancing (EmD, dehumanization (De and professional fulfillment (PF. The Lipp’s Stress Symptoms Inventory for Adults (LSSI was applied to evaluate global stress. Results: Of 830 patients evaluated with suspected ACS, 170 met the study criteria, 90% of which were men, overall average age was 52 years, and 40.5% had an average income above 11 minimum wages. The prevalence of the Burnout Syndrome was 4.1%. When we evaluated each dimension individually, we found high EE in 34.7%, high De in 52.4%, high EDi in 30.6%, and low PF in 5.9%. The overall prevalence of stress was 87.5%. Conclusion: We found a low prevalence of Burnout Syndrome in an economically active, non-elderly population among patients admitted for ACS in a tertiary and private hospital.

  16. Relationship between Traditional Chinese Medicine Syndrome Type and Coronary Arteriography of Acute Coronary Syndrome

    Institute of Scientific and Technical Information of China (English)

    WANG Xian(王显); LIN Zhong-xiang(林钟香); GE Jun-bo(葛均波); ZHANG Zhen-xian(张振贤); SHEN Lin(沈琳)

    2003-01-01

    Objective: To explore the relationship of Traditional Chinese Medicine (TCM) Syndrome type and coronary arteriography (CAG) with respect to the number and degree of stenosed branches of coronary artery (CA) and ACC/AHA stage of acute coronary syndrome (ACS), to provide an objective evidence for TCM Syndrome typing on ACS.Methods: Ninety patients of ACS with their TCM Syndrome typing and CAG successfully conducted were enrolled in this study. They were classified into 3 Syndrome types, the blood stasis type (typeⅠ), the phlegm stagnant with blood stasis type (typeⅡ), and the endogenous collateral Wind type (typeⅢ). The scores of the number and severity of the stenosis branch of CA and ACC/AHA lesion stage in different Syndrome types were calculated respectively and analysed statistically by Ridit analysis.Results: The number of stenosed branches increased gradually with the Syndrome type changing from Ⅰ→Ⅱ→Ⅲ, compared the type Ⅲ with the other two types(P<0.01). The severity of stenosis in typeⅠ and Ⅱ were similar, but that of Type Ⅲ, much aggravated was significantly different from that in the former two (P<0.01). The ACC/AHA stage of coronary lesion tended to be more complex as the Syndrome type changed, patients of TCM typeⅠ and Ⅱ had mostly lesion of stage A or B1 , while lesion in majority of patients of type Ⅲ belonged to stage B2 or C, comparison between the three types showed significant difference (P<0.01). Conclusion: Most ACS patients of TCM Syndrome type Ⅲ with tri-branch, severe stenosed coronary arteries, belong to the complex ACC/AHA stage of B2 and C.

  17. Acute bulbar palsy plus syndrome: A rare variant of Guillain-Barre syndrome.

    Science.gov (United States)

    Ray, Sanghamitra; Jain, Prakash Chand

    2016-01-01

    Guillain-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide both in adult and pediatric population. Although flaccid paralysis is the hallmark of this disease, there are some rare variants which may be easily missed unless suspected. Here, we present a very rare variant of GBS - acute bulbar palsy plus syndrome in a pediatric patient. A 13-year-old female child presented with right-sided lower motor neuron type of facial palsy and palsy of bilateral glossopharyngeal and vagus nerve of 2 weeks duration. On detailed neurological examination, motor and sensory system were normal, but the deep tendon reflexes were absent universally. Nerve conduction study showed demyelinating motor neuropathy. Based on typical clinical course and electrophysiological studies, the diagnosis was made. To the best of our knowledge, this is the first pediatric case of unilateral facial palsy with bulbar involvement without any motor abnormality.

  18. Clinical significance of Ischemia Modified Albumin in the Early Diagnosis of Patients with Acute Chest Pain%缺血修饰蛋白在急性胸痛患者早期诊断中的临床意义

    Institute of Scientific and Technical Information of China (English)

    余琦; 钮炜西; 唐发宽; 华宁; 林乐健

    2013-01-01

    目的 探讨缺血修饰蛋白(IMA)在急性胸痛患者早期诊断中的临床意义.方法 急性胸痛患者125例,分为非冠心病组(UCAD) 32例,不稳定性心绞痛组(UAP)21例,急性心肌梗死组(AMI)72例.于入院时、末次症状后8h、末次症状后24h抽血,测定血清IMA、cTnI、MYO;采用SPSS13统计软件进行分析.结果 结果显示:入院时IMA值在UCAD组、UAP组和AMI组之间比较差异有统计学意义(P<0.05);末次症状后8h,AMI组和IMA值仍与其他两组间比较差异有统计学意义(P<0.05);末次症状后24h,三组患者所测IMA值之间比较差异无统计学意义(P>0.05).125例患者中,有92例患者诊断为急性冠脉综合症(ACS).IMA的诊断敏感性最高,为82.6%,ECG仅为29.7%,cTnI为42.8%,MYO为64.3%.不同判断指标的组合在入院后即刻诊断心源性疾病的阳性率为85.2% ~ 93.6%.结论 IMA对急性胸痛患者的早期诊断具有一定的临床意义.%Objective To investigate the clinical significance of ischemia modified albumin (IMA) in the diagnosis of patients with acute chest pain. Methods Among the 125 patients with chest pain who were hospitalized in our department, 32 were grouped into non-coronary heart disease (NCAD) group, 21 into unstable angina (UAP) group and 72 into acute myocardial infarction (AMI) group. Blood sample were drown at entry, 8 hours and 24 hours after last attacking, and the levels of IMA, cTnI and MYO were determined. Statistical analysis was done by SPSS 13.O statistical package. Results The levels of IMA at entry and 8 hour after last attacking in NCAD group were significantly different compared to the other groups (P 0.05). 92 patients in total 125 patients were diagnosed as the acute coronary syndrome (ACS). The diagnostic sensitivity of IMA (82.6% ) was higher than that of electrocardiogram (29. 7) , cTnI (42. 8% ) and MYO (64. 3% ). The heart source disease's immediate diagnosis positive rates of different judgment

  19. Acute coronary syndrome in diclofenac sodium-induced type I hypersensitivity reaction : Kounis syndrome

    OpenAIRE

    Gluvic, Zoran M.; Putnikovic, Biljana; Panic, Milos; Stojkovic, Aleksandra; Rasic-Milutinovic, Zorica; Jankovic-Gavrilovic, Jelena

    2007-01-01

    Drug-induced type I hypersensitivity reactions are frequent. Sometimes, acute coronary syndrome (ACS) can be registered in such patients, which may have a serious impact on the course and management of the allergic reaction. Because of potentially atypical ACS clinical presentations, the ECG is an obligatory diagnostic tool in any allergic reaction. Coronary artery spasm is the pathophysiological basis of ACS, triggered by the action of potent vasoactive mediators (histamine, neutral protease...

  20. Prevalence of Burnout Syndrome in Patients Admitted with Acute Coronary Syndrome

    Science.gov (United States)

    Prosdócimo, Ana Cláudia Giaxa; Lucina, Luciane Boreki; Marcia, Olandoski; Jobs, Priscila Megda João; Schio, Nicolle Amboni; Baldanzi, Fernanda Fachin; Costantini, Costantino Ortiz; Benevides-Pereira, Ana Maria Teresa; Guarita-Souza, Luiz Cesar; Faria-Neto, José Rocha

    2015-01-01

    Background Burnout Syndrome is the extreme emotional response to chronic occupational stress, manifesting as physical and mental exhaustion. Although associated with higher prevalence of cardiovascular risk factors, no study so far has evaluated whether the Burnout Syndrome could be a prevalent factor in non-elderly individuals active in the labor market, admitted for acute coronary syndrome (ACS). Objective To evaluate the prevalence of the Burnout Syndrome in non-elderly, economically active patients, hospitalized with ACS. Methods Cross-sectional study conducted in a tertiary and private cardiology center, with economically active patients aged dehumanization (De) and professional fulfillment (PF). The Lipp’s Stress Symptoms Inventory for Adults (LSSI) was applied to evaluate global stress. Results Of 830 patients evaluated with suspected ACS, 170 met the study criteria, 90% of which were men, overall average age was 52 years, and 40.5% had an average income above 11 minimum wages. The prevalence of the Burnout Syndrome was 4.1%. When we evaluated each dimension individually, we found high EE in 34.7%, high De in 52.4%, high EDi in 30.6%, and low PF in 5.9%. The overall prevalence of stress was 87.5%. Conclusion We found a low prevalence of Burnout Syndrome in an economically active, non-elderly population among patients admitted for ACS in a tertiary and private hospital. PMID:25517388

  1. Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

    DEFF Research Database (Denmark)

    Sørgaard, Mathias; Linde, Jesper James; Kofoed, Klaus Fuglsang

    2016-01-01

    compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA. RESULTS: The diagnostic accuracy of PTP......OBJECTIVES: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We...... investigated the validity of the new guidelines in a population of patients with acute-onset chest pain. METHODS: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We...

  2. The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome.

    Science.gov (United States)

    McQueen, Margaret M; Duckworth, Andrew D; Aitken, Stuart A; Court-Brown, Charles M

    2013-04-17

    The aim of our study was to document the estimated sensitivity and specificity of continuous intracompartmental pressure monitoring for the diagnosis of acute compartment syndrome. From our prospective trauma database, we identified all patients who had sustained a tibial diaphyseal fracture over a ten-year period. A retrospective analysis of 1184 patients was performed to record and analyze the documented use of continuous intracompartmental pressure monitoring and the use of fasciotomy. A diagnosis of acute compartment syndrome was made if there was escape of muscles at fasciotomy and/or color change in the muscles or muscle necrosis intraoperatively. A diagnosis of acute compartment syndrome was considered incorrect if it was possible to close the fasciotomy wounds primarily at forty-eight hours. The absence of acute compartment syndrome was confirmed by the absence of neurological abnormality or contracture at the time of the latest follow-up. Of 979 monitored patients identified, 850 fit the inclusion criteria with a mean age of thirty-eight years (range, twelve to ninety-four years), and 598 (70.4%) were male (p compartment syndrome: 141 had acute compartment syndrome (true positives), six did not have it (false positives), and five underwent fasciotomy despite having a normal differential pressure reading, with subsequent operative findings consistent with acute compartment syndrome (false negatives). Of the 698 patients (82.1%) who did not undergo fasciotomy, 689 had no evidence of any late sequelae of acute compartment syndrome (true negatives) at a mean follow-up time of fifty-nine weeks. The estimated sensitivity of intracompartmental pressure monitoring for suspected acute compartment syndrome was 94%, with an estimated specificity of 98%, an estimated positive predictive value of 93%, and an estimated negative predictive value of 99%. The estimated sensitivity and specificity of continuous intracompartmental pressure monitoring for the diagnosis of

  3. Acute Respiratory Distress Syndrome as the Initial Clinical Manifestation of an Antisynthetase Syndrome

    Science.gov (United States)

    Kim, Seo-Hyun

    2016-01-01

    Antisynthetase syndrome has been recognized as an important cause of autoimmune inflammatory myopathy in a subset of patients with polymyositis and dermatomyositis. It is associated with serum antibody to aminoacyl-transfer RNA synthetases and is characterized by a constellation of manifestations, including fever, myositis, interstitial lung disease, mechanic's hand-like cutaneous involvement, Raynaud phenomenon, and polyarthritis. Lung disease is the presenting feature in 50% of the cases. We report a case of a 60-year-old female with acute respiratory distress syndrome (ARDS), which later proved to be an unexpected and initial manifestation of anti-Jo-1 antibody–positive antisynthetase syndrome. The present case showed resolution of ARDS after treatment with high-dose corticosteroids. Given that steroids are not greatly beneficial in the treatment of ARDS, it is likely that the improvement of the respiratory symptoms in this patient also resulted from the prompt suppression of the inflammatory systemic response by corticosteroids. PMID:27433180

  4. A Case of Severe Pulmonary Thromboembolism in a Young Male With Klinefelter Syndrome

    OpenAIRE

    Kang, Byung-Soo; Cho, Deok-Kyu; Koh, Won-Jun; Yoo, Seung-Hoon; Won, Ki-Bum; Cho, Yun-Hyeong; Hwang, Eui-Seock; Koh, Jong-Hoon

    2012-01-01

    A young male patient diagnosed with Klinefelter syndrome was admitted to our hospital via the emergency room with chief complaints of acute chest pain and dyspnea. Pulmonary thromboembolism was diagnosed from his chest CT images. His symptoms improved after he underwent thrombolysis and anticoagulation treatment. Klinefelter syndrome has a tendency towards hypercoagulability due to hormonal imbalance and one or more inherited thromophilic factors. Thus, Klinefelter syndrome patients with a pa...

  5. Utility of nonspecific resting electrocardiographic features for detection of coronary artery stenosis by Computed Tomography in acute chest pain patients: from the ROMICAT trial

    Science.gov (United States)

    Banerji, Dahlia; Ptaszek, Leon M.; Taylor, Carolyn; Fontes, Joao D.; Kriegel, Matthias; Irlbeck, Thomas; Nagurney, John T.; Hoffmann, Udo

    2011-01-01

    Twelve-lead surface electrocardiography (ECG) and computed tomography (CT) are used to evaluate for myocardial ischemia and coronary artery disease (CAD), respectively. We aimed to determine features on resting ECG that predict coronary artery stenosis by cardiac CT. In 309 acute chest pain patients, we compared the initial triage resting ECG to contrast-enhanced 64-slice cardiac CT angiography. We assessed for 6 quantitative (QT interval, QTc interval, QTc > 440 ms, gender-specific QTc, QT dispersion and QRS duration) and 4 qualitative ECG parameters (ST depression >0.05 to ≤0.1 mV, T wave inversion ≥0.1 mV, T wave flattening, and any T wave abnormalities) and for the presence of coronary stenosis by CT (>50% luminal narrowing). Specificities of these ECG parameters were excellent (83.6–97.0%) while sensitivities were poor (12.2–29.3%). For coronary stenosis detection, the ECG features with the greatest performance were the presence of ST depression (positive likelihood ratio [LR+] 4.09) and T wave inversion (LR+ 4.58). In multivariable analyses, the risk for coronary stenosis increased by 33–41% for every 20 ms prolongation of the QTc interval after adjusting for age, gender, and cardiac risk factors or adjustment for Framingham risk score. Similarly, there was an increase of fourfold with the presence of ST depression >0.05 to ≤0.1 mV or T wave inversion ≥0.1 mV. In acute chest pain patients, resting ECG features of QTc interval prolongation, mild ST depression, and T wave inversion are independently associated with the presence of CT coronary stenosis and their presence suggests an increase risk of CAD. PMID:21287278

  6. Evaluation of chest pain in the emergency department.

    Science.gov (United States)

    Jesse, R L; Kontos, M C

    1997-04-01

    The evaluation of chest pain in the emergency setting should be systematic, risk based, and goal driven. An effective program must be able to evaluate all patients with equal thoroughness under the assumption that any patient with chest pain could potentially be having an MI. The initial evaluation is based on the history, a focused physical examination, and the ECG. This information is sufficient to categorize patients into groups at high, moderate, and low risk. Table 14 is a template for a comprehensive chest-pain evaluation program. Patients at high risk need rapid initiation of appropriate therapy: thrombolytics or primary angioplasty for the patients with MIs or aspirin/heparin for the patients with unstable angina. Patients at moderate risk need to have an acute coronary syndrome ruled in or out expediently and additional comorbidities addressed before discharge. Patients at low risk also need to be evaluated, and once the likelihood of an unstable acute coronary syndrome is eliminated, they can be discharged with further evaluation performed as outpatients. Subsequent evaluation should attempt to assign a definitive diagnosis while also addressing issues specific to risk reduction, such as cholesterol lowering and smoking cessation. It is well documented that 4% to 5% of patients with MIs are inadvertently missed during the initial evaluation. This number is surprisingly consistent among many studies using various protocols and suggests that an initial evaluation limited to the history, physical examination, and ECG will fail to identify the small number of these patients who otherwise appear at low risk. The solution is to improve the sensitivity of the evaluation process to identify these patients. It appears that more than simple observation is required, and at the present time, no simple laboratory test can meet this need. However, success has been reported with a number of strategies including emergency imaging with either radionuclides such as

  7. Summary of 32 Patients with Cardiac Syndrome X Treated by TCM Therapy of Regulating Qi Relieving Chest Stuffiness and Promoting Blood Circulation

    Institute of Scientific and Technical Information of China (English)

    MAO Jing-yuan; ZHAO Gui-feng; WANG Zhan-wu; MA Xue-peng; ZHANG Zhen-peng; LI Ming; SHAO Lei; ZHAO Chun-yan; GE Yong-bin; WANG Heng-he; WANG Qiang; ZHANG Yun; YU Dong-ling; ZHANG Yu; HUANG Qi; ZHAO Zhi-qiang

    2007-01-01

    Objective:To evaluate the clinical effect of Liqi Kuanxiong Huoxue method(理气宽胸活血,LKH,traditional Chinese medicine,TCM therapeutic method for regulating qi,relieving chest stuffiness and promoting blood circulation) in treating patients with cardiac syndrome X (CSX).Methods:The prospective,non-randomized controlled study was conducted on 51 selected patients with CSX,who were non-randomly assigned to 2 groups,the treated group treated with LKH in addition to the conventional treatment(32 patients),and the control group treated with conventional treatment(19 patients)like nitrate,diltiazem hydrochloride,etc.The treatment course was 14 days.The changes of such symptoms as angina pectoris,TCM syndrome and indexes of treadmill exercise test before and after treatment were observed.Results:After treatment,such symptoms as chest pain and stuffy feeling and palpitation in the treated group were improved more than those in the control group(P<0.05);the total effective rate on angina pectoris and TCM syndrome in the treated group was better than that in the control group(P<0.05).The treadmill exercise test showed that the maximal metabolic equivalent(Max MET),the time of angina onset and ST segment depression by 0.1 mV were obviously improved after treatment in both groups,but the improvement in the treated group was better than that in the control group respectively (P<0.05).Conclusion:The LKH method could reduce the frequency of angina attacks and improve the clinical condition of patients with CSX.

  8. Intrapleural steroid instillation for multiple organ failure with acute respiratory distress syndrome.

    Science.gov (United States)

    Huang, Pei-Ming; Lin, Tzu-Hsin; Tsai, Pi-Ru; Ko, Wen-Je

    2013-11-01

    Acute respiratory distress syndrome (ARDS) increases mortality in patients with multiorgan dysfunction syndrome (MODS). This study evaluates the feasibility of intrapleural steroid instillation (IPSI) in patients with ARDS and MODS unresponsive to conventional extracorporeal membrane oxygenation (ECMO). Ninety-two of 467 patients who underwent ECMO between 2005 and 2009 had ARDS, and 30 consecutive adult patients of these 92 patients with severe ARDS and MODS were retrospectively analyzed in this study. Nine of these 30 patients, who did not respond to therapy and whose condition deteriorated, were managed with IPSI. All patients met the inclusion criteria of hemodynamic instability with high catecholamine infusion requirement and 100% oxygen demand in ventilation and ECMO flow. On initial diagnosis of ARDS, no differences in prognostic scorings were observed in patients who underwent conventional treatment (n = 21) and those who underwent IPSI (n = 9). Blood oxygenation, tidal volume, changing in chest radiographic findings, and survival rates were analyzed. The primary outcome was survival until discharge from the hospital. Pulmonary radiographic appearance improved after 3 days of IPSI treatment (P = 0.008); the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen also increased significantly after 5 days of IPSI treatment (P = 0.028). Moreover, the 28-day mortality rate (P = 0.017), 60-day mortality rate (P = 0.003), and survival rate (78% vs. 19%; P = 0.003) significantly improved in patients undergoing IPSI, which therefore appears to be an easily implemented and highly effective treatment for patients with severe ARDS in combination with MODS, particularly in patients who fail to respond to conventional treatment.

  9. Cynomolgus macaque as an animal model for severe acute respiratory syndrome.

    Directory of Open Access Journals (Sweden)

    James V Lawler

    2006-05-01

    Full Text Available The emergence of severe acute respiratory syndrome (SARS in 2002 and 2003 affected global health and caused major economic disruption. Adequate animal models are required to study the underlying pathogenesis of SARS-associated coronavirus (SARS-CoV infection and to develop effective vaccines and therapeutics. We report the first findings of measurable clinical disease in nonhuman primates (NHPs infected with SARS-CoV.In order to characterize clinically relevant parameters of SARS-CoV infection in NHPs, we infected cynomolgus macaques with SARS-CoV in three groups: Group I was infected in the nares and bronchus, group II in the nares and conjunctiva, and group III intravenously. Nonhuman primates in groups I and II developed mild to moderate symptomatic illness. All NHPs demonstrated evidence of viral replication and developed neutralizing antibodies. Chest radiographs from several animals in groups I and II revealed unifocal or multifocal pneumonia that peaked between days 8 and 10 postinfection. Clinical laboratory tests were not significantly changed. Overall, inoculation by a mucosal route produced more prominent disease than did intravenous inoculation. Half of the group I animals were infected with a recombinant infectious clone SARS-CoV derived from the SARS-CoV Urbani strain. This infectious clone produced disease indistinguishable from wild-type Urbani strain.SARS-CoV infection of cynomolgus macaques did not reproduce the severe illness seen in the majority of adult human cases of SARS; however, our results suggest similarities to the milder syndrome of SARS-CoV infection characteristically seen in young children.

  10. Impact of Different Obesity Assessment Methods after Acute Coronary Syndromes

    Directory of Open Access Journals (Sweden)

    Caroline N. M. Nunes

    2014-07-01

    Full Text Available Background: Abdominal obesity is an important cardiovascular risk factor. Therefore, identifying the best method for measuring waist circumference (WC is a priority. Objective: To evaluate the eight methods of measuring WC in patients with acute coronary syndrome (ACS as a predictor of cardiovascular complications during hospitalization. Methods: Prospective study of patients with ACS. The measurement of WC was performed by eight known methods: midpoint between the last rib and the iliac crest (1, point of minimum circumference (2; immediately above the iliac crest (3, umbilicus (4, one inch above the umbilicus (5, one centimeter above the umbilicus (6, smallest rib and (7 the point of greatest circumference around the waist (8. Complications included: angina, arrhythmia, heart failure, cardiogenic shock, hypotension, pericarditis and death. Logistic regression tests were used for predictive factors. Results: A total of 55 patients were evaluated. During the hospitalization period, which corresponded on average to seven days, 37 (67% patients had complications, with the exception of death, which was not observed in any of the cases. Of these complications, the only one that was associated with WC was angina, and with every cm of WC increase, the risk for angina increased from 7.5 to 9.9%, depending on the measurement site. It is noteworthy the fact that there was no difference between the different methods of measuring WC as a predictor of angina. Conclusion: The eight methods of measuring WC are also predictors of recurrent angina after acute coronary syndromes.

  11. Using machine learning techniques to differentiate acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Sougand Setareh

    2015-02-01

    Full Text Available Backgroud: Acute coronary syndrome (ACS is an unstable and dynamic process that includes unstable angina, ST elevation myocardial infarction, and non-ST elevation myocardial infarction. Despite recent technological advances in early diognosis of ACS, differentiating between different types of coronary diseases in the early hours of admission is controversial. The present study was aimed to accurately differentiate between various coronary events, using machine learning techniques. Such methods, as a subset of artificial intelligence, include algorithms that allow computers to learn and play a major role in treatment decisions. Methods: 1902 patients diagnosed with ACS and admitted to hospital were selected according to Euro Heart Survey on ACS. Patients were classified based on decision tree J48. Bagging aggregation algorithms was implemented to increase the efficiency of algorithm. Results: The performance of classifiers was estimated and compared based on their accuracy computed from confusion matrix. The accuracy rates of decision tree and bagging algorithm were calculated to be 91.74% and 92.53%, respectively. Conclusion: The proposed methods used in this study proved to have the ability to identify various ACS. In addition, using matrix of confusion, an acceptable number of subjects with acute coronary syndrome were identified in each class.

  12. Impact of Different Obesity Assessment Methods after Acute Coronary Syndromes

    Energy Technology Data Exchange (ETDEWEB)

    Nunes, Caroline N. M.; Minicucci, Marcos F.; Farah, Elaine; Fusco, Daniéliso; Azevedo, Paula S.; Paiva, Sergio A. R.; Zornoff, Leonardo A. M., E-mail: lzornoff@cardiol.br [Faculdade de Medicina de Botucatu, Botucatu, SP (Brazil)

    2014-07-15

    Abdominal obesity is an important cardiovascular risk factor. Therefore, identifying the best method for measuring waist circumference (WC) is a priority. To evaluate the eight methods of measuring WC in patients with acute coronary syndrome (ACS) as a predictor of cardiovascular complications during hospitalization. Prospective study of patients with ACS. The measurement of WC was performed by eight known methods: midpoint between the last rib and the iliac crest (1), point of minimum circumference (2); immediately above the iliac crest (3), umbilicus (4), one inch above the umbilicus (5), one centimeter above the umbilicus (6), smallest rib and (7) the point of greatest circumference around the waist (8). Complications included: angina, arrhythmia, heart failure, cardiogenic shock, hypotension, pericarditis and death. Logistic regression tests were used for predictive factors. A total of 55 patients were evaluated. During the hospitalization period, which corresponded on average to seven days, 37 (67%) patients had complications, with the exception of death, which was not observed in any of the cases. Of these complications, the only one that was associated with WC was angina, and with every cm of WC increase, the risk for angina increased from 7.5 to 9.9%, depending on the measurement site. It is noteworthy the fact that there was no difference between the different methods of measuring WC as a predictor of angina. The eight methods of measuring WC are also predictors of recurrent angina after acute coronary syndromes.

  13. Relationship between matrix metalloproteinase-9 polymorphism and acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Linlin Wang; Tiebing Zhu; Yong Li

    2007-01-01

    Objective: To investigate the relationship of matrix metalloproteinase-9 polymorphism to acute coronary syndrome and its affect on the severity of coronary artery disease. Methods: By means of polymerase chain reaction (PCR) and restriction fragment length polymorphism, genotypes of 245 patients with acute coronary syndrome(ACS) and 205 healthy subjects were tested. Genotypes displaying C-1562T functional promoter polymorphism (of the MMP-9 gene) were determined. The relationship between the polymorphism of the MMP-9 gene and ACS and the severity of coronary vessels diseased was analyzed. Results: The frequency of C/T plus T/T genotypes and T allele in patients with ACS was significantly higher than that in healthy subjects (22.1% vs 12.7% and 11.4% vs 6.6% respectively). But they were not associated with the number of coronary arteries diseased. Conclusion:The MMP-9 polymorphism may be susceptible to ACS. But there was not significant difference between the AMI and UAP subgroups.

  14. Spontaneous platelet aggregation in patients with acute coronary syndrome.

    Science.gov (United States)

    Mazurov, A V; Khaspekova, S G; Yakushkin, V V; Khachikyan, M V; Zyuryaev, I T; Ruda, M Ya

    2013-05-01

    Spontaneous platelet aggregation was evaluated in patients with acute coronary syndrome on days 1, 3-5, and 8-12 of the disease. On day 1, aggregation was analyzed after aspirin, but before clopidogrel administration; during other periods after both antiaggregants. The mean levels of spontaneous aggregation after antithrombotic therapy did not change during different periods after the onset of acute coronary syndrome, in contrast to ADP-induced aggregation that decreased after the development of clopidogrel effects (days 3-5 and 8-12). Spontaneous aggregation during different periods directly correlated (r>0.4, p<0.01) with spontaneous and ADP-induced aggregation during different periods (r=0.372, r=0.447, and r=0.543 on days 1, 3-5, and 8-12, respectively; p<0.01). No relationship between spontaneous aggregation and plasma concentration of von Willebrand's factor was detected. Spontaneous aggregation was completely suppressed after in vitro addition of prostaglandin E1 (platelet activation inhibitor), slightly (by ≈20%) decreased in the presence of antibodies to glycoprotein Ib, blocking its reactions with von Willebrand's factor, and did not change in the presence of aptamer inhibiting thrombin activity.

  15. Cardiorenal Syndrome in Acute Heart Failure: Revisiting Paradigms.

    Science.gov (United States)

    Núñez, Julio; Miñana, Gema; Santas, Enrique; Bertomeu-González, Vicente

    2015-05-01

    Cardiorenal syndrome has been defined as the simultaneous dysfunction of both the heart and the kidney. Worsening renal function that occurs in patients with acute heart failure has been classified as cardiorenal syndrome type 1. In this setting, worsening renal function is a common finding and is due to complex, multifactorial, and not fully understood processes involving hemodynamic (renal arterial hypoperfusion and renal venous congestion) and nonhemodynamic factors. Traditionally, worsening renal function has been associated with worse outcomes, but recent findings have revealed mixed and heterogeneous results, perhaps suggesting that the same phenotype represents a diversity of pathophysiological and clinical situations. Interpreting the magnitude and chronology of renal changes together with baseline renal function, fluid overload status, and clinical response to therapy might help clinicians to unravel the clinical meaning of renal function changes that occur during an episode of heart failure decompensation. In this article, we critically review the contemporary evidence on the pathophysiology and clinical aspects of worsening renal function in acute heart failure. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  16. Acute renal failure: A rare presentation of Sheehan′s syndrome

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    Manzoor A Bhat

    2012-01-01

    Full Text Available Sheehan′s syndrome occurs as a result of ischemic pituitary necrosis secondary to severe postpartum bleeding. It is one of the most common causes of hypopituitarism, characterized by variable clinical presentation. Acute kidney injury occurs rarely in Sheehan′s syndrome and most of the cases have been found to be precipitated by rhabdomyolysis. We here present a case of Sheehan′s syndrome with acute kidney injury where theprecipitating cause was chronic hypocortisolemia. We believe this is the first reported case of Sheehan′s syndrome in which acute kidney injury was precipitated by adrenal insufficiency.

  17. Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study

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    Andrew S. Allegretti

    2015-01-01

    Full Text Available Background/Aims. Acute kidney injury is a common problem for patients with cirrhosis and is associated with poor survival. We aimed to examine the association between type of acute kidney injury and 90-day mortality. Methods. Prospective cohort study at a major US liver transplant center. A nephrologist’s review of the urinary sediment was used in conjunction with the 2007 Ascites Club Criteria to stratify acute kidney injury into four groups: prerenal azotemia, hepatorenal syndrome, acute tubular necrosis, or other. Results. 120 participants with cirrhosis and acute kidney injury were analyzed. Ninety-day mortality was 14/40 (35% with prerenal azotemia, 20/35 (57% with hepatorenal syndrome, 21/36 (58% with acute tubular necrosis, and 1/9 (11% with other (p=0.04 overall. Mortality was the same in hepatorenal syndrome compared to acute tubular necrosis (p=0.99. Mortality was lower in prerenal azotemia compared to hepatorenal syndrome (p=0.05 and acute tubular necrosis (p=0.04. Ten participants (22% were reclassified from hepatorenal syndrome to acute tubular necrosis because of granular casts on urinary sediment. Conclusions. Hepatorenal syndrome and acute tubular necrosis result in similar 90-day mortality. Review of urinary sediment may add important diagnostic information to this population. Multicenter studies are needed to validate these findings and better guide management.

  18. Pediatric Acute Respiratory Distress Syndrome: Fibrosis versus Repair

    Directory of Open Access Journals (Sweden)

    Daniel eIm

    2016-03-01

    Full Text Available Clinical and basic experimental approaches to pediatric acute lung injury (ALI, including acute respiratory distress syndrome (ARDS, have historically focused on acute care and management of the patient. Additional efforts have focused on the etiology of pediatric ALI and ARDS, clinically defined as diffuse, bilateral diseases of the lung that compromise function leading to severe hypoxemia within seven days of defined insult. Insults can include ancillary events related to prematurity, can follow trauma and/or transfusion, or can present as sequelae of pulmonary infections and cardiovascular disease and/or injury. Pediatric ALI/ARDS remains one of the leading causes of infant and childhood morbidity and mortality, particularly in the developing world. Though incidence is relatively low, ranging from 2.9-9.5 cases/100,000 patients/year, mortality remains high, approaching 35% in some studies. However, this is a significant decrease from the historical mortality rate of over 50%. Several decades of advances in acute management and treatment, as well as better understanding of approaches to ventilation, oxygenation and surfactant regulation, have contributed to improvements in patient recovery. As such, there is a burgeoning interest in the long term impact of pediatric ALI/ARDS. Chronic pulmonary deficiencies in survivors appear to be caused by inappropriate injury repair, with fibrosis and predisposition to emphysema arising as irreversible secondary events that can severely compromise pulmonary development and function, as well as the overall health of the patient. In this chapter, the long term effectiveness of current treatments will be examined, as will the potential efficacy of novel, acute and long term therapies that support repair and delay or even impede the onset of secondary events, including fibrosis.

  19. Chest pain in focal musculoskeletal disorders

    DEFF Research Database (Denmark)

    Stochkendahl, Mette Jensen; Christensen, Henrik Wulff

    2010-01-01

    overlapping conditions and syndromes of focal disorders, including Tietze syndrome, costochondritis, chest wall syndrome, muscle tenderness, slipping rib, cervical angina, and segmental dysfunction of the cervical and thoracic spine, have been reported to cause pain. For most of these syndromes, evidence...

  20. Diagnostic image quality of a comprehensive high-pitch dual-spiral cardiothoracic CT protocol in patients with undifferentiated acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Bamberg, Fabian, E-mail: fbamberg@med.lmu.de [Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich (Germany); Marcus, Roy; Sommer, Wieland; Schwarz, Florian; Nikolaou, Konstantin; Becker, Christoph R.; Reiser, Maximilian F.; Johnson, Thorsten R.C. [Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich (Germany)

    2012-12-15

    Objective: To evaluate diagnostic image quality of high-pitch dual source comprehensive cardiothoracic CT protocol in patients presenting with acute undifferentiated chest pain. Materials and methods: Consecutive symptomatic subjects (n = 51) with undifferentiated acute chest pain underwent ECG-synchronized high-pitch dual-spiral chest CT angiography (Definition Flash, Siemens Medical Solutions, 2 × 100 kVp or 2 × 120 kV if BMI > 30, collimation: 128 × 0.6 mm, pitch: 3.2). Independent investigators determined the image quality of each cardiac and pulmonary vessel segment, measured contrast-to-noise-ratio (CNR), and determined radiation exposure. In addition, the prevalence of CT findings (pulmonary embolism (PE), aortic dissection (AD) and significant coronary stenosis (≥50%)) was determined. Univariate and multivariate analysis were performed to determine the subpopulation with highest diagnostic quality. Results: Among 51 subjects (66% male, average age: 63 ± 15.8), the prevalence of positive CT findings was moderate (overall: 11.7%). Overall, image quality of the pulmonary, aortic and coronary vasculature was good (1.26 ± 0.43 and CNR: 2.52) with an average radiation dose of 3.82 mSv and 3.2% of segments rated non-evaluable. The image quality was lowest in the coronary arteries (p = 0.02), depending on the heart rate (r = 0.52, p < 0.001). In subjects with a heart rate of ≤65 bpm (n = 30) subjective image quality and CNR of the coronary arteries were higher (1.6 ± 0.5 vs. 2.1 ± 0.5, p = 0.03 and 1.21 ± 0.3 vs. 1.02 ± 0.3, p = 0.05) with only 1.5% segments classified as non-evaluable. Conclusion: High-pitch dual-spiral comprehensive cardiothoracic CT provides low radiation exposure with excellent image quality at heart rates ≤65 bpm. In subjects with higher heart rates, image quality of the aortic and pulmonary vasculature remains excellent, while the assessment of the coronary arteries degrades substantially.

  1. Assessment of Acute Chest Pain with Dual-Source CT%双源CT对急性胸痛的诊断价值

    Institute of Scientific and Technical Information of China (English)

    李宇; 范占明; 余婧; 耿冀; 叶红; 晏子旭; 张兆琪

    2011-01-01

    Objective To assess the accuracy of triple rule out protocol for acute chest pain with dual-source CT in emergency department. Methods 56 consecutive patients with acute chest pain were examined with triple rule out protocol on a dual-source scanner (Siemens) at a temporal resolution of 83 ms using a body-mass-adapted contrast material injection. The scanning range included the whole chest from the first ribs to the diaphragm. The level of the carina was defined as the trigger point where the second tube was switched on additionally. The tri-phase injection protocol was used to get enough enhancement of coronary arteries,pulmonary arteries and aortas. One patient was excluded because he was unable to hold breath during scanning. The remaining subjects underwent more than 30 days follow-up. Results All examinations showed an adequate contrast enhancement of the pulmonary arteries, coronary arteries and aortas. The mean volume of contrast medium was (88±5 ) ml. The median radiation exposure was 11.6 mSy (95 %CI 6.9-13.1 ). 14 patients showed coronary arteries atherosclerosis, including coronary arterial stenosis more than 50% in 13 and 12 patients underwent the coronary stent implantation. 11 patients suffered from aortic dissection(Stanford type A), and 11 patients with pulmonary embolism (PE). In brief, the reasons of the chest pain were complex. 7 of the patients suffered from several kinds of chest diseases. The sensitivity and specificity in diagnosing acute chest pain were 98% and 96% ,respectively with CTA. There were no adverse outcomes follow-up for 30 days in this group. Conclusion Triple rule out coronary CT angiography in evaluation of the patients with acute chest pain presented to the emergency department is very helpful, safety and effective way.%目的 评价双源CT胸痛三联扫描计划对急诊胸痛诊断的准确性.方法 按照入选标准连续选取急性胸痛患者56例,采用西门子双源CT扫描仪胸痛三联扫描计划

  2. Extracorporeal Membrane Oxygenation in a Patient With Refractory Acute Respiratory Distress Syndrome Secondary to Toxic Epidermal Necrolysis.

    Science.gov (United States)

    2014-12-01

    life support (ECLS) in adults with acute respiratory distress syndrome (ARDS) has increased markedly during the past few years after suc- cessful...Extracorporeal Membrane Oxygenation in a Patient With Refractory Acute Respiratory Distress Syndrome Secondary to Toxic Epidermal Necrolysis Christy...COVERED - 4. TITLE AND SUBTITLE Extracorporeal Membrane Oxygenation in a Patient With Refractory Acute Respiratory Distress Syndrome Secondary to

  3. Acute Respiratory Distress Syndrome in Wartime Military Burns: Application of the Berlin Criteria

    Science.gov (United States)

    2014-01-01

    Acute respiratory distress syndrome in wartime military burns: Application of the Berlin criteria Slava M. Belenkiy, MD, Allison R. Buel, DO, Jeremy...Andriy I. Batchinsky, MD, Leopoldo C. Cancio, MD, and Kevin K. Chung, MD, San Antonio, Texas BACKGROUND: Acute respiratory distress syndrome (ARDS...EVIDENCE: Epidemiologic/prognostic study, level III. KEY WORDS: Mechanical ventilation; adult respiratory distress syndrome ; the Berlin definition; combat

  4. [Case report: Löffler's syndrome due to Ascaris lumbricoides mimicking acute bacterial community--acquired pneumonia].

    Science.gov (United States)

    Acar, Ali; Oncül, Oral; Cavuşlu, Saban; Okutan, Oğuzhan; Kartaloğlu, Zafer

    2009-01-01

    In this study we present a patient with Loeffler's syndrome caused by Ascaris lumbricoides who presented with the clinical findings of community-acquired pneumonia (CAP). Our patient, who was twenty-five years old, and who had had symptoms such as coughing, expectorating, dyspnea and fever for approximately ten days, was hospitalized. We auscultated polyphonic rhonchuses at the both hemithoraxes. A chest X-ray revealed bilateral lower zone patch consolidation. Acute bacterial community acquired pneumonia (CAP) was diagnosed due to these findings and empirical antibiotic treatment was begun. Repeated sputum Gram stains were negative, and both sputum and blood cultures were sterile. A sputum smear was negative for acid-fast bacilli. The patient's fever and respiratory complaint did not respond to the empirical antibiotics therapy. During the course of advanced investigations, we measured peripheric eosinophilia, and high levels of total Eo and total IgE, and observed Ascaris lumbricoides eggs during stool examination. The patient was given a diagnosis of Loeffler's syndrome. Thereupon the patient was treated successfully with one dose of albendazol 400 mg. In conclusion, we suggest that Loeffler's syndrome must be considered early in the differential diagnosis for CAP when peripheric eosinophilia is seen in patients if they live in an endemic area for parasitic disease.

  5. Chest radiographic and CT features of acute inhaled mercury poisoning%急性吸入性汞中毒胸部X线及CT表现

    Institute of Scientific and Technical Information of China (English)

    刘雨峰

    2012-01-01

    Objective To analyze chest radiographic and CT features of acute inhaled mercury poisoning. Methods 23 cases with high concentration of mercury vapour inhaled acutely were included in this study. Among them, 81 cases underwent chest radio-graphics (61 times) and 11 cases underwent CT scanning(17 times). Radiographic and CT features were analysed. Results Chest radiographs showed pneumonia in 10 cases, the lesions appeared as multiple and scattered patchy high density in bilateral lung field with obscure border, and 3 cases combined with emphysema. There were 7 cases of interstitial pneumonia, radiographs showed lung markings increased and disorder, patchy, strip and gridding high dense shadows. 6 cases had toxic bubble pulmonary edema, which presented as large patchy dense shadows, and 4 cases of interstitial pulmonary edema, K's A,B lines were seen. On CT images, pneumonia appeared as multiple and scattered patchy shadows in bilateral lung field with bullous emphysemas which were low dense thin-wall bubbly shadows. Interstitial pneumonia appeared as lung weight lung markings in creased and blurred, resulted in massive, stripe net-like dense shadows with exudative changes around the lesions. Bullous pulmonary edema appeared as large patchy or butterfly wing-like dense shadow with undefinitive borders. Conclusion The chest X-ray and CT manifestations arc of certain characteristics in acute inhalation of mercury-induced pneumonia, combined with the clinical history and laboratory examination the diagnosis may be done.%目的 分析急性吸入性汞中毒性肺炎胸部X线及CT表现.方法 23例急性吸入性汞中毒患者,拍摄胸部平片61次,其中11例行胸部CT扫描17次,分析其X线及CT表现.结果 23例入院时X线片示汞毒性实质性肺炎10例,表现为双肺野多发片状密度增高影,边缘模糊,散在分布,3例伴有泡性肺气肿.汞毒性肺间质性炎症7例,表现为肺纹理增重模糊及紊乱,呈

  6. Acute Liver Failure Due to Budd-Chiari Syndrome in the Setting of Cardiac Synovial Sarcoma

    OpenAIRE

    Stine, Jonathan G.; Newton, Kelly; Vinayak, Ajeet G

    2015-01-01

    Primary malignant tumors of the heart, specifically cardiac sarcomas, are rare and mainly diagnosed at autopsy. Acute Budd-Chiari syndrome is a recognized cause of acute liver failure and has been associated with several rare cardiac tumors: atrial myxoma, caval rhabdomyosarcoma, and primary cardiac adenocarcinoma. We present the first case of a fatal, highly differentiated cardiac synovial sarcoma that presented as acute liver failure from Budd-Chiari syndrome.

  7. Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation

    Science.gov (United States)

    Chuang, Ming-Lung; Chou, Yi-Ling; Lee, Chai-Yuan; Huang, Shih-Feng

    2017-01-01

    Abstract Background: Endotracheal intubation and prolonged immobilization of patients receiving mechanical ventilation may reduce expectoration function. High-frequency chest wall oscillation (HFCWO) may ameliorate airway secretion movement; however, the instantaneous changes in patients’ cardiopulmonary responses are unknown. Moreover, HFCWO may influence ventilator settings by the vigorous oscillation. The aim of this study was to investigate these issues. Methods: Seventy-three patients (52 men) aged 71.5 ± 13.4 years who were intubated with mechanical ventilation for pneumonic respiratory failure were recruited and randomly classified into 2 groups (HFCWO group, n = 36; and control group who received conventional chest physical therapy (CCPT, n = 37). HFCWO was applied with a fixed protocol, whereas CCPT was conducted using standard protocols. Both groups received sputum suction after the procedure. Changes in ventilator settings and the subjects’ responses were measured at preset intervals and compared within groups and between groups. Results: Oscillation did not affect the ventilator settings (all P > 0.05). The mean airway pressure, breathing frequency, and rapid shallow breathing index increased, and the tidal volume and SpO2 decreased (all P < 0.05). After sputum suction, the peak airway pressure (Ppeak) and minute ventilation decreased (all P < 0.05). The HFCWO group had a lower tidal volume and SpO2 at the end of oscillation, and lower Ppeak and tidal volume after sputum suction than the CCPT group. Conclusions: HFCWO affects breathing pattern and SpO2 but not ventilator settings, whereas CCPT maintains a steadier condition. After sputum suction, HFCWO slightly improved Ppeak compared to CCPT, suggesting that the study extends the indications of HFCWO for these patients in intensive care unit. (ClinicalTrials.gov number NCT02758106, retrospectively registered.) PMID:28248854

  8. Pediatric Acute Lung Injury Epidemiology and Natural History study: Incidence and outcome of the acute respiratory distress syndrome in children.

    Science.gov (United States)

    López-Fernández, Yolanda; Azagra, Amelia Martínez-de; de la Oliva, Pedro; Modesto, Vicent; Sánchez, Juan I; Parrilla, Julio; Arroyo, María José; Reyes, Susana Beatriz; Pons-Ódena, Martí; López-Herce, Jesús; Fernández, Rosa Lidia; Kacmarek, Robert M; Villar, Jesús

    2012-12-01

    The incidence and outcome of the acute respiratory distress syndrome in children are not well-known, especially under current ventilatory practices. The goal of this study was to determine the incidence, etiology, and outcome of acute respiratory distress syndrome in the pediatric population in the setting of lung protective ventilation. A 1-yr, prospective, multicenter, observational study in 12 geographical areas of Spain (serving a population of 3.77 million ≤ 15 yrs of age) covered by 21 pediatric intensive care units. All consecutive pediatric patients receiving invasive mechanical ventilation and meeting American-European Consensus Criteria for acute respiratory distress syndrome. None. Data on ventilatory management, gas exchange, hemodynamics, and organ dysfunction were collected. A total of 146 mechanically ventilated patients fulfilled the acute respiratory distress syndrome definition, representing a incidence of 3.9/100,000 population ≤ 15 yrs of age/yr. Pneumonia and sepsis were the most common causes of acute respiratory distress syndrome. At the time of meeting acute respiratory distress syndrome criteria, mean PaO2/FIO2 was 99 mm Hg ± 41 mm Hg, mean tidal volume was 7.6 mL/kg ± 1.8 mL/kg predicted body weight, mean plateau pressure was 27 cm H2O ± 6 cm H2O, and mean positive end-expiratory pressure was 8.9 cm ± 2.9 cm H2O. Overall pediatric intensive care unit and hospital mortality were 26% (95% confidence interval 19.6-33.7) and 27.4% (95% confidence interval 20.8-35.1), respectively. At 24 hrs, after the assessment of oxygenation under standard ventilatory settings, 118 (80.8%) patients continued to meet acute respiratory distress syndrome criteria (PaO2/FIO2 104 mm Hg ± 36 mm Hg; pediatric intensive care units mortality 30.5%), whereas 28 patients (19.2%) had a PaO2/FIO2 >200 mm Hg (pediatric intensive care units mortality 7.1%) (p = .014). This is the largest study to estimate prospectively the pediatric population-based acute

  9. Transformation of Myelodysplastic Syndrome to Acute Lymphoblastic Leukemia in a Child

    OpenAIRE

    2010-01-01

    Childhood myelodysplastic syndrome (MDS) is an uncommon condition. Unlike adult MDS, pediatric patients have a more progressive course and rapidly transform to acute myeloid leukemia. Evolution to acute lymphoblastic leukemia is extremely rare. We report a 5 year old female child who presented with refractory anemia with excess blasts and transformed into acute lymphoblastic leukemia 4 months after initial diagnosis.

  10. Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hwa Yeon; Song, In Sup (Dept. of Diagnostic Radiology Chung-Ang Univ. College of Medicine, Seoul (Korea, Republic of)); Yoo, Seung Min; Rho, Ji Young (Dept. of Diagnostic Radiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)), email: smyoo68@hanmail.net; Moon, Jae Youn; Kim, In Jai; Lim, Sang Wook; Sung, Jung Hoon; Cha, Dong Hun (Dept. of Cardiology CHA Medical Univ. Hospital, Bundang (Korea, Republic of)); White, Charles S. (Dept. of Diagnostic Radiology Univ. of Maryland, Baltimore (United States))

    2011-05-15

    Background Although triple rule-out CT angiography (TRO) to simultaneously evaluate acute coronary syndrome (ACS), pulmonary embolism (PE), and acute aortic syndrome (AAS) is increasingly used in many institutions, TRO is inevitably associated with increased radiation exposure due to extended z-axis coverage compared with dedicated coronary CT angiography (DCTA). Purpose To determine the frequency of exclusion of findings of AAS, PE, and significant incidental non-cardiac pathology that may be the cause of acute chest pain when using a restricted DCTA field of view (FOV). Material and Methods We retrospectively reviewed CT images and charts of 103 patients with acute PE and 50 patients with AAS. Either non-ECG gated dedicated pulmonary or aortic CT angiography was performed using 16- or 64-slice multidetector CT (MDCT). We analyzed the incidence of isolated PE, AAS, or significant non-cardiac pathology outside of DCTA FOV (i.e. from tracheal carina to the base of heart). Results There were two cases of isolated PE (2/103, 1.9%) excluded from the FOV of DCTA. One case of PE was isolated to the subsegmental pulmonary artery in the posterior segment of the right upper lobe. In the second case, pulmonary embolism in the left main pulmonary artery was located out of the FOV of DCTA because the left main pulmonary artery was retracted upwardly by fibrotic scar in the left upper lobe due to prior tuberculosis. There was no case of AAS and significant non-cardiac pathology excluded from the FOV of DCTA. AAS (n = 50) consisted of penetrating atherosclerotic ulcer (n = 7), intramural hematoma (n = 5) and aortic dissection (n = 38). Conclusion As isolated PE, AAS, and significant non-cardiac pathology outside of the DCTA FOV rarely occur, DCTA may replace TRO in the evaluation of patients with non-specific acute chest pain and a low pre-test probability of PE or aortic dissection

  11. Combination Chemotherapy With or Without Bone Marrow Transplantation in Treating Children With Acute Myelogenous Leukemia or Myelodysplastic Syndrome

    Science.gov (United States)

    2013-01-15

    Childhood Acute Erythroleukemia (M6); Childhood Acute Megakaryocytic Leukemia (M7); Childhood Acute Monoblastic Leukemia (M5a); Childhood Acute Monocytic Leukemia (M5b); Childhood Acute Myeloblastic Leukemia With Maturation (M2); Childhood Acute Myeloblastic Leukemia Without Maturation (M1); Childhood Acute Myelomonocytic Leukemia (M4); Childhood Myelodysplastic Syndromes; Chronic Myelomonocytic Leukemia; de Novo Myelodysplastic Syndromes; Refractory Anemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Refractory Anemia With Ringed Sideroblasts; Secondary Myelodysplastic Syndromes; Untreated Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies

  12. Presentation and In-Hospital Outcome in First Attack of Acute Coronary Syndrome among Diabetic and Non-Diabetic People.

    Science.gov (United States)

    Islam, M N; Mahmud, A A; Pandit, H; Bhuiyan, A S

    2015-07-01

    This was a prospective and observational study. One hundred and sixty five consecutive patients (75 diabetic and 90 were non-diabetic) admitted to coronary care unit in Rangpur Medical College and Hospital, Rangpur from December 2011 to June 2012 with the diagnosis of first attack of acute coronary syndrome were included in this study. Patients were selected considering the inclusion and exclusion criteria, Symptom time, typical or atypical chest pain, Dysponea, palpitation, cardiogenic shock, cardiac arrest, vital signs and Killip classes were regarded as presentation at admission. Outcome parameters observed during the hospital stay were in-hospital mortality, cardiogenic shock, congestive cardiac failure, symptomatic arrhythmias, cardiac arrest, recurrent ischemia and hospital stay. The results were obtained by calculating 'p' value by 'z' test, 't' test, chi-square test, as appropriate to see the difference between two groups. The results thus obtained were plotted on table, pie-chart, line chart, bar-diagram etc. as appropriate p value diabetic patients presented with acute coronary syndrome at earlier age (p=053). Body Mass Index was significantly more in diabetic group (25.053 ± 2.1428 vs. 24.0822 kg/m² ± 2.233 kg/m², p=0.0045). Atypical chest pain (40% vs. 24.4%, p=0.0323), Dysponea (53.3 vs. 36.7%, p=0.0315), cardiac shock (17.33 vs. 6.7%, p=0.03236) and symptom duration before presentation (31.067 ± 42.5 hours vs. 19.44 ± 30.3 hours, p=0.0471) were significantly more observed in diabetic group. In respect of outcome, diabetic patients experienced more recurrent ischemia (24% vs. 16.67%, p=0.0524) and heart failure (36% vs. 22.2%, p=0.05). Hospital stay was also found significantly higher in diabetic group (5.097 ± 1.023 vs. 4.097 ± 1.009, p=0.0078). Atypically presented group suffered significantly more from congestive heart failure p=0.0392. Triglyceride level (230.7 ± 61.7 vs. 180.1 ± 39.1, pdiabetic group. The mean value of Hba1C in diabetic

  13. Dystrophic calcinosis with both a huge calcified mass in the cervical spine and calcification in the chest wall in a patient with rheumatoid overlap syndrome.

    Science.gov (United States)

    Nakamura, Tadashi; Hirakawa, Kei; Takaoka, Hirokazu; Iyama, Ken-Ichi

    2016-05-01

    Dystrophic calcinosis in soft tissue occurs in damaged or devitalized tissues in the presence of normal calcium and phosphorous metabolism. It is often noted in subcutaneous tissues in patients with collagen vascular diseases and may involve a relatively localized area or be widespread. A 74-year-old Japanese woman with an overlap of rheumatoid arthritis, Sjögren's syndrome, and systemic sclerosis developed a huge tumor-like mass at the atlanto-axial vertebral joint region that caused severe cervical pain and difficulty in activities of daily living. She also had subcutaneous dystrophic calcification in the soft tissue of the chest wall. Calcinosis associated with systemic sclerosis is a well-recognized phenomenon, but a destructive paraspinal tumor in the cervical spine associated with overlap syndrome is extremely unique. Because calcinosis in spinal locations can be complicated by neurological involvement, patients with progressive symptoms may require surgical intervention. Surgical resection and biological therapy improved this patient's life and activities of daily living. Calcinosis is common in the conditions reviewed here, and different agents have been used for treatment. However, calcinosis management is poorly organized and lacks an accepted classification, systematic studies, and clinical therapeutic trials. The association of calcinosis and collagen vascular diseases is clinically and etiologically important. Although a combination of calcinosis and rheumatoid overlap syndrome is rare, various collagen vascular diseases may occur simultaneously. A perceptive diagnostic approach toward these diseases is critical, and early diagnosis and treatment are needed to prevent dystrophic calcinosis.

  14. A Survey on the Choice of Transportation to come to Emergency Department among Patients with Acute Coronary Syndrome of A Community in Malaysia.

    Science.gov (United States)

    Chew, K S; Wan Masliza, W M A; Nik Hisamuddin, N A R; Mohd Hashairi, F; Shaik Farid, A W; Tuan Hairulnizam, T K; Zikri, A M; Zurkurnai, Y

    2015-02-01

    Good coronary care begins from the patient's home, including early transportation. As such, it is recommended that the patients activate ambulances, rather than to use their own transportations to reach the hospitals. It is not known whether Malaysian patients prefer to use private transportations or ambulances when they develop chest pain. This study is conducted to explore the question of the choice of transportation modes among patients with acute coronary syndrome and the reasons behind their choices. This is a structured interview survey on patients diagnosed with acute coronary syndrome (ACS) in emergency department of Hospital Universiti Sains Malaysia from April 2012 to September 2012. Out of the 110 patients surveyed, 105 (95.5%) patients chose to use own transportation when they developed symptoms suggestive of ACS. Only 3 patients (2.7%) came to the emergency department within 1 hour of onset, and all these 3 patients chose to use ambulances as their modes of transportation. None of the patients who chose own transportation came within the first hour of symptoms onset. This is shown to be statistically significant (peducation as well as past history of ischemic heart disease did not significantly influence the patients' choice of transportation. The admonishment by various international resuscitation councils that patients with chest pain should be transported via ambulances may not be as straightforward as it seems. Numerous local and regional socio-cultural and logistic factors may need to be addressed.

  15. Biological Therapy in Treating Patients With Advanced Myelodysplastic Syndrome, Acute or Chronic Myeloid Leukemia, or Acute Lymphoblastic Leukemia Who Are Undergoing Stem Cell Transplantation

    Science.gov (United States)

    2017-03-27

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); B-cell Adult Acute Lymphoblastic Leukemia; B-cell Childhood Acute Lymphoblastic Leukemia; Childhood Chronic Myelogenous Leukemia; Childhood Myelodysplastic Syndromes; Chronic Myelomonocytic Leukemia; Essential Thrombocythemia; Polycythemia Vera; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Relapsing Chronic Myelogenous Leukemia; Secondary Acute Myeloid Leukemia; T-cell Adult Acute Lymphoblastic Leukemia; T-cell Childhood Acute Lymphoblastic Leukemia

  16. 813例急性胸痛患者的临床分析%A clinical analysis of 813 patients with acute chest pain

    Institute of Scientific and Technical Information of China (English)

    吴晓新; 陈墩帆; 闫春江; 丁邦晗; 张敏州

    2013-01-01

    Objective To analyze patients with acute chest pain as their chief complaint in order to improve our capability of early identifying and diagnosing high-risk patients,give them proper treatment in time and avoid misdiagnosis and improper treatment. Methods The clinical data of 813 patients with chest pain as their chief complaint admitted in the emergency department and critical care medicine department in Guangdong Provincial Traditional Chinese Medicine Hospital from January to December in 2011 were retrospectively analyzed. According to the process of diagnosis and treatment formulated by the chest pain center,all the patients must immediately finish the first electrocardiograph(EEC)examination in 10 minutes and the relevant blood biochemical examinations within 30 minutes after admission. Results In accordance with the relevant examinations,the confirmed diagnoses were as follows:there were 276 cases of unstable angina,accounting for 33.95%;145 cases of stable angina,17.84%;121 cases of acute myocardial infarction,14.88%;103 cases of respiratory system disease,12.67%;78 cases of skeletal muscle disease,9.59%;46 cases of the digestive system disease,5.66% and the high-risk non cardiac chest pain(such as aortic dissection/rupture of tumor or acute pulmonary embolism)12 cases,1.48%.Seven hundred and eighty-five patients finished the first EEC examination in 10 minutes,and 147 patients completed the chest computed tomography(CT)scan within an hour. Conclusions Acute chest pain is a common symptom in emergency department. It is necessary to identify the high-risk patients according to a process as soon as possible in order to get an accurate diagnosis and an effective treatment in time.%目的:分析总结2011年广东省中医院急诊科和重症医学科以急性胸痛为主要症状就诊患者的诊治情况,以期提高对急诊科高危胸痛患者的早期识别、诊断并及时给予对症处理,避免漏诊误诊。方法对本院2011年1月至12

  17. Apixaban with antiplatelet therapy after acute coronary syndrome.

    Science.gov (United States)

    Alexander, John H; Lopes, Renato D; James, Stefan; Kilaru, Rakhi; He, Yaohua; Mohan, Puneet; Bhatt, Deepak L; Goodman, Shaun; Verheugt, Freek W; Flather, Marcus; Huber, Kurt; Liaw, Danny; Husted, Steen E; Lopez-Sendon, Jose; De Caterina, Raffaele; Jansky, Petr; Darius, Harald; Vinereanu, Dragos; Cornel, Jan H; Cools, Frank; Atar, Dan; Leiva-Pons, Jose Luis; Keltai, Matyas; Ogawa, Hisao; Pais, Prem; Parkhomenko, Alexander; Ruzyllo, Witold; Diaz, Rafael; White, Harvey; Ruda, Mikhail; Geraldes, Margarida; Lawrence, Jack; Harrington, Robert A; Wallentin, Lars

    2011-08-25

    Apixaban, an oral, direct factor Xa inhibitor, may reduce the risk of recurrent ischemic events when added to antiplatelet therapy after an acute coronary syndrome. We conducted a randomized, double-blind, placebo-controlled clinical trial comparing apixaban, at a dose of 5 mg twice daily, with placebo, in addition to standard antiplatelet therapy, in patients with a recent acute coronary syndrome and at least two additional risk factors for recurrent ischemic events. The trial was terminated prematurely after recruitment of 7392 patients because of an increase in major bleeding events with apixaban in the absence of a counterbalancing reduction in recurrent ischemic events. With a median follow-up of 241 days, the primary outcome of cardiovascular death, myocardial infarction, or ischemic stroke occurred in 279 of the 3705 patients (7.5%) assigned to apixaban (13.2 events per 100 patient-years) and in 293 of the 3687 patients (7.9%) assigned to placebo (14.0 events per 100 patient-years) (hazard ratio with apixaban, 0.95; 95% confidence interval [CI], 0.80 to 1.11; P=0.51). The primary safety outcome of major bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) definition occurred in 46 of the 3673 patients (1.3%) who received at least one dose of apixaban (2.4 events per 100 patient-years) and in 18 of the 3642 patients (0.5%) who received at least one dose of placebo (0.9 events per 100 patient-years) (hazard ratio with apixaban, 2.59; 95% CI, 1.50 to 4.46; P=0.001). A greater number of intracranial and fatal bleeding events occurred with apixaban than with placebo. The addition of apixaban, at a dose of 5 mg twice daily, to antiplatelet therapy in high-risk patients after an acute coronary syndrome increased the number of major bleeding events without a significant reduction in recurrent ischemic events. (Funded by Bristol-Myers Squibb and Pfizer; APPRAISE-2 ClinicalTrials.gov number, NCT00831441.).

  18. Application of Ischemia Modified Albumin Inspection in Patients with Acute Chest Pain%急性胸痛患者血清缺血修饰白蛋白检测及其意义研究

    Institute of Scientific and Technical Information of China (English)

    王宇; 吕新湖; 陈素欣; 彭晓恩

    2016-01-01

    【目的】探讨缺血修饰白蛋白(IMA)在急性胸痛患者检测的应用价值。【方法】选取2014年2月至2015年7月本院收治的100例急性胸痛发作3 h 内胸痛患者,将其分为缺血性胸痛组(59例)和非缺血性胸痛组(41例),缺血性胸痛组进一步分为不稳定型心绞痛组(39例)和急性心肌梗死组(20例)。于入院后即刻、3 h、24 h 分别采集静脉血分离血清,检测肌酸激酶同工酶(CK-MB)、肌钙蛋白 I(cTnI)、IMA。【结果】入院后即刻和入院后3 h,缺血性胸痛组 IMA 高于非缺血性胸痛组,差异有统计学意义(P 0.05)。入院后24 h,缺血性胸痛组 IMA 与非缺血性胸痛组比较无统计学意义(P >0.05);而 cTnI 和 CK-MB 均高于非缺血性胸痛组,差异有统计学意义(P 0.05)。【结论】IMA 是早期诊断非缺血性胸痛和缺血性胸痛的敏感指标,但其并不能诊断区别不稳定型心绞痛和急性心肌梗死。%[Objective]To investigate the application effect of Ischemia Modified Albumin inspection in patients with acute chest pain.[Methods]100 cases of patients with acute chest pain in 3 h admitted in our hospital from Feb 2014 to July 2015 were selected and divided into ischemic chest pain group (59 cases)and non-ischemic chest pain group (41 ca-ses).The Ischemic chest pain group was further divided into unstable angina group (39 cases)and acute myocardial in-farction group (20 cases).The venous blood was collected at the instant,3 h and 24 h after admission.Creatine kinase isoenzyme (CK-MB),cardiac troponin I (cTnI)and IMA were determined.[Results]At the instant and 3 h after admis-sion,the IMA of the ischemic chest pain group was significantly higher than that of the non-ischemic chest pain group (P 0.05).At 24 h after admis-sion,there was no significant difference in IMA between the ischemic chest pain group and the non-ischemic chest pain group (P >0.05);cTnI and CK-MB of the ischemic chest pain group were significantly higher

  19. Acute cortical deafness in a child with MELAS syndrome.

    Science.gov (United States)

    Pittet, Marie P; Idan, Roni B; Kern, Ilse; Guinand, Nils; Van, Hélène Cao; Toso, Seema; Fluss, Joël

    2016-05-01

    Auditory impairment in mitochondrial disorders are usually due to peripheral sensorineural dysfunction. Central deafness is only rarely reported. We report here an 11-year-old boy with MELAS syndrome who presented with subacute deafness after waking up from sleep. Peripheral hearing loss was rapidly excluded. A brain MRI documented bilateral stroke-like lesions predominantly affecting the superior temporal lobe, including the primary auditory cortex, confirming the central nature of deafness. Slow recovery was observed in the following weeks. This case serves to illustrate the numerous challenges caused by MELAS and the unusual occurrence of acute cortical deafness, that to our knowledge has not be described so far in a child in this setting.

  20. The clinical aspects of the acute facet syndrome

    DEFF Research Database (Denmark)

    Hestbaek, Lise; Kongsted, Alice; Jensen, Tue Secher;

    2009-01-01

    group of chiropractic practitioners was seen to be a useful contribution. METHODS: During the annual congress of The European Chiropractors Union (ECU) in 2008, the authors conducted a workshop involving volunteer chiropractors. Topics were decided upon in advance, and the participants were asked...... of four topics relating to the presentation of pain: 1. location, 2. severity, 3. aggravating factors, and 4. relieving factors. Second, the groups were asked to agree on three orthopaedic and three chiropractic tests that would aid in diagnosing pain from the facet joints. Finally, they were asked...... to agree on the number, frequency and duration of chiropractic treatment. RESULTS: Thirty-four chiropractors from nine European countries participated. They described the characteristics of an acute, uncomplicated facet syndrome as follows: local, ipsilateral pain, occasionally extending into the thigh...

  1. Acute plasmacytic interstitial nephritis in a child with Down syndrome.

    Science.gov (United States)

    Al-Hermi, B E; Thorner, P S; Arbus, G S

    1999-05-01

    A 7.5-year-old boy with Down syndrome presented in acute renal failure (ARF) needing dialysis. When 1.5 years old he had a neuroblastoma, was treated for 1 year with chemotherapy and radiotherapy, and off chemotherapy had since been in remission. Renal biopsy revealed an interstitial inflammation, principally of plasma cells with some lymphocytes and eosinophils. Immunofluorescence showed no deposition of immunoglobulins or complement (C3). The plasma cells were a mixture of kappa and lambda light chain-producing cells. The patient spontaneously improved a week after admission. Initial ultrasonography showed enlarged kidneys with loss of corticomedullary differentiation. We are unaware of a report of ARF in a child, resulting primarily from a polyclonal plasmacytic interstitial nephritis. The etiology remains unclear.

  2. [Precursors of acute leukemia: myelodysplastic syndromes and myeloproliferative neoplasms].

    Science.gov (United States)

    Kreipe, H H

    2011-11-01

    Myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN) represent neoplastic proliferations of hematopoietic stem cells, which may progress to loss of differentiation and acute myeloid leukemia (AML). Transitions between MDSs and MPNs as well as combinations between both disorders occur and MPNs may acquire dysplastic features combined with cytopenia. Myelodysplastic/myeloproliferative neoplasms show dysplastic and myeloproliferative properties and have in common genetic aberrations at the stem cell level (TET2, ASXL 1, CBL, IDH 1, IDH 2, EZH2, p53, Runx1), which may be found in one cell or may affect different hematopoietic stem cells, expanding in parallel. Progress to AML follows a linear clonal evolution only in a subset of cases. Alternatively AML derives from secondary clones, devoid of any marker mutation or originates from a common aberrant progenitor cell which shares other but not the JAK2 ( V617F ) mutation.

  3. Acute respiratory distress syndrome: prevention and early recognition.

    Science.gov (United States)

    de Haro, Candelaria; Martin-Loeches, Ignacio; Torrents, Eva; Artigas, Antonio

    2013-04-24

    Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). ARDS results in increased use of critical care resources and healthcare costs, yet the overall mortality associated with these conditions remains high. Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. To date, few strategies have shown clear benefits. One of the most important obstacles to preventive interventions is the difficulty of identifying patients likely to develop ARDS. Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. This review will discuss early identification of at-risk patients and the current prevention strategies.

  4. Severe acute respiratory syndrome: 'SARS' or 'not SARS'.

    Science.gov (United States)

    Li, A M; Hon, K L E; Cheng, W T; Ng, P C; Chan, F Y; Li, C K; Leung, T F; Fok, T F

    2004-01-01

    Accurate clinical diagnosis of severe acute respiratory syndrome (SARS) based on the current World Health Organization definition is difficult and at times impossible at the early stage of the disease. Both false positive and false negative cases are commonly encountered and this could have far-reaching detrimental effects on the patients, their family and the clinicians alike. Contact history is particularly important in diagnosing SARS in children as their presenting features are often non-specific. The difficulty in making a correct diagnosis is further compounded by the lack of a sensitive rapid diagnostic test. Serology is not particularly helpful in the initial triaging of patients as it takes at least 3 weeks to become positive. Co-infection and other treatable conditions should not be missed and conventional antibiotics should remain as part of the first-line treatment regimen. We report five cases to illustrate the difficulties and dilemmas faced by clinicians in diagnosing SARS in children.

  5. Matrix metalloproteinase-9 in patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Regent Lee

    2012-01-01

    To the Editor:I congratulate Wang et al1 in reporting further evidence for the role of matrix metalloproteinase-9 (MMP9)as a biomarker in acute coronary syndrome (ACS).In this study,the Authors examined the levels of MMP9 and C-reactive protein (CRP) in patients with a clinical diagnosis of unstable angina pectoris who subsequently underwent coronary angiography to evaluate the presence of coronary artery disease.Two subgroups of patients were defined according to the presence or absence of significant angiographic coronary artery stenosis.The level of MMP9 was significantly higher in patients with angiographic evidence of significant plaque disease (plaque group) compared with those without significant coronary stenosis (non-plaque group).No significant differences in the levels of CRP were observed between the two groups.

  6. The Impact of Hypertension on Patients with Acute Coronary Syndromes

    Directory of Open Access Journals (Sweden)

    Claudio Picariello

    2011-01-01

    Full Text Available Arterial chronic hypertension (HTN is a well-known cardiovascular risk factor for development of atherosclerosis. In order to explain the relation between HTN and acute coronary syndromes the following factors should be considered: (1 risk factors are shared by the diseases, such as genetic risk, insulin resistance, sympathetic hyperactivity, and vasoactive substances (i.e., angiotensin II; (2 hypertension is associated with the development of atherosclerosis (which in turn contributes to progression of myocardial infarction. From all the registries and the data available up to now, hypertensive patients with ACS are more likely to be older, female, of nonwhite ethnicity, and having a higher prevalence of comorbidities. Data on the prognostic role of a preexisting hypertensive state in ACS patients are so far contrasting. The aim of the present paper is to focus on hypertensive patients with ACS, in order to better elucidate whether these patients are at higher risk and deserve a tailored approach for management and followup.

  7. Cerebral babesiosis and acute respiratory distress syndrome in a dog.

    Science.gov (United States)

    Daste, Thomas; Lucas, Marie-Noelle; Aumann, Marcel

    2013-01-01

    To describe a case of cerebral babesiosis and acute respiratory distress syndrome (ARDS) in a dog. A 5-year-old male neutered Scottish Terrier was referred to the emergency department of the Ecole Nationale Vétérinaire de Toulouse for evaluation of progressive dyspnea and clinical signs suggestive of central neurological disease. Thoracic radiographs showed a diffuse and heavy interstitial/alveolar lung pattern. Babesiosis was diagnosed based on blood smear evaluation. The dog died of cardiopulmonary arrest 6 hours after presentation. Cerebral babesiosis and ARDS were confirmed at necropsy. Major pathological findings included erythrocyte aggregation in the lungs, liver, and brain. This case report describes an unusual clinical presentation of Babesia canis canis infection, the most common species associated with babesiosis in Europe. In addition, this is to our knowledge the first case of Babesia-associated ARDS confirmed by histopathology in a dog. © Veterinary Emergency and Critical Care Society 2013.

  8. Hyponatremia in acute brain disease: the cerebral salt wasting syndrome.

    Science.gov (United States)

    Betjes, Michiel G.H.

    2002-02-01

    Hyponatremia in acute brain disease is a common occurrence, especially after an aneurysmal subarachnoid hemorrhage. Originally, excessive natriuresis, called cerebral salt wasting, and later the syndrome of inappropriate antidiuretic hormone secretion (SIADH), were considered to be the causes of hyponatremia. In recent years, it has become clear that most of these patients are volume-depleted and have a negative sodium balance, consistent with the original description of cerebral salt wasting. Elevated plasma concentrations of atrial or brain natriuretic peptide have been identified as the putative natriuretic factor. Hyponatremia and volume depletion may aggravate neurological symptoms, and timely treatment with adequate replacement of water and NaCl is essential. The use of fludrocortisone to increase sodium reabsorption by the renal tubules may be an alternative approach.

  9. Anti-infectious treatment in acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Min GAO

    2013-02-01

    Full Text Available Acute respiratory distress syndrome (ARDS is closely correlated with infection. Severe infection, e.g., sepsis and septic shock, can result in ARDS. Ventilator associated pneumonia (VAP is one of the common complications in ARDS related infection. As regards ARDS related infection, community acquired infection (CAI is different from hospital acquired infection (HAI in bacterial spectrum. The former is mainly caused by Streptococcus pneumonia, Hemophilus influenzae, Moraxelle catarrhalis, atypical pathogens and Klebsiella pneumoniae. However, HAI is mainly caused by Pseudomonas aeruginosa, Acinetobacter baumanii, methicillin-resistant Staphylococcus aureus(MRSA, and other drug-resistant bacteria. The drug-resistant bacterial infection not only makes treatment difficult, but also leads to an increase in mechanical ventilation time, length of ICU stay, mortality rate, and medical costs. The present paper has reviewed the relationship between ARDS and infection, therapeutic principles and measures of ARDS related infection, and introduced the optimal strategy of anti-infectious treatment of ARDS.

  10. The Pathophysiology, Diagnosis and Current Management of Acute Compartment Syndrome

    Science.gov (United States)

    Donaldson, James; Haddad, Behrooz; Khan, Wasim S

    2014-01-01

    Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of ‘pain out of proportion to the injury’. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS. PMID:25067973

  11. Acute digital ischemia: A rare presentation of antisynthetase syndrome.

    Science.gov (United States)

    Chan, Jin Ei; Palakodeti, Sandeep; Koster, Matthew J

    2017-03-01

    Antisynthetase syndrome (ASS) is recognized as a subgroup of idiopathic inflammatory myopathies (IIMs). It is associated with autoantibodies directed against aminoacyl-transfer ribonucleic acid (tRNA) synthetase enzymes. We report the first case of anti-PL-7/anti-SSA 52kD ASS presenting as acute digital ischemia, an association not described previously. Occlusive vasculopathy is a rare but serious manifestation that can be seen at presentation in patients with ASS and may herald the onset of severe interstitial lung disease (ILD). Comprehensive evaluation should be performed to confirm the presence of subclinical myositis. Extensive myositis-specific antibody testing is strongly recommended even if initial screening autoimmune serologies are unrevealing.

  12. Elevation of troponin values in differential diagnosis of chest pain in view of pulmonary thromboembolism

    Directory of Open Access Journals (Sweden)

    Vučić Rada

    2012-01-01

    Full Text Available Introduction. Acute coronary syndrome, as unstable form of ischaemic heart disease, beside clinical presentation and electrocardiographic abnormalities, is characterized by increased value of troponin one of cardiospecific enzimes. Although troponin is a high specific and sensitive indicator of acute coronary syndrome, any heart muscle injury may induce its increasing, so there are some other diseases with the increased troponin value. Case report. We presented a female patient with chest pain, admitted because of suspicioun of acute coronary sindrome. Performed coronarography excluded ischemic heart disease. Considering symtomatology, electrocardiographic abnormalities, increased troponin and D-dimer values, as well as echocardiography finding we considered pulmonary embolism as a differential diagnosis, which was confirmed by pulmoangiography. Conclusion. Isolated increased troponin values are not enough for diagnosis of acute coronary syndrome.

  13. AB022. A case of severe leptospirosis with acute respiratory distress syndrome

    Science.gov (United States)

    Akritidou, Sofia; Panagiotidou, Evangelia; Sourla, Evdokia; Konstanta, Soultana; Kotoulas, Serafim-Xrisovalantis; Bikos, Vasilios; Bagalas, Vasilios; Katalin, Fekete; Pitsiou, Georgia; Ioannis, Stanopoulos; Athanasia, Pataka

    2016-01-01

    Leptospirosis is a microbial infection which occurs in humans and animals and is caused by Leptospira (Leptospira spp.). In Greece, it occurs at a frequency of 0.22:100,000, and 24 severe cases have been reported in 2013. It manifests in three forms: anicteric (90%), icteric (5–10%) and severe. Severe leptospirosis can be a rare cause of acute respiratory distress syndrome (ARDS), leading to intubation, jaundice, alveolar bleeding and multi-organ failure. A 71-year-old male patient presented at the emergency department with dyspnea on exertion, fever, gastrointestinal disorders, muscle aches and fatigue, that started four days ago. Occupation with pigeons was also reported. Blood gas analysis revealed severe type I respiratory failure, and a chest CT was performed, revealing ARDS. The patient was intubated. Acute renal failure (urea: 238, creatinine: 4.81) that required renal replacement therapy developed along with increased bilirubin (max value of total: 8.2 with direct: 7.42), and positive direct and indirect Coombs test. Moreover, hemorrhage through the tracheal tube complicated the clinical condition, resulting to obstruction of tracheal tube. Furthermore, anemia, thrombocytopenia and severe leycocytosis were also observed (white blood cells: 42,620). Diffuse alveolar hemorrhage due to vasculitis and connective tissue disease was suspected, and a complete immunological control was ordered. Infectious pathogens, such as Str. Pneumoniae, Legionella, Mycoplasma, Leptospira spp., Chlamidia, HBV, HCV, influenza were also suspected and all the necessary samples were tested. He received levofloxacin, piperacillin/tazobactam, vibramycin, and oseltamivir, but after receiving the positive results for leptospira, antibiotic treatment was revised with the final choice of levofloxacin and piperacillin/tazobactam. Despite improvement of renal and liver function, leycocytosis, CRP and PCT values, high fever begun that was attributed at first to the Jarisch

  14. Ticagrelor: A new antiplatelet drug for acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Tirtha V Patel

    2013-01-01

    Full Text Available Coronary heart disease and acute coronary syndrome (ACS are a significant cause of morbidity and mortality all over the world. Antiplatelet agents play an essential role in the treatment of acute coronary syndrome (ACS, usually with aspirin and a thienopyridine. Currently, clopidogrel, a second generation thienopyridine, is the main drug of choice, and the combination of aspirin and clopidogrel is administered orally for the treatment of ACS. Clopidogrel, the most commonly used thienopyridine, is limited by a high degree of interpatient variability and inconsistent inhibition of platelets. Ticagrelor, a new, oral, direct-acting P2Y12 receptor antagonist, produces a more profound and consistent antiplatelet effect than clopidogrel. The U.S. Food and Drug Administration approved Ticagrelor on July 20, 2011. Furthermore, ticagrelor has at least one active metabolite, which has pharmacokinetics that are very similar to the parent compound. Therefore, ticagrelor has a more rapid onset and more pronounced platelet inhibition than other antiplatelet agents. The safety and efficacy of ticagrelor compared with clopidogrel, in an ACS patient, has been recently evaluated by the PLATelet inhibition and patient Outcomes (PLATO trial. Clinical studies of patients with both ST-elevation and non-ST-elevation ACS have shown that ticagrelor, when compared with clopidogrel, reduces the rates of vascular death and myocardial infarction. The clinical data currently available indicate that ticagrelor is a promising option for the treatment of patients with ACS and may be of particular use in those at high risk for ischemic events or in those unresponsive to clopidogrel.

  15. Influence of gender on prognosis of acute coronary syndromes.

    Science.gov (United States)

    Cabrerizo-García, José Luis; Pérez-Calvo, Juan I; Zalba-Etayo, Begoña

    2015-01-01

    Ischemic heart disease presents different features in men and women. We analyzed the relation between gender and prognosis in patients who had suffered a high-risk acute coronary syndrome (ACS). This was a prospective analytical cohort study performed at Lozano Blesa University Hospital, Zaragoza, Spain, of 559 patients diagnosed with high-risk ACS with and without ST-segment elevation according to the American College of Cardiology/American Heart Association guidelines. The sample was divided into two groups by gender and differences in epidemiologic, laboratory, electrocardiographic and echocardiographic variables and treatment were recorded. A Cox's proportional hazard model was applied and 6-month mortality was analyzed as the main variable. The median age was 65.2±12.7 years, and 21.8% were women. Baseline characteristics in women were more unfavorable, with higher GRACE scores, older age, higher prevalence of hypertension, diabetes and heart failure, lower ejection fraction and more renal dysfunction at admission. Women suffered more adverse cardiovascular events (27.9% vs. 15.8%, p=0.002). Sixty-four patients died, 18.9% of the women vs. 9.4% of the men (p=0.004). After multivariate analysis, female gender did not present an independent relation with mortality. Hemoglobin level, renal function, ejection fraction and Killip class >1 presented significant differences. Acute syndrome coronary in women has a worse prognosis than in men. Their adverse course is due to their baseline characteristics and not to their gender. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  16. A test of syndromic surveillance using a severe acute respiratory syndrome model.

    Science.gov (United States)

    Wallace, David J; Arquilla, Bonnie; Heffernan, Richard; Kramer, Martin; Anderson, Todd; Bernstein, David; Augenbraun, Michael

    2009-05-01

    We describe a field simulation that was conducted using volunteers to assess the ability of 3 hospitals in a network to manage a large influx of patients with a potentially communicable disease. This drill provided the opportunity to evaluate the ability of the New York City Department of Health and Mental Hygiene's (NYC-DOHMH) emergency department chief complaint syndromic surveillance system to detect a cluster of patients with febrile respiratory illness. The evaluation was a prospective simulation. The clinical picture was modeled on severe acute respiratory syndrome symptoms. Forty-four volunteers participated in the drill as mock patients. Records from 42 patients (95%) were successfully transmitted to the NYC-DOHMH. The electronic chief complaint for 24 (57%) of these patients indicated febrile or respiratory illness. The drill did not generate a statistical signal in the NYC-DOHMH SaTScan analysis. The 42 drill patients were classified in 8 hierarchical categories based on chief complaints: sepsis (2), cold (3), diarrhea (2), respiratory (20), fever/flu (4), vomit (3), and other (8). The number of respiratory visits, while elevated on the day of the drill, did not appear particularly unusual when compared with the 14-day baseline period used for spatial analyses. This drill with a cluster of patients with febrile respiratory illness failed to trigger a signal from the NYC-DOHMH emergency department chief complaint syndromic surveillance system. This highlighted several limitations and challenges to syndromic surveillance monitoring.

  17. Subcutaneous histiocytoid Sweet's syndrome in a patient with myelodysplastic syndrome and acute myeloblastic leukemia.

    Science.gov (United States)

    Srisuttiyakorn, Chutika; Reeve, Jennifer; Reddy, Swapna; Imaeda, Suguru; Lazova, Rossitza

    2014-05-01

    Subcutaneous histiocytoid Sweet’s syndrome is a rare variant of histiocytoid Sweet’s syndrome (SS). We present a 68-year-old woman with subcutaneous histiocytoid SS in association with refractory myelodysplastic syndrome transformed to acute myeloblastic leukemia (AML), status post induction chemotherapy and with persistent blasts (50%) in the bone marrow and blood, accompanied with neutropenia. The patient presented to the emergency room with fever and altered mental status. Clinical examination revealed approximately 20 scattered 0.5-2 cm, pink to pink-purple non-tender firm nodules on the legs and left arm. The differential diagnosis included Sweet’s syndrome (deep), leukemia cutis, infection, polyarteritis nodosa and erythema nodosum. Histopathologic examination of a biopsy from the left arm revealed a nodular infiltrate of neutrophils and histiocytoid mononuclear cells solely in the lobular compartment of the subcutaneous fat with focal areas of necrosis. Most cells in the infiltrate labeled with myeloperoxidase (MPO) including the histiocytoid cells. The cells were negative for CD34 and CD117. All special stains for microorganisms were negative. A diagnosis of subcutaneous histiocytoid SS was made. A subcutaneous histiocytoid SS should be suspected when a neutrophilic/histiocytoid panniculitis, occurring in the setting of myeloid disorders, is encountered and after exclusion of an infectious process and leukemia cutis.

  18. Azacitidine With or Without Entinostat in Treating Patients With Myelodysplastic Syndromes, Chronic Myelomonocytic Leukemia, or Acute Myeloid Leukemia

    Science.gov (United States)

    2016-03-16

    Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome; Adult Acute Myeloid Leukemia in Remission; Adult Acute Myeloid Leukemia With Inv(16)(p13.1q22); CBFB-MYH11; Adult Acute Myeloid Leukemia With t(16;16)(p13.1;q22); CBFB-MYH11; Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); RUNX1-RUNX1T1; Adult Acute Myeloid Leukemia With t(9;11)(p22;q23); MLLT3-MLL; Adult Acute Promyelocytic Leukemia With t(15;17)(q22;q12); PML-RARA; Alkylating Agent-Related Acute Myeloid Leukemia; Chronic Myelomonocytic Leukemia; de Novo Myelodysplastic Syndrome; Previously Treated Myelodysplastic Syndrome; Recurrent Adult Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndrome; Untreated Adult Acute Myeloid Leukemia

  19. Care of the Patient with Chest Pain in the Observation Unit.

    Science.gov (United States)

    Borawski, Joseph B; Graff, Louis G; Limkakeng, Alexander T

    2017-08-01

    Care of the patient presenting to an emergency department (ED) with chest pain remains a common yet challenging aspect of emergency medicine. Acute coronary syndrome presents in nonspecific fashion. The development and evolution of the ED-based observation unit has helped to safely assess and diagnose those most at risk for an adverse cardiac event. Furthermore, there are several provocative testing modalities to help assess for coronary artery disease. This article serves to describe and discuss the modern ED-based observation unit approach to patients with chest pain and/or angina equivalents presenting to an ED. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Pulmonary and extrapulmonary acute respiratory distress syndrome: are they different?

    Science.gov (United States)

    Garcia, Cristiane S N Baez; Pelosi, Paolo; Rocco, Patricia R M

    2008-06-01

    The pathogenesis of acute respiratory distress syndrome (ARDS) has been described by the presence of direct (pulmonary) and/or indirect (extrapulmonary) insult to the lung parenchyma. Evidence indicates that the pathophysiology of ARDS may differ according to the type of primary insult. This article presents a brief overview of differences between pulmonary and extrapulmonary ARDS, and discusses the interactions between morpho-functional aspects and response to differents therapies, both in experimental and clinical studies. This systematic review included clinical and experimental ARDS studies found in MedLine and SciElo databases in the last 20 years. Many researchers acknowledge that experimental pulmonary and extrapulmonary ARDS are not identical with regard to morpho-functional aspects, the response to positive end-expiratory pressure (PEEP), recruitment manoeuvre, prone position and other adjunctive therapies. However, contradictory results have been reported in different clinical studies, which could be attributed to the difficulty of classifying ARDS in one or the other category, and to the assurance regarding the onset, phase and severity of ARDS in all patients. Heterogeneous ARDS patients are still considered as belonging to one syndrome, and are therefore treated in a similar manner. Thus, it is important to understand the pathophysiology of pulmonary and extrapulmonary ARDS in an attempt to better treat these patients.