WorldWideScience

Sample records for acute chest syndrome

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

    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?

    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?

    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?

    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

    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

    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

    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.

    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].

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

    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.

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

    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

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

    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.

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

    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.

  14. 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.

    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.

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

    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...

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

    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.

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

    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.

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

    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.

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

    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.

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

    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...

  1. Acute Pancreatitis Concomitant Acute Coronary Syndrome

    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.

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

    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.

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

    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

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

    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.

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

    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.

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

    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

  7. Chest radiographic findings in acute paraquat poisoning

    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.

  8. Psychiatric syndromes associated with atypical chest pain

    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

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

    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

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

    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.

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

    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...

  12. Acute respiratory distress syndrome

    ... page: //medlineplus.gov/ency/article/000103.htm Acute respiratory distress syndrome To use the sharing features on this page, please enable JavaScript. Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that ...

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

    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.

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

    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.

  15. Non ST-elevation acute coronary syndrome

    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.

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

    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

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

    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...

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

    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 aortic and mitral valve regurgitation following blunt chest trauma.

    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.

  20. Acute Radiation Syndrome

    ... 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 ...

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

    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...

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

    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.

  3. Stiff Person Syndrome Masquerading as Acute Coronary Syndrome.

    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.

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

    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.

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

    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.

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

    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.

  7. Chest physiotherapy in children with acute bacterial pneumonia

    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...

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

    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.

  9. [Acute coronary syndrome -- 2012].

    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.

  10. Neuroleptic-induced acute respiratory distress syndrome

    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.

  11. Acute coronary syndrome

    ... 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 ...

  12. Depression following acute coronary syndrome

    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...

  13. Chest physiotherapy in children with acute bacterial pneumonia

    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.

  14. Acute Respiratory Distress Syndrome

    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.

  15. Part Ⅱ The Typical Cases of Chest Pain Syndrome

    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.

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

    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.

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

    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...

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

    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.

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

    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...

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

    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.)

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

    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.

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

    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...

  3. Nuclear cardiology in acute coronary syndromes

    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.

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

    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....

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

    1988-02-25

    feu hours) when he has teen free of pain since the present episode started, this is intermittent. Otherwise assess as continuous. Beware the patient...assumed that crewmembers with chest pain have a physical etiology for chest pain. Disorders that present with epigastric pain such as gastritis , peptic...be assumed that crewmembers with chest pain have a physical etiology for chest pain. Disorders that present with epigastric pain such as gastritis

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

    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.

  7. Chest Pain

    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.

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

    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...

  9. 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

    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

  10. Pathogenesis of Acute Respiratory Distress Syndrome

    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

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

    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.)

  12. Severe acute respiratory syndrome (SARS)

    ... 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 ...

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

    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.

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

    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.

  15. Troponin elevation in conditions other than acute coronary syndromes

    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

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

    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

    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

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

    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.

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

    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...

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

    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.

  2. Haemolytic Uraemic Syndrome Following Acute Pancreatitis

    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.

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

    1989-10-05

    push c) pulmonary edema (pinkish froth fron mouth and rales throughout lung fields) Lasix 40 mg IV push (consider rotating extremity tourniquets, if...varying degrees of impairment of myocardial function (pump failure). If rales are not heard upon chest exam and peripheral edema is absent, the...LIER M MEW Uncontrolled dysrhythmias and cardiogenic shock are the principal camplications of concern. PVC’s (more than 5 per minute) and V-tach (3 or

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

    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.

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

    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.

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

    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.

  7. Throat Infection, Neck and Chest Pain and Cardiac Response: A Persistent Infection-Related Clinical Syndrome

    Changqing ZHOU; Xiangning FU; Jiangtao YAN; Qiao FAN; Zhuoya LI; Katherine Cianflone; Daowen WANG

    2009-01-01

    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 beta1-adrenoceptor,alpha-myosin heavy chain,M2-muscarinie 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 and CD4-CD8+ lymphocytes were significantly higher and CD56+ lymphocytes lower in patients than those in controls (P<0.01). The ratio of serum pathogen antibodies positive against Coxsackie virus-B,cytomegalovirus,Mycoplasma pneumoniae and Chlamydia pneumoniae were all markedly higher in patients. These data led to identification of a persistent respiratory infection-related clinical syndrome,including persistent throat infection,neck spinal lesion,fib cartilage inflammation,symptoms of car-diac depression and dyspnea with or without anxiety.

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

    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.

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

    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.

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

    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.

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

    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...

  12. Pathobiology of acute respiratory distress syndrome.

    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

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

    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...

  14. Cynomolgus Macaque as an Animal Model for Severe Acute Respiratory Syndrome

    2006-05-01

    125– 128. 49. Wong KC, Leung KS, Hui M (2003) Severe acute respiratory syndrome (SARS) in a geriatric patient with a hip fracture. A case report. J...developed neutralizing antibodies. Chest radiographs from several animals in groups I and II revealed unifocal or multifocal pneumonia that peaked...Groups I and II revealed unifocal or multifocal pneumonia that peaked between days 8 -10 postinfection. Clinical laboratory tests were not

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

    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.)

  16. Cardiorenal Syndrome in Acute Heart Failure Syndromes

    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.

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

    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

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

    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

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

    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

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

    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

  1. Acute respiratory distress syndrome assessment after traumatic brain injury

    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

  2. Percutaneous transluminal coronary angioplasty in acute ischemic syndromes

    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

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

    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.

  4. Pharm GKB: Severe Acute Respiratory Syndrome [PharmGKB

    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)

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

    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.

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

    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

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

    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.

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

    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

  9. Chest pain: a time for concern?

    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.

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

    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

  11. Acute cardiac failure in neuroleptic malignant syndrome.

    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.

  12. Acute coronary syndromes in the community

    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

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

    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.

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

    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

  15. Sheehan syndrome: acute presentation with severe headache.

    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.

  16. Acute renal failure in neuroleptic malignant syndrome.

    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.

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

    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.

  18. Acute Abdominal Pain Secondary to Chilaiditi Syndrome

    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.

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

    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.

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

    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.

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

    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.

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

    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)

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

    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.

  4. Delayed Presentation of Acute Gluteal Compartment Syndrome.

    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.

  5. [Chest pains in the dental environment].

    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.

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

    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.

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

    Lorentzen, Vibeke; Larsen, Birte Hedegaard

    2016-01-01

    to identify and discuss patient’s mental and emotional responses, including interpretations and delaying strategies concerning Acute Coronary Syndrome symptoms, with a view to elucidating patterns in the pre-hospital decision-making process of female and male persons to contact medical services....... 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...... cardinal. Male participants often used expletives and expressed symptoms in concrete terms. Women expressed symptoms in vaguer terms. Both genders used linguistic metaphors. The implications for nursing emphasised the impact of prodromal symptoms, mental and emotional withdrawal, and linguistic...

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

    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...

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

    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. ...

  10. Acute respiratory failure following ovarian hyperstimulation syndrome

    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

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

    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.

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

    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.

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

    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.)

  14. ACUTE RESPIRATORY DISTRESS SYNDROME IN PREGNANCY

    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.

  15. Prone positioning in acute respiratory distress syndrome.

    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.

  16. Clinical Profile & Risk Factors in Acute Coronary Syndrome

    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.

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

    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.

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

    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.

  19. Acute Coronary Syndrome and ST Segment Monitoring.

    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.

  20. Acute Coronary Syndrome- Conservative vs Invasive Treatment

    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 carpal tunnel syndrome in a patient with Marfan syndrome].

    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.

  2. Chinese herbal medicine for severe acute respiratory syndrome

    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....

  3. The role of inflammatory stress in acute coronary syndrome

    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).

  4. Rivaroxaban in patients with a recent acute coronary syndrome

    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....

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

    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

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

    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.

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

    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.

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

    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....

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

    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...

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

    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.

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

    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.)

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

    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...

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

    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

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

    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.

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

    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.

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

    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

  17. Nuclear Cardiology in Acute Coronary Syndrome

    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.

  18. Acute coronary syndromes in patients with HIV

    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

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

    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.

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

    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.

  1. Acute Respiratory Distress Syndrome in Obstetric Patients

    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.

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

    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.

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

    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

  4. Acute respiratory distress syndrome: epidemiology and management approaches

    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

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

    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.

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

    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.

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

    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.

  8. Chest MRI

    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 ...

  9. Prone ventilation in acute respiratory distress syndrome

    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.

  10. Acute encephalitis syndrome following scrub typhus infection

    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.

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

    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.

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

    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.

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

    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

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

    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.

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

    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.

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

    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

  17. Impact of copeptin on diagnosis of acute coronary syndrome

    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.

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

    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

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

    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

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

    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

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

    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.

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

    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.

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

    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.

  4. Acute respiratory distress syndrome: the Berlin Definition.

    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.

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

    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.

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

    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...

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

    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

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

    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

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

    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.

  10. Acute Charles Bonnet Syndrome following Hughes procedure.

    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.

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

    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.

  12. Pathological study on severe acute respiratory syndrome

    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.

  13. Pathogenesis of severe acute respiratory syndrome

    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.

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

    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.

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

    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).

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

    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...

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

    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

  18. Acute coronary syndromes: an old age problem

    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.

  19. 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

    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

  20. 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

    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

  1. 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

    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

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

    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.

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

    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.

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

    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.

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

    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

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

    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.

  7. Treatment of 336 cases of chest trauma

    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

  8. Treatment of 336 cases of chest trauma

    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.

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

    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.

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

    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.

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

    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.

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

    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.

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

    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

  14. Tachyarrhythmias, bradyarrhythmias and acute coronary syndromes

    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

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

    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

  16. MELAS syndrome presenting as an acute surgical abdomen.

    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.

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

    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.

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

    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.

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

    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.

  20. GERSTMANN’S SYNDROME IN ACUTE STROKE PATIENTS

    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...

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

    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.

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

    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

  3. Agranulocytosis and acute coronary syndrom in apathetic hyperthyreoidism

    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

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

    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.

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

    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.

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

    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.

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

    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.

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

    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.

  9. Acute Cubital Tunnel Syndrome Secondary to Anconeus Epitrochlearis Muscle

    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.

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

    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.

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

    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

  12. Guillain-Barre Syndrome Presenting as Acute Abdomen

    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

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

    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

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

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

    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.

  16. Apixaban with antiplatelet therapy after acute coronary syndrome

    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

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

    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.

  18. Platelets and white blood cells in acute coronary syndromes

    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

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

    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…

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

    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

  1. Acute lymphoblastic leukemia in children with Down syndrome

    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...

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

    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

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

    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

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

    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.

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

    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.

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

    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...

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

    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

  8. Thin-section chest CT findings of primary Sjoegren's syndrome: correlation with pulmonary function

    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.)

  9. Characteristics of pulmonary cysts in Birt-Hogg-Dube syndrome: Thin-section CT findings of the chest in 12 patients

    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.

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

    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.

  11. 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

    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

  12. Prone position in patients with acute respiratory distress syndrome

    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

  13. [Hepatic retransplant and acute Budd Chiari syndrome. Case report].

    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.

  14. Inter-observer agreement in interpreting chest X-rays on children with acute lower respiratory tract infections and concurrent wheezing

    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.

  15. Black esophagus: Acute esophageal necrosis syndrome

    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...

  16. Early Treatment of Severe Acute Respiratory Distress Syndrome.

    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.

  17. Estimating the incidence of the acute coronary syndrome

    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...

  18. Acute respiratory distress syndrome associated with severe ulcerative colitis

    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...

  19. Tropical pyomyositis presenting as sepsis with acute respiratory distress syndrome

    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.

  20. Plasma Lactate Dehydrogenase Levels Predict Mortality in Acute Aortic Syndromes

    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...

  1. Statins as first-line therapy for acute coronary syndrome?

    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 ...

  2. Acute Compartment Syndrome of the Thigh in Combat Casualties

    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

  3. Marfan syndrome with acute abdomen: a case report

    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

  4. Network analysis reveals distinct clinical syndromes underlying acute mountain sickness.

    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.

  5. Nephrotic Syndrome and Acute Renal Failure Apparently Induced by Sunitinib

    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.

  6. Associated Factors of Acute Chest Syndrome in Children with Sickle Cell Disease in French Guiana

    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.

  7. [Chest trauma].

    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.

  8. Desmoid tumor in Gardner's Syndrome presented as acute abdomen

    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

  9. Hemorrhagic Fever with Renal Syndrome Associated with Acute Pancreatitis

    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.

  10. Acute adrenal insufficiency due to primary antiphospholipid antibody syndrome

    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.

  11. Post poliomyelitis syndrome: A rare sequel of acute poliomyelitis.

    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.

  12. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults

    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) has...

  13. The use of the biomarker “copeptin” for the diagnosis of acute chest pain in the Emergency Department

    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.

  14. Indicación de la fisioterapia respiratoria convencional en la bronquiolitis aguda Indications of conventional chest physiotherapy in acute bronchiolitis

    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.

  15. CT Manifestations of Lung Changes and Complications in Patients with Severe Acute Respiratory Syndrome

    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.

  16. A Comparison of Acute Respiratory Distress Syndrome Outcomes Between Military and Civilian Burn Patients

    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

  17. Message concerning Severe Acute Respiratory Syndrome ("SARS")

    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...

  18. Gender-specific issues in the management of patients with acute coronary syndrome

    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).

  19. Prone positioning ventilation for treatment of acute lung injury and acute respiratory distress syndrome

    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.

  20. Acute lung injury and acute respiratory distress syndrome: experimental and clinical investigations

    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.

  1. Acute myeloid leukaemia after treatment for acute lymphoblastic leukaemia in girl with Bloom syndrome.

    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.

  2. Clinical Analysis of 285 Cases of Acute Chest Pain%急诊胸痛285例临床分析

    陈建兵; 石斌; 杨婉花; 张一凡; 渚俊欢; 叶明荣

    2013-01-01

    目的 提高急诊胸痛病因认识,总结诊断及治疗经验.方法 总结分析医院285例以急性非创伤性胸痛为主要症状患者的临床资料,进行病因、症状、体征、辅助检查、诊断以及治疗的统计分析.结果 以胸痛为主要表现的内科疾病中,心源性胸痛多见(154例,54.0%),其中以心绞痛(72例,25%)、心肌梗死(55例,19.3%)、夹层动脉瘤(12例,4.2%)和心肌炎(8例,2.8%)常见;非心源性胸痛(131例,46.0%),其中以肺炎(32例,11.2%)、肺栓塞(12例,4.2%)、胸膜炎(10例,3.5%)、自发性气胸(9例,3.2%)、肺癌(6例,2.1%)和胃食管反流病(6例,2.1%)最为常见.结论 临床急诊工作中,急性胸痛的病因复杂,临床表现多样化,急诊医生应高度重视其筛查诊断,尽量减少漏诊高危的胸痛患者,使不同病因的患者尽早得到适当治疗.急诊工作是否及时、妥善,直接关系到患者的安危和预后.%Objective To discuss the pathogeny of chest pain and improve the diagnosis and treatment. Methods A total of 285 cases of emergency nontraumatic chest pain were collected to analyze the pathogeny, symptom, sign, auxiliary examination, diagnosis and treatment. Results The cardiac chest pain(154 cases,54% ) included stenocardia(72 cases,25% ) ,myocardial in-farction(55 cases,19.3% ) ,aortic dissection( 12 cases,4.2% ) and myocarditis(8 cases,2. 8% ). The non-cardiac chest pain (131 cases,46% ) include pulmonitis(32 cases,11.2% ) ,pulmonary embolism( 12 cases,4.2% ) ,pleuritis( 10 cases,3. 5% ) , spontaneity pneumothorax(9 cases,3.2% ) ,lung cancer(6 cases,2. 1% ) and gastroesophaeal reflux disease(6 cases,2. 1% ). Conclusion The acute chest pains are often with complex causes and diversified clinical presentations,thus,the emergency doctors should pay high attentions to the diagnosis and treatment for acute chest pain,which related to the safety and prognosis for patients.

  3. SB-715992 in Treating Patients With Acute Leukemia, Chronic Myelogenous Leukemia, or Advanced Myelodysplastic Syndromes

    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

  4. Stress induced cardiomyopathy presenting as acute coronary syndrome: Tako-Tsubo in Mercogliano, Southern Italy

    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

  5. IMMUNO-INFLAMATORY RESPONSES IN ACUTE CORONARY SYNDROME

    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

    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. Radial Versus Femoral Access for Acute Coronary Syndromes.

    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.

  8. Ivabradine in acute coronary syndromes: Protection beyond heart rate lowering.

    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.

  9. 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

    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

  10. 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

    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

  11. Clinical diagnostic approach to severe acute respiratory syndrome: an institution's experience

    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.

  12. Diagnosis and management of acute coronary syndrome

    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. Acute Phase Hyperglycemia among Patients Hospitalized with Acute Coronary Syndrome: Prevalence and Prognostic Significance

    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

  14. Current perspectives for management of acute respiratory insufficiency in premature infants with acute respiratory syndrome.

    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.

  15. Prediction of acute coronary syndromes by urinary proteome analysis

    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

  16. A case of lung cancer associated with acute respiratory distress syndrome after thoracic radiotherapy

    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)

  17. Acute venous thrombosis as complication and clue to diagnose a SAPHO syndrome case. A case report.

    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.

  18. Evaluation of chest pain in the emergency department.

    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

  19. [Clinico-psychopathologic varieties of the acute Kandinsky-Clerambault syndrome in schizophrenia].

    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).

  20. Neuroleptic Malignant Syndrome Associated with Refractory Acute Disseminated Encephalomyelitis

    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.

  1. [Acute respiratory distress syndrome: a review of the Berlin definition].

    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.

  2. [Corticosteroid administration for acute respiratory distress syndrome : therapeutic option?].

    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.

  3. Clinical correlation between myeloperoxidase and acute coronary syndrome

    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.

  4. Control dynamics of severe acute respiratory syndrome transmission

    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.

  5. [Pathogenesis and target therapy of acute respiratory distress syndrome].

    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.

  6. Digestive system manifestations in patients with severe acute respiratory syndrome

    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.

  7. Diagnostic image quality of a comprehensive high-pitch dual-spiral cardiothoracic CT protocol in patients with undifferentiated acute chest pain

    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.

  8. Assessment of Acute Chest Pain with Dual-Source CT%双源CT对急性胸痛的诊断价值

    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

  9. Summary of 32 Patients with Cardiac Syndrome X Treated by TCM Therapy of Regulating Qi Relieving Chest Stuffiness and Promoting Blood Circulation

    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.

  10. Chest pain in focal musculoskeletal disorders

    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...

  11. Prevalence of Burnout Syndrome in Patients Admitted with Acute Coronary Syndrome

    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.

  12. Relationship between Traditional Chinese Medicine Syndrome Type and Coronary Arteriography of Acute Coronary Syndrome

    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.

  13. A Case of Severe Pulmonary Thromboembolism in a Young Male With Klinefelter Syndrome

    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...

  14. Acute coronary syndrome in diclofenac sodium-induced type I hypersensitivity reaction : Kounis syndrome

    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...

  15. 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

    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

  16. Prevalence of Burnout Syndrome in Patients Admitted with Acute Coronary Syndrome

    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

  17. Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation

    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

  18. Intrapleural steroid instillation for multiple organ failure with acute respiratory distress syndrome.

    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.

  19. Cynomolgus macaque as an animal model for severe acute respiratory syndrome.

    James V Lawler

    2006-05-01

    Full Text Available BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSIONS: 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.

  20. Acute Respiratory Distress Syndrome as the Initial Clinical Manifestation of an Antisynthetase Syndrome

    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

  1. Acute renal failure: A rare presentation of Sheehan′s syndrome

    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.

  2. Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study

    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.

  3. Impact of Different Obesity Assessment Methods after Acute Coronary Syndromes

    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.

  4. Impact of Different Obesity Assessment Methods after Acute Coronary Syndromes

    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.

  5. Relationship between matrix metalloproteinase-9 polymorphism and acute coronary syndrome

    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.

  6. Using machine learning techniques to differentiate acute coronary syndrome

    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.

  7. Pediatric Acute Respiratory Distress Syndrome: Fibrosis versus Repair

    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.

  8. Extracorporeal Membrane Oxygenation in a Patient With Refractory Acute Respiratory Distress Syndrome Secondary to Toxic Epidermal Necrolysis.

    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

  9. 813例急性胸痛患者的临床分析%A clinical analysis of 813 patients with acute chest pain

    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

  10. [Case report: Löffler's syndrome due to Ascaris lumbricoides mimicking acute bacterial community--acquired pneumonia].

    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.

  11. Acute Respiratory Distress Syndrome in Wartime Military Burns: Application of the Berlin Criteria

    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

  12. Acute Liver Failure Due to Budd-Chiari Syndrome in the Setting of Cardiac Synovial Sarcoma

    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.

  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.

    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. 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

    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

  15. Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

    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

  16. Transformation of Myelodysplastic Syndrome to Acute Lymphoblastic Leukemia in a Child

    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.

  17. Biological Therapy in Treating Patients With Advanced Myelodysplastic Syndrome, Acute or Chronic Myeloid Leukemia, or Acute Lymphoblastic Leukemia Who Are Undergoing Stem Cell Transplantation

    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

  18. Combination Chemotherapy With or Without Bone Marrow Transplantation in Treating Children With Acute Myelogenous Leukemia or Myelodysplastic Syndrome

    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

  19. Presentation and In-Hospital Outcome in First Attack of Acute Coronary Syndrome among Diabetic and Non-Diabetic People.

    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

  20. Comparison of epicardial fat volume by computed tomography in black versus white patients with acute chest pain.

    Apfaltrer, Paul; Schindler, Andreas; Schoepf, U Joseph; Nance, John W; Tricarico, Francesco; Ebersberger, Ullrich; McQuiston, Andrew D; Meyer, Mathias; Henzler, Thomas; Schoenberg, Stefan O; Bamberg, Fabian; Vliegenthart, Rozemarijn

    2014-02-01

    Disparities in the risk of coronary artery disease (CAD) between races may be influenced by differences in the thoracic adipose tissue. We compared computed tomography (CT)-derived volumes of epicardial adipose tissue (EAT), mediastinal adipose tissue (MAT), and pericoronary fat thickness (PFT) and correlations with CAD between black and white patients. This institutional review board-approved Health Insurance Portability and Accountability Act-compliant study included 372 age- and gender-matched black versus white patients (186 black, 54 ± 11 years, 50% men; 186 white, 54 ± 11 years, 50% men) who underwent CT for chest pain evaluation. EAT, MAT, and PFT were measured. The amount of coronary calcium was quantified as calcium score. CAD was defined as ≥50% coronary artery narrowing. EAT and MAT volumes were significantly lower in black than white patients (59 [twenty-fifth to seventy-fifth percentile 39 to 84] vs 97 [67 to 132] cm(3) and 44 [27 to 77] vs 87 [52 to 157] cm(3), for both p white patients (17.2 ± 3.2 vs 18.1 ± 3.4 mm, p adipose tissue remained significant after adjustment for cardiovascular risk factors. Significant correlations were observed between EAT and MAT volumes and calcium score in black and white patients (r = 0.19 to 0.26, p white patients. In conclusion, CT-derived measurements of thoracic fat differ between symptomatic black and white patients, suggesting a differential relation between thoracic adipose tissue and CAD pathophysiology by race.

  1. Chest radiographic manifestations of scrub typhus

    KPP Abhilash

    2016-01-01

    Full Text Available Background and Rationale: Respiratory system involvement in scrub typhus is seen in 20–72% of patients. In endemic areas, good understanding and familiarity with the various radiologic findings of scrub typhus are essential in identifying pulmonary complications. Materials and Methods: Patients admitted to a tertiary care center with scrub typhus between October 2012 and September 2013 and had a chest X ray done were included in the analysis. Details and radiographic findings were noted and factors associated with abnormal X-rays were analyzed. Results: The study cohort contained 398 patients. Common presenting complaints included fever (100%, generalized myalgia (83%, headache (65%, dyspnea (54%, cough (24.3%, and altered sensorium (14%. Almost half of the patients (49.4% had normal chest radiographs. Common radiological pulmonary abnormalities included pleural effusion (14.6%, acute respiratory distress syndrome (14%, airspace opacity (10.5%, reticulonodular opacities (10.3%, peribronchial thickening (5.8%, and pulmonary edema (2%. Cardiomegaly was noted in 3.5% of patients. Breathlessness, presence of an eschar, platelet counts of 2 mg/dL had the highest odds of having an abnormal chest radiograph. Patients with an abnormal chest X-ray had a higher requirement of noninvasive ventilation (odds ratio [OR]: 13.98; 95% confidence interval CI: 5.89–33.16, invasive ventilation (OR: 18.07; 95% CI: 6.42–50.88, inotropes (OR: 8.76; 95% CI: 4.35–17.62, higher involvement of other organ systems, longer duration of hospital stay (3.18 ± 3 vs. 7.27 ± 5.58 days; P< 0.001, and higher mortality (OR: 4.63; 95% CI: 1.54–13.85. Conclusion: Almost half of the patients with scrub typhus have abnormal chest radiographs. Chest radiography should be included as part of basic evaluation at presentation in patients with scrub typhus, especially in those with breathlessness, eschar, jaundice, and severe thrombocytopenia.

  2. Chest radiography practice in critically ill patients: a postal survey in the Netherlands

    Korevaar Johanna C

    2006-07-01

    Full Text Available Abstract Background To ascertain current chest radiography practice in intensive care units (ICUs in the Netherlands. Methods Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU. Results From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50% as compared to other ICUs (68%, as well as in larger ICUs (> 20 beds, 50% as compared to smaller ICUs (P > 0.05. Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81% and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively. On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs, and after cardiopulmonary resuscitation (59%, tracheotomy (58% and mini-tracheotomy (23%. Conclusion There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy.

  3. AB022. A case of severe leptospirosis with acute respiratory distress syndrome

    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

  4. Acute cortical deafness in a child with MELAS syndrome.

    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.

  5. Hyponatremia in acute brain disease: the cerebral salt wasting syndrome.

    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.

  6. Acute digital ischemia: A rare presentation of antisynthetase syndrome.

    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.

  7. The Impact of Hypertension on Patients with Acute Coronary Syndromes

    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.

  8. Anti-infectious treatment in acute respiratory distress syndrome

    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.

  9. Matrix metalloproteinase-9 in patients with acute coronary syndrome

    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.

  10. Depression After First Hospital Admission for Acute Coronary Syndrome

    Osler, Merete; Mårtensson, Solvej; Wium-Andersen, Ida Kim

    2016-01-01

    for depression and mortality via linkage to patient, prescription, and cause-of-death registries until the end of 2012. Incidence of depression (as defined by hospital discharge or antidepressant medication use) and the relationship between depression and mortality were examined using time-to-event models......We examined incidence of depression after acute coronary syndrome (ACS) and whether the timing of depression onset influenced survival. All first-time hospitalizations for ACS (n = 97,793) identified in the Danish Patient Registry during 2001-2009 and a reference population were followed....... In total, 19,520 (20.0%) ACS patients experienced depression within 2 years after the event. The adjusted rate ratio for depression in ACS patients compared with the reference population was 1.28 (95% confidence interval (CI): 1.25, 1.30). During 12 years of follow-up, 39,523 (40.4%) ACS patients and 27...

  11. The clinical aspects of the acute facet syndrome

    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...

  12. Azacitidine With or Without Entinostat in Treating Patients With Myelodysplastic Syndromes, Chronic Myelomonocytic Leukemia, or Acute Myeloid Leukemia

    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

  13. An unusual cause of acute cor pulmonale--significance of the 'continuous diaphragm sign'.

    Mohanan, Sandeep; Sajeev, C G; Muneer, Kader; Rajesh, G; Krishnan, M N; Pillai, Vivek

    2014-01-01

    A patient presented with chest pain and clinical features of acute right heart failure. Initial work up revealed the presence of severe PAH. Acute pulmonary embolism is the commonest and most life-threatening cause for acute cor pulmonale. Even though the clinical picture suggested pulmonary embolism, a subtle sign was missed from the first chest X-ray taken in the emergency department. However on reanalysis the 'continuous diaphragm sign' later guided us towards the diagnosis. Our case represents one of the first reports of a rare etiology for acute cor pulmonale--hypersensitivity pneumonitis. Right ventricular dysfunction was caused by an acute rise in pulmonary artery pressures as well as by the compressive effects of pneumomediastinum. We emphasize the role played by a good quality chest X-ray early in the management of acute chest pain syndromes. However pulmonary embolism should be ruled out conclusively before redirecting attention to less malignant conditions.

  14. Ticagrelor: A new antiplatelet drug for acute coronary syndromes

    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. The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

    Maryam Esmaeilzadeh

    2015-10-01

    Full Text Available Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion.Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea.This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction

  16. Prehospital delay in acute coronary syndrome--an analysis of the components of delay

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian;

    2004-01-01

    more frequently atypical symptoms and increased prehospital delay caused by prolonged physician and transportation delay. Physician delay among women and men were 69 and 16 min, respectively. Patients with prior myocardial infarction had reduced prehospital delay, which was caused by shorter decision...... admitted with acute coronary syndrome is warranted. METHODS: A structured interview was conducted on 250 consecutive patients admitted alive with acute coronary syndrome. RESULTS: Median prehospital, decision, physician and transportation delays were 107, 74, 25 and 22 min, respectively. Women (n=77) had...... of acute coronary syndrome among women, and thereby contributes to unnecessary long delay to treatment. The patient's prior experience and interpretation has a significant influence on behaviour....

  17. Subcutaneous histiocytoid Sweet's syndrome in a patient with myelodysplastic syndrome and acute myeloblastic leukemia.

    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. Which method is best for an early accurate diagnosis of acute heart failure? Comparison between lung ultrasound, chest X-ray and NT pro-BNP performance: a prospective study.

    Sartini, Stefano; Frizzi, Jacopo; Borselli, Matteo; Sarcoli, Elisabetta; Granai, Carolina; Gialli, Veronica; Cevenini, Gabriele; Guazzi, Gianni; Bruni, Fulvio; Gonnelli, Stefano; Pastorelli, Marcello

    2016-07-11

    Acute heart failure is a common condition among adults presenting with dyspnea in the Emergency Department (ED), still the diagnosis is challenging as objective standardized criteria are lacking. First line work-up, other then clinical findings, is nowadays made with lung ultrasound imaging study, chest X-ray study and brain natriuretic peptide (BNP) level determination; however, it is not clear which is the best diagnostic test to be used and whether there is any real benefit for clinical judgement. We set up this study to compare the performances of these three diagnostic tools; furthermore, we combined them to find the best possible approach to dyspneic patients. This is a prospective observational study based in the ED. We enrolled adults presenting with dyspnea not trauma-related, they underwent lung ultrasound, and chest X-ray studies, and NT pro-BNP level determination. Then we compared the results with the diagnosis of acute heart failure established by an independent panel of experts. 236 patients were enrolled in the study. We find sensitivity and specificity for lung ultrasound of 57.73 and 87.97 %, for chest X-ray 74.49 and 86.26 %, for NT pro-BNP 97.59 and 27.56 %, respectively. Combining together the chest X-ray and lung ultrasound, we find the best overall performance with 84.69 % sensitivity, 77.69 % specificity and 87.07 % negative predictive value. From our results, we could not identify the "best test" to diagnose acute heart failure in an emergency setting, although we could suggest that a stepwise workup combining chest X-ray and lung ultrasound at first, then for those negative, a determination of NT pro-BNP assay would be a reasonable approach to the dyspneic patient.

  19. [Acute gamma-butyrolactone poisoning with withdrawal syndrome].

    Chwaluk, Paweł; Rejmak, Grazyna

    2011-01-01

    Gamma-butyrolactone (GBL) is a solvent that are part of many consumer products and in most countries can be legally purchased in the form of almost pure substance. After ingestion GBL is rapidly converted to gamma-hydroxybutyric acid (GHB). In recent years, GBL became a legal alternative to GHB, which is used widely since 1990s as a club drug and date rape drug. It is believed that abuse of GBL is not frequent in Europe, except for certain specific groups, mainly in urban centers in the west of the continent. We present a case of acute GBL poisoning with the withdrawal syndrome in 23-year-old man living in a rural area in eastern Poland. The patient was admitted to the Intensive Care Unit (ICU) because of coma of unknown origin. On admission erosions of the lips and mouth was seen. Ethyl alcohol was not present in blood sample, urine screening tests for drugs were negative. During his stay in the ICU patient required ventilatory support, was periodically agitated with muscular jerks and opisthotonos. The later medical history revealed that the patient from two years used GBL, which purchased as wheels cleaner. The tolerance developed, and the interruption of use of substance triggered symptoms of withdrawal. GBL abuse occurs in different social groups and is at risk for acute toxicity and the development of physical dependence.

  20. Diagnostic Utility of Neuregulin for Acute Coronary Syndrome

    Maame Yaa A. B. Yiadom

    2016-01-01

    Full Text Available The purpose of this study was to determine the diagnostic test characteristics of serum neuregulin-1β (NRG-1β for the detection of acute coronary syndrome (ACS. We recruited emergency department patients presenting with signs and symptoms prompting an evaluation for ACS. Serum troponin and neuregulin-1β levels were compared between those who had a final discharge diagnosis of myocardial infarction (STEMI and NSTEMI and those who did not, as well as those who more broadly had a final discharge diagnosis of ACS (STEMI, NSTEMI, and unstable angina. Of 319 study participants, 11% had evidence of myocardial infarction, and 19.7% had a final diagnosis of ACS. Patients with MI had median neuregulin levels of 0.16 ng/mL (IQR [0.16–24.54]. Compared to the median of those without MI, 1.46 ng/mL (IQR [0.16–15.02], there was no significant difference in the distribution of results (P=0.63. Median neuregulin levels for patients with ACS were 0.65 ng/mL (IQR [0.16–24.54]. There was no statistical significance compared to those without ACS who had a median of 1.40 ng/mL (IQR [0.16–14.19] (P=0.95. Neuregulin did not perform successfully as a biomarker for acute MI or ACS in the emergency department.

  1. A consensus statement on lipid management after acute coronary syndrome.

    Schiele, François; Farnier, Michel; Krempf, Michel; Bruckert, Eric; Ferrières, Jean

    2016-11-17

    In patients admitted for acute coronary syndrome (ACS), the guidelines of the European Society of Cardiology give a Class I, Level A recommendation for the prescription of high-intensity statins to be initiated as early as possible, regardless of the low-density lipoprotein cholesterol (LDL-C) level. Although statins are widely prescribed after ACS, the intensity of therapy and the proportion of patients achieving target LDL-C values are often not in line with recommendations due to a lack of compliance with guidelines by the physicians, a lack of compliance with treatment or poor tolerance by patients, and poor dose adaptation. In this context, a group of French physicians came together to define strategies to facilitate and improve the management of lipid-lowering therapy after ACS. This paper outlines the scientific rationale for the use of statins at the acute phase of ACS, the utility of ezetimibe, the measurement of LDL-C during the course of ACS, the opportunities for detecting familial hypercholesterolaemia and the results of the consensus for the management of lipid-lowering therapy, illustrated in two decision-making algorithms.

  2. Diagnostic Utility of Neuregulin for Acute Coronary Syndrome

    Greenberg, Jeremy; Smith, Holly M.; Sawyer, Douglas B.; Liu, Dandan; Carlise, Jahred; Tortora, Laura; Storrow, Alan B.

    2016-01-01

    The purpose of this study was to determine the diagnostic test characteristics of serum neuregulin-1β (NRG-1β) for the detection of acute coronary syndrome (ACS). We recruited emergency department patients presenting with signs and symptoms prompting an evaluation for ACS. Serum troponin and neuregulin-1β levels were compared between those who had a final discharge diagnosis of myocardial infarction (STEMI and NSTEMI) and those who did not, as well as those who more broadly had a final discharge diagnosis of ACS (STEMI, NSTEMI, and unstable angina). Of 319 study participants, 11% had evidence of myocardial infarction, and 19.7% had a final diagnosis of ACS. Patients with MI had median neuregulin levels of 0.16 ng/mL (IQR [0.16–24.54]). Compared to the median of those without MI, 1.46 ng/mL (IQR [0.16–15.02]), there was no significant difference in the distribution of results (P = 0.63). Median neuregulin levels for patients with ACS were 0.65 ng/mL (IQR [0.16–24.54]). There was no statistical significance compared to those without ACS who had a median of 1.40 ng/mL (IQR [0.16–14.19]) (P = 0.95). Neuregulin did not perform successfully as a biomarker for acute MI or ACS in the emergency department. PMID:27110055

  3. Diagnostic Utility of Neuregulin for Acute Coronary Syndrome.

    Yiadom, Maame Yaa A B; Greenberg, Jeremy; Smith, Holly M; Sawyer, Douglas B; Liu, Dandan; Carlise, Jahred; Tortora, Laura; Storrow, Alan B

    2016-01-01

    The purpose of this study was to determine the diagnostic test characteristics of serum neuregulin-1β (NRG-1β) for the detection of acute coronary syndrome (ACS). We recruited emergency department patients presenting with signs and symptoms prompting an evaluation for ACS. Serum troponin and neuregulin-1β levels were compared between those who had a final discharge diagnosis of myocardial infarction (STEMI and NSTEMI) and those who did not, as well as those who more broadly had a final discharge diagnosis of ACS (STEMI, NSTEMI, and unstable angina). Of 319 study participants, 11% had evidence of myocardial infarction, and 19.7% had a final diagnosis of ACS. Patients with MI had median neuregulin levels of 0.16 ng/mL (IQR [0.16-24.54]). Compared to the median of those without MI, 1.46 ng/mL (IQR [0.16-15.02]), there was no significant difference in the distribution of results (P = 0.63). Median neuregulin levels for patients with ACS were 0.65 ng/mL (IQR [0.16-24.54]). There was no statistical significance compared to those without ACS who had a median of 1.40 ng/mL (IQR [0.16-14.19]) (P = 0.95). Neuregulin did not perform successfully as a biomarker for acute MI or ACS in the emergency department.

  4. REPERFUSION THERAPY IN ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION

    A. L. Alyavi

    2016-01-01

    Full Text Available Aim. To compare effect of percutaneous balloon angioplasty (PCA and a systemic thrombolysis (STL on the central and intracardiac hemodynamics in patients with acute coronary syndrome (ACS with ST segment elevation.Material and methods. 80 patients with ACS with ST segment elevation were included in the study. Patients were split into 2 groups depending on reperfusion strategy. PCA was performed in 55 patients (first group. 25 patients of the second group had STL with Streptokinase, i/v, 1 500 000 units per hour. Echocardiography was performed in all patients at admission and after 3 and 7 days of treatment to evaluate intracardiac hemodynamics.Results. Both reperfusion methods significantly increase of ejection fraction (EF and maximal output speed of left ventricle (LV. Increase of LV EF in patients after PCA was higher than this in patients after STL. PCA improved LV diastolic function; STL did not change this characteristic. After PCA working diagnosis of ACS was transformed to the following final diagnosis: acute myocardial infarction (AMI with Q, AMI without Q and unstable angina in 37,5, 30,4 and 32,1% of patients, respectively. After STL diagnosis of AMI with Q was defined in all patients.Conclusion. PCA in patients with ACS with ST segment elevation results in fast improvement of global systolic and diastolic LV function. Besides, PCA prevents AMI with Q in a half of these patients.

  5. Phospholipase A2 subclasses in acute respiratory distress syndrome.

    Kitsiouli, Eirini; Nakos, George; Lekka, Marilena E

    2009-10-01

    Phospholipases A2 (PLA2) catalyse the cleavage of fatty acids esterified at the sn-2 position of glycerophospholipids. In acute lung injury-acute respiratory distress syndrome (ALI-ARDS) several distinct isoenzymes appear in lung cells and fluid. Some are capable to trigger molecular events leading to enhanced inflammation and lung damage and others have a role in lung surfactant recycling preserving lung function: Secreted forms (groups sPLA2-IIA, -V, -X) can directly hydrolyze surfactant phospholipids. Cytosolic PLA2 (cPLA2-IVA) requiring Ca2+ has a preference for arachidonate, the precursor of eicosanoids which participate in the inflammatory response in the lung. Ca(2+)-independent intracellular PLA2s (iPLA2) take part in surfactant phospholipids turnover within alveolar cells. Acidic Ca(2+)-independent PLA2 (aiPLA2), of lysosomal origin, has additionally antioxidant properties, (peroxiredoxin VI activity), and participates in the formation of dipalmitoyl-phosphatidylcholine in lung surfactant. PAF-AH degrades PAF, a potent mediator of inflammation, and oxidatively fragmented phospholipids but also leads to toxic metabolites. Therefore, the regulation of PLA2 isoforms could be a valuable approach for ARDS treatment.

  6. Admission glycaemia and outcome in patients with acute coronary syndrome.

    Müdespacher, Damaris; Radovanovic, Dragana; Camenzind, Edoardo; Essig, Manfred; Bertel, Osmund; Erne, Paul; Eberli, Franz Robert; Gutzwiller, Felix

    2007-12-01

    Some studies of patients with acute myocardial infarction have reported that hyperglycaemia at admission may be associated with a worse outcome. This study sought to evaluate the association of blood glucose at admission with the outcome of unselected patients with acute coronary syndrome (ACS). Using the Acute Myocardial Infarction and unstable angina in Switzerland (AMIS Plus) registry, ACS patients were stratified according to their blood glucose on admission: group 1: 2.80-6.99 mmol/L, group 2: 7.00-11.09 mmol/L and group 3: > 11.10 mmol/L. Odds ratios for in-hospital mortality were calculated using logistic regression models. Of 2,786 patients, 73% were male and 21% were known to have diabetes. In-hospital mortality increased from 3% in group 1 to 7% in group 2 and to 15% in group 3. Higher glucose levels were associated with larger enzymatic infarct sizes (p<0.001) and had a weak negative correlation with angiographic or echographic left ventricular ejection fraction. High admission glycaemia in ACS patients remains a significant independent predictor of in-hospital mortality (adjusted OR 1.08; 95% confidence intervals [CI] 1.05-1.14, p<0.001) per mmol/L. The OR for in-hospital mortality was 1.04 (95% CI 0.99-1.1; p=0.140) per mmol/L for patients with diabetes but 1.21 (95% CI 112-1.30; p<0.001) per mmol/L for non-diabetic patients. In conclusion, elevated glucose level in ACS patients on admission is a significant independent predictor of in-hospital mortality and is even more important for patients who do not have known diabetes.

  7. [A case of sustained cholestasis caused by acute A viral hepatitis in Dubin-Johnson syndrome].

    Ra, Sang Ho; Sung, Se Yong; Jung, Ho Yeon; Cha, Jae Hwang; Baik, Soon Koo; Cho, Mee Yon; Kim, Moon Young

    2012-04-01

    Dubin-Johnson syndrome is a rare clinical entity. It shows intermittent symptoms such as chronic or intermittent jaundice, abdominal pain, weakness, nausea, vomiting, anorexia and diarrhea. Symptoms are precipitated or aggravated by pregnancy, alcoholism, surgical procedures and intercurrent disease. Chronic idiopathic jaundice is typical of Dubin-Johnson syndrome and its prognosis is good. We describe a case of prolonged cholestasis for more than 10 months caused by acute A viral hepatitis in a patient with Dubin-Johnson syndrome. It is a first report of cholestasis complicated by acute A viral hepatitis in a patient with Dubin-Johnson syndrome.

  8. Factors Associated with Death Due to 2009 Influenza A (H1N1) Virus Infection and Acute Respiratory Distress Syndrome in Beijing, 2009-2011

    Jin-qian; Zhang; Li-cheng; Zhang; Na; Ren; Ming; Zhang; Li-min; Guo; Xing-wang; Li; Jun; Cheng

    2012-01-01

    Objective Patients with H1N1 virus infection were hospitalized and quarantined, and some of them developed into acute respiratory failure, and were transfered to the medical intensive care unit of Beijing Ditan Hospital, Capital Medical University in Beijing, China. Methods The clinical features and preliminary epidemiologic findings among 30 patients with confirmed H1N1 virus infection who developed into acute respiratory failure for ventilatory support were investigated. Results A total of 30 patients(37.43 ± 18.80 years old) with 2009 influenza A(H1N1) related acute respiratory distress syndrome(ARDS) received treatment with mechanical ventilation, 15 cases of whom were male and 17 cases died of ARDS. Fatal cases were significantly associated with an APACHE Ⅱ score(P = 0.016), but not with PaO 2 /FIO 2(P = 0.912) and chest radiograph(P = 0.333). The most common complication was acute renal failure(n = 9). Five patients received extracorporeal membrane oxygenation(ECMO), 3 of whom died and the others survived. The major causes of death were multiple organ dysfunction syndrome(MODS)(39%), intractable respiratory failure(27%) and sepsis(20%). Conclusions Most patients with respiratory failure due to influenza A(H1N1) virus infection were young, with a high mortality, particularly associated with APACHE Ⅱ score, secondary infection of lung or type 2 diabetes mellitus.

  9. A Case of Acute Budd-Chiari Syndrome Complicating Primary Antiphospholipid Syndrome Presenting as Acute Abdomen and Responding to Tight Anticoagulant Therapy

    Naofumi Chinen

    2016-01-01

    Full Text Available A 34-year-old woman with primary antiphospholipid syndrome was admitted to the Gastroenterology Department of our hospital with fever, acute abdomen, watery diarrhea, and extremely high levels of inflammatory parameters. She had a history of left lower limb deep vein thrombosis and pulmonary embolism and was taking warfarin potassium. Acute gastroenteritis was suspected and an antibiotic was administered, but symptoms progressed. Abdominal ultrasonography showed occlusion of the left hepatic vein and the middle hepatic vein and her D-dimer level was high. Accordingly, Budd-Chiari syndrome was diagnosed and high-dose intravenous infusion of heparin was initiated. Her abdominal symptoms improved and the levels of inflammatory parameters and D-dimer decreased rapidly. It is known that antiphospholipid syndrome can be complicated by Budd-Chiari syndrome that usually occurs as subacute or chronic onset, but acute onset is rare. It is difficult to diagnose acute Budd-Chiari syndrome complicating antiphospholipid syndrome and this complication generally has a poor outcome. However, the present case can get early diagnosis and successful treatment with tight anticoagulant therapy.

  10. Retrospective analysis on acute respiratory distress syndrome in ICU

    LI Jin-bao; ZHANG Liang; ZHU Ke-ming; DENG Xiao-ming

    2007-01-01

    Objective:To assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU).Methods: A retrospective analysis of 5 314 patients admitted to the ICU of our hospital from April 1994 to December 2003 was performed in this study. The ARDS patients were identified with the criteria of the American-European Consensus Conference ( AECC ). Acute physiology and chronic health evaluation Ⅲ ( APACHE in), multiple organ dysfunction syndrome score (MODS score), and lung injury score (LIS) were determined on the onset day of ARDS for all the patients. Other recorded variables included age, sex, biochemical indicators, blood gas analysis, length of stay in ICU, length of ventilation, presence or absence of tracheostomy, ventilation variables, elective operation or emergency operation.Results:Totally, 131 patients (2.5%) developed ARDS, among whom, 12 patients were excluded from this study because they died within 24 hours and other 4 patients were also excluded for their incomplete information. Therefore, there were only 115 cases (62 males and 53 females, aged 22-75 years, 58 years on average) left,accounting for 2. 2% of the total admitted patients. Their average ICU stay was (11. 27±7. 24) days and APACHE in score was 17.23±7.21. Pneumonia and sepsis were the main cause of ARDS. The non-survivors were obviously older and showed significant difference in the ICU length of stay and length of ventilation as compared with the survivors. On admission, the non-survivors had significantly higher MODS and lower BE ( base excess). The hospital mortality was 55. 7%. The main cause of death was multiple organ failure. Predictors of death at the onset of ARDS were advanced age, MODS≥8, and LIS≥2.76.Conclusions: ARDS is a frequent syndrome in this cohort. Sepsis and pneumonia are the most common risk factors. The main cause of death is multiple organ failure. The mortality is

  11. The Research Progress of Risk Stratification Score for Acute Non-traumatic Chest Pain%急性非创伤性胸痛危险分层评分的研究进展

    周洪峰(综述); 王秀杰(审校)

    2016-01-01

    Chest pain is one of the most common complaints in the emergency department .Acute coro-nary syndrome is the one of the most common and serious diseases.Using risk stratification score,clinicians can make protocol and evaluate condition more reasonably , which currently plays a positive role in triage , evaluating illness on admission and prognosis.With the emergence of some new biomakers,such as super sen-sitive troponin and fatty acid binding protein,and combined biomarkers scoring,the risk stratification score will be more widely used in clinical .%胸痛是急诊科常见的就诊原因之一。急性冠状动脉综合征是其中最常见、最危重的疾病之一,危险分层评分的应用可以帮助临床医师更加合理地评估病情、制订治疗方案。目前它们在急诊室分诊、入院病情评估及预后评估方面都有一定的积极意义。随着超敏肌钙蛋白、脂肪酸结合蛋白等新兴标志物的出现,以及标志物联合评分的研究,危险评分将进一步得到广泛的临床应用。

  12. A novel trigger for acute coronary syndromes: the effect of lunar cycles on the incidence and in-hospital prognosis of acute coronary syndromes--a 3-year retrospective study.

    Oomman, Abraham; Ramachandran, P; Shanmugapriya; Subramanian, Priya; Nagaraj, B M S

    2003-04-01

    Circadian variations in the incidence of hypertension and coronary events are well known with early morning surges. Effect of lunar cycles on various medical illnesses like seizures and psychiatric disturbances are documented. However, the effect of lunar cycles on coronary events has been sparsely documented. The authors studied the incidence of acute coronary events and admission patterns in the departments of emergency medicine and cardiology. Inclusion criteria included unstable angina, non-ST elevation myocardial infarction (MI) and ST elevation MI. Exclusion criteria included chest pain syndromes which were subsequently deemed non-cardiac by invasive or non-invasive investigations. Data from 1999 to 2001 were analysed. Admissions on full moon days were compared with those on new moon days. There were 30 full moon days and 30 new moon days and 223 admissions on full moon days and 266 on new moon days. This difference was statistically significant [p = .005]. Sixty-seven per cent were males and the rest were females. Subgroup analysis of mortality, postinfarction angina, effect on diabetics and hypertensives were done which showed an increased trend in new moon days. It is concluded that there is increased incidence of acute coronary events associated with new moon days.

  13. Ventricular Tachycardia and Resembling Acute Coronary Syndrome During Pheochromocytoma Crisis: A Case Report.

    Li, Shi-Jun; Wang, Tao; Wang, Lin; Pang, Zhan-Qi; Ma, Ben; Li, Ya-Wen; Yang, Jian; Dong, He

    2016-04-01

    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.

  14. TETANIC CRISIS IN EMERGENCY CARDIOLOGY — DIFFICULTIES DIFFERENTIAL DIAGNOSIS OF ACUTE CORONARY SYNDROME

    V. V. Rezvan

    2016-01-01

    Full Text Available The report presents a case of tetanic crisis in a patient with postoperative parathyroid insufficiency after strumectomy that emergency doctors were interpreted as an acute coronary syndrome with collapse.

  15. Scandinavian clinical practice guideline on fluid and drug therapy in adults with acute respiratory distress syndrome

    Claesson, J; Freundlich, M; Gunnarsson, I

    2016-01-01

    BACKGROUND: The objective of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) task force on fluid and drug therapy in adults with acute respiratory distress syndrome (ARDS) was to provide clinically relevant, evidence-based treatment recommendations according...

  16. Impact of a national smoking ban on hospital admission for acute coronary syndromes: a longitudinal study.

    Cronin, Edmond M

    2012-04-01

    A ban on smoking in the workplace was introduced in Ireland on March 29, 2004. As exposure to secondhand smoke has been implicated in the development of coronary disease, this might impact the incidence of acute coronary syndromes (ACS).

  17. The impact of self-care education on life expectancy in acute coronary syndrome patients

    Mahshid Choobdari

    2015-04-01

    Conclusion: Hospitalized acute coronary syndrome patients have a lower levels of life expectancy. Their life expectancy can increase through providing them with self-care education, which will lead to their independence promotion and self-esteem.

  18. Optimal timing of coronary invasive strategy in non-ST-segment elevation acute coronary syndromes

    Navarese, Eliano P; Gurbel, Paul A; Andreotti, Felicita;

    2013-01-01

    The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations....

  19. Idiopathic Acute Isolated Lateral Compartment Syndrome of a Lower Leg: A Magnetic Resonance Imaging Case Report

    Yeom, Dong Heon; Lee, Ji Hae; Cho, Woo Ho; Kim, Jae Hyung; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Ji Young; Kim, Soo Hyun; Kang, Mi Jin; Lee, Han Bee [Dept. of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Bae, Kyung Eun [Dept. of Radiology, Seoul Asan Hospital, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2013-01-15

    Acute compartment syndrome of the lower leg is usually associated with major trauma such as fracture, and most commonly occurs in the anterior or deep posterior compartments. Isolated lateral compartment syndrome is less typical and usually associated with minor trauma or exertion. There are a few reports of the acute compartment syndrome which develops without an obvious cause. However, there are few reports of idiopathic acute isolated lateral compartment syndrome, and there are no reports of the radiologic findings. This study presents a radiologic finding of idiopathic acute isolated lateral compartment of lower leg, which shows localized enlargement of the peroneal muscles with peripheral convex bowing and change of their signal intensity with fluid signal along the adjacent fascial planes on magnetic resonance imaging.

  20. Acute lower limb compartment syndrome after Cesarean section: a case report

    Sütterlin Marc

    2011-04-01

    Full Text Available Abstract Introduction Acute compartment syndrome of the lower limb is a rare but severe intra- and post-partum complication. Prompt diagnosis is essential to avoid permanent functional restriction or even the loss of the affected limb. Clinical signs and symptoms might be nonspecific, especially in the early stages; therefore, knowledge of predisposing risk factors can be helpful. Case presentation We present the case of a 32-year-old Caucasian woman with acute post-partum compartment syndrome. Conclusion Acute compartment syndrome is an important differential diagnosis for the sudden onset of intra- or post-partum lower-limb pain. Predisposing factors for the manifestation of acute compartment syndrome in an obstetric environment are augmented intra-partum blood loss, prolonged hypotensive episodes and the use of oxytocin to support or induce labor because of its vasoconstrictive properties. Treatment is prompt surgical decompression by performing fasciotomy in any affected muscular compartments.

  1. Evaluation of triple anti-platelet therapy by modified thrombelastography in patients with acute coronary syndrome

    REN Yi-hong; JIN Jing; XIN You-hong; LI Rong-bin; LI Hai-yan; LIN Lin; LIU Chun-xue; YANG Ting-shu; WANG Yu; GAI Lu-yue; LIU Hong-bin; CHEN Lian; WANG Hong-ye; WANG Chun-ya; XU Xiu-li

    2008-01-01

    @@ Most cases of acute coronary syndrome (ACS) involve coronary atherosclerosis and plaque rupture,as well as subsequent thrombosis. The initial thrombotic events leading to red thrombus formation are platelet adherence and aggregation.

  2. Incidence, Mortality and Positive Predictive Value of Type 1 Cardiorenal Syndrome in Acute Coronary Syndrome

    Pimienta González, Raquel; Couto Comba, Patricia; Rodríguez Esteban, Marcos; Alemán Sánchez, José Juan; Hernández Afonso, Julio; Rodríguez Pérez, María del Cristo; Marcelino Rodríguez, Itahisa; Brito Díaz, Buenaventura; Elosua, Roberto; Cabrera de León, Antonio

    2016-01-01

    Objectives To determine whether the risk of cardiovascular mortality associated with cardiorenal syndrome subtype 1 (CRS1) in patients who were hospitalized for acute coronary syndrome (ACS) was greater than the expected risk based on the sum of its components, to estimate the predictive value of CRS1, and to determine whether the severity of CRS1 worsens the prognosis. Methods Follow-up study of 1912 incident cases of ACS for 1 year after discharge. Cox regression models were estimated with time to event (in-hospital death, and readmission or death during the first year after discharge) as the dependent variable. Results The incidence of CRS1 was 9.2/1000 person-days of hospitalization (95% CI = 8.1–10.5), but these patients accounted for 56.6% (95% CI = 47.4–65.) of all mortality. The positive predictive value of CRS1 was 29.6% (95% CI = 23.9–36.0) for in-hospital death, and 51.4% (95% CI = 44.8–58.0) for readmission or death after discharge. The risk of in-hospital death from CRS1 (RR = 18.3; 95% CI = 6.3–53.2) was greater than the sum of risks associated with either acute heart failure (RR = 7.6; 95% CI = 1.8–31.8) or acute kidney injury (RR = 2.8; 95% CI = 0.9–8.8). The risk of events associated with CRS1 also increased with syndrome severity, reaching a RR of 10.6 (95% CI = 6.2–18.1) for in-hospital death at the highest severity level. Conclusions The effect of CRS1 on in-hospital mortality is greater than the sum of the effects associated with each of its components, and it increases with the severity of the syndrome. CRS1 accounted for more than half of all mortality, and its positive predictive value approached 30% in-hospital and 50% after discharge. PMID:27907067

  3. Chest Pain Units: A Modern Way of Managing Patients with Chest Pain in the Emergency Department

    Roberto Bassan

    2002-08-01

    Full Text Available It is estimated that 5 to 8 million individuals with chest pain or other symptoms suggestive of myocardial ischemia are seen each year in emergency departments (ED in the United States 1,2, which corresponds to 5 to 10% of all visits 3,4. Most of these patients are hospitalized for evaluation of possible acute coronary syndrome (ACS. This generates an estimated cost of 3 - 6 thousand dollars per patient 5,6. From this evaluation process, about 1.2 million patients receive the diagnosis of acute myocardial infarction (AMI, and just about the same number have unstable angina. Therefore, about one half to two thirds of these patients with chest pain do not have a cardiac cause for their symptoms 2,3. Thus, the emergency physician is faced with the difficult challenge of identifying those with ACS - a life-threatening disease - to treat them properly, and to discharge the others to suitable outpatient investigation and management.

  4. Hematopoietic Acute Radiation Syndrome (Bone marrow syndrome, Aplastic Anemia): Molecular Mechanisms of Radiation Toxicity.

    Popov, Dmitri

    Key Words: Aplastic Anemia (AA), Pluripotential Stem Cells (PSC) Introduction: Aplastic Anemia (AA) is a disorder of the pluripotential stem cells involve a decrease in the number of cells of myeloid, erythroid and megakaryotic lineage [Segel et al. 2000 ]. The etiology of AA include idiopathic cases and secondary aplastic anemia after exposure to drugs, toxins, chemicals, viral infections, lympho-proliferative diseases, radiation, genetic causes, myelodisplastic syndromes and hypoplastic anemias, thymomas, lymphomas. [Brodskyet al. 2005.,Modan et al. 1975., Szklo et al. 1975]. Hematopoietic Acute Radiation Syndrome (or Bone marrow syndrome, or Radiation-Acquired Aplastic Anemia) is the acute toxic syndrome which usually occurs with a dose of irradiation between 0.7 and 10 Gy (70- 1000 rads), depending on the species irradiated. [Waselenko et al., 2004]. The etiology of bone morrow damage from high-level radiation exposure results depends on the radiosensitivity of certain bone marrow cell lines. [Waselenko et al. 2004] Aplastic anemia after radiation exposure is a clinical syndrome that results from a marked disorder of bone marrow blood cell production. [Waselenko et al. 2004] Radiation hematotoxicity is mediated via genotoxic and other specific toxic mechanisms, leading to aplasia, cell apoptosis or necrosis, initiation via genetic mechanisms of clonal disorders, in cases such as the acute radiation-acquired form of AA. AA results from radiation injury to pluripotential and multipotential stem cells in the bone marrow. The clinical signs displayed in reticulocytopenia, anemia, granulocytopenia, monocytopenia, and thrombocytopenia. The number of marrow CD34+ cells (multipotential hematopoietic progenitors) and their derivative colony-forming unit{granulocyte-macrophage (CFU-GM) and burst forming unit {erythroid (BFU{E) are reduced markedly in patients with AA. [Guinan 2011, Brodski et al. 2005, Beutler et al.,2000] Cells expressing CD34 (CD34+ cell) are normally

  5. Acute Compartment Syndrome in the Forearm with Trans-Ulnar Single Incision.

    Suzuki, Taku; Inaba, Naoto; Sato, Kazuki

    2016-02-01

    We report a case of ulnar nerve palsy caused by diaphyseal fractures of the forearm and acute compartment syndrome. Trans-ulnar single incision with a fasciotomy of the volar and dorsal compartments was used to fix the ulna. Full recovery of the ulnar nerve was achieved six months after the surgery. In cases of acute compartment syndrome with ulnar fracture, a trans-ulnar incision with compartment release is effective for the fixation of the ulna.

  6. Women with acute coronary syndrome are less invasively examined and subsequently less treated than men

    Hvelplund, Anders; Galatius, Søren; Madsen, Mette;

    2010-01-01

    Aims To investigate if gender bias is present in today's setting of an early invasive strategy for patients with acute coronary syndrome in Denmark (population 5 million). Methods and results We identified all patients admitted to Danish hospitals with acute coronary syndrome in 2005-07 (9561 wom...... aggressively invasive way and receive less interventional treatment than men even after adjusting for differences in comorbidity and number of significant stenoses....

  7. Chest radiation - discharge

    Radiation - chest - discharge; Cancer - chest radiation; Lymphoma - chest radiation ... When you have radiation treatment for cancer, your body goes through changes. About 2 weeks after your first treatment: It may be hard ...

  8. Chest X Ray?

    ... this page from the NHLBI on Twitter. Chest X Ray A chest x ray is a fast and painless imaging test ... tissue scarring, called fibrosis. Doctors may use chest x rays to see how well certain treatments are ...

  9. MRI of the Chest

    Full Text Available ... MRI of the Chest? What is MRI of the Chest? Magnetic resonance imaging (MRI) is a noninvasive ... of page What are some common uses of the procedure? MR imaging of the chest is performed ...

  10. Acute myeloblastic leukemia-associated Marfan syndrome and Davidoff-Dyke-Masson syndrome: a case report

    Ahmet Faik Öner

    2008-12-01

    Full Text Available We present herein a 23-year-old man with acute myeloblastic leukemia (AML associated with Davidoff-Dyke-Masson syndrome (DDMS and Marfan syndrome (MS. The diagnosis of DDMS was based on findings including left facial asymmetry, left hemiparesis, mental retardation, right cerebral hemiatrophy, dilatation of the ipsilateral lateral ventricle and calvarial thickening. The diagnosis of MS was based on clinical findings including tall stature, myopia, retinitis pigmentosa, blue scleras, scoliosis, pectus excavatum, arachnodactyly and low ratio of upper/lower body segment. The patient developed hepatosplenomegaly, gingival hypertrophy and pancytopenia. Peripheral blood film and bone marrow examination showed that most of nucleated cells were blasts; immunophenotype of those cells showed CD11+, CD13+, CD14+, CD33+ and HLA-DR+. These findings confirmed the diagnosis of AML (FAB-M5. After induction chemotherapy, remission was obtained. To the best of our knowledge, our case is the third report of AML in MS syndrome, while AML associated with DDMS and MS has not been previously reported in the literature.

  11. Application effect of new triage record list on acute chest pain%胸痛患者分诊记录单的应用效果

    王国英; 赫晓慈; 朱静利; 王丽红; 高梦颖; 李彦平; 田素斋

    2015-01-01

    Objective To introduce triage standard for non-traumatic chest pain and SOAPIE triage method into triage work for acute chest pain patients, and to investigate its effect. Methods Based on triage standard for non-traumatic chest pain and SOAPIE triage method, a new triage record was established. And triage time, triage accuracy and patient satisfaction were compared with conventional methods. Results The triage time of the research group was (1. 94 ± 0. 30) minutes, which was significantly lower than (2. 27 ± 0. 35) minutes of the control group (t =6. 99,P <0. 05). The triage accuracy of the research group was 96. 0%, which was significantly higher than 82. 0% of the control group (χ2 =10. 01,P<0. 05). The score of patients′satisfaction was (98. 94 ± 1. 06), which was significantly higher than (89. 30 ± 5. 95) of the control group (t=15. 96,P <0. 01). Conclusions The new triage method can shorten the triage time, improve the triage accuracy and patients′satisfaction, which is worthy of promotion.%目的:将非创伤性胸痛的分诊标准和SOAPIE分诊方法引入急性胸痛的预检分诊工作,探讨其在急性胸痛预检分诊工作中的应用效果。方法依据SOAPIE分诊方法和非创伤性胸痛的分诊标准自行设计胸痛患者分诊记录单,比较采用常规分诊方法与该分诊方法的分诊时间、分诊准确率及患者满意度的差异。结果研究组分诊时间(1.94±0.30)min,低于对照组的(2.27±0.35)min,差异有统计学意义(t=6.99,P<0.05)。研究组分诊正确率为96.0%,高于对照组的82.0%,差异有统计学意义(χ2=10.01,P<0.05)。研究组患者满意度得分为(98.94±1.06)分,高于对照组的(89.30±5.95)分,差异有统计学意义(t=15.96,P<0.01)。结论新的分诊记录单缩短了分诊时间,提高了急性胸痛患者分诊的正确率和患者满意度,值得临床推广。

  12. Diagnosis of Acute Respiratory Distress Syndrome in Nosocomial Pneumonia

    A. N. Kuzovlev

    2009-01-01

    Full Text Available Objective: to define the informative value of the parameters of gas exchange, lung volumetry, and central hemodynamics in the diagnosis of acute respiratory distress syndrome (ARDS in nosocomial pneumonia (NP. Subjects and methods. The study included 38 patients with cancer and severe injury who were divided into 3 groups in accordance with the diagnostic criteria of ARDS and NP: 1 patients with ARDS + NP; 2 those with NP; 3 those with non-ARDS, non-PN. ARDS was diagnosed in 2 steps. At Step 1, the investigators took into account risk factors for ARDS and used the lung injury scale developed by J. Murray et al. and the ARDS diagnostic criteria defined by the American-European Consensus Conference on ARDS. At Step 2, after obtaining the data of lung volume-try (1—2 hours after Step 1, they assessed the compliance of the above criteria for ARDS with those developed by the V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, and redistributed the patients between the groups. The stage of ARDS was determined in accordance with the classification of the above Institute. All the patients underwent a comprehensive examination the key element of which was to estimate gas exchange parameters and to monitor lung volumetry and central hemodynamics by the transpulmonary thermodilution methods, by using a Pulsion PiCCO Plus monitor (Pulsion Medical Systems, Germany. The findings were statistically analyzed using a Statistica 7.0 package (arithmetic mean, error of the mean, _ Student’s test, Newman-Keuls test, correlation analysis. The difference was considered to be significant if p-value was Results. The patients with ARDS + NP were observed to have a significantly lower oxygenation index (10 ml/kg and Murray scale scores (>2 than those in patients with NP without ARDS. The reference values of the pulmonary vascular permeability index due to its inadequate informative value call for further investigation. The

  13. The cost of inpatient death associated with acute coronary syndrome

    Page II RL

    2016-02-01

    Full Text Available Robert L Page II,1 Vahram Ghushchyan,2 Jill Van Den Bos,3 Travis J Gray,3 Greta L Hoetzer,4 Durgesh Bhandary,4 Kavita V Nair1 1Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 2College of Business and Economics, American University of Armenia, Yerevan, Armenia; 3Milliman, Inc, Denver, CO, 4AstraZeneca, US Medical Affairs, Wilmington, DE, USA Background: No studies have addressed the cost of inpatient mortality during an acute coronary syndrome (ACS admission. Objective: Compare ACS-related length of stay (LOS, total admission cost, and total admission cost by day of discharge/death for patients who died during an inpatient admission with a matched cohort discharged alive following an ACS-related inpatient stay. Methods: Medical and pharmacy claims (2009–2012 were used to identify admissions with a primary diagnosis of ACS from patients with at least 6 months of continuous enrollment prior to an ACS admission. Patients who died during their ACS admission (deceased cohort were matched (one-to-one to those who survived (survived cohort on age, sex, year of admission, Chronic Condition Index score, and prior revascularization. Mean LOS, total admission cost, and total admission cost by the day of discharge/death for the deceased cohort were compared with the survived cohort. A generalized linear model with log transformation was used to estimate the differences in the total expected incremental cost of an ACS admission and by the day of discharge/death between cohorts. A negative binomial model was used to estimate differences in the LOS between the two cohorts. Costs were inflated to 2013 dollars. Results: A total of 1,320 ACS claims from patients who died (n=1,320 were identified and matched to 1,319 claims from the survived patients (n=1,319. The majority were men (68% and mean age was 56.7±6.4 years. The LOS per claim for the deceased cohort was

  14. Identifying acute coronary syndrome patients approaching end-of-life.

    Stephen Fenning

    Full Text Available BACKGROUND: Acute coronary syndrome (ACS is common in patients approaching the end-of-life (EoL, but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF and the Global Registry of Acute Coronary Events (GRACE score, to help identify patients approaching EoL. METHODS AND FINDINGS: 172 unselected consecutive patients with confirmed ACS admitted over an eight-week period were assessed using prognostic tools and followed up for 12 months. GSF criteria identified 40 (23% patients suitable for EoL care while GRACE identified 32 (19% patients with ≥ 10% risk of death within 6 months. Patients meeting GSF criteria were older (p = 0.006, had more comorbidities (1.6 ± 0.7 vs. 1.2 ± 0.9, p = 0.007, more frequent hospitalisations before (p = 0.001 and after (0.0001 their index admission, and were more likely to die during follow-up (GSF+ 20% vs GSF- 7%, p = 0.03. GRACE score was predictive of 12-month mortality (C-statistic 0.75 and this was improved by the addition of previous hospital admissions and previous history of stroke (C-statistic 0.88. CONCLUSIONS: This study has highlighted a potentially large number of ACS patients eligible for EoL care. GSF or GRACE could be used in the hospital setting to help identify these patients. GSF identifies ACS patients with more comorbidity and at increased risk of hospital readmission.

  15. New insights towards the acute nonthyroidal illness syndrome

    ANA LUIZA eMAIA

    2012-01-01

    Full Text Available The non-thyroidal illness syndrome (NTIS refers to changes in serum thyroid hormone levels observed in critically-ill patients in the absence of hypothalamic-pituitary-thyroid primary dysfunction. Affected individuals have low T3, elevated rT3 and inappropriately normal TSH levels. The pathophysiological mechanisms are poorly understood but the acute and chronic changes in pituitary–thyroid function are probably the consequence of the action of multiple factors. The early phase seems to reflect changes occurring primarily in the peripheral thyroid hormone metabolism, best seen in humans since 80-90% of the circulating T3 are derived from the pro-hormone T4. The conversion of T4-to-T3 is catalyzed by type 1 (D1 and type 2 (D2 deiodinases via outer-ring deiodination. In contrast, type 3 deiodinase (D3 catalyzes the inactivation of both T4 and T3. Over the last decades, several studies have attempted to elucidate the mechanisms underlying the changes on circulating thyroid hormones in NTIS. Increased inflammatory cytokines, which occurs in response to virtually any illness, has long been speculated to play a role in derangements of deiodinase expression. On the other hand, oxidative stress due to augmented reactive oxygen species (ROS generation is characteristic of many diseases that are associated with NTIS. Changes in the intracellular redox state may disrupt deiodinase function by independent mechanisms, which might include depletion of the as yet unidentified endogenous thiol cofactor. Here we aim to present an updated picture of the advances in understanding the mechanisms that result in the fall of thyroid hormone levels in the acute phase of NTIS.

  16. Atrial natriuretic factor in the acute nephritic and nephrotic syndromes.

    Rodríguez-Iturbe, B; Colic, D; Parra, G; Gutkowska, J

    1990-09-01

    Because the role of systemic hormones in the pathophysiology of edema in acute renal disease remains incompletely understood, we compared the levels of atrial natriuretic factor (ANF) and plasma renin activity (PRA) in patients with acute glomerulonephritis (AGN), nephrotic syndrome (NS), and normal individuals during salt deprivation and salt loading. Sixteen patients with AGN (10 males) and nine patients with NS and hypoalbuminemia (7 males) were studied on admission, and after recovery (12 AGN patients) or remission (4 NS patients). Eighteen normal controls were each studied after five days on a low (20 mEq Na/day), regular (120 mEq Na/day) and high (300 mEq Na/day) dietary salt intake. Patients with AGN and NS had comparable edema (AGN 2.8 +/- 0.53 kg; NS 3.36 +/- 0.47 kg; SE) and urinary Na excretion (mean +/- SEM: AGN 0.97 +/- 0.11 mEq/hr; NS 1.06 +/- 0.16 mEq/hr), but AGN patients had five times higher ANF (AGN 27.2 +/- 4.06 fmol/ml; NS 5.51 +/- 1.02 fmol/ml; P less than 0.001) and six times lower PRA ng/liter.sec levels (AGN 0.187 +/- 0.047; NS 1.144 +/- 0.222; P less than 0.001) than NS patients. The degree of edema was correlated with ANF levels in AGN patients (P less than 0.001) but not in NS patients. There was a strong exponential negative correlation (r = -0.773, P less than 0.0001) between ANF and PRA, in which AGN patients and Na-restricted controls were located in the opposite ends of the volume sensing-response, and NS patients in the middle, alongside controls with regular Na intake.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Acute tubulointerstitial nephritis and uveitis syndrome: A report on four adult cases

    Yosra Ben Ariba

    2017-01-01

    Full Text Available Acute tubulointerstitial nephritis and uveitis (TINU syndrome is a rare disease, generally presenting in children and young women. The interstitial nephritis may precede, follow, or develop concurrent to the uveitis. We report the clinical features and outcomes of four adult patients, aged 41-70 years with the TINU syndrome.

  18. Acute middle East respiratory syndrome coronavirus infection in livestock Dromedaries, Dubai, 2014.

    Wernery, Ulrich; Corman, Victor M; Wong, Emily Y M; Tsang, Alan K L; Muth, Doreen; Lau, Susanna K P; Khazanehdari, Kamal; Zirkel, Florian; Ali, Mansoor; Nagy, Peter; Juhasz, Jutka; Wernery, Renate; Joseph, Sunitha; Syriac, Ginu; Elizabeth, Shyna K; Patteril, Nissy Annie Georgy; Woo, Patrick C Y; Drosten, Christian

    2015-06-01

    Camels carry Middle East respiratory syndrome coronavirus, but little is known about infection age or prevalence. We studied >800 dromedaries of all ages and 15 mother-calf pairs. This syndrome constitutes an acute, epidemic, and time-limited infection in camels <4 years of age, particularly calves. Delayed social separation of calves might reduce human infection risk.

  19. Staphylococcal toxic shock syndrome presenting as acute respiratory distress and cor pulmonale.

    Zaki, S A; Shanbag, P; Chavan, V; Shenoy, P

    2010-01-01

    We describe a 7-year-old boy with staphylococcal toxic shock syndrome who presented with acute respiratory distress and cor pulmonale. We wish to highlight this unusual presentation as the diagnosis of toxic shock syndrome depends chiefly on a high degree of clinical suspicion. Early diagnosis and prompt institution of appropriate therapy will significantly reduce morbidity and mortality.

  20. Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the lithotomy position.

    Bocca, G.; Moorselaar, R.J.A. van; Feitz, W.F.J.; Staak, F.H.J.M. van der; Monnens, L.A.H.

    2002-01-01

    Compartment syndrome, rhabdomyolysis and the risk of acute renal failure are potential complications of the lithotomy position. A six-year-old girl is described who developed a compartment syndrome with rhabdomyolysis after prolonged surgery in the lithotomy position. This complication occurred thre

  1. New treatment strategies in myelodysplastic syndromes and acute myeloid leukemia : Hypomethylating agents and proteasome inhibitors

    van der Helm, Lidia Henrieke

    2016-01-01

    New treatment strategies in leukemia and myelodysplastic syndromes Treatment of acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) is challenging, especially in the large group of patients older than 60 years. In these patients, results of standard chemotherapy are often disappointing

  2. Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) in children and adults

    Gebistorf, Fabienne; Karam, Oliver; Wetterslev, Jørn

    2016-01-01

    BACKGROUND: Acute hypoxaemic respiratory failure (AHRF) and mostly acute respiratory distress syndrome (ARDS) are critical conditions. AHRF results from several systemic conditions and is associated with high mortality and morbidity in individuals of all ages. Inhaled nitric oxide (INO) has been...

  3. Acute Coronary Syndrome | EU Clinical Trials Register [EU Clinical Trials Register

    Full Text Available E.1 Medical condition or disease under investigation E.1.1Medical condition(s) being investigated Acute...stigation E.1.2Version 9.1 E.1.2Level PT E.1.2Classification code 10051592 E.1.2Term Acute coronary syndrome

  4. Cardiorenal Syndromes : An Executive Summary from the Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

    Ronco, Claudio; McCullough, Peter A.; Anker, Stefan D.; Anand, Inder; Aspromonte, Nadia; Bagshaw, Sean M.; Bellomo, Rinaldo; Berl, Tomas; Bobek, Ilona; Cruz, Dinna N.; Daliento, Luciano; Davenport, Andrew; Haapio, Mikko; Hillege, Hans; House, Andrew; Katz, Nevin M.; Maisel, Alan; Mankad, Sunil; Zanco, Pierluigi; Mebazaa, Alexandre; Palazzuoli, Alberto; Ronco, Federico; Shaw, Andrew; Sheinfeld, Geoff; Soni, Sachin; Vescovo, Giorgio; Zamperetti, Nereo; Ponikowski, Piotr; Ronco, C; Bellomo, R; McCullough, PA

    2010-01-01

    The cardiorenal syndrome (CRS) is a disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The general definition has been expanded into five subtypes reflecting the primacy of organ dysfunction and the time-frame of

  5. High frequency of BTG1 deletions in acute lymphoblastic leukemia in children with down syndrome

    Lundin, Catarina; Hjorth, Lars; Behrendtz, Mikael;

    2012-01-01

    Previous cytogenetic studies of myeloid and acute lymphoblastic leukemias in children with Down syndrome (ML-DS and DS-ALL) have revealed significant differences in abnormality patterns between such cases and acute leukemias in general. Also, certain molecular genetic aberrations characterize DS...

  6. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    Smit, M.; Buddingh, K. T.; Bosma, B; Nieuwenhuijs, V B; Hofker, H.S.; Zijlstra, J.G.

    2016-01-01

    INTRODUCTION: Severe acute pancreatitis may be complicated by intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal ischemia. The aim of this retrospective study is to describe the incidence, treatment, and outcome of patients with severe acute pancreatitis and ACS

  7. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    Smit, M.; Buddingh, K. T.; Bosma, B.; Nieuwenhuijs, V. B.; Hofker, H. S.; Zijlstra, J. G.

    2016-01-01

    Severe acute pancreatitis may be complicated by intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal ischemia. The aim of this retrospective study is to describe the incidence, treatment, and outcome of patients with severe acute pancreatitis and ACS, in particula

  8. Diagnosis and treatment of musculoskeletal chest pain: design of a multi-purpose trial

    Høilund-Carlsen Poul

    2008-03-01

    Full Text Available Abstract Background Acute chest pain is a major health problem all over the western world. Active approaches are directed towards diagnosis and treatment of potentially life threatening conditions, especially acute coronary syndrome/ischemic heart disease. However, according to the literature, chest pain may also be due to a variety of extra-cardiac disorders including dysfunction of muscles and joints of the chest wall or the cervical and thoracic part of the spine. The diagnostic approaches and treatment options for this group of patients are scarce and formal clinical studies addressing the effect of various treatments are lacking. Methods/Design We present an ongoing trial on the potential usefulness of chiropractic diagnosis and treatment in patients dismissed from an acute chest pain clinic without a diagnosis of acute coronary syndrome. The aims are to determine the proportion of patients in whom chest pain may be of musculoskeletal rather than cardiac origin and to investigate the decision process of a chiropractor in diagnosing these patients; further, to examine whether chiropractic treatment can reduce pain and improve physical function when compared to advice directed towards promoting self-management, and, finally, to estimate the cost-effectiveness of these procedures. This study will include 300 patients discharged from a university hospital acute chest pain clinic without a diagnosis of acute coronary syndrome or any other obvious cardiac or non-cardiac disease. After completion of the clinic's standard cardiovascular diagnostic procedures, trial patients will be examined according to a standardized protocol including a a self-report questionnaire; b a semi-structured interview; c a general health examination; and d a specific manual examination of the muscles and joints of the neck, thoracic spine, and thorax in order to determine whether the pain is likely to be of musculoskeletal origin. To describe the patients status with

  9. Study of High Sensitive-CRP and Cardiac Marker Enzymes in Acute Coronary Syndrome

    Srikrishna R,

    2015-04-01

    Full Text Available Background: Inflammation has been proposed as a contributor to different stages in the pathogenesis of Coronary Heart Disease (CHD. High sensitive C-Reactive Protein (hs-CRP, an acute-phase plasma protein synthesized by the liver, is the most extensively studied systemic marker of inflammation. Elevated hsCRP concentrations early in Acute Coronary Syndrome (ACS, prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. The cardiac marker enzymes Creatine Kinase myocardial bound (CK-MB, Aspartate Aminotransferase (AST and lactate dehydrogenase (LDH have been known to be increased in coronary artery diseases. Objective: The aim of the study was to measure hs-CRP levels and other cardiac marker enzymes in ACS patients and to compare the levels of hs-CRP with other cardiac marker enzymes between ST Elevation Myocardial Infarction (STEMI and Non-ST Elevation Myocardial Infarction (NSTEMI patients. Material and Methods: The study group consisted of 207 consecutive patients admitted to Sri Siddhartha Medical College Hospital within the first 6 hours from the onset of chest pain. Patients were diagnosed as Unstable Angina (UA, (n=84; STEMI (n=63 and NSTEMI (n=60. ACS patients were compared with 211 healthy age and sex matched controls. Hs-CRP, CK-MB, AST and LDH levels were measured by standard methods in both groups at baseline and forcases at 36-48 hours i.e. Peak levels. Results: ACS patients had significantly (p<0.05 higher levels of hs-CRP, CKMB, AST and LDH in comparison to controls at baseline. Hs-CRP, CK-MB, AST and LDH levels were significantly higher in STEMI patients compared to NSTEMI patients (p<0.05 at baseline. There was a significant difference regarding peak hs-CRP levels between the two groups, as STEMI patients had significantly higher peak hs-CRP levels compared to NSTEMI patients (p<0.05. Conclusion: STEMI patients have significantly higher peak hsCRP levels compared to NSTEMI patients. These data

  10. Colonic perforation in Behcet's syndrome

    Catherine M Dowling; Arnold DK Hill; Carmel Malone; John J Sheehan; Shona Tormey; Kieran Sheahan; Enda McDermott; Niall J O'Higgins

    2008-01-01

    A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet's syndrome (BS). He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases.

  11. Colonic perforation in Behcet's syndrome.

    Dowling, Catherine-M; Hill, Arnold-Dk; Malone, Carmel; Sheehan, John-J; Tormey, Shona; Sheahan, Kieran; McDermott, Enda; O'Higgins, Niall-J

    2008-11-14

    A 17-year-old gentleman was admitted to our hospital for headache, the differential diagnosis of which included Behcet's syndrome (BS). He developed an acute abdomen and was found to have air under the diaphragm on erect chest X-ray. Subsequent laparotomy revealed multiple perforations throughout the colon. This report describes an unusual complication of Behcets syndrome occurring at the time of presentation and a review of the current literature of reported cases.

  12. IL-17A facilitates platelet function through the ERK2 signaling pathway in patients with acute coronary syndrome.

    Shuang Zhang

    Full Text Available BACKGROUND: Platelet aggregation mediated by inflammation played a critical role in the development of coronary heart diseases (CHD. Our previous clinical researches showed that Th17 cells and their characteristic cytokine IL-17A were associated with the plaque destabilization in patients with acute coronary syndrome (ACS. However, the potent effect of IL-17A on platelets-induced atherothrombosis remains unknown. METHODS AND RESULTS: In this study, we detected the plasma IL-17A levels and platelet aggregation in patients with stable angina (SA, unstable angina (UA, acute myocardial infarction (AMI and chest pain syndrome (CPS. In addition, the markers of platelet activation (CD62P/PAC-1 and the mitogen-activated protein kinases (MAPKs pathway were detected in platelets from ACS patients. We found that plasma IL-17A levels and platelet aggregation in patients with ACS (UA and AMI were significantly higher than patients with SA and CPS, and the plasma IL-17A levels were positively correlated with the platelet aggregation (R = 0.47, P<0.01. In addition, in patients with ACS, the platelet aggregation, CD62P/PAC-1 and the phosphorylation of ERK2 signaling pathway were obviously elevated in platelets pre-stimulated with IL-17A in vitro. Furthermore, the specific inhibitor of ERK2 could attenuate platelet aggregation and activation triggered by IL-17A. CONCLUSION: Our experiment firstly proved that IL-17A could promote platelet function in patients with ACS via activating platelets ERK2 signaling pathway and may provide a novel target for antiplatelet therapies in CHD.

  13. Impaired circulating CD4+ LAP+ regulatory T cells in patients with acute coronary syndrome and its mechanistic study.

    Zheng-Feng Zhu

    Full Text Available OBJECTIVE: CD4(+ latency-associated peptide (LAP(+ regulatory T cells (Tregs are a newly discovered T cell subset in humans and the role of these cells in patients with acute coronary syndrome (ACS has not been explored. We designed to investigate whether circulating frequency and function of CD4(+LAP(+ Tregs are defective in ACS. METHODS: One hundred eleven ACS patients (acute myocardial infarction and unstable angina and 117 control patients were enrolled in the study. The control patients consisted of chronic stable angina (CSA and chest pain syndrome (CPS. The frequencies of circulating CD4(+LAP(+ Tregs and the expression of the transmembrane protein glycoprotein-A repetitions predominant (GARP on CD4(+ T cells were determined by flow cytometry. The function of CD4(+LAP(+ Tregs was detected using thymidine uptake. Serum interleukin-10 (IL-10 and transforming growth factor-β protein (TGF-β levels were detected using ELISA and expression of GARP mRNA in peripheral blood mononuclear cells (PBMCs was measured by real time-polymerase chain reaction. RESULTS: We found ACS patients had a significantly lower frequency of circulating CD4(+LAP(+ Tregs, and the function of these cells was reduced compared to controls. The expression of GARP in CD4(+ T cells and the serum levels of TGF-β in ACS patients were lower than those of control patients. The serum levels of IL-10 were similar between the two cohorts. CONCLUSIONS: A novel regulatory T cell subset, defined as CD4(+LAP(+ T cells is defective in ACS patients.

  14. [Tumor lysis syndrome in a pregnancy complicated with acute lymphoblastic leukemia].

    Álvarez-Goris, M P; Sánchez-Zamora, R; Torres-Aguilar, A A; Briones Garduño, J C

    2016-04-01

    Acute leukemia is rare during pregnancy, affects about 1 in 75,000 pregnancies, of all leukemias diagnosed only 28% are acute lymphoblastic leukemia, this is a risk factor to develop spontaneous tumor lysis syndrome, it's a oncologic complication potentially deadly if the prophylactic treatment its avoided. Cases of acute lymphoblastic leukemia associated with pregnancy has been poorly documented in the literature the association of these two entities to pregnancy is the first report published worldwide, so the information is limited.

  15. [Emergence of new pneumonia: besides severe acute respiratory syndrome].

    Mangiarotti, P; Pozzi, E

    2006-10-01

    Important epidemiological modifications have been registered in respiratory infections, both in immunocompetent and immunocompromised hosts. Pathogens with modified antibiotic susceptibility patterns have emerged, which display an increased antibiotic resistance, such as S. pneumoniae, S. aureus, H. influenzae. This trait has a strong impact on the therapeutic choices, particularly when an empiric antibiotic treatment is selected. The prevalence of bacterial species showing non-susceptibility to the most common prescribed antibiotics (betalactams, macrolides etc.) follows a different geographic distribution. Some pathogens have acquired a new epidemiological role in patients affected with immune deficiencies: among them P. carinii and other bacterial, fungal and viral pathogens. The emergence of new, previously unknown, species, has been registered, both bacteria (C. pneumoniae) and viruses (Metapneumovirus, Hantavirus etc.). Such aspects must be considered in the diagnosis of respiratory infections, which should include diagnostic tests for the identification of such pathogens. Among the new respiratory infections severe acute respiratory syndrome (SARS) has quickly become a health care emergency, so that efforts have been made to identify the aetiological agent as well as the main epidemiological and clinical characteristics of the disease. Avian influenza has raised great interest immediately after the first cases of human infection caused by the avian virus, especially after the outbreaks in Asian countries and in the Netherlands. A crucial step in containing infection is the prevention of the disease; efforts are directed toward this endpoint.

  16. Avascular necrosis of bone in severe acute respiratory syndrome

    Hong, N. E-mail: hongnan@bjmu.edu.cn; Du, X.K

    2004-07-01

    AIM: To report the incidence of avascular osteonecrosis (AVN) in severe acute respiratory syndrome (SARS) patients. MATERIALS AND METHODS: Sixty-seven SARS patients who had large joint pain between March 2003 and May 2003 underwent both plain radiographs and magnetic resonance imaging (MRI) examination on the same day. All patients received steroids and ribavirin treatment. All plain radiographs and MR images were analysed by two experienced musculoskeletal radiologists. Any abnormalities, location, extent, morphology, the number, size and signal intensity of lesions were evaluated. RESULTS: Twenty-eight patients were identified with AVN, The mean time to diagnosis of AVN was 119 days after the onset of SARS, or 116 days after steroid use. Three patients had early bilateral AVN of the femoral head, four patients of one femoral head, five patients of the bilateral hips and knees, four patients of the ipsilateral hip and knees, 10 patients of the knee(s), one patient of the right proximal fibula, and one patient of the knees and talus. Results of hip, knee and ankle plain radiographs were negative. CONCLUSION: AVN can occur in the patients with SARS. AVN had a strong association with steroid use. More studies are required to confirm whether the virus itself can also lead to AVN.

  17. Current status of severe acute respiratory syndrome in China

    Qing-He Nie; Xin-Dong Luo; Jian-Zhong Zhang; Qin Su

    2003-01-01

    Severe acute respiratory syndrome (SARS), also called infectious atypical pneumonia, is an emerging infectious disease caused by a novel variant of coronavirus (SARS associated coronavirus, SARS-CoV). It is mainly characterized by pulmonary infection with a high infectivity and fatality.SARS is swept across almost all the continents of the globe, and has currently involved 33 countries and regions, including the mainland China, Hong Kong, Taiwan, North America and Europe. On June 30, 2003, an acumulative total reached 8450 cases with 810 deaths. SARS epidemic was very rampant in March, April and May 2003 in the mainland of China and Hong Kong. Chinese scientists and healthcare workers cooperated closely with other scientists from all over the world to fight the disease. On April 16, 2003, World Health Organization (WHO) formally declared that SARSCoV was an etiological agent of SARS. Currently, there is no specific and effective therapy and prevention method for SARS. The main treatments include corticosteroid therapy,antiviralagents, anti-infection, mechanical ventilation and isolation. This disease can be prevented and controlled, and it is also curable. Under the endeavor of the Chinese Government, medical staffs and other related professionals,SARS has been under control in China, and Chinese scientists have also made a great contribution to SARS research.Otherstudies in developing new detection assays and therapies, and discovering new drugs and vaccines are in progress. In this paper, we briefly review the current status of SARS in China.

  18. Severe acute respiratory syndrome: vaccine on the way

    ZHANG Ding-mei; WANG Guo-ling; LU Jia-hai

    2005-01-01

    @@ In November 2002, a new disease-severe acute respiratory syndrome, or SARS-first emerged in Guangdong Province, China. Subsequently, it spread to more than 30 countries worldwide.1 The causative agent was identified to be a previously unknown member of the coronaviridae family, and was named SARS coronavirus (SARS-CoV). SARS coronavirus is a large, enveloped, positive-sense RNA virus. The genome is about 30 kb, which is predicted to contain 14 functional open reading frames (ORFs). Two large 5'-terminal ORFs (1a and 1b) encode the polymerases that are required for viral RNA synthesis. The remaining twelve ORFs encode four structural proteins [spike protein (S), envelope protein (E), membrane protein (M) and nucleocapsid protein (N)] and eight accessory proteins.2 Though the SARS-CoV genome is clear, a great deal more work will be required to develop an efficient vaccine and effective drugs. Neutralizing antibodies were detectable in the convalescent sera of SARS patients, and sera from recovered patients could be used to treat newly infected individuals.3 The data suggest that protective humoral immunity is achievable and that vaccines can be developed for prevention of SARS. In this article, we review and discuss progress towards development of a SARS vaccine.

  19. Pulmonary hypertension due to acute respiratory distress syndrome

    S.A. Ñamendys-Silva

    2014-10-01

    Full Text Available Our aims were to describe the prevalence of pulmonary hypertension in patients with acute respiratory distress syndrome (ARDS, to characterize their hemodynamic cardiopulmonary profiles, and to correlate these parameters with outcome. All consecutive patients over 16 years of age who were in the intensive care unit with a diagnosis of ARDS and an in situ pulmonary artery catheter for hemodynamic monitoring were studied. Pulmonary hypertension was diagnosed when the mean pulmonary artery pressure was >25 mmHg at rest with a pulmonary artery occlusion pressure or left atrial pressure <15 mmHg. During the study period, 30 of 402 critically ill patients (7.46% who were admitted to the ICU fulfilled the criteria for ARDS. Of the 30 patients with ARDS, 14 met the criteria for pulmonary hypertension, a prevalence of 46.6% (95% CI; 28-66%. The most common cause of ARDS was pneumonia (56.3%. The overall mortality was 36.6% and was similar in patients with and without pulmonary hypertension. Differences in patients' hemodynamic profiles were influenced by the presence of pulmonary hypertension. The levels of positive end-expiratory pressure and peak pressure were higher in patients with pulmonary hypertension, and the PaCO2 was higher in those who died. The level of airway pressure seemed to influence the onset of pulmonary hypertension. Survival was determined by the severity of organ failure at admission to the intensive care unit.

  20. Clinical Practice Guideline of Acute Respiratory Distress Syndrome

    Cho, Young-Jae; Moon, Jae Young; Shin, Ein-Soon; Kim, Je Hyeong; Jung, Hoon; Park, So Young; Kim, Ho Cheol; Sim, Yun Su; Rhee, Chin Kook; Lim, Jaemin; Lee, Seok Jeong; Lee, Won-Yeon; Lee, Hyun Jeong; Kwak, Sang Hyun; Kang, Eun Kyeong; Chung, Kyung Soo

    2016-01-01

    There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

  1. Prognostic factors in patients hospitalized with acute heart failure syndrome

    Liviu Klein; John B. O'Connell

    2006-01-01

    Each year, there are over one million hospitalizations for acute heart failure syndrome (AHFS) in the United States alone,with a similar number in Western Europe. These patients have very high short-term (2-6 months) mortality and readmission rates, while the healthcare system incurs substantial costs. Until recently, the clinical characteristics, management patterns, and outcomes of these patients have been poorly understood and, in consequence, risk stratification for these patients has not been well defined. Several risk prediction models that can accurately identify high-risk patients have been developed in the last year using data from clinical trials, large registries or administrative databases. Use of multi-variable risk models at the time of hospital admission or discharge offers better risk stratification and should be encouraged, as it allows for appropriate allocation of existing resources and development of clinical trials testing new treatment strategies for patients admitted with AHFS. The emerging observation that the prognosis for the ensuing three to six months may be obtained at presentation for AHFS has major implications for development of future therapies.

  2. Significance of lead aVR in acute coronary syndrome

    Akira; Tamura

    2014-01-01

    The 12-lead electrocardiogram(ECG)is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome(ACS).Unlike other 11 leads,lead aVR has been long neglected until recent years.However,recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS.ST-segment elevation in lead aVR can be caused by(1)transmural ischemia in the basal part of the interventricular septum caused by impaired coronary blood flow of the first major branch originating from the left anterior descending coronary artery;(2)transmural ischemia in the right ventricular outflow tract caused by impaired coronary blood flow of the large conal branch originating from the right coronary artery;and(3)reciprocal changes opposite to ischemic or non-ischemic ST-segment depression in the lateral limb and precordial leads.On the other hand,ST-segment depression in lead aVR can be caused by transmural ischemia in the inferolateral and apical regions.It has been recently shown that an analysis of T wave in lead aVR also provides useful prognostic information in the general population and patients with prior myocardial infarction.Cardiologists should pay more attention to the tracing of lead aVR when interpreting the12-lead ECG in clinical practice.

  3. Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications.

    Angeli, Fabio; Reboldi, Gianpaolo; Poltronieri, Cristina; Lazzari, Ludovico; Sordi, Martina; Garofoli, Marta; Bartolini, Claudia; Verdecchia, Paolo

    2015-12-01

    Hyperglycemia is a frequent condition in patients with acute coronary syndromes (ACS). Hyperglycemia during ACS is caused by an inflammatory and adrenergic response to ischemic stress, when catecholamines are released and glycogenolysis induced. Although the involved pathophysiological mechanisms have not yet been fully elucidated, it is believed that hyperglycemia is associated with an increase in free fat acids (which induce cardiac arrhythmias), insulin resistance, chemical inactivation of nitric oxide and the production of oxygen reactive species (with consequent microvascular and endothelial dysfunction), a prothrombotic state, and vascular inflammation. It is also related to myocardial metabolic disorders, leading to thrombosis, extension of the damaged area, reduced collateral circulation, and ischemic preconditioning. In the last few years, several observational studies demonstrated that hyperglycemia in ACS is a powerful predictor of survival, increasing the risk of immediate and long-term complications in patients both with and without previously known diabetes mellitus. Glucose management strategies in ACS may improve outcomes in patients with hyperglycemia, perhaps by reducing inflammatory and clotting mediators, by improving endothelial function and fibrinolysis and by reducing infarct size. Recent clinical trials of insulin in ACS have resulted in varying levels of benefit, but the clinical benefit of an aggressive treatment with insulin is yet unproved.

  4. Fluid in the management of the acute respiratory distress syndrome

    Karki S

    2013-06-01

    Full Text Available Introduction Non-cardiogenic pulmonary edema is the hallmark of the acute respiratory distress syndrome (ARDS. The amount of fluid and which fluid should be used in these patients is controversial. Methods 43 patients with ARDS treated in the intensive care unit (ICU of the Second Hospital, Jilin University between November 1, 2011-November 1, 2012 were prospectively analyzed and was observational. Volume and the type of fluid administered were compared to 90 day mortality and the 24 and 72 hour sequential organ failure assessment (SOFA score, lactate level, oxygenation index (PaO2/FiO2, duration of ICU stay, total ventilator days, and need for continuous renal replacement therapy (CRRT. Results Mortality was increased when hydroxylethyl starch (HES was used in the first day or plasma substitutes were used during the first 3 days (P3000 ml during the first 24 hours or >8000 ml during the first 72 hours were associated with higher SOFA scores at 24 and 72 hours (P<0.05, both comparisons. Colloid, especially higher volume colloid use was also associated with increased SOFA scores at either 24 or 72 hours. Conclusions Limiting the use of colloids and the total amount of fluid administered to patients with ARDS is associated with improved mortality and SOFA scores.

  5. Fibromyalgia after severe acute respiratory syndrome: a case report

    TIAN Xin-ping; ZENG Xiao-feng; XU Wen-bin

    2006-01-01

    @@ Since November 2002, an infectious disease with unknown cause occurred in China and many countries had been involved. Cases were reported in 28 countries and more than 5050 individuals had been infected.1 Lung is the most frequently involved organ and can be fatal in severe cases. At the end of February 2003, it was defined as Severe Acute Respiratory Syndrome (SARS) by World Health Organization. China had a SARS epidemic in the spring of 2003. More than 1000 patients were infected and some patients died of respiratory failure.Finally, a new variant of coronavirus was suspected to be the pathogen although the pathogenesis was still unclear. Since it is a new disease and we have very limited knowledge about its clinical sequela, we followed the survived patients closely in order to understand it in depth. During the follow up, we discovered an interesting patient who was finally diagnosed as fibromyalgia. We report this case herein to share our experience with clinicians who may see patients with SARS or fibromyalgia.

  6. Lung tissue remodeling in the acute respiratory distress syndrome

    Souza Alba Barros de

    2003-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterized by diffuse alveolar damage, and evolves progressively with three phases: exsudative, fibroproliferative, and fibrotic. In the exudative phase, there are interstitial and alveolar edemas with hyaline membrane. The fibropro­liferative phase is characterized by exudate organization and fibroelastogenesis. There is proliferation of type II pneumocytes to cover the damaged epithelial surface, followed by differentiation into type I pneumocytes. The fibroproliferative phase starts early, and its severity is related to the patient?s prognosis. The alterations observed in the phenotype of the pulmonary parenchyma cells steer the tissue remodeling towards either progressive fibrosis or the restoration of normal alveolar architecture. The fibrotic phase is characterized by abnormal and excessive deposition of extracellular matrix proteins, mainly collagen. The dynamic control of collagen deposition and degradation is regulated by metalloproteinases and their tissular regulators. The deposition of proteoglycans in the extracellular matrix of ARDS patients needs better study. The regulation of extracellular matrix remodeling, in normal conditions or in several pulmonary diseases, such as ARDS, results from a complex mechanism that integrate the transcription of elements that destroy the matrix protein and produce activation/inhibition of several cellular types of lung tissue. This review article will analyze the ECM organization in ARDS, the different pulmonary parenchyma remodeling mechanisms, and the role of cytokines in the regulation of the different matrix components during the remodeling process.

  7. Recent advances in pharmacotherapy of acute coronary syndrome

    Vidhi Thaker

    2016-10-01

    Full Text Available Acute coronary syndrome (ACS describes the range of myocardial ischemic states that includes unstable angina, non-ST elevated myocardial infarction (MI, or ST-elevated MI. ACS is associated with substantial morbidity and mortality and places a large financial burden on the health care system. The diagnosis of ACS begins with a thorough clinical assessment of a patient's presenting symptoms, electrocardiogram and cardiac troponin levels as well as a review of past medical history. Early risk stratification can assist clinicians in determining whether an early invasive management strategy or an initial conservative strategy should be pursued and can help determine appropriate pharmacologic therapies. Key components in the management of ACS include coronary revascularization when indicated; prompt initiation of dual antiplatelet therapy and anticoagulation; and consideration of adjuvant agents including beta blockers, inhibitors of the renin angiotensin system, and HmG-coenzyme A reductase inhibitors. It is essential for clinicians to take an individualized approach to treatment and consider long-term safety and efficacy when managing patients with a history of ACS after hospital discharge. This review identifies promising new or emerging techniques, as well as established tools, and reviews their current or potential role in clinical practice. [Int J Basic Clin Pharmacol 2016; 5(5.000: 1695-1703

  8. Critical care in the ED: potentially fatal asthma and acute lung injury syndrome

    Hodder R

    2012-08-01

    Full Text Available Rick Hodder*Divisions of Pulmonary and Critical Care, University of Ottawa and The Ottawa Hospital, Ottawa, Canada, *Dr Rick Hodder passed away on Tuesday April 17,2012. Please see the Dedication for more information on Dr Hodder.Abstract: Emergency department clinicians are frequently called upon to assess, diagnose, and stabilize patients who present with acute respiratory failure. This review describes a rapid initial approach to acute respiratory failure in adults, illustrated by two common examples: (1 an airway disease – acute potentially fatal asthma, and (2 a pulmonary parenchymal disease – acute lung injury/acute respiratory distress syndrome. As such patients are usually admitted to hospital, discussion will be focused on those initial management aspects most relevant to the emergency department clinician.Keywords: acute asthma, acute lung injury, ARDS, acute respiratory failure

  9. Acute hyponatraemia secondary to cerebral salt wasting syndrome in a patient with tuberculous meningitis.

    Ti, L K; Kang, S C; Cheong, K F

    1998-08-01

    A 30-year-old HIV-positive man presented with acute hydrocephalus secondary to tuberculous meningitis, for which an external ventricular drain was inserted. He developed marked natriuresis in the postoperative period, which resulted in acute hyponatraemia (131 to 122 mmol/l) and a contraction of his intravascular volume. A diagnosis of cerebral salt wasting syndrome was made, and he responded to sodium and fluid loading. This case highlights the differentiation of cerebral salt wasting syndrome from the more commonly occurring syndrome of inappropriate anti-diuretic hormone secretion as the aetiology of the hyponatraemia.

  10. Cardiovascular magnetic resonance of myocardial infarction after blunt chest trauma: a heartbreaking soccer-shot

    Fogarassy Peter

    2009-10-01

    Full Text Available Abstract Cardiac injury occasionally occurs as a result of blunt chest trauma. Most cardiac complications in chest trauma are due to myocardial contusion rather than direct damage to the coronary arteries. However, traumatic coronary injury has been reported, and a variety of underlying pathophysiological mechanisms have been proposed. We present a 26 year old patient presenting with an acute coronary syndrome as a consequence of a soccer-shot impact to the chest. CMR showed apical inferior infarction, as well as multiple small septal lesions which were presumed to have resulted from embolization. The culprit lesion was a proximal 75% LAD stenosis with a prominent plaque-rupture and thrombus-formation, and the distal LAD was occluded by thromboembolic material.

  11. A hospital outbreak of severe acute respiratory syndrome in Guangzhou,China

    伍卫; 王景峰; 刘品明; 陈为宪; 尹松梅; 江山平; 严励; 詹俊; 陈锡龙; 李建国; 黄子通; 黄洪章

    2003-01-01

    Objective To describe a hospital outbreak of severe acute respiratory syndrome (SARS) and summarize its clinical features and therapeutic approaches.MethodsThe outbreak started with a SARS patient from the community, and a total of 96 people (76 women and 20 men, mean age (29.5±10.3) years, 93.8% of whom were health care workers) who had exposure to this source patient became infected in a short time. Clinical data in this cohort ere collected prospectively as they were identified.Results(1) The incubation period ranged from 1 to 20 (mean: 5.9±3.5) days. The duration of hospitalization was (17.2±8.0) days. (2) The initial temperature was (38.3±0.6)℃, while the highest was (39.2±0.6)℃ (P<0.001), with fever duration of (9.0±4.2) days. (3) Other most common symptoms included fatigue (93.8%), cough (85.4%), mild sputum production (66.7%), chills (55.2%), headache (39.6%), general malaise (35.4%) and myalgia (21.9%). (4) The radiographic changes were predominantly bilateral in the middle or lower lung zones. The number of affected lung fields was 1.2±0.8 on presentation, which increased to 2.9±1.4 after admission (P<0.001). The interval from the eginning of fever to the onset of abnormal chest radiographs was (3.5±2.3) days, which increased in size, extent, and severity to the maximum (6.7±3.5) days later. The time before the lung opacities were basically absorbed was (14.9±7.8) days. (5) Leukopenia was observed In 67.7% of this cohort. The time between the onset of fever and leukopenia was (4.4±2.3) days, with the lowest white blood cell count of (2.80±0.72)×109/L. (6) The lowest arterial oxygen saturation was (94.8±3.1)% with supplementary oxygen. (7) Antibiotical therapies included tetracyclines (91.0%), aminoglycosides (83.3%), quinolones (79.2%); 18.8% of the patients received a combination of tetracyclines and aminoglycosides, while 11.5% received a combination of tetracyclines and quinolones, and

  12. Chikungunya virus infection amongst the acute encephalitis syndrome cases in West Bengal, India

    D Taraphdar

    2015-01-01

    Full Text Available Chikungunya virus (CHIKV infection from the acute encephalitis syndrome cases is an uncommon form and has been observed in the year 2010-11 from West Bengal, India. The case-1 and case-2 had the acute encephalitis syndrome; case-3 was of acute disseminated encephalomyelitis whereas the case-4 had the symptoms of meningo-encephalopathy with bulbar involvement. We are reporting four cases with neurological complications involving central nervous system (CNS due to CHIKV infection from this state for the first time. The virus has spread almost every districts of this state rapidly. At this stage, these cases are public health threat.

  13. A Case of Acute Fulminant Fat Embolism Syndrome after Liposuction Surgery.

    Byeon, Seong Wook; Ban, Tae Hyun; Rhee, Chin Kook

    2015-10-01

    Fat embolism syndrome (FES) is a clinical manifestation that consists of multiple organ dysfunction due to fat emboli. FES occurs as a complication after trauma or procedures such as surgery. The diagnostic criteria of FES have not yet been established, so clinical criteria are used for its diagnosis. The clinical course of acute fulminant FES can be rapid. Liposuction surgery, in which adipocytes are mechanically disrupted, is one cause of FES. As the number of liposuction surgeries increases, clinicians should be aware of the possibility of FES. This was the first report of a case of acute fulminant FES with severe acute respiratory distress syndrome after liposuction surgery, in Korea.

  14. Primary and Secondary Prevention of Acute Coronary Syndromes: The Role of the Statins.

    Diamantis, Evangelos; Troupis, Theodoros; Mazarakis, Antonios; Kyriakos, Giorgos; Troupis, Georgios; Skandalakis, Panagiotis

    2014-01-01

    Poor prognosis is strongly associated with Acute Coronary Syndrome (ACS) and, even though a number of treatment strategies are available, the incidence of subsequent serious complications after an acute event is still high. Statins are hypolipidemic factors and recent studies have demonstrated that they have a protective role during the process of atherogenesis and that they reduce mortality caused by cardiovascular diseases. This review tries to reveal the function of the statins as a component of the primary and secondary action of acute coronary syndrome and to describe the lifestyle changes that have the same effect as the use of statins.

  15. [Features of the course of schizophrenia manifesting as an acute Kandinsky-Clérambault syndrome].

    Dikaia, V I

    1986-01-01

    A clinical follow-up study of 57 schizophrenic patients revealed heterogeneity of the clinical role of acute Kandinsky-Clerambault syndrome in the picture of the disease. The author describes the syndrome of psychic automatism in the framework of "schizophrenic reactions" in the time-course of latent schizophrenia, in the picture of the attack in shift-like and recurrent course and in the structure of the shift resembling clinically the exacerbation of the continuously progressive process. The author also shows the correlation between the premanifest period, clinical mechanisms of the development of manifest psychosis, the structure of acute Kandinsky-Clerambault syndrome and the subsequent characteristics of the schizophrenia course. The question of prognostic significance of the differential approach to the assessment of acute Kandinsky-Clerambault syndrome and of its different clinical significance in the picture of clinical diseases is discussed.

  16. Acute Compartment Syndrome After Gastrocnemius Rupture (Tennis Leg) in a Nonathlete Without Trauma.

    Tao, Li; Jun, Huang; Muliang, Ding; Deye, Song; Jiangdong, Ni

    2016-01-01

    Acute compartment syndrome is a serious emergency that warrants urgent decompression, and tennis leg (i.e., rupture of the medial head of the gastrocnemius) is a known clinical condition that is usually treated symptomatically, with good results overall. In rare cases, acute compartment syndrome is associated with tennis leg after severe direct muscle trauma or severe exercise in athletes or physically active individuals. We present an unusual case of acute compartment syndrome secondary to tennis leg after the patient, a nonathlete, had disembarked from a truck without any trauma. Clinicians should have a high index of suspicion for atraumatic compartment syndrome, and timely surgical fasciotomy must be undertaken to avoid complications resulting from delayed diagnosis and treatment.

  17. Association of cardiovascular risk factors with the different presentations of acute coronary syndrome

    Evelise Helena Fadini Reis Brunori

    2014-08-01

    Full Text Available OBJECTIVE: to identify the relationship between different presentations of acute coronary syndrome and cardiovascular risk factors among hospitalized individuals.METHOD: cross-sectional study performed in a teaching hospital in São Paulo, in the State of São Paulo (SP. Socio-demographic, clinical and anthropometric data of 150 individuals hospitalized due to acute coronary syndrome were collected through interviews and review of clinical charts. Association between these data and the presentation of the syndrome were investigated.RESULTS: there was a predominance of ST segment elevation acute myocardial infarction. There was significant association of systemic hypertension with unstable angina and high values of low density lipoprotein with infarction, without influence from socio-demographic characteristics.CONCLUSION: arterial hypertension and high levels of low-density lipoprotein were associated with different presentations of coronary syndrome. The results can provide support for health professionals for secondary prevention programs aimed at behavioural changing.

  18. MRI of the Chest

    Full Text Available ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Chest Magnetic resonance imaging (MRI) of the chest ... limitations of MRI of the Chest? What is MRI of the Chest? Magnetic resonance imaging (MRI) is ...

  19. Noonan syndrome

    ... chest shape (most often a sunken chest called pectus excavatum) Webbed and short-appearing neck Exams and Tests ... to consider genetic counseling before having children. Images Pectus excavatum References Ali O, Donohoue PA. Noonan syndrome. In: ...

  20. Bilineal Acute Leukemia Associated With Fanconi Syndrome: The First Case Report

    Ghasem Miri-Aliabad

    2016-05-01

    Full Text Available Fanconi syndrome is a metabolic disorder involving dysfunction of the renal proximal tubules, resulting in excessive urinary excretion of several metabolites. Various factors may lead to Fanconi syndrome, as it may be a genetic disease with primary or secondary etiologies, or may be acquired. In this study, we report a unique case of Fanconi syndrome with development of a relatively rare acute leukemia, a condition that has not been reported before. The case was an 8-year-old boy with familial occurrence of Fanconi syndrome, presenting with pallor, asthenia, recurrent infections, growth failure, and a variety of biochemical and hematological abnormalities. After physical examination, radiographic studies, and comprehensive laboratory analyses, Fanconi syndrome associated with bilineal acute leukemia, of myeloid and T-lymphoid lineages, was diagnosed.

  1. [Psychopathology and various mechanisms contributing to the formation of the Kandinsky syndrome in acute alcoholic hallucinosis].

    Guliamova, N M

    1983-01-01

    Forty patients with acute alcoholic hallucinosis associated with the Kandinsky syndrome were examined clinicopsychopathologically. Manifestation of the Kandinsky syndrome was limited by associative automatism in patients with stage II alcoholism with transient hallucinosis lasting 2-4 days. In patients with stage III alcoholism with more prolonged (6-9 days) psychoses, the non-extensive Kandinsky syndrome manifested itself in integrity. Psychopathological phenomena of the syndrome in the picture of acute alcoholic hallucinosis were notable for their descriptiveness, concreteness, extreme simplicity, and instability. Senestopathic and kinesthetic automatisms were localized at the sites of real painful disorders. Therefore, apart from cerebral disorders, the peripheral sensory mechanisms are considered to be of importance in the genesis of the Kandinsky syndrome.

  2. Sorafenib in Treating Patients With Refractory or Relapsed Acute Leukemia, Myelodysplastic Syndromes, or Blastic Phase Chronic Myelogenous Leukemia

    2015-04-27

    Adult Acute Basophilic Leukemia; Adult Acute Eosinophilic Leukemia; Adult Acute Megakaryoblastic Leukemia; Adult Acute Monoblastic Leukemia; Adult Acute Monocytic Leukemia; Adult Acute Myeloid Leukemia With Inv(16)(p13.1q22); CBFB-MYH11; Adult Acute Myeloid Leukemia With Maturation; Adult Acute Myeloid Leukemia With Minimal Differentiation; 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 Myeloid Leukemia Without Maturation; Adult Acute Myelomonocytic Leukemia; Adult Acute Promyelocytic Leukemia With t(15;17)(q22;q12); PML-RARA; Adult Erythroleukemia; Adult Pure Erythroid Leukemia; Alkylating Agent-Related Acute Myeloid Leukemia; Blastic Phase; de Novo Myelodysplastic Syndrome; Previously Treated Myelodysplastic Syndrome; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndrome

  3. Plasma Histamine And Serotonin Levels In Children With Nephrotic Syndrome And Acute Poststreptococcal Glomerulonephritis

    Nagwa Mohamed and Talaat El sayed

    2005-12-01

    Full Text Available Plasma histamine and serotonin concentrations were measured using fluorimeteric assay in 40 children with renal diseases. Minimal change nephrotic syndrome (15 focal segmental glomerulosclerosis(10 and acute poststreptococcal glomerulonephritis(15 to determine the relation between plasma levels of histamine and serotonin and these various types of renal diseases in children. Plasma histamine level was significantly increased in group of children with acute poststreptococcal glomerulonephritis. Plasma serotonin levels were significantly increased in all 3 groups of patient, when compared with those of controls. Raised plasma histamine in acute poststreptococcal glomerulonephritis group may be evidence of the acute immunological inflammation and defective renal excretion due to mild renal impairment in these children. Raised plasma serotonin in all 3 groups of patients may be due to diminished uptake and release of serotonin from platelets in children with minimal change nephrotic syndrome and focal segmental glomerulosclerosis and due to defective renal execretion in children with acute poststreptococcal glomerulo-nephritis.

  4. Acute forearm compressive myopathy syndrome secondary to upper limb entrapment: an unusual cause of renal failure.

    Tachtsi, Maria D; Kalogirou, Thomas E; Atmatzidis, Stefanos K; Papadimitriou, Dimitrios K; Atmatzidis, Konstantinos S

    2011-05-01

    Compressive myopathy syndrome (SCM) is a syndrome characterized by the lesion of skeletal muscle resulting in subsequent release of intracellular contents (myoglobin, creatine phosphokinase, potassium, etc.) into the circulatory system, which can cause potentially lethal complications. There are numerous causes that can lead to SCM resulting to acute rhabdomyolysis, and many patients present with multiple causes. The most common potentially lethal complication is acute renal failure. The occurrence of acute rhabdomyolysis should be considered as a possibility in any patient who can remain stationary for long periods, or is in a coma, or is intoxicated in any form. We report the rare case of a 26-year-old patient who developed SCM caused by ischemia reperfusion, with subsequent acute rhabdomyolysis and acute renal failure after prolonged compression of the right upper extremity.

  5. Acute coronary syndrome in women of reproductive age

    Idris N

    2011-11-01

    Full Text Available Nazimah Idris1, Sharifah Sulaiha Aznal1, Sze-Piaw Chin1, Wan Azman Wan Ahmad2, Azhari Rosman3, Sinnadurai Jeyaindran4, Omar Ismail5, Robaayah Zambahari3, Kui Huan Sim6 1International Medical University, Seremban; 2University Malaya Medical Centre, PJ; 3Institut Jantung Negara, KL; 4Hospital Kuala Lumpur, KL; 5Hospital Pulau Pinang; 6Hospital Umum Sarawak, Malaysia Background: There is scarce or no data on prevalence and presentation of acute coronary syndrome (ACS among women of reproductive age. Furthermore, whether women of reproductive age presenting with ACS have the same risk factors as men and older women is not known. Objective: To analyze factors associated with ACS in women of reproductive age in comparison with older women and men of a similar age group. Methodology: A total of 9702 cases of acute coronary syndrome over a 3-year period (2006–2008 from the National Cardiovascular Disease database were analyzed, with focus on women of reproductive age (20–<40 years, looking into association with ethnicity, comorbid illness, and the ACS stratum. Comparison with older women (40–<60 years; Control 1 and men of similar age group (Control 2 was made and analyzed using Fisher's exact test and chi-square test when necessary. Results: From a total of 9702 cases, 2344 (24.2% were women. Of these, 45 (1.9% were women between 20 and <40 years, which is significantly lower than the two controls (older women 30.8%, and men of same age 6.2%, respectively; P < 0.0001. The distribution of ethnicity shows a similar pattern between the study group and the controls, but patients of Indian ethnicity were over-represented when compared with the Malaysian demographics of general population (31.3% versus 7.1%; P < 0.0001. ACS in women of reproductive age was associated with diabetes mellitus in 37.8%, hypertension in 40.0%, and dyslipidemia in 24.4% of cases, similar to men of the same age but significantly lower than the older women (P < 0.0001. Smoking

  6. Nutrition: A Primary Therapy in Pediatric Acute Respiratory Distress Syndrome

    Bryan Wilson

    2016-10-01

    Full Text Available Appropriate nutrition is an essential component of intensive care management of children with Acute Respiratory Distress Syndrome (ARDS and is linked to patient outcomes. One out of every two children in the PICU will develop malnutrition or have worsening of baseline malnutrition, and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN is associated with improved 60-day survival after pediatric critical illness and yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10. Inadequate delivery of EN is due to perceived feeding intolerance, reluctance to enterally feed children with hemodynamic instability, and fluid restriction. Underlying each of these factors is large practice variation between providers and across institutions for initiation, advancement and maintenance of EN. Strategies to improve early initiation, advancement, and to maintain delivery of EN are needed to improve morbidity and mortality from pediatric ARDS. Both over and underfeeding prolongs duration of mechanical ventilation in children and worsens other organ function such that precise calorie goals are needed. The gut is thought to act as a ‘motor’ of organ dysfunction and emerging data regarding the role of intestinal barrier functions and the intestinal microbiome on organ dysfunction and outcomes of critical illness present exciting opportunities to improve patient outcomes. Nutrition should be considered a primary rather than supportive therapy for pediatric ARDS. Precise nutritional therapies, which are titrated and targeted to preservation of intestinal barrier function, prevention of intestinal dysbiosis, preservation of lean body mass, and blunting of the systemic inflammatory response, offer great potential for improving outcomes of pediatric ARDS. In this review we examine the current evidence regarding dose, route, and timing of nutrition, current

  7. Prevalence of the catatonic syndrome in an acute inpatient sample

    Mirella eStuivenga

    2014-12-01

    Full Text Available OBJECTIVE: In this exploratory open label study we investigated the prevalence of catatonia in an acute psychiatric inpatient population. In addition, differences in symptom presentation of catatonia depending on the underlying psychiatric illness were investigated.METHODS: 130 patients were assessed with the Bush-Francis Catatonia Rating Scale (BFCRS, the Positive and Negative Syndrome Scale (PANSS, the Young Mania Rating Scale (YMRS and the Simpson-Angus Scale (SAS. A factor analysis was conducted in order to generate 6 catatonic symptom clusters. Composite scores based on this principal component analysis were calculated. RESULTS: When focusing on the first 14 items of the BFCRS, 101 patients (77.7% had at least 1 symptom scoring 1 or higher, whereas 66 patients (50.8% had at least 2 symptoms. Interestingly, when focusing on the DSM-5 criteria of catatonia, 22 patients (16.9% could be considered for this diagnosis. Furthermore, different symptom profiles were found, depending on the underlying psychopathology. Psychotic symptomatology correlated strongly with excitement symptomatology (r=.528,p<.001 and to a lesser degree with the stereotypy/mannerisms symptom cluster (r=.289; p=.001 and the echo/perseveration symptom cluster (r=.185;p=.035. Similarly, manic symptomatology correlated strongly with the excitement symptom cluster (r=.596;p<.001 and to a lesser extent with the stereotypy/mannerisms symptom cluster (r=.277;p=.001.CONCLUSION: There was a high prevalence of catatonic symptomatology. Depending on the criteria being used, we noticed an important difference in exact prevalence, which makes it clear that we need clear-cut criteria. Another important finding is the fact that the catatonic presentation may vary depending on the underlying pathology, although an unambiguous delineation between these catatonic presentations cannot be made. Future research is needed to determine diagnostical criteria of catatonia which are clinically

  8. Potential role of rivaroxaban in patients with acute coronary syndrome

    Fitchett DH

    2012-11-01

    Full Text Available David H FitchettDivision of Cardiology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, CanadaAbstract: Patients with acute coronary syndrome (ACS continue to be at risk for recurrent ischemic events, despite an early invasive strategy and the use of dual antiplatelet therapy. The anticoagulant pathway remains activated for a prolonged period after ACS and, consequently, has been a target for treatment. Early studies with warfarin indicated its benefit, but the risk of bleeding and the complexities of warfarin anticoagulation resulted in little use of this strategy. Rivaroxaban, apixaban, and dabigatran are new specific inhibitors of anticoagulant factors (Xa or IIa currently available for the prevention of thrombosis and/or thromboembolism. Thus far, studies with dabigatran and apixaban in ACS have shown no clinical benefit and bleeding has been increased. The ATLAS ACS 2-TIMI 51 trial observed the impact of rivaroxaban 2.5 mg and 5 mg twice daily in patients with recent ACS receiving current management (both early invasive strategy and dual antiplatelet therapy with aspirin and clopidogrel over a follow-up period of over 1 year. Rivaroxaban 2.5 mg twice daily reduced cardiovascular death, myocardial infarction, or stroke by 16%, and both cardiovascular and all-cause mortality by approximately 20%. Although major bleeding increased from 0.6% to 2.1% and intracranial hemorrhage from 0.2% to 0.6%, there was no increase in fatal bleeding. The role of rivaroxaban in the management of ACS is discussed in this review. The reduction in mortality is the main finding that could lead to the use of rivaroxaban in the management of ACS in high-risk individuals with a low bleeding risk.Keywords: cardiovascular death, myocardial infarction, stroke, anticoagulation, bleeding risk

  9. Clinical significance of hepatic derangement in severe acute espiratory syndrome

    Henry Lik-Yuen Chan; Ambrose Chi-Pong Kwan; Ka-Fai To; Sik-To Lai; Paul Kay-Sheung Chan; Wai-Keung Leung; Nelson Lee; Alan Wu; Joseph Jao-Yiu Sung

    2005-01-01

    AIM: Elevation of alanine aminotransferase (ALT) level iscommonly seen among patients suffering from severe acute respiratory syndrome (SARS). We report the progression and clinical significance of liver derangement in a large cohort of SARS patient.METHODS: Serial assay of serum ALT was followed in patients who fulfilled the WHO criteria of SARS. Those with elevated ALT were compared with those with normal liver functions for clinical outcome. Serology for hepatitis B virus (HBV) infection was checked. Adverse outcomes were defined as oxygen desaturation, need of intensive care unit (ICU) and mechanical ventilation and death.RESULTS: Two hundred and ninety-four patients wereincluded in this study. Seventy (24%) patients had elevatedserum ALT on admission and 204 (69%) patients hadelevated ALT during the subsequent course of illness. Using peek ALT >5xULN as a cut-off and after adjusting for potential confounding factors, the odds ratio of peek ALT >5x ULN for oxygen desaturation was 3.24 (95%CI 1.23-8.59, P = 0.018), ICU care was 3.70 (95%CT 1.38-9.89, P = 0.009), mechanical ventilation was 6.64 (95%CI 2.22-19.81, P = 0.001) and death was 7.34 (95%CI 2.28-24.89, P = 0.001). Ninety-three percent of the survived patients had ALT levels normalized or were on the improving trend during follow-up. Chronic hepatitis B was not associated with worse clinical outcomes. CONCLUSION: Reactive hepatitis is a common complication of SARS-coronavirus infection. Those patients with severehepatitis had worse clinical outcome.

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

    Wuchun Cao

    2011-02-01

    Full Text Available This 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 geographical extent but clustered in two areas: first in Guangdong Province, and about 3 months later in Beijing with its surrounding areas. Reanalysis of all available epidemiological data resulted in a total of 5327 probable cases of SARS, of whom 343 died. The resulting case fatality ratio (CFR of 6.4% was less than half of that in other SARS-affected countries or areas, and this difference could only partly be explained by younger age of patients and higher number of community acquired infections. Analysis of the impact of interventions demonstrated that strong political commitment and a centrally coordinated response was the most important factor to control SARS in mainland China, whereas the most stringent control measures were all initiated when the epidemic was already dying down. The long-term economic consequence of the epidemic was limited, much consumption was merely postponed, but for Beijing irrecoverable losses to the tourist sector were considerable. An important finding from a cohort study was that many former SARS patients currently suffer from avascular osteo­necrosis, as a consequence of the treatment with corticosteroids during their infection. The SARS epidemic provided valuable information and lessons relevant in controlling outbreaks of newly emerging infectious diseases, and has led to fundamental reforms of the Chinese health system. In particular, a comprehensive nation-wide internet-based disease reporting system was established.

  11. DEPRESSION AND ANXIETY IN PATIENT WITH ACUTE CORONARY SYNDROME

    Kadek Dwi Krisnayanti

    2013-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Depression and anxiety are two conditions that common happened in patient with acute coronary syndrome which can cause negative cardiovascular outcomes. Although the prevalencies of these two conditions are slightly high, most of them had not been treated well. The mechanisms that underly the association between depression and anxiety with the negative cardiovascular outcome are possibly correlates with their effect on inflammatory process, cathecolamine release, heart rate variability, endothelial function and also their effect on health promoting behavior. Fortunately, the standard therapies that available for these conditions are safe, effective, and can be tolerated well in most patients. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  12. PS-341 in Treating Patients With Refractory or Relapsed Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, Chronic Myeloid Leukemia in Blast Phase, or Myelodysplastic Syndrome

    2013-01-22

    Adult Acute Promyelocytic Leukemia (M3); Blastic Phase Chronic Myelogenous Leukemia; 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

  13. Use of an oscillatory PEP device to enhance bronchial hygiene in a patient of post-H1NI pneumonia and acute respiratory distress syndrome with pneumothorax.

    Narula, Deepali; Nangia, Vivek

    2014-03-07

    A 26-year-old, 14 week pregnant woman was admitted to our hospital with pneumonia with acute respiratory distress syndrome in an intubated and mechanically ventilated state. She was diagnosed to have polymicrobial infection and left-sided pneumothorax and was put on a ventilator for 2 weeks. Postextubation, she found it difficult to clear her respiratory secretions despite aggressive routine chest physiotherapy. She was planned to undergo a mini-tracheostomy for tracheobronchial toileting. However, before that, she was given a trial of Acapella, a hand-held oscillatory positive expiratory pressure (OPEP) therapy device, for facilitating airway clearance, with the aim to speed up the recovery. The patient found it easy to use and clear the secretions optimally, thus averting a mini-tracheostomy. This case report highlights the advantages of the OPEP therapy device in effective management of bronchial hygiene in patients with poor respiratory effort.

  14. A case of rheumatic fever with acute post-streptococcal glomerulonephritis and nephrotic syndrome caused by a cutaneous infection with beta-hemolytic streptococci

    Carsten Sauer Mikkelsen

    2010-01-01

    Full Text Available A middle-aged patient of Greenlandic origin was referred for skin infection of the leg. An initial minor trauma of the skin of the distal right lower extremity was complicated by bullous erysipelas which cultured positive for group A β-hemolytic streptococci (GABHS. The clinical condition deteriorated and necrotizing fasciitis developed despite relevant surgical and antibiotic treatment. Approximately 3 weeks later, the patient developed arthralgia, impaired renal function with azotemia, hypertension and severe nephrotic syndrome with periorbital and peripheral edema. A kidney biopsy demonstrated endocapillary glomerulonephritis. Concomitantly, carditis with chest pain, moderately reduced left ventricular ejection fraction and mitral regurgitation were noted. The patient had no signs of pharyngitis in the whole period. The patient thus contracted poststreptococ glomerulonephritis and furthermore she fulfilled the criteria of acute rheumatic fever following a GABHS skin infection. We suggest a possible relation between a virulent GABHS clone causing NF and ARF.

  15. Acute psychosis followed by fever: Malignant neuroleptic syndrome or viral encephalitis?

    Stojanović Zvezdana

    2014-01-01

    Full Text Available Introduction. Neuroleptic malignant syndrome is rare, but potentially fatal idiosyncratic reaction to antipsychotic medications. It is sometimes difficult to diagnose some clinical cases as neuroleptic malignant syndrome and differentiate it from the acute viral encephalitis. Case report. We reported a patient diagnosed with acute psychotic reaction which appeared for the first time. The treatment started with typical antipsychotic, which led to febrility. The clinical presentation of the patient was characterised by the signs and symptoms that might have indicated the neuroleptic malignant syndrome as well as central nervous system viral disease. In order to make a detailed diagnosis additional procedures were performed: electroencephalogram, magnetic resonance imaging of the head, lumbar puncture and a serological test of the cerebrospinal fluid. Considering that after the tests viral encephalitis was ruled out and the diagnosis of neuroleptic malignant syndrome made, antipsychotic therapy was immediately stopped. The patient was initially treated with symptomatic therapy and after that with atypical antipsychotic and electroconvulsive therapy, which led to complete recovery. Conclusion. We present the difficulties of early diagnosis at the first episode of acute psychotic disorder associated with acute febrile condition. Concerning the differential diagnosis it is necessary to consider both neuroleptic malignant syndrome and viral encephalitis, i.e. it is necessary to make the neuroradiological diagnosis and conduct cerebrospinal fluid analysis and blood test. In neuroleptic malignant syndrome treatment a combined use of electroconvulsive therapy and low doses of atypical antipsychotic are confirmed to be successful.

  16. Triple-rule-out dual-source CT angiography of patients with acute chest pain: Dose reduction potential of 100 kV scanning

    Krissak, Radko, E-mail: radko.krissak@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Henzler, Thomas; Prechel, Anne; Reichert, Miriam [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Gruettner, Joachim; Sueselbeck, Tim [1st Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Schoenberg, Stefan O.; Fink, Christian [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany)

    2012-12-15

    Purpose: To investigate the dose reduction potential of low kV triple-rule-out dual-source CT angiography (TRO-CTA) in non-obese (BMI ≤ 25 kg/m{sup 2}) patients with acute chest pain. Materials and methods: Sixty consecutive patients were randomly assigned to two different retrospectively ECG-gated TRO-CTA protocols in this prospective trial: Thirty patients were examined with a 120-kV standard protocol (320 reference mAs with automatic tube current modulation, automatically adapted pitch and ECG-pulsing) and served as the control group (group 1), an otherwise identical 100 kV protocol was used in the other thirty patients (group 2) for a radiation dose reduction. Subjective image quality was assessed on a 5 point scale (1: excellent, 5: non-diagnostic) by two blinded observers. Quantitative image analysis assessed vascular attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in different vascular segments. The effective dose was calculated from the dose length product (DLP) using a conversion coefficient of 0.017 mSv mGy{sup −1} cm{sup −1}. Results: There was no significant difference of age, BMI, heart rate, pitch or scan length between both patient groups. Subjective image quality was rated similar in both groups (group 1: 1.2 ± 0.4, group 2: average score = 1.3 ± 0.5). Vessel attenuation was significantly higher in group 2 than in group 1 (ascending aorta: 456 ± 83 HU vs. 370 ± 78 HU, p < 0.001; pulmonary artery: 468 ± 118 HU vs. 411 ± 91 HU, p = 0.03; left coronary artery: 437 ± 110 HU vs. 348 ± 89 HU, p < 0.001), however, there was no significant difference in SNR (13.2 ± 7.6 vs. 14.5 ± 7.5, p = 0.49) or CNR (13.8 ± 6.6 vs. 15.9 ± 7.7, p = 0.25). The effective radiation dose of the 100 kV protocol was significantly lower (9.6 ± 3.2 mSv vs. 18.1 ± 9.4 mSv, p < 0.0001). Conclusion: TRO-CTA with 100 kV is feasible in non-obese patients and results in diagnostic image quality and significantly reduced radiation dose.

  17. Prognostic value of blood glucose levels in diabetic patients upon admission and its outcomes in patients with acute coronary syndrome

    Adel Hamed Elbaih

    2017-01-01

    Full Text Available Background: Coronary heart disease (CHD is the main leading cause of morbidity and mortality in patients with diabetes mellitus. Hyperglycemia on admission was associated with a worse outcome for all patients admitted with ACS. Aim: To correlate the relationship between hyperglycemia with acute coronary syndrome and poor outcome. Methodology: Clinical evaluation of the patients were carried out on arrival to Emergency Department regarding: Initial assessment of patient general condition either stable or not through; ABCDE (air way and cervical spine control, breathing, circulation, neurological dysfunction and exposure. Then determine the characters and types of chest pain. Assess the condition of the patients either stable or unstable which will determine the needed investigations and plane of management. Results: the mortality was higher in patients with RBG more than 300 mg/dl (68.4 %, (10.5 % of the patients had ranged from 250 ─ < 300 mg/dl, and the patients had ranged from 200 ─ < 250 mg/dl were (10.5 %. The patients had ranged from 160 ─ < 200 mg/dl were (5.3 and there were (5.3 of the patients had ranged from 70 ─ < 160mg/dl. Conclusions: The data from this study have shown that hyperglycemia on admission was associated with a worse outcome for all patients admitted with ACS.

  18. [Vegetable oil-induced acute respiratory distress syndrome (ARDS) in near drowning: evaluation based on extravascular lung water index].

    Yoshida, Takeshi; Rinka, Hiroshi; Kaji, Arito

    2008-06-01

    Lipoid pneumonia usually presents after chronic recurrent ingestion of oily substances or accidental aspiration during "fire-eating" demonstrations. Massive exposure by near drowning extremely rare and potentially fatal. We present here a case of survival after total immersion in oil in her workplace. A 66-year-old woman who nearly drowned in a vat of vegetable oil was admitted as an emergency case with severe hypoxia after rescue. Chest computed tomography (CT) findings showed bilateral ground-glass opacity, consolidation, and the case fulfilled the criteria for acute respiratory distress syndrome (ARDS). Bronchoscopy and bronchoalveolar lavage performed on admission indicated oil droplets and marked neutrophilia (67%), which made us diagnose ARDS induced by lipoid pneumonia. We commenced treatment with pulsed steroids and strictly managed fluid balance under mechanical ventilation. Despite immediate improvement in oxygenation, the value of extravascular lung water index (EVLWI) measured by the PiCCO system consistently remained over 30 ml/Kg through her clinical course. We concluded that lipoid pneumonia is characterized by prolonged elevatation of pulmonary vascular permeability.

  19. Cyclosporin A acute encephalopathy and seizure syndrome in childhood: clinical features and risk of seizure recurrence.

    Gleeson, J G; duPlessis, A J; Barnes, P D; Riviello, J J

    1998-07-01

    Cyclosporin A is associated with an acute encephalopathy including seizures and alterations in mental status, herein referred to as cyclosporin A acute encephalopathy and seizure syndrome. The clinical history, electroencephalogram (EEG), and neuroimaging findings in 19 children with cyclosporin A acute encephalopathy and seizure syndrome over a 10-year period were reviewed in order to delineate clinical characteristics, imaging features, and to determine the risk of seizure recurrence in this population. All 19 had motor seizures associated with other features of cortical and subcortical dysfunction. The acute mean cyclosporin A level was 342 microg/L, but was within the "therapeutic" range in five cases. Brain imaging by computed tomography (CT) or magnetic resonance imaging (MRI) in the acute or subacute phase revealed lesions characteristic of cyclosporin A toxicity in 14 cases. Acute EEG abnormalities were present in all and included epileptiform discharges or focal slowing. Patients were followed for a median of 49 months (1-9 years). Follow-up imaging (n = 10) showed lesion resolution or improvement in the majority while EEG (n = 10) had normalized in only three. Seizures recurred in six patients and only in those with persistent EEG or imaging abnormalities. No patient had a second episode of cyclosporin A associated neurotoxicity or seizure. It appears that a significant risk of seizure recurrence exists following cyclosporin A acute encephalopathy and seizure syndrome and primarily in those children with persistent EEG or imaging abnormalities.

  20. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results

    Weininger, Markus [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC (United States); Ramachandra, Ashok [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Fink, Christian [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Rowe, Garrett W.; Costello, Philip [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Henzler, Thomas [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany)

    2012-12-15

    Purpose: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. Methods and materials: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel “shuttle” mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. Results: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. Conclusion: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.

  1. Takotsubo cardiomyopathy: an overlooked cause of chest pain

    Leonardo Hackbart Bermudes

    2014-06-01

    Full Text Available Takotsubo cardiomyopathy (TTC, also known as apical ballooning syndrome, broken heart syndrome, or stress-induced cardiomyopathy, is defined as a transient disturbance of the left ventricle, which is quite often associated with electrocardiographic abnormalities that may mimic acute myocardial infarction. The syndrome is also characterized by a mild alteration of cardiac biomarkers in absence of coronary blood flow obstruction on the coronariography. Clinical presentation is often manifested by angina, dyspnea, syncope, and arrhythmias. Peculiarly, the left ventricle takes the form of “tako-tsubo” (a Japanese word for “octopus trap” on the imaging workup. The authors report the case of a post-menopausal, hypertensive, dyslipidemic and type-II diabetic woman admitted at the emergency service with acute chest pain post physical exertion. Electrocardiogram showed signs of ischemia and myocardial necrosis markers were mildly increased. Echocardiography and ventriculography showed apical and mid-ventricular akinesia, with mild atherosclerotic coronary lesions. Thus diagnostic workup and the outcome followed the diagnostic criteria for TTC. The authors called attention to the potential of overlooking this diagnosis, since this syndrome is still not widely recognized.

  2. Clinical Profile with Angiographic Correlation in Naïve Acute Coronary Syndrome

    Lohiya, Balaji V; Sihag, Bhupendra K; Prajapati, Rajpal

    2016-01-01

    Introduction Despite cardiovascular diseases having grown to epidemic proportions, there are few studies from India pertaining to Acute Coronary Syndrome (ACS), more so from the region of Purvanchal which is less developed with more poverty. Our study is first of its kind in this region of patients presenting for the first time with ACS. Aim The present study was undertaken to study the clinical and angiographic characteristics of ACS patients of Purvanchal. Materials and Methods This was a prospective cohort study of 100 patients admitted with ACS. Patients were excluded if they had prior cardiac pathology like valvular heart disease, cardiomyopathy, pericardial disease, cor pulmonale, ischaemic heart disease or cardiac revascularisation. Patients who did not undergo angiography were excluded. Patients were divided into ST Elevation Myocardial Infarction (STEMI) and non STEMI (NSTEMI). Presentation delays as well as clinical characteristics analysed in each group were age, gender, presence or absence of diabetes mellitus, hypertension, dyslipidaemia, smoking, Body Mass Index (BMI), family history, duration of chest pain, and treatment received. Results Mean age of patients was 58.9 years with 27% below 50 years. Of the total 75% were males. Patients with STEMI were 65%. Median time to reach hospital was 24 hours with only 27% patients reaching hospital within 6 hours. Among patients with STEMI only 43% received fibrinolytic therapy. 23% patients had diabetes, 21% were hypertensive, 16% were smokers, family history of cardiovascular disease present in 11% and 21% had body mass index more than 30. Mean LDL was 115mg/dl and HDL 39mg/dl with 54% of patients having at least one risk factor. Factors favouring triple vessel involvement were female sex, higher age, smoking, presence of diabetes and NSTEMI. Conclusion Indians develop ACS at earlier age. Precious time is lost before seeking treatment. There is a need for aggressive risk factor modification which along with

  3. Impact of rivaroxaban on stent thrombosis and secondary prevention of cardiovascular events in acute coronary syndrome

    Krohn-Grimberghe M

    2014-05-01

    Full Text Available Marvin Krohn-Grimberghe, Christoph Bode, Constantin von zur MuhlenDepartment of Cardiology and Angiology I, Heart Center, University of Freiburg, GermanyAbstract: Angioplasty and stent implantation have greatly improved the outcome of patients with acute coronary syndrome. However, stents come with the risk of stent thrombosis, which is associated with a high rate of revascularization, myocardial infarction, and death. The inhibition of factor Xa due to rivaroxaban leads to an interruption of the intrinsic as well as the extrinsic coagulation pathway, which reduces thrombus formation as a potential mechanism to diminish the rate of stent thrombosis. In this review, we evaluate the role of rivaroxaban in the prevention of stent thrombosis and its general role in patients with acute coronary syndrome.Keywords: Rivaroxaban, stent thrombosis, acute coronary syndrome, secondary prevention

  4. Down syndrome with microgranular variant of acute promyelocytic leukemia in a child: a case report

    Jain Deepali

    2007-11-01

    Full Text Available Abstract Background Acute promyelocytic leukemia (APL accounts for less than 10% of pediatric AML. Cases of APL in Down syndrome (DS have been described in the literature rarely and it is rarer still to find the microgranular variant (M3v of APL in trisomy 21 patients. Case presentation We present a case of a five-year-old female with Down syndrome diagnosed with acute promyelocytic leukemia (APL. She came to our hospital with bleeding manifestations. Blood and bone marrow examination revealed promyelocytes showing a few fine granules and occasional Auer rods. Based on this morphology and cytochemistry, a diagnosis of APL microgranular variant (M3v was made. Conclusion This case report emphasizes the importance of a high index of suspicion in the diagnosis of acute promyelocytic leukemia microgranular variant in Down syndrome.

  5. The effect of inhaled nitric oxide in acute respiratory distress syndrome in children and adults

    Karam, O; Gebistorf, F; Wetterslev, J

    2017-01-01

    Acute respiratory distress syndrome is associated with high mortality and morbidity. Inhaled nitric oxide has been used to improve oxygenation but its role remains controversial. Our primary objective in this systematic review was to examine the effects of inhaled nitric oxide administration...... on mortality in adults and children with acute respiratory distress syndrome. We included all randomised, controlled trials, irrespective of date of publication, blinding status, outcomes reported or language. Our primary outcome measure was all-cause mortality. We performed several subgroup and sensitivity......% CI) 1.59 (1.17-2.16)) with inhaled nitric oxide. In conclusion, there is insufficient evidence to support inhaled nitric oxide in any category of critically ill patients with acute respiratory distress syndrome despite a transient improvement in oxygenation, since mortality is not reduced and it may...

  6. Acute Pulmonary Edema in an Eclamptic Pregnant Patient: A Rare Case of Takotsubo Syndrome

    Karamchandani, Kunal; Bortz, Brandon; Vaida, Sonia

    2016-01-01

    Patient: Female, 35 Final Diagnosis: Takotsubo cardiomyopathy Symptoms: Seizures Medication: — Clinical Procedure: Cesarean section Specialty: Critical Care Medicine Objective: Rare co-existance of disease or pathology Background: Acute pulmonary edema in a pregnant patient is associated with significant morbidity and mortality. Takotsubo syndrome, or stress-induced cardiomyopathy, is a rare cause of acute pulmonary edema in a pregnant patient, especially prior to delivery of the fetus. Case Report: We describe a case of a pregnant patient who presented with acute pulmonary edema and eclampsia and was found to have Takotsubo syndrome. To the best of our knowledge, eclampsia as a precipitating factor for Takotsubo syndrome has not been described in literature. Conclusions: Clinicians taking care of pregnant patients should be aware of the potential link between eclampsia and Takotsubo cardiomyopathy. Prompt correction of the precipitating cause along with supportive management as described is the key to a successful outcome. PMID:27658947

  7. Acute Pulmonary Edema in an Eclamptic Pregnant Patient: A Rare Case of Takotsubo Syndrome.

    Karamchandani, Kunal; Bortz, Brandon; Vaida, Sonia

    2016-09-23

    BACKGROUND Acute pulmonary edema in a pregnant patient is associated with significant morbidity and mortality. Takotsubo syndrome, or stress-induced cardiomyopathy, is a rare cause of acute pulmonary edema in a pregnant patient, especially prior to delivery of the fetus. CASE REPORT We describe a case of a pregnant patient who presented with acute pulmonary edema and eclampsia and was found to have Takotsubo syndrome. To the best of our knowledge, eclampsia as a precipitating factor for Takotsubo syndrome has not been described in literature. CONCLUSIONS Clinicians taking care of pregnant patients should be aware of the potential link between eclampsia and Takotsubo cardiomyopathy. Prompt correction of the precipitating cause along with supportive management as described is the key to a successful outcome.

  8. Subclavian steal syndrome presenting as recurrent pulmonary oedema associated with acute left ventricular diastolic dysfunction.

    Mangialavori, Giuseppe; Ballo, Piercarlo; Michelagnoli, Stefano; Ercolini, Leonardo; Barbanti, Enrico; Passuello, Franco; Abbondanti, Alessandro; Consoli, Lorenzo; Chechi, Tania; Fibbi, Veronica; Nannini, Marco; Chiodi, Leandro; Zuppiroli, Alfredo

    2013-01-01

    Subclavian steal syndrome typically presents as angina in patients with internal mammary artery grafts. Atypical clinical presentations have been rarely described. We report an unusual case of subclavian steal syndrome presenting as pulmonary oedema with acute left ventricular diastolic dysfunction and preserved ejection fraction in a patient with internal mammary artery graft and severe stenosis of the proximal left subclavian artery. After successful angioplasty and stenting of subclavian artery, the patient remained asymptomatic for six months, but then experienced acute diastolic dysfunction and recurrent pulmonary oedema associated with critical subclavian in-stent restenosis with stent deformation. This report points out that, in patients with internal mammary-to-LAD grafts, subclavian steal syndrome may present as acute left ventricular diastolic dysfunction and pulmonary oedema even in the presence of normal ejection fraction.

  9. Acute compartment syndrome of hand resulting from radiographic contrast iohexol extravasation

    Kolar Vishwanath Vinod

    2016-01-01

    Full Text Available Intravenous (IV administration of iodinated contrast agents (ICAs is frequently employed for image enhancement while performing radiographic studies such as computed tomography and angiography. Complications related to IV administration of ICAs such as immediate hypersensitivity reactions and nephrotoxicity are well-known. However, severe skin and soft tissue injuries and acute compartment syndrome resulting from contrast extravasation are rare. This is especially so with small volume extravasation of a low osmolar, nonionic ICA such as iohexol. Here, we report a 63-year-old woman who developed acute compartment syndrome of left hand following iohexol extravasation and had swelling, blistering, cutaneous and soft tissue necrosis. She underwent fasciotomy for acute compartment syndrome of hand and later surgical debridement of necrotic skin and soft tissues was carried out. Clinical pharmacology of ICAs, extravasation injuries following their IV administration, their management and measures to reduce them are discussed in brief.

  10. Dubin-Johnson syndrome presenting after acute viral hepatitis.

    Lahmi, Farhad; Roshani, Mohammad; Khosravi, Katayoun; Azizi, Morteza; Mohebbi, Seyed Reza; Zali, Mohammad Reza

    2011-01-01

    Elevated serum level of bilirubin is a common manifestation which is occurred in several diseases. Hyperbilirubinemia can manifest either conjugated or unconjugated. Conjugated or direct hyperbilirubinemia usually are caused by hepatocellular diseases or cholestatic liver diseases. Merely conjugated hyperbilirubinemia is the main manifestation of two congenital syndromes, including Dubin-Johnson and rotor syndrome; however it can be seen in some patients with recurrent benign intrahepatic cholestasis. This article reports a patient with Dubin- Johuson syndrome as a benign and rare condition.

  11. Establishing a murine model of the Hematopoietic Syndrome of the Acute Radiation Syndrome

    Plett, P. Artur; Sampson, Carol H.; Chua, Hui Lin; Joshi, Mandar; Booth, Catherine; Gough, Alec; Johnson, Cynthia S.; Katz, Barry P.; Farese, Ann M.; Parker, Jeffrey; MacVittie, Thomas J.; Orschell, Christie M.

    2012-01-01

    We have developed a murine model of the Hematopoietic Syndrome of the Acute Radiation Syndrome (H-ARS) for efficacy testing of medical countermeasures (MCM) against radiation according to the FDA Animal Rule. Ten to 12 week old male and female C57BL/6 mice were exposed to the LD50/30-LD70/30 dose of total body irradiation (TBI, 137Cs, 0.62-0.67 Gy min-1) in the morning hours when mice were determined to be most radiosensitive, and assessed for 30 day survival and mean survival time (MST). Antibiotics were delivered in the drinking water on days 4-30 post-TBI at a concentration based on the amount of water that lethally-irradiated mice were found to consume. The fluoroquinolones, ciprofloxacin and levofloxacin, and the tetracycline doxycycline and aminoglycoside neomycin, all significantly increased MST of decedent mice, while ciprofloxacin (p=0.061) and doxycycline + neomycin (p=0.005) showed at least some efficacy to increase 30 day survival. Blood sampling (30uL/mouse every 5th day) was found to negatively impact 30 day survival. Histopathology of tissues harvested from non-moribund mice showed expected effects of lethal irradiation, while moribund mice were largely septicemic with a preponderance of enteric organisms. Kinetics of loss and recovery of peripheral blood cells in untreated mice and those treated with two MCM, granulocyte-colony stimulating factor and Amifostine, further characterized and validated our model for use in screening studies and pivotal efficacy studies of candidate MCM for licensure to treat irradiated individuals suffering from H-ARS. PMID:22929467

  12. An old lady with anterior chest pain and unilateral facial flushing.

    Lin, Shao Hwa; Chen, Chin I; Liu, Ching Chih; Du, Ming Hai; Lam, Carlos

    2012-01-01

    Harlequin syndrome is rare and typically characterized by asymmetric flushing and sweating. Although it is usually considered idiopathic, literature review shows that it may be caused by lesion over lung apex or after central venous catheterization in the internal jugular vein. We present a 74-year-old woman who had been experiencing recurrent chest pain and right shoulder pain since 2 weeks ago. The tentative diagnosis was made by the emergency physician (EP) as acute coronary syndrome. The patient was given nitroglycerin treatment. Twelve hours later, the patient developed another episode of chest pain. The electrocardiogram and cardiac enzyme study results were, however, both normal. Further evaluation showed intermittent flushing over the left side of her face, as well as right-eye ptosis. A chest computed tomography (CT) was conducted, under the suspicion of Harlequin syndrome in combination with Horner syndrome, to derive the diagnosis of a right lung apex tumor. This case showed that history taking and physical examination are very important in the emergency department. It is particularly vital to observe the microchanges in the patient's symptoms and signs. It is also imperative to reassess the patient whose symptoms fail to improve under treatment, to look for other underlying lesions.

  13. Hemolytic uremic syndrome as a primary manifestation of acute human immunodeficiency virus infection.

    Gomes, A M; Ventura, A; Almeida, C; Correia, M; Tavares, V; Mota, M; Seabra, J

    2009-05-01

    Hemolytic uremic syndrome may be associated with human immunodeficiency virus infection but it occurs in advanced stages of human immunodeficiency virus disease. As in other forms of hemolytic uremic syndrome plasmapheresis seems to be the treatment of choice. The authors present an unusual case of hemolytic uremic syndrome associated with acute human immunodeficiency virus infection in a 38 year-old black male. The patient was admitted with fever, asthenia, nausea, diarrhea, and reduced urinary output. He was found to have anemia, thrombocytopenia and severe renal failure. Hemolytic uremic syndrome was diagnosed and he was started on plasmapheresis and hemodialysis. Serological tests were consistent with acute human immunodeficiency virus infection: the enzyme linked immunosorbent assay for human immunodeficiency virus was weakly positive, Western Blot test was negative and human immunodeficiency virus RNA quantification was positive, with > 1,000,000 copies/microl. After 4 daily treatment sessions, patient's clinical condition improved and hemoglobin, platelets, lactic dehydrogenase and renal function normalized.

  14. Incidence and Mortality of Acute Respiratory Distress Syndrome in Children : A Systematic Review and Meta-Analysis

    Schouten, LR; Veltkamp, F; Bos, AP; van Woensel, Job B M; Serpa Neto, A; Schultz, MJ; Wösten-van Asperen, RM

    2016-01-01

    Objectives: Our understanding of the acute respiratory distress syndrome in children is limited, and literature is dominated by investigations in adult patients. Recent preclinical studies suggest that the susceptibility to and severity of acute respiratory distress syndrome in children could differ

  15. Inhaled Nitric Oxide for Acute Respiratory Distress Syndrome and Acute Lung Injury in Adults and Children: A Systematic Review with Meta-Analysis and Trial Sequential Analysis

    Afshari, Arash; Brok, Jesper; Møller, Ann

    2011-01-01

    BACKGROUND: Acute hypoxemic respiratory failure, defined as acute lung injury and acute respiratory distress syndrome, are critical conditions associated with frequent mortality and morbidity in all ages. Inhaled nitric oxide (iNO) has been used to improve oxygenation, but its role remains...... be recommended for patients with acute hypoxemic respiratory failure. iNO results in a transient improvement in oxygenation but does not reduce mortality and may be harmful....

  16. Plasma Lactate Dehydrogenase Levels Predict Mortality in Acute Aortic Syndromes

    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 Departments suspected of having AAS underwent LDH assay at presentation. A final diagnosis was obtained by aortic imaging. Patients diagnosed with AAS were followed-up for in-hospital mortality. One thousand five hundred seventy-eight consecutive patients were clinically eligible, and 999 patients were included in the study. The final diagnosis was AAS in 201 (20.1%) patients. Median LDH was 424 U/L (interquartile range [IQR] 367–557) in patients with AAS and 383 U/L (IQR 331–460) in patients with alternative diagnoses (P < 0.001). Using a cutoff of 450 U/L, the sensitivity of LDH for AAS was 44% (95% confidence interval [CI] 37–51) and the specificity was 73% (95% CI 69–76). Overall in-hospital mortality for AAS was 23.8%. Mortality was 32.6% in patients with LDH ≥ 450 U/L and 16.8% in patients with LDH < 450 U/L (P = 0.006). Following stratification according to LDH quartiles, in-hospital mortality was 12% in the first (lowest) quartile, 18.4% in the second quartile, 23.5% in the third quartile, and 38% in the fourth (highest) quartile (P = 0.01). LDH ≥ 450 U/L was further identified as an independent predictor of death in AAS both in univariate and in stepwise logistic regression analyses (odds ratio 2.28, 95% CI 1.11–4.66; P = 0.025), in addition to well-established risk markers such as advanced age and hypotension. Subgroup analysis showed excess mortality in association with LDH ≥ 450 U/L in elderly, hemodynamically stable

  17. Transformation of myelodysplastic syndromes into acute myeloid leukemias

    施均; 邵宗鸿; 刘鸿; 白洁; 曹燕然; 何广胜; 凃梅峰; 王秀丽; 郝玉书; 杨天楹; 杨崇礼

    2004-01-01

    Background Myelodysplastic syndromes (MDSs), also called preleukemias, are a group of myeloid hematopoietic malignant disorders. We studied the transformation of MDS into acute myeloid leukemia (AML).Methods Leukemic transformation in 151 patients with MDS was dynamically followed up. The clinical manifestation, peripheral blood and bone marrow condition, karyotypes, immunophenotypes, response to treatment, and prognosis of AML evolution from MDS (MDS-AML) were also observed.Results During the course of this study, over the past eight years and seven months, 21 (13.91%) of 151 MDS patients progressed to overt leukemia, with a median interval of 5 (1-23) months. There were no significant differences between rates of leukemic transformation in comparison with the refractory anemia (RA), RA with excess of blasts (RAEB), and RAEB in transformation (RAEB-t) patient groups. Transformation occurred either gradually or rapidly. There were five parameters positively correlated to leukemic transformation: under 40 years of age, pancytopenia of 3 lineages, more than 15% blasts in the bone marrow, at least two abnormal karyotypes, and treatment with combined chemotherapy. All of the 21 patients with leukemia suffered from MDS-AML, and most of them were M2, M4, or M5. Two (9.52%) MDS-AML patients developed extramedullary infiltration. Leukopenia was found in 47.62% of these patients. Two thirds of these patients, whose bone marrows were generally hypercellular, suffered from neutropenia. After developing AML, 8 (47.06%) patients developed abnormal karyotypes. High expression of immature myeloid antigens, including CD33 [(49.83±24.50)%], CD13 [(36.38±33.84)%], monocytic antigen CD14 [(38.50±24.60)%], and stem cell marker CD34 [(34.67±30.59)%], were found on bone marrow mononuclear cells from MDS-AML patients after leukemic transformation. In some cases, lymphoid antigens, such as CD5, CD7, CD9, and CD19, coexisted with myeloid antigens. A low complete remission rate (31

  18. Respiratory support for severe acute respiratory syndrome: integration of efficacy and safety

    WANG Chen; CAO Zhi-xin

    2005-01-01

    @@ Severe acute respiratory syndrome (SARS) is an acute respiratory illness caused by infection with the SARS virus. The most obvious clinical characteristic of SARS is rapidly progressive pneumonia, and about 20% patients need intensive care due to acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).1-3 In the absence of effective drugs for SARS, supportive care, especially respiratory support techniques (RSTs), is of primary importance. On the other hand, offering RSTs to SARS patients may carry a high-risk of infection to healthcare workers because of the high infectivity of SARS. Therefore, the strategy of RSTs for SARS should be the integration of efficacy and safety. In this issue of the Chinese Medical Journal, an article from Hong Kong has retrospectively compared both the safety and efficacy of noninvasive positive pressure ventilation (NIPPV) with that of invasive mechanical ventilation (IMV) in the treatment of respiratory failure in SARS.

  19. Minoxidil poisoning presenting as acute coronary syndrome: a rare case scenario

    Shrikant Kalyanrao Panchal

    2014-04-01

    Full Text Available We present a case of severe minoxidil poisoning (3000 mg with resultant severe hypotension, tachycardia and subendocardial ischemia initially treated crystalloid, dopamine, aspirin, clopidogrel on the lines of acute coronary syndrome with partial haemodynamic improvement. After getting the history of minoxidil poisoning, the patient was treated with bolus doses of norepinephrine, and norepinephrine infusion, resulting in resolution of hypertension, tachycardia and reversal of ischemia. Topical minoxidil is commonly used agent for male pattern baldness. It also has got antihypertensive action when ingested, acute coronary syndrome and compensatory tachycardia with successful management with norepinephrine bolus and infusion. [Int J Res Med Sci 2014; 2(2.000: 784-785

  20. [Prehospital stage of medical aid to patients with acute coronary syndrome and elevated ST segment].

    Vertkin, A L; Morozov, S N; Fedorov, A I

    2013-01-01

    We studied effect of time on the outcome of acute coronary syndrome and elevated ST segment at the prehospital stage. Logistic regression analysis revealed two time-dependent predictors: "symptom-needle" time and total call service time. In patients undergoing prehospital thrombolysis, these indices (88 and 85 min respectively) reliably predicted the probability of fatal outcome. Their values of 71 and 77 min respectively predicted the risk of unfavourable outcome. The total call service time may serve as an indicator of the quality of work of an ambulance crew at the prehospital stage of management of acute coronary syndrome with elevated ST segment.

  1. "Sagging heart syndrome": a cause of acute lead dislodgment in two patients.

    Iskos, D; Lurie, K G; Shultz, J J; Fabian, W H; Benditt, D G

    1999-02-01

    Acute passive fixation atrial lead dislodgment occurred due to an unexpected and marked postural descent of the heart after permanent pacemaker implantation in two patients. Sagging of the heart in these two individuals may have been related to a history of morbid obesity followed by weight loss of over 100 pounds. Lead replacement with active fixation leads was required in both cases. The term "sagging heart syndrome" is proposed to describe this clinical entity. In certain adult populations, such as in patients with a history of significant weight loss, the "sagging heart syndrome" may represent a previously unrecognized cause of acute lead dislodgment.

  2. Severe acute tumor lysis syndrome in patients with germ-cell tumors

    Guilherme Alvarenga Feres

    2008-01-01

    Full Text Available Germ-cell tumors are a high-proliferative type of cancer that may evolve to significant bulky disease. Tumor lysis syndrome is rarely reported in this setting. The reports of three patients with germ-cell tumors who developed severe acute tumor lysis syndrome following the start of their anticancer therapy are presented. All patients developed renal dysfunction and multiorgan failure. Patients with extensive germ-cell tumors should be kept on close clinical and laboratory monitoring. Physicians should be aware of this uncommon but severe complication and consider early admission to the intensive care unit for the institution of measures to prevent acute renal failure.

  3. Usefulness of pregnancy-associated plasma protein A in patients with acute coronary syndrome

    Iversen, Kasper; Dalsgaard, Morten; Teisner, Ane S

    2009-01-01

    To investigate whether pregnancy-associated plasma protein-A (PAPP-A) is a prognostic marker in patients admitted with high-risk acute coronary syndrome. In patients admitted with high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and ST-segment elevation myocardial infarction...... (STEMI), risk stratification is primarily determined by the markers of myocardial necrosis and known demographic risk profiles. However, it has recently been proposed that the presence and extent of vulnerable plaques might influence the prognosis significantly. A marker for the vulnerable plaque could...

  4. Rapid Aspirin Challenge in Patients with Aspirin Allergy and Acute Coronary Syndromes.

    Cook, Kevin A; White, Andrew A

    2016-02-01

    Aspirin allergy in a patient with acute coronary syndrome represents one of the more urgent challenges an allergist may face. Adverse reactions to aspirin are reported in 1.5% of patients with coronary artery disease. A history of adverse reaction to aspirin often leads to unnecessary withholding of this medication or use of alternative antiplatelet therapy which may be inferior or more costly. Aspirin therapy has been shown to reduce morbidity and mortality in patients with coronary artery disease. Rapid aspirin challenge/desensitization in the aspirin allergic patient has been consistently shown to be both safe and successful in patients with acute coronary syndromes.

  5. How safe is the prone position in acute respiratory distress syndrome at late pregnancy?

    Samanta, Sukhen; Samanta, Sujay; Wig, Jyotsna; Baronia, A K

    2014-06-01

    We encountered a case of severe acute respiratory distress syndrome in late pregnancy due to influenza (H1N1) with refractory hypoxemia to conventional mechanical ventilation. Ventilation in prone position rescued this patient by maintaining oxygenation and sustaining improvement thereafter. Here, we discuss the mechanism of prone ventilation with special references to safety management of acute respiratory distress syndrome in the third trimester of pregnancy. It requires frequent monitoring of possible complications due to prone position and highly dedicated supporting staffs. More data are required on safety of proning in the late pregnancy.

  6. Effects of escitalopram in prevention of depression in patients with acute coronary syndrome (DECARD)

    Hansen, Baiba Hedegaard; Hanash, Jamal Abed; Rasmussen, Alice

    2012-01-01

    Depression is a major problem in patients after acute coronary syndrome (ACS) with negative impact on survival and quality of life. No studies have examined prevention of post-ACS depression. We examined whether treatment with escitalopram can prevent post-ACS depression.......Depression is a major problem in patients after acute coronary syndrome (ACS) with negative impact on survival and quality of life. No studies have examined prevention of post-ACS depression. We examined whether treatment with escitalopram can prevent post-ACS depression....

  7. Treatment of compartment syndrome of the thigh associated with acute renal failure after the Wenchuan earthquake.

    Duan, Xin; Zhang, Kaiwei; Zhong, Gang; Cen, Shiqiang; Huang, Fuguo; Lv, Jingtong; Xiang, Zhou

    2012-04-01

    Compartment syndrome of the thigh is a rare emergency often treated operatively. The purpose of this study was to evaluate the effects of nonoperative treatment for compartment syndrome of the thigh associated with acute renal failure after the 2008 Wenchuan earthquake. Nonoperative treatment, which primarily involves continuous renal replacement therapy, was performed in 6 patients (3 men and 3 women) who presented with compartment syndrome of the thigh associated with acute renal failure. The mean mangled extremity severity score (MESS) and laboratory data regarding renal function were analyzed before and after treatment, and the clinical outcome was evaluated at 17-month follow-up. Laboratory data regarding renal function showed improvements. All 6 patients survived with the affected lower limbs intact after nonoperative treatment. Follow-up revealed active knee range of motion and increased muscle strength, as well as a recovery of sensation. A positive linear correlation was found between MESS and the time required to achieve a reduction in swelling, as well as the time required for the recovery of sensation and knee range of motion (r>0.8; P<.05). Satisfactory clinical outcomes were obtained in patients with compartment syndrome of the thigh associated with acute renal failure.Urine alkalization, electrolyte and water balance, and continuous renal replacement therapy have played an important role in saving lives and extremities. Nonoperative treatment should be considered in the treatment of compartment syndrome of the thigh associated with acute renal failure.

  8. Acute renal failure in a patient with Sheehan syndrome and rhabdomyolysis.

    Soltani, Parvin; Rezvanfar, Mohammad Reza; Pirasteh, Shadi

    2008-01-01

    We report a case of acute renal failure related to rhabdomyolysis in a patient with Sheehan syndrome, while other diseases that could cause rhabdomyolysis were excluded. The patient's kidney function completely recovered with 3 sessions of intermittent hemodialysis. After thyroxine replacement therapy, musculoskeletal symptoms disappeared and creatine kinase concentrations decreased. Steroid replacement therapy was also administered. The present case suggests that rhabdomyolysis could occur in a patient with Sheehan syndrome without other precipitating factors.

  9. Severe crush syndrome complicated with acute pancreatitis: a case report and review of the literatures

    LIU Fang; ZHANG Ling; FU Ping; SU Bai-hai; CHEN Xiao-lei; LIU Ling; CHEN Wei-xia; TAO Ye; HUANG Song-min

    2009-01-01

    @@ Earthquake is one of the most catastrophic natural disasters. As we know, crush syndrome is the second most frequent cause of mortality after the direct impact of trauma.~(1-3) It is a serious clinical case that develops among casualties of earthquakes or other catastrophic events that may also result in a variety of ensuing uncommon complications. Cases of crush syndrome complicated with acute pancreatitis (AP) following the earthquakes are seldom reported.

  10. Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome

    Loretta YC Yam; Alfred YF Chan; Thomas MT Cheung; Eva LH Tsui; Jane CK Chan; Vivian CW Wong

    2005-01-01

    Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support. We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease. Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database. Intubation rate, mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions (NIV Hospital) were compared against 13 hospitals using solely invasive ventilation (IMV Hospitals). Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups. Results Both hospital groups had comparable demographics and clinical profiles, but NIV Hospital (42 patients) had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement. Compared to IMV Hospitals (451 patients), NIV Hospital had lower adjusted odds ratios for intubation (0.36, 95% CI 0.164-0.791, P=0.011) and death (0.235, 95% CI 0.077-0.716, P=0.011), and improved earlier after pulsed steroid rescue. There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation, non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.

  11. Mosaic Down syndrome and acute lymphoblastic B cell-leukemia. Case report

    Parra-Baltazar, Isabel Mónica

    2016-10-01

    Full Text Available Down syndrome (DS or trisomy 21 is a constitutional chromosomal abnormality, which may be mosaic in 1 % to 4 % of cases. DS mosaic diagnosis is difficult because most patients have a normal phenotype and show no significant clinical abnormalities. Patients with DS have a higher risk of developing acute leukemia such as acute lymphoblastic leukemia (ALL. We report the case of a 19-year old woman with mosaic trisomy 21 and ALL.

  12. Should Immune-Enhancing Formulations Be Used for Patients With Acute Respiratory Distress Syndrome?

    Roosevelt, Hannah

    2016-08-01

    The potential for regulating immune function in acute respiratory distress syndrome (ARDS) through enteral-administered anti-inflammatory lipids has generated much interest over the past 20 years. Yet recommendations remain inconclusive regarding the utilization of ω-3 fatty acids in patients with ARDS and acute lung injury (ALI). Studies are limited in number, with differing methods, small sample sizes, and conflicting results, making recommendations difficult to interpret.

  13. Aldosterone does not predict cardiovascular events following acute coronary syndrome in patients initially without heart failure

    Pitts, Reynaria; Gunzburger, Elise; Ballantyne, Christie M.; Barter, Philip J.; Kallend, David; Leiter, Lawrence A.; Leitersdorf, Eran; Nicholls, Stephen J.; Prediman K Shah; Tardif, Jean-Claude; Olsson, Anders G.; McMurray, John J.V.; Kittelson, John; Schwartz, Gregory G.

    2017-01-01

    Background: Aldosterone may have adverse effects in the myocardium and vasculature. Treatment with an aldosterone antagonist reduces cardiovascular risk in patients with acute myocardial infarction complicated by heart failure (HF) and left ventricular systolic dysfunction. However, most patients with acute coronary syndrome do not have advanced HF. Among such patients, it is unknown whether aldosterone predicts cardiovascular risk.\\ud \\ud Methods and Results: To address this question, we exa...

  14. A clinical study of acute myocardial infarction with non-thyroid sick syndrome

    高婧

    2014-01-01

    Objective The prognosis of patients with acute myocardial infarction(AMI)is related to age,comorbidities and other factors,in which non-thyroid sick syndrome(NTIS)may also be an important factor.In this study,determination of blood free triiodothyronine(FT3)was used to explore the short-term and long-term mortality relationship of NTIS with acute myocardial infarction.Methods A total of 1 019 cases of newly

  15. Chest X-Ray

    Full Text Available ... breath, persistent cough, fever, chest pain or injury. It may also be useful to help diagnose and ... have some concerns about chest x-rays. However, it’s important to consider the likelihood of benefit to ...

  16. Rapunzel Syndrome: a rare cause of acute small bowel obstruction

    Dr. Vipul D Yagnik

    2010-07-01

    Full Text Available The Rapunzel syndrome is a very rare condition where trichobezoar has extended up to the small bowel. Here we are reporting a rare case of Rapunzel syndrome in an adolescent girl with history of trichophagia who presented with small bowel obstruction. Patient underwent exploratory laparotomy and bezoar was removed through gastrotomy. Post-operative course was unremarkable.

  17. Subclinical Carpal Tunnel Syndrome in Patients with Acute Stroke

    Soroosh Dabiri

    2012-07-01

    Full Text Available Background: Stroke is the first cause of morbidity all around the world. Entrapment neuropathies are a known complication of stroke. The objective of this study is to assess the frequency of subclinical carpal tunnel syndrome in the healthy and paretic hands of stroke patients.Methods: The authors performed nerve conduction study in the first three days after admission in 39 stroke patients without subclinical carpal tunnel syndrome and 30 days after admission. Electrophysiological studies were done in both paretic and non-paretic hands. Both ulnar and median nerves were studied.Results: After one month we found subclinical carpal tunnel syndrome in 16 paretic hands and 13 healthy hands. We did not find any difference in the frequency of carpal tunnel syndrome in two sides.Conclusion: The authors suggest that simultaneous different mechanisms may act in inducing carpal tunnel syndrome in both hands of hemiparetic patients.

  18. Trastuzumab (Herceptin)-associated cardiomyopathy presented as new onset of complete left bundle-branch block mimicking acute coronary syndrome: a case report and literature review.

    Tu, Chung-Ming; Chu, Kai-Ming; Yang, Shin-Ping; Cheng, Shu-Mung; Wang, Wen-Been

    2009-09-01

    Trastuzumab (Herceptin) is well documented in reducing suffering and mortality from breast cancer. The clinically most important side effect of Herceptin is cardiotoxicity, which is reported in 2.6% to 4.5% of patients receiving trastuzumab alone and in as many as 27% of patients when trastuzumab is combined with an anthracycline in metastatic disease. We reported the case of a 50-year-old woman who presented to our emergency department (ED) because of chest pain and shortness of breath. On physical examination, holosystolic murmur over apex could be heard. Pulmonary and abdominal examinations were unremarkable. Twelve-lead electrocardiography showed sinus tachycardia and new onset of complete left bundle-branch block. Emergent transthoracic echocardiography revealed generalized hypokinesia of left ventricle and akinesia over interventricular septum and apex. She subsequently underwent immediate coronary angiography that revealed normal coronary angiography, and left ventriculogram revealed generalized hypokinesia with severe left ventricle dysfunction with ejection fraction of 33%. During right heart catheterization and endomyocardial biopsy, cardiac tamponade developed and was successfully relieved by pericardial window. She was discharged event-free 3 weeks later with conservative treatment. Although new onset of complete left bundle-branch block in a patient with chest pain may be acute coronary syndrome, careful review of medicine history is mandatory to avoid unnecessary procedure and complications.

  19. Management of flail chest.

    Miller, H A; Taylor, G.A.; Harrison, A. W.; Maggisano, R.; Hanna, S.; de Lacy, J. L.; Shulman, H.

    1983-01-01

    This paper compares the management of two groups of patients with flail chest. The 25 patients in group 1 had a flail chest without other significant injuries or shock, whereas the 57 in group 2 had a flail chest with multiple injuries, shock or both. The group 1 patients were treated with repeated multiple intercostal nerve blocks or high segmental epidural analgesia, oxygen, intensive chest physiotherapy, fluid restriction, furosemide diuretics, methylprednisolone sodium succinate and collo...

  20. Decitabine Followed by Idarubicin and Cytarabine in Treating Patients With Relapsed or Refractory Acute Myeloid Leukemia or Myelodysplastic Syndromes

    2013-10-09

    Adult Acute Megakaryoblastic Leukemia (M7); 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 Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); 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 Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts