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Sample records for chest pain design

  1. Chest Pain

    Directory of Open Access Journals (Sweden)

    Samad Shams-Vahdati

    2014-03-01

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

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

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    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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    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...... manipulation of the cervical and thoracic spine, mobilisation, and soft tissue techniques. b) Advice promoting self-management and individual instructions focusing on posture and muscle stretch (advice group). Outcome measures are pain, physical function, overall health, self-perceived treatment effect...

  4. A rhythmic chest pain

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    Lorenzo Cristoni

    2013-11-01

    Full Text Available A middle-aged man with a history of ischemic heart disease presented at the emergency department having had a forty-minute long precordial pain at home and with an electrocardiogram showing a wide complex tachycardia with left bundle branch block shaped QRS. While preparing for urgent electrical cardioversion, the physician practiced a carotid sinus massage which helped to i unveil the supraventricular origin of the arrhythmia (by slowing down heart frequency and thus displaying p waves previously hidden and ii to exclude that the aberrancy was the expression of a transmural ischemia, thanks to the narrowing of the QRS complex. The final diagnosis was atrial tachycardia. The patient consequently received amiodarone IV and was discharged in normal sinus rhythm. We emphasize the importance of correctly diagnosing any rhythm disorder before administering the treatment, if the patient’s clinical condition permits it, in order to ensure the best treatment in urgency and the most appropriate prophylaxis.

  5. A study to derive a clinical decision rule for triage of emergency department patients with chest pain: design and methodology

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    Jaffe Allan

    2008-02-01

    Full Text Available Abstract Background Chest pain is the second most common chief complaint in North American emergency departments. Data from the U.S. suggest that 2.1% of patients with acute myocardial infarction and 2.3% of patients with unstable angina are misdiagnosed, with slightly higher rates reported in a recent Canadian study (4.6% and 6.4%, respectively. Information obtained from the history, 12-lead ECG, and a single set of cardiac enzymes is unable to identify patients who are safe for early discharge with sufficient sensitivity. The 2007 ACC/AHA guidelines for UA/NSTEMI do not identify patients at low risk for adverse cardiac events who can be safely discharged without provocative testing. As a result large numbers of low risk patients are triaged to chest pain observation units and undergo provocative testing, at significant cost to the healthcare system. Clinical decision rules use clinical findings (history, physical exam, test results to suggest a diagnostic or therapeutic course of action. Currently no methodologically robust clinical decision rule identifies patients safe for early discharge. Methods/design The goal of this study is to derive a clinical decision rule which will allow emergency physicians to accurately identify patients with chest pain who are safe for early discharge. The study will utilize a prospective cohort design. Standardized clinical variables will be collected on all patients at least 25 years of age complaining of chest pain prior to provocative testing. Variables strongly associated with the composite outcome acute myocardial infarction, revascularization, or death will be further analyzed with multivariable analysis to derive the clinical rule. Specific aims are to: i apply standardized clinical assessments to patients with chest pain, incorporating results of early cardiac testing; ii determine the inter-observer reliability of the clinical information; iii determine the statistical association between the clinical

  6. CARDIOVASCULAR DISORDERS IN ADOLESCENTS WITH CHEST PAIN

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    Sri Endah Rahayuningsih

    2014-06-01

    Full Text Available Objective: To detect cardiovascular abnormalities in adolescents with chest pain. Methods: In this cross sectional study, the subjects were 25 adolescents with chest pain who came to the Cardiac Center of Dr. Hasan Sadikin General Hospital, Bandung during the period of January 2008 to January 2011. The presence of established cardiovascular disorders were based on history, physical examination, electrocardiography and echocardiography Results: It was found that 13/25 adolescents with chest pain had cardiovascular abnormalities. Of the 25 teens that came with chest pain, most of which showed normal electrocardiographic results, only 9/25 of those with dysrhythmias experienced sinus tachycardia and 8 had a first degree AV block. Echocardiography examination showed only four patients with abnormal cardiac anatomy. No correlation between nutritional status and chest pain, and cardiovascular abnormalities and chest pain (p=0.206 and p=0.632, respectively. There was a positive correlation between sex and cardiovascular abnormalities in adolescents with chest pain (p=0.007. Chest pain is a prevalent problem that is usually benign and that it frequently signals underlying cardiac disease. Conclusions: Cardiovascular abnormalities in adolescents with symptoms of chest pain are found in some cases. There is no correlation between female and male adolescents with chest pain and cardiovascular abnormalities.

  7. Chest pain and exacerbations of bronchiectasis

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    King PT

    2012-12-01

    Full Text Available Paul T King,1,2 Stephen R Holdsworth,2 Michael Farmer,1 Nicholas J Freezer,1 Peter W Holmes11Department of Respiratory and Sleep Medicine, 2Monash University Department of Medicine, Monash Medical Centre, Melbourne, Victoria, AustraliaBackground: Bronchiectasis is a common disease and a major cause of respiratory morbidity. Chest pain has been described as occurring in the context of bronchiectasis but has not been well characterized. This study was performed to describe the characteristics of chest pain in adult bronchiectasis and to define the relationship of this pain to exacerbations.Subjects and methods: We performed a prospective study of 178 patients who were followed-up for 8 years. Subjects were reviewed on a yearly basis and assessed for the presence of chest pain. Subjects who had chest pain at the time of clinical review by the investigators were included in this study. Forty-four patients (25% described respiratory chest pain at the time of assessment; in the majority of cases 39/44 (89%, this occurred with an exacerbation and two distinct types of chest pain could be described: pleuritic (n = 4 and non-pleuritic (n = 37, with two subjects describing both forms. The non-pleuritic chest pain occurred most commonly over both lower lobes and was mild to moderate in severity. The pain subsided as patients recovered. Conclusion: Non-pleuritic chest pain occurs in subjects with bronchiectasis generally in association with exacerbations.Keywords: sputum, collapse, bronchitis, airway obstruction

  8. [Chest pains in the dental environment].

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    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.

  9. Chest pain of cardiac and noncardiac origin.

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    Lenfant, Claude

    2010-10-01

    Chest pain is one of the most common symptoms driving patients to a physician's office or the hospital's emergency department. In approximately half of the cases, chest pain is of cardiac origin, either ischemic cardiac or nonischemic cardiac disease. The other half is due to noncardiac causes, primarily esophageal disorder. Pain from either origin may occur in the same patient. In addition, psychological and psychiatric factors play a significant role in the perception and severity of the chest pain, irrespective of its cause. Chest pain of ischemic cardiac disease is called angina pectoris. Stable angina may be the prelude of ischemic cardiac disease; and for this reason, it is essential to ensure a correct diagnosis. In most cases, further testing, such as exercise testing and angiography, should be considered. The more severe form of chest pain, unstable angina, also requires a firm diagnosis because it indicates severe coronary disease and is the earliest manifestation of acute myocardial infarction. Once a diagnosis of stable or unstable angina is established, and if a decision is made not to use invasive therapy, such as coronary bypass, percutaneous transluminal coronary angioplasty, or stent insertion, effective medical treatment of associated cardiac risk factors is a must. Acute myocardial infarction occurring after a diagnosis of angina greatly increases the risk of subsequent death. Chest pain in women warrants added attention because women underestimate their likelihood to have coronary heart disease. A factor that complicates the clinical assessment of patients with chest pain (both cardiac and noncardiac in origin) is the relatively common presence of psychological and psychiatric conditions such as depression or panic disorder. These factors have been found to cause or worsen chest pain; but unfortunately, they may not be easily detected. Noncardiac chest pain represents the remaining half of all cases of chest pain. Although there are a number of

  10. Chest pain: a time for concern?

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    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.

  11. Psychiatric syndromes associated with atypical chest pain

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    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

  12. CARDIOVASCULAR DISORDERS IN ADOLESCENTS WITH CHEST PAIN

    OpenAIRE

    Sri Endah Rahayuningsih; Rahmat Budi; Herry Garna

    2014-01-01

    Objective: To detect cardiovascular abnormalities in adolescents with chest pain. Methods: In this cross sectional study, the subjects were 25 adolescents with chest pain who came to the Cardiac Center of Dr. Hasan Sadikin General Hospital, Bandung during the period of January 2008 to January 2011. The presence of established cardiovascular disorders were based on history, physical examination, electrocardiography and echocardiography Results: It was found that 13/25 adolesce...

  13. CNE article: pain after lung transplant: high-frequency chest wall oscillation vs chest physiotherapy.

    Science.gov (United States)

    Esguerra-Gonzalez, Angeli; Ilagan-Honorio, Monina; Fraschilla, Stephanie; Kehoe, Priscilla; Lee, Ai Jin; Marcarian, Taline; Mayol-Ngo, Kristina; Miller, Pamela S; Onga, Jay; Rodman, Betty; Ross, David; Sommer, Susan; Takayanagi, Sumiko; Toyama, Joy; Villamor, Filma; Weigt, S Samuel; Gawlinski, Anna

    2013-03-01

    Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n=22) or vice versa (group 2, n=23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ(2) and t tests and repeated-measures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P =.04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] vs 2 [15%], P=.01). However, single lung recipients showed no significant difference in preference between the 2 treatments (11 [42%] vs 14 [54%]). Conclusions HFCWO seems to provide greater decreases in pain scores than does chest physiotherapy. Bilateral lung transplant recipients preferred HFCWO to chest physiotherapy. HFCWO may be an effective, feasible alternative to chest physiotherapy. (American Journal of Critical Care. 2013;22:115-125).

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

    Science.gov (United States)

    1988-02-25

    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

  15. Tuberculous spondylitis presenting as severe chest pain

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    Martha A. Kaeser

    2012-04-01

    Full Text Available This case report describes a 32-year-old male who presented to an emergency department with severe chest pain and a history of cough, fever, night sweats, loss of appetite and weight. Chest radiography revealed a left upper lobe consolidation and multiple compression deformities in the thoracic spine. Magnetic resonance imaging demonstrated significant kyphosis and vertebral plana at two thoracic levels. Anterior compression of the spinal cord and adjacent soft tissue masses were also noted.

  16. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

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    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila

    2013-01-01

    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. PMID:27122690

  17. The HEART score for chest pain patients

    NARCIS (Netherlands)

    Backus, B.E.

    2012-01-01

    The HEART score was developed to improve risk stratification in chest pain patients in the emergency department (ED). This thesis describes series of validation studies of the HEART score and sub studies for individual elements of the score. The predictive value of the HEART score for the occurrence

  18. Chest pain in focal musculoskeletal disorders

    DEFF Research Database (Denmark)

    Stochkendahl, Mette Jensen; Christensen, Henrik Wulff

    2010-01-01

    overlapping conditions and syndromes of focal disorders, including Tietze syndrome, costochondritis, chest wall syndrome, muscle tenderness, slipping rib, cervical angina, and segmental dysfunction of the cervical and thoracic spine, have been reported to cause pain. For most of these syndromes, evidence...

  19. The Funen Neck and Chest Pain study

    DEFF Research Database (Denmark)

    Fejer, René; Hartvigsen, Jan; Kyvik, Kirsten Ohm

    2006-01-01

    OBJECTIVE: To describe the Funen Neck and Chest Pain (FNCP) study and carry out a comprehensive non-response analysis of the quality of the survey. METHODS: The FNCP questionnaire was sent out to 7000 randomly selected individuals aged 20-71 years living in Funen County, Denmark. A full description...

  20. Examination of musculoskeletal chest pain

    DEFF Research Database (Denmark)

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

    2010-01-01

    using a standardized examination protocol, (2) to determine inter-observer reliability of single components of the protocol, and (3) to determine the effect of observer experience. Eighty patients were recruited from an emergency cardiology department. Patients were eligible if an obvious cardiac or non......-cardiac diagnosis could not be established at the cardiology department. Four observers (two chiropractors and two chiropractic students) performed general health and manual examination of the spine and chest wall. Percentage agreement, Cohen's Kappa and ICC were calculated for observer pairs (chiropractors.......01 to 0.59. Provided adequate training of observers, the examination protocol can be used in carefully selected patients in clinical settings and should be included in pre- and post-graduate clinical training....

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  2. An Atypical Cause of Atypical Chest Pain

    OpenAIRE

    2014-01-01

    The present report describes a case involving a 57-year-old HIV-positive man who presented with acute retrosternal chest pain accompanied by 24 h of fever. Septic arthritis of the manubriosternal joint was diagnosed based on magnetic resonance imaging findings in addition to Staphylococcus aureus bacteremia. To the authors’ knowledge, the present case is only the 12th reported case of manubriosternal septic arthritis, and the first in an HIV-positive patient. Early diagnosis and treatment can...

  3. Chest pain associated with moderator band pacing.

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    Goli, Anil K; Kaszala, Karoly; Osman, Mohammed N; Lucke, John; Carrillo, Roger

    2014-10-01

    A 65-year-old man was evaluated for chronic chest pain that had been present for 8 years after placement of a dual-chamber implantable cardioverter-defibrillator to treat inducible ventricular tachycardia. Previous coronary angiography had revealed nonobstructive coronary artery disease and a left ventricular ejection fraction of 0.45 to 0.50, consistent with mild idiopathic nonischemic cardiomyopathy. Evaluation with chest radiography and transthoracic echocardiography showed the implantable cardioverter-defibrillator lead to be embedded within the right ventricle at the moderator band, which had mild calcification. Treatment included extraction of the dual-coil lead and placement of a new single-coil right ventricular lead at the mid septum. The patient had complete relief of symptoms after the procedure. This case shows that chest pain can be associated with the placement of a right ventricular implantable cardioverter-defibrillator lead in the moderator band and that symptomatic relief can occur after percutaneous lead extraction and the implantation of a new right ventricular lead to the mid septal region.

  4. Taking heartache to heart: Empirical psychological modelling of chest pain

    NARCIS (Netherlands)

    A.W. Serlie (Alec)

    1996-01-01

    textabstractThe chest pain of patients visiting a cardiology out-patient's clinic is most often caused by coronary atherosclerosis, which induces an oxygen shortage in the heartmuscle and thereby pain. However, in approximately 30% of the chest pain patients no clear somatic cause can be found. Cont

  5. Staphylococcus aureus sternal osteomyelitis: a rare cause of chest pain

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    Kaur M

    2015-10-01

    Full Text Available Chest pain is a common presenting symptom with a broad differential. Life-threatening cardiac and pulmonary etiologies of chest pain should be evaluated first. However, it is critical to perform a thorough assessment for other sources of chest pain in order to limit morbidity and mortality from less common causes. We present a rare case of a previously healthy 45 year old man who presented with focal, substernal, reproducible chest pain and Staphylococcus aureus bacteremia who was later found to have primary Staphylococcus aureus sternal osteomyelitis.

  6. An atypical cause of atypical chest pain.

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    Zaheen, Ahmad; Siemieniuk, Reed A; Gudgeon, Patrick

    2014-09-01

    The present report describes a case involving a 57-year-old HIV-positive man who presented with acute retrosternal chest pain accompanied by 24 h of fever. Septic arthritis of the manubriosternal joint was diagnosed based on magnetic resonance imaging findings in addition to Staphylococcus aureus bacteremia. To the authors' knowledge, the present case is only the 12th reported case of manubriosternal septic arthritis, and the first in an HIV-positive patient. Early diagnosis and treatment can circumvent the need for surgical intervention. Based on the present case report and review of the literature, the authors summarize the epidemiology, appropriate imaging and suggestions for antibiotic therapy for this rare presentation.

  7. An Atypical Cause of Atypical Chest Pain

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    Ahmad Zaheen

    2014-01-01

    Full Text Available The present report describes a case involving a 57-year-old HIV-positive man who presented with acute retrosternal chest pain accompanied by 24 h of fever. Septic arthritis of the manubriosternal joint was diagnosed based on magnetic resonance imaging findings in addition to Staphylococcus aureus bacteremia. To the authors’ knowledge, the present case is only the 12th reported case of manubriosternal septic arthritis, and the first in an HIV-positive patient. Early diagnosis and treatment can circumvent the need for surgical intervention. Based on the present case report and review of the literature, the authors summarize the epidemiology, appropriate imaging and suggestions for antibiotic therapy for this rare presentation.

  8. Sexual, Physical, Verbal/Emotional Abuse and Unexplained Chest Pain

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    Eslick, Guy D.; Koloski, Natasha A.; Talley, Nicholas J.

    2011-01-01

    Objectives: Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained…

  9. Comparison of Depression, Anxiety, and Stress Between Mild and Severe Non-cardiac Chest Pain

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    Bahremand

    2016-05-01

    Full Text Available Background Physical and psychological factors affect one another in patients presenting with non-cardiac chest pain. Studying the psychological components of these patients may improve their treatment process. Objectives To compare depression, anxiety, and stress severity between mild and severe chest pain in patients with non-cardiac chest pain. Patients and Methods A cross-sectional design was used. The statistical population comprised patients with non-cardiac chest pain admitted to the Heart Emergency Center in Kermanshah, Iran. Using a matching method, 94 participants with mild and severe non-cardiac chest pain were selected and studied in two groups of 47. The instruments used in this study include the Comorbidity Index, the brief pain index (BPI, and the depression, anxiety, and stress scale (DASS. The multivariate analysis of variance, chi-squared test, and t-test were used for data analysis. Results After adjusting for the effects of age and comorbid conditions, results showed that there was a significant difference between the two groups in terms of depression, anxiety, and stress; the severity of these variables was exacerbated in patients with severe chest pain (P < 0.001. Conclusions Depression, anxiety, and stress are common psychological components in patients with non-cardiac chest pain especially those with severe chest pain and it is essential that health professionals pay attention to these factors. Therefore, paying attention to psychological factors could help experts to choose solutions that will decrease pain and side effects of the diseases. It may also facilitate treatment procedures among patients in severe pain. Further investigation to determine the association between these variables and non-cardiac chest pain should be considered.

  10. Relationship between chest pain severity and physiological indexes in patients with coronary artery disease

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    Ali Fakhr-Movahedi

    2016-05-01

    Full Text Available Background: Coronary artery disease is considered as main factor for patients’ hospitalization. Chest pain is the most common symptoms of patients and its assessment is an important factor in coronary artery disease. So, this study aimed to determine the relationship between the severity of chest pain with physiological indexes in patients with coronary artery disease. Methods: This study was a descriptive-analytical design that performed on 80 patients with that were hospitalized in coronary care unit of Shahid Mofatteh Hospital in Varamin city, Iran, from March to September, 2014. In this study, the relationship between the chest pain severity and blood pressure, pulse rate, respiratory rate, O2 saturation and ST segment alterations were assessed. Finally, the gathered data were analyzed by descriptive and inferential statistics. Results: The mean of chest pain severity was 6.51±2.14 in patients. Patients’ age was between 26 to 85 years old and the mean of age was 60.79±13.79 and there was no significant correlation between age and chest pain severity (P=0.985. Also male and female patients were equal. There was no significant difference between chest pain severity of men and women (P=0.471. The findings of study showed no correlation between chest pain severity and heart rate (r=-0.174 and P=0.122, respiratory rate (r=-0.013 and P=0.909, O2 saturation (r=0.051 and P=0.651, ST segment alterations (r=0.07 and P=0.539. Also, there was no significant difference between chest pain severity and systolic pressure (P=0.353, diastolic blood pressure (P=0.312 and body mass index (P=0.256 among patients. Conclusion: In this study, there were not enough evidences for relation between chest pain and physiological indexes in patients with coronary artery disease. So performing more studies in another settings and conditions recommended.

  11. Postpartum Pneumomediastinum: An Uncommon Cause for Chest Pain

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    Vladimir Revicky

    2010-01-01

    Full Text Available This case report refers to a 32-year-old primiparous woman with a mild asthma, who had a normal vaginal delivery in a birthing pool and developed an acute postpartum chest pain due to pneumomediastinum and subcutaneous chest emphysema. After 72 hours of observation, she was discharged home without any residual symptoms.

  12. Part Ⅱ The Typical Cases of Chest Pain Syndrome

    Institute of Scientific and Technical Information of China (English)

    Pan Xingfang; Shang Xiaohong

    2001-01-01

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

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

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    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.

  14. [Chest pain - not always the heart! Clinical impact of gastrointestinal diseases in non-cardiac chest pain].

    Science.gov (United States)

    Frieling, T; Bergdoldt, G; Allescher, H D; Riemann, J F

    2015-02-01

    Non cardiac chest pain (NCCP) are recurrent angina pectoris like pain without evidence of coronary heart disease in conventional diagnostic evaluation. The prevalence of NCCP is up to 70 % and may be detected in this order at all levels of the medical health care system (general practitioner, emergency department, chest pain unit, coronary care). Reduction of quality of life in NCCP is comparable, partially even higher compared to cardiac chest pain. Reasons for psychological strain are symptom recurrence in app. 50 %, nonspecific diagnosis with resulting uncertainty and insufficient integration of other medical disciplines in diagnostic work-up. Managing of patients with NCCP has to be interdisciplinary because non cardiac causes of chest pain may be found frequently. Especially gastroenterological expertise is required because in 50 - 60 % of cases gastroesophageal reflux disease (GERD), in 15 - 18 % hypercontractile esophageal motility disorders with nutcracker, jackhammer esophagus or distal esophageal spasmus or achalasia and in 32 - 35 % other esophageal alterations (e. g. infectious esophageal inflammation, drug-induced ulcer, rings, webs, eosinophilic esophagitis) as cause of chest pain may be detected. This implicates that regular interdisciplinary round wards and management of chest pain units are mandatory.

  15. A Clinical Trial of a Computer Diagnosis Program for Chest Pain

    Science.gov (United States)

    1990-12-07

    infection, myocardial infarction, and non-specific chest pain. The category " Angina " included both stable and unstable angina . Chest infection was...is suitable for use by corpsmen at sea. THE FINDINGS 132 patients with confirmed diagnoses of chest pain (myocardial infarction, angina , chest ...sea with chest pain. The diagnostic accuracy of the program for three common and serious causes of chest pain -- myocardial infarction (MI), angina

  16. Computer Assisted Diagnosis of Chest Pain. Preliminary Manual

    Science.gov (United States)

    1984-04-27

    recent change In appetite) "NORMAL (57) DECREASED. BOWELS: [recent change in bowel habits ) NORMAL 159) CONSTIPATED fi60tf cough...irritation from food or drink, by reflux of gastric contents, or by infection (the latter is uncommon in healthy people). There is a good response to...have a physical etiology for chest pain. Disorders that present with epigastric pain such as gastritis , peptic ulcer, pancreatitis, and cholelithiasis

  17. Diagnosis of chest pain with foregut symptoms in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    Bo Deng; Ru-Wen Wang; Yao-Guang Jiang; Qun-You Tan; Xiang-Li Liao; Jing-Hai Zhou; Yun-Ping Zhao; Tai-Qian Gong; Zheng Ma

    2009-01-01

    AIM: To evaluate the diagnosis of chest pain with foregut symptoms in Chinese patients. METHODS: Esophageal manomet r ic studies, 24-h introesophageal pH monitoring and 24-h electrocardiograms (Holter electrocardiography) were performed in 61 patients with chest pain. RESULTS: Thirty-nine patients were diagnosed with non-specific esophageal motility disorders (29 patients with abnormal gastroesophageal reflux and eight patients with myocardial ischemia). Five patients had diffuse spasm of the esophagus plus abnormal gastroesophageal reflux (two patients had concomitant myocardial ischemia), and one patient was diagnosed with nutcracker esophagus. CONCLUSION: The esophageal manometric studies, 24-h intra-esophageal pH monitoring and Holter electrocardiography are significant for the differential diagnosis of chest pain, particularly in patients with foregut symptoms. In cases of esophageal motility disorders, pathological gastroesophageal reflux may be a major cause of chest pain with non-specific esophageal motility disorders. Spasm of the esophageal smooth muscle might affect the heart-coronary smooth muscle, leading to myocardial ischemia.

  18. Illness perceptions, negative emotions, and pain in patients with noncardiac chest pain.

    Science.gov (United States)

    Israel, Jared I; White, Kamila S; Gervino, Ernest V

    2015-03-01

    Illness-specific cognitions are associated with outcomes in numerous health conditions, however, little is known about their role in noncardiac chest pain (NCCP). NCCP is prevalent, impairing, and associated with elevated health care utilization. Our objective was to investigate the relations between illness perceptions, emotion, and pain in a sample of 196 adult patients diagnosed with NCCP. We found that negative illness perceptions were associated with greater anxiety, depression, chest pain, and pain-related life interference while controlling for the effects of demographic and pain-related variables. These results expand current NCCP theory and may inform future treatment development.

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

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

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

  20. [Psychosomatic medicine for non-cardiac chest pain].

    Science.gov (United States)

    Funakoshi, Seiko; Hosoi, Masako; Tsuchida, Osamu

    2009-09-01

    Recently, it has become problematic that the number of noncardiac chest pain (NCCP) patients are increasing among those who come to the emergency room with chest pain as a chief complaint. They tend to come to hospitals often and over many years, even after cardiac-chest pain has been excluded from their diagnosis. Moreover, studies have shown that NCCP patients have a high prevalence of anxiety, depression and disability. However, most NCCP patients are usually treated by cardiologists or primary physicians. Ordinary biomedical approaches often fail to treat NCCP. NCCP is one of the most important functional somatic syndromes from the view of medical economics. The cause of NCCP includes gastroesophageal reflux disease, panic disorder and esophageal dysmotility. In this review article, we summarize the definition, epidemiology, pathology, and process of diagnosis of NCCP. Finally, we propose a pathological hypothesis from a psychosomatic view. We discuss the effects of anxiety, fear and hyperactive behavior induced by affective stressors on the dysmotility and the lowering of the pain threshold.

  1. Chest Pain: The Need to Consider Less Frequent Diagnosis

    Science.gov (United States)

    Morais, Anabela; Carvalho, Sofia; Cunha, Joana; Lima, Ana R.; Moreira, J. Ilídio; Faria, Trigo

    2016-01-01

    Chest pain is one of the most frequent patient's complaints. The commonest underlying causes are well known, but, sometimes, in some clinical scenarios, it is necessary to consider other diagnoses. We report a case of a 68-year-old Caucasian male, chronically hypertensive, who complained of recurrent episodes of chest pain and fever with elevated acute phase reactants. The first investigation was negative for some of the most likely diagnosis and he quickly improved with anti-inflammatory drugs. Over a few months, his symptoms continued to recur periodically, his hypertension was aggravated, and he developed headaches and lower limbs claudication. After a temporal artery biopsy that was negative for vasculitis, he underwent a positron emission tomography suggestive of Takayasu Arteritis. Takayasu Arteritis is a rare chronic granulomatous vasculitis of the aorta and its first-order branches affecting mostly females up to 50 years old. Chest pain is experienced by >40% of the patients and results from the inflammation of the aorta, pulmonary artery, or coronaries. PMID:27034853

  2. Chest Pain: The Need to Consider Less Frequent Diagnosis

    Directory of Open Access Journals (Sweden)

    Pedro Magalhães

    2016-01-01

    Full Text Available Chest pain is one of the most frequent patient’s complaints. The commonest underlying causes are well known, but, sometimes, in some clinical scenarios, it is necessary to consider other diagnoses. We report a case of a 68-year-old Caucasian male, chronically hypertensive, who complained of recurrent episodes of chest pain and fever with elevated acute phase reactants. The first investigation was negative for some of the most likely diagnosis and he quickly improved with anti-inflammatory drugs. Over a few months, his symptoms continued to recur periodically, his hypertension was aggravated, and he developed headaches and lower limbs claudication. After a temporal artery biopsy that was negative for vasculitis, he underwent a positron emission tomography suggestive of Takayasu Arteritis. Takayasu Arteritis is a rare chronic granulomatous vasculitis of the aorta and its first-order branches affecting mostly females up to 50 years old. Chest pain is experienced by >40% of the patients and results from the inflammation of the aorta, pulmonary artery, or coronaries.

  3. Evaluation of chest pain in the emergency department.

    Science.gov (United States)

    Jesse, R L; Kontos, M C

    1997-04-01

    The evaluation of chest pain in the emergency setting should be systematic, risk based, and goal driven. An effective program must be able to evaluate all patients with equal thoroughness under the assumption that any patient with chest pain could potentially be having an MI. The initial evaluation is based on the history, a focused physical examination, and the ECG. This information is sufficient to categorize patients into groups at high, moderate, and low risk. Table 14 is a template for a comprehensive chest-pain evaluation program. Patients at high risk need rapid initiation of appropriate therapy: thrombolytics or primary angioplasty for the patients with MIs or aspirin/heparin for the patients with unstable angina. Patients at moderate risk need to have an acute coronary syndrome ruled in or out expediently and additional comorbidities addressed before discharge. Patients at low risk also need to be evaluated, and once the likelihood of an unstable acute coronary syndrome is eliminated, they can be discharged with further evaluation performed as outpatients. Subsequent evaluation should attempt to assign a definitive diagnosis while also addressing issues specific to risk reduction, such as cholesterol lowering and smoking cessation. It is well documented that 4% to 5% of patients with MIs are inadvertently missed during the initial evaluation. This number is surprisingly consistent among many studies using various protocols and suggests that an initial evaluation limited to the history, physical examination, and ECG will fail to identify the small number of these patients who otherwise appear at low risk. The solution is to improve the sensitivity of the evaluation process to identify these patients. It appears that more than simple observation is required, and at the present time, no simple laboratory test can meet this need. However, success has been reported with a number of strategies including emergency imaging with either radionuclides such as

  4. Retroperitoneal Paraganglioma Presenting as a Chest Pain: A Case Report

    Directory of Open Access Journals (Sweden)

    Parag Brahmbhatt

    2013-01-01

    Full Text Available Paragangliomas are very rare tumors derived from neuroendocrine cells of autonomic nervous system. Extra-adrenal paragangliomas account for only 10 to 15% of all paragangliomas and may present incidentally as a mass. Typical triad of fluctuating hypertension, headache, and sweating is not always present which makes the diagnosis difficult sometimes. Definitive diagnosis is usually made with histologic findings and surgery is the treatment of choice. We report a case of a 53-year-old male who presented with chest pain and vomiting.

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

    OpenAIRE

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

    1984-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    Dong Hongying; Guo Ling; Shang Xiukui

    2001-01-01

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

  7. It's Not Your Heart: Group Treatment for Non-Cardiac Chest Pain

    Science.gov (United States)

    Hess, Sherry M.

    2011-01-01

    This article presents a brief group psychoeducational treatment for non-cardiac chest pain, supplemented with a composite case study. Patients present to emergency rooms for chest pain they believe is a heart attack symptom. When cardiac testing is negative, this pain is usually a panic symptom, often occurring with a cluster of other panic…

  8. Esophageal Manometry in Patients with Chest Pain and Normal Coronary Arteriogram.

    Science.gov (United States)

    Ferguson, S C; Hodges, K; Hersh, T; Jinich, H

    1981-02-01

    Evaluation of the esophagus is helpful in determining the source of chest pain. Eighteen per cent of 72 patients with a normal coronary angiogram had esophageal disease as a source of chest pain. Eight had diffuse esophageal spasm, four had reflux esophagitis and one had an esophageal ulcer. Five of eight patients with diffuse esophageal spasm had relief of symptoms with nitroglycerin. Despite normal coronary arteriogram and normal esophageal manometry 42 of 49 other patients had relief of chest pain with nitroglycerin.

  9. Evaluation and Management of Patients with Noncardiac Chest Pain

    Directory of Open Access Journals (Sweden)

    C. Shekhar

    2008-01-01

    Full Text Available Up to a third of patients undergoing coronary angiography for angina-like chest pain are found to have normal coronary arteries and a substantial proportion of these individuals continue to consult and even attend emergency departments. Initially, these patients are usually seen by cardiologists but with accumulating evidence that the pain might have a gastrointestinal origin, it may be more appropriate for them to be cared for by the gastroenterologist once a cardiological cause has been excluded. This review covers the assessment and management of this challenging condition, which includes a combination of education, reassurance, and pharmacotherapy. For the more refractory cases, behavioral treatments, such as cognitive behavioral therapy or hypnotherapy, may have to be considered.

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  11. Experimental human pain models in gastro-esophageal reflux disease and unexplained chest pain

    Institute of Scientific and Technical Information of China (English)

    Asbj(φ)rn Mohr Drewes; Lars Arendt-Nielsen; Peter Funch-Jensen; Hans Gregersen

    2006-01-01

    Methods related to experimental human pain research aim at activating different nociceptors, evoke pain from different organs and activate specific pathways and mechanisms. The different possibilities for using mechanical, electrical, thermal and chemical methods in visceral pain research are discussed with emphasis of combinations (e.g., the multimodal approach). The methods have been used widely in assessment of pain mechanisms in the esophagus and have contributed to our understanding of the symptoms reported in these patients. Hence abnormal activation and plastic changes of central pain pathways seem to play a major role in the symptoms in some patients with gastro-esophageal reflux disease and in patients with functional chest pain of esophageal origin. These findings may lead to an alternative approach for treatment in patients that does not respond to conventional medical or surgical therapy.

  12. Reconstruction of the decision-making process in assessing musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Stochkendahl, Mette J; Vach, Werner; Hartvigsen, Jan;

    2012-01-01

    The purposes of this study were to identify the most important determinants from the patient history and clinical examination in diagnosing musculoskeletal chest pain (MSCP) in patients with acute noncardiac chest pain when supported by a structured protocol and to construct a decision tree...

  13. COMPARISON OF TWO ANALGESIA TECHNIQUES FOR PAIN MANAGEMENT DURING CHEST TUBE REMOVAL AFTER CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    Gaurav

    2015-10-01

    Full Text Available BACKGROUND: This study aims to compare of two analgesia techniques for pain management during chest tube removal (CTR after cardiac surgery. Two groups were compared in terms of pain, sedation levels, and hemodynamic response removal of chest tube. METHODS: The study was designed as a prospective, randomized, double - blinded study. Forty patients who underwent coronary artery bypass graft (CABG surgery were enrolled. In postoperative period intravenous fentanyl 1μg/kg was given five minutes prior to chest tube removal (CTR. Each patient was explained about CTR procedure and VAS scoring charts. The patients were randomized into two groups as study group ( G roup S and control group ( G roup C. All patients received either adrenaline free xylocaine 2% infiltration ( G roup S, 6 ml around each of three chest tube (2 mediastinal + 1 pleural or normal saline 0.9% ( G roup C in double blind manner. Severity of pa in was recorded by asking Visual analogue scale (VAS from the patients. Faces rating scale (FRS, Behavioral rating scale (BRS and Ramsay sedation score (RSS along with hemodynamic data were also recorded, blinding to group at four time intervals; at baseline (T base , 2min ( T2m, 5 min (T5m 10 min (T10mand 20 min (T 20m. after CTR. RESULTS : The demographic characteristics of the patients in both groups were similar. Before chest tubes removal (CTR, all the scores of pain intensity (VAS, pain distress (FRS, BRS and sedation levels (RSS were comparable, but they differ significantly at T2, T5, and T10. However, these scores were comparable at T20. Patients remained alert and comfortable after 20 CTR regardless of which group they were assigned . CONCLUSION : Intravenous fentanyl 1μg/kg along with local infiltration of 2% xylocaine can substa ntially reduce pain and better regime than Intravenous fentanyl 1μg/kg alone during chest tube removal in post - coronary artery bypass graft surgery patients. Both techniques are equally safe in terms

  14. [Vertebrogenic chest pain--"pseudoangina pectoris": etiopathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy].

    Science.gov (United States)

    Grgić, Vjekoslav

    2007-01-01

    Vertebrogenic pain localised in the anterior thorax can imitate anginal pain ("pseudoangina pectoris"). The most common causes of vertebrogenic chest pain are segmental dysfunction and degenerative changes at the level of the lower cervical and upper middle thoracic spine. Segmental dysfunction is a source of pseudoradicular pain, and degenerative changes, before all disc hernia and dorsal osteophytes which are compressing corresponding nerve roots, are the sources of radicular pain which irradiates in the chest. Because of its similarity with angina pectoris, the intense chest pain caused by the cervical radiculopathy which is often followed by heart rhythm disorders and nonspecific changes of the ST-T-segment in ECG, is called "cervicogenic angina". The attacks of vertebrogenic chest pain are not rare even in patients with angina pectoris. Because of superimposed vertebrogenic pain, the manifestation of pain in patients with angina pectoris can be considerably changed which can be misinterpreted as unstable angina. From therapeutic aspect it is very important to distinguish vertebrogenic from anginal pain. That is, the change of cardiological therapy will not eliminate possible attacks of vertebrogenic pain in patients with angina pectoris. From the aspect of most recent understandings, the article describes etiopathogenesis, characteristics, diagnosis and therapy of vertebrogenic chest pain, and also the differences between vertebrogenic and anginal pain.

  15. 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.

    Science.gov (United States)

    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.

  16. Clinical assessment of chest pain and guidelines for imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gruettner, J., E-mail: joachim.gruettner@umm.de [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Henzler, T. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Sueselbeck, T. [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Fink, C. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany); Borggrefe, M.; Walter, T. [1st Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim (Germany)

    2012-12-15

    For many emergency facilities, risk assessment of patients with diffuse chest pain still poses a major challenge. In their currently valid recommendations, the international cardiological societies have defined a standardized assessment of the prognostically relevant cardiac risk criteria. Here the classic sequence of basic cardiac diagnostics including case history (cardiac risk factors), physical examination (haemodynamic and respiratory vital parameters), ECG (ST segment analysis) and laboratory risk markers (troponin levels) is paramount. The focus is, on the one hand, on timely indication for percutaneous catheterization, especially in patients at high cardiac risk with or without ST-segment elevation in the ECG, and, on the other hand, on the possibility of safely discharging patients with intermediate or low cardiac risk after non-invasive exclusion of a coronary syndrome. For patients in the intermediate or low risk group, physical or pharmacological stress testing in combination with scintigraphy, echocardiography or magnetic resonance imaging is recommended in addition to basic diagnostics. Moreover, the importance of non-invasive coronary imaging, primarily cardiac CT angiography (CCTA), is increasing. Current data show that in intermediate or low risk patients this method is suitable to reliably rule out coronary heart disease. In addition, attention is paid to the major differential diagnoses of acute coronary syndrome, particularly pulmonary embolism and aortic dissection. Here the diagnostic method of choice is thoracic CT, possibly also in combination with CCTA aiming at a triple rule-out.

  17. Takotsubo cardiomyopathy: an overlooked cause of chest pain

    Directory of Open Access Journals (Sweden)

    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.

  18. Unexplained Chest Pain and Physical Activity: Balancing Between Existential Uncertainty and Certainty.

    Science.gov (United States)

    Røysland, Ingrid Ølfarnes; Friberg, Febe

    2016-01-01

    Chest pain is one of the most common complaints in medical settings, but the majority of cases have no detectable cause. Physical activity is recommended, but is one of the major avoidance behaviors in patients with coronary heart disease. The article aims at achieving an understanding of the meaning of physical activity for people with unexplained chest pain. Fifteen people were interviewed using a phenomenological hermeneutic approach, with the results revealing four themes: "awareness of the influence of previous life experiences on the decision to be physically active," "unanswered questions related to physical activity and unexplained chest pain," "intertwinement of body and mind," and "physical activity as a source of personal growth." Comprehensive understanding was formulated as "Being physically active while living with unexplained chest pain means balancing between existential uncertainty and certainty." The results are discussed in relation to capability. It is suggested that health professionals adopt a person-centered approach.

  19. Cardiac CT for the assessment of chest pain: Imaging techniques and clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Hans-Christoph, E-mail: christoph.becker@med.uni-muenchen.de [Ludwig-Maximilians-University, Grosshadern Clinic, Department of Clinical Radiology, Marchioninistr. 15, 81377 Munich (Germany); Johnson, Thorsten [Ludwig-Maximilians-University, Grosshadern Clinic, Department of Clinical Radiology, Marchioninistr. 15, 81377 Munich (Germany)

    2012-12-15

    Immediate and efficient risk stratification and management of patients with acute chest pain in the emergency department is challenging. Traditional management of these patients includes serial ECG, laboratory tests and further on radionuclide perfusion imaging or ECG treadmill testing. Due to the advances of multi-detector CT technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary artery disease. Life-threatening causes of chest pain, such as aortic dissection and pulmonary embolism can simultaneously be assessed with a single scan, sometimes referred to as “triple rule out” scan. With appropriate patient selection, cardiac CT can accurately diagnose heart disease or other sources of chest pain, markedly decrease health care costs, and reliably predict clinical outcomes. This article reviews imaging techniques and clinical results for CT been used to evaluate patients with chest pain entering the emergency department.

  20. Chronic pseudo-angina left precordial chest pain caused by a thoracic meningioma

    OpenAIRE

    Azabou, Eric; Kumako, Vincent; Moussawi, Mahmoud; Berger, Colette; André-Obadia, Nathalie; Kocher, Laurence; Gonnaud, Pierre-Marie

    2013-01-01

    International audience; Left precordial chest pain (LPCP) evokes above all angina. Eliminating a cardiac origin is then always the first priority. When cardiac causes are eliminated, non-cardiac causes are sought in order to avoid leaving patients with undiagnosed or undifferentiated chest pain. There is a myriad of non-cardiac causes ranging from heartburn, panic attacks, pleurisy, pulmonary embolism, pneumothorax, Tietze syndrome, bruises and fractures of the ribs, to spine meningioma, neur...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-04-15

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

  2. Chest Pain and Costochondritis Associated with Vitamin D Deficiency: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Robert C. Oh

    2012-01-01

    Full Text Available Vitamin D is integral for bone health, and severe deficiency can cause rickets in children and osteomalacia in adults. Although osteomalacia can cause severe generalized bone pain, there are only a few case reports of chest pain associated with vitamin D deficiency. We describe 2 patients with chest pain that were initially worked up for cardiac etiologies but were eventually diagnosed with costochondritis and vitamin D deficiency. Vitamin D deficiency is known to cause hypertrophic costochondral junctions in children (“rachitic rosaries” and sternal pain with adults diagnosed with osteomalacia. We propose that vitamin D deficiency may be related to the chest pain associated with costochondritis. In patients diagnosed with costochondritis, physicians should consider testing and treating for vitamin D deficiency.

  3. Young Woman with a Fever and Chest Pain

    Directory of Open Access Journals (Sweden)

    Kristin H. Dwyer, MD, MPH

    2016-03-01

    Full Text Available A 26-year-old female presented to the emergency department with three days of subjective fevers, dry cough and pleuritic chest discomfort. On exam, her vital signs were significant for a heart rate of 106/minute and oxygen saturation of 95% on room air. Her lung exam revealed decreased breath sounds at the right base. A bedside lung ultrasound and a chest radiograph were performed (Figure 1a, Figure 2, and Video.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-12-15

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

  5. A Rare Cause of Chest Pain in a Young Man: Primary Pneumomediastinum

    Directory of Open Access Journals (Sweden)

    Mehmet Ekiz

    2013-06-01

    Full Text Available Spontaneous pneumomediastinum (SPM is described as the presence of air in the mediastinum. It is a rare clinical condition that often affects adult young men. Patients are rarely symptomatic and detected incidentally. Symptoms often resolve without need of treatment. Diagnosis is made by physical examination and chest X-ray, and further study is rarely needed. We aimed to highlight spontaneous pneumomedisatinum as the differential diagnosis of chest pain.

  6. Morbidity of "DSM-IV" Axis I Disorders in Patients with Noncardiac Chest Pain: Psychiatric Morbidity Linked with Increased Pain and Health Care Utilization

    Science.gov (United States)

    White, Kamila S.; Raffa, Susan D.; Jakle, Katherine R.; Stoddard, Jill A.; Barlow, David H.; Brown, Timothy A.; Covino, Nicholas A.; Ullman, Edward; Gervino, Ernest V.

    2008-01-01

    The present study examined current and lifetime psychiatric morbidity, chest pain, and health care utilization in 229 patients with noncardiac chest pain (NCCP), angina-like pain in the absence of cardiac etiology. Diagnostic interview findings based on the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; "DSM-IV"; American…

  7. Clinical Diagnosis and Treatment of Chest Pain%胸疼的临床诊治

    Institute of Scientific and Technical Information of China (English)

    周凤鸣

    2014-01-01

    目的探讨胸疼病患者的病因和诊治办法。方法对我院收治的147胸疼病患者的临床资料进行回顾性分析。结果147例胸疼病患者中,不稳定型心绞痛36例,稳定型心绞痛24例;急性心肌梗死39例;呼吸系统疾病11例,骨骼肌肉疾病15例,消化系统疾病12例;高危非心源性胸痛10例。结论胸疼患者病因多样,心源性疾病在胸疼患者中占据很大比例,详细询问病史并结合现代仪器检查,就能快速识别出高危患者,及时有效进行救治。%Objective To investigate the cause of chest pain patients and treatment approaches. Methods The hospital admit ed 147 patients with chest pain clinical data were retrospectively analyzed. Results 147 cases of chest pain in patients with unstable angina in 36 cases, 24 cases of stable angina; acute myocardial infarction in 39 cases; respiratory system 11 cases, 15 cases of musculoskeletal disorders diseases, 12 cases of digestive diseases; risk 10 cases of non-cardiac chest pain. Conclusion The cause of chest pain in patients with various cardiac diseases account for a large proportion of patients with chest pain, a detailed history and examination combined with modern equipment, we can quickly identify high-risk patients, timely and ef ective for treatment.

  8. Computer Assisted Diagnosis of Chest Pain. Adjunctive Treatment Protocols

    Science.gov (United States)

    1984-07-30

    If rales are not heard upon chest exam and peripheral edema is absent, the impairment is (at least temporarily) adequately compensated. USUAL...impressions. COMPLICATIONS AND THEIR MANAGEMENT - Uncontrolled dysrhythmias and cardiogenic shock are the complications of concern. Bursts of PVC’s (or...problem. The cardiac compromise due to M.I. may be manifested by minimal rales and dyspnea or massive pulmonary edema with shock. Lasix is

  9. Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score

    Directory of Open Access Journals (Sweden)

    Burnand Bernard

    2010-01-01

    Full Text Available Abstract Background Chest pain raises concern for the possibility of coronary heart disease. Scoring methods have been developed to identify coronary heart disease in emergency settings, but not in primary care. Methods Data were collected from a multicenter Swiss clinical cohort study including 672 consecutive patients with chest pain, who had visited one of 59 family practitioners' offices. Using delayed diagnosis we derived a prediction rule to rule out coronary heart disease by means of a logistic regression model. Known cardiovascular risk factors, pain characteristics, and physical signs associated with coronary heart disease were explored to develop a clinical score. Patients diagnosed with angina or acute myocardial infarction within the year following their initial visit comprised the coronary heart disease group. Results The coronary heart disease score was derived from eight variables: age, gender, duration of chest pain from 1 to 60 minutes, substernal chest pain location, pain increasing with exertion, absence of tenderness point at palpation, cardiovascular risks factors, and personal history of cardiovascular disease. Area under the receiver operating characteristics curve was of 0.95 with a 95% confidence interval of 0.92; 0.97. From this score, 413 patients were considered as low risk for values of percentile 5 of the coronary heart disease patients. Internal validity was confirmed by bootstrapping. External validation using data from a German cohort (Marburg, n = 774 revealed a receiver operating characteristics curve of 0.75 (95% confidence interval, 0.72; 0.81 with a sensitivity of 85.6% and a specificity of 47.2%. Conclusions This score, based only on history and physical examination, is a complementary tool for ruling out coronary heart disease in primary care patients complaining of chest pain.

  10. Severe chest pain in a pediatric ulcerative colitis patient after 5-aminosalicylic acid therapy

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Severe reactions to mesalamine products are rarely seen in pediatric patients. We report a case of a 12-year-old boy who had a severe cardiac reaction to a mesalamine product Asacol. Past medical history is significant for ulcerative colitis (UC) diagnosed at 9 years of age. Colo- noscopy one week prior to admission revealed pancoli- tis. He was treated with Asacol 800 mg three times per day and prednisone 20 mg/d. He was subsequently ad- mitted to the hospital for an exacerbation of his UC and started on intravenous solumedrol. He had improvement of his abdominal pain and diarrhea. The patient com- plained of new onset of chest pain upon initiating Asacol therapy. Electrocardiogram (ECG) revealed non-specific ST-T wave changes with T-wave inversion in the lateral leads. Echocardiogram (ECHO) revealed low-normal to mildly depressed left ventricular systolic function. The left main coronary artery and left anterior descending artery were mildly prominent measuring 5 mm and 4.7 mm, respectively. His chest pain completely resolved within 24-36 h of discontinuing Asacol. A repeat echo- cardiogram performed two days later revealed normal left ventricular function with normal coronary arteries (< 3.5 mm). Onset of chest pain after Asacol and im- mediate improvement of chest pain, as well as improve- ment of echocardiogram and ECG findings after discon- tinuing Asacol suggests that our patient suffered from a rare drug-hypersensitivity reaction to Asacol.

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

    Science.gov (United States)

    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

  12. A 34-Year-Old Woman With Recurrent Right-Sided Chest Pain and Dyspnea.

    Science.gov (United States)

    Albores, Jeffrey; Fishbein, Gregory; Bando, Joanne

    2015-11-01

    A 34-year-old woman presented with her third episode of acute-onset right-sided chest pain and dyspnea. She had two prior similar occurrences of right-sided sharp, pleuritic chest pain with radiation to the back and dyspnea. Chest radiographs during these presentations revealed a small apical right-sided pneumothorax that was managed conservatively with high-flow oxygen. All three presentations were associated with vigorous exercise and the first day of her menses. She denied cough, hemoptysis, fever, smoking history, airplane travel, scuba diving, or trauma during these presentations. The patient has been trying to conceive for the past year but has been unsuccessful because of uterine fibroids but no history of endometriosis.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    NARCIS (Netherlands)

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

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  17. Chest Pain and ST-Segment Elevation in an 18-Year-Old Man.

    Science.gov (United States)

    Kawji, Mazen M; Glancy, David Luke

    2017-02-28

    An 18-year-old man came to the hospital because of 1 day of chest pain typical of pericarditis. He had had an upper respiratory infection 10 days earlier. His electrocardiograms indicated evolving pericarditis. His echocardiogram showed mild, diffuse left ventricular hypokinesia, and his troponin I level peaked at 47.5 ng/ml. Thus, he had myopericarditis.

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

    DEFF Research Database (Denmark)

    Bang, Caecilie Larsen; Porsbjerg, Celeste

    2016-01-01

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

  19. Personality : Predictor of neurostimulation outcomes in patients with chest pain and normal coronary arteries

    NARCIS (Netherlands)

    de Vries, J; DeJongste, MJL; Versteegen, GJ; Durenkamp, A; Staal, MJ

    2006-01-01

    Objectives. To study the impact of personality traits on the effect of neurostimulation in patients with chest pain and normal coronary arteries. Materials and Methods. Using the Dutch personality questionnaire, we retrospectively studied the personality traits in 33 patients treated with neurostimu

  20. Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Stochkendahl, Mette Jensen; Sørensen, Jan; Vach, Werner;

    2016-01-01

    AIMS: To assess whether primary sector healthcare in the form of chiropractic care is cost-effective compared with self-management in patients with musculoskeletal chest pain, that is, a subgroup of patients with non-specific chest pain. METHODS AND RESULTS: 115 adults aged 18-75 years with acute......, non-specific chest pain of musculoskeletal origin were recruited from a cardiology department in Denmark. After ruling out acute coronary syndrome and receiving usual care, patients with musculoskeletal chest pain were randomised to 4 weeks of community-based chiropractic care (n=59) or to a single......-dimension questionnaire (EQ-5D) and Short Form 36-item Health Survey (SF-36)) were compared in cost-effectiveness analyses over 12 months from baseline. Mean costs were €2183 lower for the group with chiropractic care, but not statistically significant (95% CI -4410.5 to 43.0). The incremental cost-effectiveness ratio...

  1. A new specifically designed forceps for chest drain insertion.

    LENUS (Irish Health Repository)

    Andrews, Emmet

    2012-02-03

    Insertion of a chest drain can be associated with serious complications. It is recommended that the drain is inserted with blunt dissection through the chest wall but there is no specific instrument to aid this task. We describe a new reusable forceps that has been designed specifically to facilitate the insertion of chest drains.A feasibility study of its use in patients who required a chest drain as part of elective cardiothoracic operations was undertaken. The primary end-point was successful and accurate placement of the drain. The operators also completed a questionnaire rating defined aspects of the procedure. The new instrument was used to insert the chest drain in 30 patients (19 male, 11 female; median age 61.5 years (range 16-81 years)). The drain was inserted successfully without the trocar in all cases and there were no complications. Use of the instrument rated as significantly easier relative to experience of previous techniques in all specified aspects. The new device can be used to insert intercostal chest drains safely and efficiently without using the trocar or any other instrument.

  2. Gender bias revisited: new insights on the differential management of chest pain

    Directory of Open Access Journals (Sweden)

    Karatolios Konstantinos

    2011-06-01

    Full Text Available Abstract Background Chest pain is a common complaint and reason for consultation in primary care. Few data exist from a primary care setting whether male patients are treated differently than female patients. We examined whether there are gender differences in general physicians' (GPs initial assessment and subsequent management of patients with chest pain, and how these differences can be explained Methods We conducted a prospective study with 1212 consecutive chest pain patients. The study was conducted in 74 primary care offices in Germany from October 2005 to July 2006. After a follow up period of 6 months, an independent interdisciplinary reference panel reviewed clinical data of every patient and decided about the etiology of chest pain at the time of patient recruitment (delayed type-reference standard. We adjusted gender differences of six process indicators for different models. Results GPs tended to assume that CHD is the cause of chest pain more often in male patients and referred more men for an exercise test (women 4.1%, men 7.3%, p = 0.02 and to the hospital (women 2.9%, men 6.6%, p Conclusions While observed gender differences can not be explained by differences in age, CHD prevalence, and underlying risk factors, the less typical symptom presentation in women might be an underlying factor. However this does not seem to result in suboptimal management in women but rather in overuse of services for men. We consider our conclusions rather hypothesis generating and larger studies will be necessary to prove our proposed model.

  3. Osteoarthritis of the Manubriosternal Joint: An Uncommon Cause of Chest Pain.

    Science.gov (United States)

    Vaishya, Raju; Vijay, Vipul; Rai, Bibek K

    2015-11-02

    Osteoarthritis of the manubriosternal joint is a rare cause of chest pain. The diagnosis is difficult, and other serious causes of chest pain have to be ruled out first. We report one case that was treated with fusion of the manubriosternal joint using an iliac crest bone graft with a cervical locking plate and screws with excellent results. Preoperative CT scan images were used to measure the screw length and the drill stop depth. In this case report, we have shown that arthrodesis can be an effective way of treating osteoarthritis of the manubriosternal joint when other measures fail. Furthermore, the use of a cervical locking plate with appropriate and careful preoperative planning affords a safe surgical technique, rapid pain relief, and ultimately, sound and asymptomatic union of the joint.

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

    DEFF Research Database (Denmark)

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

    1991-01-01

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

  5. Conditioned pain modulation and situational pain catastrophizing as preoperative predictors of pain following chest wall surgery: a prospective observational cohort study.

    Directory of Open Access Journals (Sweden)

    Kasper Grosen

    Full Text Available BACKGROUND: Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency. METHODS: Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2-5. Pain was reevaluated at six months postoperatively. RESULTS: Patients reporting persistent pain at six months follow-up (n = 15 were not significantly different from pain-free patients (n = 16 concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3 or level of catastrophizing (Z = 0.4, P = 1.0. In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007 whereas conditioned pain modulation predicted morphine consumption (β = -0.005, P = 0.001. CONCLUSIONS: Preoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute

  6. Cardiac Hydatid Cyst: An Unusual Cause of Chest Pain

    Directory of Open Access Journals (Sweden)

    Esref Tuncer

    2013-12-01

    Full Text Available Hydatid disease is a parasitic infection caused by larvae of Echinococcus granulosus. Cardiac involvement in hydatid disease is uncommon, constituting only 0.5 - 2% of all cases of hydatidosis. Most patients with cardiac echinococcosis are asymptomatic, and the disease is often latent because a hydatid cyst in the heart grows very slowly. Only approximately 10 % of patients, especially those with large hydatid cysts, have clinical manifestations. Precordial pain is the one of the common symptoms and is most often vague and does not resemble angina pectoris.

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

    Science.gov (United States)

    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

  8. Influence of the normal personality dimension of neuroticism on chest pain symptoms and coronary artery disease.

    Science.gov (United States)

    Costa, P T

    1987-12-28

    For at least the last 200 years it has been suspected that somatic manifestations of psychological distress play a role in the medical recognition and treatment of coronary artery disease (CAD). The cardiovascular system is intricately linked to the experience of emotion, and these links may explain how and when neuroticism can cloud the diagnosis of cardiovascular disease. A possible source of anginal symptoms in the absence of angiographically documented CAD is high standing on the personality dimension of neuroticism, which is a broad dimension of individual differences in the tendency to experience negative, distressing emotions and to possess associated behavioral and cognitive traits. A brief review of the clinical cardiologic literature on chest pain is presented, with special attention to distinguishing true angina pectoris from pseudoangina and related syndromes. After a brief description of the major dimensions of normal personality, especially the domain of neuroticism, empirical evidence is reviewed on 1,191 adult men and women who 10 years earlier had made chest pain or discomfort reports part of the National Health and Nutrition Examination Survey. The findings illustrate neuroticism's links to illness and disease. When the mean initial neuroticism levels of the chest pain groups were compared, significantly higher initial levels of neuroticism were found for those who reported any pain or discomfort. As hypothesized, logistic regression results on myocardial infarction death indicated no increased risk due to neuroticism. Neuroticism was related to increased somatic complaints, including chest pain or angina-like complaints, but was not causally or etiologically related to objective signs or pathophysiologic evidence of disease, especially CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Chest pain with myocardial ischemia in a child: should we think about coronary slow flow phenomenon?

    Science.gov (United States)

    Kocabaş, Abdullah; Kardelen, Fırat; Akçurin, Gayaz; Ertuğ, Halil

    2013-10-01

    The coronary slow flow phenomenon (CSFP) is an angiographic finding characterized by delayed opacification of epicardial coronary arteries in the absence of stenotic lesion. Herein, we present a 13-year-old boy with recurrent chest pain who was diagnosed with acute ST-segment elevation myocardial infarction associated with CSFP, which has not been reported previously in the pediatric age group. Coronary angiography revealed only the presence of slow flow in the left anterior descending (LAD) coronary artery. Myocardial perfusion scintigraphy revealed a reversible perfusion defect in the LAD territory, which regressed partially at rest and showed complete improvement after dipyridamole infusion. All the symptoms, electrocardiogram abnormalities and cardiac markers returned to normal after dipyridamole treatment during the follow-up. We conclude that CSFP should be kept in mind in the differential diagnosis of chest pain with myocardial ischemia in the pediatric age group.

  10. CT coronary angiography: new risks for low-risk chest pain.

    Science.gov (United States)

    Radecki, Ryan Patrick

    2013-10-01

    Widespread conservative management of low-risk chest pain has motivated the development of a rapid triage strategy based on CT coronary angiography (CTCA) in the Emergency Department (ED). Recently, three prominent trials using this technology in the ED setting have presented results in support of its routine use. However, these studies fail to show the incremental prognostic value of CTCA over clinical and biomarker-based risk-stratification strategies, demonstrate additional downstream costs and interventions, and result in multiple harms associated with radio-contrast and radiation exposure. Observing the widespread overdiagnosis of pulmonary embolism following availability of CT pulmonary angiogram as a practice pattern parallel, CTCA use for low-risk chest pain in the ED should be advanced only with caution.

  11. Immunohistochemical analyses of a case of extralobar pulmonary sequestration with chest pain in an adult

    Directory of Open Access Journals (Sweden)

    Yuji Ohtsuki

    2013-01-01

    Full Text Available Computed tomography of a Japanese man in his mid-forties with a complaint of right-side chest pain showed a dome-shaped smooth-surfaced mediastinal mass, which was extirpated. The cut surface was highly hemorrhagic and necrotic and not related to the original pulmonary tissues. Although routine sectioning detected bronchial cartilage, immunohistochemical analyses clearly showed the presence of alveolar type II cells; only the alveolar type II cells located at the periphery of this mass showed positive staining for cytokeratins, thyroid transcription factor 1, surfactant protein A, epithelial membrane antigen and Krebs von den Lungen-6. Thus, these analyses are useful for the detection of pulmonary components, even in severely hemorrhagic and necrotic tissues with marked sequestration. The clinical diagnosis was a rare, adult type of extralobar pulmonary sequestration accompanied by chest pain.

  12. [Chest pain with ischemic electrocardiographic changes: mitral valve prolapse in pediatrics. Case report].

    Science.gov (United States)

    Matamala-Morillo, Miguel Ángel; Rodríguez-González, Moisés; Segado-Arenas, Antonio

    2015-01-01

    Chest pain is rare and usually benign in pediatrics. Cardiac etiology is even rarer. However, it is a symptom associated with ischemic heart disease and it imposes great social alarm, even in health care workers. Therefore, it is necessary to know the most common causes of this symptom in children, as well as serious diseases that can cause it, which require prompt medical attention. We report a case of chest pain associated with ischemic electrocardiographic changes in a patient with mitral valve prolapse and MASS phenotype (mitral valve prolapse, aortic root enlargement, and skeletal and skin alterations), we review the mitral valve prolapse and stress the importance of knowing it in the pediatric setting.

  13. Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department

    OpenAIRE

    Sawyer, Kelly N.; Payal Shah; Lihua Qu; Kurz, Michael C.; Clark, Carol L.; Swor, Robert A.

    2015-01-01

    Introduction: Undifferentiated chest pain in the emergency department (ED) is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT) for pulmonary embolism or dissection followed by a cardiac stress test (TRAD). An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods. Methods: This was ...

  14. Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial

    Science.gov (United States)

    Hollander, Judd E; Schaffer, Jason T; Kline, Jeffrey A; Torres, Carlos A; Diercks, Deborah B; Jones, Russell; Owen, Kelly P; Meisel, Zachary F; Demers, Michel; Leblanc, Annie; Shah, Nilay D; Inselman, Jonathan; Herrin, Jeph; Castaneda-Guarderas, Ana; Montori, Victor M

    2016-01-01

    Objective To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. Design Multicenter pragmatic parallel randomized controlled trial. Setting Six emergency departments in the United States. Participants 898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain. Interventions Patients were randomly assigned (1:1) by an electronic, web based system to shared decision making facilitated by a decision aid or to usual care. The primary outcome, selected by patient and caregiver advisers, was patient knowledge of their risk for acute coronary syndrome and options for care; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30 day rate of major adverse cardiac events. Results Compared with the usual care arm, patients in the decision aid arm had greater knowledge of their risk for acute coronary syndrome and options for care (questions correct: decision aid, 4.2 v usual care, 3.6; mean difference 0.66, 95% confidence interval 0.46 to 0.86), were more involved in the decision (observing patient involvement scores: decision aid, 18.3 v usual care, 7.9; 10.3, 9.1 to 11.5), and less frequently decided with their clinician to be admitted for cardiac testing (decision aid, 37% v usual care, 52%; absolute difference 15%; P<0.001). There were no major adverse cardiac events due to the intervention. Conclusions Use of a decision aid in patients at low risk for acute coronary syndrome increased patient knowledge about their risk, increased

  15. Chest pain in the emergency room. Importance of a systematic approach

    Directory of Open Access Journals (Sweden)

    Bassan Roberto

    2000-01-01

    Full Text Available OBJECTIVE: To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS and the rate of hospitalization in high-cost units. METHODS: One thousand and three consecutive patients with chest pain were screened according to a pre-established process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes. RESULTS: Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5 and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB (route 1 (74% of these had a final diagnosis of acute myocardial infarction [AMI]. Of the 660 patients that remained in the emergency room under observation, 77 (12% had AMI without ST segment elevation and 202 (31% had unstable angina (UA. In route 2 (high probability of ACS 17% of patients had AMI and 43% had UA, whereas in route 3 (low probability 2% had AMI and 7 % had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI ( 49%, with a positive predictive value considered only satisfactory (79%. CONCLUSION: A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds.

  16. Angina-like chest pain: a joint medical and psychiatric investigation.

    OpenAIRE

    Colgan, S M; Schofield, P.M.; Whorwell, P. J.; Bennett, D.H.; Brooks, N H; Jones, P. E.

    1988-01-01

    Sixty three patients with chest pain typical of angina and who had normal coronary angiograms were investigated for left ventricular, oesophageal and psychiatric abnormalities. An additional 21 patients, age and sex matched, who had angina and significant coronary artery disease were also studied. Eighty six per cent of the 63 patients without evidence of coronary artery disease could be demonstrated to have a physical abnormality (left ventricular dysfunction in 35%, oesophageal disorder 51%...

  17. Chest Pain of Suspected Cardiac Origin: Current Evidence-based Recommendations for Prehospital Care

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    P. Brian Savino

    2015-12-01

    Full Text Available Introduction: In the United States, emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG, ST segment elevation myocardial infarction (STEMI regionalization systems, prehospital fibrinolysis and β-blockers. Results: The protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325mg, 24% recommending 162mg and 15% recommending either, as well as nitroglycerin and opiates (58% choosing morphine. Prehospital 12- Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or β-blocker use. Conclusion: Protocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

  18. Intramural oesophageal dissection as an unusual presentation of chest pain: A case report

    Directory of Open Access Journals (Sweden)

    Ryo Mizumoto

    2015-12-01

    Conclusion: spontaneous IOD can occur in elderly patients who are anticoagulated. Fish oil has not been previously reported as having an association with IOD. This is the first known reported case of spontaneous IOD occurring in association with concurrent use of a bisphosphonate and fish oil. IOD is a rare disorder, and any anticoagulated patients presenting with severe chest pain may need careful investigation prior to definitive management.

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

    Science.gov (United States)

    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.

  20. Correlation between lipid profile and troponin I test results in patients with chest pain in Nepal

    Institute of Scientific and Technical Information of China (English)

    Arun Kumar; Brijesh Sathian

    2013-01-01

    To study the usefulness of traditional lipid profile levels in screening subjects who had developed chest pain due to cardiac event as indicated by a positive troponin I test. Methods: In this retrospective study data of the 430 patients presented to the emergency department with symptoms of cardiac ischemia who underwent both troponin and lipid profiles tests were compared with the lipid profiles of 165 normal healthy subjects (controls). The troponin was detected qualitatively when a specimen contains troponin I (cTnI) above the 99th percentile (TnI>0.5 ng/mL). The total cholesterol, high density lipoproteins cholesterol, very low density lipoproteins and triacyl glycerol levels were also analyzed and low density lipoprotein level was calculated using Friedewald’s formula. Results: Patients with chest pain and positive troponin test (with confirmed cardiac event) were found to have significantly elevated levels of total cholesterol, triacyl glycerol levels, low density lipoprotein level and significantly reduced high density lipoproteins cholesterol levels when compared to the patients who experienced only chest pain (negative troponin) and healthy controls. Conclusions: Traditional lipid profile levels is still can be used in screening populations to identify the subjects with high risk of developing cardiac event in case if the laboratory set up has not troponin test facilities.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-12-15

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

  2. Treatment of 24 Cases of Chest Pain Following Lung Cancer by Balancing Acupuncture Therapy

    Institute of Scientific and Technical Information of China (English)

    柴小姝; 吴万垠; 邓宏; 周宇姝; 赵玉军; 肖元春

    2008-01-01

    Objective: To observe the clinical efficacy of balancing acupuncture therapy in the treatment of chest pain following lung cancer. Methods: Twenty-four cases of primary bronchial lung cancer with chest pain were treated by balancing acupuncture therapy; the relief of chest pain and its relief time were observed. Results: Among the 24 cases undergoing balancing acupuncture therapy, the chest pain was absolutely relieved in 3 cases, partially relieved in 13 cases, lightly relieved in 4 cases and not relieved in 4 cases; the total response rate was 83.3%. In terms of the relief time, 9 cases responded to the balancing acupuncture therapy in 0-3 min, accounting for 37.5%; 5 cases responded in 4-6 min, accounting for 20.8%; the average responding time was (4.85±1.45) min. Conclusion: Balancing acupuncture therapy is rapid-acting, safe, convenient and inexpensive in the treatment of chest pain following lung cancer.%目的:观察平衡针法治疗肺癌胸痛患者的临床疗效.方法:将24例原发性支气管肺癌伴胸痛患者予平衡针治疗,观察患者胸痛症状改善情况及疼痛缓解时间.结果:24例接受平衡针治疗的肺癌胸痛患者中,疼痛完全缓解3例,部分缓解13例,轻度缓解4例,无缓解4例,总有效率为83.3%.从治疗后起效时间上看,9例在0~3 ming起效,占37.5%:5例在4~6 mingl起效,占20.8%;平均起效时间(4.85±1.45)min.结论:平衡针法治疗肺癌胸痛患者具有起效快速、方便安全、价格低廉的优点.

  3. Investigating the effect of anxiety sensitivity, gender and negative interpretative bias on the perception of chest pain.

    Science.gov (United States)

    Keogh, Edmund; Hamid, Rayhana; Hamid, Shahid; Ellery, Deborah

    2004-09-01

    Research suggests that anxiety sensitivity may be an important component in the negative response to pain sensations, especially those with cardiopulmonary origin. Furthermore, there is experimental evidence to suggest that such effects may be stronger in women than men. The primary aim of the current investigation was to determine the relative roles that anxiety sensitivity and gender have on the pain reports of patients referred to a hospital clinic with chest pain. A total of 78 female and 76 male adults were recruited on entry to a Rapid Access Medical Clinic. All patients had been referred with chest pain, and were administered a range of pain and anxiety measures prior to diagnosis. Results indicate that males were more likely to receive a diagnosis of cardiac chest pain, whereas females were more likely to receive a diagnosis of non-cardiac chest pain. Additionally, anxiety sensitivity was related to pain in women but not men. Finally, evidence was found for the mediating effect of negative interpretative bias on the relationship between anxiety sensitivity and pain. However, this mediating effect was only found in women. These results not only confirm that anxiety sensitivity is related to greater negative pain responses in women, but that this may be due to an increased tendency to negatively interpret sensations.

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

    Directory of Open Access Journals (Sweden)

    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 Pain

    Science.gov (United States)

    ... the heart's blood supply, particularly during exertion. Aortic dissection. This life-threatening condition involves the main artery ... to make sure you're not having aortic dissection. Follow-up testing Depending upon the results from ...

  6. Teenager with chest pain and swollen neck: a leave-it-alone condition.

    Science.gov (United States)

    Liao, Pen-Yuan; Wang, Hung-Jung

    2015-07-01

    A 19-year-old boy with shortness of breath and chest pain after strenuous exercise presented to emergency department . On physical examination, the neck and shoulders appeared to be swollen. There was crepitus on skin palpation. Chest X-ray disclosed diffuse subcutaneous emphysema and pneumomediastinum. CT showed additional finding of air in epidural space. The patient was discharged after 2 days of hospitalisation with conservative treatment uneventfully. Pneumorrhachis is usually caused by abrupt increase in intrathoracic pressure in instance of forceful vomiting, cough or asthma attack in an otherwise healthy young adult. It is usually accompanied with pneumomediastinum. The management of epidural pneumatosis should be tailored according to its primary cause. For most patients with pneumorrhachis associated to a spontaneous pneumomediastinum without neurological symptoms, this condition is generally self-limited. For epidural free air of large volume that causes neurological deficits, surgical laminectomy may be indicated.

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

    Science.gov (United States)

    Arora, Garima; Bittner, Vera

    2015-02-01

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

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

    Institute of Scientific and Technical Information of China (English)

    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.

  9. Investigating Patients with Recent Onset of Chest Pain Against NICE Guidelines in a District General Hospital Setting in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Azeem S Sheikh

    2012-09-01

    Full Text Available Background: Chest pain is a very common symptom leading to a significant number of patients visiting the primary care trusts, emergency departments and a huge number of emergency hospital admissions.Objective: The objective of our audit was to investigate whether patients with recent onset of chest pain referred to the Rapid Access Chest Pain Clinic were being investigated in accordance with the recommendations by the National Institute for Health and Clinical Excellence (NICE, in a busy District General Hospital setting.Design: Retrospective collection of dataSetting: Southend University Hospital NHS Foundation TrustPatients: We collected data over a period of three months for all the patients who underwent invasive coronary angiogram after being referred via Rapid Access Chest Pain Clinic (RACPC or General Cardiology Clinic presenting with recent onset of chest pain. A total of 157 patients were enrolled in the study. The patients were then categorised into four groups based upon their description of symptoms, age and risk factors, as defined by NICE.Results: We found that 86% (135/157 patients had estimated likelihood of CAD >60% and 51% of these had unnecessary non-invasive investigations contrary to what NICE recommends. This shows that adhering to the NICE guidelines would have saved a substantial amount of hospital resources and time of the healthcare team and the patients.Conclusions: The development of strategies for cost-conscious quality care must begin with the history, risk factors for coronary artery disease and patients’ investigations should be based on their risk stratification.

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

    Directory of Open Access Journals (Sweden)

    Shotaro Kanda

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Hai DONG

    2016-06-01

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

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

    Science.gov (United States)

    Al-Ani, Mohammad; Winchester, David E.

    2017-01-01

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

  13. Chest pain and high-sensitivity troponin: What is the evidence?

    Directory of Open Access Journals (Sweden)

    Daniel Ashmore

    2015-03-01

    Full Text Available The number of attendances and admissions of patients with chest pain to hospitals in England and Wales is increasing. Initial assessment may be unrewarding. Consequently, cardiac troponin has become the mainstay of investigation for non-ST-segment-elevation myocardial infarction and unstable angina, although only a small proportion of patients are eventually diagnosed as such. Current National Institute for Healthcare and Clinical Excellence guidance recommends measuring cardiac troponin levels on presentation and 10–12 h after onset of symptoms. A more effective diagnostic tool is needed. The aims are twofold: to increase accuracy of acute coronary syndrome diagnosis thus implementing the most appropriate management at an earlier stage while reducing costs and to provide a more rapid diagnosis to ease the anxieties of patients. Three key issues have been highlighted. The first is that many current studies do not have a ‘normal/reference’ population, making comparison between two studies difficult to interpret. Second, whether newer ‘high-sensitivity’ cardiac troponin tests can be used to rule out a myocardial infarction in a patient with chest pain is discussed. Third, whether a ‘high-sensitivity’ cardiac troponin has great enough specificity to differentiate between the number of other causes of raised troponin in a single test or whether serial testing is needed is assessed. A strategy for such serial testing is discussed. Finally, use of ‘high-sensitivity’ cardiac troponin in risk stratification of other disease processes is highlighted, which is likely to become common practice, changing the way we manage patients with, and without, chest pain.

  14. Investigation of paramedics' compliance with clinical practice guidelines for the management of chest pain.

    LENUS (Irish Health Repository)

    Figgis, Ken

    2012-01-31

    BACKGROUND: Acute coronary syndromes remain a leading cause of preventable early deaths. However, previous studies have indicated that paramedics\\' compliance with chest pain protocols is suboptimal and that many patients do not receive the benefits of appropriate prehospital treatment. AIMS: To evaluate paramedics\\' level of compliance with national clinical practice guidelines and to investigate why, in certain circumstances, they may deviate from the clinical guidelines. SETTING: The Health Service Executive Mid-Western Regional Ambulance Service which serves a mixed urban and rural population across three counties in the west of Ireland. METHOD: A retrospective review of completed ambulance Patient Care Report Forms was conducted for all adult patients with non-traumatic chest pain treated between 1 December 2007 and 31 March 2008. During the same study period, paramedics were asked to complete a prospective questionnaire survey investigating the rationale behind their treatment decisions, their estimation of patient risk and their attitudes towards the clinical practice guidelines and training. RESULTS: 382 completed Patient Care Report Forms were identified for patients with chest pain, of whom 84.8% received ECG monitoring, 75.9% were given oxygen, 44.8% were treated with sublingual glyceryl trinitrate (GTN) and 50.8% were treated with aspirin. Only 20.4% of patients had a prehospital 12-lead ECG recorded. 58 completed questionnaires were returned (response rate 15%); 64% of respondents said they had received insufficient training to identify ECG abnormalities. CONCLUSIONS: Prehospital treatment with oxygen, aspirin, sublingual GTN and ECG monitoring remains underused by paramedics, even though only a small number of patients had documented contraindications to their use. The small number of patients who received a prehospital 12-lead ECG is a cause of particular concern and suggests that incomplete patient assessment may contribute to undertreatment

  15. A 64-Year-Old Woman with Chest Pain, Limb Weakness, and Endometrial Cancer

    Directory of Open Access Journals (Sweden)

    Simon Ponthus

    2017-01-01

    Full Text Available Necrotizing autoimmune myopathy (NAM is a rare subgroup of idiopathic inflammatory myopathies (IIM. This pathology usually affects proximal limb muscles and in some cases the myocardium. Patients usually display proximal limb weakness. Muscular biopsy is required to confirm the diagnosis. We report the case of a 64-year-old woman with an atypical first presentation of NAM, manifested by chest pain in the context of metastatic endometrial cancer. The diagnosis of NAM was however made when she returned a second time with proximal limb weakness. A treatment with prednisone was then initiated, to which rituximab was rapidly associated, beside a specific chemotherapy.

  16. A Very Rare Cause of Pleuritic Chest Pain: Bilateral Pleuritis as a First Sign of Familial Mediterranean Fever

    Directory of Open Access Journals (Sweden)

    Sevket Ozkaya

    2013-01-01

    Full Text Available The familial Mediterranean fever (FMF, also called recurrent polyserositis, is characterized by reccurrent episodes of serositis at pleura, peritoneum, and synovial membrane and fever. We present a patient with recurrent bilateral pleural effusion due to serositis attacks as a first sign of FMF. A 59-year-old Turkish man suffered from recurrent pleuritic chest pain due to pleural effusion and atelectasis. The etiology was not found, and his symptoms were spontaneously recovered during several weeks. The pleuritic chest pain was associated with abdominal pain in the last attack. The gene mutation analysis revealed the homozygosity of FMF (F479L gene mutation in both our patient and his grandchild. After the colchicine treatment, the attack has not developed. In conclusion, recurrent pleural effusion and pleuritic chest pain may be the first signs of the FMF.

  17. Men making sense of their chest pain--niggles, doubts and denials.

    Science.gov (United States)

    White, A K; Johnson, M

    2000-07-01

    Participant observation was undertaken of the early admission period of 25 men admitted to hospital with acute chest pain, followed by in-depth interviews of 10 of the men after discharge. Grounded theory methods were used in the analysis to develop a model of how the men came to interpret their experiences. An emerging feature of the men's experiences was that, although they had suffered intense pain prior to admission, there had been a series of delays whilst they tried to rationalize their symptoms. We relate our discussion to literature on men and masculinity and the notion of Foucault (1975) of self-surveillance, to offer an insight into the men's self concept and social situation. Our conclusions suggest that men's self concept as 'healthy' may inhibit a speedy response to the signs and symptoms of acute coronary occlusion, increasing the risk of cardiac arrest without nearby life support.

  18. The independent association of anxiety with non-cardiac chest pain

    DEFF Research Database (Denmark)

    Smeijers, Loes; van de Pas, Harm; Nyklicek, Ivan

    2013-01-01

    Non-cardiac chest pain (NCCP) is common in clinical cardiology. Anxiety is an important factor in NCCP because of its role in the neurobehavioural processes of pain regulation. It is not well established that which specific anxiety symptoms are disproportionately elevated in NCCP and whether...... the association between anxiety and NCCP is independent of personality factors. Participants with NCCP (N = 46; mean age 44.9 ± 14.7; 67% women) were evaluated for anxiety (Spielberger State-Trait Anxiety Inventory[STAI]), clinical measures and personality factors (negative affectivity and social inhibition...... measured by the Type D inventory). Item analysis was conducted for each of the anxiety symptoms. A healthy reference group was used for comparison purposes (N = 1233; mean age 55.2 ± 14.3; 50% women). Results showed that NCCP was associated with elevated anxiety levels (STAI ≥ 45) compared to the reference...

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

    Directory of Open Access Journals (Sweden)

    Schwartzman Robert J

    2011-09-01

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

  20. Value of noninvasive assessment of patients with atypical chest pain and suspected coronary spasm using ergonovine infusion and thallium-201 scintigraphy.

    Science.gov (United States)

    DiCarlo, L A; Botvinick, E H; Canhasi, B S; Schwartz, A S; Chatterjee, K

    1984-10-01

    Twenty-six patients with known benign coronary anatomic characteristics and atypical chest pain syndromes were evaluated for the possibility of coronary spasm. Incremental intravenous ergonovine maleate infusions were administered, and thallium-201 scintigraphy was performed at the peak dosage and during recovery in the coronary care unit. With ergonovine therapy, 4 patients (16%) had chest pain associated with electrocardiographic (ECG) or scintigraphic changes. Nine patients (35%) had chest pain without associated ECG or scintigraphic changes, and 13 patients did not have chest pain in response to ergonovine administration, although 2 (8%) had ergonovine-induced scintigraphic defects. All 4 patients with ergonovine-induced chest pain and associated ECG or scintigraphic abnormalities had resolution or reduction of chest pain after medical treatment. However, 7 of the 9 patients with ergonovine-induced chest pain in the absence of ECG or scintigraphic abnormalities continued to have symptoms despite medical treatment a mean of 18 months later. In this limited study of a select group, bedside ergonovine provocation appeared safe. Many patients had chest pain, but few showed ECG or scintigraphic evidence of ischemia. Perfusion scintigraphy appears to have potential complementary value for the identification of an ischemic cardiac cause of atypical chest pain and provides a rationale for appropriate therapy.

  1. Value of noninvasive assessment of patients with atypical chest pain and suspected coronary spasm using ergonovine infusion and thallium-201 scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    DiCarlo, L.A. Jr.; Botvinick, E.H.; Canhasi, B.S.; Schwartz, A.S.; Chatterjee, K.

    1984-10-01

    Twenty-six patients with known benign coronary anatomic characteristics and atypical chest pain syndromes were evaluated for the possibility of coronary spasm. Incremental intravenous ergonovine maleate infusions were administered, and thallium-201 scintigraphy was performed at the peak dosage and during recovery in the coronary care unit. With ergonovine therapy, 4 patients (16%) had chest pain associated with electrocardiographic (ECG) or scintigraphic changes. Nine patients (35%) had chest pain without associated ECG or scintigraphic changes, and 13 patients did not have chest pain in response to ergonovine administration, although 2 (8%) had ergonovine-induced scintigraphic defects. All 4 patients with ergonovine-induced chest pain and associated ECG or scintigraphic abnormalities had resolution or reduction of chest pain after medical treatment. However, 7 of the 9 patients with ergonovine-induced chest pain in the absence of ECG or scintigraphic abnormalities continued to have symptoms despite medical treatment a mean of 18 months later. In this limited study of a select group, bedside ergonovine provocation appeared safe. Many patients had chest pain, but few showed ECG or scintigraphic evidence of ischemia. Perfusion scintigraphy appears to have potential complementary value for the identification of an ischemic cardiac cause of atypical chest pain and provides a rationale for appropriate therapy.

  2. High sensitive troponin T in individuals with chest pain of presumed ischemic origin.

    Science.gov (United States)

    Cuda, Giovanni; Lentini, Margherita; Gallo, Luigia; Lucia, Fortunata G; Giacinto Carinci, Lorenzina; Mancuso, Serafina; Biondi, Rosa A; Sinopoli, Raffaella; Casadonte, Rita; Guzzi, Pietro H; Cannataro, Mario; Mongiardo, Annalisa; Iaconetti, Claudio; Bochicchio, Angela; Curcio, Antonio; Torella, Daniele; Ricci, Pietroantonio; Indolfi, Ciro; Costanzo, Francesco

    2012-06-01

    This study was aimed at assessing the bias of high sensitive cardiac troponin T vs. the standard cardiac troponin T in a selected population with chest pain of presumed cardiac origin. Serum cTnT was determined in 132 patients and in 106 apparently healthy controls by both assays. The hs-cTnT outperformed the standard generation assay by: i) allowing a larger and earlier diagnosis of AMI (74.2 percent vs. 64.3 percent patients resulted positive at the final diagnosis of AMI when tested with the hs-cTnT or the std-cTnT assay, respectively); ii) showing a better time-dependent dynamics in patients with AMI due to a higher precision at low concentrations; iii) identifying, within the controls, 6 subjects in whom a further examination revealed the presence of chronic asymptomatic cardiac ischemia. The results underscore the excellent performance of the hs-cTnT assay in our population. The use of this test can thus be strongly recommended in subjects presenting to the emergency unit with chest pain of presumed ischemic origin in order to increase the probability of earlier diagnosis of AMI, especially in non-STEMI.

  3. Flow-mediated dilatation has no independent prognostic effect in patients with chest pain with or without ischaemic heart disease

    DEFF Research Database (Denmark)

    Ulriksen, Line Skjold; Malmqvist, Beata B; Hansen, Are;

    2009-01-01

    had significantly lower FMD than patients without IHD (p=0.002). During a mean follow-up of 4.2 years, 90 patients had an endpoint event, i.e. cardiovascular death, acute MI, unstable angina pectoris, PCI or CABG. In univariate analysis, FMD ...OBJECTIVE: The purpose of this study was to assess the prognostic effect of flow-mediated dilatation (FMD) in patients with chest pain admitted to a coronary care unit. METHODS: Endothelium-dependent FMD in the brachial artery was examined in 223 patients with acute chest pain. All patients...... endpoint (p=0.04). In multivariate analysis, adjusted for age, gender, IHD and body mass index, no association between FMD and the combined endpoint was found (p=0.99). CONCLUSION: FMD is associated with IHD, but has no independent prognostic effect in patients with chest pain....

  4. Angina-like chest pain and syncope as the clinical presentation of left ventricular endomyocardial fibrosis: a case report.

    Science.gov (United States)

    Bestetti, Reinaldo B; Corbucci, Helio A R; Fornitano, Luis D; Godoy, Moacyr F; Cury, Patricia M; Villafanha, Daniel; Santana, Domingos A; Soares, Marcelo J F; Braile, Domingo M

    2005-01-01

    A 47-year-old woman complained of angina-like chest pain, near-syncope, and syncopal episodes of 17 years' duration. Physical examination was unremarkable. A 12-lead resting ECG showed symmetrically inverted T waves in the inferior and anterolateral leads. A graded treadmill exercise stress test precipitated angina-like chest pain accompanied by a near-syncopal episode associated with a systemic arterial pressure of 60/40 mm Hg. Echocardiography disclosed left ventricular apical obliteration. Left ventriculogram showed a typical "ace of heart'' shadow as well as filling defects and apical obliteration. Endomyocardial biopsy of the left ventricle diagnosed left ventricular endomyocardial fibrosis. Thus, angina-like chest pain and near-syncopal episodes should be added to the list of clinical manifestations of pure left ventricular endomyocardial fibrosis.

  5. Prevalence of Chest Pain, Depression, Somatization, Anxiety, Global Distress, and Substance Use among Cardiac and Pulmonary Rehabilitation Patients

    Directory of Open Access Journals (Sweden)

    Eva R. Serber

    2012-01-01

    Full Text Available Psychosocial factors of cardiovascular disease receive a preponderance of attention. Little attention is paid to psychosocial factors of pulmonary disease. This paper sought to describe psychosocial characteristics and to identify differences between cardiac and pulmonary patients entering a phase II rehabilitation program. Parametric and nonparametric analyses were conducted to examine scores on the Brief Symptom Inventory-18 (BSI-18 and the CAGE-D, administered at entry as standard clinical care. Participants were 163 cardiac and 63 pulmonary patients. Scores on the BSI-18 “chest pain” item indicated that more cardiac patients report chest pain than pulmonary patients. Among all subjects, chest pain ratings were positively related to anxiety, depression, and global distress. There were equivocal proportions of anxiety and somatization in patient groups. Pulmonary patients were more likely to endorse clinically significant levels of depression and global psychological distress than cardiac patients. Cardiac patients were significantly more likely to screen positively on the CAGE-D than pulmonary patients. Findings show a relationship between symptoms of chest pain and psychological distress. Despite equivalent proportions of anxiety and somatization between groups, a greater proportion of pulmonary patients reported symptoms of depression and global psychological distress, while more cardiac patients reported chest pain. Further research is needed to examine this paradigm.

  6. Population based study of noncardiac chest pain in southern Chinese:Prevalence, psychosocial factors and health care utilization

    Institute of Scientific and Technical Information of China (English)

    Wai Man Wong; Chi Kuen Chan; Annie O.O. Chan; Shiu Kum Lam; Benjamin Chun-Yu Wong; Kwok Fai Lam; Cecilia Cheng; Wai Mo Hui; Harry Hua-Xiang Xia; Kam Chuen Lai; Wayne H.C. Hu; Jia Qing Huang; Cindy L.K. Lam

    2004-01-01

    AIM: Population-based assessment of noncardiac chest pain (NCCP) is lacking. The aim of this study was to evaluate the prevalence, psychosocial factors and health seeking behaviour of NCCP in southern Chinese.METHODS: A total of 2 209 ethnic Hong Kong Chinese households were recruited to participate in a telephone survey to study the epidemiology of NCCP using the Rose angina questionnaire, a validated gastroesophageal reflux disease (GERD) questionnaire and the hospital anxietydepression scale. NCCP was defined as non-exertional chest pain according to the Rose angina questionnaire and had not been diagnosed as ischaemic heart diseases by a physician.RESULTS: Chest pain over the past year was present in 454 subjects (20.6%, 95% CI 19-22), while NCCP was present in 307 subjects (13.9%, 95% CI 13-15). GERD was present in 51% of subjects with NCCP and 34% had consulted a physician for chest pain. Subjects with NCCP had a significantly higher anxiety (P<0.001) and depression score (P=0.007), and required more days off (P=0.021) than subjects with no chest pain. By multiple logistic regression analysis, female gender (OR 1.9, 95% CI 1.1-3.2), presence of GERD (OR 2.8, 95% CI 1.6-4.8), and social life being affected by NCCP (OR 6.9, 95% CI 3.3-15.9) were independent factors associated with health seeking behaviour in southern Chinese with NCCP.CONCLUSION: NCCP is a common problem in southern Chinese and associated with anxiety and depression. Female gender, GERD and social life affected by chest pain were associated with health care utilization in subjects with NCCP.

  7. Safety, feasibility, and results of exercise testing for stratifying patients with chest pain in the emergency room

    Directory of Open Access Journals (Sweden)

    Renato Machado Macaciel

    2003-08-01

    Full Text Available OBJECTIVE: To assess safety, feasibility, and the results of early exercise testing in patients with chest pain admitted to the emergency room of the chest pain unit, in whom acute myocardial infarction and high-risk unstable angina had been ruled out. METHODS: A study including 1060 consecutive patients with chest pain admitted to the emergency room of the chest pain unit was carried out. Of them, 677 (64% patients were eligible for exercise testing, but only 268 (40% underwent the test. RESULTS: The mean age of the patients studied was 51.7±12.1 years, and 188 (70% were males. Twenty-eight (10% patients had a previous history of coronary artery disease, 244 (91% had a normal or unspecific electrocardiogram, and 150 (56% underwent exercise testing within a 12-hour interval. The results of the exercise test in the latter group were as follows: 34 (13% were positive, 191 (71% were negative, and 43 (16% were inconclusive. In the group of patients with a positive exercise test, 21 (62% underwent coronary angiography, 11 underwent angioplasty, and 2 underwent myocardial revascularization. In a univariate analysis, type A/B chest pain (definitely/probably anginal (p<0.0001, previous coronary artery disease (p<0.0001, and route 2 (patients at higher risk correlated with a positive or inconclusive test (p<0.0001. CONCLUSION: In patients with chest pain and in whom acute myocardial infarction and high-risk unstable angina had been ruled out, the exercise test proved to be feasible, safe, and well tolerated.

  8. Management of chest pain: exploring the views and experiences of chiropractors and medical practitioners in a focus group interview

    Directory of Open Access Journals (Sweden)

    Rowell Robert M

    2005-09-01

    Full Text Available Abstract Background We report on a multidisciplinary focus group project related to the appropriate care of chiropractic patients who present with chest pain. The prevalence and clinical management, both diagnosis and treatment, of musculoskeletal chest pain in ambulatory medical settings, was explored as the second dimension of the focus group project reported here. Methods This project collected observational data from a multidisciplinary focus group composed of both chiropractic and medical professionals. The goals of the focus group were to explore the attitudes and experiences of medical and chiropractic clinicians regarding their patients with chest pain who receive care from both medical and chiropractic providers, to identify important clinical or research questions that may inform the development of 'best practices' for coordinating or managing care of chest pain patients between medical and chiropractic providers, to identify important clinical or research questions regarding the diagnosis and treatment of chest pain of musculoskeletal origin, to explore various methods that might be used to answer those questions, and to discuss the feasibility of conducting or coordinating a multidisciplinary research effort along this line of inquiry. The convenience-sample of five focus group participants included two chiropractors, two medical cardiologists, and one dual-degreed chiropractor/medical physician. The focus group was audiotaped and transcripts were prepared of the focus group interaction. Content analysis of the focus group transcripts were performed to identify key themes and concepts, using categories of narratives. Results Six key themes emerged from the analysis of the focus group interaction, including issues surrounding (1 Diagnosis; (2 Treatment and prognosis; (3 Chest pain as a chronic, multifactorial, or comorbid condition; (4 Inter-professional coordination of care; (5 Best practices and standardization of care; and (6

  9. Treatment efficacy for non-cardiovascular chest pain: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Jakob M Burgstaller

    Full Text Available BACKGROUND: Non-cardiovascular chest pain (NCCP leads to impaired quality of life and is associated with a high disease burden. Upon ruling out cardiovascular disease, only vague recommendations exist for further treatment. OBJECTIVES: To summarize treatment efficacy for patients presenting with NCCP. METHODS: Systematic review and meta-analysis. In July 2013, Medline, Web of Knowledge, Embase, EBSCOhost, Cochrane Reviews and Trials, and Scopus were searched. Hand and bibliography searches were also conducted. Randomized controlled trials (RCTs evaluating non-surgical treatments in patients with NCCP were included. Exclusion criteria were poor study quality and small sample size (<10 patients per group. RESULTS: Thirty eligible RCT's were included. Most studies assessed PPI efficacy for gastroesophageal reflux disorders (GERD, n = 10. Two RCTs included musculoskeletal chest pain, seven psychotropic drugs, and eleven various psychological interventions. Study quality was high in five RCTs and acceptable in 25. PPI treatment in patients with GERD (5 RCTs, 192 patients was more effective than placebo [pooled OR 11.7 (95% CI 5.5 to 25.0, heterogeneity I2 = 6.1%]. The pooled OR in GERD negative patients (4 RCTs, 156 patients was 0.8 (95% CI 0.2 to 2.8, heterogeneity I2 = 50.4%. In musculoskeletal NCCP (2 RCTs, 229 patients manual therapy was more effective than usual care but not than home exercise [pooled mean difference 0.5 (95% CI -0.3 to 1.3, heterogeneity I2 = 46.2%]. The findings for cognitive behavioral treatment, serotonin reuptake inhibitors, tricyclic antidepressants were mixed. Most evidence was available for cognitive behavioral treatment interventions. LIMITATIONS: Only a small number of studies were available. CONCLUSIONS: Timely diagnostic evaluation and treatment of the disease underlying NCCP is important. For patients with suspected GERD, high-dose treatment with PPI is effective. Only limited evidence was available

  10. Chest CT findings in patients with non-cardiovascular causes of chest pain: Focusing on pulmonary tuberculosis in a tuberculosis endemic country

    Energy Technology Data Exchange (ETDEWEB)

    Lee, So Won; Shim, Sung Shine; Kim, Yoo Kyung; Ryu, Yon Ju [Mokdong Hospital, Ewha Womans University School of Medicine, Seoul (Korea, Republic of)

    2015-10-15

    To review the common causes of non-cardiovascular chest pain (NCCP) according to the location and lesion type as seen on chest CT, and to evaluate CT findings in tuberculosis (TB) as a cause of NCCP. In the period 2009 to 2012, patients having NCCP without definitive evidence of acute myocardial infarction, pulmonary thromboembolism, and aortic dissection, were included. In total, 162 patients (60.5% male; 39.5% female), with a mean age of 51 years, were enrolled. CT images were evaluated by location and lesion type, for causes of NCCP. Chest CT revealed that the most common location for the cause of NCCP was the pleura (45.1%), followed by the subpleural lung parenchyma (30.2%). The most common lesion causing NCCP was TB (33.3%), followed by pneumonia (19.1%). Of the 54 TB cases, 40 (74.1%) were stable TB and 14 (25.9%) were active TB; among these 54 patients, NCCP was most commonly the result of fibrotic pleural thickening (55.6%), followed by subpleural stable pulmonary TB (14.8%). Results of chest CT revealed that TB was a major cause of NCCP in a TB endemic area. Among the TB patients, fibrotic pleural thickening in patients with stable TB was the most common cause of NCCP.

  11. Visceral chest pain in unstable angina pectoris and effects of transcutaneous electrical nerve stimulation. (TENS). A review.

    Science.gov (United States)

    Börjesson, M

    1999-04-01

    A substantial proportion of patients with chest pain referred to hospital, show signs of coronary artery disease. Anginal pain could be conceptualized as a warning signal for coronary artery disease and impending death. But, for many reasons this theory is partly disputed. Firstly, not all ischemic episodes are accompanied by anginal pain (silent ischemia). Secondly, chest pain indistinguishable from true angina pectoris may be the result of other abnormalities of thoracic viscera. Nevertheless acute severe cardiac ischemia often gives rise to anginal chest pain. Unstable angina pectoris is carrying a higher risk for future events in spite of intensive medical treatment. A special problem are patients awaiting coronary intervention because of severe ischemia and maximum medical treatment, who experience ischemic pain. New treatment regimens are needed for these patients. This review discusses the symptom of visceral pain from the heart, angina pectoris, its relation to ischemia and unstable angina pectoris. It also addresses the role of afferent nerve stimulation (transcutaneous electrical nerve stimulation, TENS) in the treatment of severe angina pectoris as well as recent findings of TENS applicability in unstable angina.

  12. An Autopsied Case of Malignant Sarcomatoid Pleural Mesothelioma in Which Chest Pain Developed Several Months Earlier without Abnormality on Imaging.

    Science.gov (United States)

    Yaguchi, Daizo; Ichikawa, Motoshi; Inoue, Noriko; Kobayashi, Daisuke; Matsuura, Akinobu; Shizu, Masato; Imai, Naoyuki; Watanabe, Kazuko

    2015-01-01

    The patient experienced chest pain for about 7 months, but a diagnosis could not be made until after death. He was diagnosed with malignant sarcomatoid pleural mesothelioma on autopsy. In this case report, difficult aspects of the diagnosis are discussed. The 70-year-old Japanese man was a driver who transported ceramic-related products. Right chest pain developed in July 2013, but no abnormality was detected on a chest computed tomography (CT) performed in September 2013, and the pain was managed as right intercostal neuralgia. A chest CT performed in late October 2013 revealed a right pleural effusion, and the patient was referred to our hospital in early November 2013. Thoracentesis was performed, but the cytology was negative, and no diagnosis could be made. Close examination was postponed because the patient developed a subarachnoid hemorrhage. He underwent (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) after discharge from the neurosurgery department, and extensive right pleural thickening and (18)F-FDG accumulation in this region were observed. Based on these findings, malignant pleural mesothelioma was suspected, and a thoracoscopy was performed under local anesthesia in early December 2013, but no definite diagnosis could be made. The patient selected best supportive care and died about 7 months after the initial development of right chest pain. The disease was definitively diagnosed as malignant sarcomatoid pleural mesothelioma by a pathological autopsy. When chronic chest pain of unknown cause is observed and past exposure to asbestos is suspected, actions to prevent delay in diagnosis should be taken, including testing for suspicion of malignant pleural mesothelioma.

  13. An Autopsied Case of Malignant Sarcomatoid Pleural Mesothelioma in Which Chest Pain Developed Several Months Earlier without Abnormality on Imaging

    Directory of Open Access Journals (Sweden)

    Daizo Yaguchi

    2015-10-01

    Full Text Available The patient experienced chest pain for about 7 months, but a diagnosis could not be made until after death. He was diagnosed with malignant sarcomatoid pleural mesothelioma on autopsy. In this case report, difficult aspects of the diagnosis are discussed. The 70-year-old Japanese man was a driver who transported ceramic-related products. Right chest pain developed in July 2013, but no abnormality was detected on a chest computed tomography (CT performed in September 2013, and the pain was managed as right intercostal neuralgia. A chest CT performed in late October 2013 revealed a right pleural effusion, and the patient was referred to our hospital in early November 2013. Thoracentesis was performed, but the cytology was negative, and no diagnosis could be made. Close examination was postponed because the patient developed a subarachnoid hemorrhage. He underwent 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET after discharge from the neurosurgery department, and extensive right pleural thickening and 18F-FDG accumulation in this region were observed. Based on these findings, malignant pleural mesothelioma was suspected, and a thoracoscopy was performed under local anesthesia in early December 2013, but no definite diagnosis could be made. The patient selected best supportive care and died about 7 months after the initial development of right chest pain. The disease was definitively diagnosed as malignant sarcomatoid pleural mesothelioma by a pathological autopsy. When chronic chest pain of unknown cause is observed and past exposure to asbestos is suspected, actions to prevent delay in diagnosis should be taken, including testing for suspicion of malignant pleural mesothelioma.

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

    Science.gov (United States)

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

    1996-09-01

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

  15. Extraesophageal manifestations of gastroesophageal reflux disease: cough, asthma, laryngitis, chest pain.

    Science.gov (United States)

    Saritas Yuksel, Elif; Vaezi, Michael F

    2012-01-01

    GER is a common condition affecting many patients in different parts of the world. It usually presents with the classic manifestations of heartburn and regurgitation; however, in some it can also present with extraesophageal manifestations such as chronic cough, laryngitis, asthma or chest pain. Commonly employed diagnostic tests such as EGD and ambulatory pH or impedance monitoring in GER, are less useful in extraesophageal syndromes due to their poor sensitivity and specificity. In contrast, empiric trials of PPI's are shown to be cost effective; however, patients may require long-term treatment to establish effectiveness. Diagnostic testing with pH and impedance monitoring are commonly reserved for patients with partial or poor response to the initial treatment with PPI's. Poor response to PPI therapy may be an important indicator for non-GER causes for patients' symptoms and should initiate a search for other potential causes.

  16. Sex difference in chest pain after implantation of newer generation coronary drug-eluting stents: a patient-level pooled analysis from the TWENTE and DUTCH PEERS trials

    NARCIS (Netherlands)

    Kok, Marlies M.; Heijden, van der Liefke C.; Sen, Hanim; Danse, Peter W.; Löwik, Marije M.; Anthonio, Rutger L.; Louwerenburg, J. (Hans) W.; Man, de Frits H.A.F.; Linssen, Gerard C.M.; IJzerman, Maarten J.; Doggen, Carine J.M.; Maas, Angela H.E.M.; Mehran, Roxana; Birgelen, von Clemens

    2016-01-01

    Objectives This study sought to assess sex differences in chest pain after percutaneous coronary intervention (PCI) with newer generation drug-eluting stents (DES). Background Sex-based data on chest pain after PCI with DES are scarce. Methods The authors performed a patient-level pooled analysis

  17. BNP was Associated with Ischemic Myocardial Scintigraphy and Death in Patients at Chest Pain Unit

    Energy Technology Data Exchange (ETDEWEB)

    Azevedo, Jader Cunha de, E-mail: jadercazevedo@gmail.com [Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Centro Universitário de Volta Redonda, Rio de Janeiro, RJ (Brazil); Reis, Bruno Cezario Costa; Barreto, Nathalia Monerat P.B. [Centro Universitário de Volta Redonda, Rio de Janeiro, RJ (Brazil); F, Diogenes S. Junior; Prezotti, Lais S. [Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ (Brazil); Procaci, Victor Rebelo; Octaviano, Vivian Werneck [Centro Universitário de Volta Redonda, Rio de Janeiro, RJ (Brazil); Volschan, Andre [Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Mesquita, Evandro Tinoco; Mesquita, Claudio Tinoco [Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil)

    2015-01-15

    Recent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events. To determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS). This study included retrospectively 125 patients admitted to the chest pain unit between 2002 and 2006, who had their BNP levels measured on admission and underwent CPM for risk stratification. BNP values were compared with the results of the MPS. The chi-square test was used for qualitative variables and the Student t test, for quantitative variables. Survival curves were adjusted using the Kaplan-Meier method and analyzed by using Cox regression. The significance level was 5%. The mean age was 63.9 ± 13.8 years, and the male sex represented 51.2% of the sample. Ischemia was found in 44% of the MPS. The mean BNP level was higher in patients with ischemia compared to patients with non-ischemic MPS (188.3 ± 208.7 versus 131.8 ± 88.6; p = 0.003). A BNP level greater than 80 pg/mL was the strongest predictor of ischemia on MPS (sensitivity = 60%, specificity = 70%, accuracy = 66%, PPV = 61%, NPV = 70%), and could predict medium-term mortality (RR = 7.29, 95% CI: 0.90-58.6; p = 0.045) independently of the presence of ischemia. BNP levels are associated with ischemic MPS findings and adverse prognosis in patients presenting with acute chest pain to the emergency room, thus, providing important prognostic information for an unfavorable clinical outcome.

  18. Chest Pain with Normal Thallium-201 Myocardial Perfusion Image – Is It Really Normal?

    Science.gov (United States)

    Liu, Pang-Yen; Lin, Wen-Yu; Lin, Li-Fan; Lin, Chin-Sheng; Lin, Wei-Shiang; Cheng, Shu-Meng; Yang, Shih-Ping; Liou, Jun-Ting

    2016-01-01

    Background Thallium-201 myocardial perfusion image (MPI) is commonly used to detect coronary artery disease in patients with chest pain. Although a normal thallium-201 MPI result is generally considered to be a good prognosis and further coronary angiogram is not recommended, there are still a few patients who suffer from unexpected acute coronary events. The aim of this study was to investigate the clinical prognosis in patients with normal thallium-201 MPI. Methods From January 2006 to August 2012, a total 22,003 patients undergoing thallium-201 MPI in one tertiary center were screened. Of these, 8092 patients had normal results and were investigated retrospectively. During follow-up, 54 patients underwent coronary angiogram because of refractory typical angina pectoris or unexpected acute coronary events. These 54 patients were divided into 2 groups: group I consisted of 26 (48.1%) patients with angiography-proven significant coronary artery stenosis, and group II consisted of 28 (51.9%) patients without significant stenosis. Results Patients in group I had a higher prevalence of prior coronary stenting and electrocardiographic features of ST depression compared with patients in group II. The multivariate analysis demonstrated that both prior coronary stenting and ST depression were risk predictors of unexpected acute coronary events in the patients with normal thallium-201 MPI [odds ratio (OR), 5.93; 95% confidence interval (CI): 1.03-34.06, p = 0.05 and OR, 7.10; 95% CI: 1.28-39.51, p = 0.03,respectively]. Conclusions Although there is a low incidence of unexpected acute coronary events in patients with chest pain and normal thallium-201 MPI, physicians should be aware of the potentials risk in certain patients in this specific population. PMID:27274174

  19. Diagnostic evaluation of the MRP-8/14 for the emergency assessment of chest pain.

    Science.gov (United States)

    Vora, Amit N; Bonaca, Marc P; Ruff, Christian T; Jarolim, Petr; Murphy, Sabina; Croce, Kevin; Sabatine, Marc S; Simon, Daniel I; Morrow, David A

    2012-08-01

    Elevated levels of myeloid-related protein (MRP)-8/14 (S100A8/A9) are associated with first cardiovascular events in healthy individuals and worse prognosis in patients with acute coronary syndrome (ACS). The diagnostic utility of MRP-8/14 in patients presenting to the emergency room with symptoms concerning for ACS is uncertain. MRP-8/14 was measured in serial serum and plasma samples in a single center prospective cohort-study of patients presenting to the emergency room with non-traumatic chest pain concerning for ACS. Final diagnosis was adjudicated by an endpoint committee. Of patients with baseline MRP-8/14 results (n = 411), the median concentration in serum was 1.57 μg/ml (25th, 75th: 0.87, 2.68) and in plasma was 0.41 μg/ml (MRP-8/14 was higher in patients presenting with MI (p MRP-8/14 was poor: sensitivity 28% (95% CI 20-38), specificity 82% (78-86), positive predictive value 36% (26-47), and negative predictive value 77% (72-81). The area under the ROC curve for diagnosis of MI with MRP-8/14 was 0.55 (95% CI 0.51-0.60) compared with 0.95 for cTnI. The diagnostic performance was not improved in early-presenters, patients with negative initial cTnI, or using later MRP-8/14 samples. Patients presenting with MI had elevated levels of serum MRP-8/14 compared to patients with non-cardiac chest pain. However, overall diagnostic performance of MRP-8/14 was poor and neither plasma nor serum MRP-8/14 offered diagnostic utility comparable to cardiac troponin.

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

    Institute of Scientific and Technical Information of China (English)

    Guo xiaobi; Feng Jianzhan; Guo Hengshan

    2005-01-01

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

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

    Science.gov (United States)

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

    2013-03-01

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

  2. Stress Tests for Chest Pain: When You Need an Imaging Test -- and When You Don't

    Science.gov (United States)

    ... disease. But chest pain can have many possible causes besides heart disease, such as indigestion, anxiety, or muscle injury. If the doctor’s initial evaluation shows that you probably don’t have a heart problem, you may not need a stress test at all. And if you do, a simple ...

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  4. Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Kelly N. Sawyer

    2015-10-01

    Full Text Available Introduction: Undifferentiated chest pain in the emergency department (ED is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT for pulmonary embolism or dissection followed by a cardiac stress test (TRAD. An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO. The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods. Methods: This was a retrospective observational study of adult patients presenting to a large, community ED for acute chest pain who had non-diagnostic electrocardiograms (ECGs and normal biomarkers. We collected demographics, ED length of stay, hospital costs, and estimated radiation exposures. We evaluated 30-day return visits for major adverse cardiac events. Results: A total of 829 patients underwent TRAD, and 642 patients had TRO. Patients undergoing TRO tended to be younger (mean 52.3 vs 56.5 years and were more likely to be male (42.4% vs. 30.4%. TRO patients tended to have a shorter ED length of stay (mean 14.45 vs. 21.86 hours, to incur less cost (median $449.83 vs. $1147.70, and to be exposed to less radiation (median 7.18 vs. 16.6mSv. No patient in either group had a related 30-day revisit. Conclusion: Use of TRO is feasible for assessment of chest pain in the ED. Both TRAD and TRO safely evaluated patients. Prospective studies investigating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation.

  5. Reduce chest pain using modified silicone fluted drain tube for chest drainage after video-assisted thoracic surgery (VATS) lung resection

    Science.gov (United States)

    Li, Xin; Hu, Bin; Miao, Jinbai

    2016-01-01

    Background The aim of this study was to assess the feasibility, efficacy and safety of a modified silicone fluted drain tube after video-assisted thoracic surgery (VATS) lung resection. Methods The prospective randomized study included 50 patients who underwent VATS lung resection between March 2015 and June 2015. Eligible patients were randomized into two groups: experimental group (using the silicone fluted drain tubes for chest drainage) and control group (using standard drain tubes for chest drainage). The volume and characteristics of drainage, postoperative (PO) pain scores and hospital stay were recorded. All patients received standard care during hospital admission. Results In accordance with the exit criteria, three patients were excluded from study. The remaining 47 patients included in the final analysis were divided into two groups: experiment group (N=24) and control group (N=23). There was no significant difference between the two groups in terms of age, sex, height, weight, clinical diagnosis and type of surgical procedure. There was a trend toward less PO pain in experimental group on postoperative day (POD) 1, with a statistically significant difference. Patients in experimental group had a reduced occurrence of fever [temperature (T) >37.4 °C] compared to the control group. Conclusions The silicone fluted drain tube is feasible and safe and may relieve patient PO pain and reduce occurrence of fever without the added risk of PO complications. PMID:26941976

  6. Physical therapy intervention in patients with non-cardiac chest pain following a recent cardiac event: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Astrid T Berg

    2015-04-01

    Full Text Available Objectives: To assess the effect of two different physical therapy interventions in patients with stable coronary heart disease and non-cardiac chest pain. Methods: A randomized controlled trial was carried out at a university hospital in Norway. A total of 30 patients with known and stable coronary heart disease and self-reported persistent chest pain reproduced by palpation of intercostal trigger points were participating in the study. The intervention was deep friction massage and heat pack versus heat pack only. The primary outcome was pain intensity after the intervention period and 3 months after the last treatment session, measured by Visual Analogue Scale, 0 to 100. Secondary outcome was health-related quality of life. Results: Treatment with deep friction massage and heat pack gave significant pain reduction compared to heat pack only (–17.6, 95% confidence interval: –30.5, –4.7; p < 0.01, and the reduction was persistent at 3 months’ follow-up (–15.2, 95% confidence interval: –28.5, –1.8; p = 0.03. Health-related quality of life improved in all three domains in patients with no significant difference between groups. Conclusion: Deep friction massage combined with heat pack is an efficient treatment of musculoskeletal chest pain in patients with stable coronary heart disease.

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

    Science.gov (United States)

    Coche, E

    2007-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  9. Dor torácica não-cardiogênica Non-cardiac chest pain

    Directory of Open Access Journals (Sweden)

    Gerson Ricardo de Souza Domingues

    2009-09-01

    ão ocupar lugar no cenário do tratamento destes pacientes.CONTEXT: Non-cardiac chest pain or functional chest pain is a syndrome with high prevalence in ocidental world. Findings on 15%-30% of coronary angiograms performed in patients with chest pain are normal. Causes significant impact in quality of life of patients and is associated with increased use of the health care facilities. DATA SOURCES: To this review the following data base were accessed: Medline, the Cochrane Library, LILACS. The limit was the last 5 years publications and were selected relevant original articles, reviews, consensus, guidelines and meta-analysis. RESULTS: Forty-four papers were selected, 28 original articles, 12 reviews, 2 guidelines, 1 consensus and 1 meta-analysis. CONCLUSIONS: Exclusion of cardiac disease is of crucial importance. On the other hand non-cardiac chest pain could be related to gastrointestinal, muscular and respiratory causes and/or psychological disturbances. Treatment aims to attack mechanism generator in order to relieve or to eliminate symptoms. Drugs are the cornerstone of treatment, exception to achalasia patients because those have better response to dilation of the esophagus or surgery, and to those who need intensive pyschological therapy. The most important drugs used are proton pump inhibitors and triciclic antidepressants, the latter, to modulate central signal process (visceral hypersensitivity and autonomic response. Recently, new diagnostic facilities, and also therapeutic modalities, such as esophageal botulin toxin injection and hypnosis are under investigations. In the near future, maybe some of them would take a place in the therapeutic scenario of these patients.

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

    Directory of Open Access Journals (Sweden)

    Elisa Conti

    2011-09-01

    Full Text Available The aim of the study is to assess if copeptin, in combination with negative troponin, is able to accelerate the rule-out of AMI in patients with chest pain. The study was retrospectively conducted on three groups of patients selected according to their discharge diagnoses: patients with non-ST elevation myocardial infarction (NSTEMI, non-cardiac chest pain (NCCP, unstable angina (UA. Comparing the levels of copeptin, we found that the diagnosis of AMI is associated more often with copeptin positive values (> 14 pmol/l than the diagnosis of NCCP and UA. However, about a quarter of our patients in which the combination of copeptin and troponin in the first blood sample was negative, the final diagnosis was AMI. According to our results, the combination of the two negative markers does not allow a safe rule out of AMI at time zero.

  11. Chest pain in children and adolescents: epigastric tenderness as a guide to reduce unnecessary work-up.

    Science.gov (United States)

    Sabri, M R; Ghavanini, A A; Haghighat, M; Imanieh, M H

    2003-01-01

    Our objective was to evaluate and highlight the significance of epigastric tenderness in children and adolescents with chest pain. In a 26-months period, patients who were referred for pediatri cardiology evaluation at Shiraz University of Medical Sciences with chief complaint of chest pain were studied. Patients with epigastric tenderness were evaluated endoscopically by gastroenterologist. Patients who had positive findings on endoscopy were appropriately treated. Since there were no serious findings on cardiac evaluation, no other treatment was necessary. The patients were re-evaluated 4 weeks later. Response to therapy was defined as relief of the initial symptoms as well as epigastric tenderness. One hundred thirty-two patients were referred for evaluation of chest pain during this period. Epigastric tenderness was found in 44 (33.3%) of these patients and endoscopy was performed. Endoscopy showed positive findings in 41 (93.2%). Thirty (75%) of these patients had varying degrees of gastritis. Duodenitis was found in six (13.6%) and gasteroduodenitis in five (11.4%). Esophagitis, which was always associated with gastritis, was seen in five (11.4%). Only three (6.8%) had normal endoscopy. Urease test was positive in three (7.3%) of the specimens. Two of the patients did not return for follow up. From the remaining 39 patients who received gastroenterology treatment, resolution of symptoms was seen in 38 (97.4%). Careful history and physical examination must guide the assessment of children and adolescents referred for evaluation of chest pain. Epigastric tenderness must be used as a reliable sign to initiate a gastrointestinal evaluation.

  12. EVALUATION OF ANXIETY & DEPRESSIVE SYMPTOMS IN PATIENTS WITH 1 ST EPISODE OF CHEST PAIN ATTENDING MEDICINE OUT PATIENT DEPARTMENT OF TERTIARY CARE TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Bhavik S.

    2015-06-01

    Full Text Available INTRODUCTION: As chest pain is an important symptom of coronary artery disease (CAD and other non - cardiac diseases , the presentation of the symptom often prompts referral to physicians for further investigation. Previous studies h ad shown significant as sociation between chest pain and D e pr e ssive and anxiety symptoms. AIMS AND OBJECTIVES: Evaluate and screen depressive symptoms , anxiety symptoms and somatic symptoms in patients with 1 st episode of chest pain attending medicine out - patient department of tertiary care teaching hospital. METHODOLGY : Cross - sectional observational study. Prior permission from institutional ethics committee of ‘SUMANDEEP VIDYAPEETH’ had been taken. 100 patients having first episosde of chest pain coming to M edicine opd of DHIRAJ HOSPITAL are recruited randomly after 1st December 2014. Each patient is given case r eport form containing sociodemographic data , patients medical history , depression and somatic symptoms scale and Hamilton’s anxiety scale (HAM - A. All data are entered in spss 16 and analysed with different ( S tatistical tests. Differences on categorical m easures will be reported as P value. The result is significant if P <0.05. RESULT: 38% & 49% patients have clinically significant depression and anxiety respectively. DSSS score is positively correlated with duration of chest pain. CONCLUSION : significant level of depression and anxiety found in 1 st episode of chest pain patients.

  13. Chest X-Ray

    Medline Plus

    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 ...

  14. Do guidelines on first impression make sense? Implementation of a chest pain guideline in primary care: a systematic evaluation of acceptance and feasibility

    Directory of Open Access Journals (Sweden)

    Kramer Lena

    2011-11-01

    Full Text Available Abstract Background Most guidelines concentrate on investigations, treatment, and monitoring instead of patient history and clinical examination. We developed a guideline that dealt with the different aetiologies of chest pain by emphasizing the patient's history and physical signs. The objective of this study was to evaluate the guideline's acceptance and feasibility in the context of a practice test. Methods The evaluation study was nested in a diagnostic cross-sectional study with 56 General Practitioners (GPs and 862 consecutively recruited patients with chest pain. The evaluation of the guideline was conducted in a mixed method design on a sub-sample of 17 GPs and 282 patients. Physicians' evaluation of the guideline was assessed via standardized questionnaires and case record forms. Additionally, practice nursing staff and selected patients were asked for their evaluation of specific guideline modules. Quantitative data was analyzed descriptively for frequencies, means, and standard deviations. In addition, two focus groups with a total of 10 GPs were held to gain further insights in the guideline implementation process. The data analysis and interpretation followed the standards of the qualitative content analysis. Results The overall evaluation of the GPs participating in the evaluation study regarding the recommendations made in the chest pain guideline was positive. A total of 14 GPs were convinced that there was a need for this kind of guideline and perceived the guideline recommendations as useful. While the long version was partially criticized for a perceived lack of clarity, the short version of the chest pain guideline and the heart score were especially appreciated by the GPs. However, change of clinical behaviour as consequence of the guideline was inconsistent. While on a concrete patient related level, GPs indicated to have behaved as the guideline recommended, the feedback on a more general level was heterogeneous. Several

  15. Low incidence of chest wall pain with a risk-adapted lung stereotactic body radiation therapy approach using three or five fractions based on chest wall dosimetry.

    Directory of Open Access Journals (Sweden)

    Thibaud P Coroller

    Full Text Available PURPOSE: To examine the frequency and potential of dose-volume predictors for chest wall (CW toxicity (pain and/or rib fracture for patients receiving lung stereotactic body radiotherapy (SBRT using treatment planning methods to minimize CW dose and a risk-adapted fractionation scheme. METHODS: We reviewed data from 72 treatment plans, from 69 lung SBRT patients with at least one year of follow-up or CW toxicity, who were treated at our center between 2010 and 2013. Treatment plans were optimized to reduce CW dose and patients received a risk-adapted fractionation of 18 Gy×3 fractions (54 Gy total if the CW V30 was less than 30 mL or 10-12 Gy×5 fractions (50-60 Gy total otherwise. The association between CW toxicity and patient characteristics, treatment parameters and dose metrics, including biologically equivalent dose, were analyzed using logistic regression. RESULTS: With a median follow-up of 20 months, 6 (8.3% patients developed CW pain including three (4.2% grade 1, two (2.8% grade 2 and one (1.4% grade 3. Five (6.9% patients developed rib fractures, one of which was symptomatic. No significant associations between CW toxicity and patient and dosimetric variables were identified on univariate nor multivariate analysis. CONCLUSIONS: Optimization of treatment plans to reduce CW dose and a risk-adapted fractionation strategy of three or five fractions based on the CW V30 resulted in a low incidence of CW toxicity. Under these conditions, none of the patient characteristics or dose metrics we examined appeared to be predictive of CW pain.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  17. Exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in coronary care units

    Directory of Open Access Journals (Sweden)

    Saadat H

    2011-10-01

    Full Text Available Habibollah Saadat¹, Hossein Shiri², Zahra Salarpour², Tahereh Ashktorab² , Hamid Alavi Majd², Zahra Saadat¹, Hosein Vakili¹ 1Cardiovascular Research Center, Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran; 2Nursing School, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Background: Most patients who present to medical centers due to chest pain do not suffer from acute coronary syndromes and do not need to be hospitalized in coronary care units (CCUs. This study was done to determine exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in CCUs of educational hospitals affiliated with a major medical university. Methods: Over a 4-month period, 550 patients with chest pain who were hospitalized in the CCUs belonging to six hospitals affiliated to the authors' medical university were recruited by census method. Using Thrombolysis in Myocardial Infarction risk score, 95 patients (17.27% were categorized as low-risk patients. This group was evaluated with respect to demographics, bed occupancy rate, mean hospitalization period, expenses during admission, and cardiovascular outcomes in the 30-day period postdischarge. Results: Mean (± standard deviation hospitalization duration was 3.04 (±0.71 days. No significant difference was seen between the six surveyed hospitals regarding hospitalization duration (P = 0.602. The highest bed occupancy rate was seen in Taleghani and Shohada Tajrish hospitals and the lowest was in Modarres Hospital. The mean paid treatment expenses by low-risk patients was IRR 2,050,000 (US$205. Mean total hospitalization expenses was US$205. No significant difference was seen between the six surveyed hospitals (P = 0.699. Of the patients studied, 89.5% did not show any cardiovascular complications in 1 month and no deaths occurred. Conclusion: Given the high bed-occupancy rate by low-risk patients, associated high hospitalization

  18. Comparison of Ice Packs Application and Relaxation Therapy in Pain Reduction during Chest Tube Removal Following Cardiac Surgery

    OpenAIRE

    2014-01-01

    Background: Usually the chest tube removal (CTR) has been described as one of the worst experiences by patients in the intensive care unit. Aim: This study aimed to compare the effects of cold therapy and relaxation on pain of CTR among the patients undergoes coronary artery bypass graft surgery. Materials and Methods: This single-blinded clinical trial was done on 80 post-cardiac surgery patients in the heart hospital of Sari-Iran. The patients were assigned to three randomized groups that i...

  19. Risk of gastrointestinal cancer in patients with unexplained chest/epigastric pain and normal upper endoscopy: a Danish 10-year follow-up study

    DEFF Research Database (Denmark)

    Munk, Estrid Muff; Drewes, Asbjørn Mohr; Gorst-Rasmussen, Anders;

    2007-01-01

    Unexplained chest/epigastric pain is a common symptom in the general population. However, it has not previously been studied whether such pain could be a marker of subsequent gastrointestinal cancer. We aimed to estimate the risk of gastrointestinal cancers in a Danish 10-year follow-up study among...... patients with chest/epigastric pain, normal upper endoscopy, and no prior discharge diagnosis of ischemic heart disease (N = 386), compared with population controls (N = 3860). The overall 10-year risk of gastrointestinal cancer (stomach, colorectal, liver, and pancreas) was 2.9% for patients...... of gastrointestinal cancer within the first year after upper endoscopy. Consequently, unexplained chest/epigastric pain might be an early gastrointestinal cancer symptom....

  20. A 15-Year-Old Boy with Anterior Chest Pain, Progressive Dyspnea, and Subcutaneous Emphysema of the Neck

    Directory of Open Access Journals (Sweden)

    Nicola Scichilone

    2009-01-01

    Full Text Available We describe the case of an adolescent who was admitted to the hospital because of sudden occurrence of chest pain, dyspnea and subcutaneous emphysema. On admission, physical examination revealed subcutaneous crepitations in the superior part of the rib cage, and auscultation of the chest showed widespread wheezing. The radiological assessment confirmed the diagnosis of pneumomediastinum and pneumothorax. A follow-up CT scan performed one week after the admission showed almost complete resolution of the radiological alterations. At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather. Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander. Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made. Although pneumomediastinum may be a complication of various respiratory diseases, including asthma, it has never been reported as the first presentation of underlying bronchial asthma. Herein, the physiopathological mechanisms, the diagnostic procedures and treatment of pneumomediastinum in asthma are discussed. We suggest that the diagnosis of asthma should be considered in the differential diagnosis of pneumomediastinum in adolescence.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-10-15

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

  2. Implementation of NICE Clinical Guideline 95 for assessment of stable chest pain in a rapid access chest pain clinic reduces the mean number of investigations and cost per patient

    Science.gov (United States)

    Lee, Alvin J X; Michail, Michael; Quaderi, Shumonta A; Richardson, James A; Aggarwal, Suneil K; Speechly-Dick, M Elsya

    2015-01-01

    Objective In 2010, the National Institute for Health and Care Excellence (NICE) in the UK published Clinical Guideline 95 (CG95) advocating risk stratification of patients using ‘CADScore’ to guide appropriate cardiac investigations for chest pain of recent onset. Implementation of the guideline in the University College London Hospitals NHS Foundation Trust was evaluated to see if it led to a reduction in the average cost of the diagnostic journey per patient and fewer investigations per patient in order to confirm a diagnosis. Methods This was a single centre study at a Tertiary Centre in Central London. The investigative journey for each patient presenting to the Rapid Access Chest Pain Clinic (RACPC) at University College London Hospitals NHS Foundation Trust was recorded. Retrospective analysis on this data was performed. Results Data for 4968 patients presenting to the RACPC from 2004 to 2012 was analysed and a size-matched cohort of 1503 patients preimplementation and postimplementation of the guidelines was compared. The mean cost of investigations postimplementation was £291.83 as compared to £319.54 preimplementation of the guidelines despite higher costs associated with some of the recommended initial investigations. The mean number of tests per patient postguidelines was 0.78 compared to 0.97 for preguidelines. An approximate twofold increase in patients not requiring tests was seen post-CG95 implementation (245 pre-CG95 vs 476 post-CG95). Conclusions The implementation of the NICE guidelines in our trust has reduced the average cost of the investigative journey and the number of investigations required per patient. PMID:25722859

  3. Comparison of ice packs application and relaxation therapy in pain reduction during chest tube removal following cardiac surgery

    Directory of Open Access Journals (Sweden)

    M A Heidari Gorji

    2014-01-01

    Full Text Available Background: Usually the chest tube removal (CTR has been described as one of the worst experiences by patients in the intensive care unit. Aim: This study aimed to compare the effects of cold therapy and relaxation on pain of CTR among the patients undergoes coronary artery bypass graft surgery. Materials and Methods: This single-blinded clinical trial was done on 80 post-cardiac surgery patients in the heart hospital of Sari-Iran. The patients were assigned to three randomized groups that included cold therapy, relaxation, and control groups. Data analysis was done by T-test, Chi-square, generalized estimating equations and repeated measures analysis variance tests. Results: The groups had no significant differences in pain intensity before CTR (P = 0.84, but immediately after CTR there was a significant difference between the treatment (cold application and relaxation groups and control groups (P = 0.001. There was no significant difference between relaxation and cold therapy groups. Conclusion: Regarding the relaxation and cold application methods showed relatively equal effects on reducing the pain owing to CTR. Thus, the use of relaxation because of economics, without side effects, easy to use and effective is recommended by the authors to the practitioners.

  4. The effect of implementation of cardiac triage scale on time indices of triage in patients with chest pain

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    Fazel-Asgharpour Azam

    2016-06-01

    Full Text Available Background and Objective: Chest patient is the most common symptom in coronary artery disease, but its diagnosis is a complex issue and high mortality is attributed to this symptom. Therefore, the timely diagnosis and treatment is essential. The present study was conducted to determine the effect of implementation of cardiac triage scale on time indices in patients with chest pain. Materials and Method: In this clinical trial study with control group,  study population was the patients referred to emergency ward of Farabi hospital in Mashhad in 2014. 60 patients were selected purposefully and then were randomly allocated into intervention and control group. The patients in intervention group were triaged through using cardiac triage scale by researcher and in control group through emergency severity index and by nurse.  Data analysis was done through using descriptive statistics, Chi-square and Mann Whitney in SPSS 21. Results: The beginning of 6- hours hospitalization (p < 0.001, the time of the first visit by specialist (p<0.001 and the time of the first electrocardiogram (p < 0.001 in intervention group was shorter than the control group. Conclusion: The results of the study showed that the special triage of cardiac patients can decrease the time of assessment and caring of them. Thus, the using of this method is recommended for early care of cardiac patients.

  5. Effect of the implementation of cardiac triage scale on the time indices of patients with chest pain

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    Azam Fazel-Asgharpour

    2016-02-01

    Full Text Available Background: Chest patient is the most common symptom in coronary artery disease, but its diagnosis is a complex issue and high mortality is attributed to this symptom. Therefore, the timely diagnosis and treatment is essential. The present study was conducted to determine the effect of implementation of cardiac triage scale on time indices in patients with chest pain. Methods: In this clinical trial study with control group, study population was the patients referred to emergency ward of Farabi hospital in Mashhad in 2014. 60 patients were selected purposefully and then were randomly allocated into intervention and control group. The patients in intervention group were triaged through using cardiac triage scale by researcher and in control group through emergency severity index and by nurse. Data analysis was done through using descriptive statistics, Chi-square and Mann Whitney in SPSS 21. Results: The beginning of 6-hours hospitalization (p < 0.001, the time of the first visit by specialist (p < 0.001 and the time of the first electrocardiogram (p < 0.001 in intervention group was shorter than the control group. Conclusion: The results of the study showed that the special triage of cardiac patients can decrease the time of assessment and caring of them. Thus, the using of this method is recommended for early care of cardiac patients.

  6. Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room

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    Roberto Bassan

    2000-05-01

    Full Text Available PURPOSE: To evaluate the efficacy of a systematic model of care for patients with chest pain and no ST segment elevation in the emergency room. METHODS: From 1003 patients submitted to an algorithm diagnostic investigation by probability of acute ischemic syndrome. We analyzed 600 ones with no elevation of ST segment, then enrolled to diagnostic routes of median (route 2 and low probability (route 3 to ischemic syndrome. RESULTS: In route 2 we found 17% acute myocardial infarction and 43% unstable angina, whereas in route 3 the rates were 2% and 7%, respectively. Patients with normal/non--specific ECG had 6% probability of AMI whereas in those with negative first CKMB it was 7%; the association of the 2 data only reduced it to 4%. In patients in route 2 the diagnosis of AMI could only be ruled out with serial CKMB measurement up to 9 hours, while in route 3 it could be done in up to 3 hours. Thus, sensitivity and negative predictive value of admission CKMB for AMI were 52% and 93%, respectively. About one-half of patients with unstable angina did not disclose objective ischemic changes on admission. CONCLUSION: The use of a systematic model of care in patients with chest pain offers the opportunity of hindering inappropriate release of patients with ACI and reduces unnecessary admissions. However some patients even with normal ECG should not be released based on a negative first CKMB. Serial measurement of CKMB up to 9 hours is necessary in patients with medium probability of AMI.

  7. A brief cognitive-behavioural intervention for treating depression and panic disorder in patients with noncardiac chest pain: a 24-week randomized controlled trial

    NARCIS (Netherlands)

    van Beek, M.H.C.T.; Oude Voshaar, R.C.; Beek, A.M.; van Zijderveld, G.A.; Visser, S.; Speckens, A.E.M.; Batelaan, N.; van Balkom, A.J.L.M.

    2013-01-01

    Background: Most patients with noncardiac chest pain experience anxiety and depressive symptoms. Commonly they are reassured and referred back to primary care, leaving them undiagnosed and untreated. Some small studies have suggested efficacy of 12 cognitive behavioral therapy (CBT) sessions. Our ai

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

    Science.gov (United States)

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

    2016-01-01

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

  9. 从胸痛、胁痛、脘痛等症状谈对中医疼痛性质的认识%Discussion on the understanding of TCM pain properties from chest pain, hypochondriac pain, epigastric pain and other symptoms

    Institute of Scientific and Technical Information of China (English)

    刘宏

    2014-01-01

    疼痛是临床上最常见的自觉症状之一,可发生于患病机体的各个部位。不同性质的疼痛反映了不同病症,胸痛、胁痛、脘痛、腹痛等不同部位疼痛症状表现为刺痛、胀痛、灼痛、冷痛、隐痛、掣痛等中医疼痛性质。%Pain is one of the most common clinical symptoms, each site can occur in the diseased body. The different properties of pain reflect different symptoms. Chest pain, hypochondriac pain, epigastric pain, abdominal pain and other symptoms of pain in different parts manifeste as tingling, swellingpain, burning pain, cold pain, dull pain, pulling pain and other TCM pain properties.

  10. DEVELOPMENT OF A CHEST FREEZER – OPTIMUM DESIGN OF AN EVAPORATOR COIL

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    K. Kalyani Radha

    2012-06-01

    Full Text Available In a country such as India, food grains, fruit, vegetables, meat, poultry and fish, are very susceptible to microbial contamination and spoilage and require stringent preservation methods. One such method is by the use of a chest freezer for the storage of frozen food. This investigation considers different loads and design parameters for the development of a chest freezer using R134a as the working fluid. Experimental designs of an evaporator coil, condenser coil and capillary tube are investigated through the development of storage periods in terms of steady state and cyclic performance, by optimising the quantity of refrigerant charge, with strict adherence to the standards and requirement for maintaining an internal temperature of -23 °C at 43 °C ambient. Cyclic load performance tests optimise the performance of individual components selected for the design of a chest freezer. The system selection has a highly balanced performance with R134a and showed 118 kJ/kg cooling capacity with 8.42 coefficient of performance (COP. By the replacement of R134a, temperatures of -23 °C are maintained inside the freezer cabinet with low power consumption and an increase in the net refrigerating effect, which in turn increases the COP. The system design has optimum efficiency with moderate costs by optimising the length and diameter of the evaporator coil, i.e., 34.15 m and 7.94 mm, respectively.

  11. Management of coronary risk factors by registered nurses versus usual care in patients with unstable angina pectoris (a chest pain evaluation in the emergency room [CHEER] substudy).

    Science.gov (United States)

    Allison, T G; Farkouh, M E; Smars, P A; Evans, R W; Squires, R W; Gabriel, S E; Kopecky, S L; Gibbons, R J; Reeder, G S

    2000-07-15

    This study examined whether nurses could manage coronary risk factors in patients with unstable angina more effectively than physicians practicing usual care. Three hundred twenty-six patients were randomized in the emergency room to a 6-month program of risk factor management by a registered nurse versus participation in usual care. The nurse intervention consisted of a 30-minute counseling visit at 6 to 10 days after the chest pain episode and a second 30-minute session 1 month later. Multiple risk factors were assessed and addressed: smoking, blood lipids, blood pressure, blood glucose, physical inactivity, weight, psychological stress, and social isolation. Compared with usual care, nurse intervention patients significantly reduced both triglycerides (-29 +/- 8 vs 5 +/- 6 mg/dl; p chest pain is feasible and more effective than usual care in terms of fostering lifestyle changes that may lower coronary risk.

  12. Ranolazine versus placebo in patients with ischemic cardiomyopathy and persistent chest pain or dyspnea despite optimal medical and revascularization therapy: randomized, double-blind crossover pilot study

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    Shammas NW

    2015-03-01

    Full Text Available Nicolas W Shammas,1 Gail A Shammas,1 Kathleen Keyes,2 Shawna Duske,1 Ryan Kelly,1 Michael Jerin3 1Midwest Cardiovascular Research Foundation, 2Cardiovascular Medicine, Private Corporation, 3St Ambrose University, Davenport, IA, USA Background: Patients with ischemic cardiomyopathy (ICM may continue to experience persistent chest pain and/or dyspnea despite pharmacologic therapy and revascularization. We hypothesized that ranolazine would reduce anginal symptoms or dyspnea in optimally treated ICM patients.Methods: In this randomized, double-blind, crossover-design pilot study, 28 patients with ICM (ejection fraction less or equal 40% were included after providing informed consent. A total of 24 patients completed both placebo and ranolazine treatments and were analyzed. All patients were on treatment with a beta blocker, an angiotensin-converting enzyme inhibitor (or angiotensin receptor blocker, and at least one additional antianginal drug. After randomization, patients received up to 1,000 mg ranolazine orally twice a day, as tolerated, versus placebo. The primary end point was change in angina as assessed by the Seattle Angina Questionnaire (SAQ, or in dyspnea as assessed by the Rose Dyspnea Scale (RDS. Change in the RDS and SAQ score from baseline was compared, for ranolazine and placebo, using the Wilcoxon signed rank test or paired t-test.Results: Patients had the following demographic and clinical variables: mean age of 71.5 years; male (82.1%; prior coronary bypass surgery (67.9%; prior coronary percutaneous intervention (85.7%; prior myocardial infarction (82.1%; diabetes (67.9%; and mean ejection fraction of 33.1%. No statistical difference was seen between baseline RDS score and that after placebo or ranolazine (n=20 (P≥0.05. There was however, an improvement in anginal frequency (8/10 patients (P=0.058, quality of life (8/10 patients (P=0.048, and mean score of all components of the SAQ questionnaire (n=10 (P=0.047 with ranolazine

  13. Impact of Fractionation and Dose in a Multivariate Model for Radiation-Induced Chest Wall Pain

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    Din, Shaun U. [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Williams, Eric L.; Jackson, Andrew [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Rosenzweig, Kenneth E. [Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York (United States); Wu, Abraham J.; Foster, Amanda [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Yorke, Ellen D. [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Rimner, Andreas, E-mail: rimnera@mskcc.org [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States)

    2015-10-01

    Purpose: To determine the role of patient/tumor characteristics, radiation dose, and fractionation using the linear-quadratic (LQ) model to predict stereotactic body radiation therapy–induced grade ≥2 chest wall pain (CWP2) in a larger series and develop clinically useful constraints for patients treated with different fraction numbers. Methods and Materials: A total of 316 lung tumors in 295 patients were treated with stereotactic body radiation therapy in 3 to 5 fractions to 39 to 60 Gy. Absolute dose–absolute volume chest wall (CW) histograms were acquired. The raw dose-volume histograms (α/β = ∞ Gy) were converted via the LQ model to equivalent doses in 2-Gy fractions (normalized total dose, NTD) with α/β from 0 to 25 Gy in 0.1-Gy steps. The Cox proportional hazards (CPH) model was used in univariate and multivariate models to identify and assess CWP2 exposed to a given physical and NTD. Results: The median follow-up was 15.4 months, and the median time to development of CWP2 was 7.4 months. On a univariate CPH model, prescription dose, prescription dose per fraction, number of fractions, D83cc, distance of tumor to CW, and body mass index were all statistically significant for the development of CWP2. Linear-quadratic correction improved the CPH model significance over the physical dose. The best-fit α/β was 2.1 Gy, and the physical dose (α/β = ∞ Gy) was outside the upper 95% confidence limit. With α/β = 2.1 Gy, V{sub NTD99Gy} was most significant, with median V{sub NTD99Gy} = 31.5 cm{sup 3} (hazard ratio 3.87, P<.001). Conclusion: There were several predictive factors for the development of CWP2. The LQ-adjusted doses using the best-fit α/β = 2.1 Gy is a better predictor of CWP2 than the physical dose. To aid dosimetrists, we have calculated the physical dose equivalent corresponding to V{sub NTD99Gy} = 31.5 cm{sup 3} for the 3- to 5-fraction groups.

  14. The role of serum D-dimer level in the diagnosis of patients admitted to the emergency department complaining of chest pain.

    Science.gov (United States)

    Orak, M; Ustündağ, M; Güloğlu, C; Alyan, O; Sayhan, M B

    2010-01-01

    This study investigated D-dimer levels in 241 patients admitted to the emergency department with sudden-onset chest pain. The patient group included those diagnosed with acute coronary syndrome (ACS; i.e., unstable angina pectoris [USAP], non-ST elevated myocardial infarction [NSTEMI], ST-elevated myocardial infarction [STEMI]); the control group included those diagnosed with non-cardiac chest pain. Mean serum levels of D-dimer, creatine kinase-MB (CK-MB) and troponin I (TPI) were compared between the groups. Levels of D-dimer, CK-MB and TPI in the patient group were significantly higher than in the control group. There were also significantly higher D-dimer, CK-MB and TPI levels in the STEMI and NSTEMI patient subgroups compared with the control group. Only the D-dimer level was significantly higher in the USAP subgroup versus the control group. The sensitivity and specificity of D-dimer for ACS were 83.7% and 95.4%, respectively, suggesting that evaluating D-dimer levels might be useful in the emergency room for diagnosing ACS and predicting mortality in patients presenting with acute chest pain.

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

    Science.gov (United States)

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

    2012-04-01

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

  16. Impact of an Abbreviated Cardiac Enzyme Protocol to Aid Rapid Discharge of Patients with Cocaine-associated Chest Pain in the Clinical Decision Unit

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    Faheem W. Guirgis

    2014-03-01

    Full Text Available Introduction: In 2007 there were 64,000 visits to the emergency department (ED for possible myocardial infarction (MI related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9-12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain. Methods: We conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB, and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge. Results: There were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103 and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0-5.1%; 95% CI, 0-3.6%. Conclusion: Application of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain. [West J Emerg Med. 2014;15(2:180–183.

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

    Science.gov (United States)

    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.

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

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    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

  19. Chest MRI

    Science.gov (United States)

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

  20. Using Coronary Artery Calcification Combined with Pretest Clinical Risk Assessment as a Means of Determining Investigation and Treatment in Patients Presenting with Chest Pain in a Rural Setting

    Directory of Open Access Journals (Sweden)

    Baskar Sekar

    2015-01-01

    Full Text Available 462 patients presenting with chest pain to a rural district general hospital underwent calcium scoring and pretest clinical risk assessment in order to stratify subsequent investigations and treatment was retrospectively reviewed. The patients were followed up for two years and further investigations and outcomes recorded. Of the 206 patients with zero calcium score, 132 patients were immediately discharged from cardiac follow-up with no further investigation on the basis of their calcium score, low pretest risk of coronary artery disease, and no significant incidental findings. After further tests, 267 patients were discharged with no further cardiac therapy, 88 patients were discharged with additional medical therapy, and 19 patients underwent coronary artery by-pass grafting or percutaneous intervention. 164 patients with incidental findings on the chest CT (computed tomography accompanying calcium scoring were reviewed, of which 88 patients underwent further tests and follow-up for noncardiac causes of chest pain. The correlations between all major risk factors and calcium scores were weak except for a combination of diabetes and hypertension in the male gender (P=0.012, The use of calcium scoring and pretest risk appeared to reduce the number of unnecessary cardiac investigations in our patients: however, the calcium scoring test produced a high number of incidental findings on the associated CT scans.

  1. Angina (Chest Pain)

    Science.gov (United States)

    ... High blood pressure Smoking Diabetes Overweight or obesity Metabolic syndrome Inactivity Unhealthy diet Older age (The risk increases for men after 45 years of age and for women after 55 years of age.) Family history of ...

  2. Chest Pain: First Aid

    Science.gov (United States)

    ... call 911 or emergency medical assistance immediately. Aortic dissection An aortic dissection is a serious condition in which a tear ... channel ruptures through the outside aortic wall, aortic dissection is usually fatal. Typical signs and symptoms include: ...

  3. Reducing the time-lag between onset of chest pain and seeking professional medical help: a theory-based review

    Directory of Open Access Journals (Sweden)

    Baxter Susan K

    2013-02-01

    Full Text Available Abstract Background Research suggests that there are a number of factors which can be associated with delay in a patient seeking professional help following chest pain, including demographic and social factors. These factors may have an adverse impact on the efficacy of interventions which to date have had limited success in improving patient action times. Theory-based methods of review are becoming increasingly recognised as important additions to conventional systematic review methods. They can be useful to gain additional insights into the characteristics of effective interventions by uncovering complex underlying mechanisms. Methods This paper describes the further analysis of research papers identified in a conventional systematic review of published evidence. The aim of this work was to investigate the theoretical frameworks underpinning studies exploring the issue of why people having a heart attack delay seeking professional medical help. The study used standard review methods to identify papers meeting the inclusion criterion, and carried out a synthesis of data relating to theoretical underpinnings. Results Thirty six papers from the 53 in the original systematic review referred to a particular theoretical perspective, or contained data which related to theoretical assumptions. The most frequently mentioned theory was the self-regulatory model of illness behaviour. Papers reported the potential significance of aspects of this model including different coping mechanisms, strategies of denial and varying models of treatment seeking. Studies also drew attention to the potential role of belief systems, applied elements of attachment theory, and referred to models of maintaining integrity, ways of knowing, and the influence of gender. Conclusions The review highlights the need to examine an individual’s subjective experience of and response to health threats, and confirms the gap between knowledge and changed behaviour. Interventions face

  4. Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain

    Science.gov (United States)

    Bedetti, Gigliola; Pasanisi, Emilio Maria; Pizzi, Carmine; Turchetti, Giuseppe; Loré, Cosimo

    2008-01-01

    Background Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients. Methods We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA) after positive troponin I or T (cTn-I or cTnT) (strategy 1); after positive exercise electrocardiography (ex-ECG) (strategy 2); after positive exercise echocardiography (ex-Echo) (strategy 3); after positive pharmacologic stress echocardiography (PhSE) (strategy 4); after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc) (strategy 5) and direct CA (strategy 6). Results The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer) and $29.673 for CA ($29.999 including cost of extra risk of cancer). The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator), the relative cost of ex-Echo is 1.5×, of a ex-SPECT-Tc is 3.1×, of a ex-ECG is 3.5×, of cTnI is ×3.8, of cTnT is ×3.9 and of a CA is 56.3×. Conclusion Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void. PMID:18510723

  5. Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain

    Directory of Open Access Journals (Sweden)

    Manhem Karin

    2008-05-01

    Full Text Available Abstract Background Unexplained chest pain (UCP is a common reason for emergency hospital admission and generates considerable health-care costs for society. Even though prior research indicates that psychological problems and impaired quality of life are common among UCP patients, there is lack of knowledge comparing UCP patients with a reference group from the general population. The aim of this study was to analyse differences between men and women with UCP and a reference group in terms of psychosocial factors as depression, anxiety, stress, social interaction and health-related quality of life (HRQOL. Methods A self-administered questionnaire about psychosocial factors was completed by 127 men and 104 women with acute UCP admitted consecutively to the Emergency Department (ED or as in-patients on a medical ward. A reference group from the general population, 490 men and 579 women, participants in the INTERGENE study and free of clinical heart disease, were selected. Results The UCP patients were more likely to be immigrants, have a sedentary lifestyle, report stress at work and have symptoms of depression and trait-anxiety compared with the reference group. After adjustment for differences in age, smoking, hypertension and diabetes, these factors were still significantly more common among patients with UCP. In a stepwise multivariate model with mutual adjustment for psychosocial factors, being an immigrant was associated with a more than twofold risk in both sexes. Stress at work was associated with an almost fourfold increase in risk among men, whereas there was no independent impact for women. In contrast, depression only emerged as an independent risk factor in women. Trait-anxiety and a low level of social interaction were not independently associated with risk in either men or women. Patients with UCP were two to five times more likely to have low scores for HRQOL. Conclusion Both men and women with UCP had higher depression scores

  6. Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain

    Directory of Open Access Journals (Sweden)

    Pizzi Carmine

    2008-05-01

    Full Text Available Abstract Background Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients. Methods We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA after positive troponin I or T (cTn-I or cTnT (strategy 1; after positive exercise electrocardiography (ex-ECG (strategy 2; after positive exercise echocardiography (ex-Echo (strategy 3; after positive pharmacologic stress echocardiography (PhSE (strategy 4; after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc (strategy 5 and direct CA (strategy 6. Results The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer and $29.673 for CA ($29.999 including cost of extra risk of cancer. The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator, the relative cost of ex-Echo is 1.5×, of a ex-SPECT-Tc is 3.1×, of a ex-ECG is 3.5×, of cTnI is ×3.8, of cTnT is ×3.9 and of a CA is 56.3×. Conclusion Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  8. Review article: Diagnostic accuracy of risk stratification tools for patients with chest pain in the rural emergency department: A systematic review.

    Science.gov (United States)

    Roche, Tina; Jennings, Natasha; Clifford, Stuart; O'connell, Jane; Lutze, Matthew; Gosden, Edward; Hadden, N Fionna; Gardner, Glenn

    2016-10-01

    Risk stratification tools for patients presenting to rural EDs with undifferentiated chest pain enable early definitive treatment in high-risk patients. This systematic review compares the most commonly used risk stratification tools used to predict the risk of major adverse cardiac event (MACE) for patients presenting to rural EDs with chest pain. A comprehensive search of MEDLINE and Embase for studies published between January 2011 and January 2015 was undertaken. Study quality was assessed using QUADAS-2 criteria and the PRISMA guidelines.Eleven studies using eight risk stratification tools met the inclusion criteria. The percentage of MACE in the patients stratified as suitable for discharge, and the percentage of patients whose scores would have recommended admission that did not experience a MACE event were used as comparisons. Using the findings of a survey of emergency physicians that found a 1% MACE rate acceptable in discharged patients, the EDACS-ADP was considered the best performer. EDACS-ADP had one of the lowest rates of MACE in those discharged (3/1148, 0.3%) and discharged one of the highest percentage of patients (44.5%). Only the GRACE tool discharged more patients (69% - all patients with scores <100) but had a MACE rate of 0.3% in discharged patients. The HFA/CSANZ guidelines achieved zero cases of MACE but discharged only 1.3% of patients.EDACS-ADP can potentially increase diagnostic efficiency of patients presenting at ED with chest pain. Further assessment of tool in a rural context is recommended.

  9. The UPBEAT nurse-delivered personalized care intervention for people with coronary heart disease who report current chest pain and depression: a randomised controlled pilot study.

    Directory of Open Access Journals (Sweden)

    Elizabeth A Barley

    Full Text Available BACKGROUND: Depression is common in people with coronary heart disease (CHD and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression. METHODS: Multi-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC or treatment as usual (TAU for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables. RESULT: 1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years were randomized. PC participants (n = 41 identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%, high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up. Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03. Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9 and illness perceptions (mean scale increase of 7.8 vs 2.5 had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000. CONCLUSIONS: Trial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU

  10. Application of Ischemia Modified Albumin Inspection in Patients with Acute Chest Pain%急性胸痛患者血清缺血修饰白蛋白检测及其意义研究

    Institute of Scientific and Technical Information of China (English)

    王宇; 吕新湖; 陈素欣; 彭晓恩

    2016-01-01

    【目的】探讨缺血修饰白蛋白(IMA)在急性胸痛患者检测的应用价值。【方法】选取2014年2月至2015年7月本院收治的100例急性胸痛发作3 h 内胸痛患者,将其分为缺血性胸痛组(59例)和非缺血性胸痛组(41例),缺血性胸痛组进一步分为不稳定型心绞痛组(39例)和急性心肌梗死组(20例)。于入院后即刻、3 h、24 h 分别采集静脉血分离血清,检测肌酸激酶同工酶(CK-MB)、肌钙蛋白 I(cTnI)、IMA。【结果】入院后即刻和入院后3 h,缺血性胸痛组 IMA 高于非缺血性胸痛组,差异有统计学意义(P 0.05)。入院后24 h,缺血性胸痛组 IMA 与非缺血性胸痛组比较无统计学意义(P >0.05);而 cTnI 和 CK-MB 均高于非缺血性胸痛组,差异有统计学意义(P 0.05)。【结论】IMA 是早期诊断非缺血性胸痛和缺血性胸痛的敏感指标,但其并不能诊断区别不稳定型心绞痛和急性心肌梗死。%[Objective]To investigate the application effect of Ischemia Modified Albumin inspection in patients with acute chest pain.[Methods]100 cases of patients with acute chest pain in 3 h admitted in our hospital from Feb 2014 to July 2015 were selected and divided into ischemic chest pain group (59 cases)and non-ischemic chest pain group (41 ca-ses).The Ischemic chest pain group was further divided into unstable angina group (39 cases)and acute myocardial in-farction group (20 cases).The venous blood was collected at the instant,3 h and 24 h after admission.Creatine kinase isoenzyme (CK-MB),cardiac troponin I (cTnI)and IMA were determined.[Results]At the instant and 3 h after admis-sion,the IMA of the ischemic chest pain group was significantly higher than that of the non-ischemic chest pain group (P 0.05).At 24 h after admis-sion,there was no significant difference in IMA between the ischemic chest pain group and the non-ischemic chest pain group (P >0.05);cTnI and CK-MB of the ischemic chest pain group were significantly higher

  11. [Rabeprazole test and comparison of the effectiveness of course treatment with rabeprazole in patients with gastroesophageal reflux disease and non-coronary chest pain].

    Science.gov (United States)

    Maev, I V; Iurenev, G L; Burkov, S G; V'iuchnova, E S

    2007-01-01

    Proton pump inhibitors (PPI) are efficient for ex juvantibus diagnostics of non-coronary chest pain (NCCP) of gastroesophageal reflux origin as well as for its course treatment. The aim of this randomized cross-over study was to compare the efficiency of rabeprasol and omeprasol as means of both diagnostics and long-term treatment. In rabeprasol group the symptoms disappeared more quickly, and the maximum effect was achieved by day three, while in omeprasol group the best results were achieved only by day six (p omeprazol patients (p < 0.05). Thus, response to rabeprasol takes place twice as quick as response to omeprasol, which makes it possible to shorten the time of NCCP diagnostics. Furthermore, rabeprasol test is more sensitive and specific. Course treatment with high doses of PPI increase the number of patients with eliminated pain syndrome, and rabeprasol here is more efficient than omeprasol.

  12. 胸痛中心的远程心电监护系统探索与实践%Research and Practice of Telemedicine ECG Monitor System Based on Chest Pain Center

    Institute of Scientific and Technical Information of China (English)

    周民伟; 向仕平; 向定成; 秦伟毅; 田燕

    2013-01-01

    The article describes the basic situation of the chest pain center, discusses the new telemedicine ECG monitor system and its applications. The study shows that the telemedicine ECG monitor system can be practiced, assessed and extended, which provides a solution for the diagnosis and treatment of acute chest pain.%本文介绍胸痛中心的基本情况,论述远程心电监护系统,对应用进行分析,表明该系统可实践可评估可推广,为急性胸痛的诊治提供解决方案.

  13. 银杏叶滴丸治疗胸痹心痛的临床疗效观察%Clinical observation on treating chest pain with Yinxingye Diwan

    Institute of Scientific and Technical Information of China (English)

    何淑娴

    2014-01-01

    Objective:To observe clinical effects of Yinxingye Diwan on treating chest pain. Methods:108 patients were randomly divided into two groups, the control of 53 cases was given routine treatment, the treatment of 55 cases was given 5 pieces of Yinxingye Diwan for 1 week. Results: Chest pain syndromes in the treatment were better improved with a statistically difference (P<0.05), ECG improvement and the occurrence of angina in the treatment was obviously better with a statistically difference (P<0.05). Conclusion:Yinxingye Diwan can improve chest pain syndromes in unstable angina patients and reduce the occurrence rate of angina, was worthy of further research.%目的:观察银杏叶滴丸治疗胸痹心痛的临床疗效。方法:将108例属中医胸痹心痛范畴的不稳定型心绞痛(UA)患者随机分组,对照组53例,给予常规规范化治疗;治疗组55例,在常规规范化治疗基础上加服银杏叶滴丸5粒,Tid,连续1周。观察两组患者治疗前后胸痹心痛证候改变、心电图的变化及心绞痛症状控制情况。结果:治疗组治疗后胸痹心痛证候较对照组明显改善,差异具有统计学意义(P<0.05)。治疗组的心电图改善情况及心绞痛的发作次数、程度的控制也明显优于对照组,差异有统计学意义(P<0.05)。结论:银杏叶滴丸能有效改善不稳定型心绞痛患者中医胸痹心痛证候,减少心绞痛的发作,值得临床推广运用及继续深入研究。

  14. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial

    Science.gov (United States)

    Rief, Matthias; Martus, Peter; Kendziora, Benjamin; Feger, Sarah; Dreger, Henryk; Priem, Sascha; Knebel, Fabian; Böhm, Marko; Schlattmann, Peter; Hamm, Bernd; Schönenberger, Eva; Laule, Michael; Zimmermann, Elke

    2016-01-01

    Objective To evaluate whether invasive coronary angiography or computed tomography (CT) should be performed in patients clinically referred for coronary angiography with an intermediate probability of coronary artery disease. Design Prospective randomised single centre trial. Setting University hospital in Germany. Participants 340 patients with suspected coronary artery disease and a clinical indication for coronary angiography on the basis of atypical angina or chest pain. Interventions 168 patients were randomised to CT and 172 to coronary angiography. After randomisation one patient declined CT and 10 patients declined coronary angiography, leaving 167 patients (88 women) and 162 patients (78 women) for analysis. Allocation could not be blinded, but blinded independent investigators assessed outcomes. Main outcome measure The primary outcome measure was major procedural complications within 48 hours of the last procedure related to CT or angiography. Results Cardiac CT reduced the need for coronary angiography from 100% to 14% (95% confidence interval 9% to 20%, Pcoronary angiography: 75% (53% to 90%) v 15% (10% to 22%), Pcoronary angiography group: 3.6% (1% to 8%) v 10.5% (6% to 16%), P=0.014. CT shortened the median length of stay in the angiography group from 52.9 hours (interquartile range 49.5-76.4 hours) to 30.0 hours (3.5-77.3 hours, Pcoronary angiography group (adjusted hazard ratio 0.90, 95% confidence interval 0.30 to 2.69, P=0.86). 79% of patients stated that they would prefer CT for subsequent testing. The study was conducted at a University hospital in Germany and thus the performance of CT may be different in routine clinical practice. The prevalence was lower than expected, resulting in an underpowered study for the predefined primary outcome. Conclusions CT increased the diagnostic yield and was a safe gatekeeper for coronary angiography with no increase in long term events. The length of stay was shortened by 22.9 hours with CT, and

  15. Implementation of a prehospital triage system for patients with chest pain and logistics for primary percutaneous coronary intervention in the region of Amsterdam, the Netherlands.

    Science.gov (United States)

    Adams, Rob; Appelman, Yolande; Bronzwaer, Jean G; Slagboom, Ton; Amoroso, Giovanni; van Exter, Pieternel; Tijssen, G P Jan; de Winter, Robbert J

    2010-10-01

    We aimed to describe the logistics of a prehospital triage system for patients with acute chest pain in the region of Amsterdam, The Netherlands. Ambulance electrocardiograms (ECGs) were evaluated immediately in 1 of the percutaneous coronary intervention (PCI)-capable centers. Patients accepted for primary PCI (PPCI) were directly transferred to the catheterization laboratory. Two thousand three hundred fifty ECGs of 2,192 patients were transmitted to the region's intervention centers. Median duration of chest complaints before ambulance dispatch was 67 minutes; ambulance crews recorded the first ECG within 7 minutes after arrival. Actual transmission of the ECG took an additional (median) 10 minutes. Seven hundred eleven patients (32.4%) were transported to the catheter laboratory and were treated with PPCI. Time between first prehospital ECG and start of PPCI procedure was 66 minutes. The PPCI procedure started 36 minutes after ambulance arrival at the hospital. In conclusion, the results of this study compare favorably to other reported performances of prehospital triage systems of PPCI for ST-segment elevated myocardial infarction and demonstrate that the European Society of Cardiology and American Heart Association guidelines for treatment of patients with ST-segment elevated myocardial infarction can be met.

  16. Accuracy of dual-source CT to identify significant coronary artery disease in patients with uncontrolled hypertension presenting with chest pain: comparison with coronary angiography.

    Science.gov (United States)

    Marwan, Mohamed; Pflederer, Tobias; Schepis, Tiziano; Seltmann, Martin; Klinghammer, Lutz; Muschiol, Gerd; Ropers, Dieter; Daniel, Werner G; Achenbach, Stephan

    2012-06-01

    It has been previously reported that the sensitivity and specificity of multislice CT for detecting significant CAD (coronary artery disease) is high. Chest pain is a common presentation in patients with uncontrolled hypertension. We investigated the sensitivity and specificity of dual-source CT to detect and rule out significant CAD in patients presenting with uncontrolled hypertension accompanied by chest pain. 260 consecutive patients presenting with acute chest pain in the context of stage 2 hypertension (systolic pressure ≥160 and/or diastolic pressure ≥100) were enrolled in the study. After admission, control of blood pressure and risk stratification, 82 patients were excluded due to renal insufficiency, prior coronary revascularisation or refused participation in the study. 90 further patients with low pre-test probability of CAD were also excluded. 88 remaining patients were subjected to CT coronary angiography using dual-source CT (Definition, Siemens Medical Solutions, Forchheim, Germany) within 24 h before invasive coronary angiography. A contrast-enhanced volume dataset was acquired (120 kV, 400 mAs/rot, collimation 2 × 64 × 0.6 mm, retrospective ECG gating). Data sets were evaluated concerning the presence or absence of significant coronary stenoses and validated against invasive coronary angiography. A significant stenosis was assumed if the diameter reduction was ≥50%. 88 patients (mean age 66 ± 11 years, mean heart rate 61 ± 9 bpm) were evaluated regarding the presence or absence of significant CAD (at least one stenosis ≥50% diameter reduction). Mean systolic blood pressure on presentation was 203 ± 20 mmHg and mean diastolic blood pressure was 103 ± 13 mmHg. On a per patient basis, the sensitivity and specificity for dual-source CT to detect significant CAD in vessels >1.5 mm diameter was 100% (36/36, 95% CI 90-100) and 90% (47/52, 95% CI 79-97), respectively with a negative predictive value (NPV) of 100% (47/47, 95% CI 92-100) and a

  17. Clinically integrated multi-organ point-of-care ultrasound for undifferentiated respiratory difficulty, chest pain, or shock: a critical analytic review.

    Science.gov (United States)

    Ha, Young-Rock; Toh, Hong-Chuen

    2016-01-01

    Rapid and accurate diagnosis and treatment are paramount in the management of the critically ill. Critical care ultrasound has been widely used as an adjunct to standard clinical examination, an invaluable extension of physical examination to guide clinical decision-making at bedside. Recently, there is growing interest in the use of multi-organ point-of-care ultrasound (MOPOCUS) for the management of the critically ill, especially in the early phase of resuscitation. This article will review the role and utility of symptom-based and sign-oriented MOPOCUS in patients with undifferentiated respiratory difficulty, chest pain, or shock and how it can be performed in a timely, effective, and efficient manner.

  18. A Young Man Presenting with Pleuritic Chest Pain and Fever after Electrophysiological Study and Implantable Cardioverter-Defibrillator Placement: Diagnostic Difficulties and Value of Bedside Thoracic Sonography.

    Science.gov (United States)

    Faraone, Antonio; Fortini, Alberto

    2015-01-01

    We describe the case of a 23-year-old man presenting with recurrent pleuritic chest pain and prolonged fever after electrophysiology testing and placement of an implantable cardioverter-defibrillator because of a suspected arrhythmogenic right ventricular dysplasia. The clinical suspicion was initially directed toward pneumonia with pleural effusion and later toward an infection of the cardiac device complicated by septic pulmonary embolism. The definitive diagnosis of pulmonary embolism and infarction was suggested by a point-of-care thoracic sonography, performed at the bedside by a clinician caring for the patient, and then confirmed by contrast enhanced computed tomography, which also showed thrombosis of the left iliofemoral vein, site of percutaneous puncture for cardiac catheterization. Prolonged fever was attributable to a concomitant Epstein-Barr virus primary infection that acted as confounding factor. The present report confirms the value of bedside thoracic sonography in the diagnostic evaluation of patients with nonspecific respiratory symptoms.

  19. A Young Man Presenting with Pleuritic Chest Pain and Fever after Electrophysiological Study and Implantable Cardioverter-Defibrillator Placement: Diagnostic Difficulties and Value of Bedside Thoracic Sonography

    Directory of Open Access Journals (Sweden)

    Antonio Faraone

    2015-01-01

    Full Text Available We describe the case of a 23-year-old man presenting with recurrent pleuritic chest pain and prolonged fever after electrophysiology testing and placement of an implantable cardioverter-defibrillator because of a suspected arrhythmogenic right ventricular dysplasia. The clinical suspicion was initially directed toward pneumonia with pleural effusion and later toward an infection of the cardiac device complicated by septic pulmonary embolism. The definitive diagnosis of pulmonary embolism and infarction was suggested by a point-of-care thoracic sonography, performed at the bedside by a clinician caring for the patient, and then confirmed by contrast enhanced computed tomography, which also showed thrombosis of the left iliofemoral vein, site of percutaneous puncture for cardiac catheterization. Prolonged fever was attributable to a concomitant Epstein-Barr virus primary infection that acted as confounding factor. The present report confirms the value of bedside thoracic sonography in the diagnostic evaluation of patients with nonspecific respiratory symptoms.

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

    Institute of Scientific and Technical Information of China (English)

    李宇; 范占明; 余婧; 耿冀; 叶红; 晏子旭; 张兆琪

    2011-01-01

    Objective To assess the accuracy of triple rule out protocol for acute chest pain with dual-source CT in emergency department. Methods 56 consecutive patients with acute chest pain were examined with triple rule out protocol on a dual-source scanner (Siemens) at a temporal resolution of 83 ms using a body-mass-adapted contrast material injection. The scanning range included the whole chest from the first ribs to the diaphragm. The level of the carina was defined as the trigger point where the second tube was switched on additionally. The tri-phase injection protocol was used to get enough enhancement of coronary arteries,pulmonary arteries and aortas. One patient was excluded because he was unable to hold breath during scanning. The remaining subjects underwent more than 30 days follow-up. Results All examinations showed an adequate contrast enhancement of the pulmonary arteries, coronary arteries and aortas. The mean volume of contrast medium was (88±5 ) ml. The median radiation exposure was 11.6 mSy (95 %CI 6.9-13.1 ). 14 patients showed coronary arteries atherosclerosis, including coronary arterial stenosis more than 50% in 13 and 12 patients underwent the coronary stent implantation. 11 patients suffered from aortic dissection(Stanford type A), and 11 patients with pulmonary embolism (PE). In brief, the reasons of the chest pain were complex. 7 of the patients suffered from several kinds of chest diseases. The sensitivity and specificity in diagnosing acute chest pain were 98% and 96% ,respectively with CTA. There were no adverse outcomes follow-up for 30 days in this group. Conclusion Triple rule out coronary CT angiography in evaluation of the patients with acute chest pain presented to the emergency department is very helpful, safety and effective way.%目的 评价双源CT胸痛三联扫描计划对急诊胸痛诊断的准确性.方法 按照入选标准连续选取急性胸痛患者56例,采用西门子双源CT扫描仪胸痛三联扫描计划

  1. Automated Computer-Assisted Diagnosis of Obstructive Coronary Artery Disease in Emergency Department Patients Undergoing 256-Slice Coronary Computed Tomography Angiography for Acute Chest Pain.

    Science.gov (United States)

    Hashoul, Sharbell; Gaspar, Tamar; Halon, David A; Lewis, Basil S; Shenkar, Yuval; Jaffe, Ronen; Peled, Nathan; Rubinshtein, Ronen

    2015-10-01

    A 256-slice coronary computed tomography angiography (CCTA) is an accurate method for detection and exclusion of obstructive coronary artery disease (OBS-CAD). However, accurate image interpretation requires expertise and may not be available at all hours. The purpose of this study was to evaluate the usefulness of a fully automated computer-assisted diagnosis (COMP-DIAG) tool for exclusion of OBS-CAD in patients in the emergency department (ED) presenting with chest pain. Three hundred sixty-nine patients in ED without known coronary disease underwent 256-slice CCTA as part of the assessment of chest pain of uncertain origin. COMP-DIAG (CorAnalyzer II) automatically reported presence or exclusion of OBS-CAD (>50% stenosis, ≥1 vessel). Performance characteristics of COMP-DIAG for exclusion and detection of OBS-CAD were determined using expert reading as the reference standard. Seventeen (5%) studies were unassessable by COMP-DIAG software, and 352 patients (1,056 vessels) were therefore available for analysis. COMP-DIAG identified 33% of assessable studies as having OBS-CAD, but the prevalence of OBS-CAD on CCTA was only 18% (66 of 352 patients) by standard expert reading. However, COMP-DIAG correctly identified 61 of the 66 patients (93%) with OBS-CAD with 21 vessels (2%) with OBS-CAD misclassified as negative. In conclusion, compared to expert reading, automated computer-assisted diagnosis using the CorAnalyzer showed high sensitivity but only moderate specificity for detection of obstructive coronary disease in patients in ED who underwent 256-slice CCTA. The high negative predictive value of this computer-assisted algorithm may be useful in the ED setting.

  2. Resting {sup 123}I-BMIPP scintigraphy for detection of organic coronary stenosis and therapeutic outcome in patients with chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Yamabe, Hiroshi; Fujiwara, Sei; Rin, Kouten; Ando, Makoto; Yokoyama, Mitsuhiro [Kobe Univ. (Japan). School of Medicine; Sakamoto, Takaaki; Ishida, Toshiharu; Itagane, Hiroshi; Mori, Takao

    2000-06-01

    Resting {sup 123}I-BMIPP scintigraphy can detect coronary artery disease based on persistent abnormality of myocardial fatty acid metabolism after transient ischemia. The present study aimed to determine the value of resting {sup 123}I-BMIPP scintigraphy in diagnosing coronary artery disease and predicting the therapeutic outcome in patients with chest pain symptom. Five hospitals participated in this study, and scintigraphic and angiographic studies were performed in 104 patients without myocardial infarction. Twenty of them had non-coronary artery disease (chest pain syndrome), 26 had stable effort angina, 35 had unstable angina with organic coronary lesions, and 23 had vasospastic angina without significant organic stenosis. Overall sensitivity for diagnosing angina pectoris (stable, unstable and vasospastic) was 45%, and overall specificity for excluding non-coronary artery disease was 80%. The incidence of positive {sup 123}I-BMIPP was 54% among patients with organic coronary stenosis (50% in stable angina and 61% in unstable angina with organic stenosis), but it was low (22%) in vasospastic angina without organic stenosis. Patients with advanced coronary stenosis and multi-vessel disease were found to have a higher incidence of positive {sup 123}I-BMIPP. A positive {sup 123}I-BMIPP result was correlated with a higher rate of subsequent intervention therapy (catheter intervention or CABG) than a negative result (48% versus 27%, p=0.03 at one month; and 63% versus 35%, p=0.008 at one year). Resting {sup 123}I-BMIPP scintigraphy was valuable in detecting advanced coronary lesions in angina patients associated with a high incidence of subsequent intervention therapy. (author)

  3. Cost-effectiveness of exercise {sup 201}Tl myocardial SPECT in patients with chest pain assessed by decision-tree analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kosuda, Shigeru; Momiyama, Yukihiko; Ohsuzu, Fumitaka; Kusano, Shoichi [National Defense Medical Coll., Tokorozawa, Saitama (Japan); Ichihara, Kiyoshi

    1999-09-01

    To evaluate the potential cost-effectiveness of exercise {sup 201}Tl myocardial SPECT in outpatients with angina-like chest pain, we developed a decision-tree model which comprises three 1000-patients groups, i.e., a coronary arteriography (CAG) group, a follow-up group, and a SPECT group, and total cost and cardiac events, including cardiac deaths, were calculated. Variables used for the decision-tree analysis were obtained from references and the data available at out hospital. The sensitivity and specificity of {sup 201}Tl SPECT for diagnosing angina pectoris, and its prevalence were assumed to be 95%, 85%, and 33%, respectively. The mean costs were 84.9 x 10{sup 4} yen/patient in the CAG group, 30.2 x 10{sup 4} yen/patient in the follow-up group, and 71.0 x 10{sup 4} yen/patient in the SPECT group. The numbers of cardiac events and cardiac deaths were 56 and 15, respectively in the CAG group, 264 and 81 in the follow-up group, and 65 and 17 in the SPECT group. SPECT increases cardiac events and cardiac deaths by 0.9% and 0.2%, but it reduces the number of CAG studies by 50.3%, and saves 13.8 x 10{sup 4} yen/patient, as compared to the CAG group. In conclusion, the exercise {sup 201}Tl myocardial SPECT strategy for patients with chest pain has the potential to reduce health care costs in Japan. (author)

  4. 胸痛应警惕双硫仑样反应%Chest Pain Should be Wary of Disulfiram-like Reaction

    Institute of Scientific and Technical Information of China (English)

    陈蓓雷

    2013-01-01

    目的:探讨胸痛应警惕双硫仑反应的发生机制及治疗方法。方法通过观察2011年1月~2013年9月,在我院急诊科就诊的双硫仑样反应的18例患者的临床表现、治疗和预后,分析双硫仑样反应的发生机制和防治措施。结果18例患者均经输液,重者应用速尿和纳洛酮,症状于6h内消失。结论详细询问病史及早识别因双硫仑样反应导致的胸痛,及时作出正确处理,避免不必要的医疗资源的浪费。%Objective: To investigate the pathogenesis and treatment of chest pain should be wary of disulfiram reaction. Methods: 2011 January to 2013 September by observing, in clinical manifestation, treatment and prognosis of 18 cases of disulfiram like reaction to the emergency department of our hospital from the patients, the occurrence mechanism and prevention measures of disulfiram like reaction. Results:al the 18 patients after infusion, or application of furosemide and naloxone, symptoms disappeared within 6h. Conclusion: Ask for details of the history of early identification caused by disulfiram like reaction of chest pain, make correct treatment, to avoid unnecessary waste of medical resources.

  5. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationale

    Science.gov (United States)

    Laméris, Wytze; van Randen, Adrienne; Dijkgraaf, Marcel GW; Bossuyt, Patrick MM; Stoker, Jaap; Boermeester, Marja A

    2007-01-01

    Background The acute abdomen is a frequent entity at the Emergency Department (ED), which usually needs rapid and accurate diagnostic work-up. Diagnostic work-up with imaging can consist of plain X-ray, ultrasonography (US), computed tomography (CT) and even diagnostic laparoscopy. However, no evidence-based guidelines exist in current literature. The actual diagnostic work-up of a patient with acute abdominal pain presenting to the ED varies greatly between hospitals and physicians. The OPTIMA study was designed to provide the evidence base for constructing an optimal diagnostic imaging guideline for patients with acute abdominal pain at the ED. Methods/design Thousand consecutive patients with abdominal pain > 2 hours and < 5 days will be enrolled in this multicentre trial. After clinical history, physical and laboratory examination all patients will undergo a diagnostic imaging protocol, consisting of plain X-ray (upright chest and supine abdomen), US and CT. The reference standard will be a post hoc assignment of the final diagnosis by an expert panel. The focus of the analysis will be on the added value of the imaging modalities over history and clinical examination, relative to the incremental costs. Discussion This study aims to provide the evidence base for the development of a diagnostic algorithm that can act as a guideline for ED physicians to evaluate patients with acute abdominal pain. PMID:17683592

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

    Energy Technology Data Exchange (ETDEWEB)

    Bamberg, Fabian, E-mail: fbamberg@med.lmu.de [Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich (Germany); Marcus, Roy; Sommer, Wieland; Schwarz, Florian; Nikolaou, Konstantin; Becker, Christoph R.; Reiser, Maximilian F.; Johnson, Thorsten R.C. [Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Munich (Germany)

    2012-12-15

    Objective: To evaluate diagnostic image quality of high-pitch dual source comprehensive cardiothoracic CT protocol in patients presenting with acute undifferentiated chest pain. Materials and methods: Consecutive symptomatic subjects (n = 51) with undifferentiated acute chest pain underwent ECG-synchronized high-pitch dual-spiral chest CT angiography (Definition Flash, Siemens Medical Solutions, 2 × 100 kVp or 2 × 120 kV if BMI > 30, collimation: 128 × 0.6 mm, pitch: 3.2). Independent investigators determined the image quality of each cardiac and pulmonary vessel segment, measured contrast-to-noise-ratio (CNR), and determined radiation exposure. In addition, the prevalence of CT findings (pulmonary embolism (PE), aortic dissection (AD) and significant coronary stenosis (≥50%)) was determined. Univariate and multivariate analysis were performed to determine the subpopulation with highest diagnostic quality. Results: Among 51 subjects (66% male, average age: 63 ± 15.8), the prevalence of positive CT findings was moderate (overall: 11.7%). Overall, image quality of the pulmonary, aortic and coronary vasculature was good (1.26 ± 0.43 and CNR: 2.52) with an average radiation dose of 3.82 mSv and 3.2% of segments rated non-evaluable. The image quality was lowest in the coronary arteries (p = 0.02), depending on the heart rate (r = 0.52, p < 0.001). In subjects with a heart rate of ≤65 bpm (n = 30) subjective image quality and CNR of the coronary arteries were higher (1.6 ± 0.5 vs. 2.1 ± 0.5, p = 0.03 and 1.21 ± 0.3 vs. 1.02 ± 0.3, p = 0.05) with only 1.5% segments classified as non-evaluable. Conclusion: High-pitch dual-spiral comprehensive cardiothoracic CT provides low radiation exposure with excellent image quality at heart rates ≤65 bpm. In subjects with higher heart rates, image quality of the aortic and pulmonary vasculature remains excellent, while the assessment of the coronary arteries degrades substantially.

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  10. 813例急性胸痛患者的临床分析%A clinical analysis of 813 patients with acute chest pain

    Institute of Scientific and Technical Information of China (English)

    吴晓新; 陈墩帆; 闫春江; 丁邦晗; 张敏州

    2013-01-01

    Objective To analyze patients with acute chest pain as their chief complaint in order to improve our capability of early identifying and diagnosing high-risk patients,give them proper treatment in time and avoid misdiagnosis and improper treatment. Methods The clinical data of 813 patients with chest pain as their chief complaint admitted in the emergency department and critical care medicine department in Guangdong Provincial Traditional Chinese Medicine Hospital from January to December in 2011 were retrospectively analyzed. According to the process of diagnosis and treatment formulated by the chest pain center,all the patients must immediately finish the first electrocardiograph(EEC)examination in 10 minutes and the relevant blood biochemical examinations within 30 minutes after admission. Results In accordance with the relevant examinations,the confirmed diagnoses were as follows:there were 276 cases of unstable angina,accounting for 33.95%;145 cases of stable angina,17.84%;121 cases of acute myocardial infarction,14.88%;103 cases of respiratory system disease,12.67%;78 cases of skeletal muscle disease,9.59%;46 cases of the digestive system disease,5.66% and the high-risk non cardiac chest pain(such as aortic dissection/rupture of tumor or acute pulmonary embolism)12 cases,1.48%.Seven hundred and eighty-five patients finished the first EEC examination in 10 minutes,and 147 patients completed the chest computed tomography(CT)scan within an hour. Conclusions Acute chest pain is a common symptom in emergency department. It is necessary to identify the high-risk patients according to a process as soon as possible in order to get an accurate diagnosis and an effective treatment in time.%目的:分析总结2011年广东省中医院急诊科和重症医学科以急性胸痛为主要症状就诊患者的诊治情况,以期提高对急诊科高危胸痛患者的早期识别、诊断并及时给予对症处理,避免漏诊误诊。方法对本院2011年1月至12

  11. Palpation for muscular tenderness in the anterior chest wall

    DEFF Research Database (Denmark)

    Christensen, Henrik Wulff; Vach, Werner; Manniche, Claus;

    2003-01-01

    OBJECTIVE: To asses the interobserver and intraobserver reliability (in terms of day-to-day and hour-to-hour reliability) of palpation for muscular tenderness in the anterior chest wall. DESIGN: A repeated measures designs was used. SETTING: Department of Nuclear Medicine, Odense University...... Hospital, Denmark. PARTICIPANTS: Two experienced chiropractors examined 29 patients and 27 subjects in the interobserver part, and 1 of the 2 chiropractors examined 14 patients and 15 subjects in the intraobserver studies. INTERVENTION: Palpation for muscular tenderness was done in 14 predetermined areas...... palpating for intercostal tenderness or tenderness in the minor and major pectoral muscles in a population of patients with and without chest pain. This may hamper the ability of clinicians to diagnose and classify the musculoskeletal component of chest pain if based exclusively on palpation of the anterior...

  12. Common Acupoints in Chest and Abdomen

    Institute of Scientific and Technical Information of China (English)

    Journal of Acupuncture and Tuina Science Editor; CUI Xue-jun

    2003-01-01

    @@ Tiantu (CV 21) Location: In the center of the suprasternal fossa(Fig. l ). Indications: Cough, dyspnea, chest pain, pharyngolaryngeal swelling and pains, sudden hoarseness of the voice, goiter, globus hystericus, and dysphagia.

  13. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  14. Design of low temperature field storage-transport chest%野战低温储运箱设计

    Institute of Scientific and Technical Information of China (English)

    吴太虎; 魏建仓; 孙建军; 刘统新

    2011-01-01

    Objective:This low temperature field storage-transport chest was researched for emergency storage of drugs,biological products,blood and other medical first aid supplies in the field or emergency medical aid conditions.Methods:It consists of two parts,chest body structure and electrical control system.The chest body structures consist of chest body and chest cover which is mounded through rotational molding.The electric control system consists of compressor drive and output control for fan part,temperature collect,display and operation part,temperature record and USB download part and backup battery charging system part.Results:It is proved that the system design the temperature inside is reasonable and reliable with two operation modes of cold storage and refrigeration storage.Conclusion:It is very suitable for emergency transport and storage of temperature sensitive supplies in the medical emergency field.%目的:为野战或应急医学救援条件下的药品、生物制品、血液等医用急救物资的野外应急运输和储存,研制一款野战低温储运箱。方法:低温储运箱由箱体结构和电气控制系统两部分组成,箱体结构部分包括箱体和箱盖,箱体和箱盖采用滚塑一体成型方式成型;电气控制系统包括压缩机驱动与风扇输出控制部分、温度采集与显示操作部分、温度记录与USB下载部分和后备电池充电系统部分。结果:通过性能试验和使用证明野战低温储运箱系统设计合理,温度可靠,具有冷冻和冷藏双重工作模式。结论:野战低温储运箱很适合医学救援现场温度敏感物资的应急运输和储存。

  15. [Chest trauma].

    Science.gov (United States)

    Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

    2011-01-01

    Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe.

  16. High-resolution computed tomography in patients with atypical 'cardiac' chest pain: a study investigating patients at 10-year cardiovascular risks defined by the Framingham and PROCAM scores

    Institute of Scientific and Technical Information of China (English)

    Choon Kiat ANG; Kui Hian SIM; Alan Yean Yip FONG; Sze Piaw CHIN; Tiong Kiam ONG; Seyfarth M Tobias; Wei Ling CHAN; Chee Khoon LIEW; Rapaee ANNUAR; Houng Bang LIEW

    2006-01-01

    Background and objective Atypical 'cardiac' chest pain (ACCP) is not usually caused by myocardial ischaemia. Current noninvasive investigations for these symptoms are not yet as accurate as invasive coronary angiography. The latest 64-row multi-detector computed tomography (MDCT) technology is non-invasive, has high specificity and negative predictive values for the detection of significant coronary disease. Our aim was to investigate if this modality can provide more information in the assessment of outpatients with ACCP in addition to established cardiovascular risk scores. Methods Seventy consecutive patients presenting to the outpatient clinic with ACCP underwent 64-row MDCT scan of the coronary arteries. They were categorized into low, medium or high risk groups based upon the Framingham and PROCAM scores. We defined a clinically abnormal MDCT scan as coronary stenosis =50% or calcium score >400 Agatston. Results Fifty-three (75.7%) patients did not have clinically abnormal scans. Framingham score classified 43 patients as low-risk while PROCAM classified 59 patients as low-risk. MDCT scans were abnormal for 18.6% and 22.0% of the respective low-risk group of patients. For patients with medium-to-high risk, 33.3% and 36.4% of Framingham and PROCAM patient groups respectively had abnormal MDCT scans. Conclusion MDCT adds valuable information in the assessment of patients with ACCP by identifying a significant proportion of patients categorized as low-risk to have underlying significant coronary stenosis and coronary calcification by established cardiovascular risk scores.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-05-15

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

  18. PROspective Multicenter Imaging Study for Evaluation of Chest Pain: Rationale and Design of the PROMISE Trial

    Science.gov (United States)

    Douglas, Pamela S.; Hoffmann, Udo; Lee, Kerry L.; Mark, Daniel B.; Al-Khalidi, Hussein R.; Anstrom, Kevin; Dolor, Rowena J.; Kosinski, Andrzej; Krucoff, Mitchell W.; Mudrick, Daniel W.; Patel, Manesh R.; Picard, Michael H.; Udelson, James E.; Velazquez, Eric J.; Cooper, Lawton

    2014-01-01

    Background Suspected coronary artery disease (CAD) is one of the most common, potentially life threatening diagnostic problems clinicians encounter. However, no large outcome-based randomized trials have been performed to guide the selection of diagnostic strategies for these patients. Methods The PROMISE study is a prospective, randomized trial comparing the effectiveness of two initial diagnostic strategies in patients with symptoms suspicious for CAD. Patients are randomized to either: 1) functional testing (exercise electrocardiogram, stress nuclear imaging, or stress echocardiogram); or 2) anatomic testing with >=64 slice multidetector coronary computed tomographic angiography. Tests are interpreted locally in real time by subspecialty certified physicians and all subsequent care decisions are made by the clinical care team. Sites are provided results of central core lab quality and completeness assessment. All subjects are followed for ≥1 year. The primary end-point is the time to occurrence of the composite of death, myocardial infarction, major procedural complications (stroke, major bleeding, anaphylaxis and renal failure) or hospitalization for unstable angina. Results Over 10,000 symptomatic subjects were randomized in 3.2 years at 193 US and Canadian cardiology, radiology, primary care, urgent care and anesthesiology sites. Conclusion Multi-specialty community practice enrollment into a large pragmatic trial of diagnostic testing strategies is both feasible and efficient. PROMISE will compare the clinical effectiveness of an initial strategy of functional testing against an initial strategy of anatomic testing in symptomatic patients with suspected CAD. Quality of life, resource use, cost effectiveness and radiation exposure will be assessed. Clinical trials.gov identifier NCT01174550 PMID:24890527

  19. The 2017 International Joint Working Group recommendations of the Indian College of Cardiology, the Academic College of Emergency Experts, and INDUSEM on the management of low-risk chest pain in emergency departments across India.

    Science.gov (United States)

    Chauhan, Vivek; Shah, Pavitra Kotini; Galwankar, Sagar; Sammon, Maura; Hosad, Prabhakar; Beeresha; Erickson, Timothy B; Gaieski, David F; Grover, Joydeep; Hegde, Anupama V; Hoek, Terry Vanden; Jarwani, Bhavesh; Kataria, Himanshu; LaBresh, Kenneth A; Manjunath, Cholenahally Nanjappa; Nagamani, A C; Patel, Anjali; Patel, Ketan; Ramesh, D; Rangaraj, R; Shamanur, Narendra; Sridhar, L; Srinivasa, K H; Tyagi, Shweta

    2017-01-01

    There have been no published recommendations for the management of low-risk chest pain in emergency departments (EDs) across India. This is despite the fact that chest pain continues to be one of the most common presenting complaints in EDs. Risk stratification of patients utilizing an accelerated diagnostic protocol has been shown to decrease hospitalizations by approximately 40% with a low 30-day risk of major adverse cardiac events. The experts group of academic leaders from the Indian College of Cardiology and Academic College of Emergency Experts in India partnered with academic experts in emergency medicine and cardiology from leading institutions in the UK and USA collaborated to study the scientific evidence and make recommendations to guide emergency physicians working in EDs across India.

  20. Evaluation of a novel portable capacitive ECG system in the clinical practice for a fast and simple ECG assessment in patients presenting with chest pain: FIDET (Fast Infarction Diagnosis ECG Trial)

    OpenAIRE

    Rasenack, Eva; Oehler, Martin; Elsässer, Albrecht; Schilling, Meinhard; Maier, Lars

    2012-01-01

    Background Electrocardiogram (ECG) assessment plays a crucial role in patients presenting with chest pain and suspected acute coronary syndrome (ACS). In a pilot study, we previously evaluated a capacitive ECG system (cECG) as a novel ECG technique for a fast and simple ECG assessment in patients with ST-elevation myocardial infarction (STEMI). In a next step, the sensitivity and specificity of this novel ECG technique have to be assessed in patients with ACS. Hypothesis The Fast Infarction D...

  1. The Quality Management of the Cloud Platform Database of the Chest Pain Certification%胸痛中心认证云平台数据库的质量管理

    Institute of Scientific and Technical Information of China (English)

    董凤英; 张琰; 廖炜红; 谢志泉; 秦伟毅; 周民伟; 向定成

    2015-01-01

    目的:探讨应用中国胸痛中心认证数据管理云平台,如何获取并维护高质量数据。方法:介绍广州军区广州总医院在应用该数据库过程中积累的经验。包括:制定规范胸痛患者诊治流程;数据填写首诊负责制;强化“没有记录就没有发生”的概念;杜绝造假;分级管理,有专人负责数据管理;定期培训;定期举办质量分析会议。结果:医院最终缩短了STEMI患者门-球时间、发病-球囊扩张时间,降低了死亡率,提高了胸痛患者救治水平。结论:做好胸痛中心数据库的管理和质量控制至关重要,必须纳入胸痛中心管理的核心环节之中。%Objective: How to obtain and maintain high-quality data by using the China Chest Pain Certification Data Management Cloud Platform. Method: Introduce our hospital's experience in the application of the database as follows: develop a standardized process of diagnosis and treatment for the chest pain patient; fill the data follow the first diagnosis responsibility; strengthen the concept that "no record has not happened"; to prevent fraud; manage the data Hierarchically, and there is a person responsible for the data management; organize the training regularly; hold the meeting to analyze the data quality regularly. Result: Finally, we shorten the STEMI patient's door-ball time and the onset-balloon expansion time, reduced the mortality rate, and improved the level of treatment of patients with chest pain. Conclusion: it's very important to manage the Chest Pain Database and control the quality well, and it must be included the core part of the Chest Pain Management.

  2. Non-Cardiac Chest Pain

    Science.gov (United States)

    ... PPI’s can also be employed and include: Esomeprazole, Lansoprazole, Rabeprazole, and Pantoprazole. For patients not responding to ... 2013. Return to Top GI Health Centers Colorectal Cancer Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome ...

  3. Depressão maior em pacientes com dor torácica não cardíaca: Quem vai tratar? Major depression in patients with non-cardiac chest pain: Who is going to treat?

    Directory of Open Access Journals (Sweden)

    Renério Fráguas

    2009-01-01

    Full Text Available OBJETIVO: Investigar a presença de transtornos psiquiátricos em pacientes com dor torácica de origem não cardíaca que não respondem aos tratamentos regulares. MÉTODO: Dezoito pacientes com dor torácica sem origem cardíaca e considerados por seus clínicos como não respondentes aos tratamentos regulares instituídos foram avaliados por um psiquiatra treinado. As entrevistas foram realizadas com base no Present State Examination e os diagnósticos psiquiá-tricos, de acordo com os critérios do Manual de Diagnóstico e Estatística da Associação Psiquiátrica Americana, 3ª Edição Revisada (DSM-III-R. RESULTADOS: Depressão maior no momento da avaliação foi diagnosticada em 6 (30% pacientes, somatização em 1 (6% e transtorno do pânico em 1 (6% paciente. Sete pacientes estavam recebendo antidepressivos tricíclicos com doses OBJECTIVE: To investigate the presence of psychiatric disorders in patients with chest pain not responsive to treatment. METHOD: We evaluated 18 patients judged by their physicians to have a chest pain not responsive to usual treatment, which included anti-pain medicines and investigation and treatment of possible etiological causes such as coronary artery disease, and gastroesophageal reflux disease. A psychiatrist interviewed the patients using the Present State Examination and made the diagnosis based on the DSM-III-R criteria. Current major depression was diagnosed in 6 (30% patients, somatization in 1 (6% and panic disorder in 1 (6% patient. Seven patients were receiving tricyclics antidepressant with doses > 75 mg/day. DISCUSSION: Patients were receiving doses of tricyclics antidepressants efficacious for pain but not for major depression. It is possible that the low dose of antidepressants used to treat pain may partially ameliorate depressive symptoms, making the appropriate diagnosis and treatment of major depression even more difficult, consequently contributing to the persistence of pain and other

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  5. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  6. 电子伤票在急性胸痛病人救治中的应用%The Application of Electronic Medicine Tag in the Treatment of Patients with Acute Chest Pain

    Institute of Scientific and Technical Information of China (English)

    唐绍辉; 田燕; 秦伟毅; 周民伟

    2015-01-01

    In the light of the emerge of internet of things and widely application of smart wearable equipment, especially the smart wearable equipment is believed to be a breakthrough for the development and application of medical and health care field in the time of internet of things 2.0. The main aim of this article is that, aiming to solve abovementioned problem, by using the technology of internet of things and IT, we will develop a kind of smart wearable equipment, an E-note paper (wrist band) to mark wounds. We will illustrate in details over its design and working theory and its practical application in the therapy of patients with acute chest pain which is always a fatal cause of death.%随着物联网技术的兴起和智能可穿戴设备的广泛应用,可穿戴设备成为医疗卫生领域物联网2.0时代发展及应用的突破点。主要目的是针对上述问题,通过物联网技术研发一种智能可穿戴设备—利用信息技术研究制作电子化的伤票(腕带),并对其原理及针对可致命的急性胸痛病人救治中应用进行了详细阐述。

  7. Solitary Plasmacytoma of the Chest Wall

    Directory of Open Access Journals (Sweden)

    Servet Kayhan

    2014-03-01

    Full Text Available A previously healthy 55-year-old man with right sided lateral chest pain admitted to clinic. It was found a solid and painful mass at the right 4th rib in physical examination. Chest X-ray and thoracic computarized tomography showed an opacity measured 60x33 mm within the right chest wall destructing the 4th rib. Needle aspiration was performed from tumor and cytologic examination showed atypic plasma cell infiltration. The patient was scheduled for a chest wall resection and reconstructive surgery. Examination of a permanent section showed that the chest wall tumor was solitary plasmacytoma. There was no evidence of multiple myeloma recurrence after two years from the operation.

  8. 不同性别非冠心病胸痛患者的临床分析%The Clinical Analysis of Chest Pain in Patients with Non-Coronary Artery Disease in Different Gender

    Institute of Scientific and Technical Information of China (English)

    雒芳玲; 杜学芹; 张峰; 林文华

    2012-01-01

    目的:分析不同性别的非冠心病胸痛患者的临床特征.方法:通过冠状动脉造影(CAG)/冠状动脉CT(CTCA)及单光子发射型计算机断层心肌灌注显像(SPECT-MPI)明确诊断为非冠心病胸痛的患者141例,按性别分组,对比分析2组患者的临床特点、误诊原因、病因、用药情况及精神状态.结果:141例中女85例,男56例.女性患者病史长(P< 0.01),发病年龄高(P<0.05),吸烟率低,更多伴放射性疼痛及心电图ST-T改变(P< 0.01).81.2%女性和55.4%男性未及时行CAG/CTCA检查而延误诊断.功能性疾病为胸痛主要病因,不同性别差异无统计学意义(P>0.05).排除冠心病前女性患者用药比例高于男性(P<0.01),排除冠心病后,男性和女性患者焦虑、抑郁均较排除冠心病前明显降低(P< 0.01),94.9%女性和全部男性停服药物.结论:非冠心病胸痛患者临床特征存在明显的性别差异,女性更易被长期误诊.%Objective: To analyze clinical features of different gender patients with chest pain and non-coronary artery disease. Methods: One hundred and forty-one non-coronary artery disease patients with chest pain were diagnosed by coronary arteriongraphy (CAG)/computerized tomography of coronary artery (CTCA) and single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). Patients were divided into male and female groups. The clinical features, misdiagnosed cause, etiological factor, medication and mental status were analyzed in two groups. Results: There were 85 females and 56 males in 141 non-coronary heart disease patients with chest pain. There were longer history (P < 0.01), higher age of onset (P < 0.05) and lower smoking rate in female patients. And they were more likely associated with radiation of pain and ST-T changes of electrocardiogram (ECG) (P < 0.01). There were delayed diagnosis in 81.2% female patients and 55.4% male patients without timely perform of CAG/CTCA examination

  9. Pleural controversy: optimal chest tube size for drainage.

    Science.gov (United States)

    Light, Richard W

    2011-02-01

    In recent years, a higher and higher percentage of patients with pleural effusions or pneumothorax are being treated with small-bore (10-14 F) chest tubes rather than large-bore (>20 F). However, there are very few randomized controlled studies comparing the efficacy and complication rates with the small- and large-bore catheters. Moreover, the randomized trials that are available have flaws in their design. The advantages of the small-bore catheters are that they are easier to insert and there is less pain with their insertion while they are in place. The placement of the small-bore catheters is probably more optimal when placement is done with ultrasound guidance. Small-bore chest tubes are recommended when pleurodesis is performed. The success of the small-bore indwelling tunnelled catheters that are left in place for weeks documents that the small-bore tubes do not commonly become obstructed with fibrin. Patients with complicated parapneumonic effusions are probably best managed with small-bore catheters even when the pleural fluid is purulent. Patients with haemothorax are best managed with large-bore catheters because of blood clots and the high volume of pleural fluid. Most patients with pneumothorax can be managed with aspiration or small-bore chest tubes. If these fail, a large-bore chest tube may be necessary. Patients on mechanical ventilation with barotrauma induced pneumothoraces are best managed with large-bore chest tubes.

  10. Chest radiation - discharge

    Science.gov (United States)

    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 ...

  11. Chest X Ray?

    Science.gov (United States)

    ... 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 ...

  12. MRI of the Chest

    Medline Plus

    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 ...

  13. A dor torácica em mulheres no atendimento de emergência: conduta e evolução Chest pain in women in the emergency room: management and evolution

    Directory of Open Access Journals (Sweden)

    Janice Jardim Santos

    2005-02-01

    Full Text Available OBJETIVO: Avaliar o diagnóstico de dor torácica em mulheres atendidas em um serviço de emergência em relação à evolução clínica, descrevendo sua influência sobre o manejo terapêutico, quando comparadas aos homens. MÉTODOS: Estudo de coorte contemporâneo, comparando 67 pacientes entre 50 e 65 anos (35 mulheres e 32 homens atendidos de forma consecutiva por dor torácica na sala de emergência (SE e acompanhados por 120 dias. Os desfechos avaliados foram: diagnóstico de infarto agudo do miocárdio (IAM, angina instável (AI, angina estável (AE, isquemia cerebral, cirurgia de revascularização miocárdica (CRM, angioplastia (ACTP, morte e hospitalizações. RESULTADOS: Na SE, não houve diferença significativa relacionada ao sexo quanto aos exames realizados para diagnóstico da dor torácica; entretanto, proporcionalmente, as mulheres receberam menos medicação cardiológica e mais tranqüilizantes. Ao término do atendimento na SE, as mulheres foram significativamente menos hospitalizadas (p=0,02. Na evolução clínica posterior, não houve diferença entre os dois sexos quanto à ocorrência de IAM, AI, AE, isquemia cerebral, CRM, ACTP e morte. CONCLUSÃO: Comparando a acurácia diagnóstica da dor torácica na SE entre mulheres e homens, não houve diferença significativa quanto ao número de exames realizados, mas a hospitalização foi menos indicada e o manejo terapêutico cardiológico foi menos intenso entre o sexo feminino. A evolução clínica evidenciou incidência igual de desfechos entre os dois sexos, o que sinaliza para a necessidade de atenção ao sintoma dor torácica independentemente do sexo.OBJECTIVE: To evaluate the diagnosis of chest pain in women receiving medical care in the emergency room in relation to follow-up, as well as describing its influence on the therapeutic management when compared to men. METHODS: A current cohort study compared 67 patients of ages ranging from 50 to 65 years (35 women

  14. Freqüência de precordialgia em mulheres chagásicas e não-chagásicas Chest pain frequency in chagasic and non-chagasic women

    Directory of Open Access Journals (Sweden)

    Vitorino Modesto dos Santos

    1998-02-01

    Full Text Available O objetivo do estudo foi comparar a freqüência de precordialgia em mulheres chagásicas com grupo de não-chagásicas. Realizou-se estudo retrospectivo, amostral, do tipo corte transversal, com mulheres (n = 647, de idade 340 anos, chagásicas (n = 362 e controles (n = 285. Precordialgia foi definida por queixa de dor retroesternal relacionada ou não a esforço físico. As chagásicas foram classificadas nas formas indeterminada (n = 125, megas (n = 58 e cardíaca (n = 179. A idade (57,0 ± 11,3 vs 57,3 ± 10,4 anos e porcentagem de brancas (75,8% vs 77,1% foram similares entre chagásicas e controles, respectivamente. Precordialgia foi mais freqüente (p The aim of this study was to compare the frequency of precordialgia between chagasic and non-chagasic women. A cross-sectional study comprised 647 female aged 340, chagasic (n = 362 and controls (n = 285 was done at a Brazilian university hospital. Chagasic were classified as cardiac (n = 179, megas (n = 58 or indeterminate (n = 125 clinical forms. Chest pain was ascertained by typical or atypical retrosternal pain. Age (57.0 ± 11.3 vs 57.3 ± 10.4 years, and percentage of white women (75.8% vs 77.1% were similar between chagasic and controls, respectively. Chest pain was more prevalent (p < 0.01 among chagasic (14.6% than controls (5.6%, mainly in the cardiac form (relative risk = 2.41; range: 1.38-4.23, a phenomenon possibly related to cardiac parasympathetic denervation and myocardial microvascular changes.

  15. Diagnostic value of 64-slice spiral computed tomography chest angiography triple examination in acute chest pain%64排螺旋CT血管成像胸部三联检查对急性胸痛的诊断价值

    Institute of Scientific and Technical Information of China (English)

    齐晨晖; 范红燕; 史琼玉

    2012-01-01

    Objective To explore the clinical value of triple examination with 64-slice spiral CT chest angiography(CTA) in diagnosis of acute chest pain. Methods 80 patients with acute chest pain as study group underwent CTA. The examinations of coronary artery,pulmonary artery and aorta were done one time under ECG-gated. 50 patients received only 64-slice computed tomography coronary angiography, pulmonary angiography and aortic angiography as control group. The image quality of CTA in two groups was evaluated. Results The image quality of control group was better than that of study group, but there was of significant statistical difference between study group and the control group (χ =324. 4,P = 0. 00). There were no statistical difference between two groups and intragroup about the image quality of aorta, pulmonary artery including ascending aorta,aortic arch,descending aorta and the central pulmonary artery, peripheral pulmonary artery (P>0. 05) , the image quality of two groups was as the same as batter. Conclusion 64-slice spiral CT chest angiography triple examination can display aorta, pulmonary artery and coronary artery with good image quality, it has a important clinical value in differential diagnosis of the cause of acute chest pain.%目的 探讨64排螺旋CT血管成像(computed tomography angiography,CTA)胸部三联检查在急性胸痛诊断中的临床应用价值.方法 收集本院以急性胸痛为首发症状者80例为研究组,行64排螺旋CT胸部动脉成像,在心电门控下一次性完成主动脉、肺动脉及冠状动脉扫描;选择单纯行冠状动脉、肺动脉及主动脉CTA扫描者各50例为对照组,评价胸部CTA三联检查成像质量.结果 冠状动脉成像质量研究组与对照组比较有显著统计学差异(χ2=324.4,P=0.00),对照组优于研究组.主动脉和肺动脉成像质量在升主动脉、主动脉弓、降主动脉及中央肺动、外周肺动脉2组整体和组间比均无统计学差异(P>0.05),2

  16. Research design considerations for chronic pain prevention clinical trials

    DEFF Research Database (Denmark)

    Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C

    2015-01-01

    , outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (ie, chronic postsurgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues...

  17. MRI of the Chest

    Medline Plus

    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 ...

  18. Research design considerations for chronic pain prevention clinical trials: IMMPACT recommendations.

    Science.gov (United States)

    Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C; Farrar, John T; Fillingim, Roger B; Gilron, Ian; Markman, John D; Oaklander, Anne Louise; Polydefkis, Michael J; Raja, Srinivasa N; Robinson, James P; Woolf, Clifford J; Ziegler, Dan; Ashburn, Michael A; Burke, Laurie B; Cowan, Penney; George, Steven Z; Goli, Veeraindar; Graff, Ole X; Iyengar, Smriti; Jay, Gary W; Katz, Joel; Kehlet, Henrik; Kitt, Rachel A; Kopecky, Ernest A; Malamut, Richard; McDermott, Michael P; Palmer, Pamela; Rappaport, Bob A; Rauschkolb, Christine; Steigerwald, Ilona; Tobias, Jeffrey; Walco, Gary A

    2015-07-01

    Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (ie, chronic postsurgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (ie, surgery, viral infection, injury, and toxic or noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.

  19. Effects of LBL and PBL teaching mode on emergency triage of acute chest pain%LBL和PBL双轨教学模式在急性胸痛分诊培训中的应用效果

    Institute of Scientific and Technical Information of China (English)

    王国英; 赫晓慈; 李彩霞; 张呈; 田姣; 崔颖; 田素斋

    2015-01-01

    Objective To explore the application effects of LBL and PBL teaching mode on emergency triage of acute chest pain. Methods In 2013, the scenario simulation method combining with LBL and PBL teaching mode were applied in training 22 triage nurses on emergency triage of acute chest pain, and triage accuracy and theoretical level of acute chest pain were compared between two groups of nurses (6-10 years and >10 years) . Results After training, > 10 years group showed an increasing in triage accuracy rate from 89. 80% to 98. 31%, as well as the 6-10 years group, which the triage accuracy rate increased from 74. 51% to 92. 68% (χ2 =3. 91,5. 22;P10 years group increased from (84. 00 ± 3. 74) to (90. 00 ± 1. 79);and 6-10 years group increased from (76. 50 ± 4. 72) to (86. 50 ± 4. 13) (t=3. 54,6. 38;P10年组护士培训前后分诊急性胸痛患者的分诊正确率及急性胸痛理论知识水平有无差异。结果培训后,>10年组护士分诊准确率由89.80%提高至98.31%,6~10年组护士分诊准确率由74.51%提高至92.68%,培训前后比较差异有统计学意义(χ2值分别为3.91,5.22;P10年组护士急性胸痛理论考核成绩由(84.00±3.74)分提高至(90.00±1.79)分,6~10年组护士由(76.50±4.72)分提高至(86.50±4.13)分,培训前后比较差异有统计学意义(t值分别为3.54,6.38;P<0.05)。结论将LBL、PBL和情景模拟教学法运用于急性胸痛分诊培训中,提升了护士的理论成绩,提高分诊正确率,值得推广。

  20. Papel dos testes provocativos esofagianos na investigação de pacientes com dor torácica de origem indeterminada Role of esophageal provocative tests in the investigation of patients with chest pain of undetermined origin

    Directory of Open Access Journals (Sweden)

    Luiz J. Abrahão Jr.

    2005-09-01

    a dor era provável e em 6 dos 14 pacientes (42,8% com exames habitualmente empregados normais ou inconclusivos [ganho diagnóstico de 45% (18/40]. Dois pacientes com testes provocativos negativos apresentaram o índice de sintomas positivo à pHmetria, totalizando 25 (62,5% pacientes com dor esofagiana comprovada. CONCLUSÃO: Os testes provocativos permitiram apontar a dor como de origem esofagiana comprovada em 62,5% dos casos, o que representou um ganho diagnóstico de 45% quando comparados aos exames habitualmente empregados, constituindo ferramenta importante na investigação de pacientes com dor torácica de origem indeterminada.BACKGROUND: Traditional methods employed in esophageal investigation of patients with chest pain of undetermined origin includes upper endoscopy, esophageal manometry and pH monitoring. These methods many times disclose abnormalities that can only be enrolled as the possible cause of chest pain. Provocative tests can reproduce pain in the laboratory, establishing its esophageal origin. OBJECTIVES: Determine the positivity of acid perfusion test, edrophonium and balloon distension in patients with chest pain of undetermined origin and compare with results of traditional exams, establishing the gain for the diagnosis of esophageal pain. RESULTS: Forty patients with chest pain of undetermined origin (normal coronary angiography, 80% female, mean age of 54.7 years were submitted to traditional exams and provocative tests. Upper endoscopy disclosed erosive esophagitis in two (5% and peptic ulcer in one (2.5%, esophageal manometry was abnormal in 60%. pH monitoring was abnormal in 14 (35% with a positive symptom index in 7. Chest pain was considered of proved esophageal origin by traditional exams in 7 (17.5% patients with a positive symptom index and of probable esophageal origin in 19 (47.5% being 8 with gastroesophageal reflux disease and 11 abnormal esophageal motility. In 14 (35% an esophageal origin could not be demonstrated. The acid

  1. Design and evaluation of a ubiquitous chest-worn cardiopulmonary monitoring system for healthcare application: a pilot study.

    Science.gov (United States)

    Zheng, Jiewen; Ha, Congying; Zhang, Zhengbo

    2017-02-01

    Ambulatory recording of physiological data will provide us deep insight into the physical condition of patients and athletes, and assessing treatment effects and training performances. This study presents a miniature wearable cardiopulmonary monitoring system called "Smart Chest Strap," which consists of an elastic band worn around the user's chest with integrated sensors, a physiological signals acquisition unit, and a mobile phone. The physiological signals including electrocardiogram, respiratory inductance plethysmograph, and accelerations (ACC) are sampled, digitalized, stored, and simultaneously transmitted to a mobile phone via Bluetooth. A medical validation test with participants performing discontinuous incremental treadmill (0-12 km/h) exercise was conducted. The results indicate nearly perfect correlations (0.999, 0.996, 0.994), small mean bias (0.60 BPM, 0.51 BPM, 0.05 g), and narrow limits of agreement (±2.90 BPM, ±1.81 BPM, ±0.09 g) for heart rate (HR), breathing rate (BR), and ACC represented as vector magnitude units (VMUs). There is a general trend of decrease in accuracy, precision, and correlation for HR, BR, and VMU as velocity increases, but these validity statistics are all within acceptable error limits and clinically accepted. The findings demonstrate that the Smart Chest Strap is valid and will have wider applications in healthcare, sports, and scientific research areas.

  2. Clinical Events and Patient-Reported Chest Pain in All-Comers Treated With Resolute Integrity and Promus Element Stents : 2-Year Follow-Up of the DUTCH PEERS (DUrable Polymer-Based STent CHallenge of Promus ElemEnt Versus ReSolute Integrity) Randomized Trial (TWENTE II)

    NARCIS (Netherlands)

    Sen, Hanim; Lam, Ming Kai; Löwik, Marije M.; Danse, Peter W.; Jessurun, Gillian A.J.; Houwelingen, van K. Gert; Anthonio, Rutger; Gin, R. Melvyn Tjon Joe; Hautvast, Raymond W.M.; Louwerenburg, J. (Hans) W.; Man, de Frits H.A.F.; Stoel, Martin G.; Heijden, van der Liefke C.; Linssen, Gerard C.M.; IJzerman, Maarten J.; Tandjung, Kenneth; Doggen, Carine J.M.; Birgelen, von Clemens

    2015-01-01

    Objectives This study assessed clinical events and patient-reported chest pain 2 years after treatment of all-comers with Resolute Integrity zotarolimus-eluting stents (Medtronic Vascular, Santa Rosa, California) and Promus Element everolimus-eluting stents (Boston Scientific, Natick, Massachusetts)

  3. Management of flail chest.

    OpenAIRE

    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...

  4. Childhood abdominal pain in primary care : design and patient selection of the HONEUR abdominal pain cohort

    NARCIS (Netherlands)

    Spee, Leo A A; van den Hurk, Arjan P J M; van Leeuwen, Yvonne; Benninga, Marc A; Bierma-Zeinstra, Sita M A; Passchier, Jan; Berger, Marjolein Y

    2010-01-01

    BACKGROUND: Abdominal pain in children is a common complaint presented to the GP. However, the prognosis and prognostic factors of childhood abdominal pain are almost exclusively studied in referred children. This cohort study aims at describing prognosis and prognostic factors of childhood abdomina

  5. American College of Chest Physicians

    Science.gov (United States)

    ... Master Fellows Staff & Contact Us CHEST Newsroom Staff Job Opportunities at CHEST Contact Us Industry Support Industry Support ... of Global Governors Master Fellows CHEST Newsroom Staff Job Opportunities at CHEST Contact Us Industry Support Industry Advisory ...

  6. The One-step Imaging Study of Acute Chest Pain Trilogy by 64 Slice Spiral CT%急性胸痛三联症64层螺旋CT“一站式成像”的研究

    Institute of Scientific and Technical Information of China (English)

    李欣; 孙吉林; 戴国华; 付英杰; 李志远; 柳溪

    2011-01-01

    [Abstract] Objective To investigate the image quality and ability of one-time unified examination of the 64-slice spiral CT(MSCT)in showing coronary artery, pulmonary artery and aorta. Materials and Methods 60 patients with acute chest pain received unified examination of coronary artery .pulmonary artery, aorta with 64-slice MSCT using ECG-gated function respectively. The coronary artery,pulmonary artery and aorta were imaged by using a variety of reconstruction techniques compare to 50 cases with pure 64-slice MSCT coronary angiography ,30 cases with pulmonary artery imaging and 20 cases with aortic imaging. The results from the above examinations were analyzed to evaluate whether or not the quality of the images could meet the need of the clinical diagnosis. Results The average scan time of one step examination was(8.0 ± 1.5)S,and the dose of contrast medium injected was 100 ml,and the injection flow rate of 4.0 -4.5 ml/s. There was significant difference between the chest pain group and the control group in the images of the coronary artery (P 0.05;P=0.44, >0.05;P =0.068, >0.05).The image quality of the chest pain group was as good as the one of the control group. There was significant difference between two groups and intragroup in the images of the central, peripheral and whole pulmonary artery in chest pain group and the control group (P<0.01 ;P<0.01 ;P<0.01).The image quality of the chest pain group was better than the one of the control group. Conclusion The one-step examination of coronary artery .pulmonary artery,aorta by 64-slice MSCT can be finished within 10 seconds. The image quality of aorta, pulmonary artery is excellent. There is no significant difference between the image quality of the single aorta imaging and the unified examination of the MSCT,of which image quality is better than that of single pulmonary artery MSCT. The image of the coronary artery in one time unified examination is good,can meet the needs of the clinical diagnosis,but is

  7. Research design considerations for single-dose analgesic clinical trials in acute pain

    DEFF Research Database (Denmark)

    Cooper, Stephen A; Desjardins, Paul J; Turk, Dennis C

    2016-01-01

    sensitivity. Recommendations are presented on assessment measures, study designs, and operational factors. Although most of the methodological advances have come from studies of postoperative pain after dental impaction, bunionectomy, and other surgeries, the design considerations discussed are applicable...

  8. A Novel Design of Needle Aspiration Biopsy Monitoring Instrument (NAOMI Tested on a Low Cost Chest Phantom

    Directory of Open Access Journals (Sweden)

    Surakusumah Rino Ferdian

    2016-01-01

    Full Text Available Needle biopsy is a medical intervention method for taking a lung tissue sample that suspected as a cancer. The disadvantage is the physicians directly visualize the anatomical structures in an open surgery for lung cancer biopsy procedure. There is a need to develop an instrument that may help the physician to guarantee the accuracy and efficiency while performing needle aspiration biopsy. Therefore, a needle aspiration biopsy monitoring instrument or named as NAOMI is proposed. It consists of a microcontroller system, an IMU sensor, an ultrasonic ranging module, a bluetooth module, and a 9V lithium battery. The experimental testing consist of performance testing, functional testing using chest phantom, and user acceptances. The results showed that the NAOMI improve the accuracy and efficiency while performing the needle biopsy operation.

  9. Clinical significance of Ischemia Modified Albumin in the Early Diagnosis of Patients with Acute Chest Pain%缺血修饰蛋白在急性胸痛患者早期诊断中的临床意义

    Institute of Scientific and Technical Information of China (English)

    余琦; 钮炜西; 唐发宽; 华宁; 林乐健

    2013-01-01

    目的 探讨缺血修饰蛋白(IMA)在急性胸痛患者早期诊断中的临床意义.方法 急性胸痛患者125例,分为非冠心病组(UCAD) 32例,不稳定性心绞痛组(UAP)21例,急性心肌梗死组(AMI)72例.于入院时、末次症状后8h、末次症状后24h抽血,测定血清IMA、cTnI、MYO;采用SPSS13统计软件进行分析.结果 结果显示:入院时IMA值在UCAD组、UAP组和AMI组之间比较差异有统计学意义(P<0.05);末次症状后8h,AMI组和IMA值仍与其他两组间比较差异有统计学意义(P<0.05);末次症状后24h,三组患者所测IMA值之间比较差异无统计学意义(P>0.05).125例患者中,有92例患者诊断为急性冠脉综合症(ACS).IMA的诊断敏感性最高,为82.6%,ECG仅为29.7%,cTnI为42.8%,MYO为64.3%.不同判断指标的组合在入院后即刻诊断心源性疾病的阳性率为85.2% ~ 93.6%.结论 IMA对急性胸痛患者的早期诊断具有一定的临床意义.%Objective To investigate the clinical significance of ischemia modified albumin (IMA) in the diagnosis of patients with acute chest pain. Methods Among the 125 patients with chest pain who were hospitalized in our department, 32 were grouped into non-coronary heart disease (NCAD) group, 21 into unstable angina (UAP) group and 72 into acute myocardial infarction (AMI) group. Blood sample were drown at entry, 8 hours and 24 hours after last attacking, and the levels of IMA, cTnI and MYO were determined. Statistical analysis was done by SPSS 13.O statistical package. Results The levels of IMA at entry and 8 hour after last attacking in NCAD group were significantly different compared to the other groups (P 0.05). 92 patients in total 125 patients were diagnosed as the acute coronary syndrome (ACS). The diagnostic sensitivity of IMA (82.6% ) was higher than that of electrocardiogram (29. 7) , cTnI (42. 8% ) and MYO (64. 3% ). The heart source disease's immediate diagnosis positive rates of different judgment

  10. 缺血修饰白蛋白对胸痛的早期诊断价值研究%Study of early diagnostic value of ischemia modified albumin for chest pain

    Institute of Scientific and Technical Information of China (English)

    李贵华; 任文林; 李莉; 詹小娜

    2011-01-01

    目的 评价缺血修饰白蛋白(ischemia modified albumin,IMA)对以胸痛为主诉到急诊室的患者的早期诊断价值.方法 入选188例研究对象,包括142例有胸痛症状,怀疑急性冠脉综合征(ACS)的患者及46例健康志愿者.依据肌钙蛋白检测结果,患者组肌钙蛋白阳性的69例为胸痛1组,肌钙蛋白阴性的73例为胸痛2组,其中10例患者依据临床特点及心电图等检查确诊为不稳定型心绞痛.组间比较采用方差分析,并绘制ROC曲线,根据ROC曲线选定IMA的理想截断点.结果 肌钙蛋白阳性组IMA平均值明显高于肌钙蛋白阴性组[(126.44±9.73)U/mL vs(101.93±8.67)U/mL,P<0.01],以IMA的检测值99.5 U/mL为截断点,IMA诊断ACS的敏感度为96.3%,特异度为57.1%.结论 IMA可能是急诊室早期排除胸痛患者为ACS的有用指标.%Objective To evaluate whether ischemia modified albumin ( IMA) is a useful biomarker for the identification of acute coronary syndrome ( ACS) in patients presenting with acute chest pain at early stage in emergency department. Methods We selected 188 subjects: 142 consecutive patients with chest pain were suspected of ACS and 46 heathy volunteers. According to the result of troponin Ⅰ( TnI) , all the patients were classified to either the TnI positive group ( n = 69) or Tropin Ⅰnegative group ( n = 73 ) , among TnI negative group there were 10 patients whose final diagnosis were unstable angina pectoris. SNOVA was used to compare IMA between different groups, and receiver operating characteristicl( ROC) was obtained. The ideal cutoff value of IMA was calculated by the ROC curve analysis. Results Mean IMA levels were higher in the patients with positive TnI ( 126.44±9.73) U/mL than in the patients with negative TnI ( 101.93±8.67) U/mL ( P < 0.01). Based on IMA levels (99.5 U/mL) , IMA had a sensitivity of 96.3% and specificity of 57.1% for the diagnosis of ACS. Conclusion IMA may be a useful biomarker to rule out ACS in patients

  11. Research design considerations for single-dose analgesic clinical trials in acute pain: IMMPACT recommendations.

    Science.gov (United States)

    Cooper, Stephen A; Desjardins, Paul J; Turk, Dennis C; Dworkin, Robert H; Katz, Nathaniel P; Kehlet, Henrik; Ballantyne, Jane C; Burke, Laurie B; Carragee, Eugene; Cowan, Penney; Croll, Scott; Dionne, Raymond A; Farrar, John T; Gilron, Ian; Gordon, Debra B; Iyengar, Smriti; Jay, Gary W; Kalso, Eija A; Kerns, Robert D; McDermott, Michael P; Raja, Srinivasa N; Rappaport, Bob A; Rauschkolb, Christine; Royal, Mike A; Segerdahl, Märta; Stauffer, Joseph W; Todd, Knox H; Vanhove, Geertrui F; Wallace, Mark S; West, Christine; White, Richard E; Wu, Christopher

    2016-02-01

    This article summarizes the results of a meeting convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) on key considerations and best practices governing the design of acute pain clinical trials. We discuss the role of early phase clinical trials, including pharmacokinetic-pharmacodynamic (PK-PD) trials, and the value of including both placebo and active standards of comparison in acute pain trials. This article focuses on single-dose and short-duration trials with emphasis on the perioperative and study design factors that influence assay sensitivity. Recommendations are presented on assessment measures, study designs, and operational factors. Although most of the methodological advances have come from studies of postoperative pain after dental impaction, bunionectomy, and other surgeries, the design considerations discussed are applicable to many other acute pain studies conducted in different settings.

  12. Flail chest and pulmonary contusion.

    Science.gov (United States)

    Bastos, Renata; Calhoon, John H; Baisden, Clinton E

    2008-01-01

    Flail chest is most often accompanied by a significant underlying pulmonary parenchymal injury and can be a life-threatening thoracic injury. Its management is often complicated by the other injuries it is frequently associated with. Similarly, mortality and morbidity are dictated most often by the associated injuries and findings. Its treatment is complex and should first be one of pain management, judicious fluid resuscitation, and excellent pulmonary toilet. In those patients requiring mechanical ventilatory support, or who require ipsilateral thoracocotomy, rib stabilization may be considered depending on a host of potentially conflicting indications and contraindications. At the end of this section are listed the current major recommendations and their levels of evidence.

  13. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    Science.gov (United States)

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  14. Primary Experiences in 320-Row-640-Slice Dynamic CT for Checking Acute Chest Pain%320排640层动态容积CT 在急性胸痛检查中的初步探讨

    Institute of Scientific and Technical Information of China (English)

    马国军; 于淑靖; 何翔; 郑婧; 魏书恒; 王燕

    2011-01-01

    Objective: To evaluate the image quality and clinic value of dynamic CT checking triple rule-out.Method:38 patients suffering acute chest pain were continuously selected and accepted 320-row-640-slice dynamic CT examination.The scan protocol was helical scanning the whole chest, under ECG-gate,intelligent and automatically trigger.80~90ml contrast media was needed.Two professional doctors measure the CT value of ascending main aorta,decline main aorta and pulmonary artery separately in pulmonary trunk level .The image quality of coronary artery was evaluated,which was graded in three levels:good,well,bad.The dose of radiation was also evaluated .Result: The average CT value of ascending main aorta, decline main aorta and pulmonary artery was (401 ±57)HU,(397±49) HU,(331 ±31)HU.84.7% of all image quality of coronary artery were good,13.2% were well,2.1% were bad.4 patients were diagnosed lung infection with pleurar effusion, 1 patient was lung cancer,2 patients pulmonary embolism,1 patient dissection of aorta,2 patients artrial myxoma.The degree of stenosis was more than 50% in 12 patients' coronary artery.Average radiation dose was (22 ±2.1)mSv. Conclusion:This scanning protocol can achieve high quality image of main aorta,pulmonary artery and coronary artery comparing with the reports of literature.lt is very valuable for finding pathogen of acute chest pain.The dose of contrast media and radiation were lower.%目的:探讨320 排640 层动态容积CT 胸痛三联检查的图像质量及临床价值.方法:连续选取38 例急性胸痛患者行320 排640 层动态容积CT 检查.扫描方案为心电门控下全胸部螺旋扫描(160 mm×0.5mm),采用智能自动触发技术.对比剂用量为80~90ml( 碘海醇350).分别由2位专业医生测定肺动脉干层面的升主动脉、降主动脉、肺动脉干CT 值并评价冠脉质量,冠脉质量分为优、良、差三级.同时评价辐射剂量.结果:升主动脉、降主动脉、肺动脉平均CT

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

    Directory of Open Access Journals (Sweden)

    Verdon François

    2007-09-01

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

  16. Comparison of Fentanyl with Sufentanil for Chest Tube Removal

    Directory of Open Access Journals (Sweden)

    M Golmohammadi

    2008-11-01

    Full Text Available Background: After cardiac surgery, the chest tubes cause pain and their removal is painful and unpleasant forpatients. The aim of this research was to study and compare the analgesic effect of fentanyl and sufentanil on painrelief during chest tube removal in post-cardiac surgical patients.Patients and Methods: A total of 80 patients scheduled for elective cardiac surgery, were recruited in prospective,randomized and double-blind study. Patients received 1.5μg/kg fentanyl or 0.15μg/kg sufentanyl, intravenously10 minutes before removal of chest tube. Pain intensity was assessed by measuring visual analogscale (VAS pain score, 10 minutes before, during, and 5 and10 minutes after removing chest tubes. Level ofsedation, heart rate, arterial blood pressure, and oxygenation saturation were recorded at each stage by a blindedobserver.Results: Mean pain intensity scores 10 minutes before removal of chest tube in fentanyl, and sufentanil groupswere 29.5±12.1 and 31±11.2 respectively. Pain scores during chest tube removal were 38.5±11.6 in fentanylgroup and 44.7±12.8 in sufentanil group (P =0.02. In addition, pain scores during chest tube removal were significantly(P value=0.02 more reduced in fentanyl (17.21±7.5 than in sufentanil group (21.51±11.2. Sedationscores remained low in two groups. None of the patients showed any adverse side effects of opioids. No differenceswere seen in the heart rate or arterial blood pressure, but oxygenation saturation was significantly greaterin sufentanil group than in fentanyl group.Conclusion: Both fentanyl and sufentanil provide adequate analgesia for chest tube removal without increasinguntoward side effects.

  17. Innovation and Design of a Web-Based Pain Education Interprofessional Resource

    Directory of Open Access Journals (Sweden)

    Leila Lax

    2011-01-01

    Full Text Available INTRODUCTION: The present article describes educational innovation processes and design of a web-based pain interprofessional resource for prelicensure health science students in universities across Canada. Operationalization of educational theory in design coupled with formative evaluation of design are discussed, along with strategies that support collaborative innovation.

  18. The Systematic Evaluation of Instruments Designed to Assess Pain in Persons with Limited Ability to Communicate*

    Directory of Open Access Journals (Sweden)

    Michèle Aubin

    2007-01-01

    Full Text Available Chronic pain is often underdetected and undertreated in long-term care facilities. The use of self-report measures of pain (such as the visual analogue scale is often problematic for older adults residing in long-term care because of the high prevalence of visual and auditory deficits and severe cognitive impairment. Observational measures of pain have been developed to address this concern. A systematic grid designed to assess the properties of existing observational measures of pain was used for seniors with dementia. The grid focused on the evaluation of content validity (12 items, construct validity (12 items, reliability (13 items and clinical utility (10 items. Among the 24 instruments that were evaluated, several were deemed to be promising in the assessment of pain among older persons with severe dementia. Nonetheless, additional research is needed before their routine integration in the practices of long-term care settings.

  19. Usefulness of fractional flow reserve measurements to defer revascularization in patients with stable or unstable angina pectoris, non-ST-elevation and ST-elevation acute myocardial infarction, or atypical chest pain.

    Science.gov (United States)

    Potvin, Jean-Michel; Rodés-Cabau, Josep; Bertrand, Olivier F; Gleeton, Onil; Nguyen, Can Nanh; Barbeau, Gerald; Proulx, Guy; De Larochellière, Robert; Déry, Jean-Pierre; Batalla, Nuria; Dana, Ali; Facta, Alvaro; Roy, Louis

    2006-08-01

    This study determined the safety of deferring coronary revascularization based on a fractional flow reserve (FFR) value > or = 0.75 in a series of consecutive unselected coronary patients with moderate coronary lesions, including patients with unstable angina, myocardial infarction (MI), and/or positive noninvasive test findings. The study included 201 consecutive coronary patients (mean age 62 +/- 10 years; 65% men) with 231 lesions evaluated by FFR measurement for which revascularization was deferred based on a FFR value > or = 0.75. Lesions associated with a positive noninvasive test result were those located in an artery supplying a myocardial territory in which myocardial ischemia was demonstrated by a noninvasive test. Cardiac events (cardiac death, MI, revascularization) and Canadian Cardiovascular Society angina class were evaluated at follow-up. Indications for coronary angiography included unstable angina or MI (62%), stable angina (30%), or atypical chest pain (8%). Forty-four patients (22%) had > or = 1 coronary lesion associated with a positive noninvasive test result in which FFR was evaluated. Mean FFR value was 0.87 +/- 0.06 and mean lesion percent diameter stenosis was 41 +/- 8%. At 11 +/- 6 months of follow-up, cardiac events occurred in 20 patients (10%), and no significant differences were observed between patients with unstable angina or MI and those with stable angina (9% vs 13%, p = 0.44) or between patients with and without lesions associated with positive noninvasive test results (9% vs 10%, p = 1.00). At the end of follow-up, 88% of patients were asymptomatic in angina class 0 or I, with no differences across various groups. In conclusion, these results suggest that patients with moderate coronary lesions can be safely managed without revascularization on the basis of FFR measurements, irrespective of clinical presentation and/or presence of positive noninvasive test results.

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  1. Chest computed tomography

    DEFF Research Database (Denmark)

    Loeve, Martine; Krestin, Gabriel P.; Rosenfeld, Margaret

    2013-01-01

    Clinical trials for the treatment of cystic fibrosis (CF) lung disease are important to test and optimize new therapeutic interventions. To evaluate the effect of these interventions, sensitive and accurate outcome measures are needed. The most commonly used endpoints are spirometric variables...... are not suitable to study CF lung disease in young children. Chest computed tomography (CT) holds great promise for use as a sensitive surrogate endpoint in CF. A large body of evidence has been produced to validate the use of chest CT as primary endpoint to study CF lung disease. However, before chest CT can...

  2. Digital chest radiography

    DEFF Research Database (Denmark)

    Debess, Jeanne Elisabeth; Johnsen, Karen Kirstine; Thomsen, Henrik

    2015-01-01

    on collimation and dose reduction in digital chest radiography Methods and Materials A retrospective study of digital chest radiography is performed to evaluate the primary x-ray tube collimation of the PA and lateral radiographs. Data from one hundred fifty self-reliant female patients between 15 and 55 years...... collimations depending on side of radiograph. Results from dose reduction will be presented on the congress Conclusion: Correct positioning and collimation of digital chest radiographs can reduce the radiation dose significant to the patients and by that improve the quality of basic radiography....

  3. A vibração torácica na fisioterapia respiratória de recém-nascidos causa dor? Does chest vibration during respiratory physiotherapy in neonates cause pain?

    Directory of Open Access Journals (Sweden)

    Fernanda de Cordoba Lanza

    2010-03-01

    Full Text Available OBJETIVO: Avaliar a dor em recém-nascidos pré-termo (RNPT submetidos à fisioterapia respiratória em Unidade de Terapia Intensiva Neonatal. MÉTODOS: Estudo transversal realizado com recém-nascidos prematuros, com indicação de fisioterapia respiratória, em respiração espontânea. Foi aplicada uma técnica de vibração torácica com a mão do terapeuta realizando pequenas oscilações sobre o tórax do paciente e feita a avaliação da frequência cardíaca (FC, frequência respiratória (FR, saturação de pulso de oxigênio (SpO2 e do Sistema de Codificação da Atividade Facial Neonatal (NFCS para a avaliação da dor antes, durante, imediatamente após (pós-i e 30 minutos após (pós-30 a vibração no tórax do paciente. Utilizou-se a análise de variância para medidas repetidas para comparação entre as fases, considerando-se significante pOBJECTIVE: To observe pain score during chest physiotherapy (CP in preterm newborns (PTNB assisted in a Neonatal Intensive Care Unit. METHODS: A cross-sectional study was carried out with PTNB with spontaneous breathing that needed respiratory physiotherapy. A vibration technique was employed, with the hand of the therapist applying oscillations on the patients' thorax. The following variables were assessed: heart rate (HR, respiratory rate (RR and oxygen saturation (O2Sat, as well as the Neonatal Facial Coding System (NFCS to analyze pain before (pre, during, just after and 30 minutes after the thoracic vibration technique. Repeated measures analysis of variance was applied to analyze the protocol phases, being significant p<0.05. RESULTS: Thirteen PTNB were assessed. The mean gestational age was 32.5±2.0 weeks, and the birth weight was 1830±442g. No pain was observed during the evaluation: "pre": 0.5±1.7; "during": 1.5±1.4; "just after": 1.0±1.3; "30 min after": 0±0.3, but there was difference in the NFCS scores between the periods "just after" and "30 minutes after" (p<0.05. The HR

  4. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA: Design and rationale

    Directory of Open Access Journals (Sweden)

    Bossuyt Patrick MM

    2007-08-01

    Full Text Available Abstract Background The acute abdomen is a frequent entity at the Emergency Department (ED, which usually needs rapid and accurate diagnostic work-up. Diagnostic work-up with imaging can consist of plain X-ray, ultrasonography (US, computed tomography (CT and even diagnostic laparoscopy. However, no evidence-based guidelines exist in current literature. The actual diagnostic work-up of a patient with acute abdominal pain presenting to the ED varies greatly between hospitals and physicians. The OPTIMA study was designed to provide the evidence base for constructing an optimal diagnostic imaging guideline for patients with acute abdominal pain at the ED. Methods/design Thousand consecutive patients with abdominal pain > 2 hours and Discussion This study aims to provide the evidence base for the development of a diagnostic algorithm that can act as a guideline for ED physicians to evaluate patients with acute abdominal pain.

  5. Chest tube insertion - slideshow

    Science.gov (United States)

    ... presentations/100008.htm Chest tube insertion - series—Normal anatomy To use the sharing features ... pleural space is the space between the inner and outer lining of the lung. It is normally very thin, and lined only ...

  6. MRI of the Chest

    Medline Plus

    Full Text Available ... of the chest uses a powerful magnetic field, radio waves and a computer to produce detailed pictures ... medical conditions. MRI uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed ...

  7. MRI of the Chest

    Medline Plus

    Full Text Available ... primarily used to assess abnormal masses such as cancer and determine the size, extent and degree of ... chest is performed to: assess abnormal masses, including cancer of the lungs or other tissues, which either ...

  8. MRI of the Chest

    Medline Plus

    Full Text Available ... detailed pictures of the structures within the chest. It is primarily used to assess abnormal masses such ... and determine the size, extent and degree of its spread to adjacent structures. It’s also used to ...

  9. Neonatal Chest Wall Rhabdomyosarcoma.

    Science.gov (United States)

    Feldman, Michael; Steiner, Zvi; Groisman, Gabriel; Nadir, Erez

    2015-06-01

    An infant was born at term with a huge chest mass diagnosed as rhabdomyosarcoma. Treatment consisted of surgical resection and chemotherapy. We describe this very rare congenital mass and the problematic therapeutic management of such a tumor in a newborn.

  10. Neonatal Chest Wall Rhabdomyosarcoma

    OpenAIRE

    Feldman, Michael; Steiner, Zvi; Groisman, Gabriel; Nadir, Erez

    2015-01-01

    An infant was born at term with a huge chest mass diagnosed as rhabdomyosarcoma. Treatment consisted of surgical resection and chemotherapy. We describe this very rare congenital mass and the problematic therapeutic management of such a tumor in a newborn.

  11. Systematic review of enriched enrolment, randomised withdrawal trial designs in chronic pain: a new framework for design and reporting.

    Science.gov (United States)

    Moore, R Andrew; Wiffen, Philip J; Eccleston, Christopher; Derry, Sheena; Baron, Ralf; Bell, Rae F; Furlan, Andrea D; Gilron, Ian; Haroutounian, Simon; Katz, Nathaniel P; Lipman, Arthur G; Morley, Stephen; Peloso, Paul M; Quessy, Steve N; Seers, Kate; Strassels, Scott A; Straube, Sebastian

    2015-08-01

    Enriched enrolment, randomised withdrawal (EERW) pain trials select, before randomisation, patients who respond by demonstrating a predetermined degree of pain relief and acceptance of adverse events. There is uncertainty over the value of this design. We report a systematic review of EERW trials in chronic noncancer pain together with a critical appraisal of methods and potential biases in the methods used and recommendations for the design and reporting of future EERW trials. Electronic and other searches found 25 EERW trials published between 1995 and June 2014, involving 5669 patients in a randomised withdrawal phase comparing drug with placebo; 13 (median, 107 patients) had a randomised withdrawal phase of 6 weeks or less, and 12 (median, 334) lasted 12 to 26 weeks. Risks of bias included short duration, inadequate outcome definition, incomplete outcome data reporting, small size, and inadequate dose tapering on randomisation to placebo. Active treatment was usually better than placebo (22/25 trials). This review reduces the uncertainty around the value of EERW trials in pain. If properly designed, conducted, and reported, they are feasible and useful for making decisions about pain therapies. Shorter, small studies can be explanatory; longer, larger studies can inform practice. Current evidence is inadequate for valid comparisons in outcome between EERW and classical trials, although no gross differences were found. This systematic review provides a framework for assessing potential biases and the value of the EERW trials, and for the design of future studies by making recommendations for the conduct and reporting of EERW trials.

  12. Gastroesophageal reflux disease in noncardiac chest pain.

    Science.gov (United States)

    Faybush, Elisa M; Fass, Ronnie

    2004-03-01

    After a cardiac source has been excluded, the most likely cause of NCCP is GERD. Clinical history often cannot make the diagnosis of GERD-related NCCP. The PPI test is a simple, highly sensitive, and cost-effective tool that should be the first diagnostic test used in evaluating these patients. Patients with GERD-related NCCP require long-term therapy with a PPI,commonly double the standard dose. The introduction of the wireless pH system and the multi-channel intraluminal impedance will help us to further understand the role of GERD in NCCP. Treatment of NCCP has dramatically improved since the introduction of the PPI class of drugs.However, better therapeutic modalities should be sought out to further improve our current treatment of GERD-related NCCP.

  13. [Isolated chest trauma in elderly patients].

    Science.gov (United States)

    Yersin, Bertrand; Carron, Pierre-Nicolas; Pasquier, Mathieu; Zingg, Tobias

    2015-08-12

    In elderly patients, a blunt trauma of the chest is associated with a significant risk of complications and mortality. The number of ribs fractures (≥ 4), the presence of bilateral rib fractures, of a pulmonary contusion, of existent comorbidities or acute extra-thoracic traumatic lesions, and lastly the severity of thoracic pain, are indeed important risk factors of complications and mortality. Their presence may require hospitalization of the patient. When complications do occur, they are represented by alveolar hypoventilation, pulmonary atelectasia and broncho-pulmonary infections. When hospitalization is required, it may allow for the specific treatment of thoracic pain, including locoregional anesthesia techniques.

  14. Musculoskeletal problems of the chest wall in athletes.

    Science.gov (United States)

    Gregory, Peter L; Biswas, Anita C; Batt, Mark E

    2002-01-01

    Chest pain in the athlete has a wide differential diagnosis. Pain may originate from structures within the thorax, such as the heart, lungs or oesophagus. However, musculoskeletal causes of chest pain must be considered. The aim of this review is to help the clinician to diagnose chest wall pain in athletes by identifying the possible causes, as reported in the literature. Musculoskeletal problems of the chest wall can occur in the ribs, sternum, articulations or myofascial structures. The cause is usually evident in the case of direct trauma. Additionally, athletes' bodies may be subjected to sudden large indirect forces or overuse, and stress fractures of the ribs caused by sporting activity have been extensively reported. These have been associated with golf, rowing and baseball pitching in particular. Stress fractures of the sternum reported in wrestlers cause pain and tenderness of the sternum, as expected. Diagnosis is by bone scan and limitation of activity usually allows healing to occur. The slipping rib syndrome causes intermittent costal margin pain related to posture or movement, and may be diagnosed by the 'hooking manoeuvre', which reproduces pain and sometimes a click. If reassurance and postural advice fail, good results are possible with resection of the mobile rib. The painful xiphoid syndrome is a rare condition that causes pain and tenderness of the xiphoid and is self-limiting. Costochondritis is a self-limiting condition of unknown aetiology that typically presents with pain around the second to fifth costochondral joints. It can be differentiated from Tietze's syndrome in which there is swelling and pain of the articulation. Both conditions eventually settle spontaneously although a corticosteroid injection may be useful in particularly troublesome cases. The intercostal muscles may be injured causing tenderness between the ribs. Other conditions that should be considered include epidemic myalgia, precordial catch syndrome and referred pain

  15. Research design considerations for confirmatory chronic pain clinical trials: IMMPACT recommendations.

    Science.gov (United States)

    Dworkin, Robert H; Turk, Dennis C; Peirce-Sandner, Sarah; Baron, Ralf; Bellamy, Nicholas; Burke, Laurie B; Chappell, Amy; Chartier, Kevin; Cleeland, Charles S; Costello, Ann; Cowan, Penney; Dimitrova, Rozalina; Ellenberg, Susan; Farrar, John T; French, Jacqueline A; Gilron, Ian; Hertz, Sharon; Jadad, Alejandro R; Jay, Gary W; Kalliomäki, Jarkko; Katz, Nathaniel P; Kerns, Robert D; Manning, Donald C; McDermott, Michael P; McGrath, Patrick J; Narayana, Arvind; Porter, Linda; Quessy, Steve; Rappaport, Bob A; Rauschkolb, Christine; Reeve, Bryce B; Rhodes, Thomas; Sampaio, Cristina; Simpson, David M; Stauffer, Joseph W; Stucki, Gerold; Tobias, Jeffrey; White, Richard E; Witter, James

    2010-05-01

    There has been an increase in the number of chronic pain clinical trials in which the treatments being evaluated did not differ significantly from placebo in the primary efficacy analyses despite previous research suggesting that efficacy could be expected. These findings could reflect a true lack of efficacy or methodological and other aspects of these trials that compromise the demonstration of efficacy. There is substantial variability among chronic pain clinical trials with respect to important research design considerations, and identifying and addressing any methodological weaknesses would enhance the likelihood of demonstrating the analgesic effects of new interventions. An IMMPACT consensus meeting was therefore convened to identify the critical research design considerations for confirmatory chronic pain trials and to make recommendations for their conduct. We present recommendations for the major components of confirmatory chronic pain clinical trials, including participant selection, trial phases and duration, treatment groups and dosing regimens, and types of trials. Increased attention to and research on the methodological aspects of confirmatory chronic pain clinical trials has the potential to enhance their assay sensitivity and ultimately provide more meaningful evaluations of treatments for chronic pain.

  16. 相干对比成像在可疑心源性胸痛危险分层中的应用%Application of Coherent Contrast Imaging in Risk Stratification for Patients with Suspected Cardiac Chest Pain

    Institute of Scientific and Technical Information of China (English)

    刘婷婷; 陈小林; 汤立军; 余泽洪; 文达辉; 查道刚; 刘伊丽

    2011-01-01

    Objective To explore the incremental value of coherent contrast imaging (CCI) over routine evaluation in risk stratification for patients with chest pain (CP) and no ST-segment elevation. Methods In addition to routine clinical evaluation, 203 patients with suspected cardiac CP and no ST-segment elevation were evaluated for left ventricular regional function (RF) and myocardial perfusion (MP) using myocardial contrast echocardiography (MCE). Acute myocardial infarction, unstable angina pectoris, congestive heart failure (CHF) and cardiac-related death were considered as events within 48 h (early) and 1 year (late). Results Of the 203 patients studied, 33 (16. 3%) had early events, and 59 (29. 1%) had late events. Abnormal RF increased the prognostic information of clinical and EKG variables significantly (P<0. 0001). And abnormal MP could further increase prognostic information significantly (P<0. 0001). Conclusions CCI could be a valuable tool in the early triage and management of patients with suspected cardiac CP and no ST-segment elevation.%目的 探讨相干对比成像(CCI)技术在无ST段抬高的可疑心源性胸痛患者危险分层中的应用价值.方法 203例无ST段抬高的可疑心源性胸痛患者在常规临床评估后用CCI技术行心肌声学造影(MCE),评价左心室局部心肌运动功能(RF)和心肌灌注(MP).观察48 h(早期)和1年(晚期)随访期内急性心肌梗死、不稳定型心绞痛、心力衰竭和死亡等事件的发生情况.结果 在203例患者中,33例(16.3%)发生早期事件,59例(29.1%)发生晚期事件.RF异常显著增加常规临床评估及心电图预测心脏事件的价值(P<0.000 1),MP异常将进一步提高预测价值(P<0.000 1).结论 CCI在可疑心源性胸痛患者早期危险分层和处理中发挥重要作用.

  17. Significant efficiency findings while controlling for the frequent confounders of CAI research in the PlanAlyzer project's computer-based, self-paced, case-based programs in anemia and chest pain diagnosis.

    Science.gov (United States)

    Lyon, H C; Healy, J C; Bell, J R; O'Donnell, J F; Shultz, E K; Wigton, R S; Hirai, F; Beck, J R

    1991-04-01

    Richard E. Clark in his widely published comprehensive studies and meta-analyses of the literature on computer assisted instruction (CAI) has decried the lack of carefully controlled research, challenging almost every study which shows the computer-based intervention to result in significant post-test proficiency gains over a non-computer-based intervention. We report on a randomized study in a medical school setting where the usual confounders found by Clark to plague most research, were carefully controlled. PlanAlyzer is a microcomputer-based, self-paced, case-based, event-driven system for medical education which was developed and used in carefully controlled trials in a second year medical school curriculum to test the hypothesis that students with access to the interactive programs could integrate their didactic knowledge more effectively and/or efficiently than with access only to traditional textual "nonintelligent" materials. PlanAlyzer presents cases, elicits and critiques a student's approach to the diagnosis of two common medical disorders: anemias and chest pain. PlanAlyzer uses text, hypertext, images and critiquing theory. Students were randomized, one half becoming the experimental group who received the interactive PlanAlyzer cases in anemia, the other half becoming the controls who received the exact same content material in a text format. Later in each year there was a crossover, the controls becoming the experimentals for a similar intervention with the cardiology PlanAlyzer cases. Preliminary results at the end of the first two full trials shows that the programs have achieved most of the proposed instructional objectives, plus some significant efficiency and economy gains. 96 faculty hours of classroom time were saved by using PlanAlyzer in their place, while maintaining high student achievement. In terms of student proficiency and efficiency, the 328 students in the trials over two years were able to accomplish the project's instructional

  18. CHEST PHYSIOTHERAPY FOR INFANTS

    Directory of Open Access Journals (Sweden)

    Preeti S. Christian (M.P.T Cardiopulmonary Conditions

    2014-10-01

    Full Text Available In the normal lung, secretions are removed by Mucociliary activity, normal breathing cycles, and cough. In disease, increased secretion viscosity and volume, dyskinesia of the cilia, and ineffective cough combine to reduce the ability to clear secretions, and may increase exacerbations and infections. Many chest physiotherapy techniques like postural drainage, percussion and vibration are used since many years. These techniques are derived from adult studies but these techniques are quite stressful for the infants as the infant respiratory system is different from the adult respiratory system. Advance chest physiotherapy techniques were developed specifically for infants; in accordance with their physiological characteristics. So this review is to introduce some new chest physiotherapy helpful for newborn infants.

  19. Designing, validation, and feasibility of integrated yoga therapy module for chronic low back pain

    Directory of Open Access Journals (Sweden)

    Nitin J Patil

    2015-01-01

    Conclusion: The designed IYTM was validated by thirty yoga experts and later evaluated on a small sample. This study has shown that the validated IYTM is feasible, had no adverse effects and was useful in alleviating pain, disability, and perceived stress in patients with CLBP. However, randomized control trials with larger sample are needed to strengthen the study.

  20. MRI of the Chest

    Medline Plus

    Full Text Available ... vertebrae, ribs and sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around the heart) disease. characterize mediastinal or pleural lesions seen by other ... chemical changes in the tissues. As the hydrogen atoms return to their usual ...

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

    Institute of Scientific and Technical Information of China (English)

    Beuy Joob; Viroj Wiwanitkit

    2013-01-01

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

  2. Sandstorm in the chest?

    Directory of Open Access Journals (Sweden)

    Talluri MR

    2011-07-01

    Full Text Available A 32 year old female presented with dry cough and progressive breathlessness of one year duration. There was no history suggestive of collagen vascular disease, lung parenchymal infection or allergic airway disease. Clinical evaluation showed basal fine inspiratory crepitations. Radiographic examination of the chest revealed a black pleura line and lung parenchymal calcification. CT scan of the chest demonstrated nodular calcification of lung parenchyma with a “crazy pavement” pattern, which is suggestive of alveolar calcification. Pulmonary function test showed a severe restrictive defect. On transbronchial lung biopsy calcific spherules suggestive of the alveolar microlithiasis were seen. Diagnosis of pulmonary alveolar microlithiasis was made and symptomatic treatment was given, as there is no specific therapy available. The case illustrates an unusual cause of shortness of breath in a young female with striking radiographic features.

  3. Digital chest radiography

    DEFF Research Database (Denmark)

    Debess, Jeanne Elisabeth; Vejle-Sørensen, Jens Kristian; Thomsen, Henrik;

    2015-01-01

    of clinical supervisors. Optimal collimation is determined by European and Regional Danish guidelines. The areal between current and optimal collimation is calculated. The experimental research is performed in September - October 2014 Siemens Axiom Aristos digital radiography system DR using 150 kV, 1,25 -3......Purpose: Quality improvement of basic radiography focusing on collimation and dose reduction in digital chest radiography Methods and Materials:A retrospective study of digital chest radiography is performed to evaluate the primary x-ray tube collimation of the PA and lateral radiographs. Data from...... one hundred fifty self-reliant female patients between 15 and 55 years of age are included in the study. The clinical research is performed between September and November 2014 where 3rd year Radiography students collect data on four Danish x-ray departments using identical procedures under guidance...

  4. Manual and Electroacupuncture for Labour Pain: Study Design of a Longitudinal Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Linda Vixner

    2012-01-01

    Full Text Available Introduction. Results from previous studies on acupuncture for labour pain are contradictory and lack important information on methodology. However, studies indicate that acupuncture has a positive effect on women’s experiences of labour pain. The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain as the primary outcome. This paper will present in-depth information on the design of the study, following the CONSORT and STRICTA recommendations. Methods. The study was designed as a randomized controlled trial based on western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture, or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. A Visual Analogue Scale was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment. This trial is registered at ClinicalTrials.gov: NCT01197950.

  5. CHEST PHYSIOTHERAPY FOR INFANTS

    OpenAIRE

    2014-01-01

    In the normal lung, secretions are removed by Mucociliary activity, normal breathing cycles, and cough. In disease, increased secretion viscosity and volume, dyskinesia of the cilia, and ineffective cough combine to reduce the ability to clear secretions, and may increase exacerbations and infections. Many chest physiotherapy techniques like postural drainage, percussion and vibration are used since many years. These techniques are derived from adult studies but these techniques are quite str...

  6. Anterior chest wall involvement in patients with pustulosis palmoplantaris.

    Science.gov (United States)

    Jurik, A G

    1990-01-01

    With the aim of determining the frequency and radiographic features of anterior chest wall involvement in patients with pustulosis palmoplantaris, a questionnaire was sent to 107 patients. Ninety-three patients returned the questionnaire, five of whom were excluded from further analysis due to the appearance of psoriatic lesions. Twenty-five (28%) of the remaining 88 patients reported pain and/or swelling of joints or bones in the anterior chest wall. All were examined radiographically, using tomography, and a group of 20 patients without anterior chest wall complaints were examined similarly. Sixteen of the patients with, but none of the patients without, complaints were found to have arthro-osteitis of the anterior chest wall, consisting of diffuse sclerosis of the manubrium sterni in one patient, localized sclerosis in seven patients, and sequelae of arthritis of the sternoclavicular, upper sternocostal and/or manubriosternal joint in eight patients.

  7. [Design of low-intermediate frequency electrotherapy and pain assessment system].

    Science.gov (United States)

    Liang, Chunyan; Tian, Xuelong; Yu, Xuehong; Luo, Hongyan

    2014-06-01

    Aiming at the single treatment and the design separation between treatment and assessment in electrotherapy equipment, a kind of system including low-intermediate frequency treatment and efficacy evaluation was developed. With C8051F020 single-chip microcomputer as the core and the circuit design and software programming used, the system realized the random switch of therapeutic parameters, the collection, display and data storage of pressure pain threshold in the assessment. Experiment results showed that the stimulus waveform, current intensity, frequency, duty ratio of the system output were adjustable, accurate and reliable. The obtained pressure pain threshold had a higher accuracy (< 0.3 N) and better stability, guiding the parameter choice in the precise electrical stimulation. It, therefore, provides a reliable technical support for the treatment and curative effect assessment.

  8. The neonatal chest

    Energy Technology Data Exchange (ETDEWEB)

    Lobo, Luisa [Servico de Imagiologia Geral do Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisbon (Portugal)]. E-mail: mluisalobo@gmail.com

    2006-11-15

    Lung diseases represent one of the most life threatening conditions in the newborn. Important progresses in modern perinatal care has resulted in a significantly improved survival and decreased morbidity, in both term and preterm infants. Most of these improvements are directly related to the better management of neonatal lung conditions, and infants of very low gestational ages are now surviving. This article reviews the common spectrum of diseases of the neonatal lung, including medical and surgical conditions, with emphasis to the radiological contribution in the evaluation and management of these infants. Imaging evaluation of the neonatal chest, including the assessment of catheters, lines and tubes are presented.

  9. Yoga for veterans with chronic low back pain: Design and methods of a randomized clinical trial.

    Science.gov (United States)

    Groessl, Erik J; Schmalzl, Laura; Maiya, Meghan; Liu, Lin; Goodman, Debora; Chang, Douglas G; Wetherell, Julie L; Bormann, Jill E; Atkinson, J Hamp; Baxi, Sunita

    2016-05-01

    Chronic low back pain (CLBP) afflicts millions of people worldwide, with particularly high prevalence in military veterans. Many treatment options exist for CLBP, but most have limited effectiveness and some have significant side effects. In general populations with CLBP, yoga has been shown to improve health outcomes with few side effects. However, yoga has not been adequately studied in military veteran populations. In the current paper we will describe the design and methods of a randomized clinical trial aimed at examining whether yoga can effectively reduce disability and pain in US military veterans with CLBP. A total of 144 US military veterans with CLBP will be randomized to either yoga or a delayed treatment comparison group. The yoga intervention will consist of 2× weekly yoga classes for 12weeks, complemented by regular home practice guided by a manual. The delayed treatment group will receive the same intervention after six months. The primary outcome is the change in back pain-related disability measured with the Roland-Morris Disability Questionnaire at baseline and 12-weeks. Secondary outcomes include pain intensity, pain interference, depression, anxiety, fatigue/energy, quality of life, self-efficacy, sleep quality, and medication usage. Additional process and/or mediational factors will be measured to examine dose response and effect mechanisms. Assessments will be conducted at baseline, 6-weeks, 12-weeks, and 6-months. All randomized participants will be included in intention-to-treat analyses. Study results will provide much needed evidence on the feasibility and effectiveness of yoga as a therapeutic modality for the treatment of CLBP in US military veterans.

  10. Plasmacytoma presenting as missing rib on chest film: a case report and review of the literature.

    Science.gov (United States)

    Caffery, Terrell; Foy, Matthew

    2014-01-01

    A 33-year-old man presented to the emergency department (ED) with chief complaint of chest pain, persisting for approximately one year. Chest X-ray revealed he was missing the right posterior fifth rib. Physical examination showed no surgical scars, and he reported no history of chest trauma. A CT of his chest demonstrated a mass involving the posterior aspect of the right fifth rib, and subsequent biopsy revealed plasma cells. Laboratory results indicated the tumor was a solitary plasmacytoma of the rib. He was referred to oncology and treated with radiation therapy. This case report illustrates an unusual presentation of a solitary plasmacytoma of the rib.

  11. Electronic versus traditional chest tube drainage following lobectomy

    DEFF Research Database (Denmark)

    Lijkendijk, Marike; Licht, Peter B; Neckelmann, Kirsten

    2015-01-01

    OBJECTIVES: Electronic drainage systems have shown superiority compared with traditional (water seal) drainage systems following lung resections, but the number of studies is limited. As part of a medico-technical evaluation, before change of practice to electronic drainage systems for routine...... thoracic surgery, we conducted a randomized controlled trial (RCT) investigating chest tube duration and length of hospitalization. METHODS: Patients undergoing lobectomy were included in a prospective open label RCT. A strict algorithm was designed for early chest tube removal, and this decision...... time for chest tube removal, as well as length of hospitalization. RESULTS: A total of 105 patients were randomized. We found no significant difference between the electronic group and traditional group in optimal chest tube duration (HR = 0.83; 95% CI: 0.55-1.25; P = 0.367), actual chest tube duration...

  12. Compreendendo o significado da dor torácica isquêmica de pacientes admitidos na sala de emergência Comprendiendo el significado del dolor torácico por isquemia de pacientes admitidos en la sala de emergencia Understanding the meanings of ischemic chest pain of patients admitted in the emergency room

    Directory of Open Access Journals (Sweden)

    Rachel Damaceno de Araújo

    2007-12-01

    equipo de enfermería para amenizar estos sentimientos.Nursing professionals who work in emergency units are constantly facing patients with ischemic chest pain. This study aimed at understanding the meanings of patients with ischemic chest pain when they are in the emergency room. It is a study with qualitative approach that was carried with ten patients admitted in an emergency room in a private hospital in the south zone of São Paulo city. Data were collected through semi-structured interviews and analyzed according to content analysis approach. Resulting thematic axes were: meaning of chest pain and feelings when facing the symptoms. As results it was possible to observe the fear of death, family concerns were more significant. It was concluded that patients with ischemic chest pain need special support from the nursing team in order to decrease or diminish those feelings.

  13. A comparative study for Triple-Rule-out with different tube voltage technique of Dual-Source CT in acute chest pain%双源 CT不同管电压技术诊断急性胸痛三联症效果比较

    Institute of Scientific and Technical Information of China (English)

    王皆欢; 陈东风; 王少春; 孙占国; 王林省; 张谷青

    2014-01-01

    目的:对比双源CT胸痛三联检查在两种不同电压下显示急性胸痛患者肺动脉、主动脉及冠状动脉的图像质量以及患者所受的辐射剂量,以评估低电压扫描在急性胸痛患者推广应用的可行性。方法利用双源C T胸痛三联扫描模式,结合回顾性心电门控技术对361例胸痛三联检查患者进行统计分析,比较主动脉、肺动脉及冠状动脉的图像质量及辐射的有效剂量。结果120kV组与100kV组在图像质量的主观评分对比中差异无统计学意义(P>0.05),在患者辐射剂量的对比中,120kV组的辐射剂量大于100kV组,差异有统计学意义(P<0.05)。结论双源CT胸痛三联检查两种不同管电压扫描对急性胸痛患者的肺动脉、主动脉及冠状动脉的成像质量无影响,并且应用100kV 管电压扫描可以降低患者所受的辐射剂量,可以作为急性胸痛患者的首选。%Objective To compare the value of triple-rule-out (TRO) dual-source computed tomography angiog-raphy in acute chest pain patients with diseases of pulmonary artery ,aortic and coronary artery and radiation dose in two different voltage as well as the feasibility of generalizing and applying in patients with acute chest pain . Methods 361 patients with chest pain were analyzed statistically underwent triple-rule-out (TRO) dual-source CT combined with retrospective ECG-gated technique ,and then compare with image quality of aorta ,pulmonary artery and coronary artery and effective radiation dose .Results Subjective score of image quality of the voltage 120kV and 100kV group had no statistical significance(P>0.05) .The difference was statistically significant(P<0.05)in comparison of radiation dose .The effective radiation dose of the voltage 100kV group was lower than that of the voltage 120kV group .Conclusion The quality of pictures of pulmonary artery ,coronary artery and aorta are not affected in different tube tension

  14. The value explore of endoscopic esophagus negative esophageal source chest pain by high resolution pressure diagnostic%食管高分辨率测压诊断内镜阴性食管源性胸痛的价值探讨

    Institute of Scientific and Technical Information of China (English)

    张春敭; 杨洋; 刘东雷; 吴恺; 吴彬; 卢家奇; 潘丽红; 赵松

    2015-01-01

    目的 探讨食管高分辨率测压、24 h食管pH值监测诊断内镜阴性食管源性胸痛的价值.方法 选择2012年10月至2013年10月231例非心源性胸痛患者,监测其食管测压及24h食管pH值.结果 食管测压及监测结果显示,无异常者131例(56.7%),异常者100例(43.3%).异常者中男51例,女49例,年龄20~ 70岁,平均年龄(55.1±10.9)岁.异常者中20例胡桃夹食管(20%),6例弥漫性食管痉挛(6%),5例贲门失弛缓症(5%),30例非特异性食管运动功能障碍(30%),32例胃食管反流病(32%),7例酸敏感食管(7%).结论 24 h食管pH监测对发现诊断食管源性胸痛作用显著,内镜阴性食管源性胸痛以胃食管反流病引起的最多.%Objective To study the value explore of endoscopic esophagus negative esophageal source chest pain by high resolution pressure and 24 h esophageal pH monitoring diagnostic.Methods 231 cases with non cardiac chest pain were chosen between October 2012 to October 2013,and monitored the esophageal pressure and 24 h esophageal pH value.Results The results showed that there was no abnormality in 131 cases(56.7%),and abnormalities were found in 100 cases(43.3%),51 cases of male and 49 cases of female,average age was(55.1 ± 10.9) years.Nutcracker esophagus were 20 cases(20%),6 cases of diffuse esophageal spasm(6%),5 cases were cardiac relaxation loss(5%),30 cases were nonspecific esophageal motor dysfunction(30%),32 cases were gastroesophageal reflux disease(32%),7 cases were diagnosed as sensitive esophageal acid(7%).Conclusion 24 h esophageal pH monitoring has significantly effect on the diagnosis of esophageal source of chest pain,and negative esophageal source chest pain caused by gastroesophageal reflux disease is the most.

  15. Effect of needle design on pain from dental local anesthetic injections.

    Science.gov (United States)

    McPherson, Joanna Saenz; Dixon, Sara A; Townsend, Richard; Vandewalle, Kraig S

    2015-01-01

    The purpose of this randomized, double-blind clinical study was to evaluate the effectiveness of a larger-bore compared with a standard-bore dental local anesthetic needle of the same gauge in reducing pain during inferior alveolar (IA) and long buccal (LB) nerve block injections. Twenty active duty military or Department of Defense beneficiaries undergoing dental treatment were anesthetized using a split-mouth design with 4 anesthetic dental injections. Both sides of the mouth received IA nerve block and LB nerve injections, one using the 27-gauge large-bore Septoject XL needle and other using a 27-gauge standard-bore Septoject needle. Patients rated the pain experienced with each method using a visual analogue scale (VAS). The IA injection mean VAS score and standard deviation were 38.9 ± 22.7 mm and 37.1 ± 22.4 mm, respectively, for the larger and standard-bore needles. The LB injection mean VAS score and standard deviation were 33.5 ± 22.8 mm and 35.1 ± 19.6 mm, respectively, for the larger and standard-bore needles. The data were analyzed with a paired t test (α = .05). No significant difference was found between the IA (P = .70) or LB injections (P = .73). The use of a larger-bore 27-gauge needle did not reduce pain on injection compared with the standard-bore 27-gauge needle.

  16. Etiology and prognosis of pregnancy-related pelvic girdle pain; design of a longitudinal study

    Directory of Open Access Journals (Sweden)

    Kroese Mariëlle EAL

    2005-01-01

    Full Text Available Abstract Background Absence of knowledge of pregnancy-related pelvic girdle pain (PPGP has prompted the start of a large cohort study in the Netherlands. The objective of this study was to investigate the prevalence and incidence of PPGP, to identify risk factors involved in the onset and to determine the prognosis of pregnancy-related pelvic girdle pain. Methods/design 7,526 pregnant women of the southeast of the Netherlands participated in a prospective cohort study. During a 2-year period, they were recruited by midwives and gynecologists at 14 weeks of pregnancy. Participants completed a questionnaire at baseline, at 30 weeks of pregnancy, at 2 weeks after delivery, at 6 months after delivery and at 1 year after delivery. The study uses extensive questionnaires with questions ranging from physical complaints, limitations in activities, restriction in participation, work situation, demographics, lifestyle, pregnancy-related factors and psychosocial factors. Discussion This large-scale prospective cohort study will provide reliable insights in incidence, prevalence and factors related to etiology and prognosis of pregnancy-related pelvic girdle pain.

  17. Android-based design and implementation of intelligent medical chest system for combat readiness%基于Android平台的智能战备药箱系统设计与实现

    Institute of Scientific and Technical Information of China (English)

    唐维维; 王虹

    2015-01-01

    Objective To design and implement an Android -based medical chest system to realize informatized management of military medicine and equipment.Methods RFID tag was attached to the materials in the chest, and reading module with multiple antenna, Bluetooth module and responder were installed on the chest, Android-based PDA was developed to realize information communication.Results Trials proved that the system could perform auto classified management and precision locating of the materials in the chest, and could provide direction for medicine taking.Conclusion The system enhances the efficiency of the staff and ensures the accuracy and safety of medicine taking, and thus can be popularized in military hospitals.%目的:设计一种智能化战备药箱管理系统,对战备医疗救援所需的药品物资进行快捷、安全、准确的智能化管理,以提高军队医疗战备物资的信息化管理水平.方法:在战备物资中嵌入储存有相应信息的射频识别(radio freque-ncy identification,RFID)技术标签,并在药箱上安装多天线巡读模块、蓝牙模块以及药箱应答器,最终完成与基于Android系统的手持个人数字助手(personal digital assistant,PDA)设备进行信息数据交互.结果:经测试,该系统可对药箱内的所有药品物资进行实时自动分类统计管理,并可精确定位药品位置,且能提供相应药品的使用说用,实现了药品物资的智能管理.结论:该系统在战备环境中大大提高了医护人员的工作效率,并保证了用药准确性及安全性,适合在军队医院中推广应用,具有较大的可行性及发展空间.

  18. Application of flash dual-source computed tomography angiography in free heart rate triple-rule-out chest pain examination%炫速双源CT在自由心率胸痛三联成像中的应用价值

    Institute of Scientific and Technical Information of China (English)

    陈洪亮; 邱丽华; 刁显明; 张君海; 袁梦华; 敖永胜; 陈丽

    2016-01-01

    目的 探讨炫速双源CT在自由心率胸痛三联成像中的图像质量和临床价值.方法 2014年5月至2015年4月胸痛患者行炫速双源CT扫描整个胸部,同时行冠状动脉数字减影血管造影(DSA)检查,共104例.采用多种重组方式显示冠状动脉、肺动脉、主动脉,评价成像质量和能否满足临床诊断需要,并对冠状动脉狭窄情况与DSA进行对比.结果 扫描时间为(7.3±1.9)s.升主动脉CT值为(440.5±84.3)Hu;肺动脉平均CT值为(344.5±88.8)Hu,主动脉和肺动脉图像质量全部为优.全组1352段冠状动脉质量基本能满足诊断,其中优89.5%,良10.3%,差0.2%.共15段管腔重度狭窄(其中3段闭塞),27段管腔中度狭窄,43段管腔轻度狭窄,与DSA比较差异无统计学意义(P>0.05).结论 炫速双源CT扫描速度快,时间分辨率高,自由心率胸主动脉、肺动脉和冠状动脉成像图像质量好,对胸痛三联症的及时准确诊断具有较大的临床意义.%Objective To evaluate the imaging quality and clinical value of the flash dual-source CT in the free heart rate triple-rule-out chest pain examination. Methods From May 2015 to April 2015, a total of 104 patients with chest pain underwent both flash dual-source CT to scan the entire chest and digital subtraction angiography (DSA) to ex-amine coronary artery. Various combination methods were utilized to image aorta, pulmonary artery and coronary ar-tery for evaluating whether the flash dual-source CT imaging quality to meet the needs of clinical diagnosis. The flash dual-source CT image of coronary stenosis also was compared with DSA. Results With scanning time of (7.3 ± 1.9) s, the ascending aorta CT value of (440.5±84.3) Hu, pulmonary average CT value of (344.5±88.8) Hu, the aorta and pul-monary artery image quality is both excellent. Full set of 1352 segments of coronary artery qualities can meet the needs of clinical diagnosis with excellent 89.5%, good 10.3%and only 0.2%poor. Compared with DSA

  19. Radiology illustrated. Chest radiology

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Soo [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of). Dept. of Radiology; Han, Joungho [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of). Dept. of Pathology; Chung, Man Pyo [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of). Dept. of Medicine; Jeong, Yeon Joo [Pusan National Univ. Hospital, Busan (Korea, Republic of). Dept. of Radiology

    2014-04-01

    Pattern approach to the diagnosis of lung diseases based on CT scan appearances. Guide to quick and reliable differential diagnosis. CT-pathology correlation. Emphasis on state-of-the-art MDCT. The purpose of this atlas is to illustrate how to achieve reliable diagnoses when confronted by the different abnormalities, or ''disease patterns'', that may be visualized on CT scans of the chest. The task of pattern recognition has been greatly facilitated by the advent of multidetector CT (MDCT), and the focus of the book is very much on the role of state-of-the-art MDCT. A wide range of disease patterns and distributions are covered, with emphasis on the typical imaging characteristics of the various focal and diffuse lung diseases. In addition, clinical information relevant to differential diagnosis is provided and the underlying gross and microscopic pathology is depicted, permitting CT-pathology correlation. The entire information relevant to each disease pattern is also tabulated for ease of reference. This book will be an invaluable handy tool that will enable the reader to quickly and easily reach a diagnosis appropriate to the pattern of lung abnormality identified on CT scans.

  20. Chest radiographic findings of leptospirosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mee Hyun; Jung, Hee Tae; Lee, Young Joong; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of)

    1986-04-15

    1. A study on chest radiographic findings of 54 cases with pneumonia like symptoms was performed. Of 54 cases, 8 cases were confirmed to be leptospirosis and 7 cases were leptospirosis combined with Korean hemorrhagic fever. 2. Of 8 cases of leptospirosis, 4 cases showed abnormal chest radiographic findings: acinar nodular type 2, massive confluent consolidation type 2. Of 7 cases of leptospirosis combined with Korean hemorrhagic fever: acinar nodular type 3, massive confluent consolidation type 1, and increased interstitial markings type 1 respectively. 3. It was considered to be difficult to diagnose the leptospirosis on chest radiographic findings alone, especially the case combined with Korean hemorrhagic fever.

  1. Interpretation of neonatal chest radiography

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hye Kyung [Dept. of Radiology, Kangwon National University Hospital, Chuncheon (Korea, Republic of)

    2016-05-15

    Plain radiographs for infants in the neonatal intensive care unit are obtained using the portable X-ray equipment in order to evaluate the neonatal lungs and also to check the position of the tubes and catheters used for monitoring critically-ill neonates. Neonatal respiratory distress is caused by a variety of medical or surgical disease conditions. Clinical information about the gestational week, respiratory symptoms, and any events during delivery is essential for interpretation of the neonatal chest radiographs. Awareness of common chest abnormality in the prematurely born or term babies is also very important for chest evaluation in the newborn. Furthermore, knowledge about complications such as air leaks and bronchopulmonary dysplasia following treatment are required to accurately inform the clinicians. The purpose of this article was to briefly review radiographic findings of chest diseases in newborns that are relatively common in daily practice.

  2. CHEST WALL HAMARTOMA : Case Report

    OpenAIRE

    Gülden DİNİZ; Ortaç, Ragıp; Aktaş, Safiye; TEMİR, Günyüz; HOŞGÖR, Münevver; Karaca, İrfan

    2005-01-01

    A case of four-month – old girl diagnosed as chest wall hamartoma is presented. This entity is an extremely rare but characteristic lesion of the ribs usually presenting in the neonate or infant with a mass or respiratory symptoms. Complete sponraneous regression of the lesion has been reported. Recently conservative management of asymptomatic childiren was recommended. Although rare, this condition ought to be kept in mind while dealing with infantile chest wall masses to avoid an errone...

  3. CHEST WALL HAMARTOMA : Case Report

    OpenAIRE

    Gülden DİNİZ; Ortaç, Ragıp; Aktaş, Safiye; HOŞGÖR, Günyüz TEMİR2Münevver; Karaca, İrfan

    2005-01-01

    A case of four-month – old girl diagnosed as chest wall hamartoma is presented. This entity is an extremely rare but characteristic lesion of the ribs usually presenting in the neonate or infant with a mass or respiratory symptoms. Complete sponraneous regression of the lesion has been reported. Recently conservative management of asymptomatic childiren was recommended. Although rare, this condition ought to be kept in mind while dealing with infantile chest wall masses to avoid...

  4. Thrombophlebitis of the lateral chest wall (Mondor′s disease

    Directory of Open Access Journals (Sweden)

    D Crisan

    2014-01-01

    Full Text Available Mondor′s disease is a rare condition, which involves the thrombophlebitis of the superficial veins of the breast and anterior chest wall. A 37-year-old woman presented with sudden onset of local pain and edema on her right chest wall, accompanied by a longitudinal retraction of the skin during arm abduction in the area. Clinical, histological and ultrasonographic findings confirmed Mondor′s disease and the treatment was symptomatic, using pain relievers and warm compresses. The symptomatology remitted within 2 weeks of therapy. Mondor′s disease is a rare condition where ultrasound complements the clinical evaluation and allows the characterization of certain abnormalities, which correlated with functional biochemical data and other procedures may substitute the need of biopsy.

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

    Institute of Scientific and Technical Information of China (English)

    王旭; 聂绍平; 曾哲淳

    2015-01-01

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

  6. A risk assessment on primary level in hs-cTnT level no more than 14 ng/L in the onset of acute myocar-dial infarction in patients with chest pain%胸痛患者初次hs-cTnT水平≤14 ng/L发生急性心肌梗死的危险性评价

    Institute of Scientific and Technical Information of China (English)

    郭英; 黄华兰; 朱帅; 李贵星

    2016-01-01

    目的:研究胸痛患者初次hs-cTnT水平≤14 ng/L时发生急性心肌梗死(AMI)的危险性。方法:纳入2012年1月至2013年12月因胸痛就诊于四川大学华西医院急诊科患者3096例,根据初次hs-cTnT水平、心电图将患者分为hs-cTnT≤14 ng/L且心电图提示无缺血表现组和hs-cTnT >14 ng/L组,计算30 d内两组发生心肌梗死和死亡的危险度及阴性预测值。结果:30 d 内hs-cTnT≤14 ng/L 组发生AMI 37例,绝对危险度为2.35(1.86~2.74),30 d 内有4例患者死亡,绝对危险度为0.29(0.12~0.53);初次 hs-cTnT水平≤14 ng/L 且心电图提示无缺血表现组发生 AMI 9例,绝对危险度为0.58(0.42~0.74),30 d 内无患者死亡。结论:胸痛患者初次hs-cTnT水平≤14 ng/L 且心电图提示无缺血表现可基本排除AMI,阴性预测值为99.6%,准确性高,动态监测5 h hs-cTnT≤14 ng/L直接排除AMI。%Objective To investigate the association of chest pain patients with primary level in high-sensitivity troponin T (hs-cTnT) level no more than 14 ng/L in the onset of acute myocardial infarction in pa-tients with chest pain. Methods We enrolled 3 096 participants from January 2012 to December 2013 in West China Hospital, Sichuan University. All patients were classified two groups (hs-cTnT > 14 ng/L, hs-cTnT ≤14 ng/L and no ischemia on ECG) according to hs-cTnT levels and ECG. We evaluated the risk of myocardial in-farction and death and negative predictive value in 30 days. Results Thirty-seven patients were diagnosed in having acute myocardial infarction (AMI) and 4 patients were dead in the hs-cTnT > 14 ng/L group in 30 days in the absolute risk 2.35(1.86-2.74) and 0.29(0.12-0.53); 9 patients were diagnosed as having AMI and no patients were dead in the hs-cTnT ≤ 14 ng/L group in 30 days in the absolute risk 0.58 (0.42-0.74). Conclu-sion Chest pain patients whose primary levels no more than 14

  7. Method and Comparison of the Application of Access and Epi Data Software in Constructing the Chest Stuffiness and Pains Clinical Research Database%应用Access,EpiData软件建设胸痹心痛临床研究数据库的方法及其比较

    Institute of Scientific and Technical Information of China (English)

    吴东宁; 何丽云; 王鑫; 艾艳柯; 天才; 吕晓颖

    2016-01-01

    Objective To introduce the method of the application of Access and Epi Data software in constructing the chest stuffiness and pains clinical research database and compare them for studying the feasibility and practicability. Methods The steps and processes of constructing database by applying Access and Epi Data software were retrospectively introduced and compared taking the chest stuffiness and pains clinical research case report form as example. Results The common characteristics are small space occupation, friendly interface, intuitive, easy to learn, convenient operation, good service in data management; The main differences are the costs, storage space, auto save, network function, management authority and export formats etc. Conclusion The method of the application of Access and Epi Data software in constructing the chest stuffiness and pains clinical research database is easy and practical, which is suitable for clinical research of general tradi-tional Chinese medicine at present in China and research and use carried out by the clinical units taking the department or doctor as main body, and it is of major significance to the popularity, standardization and progress of data management.%目的:介绍应用Access,Epi Data软件建设胸痹心痛临床研究数据库的方法并进行比较,以探讨其可行性、实用性。方法以胸痹心痛临床研究的病例报告表(CRF)为例,分别介绍应用Access,Epi Data软件建设数据库的步骤和流程,并进行比较。结果应用Access,Epi Data软件建设胸痹心痛临床研究数据库的共同特点为院占用空间较小,界面友好,直观性强,简单易学,操作方便,可以较好的服务于数据管理;区别主要在于费用、存储空间、自动保存、网络功能、管理权限和导出格式等方面。结论应用Access,Epi Data软件建设胸痹心痛临床研究数据库的方法简单、实用,对于我国现阶段一般的中医药临床

  8. B-type natriuretic peptide is a long-term predictor of all-cause mortality, whereas high-sensitive C-reactive protein predicts recurrent short-term troponin T positive cardiac events in chest pain patients: a prognostic study

    Directory of Open Access Journals (Sweden)

    Staines Harry

    2008-11-01

    Full Text Available Abstract Background Few studies have addressed whether the combined use of B-type natriuretic peptide (BNP and high-sensitive C-reactive protein (hsCRP improves risk stratification for mortality and cardiovascular events in a population with chest pain and suspected acute coronary syndromes (ACS. Therefore, we wanted to assess the incremental prognostic value of these biomarkers with respect to long-term all-cause mortality and recurrent troponin T (TnT positive cardiac events in 871 patients admitted to the emergency department. Methods Blood samples were obtained immediately following admission. Results After a follow-up period of 24 months, 129 patients had died. The BNP levels were significantly higher among patients dying than in long-term survivors (401 (145–736 versus 75 (29–235 pq/mL [median, 25 and 75% percentiles], p = 0.000. In a multivariable Cox regression model for death within 2 years, the hazard ratio (HR for BNP in the highest quartile (Q4 was 5.13 (95% confidence interval (CI, 1.97–13.38 compared to the lowest quartile (Q1 and was associated with all-cause mortality above and beyond age, congestive heart failure and the index diagnosis ST-segment elevation myocardial infarction. HsCRP rendered no prognostic information for all-cause mortality. However, within 30 days, the adjusted HR for patients with recurrent TnT cardiac positive events hsCRP in Q4 was 14.79 (95% CI, 1.89–115.63 compared with Q1 and was associated with recurrent ischemic events above and beyond age, hypercholesterolemia and TnT values at admission. Conclusion BNP may act as a clinically useful biomarker when obtained at admission in an unselected patient population following hospitalization with chest pain and potential ACS, and may provide complementary prognostic information to established risk determinants at long-term follow-up. Our data do not support the hypothesis that the additional assessment of hsCRP will lead to better risk stratification

  9. Application value of MINI-VIDAS automated multiparametric analyzer for immunoanalysis of acute chest pain in military hospital%MINI-VIDAS型全自动荧光免疫分析仪在军队医院胸痛急诊中的应用

    Institute of Scientific and Technical Information of China (English)

    姜佳星; 邹子扬; 刘俊双

    2015-01-01

    目的:应用MINI-VIDAS型全自动荧光免疫分析仪对胸痛急诊官兵进行辅助诊断,评价其临床应用价值.方法:将主诉为胸痛症状的急诊就医官兵随机分为A、B 2组,每组764人,A组应用常规辅助检查方法,B组在常规辅助检查基础上应用MINI-VIDAS型全自动荧光免疫分析仪做心脏标志物的即时检测,比较2组在来院-确诊时间、诊断符合率、住院率、住院时间、痊愈好转率等方面的区别,并进行统计学处理.结果:2组在来院-确诊时间、诊断符合率方面比较具有统计学差异(P0.05).结论:应用MINI-VIDAS型全自动荧光免疫分析仪进行心脏标志物的即时检测,可明显提高对胸痛急诊官兵的诊疗水平,可在军队医院医疗保障工作中推广应用.%Objective To apply MINI-VIDAS automated multiparametric analyzer to auxiliary diagnosis of the serviceman in order to evaluate its clinical value.Methods Totally 1 528 servicemen complaining of acute chest pain were divided into group A and group B equally; the ones in group A went through conventional examination, and the ones in group B underwent conventional examination combined with instant examination with MINI-VIDAS automated multiparametric analyzer. The differences between the two groups were compared for the interval from hospitalization to definite diagnosis, diagnosis correctness, hospitalization rate, length of stay, recovery rate, improvement rate and etc, and then statistical analysis was carried out.Results The two groups had significant differences in the interval from hospitalization to definite diagnosis and diagnosis correctness (P0.05).Conclusion MINI-VIDAS automated multiparametric analyzer can be used for the instant examination of cardiac marker to improve the diagnosis of the acute chest pain, and thus can be popularized in military hospital.

  10. Sternoclavicular joint septic arthritis with chest wall abscess in a healthy adult: a case report

    OpenAIRE

    Tanaka, Yoshihito; Kato, Hisaaki; SHIRAI, Kunihiro; NAKAJIMA, Yasuhiro; YAMADA, Noriaki; Okada, Hideshi; Yoshida, Takahiro; Toyoda, Izumi; Ogura, Shinji

    2016-01-01

    Background Septic arthritis of the sternoclavicular joint is rare. It can be associated with serious complications such as osteomyelitis, chest wall abscess, and mediastinitis. In this report, we describe a case of an otherwise healthy adult with septic arthritis of the sternoclavicular joint with chest wall abscess. Case presentation A 68-year-old Japanese man presented to our hospital complaining of pain and erythema near the right sternoclavicular joint. Despite 1 week of oral antibiotics,...

  11. Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Herbert Rob D

    2007-02-01

    Full Text Available Abstract Background Manipulation is a common treatment for non-specific neck pain. Neck manipulation, unlike gentler forms of manual therapy such as mobilisation, is associated with a small risk of serious neurovascular injury and can result in stroke or death. It is thought however, that neck manipulation provides better results than mobilisation where clinically indicated. There is long standing and vigorous debate both within and between the professions that use neck manipulation as well as the wider scientific community as to whether neck manipulation potentially does more harm than good. The primary aim of this study is to determine whether neck manipulation provides more rapid resolution of an episode of neck pain than mobilisation. Methods/Design 182 participants with acute and sub-acute neck pain will be recruited from physiotherapy, chiropractic and osteopathy practices in Sydney, Australia. Participants will be randomly allocated to treatment with either manipulation or mobilisation. Randomisation will occur after the treating practitioner decides that manipulation is an appropriate treatment for the individual participant. Both groups will receive at least 4 treatments over 2 weeks. The primary outcome is number of days taken to recover from the episode of neck pain. Cox regression will be used to compare survival curves for time to recovery for the manipulation and mobilisation treatment groups. Discussion This paper presents the rationale and design of a randomised controlled trial to compare the effectiveness of neck manipulation and neck mobilisation for acute and subacute neck pain.

  12. MRI of the Chest

    Medline Plus

    Full Text Available ... provides movie-like sequential imaging of the cardiovascular system that is important to assess the health and ... the magnet. Some MRI units, called short-bore systems , are designed so that the magnet does not ...

  13. Delay generating factors when requesting medical or nursing treatment by women who have chest pains due to a coronary origin Factores que intervienen en la demora de la solicitud de atención médica o de enfermería en mujeres que presentan dolor torácico de origen coronario

    Directory of Open Access Journals (Sweden)

    SOTO MORALES ALEJANDRA MARÍA

    2007-12-01

    Full Text Available Coronary illness constitutes one of the main causes of death among women over 45 years of age. The context in whichsuchillnessarisesamong womenisdeterminedby different factors that constitute a process that generates delays in requesting medical attention and the onset of timely treatment. This descriptive study with a qualitative approach had as objective to identify factors that resulted in delaying request for medical attention among twelve women who had chest pains or symptoms of cardiac ischemic origin, who registered at the Federico Lleras Acosta Hospital and at the clinics Minerva y Medicádiz of the city of Ibagué during the months of August thru November of 2005. The information was gathered via semi structured interviews based on the topic guidelines of the symptom management process; such was then analyzed under the content analysis technique. Delay generating factors when requesting medical treatment by women who have ischemic coronary chest pains in terms of the phases to manage the symptoms are: valuation of the symptom: characteristics of the type of pain, experience with such pain, unprotected by loved ones, a sense of worry for others, disability, fears, underestimating the symptom, attributing the cause; measuring the response capacity: facing the symptom according to beliefs, and selecting the type of assistance: dependent on others and prior experiences with health providers. The factors found are sequential and interrelated. The study identified that factors such as being dependent on others, loved ones not caring and the feeling of not wanting to worry others were definitive in the delay process.La enfermedad coronaria constituye una de las principales causas de muerte en las mujeres mayores de 45 años. El contexto en el que se desarrolla esta enfermedad en la mujer está determinado por diferentes factores que conforman un proceso que genera demora en la solicitud de atención y en la instauración de

  14. Factores que intervienen en la demora de la solicitud de atención médica o de enfermería en mujeres que presentan dolor torácico de origen coronario Delay generating factors when requesting medical or nursing treatment by women who have chest pains due to a coronary origin

    Directory of Open Access Journals (Sweden)

    ALEJANDRA MARÍA SOTO MORALES

    2007-12-01

    whichsuchillnessarisesamong womenisdeterminedby different factors that constitute a process that generates delays in requesting medical attention and the onset of timely treatment. This descriptive study with a qualitative approach had as objective to identify factors that resulted in delaying request for medical attention among twelve women who had chest pains or symptoms of cardiac ischemic origin, who registered at the Federico Lleras Acosta Hospital and at the clinics Minerva y Medicádiz of the city of Ibagué during the months of August thru November of 2005. The information was gathered via semi structured interviews based on the topic guidelines of the symptom management process; such was then analyzed under the content analysis technique. Delay generating factors when requesting medical treatment by women who have ischemic coronary chest pains in terms of the phases to manage the symptoms are: valuation of the symptom: characteristics of the type of pain, experience with such pain, unprotected by loved ones, a sense of worry for others, disability, fears, underestimating the symptom, attributing the cause; measuring the response capacity: facing the symptom according to beliefs, and selecting the type of assistance: dependent on others and prior experiences with health providers. The factors found are sequential and interrelated. The study identified that factors such as being dependent on others, loved ones not caring and the feeling of not wanting to worry others were definitive in the delay process.

  15. Contemporary management of flail chest.

    Science.gov (United States)

    Vana, P Geoff; Neubauer, Daniel C; Luchette, Fred A

    2014-06-01

    Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

  16. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

    Institute of Scientific and Technical Information of China (English)

    Mojtaba Chardoli; Toktam Hasan-Ghaliaee; Hesam Akbari; Vafa Rahimi-Movaghar

    2013-01-01

    Objective:Thoracic injuries are responsible for 25% of deaths of blunt traumas.Chest X-ray (CXR) is the first diagnostic method in patients with blunt trauma.The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT) in hemodynamically stable patients with blunt chest trauma.Methods:Study was conducted at the emergency department of S ina Hospital from March 2011 to March 2012.Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included.All patients underwent the same diagnostic protocol which consisted of physical examination,CXR and CT scan respectively.Results:Two hundreds patients (84% male and 16% female) were included with a mean age of(37.9±13.7) years.Rib fracture was the most common finding of CXR (12.5%) and CT scan (25.5%).The sensitivity of CXR for hemothorax,thoracolumbar vertebra fractures and rib fractures were 20%,49% and 49%,respectively.Pneumothorax,foreign body,emphysema,pulmonary contusion,liver hematoma and sternum fracture were not diagnosed with CXR alone.Conclusion:Applying CT scan as the first-line diagnostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome.

  17. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2013-12-01

    Full Text Available 【Abstract】 Objective: Thoracic injuries are respon- sible for 25% of deaths of blunt traumas. Chest X-ray (CXR is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT in hemodynami- cally stable patients with blunt chest trauma. Methods: Study was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively. Results: Two hundreds patients (84% male and 16% female were included with a mean age of (37.9±13.7 years. Chin J Traumatol 2013;16(6:351-354 Rib fracture was the most common finding of CXR (12.5% and CT scan (25.5%. The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and ster- num fracture were not diagnosed with CXR alone. Conclusion: Applying CT scan as the first-line diag- nostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome. Key words: Radiography; Thoracic injuries; Tomography, X-ray computed

  18. COMBINED EFFECT OF PNF STRETCHING WITH CHEST MOBILITY EXERCISES ON CHEST EXPANSION AND PULMONARY FUNCTIONS FOR ELDERLY

    Directory of Open Access Journals (Sweden)

    Vinod Babu .K

    2015-06-01

    Full Text Available Background: PNF stretching and chest mobility exercises found to be effective in elder patients, however the combined effectiveness of these techniques were unknown. The purpose of this study is to find the effect of Hold-relax PNF stretching technique for pectoralis muscle combined with chest mobility exercises on improvement of chest expansion and pulmonary function for elderly subjects. Method: An Experimental study design, 30 subjects with age group above 60 years were randomized 15 subjects each into Study and Control group. Control group received Supervised Active Assisted Exercise Program while Study group received Hold-relax PNF Stretching for pectoralis muscle, Chest Mobility Exercises Program and supervised Active Assisted Exercise Program for a period of one week. Outcome measures such as chest expansion at axilla and xiphisternum and pulmonary function test such as FEV1, FVC and FEV1/FVC were measured before and after one week of treatment. Results: Analysis using paired ‘t’ test within the group found that there is no statistically significant difference within control group where as there is a statistical significant difference within study group. Comparative analysis of pre-intervention means shown that there is no statistically significant difference between the groups. Comparative analysis of post-intervention means shown that there is a statistically significant difference in means of Chest expansion, FEV1/FVC and there is no statistical significant difference in FEV1 and FVC between study and control groups. Conclusion: It is concluded that one week of combined Hold-relax PNF stretching for pectoralis muscle with chest mobility exercises shown significant improvement in chest expansion and pulmonary function test such as forced expiratory volume and forced vital capacity than only active assisted exercise program for elderly subjects.

  19. The influences of instillation of bupivacaine through chest and axillary drains into the wound to the postoperative pain and immunity of modified radical mastectomy%引流管灌注布比卡因对乳腺癌改良根治术患者术后疼痛和免疫的影响

    Institute of Scientific and Technical Information of China (English)

    路喻清; 冯阳阳; 蔡惠

    2016-01-01

    目的:探究乳腺癌改良根治术术后通过引流管灌注布比卡因对患者术后疼痛和免疫的影响.方法:收集于2014年1月至2015年6月就诊并手术的乳腺癌患者,随机分为乳腺癌改良根治术术后通过引流管灌注组(实验组)和生理盐水灌注组(对照组),并采集患者术前术后血清,分别对两组患者进行术后疼痛评分和血清免疫因子IL-1β、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IFNγ、TNF-α的测定.结果:实验组的疼痛分数无论是在术后24小时后还是48小时后均明显小于对照组(P<0.05),差异具有统计学意义.9种免疫因子中,仅有IL-1β和IL-10的术前术后变化在实验组和对照组是有差异的,IL-1β在两组术后均趋近减少,但实验组幅度更大(P<0.05);IL-10术后在实验组增加,但在对照组减少,差异具有统计学意义(P<0.05).结论:通过引流管灌注布比卡因对乳腺癌改良根治术患者进行术后麻醉可以减轻患者的术后疼痛、调节患者免疫、促进抑癌免疫的产生.%Objective:Studing postoperative pain and immunityof modified radical mastectomyafter using instilla-tion of bupivacaine through chest and axillary drains into the wound. Methods:Primary breast cancer patients,were randomized to Bupivacaine(n=29)or control(n=27)groups. Postoperative pain and serum concentrations of 9cy-tokines(IL-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IFNγ,TNF-α)were measured. Results:There was a significant difference in 24h and 48h postoperative painbetween the groups(P<0. 05). Patients in the bupivacaine-group showed a greater percentage decrease in postoperative compared with preoperative IL-1β(P<0. 05),anda significant increase in IL-10compared with the control group(P<0. 05). Conclusion:Using instillation of bupiva-caine through chest and axillary drains into the wound after the modified radical mastectomy can reduce postoperative pain and regulate the immunity to inhibit tumor.

  20. Mechanisms of cardiac pain.

    Science.gov (United States)

    Foreman, Robert D; Garrett, Kennon M; Blair, Robert W

    2015-04-01

    Angina pectoris is cardiac pain that typically is manifested as referred pain to the chest and upper left arm. Atypical pain to describe localization of the perception, generally experienced more by women, is referred to the back, neck, and/or jaw. This article summarizes the neurophysiological and pharmacological mechanisms for referred cardiac pain. Spinal cardiac afferent fibers mediate typical anginal pain via pathways from the spinal cord to the thalamus and ultimately cerebral cortex. Spinal neurotransmission involves substance P, glutamate, and transient receptor potential vanilloid-1 (TRPV1) receptors; release of neurokinins such as nuclear factor kappa b (NF-kb) in the spinal cord can modulate neurotransmission. Vagal cardiac afferent fibers likely mediate atypical anginal pain and contribute to cardiac ischemia without accompanying pain via relays through the nucleus of the solitary tract and the C1-C2 spinal segments. The psychological state of an individual can modulate cardiac nociception via pathways involving the amygdala. Descending pathways originating from nucleus raphe magnus and the pons also can modulate cardiac nociception. Sensory input from other visceral organs can mimic cardiac pain due to convergence of this input with cardiac input onto spinothalamic tract neurons. Reduction of converging nociceptive input from the gallbladder and gastrointestinal tract can diminish cardiac pain. Much work remains to be performed to discern the interactions among complex neural pathways that ultimately produce or do not produce the sensations associated with cardiac pain.

  1. Experimental research and design of superheated steam vacuum drying chest based on sea cucumber%海参过热蒸汽真空干燥装置的设计与试验

    Institute of Scientific and Technical Information of China (English)

    赵火英; 袁陆峰

    2012-01-01

    结合过热蒸汽干燥和真空干燥方式的特点,完成海参过热蒸汽真空干燥箱的设计.以海参为被干燥物料,进行不同工况下海参过热蒸汽真空干燥特性的试验研究,主要分析物料质量和脱水率的变化规律以及不同蒸汽温度下干燥速率的变化规律.结果表明:在相同真空度下,过热蒸汽温度越高,干燥速率越快,而且过热蒸汽干燥初期的速率最快.%The superheated steam vacuum drying chest has been designed by combining the good qualities of the superheated steam drying and the vacuum drying. Some kind of sea cucumber has been dried by superheated steam under different kinds of drying conditions. The regularity of quality, dehydration rate and drying velocity changes has been mainly analyzed. The results indicate that the temperature of superheated steam is the primary influencing factor of the drying velocity under the same vacuum pressure, and the higher temperature is, the faster drying velocity can reach. The drying velocity is the fastest at the initial stage along the drying process.

  2. Future directions: advances and implications of virtual environments designed for pain management.

    Science.gov (United States)

    Wiederhold, Brenda K; Soomro, Ahmad; Riva, Giuseppe; Wiederhold, Mark D

    2014-06-01

    Pain symptoms have been addressed with a variety of therapeutic measures in the past, but as we look to the future, we begin encountering new options for patient care and individual health and well-being. Recent studies indicate that computer-generated graphic environments--virtual reality (VR)--can offer effective cognitive distractions for individuals suffering from pain arising from a variety of physical and psychological illnesses. Studies also indicate the effectiveness of VR for both chronic and acute pain conditions. Future possibilities for VR to address pain-related concerns include such diverse groups as military personnel, space exploration teams, the general labor force, and our ever increasing elderly population. VR also shows promise to help in such areas as drug abuse, at-home treatments, and athletic injuries.

  3. The design and methods of the aging successfully with pain study.

    Science.gov (United States)

    Morone, Natalia E; Greco, Carol M; Rollman, Bruce L; Moore, Charity G; Lane, Bridget; Morrow, Lisa; Glynn, Nancy W; Delaney, Jill; Albert, Steven M; Weiner, Debra K

    2012-03-01

    Chronic low back pain (CLBP) is widespread among older adults (≥ 65 years) and is often treated inadequately. With a rapidly growing aging population, CLBP will increase and so will the demand for treatment. We believe that mind-body therapies can help to meet this demand. We present the methodology of a randomized, controlled clinical trial of 300 individuals with CLBP aged 65 years or older. The specific aims are, 1) to determine the effectiveness of a mindfulness meditation program in increasing function and reducing pain among older adults with CLBP, and 2) to evaluate the impact of mindfulness meditation on neuropsychological performance in older adults with CLBP. The intervention program is modeled on the Mindfulness-Based Stress Reduction Program (MBSR) and the control is adapted from the 10 Keys to Healthy Aging. We will measure self-reported and objectively measured physical function and include a variety of measures to assess pain intensity and pain interference and psychological function. Our primary hypothesis is that the MBSR program will be more effective than the 10 Keys program in increasing function and decreasing pain. The proposed study represents the first large, well-controlled, comprehensive examination of the effects of a mind-body program on older adults with chronic pain.

  4. Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important?

    Directory of Open Access Journals (Sweden)

    Schneir, Aaron

    2001-07-01

    Full Text Available The purpose of this study was to describe the clinical findings in patients with splenic injury and to determine if isolated left lower chest injury may be the single clinical indicator of splenic injury. The medical records of all adult blunt trauma patients with splenic injury over a 14 month period were reviewed. Significant left lower chest injury was considered present if the patient had left sided pleuritic chest pain with tenderness to ribs 7-12 or if these ribs were visualized as fractured on any imaging study. Patients were considered to have clinical findings suggestive of splenic injury if they had pre-hospital or emergency department hypotension, abdominal pain or tenderness, a Glasgow coma scale < 15, or gross hematuria. Ninety patients had splenic injury. Thirty-nine (43%. 95% CI 33, 54% patients had significant left lower chest injury. In five (6%. 95% CI 2, 12% patients, injury to this portion of the chest was the single indicator of splenic injury. Nearly half the patients with splenic injury will have significant injury to the left lower chest and this finding may be the only indicator of splenic injury.

  5. Actinomycosis - Left Post Chest Wall

    Directory of Open Access Journals (Sweden)

    Kafil Akhtar, M. Naim, S. Shamshad Ahmad, Nazoora Khan, Uroos Abedi, A.H. Khan*

    2008-01-01

    Full Text Available A forty year old female of weak body built presented with recurring small hard lumps in let posteriorchest wall for 3 years and discharging ulcers for 3 months duration. Clinically, the provisional diagnosiswas malignancy with secondary infection. FNAC showed features suggestive of dysplasia buthistopathology confirmed the diagnosis as actinomycosis. The present case is reported due to rare incidenceof actinomycosis at post chest wall with muscle involvement.

  6. Chest wall, lung, and pleural space trauma.

    Science.gov (United States)

    Miller, Lisa A

    2006-03-01

    Chest radiographs frequently underestimate the severity and extent of chest trauma and, in some cases, fail to detect the presence of injury. CT is more sensitive than chest radiography in the detection of pulmonary, pleural, and osseous abnormalities in the patient who has chest trauma. With the advent of multidetector CT (MDCT), high-quality multiplanar reformations are obtained easily and add to the diagnostic capabilities of MDCT. This article reviews the radiographic and CT findings of chest wall, pleural, and pulmonary injuries that are seen in the patient who has experienced blunt thoracic trauma.

  7. Nordic Walking and chronic low back pain: design of a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Hartvigsen Jan

    2006-10-01

    Full Text Available Abstract Background Low Back Pain is a major public health problem all over the western world. Active approaches including exercise in the treatment of low back pain results in better outcomes for patients, but it is not known exactly which types of back exercises are most beneficial or whether general physical activity provide similar benefits. Nordic Walking is a popular and fast growing type of exercise in Northern Europe. Initial studies have demonstrated that persons performing Nordic Walking are able to exercise longer and harder compared to normal walking thereby increasing their cardiovascular metabolism. Until now no studies have been performed to investigate whether Nordic Walking has beneficial effects in relation to low back pain. The primary aim of this study is to investigate whether supervised Nordic Walking can reduce pain and improve function in a population of chronic low back pain patients when compared to unsupervised Nordic Walking and advice to stay active. In addition we investigate whether there is an increase in the cardiovascular metabolism in persons performing supervised Nordic Walking compared to persons who are advised to stay active. Finally, we investigate whether there is a difference in compliance between persons receiving supervised Nordic Walking and persons doing unsupervised Nordic Walking. Methods One hundred and fifty patients with low back pain for at least eight weeks and referred to a specialized secondary sector outpatient back pain clinic are included in the study. After completion of the standard back centre treatment patients are randomized into one of three groups: A Nordic Walking twice a week for eight weeks under supervision of a specially trained instructor; B Unsupervised Nordic Walking for eight weeks after one training session with an instructor; C A one hour motivational talk including advice to stay active. Outcome measures are pain, function, overall health, cardiovascular ability and

  8. D-二聚体和肌钙蛋白I比值在致命性胸痛病因诊断中的应用%Application of the ratio of D-dimer and Troponin I in etiological diagnosis of acute chest pain

    Institute of Scientific and Technical Information of China (English)

    夏武杰; 杨鹏麟

    2016-01-01

    Objective To investigate the value of plasma d- dimer, troponin I and their ratio in etiological diagnosis of acute chest pain. Methods The data of 786 patients (534 male, 252 female, aged from 28 to 93 years) admission for acute chest pain and diagnosed as either acute myocardial infarction (AMI), acute pulmonary embolism (APE) or acute aorta dissection (AAD) were analyzed retrospectively. AMI was divided into ST segment elevation and non- ST segment elevation myocardial infarciton (STEMI, NSTEMI). Serum d- dimer, troponin I and their ratio were analyzed. The receiver operating characteristic curve (ROC curve) was performed to determine the value of d- dimer, troponin I, the ratio of d- dimer to troponin I (Rd) and troponin I to d- dimer (Rc) in the differential diagnosis of STEMI, NSTEMI, APE and AAD. Results D- dimer was significantly higher in AAD(11.13μg/ml) and APE groups(3.92μg/ml)than STEMI(0.38μg/ml) and NSTEMI groups(0.34μg/ml)(al P<0.05). There was significant difference between ADD and APE groups(P<0.05) and no significant difference between STEMI and NSTEMI groups. Troponin I was significantly higher in STEMI group(5.000ng/ml) than in NSTEMI group (3.035 ng/ml)(P<0.05). Both of them were significantly higher than 0.030 ng/ml in APE and AAD groups (al P<0.05). From STEMI to NSTEMI to APE to AAD, Rc was decreasing and Rd was increasing. There was significant difference between any two groups (al P<0.05). The ROC curve showed that Rc was superior to troponin I and Rd superior to d- dimer in the differential diagnosis of these diseases. Conclusion The ratios of D- dimmer to troponin I and troponin I to D- dimmer are benefit to improve the sensitivity and specificity of each parameter in the diagnosis of acute chest pain.%目的:探讨D-二聚体、肌钙蛋白I及其比值在鉴别致命性胸痛病因诊断中的应用。方法因胸痛或胸闷至我院急诊确诊为心肌梗死、肺栓塞、主动脉夹层的患者786例,男性534

  9. 双源CT前瞻性心电门控扫描在急性胸痛诊断中应用的可行性%Feasibility of Prospective EGG-Dual-Source CT in the Diagnosis of Patients with Acute Chest Pain

    Institute of Scientific and Technical Information of China (English)

    陈丹; 周嘉慧; 史雅文

    2012-01-01

    Objective To evaluate the feasibility of prospective ECG gated dual-source CT (DSCT)in patients with acute chest pain in different heart rate. Methods Forty two patients with acute chest pain underwent prospective ECG-ga ted DSCT scan. The patients were divided into two groups. In group A, the heart rate of patients was = 75 beats / min, data set was reconstructed in 70% R-R interval, ECG pulse window was set to 62% -78% . In group B, the heart rate of patients was > 75 beats / min, data set was reconstructed in 40% R-R interval, ECG pulse window was set to 32% -48%. Two experienced radiologists assessed the image quality of two groups, The images were target reconstructed on pul monary artery, aorta, coronary arteries, and the radiation dose was calculated. \\2 test was used to explore significant differ ences in assessable segments coronary artery . Two independent samples t-test was used to explore significant differences in vessel attenuation of ascending aorta and pulmonary trunk. As well as, the CT coronary angiographic images of 16 cases were compared with DSA. Results Only one case, the attenuation of ascending aorta did not meet the diagnostic criteria. The attenuation of ascending aorta and pulmonary trunk had not statistical difference between group A and B (t values were 0.254,0. 700, P values were > 0. 05). The assessable segments of coronary arteries of group A and B were 278/284 (97. 89% ) , 297/307 {96. 74% ) , and there was no statistical difference between two groups. There was good consistency between CT coronary angiographic images and DSA images. The average effective dose was (8. 67 ±2. 54)mSv. Conclu sion Prospective ECG gated DSCT angiography offers a very good image quality without heart rate control in patients with acute chest pain.%目的 探讨应用双源CT( dual-source CT,DSCT)前瞻性心电门控扫描对不同心率的急性胸痛患者诊断的可行性.方法 对42例急性胸痛患者进行DSCT前瞻性心电门控心胸联合

  10. Effect of corticosteroid injection for trochanter pain syndrome: design of a randomised clinical trial in general practice

    Directory of Open Access Journals (Sweden)

    Verhaar Jan AN

    2007-09-01

    Full Text Available Abstract Background Regional pain in the hip in adults is a common cause of a general practitioner visit. A considerable part of patients suffer from (greater trochanteric pain syndrome or trochanteric bursitis. Local corticosteroid injections is one of the treatment options. Although clear evidence is lacking, small observational studies suggest that this treatment is effective in the short-term follow-up. So far, there are no randomised controlled trials available evaluating the efficacy of injection therapy. This study will investigate the efficacy of local corticosteroid injections in the trochanter syndrome in the general practice, using a randomised controlled trial design. The cost effectiveness of the corticosteroid injection therapy will also be assessed. Secondly, the role of co-morbidity in relation to the efficacy of local corticosteroid injections will be investigated. Methods/Design This study is a pragmatic, open label randomised trial. A total of 150 patients (age 18–80 years visiting the general practitioner with complaints suggestive of trochanteric pain syndrome will be allocated to receive local corticosteroid injections or to receive usual care. Usual care consists of analgesics as needed. The randomisation is stratified for yes or no co-morbidity of low back pain, osteoarthritis of the hip, or both. The treatment will be evaluated by means of questionnaires at several time points within one year, with the 3 month and 1 year evaluation of pain and recovery as primary outcome. Analyses of primary and secondary outcomes will be made according to the intention-to-treat principle. Direct and indirect costs will be assessed by questionnaires. The cost effectiveness will be estimated using the following ratio: CE ratio = (cost of injection therapy minus cost of usual care/(effect of injection therapy minus effect of usual care. Discussion This study design is appropriate to estimate effectiveness and cost-effectiveness of the

  11. Craniofacial pain of cardiac origin : an interdisciplinary study

    OpenAIRE

    Kreiner, Marcelo

    2011-01-01

    Referred pain is frequently associated with misdiagnosis and unnecessary therapy directed to the pain location instead of its origin. When craniofacial pain is the sole symptom of myocardial ischemia, failure to recognize its cardiac source can endanger the patient. In particular, patients with acute myocardial infarction (AMI) who do not experience chest pain run a very high risk of misdiagnosis and death. Pain that is limited to the craniofacial region during myocardial ischemia has so far ...

  12. Uso da cintilografia miocárdica em repouso durante dor torácica para descartar infarto agudo do miocárdio Utilización de la centellografía miocárdica en reposo durante dolor torácico para descartar infarto agudo de miocardio Use of resting myocardial scintigraphy during chest pain to exclude diagnosis of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Gustavo Borges Barbirato

    2009-04-01

    miocardio. MÉTODOS: Un total de 108 pacientes ingresados con dolor torácico, o hasta tras 4 horas del término de los síntomas, con electrocardiograma no diagnostico, realizaron centellografía en reposo y dosificaciones de troponina I. No se excluyeron a los pacientes con pasado de infarto de miocardio (IM (24 pacientes. Se dosificó troponina I al ingreso y tras 6 horas del ingreso. Médicos nucleares realizaron análisis ciego de las imágenes. Se confirmó infarto de miocardio, con elevación de la troponina I mayor que tres veces el control. RESULTADOS: La imagen de perfusión en reposo se mostró anormal en todos los seis pacientes con IM. Sólo un paciente presentó imagen normal y elevación de la troponina. Otros 55 pacientes obtuvieron imagen positiva sin IM y 46 pacientes presentaron imágenes y troponinas normales. La prevalencia de la enfermedad fue de un 6,5%. Fue de un 85,7% la sensibilidad de la imagen de reposo durante dolor torácico para la evidencia de IM, y la especificidad de un 45,5%. El valor predictivo negativo fue de un 97,7%. CONCLUSIÓN: Pacientes sometidos al protocolo de dolor torácico con centellografía de perfusión miocárdica demostraron un excelente valor predictivo negativo para la exclusión del diagnóstico de infarto de miocardio. Estos resultados sugieren que la imagen de perfusión en reposo es una herramienta importante en la unidad de dolor torácico.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 99mTc-Tetrofosmin scintigraphy during an episode of chest pain to exclude the diagnosis of acute myocardial infarction. METHODS: One hundred and eight patients admitted with chest pain, or up to four hours after the end of symptoms and nondiagnostic electrocardiogram, underwent resting scintigraphy and measurement of troponin I concentrations. Patients with a history of myocardial

  13. Chest neoplasms with infectious etiologies.

    Science.gov (United States)

    Restrepo, Carlos S; Chen, Melissa M; Martinez-Jimenez, Santiago; Carrillo, Jorge; Restrepo, Catalina

    2011-12-28

    A wide spectrum of thoracic tumors have known or suspected viral etiologies. Oncogenic viruses can be classified by the type of genomic material they contain. Neoplastic conditions found to have viral etiologies include post-transplant lymphoproliferative disease, lymphoid granulomatosis, Kaposi's sarcoma, Castleman's disease, recurrent respiratory papillomatosis, lung cancer, malignant mesothelioma, leukemia and lymphomas. Viruses involved in these conditions include Epstein-Barr virus, human herpes virus 8, human papillomavirus, Simian virus 40, human immunodeficiency virus, and Human T-lymphotropic virus. Imaging findings, epidemiology and mechanism of transmission for these diseases are reviewed in detail to gain a more thorough appreciation of disease pathophysiology for the chest radiologist.

  14. A theory-based educational intervention targeting nurses' attitudes and knowledge concerning cancer-related pain management: A study protocol of a quasi-experimental design

    Directory of Open Access Journals (Sweden)

    Gustafsson Markus

    2011-09-01

    Full Text Available Abstract Background Pain is one of the most frequent problems among patients diagnosed with cancer. Despite the availability of effective pharmacological treatments, this group of patients often receives less than optimal treatment. Research into nurses' pain management highlights certain factors, such as lack of knowledge and attitudes and inadequate procedures for systematic pain assessment, as common barriers to effective pain management. However, educational interventions targeting nurses' pain management have shown promise. As cancer-related pain is also known to have a negative effect on vital aspects of the patient's life, as well as being commonly associated with problems such as sleep, fatigue, depression and anxiety, further development of knowledge within this area is warranted. Methods/design A quasi-experimental study design will be used to investigate whether the implementation of guidelines for systematic daily pain assessments following a theory-based educational intervention will result in an improvement in knowledge and attitude among nurses. A further aim is to investigate whether the intervention that targets nurses' behaviour will improve hospital patients' perception of pain. Data regarding nurses' knowledge and attitudes to pain (primary outcome, patient perception regarding pain (secondary outcome, together with socio-demographic variables, will be collected at baseline and at four weeks and 12 weeks following the intervention. Discussion Nursing care is nowadays acknowledged as an increasingly complicated activity and "nursing complexity is such that it can be seen as the quintessential complex intervention." To be able to change and improve clinical practice thus requires multiple points of attack appropriate to meet complex challenges. Consequently, we expect the theory-based intervention used in our quasi-experimental study to improve care as well as quality of life for this group of patients and we also envisage that

  15. Childhood violence and adult chronic pain among indigenous Sami and non-Sami populations in Norway: a SAMINOR 2 questionnaire study

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    Astrid M. A. Eriksen

    2016-10-01

    Full Text Available Background: Internationally, studies have shown that childhood violence is associated with chronic pain in adulthood. However, to date, this relationship has not been examined in any indigenous population. Objective: The main objectives of this study were to investigate the association between childhood violence and reported chronic pain, number of pain sites and the intensity of pain in adulthood in indigenous Sami and non-Sami adults, and to explore ethnic differences. Design: The study is based on the SAMINOR 2 questionnaire study, a larger population-based, cross-sectional survey on health and living conditions in multiethnic areas with both Sami and non-Sami populations in Mid- and Northern Norway. Our study includes a total of 11,130 adult participants: 2,167 Sami respondents (19.5% and 8,963 non-Sami respondents (80.5%. Chronic pain was estimated by reported pain located in various parts of the body. Childhood violence was measured by reported exposure of emotional, physical and/or sexual violence. Results: Childhood violence was associated with adult chronic pain in several pain sites of the body regardless of ethnicity and gender. Childhood violence was also associated with increased number of chronic pain sites and higher pain intensity compared to those not exposed to childhood violence. However, among Sami men, this association was only significant for pain located in chest, hips/legs and back, and non-significant for increased number of chronic pain sites (adjusted model, and higher pain intensity. Conclusion: Respondents exposed to childhood violence reported more chronic pain in several parts of the body, increased number of chronic pain sites and more intense pain in adulthood than respondents reporting no childhood violence. However, among Sami men, this association was weaker and also not significant for increased number of chronic pain sites and higher pain intensity.

  16. Technique for chest compressions in adult CPR

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    Rajab Taufiek K

    2011-12-01

    Full Text Available Abstract Chest compressions have saved the lives of countless patients in cardiac arrest as they generate a small but critical amount of blood flow to the heart and brain. This is achieved by direct cardiac massage as well as a thoracic pump mechanism. In order to optimize blood flow excellent chest compression technique is critical. Thus, the quality of the delivered chest compressions is a pivotal determinant of successful resuscitation. If a patient is found unresponsive without a definite pulse or normal breathing then the responder should assume that this patient is in cardiac arrest, activate the emergency response system and immediately start chest compressions. Contra-indications to starting chest compressions include a valid Do Not Attempt Resuscitation Order. Optimal technique for adult chest compressions includes positioning the patient supine, and pushing hard and fast over the center of the chest with the outstretched arms perpendicular to the patient's chest. The rate should be at least 100 compressions per minute and any interruptions should be minimized to achieve a minimum of 60 actually delivered compressions per minute. Aggressive rotation of compressors prevents decline of chest compression quality due to fatigue. Chest compressions are terminated following return of spontaneous circulation. Unconscious patients with normal breathing are placed in the recovery position. If there is no return of spontaneous circulation, then the decision to terminate chest compressions is based on the clinical judgment that the patient's cardiac arrest is unresponsive to treatment. Finally, it is important that family and patients' loved ones who witness chest compressions be treated with consideration and sensitivity.

  17. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Christensen, Robin Daniel Kjersgaard; Thomsen, Bente

    2011-01-01

    is to present the design of a randomised controlled trial (RCT) aimed at evaluating the effectiveness of a combined individual physical and cognitive behavioural-graded activity program on self-reported general physical function, in addition to neck function, pain, disability and quality of life in patients......ABSTRACT: BACKGROUND: Many patients suffer from chronic neck pain following a whiplash injury. A combination of cognitive, behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders. The objective...... with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline. METHODS: The design is a two-centre, RCT-study with a parallel group design. Included are whiplash patients with chronic neck pain for more than 6 months, recruited...

  18. Anterior chest wall examination reviewed

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    F. Trotta

    2011-09-01

    Full Text Available Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondiloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the “activity” of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

  19. Potential of ultrasound in the pediatric chest

    Energy Technology Data Exchange (ETDEWEB)

    Trinavarat, Panruethai, E-mail: pantrinavarat@hotmail.com [Department of Radiology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330 (Thailand); Riccabona, Michael, E-mail: michael.riccabona@klinikum-graz.at [Department of Radiology, Division of Pediatric Radiology, University Hospital Graz (Austria)

    2014-09-15

    Ultrasound (US) of chest, even with inherent limitations of the US beam and air, has been useful in many pediatric chest conditions. It has extended its role and is now widely used by many subspecialists in medicine. This review article will cover techniques, indications, and applications of chest US in neonates, infants and children, including also different common as well as some rare and modern aspects and applications, such as pleural effusion, pneumothorax, pulmonary lesions, mediastinum, diaphragm, and chest wall. Other related imaging modalities are also briefly discussed.

  20. Relevant surgical anatomy of the chest wall.

    Science.gov (United States)

    Naidu, Babu V; Rajesh, Pala B

    2010-11-01

    The chest wall, like other regional anatomy, is a remarkable fusion of form and function. Principal functions are the protection of internal viscera and an expandable cylinder facilitating variable gas flow into the lungs. Knowledge of the anatomy of the whole cylinder (ribs, sternum, vertebra, diaphragm, intercostal spaces, and extrathoracic muscles) is therefore not only important in the local environment of a specific chest wall resection but also in its relation to overall function. An understanding of chest wall kinematics might help define the loss of function after resection and the effects of various chest wall substitutes. Therefore, this article is not an exhaustive anatomic description but a focused summary and discussion.

  1. Potential of ultrasound in the pediatric chest.

    Science.gov (United States)

    Trinavarat, Panruethai; Riccabona, Michael

    2014-09-01

    Ultrasound (US) of chest, even with inherent limitations of the US beam and air, has been useful in many pediatric chest conditions. It has extended its role and is now widely used by many subspecialists in medicine. This review article will cover techniques, indications, and applications of chest US in neonates, infants and children, including also different common as well as some rare and modern aspects and applications, such as pleural effusion, pneumothorax, pulmonary lesions, mediastinum, diaphragm, and chest wall. Other related imaging modalities are also briefly discussed.

  2. Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

    Directory of Open Access Journals (Sweden)

    Clark Michael E

    2010-04-01

    Full Text Available Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR, and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The

  3. Rationale, design, and protocol for the prevention of low back pain in the military (POLM trial (NCT00373009

    Directory of Open Access Journals (Sweden)

    Dugan Jessica L

    2007-09-01

    Full Text Available Abstract Background There are few effective strategies reported for the primary prevention of low back pain (LBP. Core stabilization exercises targeting the deep abdominal and trunk musculature and psychosocial education programs addressing patient beliefs and coping styles represent the current best evidence for secondary prevention of low back pain. However, these programs have not been widely tested to determine if they are effective at preventing the primary onset and/or severity of LBP. The purpose of this cluster randomized clinical trial is to determine if a combined core stabilization exercise and education program is effective in preventing the onset and/or severity of LBP. The effect of the combined program will be compared to three other standard programs. Methods/Design Consecutive Soldiers participating in advanced individual training (AIT will be screened for eligibility requirements and consented to study participation, as appropriate. Companies of Soldiers will be randomly assigned to receive the following standard prevention programs; a core stabilization exercise program (CSEP alone, a CSEP with a psychosocial education (PSEP, a traditional exercise (TEP, or a TEP with a PSEP. Proximal outcome measures will be assessed at the conclusion of AIT (a 12 week training period and include imaging of deep lumbar musculature using real-time ultrasound imaging and beliefs about LBP by self-report questionnaire. We are hypothesizing that Soldiers receiving the CSEP will have improved thickness of selected deep lumbar musculature (transversus abdominus, multifidi, and erector spinae muscles. We are also hypothesizing that Soldiers receiving the PSEP will have improved beliefs about the management of LBP. After AIT, Soldiers will be followed monthly to measure the distal outcomes of LBP occurrence and severity. This information will be collected during the subsequent 2 years following completion of AIT using a web-based data entry system

  4. The design and methods of the Aging Successfully with Pain study

    OpenAIRE

    Morone, Natalia E.; Greco, Carol M.; Rollman, Bruce L.; Moore, Charity G.; Lane, Bridget; Morrow, Lisa; Glynn, Nancy W.; Delaney, Jill; Albert, Steven M.; Weiner, Debra K.

    2011-01-01

    Chronic low back pain (CLBP) is widespread among older adults (≥ 65 years) and is often treated inadequately. With a rapidly growing aging population, CLBP will increase and so will the demand for treatment. We believe that mind-body therapies can help to meet this demand. We present the methodology of a randomized, controlled clinical trial of 300 individuals with CLBP aged 65 years or older. The specific aims are, 1) to determine the effectiveness of a mindfulness meditation program in incr...

  5. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationale

    OpenAIRE

    Bossuyt Patrick MM; Dijkgraaf Marcel GW; van Randen Adrienne; Laméris Wytze; Stoker Jaap; Boermeester Marja A

    2007-01-01

    Abstract Background The acute abdomen is a frequent entity at the Emergency Department (ED), which usually needs rapid and accurate diagnostic work-up. Diagnostic work-up with imaging can consist of plain X-ray, ultrasonography (US), computed tomography (CT) and even diagnostic laparoscopy. However, no evidence-based guidelines exist in current literature. The actual diagnostic work-up of a patient with acute abdominal pain presenting to the ED varies greatly between hospitals and physicians....

  6. Groin pain

    Science.gov (United States)

    Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg: This problem often occurs in people who play sports such as ...

  7. Effectiveness of anodal transcranial direct current stimulation in patients with chronic low back pain: Design, method and protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Luedtke Kerstin

    2011-12-01

    Full Text Available Abstract Background Electrical stimulation of central nervous system areas with surgically implanted stimulators has been shown to result in pain relief. To avoid the risks and side effects of surgery, transcranial direct current stimulation is an option to electrically stimulate the motor cortex through the skull. Previous research has shown that transcranial direct current stimulation relieves pain in patients with fibromyalgia, chronic neuropathic pain and chronic pelvic pain. Evidence indicates that the method is pain free, safe and inexpensive. Methods/Design A randomised controlled trial has been designed to evaluate the effect of transcranial direct current stimulation over the motor cortex for pain reduction in patients with chronic low back pain. It will also investigate whether transcranial direct current stimulation as a prior treatment enhances the symptom reduction achieved by a cognitive-behavioural group intervention. Participants will be randomised to receive a series of 5 days of transcranial direct current stimulation (2 mA, 20 mins or 20 mins of sham stimulation; followed by a cognitive-behavioural group programme. The primary outcome parameters will measure pain (Visual Analog Scale and disability (Oswestry Disability Index. Secondary outcome parameters will include the Fear Avoidance Beliefs Questionnaire, the Funktionsfragebogen Hannover (perceived function, Hospital Anxiety Depression Scale, bothersomeness and Health Related Quality of Life (SF 36, as well as Patient-Perceived Satisfactory Improvement. Assessments will take place immediately prior to the first application of transcranial direct current stimulation or sham, after 5 consecutive days of stimulation, immediately after the cognitive-behavioural group programme and at 4 weeks, 12 weeks and 24 weeks follow-up. Discussion This trial will help to determine, whether transcranial direct current stimulation is an effective treatment for patients with chronic low back

  8. Analgesic efficacy of lidocaine and multimodal analgesia for chest tube removal: A randomized trial study

    Directory of Open Access Journals (Sweden)

    Valdecy Ferreira de Oliveira Pinheiro

    2015-12-01

    Full Text Available Objective: to assess the analgesic efficacy of subcutaneous lidocaine and multimodal analgesia for chest tube removal following heart surgery. Methods: sixty volunteers were randomly allocated in two groups; 30 participants in the experimental group were given 1% subcutaneous lidocaine, and 30 controls were given a multimodal analgesia regime comprising systemic anti-inflammatory agents and opioids. The intensity and quality of pain and trait and state anxiety were assessed. The association between independent variables and final outcome was assessed by means of the Chi-squared test with Yates' correction and Fisher's exact test. Results: the groups did not exhibit significant difference with respect to the intensity of pain upon chest tube removal (p= 0.47. The most frequent descriptors of pain reported by the participants were pressing, sharp, pricking, burning and unbearable. Conclusion: the present study suggests that the analgesic effect of the subcutaneous administration of 1% lidocaine combined with multimodal analgesia is most efficacious.

  9. Exploring Changes in Valued Action in the Presence of Chronic Debilitating Pain in Acceptance and Commitment Therapy for Youth – A Single-Subject Design Study

    Science.gov (United States)

    Kemani, Mike K.; Olsson, Gunnar L.; Holmström, Linda; Wicksell, Rikard K.

    2016-01-01

    Objective: The objective of the study was to improve the understanding of processes of change in Acceptance and Commitment Therapy for youth with chronic debilitating pain by exploring the relation between individual change patterns in pain intensity and valued activities. Method: A single-subject design across three adolescents suffering from longstanding debilitating pain was utilized. Pain intensity and participation in valued activities were rated daily. Visual analysis of the graphed data was performed to evaluate the effects of the intervention, and the relationship between pain intensity and values-based activity. Results: The graphed data illustrated that pain levels did not decrease from the baseline period to the follow-up period. In contrast, compared to baseline ratings values oriented behaviors increased from the start of treatment to the follow-up period. Conclusion: Results illustrate that increases in values-based behavior may occur without corresponding decreases in pain, and warrant further research on change processes in ACT for youth suffering from chronic pain. PMID:28082933

  10. Prognóstico em médio prazo da cintilografia de perfusão miocárdica de estresse na unidade de dor torácica Medium term prognostic value of stress myocardial perfusion scintigraphy in a chest pain unit

    Directory of Open Access Journals (Sweden)

    Jader Cunha de Azevedo

    2007-05-01

    Full Text Available OBJETIVO: Determinar o valor prognóstico da cintilografia de perfusão miocárdica (CPM de estresse quando aplicada aos pacientes com suspeita de síndrome coronariana aguda (SCA. MÉTODOS: Estudo retrospectivo, onde pacientes internados na unidade de dor torácica (UDT, de dezembro de 2002 a abril de 2004, com suspeita de SCA, depois de afastado infarto agudo do miocárdio (IAM ou de angina instável de alto risco, realizaram CPM sob estresse. RESULTADOS: Selecionados 301 pacientes, idade média 65,3±12,5 anos e 164 (54,5% homens. O exame foi iniciado em média 13±12 horas após a internação. Encontrou-se isquemia miocárdica (ISQ em 142 pacientes (47,2%. O sexo masculino (n=94, p=OBJECTIVE: To evaluate the prognostic value of stress myocardial perfusion scintigraphy (MPS applied to patients with suspected acute coronary syndrome (ACS. METHODS: Retrospective study. Patients with suspected acute coronary syndrome (ACS admitted into the chest pain unit (CPU from December 2002 to April 2004, after exclusion of acute myocardial infarction (AMI and high risk unstable angina they underwent stress MPS. RESULTS: Selected 301 patients, 65.3 ± 12.5 years and 164 (54.5% male gender. The test was performed 13 ± 12 hours after admission. Myocardial ischemia (ISQ was found in 142 patients (47.2%. Male gender (n=94, p=<0.0001, history of diabetes mellitus (n=31, p=0.033, past of AMI (n=52, p=<0.0001, past of surgical myocardial revascularization (n=46, p=<0.0001 and past of percutaneous revascularization (n=68, p=<0.0001 presented correlation with ISQ. The follow-up was 697.7 ± 326.6 days. No MPS variable correlated with the occurrence of primary outcome. Abnormal scintigraphy (n=76, p < 0.0001, ISQ (n=73, p < 0.0001 and post-stress left ventricular ejection fraction below 45% (n=21, p=0.006 correlated with secondary outcome. The presence of ISQ was the major variable in the multivariate analysis for the prediction of secondary outcome (RR = 6.5; CI

  11. Post-traumatic pulmonary pseudocyst with hemopneumothorax following blunt chest trauma: a case report

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    Fagkrezos Dimitris

    2012-10-01

    Full Text Available Abstract Introduction Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung and develops after blunt chest trauma and even more rarely following penetrating injuries. It is generally seen in young adults presenting with cough, chest pain, hemoptysis, and dyspnea. Post-traumatic pulmonary pseudocyst should be included in the differential diagnosis of cavitary pulmonary lesions. We describe the case of a 60-year-old Caucasian Greek woman who sustained traumatic pulmonary pseudocyst with hemopneumothorax due to a blunt chest trauma after a traffic accident. Case presentation After a traffic accident, a 60-year-old Caucasian Greek woman sustained a hemopneumothorax due to a blunt chest trauma. There was evidence of an extensive contusion in the posterior and lateral segments of the right lower lobe, a finding that was attributed to an early sign of a cavitation, and the presence of a thin-walled air cavity was detected on the anterior segment of the right lower lobe in the control computed tomography taken 24 hours after admission. Our patient was treated by catheter aspiration, and the findings of computed tomography evaluation about one month later showed complete resolution of one of the two air-filled cavitary lesions. The second pseudocyst also disappeared completely, as shown by the control computed tomography scan performed six months later. Conclusions Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma, and computed tomography is a more valuable imaging technique than chest radiograph for early diagnosis.

  12. Remote interpretation of chest roentgenograms.

    Science.gov (United States)

    Andrus, W S; Hunter, C H; Bird, K T

    1975-04-01

    A series of 98 chest films was interpreted by two physicians on the basis of monitor display of the transmitted television signal representing the roentgenographic image. The transmission path was 14 miles long, and included one active repeater station. Receiver operating characteristic curves were drawn to compare interpretations rendered on television view of the image with classic, direct view interpretations of the same films. Performance in these two viewing modes was found to be quite similar. When films containing only hazy densities lacking internal structure or sharp margins, were removed from the sample, interpretation of the remaining films was essentially identical via the two modes. Since hazy densities are visible on retrospective examination, interpretation of roentgenograms at a distance via television appears to be a feasible route for delivery of radiologic services.

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

    OpenAIRE

    2016-01-01

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

  14. Effectiveness of behavioural graded activity compared with physiotherapy treatment in chronic neck pain: design of a randomised clinical trial [ISRCTN88733332

    OpenAIRE

    2004-01-01

    Abstract Background Chronic neck pain is a common complaint in the Netherlands with a point prevalence of 14.3%. Patients with chronic neck pain are often referred to a physiotherapist and, although many treatments are available, it remains unclear which type of treatment is to be preferred. The objective of this article is to present the design of a randomised clinical trial, Ephysion, which examines the clinical and cost effectiveness of behavioural graded activity compared with a physiothe...

  15. Volume Modulated Arc Therapy (VMAT for pulmonary Stereotactic Body Radiotherapy (SBRT in patients with lesions in close approximation to the chest wall

    Directory of Open Access Journals (Sweden)

    Thomas J. FitzGerald

    2013-02-01

    Full Text Available Chest wall pain and discomfort has been recognized as a significant late effect of radiation therapy in historical and modern treatment models. Stereotactic Body Radiotherapy (SBRT is becoming an important treatment tool in oncology care for patients with intrathoracic lesions. For lesions in close approximation to the chest wall including lesions requiring motion management, SBRT techniques can deliver high dose to the chest wall. As an unintended target of consequence, there is possibility of generating significant chest wall pain and discomfort as a late effect of therapy. The purpose of this paper is to evaluate the potential role of Volume Modulated Arc Therapy (VMAT technologies in decreasing chest wall dose in SBRT treatment of pulmonary lesions in close approximation to the chest wall.Ten patients with pulmonary lesions of various sizes and topography in close approximation to the chest wall were selected for retrospective review. All volumes including target, chest wall, ribs, and lung were contoured with maximal intensity projection maps and four-dimensional computer tomography planning. Radiation therapy planning consisted of static techniques including Intensity Modulated Radiation Therapy compared to VMAT therapy to a dose of 60Gy in 12Gy fractions. Dose volume histogram to rib, chest wall, and lung were compared between plans with statistical analysis.In all patients dose and volume were improved to ribs and chest wall using VMAT technologies compared to static field techniques. On average, volume receiving 30Gy to the chest wall was improved by 72%;the ribs by 60%. In only one patient did the VMAT treatment technique increase pulmonary volume receiving 20Gy (V20.VMAT technology has potential of limiting radiation dose to sensitive chest wall regions in patients with lesions in close approximation to this structure. This would also have potential value to lesions treated with SBRT in other body regions where targets abut critical

  16. Role of stationary esophageal manometry in clinical practice: Manometric results in patients with gastroesophageal reflux, dysphagia or non-cardiac chest pain Papel de la manometría esofágica estacionaria en la práctica clínica: Resultados manométricos en pacientes con reflujo gastroesofágico, disfagia y dolor torácico no cardiaco

    Directory of Open Access Journals (Sweden)

    C. Ciriza de los Ríos

    2004-09-01

    Full Text Available The present study was carried out to evaluate the diagnostic usefulness of stationary esophageal manometry in 263 patients divided into three groups: 150 patients with reflux symptoms, 68 with dysphagia, and 45 with non-cardiac chest pain. Patients with endoscopic abnormalities were excluded. Standard manometry was performed following the station pull-through technique. In the group of patients with reflux symptoms 40.7% had a normal manometry and 57.3% had abnormalities, being the most frequent (43% hypotensive lower esophageal sphincter. In the dysphagia group, 20.6% of manometries were normal and 79.4% were abnormal, of which achalasia was the most frequent disorder (53.7%. In the case of non-cardiac chest pain, 42.2% of patients had a normal manometry and 57.8% an abnormal one, of which hypotensive lower esophageal sphincter was the most frequent abnormality. A significant higher proportion of manometric alterations were found in the dysphagia group compared to reflux symptoms and non-cardiac chest pain (p El presente estudio ha sido realizado para evaluar la utilidad diagnóstica de la manometría esofágica estacionaria en 263 pacientes divididos en 3 grupos: 150 pacientes con síntomas de reflujo gastroesofágico, 68 con disfagia y 45 con dolor torácico no cardiaco. Se excluyeron los pacientes con alteraciones endoscópicas. La manometría se realizó según la técnica de retirada estacionaria. Entre los pacientes con síntomas de reflujo gastroesofágico, el 40,7% tuvieron una manometría normal y el 57,3% presentaron alteraciones, siendo la presencia de un esfínter esofágico inferior hipotenso la alteración más frecuente (43%. En el grupo de disfagia, el 20,6% de las manometrías fueron normales y el 79,4% anormales, siendo la achalasia el trastorno motor más frecuente (53,7%. En el grupo con dolor torácico no cardiaco, el 42,2% de los pacientes tuvieron manometría normal y el 57,8% anormal, siendo esfínter esofágico inferior

  17. Chest CT in children: anesthesia and atelectasis

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley; Gawande, Rakhee [Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Krane, Elliot J. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA (United States); Holmes, Tyson H. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Psychiatry and Behavioral Sciences, Stanford, CA (United States); Robinson, Terry E. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Pulmonary Medicine and Cystic Fibrosis Center for Excellence in Pulmonary Biology, Stanford, CA (United States)

    2014-02-15

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

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

    Science.gov (United States)

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

    2009-12-01

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

  19. Colon in the chest: an incidental dextrocardia: a case report study.

    Science.gov (United States)

    Abd Elrazek, Abd Elrazek; Shehab, Abdullah; Elnour, Asim A; Al Nuaimi, Saif K; Baghdady, Shazly

    2015-02-01

    Diaphragmatic injury is an uncommon traumatic injury (Dextrocardia was an incidental finding, diagnosed by electrocardiography, chest radiograph, and CT chest. Parts of the colon, small intestine, and stomach were within the thorax in the left side due to left diaphragmatic hernia of a nontraumatic cause. Acquired incidental dextrocardia was the main problem due to displacement of the heart to contralateral side by the GI (gastrointestinal) viscera (left diaphragmatic hernia).The patient was prepared for the laparoscopic surgical repair, using a polyethylene mesh 20 cm to close the defect, and the patient recovered with accepted general condition. However, 5 days postoperative, the patient passed away suddenly due to unexplained cardiac arrest.Intrathoracic herniation of abdominal viscera should be considered in patients presented with sudden chest pain concomitant with a history of increased intra-abdominal pressure.

  20. Abdominal pain

    Science.gov (United States)

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is does not always reflect the seriousness ...

  1. Chronic Pain

    Science.gov (United States)

    ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

  2. Heel pain

    Science.gov (United States)

    Pain - heel ... Heel pain is most often the result of overuse. However, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: Swelling and pain in the Achilles tendon ...

  3. Flank pain

    Science.gov (United States)

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  4. Neck pain and disability due to neck pain: what is the relation?

    DEFF Research Database (Denmark)

    Fejer, René; Hartvigsen, Jan

    2008-01-01

    Pain and disability are interrelated, but the relationship between pain and disability is not straightforward. The objective of this study was to investigate the relationship between neck pain (NP) intensity, NP duration, and disability based on the population-based 'Funen Neck and Chest Pain......' study. Pain intensity was measured using 11-box numerical rating scales, pain duration was measured using the Standardized Nordic Questionnaire, and disability was measured by the Copenhagen Neck Functional Disability Scale. Spearman rank correlation coefficients and logistic regression analyses were...... used to measure correlations and strength of associations between pain intensity, pain duration, and disability given domain specific characteristics (socioeconomic, health and physical, comorbidity, and variables related to consequences of NP). Neck pain was very common, but mainly mild and did...

  5. NERVE BLOCKING (PAIN CONTROL AFTER THORACOTOMY WITH BUPIVACAINE:EPIDURAL VS INTERCOSTAL

    Directory of Open Access Journals (Sweden)

    A GHAFOURI

    2001-09-01

    Full Text Available Introduction. Use of analgesics is an evitable and necessary part of thoracic surgery. This study was designed to compare analgesic effects of persistent thoracic epidural anesthesia versus persistent intercostal nerve block and determine their role in opioid need after thoracotomy. Methods. 116 patients above 20 years old who were candidate for thoracotomy through either posterolateral or thoracoabdominal incision were situatedin one of three group for pain relief. For the first group, pain relieved by petidine and pentazosin. In 2nd group, pain relived by thoracic epidural anesthesia with bupivacaine catheters which were inserted between costal and plural space. In 3rd group, bupivacaine was introduced through 3rd and 4th intercostal space by catheter (2 mg/kg in devided doses. Pain was meseared by visual analogue scale and quantified by surgical residents through a method bupivacaine was injected. If Bupivacaine did not relieve pain, then opioid was used as adjuvant. Results. The study showed that epidural group needed less opioids and had more cooperation in comparison with two other group. The intercostal group complained of pain at chest tube site. Discussion. In thoracotomized patients, pain control is more effective via epidural anesthesia in turns of opioid side effects, expenses and patient comfort.

  6. Feasible Dose Reduction in Routine Chest Computed Tomography Maintaining Constant Image Quality Using the Last Three Scanner Generations: From Filtered Back Projection to Sinogram-affirmed Iterative Reconstruction and Impact of the Novel Fully Integrated Detector Design Minimizing Electronic Noise

    Directory of Open Access Journals (Sweden)

    Lukas Ebner

    2014-01-01

    Full Text Available Objective:The aim of the present study was to evaluate a dose reduction in contrast-enhanced chest computed tomography (CT by comparing the three latest generations of Siemens CT scanners used in clinical practice. We analyzed the amount of radiation used with filtered back projection (FBP and an iterative reconstruction (IR algorithm to yield the same image quality. Furthermore, the influence on the radiation dose of the most recent integrated circuit detector (ICD; Stellar detector, Siemens Healthcare, Erlangen, Germany was investigated. Materials and Methods: 136 Patients were included. Scan parameters were set to a thorax routine: SOMATOM Sensation 64 (FBP, SOMATOM Definition Flash (IR, and SOMATOM Definition Edge (ICD and IR. Tube current was set constantly to the reference level of 100 mA automated tube current modulation using reference milliamperes. Care kV was used on the Flash and Edge scanner, while tube potential was individually selected between 100 and 140 kVp by the medical technologists at the SOMATOM Sensation. Quality assessment was performed on soft-tissue kernel reconstruction. Dose was represented by the dose length product. Results: Dose-length product (DLP with FBP for the average chest CT was 308 mGycm ± 99.6. In contrast, the DLP for the chest CT with IR algorithm was 196.8 mGycm ± 68.8 (P = 0.0001. Further decline in dose can be noted with IR and the ICD: DLP: 166.4 mGycm ± 54.5 (P = 0.033. The dose reduction compared to FBP was 36.1% with IR and 45.6% with IR/ICD. Signal-to-noise ratio (SNR was favorable in the aorta, bone, and soft tissue for IR/ICD in combination compared to FBP (the P values ranged from 0.003 to 0.048. Overall contrast-to-noise ratio (CNR improved with declining DLP. Conclusion: The most recent technical developments, namely IR in combination with integrated circuit detectors, can significantly lower radiation dose in chest CT examinations.

  7. Tuberculosis, advanced - chest x-rays (image)

    Science.gov (United States)

    Tuberculosis is an infectious disease that causes inflammation, the formation of tubercules and other growths within tissue, ... death. These chest x-rays show advanced pulmonary tuberculosis. There are multiple light areas (opacities) of varying ...

  8. Research designs for proof-of-concept chronic pain clinical trials

    DEFF Research Database (Denmark)

    Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C

    2014-01-01

    -pharmacodynamic relationships, and minimization of missing data. Efficiency of single-dose studies for treatments with rapid onset is discussed. The trade-off between parallel-group and crossover designs with respect to overall sample sizes, trial duration, and applicability is summarized. The advantages and disadvantages...... indication and thus whether it is worth investing the financial resources and participant exposure necessary for a confirmatory trial of that intervention. A challenge in designing POC trials is obtaining sufficient information to make this important go/no-go decision in a cost-effective manner. An IMMPACT...... consensus meeting was convened to discuss design considerations for POC trials in analgesia, with a focus on maximizing power with limited resources and participants. We present general design aspects to consider including patient population, active comparators and placebos, study power, pharmacokinetic...

  9. Short-term prognosis of mild coronary stenosis diagnosed by coronary computerized tomography in patients with acute chest pain%冠状动脉轻度狭窄急性胸痛低危患者的短期预后

    Institute of Scientific and Technical Information of China (English)

    田洪森; 要跟东; 赵梦华; 徐宝元; 张凯; 刘津军; 石建平; 沈玉珏; 霍燕飞

    2013-01-01

    目的:探讨冠状动脉CT成像显示为轻度狭窄(狭窄程度25%~50%)的急性胸痛低危患者的短期预后以明确其是否需要进一步行诊断性检查。方法纳入2008年3月~2012年2月邯郸市中心医院心肌梗死溶栓(TIMI)危险评分为低危、冠状动脉CT成像显示为轻度狭窄的急性胸痛患者215例。通过观察患者30天内的主要不良心血管事件(心肌梗死、不稳定心绞痛、冠状动脉血运重建和心血管死亡),以明确行进一步诊断检查的必要性。结果30 d随访期间,仅1例患者(0.5%)发生了主要不良心血管事件(95%CI:0%~2.6%),该患者在住院期间第3次复查肌钙蛋白T时呈阳性结果。无患者发生心血管死亡或需要血运重建。结论冠状动脉CT成像显示为轻度狭窄的急性胸痛患者近期发生主要不良心血管事件的可能性非常低,对此类患者行系列心脏生物学标志物检查有可能获益,但无需行进一步诊断检查。%Objective To investigate the short-term prognosis of mild coronary stenosis (25%-50%) diagnosed by coronary computerized tomography (CT) in the patients with acute chest pain, and determine if they need further diagnostic examinations. Methods The patients (n=215) with lower risk TIMI scores and mild coronary stenosis diagnosed by coronary CT were chosen from Handan Central Hospital from Mar. 2008 to Feb. 2012. The necessity of further diagnostic examinations was determined through observing the incidence of major adverse cardiovascular events (MACE) within 30 days including myocardial infarction, unstable angina, coronary revascularization and cardiovascular death. Results During 30-dya follow-up period, there was only one patients (0.5%) with MACE (95%CI:0%~2.6%), who had positive results of cardiac troponin T reexamined for three times during hospitalization. No patients experienced cardiovascular death or required coronary revascularization. Conclusion The

  10. Pneumomediastinum in Blunt Chest Trauma: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Gregory Mansella

    2014-01-01

    Full Text Available Blunt trauma is the most common mechanism of injury in patients with pneumomediastinum and may occur in up to 10% of patients with severe blunt thoracic and cervical trauma. In this case report we present a 24-year-old man with pneumomediastinum due to blunt chest trauma after jumping from a bridge into a river. He complained of persistent retrosternal pain with exacerbation during deep inspiration. Physical examination showed only a slight tenderness of the sternum and the extended Focused Assessment with Sonography for Trauma (e-FAST was normal. Pneumomediastinum was suspected by chest X-ray and confirmed by computed tomography, which showed a lung contusion as probable cause of the pneumomediastinum due to the “Mackling effect.” Sonographic findings consistent with pneumomediastinum, like the “air gap” sign, are helpful for quick bedside diagnosis, but the diagnostic criteria are not yet as well established as for pneumothorax. This present case shows that despite minimal findings in physical examination and a normal e-FAST a pneumomediastinum is still possible in a patient with chest pain after blunt chest trauma. Therefore, pneumomediastinum should always be considered to prevent missing major aerodigestive injuries, which can be associated with a high mortality rate.

  11. Relevant surgical anatomy of the chest wall

    OpenAIRE

    Rajesh, Pala Babu; Naidu, Babu V.

    2010-01-01

    The chest wall, like other regional anatomy, is a remarkable fusion of form and function. Principal functions are the protection of internal viscera and an expandable cylinder facilitating variable gas flow into the lungs. Knowledge of the anatomy of the whole cylinder (ribs, sternum, vertebra, diaphragm, intercostal spaces, and extrathoracic muscles) is therefore not only important in the local environment of a specific chest wall resection but also in its relation to overall function. An un...

  12. Effectiveness of behavioural graded activity compared with physiotherapy treatment in chronic neck pain: design of a randomised clinical trial [ISRCTN88733332

    Directory of Open Access Journals (Sweden)

    Vos Cees J

    2004-10-01

    Full Text Available Abstract Background Chronic neck pain is a common complaint in the Netherlands with a point prevalence of 14.3%. Patients with chronic neck pain are often referred to a physiotherapist and, although many treatments are available, it remains unclear which type of treatment is to be preferred. The objective of this article is to present the design of a randomised clinical trial, Ephysion, which examines the clinical and cost effectiveness of behavioural graded activity compared with a physiotherapy treatment for patients with chronic non-specific neck pain. Methods Eligible patients with non-specific neck pain persisting longer than 3 months will be randomly allocated to either the behavioural graded activity programme or to the physiotherapy treatment. The graded activity programme is based on an operant approach, which uses a time-contingent method to increase the patient's activity level. This treatment is compared with physiotherapy treatment using a pain-contingent method. Primary treatment outcome is the patient's global perceived effect concerning recovery from the complaint. Global perceived effect on daily functioning is also explored as primary outcome to establish the impact of treatment on daily activity. Direct and indirect costs will also be assessed. Secondary outcomes include the patient's main complaints, pain intensity, medical consumption, functional status, quality of life, and psychological variables. Recruitment of patients will take place up to the end of the year 2004 and follow-up measurement will continue until end 2005.

  13. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Hansen Inge

    2011-12-01

    Full Text Available Abstract Background Many patients suffer from chronic neck pain following a whiplash injury. A combination of cognitive, behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders. The objective is to present the design of a randomised controlled trial (RCT aimed at evaluating the effectiveness of a combined individual physical and cognitive behavioural-graded activity program on self-reported general physical function, in addition to neck function, pain, disability and quality of life in patients with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline. Methods/Design The design is a two-centre, RCT-study with a parallel group design. Included are whiplash patients with chronic neck pain for more than 6 months, recruited from physiotherapy clinics and an out-patient hospital department in Denmark. Patients will be randomised to either a pain management (control group or a combined pain management and training (interventiongroup. The control group will receive four educational sessions on pain management, whereas the intervention group will receive the same educational sessions on pain management plus 8 individual training sessions for 4 months, including guidance in specific neck exercises and an aerobic training programme. Patients and physiotherapists are aware of the allocation and the treatment, while outcome assessors and data analysts are blinded. The primary outcome measures will be Medical Outcomes Study Short Form 36 (SF36, Physical Component Summary (PCS. Secondary outcomes will be Global Perceived Effect (-5 to +5, Neck Disability Index (0-50, Patient Specific Functioning Scale (0-10, numeric rating scale for pain bothersomeness (0-10, SF-36 Mental Component Summary (MCS, TAMPA scale of Kinesiophobia (17-68, Impact of Event Scale (0-45, EuroQol (0

  14. Association of mechanical chest compression and prehospital thrombolysis.

    Science.gov (United States)

    Chenaitia, Hichem; Fournier, Marc; Brun, Jean Paul; Michelet, Pierre; Auffray, Jean Pierre

    2012-07-01

    Pulmonary embolism (PE) is a common cause of sudden death; the use of prehospital thrombolysis is currently a last-resort option and requires a prolonged cardiopulmonary resuscitation (CPR). Novel mechanical devices have recently been introduced that provides automatic mechanical chest compression (AMCC) according to the guidelines and continually without decrease efficiency throughout prolonged resuscitation. A 54 year-old woman with a history of breast cancer experienced sudden chest pain and severe dyspnea. A mobile intensive care unit was dispatched to her home. During physical examination, she suddenly collapsed with pulseless electrical activity as the initial rhythm. Prehospital thrombolysis during CPR combined with use of AMCC was performed based on a strongly suspected diagnosis of massive PE. After 75 minutes of effective CPR, return of spontaneous circulation was attained. After admission to an intensive care unit, computed tomographic scan confirmed bilateral PE. The patient was discharged 3 weeks after CPR in good neurologic condition. To our knowledge, this is the first case describing combined use of thrombolysis and AMCC in out-ofhospital cardiac arrest. However, for the time being, prehospital thrombolysis in CPR continues to be a measure that should only be performed on a case-by-case basis based on informed decision. Further studies are needed to evaluate the efficacy and safety of AMCC with thrombolysis and thus prolonged CPR.

  15. Estimated Probabililty of Chest Injury During an International Space Station Mission

    Science.gov (United States)

    Lewandowski, Beth E.; Milo, Eric A.; Brooker, John E.; Weaver, Aaron S.; Myers, Jerry G., Jr.

    2013-01-01

    The Integrated Medical Model (IMM) is a decision support tool that is useful to spaceflight mission planners and medical system designers when assessing risks and optimizing medical systems. The IMM project maintains a database of medical conditions that could occur during a spaceflight. The IMM project is in the process of assigning an incidence rate, the associated functional impairment, and a best and a worst case end state for each condition. The purpose of this work was to develop the IMM Chest Injury Module (CIM). The CIM calculates the incidence rate of chest injury per person-year of spaceflight on the International Space Station (ISS). The CIM was built so that the probability of chest injury during one year on ISS could be predicted. These results will be incorporated into the IMM Chest Injury Clinical Finding Form and used within the parent IMM model.

  16. Modifying tetramethyl–nitrophenyl–imidazoline with amino acids: design, synthesis, and 3D-QSAR for improving inflammatory pain therapy

    Directory of Open Access Journals (Sweden)

    Jiang X

    2015-04-01

    Full Text Available Xueyun Jiang,1 Yuji Wang,1 Haimei Zhu,1 Yaonan Wang,1 Ming Zhao,1,2 Shurui Zhao,1 Jianhui Wu,1 Shan Li,1 Shiqi Peng11Beijing Area Major Laboratory of Peptide and Small Molecular Drugs, Engineering Research Center of Endogenous Prophylactic of Ministry of Education of China, Beijing Laboratory of Biomedical Materials, College of Pharmaceutical Sciences, Capital Medical University, Beijing, People’s Republic of China; 2Faculty of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, TaiwanAbstract: With the help of pharmacophore analysis and docking investigation, 15 novel 1-(4,4,5,5-tetramethyl-2-(3-nitrophenyl-4,5-dihydroimidazol-1-yl-oxyacetyl-L-amino acids (6a–o were designed, synthesized, and assayed. On tail-flick and xylene-induced ear edema models, 10 µmol/kg 6a–o exhibited excellent oral anti-inflammation and analgesic activity. The dose-dependent assay of their representative 6f indicates that the effective dose should be 3.3 µmol/kg. The correlation of the three-dimensional quantitative structure–activity relationship with the docking analysis provides a basis for the rational design of drugs to treat inflammatory pain.Keywords: tetramethylimidazoline, analgesic, anti-inflammatory, 3D-QSAR

  17. Over-, under- and misuse of pain treatment in Germany

    Directory of Open Access Journals (Sweden)

    Dietl, Markus

    2011-01-01

    with regard to opiate prescription and an overuse regarding unspecific chest pain and chronic low back pain (LBP can be observed. The results show the benefit and the cost-effectiveness of interdisciplinary as well as multi-professional approaches, multimodal pain therapy and cross-sectoral integrated medical care. Only rough values can be determined about the care situation regarding the supply of pain therapeutic and palliative medical facilities as the data are completely insufficient. Discussion: Due to the broad research question the HTA-report contains inevitably different outcomes and study designs which partially differ qualitatively very strong from each other. In the field of palliative care hospices for in-patients and palliative wards as well as hospices for out-patients are becoming more and more important. Palliative care is a basic right of all terminally ill persons. Conclusion: Despite the relatively high number of studies in Germany the HTA-report shows a massive lack in health care research. Based on the studies a further expansion of out-patient pain and palliative care is recommended. Further training for all involved professional groups must be improved. An independent empirical analysis is necessary to determine over or undertreatment in pain care.

  18. Radiation induced osteosarcoma of the chest wall

    Energy Technology Data Exchange (ETDEWEB)

    Sugimoto, Tsutomu; Yuki, Yoshihiro; Oizumi, Hiroyuki; Iijima, Yoshiyuki; Fujishima, Tsukasa; Shimazaki, Yasuhisa [Yamagata Univ. (Japan). School of Medicine

    1996-11-01

    We report a successful resection of an osteosarcoma in the chest wall developed 25 years after irradiation. A 74-year-old woman was admitted to our hospital for her swelling in the left chest wall at August 24, 1995. At 49-year-old, she had undergone an operation and postoperative irradiation for left breast cancer. A computed tomography demonstrated a mass in the left chest wall that destructed the first rib, extending into the pleural space and invaded into the left common carotid and subclavian arteries. We planned a radical resection of the mass after repeated CT scannings, since it was histopathologically diagnosed as a chondrosarcoma and showed a rapid growth. The tumor was completely removed with radical transmediastinal forequarter amputation of the partial chest wall and total left upper extremity. The left common carotid artery was partially replaced with 6 mm EPTFE vascular prosthesis. The chest wall was reconstructed with Marlex-mesh prosthesis and a myocutaneous flap. She was discharged uneventfully and has not shown any evidence of recurrence. (author)

  19. Designing a workplace return-to-work program for occupational low back pain: an intervention mapping approach

    Directory of Open Access Journals (Sweden)

    Ammendolia Carlo

    2009-06-01

    Full Text Available Abstract Background Despite over 2 decades of research, the ability to prevent work-related low back pain (LBP and disability remains elusive. Recent research suggests that interventions that are focused at the workplace and incorporate the principals of participatory ergonomics and return-to-work (RTW coordination can improve RTW and reduce disability following a work-related back injury. Workplace interventions or programs to improve RTW are difficult to design and implement given the various individuals and environments involved, each with their own unique circumstances. Intervention mapping provides a framework for designing and implementing complex interventions or programs. The objective of this study is to design a best evidence RTW program for occupational LBP tailored to the Ontario setting using an intervention mapping approach. Methods We used a qualitative synthesis based on the intervention mapping methodology. Best evidence from systematic reviews, practice guidelines and key articles on the prognosis and management of LBP and improving RTW was combined with theoretical models for managing LBP and changing behaviour. This was then systematically operationalized into a RTW program using consensus among experts and stakeholders. The RTW Program was further refined following feedback from nine focus groups with various stakeholders. Results A detailed five step RTW program was developed. The key features of the program include; having trained personnel coordinate the RTW process, identifying and ranking barriers and solutions to RTW from the perspective of all important stakeholders, mediating practical solutions at the workplace and, empowering the injured worker in RTW decision-making. Conclusion Intervention mapping provided a useful framework to develop a comprehensive RTW program tailored to the Ontario setting.

  20. Chronic Pain

    Science.gov (United States)

    ... a problem you need to take care of. Chronic pain is different. The pain signals go on ... there is no clear cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis ...

  1. Current management and prognostic factors in physiotherapy practice for patients with shoulder pain: Design of a prospective cohort study

    NARCIS (Netherlands)

    Y.H.J.M. Karel (Yasmaine H. J.); G.G.M. Scholten-Peeters (Gwendolijne); M. Thoomes-De Graaf (Marloes); E. Duijn (Edwin); R.P.G. Ottenheijm (Ramon P.); M.P.J. van den Borne (Maaike P.); B.W. Koes (Bart); A.P. Verhagen (Arianne); G.J. Dinant; E. Tetteroo (Eric); A. Beumer (Annechien); J.B. van Broekhoven (Joost); M. Heijmans (Marcel)

    2013-01-01

    textabstractBackground: Shoulder pain is disabling and has a considerable socio-economic impact. Over 50% of patients presenting in primary care still have symptoms after 6 months; moreover, prognostic factors such as pain intensity, age, disability level and duration of complaints are associated wi

  2. Effectiveness and cost-effectiveness of shortening rehabilitation programs for patients with chronic musculoskeletal pain; Design of a RCT

    NARCIS (Netherlands)

    Waterschoot, F.P.C.; Geertzen, J.H.B.; Dijkstra, P.U.; Reneman, M.F.

    2011-01-01

    Background and Aims: Pain Rehabilitation Programs (PRP's) are proven effective for patients with chronic musculoskeletal pain (CMP). Evidence about the relationship of dose on the effect of PRP however, is unavailable. We hypothesized that shortening PRP will not be inferior to care as usual. The ai

  3. Effect of corticosteroid injection for trochanter pain syndrome: Design of a randomised clinical trial in general practice

    NARCIS (Netherlands)

    A. Brinks (Tineke); R.M. van Rijn (Rogier); A.M. Bohnen (Arthur); G.L.J. Slee (Gabriël); J.A.N. Verhaar (Jan); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita)

    2007-01-01

    textabstractBackground. Regional pain in the hip in adults is a common cause of a general practitioner visit. A considerable part of patients suffer from (greater) trochanteric pain syndrome or trochanteric bursitis. Local corticosteroid injections is one of the treatment options. Although clear evi

  4. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree......Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...

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

    Directory of Open Access Journals (Sweden)

    Ronga Alexandre

    2012-08-01

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

  6. Prephonatory chest wall posturing in stutterers.

    Science.gov (United States)

    Baken, R J; McManus, D A; Cavallo, S A

    1983-09-01

    The possibility that prephonatory chest wall posturing is abnormal in stutterers was explored by observing rib cage and abdominal hemicircumference changes during the interval between the presentation of a stimulus and the production of/alpha/by a group of stutterers (N = 5). It was found that the patterns of chest wall adjustment for phonation were qualitatively identical in the stutterers and in a comparable group of normal men studied previously. There was, however, a significant difference in the way in which lung volume changed during the execution of the chest wall adjustment. This was considered to be indicative of delayed glottal closure among the stutterers rather than representative of a primary ventilatory disturbance.

  7. Imaging of Chest Wall Lesions in Children

    Directory of Open Access Journals (Sweden)

    A. Hekmatnia

    2008-01-01

    Full Text Available Chest wall lesions in childhood include a wide range of pathologies; Benign lesions include lipoma, neurofibroma, lymphangioma, hemangioma, and mesenchymal hamartoma."nMalignant lesions include Neuroblastoma, Rhabdo-myosarcoma, Ewing sarcoma, and Askin tumor."nSystemic diseases such as leukemia, lymphoma, Langerhans cell histiocytosis, and also infections such as tuberculosis, and actinomycosis may also cause chest wall lesions."nThe imaging characteristics of these lesions are re-viewed, but only a minority of the lesions shows diagnostic imaging features, and most of lesions re-quire biopsy and histopathological examination for "ndefinitive diagnosis."nThe role of different modalities is discussed with an emphasis on magnetic resonance imaging for demonstrating lesion morphology and local spread. Computed tomography and neuclear medicine being used mainly to assess remote disease."nIn this lecture, we discuss about imaging of chest wall lesions in children.

  8. Cardiogenic shock following blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Rodríguez-González Fayna

    2010-01-01

    Full Text Available Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent cause of cardiac contusions resulting from a direct blow to the chest. Other causes of blunt cardiac injury are numerous and include violent fall impacts, interpersonal aggression, explosions, and various types of high-risk sports. Myocardial contusion is difficult to diagnose; clinical presentation varies greatly, ranging from lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. We present a case of cardiac contusion due to blunt chest trauma secondary to a fall impact, which manifested as cardiogenic shock.

  9. [Chest wall mesenchymal hamartoma: a case report].

    Science.gov (United States)

    Morales, Olga Lucía; Valencia, María de la Luz; Gómez, Carolina; Pérez, María del Pilar; Sanín, Emilio; Vásquez, Luz Marina

    2010-01-01

    Chest wall mesenchymal hamartoma is an extremely rare benign tumor. Approximately 80 cases have been reported in the literature. Most tumors are manifested at birth with a painless palpable mass of the chest wall, usually unilateral. Respiratory symptoms result from extrinsic compression of the pulmonary parenchyma, and the severity of the symptoms will depend on the size and location of the lesion. Imaging features are characteristic, but definitive diagnosis is histological. Herein, a case is described of a four month old infant with diagnosis of chest wall mesenchymal hamartoma, manifested at birth. Different treatment options are described, including expectations from tumor management, the possibility of spontaneous regression, and the morbidity associated with the surgical option.

  10. The Association Between Neck Pain and Pulmonary Function: A Systematic Review.

    Science.gov (United States)

    Kahlaee, Amir Hossein; Ghamkhar, Leila; Arab, Amir Massoud

    2017-03-01

    The aim of this study was to systematically review the evidence on respiratory function changes in patients with chronic neck pain. MEDLINE, Elsevier, ProQuest, PubMed, Scopus, Springer, and Google scholar electronic databases were explored thorough December 2015. English-language studies investigating cervical musculoskeletal and respiratory parameters in patients with chronic neck pain were included. Characteristics of the patients, sampling method and size, musculoskeletal and respiratory parameters studied, and appropriateness of the statistical tests were considered. Studies were rated based on study design and performance. Of the 68 studies reviewed, 9 observational studies met our inclusion criteria. Significant difference in maximum inspiratory and expiratory pressures were reported in patients with chronic neck pain compared to asymptomatic subjects. Some of the respiratory volumes were found to be lower in patients with chronic neck pain. Muscle strength and endurance, cervical range of motion, and psychological states were found to be significantly correlated with respiratory parameters. Lower Pco2 in patients and significant relationship between chest expansion and neck pain were also shown. Respiratory retraining was found to be effective in improving some cervical musculoskeletal and respiratory impairment. Functional pulmonary impairments accompany chronic neck pain. Based on the observed association, investigation of the effectiveness of management of CNP on respiratory function is strongly suggested.

  11. Rational design of sulfonated A3 adenosine receptor-selective nucleosides as pharmacological tools to study chronic neuropathic pain.

    Science.gov (United States)

    Paoletta, Silvia; Tosh, Dilip K; Finley, Amanda; Gizewski, Elizabeth T; Moss, Steven M; Gao, Zhan-Guo; Auchampach, John A; Salvemini, Daniela; Jacobson, Kenneth A

    2013-07-25

    (N)-Methanocarba(bicyclo[3.1.0]hexane)adenosine derivatives were probed for sites of charged sulfonate substitution, which precludes diffusion across biological membranes, e.g., blood-brain barrier. Molecular modeling predicted that sulfonate groups on C2-phenylethynyl substituents would provide high affinity at both mouse (m) and human (h) A3 adenosine receptors (ARs), while a N(6)-p-sulfophenylethyl substituent would determine higher hA3AR vs mA3AR affinity. These modeling predictions, based on steric fitting of the binding cavity and crucial interactions with key residues, were confirmed by binding/efficacy studies of synthesized sulfonates. N(6)-3-Chlorobenzyl-2-(3-sulfophenylethynyl) derivative 7 (MRS5841) bound selectively to h/m A3ARs (Ki(hA3AR) = 1.9 nM) as agonist, while corresponding p-sulfo isomer 6 (MRS5701) displayed mixed A1/A3AR agonism. Both nucleosides administered ip reduced mouse chronic neuropathic pain that was ascribed to either A3AR or A1/A3AR using A3AR genetic deletion. Thus, rational design methods based on A3AR homology models successfully predicted sites for sulfonate incorporation, for delineating adenosine's CNS vs peripheral actions.

  12. Chest wall abscess due to Prevotella bivia

    Institute of Scientific and Technical Information of China (English)

    Gwo-jong HSU; Cheng-ren CHEN; Mei-chu LAI; Shi-ping LUH

    2009-01-01

    Prevotella bivia is associated with pelvic inflammatory disease. A 77-year-old man developed a rapidly growing chest wall abscess due to P. Bivia within days. He underwent surgical resection of the infected area; his postoperative course was un-eventful. This is the first case of chest wall abscess due to P. Bivia infection. Its correct diagnosis cannot be underestimated be-cause fulminam infections can occur in aged or immunocompromised patients if treated incorrectly. Prompt, appropriate surgical management, and antibiotic therapy affect treatment outcome.

  13. Diagnosis and Treatment of Chest Injury and Emergency Diseases of Chest Organs

    Directory of Open Access Journals (Sweden)

    A. M. Khadjibaev

    2016-01-01

    Full Text Available Goal of research: to evaluate efficiency of videothoracoscopy in diagnosis and treatment of patients with injuries and emergency diseases ща chest organs.Material and methods: Study wasbased on treatment results analysis of 2111 patients with injuries and chest organs emergency diseases, who were treated at Republican Research Centre of Emergency Medicine in 2001-2014. Chest trauma made up 1396 (66,1% victims. There were 477 (22,6% patients with spontaneous pneumothorax. At the stages of initial diagnosis, the radiologic evaluations, CT investigations and videothoracoscopies were performed. In chest trauma patients the videothoracoscopy underwent in 844 cases, in spontaneous pneu#mothorax this method was employed in 290 patients. Complicated forms of lung echinococcosis were observed in 238 (11,3% patients and complicated forms of lung echinococcosis were evident in 72 patients.Results. Videothoracoscopy and video-assisted interventions allowed to eliminate lungs and pleura pathology in 1206 (57,1% patients, whereas the traditional methods were effective only in 905 cases (42,9%.Conclusions. Investigation methods such as multiplanar radioscopy, radiography, chest CT and videothora-coscopy must be included into algorithm of diagnosis and surgical treatment of chest injuries and emergency diseases of chest organs. At chest trauma the videothoracoscopy allows to avoid broad thoracotomy from 9,4% to 4,7% of cases, to reduce the frequency of repeated interventions from 17,4% to 0,5% and diminish a number of early postsurgery complications from 25,4% to 10,9%. Videothoracoscopy of chest traumas allows to reduce frequency of repeated interventions from 19,8 to 1,7%.

  14. Rationale, design, and implementation protocol of the Dutch clinical practice guideline Pain in patients with cancer: a cluster randomised controlled trial with short message service (SMS and interactive voice response (IVR

    Directory of Open Access Journals (Sweden)

    te Boveldt Nienke

    2011-12-01

    Full Text Available Abstract Background One-half of patients with cancer have pain. In nearly one out of two cancer patients with pain, this was undertreated. Inadequate pain control still remains an important problem in this group of patients. Therefore, in 2008 a national, evidence-based multidisciplinary clinical practice guideline 'pain in patients with cancer' has been developed. Yet, publishing a guideline is not enough. Implementation is needed to improve pain management. An innovative implementation strategy, Short Message Service with Interactive Voice Response (SVS-IVR, has been developed and pilot tested. This study aims to evaluate on effectiveness of this strategy to improve pain reporting, pain measurement and adequate pain therapy. In addition, whether the active role of the patient and involvement of caregivers in pain management may change. Methods/design A cluster randomised controlled trial with two arms will be performed in six oncology outpatient clinics of hospitals in the Southeastern region of the Netherlands, with three hospitals in the intervention and three in the control condition. Follow-up measurements will be conducted in all hospitals to study the long-term effect of the intervention. The intervention includes training of professionals (medical oncologists, nurses, and general practitioners and SMS-IVR to report pain in patients with cancer to improve pain reporting by patients, pain management by medical oncologists, nurses, and general practitioners, and decrease pain intensity. Discussion This innovative implementation strategy with technical tools and the involvement of patients, may enhance the use of the guideline 'pain in patients with cancer' for pain management. Short Message Service alerts may serve as a tool to support self-management of patients. Therefore, the SMS-IVR intervention may increase the feeling of having control over one's life. Trail registration Netherlands Trial Register (NTR: NTR2739

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

    Science.gov (United States)

    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.

  16. Pelvic Pain

    Science.gov (United States)

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  17. When to Remove a Chest Tube.

    Science.gov (United States)

    Novoa, Nuria M; Jiménez, Marcelo F; Varela, Gonzalo

    2017-02-01

    Despite the increasing knowledge about the pleural physiology after lung resection, most practices around chest tube removal are dictated by personal preferences and experience. This article discusses recently published data on the topic and suggests opportunities for further investigation and future improvements.

  18. Treatment of 336 cases of chest trauma

    Directory of Open Access Journals (Sweden)

    ZHANG Jing

    2012-06-01

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

  19. VAC® for external fixation of flail chest

    DEFF Research Database (Denmark)

    Winge, Rikke; Berg, Jais O; Albret, Rikke

    2012-01-01

    A large aterior chest wall defect following tumor resection was reconstructed with a Gore-Tex® membrane and a combined musculocutaneous rectus femoris and tensor fasciae latae free flap. Subsequent paradoxical respiration impeded weaning from the ventilator. Appliance of Vacuum Assisted Closure...

  20. Treatment of 336 cases of chest trauma

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

  1. Chest radiography in the critically ill

    NARCIS (Netherlands)

    Kröner, A.

    2016-01-01

    Introduction: The chest radiograph (CXR) is a frequently obtained test to complement physical examination in ICU and post-surgery PACU patients. The opinion on indications for a CXR in these two patient categories varies worldwide. One approach is to obtain CXR on indication only, i.e., when there i

  2. Chest injury in victims of Bam earthquake

    Institute of Scientific and Technical Information of China (English)

    Seyed Mohammad Ghodsi; Moosa Zargar; Ali Khaji; Mojgan Karbakhsh

    2006-01-01

    Objective: To analyze the data of trauma patients with thoracic injury in the earthquake of Bam admitted to hospitals of Tehran University of Medical Science (TUMS)for better understanding the type and consequence of thoracic injuries in a major earthquake.Methods: After Bam earthquake registering 6.5 on the Richter scale, 526 trauma patients were admitted to hospitals of TUMS. Among them, 53 patients sustained thoracic injury.Results: This group was composed of 21 females (39.6%) and 32 males (60.4%). Fifteen patients (28.3%) had isolated chest injuries. Rib fracture (36.4%) was the most common injury in our patients and haemo/pneumothorax (25.5%) followed. Superficial injury was the most common accompanying injury. Multipletrauma patients with chest injury had higher injury severity score (ISS) versus patients with isolated chest injury (P =0.003).Conclusions: Chest wall injuries and haemo/pneumothorax comprise a considerable number of injuries in survival victims of earthquakes. Consequently, the majority of these patients can be treated with observation or tube thoracostomy. We should train and equip the health workers and members of rescue teams to treat and manage these patients in the field.

  3. Cardiac injuries in blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Tobon-Gomez Catalina

    2009-09-01

    Full Text Available Abstract Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use of Cardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a 12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualization of myocardial damage resulting from the trauma.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  5. Evaluation of the safety of high-frequency chest wall oscillation (HFCWO therapy in blunt thoracic trauma patients

    Directory of Open Access Journals (Sweden)

    Becker Brian

    2008-10-01

    Full Text Available Abstract Background Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequently have chest tubes, drains, catheters, etc. which could become dislodged during HFCWO. This prospective observational study was conducted to determine if HFCWO treatment, as provided by The Vest™ Airway Clearance System (Hill-Rom, Saint Paul, MN, was safe and well tolerated by these patients. Methods Twenty-five blunt thoracic trauma patients were entered into the study. These patients were consented. Each patient was prescribed 2, 15 minute HFCWO treatments per day using The Vest® Airway Clearance System (Hill-Rom, Inc., St Paul, MN. The Vest® system was set to a frequency of 10–12 Hz and a pressure of 2–3 (arbitrary unit. Physiological parameters were measured before, during, and after treatment. Patients were free to refuse or terminate a treatment early for any reason. Results No chest tubes, lines, drains or catheters were dislodged as a result of treatment. One patient with flail chest had a chest tube placed after one treatment due to increasing serous effusion. No treatments were missed and continued without further incident. Post treatment survey showed 76% experienced mild or no pain and more productive cough. Thirty days after discharge there were no deaths or hospital re-admissions. Conclusion This study suggests that HFCWO treatment is safe for trauma patients with lung and chest wall injuries. These findings support further work to demonstrate the airway clearance benefits of HFCWO treatment.

  6. Interventional chest procedures in pregnancy.

    LENUS (Irish Health Repository)

    Morgan, Ross K

    2012-02-01

    Interventional pulmonology encompasses diagnostic and therapeutic bronchoscopic procedures, and pleural interventions. In the last 10 years older techniques have been refined and exciting new technologies have extended the reach and application of the instruments used. The main areas within pulmonary medicine for which these interventions have a role are malignant and nonmalignant airway disease, pleural effusion, pneumothorax, and artificial airways. There are no data from well-designed prospective trials to guide recommendations for interventional pulmonary procedures in pregnancy. The recommendations provided in this article are based on critical review of reported case series, opinion from recognized experts, and personal observations.

  7. Interventional chest procedures in pregnancy.

    LENUS (Irish Health Repository)

    Morgan, Ross K

    2011-03-01

    Interventional pulmonology encompasses diagnostic and therapeutic bronchoscopic procedures, and pleural interventions. In the last 10 years older techniques have been refined and exciting new technologies have extended the reach and application of the instruments used. The main areas within pulmonary medicine for which these interventions have a role are malignant and nonmalignant airway disease, pleural effusion, pneumothorax, and artificial airways. There are no data from well-designed prospective trials to guide recommendations for interventional pulmonary procedures in pregnancy. The recommendations provided in this article are based on critical review of reported case series, opinion from recognized experts, and personal observations.

  8. Targeting the minor pocket of C5aR for the rational design of an oral allosteric inhibitor for inflammatory and neuropathic pain relief

    Science.gov (United States)

    Moriconi, Alessio; Cunha, Thiago M.; Souza, Guilherme R.; Lopes, Alexandre H.; Cunha, Fernando Q.; Carneiro, Victor L.; Pinto, Larissa G.; Brandolini, Laura; Aramini, Andrea; Bizzarri, Cinzia; Bianchini, Gianluca; Beccari, Andrea R.; Fanton, Marco; Bruno, Agostino; Costantino, Gabriele; Bertini, Riccardo; Galliera, Emanuela; Locati, Massimo; Ferreira, Sérgio H.; Teixeira, Mauro M.; Allegretti, Marcello

    2014-01-01

    Chronic pain resulting from inflammatory and neuropathic disorders causes considerable economic and social burden. Pharmacological therapies currently available for certain types of pain are only partially effective and may cause severe adverse side effects. The C5a anaphylatoxin acting on its cognate G protein-coupled receptor (GPCR), C5aR, is a potent pronociceptive mediator in several models of inflammatory and neuropathic pain. Although there has long been interest in the identification of C5aR inhibitors, their development has been complicated, as for many peptidomimetic drugs, mostly by poor drug-like properties. Herein, we report the de novo design of a potent and selective C5aR noncompetitive allosteric inhibitor, DF2593A, guided by the hypothesis that an allosteric site, the “minor pocket,” previously characterized in CXC chemokine receptors-1 and -2, is functionally conserved in the GPCR class. In vitro, DF2593A potently inhibited C5a-induced migration of human and rodent neutrophils. In vivo, oral administration of DF2593A effectively reduced mechanical hyperalgesia in several models of acute and chronic inflammatory and neuropathic pain, without any apparent side effects. Mechanical hyperalgesia after spared nerve injury was also reduced in C5aR−/− mice compared with WT mice. Furthermore, treatment of C5aR−/− mice with DF2593A did not produce any further antinociceptive effect compared with C5aR−/− mice treated with vehicle. The successful medicinal chemistry strategy confirms that a conserved minor pocket is amenable for the rational design of selective inhibitors and the pharmacological results support that the allosteric blockade of the C5aR represents a highly promising therapeutic approach to control chronic inflammatory and neuropathic pain. PMID:25385614

  9. Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Verkerk Karin

    2011-11-01

    Full Text Available Abstract Background There has been increasing focus on factors predicting the development of chronic musculoskeletal disorders. For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery. We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain. Methods/Design All participating patients were recruited (Jan 2003-Dec 2008 from the same rehabilitation centre and were evaluated by means of (postal questionnaires and physical examinations at baseline, during the 2-month therapy program, and at 5 and 12 months after start of therapy. The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate (movement behaviour aimed at physical and functional recovery. The program is part of regular care and consists of 16 sessions of 3 hours each, over an 8-week period (in total 48 hours, followed by a 3-month self-management program. The primary outcomes are low back pain intensity, disability, quality of life, patient's global perceived effect of recovery, and participation in work. Baseline characteristics include information on socio-demographics, low back pain, employment status, and additional clinical items status such as fatigue, duration of activities, and fear of kinesiophobia. Prognostic variables are determined for recovery at short-term (5 months and long-term (12 months follow-up after start of therapy. Discussion In a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint.

  10. [Chest Wall Reconstruction Using Titanium Plates Sandwiched Between Sheets after Resection of Chest Wall Chondrosarcoma].

    Science.gov (United States)

    Endoh, Makoto; Oizumi, Hiroyuki; Kato, Hirohisa; Suzuki, Jun; Watarai, Hikaru; Hamada, Akira; Suzuki, Katsuyuki; Takahashi, Ai; Nakahashi, Kenta; Sugawara, Masato; Tsuchiya, Takashi; Sadahiro, Mitsuaki

    2016-07-01

    Extensive chest wall resection carries the risk of difficult reconstruction and surgical complications. We report our experience on chest wall reconstruction using titanium plates for a wide thoracic defect after tumor resection. A 74-year-old man was diagnosed with chondrosarcoma of the 6th rib on the right. He needed extensive chest wall resection because of skip lesions on 4th rib noted on operative inspection, leaving a defect measuring 33 × 20 cm. Reconstruction using 5 transverse titanium plates sandwiched between an expanded polytetrafluoroethylene patch and a polypropylene mesh sheet stabilized the chest wall. This reconstruction allowed successful separation from ventilatory support after operation. The postoperative course was uneventful, and he was discharged on postoperative day 20. The advantages of this form of reconstruction over conventional prostheses are rigidity, and stability and usability.

  11. Profile of care given to patients with blunt chest injuries within the first 48 hours

    Directory of Open Access Journals (Sweden)

    E Nyangena

    2000-09-01

    Full Text Available This study was conducted in the trauma unit of a large academic hospital in Johannesburg, South Africa. The study aimed at describing the nature of care that patients with blunt chest injuries received during the first 48 hours after injury. A descriptive survey was chosen using retrospective and prospective record review to obtain data. The sample comprised 60 records of patients who were admitted to the hospital due to blunt chest injuries between January 1997 and June 1998. Descriptive statistics were used to present and analyse data. The study showed that: (i Blunt chest trauma victims received a thorough initial assessment and care. No missed injuries were identified on subsequent assessment; (ii More than half of the patients spent over one hour in the accident/emergency department before admission to the trauma ward or intensive care unit (ICU; (iii Motor vehicle accidents (MVA were the commonest cause of injury while pedestrian vehicle accidents (PVA were often fatal; (iv Nurses are good providers of care but poor in prescribing and documenting care; (v Pain assessment and psychosocial care was often neglected; (vi Less than half the patients developed complications during the first 48 hours; pain and pneumonia being the most common complications encountered.

  12. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle

    2017-01-01

    OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark....... PARTICIPANTS: Sixty patients for major lung resection. INTERVENTIONS: Postoperative observation of ipsilateral shoulder pain. MEASUREMENTS AND MAIN RESULTS: Postoperative numeric rating scale score of shoulder pain and thoracic pain and postoperative examination of the sites of shoulder pain...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...

  13. The Paradox of Painful Art

    Science.gov (United States)

    Smuts, Aaron

    2007-01-01

    Many of the most popular genres of narrative art are designed to elicit negative emotions: emotions that are experienced as painful or involving some degree of pain, which people generally avoid in their daily lives. Traditionally, the question of why people seek out such experiences of painful art has been presented as the paradox of tragedy, and…

  14. 20 CFR 718.102 - Chest roentgenograms (X-rays).

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Chest roentgenograms (X-rays). 718.102... roentgenograms (X-rays). (a) A chest roentgenogram (X-ray) shall be of suitable quality for proper classification...-rays as described in Appendix A. (b) A chest X-ray to establish the existence of pneumoconiosis...

  15. 46 CFR 194.10-20 - Magazine chest construction.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Magazine chest construction. 194.10-20 Section 194.10-20... construction. (a) Magazine chests shall be of watertight metal construction with flush interior. The body and...) Chests shall be secured to the vessel's structure by means of permanently installed foundation clips...

  16. Chest radiographic manifestations of scrub typhus

    Directory of Open Access Journals (Sweden)

    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.

  17. The PEX study – Exercise therapy for patellofemoral pain syndrome: design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749

    Directory of Open Access Journals (Sweden)

    Verhaar Jan AN

    2006-03-01

    Full Text Available Abstract Background Patellofemoral complaints are frequently seen in younger and active patients. Clinical strategy is usually based on decreasing provoking activities as sports and demanding knee activities during work and leisure and reassuring the patient on the presumed good outcome. Exercise therapy is also often prescribed although evidence on effectiveness is lacking. The objective of this article is to present the design of a randomized clinical trial that examines the outcome of exercise therapy supervised by a physical therapist versus a clinically accepted "wait and see" approach (information and advice about the complaints only. The research will address to both effectiveness and cost effectiveness of supervised exercise therapy in patients with patellofemoral pain syndrome (PFPS. Methods/design 136 patients (adolescents and young adults with patellofemoral pain syndrome are recruited in general practices and sport medicine centers. They will be randomly allocated receiving either 3 months of exercise therapy (or usual care. The primary outcome measures are pain, knee function and perception of recovery after 3 months and 12 months of follow up and will be measured by self reporting. Measurements will take place at baseline, 6 weeks, and 3 monthly until 1 year after inclusion in the study. Secondary outcome measurements include an economic evaluation. A cost-utility analysis will be performed that expresses health improvements in Quality Adjusted Life Years (QALYs and incorporates direct medical costs and productivity costs Discussion This study has been designed after reviewing the literature on exercise therapy for patellofemoral pain syndrome. It was concluded that to merit the effect of exercise therapy a trial based on correct methodological concept needed to be executed. The PEX study is a randomized clinical trial where exercise therapy is compared to usual care. This trial started in April 2005 and will finish in June 2007

  18. Incidental finding of unilateral isolated aplasia of serratus anterior muscle and winged scapula on chest radiograph: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Joon Sung; Park, Hyun Jin; Ko, Jeong Min [Dept. of Radiology, St. Vincent' s Hospital, College of Medicine, The Catholic University of Korea, Suwon (Korea, Republic of)

    2014-10-15

    The isolated aplasia of the serratus anterior muscle with winging of scapula is very rare, and only a few cases are reported. Here, we present a case of a 30-year-old Korean male who initially presented with a left flank pain. His physical exam did not show any significant finding in his right shoulder. However, his chest radiograph showed absence of right serratus anterior muscle and slightly elevated and medially rotated right scapula. Subsequent CT scan showed the right serratus anterior muscle aplasia and medial winging of the right scapula. This case is unique in two aspects. First, the combination of abnormalities is different from the typical congenital abnormalities involving shoulder girdle, such as Sprengel deformity or Poland syndrome. Secondly, this was incidentally diagnosed with chest radiograph, without clinical impression. Careful reading of chest radiograph can help the radiologists to detect such clinically silent abnormalities.

  19. Pain Control After Surgery: Pain Medicines

    Science.gov (United States)

    ... Shortfall Questionnaire Home Prevention and Wellness Staying Healthy Pain Control After Surgery: Pain Medicines Pain Control After Surgery: Pain Medicines Prevention and WellnessStaying Healthy ...

  20. Chest radiographic findings in acute paraquat poisoning

    Energy Technology Data Exchange (ETDEWEB)

    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.

  1. Injuries of the chestFNx01

    Directory of Open Access Journals (Sweden)

    Deodhar S

    1979-01-01

    Full Text Available Thirty cases of chest injuries were admitted in the Department of Surgery, K.E.M. Hospital, Bombay. These injuries seem to be fairly common. Detailed examination at the time of admission is necessary to assess the clinical presentation and the presence of major complications. Institution of intra-peritoneal drainage, restoration of negative intra-pleural pressure and active respiratory physiotherapy constitute an important part of the treatment. The literature on this subject is briefly reviewed

  2. VAC® for external fixation of flail chest

    Directory of Open Access Journals (Sweden)

    Rikke Winge

    2012-06-01

    Full Text Available A large anterior chest wall defect following tumor resection was reconstructed with a Gore- Tex® membrane and a combined musculocutaneous rectus femoris and tensor fasciae latae free flap. Subsequent paradoxical respiration impeded weaning from the ventilator. Appliance of Vacuum Assisted Closure® (VAC® resulted in immediate chest wall stability and a decrease in the patient’s need for respiratory support. Shortly thereafter, the VAC® was discontinued and the patient was discharged from the intensive care unit (ICU. This case report is the first to describe the successful use of VAC® as an adjuvant to a one-stage procedure for large thoracic wall reconstruction, allowing sufficient temporary external fixation to eliminate paradoxical respiration and plausibly shorten the stay in the ICU. No adverse effects on flap healing or haemodynamics were recorded. It is likely that external VAC® can improve thoracic stability and pulmonary function in a patient with flail chest and decrease the need for mechanical ventilation.

  3. Practical implementation of the guidelines for unstable angina/non-ST-segment elevation myocardial infarction in the emergency department: a scientific statement from the American Heart Association Council on Clinical Cardiology (Subcommittee on Acute Cardiac Care), Council on Cardiovascular Nursing, and Quality of Care and Outcomes Research Interdisciplinary Working Group, in Collaboration With the Society of Chest Pain Centers.

    Science.gov (United States)

    Gibler, W Brian; Cannon, Christopher P; Blomkalns, Andra L; Char, Douglas M; Drew, Barbara J; Hollander, Judd E; Jaffe, Allan S; Jesse, Robert L; Newby, L Kristin; Ohman, E Magnus; Peterson, Eric D; Pollack, Charles V

    2005-05-24

    In the United States each year, >5.3 million patients present to emergency departments with chest discomfort and related symptoms. Ultimately, >1.4 million individuals are hospitalized for unstable angina and non-ST-segment elevation myocardial infarction. For emergency physicians and cardiologists alike, these patients represent an enormous challenge to accurately diagnose and appropriately treat. This update of the 2002 American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction (UA/NSTEMI) provides an evidence-based approach to the diagnosis and treatment of these patients in the emergency department, in-hospital, and after hospital discharge. Despite publication of the guidelines several years ago, many patients with UA/NSTEMI still do not receive guidelines-indicated therapy.

  4. Low back pain - acute

    Science.gov (United States)

    Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back ... lower back supports most of your body's weight. Low back pain is the number two reason that ...

  5. Orofacial Pain

    Science.gov (United States)

    ... spasms in the head, neck and jaw; migraines, cluster or frequent headaches; or pain with the teeth, ... periods of time. Signs that may indicate a headache of dental origin include: ; Pain behind the eyes ...

  6. Urination Pain

    Science.gov (United States)

    ... Health Growth & Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & Behavior School & Family Life First Aid & ... decreased appetite or activity irritability nausea or vomiting lower back pain or abdominal (belly) pain wetting accidents (in potty- ...

  7. Period Pain

    Science.gov (United States)

    ... You may also have other symptoms, such as lower back pain, nausea, diarrhea, and headaches. Period pain is not ... Taking a hot bath Doing relaxation techniques, including yoga and meditation You might also try taking over- ...

  8. [Oral pain].

    Science.gov (United States)

    Benslama, Lotfi

    2002-02-15

    Pain, a major symptom of stomatological disease, usually leads to a specialist consultation. Most commonly it is caused by dental caries and differs in nature and in intensity according to the stage of disease: dentinitis, pulpitis, desmodontitis and dental abscess. Added to this is peridental pain and the pre- and post-operative pains related to these diseases. Almost all oral-maxillary pathology is painful, be it boney such as in osteomyelitis and fractures, mucosal in gingivo-stomatitis and aphthous ulcers, or tumourous. However, besides the "multidisciplinary" facial pains such as facial neuralgia and vascular pain, two pain syndromes are specific to stomatology: pain of the tempero-mandibular joint associated with problems of the bite and glossodynia, a very common somatic expression of psychological problems.

  9. Back Pain

    Science.gov (United States)

    ... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...

  10. Pain Assessment

    Science.gov (United States)

    ... acupuncture, chiropractic care, massage or other manual therapies, yoga, herbal and nutritional therapies, or others. This information helps the health care provider understand the nature of the pain or the potential benefits of treatment. The goals of the comprehensive pain ...

  11. Breast pain

    Science.gov (United States)

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some swelling and tenderness just before your period ...

  12. Phantom Pain

    Science.gov (United States)

    ... the pain, such as reading or listening to music. Stay physically active. Get your exercise by doing ... Sept. 16, 2014. Alviar MJM, et al. Pharmacologic interventions for treating phantom limb pain. Cochrane Database of ...

  13. Neck Pain

    Science.gov (United States)

    ... antidepressants for pain relief. Therapy Physical therapy. A physical therapist can teach you correct posture, alignment and neck- ... therapy, under supervision of a medical professional and physical therapist, may provide relief of some neck pain, especially ...

  14. Phantom Pain

    NARCIS (Netherlands)

    Wolff, Andre; Vanduynhoven, Eric; van Kleef, Maarten; Huygen, Frank; Pope, Jason E.; Mekhail, Nagy

    2011-01-01

    Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation. The reported incidence of phantom limb pain after trauma, injury or peripheral vascular diseases is 60% to 80%. Over half the p

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

    2015-05-15

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  17. Chest physiotherapy in preterm infants with lung diseases

    Directory of Open Access Journals (Sweden)

    Cota Francesco

    2010-09-01

    Full Text Available Abstract Background In neonatology the role of chest physiotherapy is still uncertain because of the controversial outcomes. Methods The aim of this study was to test the applicability in preterm infants of 'reflex rolling', from the Vojta method, in preterm neonates with lung pathology, with particular attention to the effects on blood gases and oxygen saturation, on the spontaneous breathing, on the onset of stress or pain. The study included 34 preterm newborns with mean gestational age of 30.5 (1.6 weeks - mean (DS - and birth weight of 1430 (423 g - mean (DS -, who suffered from hyaline membrane disease, under treatment with nasal CPAP (continuous positive airways pressure, or from pneumonia, under treatment with oxygen-therapy. The neonates underwent phase 1 of 'reflex rolling' according to Vojta method three times daily. Respiratory rate, SatO2, transcutaneous PtcCO2 e PtcO2 were monitored; in order to evaluate the onset of stress or pain following the stimulations, the NIPS score and the PIPP score were recorded; cerebral ultrasound scans were performed on postnatal days 1-3-5-7, and then weekly. Results In this population the first phase of Vojta's 'reflex rolling' caused an increase of PtcO2 and SatO2 values. No negative effects on PtcCO2 and respiratory rate were observed, NIPS and PIPP stress scores remained unmodified during the treatment; in no patient the intraventricular haemorrhage worsened in time and none of the infants developed periventricular leucomalacia. Conclusions Our experience, using the Vojta method, allows to affirm that this method is safe for preterm neonates, but further investigations are necessary to confirm its positive effects and to evaluate long-term respiratory outcomes.

  18. Inpatient management of sickle cell pain: a 'snapshot' of current practice.

    Science.gov (United States)

    Miller, Scott T; Kim, Hae-Young; Weiner, Debra; Wager, Carrie G; Gallagher, Dianne; Styles, Lori; Dampier, Carlton D

    2012-03-01

    The Sickle Cell Disease Clinical Research Network (SCDCRN) designed the PROACTIVE Feasibility Study (ClinicalTrials.gov NCT00951808) to determine whether elevated serum levels of secretory phospholipase A2 (sPLA2) during hospitalization for pain would permit preemptive therapy of sickle cell acute chest syndrome (ACS) by blood transfusion. While PROACTIVE was not designed to assess pain management and was terminated early due to inadequate patient accrual, collection of clinical data allowed a "snapshot" of current care by expert providers. Nearly half the patients admitted for pain were taking hydroxyurea; hydroxyurea did not affect length of stay. Providers commonly administered parenteral opioid analgesia, usually morphine or hydromorphone, to adults and children, generally by patient-controlled analgesia (PCA). Adult providers were more likely to prescribe hydromorphone and did so at substantially higher morphine equivalent doses than were given to adults receiving morphine; the latter received doses similar to children who received either medication. All subjects treated with PCA received higher daily doses of opioids than those treated by time-contingent dosing. Physicians often restricted intravenous fluids to less than a maintenance rate and underutilized incentive spirometry, which reduces ACS in patients hospitalized for pain.

  19. Spontaneous pain attacks: neuralgic pain

    NARCIS (Netherlands)

    de Bont, L.G.

    2006-01-01

    Paroxysmal orofacial pains can cause diagnostic problems, especially when different clinical pictures occur simultaneously. Pain due to pulpitis, for example, may show the same characteristics as pain due to trigeminal neuralgia would. Moreover, the trigger point of trigeminal neuralgia can either b

  20. Spontaneous massive hemothorax secondary to chest wall chondrosarcoma: a case report.

    Science.gov (United States)

    Rad, Mohammad Ghasemi; Mahmodlou, Rahim; Mohammadi, Afshin; Mladkova, Nikol; Noorozinia, Farahnaz

    2011-01-01

    We present the case of a 30-year-old man with no past history of disease or recent trauma, who was seen in the emergency room after developing sharp pain in the left hemithorax. Chest roentgenogram showed costopherenic angle blunting and an oval mass in the left mediastinum. A computed tomographic scan showed extrapleural mass with coarse calcifications and pleural effusion, confirmed by magnetic resonance imaging. The tumor was biopsied and removed during thoracotomy. The pathology reported revealed chondrosarcoma, which is a rare cause for a spontaneous massive hemothorax. Invasion of the intercostals vessels by the tumor was the probable cause of hemothorax in this patient.

  1. A randomized controlled trial of tai chi for long-term low back pain (TAI CHI: Study rationale, design, and methods

    Directory of Open Access Journals (Sweden)

    Hall Amanda M

    2009-05-01

    Full Text Available Abstract Background Low back pain persisting for longer than 3 months is a common and costly condition for which many current treatments have low-moderate success rates at best. Exercise is among the more successful treatments for this condition, however, the type and dosage of exercise that elicits the best results is not clearly defined. Tai chi is a gentle form of low intensity exercise that uses controlled movements in combination with relaxation techniques and is currently used as a safe form of exercise for people suffering from other chronic pain conditions such as arthritis. To date, there has been no scientific evaluation of tai chi as an intervention for people with back pain. Thus the aim of this study will be to examine the effects of a tai chi exercise program on pain and disability in people with long-term low back pain. Methods and design The study will recruit 160 healthy individuals from the community setting to be randomised to either a tai chi intervention group or a wait-list control group. Individuals in the tai chi group will attend 2 tai chi sessions (40 minutes/week for 8 weeks followed by 1 tai chi session/week for 2 weeks. The wait-list control will continue their usual health care practices and have the opportunity to participate in the tai chi program once they have completed the follow-up assessments. The primary outcome will be bothersomeness of back symptoms measured with a 0–10 numerical rating scale. Secondary outcomes include, self-reports of pain-related disability, health-related quality of life and global perceived effect of treatment. Statistical analysis of primary and secondary outcomes will be based on the intention to treat principle. Linear mixed models will be used to test for the effect of treatment on outcome at 10 weeks follow up. This trial has received ethics approval from The University of Sydney Human Research Ethics Committee. HREC Approval No.10452 Discussion This study will be the first

  2. Physiotherapy for pain

    DEFF Research Database (Denmark)

    Ginnerup-Nielsen, Elisabeth; Christensen, Robin; Thorborg, Kristian

    2016-01-01

    OBJECTIVES: To empirically assess the clinical effects of physiotherapy on pain in adults. DESIGN: Using meta-epidemiology, we report on the effects of a 'physiotherapy' intervention on self-reported pain in adults. For each trial, the group difference in the outcome 'pain intensity' was assessed...... as standardised mean differences (SMD) with 95% CIs. Stratified analyses were conducted according to patient population (International Classification of Diseases-10 classes), type of physiotherapy intervention, their interaction, as well as type of comparator group and risks of bias. The quality of the body...... 'no intervention' or of a sham-controlled design were selected. Only articles written in English were eligible. RESULTS: An overall moderate effect of physiotherapy on pain corresponding to 0.65 SD-units (95% CI 0.57 to 0.73) was found based on a moderate inconsistency (I(2)=51%). Stratified...

  3. Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients’ Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment

    Science.gov (United States)

    Groothuis-Oudshoorn, Catharina GM; Vollenbroek-Hutten, Miriam MR; IJzerman, Maarten J

    2017-01-01

    Background Patient-centered design that addresses patients’ preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients’ preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients’ perspective. In addition, limited evidence is available about the best way to explore patients’ preferences. Therefore, the assessment of patients’ preferences regarding telemedicine is an important step toward the design of effective patient-centered care. Objective To identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them. Methods A discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations. Results Physician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients’ treatment preferences (Phealth care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation. Conclusions “Intermediate” telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home

  4. Efficacy of manipulation for non-specific neck pain of recent onset: design of a randomised controlled trial

    OpenAIRE

    2007-01-01

    Abstract Background Manipulation is a common treatment for non-specific neck pain. Neck manipulation, unlike gentler forms of manual therapy such as mobilisation, is associated with a small risk of serious neurovascular injury and can result in stroke or death. It is thought however, that neck manipulation provides better results than mobilisation where clinically indicated. There is long standing and vigorous debate both within and between the professions that use neck manipulation as well a...

  5. Pitfalls and variants in pediatric chest imaging.

    Science.gov (United States)

    García Asensio, D; Fernández Martín, M

    2016-05-01

    Most pitfalls in the interpretation of pediatric chest imaging are closely related with the technique used and the characteristics of pediatric patients. To obtain a quality image that will enable the correct diagnosis, it is very important to use an appropriate technique. It is important to know how technical factors influence the image and to be aware of the possible artifacts that can result from poor patient cooperation. Moreover, radiologists need to be familiar with the normal anatomy in children, with the classic radiologic findings, and with the anatomic and developmental variants to avoid misinterpreting normal findings as pathological.

  6. Atrioventricular Dissociation following Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Salim Surani

    2014-01-01

    Full Text Available Blunt chest trauma (BCT is a common clinical presentation seen in emergency departments. Few cases of cardiac conduction abnormalities due to BCT have been reported in the medical literature. This dysrhythmias may present as permanent conduction defects requiring permanent pacemaker or may have temporary conduction abnormalities requiring temporary pacemaker or supportive care. We present the case of a young woman who suffered from BCT after being kicked by a horse with the development of a significant substernal hematoma. She developed temporary atrioventricular block, which was completely resolved with the decrease in the size of the substernal hematoma suffered.

  7. Pain genes.

    Directory of Open Access Journals (Sweden)

    Tom Foulkes

    2008-07-01

    Full Text Available Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors signal the existence of tissue damage to the central nervous system (CNS, where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.

  8. The comparison of three high-frequency chest compression devices.

    Science.gov (United States)

    Lee, Yong W; Lee, Jongwon; Warwick, Warren J

    2008-01-01

    High-frequency chest compression (HFCC) is shown to enhance clearance of pulmonary airway secretions. Several HFCC devices have been designed to provide this therapy. Standard equipment consists of an air pulse generator attached by lengths of tubing to an adjustable, inflatable vest/jacket (V/J) garment. In this study, the V/Js were fitted over a mannequin. The three device air pulse generators produced characteristic waveform patterns. The variations in the frequency and pressure setting of devices were consistent with specific device design features. These studies suggest that a better understanding of the effects of different waveform, frequency, and pressure combinations may improve HFCC therapeutic efficacy of three different HFCC machines. The V/J component of HFCC devices delivers the compressive pulses to the chest wall to produce both airflow through and oscillatory effects in the airways. The V/J pressures of three HFCC machines were measured and analyzed to characterize the frequency, pressure, and waveform patterns generated by each of three device models. The dimensions of all V/Js were adjusted to a circumference of approximately 110% of the chest circumference. The V/J pressures were measured, and maximum, minimum, and mean pressure, pulse pressure, and root mean square of three pulse generators were calculated. Jacket pressures ranged between 2 and 34 mmHg. The 103 and 104 models' pulse pressures increased with the increase in HFCC frequency at constant dial pressure. With the ICS the pulse pressure decreased when the frequency increased. The waveforms of models 103 and 104 were symmetric sine wave and asymmetric sine wave patterns, respectively. The ICS had a triangular waveform. At 20 Hz, both the 103 and 104 were symmetric sine waveform but the ICS remained triangular. Maximum crest factors emerged in low-frequency and high-pressure settings for the ICS and in the high-frequency and low-pressure settings for models 103 and 104. Recognizing the

  9. Bacteriological research for the contamination of equipment in chest radiography

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung Gu; Song, Woon Heung; Kweon, Dae Cheol [Shinhan University, Uijeongbu (Korea, Republic of)

    2015-12-15

    The purpose is to determine the degree of contamination of the equipment for infection control in chest radiography of the radiology department. We confirmed by chemical and bacterial identification of bacteria of the equipment and established a preventive maintenance plan. Chest X-ray radiography contact area on the instrument patients shoulder, hand, chin, chest lateral radiography patient contact areas with a 70% isopropyl alcohol cotton swab were compared to identify the bacteria before and after sterilization on the patient contact area in the chest radiography equipment of the department. The gram positive Staphylococcus was isolated from side shoots handle before disinfection in the chest radiography equipment. For the final identification of antibiotic tested that it was determined by performing the nobobiocin to the sensitive Staphylococcus epidermidis. Chest radiography equipment before disinfecting the handle side of Staphylococcus epidermidis bacteria were detected using a disinfectant should be to prevent hospital infections.

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

    Directory of Open Access Journals (Sweden)

    A. M. Golubev

    2012-01-01

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

  11. Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

    Science.gov (United States)

    Temkit, M’hamed; Ewais, MennatAllah M.; Luckritz, Todd C.; Stearns, Joshua D.; Craner, Ryan C.; Gaitan, Brantley D.; Ramakrishna, Harish; Thunberg, Christopher A.; Weis, Ricardo A.; Myers, Kelly M.; Merritt, Marianne V.; Rosenfeld, David M.

    2016-01-01

    Background Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients’ pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q). Methods Patients undergoing MIRPE (modified Nuss) underwent random assignment to TEA or On-Q group. Both groups received intravenous, patient-controlled opioid analgesia, with concomitant delivery of local anesthetic. Primary outcomes were length of stay (LOS), opioid use, and pain scores. Results Of 85 randomly assigned patients, 68 completed the study [52 men, 76.5%; mean (range) age, 32.2 (20.0–58.0) years; Haller index, 5.9 (range, 3.0-26.7)]. The groups were equally matched for preoperative variables; however, the On-Q arm had more patients (60.3%). No significant differences were found between groups in mean daily pain scores (P=0.52), morphine-equivalent opioid usage (P=0.28), or hospital stay 3.5 vs. 3.3 days (TEA vs. On-Q; P=0.55). Thirteen patients randomized to TEA refused the epidural and withdrew from the study because they perceived greater benefit of the On-Q system. Conclusions Postoperative pain management in adults after MIRPE can be difficult. Both continuous local anesthetic delivery by TEA and On-Q catheters with concomitant, intravenous, patient-controlled anesthesia maintained acceptable analgesia with a reasonable LOS. In our cohort, there was preference for the On-Q system for pain management. PMID:27621865

  12. Neuropathic pain

    DEFF Research Database (Denmark)

    Colloca, Luana; Ludman, Taylor; Bouhassira, Didier

    2017-01-01

    Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7-10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing...... to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central...... nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased...

  13. Bone pain

    DEFF Research Database (Denmark)

    Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

    2016-01-01

    Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

  14. Development and evaluation of a novel taekwondo chest protector to improve mobility when performing axe kicks.

    Science.gov (United States)

    Woo, J H; Ko, J Y; Choi, E Y; Her, J G; O'Sullivan, D M

    2013-03-01

    The axe kick, in Olympic style taekwondo, has been identified as the most popular scoring technique aimed to the head during full contact competition. The first purpose of this study was to identify and investigate design issues with the current World Taekwondo Federation approved chest protector. A secondary purpose was to develop a novel chest protector addressing the identified design issues and to conduct a biomechanical analysis. Fifteen male elite Taekwondo players were selected to perform three different styles of the axe kick, i.e., front, in-out, and out-in axe kick five times each for a total of 45 kicks. Two-way repeated measures ANOVA showed significant differences between the novel and existing chest protector conditions for vertical height of the toe, downward kicking foot speed, hip flexion angle and ipsilateral shoulder flexion extension range of motion (ROM) (p 0.05). These results indicate that the novel chest protector interferes less with both the lower and upper limbs during the performance of the axe kick and provides a more natural, free-moving alternative to the current equipment used.

  15. Scope and limitations of sonography of the chest during childhood

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, K.; Mayr, B.; Fendel, H.

    1986-05-01

    The advantages and limitations of the sonographic examination of the chest in 16 children are described. Partial opacification of the chest has been found in nine, a total 'white' hemithorax in 7 children. Sonographic guided taps of the chest were performed in 3 children. Necessity, extent and yield of additional radiological examinations, especially computed tomography of the thorax, are discussed in detail.

  16. Chest physiotherapy in children with acute bacterial pneumonia

    OpenAIRE

    2015-01-01

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

  17. Optical compensation device for chest film radiography

    Science.gov (United States)

    Gould, Robert G.; Hasegawa, Bruce H.; DeForest, Sherman E.; Schmidt, Gregory W.; Hier, Richard G.

    1990-07-01

    Although chest radiography is the most commonly performed radiographic examination and one of the most valuable and cost-effective studies in medicine it suffers from relatively high error rates in both missing pathology and false positive interpretations. Detectability of lung nodules and other structures in underpenetrated regions of the chest film can be improved by both exposure and optical compensation but current compensation systems require major capital cost or a significant change in normal clinical practice. A new optical compensation system called the " Intelligent X-Ray Illuminator" (IXI) automatically and virtually instantaneously generates a patient-specific optical unsharp mask that is projected directly on a radiograph. When a radiograph is placed on the IXI which looks much like a conventional viewbox it acquires a low-resolution electronic image of this film from which the film transmission is derived. The transmission information is inverted and blurred in an image processor to form an unsharp mask which is fed into a spatial light modulator (SLM) placed between a light source and the radiograph. The SLM tailors the viewbox luminance by decreasing illumination to underexposed (i. e. transmissive) areas of the radiograph presenting the observer with an optically unsharp-masked image. The IXI uses the original radiograph and will allow it to be viewed on demand with conventional (uniform illumination. Potentially the IXI could introduce the known beneficial aspects of optical unsharp masking into radiology at low capital

  18. Cross-chest liposuction in gynaecomastia

    Directory of Open Access Journals (Sweden)

    Biju Murali

    2011-01-01

    Full Text Available Background: Gynaecomastia is usually treated with liposuction or liposuction with excision of the glandular tissue. The type of surgery chosen depends on the grade of the condition. Objective: Because gynaecomastia is treated primarily as a cosmetic procedure, we aimed at reducing the invasiveness of the surgery. Materials and Methods: The technique complies with all recommended protocols for different grades of gynaecomastia. It uses liposuction, gland excision, or both, leaving only minimal post-operative scars. The use of cross-chest liposuction through incisions on the edge of the areola helps to get rid of all the fat under the areola without an additional scar as in the conventional method. Results: This is a short series of 20 patients, all with bilateral gynaecomastia (i.e., 40 breasts, belonging to Simon′s Stage 1 and 2, studied over a period of 2 years. The average period of follow-up was 15 months. Post-operative complications were reported in only two cases, with none showing long-term complications or issues specifically due to the procedure. Conclusions : Cross-chest liposuction for gynaecomastia is a simple yet effective surgical tool in bilateral gynaecomastia treatment to decrease the post-operative scars. The use of techniques like incision line drain placement and post-drain removal suturing of wounds aid in decreasing the scar.

  19. Molecular Signatures of Chronic Pain Subtypes

    Science.gov (United States)

    2013-01-01

    problematic; patients experience not only nociceptive pain but also acute neuralgia and occasion- ally the immediate onset of phantom limb pain .8...post-thoracotomy pain have been initiated preoperatively.69 This preemptive effect is designed to reduce nociceptive traffic to the spinal cord and... nociceptive and inflammatory pain and has been linked to temporomandibular joint pain syndromes [50]. Even studies of COMT, however, have demonstrated

  20. Unilateral facial pain and lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Shakespeare, T.P.; Stevens, M.J. [Royal North Shore Hospital, Crows Nest, NSW (Australia)

    1996-02-01

    Facial pain in lung cancer patients may be secondary to metastatic disease to the brain or skull base. Since 1983 there have been 19 published reports of hemi-facial pain as a non-metastatic complication of lung carcinoma. This report describes an additional case in whom unilateral face pain preceded the diagnosis of lung cancer by 9 months. A clinical diagnosis of trigeminal neuralgia was made after a normal brain CT scan. Later on the patient complained of global lethargy, weight loss and haemoptysis. A chest X-ray disclosed a 6 cm right hilar mass that was further defined with a whole body CT scan. The neural mechanism of the unilateral facial pain is discussed and the literature reviewed. 14 refs., 1 tab.

  1. Central pain.

    Science.gov (United States)

    Singh, Supreet

    2014-12-01

    Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topic addressed in this issue is central pain, a neuropathic pain syndrome caused by a lesion in the brain or spinal cord that sensitizes one's perception of pain. It is a debilitating condition caused by various diseases such as multiple sclerosis, strokes, spinal cord injuries, or brain tumors. Varied symptoms and the use of pharmacological medicines and nonpharmacological therapies will be addressed.

  2. Chest trauma in children: current imaging guidelines and techniques.

    LENUS (Irish Health Repository)

    Moore, Michael A

    2011-09-01

    Given the heterogeneous nature of pediatric chest trauma, the optimal imaging approach is tailored to the specific patient. Chest radiography remains the most important imaging modality for initial triage. The decision to perform a chest computed tomography scan should be based on the nature of the trauma, the child\\'s clinical condition, and the initial radiographic findings, taking the age-related pretest probabilities of serious injury into account. The principles of as low as reasonably achievable and Image Gently should be followed. The epidemiology and pathophysiology, imaging techniques, characteristic findings, and evidence-based algorithms for pediatric chest trauma are discussed.

  3. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    Directory of Open Access Journals (Sweden)

    João Palas

    2014-01-01

    Full Text Available Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  4. Multidetector computer tomography: evaluation of blunt chest trauma in adults.

    Science.gov (United States)

    Palas, João; Matos, António P; Mascarenhas, Vasco; Herédia, Vasco; Ramalho, Miguel

    2014-01-01

    Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  5. Measuring chest circumference change during respiration with an electromagnetic biosensor.

    Science.gov (United States)

    Padasdao, Bryson; Shahhaidar, Ehsaneh; Boric-Lubecke, Olga

    2013-01-01

    In this paper, an off-the-shelf DC motor is modified into a chest belt and used to successfully measure circumference change on a mechanical chest model, while simultaneously harvesting significant power. Chest circumference change can provide information on tidal volume, which is vital in assessing lung function. The chest circumference change is calculated from the motor's voltage output. Calculated values are within 0.95mm of measured circumference changes, with a standard deviation of 0.37mm. The wearable motor can also harvest at least 29.4µW during normal breathing.

  6. Does anterior trunk pain predict a different course of recovery in chronic low back pain?

    Science.gov (United States)

    Panagopoulos, John; Hancock, Mark J; Kongsted, Alice; Hush, Julia; Kent, Peter

    2014-05-01

    Patient characteristics associated with the course and severity of low back pain (LBP) and disability have been the focus of extensive research, however, known characteristics do not explain much of the variance in outcomes. The relationship between anterior trunk pain (ATP) and LBP has not been explored, though mechanisms for visceral referred pain have been described. Study objectives were: (1) determine prevalence of ATP in chronic LBP patients, (2) determine whether ATP is associated with increased pain and disability in these patients, and (3) evaluate whether ATP predicts the course of pain and disability in these patients. In this study, spinal outpatient department patients mapped the distribution of their pain and patients describing pain in their chest, abdomen or groin were classified with ATP. Generalized estimating equations were performed to investigate the relationship between ATP and LBP outcomes. A total of 2974 patients were included and 19.6% of patients reported ATP. At all time points, there were significant differences in absolute pain intensity and disability in those with ATP compared with those without. The presence of ATP did not affect the clinical course of LBP outcomes. The results of this study suggest that patients who present with LBP and ATP have higher pain and disability levels than patients with localised LBP. Visceral referred pain mechanisms may help to explain some of this difference.

  7. Safety of early pain relief for acute abdominal pain.

    OpenAIRE

    Attard, A.R.; Corlett, M. J.; Kidner, N. J.; Leslie, A. P.; Fraser, I. A.

    1992-01-01

    OBJECTIVES--(a) to determine the efficacy of papaveretum in treating pain when administered early to patients presenting with acute abdominal pain and (b) to assess its effect on subsequent diagnosis and management. DESIGN--Prospective, randomised, placebo controlled study. SETTING--Walsgrave Hospital, Coventry. SUBJECTS--100 consecutive patients with clinically significant abdominal pain who were admitted as emergencies to a surgical firm. INTERVENTIONS--Intramuscular injection of up to 20 m...

  8. Pain frequency moderates the relationship between pain catastrophizing and pain

    OpenAIRE

    2014-01-01

    Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequen...

  9. Pain frequency moderates the relationship between pain catastrophizing and pain

    OpenAIRE

    2014-01-01

    Background Pain frequency has been shown to influence sensitization, psychological distress and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale, Beck Depression Inventory and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency Results In...

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  11. Large hiatal hernia at chest radiography in a woman with cardiorespiratory symptoms.

    Science.gov (United States)

    Torres, Daniele; Parrinello, Gaspare; Cardillo, Mauro; Pomilla, Marina; Trapanese, Caterina; Michele, Bellanca; Lupo, Umberto; Schimmenti, Caterina; Cuttitta, Francesco; Pietrantoni, Rossella; Vogiatzis, Danai; Licata, Giuseppe

    2012-11-01

    Hiatal hernia (HH) is a frequent entity. Rarely, it may exert a wide spectrum of clinical presentations mimicking acute cardiovascular events such as angina-like chest pain until manifestations of cardiac compression that can include postprandial syncope, exercise intolerance, respiratory function, recurrent acute heart failure, and hemodynamic collapse. A 69-year-old woman presented to the emergency department complaining of fatigue on exertion, cough, and episodes of restrosternal pain with less than 1 hour of duration. Her medical history only included some episodes of bronchitis and no history of hypertension. The 12-lead electrocardiogram demonstrated sinus rhythm with right bundle-branch block. Laboratory tests, including cardiac troponin I, were within normal reference values. Chest radiography showed no significant pulmonary alterations and revealed in mediastinum a huge abnormal shadow overlapping the right heart compatible with a gastric bubble.The gastroscopy confirmed a large HH. A 2-dimensional transthoracic echocardiogram, using all standard and modified apical and parasternal views, revealed an echolucent mass, compatible with HH, compressing the right atrium. Also, it showed an altered left ventricular relaxation and a mild increase of pulmonary artery pressure (35 mm Hg). Spirometry showed a mild obstruction of the small airways, whereas coronary angiography showed normal coronary arteries. We concluded that the patient's symptomatology was related to the compressive effects of the large hiatal ernia, a neglected cause of cardiorespiratory symptoms. The surgical repair of HH was indicated.

  12. Pain Assessment Using The Adolescent Pediatric Pain Tool: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Ananda Maria Fernandes

    2014-01-01

    Full Text Available BACKGROUND: The Adolescent Pediatric Pain Tool (APPT is a multidimensional pain assessment tool designed to assess pain location (body outline diagram, intensity (word graphic rating scale and quality (list of pain descriptors in hospitalized children eight to 17 years of age.

  13. Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence

    Science.gov (United States)

    Zeitani, Jacob; Russo, Marco; Pompeo, Eugenio; Sergiacomi, Gian Luigi; Chiariello, Luigi

    2016-01-01

    Background The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. Methods In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included the presence of hemisternum diastases associated with multiple (≥3) bone fractures and radiologic evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm excursion, synchronous and paradoxical chest wall motion. Results Follow-up was 100% complete (mean 85±24 months). CWPM was inversely correlated with single lung VC (Spearman R=−0.72, p=0.0003), global VC (R=−0.51, p=0.02) and diaphragm excursion (R=−0.80, p=0.0003), whereas it proved directly correlated with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC. Conclusion Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring and it is associated with better clinical outcomes with less pain and dyspnea. PMID:27733997

  14. Routine chest drainage after patent ductus arteriosis ligation is not necessary.

    Directory of Open Access Journals (Sweden)

    Samuel Kai San YAPP

    2010-12-01

    Full Text Available Introduction: Chest drain insertion after surgical patent ductus arteriosus (PDA ligation creates significant morbidities in terms of pain, pleural space infection, reduced mobility as well as prolonged hospital stay. We investigated the safety and efficacy of performing drainless thoracotomy closure following PDA ligation in a paediatric population. Materials and Methods: Retrospective analysis of data collected from 13 paediatric patients undergoing PDA ligation at RIPAS hospital by a single surgeon over a period of five years (2001 to 2006 was performed. All continuous data were presented as mean ± standard deviation. Results: PDA ligation was performed via a left thoracotomy in 13 pediatric patients with a mean age of 2.24 ± 2.03 years (ten females and three males. Mean duration of the procedures was 67 ± 12 minutes. There was minimal blood loss and no transfusion was required. Postoperatively, ten patients required only oral paracetamol for pain relief. Two patients required additional non steroidal anti-inflammatory drugs (NSAIDs. One patient had one dose of pethidine immediately post-operatively. Post-operative chest radiographs confirmed full expansion of the left lung except in one patient who had a small apical pneumothorax. Two other patients developed mild surgical emphysema despite full expansion of the left lung. All three cases resolved spontaneously after a day. Median post-operative stay was two days. There were no cases of left recurrent nerve injuries and no mortality. Conclusion: Routine chest drainage is not necessary following uncomplicated surgical PDA ligation and patients recovered quicker and are discharge earlier.

  15. Neuropathic pain

    Directory of Open Access Journals (Sweden)

    Giuseppe Re

    2009-02-01

    Full Text Available Neuropathic pain is the expression of a dysfunction or primary lesion of a nerve in the peripheral or central nervous system, or both, rather than the biological signal transmitted by the nerve following peripheral nociceptor activation. It represents about 20% of all painful syndromes, with an estimated prevalence of 1.5%, however is actual incidence is hard to pinpoint due to the difficulties encountered in distinguishing it from chronic pain, of which it represents a significant percentage, on account of the not infrequent concurrence of conditions. It is crucial to recognise the variety of symptoms with which it can present: these can be negative and positive and, in turn, motor, sensitive and autonomic. In public health terms, it is important to emphasise that the diagnosis of neuropathic pain does not in most cases require sophisticated procedures and does not therefore weigh on health expenditure. In clinical practice, a validated scale (the LANSS is mentioned is useful for identifying patients presenting neuropathic pain symptoms. Therapy is based on three categories of medication: tricyclic antidepressants, anti-epileptics and opioids at high doses: neuropathic pain has a bad reputation for often resisting common therapeutic approaches and responding less well that nociceptor pain to monotherapy. Therapeutic strategies are all the more adequate the more they are based on symptoms and therefore on the pain generation mechanisms, although the recommendations are dictated more by expert opinions that double-blind randomised trials.

  16. Interventional Analgesic Management of Lung Cancer Pain

    Science.gov (United States)

    Hochberg, Uri; Elgueta, Maria Francisca; Perez, Jordi

    2017-01-01

    Lung cancer is one of the four most prevalent cancers worldwide. Comprehensive patient care includes not only adherence to clinical guidelines to control and when possible cure the disease but also appropriate symptom control. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer; it can arise from local invasion of chest structures or metastatic disease invading bones, nerves, or other anatomical structures potentially painful. Pain can also be a consequence of therapeutic approaches like surgery, chemotherapy, or radiotherapy. Conventional medical management of cancer pain includes prescription of opioids and coadjuvants at doses sufficient to control the symptoms without causing severe drug effects. When an adequate pharmacological medical management fails to provide satisfactory analgesia or when it causes limiting side effects, interventional cancer pain techniques may be considered. Interventional pain management is devoted to the use of invasive techniques such as joint injections, nerve blocks and/or neurolysis, neuromodulation, and cement augmentation techniques to provide diagnosis and treatment of pain syndromes resistant to conventional medical management. Advantages of interventional approaches include better analgesic outcomes without experiencing drug-related side effects and potential for opioid reduction thus avoiding central side effects. This review will describe various pain syndromes frequently described in lung cancer patients and those interventional techniques potentially indicated for those cases. PMID:28261561

  17. Effects of Mindfulness Meditation on Chronic Pain

    DEFF Research Database (Denmark)

    la Cour, Peter; Petersen, Marian

    2015-01-01

    OBJECTIVE: This randomized controlled clinical trial investigated the effects of mindfulness meditation on chronic pain. DESIGN: A total of 109 patients with nonspecific chronic pain were randomized to either a standardized mindfulness meditation program (mindfulness-based stress reduction [MBSR...

  18. An unusual cause for recurrent chest infections.

    LENUS (Irish Health Repository)

    Lobo, Ronstan

    2012-10-01

    We present a case of an elderly non-smoking gentleman who, since 2005, had been admitted multiple times for recurrent episodes of shortness of breath, wheeze, cough and sputum. The patient was treated as exacerbations of chronic obstructive pulmonary disease (COPD) and\\/or lower respiratory tract infections. Bronchoscopy was done which revealed multiple hard nodules in the trachea and bronchi with posterior tracheal wall sparing. Biopsies confirmed this as tracheopathia osteochondroplastica (TO). He had increasing frequency of admission due to methicillin-resistant Staphylococcus aureus and pseudomonas infections, which failed to clear despite intravenous, prolonged oral and nebulised antibiotics. The patient developed increasing respiratory distress and respiratory failure. The patient died peacefully in 2012. This case report highlights the typical pathological and radiological findings of TO and the pitfalls of misdiagnosing patients with recurrent chest infections as COPD.

  19. Pleural fluids associated with chest infection.

    Science.gov (United States)

    Quadri, Amal; Thomson, Anne H

    2002-12-01

    Pleural effusions are commonly associated with pneumonias and a small number of these progress to empyema. An understanding of the physiology and pathophysiology of pleural fluid aids the clinician in the management of empyema. There remains much debate about the optimal treatment of empyema in children. Early recognition of the condition is important since delayed therapy may result in unnecessary morbidity. Conventional management with high dose parenteral antibiotics and chest tube drainage remains the mainstay of therapy. However, this treatment modality may fail if the pleural fluid becomes viscous and loculated and, therefore, a more aggressive approach is required. Intrapleural fibrinolytic therapy has been shown to decrease the length of hospital stay and may reduce the need for surgical intervention. The prognosis in children with parapneumonic empyema is excellent with the vast majority retaining normal lung function at long term follow-up.

  20. Diagnosing Myocardial Contusion after Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Zahra Alborzi

    2016-10-01

    Full Text Available A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is a major cause of rapid death which happens after blunt chest trauma and should be suspected at triage in the emergency department. We demonstrated that suspected myocardial contusion patients who have normal electrocardiograms (ECGs and biomarker tests can be safely discharged. However, if the test results are abnormal, the next steps should be echocardiography and more advanced measures. Diagnosing myocardial contusion is very difficult because of its nonspecific symptoms. If a myocardial contusion happens, cardiogenic shock or arrhythmia must be anticipated, and the patient must be carefully monitored.

  1. Relevance of an incidental chest finding

    Science.gov (United States)

    Cortés-Télles, Arturo; Mendoza, Daniel

    2012-01-01

    Solitary pulmonary nodule represents 0.2% of incidental findings in routine chest X-ray images. One of the main diagnoses includes lung cancer in which small-cell subtype has a poor survival rate. Recently, a new classification has been proposed including the very limited disease stage (VLD stage) or T1-T2N0M0 with better survival rate, specifically in those patients who are treated with surgery. However, current recommendations postulate that surgery remains controversial as a first-line treatment in this stage. We present the case of a 46-year-old female referred to our hospital with a preoperative diagnosis of a solitary pulmonary nodule. On initial approach, a biopsy revealed a small cell lung cancer. She received multimodal therapy with surgery, chemotherapy, and prophylactic cranial irradiation and is currently alive without recurrence on a 2-year follow-up. PMID:22345914

  2. Tuberculosis abscess of the chest wall.

    Science.gov (United States)

    Cataño, Juan; Perez, Jefferson

    2014-10-01

    A 42-year-old male presented in June of 2011 with nocturnal fevers, night sweats, an 8-kg weight loss, and a cutaneous right chest wall mass. In March of 2013, a computed tomographic scan of the thorax showed a 54 × 18 × 26-mm right lower lobe mass with peripheral calcifications, and in May of 2013, he was admitted for a segmental lobectomy, in which histologic examination of the pulmonary tissue revealed granulomas with multinucleated giant cells. The tissue was negative for acid-fast bacillae on Ziehl-Neelsen stain, and culture grew Mycobacterium tuberculosis. Therefore, he was started on four first-line antituberculosis medications and showed rapid symptomatic improvement.

  3. Chest magnetic resonance imaging: a protocol suggestion

    Directory of Open Access Journals (Sweden)

    Bruno Hochhegger

    2015-12-01

    Full Text Available Abstract In the recent years, with the development of ultrafast sequences, magnetic resonance imaging (MRI has been established as a valuable diagnostic modality in body imaging. Because of improvements in speed and image quality, MRI is now ready for routine clinical use also in the study of pulmonary diseases. The main advantage of MRI of the lungs is its unique combination of morphological and functional assessment in a single imaging session. In this article, the authors review most technical aspects and suggest a protocol for performing chest MRI. The authors also describe the three major clinical indications for MRI of the lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.

  4. Chest magnetic resonance imaging: a protocol suggestion*

    Science.gov (United States)

    Hochhegger, Bruno; de Souza, Vinícius Valério Silveira; Marchiori, Edson; Irion, Klaus Loureiro; Souza Jr., Arthur Soares; Elias Junior, Jorge; Rodrigues, Rosana Souza; Barreto, Miriam Menna; Escuissato, Dante Luiz; Mançano, Alexandre Dias; Araujo Neto, César Augusto; Guimarães, Marcos Duarte; Nin, Carlos Schuler; Santos, Marcel Koenigkam; Silva, Jorge Luiz Pereira e

    2015-01-01

    In the recent years, with the development of ultrafast sequences, magnetic resonance imaging (MRI) has been established as a valuable diagnostic modality in body imaging. Because of improvements in speed and image quality, MRI is now ready for routine clinical use also in the study of pulmonary diseases. The main advantage of MRI of the lungs is its unique combination of morphological and functional assessment in a single imaging session. In this article, the authors review most technical aspects and suggest a protocol for performing chest MRI. The authors also describe the three major clinical indications for MRI of the lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation. PMID:26811555

  5. An improved automatic computer aided tube detection and labeling system on chest radiographs

    Science.gov (United States)

    Ramakrishna, Bharath; Brown, Matthew; Goldin, Jonathan; Cagnon, Christopher; Enzmann, Dieter

    2012-03-01

    Tubes like Endotracheal (ET) tube used to maintain patient's airway and the Nasogastric (NG) tube used to feed the patient and drain contents of the stomach are very commonly used in Intensive Care Units (ICU). The placement of these tubes is critical for their proper functioning and improper tube placement can even be fatal. Bedside chest radiographs are considered the quickest and safest method to check the placement of these tubes. Tertiary ICU's typically generate over 250 chest radiographs per day to confirm tube placement. This paper develops a new fully automatic prototype computer-aided detection (CAD) system for tube detection on bedside chest radiographs. The core of the CAD system is the randomized algorithm which selects tubes based on their average repeatability from seed points. The CAD algorithm is designed as a 5 stage process: Preprocessing (removing borders, histogram equalization, anisotropic filtering), Anatomy Segmentation (to identify neck, esophagus, abdomen ROI's), Seed Generation, Region Growing and Tube Selection. The preliminary evaluation was carried out on 64 cases. The prototype CAD system was able to detect ET tubes with a True Positive Rate of 0.93 and False Positive Rate of 0.02/image and NG tubes with a True Positive Rate of 0.84 and False Positive Rate of 0.02/image respectively. The results from the prototype system show that it is feasible to automatically detect both tubes on chest radiographs, with the potential to significantly speed the delivery of imaging services while maintaining high accuracy.

  6. Resuscitation, prolonged cardiac arrest, and an automated chest compression device

    DEFF Research Database (Denmark)

    Risom, Martin; Jørgensen, Henrik; Rasmussen, Lars S;

    2010-01-01

    The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest.......The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest....

  7. Automatic segmentation of pulmonary segments from volumetric chest CT scans.

    NARCIS (Netherlands)

    Rikxoort, E.M. van; Hoop, B. de; Vorst, S. van de; Prokop, M.; Ginneken, B. van

    2009-01-01

    Automated extraction of pulmonary anatomy provides a foundation for computerized analysis of computed tomography (CT) scans of the chest. A completely automatic method is presented to segment the lungs, lobes and pulmonary segments from volumetric CT chest scans. The method starts with lung segmenta

  8. Low dose computed tomography of the chest : Applications and limitations

    NARCIS (Netherlands)

    Gietema, H.A.

    2007-01-01

    In areas with a high intrinsic contrast such as the chest, radiation dose can be reduced for specific indications. Low dose chest CT is feasible and cannot only be applied for lung cancer screening, but also in daily routine and for early detection of lung destruction. We showed in a small sample of

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

    Science.gov (United States)

    Postiaux, Guy; Zwaenepoel, Bruno; Louis, Jacques

    2013-09-01

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

  10. Giant pericardial cyst mimicking dextrocardia on chest X-ray.

    Science.gov (United States)

    Hamad, Hamad M; Galrinho, Ana; Abreu, João; Valente, Bruno; Bakero, Luis; Ferreira, Rui C

    2013-01-01

    Pericardial cysts are rare benign congenital malformations, usually small, asymptomatic and detected incidentally on chest X-ray as a mass located in the right costophrenic angle. Giant pericardial cysts are very uncommon and produce symptoms by compressing adjacent structures. In this report, the authors present a case of a symptomatic giant pericardial cyst incorrectly diagnosed as dextrocardia on chest X-ray.

  11. Measurement of characteristic leap interval between chest and falsetto registers

    NARCIS (Netherlands)

    Miller, DG; Svec, JG; Schutte, HK

    2002-01-01

    A markedly smaller time constant distinguishes a chest-falsetto leap from the more usual execution of a sung interval by muscular adjustments in the length and tension of the vocal folds. The features of such a chest-falsetto leap are examined in detail with respect to F-0, peak-to-peak amplitude of

  12. Effect of rib-cage structure on acoustic chest impedance

    DEFF Research Database (Denmark)

    Zimmermann, Niels Henrik; Møller, Henrik; Hansen, John;

    2011-01-01

    When a stethoscope is placed on the surface of the chest, the coupler picks up sound from heart and lungs transmitted through the tissues of the ribcage and from the surface of the skin. If the acoustic impedance of the chest surface is known, it is possible to optimize the coupler for picking up...

  13. Management of chest drainage tubes after lung surgery.

    Science.gov (United States)

    Satoh, Yukitoshi

    2016-06-01

    Since chest tubes have been routinely used to drain the pleural space, particularly after lung surgery, the management of chest tubes is considered to be essential for the thoracic surgeon. The pleural drainage system requires effective drainage, suction, and water-sealing. Another key point of chest tube management is that a water seal is considered to be superior to suction for most air leaks. Nowadays, the most common pleural drainage device attached to the chest tube is the three-bottle system. An electronic chest drainage system has been developed that is effective in standardizing the postoperative management of chest tubes. More liberal use of digital drainage devices in the postoperative management of the pleural space is warranted. The removal of chest tubes is a common procedure occurring almost daily in hospitals throughout the world. Extraction of the tube is usually done at the end of full inspiration or at the end of full expiration. The tube removal technique is not as important as how it is done and the preparation for the procedure. The management of chest tubes must be based on careful observation, the patient's characteristics, and the operative procedures that had been performed.

  14. Options for assessing and measuring chest wall motion.

    Science.gov (United States)

    Seddon, Paul

    2015-01-01

    Assessing chest wall motion is a basic and vital component in managing the child with respiratory problems, whether these are due to pathology in the lungs, airways, chest wall or muscles. Since the 1960s, clinical assessment has been supplemented with an ever-growing range of technological options for measuring chest wall motion, each with unique advantages and disadvantages. Measurements of chest wall motion can be used to: (1) Assess respiratory airflow and volume change, as a non-invasive alternative to measurement at the airway opening, (2) Monitor breathing over long periods of time, to identify apnoea and other types of sleep-disordered breathing, (3)Identify and quantify patterns of abnormal chest wall movement, whether between ribcage and abdominal components (thoracoabdominal asynchrony) or between different regions of the ribcage (eg in scoliosis and pectus excavatum). Measuring chest wall motion allows us to do things which simply cannot be done by more mainstream respiratory function techniques measuring flow at the airway opening: it allows respiratory airflow to be measured when it would otherwise be impossible, and it tells us how the different parts of the chest wall (eg ribcage vs abdomen, right vs left) are moving in order to generate that airflow. The basis of the different techniques available to assess and measure chest wall motion will be reviewed and compared, and their relevance to paediatric respiratory practice assessed.

  15. Segmentation of anatomical structures in chest CT scans

    NARCIS (Netherlands)

    van Rikxoort, E.M.

    2009-01-01

    In this thesis, methods are described for the automatic segmentation of anatomical structures from chest CT scans. First, a method to segment the lungs from chest CT scans is presented. Standard lung segmentation algorithms rely on large attenuation differences between the lungs and the surrounding

  16. Quantitative evaluation of correlation of dose and FDG-PET uptake value with clinical chest wall complications in patients with lung cancer treated with stereotactic body radiation therapy.

    Science.gov (United States)

    Algan, O; Confer, M; Algan, S; Matthiesen, C; Herman, T; Ahmad, S; Ali, I

    2015-01-01

    The aim of this study was to investigate quantitatively the dosimetric factors that increase the risk of clinical complications of rib fractures or chest wall pain after stereotactic body radiation therapy (SBRT) to the lung. The correlations of clinical complications with standard-uptake values (SUV) and FDG-PET activity distributions from post-treatment PET-imaging were studied. Mean and maximum doses from treatment plans, FDG-PET activity values on post-SBRT PET scans and the presence of clinical complications were determined in fifteen patients undergoing 16 SBRT treatments for lung cancer. SBRT treatments were delivered in 3 to 5 fractions using 5 to 7 fields to prescription doses in the range from 39.0 to 60.0 Gy. The dose and FDG-PET activity values were extracted from regions of interest in the chest wall that matched anatomically. Quantitative evaluation of the correlation between dose deposition and FDG-PET activity was performed by calculating the Pearson correlation coefficient using pixel-by-pixel analysis of dose and FDG-PET activity maps in selected regions of interest associated with clinical complications. Overall, three of fifteen patients developed rib fractures with chest wall pain, and two patients developed pain symptoms without fracture. The mean dose to the rib cage in patients with fractures was 37.53 Gy compared to 33.35 Gy in patients without fractures. Increased chest wall activity as determined by FDG-uptake was noted in patients who developed rib fractures. Enhanced activity from PET-images correlated strongly with high doses deposited to the chest wall which could be predicted by a linear relationship. The local enhanced activity was associated with the development of clinical complications such as chest wall inflammation and rib fracture. This study demonstrates that rib fractures and chest wall pain can occur after SBRT treatments to the lung and is associated with increased activity on subsequent PET scans. The FDG-PET activity

  17. Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651

    Directory of Open Access Journals (Sweden)

    Anema Johannes R

    2007-09-01

    Full Text Available Abstract Background Chronic low back pain (LBP is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW. The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP. Methods/Design The design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam (the Netherlands. Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient's general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6

  18. Pain Disorder

    Directory of Open Access Journals (Sweden)

    Carlos Capela

    2014-06-01

    Full Text Available Pain disorder is a psychiatric disorder diagnosed when the pain becomes the predominant focus of the clinical presentation and causes significant distress or impairment. Besides the high economic impact, there is a reciprocal relationship with the affective state. Pain is a subjective sensation and its severity and quality of experience in an individual is dependent on a complex mix of factors. In the treatment of acute pain, the primary purpose is pain relief, while chronic pain typically requires a combination of psychotropic drugs. In this context, it is also important to recognize and treat depression. Psychological treatments aimed at providing mechanisms to allow patients to "control and live with the pain" rather than aspire to eliminate it completely. A growing group of researchers proposes the elimination of the chapter of Somatoform Disorders and the modification of the category "psychological factors affecting a medical condition" to "psychological factors affecting an identified or feared medical condition" with clinical entities as ubchapters, largely based upon Diagnostics for Psychosomatic Research criteria.

  19. Fetal pain?

    Science.gov (United States)

    Vanhatalo, S; van Nieuwenhuizen, O

    2000-05-01

    During the last few years a vivid debate, both scientifically and emotionally, has risen in the medical literature as to whether a fetus is able to feel pain during abortion or intrauterine surgery. This debate has mainly been inspired by the demonstration of various hormonal or motor reactions to noxious stimuli at very early stages of fetal development. The aims of this paper are to review the literature on development of the pain system in the fetus, and to speculate about the relationship between "sensing" as opposed to "feeling" pain and the number of reactions associated with painful stimuli. While a cortical processing of pain theoretically becomes possible after development of the thalamo-cortical connections in the 26th week of gestation, noxious stimuli may trigger complex reflex reactions much earlier. However, more important than possible painfulness is the fact that the noxious stimuli, by triggering stress responses, most likely affect the development of an individual at very early stages. Hence, it is not reasonable to speculate on the possible emotional experiences of pain in fetuses or premature babies. A clinically relevant aim is rather to avoid and/or treat any possibly noxious stimuli, and thereby prevent their potential adverse effects on the subsequent development.

  20. [Musculoskeletal pain].

    Science.gov (United States)

    Casser, H-R; Schaible, H-G

    2015-10-01

    Among the clinically relevant pain conditions, pain in the musculoskeletal system is most frequent. This article reports extensive epidemiological data on musculoskeletal system pain in Germany and worldwide. Since back pain is most frequent, the diagnostics and therapeutic algorithms of acute, recurring, and chronic lower back pain in Germany will be particularly addressed. The importance of the physiologic-organic, the cognitive-emotional, the behavioral, and the social level to diagnostics and treatment will be discussed. We will also focus on osteoarthritic pain and address its epidemiology, clinical importance, and significance for the health care system. This article will list some reasons why the musculoskeletal system in particular is frequently the site of chronic pain. The authors believe that these reasons are to be sought in the complex structures of the musculoskeletal system; in the particular sensitivity of the deep somatic nociceptive system for long-term sensitization processes, as well as the ensuing nervous system reactions; and in the interactions between the nervous and immune systems. The article will give some insights into the research carried out on this topic in Germany.