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Sample records for low-risk chest pain

  1. Association of chest pain and risk of cardiovascular disease with coronary atherosclerosis in patients with inflammatory joint diseases

    Directory of Open Access Journals (Sweden)

    Silvia eRollefstad

    2015-11-01

    Full Text Available Objectives: The relation between chest pain and coronary atherosclerosis (CA in patients with inflammatory joint diseases (IJD has not been explored previously. Our aim was to evaluate the associations of the presence of chest pain and the predicted 10-year risk of cardiovascular disease (CVD by use of several CVD risk algorithms, with multi-detector computer tomography (MDCT coronary angiography verified CA. Methods: Detailed information concerning chest pain and CVD risk factors was obtained in 335 patients with rheumatoid arthritis (RA and ankylosing spondylitis (AS. In addition, 119 of these patients underwent MDCT coronary angiography.Results: Thirty-one percent of the patients (104/335 reported chest pain. Only 6 patients (1.8% had atypical angina pectoris (pricking pain at rest. In 69 patients without chest pain, two thirds had CA, while in those who reported chest pain (n=50, CA was present in 48.0%. In a logistic regression analysis, chest pain was not associated with CA (dependent variable (p=0.43. About 30% (Nagelkerke R2 of CA was explained by any of the CVD risk calculators: SCORE, Framingham Risk Score or Reynolds Risk Score.Conclusion: The presence of chest pain was surprisingly infrequently reported in patients with IJD who were referred for a CVD risk evaluation. However, when present, chest pain was weakly associated with CA, in contrast to the predicted CVD risk by several risk calculators which was highly associated with the presence of CA. These findings suggest that clinicians treating patients with IJD should be alert of coronary atherosclerotic disease also in absence of chest pain symptoms.

  2. Identifying emergency department patients with chest pain who are at low risk for acute coronary syndromes [digest].

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    Markel, David; Kim, Jeremy

    2017-07-21

    Though a minority of patients presenting to the emergency department with chest pain have acute coronary syndromes,identifying the patients who may be safely discharged and determining whether further testing is needed remains challenging. From the prehospital care setting to disposition and follow-up, this systematic review addresses the fundamentals of the emergency department evaluation of patients determined to be at low risk for acute coronary syndromes or adverse outcomes. Clinical risk scores are discussed, as well as the evidence and indications for confirmatory testing. The emerging role of new technologies, such as high-sensitivity troponin assays and advanced imaging techniques, are also presented. [Points & Pearls is a digest of Emergency Medicine Practice].

  3. Efficacy of Implementation of a Chest Pain Center at a Community Hospital.

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    Davis, Alexandra; Chiu, Jason; Lau, Stanley K; Kok, Yih Jen; Wu, Jonathan Y H

    2017-12-01

    Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, Asian-based community hospital in the United States. Additionally, this assessment sought to evaluate the effectiveness and safety of a HEART protocol in the first 4 months after its adoption. The facility implemented the CPC, an observation unit, in October 2016. ED physicians risk stratified patients using the HEART score. The guidelines allow ED physicians to stratify patients into 3 categories: to discharge low-risk patients, observe moderate-risk patients in the CPC, and admit high-risk patients. Patients in the CPC received additional diagnostic work-up under the care of ED physicians and cardiologists for less than 24 hours. In addition, CPC patients were followed-up 2 and 30 days after discharge. A total of 172 patients presented at the ED with a chief complaint of chest pain. The majority of the patients were classified into the moderate-risk group (n = 101). Low-risk patients spent significantly less hours in the hospital than the moderate- and high-risk groups, and the high-risk group spent more time in the hospital than the moderate-risk group. The staff followed-up with 74 CPC patients through telephone calls to assess if patients were still experiencing chest pain and if they had followed-up with a cardiologist or primary care physician. The 2- and 30-day survival rates were 100% and 97%, respectively. The data showed a significant reduction in total length of stay for all chest pain patients. This retrospective program evaluation demonstrated some evidence in using HEART score to safely risk stratify chest pain patients to the appropriate level of care. As healthcare moves from a fee-for-service environment to value-based purchasing, hospitals need to devise and implement innovative strategies to provide efficient, beneficial, and safe care for the patients.

  4. Usefulness of technetium-99m tetrofosmin single-photon emission computed tomography for short-term risk stratification in patients with acute chest pain in the emergency room

    International Nuclear Information System (INIS)

    Kawahito, Michitomo; Kondo, Makoto; Abe, Yoshiteru

    2003-01-01

    High-risk patients with acute coronary syndrome are difficult to distinguish from low-risk patients with chest pain in the emergency room. Technetium-99 m ( 99m Tc) tetrofosmin single-photon emission computed tomography (SPECT) was investigated to exclude high-risk patients with chest pain in the emergency room. 99m Tc-tetrofosmin SPECT was evaluated using a four-point scoring system in 228 patients (144 men, 84 women, mean age 68±12 years) with chest pain. Negative was defined as the myocardial segments with a defect score (DS) of 99m Tc-tetrofosmin; no significance (NS)), 84.9% (NS) and 60.4% (p 99m Tc-tetrofosmin SPECT is a useful method to exclude high-risk patients among patients with chest pain in the emergency room. (author)

  5. Chest Pain: First Aid

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    First aid Chest pain: First aid Chest pain: First aid By Mayo Clinic Staff Causes of chest pain can vary from minor problems, such as indigestion ... 26, 2018 Original article: http://www.mayoclinic.org/first-aid/first-aid-chest-pain/basics/ART-20056705 . Mayo ...

  6. Clinical utility of coronary CT angiography with low-dose chest CT in the evaluation of patients with atypical chest pain: a preliminary report

    International Nuclear Information System (INIS)

    Lim, Soo Jin; Choo, Ki Seok; Kim, Chang Won

    2008-01-01

    To determine the clinical utility of coronary CT angiography (CCTA) with low-dose chest CT in the evaluation of patients with atypical chest pain. Ninety-six patients (mean age 60.2 years; age range, 41-68 years; 70 males) were referred for CCTA with low-dose chest CT (16-slice MDCT, Siemens) for an evaluation of atypical chest pain. When significant stenoses (lumen diameter reduction > 50%) were detected on CCTA, invasive coronary angiography (CA) was performed as the standard of reference. In all patients, medical chart review or telephone contact with patients was used to evaluate the contribution of CCTA with low-dose chest CT to the final clinical diagnosis, at least 6 months after performing CCTA. Among 96 patients, seven patients (7%) had significant stenoses as detected on CCTA, whereas two patients (2%) had significant stenoses and five patients had insignificant stenoses or no stenosis, as detected on conventional catheter angiography. In 18 (19%) of the 89 patients without significant stenosis detected on CCTA, this protocol provided additional information that suggested or confirmed an alternate clinical diagnosis. In patients with atypical chest pain, CCTA with low-dose chest CT could help to exclude ischemic heart disease and could provide important ancillary information for the final diagnosis

  7. The HEART score is useful to predict cardiovascular risks and reduces unnecessary cardiac imaging in low-risk patients with acute chest pain.

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    Dai, Siping; Huang, Bo; Zou, Yunliang; Guo, Jianbin; Liu, Ziyong; Pi, Dangyu; Qiu, Yunhong; Xiao, Chun

    2018-06-01

    The present study was to investigate whether the HEART score can be used to evaluate cardiovascular risks and reduce unnecessary cardiac imaging in China.Acute coronary syndrome patients with the thrombosis in myocardial infarction risk score risk HEART score group and 2 patients (1.5%) in the high risk HEART score group had cardiovascular events. The sensitivity of HEART score to predict cardiovascular events was 100% and the specificity was 46.7%. The potential unnecessary cardiac testing was 46.3%. Cox proportional hazards regression analysis showed that per one category increase of the HEART score was associated with nearly 1.3-fold risk of cardiovascular events.In the low-risk acute chest pain patients, the HEART score is useful to physicians in evaluating the risk of cardiovascular events within the first 30 days. In addition, the HEART score is also useful in reducing the unnecessary cardiac imaging.

  8. Obesity Increases the Risk of Chest Wall Pain From Thoracic Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Welsh, James; Thomas, Jimmy; Shah, Deep; Allen, Pamela K.; Wei, Xiong; Mitchell, Kevin; Gao, Song; Balter, Peter; Komaki, Ritsuko; Chang, Joe Y.

    2011-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. Patients and Methods: We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0. Results: Of 360 patients in the database, 265 (268 tumors) had tumors within 30 , or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI ≥29 had almost twice the risk of chronic pain (p = 0.03). Among patients with BMI >29, diabetes mellitus was a significant contributing factor to the development of chest pain. Conclusion: Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.

  9. Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.

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    Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

    2015-01-01

    The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (pdiagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (pdiagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (pdiagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), pdiagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

  10. Development and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol

    NARCIS (Netherlands)

    Than, Martin; Flaws, Dylan; Sanders, Sharon; Doust, Jenny; Glasziou, Paul; Kline, Jeffery; Aldous, Sally; Troughton, Richard; Reid, Christopher; Parsonage, William A.; Frampton, Christopher; Greenslade, Jaimi H.; Deely, Joanne M.; Hess, Erik; Sadiq, Amr Bin; Singleton, Rose; Shopland, Rosie; Vercoe, Laura; Woolhouse-Williams, Morgana; Ardagh, Michael; Bossuyt, Patrick; Bannister, Laura; Cullen, Louise

    2014-01-01

    Risk scores and accelerated diagnostic protocols can identify chest pain patients with low risk of major adverse cardiac event who could be discharged early from the ED, saving time and costs. We aimed to derive and validate a chest pain score and accelerated diagnostic protocol (ADP) that could

  11. Implementation of a chest pain management service improves patient care and reduces length of stay.

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    Scott, Adam C; O'Dwyer, Kristina M; Cullen, Louise; Brown, Anthony; Denaro, Charles; Parsonage, William

    2014-03-01

    Chest pain is one of the most common complaints in patients presenting to an emergency department. Delays in management due to a lack of readily available objective tests to risk stratify patients with possible acute coronary syndromes can lead to an unnecessarily lengthy admission placing pressure on hospital beds or inappropriate discharge. The need for a co-ordinated system of clinical management based on enhanced communication between departments, timely and appropriate triage, clinical investigation, diagnosis, and treatment was identified. An evidence-based Chest Pain Management Service and clinical pathway were developed and implemented, including the introduction of after-hours exercise stress testing. Between November 2005 and March 2013, 5662 patients were managed according to a Chest Pain Management pathway resulting in a reduction of 5181 admission nights by more timely identification of patients at low risk who could then be discharged. In addition, 1360 days were avoided in high-risk patients who received earlier diagnosis and treatment. The creation of a Chest Pain Management pathway and the extended exercise stress testing service resulted in earlier discharge for low-risk patients; and timely treatment for patients with positive and equivocal exercise stress test results. This service demonstrated a significant saving in overnight admissions.

  12. The approach to patients with possible cardiac chest pain.

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    Parsonage, William A; Cullen, Louise; Younger, John F

    2013-07-08

    Chest pain is a common reason for presentation in hospital emergency departments and general practice. Some patients presenting with chest pain to emergency departments and, to a lesser extent, general practice will be found to have a life-threatening cause, but most will not. The challenge is to identify those who do in a safe, timely and cost-effective manner. An acute coronary syndrome cannot be excluded on clinical grounds alone. In patients with ongoing symptoms of chest pain, without an obvious other cause, ST-segment-elevation myocardial infarction should be excluded with a 12-lead electrocardiogram at the first available opportunity. Significant recent advances in the clinical approach to patients with acute chest pain, including better understanding of risk stratification, increasingly sensitive cardiac biomarkers and new non-invasive tests for coronary disease, can help clinicians minimise the risk of unexpected short-term adverse cardiac events. An approach that integrates these advances is needed to deliver the best outcomes for patients with chest pain. All hospital emergency departments should adopt such a strategic approach, and general practitioners should be aware of when and how to access these facilities.

  13. Non-traumatic thoracic emergencies: acute chest pain: diagnostic strategies

    International Nuclear Information System (INIS)

    Bonomo, Lorenzo; Di Fabio, Francesca; Rita Larici, Anna; Merlino, Biagio; Luigia Storto, Maria

    2002-01-01

    Acute chest pain may represent the initial and/or accompanying symptom in a variety of disease processes that may occur in the cardiovascular system, respiratory system, gastrointestinal tract, or musculoskeletal system. Although clinical history, risk factors, and physical examination are important factors in establishing the etiology of symptoms in patients presenting with acute chest pain, imaging modalities are frequently utilized. Noncardiac causes of acute chest pain are reviewed in this paper with special reference to the most recently published literature and emphasis on acute aortic diseases. Imaging modalities with indication of appropriateness, optimal technique and practical keys for interpretation are discussed. (orig.)

  14. Acute chest pain after bench press exercise in a healthy young adult.

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    Smereck, Janet A; Papafilippaki, Argyro; Sudarshan, Sawali

    2016-01-01

    Bench press exercise, which involves repetitive lifting of weights to full arm extension while lying supine on a narrow bench, has been associated with complications ranging in acuity from simple pectoral muscle strain, to aortic and coronary artery dissection. A 39-year-old man, physically fit and previously asymptomatic, presented with acute chest pain following bench press exercise. Diagnostic evaluation led to the discovery of critical multivessel coronary occlusive disease, and subsequently, highly elevated levels of lipoprotein (a). Judicious use of ancillary testing may identify the presence of "high-risk" conditions in a seemingly "low-risk" patient. Emergency department evaluation of the young adult with acute chest pain must take into consideration an extended spectrum of potential etiologies, so as to best guide appropriate management.

  15. Noncardiac chest pain: diagnosis and management.

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    Yamasaki, Takahisa; Fass, Ronnie

    2017-07-01

    Noncardiac chest pain (NCCP) has been defined as recurrent chest pain that is indistinguishable from ischemic heart pain after excluding a cardiac cause. NCCP is a common and highly challenging clinical problem in Gastrointestinal practice that requires targeted diagnostic assessment to identify the underlying cause of the symptoms. Treatment is tailored according to the cause of NCCP: gastroesophageal reflux disease (GERD), esophageal dysmotility or functional chest pain. The purpose of this review is to discuss the current diagnosis and treatment of NCCP. Utilization of new diagnostic techniques such as pH-impedance and high-resolution esophageal manometry, and the introduction of a new definition for functional chest pain have helped to better diagnose the underlying mechanisms of NCCP. A better therapeutic approach toward GERD-related NCCP, the introduction of new interventions for symptoms due to esophageal spastic motor disorders and the expansion of the neuromodulator armamentarium for functional chest pain have changed the treatment landscape of NCCP. GERD is the most common esophageal cause of NCCP, followed by functional chest pain and esophageal dysmotility. The proton pump inhibitor test, upper endoscopy, wireless pH capsule and pH-impedance are used to identify GERD-induced NCCP. High-resolution esophageal manometry is the main tool to identify esophageal motor disorder in non-GERD-related NCCP. Negative diagnostic assessment suggests functional chest pain. Potent antireflux treatment is offered to patients with GERD-related NCCP; medical, endoscopic or surgical interventions are considered in esophageal dysmotility; and neuromodulators are prescribed for functional chest pain. Assessment and treatment of psychological comorbidity should be considered in all NCCP patients.

  16. Chest pain

    International Nuclear Information System (INIS)

    Martinez A, Juan Carlos; Saenz M, Oscar; Martinez M, Camilo; Gonzales A Francisco; Nicolas R, Jose; Vergara V, Erika P; Pereira G, Alberto M

    2010-01-01

    In emergency departments, chest pain is one of the leading motives of consultation. We thus consider it important to review aspects such as its classification, causes, and clinical profiles. Initial assessment should include a full clinical history comprising thorough anamnesis and physical examination. Adequate interpretation of auxiliary tests, ordered in accordance with suspected clinical conditions, should lead to accurate diagnosis. We highlight certain symptoms and clinical signs, ECG and X-ray findings, cardiac bio markers, arterial blood gases, and CT-scanning. Scores of severity and prognosis such as TIMI are assessed. Optimal treatment of the clinical conditions leading to chest pain depends on adequate initial approach and assessment.

  17. Pre-test probability risk scores and their use in contemporary management of patients with chest pain: One year stress echo cohort study

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    Demarco, Daniela Cassar; Papachristidis, Alexandros; Roper, Damian; Tsironis, Ioannis; Byrne, Jonathan; Monaghan, Mark

    2015-01-01

    Objectives To compare how patients with chest pain would be investigated, based on the two guidelines available for UK cardiologists, on the management of patients with stable chest pain. The UK National Institute of Clinical Excellence (NICE) guideline which was published in 2010 and the European society of cardiology (ESC) guideline published in 2013. Both guidelines utilise pre-test probability risk scores, to guide the choice of investigation. Design We undertook a large retrospective study to investigate the outcomes of stress echocardiography. Setting A large tertiary centre in the UK in a contemporary clinical practice. Participants Two thirds of the patients in the cohort were referred from our rapid access chest pain clinics. Results We found that the NICE risk score overestimates risk by 20% compared to the ESC Risk score. We also found that based on the NICE guidelines, 44% of the patients presenting with chest pain, in this cohort, would have been investigated invasively, with diagnostic coronary angiography. Using the ESC guidelines, only 0.3% of the patients would be investigated invasively. Conclusion The large discrepancy between the two guidelines can be easily reduced if NICE adopted the ESC risk score. PMID:26673458

  18. Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: the Nambour Short Low-Intermediate Chest pain project.

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    George, Terry; Ashover, Sarah; Cullen, Louise; Larsen, Peter; Gibson, Jason; Bilesky, Jennifer; Coverdale, Steven; Parsonage, William

    2013-08-01

    Emergency physicians can feel pressured by opposing forces of clinical reality and the need to publish successful key performance indicators in an environment of increasing demands and cost containment. This is particularly relevant to management of patients with undifferentiated chest pain and possible acute coronary syndrome. Unreliability of clinical assessment and high risk of adverse outcomes for all concerned exist, yet national guidelines are at odds with efforts to reduce ED crowding and access block. We report findings from the Nambour Short Low-Intermediate Chest pain risk trial, which safely introduced an accelerated diagnostic protocol with reduced ED length of stay and high patient acceptability. Over a 7-month period, there were no major adverse cardiac events by 30 days in 19% of undifferentiated chest pain presentations with possible acute coronary syndrome discharged after normal sensitive cardiac troponin taken 2 h after presentation and scheduled to return for outpatient exercise stress test. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  19. Value of Low Triiodothyronine and Subclinical Myocardial Injury for Clinical Outcomes in Chest Pain.

    Science.gov (United States)

    Lee, Young-Min; Ki, Young-Jae; Choi, Dong-Hyun; Kim, Bo-Bae; Shin, Byung Chul; Song, Heesang; Kim, Dong-Min

    2015-11-01

    Low triiodothyronine (T3) levels and subclinical myocardial injury may be associated with adverse cardiac and cerebrovascular (CCV) events in individuals without clinically apparent coronary heart disease (CHD). The aim of this study was to determine the associations of a low T3 level and subclinical myocardial injury with the development of adverse CCV events in individuals without clinically apparent CHD. T3 and high-sensitivity cardiac troponin T (hs-cTnT) levels were analyzed in 250 patients with chest pain free of CHD and heart failure. The primary end point was the composite of sudden cardiac death, ischemic stroke, newly developed atrial fibrillation, pericardial effusion and thrombosis. Throughout a mean follow-up of 15.6 months, the primary end point happened in 17 patients (6.8%). Kaplan-Meier analysis disclosed a notably higher overall occurrence rate in patients with hs-cTnT levels ≥0.014 ng/mL and in patients with T3 <60 ng/dL. An exaggerated hazard was observed in patients with combined high hs-cTnT and low T3 levels. After adjustment, the hazard ratio for overall events in patients with high hs-cTnT/low T3 versus normal hs-cTnT/T3 was 11.72 (95% confidence interval, 2.83-48.57; P = 0.001). In patients with chest pain without clinically obvious CHD, high hs-cTnT combined with low T3 was associated with adverse cardiac/CCV events and was an independent predictor of overall events even after adjustment. These data suggest the importance of systemic factors, such as low T3 syndrome, in the development of adverse cardiac/CCV events beyond advancing clinical atherosclerotic coronary disease in patients with chest pain.

  20. 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.

  1. 3 for the Price of 1: Teaching Chest Pain Risk Stratification in a Multidisciplinary, Problem-based Learning Workshop

    Directory of Open Access Journals (Sweden)

    Cynthia Burns

    2018-03-01

    Full Text Available Introduction: Chest pain is a common chief complaint among patients presenting to health systems and often leads to complex and intensive evaluations. While these patients are often cared for by a multidisciplinary team (primary care, emergency medicine, and cardiology, medical students usually learn about the care of these patients in a fragmented, single-specialty paradigm. The present and future care of patients with chest pain is multidisciplinary, and the education of medical students on the subject should be as well. Our objective was to evaluate the effectiveness of a multidisciplinary, problem-based learning workshop to teach third-year medical students about risk assessment for patients presenting with chest pain, specifically focusing on acute coronary syndromes. Methods: To create an educational experience consistent with multidisciplinary team-based care, we designed a multidisciplinary, problem-based learning workshop to provide medical students with an understanding of how patients with chest pain are cared for in a systems-based manner to improve outcomes. Participants included third-year medical students (n=219 at a single, tertiary care, academic medical center. Knowledge acquisition was tested in a pre-/post-retention test study design. Results: Following the workshop, students achieved a 19.7% (95% confidence interval [CI] [17.3–22.2%] absolute increase in scores on post-testing as compared to pre-testing. In addition, students maintained an 11.1% (95% CI [7.2–15.0%] increase on a retention test vs. the pre-test. Conclusion: A multidisciplinary, problem-based learning workshop is an effective method of producing lasting gains in student knowledge about chest pain risk stratification.

  2. Clinical utility of the HEART score in patients admitted with chest pain to an inner-city hospital in the USA.

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    Patnaik, Soumya; Shah, Mahek; Alhamshari, Yaser; Ram, Pradhum; Puri, Ritika; Lu, Marvin; Balderia, Percy; Imms, John B; Maludum, Obiora; Figueredo, Vincent M

    2017-06-01

    Chest pain is one of the most common presentations to a hospital, and appropriate triaging of these patients can be challenging. The HEART score has been used for such purposes in some countries and only a few validation studies from the USA are available. We aim to determine the utility of the HEART score in patients presenting with chest pain to an inner-city hospital in the USA. We retrospectively screened 417 consecutive patients admitted with chest pain to the observation/telemetry units at Einstein Medical Center Philadelphia. After applying inclusion and exclusion criteria, 299 patients were included in the analysis. Patients were divided into low-risk (0-3) and intermediate-high (≥4)-risk HEART score groups. Baseline characteristics, thrombolysis in myocardial infarction score, need for revascularization during index hospitalization, and major adverse cardiovascular events (MACE) at 6 weeks and 12 months were recorded. There were 98 and 201 patients in the low-score group and intermediate-high-score group, respectively. Compared with the low-score group, patients in the intermediate-high-risk group had a higher incidence of revascularization during the index hospital stay (16.4 vs. 0%; P=0.001), longer hospital stay, higher MACE at 6 weeks (9.5 vs. 0%) and 12 months (20.4 vs. 3.1%), and higher cardiac readmissions. HEART score of at least 4 independently predicted MACE at 12 months (odds ratio 7.456, 95% confidence interval: 2.175-25.56; P=0.001) after adjusting for other risk factors in regression analysis. HEART score of at least 4 was predictive of worse outcomes in patients with chest pain in an inner-city USA hospital. If validated in multicenter prospective studies, the HEART score could potentially be useful in risk-stratifying patients presenting with chest pain in the USA and could impact clinical decision-making.

  3. 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......The musculoskeletal system is a recognized source of chest pain. However, despite the apparently benign origin, patients with musculoskeletal chest pain remain under-diagnosed, untreated, and potentially continuously disabled in terms of anxiety, depression, and activities of daily living. Several...... arises mainly from case stories and empiric knowledge. For segmental dysfunction, clinical features of musculoskeletal chest pain have been characterized in a few clinical trials. This article summarizes the most commonly encountered syndromes of focal musculoskeletal disorders in clinical practice....

  4. Nonspecific motility disorders, irritable esophagus, and chest pain.

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    Krarup, Anne Lund; Liao, Donghua; Gregersen, Hans; Drewes, Asbjørn Mohr; Hejazi, Reza A; McCallum, Richard W; Vega, Kenneth J; Frazzoni, Marzio; Frazzoni, Leonardo; Clarke, John O; Achem, Sami R

    2013-10-01

    This paper presents commentaries on whether Starling's law applies to the esophagus; whether erythromycin affects esophageal motility; the relationship between hypertensive lower esophageal sphincter and vigorous achalasia; whether ethnic- and gender-based norms affect diagnosis and treatment of esophageal motor disorders; health care and epidemiology of chest pain; whether normal pH excludes esophageal pain; the role of high-resolution manometry in noncardiac chest pain; whether pH-impedance should be included in the evaluation of noncardiac chest pain; whether there are there alternative therapeutic options to PPI for treating noncardiac chest pain; and the usefulness of psychological treatment and alternative medicine in noncardiac chest pain. © 2013 New York Academy of Sciences.

  5. Positive and Negative Affect Is Related to Experiencing Chest Pain During Exercise-Induced Myocardial Ischemia.

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    Stébenne, Philippe; Bacon, Simon L; Austin, Anthony; Paine, Nicola J; Arsenault, André; Laurin, Catherine; Meloche, Bernard; Gordon, Jennifer; Dupuis, Jocelyn; Lavoie, Kim L

    2017-05-01

    Silent myocardial ischemia is thought to be associated with worse cardiovascular outcomes due to a lack of perception of pain cues that initiate treatment seeking. Negative affect (NA) has been associated with increased pain reporting and positive affect (PA) with decreased pain reporting, but these psychological factors have not been examined within the context of myocardial ischemia. This study evaluated the associations between PA, NA, and chest pain reporting in patients with and without ischemia during exercise testing. A total of 246 patients referred for myocardial perfusion single-photon emission computed tomography exercise stress testing completed the positive and negative affect schedule-expanded version, a measure of PA and NA. Presence of chest pain and myocardial ischemia were evaluated using standardized protocols. Logistic regression analyses revealed that for every 1-point increase in NA, there was a 13% higher chance for ischemic patients (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.02 to 1.26) and an 11% higher chance in nonischemic patients (OR = 1.11; 95% CI = 1.03 to 1.19) to report chest pain. A significant interaction of PA and NA on chest pain reporting (β = 0.02; 95% CI = 0.002 to 0.031) was also observed; nonischemic patients with high NA and PA reported more chest pain (57%) versus patients with low NA and low PA (13%), with high NA and low PA (17%), and with high PA and low NA (7%). Patients who experience higher NA are more likely to report experiencing chest pain. In patients without ischemia, high NA and PA was also associated with a higher likelihood of reporting chest pain. Results suggest that high levels of PA as well as NA may increase the experience and/or reporting of chest pain.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-12-15

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

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

    International Nuclear Information System (INIS)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro; Rochitte, Carlos Eduardo

    2013-01-01

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

  8. Dual-source CT in chest pain diagnosis

    International Nuclear Information System (INIS)

    Johnson, Thorsten R.C.; Nikolaou, K.; Fink, C.; Rist, C.; Reiser, M.F.; Becker, C.R.; Becker, A.; Knez, A.

    2007-01-01

    With the depiction of pulmonary arteries, coronary arteries, and the aorta, CT angiography of the chest offers a comprehensive diagnostic work-up of unclear chest pain. The aim of this study was to assess the diagnostic accuracy of dual-source CT in this patient group. A total of 47 patients suffering from unclear chest pain were examined with a Siemens Somatom Definition. Volume and flow of contrast media (Ultravist, Schering) were adapted to the body weight. The examinations were evaluated with regard to image quality and contrast opacification and to the diagnostic accuracy with reference to the final clinical diagnosis. Adequate contrast opacification was achieved in all examinations. The depiction of the coronary arteries was diagnostic in all cases. The cause of chest pain could be identified in 41 cases. Among the diagnoses were coronary and myocardial pathologies, valvular disease, aortic aneurysms and dissections, pulmonary embolism, and pneumonic consolidation. DSCT angiography of the chest offers a very good image quality even at high heart rates so that a high diagnostic accuracy is achieved in patients with acute chest pain. (orig.) [de

  9. The role of CT in assessing chest pain

    International Nuclear Information System (INIS)

    Capsa, R.

    2012-01-01

    Full text: Objective: Thoracic pain represents the common feature of a wide range of diseases of different causes. Usually, chest pain requires a fast workup, in order to eliminate potentially hazardous underlying conditions. The objective of the paper consists of presenting the role of computerized tomography (CT) in assessing the different causes and conditions related to chest pain. Materials and methods: The educational presentation relies on current literature data and mostly on images obtained from patients admitted in the various clinics and departments of our hospital, suffering from chest pain as admittance condition or as a symptom appeared during the hospital stay. Results: There are various radiological and imaging options for assessing a patient with chest pain, with reference to the underlying condition, type of pain onset (acute or chronic), specific indications and contraindications. From all these, CT is considered one of the most useful imaging options, in terms of diagnosis accuracy, fast workup, cost and availability. This paper focuses on the role of CT, presenting the most important diseases and conditions related to potential occurrence of chest pain and the most specific CT signs and findings usually reported in this setting. Furthermore, the presentation separates acute and chronic conditions, presenting the actual imaging protocols employed in this circumstances. Finally, there are considerations regarding CT rule-out protocols used in patients with acute chest pain in emergency conditions. Conclusions: Fast and accurate diagnosis is crucial for patient outcome, often life-saving, but currently there is no single algorithm in the imaging assessment of chest pain, while choosing the best imaging option relies mainly on history, clinical and laboratory data. CT is one of the most important imaging options available in patients with both acute and chronic chest pain. CT rule-out techniques have still to establish their clear role in a

  10. Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.

    Science.gov (United States)

    Reamy, Brian V; Williams, Pamela M; Odom, Michael Ryan

    2017-09-01

    Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be ruled out using history and physical examination, electrocardiography, troponin assays, and chest radiography before another diagnosis is made. Validated clinical decision rules are available to help exclude coronary artery disease. Viruses are common causative agents of pleuritic chest pain. Coxsackieviruses, respiratory syncytial virus, influenza, parainfluenza, mumps, adenovirus, cytomegalovirus, and Epstein-Barr virus are likely pathogens. Treatment is guided by the underlying diagnosis. Nonsteroidal anti-inflammatory drugs are appropriate for pain management in those with virally triggered or nonspecific pleuritic chest pain. In patients with persistent symptoms, persons who smoke, and those older than 50 years with pneumonia, it is important to document radiographic resolution with repeat chest radiography six weeks after initial treatment.

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

    International Nuclear Information System (INIS)

    Gruettner, Joachim; Fink, Christian; Walter, Thomas; Meyer, Mathias; Apfaltrer, Paul; Schoepf, U. Joseph; Saur, Joachim; Sueselbeck, Tim; Traunwieser, Dominik; Takx, Richard

    2013-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-01-15

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

  13. Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T

    NARCIS (Netherlands)

    Bholasingh, Radha; Cornel, Jan Hein; Kamp, Otto; van Straalen, Jan P.; Sanders, Gerard T.; Tijssen, Jan G. P.; Umans, Victor A. W. M.; Visser, Cees A.; de Winter, Robbert J.

    2003-01-01

    OBJECTIVES We prospectively studied the prognostic value of predischarge dobutamine stress echocardiography (I)SE) in low-risk chest pain patients with a normal or nondiagnostic electrocardiogram (ECG) and a negative serial troponin T. BACKGROUND Noninvasive stress testing is recommended before

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

    International Nuclear Information System (INIS)

    Becker, Hans-Christoph; Johnson, Thorsten

    2012-01-01

    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.

  15. Diagnostic Evaluation of Nontraumatic Chest Pain in Athletes.

    Science.gov (United States)

    Moran, Byron; Bryan, Sean; Farrar, Ted; Salud, Chris; Visser, Gary; Decuba, Raymond; Renelus, Deborah; Buckley, Tyler; Dressing, Michael; Peterkin, Nicholas; Coris, Eric

    This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes. Cross-referencing published articles from the databases searched discovered additional articles. No dissertations, theses, or meeting proceedings were reviewed. The authors discuss the scope of this complex problem and the diagnostic dilemma chest pain in athletes can provide. Next, the authors delve into the vast differential and attempt to simplify this process for the sports medicine physician by dividing potential etiologies into cardiac and noncardiac conditions. Life-threatening causes of chest pain in athletes may be cardiac or noncardiac in origin, which highlights the need for the sports medicine physician to consider pathology in multiple organ systems simultaneously. This article emphasizes the importance of ruling out immediately life threatening diagnoses, while acknowledging the most common causes of noncardiac chest pain in young athletes are benign. The authors propose a practical algorithm the sports medicine physician can use as a guide for the assessment and diagnostic work-up of the athlete with chest pain designed to help the physician arrive at the correct diagnosis in a clinically efficient and cost-effective manner.

  16. Radiological diagnostic in acute chest pain

    International Nuclear Information System (INIS)

    Kawel, Nadine; Bremerich, Jens

    2010-01-01

    Acute chest pain is one of the main symptoms leading to a consultation of the emergency department. Main task of the initial diagnostic is the confirmation or exclusion of a potentially life threatening cause. Conventional chest X-ray and computed tomography are the most significant techniques. Due to limited availability and long examination times magnetic resonance tomography rather plays a limited role in routine clinical workup. In the following paper we will systematically review the radiological diagnostic of the acute life threatening causes of chest pain. Imaging modalities, technical aspects and image interpretation will be discussed. (orig.)

  17. Omega-3 index and prognosis in acute coronary chest pain patients with a low dietary intake of omega-3.

    Science.gov (United States)

    de la Fuente, Ricardo León; Naesgaard, Patrycja Anna; Nilsen, Stein Tore; Woie, Leik; Aarsland, Torbjørn; Gundersen, Thomas; Nilsen, Dennis W T

    2013-04-01

    The omega-3 index (eicosapentaenoic acid + docosahexaenoic acid) content in red blood cell membranes has been suggested as a novel risk marker for cardiac death. Objective. To assess the ability of the omega-3 index to predict all-cause mortality, cardiac death and sudden cardiac death following hospitalization with an acute coronary syndrome (ACS), and to include arachidonic acid (AA) in risk assessment. The omega-3 index was measured in 572 consecutive patients (median 63 years and 59% males) admitted with chest pain and suspected ACS in an inland Northern Argentinean city with a dietary habit that was essentially based on red meat and a low intake of fish. Clinical endpoints were collected during a 5-year follow-up period, median 3.6 years, range 1 day to 5.5 years. Stepwise Cox regression analysis was employed to compare the rate of new events in the quartiles of the omega-3 index measured at inclusion. Multivariable analysis was performed. No statistical significant differences in baseline characteristics were noted between quartiles of the omega-3 index. The median of the adjusted omega-3 index was 3.6%. During the follow-up period, 100 (17.5%) patients died. Event rates were similar in all quartiles of the omega-3 index, with no statistical significant differences. AA added no prognostic information. In a population with a low intake of fish and fish oils, the adjusted omega-3 index did not predict fatal events following hospitalization in patients with acute chest pain and suspected ACS.

  18. Chest pain in daily practice: occurrence, causes and management.

    Science.gov (United States)

    Verdon, François; Herzig, Lilli; Burnand, Bernard; Bischoff, Thomas; Pécoud, Alain; Junod, Michel; Mühlemann, Nicole; Favrat, Bernard

    2008-06-14

    We assessed the occurrence and aetiology of chest pain in primary care practice. These features differ between primary and emergency care settings, where most previous studies have been performed. 59 GPs in western Switzerland recorded all consecutive cases presenting with chest pain. Clinical characteristics, laboratory tests and other investigations as well as the diagnoses remaining after 12 months of follow-up were systematically registered. Among 24,620 patients examined during a total duration of 300 weeks of observation, 672 (2.7%) presented with chest pain (52% female, mean age 55 +/- 19(SD)). Most cases, 442 (1.8%), presented new symptoms and in 356 (1.4%) it was the reason for consulting. Over 40 ailments were diagnosed: musculoskeletal chest pain (including chest wall syndrome) (49%), cardiovascular (16%), psychogenic (11%), respiratory (10%), digestive (8%), miscellaneous (2%) and without diagnosis (3%). The three most prevalent diseases were: chest wall syndrome (43%), coronary artery disease (12%) and anxiety (7%). Unstable angina (6), myocardial infarction (4) and pulmonary embolism (2) were uncommon (1.8%). Potentially serious conditions including cardiac, respiratory and neoplasic diseases accounted for 20% of cases. A large number of laboratory tests (42%), referral to a specialist (16%) or hospitalisation (5%) were performed. Twentyfive patients died during follow-up, of which twelve were for a reason directly associated with thoracic pain [cancer (7) and cardiac causes (5)]. Thoracic pain was present in 2.7% of primary care consultations. Chest wall syndrome pain was the main aetiology. Cardio - vascular emergencies were uncommon. However chest pain deserves full consideration because of the occurrence of potentially serious conditions.

  19. Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain.

    Science.gov (United States)

    Lee, Jea-Geun; Choi, Joon Hyouk; Kim, Song-Yi; Kim, Ki-Seok; Joo, Seung-Jae

    2016-03-01

    A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R(2)=0.092, p=0.004; β= -0.525, R(2)=0.290, p=0.010). No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group.

  20. Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

    OpenAIRE

    Lee, Jea-Geun; Choi, Joon Hyouk; Kim, Song-Yi; Kim, Ki-Seok; Joo, Seung-Jae

    2016-01-01

    Background and Objectives A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Subjects and Methods Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were ex...

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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 amo...

  3. Approach to chest pain and acute myocardial infarction.

    Science.gov (United States)

    Pandie, S; Hellenberg, D; Hellig, F; Ntsekhe, M

    2016-03-01

    Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers are key components of an effective chest pain assessment. The first priority is excluding serious chest pain syndromes, namely acute coronary syndromes (ACSs), aortic dissection, pulmonary embolism, cardiac tamponade and tension pneumothorax. On history, the mnemonic SOCRATES (Site Onset Character Radiation Association Time Exacerbating/relieving factor and Severity) helps differentiate cardiac from non-cardiac pain. On examination, evaluation of vital signs, evidence of murmurs, rubs, heart failure, tension pneumothoraces and chest infections are important. A 12-lead ECG should be interpreted within 10 minutes of first medical contact, specifically to identify ST elevation myocardial infarction (STEMI). High-sensitivity troponins improve the rapid rule-out of myocardial infarction (MI) and confirmation of non-ST elevation MI (NSTEMI). ACS (STEMI and NSTEMI/unstable anginapectoris (UAP)) result from acute destabilisation of coronary atheroma with resultant complete (STEMI) or subtotal (NSTEMI/UAP) thrombotic coronary occlusion. The management of STEMI patients includes providing urgent reperfusion: primary percutaneous coronary intervention(PPCI) if available, deliverable within 60 - 120 minutes, and fibrinolysis if PPCI is not available. Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), anticoagulation (heparin or low-molecular-weight heparin) and cardiac monitoring.

  4. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

    Science.gov (United States)

    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

  5. The relevance of accuracy of heartbeat perception in noncardiac and cardiac chest pain.

    Science.gov (United States)

    Schroeder, Stefanie; Gerlach, Alexander L; Achenbach, Stephan; Martin, Alexandra

    2015-04-01

    The development and course of noncardiac chest pain are assumed to be influenced by interoceptive processes. It was investigated whether heartbeat perception was enhanced in patients suffering from noncardiac chest pain and to what degree it was associated with self-reported cognitive-perceptual features and chest pain characteristics. A total of 42 patients with noncardiac chest pain (NCCP), 35 patients with cardiac chest pain, and 52 healthy controls were recruited. Heartbeat perception was assessed using the Schandry task and a modified Brener-Kluvitse task. Self-report measures assessed anxiety sensitivity, somatosensory amplification, heart-focused anxiety, and chest pain characteristics. Heartbeat perception was not more accurate in patients with NCCP, compared to patients with cardiac chest pain and healthy controls. However, in patients with NCCP, the error score (Schandry task) was significantly associated with stronger chest pain impairment, and the response bias (Brener-Kluvitse task) was associated with lower chest pain intensity. Against assumptions of current etiological models, heartbeat perception was not enhanced in patients with NCCP. Chest pain characteristics and particularly their appraisal as threatening might be more relevant to NCCP than the perceptional accuracy of cardiac sensations and should be focused in psychological interventions. However, associations with chest pain impairment suggest cardiac interoception to influence the course of NCCP.

  6. Chest pain in patients with arterial hypertension, angiographically normal coronary arteries and stiff aorta: the aortic pain syndrome.

    Science.gov (United States)

    Stakos, Dimitrios A; Tziakas, Dimitrios N; Chalikias, George; Mitrousi, Konstantina; Tsigalou, Christina; Boudoulas, Harisios

    2013-01-01

    Arterial hypertension is often associated with a stiff aorta as a result of collagen accumulation in the aortic wall and may produce chest pain. In the present study, possible interrelationships between aortic function, collagen turnover and exercise-induced chest pain in patients with arterial hypertension and angiographically normal coronary arteries were investigated. Ninety-seven patients with arterial hypertension, angiographically normal coronary arteries and no evidence of myocardial ischemia on nuclear cardiac imaging during exercise test were studied. Of these, 43 developed chest pain during exercise (chest pain group) while 54 did not (no chest pain group). Carotid femoral pulse-wave velocity (PWVc-f) was used to assess the elastic properties of the aorta. Amino-terminal pro-peptides of pro-collagen type I, (PINP, reflecting collagen synthesis), serum telopeptides of collagen type I (CITP, reflecting collagen degradation), pro-metalloproteinase 1 (ProMMP-1), and tissue inhibitor of metalloproteinase 1 (TIMP-1, related to collagen turnover) were measured in plasma by immunoassay. The chest pain group had higher PWVc-f, higher and /CITP ratio, and lower proMMP-1/ TIMP-1 ratio compared to the no chest pain group. PWVc-f (t=2.53, p=0.02) and PINP (t=2.42, p=0.02) were independently associated with the presence of chest pain in multiple regression analysis. Patients with arterial hypertension, exercise-induced chest pain and angiographically normal coronary arteries, without evidence of exercise-induced myocardial ischemia, had a stiffer aorta compared to those without chest pain. Alterations in collagen type I turnover that favor collagen accumulation in the aortic wall may contribute to aortic stiffening and chest pain in these patients.

  7. 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.

  8. The relationship between chest pain during thallium-201 scintigraphy with dipyridamole and myocardial ischemia

    International Nuclear Information System (INIS)

    Takeishi, Yasuchika; Tono-oka, Ichiro; Meguro, Mitsuhiko; Hoshi, Hikaru; Masakane, Ikuto; Ikeda, Kozue; Tsuiki, Kai; Yasui, Shoji

    1991-01-01

    Dipyridamole thallium-201 scintigraphy (DP-Tl) and coronary angiography were studied on 74 patients with suspected coronary artery disease. We compared the clinical features, hemodynamic responses, angiographic results and scintigraphic findings of patients who had chest pain during DP-Tl testing ('chest pain' group) with those of patients who did not have chest pain ('no pain' group). Thirty eight (51%) of the 74 patients developed chest pain. Heart rate and rate pressure product during DP infusion of 'chest pain' group were greater than those of the 'no pain' group (p<0.05). Ischemic ST depression was more frequently observed among 'chest pain' patients (p<0.01). There were no differences in angiographic severity of coronary artery disease between 'chest pain' and 'no pain' group. Also, we could find no differences in extent and severity scores of perfusion defects and washout abnormalities between the two groups. However, when patients with myocardial infarction were excluded, the 'chest pain' group had significantly greater extent and severity scores of washout abnormalities than the 'no pain' group (extent score: 38±8 vs 18±5, p<0.05, severity score: 55±15 vs 18±7, p<0.01). Our study indicated that in patients without myocardial infarction, patients with 'chest pain' had more severe ischemia than 'no pain' patients. But in patients with myocardial infarction, myocardial ischemia not accompanied by chest pain might be as severe as that with chest pain. The presence or absence of myocardial infarction might have great influence on results regarding the relation of chest pain to myocardial ischemia. (author)

  9. Rationale and design of a randomized trial comparing initial stress echocardiography versus coronary CT angiography in low-to-intermediate risk emergency department patients with chest pain.

    Science.gov (United States)

    Levsky, Jeffrey M; Haramati, Linda B; Taub, Cynthia C; Spevack, Daniel M; Menegus, Mark A; Travin, Mark I; Vega, Shayna; Lerer, Rikah; Brown-Manhertz, Durline; Hirschhorn, Esther; Tobin, Jonathan N; Garcia, Mario J

    2014-07-01

    Comparative effectiveness research (CER) has become a major focus of cardiovascular disease investigation to optimize diagnosis and treatment paradigms and decrease healthcare expenditures. Acute chest pain is a highly prevalent reason for evaluation in the Emergency Department (ED) that results in hospital admission for many patients and excess expense. Improvement in noninvasive diagnostic algorithms can potentially reduce unnecessary admissions. To compare the performance of treadmill stress echocardiography (SE) and coronary computed tomography angiography (CTA) in ED chest pain patients with low-to-intermediate risk of significant coronary artery disease. This is a single-center, randomized controlled trial (RCT) comparing SE and CTA head-to-head as the initial noninvasive imaging modality. The primary outcome measured is the incidence of hospitalization. The study is powered to detect a reduction in admissions from 28% to 15% with a sample size of 400. Secondary outcomes include length of stay in the ED/hospital and estimated cost of care. Safety outcomes include subsequent visits to the ED and hospitalizations, as well as major adverse cardiovascular events at 30 days and 1 year. Patients who do not meet study criteria or do not consent for randomization are offered entry into an observational registry. This RCT will add to our understanding of the roles of different imaging modalities in triaging patients with suspected angina. It will increase the CER evidence base comparing SE and CTA and provide insight into potential benefits and limitations of appropriate use of treadmill SE in the ED. © 2013, Wiley Periodicals, Inc.

  10. Comparison of traditional cardiovascular risk models and coronary atherosclerotic plaque as detected by computed tomography for prediction of acute coronary syndrome in patients with acute chest pain.

    Science.gov (United States)

    Ferencik, Maros; Schlett, Christopher L; Bamberg, Fabian; Truong, Quynh A; Nichols, John H; Pena, Antonio J; Shapiro, Michael D; Rogers, Ian S; Seneviratne, Sujith; Parry, Blair Alden; Cury, Ricardo C; Brady, Thomas J; Brown, David F; Nagurney, John T; Hoffmann, Udo

    2012-08-01

    The objective was to determine the association of four clinical risk scores and coronary plaque burden as detected by computed tomography (CT) with the outcome of acute coronary syndrome (ACS) in patients with acute chest pain. The hypothesis was that the combination of risk scores and plaque burden improved the discriminatory capacity for the diagnosis of ACS. The study was a subanalysis of the Rule Out Myocardial Infarction Using Computer-Assisted Tomography (ROMICAT) trial-a prospective observational cohort study. The authors enrolled patients presenting to the emergency department (ED) with a chief complaint of acute chest pain, inconclusive initial evaluation (negative biomarkers, nondiagnostic electrocardiogram [ECG]), and no history of coronary artery disease (CAD). Patients underwent contrast-enhanced 64-multidetector-row cardiac CT and received standard clinical care (serial ECG, cardiac biomarkers, and subsequent diagnostic testing, such as exercise treadmill testing, nuclear stress perfusion imaging, and/or invasive coronary angiography), as deemed clinically appropriate. The clinical providers were blinded to CT results. The chest pain score was calculated and the results were dichotomized to ≥10 (high-risk) and modeling was performed to examine the association of risk scores and coronary plaque burden to the outcome of ACS. Unadjusted models were individually fitted for the coronary plaque burden and for Goldman, Sanchis, TIMI, and chest pain scores. In adjusted analyses, the authors tested whether the association between risk scores and ACS persisted after controlling for the coronary plaque burden. The prognostic discriminatory capacity of the risk scores and plaque burden for ACS was assessed using c-statistics. The differences in area under the receiver-operating characteristic curve (AUC) and c-statistics were tested by performing the -2 log likelihood ratio test of nested models. A p value capacity for the diagnosis of ACS. Plaque burden was

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-10-15

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

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

    International Nuclear Information System (INIS)

    Runza, G.; La Grutta, L.; Alaimo, V.; Evola, S.; Lo Re, F.; Bartolotta, T.V.; Cademartiri, F.; Midiri, M.

    2007-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Alexander John Scumpia

    2015-10-01

    Full Text Available 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%–6.0% 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.

  14. Clinical assessment of chest pain and guidelines for imaging

    International Nuclear Information System (INIS)

    Gruettner, J.; Henzler, T.; Sueselbeck, T.; Fink, C.; Borggrefe, M.; Walter, T.

    2012-01-01

    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.

  15. 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.

  16. Management of non-traumatic chest pain by the French Emergency Medical System: Insights from the DOLORES registry.

    Science.gov (United States)

    Manzo-Silberman, Stéphane; Assez, Nathalie; Vivien, Benoît; Tazarourte, Karim; Mokni, Tarak; Bounes, Vincent; Greffet, Agnès; Bataille, Vincent; Mulak, Geneviève; Goldstein, Patrick; Ducassé, Jean Louis; Spaulding, Christian; Charpentier, Sandrine

    2015-03-01

    The early recognition of acute coronary syndromes is a priority in health care systems, to reduce revascularization delays. In France, patients are encouraged to call emergency numbers (15, 112), which are routed to a Medical Dispatch Centre where physicians conduct an interview and decide on the appropriate response. However, the effectiveness of this system has not yet been assessed. To describe and analyse the response of emergency physicians receiving calls for chest pain in the French Emergency Medical System. From 16 November to 13 December 2009, calls to the Medical Dispatch Centre for non-traumatic chest pain were included prospectively in a multicentre observational study. Clinical characteristics and triage decisions were collected. A total of 1647 patients were included in the study. An interview was conducted with the patient in only 30.5% of cases, and with relatives, bystanders or physicians in the other cases. A Mobile Intensive Care Unit was dispatched to 854 patients (51.9%) presenting with typical angina chest pains and a high risk of cardiovascular disease. Paramedics were sent to 516 patients (31.3%) and a general practitioner was sent to 169 patients (10.3%). Patients were given medical advice only by telephone in 108 cases (6.6%). Emergency physicians in the Medical Dispatch Centre sent an effecter to the majority of patients who called the Emergency Medical System for chest pain. The response level was based on the characteristics of the chest pain and the patient's risk profile. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  17. Predictors of Adverse Outcomes of Patients with Chest Pain and ...

    African Journals Online (AJOL)

    Background: Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at ...

  18. Editor's Choice-The organization of chest pain units: Position statement of the Acute Cardiovascular Care Association.

    Science.gov (United States)

    Claeys, Marc J; Ahrens, Ingo; Sinnaeve, Peter; Diletti, Roberto; Rossini, Roberta; Goldstein, Patrick; Czerwińska, Kasia; Bueno, Héctor; Lettino, Maddalena; Münzel, Thomas; Zeymer, Uwe

    2017-04-01

    Chest pain units are defined as organizational short stay units with specific management protocols designed to facilitate and optimize the diagnosis of patients presenting with chest pain in the emergency department. The present document is intended to standardize and facilitate the installation of chest pain units nearby to the emergency department or as an integral part of the emergency department. Recommendations on organizational structure, physical and technical requirements and on disease management are presented. More standardized installation and implementation of chest pain units will enhance the quality of chest pain units and improve the quality of care of our chest pain patients.

  19. Coronary Artery Calcium as an Independent Surrogate Marker in the Risk Assessment of Patients With Atrial Fibrillation and an Intermediate Pretest Likelihood for Coronary Artery Disease Admitted to a German Chest Pain Unit.

    Science.gov (United States)

    Breuckmann, Frank; Olligs, Jan; Hinrichs, Liane; Koopmann, Matthias; Lichtenberg, Michael; Böse, Dirk; Fischer, Dieter; Eckardt, Lars; Waltenberger, Johannes; Garvey, J Lee

    2016-03-01

    About 10% of patients admitted to a chest pain unit (CPU) exhibit atrial fibrillation (AF). To determine whether calcium scores (CS) are superior over common risk scores for coronary artery disease (CAD) in patients presenting with atypical chest pain, newly diagnosed AF, and intermediate pretest probability for CAD within the CPU. In 73 subjects, CS was related to the following risk scores: Global Registry of Acute Coronary Events (GRACE) score, including a new model of a frequency-normalized approach; Thrombolysis In Myocardial Infarction score; European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE); Framingham risk score; and Prospective Cardiovascular Münster Study score. Revascularization rates during index stay were assessed. Median CS was 77 (interquartile range, 1-270), with higher values in men and the left anterior descending artery. Only the modified GRACE (ρ = 0.27; P = 0.02) and the SCORE (ρ = 0.39; P risk scores and calcium burden, as well as revascularization rates during index stay, were low. By contrast, the determination of CS may be used as an additional surrogate marker in risk stratification in AF patients with intermediate pretest likelihood for CAD admitted to a CPU. © 2016 Wiley Periodicals, Inc.

  20. Acute chest pain: a purely clinical problem or a question for radiology

    International Nuclear Information System (INIS)

    Loewe, C.

    2008-01-01

    Acute chest pain represents a very common clinical occurrence and at the same time poses a severe diagnostic dilemma. It can be due to an acute life-threatening event such as acute cardiac infarct, or a relatively harmless condition of pain and illness (e.g. vertebrogenic pain) under the main symptom category of acute chest pain. This often unclear symptomatic, behind which there can always be a life-threatening disease leads to an exaggerated grouping of patients into emergency cases and to an increased number of inpatients for observation. The diagnosis of acute coronary syndrome with no initial ECG changes typical for ischemia is especially problematic. The availability of modern multidetector computed tomography is becoming increasingly more important for radiologists in the diagnosis and clarification of acute chest pain. In this article the clinical difficulties and radiology options for the diagnosis of patients with acute chest pain will be presented and possible future algorithms for diagnosis will be discussed. (orig.) [de

  1. Chest Wall Volume Receiving >30 Gy Predicts Risk of Severe Pain and/or Rib Fracture After Lung Stereotactic Body Radiotherapy

    International Nuclear Information System (INIS)

    Dunlap, Neal E.; Cai, Jing; Biedermann, Gregory B.; Yang, Wensha; Benedict, Stanley H.; Sheng Ke; Schefter, Tracey E.; Kavanagh, Brian D.; Larner, James M.

    2010-01-01

    Purpose: To identify the dose-volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy. Methods and Materials: From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving ≥20, ≥30, ≥40, ≥50, and ≥60 Gy was determined and related to the risk of CW toxicity. Results: Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose-response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R 2 = 0.9552). A volume threshold of 30 cm 3 was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm 3 receiving 30 Gy. Conclusion: The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to 3 , if possible, to reduce the risk of toxicity without compromising tumor coverage.

  2. 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...

  3. Assessment of chest pain in the emergency room: What is the role of multidetector CT?

    International Nuclear Information System (INIS)

    White, Charles; Read, Katrina; Kuo, Dick

    2006-01-01

    Chest pain is one of the most frequent complaints for patients seen in the emergency department. The current article describes the clinical stratification of patients who present to the emergency department with chest pain and discusses imaging options and analysis for these patients. It reviews conventional imaging approaches to assessing chest pain including chest radiography and stress testing. The main discussion focuses on the potential utility use of cross-sectional imaging, particularly multidetector CT, in the evaluation of chest pain in the emergency department

  4. Platelet function testing to predict hyporesponsiveness to clopidogrel in patients with chest pain seen in the emergency department

    Directory of Open Access Journals (Sweden)

    Sharma RK

    2013-05-01

    Full Text Available Rakesh K Sharma,1 Stephen W Erickson,1 Rohit Sharma,2 Donald J Voelker,1 Hanumanth K Reddy,1 Harvinder Dod,2 James D Marsh1 1Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, 2Medical Center of South Arkansas, El Dorado, AR, USA Background: A dual antiplatelet regimen has been shown to reduce the risk of major adverse cardiovascular events after percutaneous coronary intervention. However, there is little information available on inhibition of platelet aggregation in patients with a prior coronary stent presenting with chest pain. This study evaluated the prevalence of hyporesponsiveness to clopidogrel and factors associated with this in patients presenting to our emergency department with chest pain who had previously undergone coronary stent placement and were prescribed dual antiplatelet therapy. Methods: Responsiveness to clopidogrel was evaluated in a cohort of 533 consecutive stented patients presenting to the emergency department with chest pain. P2Y12 reaction units (PRU and percent P2Y12 inhibition with clopidogrel were measured in all patients. Of 533 patients, 221 (41.6% had PRU ≥ 230. A multivariate logistic regression model was used to determine the relationship between hyporesponsiveness to clopidogrel (defined as PRU ≥ 230 and several potential risk factors, ie, gender, age, race, type 1 or type 2 diabetes, hypertension, smoking, chronic renal failure, and obesity. Results: There was a greater risk of hyporesponsiveness in African Americans than in non-African American patients (adjusted odds ratio [OR] = 2.165, in patients with type 2 diabetes than in those without (adjusted OR = 2.109, and in women than in men (adjusted OR = 1.813, as well as a greater risk of hyporesponsiveness with increasing age (adjusted OR = 1.167 per decade. Conclusion: There was a high prevalence of hyporesponsiveness to clopidogrel in patients presenting with chest pain and a prior coronary stent. Non

  5. Predictive risk factors for chronic low back pain in Parkinson's disease.

    Science.gov (United States)

    Ozturk, Erhan Arif; Kocer, Bilge Gonenli

    2018-01-01

    Although previous studies have reported that the prevalence of low back pain in Parkinson's disease was over 50% and low back pain was often classified as chronic, risk factors of chronic low back pain have not been previously investigated. The aim of this study was to determine the predictive risk factors of chronic low back pain in Parkinson's disease. One hundred and sixty-eight patients with Parkinson's disease and 179 controls were consecutively included in the study. Demographic data of the two groups and disease characteristics of Parkinson's disease patient group were recorded. Low back pain lasting for ≥3 months was evaluated as chronic. Firstly, the bivariate correlations were calculated between chronic low back pain and all possible risk factors. Then, a multivariate regression was used to evaluate the impact of the predictors of chronic low back pain. The frequency of chronic low back pain in Parkinson's disease patients and controls were 48.2% and 26.7%, respectively (p chronic low back pain in Parkinson's disease were general factors including age (odds ratio = 1.053, p = 0.032) and Hospital Anxiety and Depression Scale - Depression subscore (odds ratio = 1.218, p = 0.001), and Parkinson's disease-related factors including rigidity (odds ratio = 5.109, p = 0.002) and posture item scores (odds ratio = 5.019, p = 0.0001). The chronic low back pain affects approximately half of the patients with Parkinson's disease. Prevention of depression or treatment recommendations for managing depression, close monitoring of anti- parkinsonian medication to keep motor symptoms under control, and attempts to prevent, correct or reduce abnormal posture may help reduce the frequency of chronic low back pain in Parkinson's disease. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. [Chest pain in the emergency department : Differential diagnosis and diagnostic strategy].

    Science.gov (United States)

    Köhnlein, T

    2017-01-01

    Chest pain as the leading symptom in emergency patients can have numerous causes and requires an immediate and targeted diagnostic and therapeutic strategy. Clinical scoring systems facilitate risk assessment for individual patients. In the emergency department, critical factors for success are defined professional qualification standards for physicians and nursing staff combined with a well-functioning organization of all technical procedures.

  7. Association between depression and anxiety symptoms and major atherosclerosis risk factors in patients with chest pain

    International Nuclear Information System (INIS)

    Vural, M.; Satiroglu, Oe.; Goeksel, I.; Akbas, B.; Karabay, Oe.

    2007-01-01

    Psychological variables, such as depression and anxiety, are known as independent risk factors for coronary artery disease (CAD), suggesting the interaction of psychological and physiological factors in the development of CAD. In the present study, we analyzed the possible association between depressive and anxiety symptoms and major atherosclerotic risk factors in patients with chest pain warranting coronary angiography. The patients without CAD (n=159) and those with CAD (n=155) were evaluated for the severity of depression and anxiety by the symptom scales; high scores indicate severe symptoms. Age, male/female ratio, prevalence of diabetes mellitus (DM), and depression level were significantly higher in the CAD group. Among a total of 314 patients with chest pain, the mean depression score was higher in patients with DM (16.01±8.12 vs 13.01±9.6, p=0.01) and those with hypercholesterolemia (15.43±9.61 vs 12.53±9.61, p=0.02). The mean anxiety score was also higher in patients with DM (20.81±12.85 vs 16.51±12.09, p=0.008), hypercholesterolemia (20.67±13.11 vs 15.29±11.36, p=0.002), or hypertension (20.74±12.94 vs 14.1±10.8, p=0.001). Thus, DM and hypercholesterolemia are associated with depression and anxiety, while hypertension is only related to anxiety. In contrast, smoking and family history of atherosclerosis are not related to depression and anxiety scores. These results suggest depression and anxiety symptoms may contribute to the development and progression of CAD, especially in patients with DM or hypercholesterolemia. (author)

  8. Chest pain following oesophageal stenting for malignant dysphagia

    Energy Technology Data Exchange (ETDEWEB)

    Golder, Mark; Tekkis, Paris P.; Kennedy, Colette; Lath, Sadaf; Toye, Rosemary; Steger, Adrian C

    2001-03-01

    AIM: The palliative use of self-expanding metallic stents has been widely reported to relieve dysphagia in cases of oesophageal carcinoma. Little has been documented on the severity of chest pain following oesophageal stenting. The aim of this study was to investigate the association of pain with oesophageal stenting for malignant dysphagia. METHODS: Fifty-two patients with inoperable oesophageal carcinoma underwent stent placement between 1995-1999. Daily opioid analgesic requirements (mg of morphine equivalent doses) were monitored for 3 days before and 7 days after stenting. The degree of palliation was expressed as a dysphagia score (0-3). Hospital stay, readmission days, stent complications and patient survival time were also recorded. RESULTS: Twenty-six patients (50%) required opioid analgesia for chest pain (median dose: 80 mg morphine/day) within 48 h of the procedure compared to 11 (21.2%) patients before stenting (P = 0.0041). A significant increase was evident in the analgesic consumption following stent deployment (P < 0.001). The dysphagia score improved by a median value of 1 (CI 0.25)P < 0.001, with a re-intervention rate of 11.5%. The median survival time was 40 days post stenting (range 1-120). CONCLUSION: A significant proportion of patients developed chest pain after oesophageal stenting, requiring high dose opioid analgesia. As the origin of the pain is still unknown, pre-emptive analgesia may a play role in reducing stent-related morbidity and possibly in-hospital stay. Golder, M. et al. (2001)

  9. Chest pain following oesophageal stenting for malignant dysphagia

    International Nuclear Information System (INIS)

    Golder, Mark; Tekkis, Paris P.; Kennedy, Colette; Lath, Sadaf; Toye, Rosemary; Steger, Adrian C.

    2001-01-01

    AIM: The palliative use of self-expanding metallic stents has been widely reported to relieve dysphagia in cases of oesophageal carcinoma. Little has been documented on the severity of chest pain following oesophageal stenting. The aim of this study was to investigate the association of pain with oesophageal stenting for malignant dysphagia. METHODS: Fifty-two patients with inoperable oesophageal carcinoma underwent stent placement between 1995-1999. Daily opioid analgesic requirements (mg of morphine equivalent doses) were monitored for 3 days before and 7 days after stenting. The degree of palliation was expressed as a dysphagia score (0-3). Hospital stay, readmission days, stent complications and patient survival time were also recorded. RESULTS: Twenty-six patients (50%) required opioid analgesia for chest pain (median dose: 80 mg morphine/day) within 48 h of the procedure compared to 11 (21.2%) patients before stenting (P = 0.0041). A significant increase was evident in the analgesic consumption following stent deployment (P < 0.001). The dysphagia score improved by a median value of 1 (CI 0.25)P < 0.001, with a re-intervention rate of 11.5%. The median survival time was 40 days post stenting (range 1-120). CONCLUSION: A significant proportion of patients developed chest pain after oesophageal stenting, requiring high dose opioid analgesia. As the origin of the pain is still unknown, pre-emptive analgesia may a play role in reducing stent-related morbidity and possibly in-hospital stay. Golder, M. et al. (2001)

  10. 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.

  11. Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

    DEFF Research Database (Denmark)

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

    2016-01-01

    OBJECTIVES: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. ...... useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.......OBJECTIVES: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We...... investigated the validity of the new guidelines in a population of patients with acute-onset chest pain. METHODS: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We...

  12. Use of the hospital anxiety and depression scale (HADS in a cardiac emergency room: chest pain unit

    Directory of Open Access Journals (Sweden)

    Gastão L. F. Soares-Filho

    2009-03-01

    Full Text Available OBJECTIVE: To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION: Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. METHODOLOGY: Patients were assessed by the "Hospital Anxiety and Depression Scale" as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered "probable case" of anxiety or depression. RESULTS: According to the protocol, 59 (45.4% of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6% presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1% had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. CONCLUSION: The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.

  13. Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit.

    Science.gov (United States)

    Soares-Filho, Gastão L F; Freire, Rafael C; Biancha, Karla; Pacheco, Ticiana; Volschan, André; Valença, Alexandre M; Nardi, Antonio E

    2009-01-01

    To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. Patients were assessed by the 'Hospital Anxiety and Depression Scale' as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered 'probable case' of anxiety or depression. According to the protocol, 59 (45.4%) of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6%) presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.

  14. Resource reduction in pediatric chest pain: Standardized clinical assessment and management plan.

    Science.gov (United States)

    Saleeb, Susan F; McLaughlin, Sarah R; Graham, Dionne A; Friedman, Kevin G; Fulton, David R

    2018-01-01

    Using a Standardized Clinical Assessment and Management Plan (SCAMP) for pediatric patients presenting to clinic with chest pain, we evaluated the cost impact associated with implementation of the care algorithm. Prior to introduction of the SCAMP, we analyzed charges for 406 patients with chest pain, seen in 2009, and predicted 21% reduction of overall charges had the SCAMP methodology been used. The SCAMP recommended an echocardiogram for history, examination, or ECG findings suggestive of a cardiac etiology for chest pain. Resource utilization was reviewed for 1517 patients (7-21 years) enrolled in the SCAMP from July 2010 to April 2014. Compared to the 2009 historic cohort, patients evaluated by the SCAMP had higher rates of exertional chest pain (45% vs 37%) and positive family history (5% vs 1%). The SCAMP cohort had fewer abnormal physical examination findings (1% vs 6%) and abnormal electrocardiograms (3% vs 5%). Echocardiogram use increased in the SCAMP cohort compared to the 2009 historic cohort (45% vs 41%), whereas all other ancillary testing was reduced: exercise stress testing (4% SCAMP vs 28% historic), Holter (4% vs 7%), event monitors (3% vs 10%), and MRI (1% vs 2%). Total charges were reduced by 22% ($822 625) by use of the Chest Pain SCAMP, despite a higher percentage of patients for whom echocardiogram was recommended compared to the historic cohort. The Chest Pain SCAMP effectively streamlines cardiac testing and reduces resource utilization. Further reductions can be made by algorithm refinement regarding echocardiograms for exertional symptoms. © 2017 Wiley Periodicals, Inc.

  15. Ultrasound assisted evaluation of chest pain in the emergency department.

    Science.gov (United States)

    Colony, M Deborah; Edwards, Frank; Kellogg, Dylan

    2018-04-01

    Chest pain is a commonly encountered emergency department complaint, with a broad differential including several life-threatening possible conditions. Ultrasound-assisted evaluation can potentially be used to rapidly and accurately arrive at the correct diagnosis. We propose an organized, ultrasound assisted evaluation of the patient with chest pain using a combination of ultrasound, echocardiography and clinical parameters. Basic echo techniques which can be mastered by residents in a short time are used plus standardized clinical questions and examination. Information is kept on a checklist. We hypothesize that this will result in a quicker, more accurate evaluation of chest pain in the ED leading to timely treatment and disposition of the patient, less provider anxiety, a reduction in the number of diagnostic errors, and the removal of false assumptions from the diagnostic process. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Anxiety, depression, suicidal ideation, and stressful life events in non-cardiac adolescent chest pain: a comparative study about the hidden part of the iceberg.

    Science.gov (United States)

    Eliacik, Kayi; Kanik, Ali; Bolat, Nurullah; Mertek, Hilal; Guven, Baris; Karadas, Ulas; Dogrusoz, Buket; Bakiler, Ali Rahmi

    2017-08-01

    Chest pain in adolescents is rarely associated with cardiac disease. Adolescents with medically unexplained chest pain usually have high levels of anxiety and depression. Psychological stress may trigger non-cardiac chest pain. This study evaluated risk factors that particularly characterise adolescence, such as major stressful events, in a clinical population. The present study was conducted on 100 adolescents with non-cardiac chest pain and 76 control subjects. Stressful life events were assessed by interviewing patients using a 36-item checklist, along with the Children's Depression Inventory and Spielberger's State-Trait Anxiety Inventory for children, in both groups. Certain stressful life events, suicidal thoughts, depression, and anxiety were more commonly observed in adolescents with non-cardiac chest pain compared with the control group. Moreover, binary logistic regression analysis showed that trouble with bullies, school-related problems, and depression may trigger non-cardiac chest pain in adolescents. Non-cardiac chest pain on the surface may point to the underlying psychosocial health problems such as depression, suicidal ideas, or important life events such as academic difficulties or trouble with bullies. The need for a psychosocial evaluation that includes assessment of negative life events and a better management have been discussed in light of the results.

  17. 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.

  18. Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients.

    Science.gov (United States)

    Moumneh, Thomas; Richard-Jourjon, Vanessa; Friou, Emilie; Prunier, Fabrice; Soulie-Chavignon, Caroline; Choukroun, Jacques; Mazet-Guilaumé, Betty; Riou, Jérémie; Penaloza, Andréa; Roy, Pierre-Marie

    2018-03-02

    In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study. Patients admitted to the ED for non-traumatic chest pain were included, and followed-up at 6 weeks. The main study endpoint was the 6-week rate of MACE (myocardial infarction, coronary angioplasty, coronary bypass, and sudden unexplained death). 641 patients were included, of whom 9.5% presented a MACE at 6 weeks. The CARE rule was negative for 31.2% of patients, and none presented a MACE during follow-up [0, 95% confidence interval: (0.0-1.9)]. The HEART score was ≤ 3 for 63.0% of patients, and none presented a MACE during follow-up [0% (0.0-0.9)]. With an incidence below 2% in the negative group, the CARE rule seemed able to safely rule out a MACE without any biological test for one-third of patients with chest pain and the HEART score for another third with a single troponin assay.

  19. Thallium myocardial scanning in the emergency department evaluation of chest pain

    International Nuclear Information System (INIS)

    Mace, S.E.

    1989-01-01

    Chest pain is a common complaint of patients seen in the emergency department. The causes are legion, and range from the non-life threatening to the potentially catastrophic. Thallium heart scanning was done prospectively in 20 patients with a ''classic'' history for myocardial infarction (eight patients) or atypical chest pain and/or associated symptoms plus an abnormal ECG (12 patients) to discern a subset of patients from whom thallium scintography may be indicated in the emergency department. Although further investigation is needed, our preliminary study suggests that myocardial scanning with thallium can be a safe, fairly rapid, and useful objective parameter in the emergency department detection of suspected myocardial infarction, and in differential diagnosis of chest pain when other data such as the history, physical examination, ECG, or enzymes are inconclusive

  20. Biological risk indicators for recurrent non-specific low back pain in adolescents.

    Science.gov (United States)

    Jones, M A; Stratton, G; Reilly, T; Unnithan, V B

    2005-03-01

    A matched case-control study was carried out to evaluate biological risk indicators for recurrent non-specific low back pain in adolescents. Adolescents with recurrent non-specific low back pain (symptomatic; n = 28; mean (SD) age 14.9 (0.7) years) and matched controls (asymptomatic; n = 28; age 14.9 (0.7) years) with no history of non-specific low back pain participated. Measures of stature, mass, sitting height, sexual maturity (Tanner self assessment), lateral flexion of the spine, lumbar sagittal plane mobility (modified Schober), hip range of motion (Leighton flexometer), back and hamstring flexibility (sit and reach), and trunk muscle endurance (number of sit ups) were performed using standardised procedures with established reliability. Backward stepwise logistic regression analysis was performed, with the presence/absence of recurrent low back pain as the dependent variable and the biological measures as the independent variables. Hip range of motion, trunk muscle endurance, lumbar sagittal plane mobility, and lateral flexion of the spine were identified as significant risk indicators of recurrent low back pain (plow back pain in a group of adolescents. These risk indicators identify the potential for exercise as a primary or secondary prevention method.

  1. Chest pain related to crack cocaine smoking

    International Nuclear Information System (INIS)

    Eurman, D.W.; Potash, H.I.; Eyler, W.R.; Beute, G.H.; Paganussi, P.

    1988-01-01

    The chest radiographs of 80 patients coming to emergency room because of chest pain and/or shortness of breath following the smoking of highly potent crack cocaine were retrospectively reviewed. Four showed intrathoracic free air (pneumomediastinum in two, hemopneumothorax in one, and pneumothorax in one). Four other patients showed subsegmental atelectasis or parenchymal infiltrate. Radiographic detection of these abnormalities was of importance in the clinical management of the patients. This spectrum of findings is presented with a discussion of the pathophysiologic mechanisms and other potential complications of this form of drug abuse

  2. Invasive treatment of NSTEMI patients in German Chest Pain Units - Evidence for a treatment paradox.

    Science.gov (United States)

    Schmidt, Frank P; Schmitt, Claus; Hochadel, Matthias; Giannitsis, Evangelos; Darius, Harald; Maier, Lars S; Schmitt, Claus; Heusch, Gerd; Voigtländer, Thomas; Mudra, Harald; Gori, Tommaso; Senges, Jochen; Münzel, Thomas

    2018-03-15

    Patients with non ST-segment elevation myocardial infarction (NSTEMI) represent the largest fraction of patients with acute coronary syndrome in German Chest Pain units. Recent evidence on early vs. selective percutaneous coronary intervention (PCI) is ambiguous with respect to effects on mortality, myocardial infarction (MI) and recurrent angina. With the present study we sought to investigate the prognostic impact of PCI and its timing in German Chest Pain Unit (CPU) NSTEMI patients. Data from 1549 patients whose leading diagnosis was NSTEMI were retrieved from the German CPU registry for the interval between 3/2010 and 3/2014. Follow-up was available at median of 167days after discharge. The patients were grouped into a higher (Group A) and lower risk group (Group B) according to GRACE score and additional criteria on admission. Group A had higher Killip classes, higher BNP levels, reduced EF and significant more triple vessel disease (pGerman Chest Pain Units. This treatment paradox may worsen prognosis in patients who could derive the largest benefit from early revascularization. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  3. Development of quality metrics for ambulatory pediatric cardiology: Chest pain.

    Science.gov (United States)

    Lu, Jimmy C; Bansal, Manish; Behera, Sarina K; Boris, Jeffrey R; Cardis, Brian; Hokanson, John S; Kakavand, Bahram; Jedeikin, Roy

    2017-12-01

    As part of the American College of Cardiology Adult Congenital and Pediatric Cardiology Section effort to develop quality metrics (QMs) for ambulatory pediatric practice, the chest pain subcommittee aimed to develop QMs for evaluation of chest pain. A group of 8 pediatric cardiologists formulated candidate QMs in the areas of history, physical examination, and testing. Consensus candidate QMs were submitted to an expert panel for scoring by the RAND-UCLA modified Delphi process. Recommended QMs were then available for open comments from all members. These QMs are intended for use in patients 5-18 years old, referred for initial evaluation of chest pain in an ambulatory pediatric cardiology clinic, with no known history of pediatric or congenital heart disease. A total of 10 candidate QMs were submitted; 2 were rejected by the expert panel, and 5 were removed after the open comment period. The 3 approved QMs included: (1) documentation of family history of cardiomyopathy, early coronary artery disease or sudden death, (2) performance of electrocardiogram in all patients, and (3) performance of an echocardiogram to evaluate coronary arteries in patients with exertional chest pain. Despite practice variation and limited prospective data, 3 QMs were approved, with measurable data points which may be extracted from the medical record. However, further prospective studies are necessary to define practice guidelines and to develop appropriate use criteria in this population. © 2017 Wiley Periodicals, Inc.

  4. How do patients with chest pain access Emergency Department care?

    Science.gov (United States)

    Van Severen, Evie; Willemsen, Robert; Vandervoort, Pieter; Sabbe, Marc; Dinant, Geert-Jan; Buntinx, Frank

    2017-12-01

    It is important that patients with symptoms of acute coronary syndrome receive appropriate medical care as soon as possible. Little is known about the preadmission actions that patients with chest pain take before arrival at the Emergency Department (ED). This study aimed to describe the actions of patients with chest pain or pressure after onset of symptoms. What is the first action following onset of symptoms? Who is the first lay or professional person to be contacted? Which steps are taken first? How is the patient transported to the hospital? Consecutive patients, arriving at the ED of two large hospitals in Belgium, were asked additional questions during the initial assessment. Overall, 35% of 412 consecutive patients with chest pain admitted to the ED were diagnosed with acute coronary syndrome. A total of 57% contacted a GP between symptom onset and arrival at the ED. Only 32% of the patients were transported to the ED by ambulance, 16% drove themselves and 52% arrived by other means of transport (by family, neighbour, GP, public transport). In Belgium, the GP is still the first professional to be contacted for most patients. Other patients initially rely on their partner, family or friends when symptoms emerge. Too often, patients with chest pain rely on other transport to get to the ED instead of calling the Emergency Medical Services. This study included only patients who ultimately attended the ED.

  5. Technetium-99m-Sestamibi in the diagnosis of acute chest pain

    International Nuclear Information System (INIS)

    Gilleece, T.; Salehi, N.; Better, N.

    1998-01-01

    Full text: A 45-year-old male was admitted to coronary care with a two-day history of recurrent chest pain. Despite maximal medical therapy, pain persisted. Examination and ECG with pain, were normal, suspicion of ischaemia was moderately high but coronary angiography was not immediately available. Technetium-99m-Sestamibi was prepared at the start of the day according to the standard preparation protocol (Du Pont). Coronary Care informed the Nuclear Medicine Department immediately the patient experienced a further episode of chest pain. Technetium-99m-Sestamibi was administered in coronary care, 4.30 minutes after being advised of the onset of further chest pain. Images were acquired 60 minute post-injection; 15 minutes after the patient had been given 200 mL of milk. A triple-headed gamma camera was used to acquire SPECT images over a 1200 arc, 30 frames of 30 seconds using a 64 x 64 matrix. The patient was laying prone with arms raised out of the field of view. Images showed a normal distribution of technetium-99m -Sestamibi throughout the myocardium. Due to ongoing clinical suspicion by the treating physician, coronary angiography was subsequently performed. This showed normal coronary arteries. Medical therapy was ceased and the patient discharged the next day. We concluded that the chest pain at the time of injection was not ischaemic. Previous trials had shown a 95% sensitivity for this method of diagnosing ischaemia. This method permits a novel and simple technique for diagnosing myocardial ischaemia and obviating the need for cardiac catheterization in this group of patients

  6. Frequency of chest pain in primary care, diagnostic tests performed and final diagnoses.

    Science.gov (United States)

    Hoorweg, Beatrijs Bn; Willemsen, Robert Ta; Cleef, Lotte E; Boogaerts, Tom; Buntinx, Frank; Glatz, Jan Fc; Dinant, Geert Jan

    2017-11-01

    Observational study of patients with chest pain in primary care: determination of incidence, referral rate, diagnostic tests and (agreement between) working and final diagnoses. 118 general practitioners (GPs) in the Netherlands and Belgium recorded all patient contacts during  2weeks. Furthermore, patients presenting with chest pain were registered extensively. A follow-up form was filled in after 30 days. 22 294 patient contacts were registered. In 281 (1.26%), chest pain was a reason for consulting the GP (mean age for men 54.4/women 53 years). In this cohort of 281 patients, in 38.1% of patients, acute coronary syndrome (ACS) was suspected at least temporarily during consultation, 40.2% of patients were referred to secondary care and 512 diagnostic tests were performed by GPs and consulted specialists. Musculoskeletal pain was the most frequent working (26.1%) and final diagnoses (33.1%). Potentially life-threatening diseases as final diagnosis (such as myocardial infarction) accounted for 8.4% of all chest pain cases. In 23.1% of cases, a major difference between working and final diagnoses was found, in 0.7% a severe disease was initially missed by the GP. Chest pain was present in 281 patients (1.26% of all consultations). Final diagnoses were mostly non-life-threatening. Nevertheless, in 8.4% of patients with chest pain, life-threatening underlying causes were identified. This seems reflected in the magnitude and wide variety of diagnostic tests performed in these patients by GPs and specialists, in the (safe) overestimation of life-threatening diseases by GPs at initial assessment and in the high referral rate we found. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Exercise tolerance test in patients presenting with chest pain and normal electrocardiogram

    International Nuclear Information System (INIS)

    Sharieff, S.; Khan, Shah-e-Zaman

    2002-01-01

    Objective: To report the prevalence of abnormal exercise tolerance test (ETT) responses and to assess the risk factors for ischemic heart disease (IHD) in a population referred for the evaluation of chest pain with a normal baseline electrocardiogram (ECG). Design: A prospective study. The study was conducted at the National Institute of cardiovascular Diseases (NICVD), Karachi, Pakistan between 1st January 2000 and 31 December 2000. Subjects and Methods: One thousand one hundred and twenty-seven consecutive adult patients presenting in the outpatient department (OPD) with history of chest pain and having a normal baseline ECG were the subjects of the study after excluding patients with indeterminate or inconclusive test response. All these subjects underwent ETT and were screened for risk factor for IHD. Results: Of the patients studied 56.6% had abnormal ETT response. Male to female ratio of all patients was 4.85:1 Overall mean age was 50.3 +- 8.8 years. 65.9% of diabetic patients had ETT Suggestive of silent myocardial ischemia (p=0.012). Age > 50 year (p= <0.0001), male sex (p=0.015), diabetes mellitus (p=0.0033) and positive family history of IHD (p=0.0014) were the risk factor found in patient with abnormal ETT response. Conclusion: Age of more than 50 years, male gender, diabetes mellitus and positive family history of IHD are the significant risk factors for the development of ischemic heart disease in our population. Silent myocardial ischemic is common in diabetics. (author)

  8. Estimation of the radiation exposure of a chest pain protocol with ECG-gating in dual-source computed tomography

    International Nuclear Information System (INIS)

    Ketelsen, Dominik; Luetkhoff, Marie H.; Thomas, Christoph; Werner, Matthias; Tsiflikas, Ilias; Reimann, Anja; Kopp, Andreas F.; Claussen, Claus D.; Heuschmid, Martin; Buchgeister, Markus; Burgstahler, Christof

    2009-01-01

    The aim of the study was to evaluate radiation exposure of a chest pain protocol with ECG-gated dual-source computed tomography (DSCT). An Alderson Rando phantom equipped with thermoluminescent dosimeters was used for dose measurements. Exposure was performed on a dual-source computed tomography system with a standard protocol for chest pain evaluation (120 kV, 320 mAs/rot) with different simulated heart rates (HRs). The dose of a standard chest CT examination (120 kV, 160 mAs) was also measured. Effective dose of the chest pain protocol was 19.3/21.9 mSv (male/female, HR 60), 17.9/20.4 mSv (male/female, HR 80) and 14.7/16.7 mSv (male/female, HR 100). Effective dose of a standard chest examination was 6.3 mSv (males) and 7.2 mSv (females). Radiation dose of the chest pain protocol increases significantly with a lower heart rate for both males (p = 0.040) and females (p = 0.044). The average radiation dose of a standard chest CT examination is about 36.5% that of a CT examination performed for chest pain. Using DSCT, the evaluated chest pain protocol revealed a higher radiation exposure compared with standard chest CT. Furthermore, HRs markedly influenced the dose exposure when using the ECG-gated chest pain protocol. (orig.)

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

    Science.gov (United States)

    ... Resources Adult , Geriatric Stress Tests for Chest Pain Stress Tests for Chest Pain When you need an ... pain isn’t from heart disease. A cardiac stress test makes the heart work hard so your ...

  10. CT coronary angiographic evaluation of suspected anginal chest pain.

    Science.gov (United States)

    Moss, Alastair J; Newby, David E

    2016-02-15

    Non-invasive imaging plays a critical role in the assessment of patients presenting with suspected angina chest pain. However, wide variations in practice across Europe and North America highlight the lack of consensus in selecting the appropriate first-line test for the investigation of coronary artery disease (CAD). CT coronary angiography (CTCA) has a high negative predictive value for excluding the presence of CAD. As such, it serves as a potential 'gatekeeper' to downstream testing by reducing the rate of inappropriate invasive coronary angiography. Two recent large multicentre randomised control trials have provided insights into whether CTCA can be incorporated into chest pain care pathways to improve risk stratification of CAD. They demonstrate that using CTCA enhances diagnostic certainty and improves the targeting of appropriate invasive investigations and therapeutic interventions. Importantly, reductions in cardiac death and non-fatal myocardial infarction appear to be attained through the more appropriate use of preventative therapy and coronary revascularisation when guided by CTCA. With this increasing portfolio of evidence, CTCA should be considered the non-invasive investigation of choice in the evaluation of patients with suspected angina pectoris due to coronary heart disease. NCT01149590, post-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Chest pain: Coronary CT in the ER

    NARCIS (Netherlands)

    E. Maffei (Erica); S. Seitun (Sara); A.I. Guaricci (Andrea); F. Cademartiri (Filippo)

    2016-01-01

    textabstractCardiac CT has developed into a robust clinical tool during the past 15 years. Of the fields in which the potential of cardiac CT has raised more interest is chest pain in acute settings. In fact, the possibility to exclude with high reliability obstructive coronary artery disease (CAD)

  12. 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...

  13. Heartburn or Chest Pain: When Is It Heart Attack?

    Science.gov (United States)

    ... of cardiovascular imaging in emergency department patients with chest pain: A joint document of the American College of Radiology Appropriateness Criteria Committee and the American College of ...

  14. Implementation of a rapid chest pain protocol in the emergency department: A quality improvement project.

    Science.gov (United States)

    Bunch, Azalea Marie; Leasure, A Renee; Carithers, Cathrin; Burnette, Robert E; Berryman, Michael Scott

    2016-02-01

    The purpose of this quality improvement (QI) project is to compare the effectiveness of a rapid 90-min chest pain screening and evaluation protocol to a 120-min screening and evaluation protocol in determining patient readiness for hospital admission or discharge home. The existing chest pain protocol utilized in the emergency department (ED) was revised based on a review of current research changing initial screening and reevaluation times from 120 to 90 min. A prospective comparative study of patients presenting to the ED with chest pain was performed comparing the existing chest pain protocol of 120 min (standard care) with a rapid screening evaluation protocol of 90 min. A total of 128 patients presenting to an ED in Texas with chest pain comprised the sample for this study. There was a significant difference in the number of minutes between the groups for readiness for disposition. The average time from chest pain evaluation to readiness for disposition home, observation, or admission decreased from an average of 191 min in the standard care group to an average of 118 min in the rapid screening group. Use of the rapid screening and evaluation protocol decreased the time to disposition by an average of 73 min, which enhanced ED flow without influencing disposition and patient safety. ©2015 American Association of Nurse Practitioners.

  15. [Chronic chest pain after rib fracture: It can cause a disability?

    Science.gov (United States)

    Rabiou, S; Ouadnouni, Y; Lakranbi, M; Traibi, A; Antoini, F; Smahi, M

    2018-04-01

    The rib fractures and instability of the chest wall are the main lesions of closed chest trauma. These lesions can be a source of chronic, often disabling with daily discomfort resulting limitation of some activities. The objective of this study was to assess the prevalence of this phenomenon in order to improve the quality of early care. Through an observational retrospective cohort study on a number of 41 patients supported and monitored for traumatic rib fractures at the Military Hospital of Meknes during the period from October 2010 to March 2016. The circumstances of the accident were dominated by accidents of public roads (86%) and concerned the young adult male. Radiographs have enumerated 165 fracture lines with an average of 4 rib fractures per patient. These were unilateral fractures in 88% of cases, and concerned the means arc in 46% of cases. The rib fracture was undisplaced fracture in 39% of patients, whereas in 2 patients, a flail chest was present. Post-traumatic hemothorax (63% of cases) were the thoracic lesions most commonly associated with rib fractures. The initial management consisted in the use of analgesics systemically in all patients. The retrospective evaluation of pain by the verbal scale was possible in 30 patients. The persistent pain was noted in 60% of cases. This pain was triggered by a simple effort to moderate in 55% of cases, and hard effort in 28% of cases. In 17% of patients, even at rest, the pain occurred intermittently. The impact in terms of disability was mild to moderate in 28% of cases and important in 17%. The neuropathic pain was found in 3 patients. Therapeutically, the first and second levels of analgesics were sufficient to relieve pain. The neuroleptics were required for 2 patients. Our study confirms the persistence of chronic painful, sometimes lasting several years after the initial chest trauma. This pain is responsible of disability triggered most often after exercise. Copyright © 2017 Elsevier Masson

  16. Assessment of chest pain in hypertrophic cardiomyopathy using exercise thallium-201 myocardial scintigraphy

    International Nuclear Information System (INIS)

    Pitcher, D.; Wainwright, R.; Maisey, M.; Curry, P.; Sowton, E.

    1980-01-01

    Exercise thallium-201 myocardial scintigraphy was performed in 23 patients with hypertrophic cardiomyopathy. Eighteen patients presented with chest pain which was a persistent symptom in 11. Selective coronary arteriography was performed in 16 patients and showed normal coronary arteries in 15 and insignificant luminal irregularities in one patient. Eighteen patients had abnormal scintigrams. Three had an abnormal distribution of tracer entirely attributable to asymmetric septal hypertrophy, whereas 15 had discrete tracer uptake defects which could not be explained solely by myocardial hypertrophy. In this latter group of patients three scintigraphic patterns were identified: (1) in 10 patients defects were seen in scintigrams immediately after exercise but not in delayed images obtained four to six hours later. Eight of these patients had chest pain. (2) Four patients had uptake defects seen in both initial and delayed images. One patient had chest pain. (3) In three patients, one of whom had chest pain, tracer defects were seen only in delayed images and were not apparent in the initial scintigrams. Chest pain occurred in eight out of 10 patients with scintigraphic evidence of myocardial ischaemia but was present in only three out of 13 patients with non-ischaemic scintigrams. The value of exercise thallium-201 myocardial imaging as a diagnostic technique in hypertrophic cardiomyopathy appears limited. Scintigraphic evidence of regional myocardial ischaemia in the absence of significant coronary artery disease, however, contributes to an understanding of the mechanism of angina production in patients with hypertrophic cardiomyopathy. (author)

  17. The clinical value of chest pain during thallium-201 scintigraphy with dipyridamole

    International Nuclear Information System (INIS)

    Takeishi, Yasuchika; Tono-oka, Ichiro; Meguro, Mitsuhiko; Hoshi, Hikaru; Yamaguchi, Yoshiko; Masakane, Ikuto; Tsuiki, Kai; Yasui, Shoji

    1990-01-01

    Sixty patients with suspected coronary artery disease underwent both dipyridamole-loaded thallium-201 scintigraphy and cardiac catheterization. Thirty four patients (57%) developed chest pain during dipyridamole stress testing (the pain group), and the other 26 did not (the no-pain group). Regarding sex, age, history of myocardial infarction, and the presence of coronary artery disease, there was no difference between the pain and no-pain groups. The pain group had significantly increased pulse rate and rate-pressure-product, as compared with the no-pain group. ST depression was more frequently observed in the pain group than the no-pain group. There was no significant difference in the angiographic involvement and the severity of coronary artery disease between the two groups. Nor was there significant difference in dipyridamole-loaded scintigraphic findings, such as defect size, and the extent and degree of decreased washout. However, for patients without a history of myocardial infarction, the pain group had a farther decreased washout than the no-pain group. Chest pain associated with iv injection of dipyridamole may have implications for the occurrence of serious ischemia. (N.K.)

  18. Radiological diagnosis and therapy of chest pain

    International Nuclear Information System (INIS)

    Kutzner, J.; Ernst, H.

    1980-01-01

    The causes and localization of chest pain are numerous. They can derive from infections, traumas, or tumors. Possible sites of origin are: skeletal portions, vertebral column, ribs, and sternum, as well as mediastinum and pleura. In women, occurrence tends to be cyclic and affect the mamma region. Radiological diagnosis includes radiography, nuclear techniques as well as whole body computer-tomography. Radiation therapy is indicated in cases of mediastinal tumor formation. Radiation of painful osteolytic vertebral metastases and rib destructions proves to be an efficient palliative measure. (orig.) [de

  19. Respiratory distress and chest pain: a perforated peptic ulcer with an unusual presentation.

    Science.gov (United States)

    Bruner, David I; Gustafson, Corey

    2011-06-22

    Dyspnea and chest pain are common presenting complaints to the ED, and coupled together can present a challenging diagnostic dilemma in patients in extremis. A thoughtful evaluation is required, giving due diligence to the immediate life threats as well as multiple etiologies which can cause serious morbidity. A perforated peptic ulcer is one such possibility and requires rapid diagnosis and prompt intervention to avoid the associated high risk of morbidity and mortality. We present a case report of a 54 year old man with respiratory distress and chest pain as the initial Emergency Department presentation of a perforated duodenal ulcer. We discuss an unusual presentation of a perforated duodenal ulcer that was recognized in the emergency department and treated promptly. The patient was surgically treated immediately, had a prolonged and complicated post-operative course, but is ultimately doing well. We also provide a brief literature review of the risk factors, imaging choices, and management decision required to treat a perforated ulcer. Perforated ulcers can have highly varied presentations and are occasionally difficult to diagnose in a complicated patient. Knowledge of the risk factors and a thorough history and physical can point to the diagnosis, but timely and appropriate imaging is often required because delays in diagnosis and treatment lead to poor outcomes. Early administration of antibiotics and immediate surgical repair are necessary to limit morbidity and mortality.

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

    International Nuclear Information System (INIS)

    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

    2009-01-01

    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 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)

  1. Approach to chest pain and acute myocardial infarction | Pandie ...

    African Journals Online (AJOL)

    Approach to chest pain and acute myocardial infarction. ... Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers ... Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), ...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-01-15

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

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

    International Nuclear Information System (INIS)

    Henzler, Thomas; Gruettner, Joachim; Meyer, Mathias; Rothhaar, Baerbel; Apfaltrer, Paul; Metzger, Franz; Borggrefe, Martin; Schoepf, U. Joseph; Schoenberg, Stefan O.

    2013-01-01

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

  4. Peripheral arterial tonometry cannot detect patients at low risk of coronary artery disease

    NARCIS (Netherlands)

    M.M. van den Heuvel (Mieke); O. Sorop (Oana); P. Musters (Paul); R.T. van Domburg (Ron); T.W. Galema (Tjebbe); D.J.G.M. Duncker (Dirk); W.J. van der Giessen (Wim); K. Nieman (Koen)

    2015-01-01

    textabstractBackground Endothelial dysfunction precedes coronary artery disease (CAD) and can be measured by peripheral arterial tonometry (PAT). We examined the applicability of PAT to detect a low risk of CAD in a chest pain clinic. Methods In 93 patients, PAT was performed resulting in reactive

  5. Functional chest pain responds to biofeedback treatment but functional heartburn does not: what is the difference?

    Science.gov (United States)

    Shapiro, Michael; Shanani, Ram; Taback, Hanna; Abramowich, Dov; Scapa, Eitan; Broide, Efrat

    2012-06-01

    Patients with functional esophageal disorders represent a challenging treatment group. The purpose of this study was to evaluate the role of biofeedback in the treatment of patients with functional esophageal disorders. In this prospective study, patients with typical/atypical symptoms of gastroesophageal reflux disease underwent upper endoscopy and 24-h pH monitoring. All patients filled out gastroesophageal Reflux Disease Symptom, Hospital Anxiety and Depression, and Symptom Stress Rating questionnaires. Patients with functional heartburn and those with functional chest pain were offered biofeedback treatment. A global assessment questionnaire was filled out at the end of treatment and then 2.8 (range 1-4) years later. From January 2006 to December 2009, 22 patients with functional esophageal diseases were included in the study. Thirteen had functional heartburn and nine had functional chest pain. Six patients from each group received biofeedback treatment. After treatment for 1-4 years, patients with functional chest pain showed significant improvements in symptoms compared with those who were not treated. Patients with functional heartburn showed no improvement. Patients with functional chest pain had a longer time of esophageal acid exposure than those with functional heartburn. Patients with functional chest pain have different central and intraesophageal factors associated with symptom generation in comparison with patients with functional heartburn. Biofeedback is a useful tool in the treatment of patients with functional chest pain, but not for those with functional heartburn.

  6. Chest pain in rubber chemical workers exposed to carbon disulphide and methaemoglobin formers

    Energy Technology Data Exchange (ETDEWEB)

    Oliver, L.C.; Weber, R.P.

    1984-08-01

    A cross sectional prevalence study of chest pain in 94 rubber chemical workers exposed to carbon disulfide (CS2) and methemoglobin forming aromatic amines was carried out. The purpose of the study was to determine whether the prevalence of chest pain or coronary heart disease (CHD), or both, in exposed individuals exceeded that of a group of non-exposed individuals from the same plant. Cardiovascular, smoking, and occupational histories were obtained. Blood pressure, height, weight, serum cholesterol, and fasting blood glucose were measured. Resting electrocardiograms (ECGs) were obtained on all study participants, as were exercise stress tests on selected exposed individuals. Matching eliminated important known risk factors for coronary artery disease. Both chest pain and angina were significantly related to exposure, controlling for age and cigarette smoking. This association was not dependent on duration of exposure as defined by 10 or more years of employment in the department of interest. CHD as defined by angina, a history of myocardial infarction, or a coronary ECG or a combination of these occurred more frequently among exposed workers. The number of abnormal ECGs in the exposed group was twice that in the control group, but the difference was not statistically significant. Age rather than exposure appeared to be the important variable associated with raised blood pressure. Neither biological measures of exposure nor ECGs showed an acute effect of workplace exposures on the myocardium. Possible additive or multiplicative effects of individual chemical agents could not be evaluated. Appropriate modification of medical surveillance of rubber chemical workers with exposure to CS2 and aromatic amines is warranted.

  7. Pain in the chest in a user of cocaine

    International Nuclear Information System (INIS)

    Wiener, M.D.; Putnam, C.E.

    1987-01-01

    A 21-year-old man presented with pleuritic substernal chest pain of one hour's duration. The pain was exacerbated in a supine position and did not radiate. Questioning revealed that he was a recreational user of cocaine and had inhaled free-based cocaine via a pipe the previous evening and as recently as two hours before admission to the hospital. Physical examination demonstrated an anxious young man with a respiratory rate of 26 breaths per minute and shallow. He was afebrile with normal heart rate and blood pressure. His sternum was tender to palpation, and auscultation revealed precordial crepitus synchronous with systole. His electrocardiogram showed sinus rhythm at a rate of 62 beats per minute. Posteroanterior and lateral roentgenograms of the chest were obtained. A diagnosis of spontaneous pneumomediastinum was made

  8. 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; Li, Hui

    2016-02-01

    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. 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. 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. 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.

  9. 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

    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......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...

  10. Man in his 50s with chest pain and dyspnoea.

    Science.gov (United States)

    Obayashi, Yuki; Izumi, Chisato; Nakagawa, Yoshihisa

    2018-05-01

    A man in his 50s with sudden-onset chest pain and dyspnoea was transferred to the emergency room. He had a history of aortic valve replacement due to aortic regurgitation with a mechanical valve 6 years previously. Heart rate was 90 bpm, and blood pressure was too low to measure. In the emergency room, he presented with severe dyspnoea and a chest X-ray showed severe lung congestion (figure 1A). ECG showed complete left bundle branch block. His respiratory status rapidly worsened, and he went into cardiopulmonary arrest. After cardiopulmonary resuscitation, transthoracic echocardiography was performed (figure 1B, online supplementary video 1).DC1SP110.1136/heartjnl-2017-312477.supp1Supplementary file 1 heartjnl;104/10/868/F1F1F1Figure 1(A) Chest X-ray. (B) Colour Doppler image from apical five-chamber view. What is the most likely cause of the patient's cardiopulmonary arrest?Myocardial infarction in left main trunkAortic dissectionProsthetic valve thrombosisProsthetic valve embolisationPulmonary embolism. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  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. Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit

    OpenAIRE

    Soares-Filho, Gastão L. F.; Freire, Rafael C.; Biancha, Karla; Pacheco, Ticiana; Volschan, André; Valença, Alexandre M.; Nardi, Antonio E.

    2009-01-01

    OBJECTIVE: To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION: Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. METHODOLOGY: Patients were assessed by the "Hospital Anxiety and Depression Scale" as a screening instrument wile following a systematized protocol to rule out the...

  13. Torsed pulmonary sequestration presenting as a painful chest mass

    International Nuclear Information System (INIS)

    Shah, Ricki; Carver, Terrence W.; Rivard, Douglas C.

    2010-01-01

    Pulmonary sequestration is a congenital abnormality that can be divided into intralobar or extralobar types. Both types are characterized by pulmonary tissue that does not communicate with the bronchial tree or pulmonary arteries and typically has its arterial supply arising from the descending aorta. We report a case of an 11-year-old girl with extralobar sequestration who presented with torsion causing abdominal pain and pleuritic chest pain. (orig.)

  14. Diagnostic pattern of patients with acute chest pain and symptoms of patients with myocardial infarction

    DEFF Research Database (Denmark)

    Davodian, D.; Lindskou, T. A.; Søvsø, M. B.

    2018-01-01

    diseases, and 90.4% did not have MI. However, most MI-patients presented with chest pain and these had better outcomes than the ones without chest pain. Conflict of interest None Funding The professorship of EFC is supported by a grant administered by Aalborg University from the Danish philanthropic...

  15. MIBI Tc-99m uptake due to breast cancer recurrence as an incidental finding in a patient with atypical chest pain

    International Nuclear Information System (INIS)

    Saavedra, P.; Cano, R.; Morales, R.; Urquiaga, J.; Negron, S.; Munoz, L.; Aguilar, C.; Mendoza, G.; Lopez, D.; Carlos, I.

    2005-01-01

    The purpose of this paper is lo report incidental findings of uptake of Tc99m-MIBI in anterior chest in a patient evaluated for a typical chest pain. A retrospective data collection was performed through chart review of the patient, a 67 year-old women, who had atypical chest pain with cardiac risk factors (hypertension, obesity, hypercholesterolemia, diabetes) with history of left total mastectomy (1995) without adjuvant chemotherapy and negative follow-up. Myocardial Perfusion imaging with Tc99m-MIBI was normal and showed uptake in anterior left chest in sagital views, described as suspected recurrent breast cancer. Oncological and cardiological evaluation of the patient was done and detected minimal palpable lesion in the surgery scar. Incisional biopsy of the lump in the surgery scar was positive for Infiltrative Ductal Breast Carcinoma. Tc-99m-MIBI is useful for detection of recurrence of breast carcinoma in surgery scar

  16. Clinical and Radiologic Predictive Factors of Rib Fractures in Outpatients With Chest Pain.

    Science.gov (United States)

    Zhang, Liang; McMahon, Colm J; Shah, Samir; Wu, Jim S; Eisenberg, Ronald L; Kung, Justin W

    To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients. Following Institutional Review Board approval, we performed a retrospective review of 339 consecutive cases in which a frontal chest radiograph and dedicated rib series had been obtained for chest pain in the outpatient setting. The frontal chest radiograph and dedicated rib series were sequentially reviewed in consensus by two fellowship-trained musculoskeletal radiologists blinded to the initial report. The consensus interpretation of the dedicated rib series was used as the gold standard. Multiple variable logistic regression analysis assessed clinical and radiological factors associated with rib fractures. Fisher exact test was used to assess differences in medical treatment between the 2 groups. Of the 339 patients, 53 (15.6%) had at least 1 rib fracture. Only 20 of the 53 (37.7%) patients' fractures could be identified on the frontal chest radiograph. The frontal chest radiograph had a sensitivity of 38% and specificity of 100% when using the rib series as the reference standard. No pneumothorax, new mediastinal widening or pulmonary contusion was identified. Multiple variable logistic regression analysis of clinical factors associated with the presence of rib fractures revealed a significant association of trauma history (odds ratio 5.7 [p rib fractures in this population demonstrated a significant association of pleural effusion with rib fractures (odds ratio 18.9 [p rib fractures received narcotic analgesia in 47.2% of the cases, significantly more than those without rib fractures (21.3%, p rib fractures have a higher association with a history of minor trauma and age ≥40 in the adult population. Radiographic findings associated with rib fractures include pleural effusion. The frontal chest radiograph alone has low sensitivity in

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

    Science.gov (United States)

    Drewes, Asbjørn Mohr; Arendt-Nielsen, Lars; Funch-Jensen, Peter; Gregersen, Hans

    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. PMID:16718803

  18. Estimated risk of radiation-induced cancer from paediatric chest CT: two-year cohort study

    Energy Technology Data Exchange (ETDEWEB)

    Niemann, Tilo [Cantonal Hospital Baden, Department of Radiology, Baden (Switzerland); University Lille Nord de France, Department of Thoracic Imaging, Hospital Calmette, Lille (France); Colas, Lucie; Santangelo, Teresa; Faivre, Jean Baptiste; Remy, Jacques; Remy-Jardin, Martine [University Lille Nord de France, Department of Thoracic Imaging, Hospital Calmette, Lille (France); Roser, Hans W.; Bremerich, Jens [University of Basel Hospital, Clinic of Radiology and Nuclear Medicine, Medical Physics, Basel (Switzerland)

    2015-03-01

    The increasing absolute number of paediatric CT scans raises concern about the safety and efficacy and the effects of consecutive diagnostic ionising radiation. To demonstrate a method to evaluate the lifetime attributable risk of cancer incidence/mortality due to a single low-dose helical chest CT in a two-year patient cohort. A two-year cohort of 522 paediatric helical chest CT scans acquired using a dedicated low-dose protocol were analysed retrospectively. Patient-specific estimations of radiation doses were modelled using three different mathematical phantoms. Per-organ attributable cancer risk was then estimated using epidemiological models. Additional comparison was provided for naturally occurring risks. Total lifetime attributable risk of cancer incidence remains low for all age and sex categories, being highest in female neonates (0.34%). Summation of all cancer sites analysed raised the relative lifetime attributable risk of organ cancer incidence up to 3.6% in female neonates and 2.1% in male neonates. Using dedicated scan protocols, total lifetime attributable risk of cancer incidence and mortality for chest CT is estimated low for paediatric chest CT, being highest for female neonates. (orig.)

  19. Esophageal Manometry with Provocative Testing in Patients with Noncardiac Angina-Like Chest Pain

    Directory of Open Access Journals (Sweden)

    William G Paterson

    1991-01-01

    Full Text Available In a five year period 238 of 594 esophageal manometric studies performed in the authors’ laboratory were done on patients whose major reason for referral was noncardiac angina-like chest pain. Standard eophageal manometry was performed followed by an acid-antacid perfusion period (Bernstein test and then subcutaneous bethanechol (80 μg/kg to a maximum of 5 mg was adminstered. Baseline manometry was normal in 38% of patients and was diagnostic of ‘nutcracker’ esophagus, nonspecific esophageal motility disorder, diffuse esophageal spasm and isolated hypertensive lower esophageal sphincter in 24%, 19%, 16% and 3% of patients, respectively. Ninety-six of 238 patients (40% experienced reproduction of their presenting angina-like chest pain during acid perfusion. In 80% of these patients there were associated esophageal motor abnormal ilies induced by the acid perfusion. Thirty-six of 212 (17% experienced pain reproduction following the injection of bethanechol; however, 16 of these had already had their presenting chest pain reproduced during the acid perfusion study. In two-thirds of the patients with pain reproduction following bechanechol there was an associated bethanechol-induced esophageal motility disorder. Overall 49% of patients had their pain reproduced during provocative testing. The acid perfusion test reproduced the pain much more frequently than bethanechol simulation. This study reaffirms the value of esophageal manometry and provocative testing in this group of patients.

  20. 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

  1. Picture quiz: a case of sudden severe chest pain.

    Science.gov (United States)

    Rabia, Mustafa Abu; Sullivan, P; Stivaros, Stavros M

    2007-01-01

    An 18-year-old male with no previous medical history presented to hospital with sudden onset of acute epigastric pain radiating to the anterior chest wall and both shoulders. There was no history of recent trauma and he had not been vomiting.

  2. Use of the Theoretical Domains Framework to evaluate factors driving successful implementation of the Accelerated Chest pain Risk Evaluation (ACRE) project.

    Science.gov (United States)

    Skoien, Wade; Page, Katie; Parsonage, William; Ashover, Sarah; Milburn, Tanya; Cullen, Louise

    2016-10-12

    The translation of healthcare research into practice is typically challenging and limited in effectiveness. The Theoretical Domains Framework (TDF) identifies 12 domains of behaviour determinants which can be used to understand the principles of behavioural change, a key factor influencing implementation. The Accelerated Chest pain Risk Evaluation (ACRE) project has successfully translated research into practice, by implementing an intervention to improve the assessment of low to intermediate risk patients presenting to emergency departments (EDs) with chest pain. The aims of this paper are to describe use of the TDF to determine which factors successfully influenced implementation and to describe use of the TDF as a tool to evaluate implementation efforts and which domains are most relevant to successful implementation. A 30-item questionnaire targeting clinicians was developed using the TDF as a guide. Questions encompassed ten of the domains of the TDF: Knowledge; Skills; Social/professional role and identity; Beliefs about capabilities; Optimism; Beliefs about consequences; Intentions; Memory, attention and decision processes; Environmental context and resources; and Social influences. Sixty-three of 176 stakeholders (36 %) responded to the questionnaire. Responses for all scales showed that respondents were highly favourable to all aspects of the implementation. Scales with the highest mean responses were Intentions, Knowledge, and Optimism, suggesting that initial education and awareness strategies around the ACRE project were effective. Scales with the lowest mean responses were Environmental context and resources, and Social influences, perhaps highlighting that implementation planning could have benefitted from further consideration of the factors underlying these scales. The ACRE project was successful, and therefore, a perfect case study for understanding factors which drive implementation success. The overwhelmingly positive response suggests that it

  3. Inflammation and Rupture of a Congenital Pericardial Cyst Manifesting Itself as an Acute Chest Pain Syndrome.

    Science.gov (United States)

    Aertker, Robert A; Cheong, Benjamin Y C; Lufschanowski, Roberto

    2016-12-01

    We present the case of a 63-year-old woman with a remote history of supraventricular tachycardia and hyperlipidemia, who presented with recurrent episodes of acute-onset chest pain. An electrocardiogram showed no evidence of acute coronary syndrome. A chest radiograph revealed a prominent right-sided heart border. A suspected congenital pericardial cyst was identified on a computed tomographic chest scan, and stranding was noted around the cyst. The patient was treated with nonsteroidal anti-inflammatory drugs, and the pain initially abated. Another flare-up was treated similarly. Cardiac magnetic resonance imaging was then performed after symptoms had resolved, and no evidence of the cyst was seen. The suspected cause of the patient's chest pain was acute inflammation of a congenital pericardial cyst with subsequent rupture and resolution of symptoms.

  4. NICE recommendations for the assessment of stable chest pain: assessing the early economic and service impact in the rapid-access chest pain service.

    Science.gov (United States)

    Ashrafi, Reza; Raga, Santosh; Abdool, Ali; Disney, Andrew; Wong, Peter; Davis, Gershan K

    2013-05-01

    In 2010, guidelines published by the National Institute for Clinical Excellence (NICE) suggested a change in the way patients with stable chest pain of suspected cardiac origin were investigated. These guidelines removed exercise treadmill testing from routine use and introduced cardiac CT to regular use. To investigate whether these guidelines had improved our service provision by reducing the number of further investigations required to make a diagnosis, and to see if our costs had increased now that the less expensive exercise treadmill tests were not recommended. Clinic letters were used to assess patients pretest likelihood of coronary artery disease for two six-month cohorts of consecutive patients seen in the rapid access chest pain clinic (January-June 2010 and July-December 2011) using NICE published methodology, and to ascertain which investigations patients had. Using NICE modelled costs, we generated comparative hypothetical costs for each cohort and an average cost per patient. In the January-June 2010 cohort, 435 patients with chest pain were seen, and in July-December 2011, 334 patients were seen. In the pre-NICE guidelines cohort, 23% of patients required two investigations as compared with 11.4% in the post-NICE guidelines cohort, with no patient requiring three investigations as compared with 3% in the original cohort. There was no significant increase in costs per patient in the post-NICE guidance group. Implementing NICE guidance reduced the number of investigations needed per patient, and did not prove more expensive for our department in the short term.

  5. Clinical features and prognosis of patients with acute non-specific chest pain in emergency and cardiology departments after the introduction of high-sensitivity troponins

    DEFF Research Database (Denmark)

    Ilangkovan, Nivethitha; Mickley, Hans; Diederichsen, Axel

    2017-01-01

    OBJECTIVES: To determine the incidence of clinical, cardiac-related endpoints and mortality among patients presenting to an emergency or cardiology department with non-specific chest pain (NSCP), and who receive testing with a high-sensitivity troponin. A second objective was to identify risk...... factors for the above-noted endpoints during 12 months of follow-up. DESIGN: A prospective multicentre study. SETTING: Emergency and cardiology departments in Southern Denmark. SUBJECTS: The study enrolled 1027 patients who were assessed for acute chest pain in an emergency or cardiology department...

  6. Chest X-Ray

    Medline Plus

    Full Text Available ... evaluate shortness of breath, persistent cough, fever, chest pain or injury. It may also be useful to ... of ionizing radiation, the benefit of an accurate diagnosis far outweighs any risk. For more information about ...

  7. Diagnostic value of exercise-induced changes in circulating high sensitive troponin T in stable chest pain patients

    DEFF Research Database (Denmark)

    Mouridsen, Mette Rauhe; Nielsen, Olav Wendelboe; Pedersen, Ole Dyg

    2013-01-01

    We investigated the diagnostic value of exercise-induced increase in cardiac Troponin T (cTnT) in stable chest pain subjects.......We investigated the diagnostic value of exercise-induced increase in cardiac Troponin T (cTnT) in stable chest pain subjects....

  8. Presenting characteristics and processing times for culturally and linguistically diverse (CALD) patients with chest pain in an emergency department: Time, Ethnicity, and Delay (TED) Study II.

    Science.gov (United States)

    Wechkunanukul, Kannikar; Grantham, Hugh; Teubner, David; Hyun, Karice K; Clark, Robyn A

    2016-10-01

    To date there has been limited published data presenting the characteristics and timeliness of the management in an Emergency Department (ED) for culturally and linguistically diverse (CALD) patients presenting with chest pain. This study aimed to describe the presenting characteristics and processing times for CALD patients with chest pain compared to the Australian-born population, and current guidelines. This study was a cross sectional analysis of a cohort of patients who presented with chest pain to the metropolitan hospital between 1 July 2012 and 30 June 2014. Of the total study population (n=6640), 1241 (18.7%) were CALD and 5399 (81.3%) were Australian-born. CALD patients were significantly older than Australian-born patients (mean age 62 vs 56years, p<0.001). There were no differences in the proportion of patients who had central chest pain (74.9% vs 75.7%, p=0.526); ambulance utilisation (41.7% vs 41.1%, p=0.697); and time to initial treatment in ED (21 vs 22min, p=0.375). However, CALD patients spent a significantly longer total time in ED (5.4 vs 4.3h, p<0.001). There was no difference in guideline concordance between the two groups with low rates of 12.5% vs 13%, p=0.556. Nonetheless, CALD patients were 22% (95% CI, 0.65, 0.95, p=0.015) less likely to receive the guideline management for chest pain. The initial emergency care was equally provided to all patients in the context of a low rate of concordance with three chest pain related standards from the two guidelines. Nonetheless, CALD patients spent a longer time in ED compared to the Australian-born group. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. The effect of Tc99m Sestamibi scans during acute chest pain on clinical management

    International Nuclear Information System (INIS)

    Baldey, A.; Cameron, P.; Grigg, L.; Knott, J.; Better, N.

    1998-01-01

    Full text: The aim of this study is to assess whether the increased sensitivity and specificity of Tc99m sestamibi scans, during acute chest pain, will lead to alteration in clinical management and potential cost saving in an Australian population. Consecutive patients who presented with acute chest pain were injected 800 MBq of Tc99m sestamibi during pain (Hot MlBI) and SPECT imaging performed 1-6 hours later. The population was those only with a 'intermediate risk' of myocardial ischaemia The patients included in patients, those in the Emergency Department, and those with a previous history of cardiac disease. 25% of patients required a second, pain free study the following day to differentiate acute ischaemia from prior infarction. A question sheet was filled out by the requesting physician prior to the study indicating the likelihood of cardiac disease and the proposed management if no 'Hot MIBI' scan was available. The treatment that the patient subsequently received was ascertained from the patient's medical record. Of the 28 patients, a prediction whether to or not to proceed to coronary angiography was made in 13 patients prior to the MIBI study being performed. Of the 13, 5 would have had coronary angiography performed. and in all 5, the decision to proceed to coronary angiography was averted by the 'Hot MIBI'. Of note, 3 patients were admitted purely because of an abnormal 'Hot MIBI'. The 'Hot MIBI' was able to reduce coronary care admissions by 83% reduce all admissions by 17%, and avert coronary angiography in 38% of patients. In this intermediate risk category patient, this translates to not only admissions saved but potential cost saving

  10. A 26-year-old man with dyspnea and chest pain

    Directory of Open Access Journals (Sweden)

    Saurabh Mittal

    2017-01-01

    Full Text Available A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation.

  11. 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 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.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.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.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 postoperative phase. These findings may have

  12. Assessing a risk tailored intervention to prevent disabling low back pain - protocol of a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Marnitz Ulf

    2010-01-01

    Full Text Available Abstract Background Although most patients with low back pain (LBP recover within a few weeks a significant proportion has recurrent episodes or will develop chronic low back pain. Several mainly psychosocial risk factors for developing chronic LBP have been identified. However, effects of preventive interventions aiming at behavioural risk factors and unfavourable cognitions have yielded inconsistent results. Risk tailored interventions may provide a cost efficient and effective means to take systematic account of the individual risk factors but evidence is lacking. Methods/Design This study will be a cluster-randomised controlled trial comparing screening and a subsequent risk tailored intervention for patients with low back pain to prevent chronic low back pain compared to treatment as usual in primary care. A total of 600 patients from 20 practices in each study arm will be recruited in Berlin and Goettingen. The intervention comprises the following elements: Patients will be assigned to one of four risk groups based on a screening questionnaire. Subsequently they receive an educational intervention including information and counselling tailored to the risk group. A telephone/email consulting service for back pain related problems are offered independent of risk group assignment. The primary outcomes will be functional capacity and sick leave. Discussion This trial will evaluate the effectiveness of screening for risk factors for chronic low back pain followed by a risk tailored intervention to prevent chronic low back pain. This trial will contribute new evidence regarding the flexible use of individual physical and psychosocial risk factors in general practice. Trial registration ISRCTN 68205910

  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

    . 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...... to treatment guided by either coronary CTA or standard care (bicycle exercise electrocardiogram or myocardial perfusion imaging). In the coronary CTA-guided group, a functional test was included in cases of nondiagnostic coronary CTA images or coronary stenoses of borderline severity. The primary endpoint...... electrocardiograms and troponin values compared to standard care with a functional test. (Cardiac-CT in the Treatment of Acute Chest Pain [CATCH]; NCT01534000)....

  14. Costovertebral joint dysfunction: another misdiagnosed cause of atypical chest pain.

    Science.gov (United States)

    Arroyo, J. F.; Jolliet, P.; Junod, A. F.

    1992-01-01

    The diagnostic work-up of atypical chest pain frequently leads to invasive procedures. However, this painful symptomatology can sometimes be of benign origin and respond to simple therapeutic manoeuvres. A number of musculoskeletal conditions such as costovertebral joint dysfunctions should be carefully considered. We report five cases in which patient discomfort and high costs could have been avoided if awareness of these conditions had led to a correct diagnosis upon initial physical examination. PMID:1448407

  15. Can ECG-gated MDCT be considered an obligatory step to plan and manage a new chest-pain unit?

    International Nuclear Information System (INIS)

    Runza, G.; Alaimo, V.; La Grutta, L.; Galia, M.; Basile, A.; Cademartiri, F.; Krestin, G.P.; Midiri, M.

    2007-01-01

    The recent improvements in multi-detector computed tomography technology and its application in cardiac field allow to consider this non-invasive imaging technique as a promising comprehensive method for detecting significant coronary stenoses in a chest-pain unit. The possibility to use the ECG-synchronisation acquisition protocol, normally limited to the cardiac volume, for the entire thoracic vascular system should have the remarkable potential to reduce invasive and non-invasive procedures actually used to investigate acute chest pain and the number of unnecessary hospital admissions without reducing appropriate admissions in patients with chest pain

  16. Myocardial bridging causing ischemia and recurrent chest pain: a case report

    Directory of Open Access Journals (Sweden)

    Abdou Mohamed

    2011-07-01

    Full Text Available Abstract Background Myocardial bridging is present when a segment of a major epicardial coronary artery runs intramurally through the myocardium. It usually has a benign prognosis, but in some cases myocardial ischemia, infarction and sudden cardiac death have been reported. We are here reporting a case of myocardial bridging which was complicated with recurrent chest pain and transient ST-segment elevation during exercise treadmill test. Case presentation A 40 year-old-man presented with recurrent retrosternal chest pain of 2 months duration. He had history of smoking and was obese, otherwise no physical abnormalities were detected by examination. Electrocardiogram and blood tests were normal apart from impaired glucose tolerance with elevated triglycerides and decreased level of high density lipoprotein cholesterol. While doing exercise treadmill test, the patient developed chest pain and significant ST-segment elevation in almost all precordial leads that persisted for about 15 minutes through recovery. We decided to admit the patient to the coronary care unit for further management and to perform coronary angiogram. Myocardial bridging was observed in the mid segment of the left anterior descending coronary artery. Medical treatment was decided. At one year follow up, our patient was healthy and had no cardiac complaints. In conclusion, myocardial bridging may predispose to coronary vasospasm that may leads to ischemic complications.

  17. Predictive ability of an early diagnostic guess in patients presenting with chest pain; a longitudinal descriptive study.

    Science.gov (United States)

    Verdon, François; Junod, Michel; Herzig, Lilli; Vaucher, Paul; Burnand, Bernard; Bischoff, Thomas; Pécoud, Alain; Favrat, Bernard

    2010-02-21

    The intuitive early diagnostic guess could play an important role in reaching a final diagnosis. However, no study to date has attempted to quantify the importance of general practitioners' (GPs) ability to correctly appraise the origin of chest pain within the first minutes of an encounter. The validation study was nested in a multicentre cohort study with a one year follow-up and included 626 successive patients who presented with chest pain and were attended by 58 GPs in Western Switzerland. The early diagnostic guess was assessed prior to a patient's history being taken by a GP and was then compared to a diagnosis of chest pain observed over the next year. Using summary measures clustered at the GP's level, the early diagnostic guess was confirmed by further investigation in 51.0% (CI 95%; 49.4% to 52.5%) of patients presenting with chest pain. The early diagnostic guess was more accurate in patients with a life threatening illness (65.4%; CI 95% 64.5% to 66.3%) and in patients who did not feel anxious (62.9%; CI 95% 62.5% to 63.3%). The predictive abilities of an early diagnostic guess were consistent among GPs. The GPs early diagnostic guess was correct in one out of two patients presenting with chest pain. The probability of a correct guess was higher in patients with a life-threatening illness and in patients not feeling anxious about their pain.

  18. Predictive ability of an early diagnostic guess in patients presenting with chest pain; a longitudinal descriptive study

    Directory of Open Access Journals (Sweden)

    Bischoff Thomas

    2010-02-01

    Full Text Available Abstract Background The intuitive early diagnostic guess could play an important role in reaching a final diagnosis. However, no study to date has attempted to quantify the importance of general practitioners' (GPs ability to correctly appraise the origin of chest pain within the first minutes of an encounter. Methods The validation study was nested in a multicentre cohort study with a one year follow-up and included 626 successive patients who presented with chest pain and were attended by 58 GPs in Western Switzerland. The early diagnostic guess was assessed prior to a patient's history being taken by a GP and was then compared to a diagnosis of chest pain observed over the next year. Results Using summary measures clustered at the GP's level, the early diagnostic guess was confirmed by further investigation in 51.0% (CI 95%; 49.4% to 52.5% of patients presenting with chest pain. The early diagnostic guess was more accurate in patients with a life threatening illness (65.4%; CI 95% 64.5% to 66.3% and in patients who did not feel anxious (62.9%; CI 95% 62.5% to 63.3%. The predictive abilities of an early diagnostic guess were consistent among GPs. Conclusions The GPs early diagnostic guess was correct in one out of two patients presenting with chest pain. The probability of a correct guess was higher in patients with a life-threatening illness and in patients not feeling anxious about their pain.

  19. Low pressure pain thresholds are associated with, but does not predispose for, low back pain

    DEFF Research Database (Denmark)

    O'Neill, Søren; Kjær, Per; Graven-Nielsen, Thomas

    2011-01-01

    Chronic pain is often associated with hyperalgesia in cross-sectional studies. In the present study, a random cohort of 40-year-old individuals (n = 264) from the general population was assessed for low back pain (LBP) status and pressure pain threshold (PPT), with follow-up assessment 4 and 8......-lasting LBP, those with a low PPT at baseline (lower 10% percentile) had no increased risk of developing LBP (p > 0.05). The findings indicate that PPT decreases as a consequence of long-lasting pain, whereas a low PPT seems not to constitute a separate risk factor for the development of LBP....

  20. Myocardial perfusion abnormality and chest pain in patients with hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa

    1991-01-01

    To investigate the role of myocardial ischemia in the development of chest pain in patients with hypertrophic cardiomyopathy (HCM), exercise stress (Ex) redistribution myocardial single photon emission CT's (SPECT's) with thallium-201 (Tl) were obtained in 27 patients with HCM. In all patients, coronary arteries were normal arteriographically. Patients were classified into NYHA Class I, II and III according to the frequency and severity of the chest pain during daily life. In these 3 groups, age, sex and intraventricular septal thickness measured by echocardiography were not different. Types of myocardial perfusion obtained by myocardial SPECT's were divided into 5: (1) normal perfusion, (2) no perfusion defect with abnormal myocardial Tl washout rate (WOR) during 3 hours (<30%) [Def(-)/WORabn], (3) reversible perfusion defect (RD), (4) fixed defect with abnormal WOR (FD/WORabn), and (5) fixed defect with normal WOR (FD/WORnl). In 14 patients of Class I, 9 patients (64%) showed normal perfusion but the rest showed perfusion abnormality (def(-)/WORabn in 3 and RD in 2). In Class II and III, all patients showed perfusion abnormalities of RD, FD/WORabn or FD/WORnl. As the functional class progressed from Class II to III, the ratio of fixed defect (both WORnl and WORabn) to RD increased, but it was not statistically significant. In 2 patients in whom Ex SPECT's were repeated because of the progression of the chest pain, the severity of the perfusion abnormality also progressed. Perfusion abnormalities were observed most frequently in anterior (35%), then inferior/posterior (20%) and septal wall (18%). The frequency of Ex induced ECG abnormalities (ST-depression or T wave changes) increased as the NYHA Class progressed (Class III vs I p<0.05). These findings suggested the following: chest pain in patients with HCM relates to the myocardial ischemia which may originate in the myocardial small arteries, and when the lesions progress myocardial necrosis may ensue. (author)

  1. Deployment-related risk factors of low back pain

    DEFF Research Database (Denmark)

    Nissen, Lars Ravnborg; Marott, Jacob Louis; Gyntelberg, Finn

    2014-01-01

    Where much is known about the consequences of spinal and low back pain (LBP) during military deployments, there is lesser knowledge of risk factors for LBP among the deployed forces. The objective of this study was to identify deployment-related exposures associated with LBP. The study was a ques...... their subordinates and involve medical personnel, especially deployed physiotherapists, by giving advice to soldiers of different military occupational specialties on how to optimize ergonomics at work....

  2. Scapulothoracic bursitis as a significant cause of breast and chest wall pain: underrecognized and undertreated.

    Science.gov (United States)

    Boneti, Cristiano; Arentz, Candy; Klimberg, V Suzanne

    2010-10-01

    Pain is one of the most commonly reported breast complaints. Referred pain from inflammation of the shoulder bursa is often overlooked as a cause of breast pain. The objective of this study is to evaluate the role of shoulder bursitis as a cause of breast/chest pain. An IRB-approved retrospective review from July 2005 to September 2009 identified 461 patients presenting with breast/chest pain. Cases identified with a trigger point in the medial aspect of the ipsilateral scapula were treated with a bursitis injection at the point of maximum tenderness. The bursitis injection contains a mixture of local anesthetic and corticosteroid. Presenting complaint, clinical response and associated factors were recorded and treated with descriptive statistics. Average age of the study group was 53.4 ± 12.7 years, and average BMI was 30.4 ± 7.4. One hundred and three patients were diagnosed with shoulder bursitis as the cause of breast pain and received the bursitis injection. Most cases (81/103 or 78.6%) presented with the breast/chest as the site of most significant discomfort, where 8.7% (9/103) had the most severe pain at the shoulder, 3.9% (4/103) at the axilla and 3.9% (4/103) at the medial scapular border. Of the treated patients, 83.5% (86/103) had complete relief of the pain, 12.6% (13/103) had improvement of symptoms with some degree of residual pain, and only 3.9%(4/103) did not respond at all to the treatment. The most commonly associated factor to the diagnosis of bursitis was the history of a previous mastectomy, present in 27.2% (28/103) of the cases. Shoulder bursitis represents a significant cause of breast/chest pain (22.3% or 103/461) and can be successfully treated with a local injection at site of maximum tenderness in the medial scapular border.

  3. Suicidal ideation and the risk of suicide in patients with fibromyalgia: a comparison with non-pain controls and patients suffering from low-back pain

    Directory of Open Access Journals (Sweden)

    Jimenez-Rodriguez I

    2014-04-01

    Full Text Available Irene Jimenez-Rodríguez,1 Juan Miguel Garcia-Leiva,1 Beatriz M Jimenez-Rodriguez,2 Emilia Condés-Moreno,3 Fernando Rico-Villademoros,1 Elena P Calandre11Instituto de Neurociencias, Universidad de Granada, Granada, Spain; 2Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain; 3Departamento de Especialidades Biomédicas, Universidad Europea de Madrid, Villaviciosa de Odón, SpainAbstract: Fibromyalgia is associated with an increased rate of mortality from suicide. In fact, this disease is associated with several characteristics that are linked to an increased risk of suicidal behaviors, such as being female and experiencing chronic pain, psychological distress, and sleep disturbances. However, the literature concerning suicidal behaviors and their risk factors in fibromyalgia is sparse. The objectives of the present study were to evaluate the prevalence of suicidal ideation and the risk of suicide in a sample of patients with fibromyalgia compared with a sample of healthy subjects and a sample of patients with chronic low-back pain. We also aimed to evaluate the relevance of pain intensity, depression, and sleep quality as variables related to suicidal ideation and risks. Logistic regression was applied to estimate the likelihood of suicidal ideation and the risk of suicide adjusted by age and sex. We also used two logistic regression models using age, sex, pain severity score, depression severity, sleep quality, and disease state as independent variables and using the control group as a reference. Forty-four patients with fibromyalgia, 32 patients with low-back pain, and 50 controls were included. Suicidal ideation, measured with item 9 of the Beck Depression Inventory, was almost absent among the controls and was low among patients with low-back pain; however, suicidal ideation was prominent among patients with fibromyalgia (P<0.0001. The risk of suicide, measured with the Plutchik Suicide Risk Scale, was also

  4. Painful Vaso-occlusive Crisis as a  Prodromal Phase of Acute Chest Syndrome. Is Only One Chest X-ray Enough? A Case Report

    Directory of Open Access Journals (Sweden)

    Charalambos Neocleous

    2013-01-01

    Full Text Available The predominant pathophysiological feature of homozygous sickle cell anemia (SCA is the vaso-occlusion. Vaso-occlusion can be associated with painful crises, which are the primary reason for those patients to seek medical care. Vaso-occlusion is responsible for the acute chest syndrome (ACS with large morbidity and mortality or more rarely (and especially in adults for priapism and acute neurological events (strokes. A 10-year-old boy with homozygous SCA was admitted to the Pediatric Emergencies with painful vaso-occlusive crisis and fever. Initially he had normal chest X-ray but, after 24-hour-hospitalization, he developed  ACS with new chest X-ray findings. He was treated with broad spectrum antibiotics, blood transfusions and bronchodilators and after a  six-day treatment, he was significantly improved. The patient was discharged 13 days later with no other therapy at home. The possibility of  ACS development should be still considered, even when a  known patient with SCA presents a  painful vaso-occlusive crisis with an initial normal chest X-ray. Therefore, repeated clinical examination is required and possible changes in  the clinical status could indicate the necessity of a  new radiographic examination. In  this way, early  ACS could be recognized and the catastrophic consequences due to this syndrome could be avoided.

  5. An Unusual Cause of Precordial Chest Pain

    Directory of Open Access Journals (Sweden)

    Sevket Ozkaya

    2013-01-01

    Full Text Available Extraskeletal chondrosarcoma in anterior mediastinum is very rare. A 45-year-old male patient was admitted to the hospital with precordial chest pain. A large and well-shaped mass in the anterior mediastinum was seen radiologically, and there was a clearly compression of the heart by the mass. The lesion was totally resected, and extraskeletal mediastinal chondrosarcoma was histopathologically diagnosed. We aimed to present and discuss the radiologic, clinic, and histopathologic features of unusual presentation of extraskeletal chondrosarcoma in a case.

  6. Diagnostic yield of 24-hour esophageal manometry in non-cardiac chest pain.

    Science.gov (United States)

    Barret, M; Herregods, T V K; Oors, J M; Smout, A J P M; Bredenoord, A J

    2016-08-01

    In the past, ambulatory 24-h manometry has been shown useful for the evaluation of patients with non-cardiac chest pain (NCCP). With the diagnostic improvements brought by pH-impedance monitoring and high-resolution manometry (HRM), the contribution of ambulatory 24-h manometry to the diagnosis of esophageal hypertensive disorders has become uncertain. Our aim was to assess the additional diagnostic yield of ambulatory manometry to HRM and ambulatory pH-impedance monitoring in this patient population. All patients underwent 24-h ambulatory pressure-pH-impedance monitoring and HRM. Patients had retrosternal pain as a predominant symptom and no explanation after cardiologic and digestive endoscopic evaluations. Diagnostic measurements were analyzed by two independent physicians. Fifty-nine patients met the inclusion criteria; 37.3% of the patients had their symptoms explained by abnormalities on pH-impedance monitoring and 6.8% by ambulatory manometry. Functional chest pain was diagnosed in 52.5% of the patients. High-resolution manometry, using the Chicago Classification v3.0 criteria alone, did not identify any of the four patients with esophageal spasm on ambulatory manometry. However, taking into account other abnormalities, such as simultaneous (rapid) or repetitive contractions, HRM had a sensitivity of 75% and a specificity of 98.2% for the diagnosis of esophageal spasm. In the work-up of NCCP, ambulatory 24-h manometry has a low additional diagnostic yield. However, it remains the best technique to identify esophageal spasm as the cause of symptoms. This is particularly useful when an unequivocal diagnosis is needed before treatment. © 2016 John Wiley & Sons Ltd.

  7. Prevalence and risk factors of low back pain among undergraduate ...

    African Journals Online (AJOL)

    Conclusion: LBP is frequent among undergraduate students of a sports and physical education institute in Tunisia. It is strongly associated with fatigue after the long periods of training in different sports. Gymnastics, judo, handball, and volleyball were identified as high-risk sports for causing LBP. Keywords: low back pain; ...

  8. Does anterior trunk pain predict a different course of recovery in chronic low back pain?

    DEFF Research Database (Denmark)

    Panagopoulos, John; Hancock, Mark J; Kongsted, Alice

    2014-01-01

    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...

  9. The association between ethnicity and delay in seeking medical care for chest pain: a systematic review.

    Science.gov (United States)

    Wechkunanukul, Kannikar; Grantham, Hugh; Damarell, Raechel; Clark, Robyn A

    2016-07-01

    Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide, and chest pain is one of the most common symptoms of ACSs. A rapid response to chest pain by patients and appropriate management by health professionals are vital to improve survival rates.People from different ethnic groups are likely to have different perceptions of chest pain, its severity and the need for urgent treatment. These differences in perception may contribute to differences in response to chests pain and precipitate unique coping strategies. Delay in seeking medical care for chest pain in the general population has been well documented; however, limited studies have focused on delay times within ethnic groups. There is little research to date as to whether ethnicity is associated with the time taken to seek medical care for chest pain. Consequently, addressing this gap in knowledge will play a crucial role in improving the health outcomes of culturally and linguistically diverse (CALD) patients suffering from chest pain and for developing appropriate clinical practice and public awareness for these populations. The current review aimed to determine if there is an association between ethnicity and delay in seeking medical care for chest pain among CALD populations. Patients from different ethnic minority groups presenting to emergency departments (EDs) with chest pain. The current review will examine studies that evaluate the association between ethnicity and delay in seeking medical care for chest pain among CALD populations. The current review will consider quantitative studies including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. The current review will consider studies that measure delay time as the main outcome. The time will be measured as the interval between the time of symptom onset and time to reach an

  10. A Comparison of the Updated Diamond-Forrester, CAD Consortium, and CONFIRM History-Based Risk Scores for Predicting Obstructive Coronary Artery Disease in Patients With Stable Chest Pain: The SCOT-HEART Coronary CTA Cohort.

    Science.gov (United States)

    Baskaran, Lohendran; Danad, Ibrahim; Gransar, Heidi; Ó Hartaigh, Bríain; Schulman-Marcus, Joshua; Lin, Fay Y; Peña, Jessica M; Hunter, Amanda; Newby, David E; Adamson, Philip D; Min, James K

    2018-04-13

    This study sought to compare the performance of history-based risk scores in predicting obstructive coronary artery disease (CAD) among patients with stable chest pain from the SCOT-HEART study. Risk scores for estimating pre-test probability of CAD are derived from referral-based populations with a high prevalence of disease. The generalizability of these scores to lower prevalence populations in the initial patient encounter for chest pain is uncertain. We compared 3 scores among patients with suspected CAD in the coronary computed tomographic angiography (CTA) randomized arm of the SCOT-HEART study for the outcome of obstructive CAD by coronary CTA: the updated Diamond-Forrester score (UDF), CAD Consortium clinical score (CAD2), and CONFIRM risk score (CRS). We tested calibration with goodness-of-fit, discrimination with area under the receiver-operating curve (AUC), and reclassification with net reclassification improvement (NRI) to identify low-risk patients. In 1,738 patients (58 ± 10 years and 44.0% women), overall calibration was best for UDF, with underestimation by CRS and CAD2. Discrimination by AUC was highest for CAD2 at 0.79 (95% confidence interval [CI]: 0.77 to 0.81) than for UDF (0.77 [95% CI: 0.74 to 0.79]) or CRS (0.75 [95% CI: 0.73 to 0.77]) (p CAD2 (NRI 0.31, 95% CI: 0.27 to 0.35) followed by CRS (NRI 0.21, 95% CI: 0.17 to 0.25) compared with UDF (p CAD and uniform CAD evaluation by coronary CTA, CAD2 provided the best discrimination and classification, despite overestimation of obstructive CAD as evaluated by coronary CTA. CRS exhibited intermediate performance followed by UDF for discrimination and reclassification. Copyright © 2018. Published by Elsevier Inc.

  11. Another cause of chest pain: Staphylococcus aureus sternal osteomyelitis in an otherwise healthy adult

    Directory of Open Access Journals (Sweden)

    Vacek TP

    2014-09-01

    Full Text Available Thomas P Vacek, Shahnaz Rehman, Shipeng Yu, Ankush Moza, Ragheb Assaly Department of Internal Medicine, The University of Toledo Medical Center, Toledo OH, USAAbstract: Chest pain requires a detailed differential diagnosis with good history-taking skills to differentiate between cardiogenic and noncardiogenic causes. Moreover, when other symptoms such as fever and elevated white blood cell count are involved, it may be necessary to consider causes that include infectious sources. A 53-year-old female with no significant past medical history returned to the hospital with recurrent complaints of chest pain that was constant, substernal, reproducible, and exacerbated with inspiration and expiration. The chest pain was thought to be noncardiogenic, as electrocardiography did not demonstrate changes, and cardiac enzymes were found to be negative for signs of ischemia. The patient's blood cultures were analyzed from a previous admission and were shown to be positive for Staphylococcus aureus. The patient was started empirically on vancomycin, which was later switched to ceftriaxone as the bacteria were more sensitive to this antibiotic. A transthoracic echocardiogram did not demonstrate any vegetation or signs of endocarditis. There was a small right pleural effusion discovered on X-ray. Therefore, computed tomography as well as magnetic resonance imaging of the chest were performed, and showed osteomyelitis of the chest. The patient was continued on intravenous ceftriaxone for a total of 6 weeks. Tests for HIV, hepatitis A, B, and C were all found to be negative. The patient had no history of childhood illness, recurrent infections, or previous trauma to the chest, and had had no recent respiratory infections, pneumonia, or any underlying lung condition. Hence, her condition was thought to be a case of primary sternal osteomyelitis without known cause.Keywords: substernal, pleuritic, myocardial infarction, differential

  12. The combined effects of cold therapy and music therapy on pain following chest tube removal among patients with cardiac bypass surgery.

    Science.gov (United States)

    Yarahmadi, Sajad; Mohammadi, Nooredin; Ardalan, Arash; Najafizadeh, Hassan; Gholami, Mohammad

    2018-05-01

    Chest tube removal is an extremely painful procedure and patients may not respond well to palliative therapies. This study aimed to examine the effect of cold and music therapy individually, as well as a combination of these interventions on reducing pain following chest tube removal. A factorial randomized-controlled clinical trial was performed on 180 patients who underwent cardiac surgery. Patients were randomized into four groups of 45. Group A used ice packs for 20 minutes prior to chest tube removal. Group B was assigned to listen to music for a total length of 30 minutes which started 15 minutes prior to chest tube removal. Group C received a combination of both interventions; and Group D received no interventions. Pain intensity was measured in each group every 15 minutes for a total of 3 readings. Analysis of variance, Tukey and Bonferroni post hoc tests, as well as repeated measures ANOVA were employed for data analysis. Cold therapy and combined method intervention effectively reduced the pain caused by chest tube removal (P < 0.001). Additionally, there were no statistically significant difference in pain intensity scores between groups at 15 minutes following chest tube removal (P = 0.07). Cold and music therapy can be used by nursing staff in clinical practice as a combined approach to provide effective pain control following chest tube removal. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. 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

    minimal intervention in patients without acute coronary syndrome but with musculoskeletal chest pain. Results suggest that chiropractic treatment might be useful; but further research in relation to patient selection, standardization of interventions, and identification of potentially active ingredients......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...

  14. New Guidelines for the Management of Chest Pain: Lessons From a Recent Audit in Tauranga, New Zealand

    Science.gov (United States)

    Chapman, Andrew R; Leslie, Stephen J; Sage, Derek K

    2012-01-01

    Background Protocol based care is known to improve the outcomes of patients admitted with recent onset chest pain. The aim of this clinical review was to investigate chest pain management, using newly published guidance from NICE, in the emergency department of a regional hospital in New Zealand. Methods All admissions with chest pain during the period of September-October 2010 were identified retrospectively (n = 599), and a sufficiently powered random sample (n = 120) taken. Relevant data was identified from patient notes, including basic demographics and specific management details. Results One hundred and eighteen patients were analysed (M = 65, F = 53), 99.2% received an ECG on admission, yet only 59.3% of patients had documented evidence of a repeat ECG, with admissions during the day less likely to receive one compared to those admitted overnight (51.5% vs 69.2%, P = 0.04). Younger patients (< 39 years) appeared less likely to receive aspirin than older patients (38.9% vs 80.0%, P = 0.06), 21.3% of patients failed to receive 300 mg aspirin, and 45.6% of patients received oxygen despite normal saturations. Conclusions Despite good performance in a number of areas, this clinical review has highlighted that some standards, such as repeat ECGs, administration of aspirin therapy and appropriate use of oxygen are not being met in all patients with chest pain. A chest pain management pathway is to be implemented for all relevant admissions, to ensure that essential aspects of care are not missed. Timely dissemination and implementation of new clinical guidelines remains a challenge in clinical practice. PMID:28357018

  15. [Improvement in health care quality for patients from the thoracic/chest pain unit in a regional hospital].

    Science.gov (United States)

    Castellano Ortega, M A; Romero de Castilla, R J; Rus Mansilla, C; Cortez Quiroga, G A; Bayona Gómez, A J; Duran Torralba, M C

    2011-01-01

    The evaluation of an improvement cycle in patients suffering thoracic/chest pain in hospital emergencies, especially in those who could benefit from the early Bruce Treadmill Test. A multidisciplinary group care protocol was designed, which identified improvement opportunities and gave priority to the fact that «an early Bruce Treadmill Test was carried out on fewer occasions than recommended». Causes were analysed (Ishikawa diagram) and six quality criteria were defined. These criteria were evaluated in a random sample of 30 patients out of the total of 180 who used the ergometer at the Hospital in the first six months of 2007, as well as questionnaire for the doctors. Corrective measures were introduced: circulation, accessibility through intranet and explicit information for new employees (doctors). The second evaluation was carried out during the first six-months of 2008 using another random sample of 30 patients from a total of 120. In the first evaluation, the classification of the risk according to the protocol was very low (100% non-compliance) and patients whose admission to the Chest Pain Unit was recommended and an early Bruce Treadmill Test (74% criteria failure) were referred to cardiology clinics. After implementation of the corrective measures, we obtain a general improvement in all the criteria, but very significant from the previous ones, with non-compliances being reduced to 17% in classification and to the 23% in referrals. The structured cycle has helped resolve the priority problem in the short-term. The adopted measures have mainly been organisational, dependent on the professionals involved, and at a very low cost. Simple but organised methodological approaches should be taken into account before the incorporation of higher cost technologies. Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.

  16. 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

  17. Myocardial perfusion 320-row multidetector computed tomography-guided treatment strategy for the clinical management of patients with recent acute-onset chest pain: Design of the CArdiac cT in the treatment of acute CHest pain (CATCH)-2 randomized controlled trial.

    Science.gov (United States)

    Sørgaard, Mathias; Linde, Jesper J; Hove, Jens D; Petersen, Jan R; Jørgensen, Tem B S; Abdulla, Jawdat; Heitmann, Merete; Kragelund, Charlotte; Hansen, Thomas Fritz; Udholm, Patricia M; Pihl, Christian; Kühl, J Tobias; Engstrøm, Thomas; Jensen, Jan Skov; Høfsten, Dan E; Kelbæk, Henning; Kofoed, Klaus F

    2016-09-01

    Patients admitted with chest pain are a diagnostic challenge because the majority does not have coronary artery disease (CAD). Assessment of CAD with coronary computed tomography angiography (CCTA) is safe, cost-effective, and accurate, albeit with a modest specificity. Stress myocardial computed tomography perfusion (CTP) has been shown to increase the specificity when added to CCTA, without lowering the sensitivity. This article describes the design of a randomized controlled trial, CATCH-2, comparing a clinical diagnostic management strategy of CCTA alone against CCTA in combination with CTP. Patients with acute-onset chest pain older than 50 years and with at least one cardiovascular risk factor for CAD are being prospectively enrolled to this study from 6 different clinical sites since October 2013. A total of 600 patients will be included. Patients are randomized 1:1 to clinical management based on CCTA or on CCTA in combination with CTP, determining the need for further testing with invasive coronary angiography including measurement of the fractional flow reserve in vessels with coronary artery lesions. Patients are scanned with a 320-row multidetector computed tomography scanner. Decisions to revascularize the patients are taken by the invasive cardiologist independently of the study allocation. The primary end point is the frequency of revascularization. Secondary end points of clinical outcome are also recorded. The CATCH-2 will determine whether CCTA in combination with CTP is diagnostically superior to CCTA alone in the management of patients with acute-onset chest pain. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Discriminative Power of the HEART Score for Obstructive Coronary Artery Disease in Acute Chest Pain Patients Referred for CCTA.

    Science.gov (United States)

    Kolff, Adriana Q; Bom, Michiel J; Knol, Remco J J; van de Zant, Friso M; van der Zee, Petrus M; Cornel, Jan H

    2016-03-01

    To investigate the ability of the HEART score to predict the presence of obstructive coronary artery disease (CAD) determined by coronary computed tomography angiography (CCTA) and its ability to predict the occurrence of major adverse cardiac events (MACE) in patients referred for CCTA after emergency department (ED) presentation. From December 2011 to August 2014, 710 ED patients with chest pain who underwent CCTA within 30 days were included. The HEART score was retrospectively calculated and patients were followed for MACE, comprised of death, myocardial infarction, and revascularization. Association of CAD at CCTA in the different categories of the HEART score was analyzed using χ test. The performance of the HEART score in discriminating between those with and without obstructive CAD was evaluated by receiver operating characteristics. Kaplan-Meier analysis was used to assess MACE-free survival stratified by HEART-score categories. During median follow-up of 826 days (interquartile range: 563-1056), MACE occurred in 46 (6.5%) patients; 3 (0.4%) myocardial infarction, 8 (1.1%) death, and 36 (5.1%) revascularizations. A low HEART score was a significant predictor for MACE-free survival (P = 0.010). CCTA revealed obstructive CAD in 11.7% of patients, with no significant difference between patients with a low and intermediate/high HEART score, respectively 10.7% and 13.2% (P = 0.29). The ability of the HEART score to identify obstructive CAD was poor with an AUC of the receiver operating characteristics curve of 0.53. The HEART score does not adequately identify patients with obstructive CAD at CCTA. It does however predict occurrence of MACE in medium-term follow-up. Excluding patients from additional testing based solely on a low HEART score may lead to suboptimal patient management. CCTA had important implications on patient management and may be a more appropriate tool to further stratify risk in ED chest pain patients.

  19. 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.

  20. Potential risk factors of persistent low back pain developing from mild low back pain in urban Japanese workers.

    Directory of Open Access Journals (Sweden)

    Ko Matsudaira

    Full Text Available STUDY DESIGN: Two-year, prospective cohort data from the Japan epidemiological research of occupation-related back pain study in urban settings were used for this analysis. OBJECTIVE: To examine the association between aggravated low back pain and psychosocial factors among Japanese workers with mild low back pain. SUMMARY OF BACKGROUND DATA: Although psychosocial factors are strongly indicated as yellow flags of low back pain (LBP leading to disability, the association between aggravated LBP and psychosocial factors has not been well assessed in Japanese workers. METHODS: At baseline, 5,310 participants responded to a self-administered questionnaire including questions about individual characteristics, ergonomic work demands, and work-related psychosocial factors (response rate: 86.5%, with 3,811 respondents completing the 1-year follow-up questionnaire. The target outcome was aggravation of mild LBP into persistent LBP during the follow-up period. Incidence was calculated for the participants with mild LBP during the past year at baseline. Logistic regression was used to explore risk factors associated with persistent LBP. RESULTS: Of 1,675 participants who had mild LBP during the preceding year, 43 (2.6% developed persistent LBP during the follow-up year. Multivariate analyses adjusted for individual factors and an ergonomic factor found statistically significant or almost significant associations of the following psychosocial factors with persistent LBP: interpersonal stress at work [adjusted odds ratio (OR: 1.96 and 95% confidence interval (95%CI: 1.00-3.82], job satisfaction (OR: 2.34, 95%CI: 1.21-4.54, depression (OR: 1.92, 95%CI: 1.00-3.69, somatic symptoms (OR: 2.78, 95%CI: 1.44-5.40, support from supervisors (OR: 2.01, 95%CI: 1.05-3.85, previous sick-leave due to LBP (OR: 1.94, 95%CI: 0.98-3.86 and family history of LBP with disability (OR: 1.98, 95%CI: 1.04-3.78. CONCLUSIONS: Psychosocial factors are important risk factors for

  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. Conceptus radiation dose and risk from chest screen-film radiography

    International Nuclear Information System (INIS)

    Damilakis, John; Perisinakis, Kostas; Dimovasili, Evangelia; Prassopoulos, Panos; Gourtsoyiannis, Nicholas; Varveris, Haralambos

    2003-01-01

    The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d a ) was estimated for 51 women of childbearing age from chest CT examinations. The value of d a was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10 -3 mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d a estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is no need for

  3. Conceptus radiation dose and risk from chest screen-film radiography.

    Science.gov (United States)

    Damilakis, John; Perisinakis, Kostas; Prassopoulos, Panos; Dimovasili, Evangelia; Varveris, Haralambos; Gourtsoyiannis, Nicholas

    2003-02-01

    The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d(a)) was estimated for 51 women of childbearing age from chest CT examinations. The value of d(a) was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10(-3) mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d(a) estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is no need for

  4. Conceptus radiation dose and risk from chest screen-film radiography

    Energy Technology Data Exchange (ETDEWEB)

    Damilakis, John; Perisinakis, Kostas; Dimovasili, Evangelia [Department of Medical Physics, University of Crete, Faculty of Medicine, P.O. Box 1393, 714 09 Iraklion, Crete (Greece); Prassopoulos, Panos; Gourtsoyiannis, Nicholas [Department of Radiology, University of Crete, Faculty of Medicine, P.O. Box 1393, 714 09 Iraklion, Crete (Greece); Varveris, Haralambos [Department of Radiotherapy, University of Crete, Faculty of Medicine, P.O. Box 1393, 714 09 Iraklion, Crete (Greece)

    2003-02-01

    The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d{sub a}) was estimated for 51 women of childbearing age from chest CT examinations. The value of d{sub a} was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10{sup -3} mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d{sub a} estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is

  5. Total sitting time, leisure time physical activity and risk of hospitalization due to low back pain

    DEFF Research Database (Denmark)

    Balling, Mie; Holmberg, Teresa; Petersen, Christina B

    2018-01-01

    AIMS: This study aimed to test the hypotheses that a high total sitting time and vigorous physical activity in leisure time increase the risk of low back pain and herniated lumbar disc disease. METHODS: A total of 76,438 adults answered questions regarding their total sitting time and physical...... activity during leisure time in the Danish Health Examination Survey 2007-2008. Information on low back pain diagnoses up to 10 September 2015 was obtained from The National Patient Register. The mean follow-up time was 7.4 years. Data were analysed using Cox regression analysis with adjustment...... disc disease. However, moderate or vigorous physical activity, as compared to light physical activity, was associated with increased risk of low back pain (HR = 1.16, 95% CI: 1.03-1.30 and HR = 1.45, 95% CI: 1.15-1.83). Moderate, but not vigorous physical activity was associated with increased risk...

  6. Esophageal dynamics scintigraphy in noncoronarian chest pain

    International Nuclear Information System (INIS)

    Oliveira Lemme, E.M. de.; Souto, F.J.D.; Penas, M.E.

    1990-01-01

    A group of 27 patients with noncoronarian chest pain (NCCP) was submitted to radionuclide transit as part of esophageal disorders investigation. Features were compared with radiological examinations: barium swallow (BS) and bread-barium swallow (BBS). Abnormal radionuclide transit was found in 63% of patients and incoordinating pattern was the most frequent finding. Motor disorders were detected in 18.5% and 33% of patients by BS and BBS respectively. We conclude that radionuclide transit is a sensitive method for investigation of esophageal motor disorders and we recommend it as a screening test in NCCP, since it is a simple and very well tolerated technique. (author)

  7. 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.)

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

    International Nuclear Information System (INIS)

    Schertler, Thomas; Scheffel, Hans; Frauenfelder, Thomas; Desbiolles, Lotus; Leschka, Sebastian; Stolzmann, Paul; Marincek, Borut; Alkadhi, Hatem; Seifert, Burkhardt; Flohr, Thomas G.

    2007-01-01

    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.)

  9. Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey

    Science.gov (United States)

    Yang, Haiou; Haldeman, Scott; Lu, Ming-Lun; Baker, Dean

    2017-01-01

    Objectives The objectives of this study were to estimate prevalence of low back pain, to investigate associations between low back pain and a set of emerging workplace risk factors and to identify worker groups with an increased vulnerability for low back pain in the US. Methods The data used for this study came from the 2010 National Health Interview Survey (NHIS), which was designed to collect data on health conditions and related risk factors obtained from the US civilian population. The variance estimation method was used to compute weighted data for prevalence of low back pain. Multivariable logistic regression analyses stratified by sex and age were performed to determine the odds ratios (ORs) and the 95% Confidence Interval (CI) for low back pain. The examined work-related psychosocial risk factors included work-family imbalance, exposure to a hostile work environment and job insecurity. Work hours, occupation and other work organizational factors (non-standard work arrangements and alternative shifts) were also examined. Results The prevalence rate of self-reported low back pain in previous three months among workers in the U.S. was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. We found significant associations between low back pain and a set of psychosocial factors, including work-family imbalance (OR 1.27, CI 1.15–1.41), exposure to hostile work (OR 1.39, CI 1.25–1.55), and job insecurity (OR 1.44, CI 1.24–1.67), while controlling for demographic characteristics and other health related factors. Older workers who had non-standard work arrangements were more likely to report low back pain. Females who worked 41–45 hours per week and younger workers who worked over 60 hours per week had an increased risk for low back pain. Workers from several occupation groups, including, male healthcare practitioners, female and younger healthcare support workers, and female farming, fishing and forestry workers had

  10. Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey.

    Science.gov (United States)

    Yang, Haiou; Haldeman, Scott; Lu, Ming-Lun; Baker, Dean

    2016-09-01

    The objectives of this study were to estimate prevalence of low back pain, to investigate associations between low back pain and a set of emerging workplace risk factors, and to identify worker groups with an increased vulnerability for low back pain in the United States. The data used for this cross-sectional study came from the 2010 National Health Interview Survey, which was designed to collect data on health conditions and related risk factors from the US civilian population. The variance estimation method was used to compute weighted data for prevalence of low back pain. Multivariable logistic regression analyses stratified by sex and age were performed to determine the odds ratios (ORs) and the 95% confidence interval (CI) for low back pain. The examined work-related psychosocial risk factors included work-family imbalance, exposure to a hostile work environment, and job insecurity. Work hours, occupation, and other work organizational factors (nonstandard work arrangements and alternative shifts) were also examined. The prevalence of self-reported low back pain in the previous 3 months among workers in the United States was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. We found significant associations between low back pain and a set of psychosocial factors, including work-family imbalance (OR 1.27, CI 1.15-1.41), exposure to hostile work (OR 1.39, CI 1.25-1.55), and job insecurity (OR 1.44, CI 1.24-1.67), while controlling for demographic characteristics and other health-related factors. Older workers who had nonstandard work arrangements were more likely to report low back pain. Women who worked 41 to 45 hours per week and younger workers who worked >60 hours per week had an increased risk for low back pain. Workers from several occupation groups, including male health care practitioners, female and younger health care support workers, and female farming, fishing, and forestry workers, had an increased risk of

  11. Diagnostic value for coronary artery disease of ST depression and chest pain during dipyridamole loading

    International Nuclear Information System (INIS)

    Yonezawa, Yoshihiro; Doi, Yoshinori; Aono, Tadashi; Odawara, Hiroaki; Chikamori, Taishiro; Yamada, Mitsutoshi; Takata, Jun; Ozawa, Toshio; Hamashige, Naohisa.

    1991-01-01

    The diagnostic significance of both ST depression and chest pain during dipyridamole loading was assessed in 437 patients with coronary artery disease (CRD) who have received dipyridamole-loading thallium-201 myocardial scintigraphy and coronary arteriography. ST depression and chest pain were induced in 35% and 42%, respectively. ST depression occurred in 23% for one vessel disease, 55% for two-vessel disease, 67% for three-vessel disease, and 11% for non-significant disease. In the absence of myocardial infarction, it occurred in as many as 78% for two-vessel disease and 94% for three-vessel disease. ST depression had a sensitivity of 51% and a specificity of 89%. Chest pain had a lower specificity (77%), whereas the sensitivity remained the same (51%). In 42 (31%) of 134 patients with ST depression, coronary revascularization was necessary in the early stage. With a median follow up of 29 months, 3 patients (2%) died of cardiac events, and 12 (9%) had nonfatal cardiac complications. There was a significant correlation between reversible defects (RD) on myocardial scintigrams and ST depression; RD were seen in 81% of ST depression cases, and ST depression occurred in 51% of 210 RD cases. The more diseased vessels, the more frequently ST depression occurred in accordance with RD on myocardial scintigrams. Both ST depression and chest pain during dipyridamole loading tended to be associated with myocardial ischemia, suggesting the diagnostic value in CRD patients with limited exercise loading. RD on myocardial scintigrams was considered attributable to coronary steal phenomenon for multi-vessel disease and to the difference in the relative increase of the coronary flow for single vessel disease. (N.K.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-12-15

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

  13. Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study.

    Science.gov (United States)

    Soltani, Mohammadhossien; Mirzaei, Masoud; Amin, Ahmad; Emami, Mahmoud; Aryanpoor, Reza; Shamsi, Farimah; Sarebanhassanabadi, Mohammadtaghi

    2016-07-01

    Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at investigating 30 days' adverse outcomes of patients discharged from ED of a major heart center in Iran. Out of 1638 chest pain admissions to the centre during 2010-2011, 962 patients (mean age= 50.9±15.9 years) who were admitted to Afshar Heart Center's ED with chest pain as their chief complaint, and discharged with primary diagnosis of non-cardiac chest pain, were followed for any adverse cardiac events 30 days post discharge. The adverse events were: unstable angina, non-ST-elevated myocardial infarction (NSTEMI), ST elevated myocardial infarction (STEMI), coronary revascularization (percutaneous angioplasty, coronary artery bypass grafting) and death. Adverse cardiac events, including acute coronary syndrome (ACS), revascularization and death were observed in 30 patients (3.1%) including: acute MI n=5 (0.5%, sudden cardiac death inn=1 (0.1%, coronary revascularization in n=8 (0.8%) and hospitalization due to unstable angina/NSTEMI in n=16 (1-7%). Adverse events were seen more frequently in patients with history of hypertension, dyslipidemia and previous coronary artery disease. In univariate analysis, the chance of postdischarge adverse cardiac events was higher in patients with hypertension (OR=9.36, CI=3.24-27.03), previous coronary artery disease (OR= 3.8, CI=1.78-8.0), dyslipidemia (OR=3.5, CI=1.7-7.38) and discharge against medical advice (OR=2.85, CI= 1.37-5.91). The extent of adverse cardiac events in patients with a primary diagnosis of non-cardiac chest pain within 30 days of discharge was significant, mandating nation-wide registries to provide better care for these patients.

  14. Psychosocial Risk Factors for Low Back Pain and Absenteeism among Slovenian Professional Drivers.

    Science.gov (United States)

    Kresal, Friderika; Suklan, Jana; Roblek, Vasja; Jerman, Andrej; Meško, Maja

    2017-06-01

    The aim of this study was to determine the most common psychosocial risk factors for absenteeism and the extent to which low back pain occurs among Slovenian professional drivers as result of various psychosocial risk factors. The study involved 275 professional drivers, mostly men (mean age 41.6 years). Statistical data analysis was conducted using SPSS package version 21, MS Excel version 2007 and Pajek, version 3. The main method for data processing was regression analysis. The results of the quantitative survey showed that lower back pain is mostly caused by lifting and carrying heavy loads, inadequate working conditions, poor physical fitness, regular nights out, shift work, and stress. Dissatisfaction with work, shift work and unsuitable working conditions significantly affect the incidence of low back pain. Absenteeism is influenced by factors such as dissatisfaction at work, disrespectful attitude of managers, unsuitable working conditions, personal dissatisfaction, lack of understanding of the partner, and enjoying nightlife on a regular basis. The study clarifies the unexplained holistic psychosocial risk factors and treatment effects on health in the population of professional drivers. Such factors can lead to absenteeism. The study also provides initial demonstration research in the Slovenian practice. Furthermore, it provides solutions in a holistic approach to solve the problem of risk factors management. Copyright© by the National Institute of Public Health, Prague 2017

  15. A new score for the diagnosis of acute coronary syndrome in acute chest pain with non-diagnostic ECG and normal troponin.

    Science.gov (United States)

    Boubaker, Hamdi; Grissa, Mohamed Habib; Beltaief, Kaouther; Amor, Mohamed Haj; Mdimagh, Zouhaier; Boukhris, Amor; Ben Amor, Mehdi; Dridi, Zohra; Letaief, Mondher; Bouida, Wahid; Boukef, Riadh; Najjar, Fadhel; Nouira, Semir

    2015-10-01

    Acute coronary syndrome (ACS) represents a difficult diagnostic challenge in patients with undifferentiated chest pain. There is a need for a valid clinical score to improve diagnostic accuracy. To compare the performance of a model combining the Thrombolysis in Myocardial Infarction (TIMI) score and a score describing chest pain (ACS diagnostic score: ACSD score) with that of both scores alone in the diagnosis of ACS in ED patients with chest pain associated with a non-diagnostic ECG and normal troponin. In this observational cohort study, we enrolled 809 patients admitted to a chest pain unit with normal ECG and normal troponin. They were prospectively evaluated in order to calculate TIMI score, chest pain characteristics score and ACSD score. Diagnosis of ACS was the primary outcome and defined on the basis of 2 cardiologists after reviewing the patient medical records and follow-up data. Mortality and major cardiovascular events were followed for 1 month for patients discharged directly from ED. Discriminative power of scores was evaluated by the area under the ROC curve. ACS was confirmed in 90 patients (11.1%). The area under the ROC curve for ACSD score was 0.85 (95% CI 0.80 to 0.90) compared with 0.74 (95% CI 0.67 to 0.81) for TIMI and 0.79 (95% CI 0.74 to 0.84) for chest pain characteristics score. A threshold value of 9 appeared to optimise sensitivity (92%) and negative predictive value (99%) without excessively compromising specificity (62%) and positive predictive value (23%). The ACSD score showed a good discrimination performance and an excellent negative predictive value which allows safely ruling out ACS in ED patients with undifferentiated chest pain. Our findings should be validated in a larger multicentre study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Protocol Adherence in Prehospital Medical Care Provided for Patients with Chest Pain and Loss of Consciousness; a Brief Report

    Directory of Open Access Journals (Sweden)

    Mostafa Mehrara

    2017-01-01

    Full Text Available Introduction: Although many protocols are available in the field of the prehospital medical care (PMC, there is still a notable gap between protocol based directions and applied clinical practice. This study measures the rate of protocol adherence in PMC provided for patients with chest pain and loss of consciousness (LOC.Method: In this cross-sectional study, 10 educated research assistants audited the situation of provided PMC for non-traumatic chest pain and LOC patients, presenting to the emergency department of a tertiary level teaching hospital, compare to national recommendations in these regards.Results: 101 cases with the mean age of 56.7 ± 12.3 years (30-78 were audited (55.4% male. 61 (60.3% patients had chest pain and 40 (39.7% cases had LOC. Protocol adherence rates for cardiac monitoring (62.3%, O2 therapy (32.8%, nitroglycerin administration (60.7%, and aspirin administration (52.5% in prehospital care of patients with chest pain were fair to poor. Protocol adherence rates for correct patient positioning (25%, O2 therapy (75%, cardiac monitoring (25%, pupils examination (25%, bedside glucometery (50%, and assessing for naloxone administration (55% in prehospital care of patients with LOC were fair to poor.Conclusion: There were more than 20% protocol violation regarding prehospital care of chest pain patients regarding cardiac monitoring, O2 therapy, and nitroglycerin and aspirin administration. There were same situation regarding O2 therapy, positioning, cardiac monitoring, pupils examination, bedside glucometery, and assessing for naloxone administration of LOC patients in prehospital setting.

  17. Thin chest wall is an independent risk factor for the development of pneumothorax after chest tube removal.

    Science.gov (United States)

    Anand, Rahul J; Whelan, James F; Ferrada, Paula; Duane, Therese M; Malhotra, Ajai K; Aboutanos, Michel B; Ivatury, Rao R

    2012-04-01

    The factors contributing to the development of pneumothorax after removal of chest tube thoracostomy are not fully understood. We hypothesized that development of post pull pneumothorax (PPP) after chest tube removal would be significantly lower in those patients with thicker chest walls, due to the "protective" layer of adipose tissue. All patients on our trauma service who underwent chest tube thoracostomy from July 2010 to February 2011 were retrospectively reviewed. Patient age, mechanism of trauma, and chest Abbreviated Injury Scale score were analyzed. Thoracic CTs were reviewed to ascertain chest wall thickness (CW). Thickness was measured at the level of the nipple at the midaxillary line, as perpendicular distance between skin and pleural cavity. Chest X-ray reports from immediately prior and after chest tube removal were reviewed for interval development of PPP. Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients. Patients who died before chest tube removal (n = 11), or those without thoracic CT scans (n = 13) were excluded. PPP occurred in 29.9 per cent of chest tube removals (20/67). When PPP was encountered, repeat chest tube was necessary in 20 per cent of cases (4/20). After univariate analysis, younger age, penetrating mechanism, and thin chest wall were found to be significant risk factors for development of PPP. Chest Abbreviated Injury Scale score was similar in both groups. Logistic regression showed only chest wall thickness to be an independent risk factor for development of PPP.

  18. Chest pain control with kinesiology taping after lobectomy for lung cancer: initial results of a randomized placebo-controlled study.

    Science.gov (United States)

    Imperatori, Andrea; Grande, Annamaria; Castiglioni, Massimo; Gasperini, Laura; Faini, Agnese; Spampatti, Sebastiano; Nardecchia, Elisa; Terzaghi, Lorena; Dominioni, Lorenzo; Rotolo, Nicola

    2016-08-01

    Kinesiology taping (KT) is a rehabilitative technique performed by the cutaneous application of a special elastic tape. We tested the safety and efficacy of KT in reducing postoperative chest pain after lung lobectomy. One-hundred and seventeen consecutive patients, both genders, age 18-85, undergoing lobectomy for lung cancer between January 2013 and July 2015 were initially considered. Lobectomies were performed by the same surgical team, with thoracotomy or video-assisted thoracoscopic surgery (VATS) access. Exclusion criteria (n = 25 patients) were: previous KT exposure, recent trauma, pre-existing chest pain, lack of informed consent, >24-h postoperative intensive care unit treatment. After surgery, the 92 eligible patients were randomized to KT experimental group (n = 46) or placebo control group (n = 46). Standard postoperative analgesia was administered in both groups (paracetamol/non-steroidal anti-inflammatory drugs, epidural analgesia including opioids), with supplemental analgesia boluses at patient request. On postoperative day 1 in addition, in experimental group patients a specialized physiotherapist applied KT, with standardized tape length, tension and shape, over three defined skin areas: at the chest access site pain trigger point; over the ipsilateral deltoid/trapezius; lower anterior chest. In control group, usual dressing tape mimicking KT was applied over the same areas, as placebo. Thoracic pain severity score [visual analogue scale (VAS) ranging 0-10] was self-assessed by all patients on postoperative days 1, 2, 5, 8, 9 and 30. The KT group and the control group had similar demographics, lung cancer clinico-pathological features and thoracotomy/VATS ratio. Postoperatively, the two groups also resulted similar in supplemental analgesia, complication rate, mean duration of chest drainage and length of stay. There were no adverse events with KT application. After tape application, KT patients reported overall less thoracic pain than the

  19. Comparative effectiveness of coronary CT angiography vs stress cardiac imaging in patients following hospital admission for chest pain work-up: The Prospective First Evaluation in Chest Pain (PERFECT) Trial.

    Science.gov (United States)

    Uretsky, Seth; Argulian, Edgar; Supariwala, Azhar; Agarwal, Shiv K; El-Hayek, Georges; Chavez, Patricia; Awan, Hira; Jagarlamudi, Ashadevi; Puppala, Siva P; Cohen, Randy; Rozanski, Alan

    2017-08-01

    Because the frequency of cardiac event rates is low among chest pain patients following either performance of coronary CT angiography (CCTA) or stress testing, there is a need to better assess how these tests influence the central management decisions that follow from cardiac testing. The present study was performed to assess the relative impact of CCTA vs stress testing on medical therapies and downstream resource utilization among patients admitted for the work-up of chest pain. The admitted patients were randomized in a 1:1 ratio to either cardiac imaging stress test or CCTA. Primary outcomes were time to discharge, change in medication usage, and frequency of downstream testing, cardiac interventions, and cardiovascular re-hospitalizations. We randomized 411 patients, 205 to stress testing, and 206 to CCTA. There were no differences in time to discharge or initiation of new cardiac medications at discharge. At 1 year follow-up, there was no difference in the number of patients who underwent cardiovascular downstream tests in the CCTA vs stress test patients (21% vs 15%, P = .1) or cardiovascular hospitalizations (14% vs 16%, P = .5). However, there was a higher frequency of invasive angiography in the CCTA group (11% vs 2%, P = .001) and percutaneous coronary interventions (6% vs 0%, P work-up to either CCTA or to stress testing resulted in similar discharge times, change in medical therapies at discharge, frequency of downstream noninvasive testing, and repeat hospitalizations. However, a higher frequency of invasive coronary angiography and revascularization procedures were performed in the CCTA arm. (ClinicalTrials.gov number, NCT01604655.).

  20. Utilizing DMAIC six sigma and evidence-based medicine to streamline diagnosis in chest pain.

    Science.gov (United States)

    Kumar, Sameer; Thomas, Kory M

    2010-01-01

    The purpose of this study was to quantify the difference between the current process flow model for a typical patient workup for chest pain and development of a new process flow model that incorporates DMAIC (define, measure, analyze, improve, control) Six Sigma and evidence-based medicine in a best practices model for diagnosis and treatment. The first stage, DMAIC Six Sigma, is used to highlight areas of variability and unnecessary tests in the current process flow for a patient presenting to the emergency department or physician's clinic with chest pain (also known as angina). The next stage, patient process flow, utilizes DMAIC results in the development of a simulated model that represents real-world variability in the diagnosis and treatment of a patient presenting with angina. The third and final stage is used to analyze the evidence-based output and quantify the factors that drive physician diagnosis accuracy and treatment, as well as review the potential for a broad national evidence-based database. Because of the collective expertise captured within the computer-oriented evidence-based model, the study has introduced an innovative approach to health care delivery by bringing expert-level care to any physician triaging a patient for chest pain anywhere in the world. Similar models can be created for other ailments as well, such as headache, gastrointestinal upset, and back pain. This updated way of looking at diagnosing patients stemming from an evidence-based best practice decision support model may improve workflow processes and cost savings across the health care continuum.

  1. Nursing patients with acute chest pain: practice guided by the Prince Edward Island conceptual model for nursing.

    Science.gov (United States)

    Blanchard, Janelle F; Murnaghan, Donna A

    2010-01-01

    Current research suggests that pain is a relatively common phenomenon with 60-90% of patients presenting to emergency departments reporting pain (e.g., chest pain, trauma, extremity fractures and migraine headache) that require treatment [Hogan, S.L., 2005. Patient satisfaction with pain management in the emergency department. Advanced Emergency Nursing Journal 27(4), 284-294]. This article explores the use of conceptual theoretical empirical (C-T-E) framework to guide a senior nursing student in a case study of patient with chest pain. The Middle Range Theory of Pain described by Good [Good, M., 1998. A middle-range theory of acute pain management: use in research. Nursing Outlook 46(3), 120-124] and Melzack's [Melzack, R., 1987. The short-form McGill pain questionnaire. Pain, 30, 191-197] short form McGill pain questionnaire were applied along with the Prince Edward Island conceptual model (PEICM) for nursing. Results indicate that the nursing student increased her ability to work in partnership, assess relevant and specific information, and identify a number of strategies to help the patient achieve pain control by using a complement of pharmacological and non-pharmacological interventions. Moreover, the C-T-E approach provided an organized and systematic theoretical approach for the nursing student to assist a patient in pain control.

  2. The greatest risk for low-back pain among newly educated female health care workers; body weight or physical work load?

    DEFF Research Database (Denmark)

    Jensen, Jette Nygaard; Holtermann, Andreas; Clausen, Thomas

    2012-01-01

    Low back pain (LBP) represents a major socioeconomic burden for the Western societies. Both life-style and work-related factors may cause low back pain. Prospective cohort studies assessing risk factors among individuals without prior history of low back pain are lacking. This aim of this study...

  3. Physical activity level at work and risk of chronic low back pain: A follow-up in the Nord-Trøndelag Health Study.

    Science.gov (United States)

    Heuch, Ingrid; Heuch, Ivar; Hagen, Knut; Zwart, John-Anker

    2017-01-01

    Physical activity in leisure time seems to reduce the risk of low back pain, but it is not known whether occupational activity, as recorded in a representative working population, produces a higher or lower risk. To study associations between physical activity level at work and risk of chronic low back pain. Associations were examined in a Norwegian prospective study using data from the HUNT2 and HUNT3 surveys carried out in the whole county of Nord-Trøndelag. Participants were 7580 women and 7335 men who supplied information about physical activity level at work. Levels considered were sedentary work, work involving walking but no heavy lifting, work involving walking and heavy lifting, and particularly strenuous physical work. Nobody in the cohort was affected by chronic low back pain at baseline. After 11 years, participants reported whether they suffered from chronic low back pain. Generalized linear modelling with adjustment for potential confounders was applied to assess associations with risk factors. In age-adjusted analyses both women and men showed statistically significant associations between physical activity at work and risk of chronic low back pain, suggesting positive relationships. For particularly strenuous physical work the relative risk of chronic low back pain was 1.30 (95% CI: 1.00-1.71) in women and 1.36 (95% CI 1.17-1.59) in men, compared to sedentary work. Women still showed a general association with activity level after adjustment for education, leisure time physical activity, BMI, smoking and occupational category. In men, the higher risk was only maintained for particularly strenuous work. In this cohort, women had a higher risk of chronic low back pain with work involving walking and heavy lifting or particularly strenuous work, compared to sedentary work. Men participating in particularly strenuous work also experienced a higher risk of chronic low back pain.

  4. Physical activity level at work and risk of chronic low back pain: A follow-up in the Nord-Trøndelag Health Study.

    Directory of Open Access Journals (Sweden)

    Ingrid Heuch

    Full Text Available Physical activity in leisure time seems to reduce the risk of low back pain, but it is not known whether occupational activity, as recorded in a representative working population, produces a higher or lower risk.To study associations between physical activity level at work and risk of chronic low back pain.Associations were examined in a Norwegian prospective study using data from the HUNT2 and HUNT3 surveys carried out in the whole county of Nord-Trøndelag. Participants were 7580 women and 7335 men who supplied information about physical activity level at work. Levels considered were sedentary work, work involving walking but no heavy lifting, work involving walking and heavy lifting, and particularly strenuous physical work. Nobody in the cohort was affected by chronic low back pain at baseline. After 11 years, participants reported whether they suffered from chronic low back pain. Generalized linear modelling with adjustment for potential confounders was applied to assess associations with risk factors.In age-adjusted analyses both women and men showed statistically significant associations between physical activity at work and risk of chronic low back pain, suggesting positive relationships. For particularly strenuous physical work the relative risk of chronic low back pain was 1.30 (95% CI: 1.00-1.71 in women and 1.36 (95% CI 1.17-1.59 in men, compared to sedentary work. Women still showed a general association with activity level after adjustment for education, leisure time physical activity, BMI, smoking and occupational category. In men, the higher risk was only maintained for particularly strenuous work.In this cohort, women had a higher risk of chronic low back pain with work involving walking and heavy lifting or particularly strenuous work, compared to sedentary work. Men participating in particularly strenuous work also experienced a higher risk of chronic low back pain.

  5. Risk of peptic ulcer, oesophagitis, pancreatitis or gallstone in patients with unexplained chest/epigastric pain and normal upper endoscopy: a 10-year Danish cohort study

    DEFF Research Database (Denmark)

    Munk, E M; Drewes, A M; Gorst-Rasmussen, Anders

    2007-01-01

    BACKGROUND: No studies have examined the risk of upper gastrointestinal diseases among patients with unexplained chest/epigastric pain (UCEP) and a normal upper endoscopy. AIM: To examine the relative risk of peptic ulcer, oesophagitis, pancreatitis or gallstone in UCEP patients. METHODS...... for peptic ulcer, oesophagitis, pancreatitis or gallstone. RESULTS: Compared with controls, the adjusted relative risks among UCEP patients or = 1 year after upper endoscopy were for peptic ulcer 2.0 [95% confidence interval (CI) 0.2-18.4] and 1.7 (95% CI 0.9-3.4), for oesophagitis 8.2 (95% CI 1.......2-59.2) and 1.9 (95% CI 0.7-5.0), for pancreatitis 9.2 (95% CI 2.0-41.8) and 3.9 (95% CI 1.4-10.5), and for gallstone 14.1 (95% CI 5.4-37.2) and 3.3 (95% CI 1.9-5.8). CONCLUSIONS: UCEP is positively associated with all study outcomes especially in the first year after upper endoscopy, indicating that peptic...

  6. The greatest risk for low-back pain among newly educated female health care workers; body weight or physical work load?

    Directory of Open Access Journals (Sweden)

    Jensen Jette

    2012-06-01

    Full Text Available Abstract Background Low back pain (LBP represents a major socioeconomic burden for the Western societies. Both life-style and work-related factors may cause low back pain. Prospective cohort studies assessing risk factors among individuals without prior history of low back pain are lacking. This aim of this study was to determine risk factors for developing low back pain (LBP among health care workers. Methods Prospective cohort study with 2,235 newly educated female health care workers without prior history of LBP. Risk factors and incidence of LBP were assessed at one and two years after graduation. Results Multinomial logistic regression analyses adjusted for age, smoking, and psychosocial factors showed that workers with high physical work load had higher risk for developing LBP than workers with low physical work load (OR 1.8; 95% CI 1.1–2.8. In contrast, workers with high BMI were not at a higher risk for developing LBP than workers with a normal BMI. Conclusion Preventive initiatives for LBP among health care workers ought to focus on reducing high physical work loads rather than lowering excessive body weight.

  7. Do illness perceptions of people with chronic low back pain differ from people without chronic low back pain?

    NARCIS (Netherlands)

    van Wilgen, C. Paul; van Ittersum, Miriam W.; Kaptein, Ad A.

    Objectives To determine why some people develop chronic low back pain, and whether illness perceptions are an important risk factor in the transition from acute to chronic low back pain. Design Cross-sectional study. Participants Four hundred and two members of the general Dutch population, with and

  8. Persistent chest pain following oral dipyridamole for thallium 201 myocardial imaging

    International Nuclear Information System (INIS)

    Kwai, A.H.; Jacobson, A.F.; McIntyre, K.M.; Williams, W.H.; Tow, D.E.

    1990-01-01

    A patient was admitted to the hospital with acute chest pain. After acute myocardial infarction was ruled out, he underwent a stress thallium 201 scintigraphy using oral dipyridamole and developed persistent angina with sedimentation time segement elevation. This complication has not been reported previously. It is recommended that appropriate intervention be available if severe ischemia develops following administration of dipyridamole for diagnostic imaging. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-04-15

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

  10. Effect of thoracic mobilization on respiratory parameters in chronic non-specific low back pain: A randomized controlled trial.

    Science.gov (United States)

    Babina, R; Mohanty, P P; Pattnaik, M

    2016-02-19

    Altered respiratory function has been found to be associated with back pain. Limited chest excursion in subjects with chronic low back pain (CLBP) may be due to co-contraction or bracing of erector spinae and abdominal muscles; their flexed spinal posture; and/or their compromised spinal stability resulting from dysfunctional transversus abdominis. To check for the effects of thoracic mobilization on respiratory parameters in subjects with chronic non-specific low back pain. Sixty-two subjects (excluding 11 dropouts) with CLBP of age group 30-60 were randomly allocated to two groups. Both groups received individualized treatment for low back pain (LBP) and HEP (home exercise program) regime of breathing exercises. In addition, group 1 received Maitland's Central postero-anterior vertebral pressure for thoracic spine (T1-T8). Total treatment duration was 10 sessions in 2 weeks (5 sessions/week). Results showed significant improvement in respiratory parameters viz. Forced Vital Capacity (FVC), Sustained Maximal Inspiratory Pressure (SMIP) and Chest Wall Expansion (CWE) and Oswestry Disability Index (ODI) in both groups (pchronic low back pain with or without radiation to lower limbs when treated with thoracic central PA mobilization, in addition to LBP specific treatment and breathing exercises, show an improvement in respiratory parameters and reduction in disability.

  11. Guideline-adherence and perspectives in the acute management of unstable angina - Initial results from the German chest pain unit registry.

    Science.gov (United States)

    Breuckmann, Frank; Hochadel, Matthias; Darius, Harald; Giannitsis, Evangelos; Münzel, Thomas; Maier, Lars S; Schmitt, Claus; Schumacher, Burghard; Heusch, Gerd; Voigtländer, Thomas; Mudra, Harald; Senges, Jochen

    2015-08-01

    We investigated the current management of unstable angina pectoris (UAP) in certified chest pain units (CPUs) in Germany and focused on the European Society of Cardiology (ESC) guideline-adherence in the timing of invasive strategies or choice of conservative treatment options. More specifically, we analyzed differences in clinical outcome with respect to guideline-adherence. Prospective data from 1400 UAP patients were collected. Analyses of high-risk criteria with indication for invasive management and 3-month clinical outcome data were performed. Guideline-adherence was tested for a primarily conservative strategy as well as for percutaneous coronary intervention (PCI) within management was performed in 38.2%. In UAP patients at risk, undertreatment caused by an insufficient consideration of risk criteria was obvious in 78%. Reciprocally, overtreatment in the absence of adequate risk markers was performed in 27%, whereas a guideline-conforming primarily conservative strategy was chosen in 73% of the low-risk patients. Together, the 3-month major adverse coronary and cerebrovascular events (MACCE) were low (3.6%). Nonetheless, guideline-conforming treatment was even associated with significantly lower MACCE rates (1.6% vs. 4.0%, p<0.05). The data suggest an inadequate adherence to ESC guidelines in nearly two thirds of the patients, particularly in those patients at high to intermediate risk with secondary risk factors, emphasizing the need for further attention to consistent risk profiling in the CPU and its certification process. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  12. Low back pain in military recruits in relation to social background and previous low back pain. A cross-sectional and prospective observational survey

    Directory of Open Access Journals (Sweden)

    Weidick Flemming

    2005-05-01

    Full Text Available Abstract Background Traditionally, studies on the etiology of low back pain have been carried out in adult populations. However, since low back pain often appears early in life, more research on young populations is needed. This study focuses on the importance of social background factors and previous low back pain in the development of low back pain in military recruits. Methods During a three-month period, Danish military recruits with different social backgrounds live and work under the same conditions. Thus, there is an opportunity to investigate the influence of social background on the development of low back pain, when persons are removed from their usual environment and submitted to a number of new stressors. In addition, the importance of the recruits' previous low back pain history in relation to low back pain during military service was studied. This was done by means of questionnaires to 1,711 recruits before and after this three-month period. Results Sedentary occupation was negatively associated with long-lasting low back pain (>30 days during the past year at baseline with an odds ratios of 0.55 (95% CI: 0.33–0.90. This effect vanished during service. Having parents with higher education increased the risk of low back pain during service (OR: 1.9;1.2–3.0, for the highest educated group, but not of the consequences (leg pain and exemption from duty, whereas high IQ decreased the risk of these consequences (odds ratios as low as 0.2;0.1–0.8 for exemption from duty in the group with highest IQ. Long-lasting low back pain prior to service increased the risk of long-lasting low back pain (OR: 4.8;2.1–10.8, leg pain (OR: 3.3;1.3–8.3 and exemption from duty during service (OR: 5.9;2.4–14.8. Conclusion Sedentary occupation is negatively associated with low back pain at baseline. This protective effect disappears, when the person becomes physically active. For predicting trouble related to the low back during service, the

  13. Patient-specific radiation dose and cancer risk for pediatric chest CT.

    Science.gov (United States)

    Li, Xiang; Samei, Ehsan; Segars, W Paul; Sturgeon, Gregory M; Colsher, James G; Frush, Donald P

    2011-06-01

    To estimate patient-specific radiation dose and cancer risk for pediatric chest computed tomography (CT) and to evaluate factors affecting dose and risk, including patient size, patient age, and scanning parameters. The institutional review board approved this study and waived informed consent. This study was HIPAA compliant. The study included 30 patients (0-16 years old), for whom full-body computer models were recently created from clinical CT data. A validated Monte Carlo program was used to estimate organ dose from eight chest protocols, representing clinically relevant combinations of bow tie filter, collimation, pitch, and tube potential. Organ dose was used to calculate effective dose and risk index (an index of total cancer incidence risk). The dose and risk estimates before and after normalization by volume-weighted CT dose index (CTDI(vol)) or dose-length product (DLP) were correlated with patient size and age. The effect of each scanning parameter was studied. Organ dose normalized by tube current-time product or CTDI(vol) decreased exponentially with increasing average chest diameter. Effective dose normalized by tube current-time product or DLP decreased exponentially with increasing chest diameter. Chest diameter was a stronger predictor of dose than weight and total scan length. Risk index normalized by tube current-time product or DLP decreased exponentially with both chest diameter and age. When normalized by DLP, effective dose and risk index were independent of collimation, pitch, and tube potential (chest CT protocols. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101900/-/DC1. RSNA, 2011

  14. Prognostic significance of normal quantitative planar thallium-201 stress scintigraphy in patients with chest pain

    International Nuclear Information System (INIS)

    Wackers, F.J.; Russo, D.J.; Russo, D.; Clements, J.P.

    1985-01-01

    The prognostic significance of normal quantitative planar thallium-201 stress scintigraphy was evaluated in patients with a chest pain syndrome. The prevalence of cardiac events during follow-up was related to the pretest (that is, before stress scintigraphy) likelihood of coronary artery disease determined on the basis of symptoms, age, sex and stress electrocardiography. In a consecutive series of 344 patients who had adequate thallium-201 stress scintigrams, 95 had unequivocally normal studies by quantitative analysis. The pretest likelihood of coronary artery disease in the 95 patients had a bimodal distribution. During a mean follow-up period of 22 +/- 3 months, no patient died. Three patients (3%) had a cardiac event: two of these patients (pretest likelihood of coronary artery disease 54 and 94%) had a nonfatal myocardial infarction 8 and 22 months, respectively, after stress scintigraphy, and one patient (pretest likelihood 98%) underwent percutaneous transluminal coronary angioplasty 16 months after stress scintigraphy for persisting anginal complaints. Three patients were lost to follow-up; all three had a low pretest likelihood of coronary artery disease. It is concluded that patients with chest pain and normal findings on quantitative thallium-201 scintigraphy have an excellent prognosis. Cardiac events are rare (infarction rate 1% per year) and occur in patients with a moderate to high pretest likelihood of coronary artery disease

  15. Prognosis with chest pain and normal thallium-201 exercise scintigrams

    International Nuclear Information System (INIS)

    Pamelia, F.X.; Gibson, R.S.; Watson, D.D.; Craddock, G.B.; Sirowatka, J.; Beller, G.A.

    1985-01-01

    The goal of this study was to determine the prognostic value of a normal exercise thallium-201 (TI-201) scintigram by quantitative criteria in a consecutive series of 349 patients with chest pain. Follow- up was obtained in 345 patients (99%) from 8 to 45 months (mean 34 +/- 7). Of these, 60% were men, 26% had typical angina, 21% had chest pain during exercise testing, 29% were unable to achieve 85% or more of maximal predicted heart rate, and in 9% ischemic ST depression (1.0 mm or greater) developed during exercise. At the time of exercise testing, 45% of patients were taking nitrates and 38% were receiving a beta- blocking drug. During the follow-up period, there were 5 cardiac deaths (0.51%/year), of which 2 were sudden, 6 patients had a nonfatal myocardial infarction (MI) (0.61%/year). Two of the 5 patients who died and 1 who had MI had angiographically normal coronary arteries. The event rate was significantly higher (p less than 0.01) in patients referred for early catheterization (5 of 53; 9%) compared with the rate for those not undergoing early angiography (6 of 298; 2%). However, the event rate was similar in those who underwent catheterization with angiographically normal coronary arteries and in those who had significant coronary artery disease

  16. 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

    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

  17. Application of triple rule-out with 64-slice spiral CT in the diagnosis of acute chest pain

    International Nuclear Information System (INIS)

    Li Pengyu; Li Kuncheng; Du Xiangyin; Cao Lizhen; Liu Jiabin; Yang Yanhuui; Liang Zhigang; Zhu Xiaolian; Liu Jian

    2007-01-01

    Objective: To investigate the performance of triple rule-out with 64-slice spiral CT in the combined examination of pulmonary artery, thoracic aorta and coronary artery for patients with acute chest pain. Methods: Seventy patients who presented with acute chest pain were included in the study. All of the patients underwent retrospective ECG-gated 64-slice computed tomography triple rule-out examination to evaluate the pulmonary arteries, thoracic aorta and coronary arteries. Multi-planar reconstruction (MPR), maximum intensity projection (MIP), curved-planar reconstruction (CPR) and volume rendering (VR) were used to display pulmonary arteries, thoracic aorta and coronary arteries. We evaluated the image quality of coronary artery and the enhancement of the pulmonary artery and thoracic aorta to estimate if the examination can fulfill the clinical demand for the differential diagnosis of acute chest pain. Results: The mean scan time was (8.5±1.0) s, and the dose of contrast medium injected was 100 ml. There were 95.7% (67/70) of patients whose CT values detected in the pulmonary artery and thoracic aorta after enhancement Were ≥200 HU. The image quality of 85.8% (720/839) coronary segments was classified as excellent, 8.6% (72/839) as good, and 5.6% (47/839) as poor. There were 20 eases with coronary stenoses ≥50%, 2 cases with pulmonary embolism, and 2 cases with aortic dissection. Conclusion: The triple rule-out examination with 64-slice spiral CT could depict pulmonary artery, thoracic aorta, and coronary artery in 8 s with good image quality. It has great potential in the etiological diagnosis for the patients with acute chest pain. (authors)

  18. Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain

    Directory of Open Access Journals (Sweden)

    Jeremiah S. Hinson

    2017-02-01

    Full Text Available Introduction: Our goal was to reduce ordering of coagulation studies in the emergency department (ED that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR. Methods: We used a pre and post quasi-experimental study design to evaluate the impact of an EMRbased intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies. Coagulation order frequency was measured via detailed review of randomly sampled encounters during two-month periods before and after intervention. We classified existing orders as clinically indicated or non-value added. Order frequencies were calculated as percentages, and we assessed differences between groups by chi-square analysis. Results: Pre-intervention, 73.8% (76/103 of patients with chest pain had coagulation studies ordered, of which 67.1% (51/76 were non-value added. Post-intervention, 38.5% (40/104 of patients with chest pain had coagulation studies ordered, of which 60% (24/40 were non-value added. There was an absolute reduction of 35.3% (95% confidence interval [CI]: 22.7%, 48.0% in the total ordering of coagulation studies and 26.4% (95% CI: 13.8%, 39.0% in non-value added order placement. Conclusion: Simple EMR-based interactive prompts can serve as effective deterrents to indiscriminate ordering of diagnostic studies. [West J Emerg Med. 2017;18(2267-269.

  19. Prevalence and risk factors for low back pain among shopkeepers/salesman at model town link road, lahore, pakistan

    International Nuclear Information System (INIS)

    Hussain, T.; Taufiq, F.; Hassan, T.U.

    2017-01-01

    Objective: To find the prevalence and intensity of low back pain (LBP) among shopkeepers and their associated risk factors and to determine working postures and activities of shopkeepers which make them vulnerable to low back pain. Methodology: This cross sectional study was conducted at Model Town Link Road, Lahore, Pakistan for a period of five months. 96 shopkeepers were selected by non-probability convenience sampling. Prevalence was measured by modified Nordic questionnaire and intensity of pain by Visual Analog Scale. Results: Prevalence of LBP was 56.25%. Of these, 81(84.38%) were male and 15(15.63%) were female. LBP was most common in age group 18-24 years. 58.8% of them had difficulty at job due to LBP. More working hours and prolonged standing or sitting in poor postures were associated with LBP. Conclusion: About half of the shopkeepers (56.25%) suffered from LBP. Working hours and poor posture were risk factors. Therefore, ergonomic advice is needed to prevent from low back pain. (author)

  20. Rib fixation for severe chest deformity due to multiple rib fractures.

    Science.gov (United States)

    Igai, Hitoshi; Kamiyoshihara, Mitsuhiro; Nagashima, Toshiteru; Ohtaki, Yoichi

    2012-01-01

    The operative indications for rib fracture repair have been a matter of debate. However, several reports have suggested that flail chest, pain on respiration, and chest deformity/defect are potential conditions for rib fracture repair. We describe our experience of rib fixation in a patient with severe chest deformity due to multiple rib fractures. A 70-year-old woman was admitted with right-sided multiple rib fractures (2nd to 7th) and marked chest wall deformity without flailing caused by an automobile accident. Collapse of the chest wall was observed along the middle anterior axillary line. At 11 days after the injury, surgery was performed to repair the chest deformity, as it was considered to pose a risk of restrictive impairment of pulmonary function or chronic intercostal pain in the future. Operative findings revealed marked displacement of the superior 4 ribs, from the 2nd to the 5th, and collapse of the osseous chest wall towards the thoracic cavity. After exposure of the fracture regions, ribs fixations were performed using rib staplers. The total operation time was 90 minutes, and the collapsed portion of the chest wall along the middle anterior axillary line was reconstructed successfully.

  1. Validation of an accelerated high-sensitivity troponin T assay protocol in an Australian cohort with chest pain.

    Science.gov (United States)

    Parsonage, William A; Greenslade, Jaimi H; Hammett, Christopher J; Lamanna, Arvin; Tate, Jillian R; Ungerer, Jacobus P; Chu, Kevin; Than, Martin; Brown, Anthony F T; Cullen, Louise

    2014-02-17

    To validate an accelerated biomarker strategy using a high-sensitivity cardiac troponin T (hs-cTnT) assay for diagnosing acute myocardial infarction (AMI) in patients presenting to the emergency department with chest pain; and to validate this strategy in combination with the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand risk stratification model. Single-centre, prospective, observational cohort study of 764 adults presenting to a tertiary hospital with symptoms of possible acute coronary syndrome between November 2008 and February 2011. AMI or cardiac death within 24 hours of presentation (primary), and major adverse cardiac events within 30 days (secondary). An elevated hs-cTnT assay result above the 99th percentile at either the 0 h or 2 h time points had sensitivity of 96.4% (95% CI, 87.9%-99.0%), specificity of 82.6% (95% CI, 79.7%-85.2%), negative predictive value of 99.7% (95% CI, 98.8%-99.9%) and positive predictive value of 30.5% (95% CI, 24.2%-37.6%) for diagnosing AMI. Compared with a traditional 6 h cardiac troponin testing strategy, the accelerated strategy led to reclassification of risk in only two patients with adverse cardiac outcomes, with no net effect on appropriate management. In patients presenting with chest pain, an accelerated biomarker strategy using the hs-cTnT assay performed well in the initial diagnosis of AMI. The accelerated strategy was also effective when incorporated into a comprehensive strategy of risk stratification that included clinical and demographic factors. The time saved by this approach could have a major impact on health service delivery. Australian New Zealand Clinical Trials Registry ACTRN12610000053022.

  2. Low back pain among nurses in Slovenian hospitals: cross-sectional study.

    Science.gov (United States)

    Skela-Savič, B; Pesjak, K; Hvalič-Touzery, S

    2017-12-01

    The study investigated the prevalence and factors predicting low back pain among nurses in Slovenian hospitals. The risk factors for low back pain are physical and psychosocial. Implementation of interventions for reducing low back pain calls for management support, accessible equipment, education, knowledge and risk assessment. Low back pain prevalence and incidence among healthcare workers is very high compared to the general population and is a strong risk factor for long-term sickness absence. A cross-sectional study design was utilized. We used validated instruments: Nordic Musculoskeletal Disorder Questionnaire, Stanford Presenteeism Scale and Perceived Stress Scale. The sample included 1744 nursing employees from 16 Slovenian hospitals, ranging from practical nurses, registered nurses, nurses with a bachelor's degree and those with a master's degree. Results revealed a prevalence of low back pain among 85.9% of respondents. Relevant risk factors included female gender, age, length of employment, years in current position, shift work and the number of nurses per shift. In the regression model, factors predicting low back pain included presenteeism with a negative effect on work, presenteeism and maintaining work productivity, inability to control daily life, number of nurses per shift and respondents' age. Future activities should be oriented towards eliminating or reducing risks for low back pain incidents and towards different strategies, guidelines and actions which empower individuals and provide knowledge to manage and prevent low back pain. Slovenian healthcare system planning needs a national strategy to successfully promote LBP preventive and controlling strategies. Management can plan preventive and curative measures to reduce low back pain prevalence among nursing personnel. Management should also implement policies reflecting research findings. © 2017 International Council of Nurses.

  3. Effects of prehospital nitroglycerin on hemodynamics and chest pain intensity.

    Science.gov (United States)

    Engelberg, S; Singer, A J; Moldashel, J; Sciammarella, J; Thode, H C; Henry, M

    2000-01-01

    To assess the effects of prehospital nitroglycerin (NTG) on vital signs and chest pain intensity. A retrospective review of advanced life support (ALS) run sheets was performed in a suburban volunteer emergency medical services (EMS) system receiving 8,000 annual ALS calls. All consecutive patients who were administered NTG by EMS were included. Standardized forms were used to collect data on patient demographics, history, and physical exam. Patients assessed their chest pain (CP) before and after NTG on a verbal numeric scale of 0-10 from least to most severe. The presence of syncope, dysrhythmias, or profound hypotension [loss of peripheral pulses, a systolic blood pressure (SBP) of 100 mm Hg in BP] was noted. Results. One thousand six hundred sixty-two patients received NTG over 18 months, their mean age was 66 years, and 48% were female. Indications for NTG included CP (83%), dyspnea (45%), and congestive heart failure (20%). After NTG administration, the CP score decreased from 6.9 to 4.4 (mean difference = 2.6; 95% CI = 2.4 to 2.8). The CP completely resolved in 10% of the patients. Mean decreases in SBPs and diastolic BPs were 11.8 mm Hg (95% CI = 10.7 to 13.0) and 4.0 mm Hg (95% CI = 2.9 to 5.1). The mean pulse rate increased by 2.7 beats/min (95% CI = 0.6 to 4.9). There were 12 patients with adverse events [0.7% (95% CI = 0.4% to 1.3%)], including profound bradycardia and hypotension (1), transient drop in SBP of 100 mm Hg responding to fluids (6), post-NTG SBP <90 mm Hg (4), and syncope (1). There were no deaths in the prehospital setting. Use of prehospital NTG appears safe. While NTG reduces CP, most patients have residual pain.

  4. 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.

  5. National Institute for Health and Care Excellence updates the stable chest pain guideline with radical changes to the diagnostic paradigm.

    Science.gov (United States)

    Timmis, Adam; Roobottom, Carl A

    2017-07-01

    In the 2016 update of the stable chest pain guideline, the National Institute for Health and Care Excellence (NICE) has made radical changes to the diagnostic paradigm that it-like other international guidelines-had previously placed at the centre of its recommendations. No longer are quantitative assessments of the disease probability considered necessary to determine the need for diagnostic testing and the choice of test. Instead, the recommendation is for no diagnostic testing if chest pain is judged to be 'non-anginal' and CT coronary angiography (CTCA) in patients with 'typical' or 'atypical' chest pain with additional perfusion imaging only if there is uncertainty about the functional significance of coronary lesions. The new emphasis on anatomical-as opposed to functional-testing is driven in large part by cost-effectiveness analysis and despite inevitable resource implications NICE calculates that annual savings for the population of England will be significant. In making CTCA the default diagnostic testing strategy in its updated chest pain guideline, NICE has responded emphatically to calls from trialists for CTCA to have a greater role in the diagnostic pathway of patients with suspected angina. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. 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

    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...... underwent a stress test at the time of admittance. On the basis of a positive stress test, a prior myocardial infarction (MI), prior percutaneous coronary intervention (PCI) or coronary bypass surgery (CABG), 137 patients were categorized as having ischaemic heart disease (IHD). RESULTS: Patients with IHD...

  7. Exercise radionuclide ventriculographic responses in hypertensive patients with chest pain

    International Nuclear Information System (INIS)

    Wasserman, A.G.; Katz, R.J.; Varghese, P.J.; Leiboff, R.H.; Bren, G.G.; Schlesselman, S.; Varma, V.M.; Reba, R.C.; Ross, A.M.

    1984-01-01

    The effectiveness of exercise-treadmill testing in diagnosing coronary-artery disease in hypertensive patients is limited by a high rate of false positivity. Exercise radionuclide ventriculography, however, relies on different criteria (ejection fraction and wall motion), and we have evaluated this procedure in 37 hypertensive and 109 normotensive patients with chest pain, using coronary arteriography as an indicator of coronary disease. In the hypertensive cohort there was no difference in the ejection fraction at rest between the 17 patients with coronary disease and the 20 without it. Neither group had a significant mean (+/- S.E.M.) change in ejection fraction from rest to exercise (-1.9 +/- 2 and 1.4 +/- 1%, respectively). A wall-motion abnormality developed during exercise in 5 of the 17 hypertensive patients with coronary disease (29%) and in 4 of the 20 without it (20%) (P = not significant). In the normotensive cohort, however, the peak-exercise ejection fractions were significantly different. The 71 patients with coronary disease had a mean decrease of 3.6 +/- 1%, in contrast to the patients without coronary disease, who had an increase of +/- 1% (P < 0.001). An exercise-induced wall-motion abnormality was seen in 35 of the 71 patients with coronary disease (48%), as compared with 3 of the 38 without it (8%) (P < 0.001). We conclude that exercise radionuclide ventriculography is inadequate as a screening test for coronary atherosclerosis in hypertensive patients with chest pain. 28 references, 2 figures, 3 tables

  8. First Update of the Criteria for Certification of Chest Pain Units in Germany: Facelift or New Model?

    Science.gov (United States)

    Breuckmann, Frank; Rassaf, Tienush

    2016-03-01

    In an effort to provide a systematic and specific standard-of-care for patients with acute chest pain, the German Cardiac Society introduced criteria for certification of specialized chest pain units (CPUs) in 2008, which have been replaced by a recent update published in 2015. We reviewed the development of CPU establishment in Germany during the past 7 years and compared and commented the current update of the certification criteria. As of October 2015, 228 CPUs in Germany have been successfully certified by the German Cardiac Society; 300 CPUs are needed for full coverage closing gaps in rural regions. Current changes of the criteria mainly affect guideline-adherent adaptions of diagnostic work-ups, therapeutic strategies, risk stratification, in-hospital timing and education, and quality measures, whereas the overall structure remained unchanged. Benchmarking by participation within the German CPU registry is encouraged. Even though the history is short, the concept of certified CPUs in Germany is accepted and successful underlined by its recent implementation in national and international guidelines. First registry data demonstrated a high standard of quality-of-care. The current update provides rational adaptions to new guidelines and developments without raising the level for successful certifications. A periodic release of fast-track updates with shorter time frames and an increase of minimum requirements should be considered.

  9. 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.)

  10. 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

    suggested that chiropractic care was cost-effective with a probability of 97%, given a threshold value of €30 000 per QALY gained. In both groups, there was an increase in the health-related quality of life, and the mean increases were similar over the 12-month evaluation period. The mean differences......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......-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...

  11. 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.

  12. 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 ...

  13. The effects of topical heat therapy on chest pain in patients with acute coronary syndrome: a randomised double-blind placebo-controlled clinical trial.

    Science.gov (United States)

    Mohammadpour, Ali; Mohammadian, Batol; Basiri Moghadam, Mehdi; Nematollahi, Mahmoud Reza

    2014-12-01

    To investigate the effects of local heat therapy on chest pain in patients with acute coronary syndrome. Chest pain is a very common complaint in patients with acute coronary syndrome. It is managed both pharmacologically and nonpharmacologically. Pharmacological pain management is associated with different side effects. This was a randomised double-blind placebo-controlled clinical trial conducted in 2013. A convenience sample of 66 patients with acute coronary syndrome was selected from a coronary care unit of a local teaching hospital affiliated to Gonabad University of Medical Sciences, Gonabad, Iran. Patients were randomly assigned to either the experimental or the placebo group. Patients in the experimental and the placebo groups received local heat therapy using a hot pack warmed to 50 and 37 °C, respectively. We assessed chest pain intensity, duration and frequency as well as the need for opioid analgesic therapy both before and after the study. The study instrument consisted of a demographic questionnaire, the McGill Pain Questionnaire, and a data sheet for documenting pain frequency and duration as well as the need for analgesic therapy. The placebo heat therapy did not significantly decrease the intensity, the duration and the frequency of pain episodes. However, pain intensity, duration and frequency in the experimental group decreased significantly after the study. Moreover, the groups differed significantly in terms of the need for opioid analgesic therapy neither before nor after the intervention. Local heat therapy is an effective intervention for preventing and relieving chest pain in patients with acute coronary syndrome. Effective pain management using local heat therapy could help nurses play an important role in providing effective care to patients with acute coronary syndrome and in minimising adverse effects associated with pain medications. © 2014 John Wiley & Sons Ltd.

  14. The effect of chronic low back pain on tactile suppression during back movements.

    Science.gov (United States)

    Van Damme, Stefaan; Van Hulle, Lore; Danneels, Lieven; Spence, Charles; Crombez, Geert

    2014-10-01

    The aim of the present study was to examine whether tactile suppression, the phenomenon whereby tactile perception is suppressed during movement, would occur in the context of back movements. Of particular interest, it was investigated if tactile suppression in the back would be attenuated in those suffering from chronic low back pain. Individuals with chronic low back pain (N = 30) and a matched control group (N = 24) detected tactile stimuli on three possible locations (back, arm, chest) while performing a back or arm movement, or no movement. We hypothesized that the movements would induce tactile suppression, and that this effect would be largest for low-intense stimuli on the moving body part. We further hypothesized that, during back movements, tactile suppression on the back would be less pronounced in the chronic low back pain group than in the control group. The results showed the expected general tactile suppression effects. The hypothesis of back-specific attenuation of tactile suppression in the chronic low back pain group was not supported. However, back-specific tactile suppression in the chronic low back pain group was less pronounced in those who performed the back movements more slowly. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Elastofibroma dorsi: a forgotten cause of chest pain

    Directory of Open Access Journals (Sweden)

    Filipa Vieira

    2017-01-01

    Full Text Available Objectives: Elastofibroma dorsi is an uncommon benign tumor, typically located in the subscapularis region. Our goal is to describe the main features of elastofibroma dorsi to increase awareness of its existence and proper management. Material and Methods: We report a case of a 59-year-old woman with bilateral Elastofibroma dorsi and made a brief review of the epidemiological, clinical and radiodiagnostic features of this entity. Results: Imaging features can confidently diagnose this lesion, especially MRI, in addition to physical examination, with no need for biopsy. Conclusions: This entity should be part of the differential diagnosis in patients with chest pain in order to avoid unnecessary medical, radiological or surgical procedures and provide proper management of such lesions.

  16. A combination of troponin T and 12-lead electrocardiography: a valuable tool for early prediction of long-term mortality in patients with chest pain without ST-segment elevation.

    Science.gov (United States)

    Jernberg, Tomas; Lindahl, Bertil

    2002-11-01

    Electrocardiography (ECG) obtained on admission and a troponin T (tn-T) level measured early after admission are simple and accessible methods for predicting outcome in patients with suspected unstable angina or myocardial infarction without persistent ST-elevations. However, there are few studies about the combination of these 2 methods as a means of predicting long-term outcome. ECG was obtained on admission, and a tn-T level was analyzed on admission and after 6 hours in 710 consecutive patients admitted because of chest pain and no ST-elevations. Patients were observed for a median time of 40 months for death. ST-segment depressions > or =0.05 mV were present in 266 patients (37%). These patients had a 9.7-fold increased risk of death, compared with patients with normal ECG results. Isolated T-Wave inversions or pathological signs other than ST-T changes were present in 196 patients (28%), who had a 4.5-fold increased risk of death compared with patients who had normal ECG results. At 6 hours after admission, 169 patients (24%) had at least 1 sample of tn-T > or =0.10 microg/L, which resulted in an 3.7-fold increased risk of death. In a multivariate analysis, both ECG on admission and tn-T level came out as independent predictors of outcome. When these methods were combined, patients could be divided into low- (tn-T level or =0.10 microg/L or ST-segment depression), and high-risk groups (tn-T level > or =0.10 microg/L and ST-segment depression). ECG and tn-T level are valuable tools to quickly risk stratify patients with chest pain. The combination of these methods is superior to either one alone.

  17. Enterogastroesophageal reflux detected on 99m-technetium sestamibi cardiac imaging as a cause of chest pain

    International Nuclear Information System (INIS)

    Erdogan, Zeynep; Silov, Güler; Özdal, Aysegül; Turhal, Özgül

    2013-01-01

    Myocardial perfusion imaging (MPI) with technetium-99m sestamibi ( 99m Tc MIBI) is considered a diagnostic technique that is widely used for the investigation of suspected coronary artery disease. Incidental inspection of an extracardiac activity is indirect, but important marker, which can identify a potentially treatable non-coronary cause for chest pain that may mimic cardiac symptoms. Here, we present an illustrative case in which significant enterogastroesophageal reflux of 99m Tc MIBI occurred during the cardiac imaging following prompt hepatobiliary clearance. Because, there was normal myocardial perfusion on MPI, presence of gastroesophageal reflux (GER) on GER scintigraphy and detection of mild inflammation with pathologically confirmed hyperplastic polyp by endoscopy, in view of the above findings we concluded that the probable cause of chest pain was reflux. (author)

  18. FLAIL CHEST

    Directory of Open Access Journals (Sweden)

    Anton Crnjac

    2003-12-01

    Full Text Available Background. Major thoracic trauma is consistent with high mortality rate because of associated injuries of vital thoracic organs and dangerous complications. The flail chest occurs after disruption of the skeletal continuity of chest wall and demands because of its pathophysiological complexity rapid and accurate diagnosis and treatment.Conclusions. Basic pathophysiological mechanism of the flail chest is respiratory distress, which is provoked by pulmonary contusions and paradoxical chest wall motion. The treatment should be pointed to improvement and support of respiratory functions and include aggressive pain control, pulmonary physiotherapy and selective mechanical ventilation. Views about operative fixation of the flail chest are still controversial. Neither mortality rate neither long-term disability are improved after operative fixation.

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

    International Nuclear Information System (INIS)

    Lee, So Won; Shim, Sung Shine; Kim, Yoo Kyung; Ryu, Yon Ju

    2015-01-01

    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

  20. 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.

  1. Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis

    Science.gov (United States)

    2013-01-01

    Background Non-cardiovascular chest pain (NCCP) has a high healthcare cost, but insufficient guidelines exist for its diagnostic investigation. The objective of the present work was to identify important diagnostic indicators and their accuracy for specific and non-specific conditions underlying NCCP. Methods A systematic review and meta-analysis were performed. In May 2012, six databases were searched. Hand and bibliography searches were also conducted. Studies evaluating a diagnostic test against a reference test in patients with NCCP were included. Exclusion criteria were having diagnostic tests for acute cardiovascular disease. Diagnostic accuracy is given in likelihood ratios (LR): very good (LR+ >10, LR- diagnostic test sensitivity and specificity was performed by applying a hierarchical Bayesian model. Results Out of 6,316 records, 260 were reviewed in full text, and 28 were included: 20 investigating gastroesophageal reflux disorders (GERD), 3 musculoskeletal chest pain, and 5 psychiatric conditions. Study quality was good in 15 studies and moderate in 13. GERD diagnosis was more likely with typical GERD symptoms (LR + 2.70 and 2.75, LR- 0.42 and 0.78) than atypical GERD symptoms (LR + 0.49, LR- 2.71). GERD was also more likely with a positive response to a proton pump inhibitor (PPI) test (LR + 5.48, 7.13, and 8.56; LR- 0.24, 0.25, and 0.28); the posterior mean sensitivity and specificity of six studies were 0.89 (95% credible interval, 0.28 to 1) and 0.88 (95% credible interval, 0.26 to 1), respectively. Panic and anxiety screening scores can identify individuals requiring further testing for anxiety or panic disorders. Clinical findings in musculoskeletal pain either had a fair to moderate LR + and a poor LR- or vice versa. Conclusions In patients with NCCP, thorough clinical evaluation of the patient’s history, symptoms, and clinical findings can indicate the most appropriate diagnostic tests. Treatment response to high-dose PPI

  2. Total sitting time, leisure time physical activity and risk of hospitalization due to low back pain: The Danish Health Examination Survey cohort 2007-2008.

    Science.gov (United States)

    Balling, Mie; Holmberg, Teresa; Petersen, Christina B; Aadahl, Mette; Meyrowitsch, Dan W; Tolstrup, Janne S

    2018-02-01

    This study aimed to test the hypotheses that a high total sitting time and vigorous physical activity in leisure time increase the risk of low back pain and herniated lumbar disc disease. A total of 76,438 adults answered questions regarding their total sitting time and physical activity during leisure time in the Danish Health Examination Survey 2007-2008. Information on low back pain diagnoses up to 10 September 2015 was obtained from The National Patient Register. The mean follow-up time was 7.4 years. Data were analysed using Cox regression analysis with adjustment for potential confounders. Multiple imputations were performed for missing values. During the follow-up period, 1796 individuals were diagnosed with low back pain, of whom 479 were diagnosed with herniated lumbar disc disease. Total sitting time was not associated with low back pain or herniated lumbar disc disease. However, moderate or vigorous physical activity, as compared to light physical activity, was associated with increased risk of low back pain (HR = 1.16, 95% CI: 1.03-1.30 and HR = 1.45, 95% CI: 1.15-1.83). Moderate, but not vigorous physical activity was associated with increased risk of herniated lumbar disc disease. The results suggest that total sitting time is not associated with low back pain, but moderate and vigorous physical activity is associated with increased risk of low back pain compared with light physical activity.

  3. High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study.

    Science.gov (United States)

    Hoogendoorn, W E; Bongers, P M; de Vet, H C W; Ariëns, G A M; van Mechelen, W; Bouter, L M

    2002-05-01

    To determine whether physical and psychosocial load at work influence sickness absence due to low back pain. The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for musculoskeletal disorders. Workers from 21 companies located throughout The Netherlands participated in the part of this study on sickness absence due to low back pain. The study population consisted of 732 workers with no sickness absences of 3 days or longer due to low back pain in the 3 months before the baseline survey and complete data on the reasons for absences during the follow up period. The mean (range) period of follow up in this group was 37 (7-44) months. Physical load at work was assessed by analyses of video recordings. Baseline information on psychosocial work characteristics was obtained by a questionnaire. Data on sickness absence were collected from company records. The main outcome measure was the rate of sickness absences of 3 days or longer due to low back pain during the follow up period. After adjustment of the work related physical and psychosocial factors for each other and for other potential determinants, significant rate ratios ranging from 2.0 to 3.2 were found for trunk flexion, trunk rotation, lifting, and low job satisfaction. A dose-response relation was found for trunk flexion, but not for trunk rotation or lifting. Non-significant rate ratios of about 1.4 were found for low supervisor support and low coworker support. Quantitative job demands, conflicting demands, decision authority, and skill discretion showed no relation with sickness absence due to low back pain. Flexion and rotation of the trunk, lifting, and low job satisfaction are risk factors for sickness absence due to low back pain. Some indications of a relation between low social support, either from supervisors or coworkers, and sickness absence due to low back pain are also present.

  4. Chest X ray examination of workers exposed to pneumoconiosis risk

    International Nuclear Information System (INIS)

    Indovina, P.L.; Reggiani, A.; Calicchia, A.; Nicolosi, A.

    1986-01-01

    Chest X-ray examination of workers exposed to pneumoconiosis risk: critical analysis of legal and radiation protection aspects. Chest X-ray examination is one of the most common radiological examinations practised in Italy. According to Presidential Decree 1124/65, workers exposed to risk of asbestosis and silicosis must undergo a chest radiography once a year, on occasion of the periodic medical examination. Basic requirements aimed at the radiation protection of the patient must therefore be complied with, and optimization of the chest radiography execution procedures is required. This paper illustrates the results obtained with the implementation of the NEXT programme in Italy for this kind of X-ray examination. The main objective of the NEXT programme is the optimization of radiological techniques. On the basis of the most recent publications in the field of radiation protection, a critical analysis is made of the laws in force in Italy

  5. 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

  6. Prevalence and risk factors of chronic post-thoracotomy pain in Chinese patients from Peking Union Medical College Hospital.

    Science.gov (United States)

    Wang, Hai-Tang; Liu, Wei; Luo, Ai-Lun; Ma, Chao; Huang, Yu-Guang

    2012-09-01

    In clinical practice, the mechanisms underlying chronic post-surgical pain (CPSP) remain insufficiently understood. The primary goals of this study were to determine the incidence of chronic pain after thoracic surgery and to identify possible risk factors associated with the development of chronic post-thoracotomy pain in Chinese patients. The secondary goal was to determine whether the difference between pre- and post-operative white blood cell (WBC) counts could predict the prevalence of CPSP after thoracotomy. The impact of chronic pain on daily life was also investigated. We contacted by phone 607 patients who had undergone thoracotomy at our hospital during the period February 2009 to May 2010. Statistical comparisons were made between patients with or without CPSP. were ultimately analyzed from 466 qualified patients. The overall incidence of CPSP was 64.5%. Difference between pre- and post-operative WBC counts differed significantly between patients with or without CPSP (P factor for the development of CPSP following thoracotomy (P factors for chronic pain included younger age (operative pain (P = 0.005) and the duration of chest tube drainage (P factoring surgical patients during peri-operative period. Besides, age, diabetes mellitus, acute post-operative pain, and duration of chest tube drainage may also play a role in chronic post-surgical pain occurrence.

  7. [LOW BACK PAIN AT NEW WORKING AMBIENT IN ERA OF NEW ECONOMY: A SYSTEMATIC REVIEW ABOUT OCCUPATIONAL RISK FACTORS].

    Science.gov (United States)

    Pranjić, Nurka; Maleš-Bilić, Ljiljana

    2015-03-01

    Low back pain is the second most common symptom-related reason for physician visits and the first reason of working disability. Low back pain is a ubiquitous complaint, with particularly high prevalence among people in their working years (67%). For many individuals, episodes of back pain are self-limited and resolve without specific therapy. For others, however, back pain is recurrent or chronic, causing significant pain that interferes with employment and quality of life. Many occupations have been anecdotally linked to certain low back pain syndrome. However, the relationship between the work environment and the patient's symptoms, though clearly perceived by the patient to be causative, may be less certain. The injury model of an occupational disorder proposes that specific work activities are the cause of the patient's pain. The injury model for low back pain; implicating a causal connection with specific work activities, is complex and controversial. Determining whether a patient's low back pain is a consequence of his or her occupational activity, and how best to treat symptoms to maximize functionality and potential for a return to full employment capacity, can be challenging. In this systematic review which included patients/employees with low back pain, the following databases were searched: Pub Med, Embase, Medline and Web of science. The role of occupational mechanical exposure e.g. lifting as a risk factors for low back surgery has been debated for several decades. Diagnostic uncertainty exists even for those with back symptoms and well-described findings on scan, as these findings are common even in subjects without back pain, and may be unrelated to the symptoms. As an example, herniated disks can be identified in significant numbers of CT or MRI low back studies in subjects with no back pain. In further analysis, lifestyle factors and occupational psychosocial exposures will be addressed. Many physicians, including those practicing in primary care

  8. Is lumbar lordosis related to low back pain development during prolonged standing?

    Science.gov (United States)

    Sorensen, Christopher J; Norton, Barbara J; Callaghan, Jack P; Hwang, Ching-Ting; Van Dillen, Linda R

    2015-08-01

    An induced-pain paradigm has been used in back-healthy people to understand risk factors for developing low back pain during prolonged standing. The purposes of this study were to (1) compare baseline lumbar lordosis in back-healthy participants who do (Pain Developers) and do not (Non-Pain Developers) develop low back pain during 2 h of standing, and (2) examine the relationship between lumbar lordosis and low back pain intensity. Cross-sectional. First, participants stood while positions of markers placed superficial to the lumbar vertebrae were recorded using a motion capture system. Following collection of marker positions, participants stood for 2 h while performing light work tasks. At baseline and every 15 min during standing, participants rated their low back pain intensity on a visual analog scale. Lumbar lordosis was calculated using marker positions collected prior to the 2 h standing period. Lumbar lordosis was compared between pain developers and non-pain developers. In pain developers, the relationship between lumbar lordosis and maximum pain was examined. There were 24 (42%) pain developers and 33 (58%) non-pain developers. Lumbar lordosis was significantly larger in pain developers compared to non-pain developers (Mean difference = 4.4°; 95% Confidence Interval = 0.9° to 7.8°, Cohen's d = 0.7). The correlation coefficient between lumbar lordosis and maximum pain was 0.46 (P = 0.02). The results suggest that standing in more lumbar lordosis may be a risk factor for low back pain development during prolonged periods of standing. Identifying risk factors for low back pain development can inform preventative and early intervention strategies. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Chronic low back pain and the risk of depression or anxiety symptoms

    DEFF Research Database (Denmark)

    Fernandez, Matt; Colodro-Conde, Lucia; Hartvigsen, Jan

    2017-01-01

    .63-5.51). CONCLUSIONS: The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses.......BACKGROUND CONTEXT: Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bidirectional. There is limited knowledge regarding causal relationships. PURPOSE: This study aims to investigate whether chronic low back pain (LBP) increases the risk...... of depression or anxiety symptoms, after adjusting for shared familial factors. STUDY DESIGN: This is a longitudinal, genetically informative study design from the Murcia Twin Registry in Spain. PATIENT SAMPLE: The patient sample included 1,269 adult twins with a mean age of 53 years. OUTCOME MEASURES...

  10. Prognostic value of CT-derived left atrial and left ventricular measures in patients with acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Takx, Richard A.P. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, University Medical Center Utrecht (Netherlands); Vliegenthart, Rozemarijn [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); University of Groningen/University Medical Center Groningen, Center for Medical Imaging − North East Netherlands, Department of Radiology, Groningen (Netherlands); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Nance, John W. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Bamberg, Fabian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tuebingen, Tuebingen (Germany); Abro, Joseph A. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Carr, Christine M. [Division of Emergency Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Litwin, Sheldon E. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); and others

    2017-01-15

    Highlights: • LV mass and LA diameter are independent prognostic factor for composite MACE. • LV mass and LA diameter were not significant prognostic factors for MACE in African Americans. • Assessment of LV mass by CT may have a role in the management of patients. - Abstract: Purpose: To determine which left atrial (LA) and left ventricular (LV) parameters are associated with future major adverse cardiac event (MACE) and whether these measurements have independent prognostic value beyond risk factors and computed tomography (CT)-derived coronary artery disease measures. Materials and methods: This retrospective analysis was performed under an IRB waiver and in HIPAA compliance. Subjects underwent coronary CT angiography (CCTA) using a dual-source CT system for acute chest pain evaluation. LV mass, LV ejection fraction (EF), LV end-systolic volume (ESV) and LV end-diastolic volume (EDV), LA ESV and LA diameter, septal wall thickness and cardiac chamber diameters were measured. MACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, or late revascularization. The association between cardiac CT measures and the occurrence of MACE was quantified using Cox proportional hazard analysis. Results: 225 subjects (age, 56.2 ± 11.2; 140 males) were analyzed, of whom 42 (18.7%) experienced a MACE during a median follow-up of 13 months. LA diameter (HR:1.07, 95%CI:1.01–1.13 per mm) and LV mass (HR:1.05, 95%CI:1.00–1.10 per g) remained significant prognostic factor of MACE after controlling for Framingham risk score. LA diameter and LV mass were also found to have prognostic value independent of each other. The other morphologic and functional cardiac measures were no significant prognostic factors for MACE. Conclusion: CT-derived LA diameter and LV mass are associated with future MACE in patients undergoing evaluation for chest pain, and portend independent prognostic value beyond traditional risk factors, coronary calcium score, and

  11. Functional Movement Screen: Pain versus composite score and injury risk.

    Science.gov (United States)

    Alemany, Joseph A; Bushman, Timothy T; Grier, Tyson; Anderson, Morgan K; Canham-Chervak, Michelle; North, William J; Jones, Bruce H

    2017-11-01

    The Functional Movement Screen (FMS™) has been used as a screening tool to determine musculoskeletal injury risk using composite scores based on movement quality and/or pain. However, no direct comparisons between movement quality and pain have been quantified. Retrospective injury data analysis. Male Soldiers (n=2154, 25.0±1.3years; 26.2±.7kg/m 2 ) completed the FMS (scored from 0 points (pain) to 3 points (no pain and perfect movement quality)) with injury data over the following six months. The FMS is seven movements. Injury data were collected six months after FMS completion. Sensitivity, specificity, receiver operator characteristics and positive and negative predictive values were calculated for pain occurrence and low (≤14 points) composite score. Risk, risk ratios (RR) and 95% confidence intervals were calculated for injury risk. Pain was associated with slightly higher injury risk (RR=1.62) than a composite score of ≤14 points (RR=1.58). When comparing injury risk between those who scored a 1, 2 or 3 on each individual movement, no differences were found (except deep squat). However, Soldiers who experienced pain on any movement had a greater injury risk than those who scored 3 points for that movement (pmovements in which pain occurrence increased, so did injury risk (p<0.01). Pain occurrence may be a stronger indicator of injury risk than a low composite score and provides a simpler method of evaluating injury risk compared to the full FMS. Published by Elsevier Ltd.

  12. Acute ECG changes and chest pain induced by neck motion in patients with cervical hernia--a case report.

    Science.gov (United States)

    Güler, N; Bilge, M; Eryonucu, B; Cirak, B

    2000-10-01

    We report two cases of acute cervical angina and ECG changes induced by anteflexion of the head. Cervical angina is defined as chest pain that resembles true cardiac angina but originates from cervical discopathy with nerve root compression. In these patients, Prinzmetal's angina, valvular heart disease, congenital heart disease, left ventricular aneurysm, and cardiomyopathy were excluded. After all, the patient's chest pain was reproduced by anteflexion of head, at this time, their ECGs showed nonspecific ST-T changes in the inferior and anterior leads different from the basal ECG. ECG changes returned to normal when the patient's neck moved to the neutral position. To our knowledge, these are the first cases of cervical angina associated with acute ECG changes by neck motion.

  13. 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 strain - new ... lower back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

  14. Are low back pain and low physical capacity risk indicators for dropout among recently qualified eldercare workers?

    DEFF Research Database (Denmark)

    Faber, Anne; Giver, Hanne; Strøyer, Jesper

    2010-01-01

    BACKGROUND: A high job turnover and dropout among eldercare workers has led to a significant shortage of qualified manpower in the Danish eldercare sector. OBJECTIVES: The predictive effect of some non-work-related causes for leaving the eldercare sector 2 years after qualification, physical...... either in the eldercare sector, in other health- and welfare sectors, in all other sectors, under education, or outside labour market, 2 years after qualification. RESULTS: Disability due to and duration of low back pain were significant predictors for dropout from the eldercare sector 2 years after...... qualification. Low physical capacity was not. Data on duration of low back pain suggest a trend towards a dose-response relationship: The longer the duration of low back pain, the higher odds for dropout. CONCLUSIONS: Low back pain and disability due to low back pain during the last year of education were...

  15. How Effective Is the Use of Metaphor Therapy on Reducing Psychological Symptoms and Pain Discomfort in Patients with Non-Cardiac Chest Pain: A Randomized, Controlled Trial

    Directory of Open Access Journals (Sweden)

    Mostafa Bahremand

    2016-06-01

    Full Text Available Introduction: Psychological symptoms of non-cardiac chest pain (NCCP including perceptual, emotional, and behavioral problems can effect patient perception of chest pain. This study was conducted to determine the effect of metaphor therapy on mitigating depression, anxiety, stress, and pain discomfort in patients with NCCP. Materials and Methods: This randomized, controlled, trial was conducted on 28 participants, who had visited the emergency department of Kermanshah Imam Ali Heart Hospital because of experiencing NCCP during the June to September 2014. The patients were randomly assigned to metaphor therapy and control groups (n=14 for each group during a four-week period. Our data collection questionnaires included Pain Discomfort Scale (PDS and Depression, Anxiety and Stress Scale (DASS. Chi-square and MANCOVA tests were run, using SPSS version 20. Results: Twenty patients (71.4% completed the trial period until the final assessment. Our findings showed that metaphor therapy couldn’t lower depression, anxiety, stress, and pain discomfort; In fact, there was not a significant difference between the metaphor therapy and control groups regarding the aforementioned variables (P>0.05. Conclusions: Although the study results did not support the effectiveness of metaphor therapy for NCCP, further studies on the potential role of metaphor therapy in attenuating NCCP symptoms seem to be necessary.

  16. Participatory ergonomics to reduce exposure to psychosocial and physical risk factors for low back pain and neck pain: results of a cluster randomised controlled trial.

    Science.gov (United States)

    Driessen, Maurice T; Proper, Karin I; Anema, Johannes R; Knol, Dirk L; Bongers, Paulien M; van der Beek, Allard J

    2011-09-01

    This study investigated the effectiveness of the Stay@Work participatory ergonomics programme to reduce workers' exposure to psychosocial and physical risk factors. 37 departments (n=3047 workers) from four Dutch companies participated in this cluster randomised controlled trial; 19 (n=1472 workers) were randomised to an intervention group (participatory ergonomics) and 18 (n=1575 workers) to a control group (no participatory ergonomics). During a 6 h meeting guided by an ergonomist, working groups devised ergonomic measures to reduce psychosocial and physical workload and implemented them within 3months in their departments. Data on psychosocial and physical risk factors for low back pain and neck pain were collected at baseline and after 6 months. Psychosocial risk factors were measured using the Job Content Questionnaire and physical risk factors using the Dutch Musculoskeletal Questionnaire. Intervention effects were studied using multilevel analysis. Intervention group workers significantly increased on decision latitude (0.29 points; 95% CI 0.07 to 0.52) and decision authority (0.16 points; 95% CI 0.04 to 0.28) compared to control workers. However, exposure to awkward trunk working postures significantly increased in the intervention group (OR 1.86; 95% CI 1.15 to 3.01) compared to the control group. No significant differences between the intervention and control group were found for the remaining risk factors. After 6months, loss to follow-up was 35% in the intervention group and 29% in the control group. Participatory ergonomics was not effective in reducing exposure to psychosocial and physical risk factors for low back pain and neck pain among a large group of workers. ISRCTN27472278.

  17. Epidemiology of low back pain.

    Science.gov (United States)

    Skovron, M L

    1992-10-01

    At present, although there have been many epidemiological studies of risk factors for low back pain, there are few risk factors established in prospective studies; and our understanding of them remains relatively crude. Individuals in jobs requiring manual materials handling, particularly repeated heavy lifting and lifting while twisting, are at increased risk of back pain leading to work absence. In addition, exposure to whole-body vibration and job requirements for static postures are associated with back pain. Individual trunk strength has not been consistently demonstrated as associated with back pain; although there is some suggestion that when work requirements for heavy lifting exceed individual capacities, back pain is more likely to occur. The pattern of peak age at onset in the 20's is consistent with back pain development early in working life. Among other individual characteristics, only cigarette smoking has consistently been associated with back pain; and the biological mechanism for this finding is not understood. Evidence with respect to spinal flexibility, aerobic capacity, educational attainment and other variables is suggestive but not consistent. There is some evidence that the individual's relation to work, expressed as job satisfaction or supervisor rating, is also related to work absence due to back pain. While it is possible to describe, however crudely, the characteristics placing people at risk for back pain leading to work absence and/or medical attention, the problem of predicting chronicity and thus identifying patients for more intensive clinical intervention remains unresolved. At this time, only age of the patient and certain clinical features of the back pain such as the presence of sciatic symptoms, duration of the current episode, and history of prior episodes are consistently demonstrated predictors. In chronic patients, there is suggestive evidence that spinal flexibility, trunk strength, and certain psychological

  18. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation.

    Science.gov (United States)

    Jernberg, Tomas; Stridsberg, Mats; Venge, Per; Lindahl, Bertil

    2002-08-07

    The study evaluated the prognostic value of single measurement of N-terminal pro brain natriuretic peptide (NT-proBNP) obtained on admission in patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation. Patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation constitute a large and heterogeneous population. Early risk stratification has been based on clinical background factors, electrocardiography (ECG) and biochemical markers of myocardial damage. The neurohormonal activation has, so far, received less attention. The NT-proBNP was analyzed on admission in 755 patients admitted because of chest pain and no ST-segment elevation. Patients were followed concerning death for 40 months (median). The median NT-proBNP level was 400 (111 to 1646) ng/l. Compared to the lowest quartile, patients in the second, third and fourth quartiles had a relative risk of subsequent death of 4.2 (1.6 to 11.1), 10.7 (4.2 to 26.8) and 26.6 (10.8 to 65.5), respectively. When NT-proBNP was added to a Cox regression model including clinical background factors, ECG and troponin T, the NT-proBNP levels were independently associated with prognosis. A single measurement of NT-proBNP on admission will substantially improve the early risk stratification of patients with symptoms suggestive of an acute coronary syndrome and no ST-segment elevation. A combination of clinical background factors, ECG, troponin T and NT-proBNP obtained on admission will provide a highly discerning tool for risk stratification and further clinical decisions.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-05-15

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

  20. New low back pain in nurses: work activities, work stress and sedentary lifestyle.

    Science.gov (United States)

    Yip, Vera Yin Bing

    2004-05-01

    Low back pain is common among nurses. Previous studies have shown that the risk of low back pain increases rapidly with greater amounts of physical work and psychological stress, but is inversely related to leisure activities. However, these previous studies were predominantly retrospective in design and not many took account of three factors simultaneously. This 12-month prospective study examined the relationships between work activities, work stress, sedentary lifestyle and new low back pain. A total of 144 nurses from six Hong Kong district hospitals completed a face-to-face baseline interview, which was followed-up by a telephone interview. The main study measures were demographic characteristics, work activities, work stress, physical leisure activities and the nature of new low back pain during the 12-month follow-up period. Level of work stress, quality of relationships at work, level of enjoyment experienced at work, and work satisfaction were self-reported. Fifty-six (38.9%) nurses reported experiencing new low back pain. Sedentary leisure time activity was not associated with new low back pain. Being comparatively new on a ward (adjusted relative risk 2.90), working in bending postures (adjusted relative risk 2.76) and poor work relationships with colleagues (adjusted relative risk 2.52) were independent predictors of new low back pain. The findings of this study suggest that low back pain is a common problem in the population of nurses in Hong Kong. Being comparatively new on a ward, bending frequently during work and having poor work relationships with colleagues are independent predictors of new low back pain. Training for high-risk work activities and ergonomic assessment of awkward work postures are essential. Moreover, relaxation and team-building workshops for nurses, especially those who are less experienced in the type of work on their current ward, are recommended.

  1. Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain.

    Science.gov (United States)

    Rawshani, Nina; Rawshani, Araz; Gelang, Carita; Herlitz, Johan; Bång, Angela; Andersson, Jan-Otto; Gellerstedt, Martin

    2017-12-01

    In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality). The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n=13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG. In the overall cohort, 21% (n=2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n=1159) did not undergo a pre-hospital ECG while 32% (n=1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; pECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Diagnosis of Coronary Artery Disease in Patients with Chest Pain by Means of Magnetocardiography

    International Nuclear Information System (INIS)

    Kwon, H.; Kim, K.; Kim, J. M.; Lee, Y. H.; Kim, T. E.; Lim, H. K.; Park, Y. K.; Ko, Y. G.; Chung, N.

    2006-01-01

    Magnetocardiography(MCG) has been proposed as a novel and non-invasive diagnostic tool for the detection of cardiac electrical abnormality associated with myocardial ischemia. In our previous study, we have proposed a new classification method of MCG parameters, based on the different populations of the parameters between coronary artery disease(CAD) patients, symptomatic patients and healthy volunteers. We used four parameters, representing the directional changes of the electrical activity in the period of an R-ST-T interval. In patients with chest pain and without ST-segment elevation, who were selected consecutively from all patients admitted to the hospital in 2004, the patients with CAD could be classified with a higher sensitivity than conventional methods, showing that the proposed method can be useful for the diagnosis of CAD with MCG. In this study, we examined the validity of the algorithm with the prior probability distribution in diagnosis of new patients admitted to the hospital in 2005. In the results, presence of CAD could be found with sensitivity and specificity of 81.3% and 71.4%, respectively, in patients with chest pain and non-diagnostic ECG findings

  3. 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.

  4. 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 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.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.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.Trial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU.Controlled-Trials.com ISRCTN21615909.

  5. What low back pain is and why we need to pay attention.

    Science.gov (United States)

    Hartvigsen, Jan; Hancock, Mark J; Kongsted, Alice; Louw, Quinette; Ferreira, Manuela L; Genevay, Stéphane; Hoy, Damian; Karppinen, Jaro; Pransky, Glenn; Sieper, Joachim; Smeets, Rob J; Underwood, Martin

    2018-03-20

    Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public

  6. Prognostic psychosocial factors for disabling low back pain in Japanese hospital workers.

    Science.gov (United States)

    Yoshimoto, Takahiko; Oka, Hiroyuki; Katsuhira, Junji; Fujii, Tomoko; Masuda, Katsuhiko; Tanaka, Sakae; Matsudaira, Ko

    2017-01-01

    Although the occupational health field has identified psychosocial factors as risk factors for low back pain that causes disability, the association between disabling low back pain and psychosocial factors has not been examined adequately in Japanese hospital workers. Therefore, this study examined the association between low back pain, which interfered with work, and psychosocial factors in Japanese hospital workers. This cross-sectional study was conducted at a hospital in Japan. In total, 280 hospital workers were recruited from various occupational settings. Of these, 203 completed a self-administered questionnaire that included items concerning individual characteristics, severity of low back pain, fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), somatic symptoms (Somatic Symptom Scale-8), psychological distress (K6), workaholism, and work-related psychosocial factors (response rate: 72.5%). Logistic regression was used to explore risk factors associated with disabling low back pain. Of the 203 participants who completed questionnaires, 36 (17.7%) reported low back pain that interfered with their work. Multivariate analyses with individual factors and occupations adjusted for showed statistically significant associations between disabling low back pain and fear-avoidance beliefs (adjusted odds ratio [OR]: 2.619, 95% confidence interval [CI]: 1.003-6.538], somatic symptoms (OR: 4.034, 95% CI: 1.819-9.337), and interpersonal stress at work (OR: 2.619, 95% CI: 1.067-6.224). Psychosocial factors, such as fear-avoidance beliefs, somatic symptoms, and interpersonal relationships at work, were important risk factors in low back pain that interfered with work in Japanese hospital workers. With respect to occupational health, consideration of psychosocial factors is required to reduce disability related to low back pain.

  7. Toxicity risk of non-target organs at risk receiving low-dose radiation: case report

    International Nuclear Information System (INIS)

    Shueng, Pei-Wei; Lin, Shih-Chiang; Chang, Hou-Tai; Chong, Ngot-Swan; Chen, Yu-Jen; Wang, Li-Ying; Hsieh, Yen-Ping; Hsieh, Chen-Hsi

    2009-01-01

    The spine is the most common site for bone metastases. Radiation therapy is a common treatment for palliation of pain and for prevention or treatment of spinal cord compression. Helical tomotherapy (HT), a new image-guided intensity modulated radiotherapy (IMRT), delivers highly conformal dose distributions and provides an impressive ability to spare adjacent organs at risk, thus increasing the local control of spinal column metastases and decreasing the potential risk of critical organs under treatment. However, there are a lot of non-target organs at risk (OARs) occupied by low dose with underestimate in this modern rotational IMRT treatment. Herein, we report a case of a pathologic compression fracture of the T9 vertebra in a 55-year-old patient with cholangiocarcinoma. The patient underwent HT at a dose of 30 Gy/10 fractions delivered to T8-T10 for symptom relief. Two weeks after the radiotherapy had been completed, the first course of chemotherapy comprising gemcitabine, fluorouracil, and leucovorin was administered. After two weeks of chemotherapy, however, the patient developed progressive dyspnea. A computed tomography scan of the chest revealed an interstitial pattern with traction bronchiectasis, diffuse ground-glass opacities, and cystic change with fibrosis. Acute radiation pneumonitis was diagnosed. Oncologists should be alert to the potential risk of radiation toxicities caused by low dose off-targets and abscopal effects even with highly conformal radiotherapy

  8. Ethnic variations in chest pain and angina in men and women: Scottish Ethnicity and Health Linkage Study of 4.65 million people.

    Science.gov (United States)

    Bhopal, Raj S; Bansal, Narinder; Fischbacher, Colin; Brown, Helen; Capewell, Simon

    2012-12-01

    European research on ethnic variations in cardiovascular disease has mostly examined mortality endpoints using country of birth as a proxy for ethnicity. We report on chest pain and angina by ethnic group. Retrospective cohort linking the Census 2001 for Scotland (providing 14 ethnic group categories) and hospital discharge/community and hospital deaths data. Directly age-standardized rates and rate ratios were calculated. Risk ratios were adjusted for age and then highest educational qualification of the individual using Poisson regression. Ratios were multiplied by 100 and 95% confidence intervals (CI) were calculated. The reference was the White Scottish population (100). In the results below, the 95% CI excludes 100. There was raised chest pain mortality/hospital discharge risk in Indian men (rate ratio 141.2), Other South Asian women (rate ratio 140.9), and Pakistanis (rate ratio 216.2 in men, 243.0 in women). Rate ratios were lowest in other White British (rate ratio 76.1 in men, 73.7 in women) and Chinese (rate ratio 67.6 in men, 76.7 in women). Adjustment for age and education attenuated, but did not abolish, differences in other White British (risk ratio from 73.5 to 83.5) and Pakistani (risk ratio from 209.0 to 198.2) male populations and increased them in most others, e.g. other South Asian men (from risk ratio of 128.9 to 140.1). Pakistani populations had the highest risk of angina (rate ratio 189.3 in men, 159.7 in women). Other White British (rate ratio 81.4 for men, 78.0 for women), Other White (rate ratio 89.6 men, 85.2 women), and Chinese (rate ratio 60.5 men, 67.4 women) had the lowest risk. Adjustment for education did not greatly alter these patterns. There were important ethnic variations. The results call for replication elsewhere in Europe and targeted prevention programmes and vigilant diagnosis and management by clinicians.

  9. Influence of timing of chest tube removal on early outcome of patients underwent lung resection

    Directory of Open Access Journals (Sweden)

    Ahmed Labib Dokhan

    2016-05-01

    Conclusion: Early removal of chest tube may have beneficial effect on control of post-thoracotomy pain, improvement of pulmonary functions and decreasing the risk of complications after lung resection.

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

    Directory of Open Access Journals (Sweden)

    Luis Cláudio Lemos Correia

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

  11. Incremental value of clinical assessment, supine exercise electrocardiography, and biplane exercise radionuclide ventriculography in the prediction of coronary artery disease in men with chest pain

    International Nuclear Information System (INIS)

    Currie, P.J.; Kelly, M.J.; Harper, R.W.; Federman, J.; Kalff, V.; Anderson, S.T.; Pitt, A.

    1983-01-01

    The incremental value of clinical assessment, exercise electrocardiography (ECG) and biplane radionuclide ventriculography (RVG) in the prediction of coronary artery disease (CAD) was assessed in 105 men without myocardial infarction who were undergoing coronary angiography for investigation of chest pain. Independent clinical assessment of chest pain was made prospectively by 2 physicians. Graded supine bicycle exercise testing was symptom-limited. Right anterior oblique ECG-gated first-pass RVG and left anterior oblique ECG-gated equilibrium RVG were performed at rest and exercise. Regional wall motion abnormalities were defined by agreement of 2 of 3 blinded observers. A combined strongly positive exercise ECG response was defined as greater than or equal to 2 mm ST depression or 1.0 to 1.9 mm ST depression with exercise-induced chest pain. A multivariate logistic regression model for the preexercise prediction of CAD was derived from the clinical data and selected 2 variables: chest pain class and cholesterol level. A second model assessed the incremental value of the exercise test in prediction of CAD and found 2 exercise variables that improved prediction: RVG wall motion abnormalities, and a combined strongly positive ECG response. Applying the derived predictive models, 37 of the 58 patients (64%) with preexercise probabilities of 10 to 90% crossed either below the 10% probability threshold or above the 90% threshold and 28 (48%) also moved across the 5 and 95% thresholds. Supine exercise testing with ECG and biplane RVG together, but neither test alone, effectively adds to clinical prediction of CAD. It is most useful in men with atypical chest pain and when the ECG and RVG results are concordant

  12. Case report: patient with Weil’s disease, chest pain, hepatitis b, hepatorenal syndrome, and electrolyte imbalance

    Science.gov (United States)

    Mustopa; Susilo, R. S. B.; Arifin; Redhono, D.; Sumandjar, T.

    2018-03-01

    A 48-years-old man was hospitalized due to febrile for 5 days accompanied by headache and left chest pain radiating into the back. Pain calf, abdominal pain and tea color urine has occured since 1 week before admission. Physical examination revealed temperature 38.5° C, conjungtival suffusion, jaundice sclera, irregularheart sound, hepatomegaly, gastrocnemius tenderness, Faine score 23. Laboratory tests showed leukocytosis, thrombocytopenia, elevated transaminase enzyme, ureum 181 mg/dl, creatinine 4.3 mg/dl, albumin 2.4 g/dl, sodium 110 mmol/L, potassium 2.3 mmol/L, reactive HbsAg, CKMB 68.06 ng/ml, increased HBV-DNA, negative IgM anti Leptospira. MAT demonstrated 4 positive serovar. Electrocardiography revealed AF rapid ventrikel response. Chest x-ray showed cardiomegaly. Abdominal ultrasound revealed hepatomegaly with chronic parenchimal liver disease, renal insuficiency. Fibroscan showed severe fibrosis. Patient was diagnosed with Weil’s disease and hepatorenal syndrome as complication. Patient was given clavulanate amoxicillin injections. This patient was not dialysis, only fluid balance monitoring and checked ureum-creatinine per 3 days, and there was improvement of ureum-creatinine. Hepatorenal syndrome in Weil’s disease contributed to electrolyte imbalance. In addition, chronic hepatitis B on this patient was treated with tenofovir.

  13. 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.

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

    Science.gov (United States)

    Verdon, François; Burnand, Bernard; Herzig, Lilli; Junod, Michel; Pécoud, Alain; Favrat, Bernard

    2007-09-12

    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). 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. 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. 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.

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

    Science.gov (United States)

    Verdon, François; Burnand, Bernard; Herzig, Lilli; Junod, Michel; Pécoud, Alain; Favrat, Bernard

    2007-01-01

    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. PMID:17850647

  16. Drug-induced chest pain and myocardial infarction. Reports to a national centre and review of the literature

    NARCIS (Netherlands)

    J.P. Ottervanger (Jan Paul); J.H.P. Wilson (Paul); B.H.Ch. Stricker (Bruno)

    1997-01-01

    textabstractObjectives: To analyse reports of drug-induced myocardial infarction and chest pain sent to a national reporting centre. To review which drugs were suspected of exhibiting these adverse events and what mechanisms were involved. Methods: During the 20-year period 1975 through 1994, a

  17. Negative beliefs about low back pain are associated with persistent high intensity low back pain.

    Science.gov (United States)

    Ng, Sin Ki; Cicuttini, Flavia M; Wang, Yuanyuan; Wluka, Anita E; Fitzgibbon, Bernadette; Urquhart, Donna M

    2017-08-01

    While previous cross-sectional studies have found that negative beliefs about low back pain are associated with pain intensity, the relationship between back beliefs and persistent low back pain is not well understood. This cohort study aimed to examine the role of back beliefs in persistent low back pain in community-based individuals. A hundred and ninety-two participants from a previous musculoskeletal health study were invited to take part in a two-year follow-up study. Beliefs about back pain were assessed by the Back Beliefs Questionnaire (BBQ) at baseline and low back pain intensity was measured by the Chronic Pain Grade Questionnaire at baseline and follow-up. Of the 150 respondents (78.1%), 16 (10.7%) reported persistent high intensity low back pain, 12 (8.0%) developed high intensity low back pain, in 16 (10.7%) their high intensity low back pain resolved and 106 (70.7%) experienced no high intensity low back pain. While participants were generally positive about low back pain (BBQ mean (SD) = 30.2 (6.4)), those with persistent high intensity pain reported greater negativity (BBQ mean (SD) = 22.6 (4.9)). Negative beliefs about back pain were associated with persistent high intensity low back pain after adjusting for confounders (M (SE) = 23.5 (1.6) vs. >30.1 (1.7), p back beliefs were associated with persistent high intensity low back pain over 2 years in community-based individuals. While further longitudinal studies are required, these findings suggest that targeting beliefs in programs designed to treat and prevent persistent high intensity low back pain may be important.

  18. Low back pain

    DEFF Research Database (Denmark)

    Buchbinder, Rachelle; van Tulder, Maurits; Öberg, Birgitta

    2018-01-01

    Low back pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population.1 Because these population shifts are more rapid in low-income and middle-income countries, where adequate resources to address the problem might...... not exist, the effects will probably be more extreme in these regions. Most low back pain is unrelated to specific identifiable spinal abnormalities, and our Viewpoint, the third paper in this Lancet Series,2,3 is a call for action on this global problem of low back pain....

  19. Esophageal Manometry with Provocative Testing in Patients with Noncardiac Angina-Like Chest Pain

    OpenAIRE

    Paterson, William G; Marciano-D’Amore, Delia A; Beck, Ivan T; Da Costa, Laurington R

    1991-01-01

    In a five year period 238 of 594 esophageal manometric studies performed in the authors’ laboratory were done on patients whose major reason for referral was noncardiac angina-like chest pain. Standard eophageal manometry was performed followed by an acid-antacid perfusion period (Bernstein test) and then subcutaneous bethanechol (80 μg/kg to a maximum of 5 mg) was adminstered. Baseline manometry was normal in 38% of patients and was diagnostic of ‘nutcracker’ esophagus, nonspecific esophagea...

  20. Low-dosage helical CT applications for chest medical checkup and lung cancer screening

    International Nuclear Information System (INIS)

    Wang Ping; Cui Fa; Liang Huanqing; Zheng Minfei

    2005-01-01

    Objective: A discussion on low-dosage helical CT applications on chest medical checkup and lung cancer screening. Methods: On the 100 chest medical check up with three different of protocols, including standard-dosage (the tube current was 230 mAs) were compared with low-dose (tube current was 50 mAs or 30 mAs). Results: Low-dosage helical CT scan provides excellent images. In 100 chest medical checkup, 39 nodules or masses were revealed, enlarged lymph node was noted in 1 case; emphysema or bullae was demonstrated in 3 segments; thickening of bronchial wall was shown in 2 cases; and localized pleural thickening was found in 1 case. Conclusion: In chest checkup or lung cancer screening low-dosage helical CT (tube current 30 mAs) will not only guarantee image quality but also reduce the radiation dose during the examination. (authors)

  1. Pilates for low back pain.

    Science.gov (United States)

    Yamato, Tiê P; Maher, Christopher G; Saragiotto, Bruno T; Hancock, Mark J; Ostelo, Raymond W J G; Cabral, Cristina M N; Costa, Luciola C Menezes; Costa, Leonardo O P

    2016-01-01

    Non-specific low back pain is a major health problem worldwide. Interventions based on exercises have been the most commonly used treatments for patients with this condition. Over the past few years, the Pilates method has been one of the most popular exercise programmes used in clinical practice. To determine the effects of the Pilates method for patients with non-specific acute, subacute or chronic low back pain. We conducted the searches in CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro and SPORTDiscus from the date of their inception to March 2014. We updated the search in June 2015 but these results have not yet been incorporated. We also searched the reference lists of eligible papers as well as six trial registry websites. We placed no limitations on language or date of publication. We only included randomized controlled trials that examined the effectiveness of Pilates intervention in adults with acute, subacute or chronic non-specific low back pain. The primary outcomes considered were pain, disability, global impression of recovery and quality of life. Two independent raters performed the assessment of risk of bias in the included studies using the 'Risk of bias' assessment tool recommended by The Cochrane Collaboration. We also assessed clinical relevance by scoring five questions related to this domain as 'yes', 'no' or 'unclear'. We evaluated the overall quality of evidence using the GRADE approach and for effect sizes we used three levels: small (mean difference (MD) 20% of the scale). We converted outcome measures to a common 0 to 100 scale when different scales were used. The search retrieved 126 trials; 10 fulfilled the inclusion criteria and we included them in the review (a total sample of 510 participants). Seven studies were considered to have low risk of bias, and three were considered as high risk of bias.A total of six trials compared Pilates to minimal intervention. There is low quality evidence that Pilates reduces pain compared with minimal

  2. Putting Physical Activity While Experiencing Low Back Pain in Context: Balancing the Risks and Benefits.

    Science.gov (United States)

    Darlow, Ben; Perry, Meredith; Dean, Sarah; Mathieson, Fiona; Baxter, G David; Dowell, Anthony

    2016-02-01

    To analyze attitudes and beliefs about movement and physical activity in people with low back pain (LBP) and compare these beliefs between people with acute and chronic LBP. Qualitative inductive analysis of data collected via face-to-face semistructured interviews. Interviews were audio-recorded and transcribed verbatim. Participants were purposively recruited from 1 region of New Zealand. Persons with LBP (N=23), consisting of individuals with acute LBP (3mo; n=11). Not applicable. Themes that emerged from participant interview transcripts using analysis based on Interpretative Description. Participants with acute and chronic LBP made judgments about physical activity and rest using the same conceptual model. Concerns about creating more pain, tissue damage, or impairment influenced the physical activity judgments of most participants with acute and chronic LBP. These perceived risks were balanced against the perceived benefits, the most important of which were psychological or social rather than physical. Judgments made by those with acute and chronic LBP were context dependent and influenced by the nature and duration of pain, the type of physical activity, the importance of the activity, and the participant's previous experience. Participants with acute pain who had not experienced back pain previously often expressed more uncertainty, whereas those with chronic LBP appeared to have developed cognitive rules that determined physical activity decisions. Exploring the perceived risks, benefits, and contextual factors that influence decisions about physical activity and rest may help clinicians to understand the behavior of patients with acute and chronic LBP. Clinicians may best support their patients to engage in physical activity by providing an informed assessment of risks and an explanation about the range of potential benefits. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. Pragmatic approach to chest pain patients discharged with undetectable high-sensitivity troponin T and normal electrocardiogram: the STABS + CT protocol.

    Science.gov (United States)

    Bishop, Warrick; Girao, Gary

    2017-06-01

    A strategy that discharges chest pain patients with negative high-sensitivity troponin and non-ischaemic electrocardiography changes may still result in 0.44% of patients experiencing myocardial infarction within 30 days. We observed that a pragmatic approach that systematically discharged 25 patients on cardio-protective medications of aspirin, metoprolol and atorvastatin followed with prompt (<10 days) coronary computed tomography angiography resulted in no major adverse cardiac event and adverse drug reaction 30 days post-presentation. The strategy resulted in three patients (12%) ultimately diagnosed with likely unstable angina, which required planned coronary intervention in two patients and medical management in one patient. No unplanned readmissions for chest pains were noted from initial presentation through to 6-month follow up. © 2017 Royal Australasian College of Physicians.

  4. 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.

  5. Technetium-99m sestamibi myocardial tomography based on dipyridamole echocardiography testing in hypertensive patients with chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Schillaci, O. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy); Moroni, C. [Department of Internal Medicine, University ``La Sapienza``, Rome (Italy); Scopinaro, F. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy); Tavolaro, R. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy); Danieli, R. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy); Bossini, A. [Department of Internal Medicine, University ``La Sapienza``, Rome (Italy); Cassone, R. [Department of Internal Medicine, University ``La Sapienza``, Rome (Italy); Colella, A.C. [Section of Nuclear Medicine, Department of Experimental Medicine and Pathology, University ``La Sapienza``, Rome (Italy)

    1997-07-01

    The aim of this study was to evaluate the diagnostic capability of technetium-99m sestamibi tomography based on dipyridamole echocardiography testing in hypertensives with chest pain, and to compare the scintigraphic results with those of coronary angiography, exercise electrocardiography and dipyridamole echocardiography. Forty subjects with mild to moderate hypertension, chest pain and no previous myocardial infarction were submitted to {sup 99m}Tc-sestamibi tomography (at rest and after high-dose dipyridamole echocardiography) and to exercise electrocardiography testing. At coronary angiography 22 patients (group A) had significant epicardial coronary artery disease ({>=}70% stenosis of at least one major vessel) and 18 normal main coronary vessels (group B). Dipyridamole {sup 99m}Tc-sestamibi imaging was positive in 21/22 patients of group A and in 5/18 of group B. Dipyridamole echocardiography was positive in 18/22 patients of group A and in 5/18 of group B. Exercise electrocardiography was positive in 15/22 patients of group A and in 11/18 of group B. Four out of five subjects in group B with positive results in all the tests showed a slow run-off of angiographic contrast medium, probably due to small-vessel disease. Significant epicardial coronary artery disease in hypertensives with chest pain is unlikely when dipyridamole {sup 99m}Tc-sestamibi tomography is negative. When scintigraphy is positive, either epicardial coronary artery disease or a small-vessel disease condition is possible. The association of scintigraphy with dipyridamole echocardiography testing allows the assessment of contractile function and myocardial perfusion by a single pharmacological stress. (orig./AJ). With 3 figs., 2 tabs.

  6. Physical activity and time spent sitting as a risk factor for low-back pain: longitudinal data from the HUNT study

    OpenAIRE

    Venseth, Torje Bragstad

    2014-01-01

    Background: Low back pain (LBP) is the most common pain condition with a lifetime prevalence of 70 %. One of the most investigated risk factor for LBP is sedentary lifestyle. This is of great interest as sitting is the more dominant occupational activity in today’s society. Aim: The aim of this study was to prospectively investigate if the risk of chronic LBP is associated with time spent sitting, leisure time physical activity, and occupational activity. We also examined the combined eff...

  7. Feasibility of an automatic computer-assisted algorithm for the detection of significant coronary artery disease in patients presenting with acute chest pain

    International Nuclear Information System (INIS)

    Kang, Ki-Woon; Chang, Hyuk-Jae; Shim, Hackjoon; Kim, Young-Jin; Choi, Byoung-Wook; Yang, Woo-In; Shim, Jee-Young; Ha, Jongwon; Chung, Namsik

    2012-01-01

    Automatic computer-assisted detection (auto-CAD) of significant coronary artery disease (CAD) in coronary computed tomography angiography (cCTA) has been shown to have relatively high accuracy. However, to date, scarce data are available regarding the performance of auto-CAD in the setting of acute chest pain. This study sought to demonstrate the feasibility of an auto-CAD algorithm for cCTA in patients presenting with acute chest pain. We retrospectively investigated 398 consecutive patients (229 male, mean age 50 ± 21 years) who had acute chest pain and underwent cCTA between Apr 2007 and Jan 2011 in the emergency department (ED). All cCTA data were analyzed using an auto-CAD algorithm for the detection of >50% CAD on cCTA. The accuracy of auto-CAD was compared with the formal radiology report. In 380 of 398 patients (18 were excluded due to failure of data processing), per-patient analysis of auto-CAD revealed the following: sensitivity 94%, specificity 63%, positive predictive value (PPV) 76%, and negative predictive value (NPV) 89%. After the exclusion of 37 cases that were interpreted as invalid by the auto-CAD algorithm, the NPV was further increased up to 97%, considering the false-negative cases in the formal radiology report, and was confirmed by subsequent invasive angiogram during the index visit. We successfully demonstrated the high accuracy of an auto-CAD algorithm, compared with the formal radiology report, for the detection of >50% CAD on cCTA in the setting of acute chest pain. The auto-CAD algorithm can be used to facilitate the decision-making process in the ED.

  8. Myocardial perfusion assessed by contrast echocardiography and single photon emission computed tomography in the evaluation of patients with acute chest pain and normal electrocardiogram

    International Nuclear Information System (INIS)

    Soares, J. Jr.; Ferreira, S.M.A.; Matias, W. Jr.; Giorgi, M.C.P.; Izaki, M.; Luz, P.L.; Ramires, J.A.F.; Meneghetti, J.C.

    2002-01-01

    Aim : Evaluation of diagnostic accuracy of myocardial contrast echocardiography (MCE) in comparison with single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia in patients with acute chest pain. Material and Methods : Eighteen patients (pts) with chest pain lasting ≥30 minutes, occurring within 6 hours of emergency room presentation and a normal or no diagnostic electrocardiogram were studied. Pts underwent rest MCE and SPECT. For both exams myocardial perfusion was assessed in the same 7 segments (apical, anterior, inferior, anteroseptal, inferoseptal, lateral and posterior) of left ventricle. A total of 126 segments were analyzed. Images were classified as positive for ischemia if they had a perfusion defect. Coronary angiography was performed if MCE or SPECT images were classified as positive for ischemia or by clinical indication. Otherwise the patients underwent stress SPECT. Significant coronary artery disease (CAD) was defined as ≥70% stenosis in a major coronary artery or its branches. Final diagnosis of an acute coronary event (ACE) was established in the presence of positive findings in MCE or SPECT in addition to significant CAD in the corresponding territory. Kappa statistics were calculated to evaluate the concordance between MCE and SPECT. κ values of ≤0.4, >0.4 and >0.7 indicate fair, good and excellent agreement, respectively. Results: Thirteen out of 18 pts underwent coronary angiography (seven pts had positive findings on SPECT, 2 on MCE, 2 on both exams and 1 had clinical indication). Significant CAD was detected on six. Five pts underwent stress SPECT and no perfusion defect was detected. Therefore, six pts (33.3%) had an ACE and 12 (66.6%) had not. There were no statistical differences between groups according to age, gender, duration of pain, free pain interval, presence of risk factors and antecedents. Concordance between MCE and SPECT for evaluation of perfusion defects showed a ? coefficient of 0

  9. Low back pain - chronic

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007422.htm Low back pain - chronic To use the sharing features on this page, please enable JavaScript. Low back pain refers to pain that you feel in your ...

  10. Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: Identification of risk factors, preventive factors and key elements for treatment – A cohort study

    Directory of Open Access Journals (Sweden)

    Viniol Annika

    2012-05-01

    Full Text Available Abstract Background Chronic localized pain syndromes, especially chronic low back pain (CLBP, are common reasons for consultation in general practice. In some cases chronic localized pain syndromes can appear in combination with chronic widespread pain (CWP. Numerous studies have shown a strong association between CWP and several physical and psychological factors. These studies are population-based cross-sectional and do not allow for assessing chronology. There are very few prospective studies that explore the predictors for the onset of CWP, where the main focus is identifying risk factors for the CWP incidence. Until now there have been no studies focusing on preventive factors keeping patients from developing CWP. Our aim is to perform a cross sectional study on the epidemiology of CLBP and CWP in general practice and to look for distinctive features regarding resources like resilience, self-efficacy and coping strategies. A subsequent cohort study is designed to identify the risk and protective factors of pain generalization (development of CWP in primary care for CLBP patients. Methods/Design Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months. Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly for pain generalization (outcome: incident CWP. Discussion This cohort study will be the largest

  11. Deep convolutional neural networks for automatic coronary calcium scoring in a screening study with low-dose chest CT

    Science.gov (United States)

    Lessmann, Nikolas; Išgum, Ivana; Setio, Arnaud A. A.; de Vos, Bob D.; Ciompi, Francesco; de Jong, Pim A.; Oudkerk, Matthjis; Mali, Willem P. Th. M.; Viergever, Max A.; van Ginneken, Bram

    2016-03-01

    The amount of calcifications in the coronary arteries is a powerful and independent predictor of cardiovascular events and is used to identify subjects at high risk who might benefit from preventive treatment. Routine quantification of coronary calcium scores can complement screening programs using low-dose chest CT, such as lung cancer screening. We present a system for automatic coronary calcium scoring based on deep convolutional neural networks (CNNs). The system uses three independently trained CNNs to estimate a bounding box around the heart. In this region of interest, connected components above 130 HU are considered candidates for coronary artery calcifications. To separate them from other high intensity lesions, classification of all extracted voxels is performed by feeding two-dimensional 50 mm × 50 mm patches from three orthogonal planes into three concurrent CNNs. The networks consist of three convolutional layers and one fully-connected layer with 256 neurons. In the experiments, 1028 non-contrast-enhanced and non-ECG-triggered low-dose chest CT scans were used. The network was trained on 797 scans. In the remaining 231 test scans, the method detected on average 194.3 mm3 of 199.8 mm3 coronary calcifications per scan (sensitivity 97.2 %) with an average false-positive volume of 10.3 mm3 . Subjects were assigned to one of five standard cardiovascular risk categories based on the Agatston score. Accuracy of risk category assignment was 84.4 % with a linearly weighted κ of 0.89. The proposed system can perform automatic coronary artery calcium scoring to identify subjects undergoing low-dose chest CT screening who are at risk of cardiovascular events with high accuracy.

  12. Chest Low-Dose Computed Tomography for Early Lung Cancer Diagnosis as an Opportunity to Diagnose Vertebral Fractures in HIV-Infected Smokers, an ANRS EP48 HIV CHEST Substudy.

    Science.gov (United States)

    Thouvenin, Yann; Makinson, Alain; Cournil, Amandine; Eymard-Duvernay, Sabrina; Lentz, Pierre; Delemazure, Anne-Sophie; Corneloup, Olivier; Fabre, Sylvie; Quesnoy, Mylène; Poire, Sylvain; Brillet, Pierre-Yves; Cyteval, Catherine; Reynes, Jacques; Le Moing, Vincent

    2015-07-01

    To estimate the prevalence of vertebral fractures on chest low-dose computed tomography (LDCT) in HIV-infected smokers. Cross-sectional study of vertebral fractures visualized on chest LDCT from a multicenter prospective cohort evaluating feasibility of chest LDCT for early lung cancer diagnosis in HIV-infected subjects. Subjects were included if 40 years or older, had been active smokers within the last 3 years of at least 20 pack-years, and had a CD4 T-lymphocyte nadir cell count 100 cells per microliter. Spinal reconstructed sagittal planes obtained from chest axial native acquisitions were blindly read by a musculoskeletal imaging specialist. Assessment of the fractured vertebra used Genant semiquantitative method. The study end point was the prevalence of at least 1 vertebral fracture. Three hundred ninety-seven subjects were included. Median age was 49.5 years, median smoking history was 30 pack-years, median last CD4 count was 584 cells per microliter, and median CD4 nadir count was 168 cells per microliter; 90% of subjects had a viral load below 50 copies per milliliter. At least 1 fracture was visible in 46 (11.6%) subjects. In multivariate analysis, smoking ≥40 packs-years [OR = 2.5; 95% CI: (1.2 to 5.0)] was associated with an increased risk of vertebral fracture, while HIV viral load <200 copies per milliliter [OR = 0.3; 95% CI: (0.1 to 0.9)] was protective. Prevalence of vertebral fractures on chest LDCT was 11.6% in this high-risk population. Smoking cessation and early introduction of antiretroviral therapy for prevention of vertebral fractures could be beneficial. Chest LDCT is an opportunity to diagnose vertebral fractures.

  13. [Relationship between performance rating and risk of low back pain in manufacturing line workers].

    Science.gov (United States)

    Higuchi, Yoshiyuki; Funahashi, Atsushi; Izumi, Hiroyuki; Kumashinro, Masaharu

    2012-03-01

    It is possible that the performance rating of line workers is affected by the risk factors for musculoskeletal disorders that are included in their work more so than by the actual takt time. To investigate whether performance rating relates to the risk factors for musculoskeletal disorders, we analyzed a dataset obtained from a self-administered questionnaire answered by assembly line workers (n=1579). As a result, performance rating had a significant association with unsuitable work environments, poor working postures and handling of heavy loads. The workers who reported the fastest rating had a higher exposure than others to the risk factors for occupational low back pain. The results of our study support the effectiveness of performance rating as an index of work burden.

  14. Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain

    International Nuclear Information System (INIS)

    Brown, K.A.; Boucher, C.A.; Okada, R.D.; Guiney, T.E.; Newell, J.B.; Strauss, H.W.; Pohost, G.M.

    1983-01-01

    Accurate prognostic information is important in determining optimal management of patients presenting for evaluation of chest pain. In this study, the ability of exercise thallium-201 myocardial imaging to predict future cardiac events (cardiovascular death or nonfatal myocardial infarction) was correlated with clinical, coronary and left ventricular angiographic and exercise electrocardiographic data in 139 consecutive, nonsurgically managed patients followed-up over a 3 to 5 year period (mean follow-up, 3.7 +/- 0.9), using a logistic regression analysis. Among patients without prior myocardial infarction (100 of 139), the number of myocardial segments with transient thallium-201 defects was the only statistically significant predictor of future cardiac events when all patient variables were evaluated. Among patients with myocardial infarction before evaluation (39 of 139), angiographic ejection fraction was the only significant predictor of future cardiac events when all variables were considered. This study suggests an approach to evaluate the risk of future cardiac events in patients with possible ischemic heart disease

  15. Patient clusters in acute, work-related back pain based on patterns of disability risk factors.

    Science.gov (United States)

    Shaw, William S; Pransky, Glenn; Patterson, William; Linton, Steven J; Winters, Thomas

    2007-02-01

    To identify subgroups of patients with work-related back pain based on disability risk factors. Patients with work-related back pain (N = 528) completed a 16-item questionnaire of potential disability risk factors before their initial medical evaluation. Outcomes of pain, functional limitation, and work disability were assessed 1 and 3 months later. A K-Means cluster analysis of 5 disability risk factors (pain, depressed mood, fear avoidant beliefs, work inflexibility, and poor expectations for recovery) resulted in 4 sub-groups: low risk (n = 182); emotional distress (n = 103); severe pain/fear avoidant (n = 102); and concerns about job accommodation (n = 141). Pain and disability outcomes at follow-up were superior in the low-risk group and poorest in the severe pain/fear avoidant group. Patients with acute back pain can be discriminated into subgroups depending on whether disability is related to pain beliefs, emotional distress, or workplace concerns.

  16. Systematic review of conservative interventions for subacute low back pain.

    Science.gov (United States)

    Pengel, Heloise M; Maher, Chris G; Refshauge, Kathryn M

    2002-12-01

    To evaluate the effect of conservative interventions on clinically relevant outcome measures for patients with subacute low back pain. This is particularly important because effective treatment for subacute low back pain will prevent the transition to chronic low back pain, a condition that is largely responsible for the high health care costs of low back pain. Systematic review of randomized controlled trials. Methodological quality of each trial was assessed. Effect sizes and 95% confidence intervals were calculated for pain and disability and risk ratios for return to work. Thirteen trials were located, evaluating the following interventions: manipulation, back school, exercise, advice, transcutaneous electrical nerve stimulation (TENS), hydrotherapy, massage, corset, cognitive behavioural treatment and co-ordination of primary health care. Most studies were of low quality and did not show a statistically significant effect of intervention. For the strict duration of low back pain (six weeks to three months), no evidence of high internal validity was found but when other methodological criteria were considered, evidence was found for the efficacy of advice. Furthermore, there is evidence that when a broader view is taken of the duration of subacute low back pain (seven days to six months), other treatments (e.g. manipulation, exercise, TENS) may be effective. Our review identified a major gap in the evidence for interventions that are currently recommended in clinical practice guidelines for the treatment of subacute low back pain. Lack of a uniform definition of subacute low back pain further limited current evidence.

  17. Exercise left ventricular performance in patients with chest pain, ischemic-appearing exercise electrocardiograms, and angiographically normal coronary arteries

    International Nuclear Information System (INIS)

    Berger, H.J.; Sands, M.J.; Davies, R.A.; Wackers, F.J.; Alexander, J.; Lachman, A.S.; Williams, B.W.; Zaret, B.L.

    1981-01-01

    Left ventricular performance was evaluated using first-pass radionuclide angiocardiography in 31 patients with chest pain, an ischemic-appearing exercise electrocardiogram, and angiographically normal coronary arteries at rest and during maximal upright bicycle exercise. 201 Tl imaging was done in all patients after treadmill exercise and in selected patients after ergonovine provocation. Resting left ventricular performance was normal in all patients. An abnormal ejection fraction response to exercise was detected in 12 of 31 patients. Regional dysfunction was present during exercise in four patients, all of whom also had abnormal global responses. Three of these 12 patients and two additional patients had exercise-induced 201 Tl perfusion defects. In all nine patients who underwent ergonovine testing, there was no suggestion of coronary arterial spasm. Thus, left ventricular dysfunction during exercise, in the presence of normal resting performance, was found in a substantial number of patients with chest pain, an ischemic-appearing exercise electrocardiogram, and normal coronary arteries

  18. 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.

  19. Pilates for Low Back Pain: Complete Republication of a Cochrane Review.

    Science.gov (United States)

    Yamato, Tiê P; Maher, Christopher G; Saragiotto, Bruno T; Hancock, Mark J; Ostelo, Raymond W J G; Cabral, Cristina M N; Costa, Luciola C Menezes; Costa, Leonardo O P

    2016-06-01

    Systematic review. To determine the effects of the Pilates method for patients with nonspecific acute, subacute, or chronic low back pain. The Pilates method is one of the most common forms of intervention based on exercise used for treating patients with low back pain. However, its effectiveness is not well established. We conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, and SPORTDiscus up to March 2014. We included randomized controlled trials examining the effectiveness of Pilates in patients with acute, subacute, or chronic nonspecific low back pain. The outcomes evaluated were pain, disability, function, and global impression of recovery. Two independent reviewers screened for potentially eligible studies, assessed risk of bias, and extracted the data. We evaluated the overall quality of evidence using the GRADE approach and treatment effect sizes were described using mean differences and 95% confidence intervals. Searches retrieved 126 trials, of which 10 were included in the review (n = 510 participants). Seven studies were considered to have low risk of bias, and three were considered at high risk of bias. When compared to minimal intervention, Pilates reduces pain at short and intermediate term with low- to moderate-quality evidence and medium effect sizes. For disability, there is also a significant difference in favor to Pilates with low- to moderate-quality evidence and small effect size for short term and medium effect size for intermediate term compared with minimal intervention. It is unclear whether Pilates is better than other exercises for short-term pain, but there is low-quality evidence that Pilates reduces pain at intermediate term. For disability, there is moderate-quality evidence that there is no significant difference between Pilates and other exercises in either the short term or the intermediate term. There is low- to moderate-quality evidence that Pilates is more effective than minimal intervention with most of the

  20. The single chest tube versus double chest tube application after pulmonary lobectomy: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Xuefei Zhang

    2016-01-01

    Conclusion: Compared with the double chest tube, the single chest tube significantly decreases amount of drainage, duration of chest tube drainage, pain score, the number of patients who need thoracentesis, and cost. Although there is convincing evidence to confirm the results mentioned herein, they still need to be confirmed by large-sample, multicenter, randomized, controlled trials.

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

    Science.gov (United States)

    Mogensen, Christian Backer; Christiansen, Maja; Jørgensen, Jess Bjerre; Staehr, Peter Bisgaard

    2015-10-01

    Among patients with acute chest pain, acute coronary syndrome (ACS) is seen only in a minority of the patients, which raises the question, whether it is possible to separate a group with a high risk of ACS for admission to a cardiac care unit (CCU) from those with a low risk who would be treated at an emergency department (ED). The aim of this study was to describe a risk stratification model for a Danish context. This was a historic prospective cohort study of patients with suspicion of ACS. The patient was defined as a low-risk patient and admitted to the ED if: 1) electrocardiogram (ECG) was normal, 2) the patient did not have persisting chest pain and 3) there was no history of ischaemic heart disease, heart failure or cardioverter defibrillator. Otherwise, patients were admitted to the CCU. The primary outcome was whether the ACS diagnosis was confirmed or rejected. We included a total of 488 patients with suspicion of ACS, 50% of whom were low-risk patients. 17% had a verified ACS; 10% of those in the low-risk group and 24% of those in the high-risk group (p = 0.0001). Among the verified ACS cases, 71% went primarily to the CCU. The odds ratio for an ACS if assigned to the high-risk group was 3.0. Allocation to the high-risk group, male gender and age above 60 years was associated with a higher risk of ACS. For patients fulfilling the high-risk definition, sensitivity was 71%, specificity 55%, negative predictive value 90% and positive predictive value 24% for an ACS. The model for stratification separated patients into two equal groups, allocated 71% of all ACS directly to the CCU and could not be improved by any of the additional factors examined. Further development of referral strategies for chest pain patients is required. none. not relevant.

  2. Low back pain in young elite field hockey players, football players and speed skaters: Prevalence and risk factors

    NARCIS (Netherlands)

    van Hilst, Jony; Hilgersom, Nick F. J.; Kuilman, Miriam C.; F M Kuijer, P. Paul; Frings-Dresen, Monique H. W.

    2015-01-01

    Low back pain (LBP) hampers performance and experiencing an episode of LBP is strongly associated with recurrent episodes. The prevalence of LBP and associated risk factors among young elite athletes in popular sports in the Netherlands were studied. A questionnaire-based cross-sectional study was

  3. Surgical treatment of chest instability

    International Nuclear Information System (INIS)

    Kitka, M.; Masek, M.

    2015-01-01

    Fractures of the ribs is the most common thoracic injury after blunt trauma. Chest wall instability (flail chest) is a common occurrence in the presence of multiple ribs fracture. Unilateral or bilateral fractures more ribs anteriorly or posteriorly will produce enough instability that paradoxical respiratory motion results in hypoventilation of an unacceptable degree. Open approach and surgical stabilisation of the chest preserved pulmonary function, improved pain control, minimized posttraumatic deformities and shorter back to work time. (author)

  4. Assessment of coronary flow reserve by sestamibi imaging in patients with typical chest pain and normal coronary arteries

    International Nuclear Information System (INIS)

    Storto, Giovanni; Sorrentino, Anna R.; Pellegrino, Teresa; Liuzzi, Raffaele; Cuocolo, Alberto; Petretta, Mario

    2007-01-01

    We assessed coronary flow reserve (CFR) by sestamibi imaging in patients with typical chest pain, positive exercise stress test and normal coronary vessels. Thirty-five patients with typical chest pain and normal angiogram and 12 control subjects with atypical chest pain underwent dipyridamole/rest 99m Tc-sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress to rest MBF. Rest MBF and CFR were corrected for rate-pressure product (RPP) and expressed as normalised MBF (MBF n ) and normalised CFR (CFR n ). Coronary vascular resistances (CVR) were calculated as the ratio between mean arterial pressure and estimated MBF. At rest, estimated MBF and MBF n were lower in controls than in patients (0.98 ± 0.4 vs 1.30 ± 0.3 counts/pixel/s and 1.14 ± 0.5 vs 1.64 ± 0.6 counts/pixel/s, respectively, both p n was still higher in controls than in patients (2.1 ± 0.5 vs 1.29 ± 0.5, p < 0.0001). At baseline, CVR values were lower (p < 0.01) in patients than in controls. Dipyridamole-induced changes in CVR were greater (p < 0.0001) in controls (-63%) than in patients (-35%). In the overall study population, a significant correlation between dipyridamole-induced changes in CVR and CFR was observed (r = -0.88, p < 0.0001). SPECT might represent a useful non-invasive method for assessing coronary vascular function in patients with angina and a normal coronary angiogram. (orig.)

  5. Low Yield of Chest Radiography in a Large Tuberculosis Screening Program1

    Science.gov (United States)

    Pollock, Nira R.

    2010-01-01

    Purpose: To assess the frequency and spectrum of abnormalities on routine screening chest radiographs in the pre-employment evaluation of health care workers with positive tuberculin skin test (TST) results. Materials and Methods: The institutional review board approved this HIPAA-compliant retrospective study and waived the need for written informed patient consent. Chest radiographic reports of all 2586 asymptomatic individuals with positive TST results who underwent pre-employment evaluation between January 1, 2003, and December 31, 2007, were evaluated to determine the frequency of detection of evidence of active tuberculosis (TB) or latent TB infection (LTBI) and the spectrum of imaging findings. All chest radiographs interpreted as positive were reviewed by an experienced board-certified radiologist. If there was a discrepancy between the two readings, a second experienced radiologist served as an independent and final arbiter. Any follow-up chest radiographs or computed tomographic images that had been acquired by employee health services or by the employee’s private physician as a result of a suspected abnormality detected at initial screening were also evaluated. Results: Of the 159 (6.1%) chest radiographic examinations that yielded abnormal results, there were no findings that were consistent with active TB. There were 92 cases of calcified granulomas, calcified lymph nodes, or both; 25 cases of apical pleural thickening; 16 cases of fibrous scarring; and 31 cases of noncalcified nodules. All cases of fibrous scarring involved an area smaller than 2 cm2. All noncalcified nodules were 4 mm in diameter or smaller, with the exception of one primary lung malignancy and one necrotizing granuloma (negative for acid-fast bacilli) that grew Mycobacterium kansasii on culture. Conclusion: Universal chest radiography in a large pre-employment TB screening program was of low yield in the detection of active TB or increased LTBI reactivation risk, and it provided

  6. Trajectories of low back pain

    DEFF Research Database (Denmark)

    Axén, Iben; Leboeuf-Yde, Charlotte

    2013-01-01

    Low back pain is not a self-limiting problem, but rather a recurrent and sometimes persistent disorder. To understand the course over time, detailed investigation, preferably using repeated measurements over extended periods of time, is needed. New knowledge concerning short-term trajectories...... indicates that the low back pain 'episode' is short lived, at least in the primary care setting, with most patients improving. Nevertheless, in the long term, low back pain often runs a persistent course with around two-thirds of patients estimated to be in pain after 12 months. Some individuals never have...... low back pain, but most have it on and off or persistently. Thus, the low back pain 'condition' is usually a lifelong experience. However, subgroups of patients with different back pain trajectories have been identified and linked to clinical parameters. Further investigation is warranted...

  7. Subxyphoid pleural drain confers lesser impairment in respiratory muscle strength, oxygenation and lower chest pain after off-pump coronary artery bypass grafting: a randomized controlled trial.

    Science.gov (United States)

    Cancio, Andreia S A; Guizilini, Solange; Bolzan, Douglas W; Dauar, Renato B; Succi, José E; de Paola, Angelo A V; Carvalho, Antonio C de Camargo; Gomes, Walter J

    2012-01-01

    To evaluate respiratory muscle strength, oxygenation and chest pain in patients undergoing off-pump coronary artery bypass (OPCAB) using internal thoracic artery grafts comparing pleural drain insertion site at the subxyphoid region versus the lateral region. Forty patients were randomized into two groups in accordance with the pleural drain site. Group II (n = 19) -pleural drain exteriorized in the intercostal space; group (SI) (n = 21) chest tube exteriorized at the subxyphoid region. All patients underwent assessment of respiratory muscle strength (inspiratory and expiratory) on the pre, 1, 3 and 5 postoperative days (POD). Arterial blood gas analysis was collected on the pre and POD1. The chest pain sensation was measured 1, 3 and 5 POD. A significant decrease in respiratory muscle strength (inspiratory and expiratory) was seen in both groups until POD5 (P pleural drainage showed less decrease in respiratory muscle strength, better preservation of blood oxygenation and reduced thoracic pain compared to patients with intercostal drain on early OPCAB postoperative.

  8. Physician discretion is safe and may lower stress test utilization in emergency department chest pain unit patients.

    Science.gov (United States)

    Napoli, Anthony M; Arrighi, James A; Siket, Matthew S; Gibbs, Frantz J

    2012-03-01

    Chest pain unit (CPU) observation with defined stress utilization protocols is a common management option for low-risk emergency department patients. We sought to evaluate the safety of a joint emergency medicine and cardiology staffed CPU. Prospective observational trial of consecutive patients admitted to an emergency department CPU was conducted. A standard 6-hour observation protocol was followed by cardiology consultation and stress utilization largely at their discretion. Included patients were at low/intermediate risk by the American Heart Association, had nondiagnostic electrocardiograms, and a normal initial troponin. Excluded patients were those with an acute comorbidity, age >75, and a history of coronary artery disease, or had a coexistent problem restricting 24-hour observation. Primary outcome was 30-day major adverse cardiovascular events-defined as death, nonfatal acute myocardial infarction, revascularization, or out-of-hospital cardiac arrest. A total of 1063 patients were enrolled over 8 months. The mean age of the patients was 52.8 ± 11.8 years, and 51% (95% confidence interval [CI], 48-54) were female. The mean thrombolysis in myocardial infarction and Diamond & Forrester scores were 0.6% (95% CI, 0.51-0.62) and 33% (95% CI, 31-35), respectively. In all, 51% (95% CI, 48-54) received stress testing (52% nuclear stress, 39% stress echocardiogram, 5% exercise, 4% other). In all, 0.9% patients (n = 10, 95% CI, 0.4-1.5) were diagnosed with a non-ST elevation myocardial infarction and 2.2% (n = 23, 95% CI, 1.3-3) with acute coronary syndrome. There was 1 (95% CI, 0%-0.3%) case of a 30-day major adverse cardiovascular events. The 51% stress test utilization rate was less than the range reported in previous CPU studies (P < 0.05). Joint emergency medicine and cardiology management of patients within a CPU protocol is safe, efficacious, and may safely reduce stress testing rates.

  9. Physical risk factors for low back pain among young sedentary individuals - A prospective study

    Directory of Open Access Journals (Sweden)

    Saddam Husen Meman

    2017-01-01

    Full Text Available Aims: To find the relationship of several physical risk factors on the occurrence of low back pain (LBP over a period of 6 months among young sedentary individuals. Settings and Design: Yenepoya University, Mangaluru, India; prospective cohort design. Methods and Material: In this study, total number of 187 students of Yenepoya University, aged 18 to 30 years, with the international physical activity questionnaire (IPAQ score of less than 600 metabolic equivalent (MET minutes /week were recruited through convenience sampling. Participants were assessed for body mass index (BMI, hamstring and iliopsoas muscle tightness, abdominal and back muscle strength and endurance, and trunk range of motion (ROM at baseline. All measurements were taken by using standardized procedures. Statistical Analysis Used: Frequency distribution, Karl Pearson's correlation test by SPSS. Results: The Logistic regression analysis showed that there was a significant positive correlation between low back pain and trunk flexion ROM with odds ratio of 1.671 (P < 0.001, LBP and trunk extension ROM with odds ratio of 1.602 (P < 0.001, LBP and abdominal endurance with odds ratio of 1.602 (P < 0.001, LBP and BMI of overweight with odds ratio of 1.534 (P < 0.001, LBP and BMI of obese with odds ratio of 1.429 (P < 0.001. Conclusions: The study shows that there is a statistically significant correlation between trunk flexion and extension ROM, abdominal muscle endurance and BMI of obese & overweight category with low back pain, among young sedentary individuals.

  10. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain.

    Science.gov (United States)

    Marin, Teresa J; Van Eerd, Dwayne; Irvin, Emma; Couban, Rachel; Koes, Bart W; Malmivaara, Antti; van Tulder, Maurits W; Kamper, Steven J

    2017-06-28

    responsible. We used standard methodological procedures expected by Cochrane. In particular, the data extraction and 'risk of bias' assessment were conducted by two people, independently. We used the Cochrane tool to assess risk of bias and the GRADE approach to assess the overall quality of the evidence for each outcome. We included a total of nine RCTs (981 participants) in this review. Five studies were conducted in Europe and four in North America. Sample sizes ranged from 33 to 351. The mean age across trials ranged between 32.0 and 43.7 years.All included studies were judged as having high risk of performance bias and high risk of detection bias due to lack of blinding, and four of the nine studies suffered from at least one additional source of possible bias.In MBR compared to usual care for subacute LBP, individuals receiving MBR had less pain (four studies with 336 participants; SMD -0.46, 95% CI -0.70 to -0.21, moderate-quality of evidence due to risk of bias) and less disability (three studies with 240 participants; SMD -0.44, 95% CI -0.87 to -0.01, low-quality of evidence due to risk of bias and inconsistency), as well as increased likelihood of return-to-work (three studies with 170 participants; OR 3.19, 95% CI 1.46 to 6.98, very low-quality of evidence due to serious risk of bias and imprecision) and fewer sick leave days (two studies with 210 participants; SMD -0.38 95% CI -0.66 to -0.10, low-quality of evidence due to risk of bias and imprecision) at 12-month follow-up. The effect sizes for pain and disability were low in terms of clinical meaningfulness, whereas effects for work-related outcomes were in the moderate range.However, when comparing MBR to other treatments (i.e. brief intervention with features from a light mobilization program and a graded activity program, functional restoration, brief clinical intervention including education and advice on exercise, and psychological counselling), we found no differences between the groups in terms of pain

  11. Differences in Presentation, Management and Outcomes in Women and Men Presenting to an Emergency Department With Possible Cardiac Chest Pain.

    Science.gov (United States)

    Ruane, Lorcan; H Greenslade, Jaimi; Parsonage, William; Hawkins, Tracey; Hammett, Christopher; Lam, Carolyn Sp; Knowlman, Thomas; Doig, Shaela; Cullen, Louise

    2017-12-01

    Research suggests that female patients with acute coronary syndrome (ACS) experience delays in emergency department (ED) management and are less likely to receive guideline-based treatments and referrals for follow-up testing. Women are often found to have poorer clinical outcomes in comparison to men. This study aimed to assess current sex differences in the presentation, management and outcomes of patients with undifferentiated chest pain presenting to a tertiary ED. Data were analysed from two prospective studies conducted at a single Australian site between 2007 and 2014. Eligible patients were those of 18 years of age or older presenting with at least 5 minutes of chest pain or other symptoms for which the treating physician planned to investigate for possible ACS. Presenting symptoms, ED time measures, follow-up testing and outcomes, including 30-day ACS and mortality, were measured and compared between male and female patients. Of 2349 (60% men) patients presenting with chest pain, 153 men and 51 women were diagnosed with ACS within 30days . Presenting symptoms were similar in men and women with confirmed ACS. Time from symptom onset to ED presentation, time spent in the ED and total time in hospital were similar between the sexes. Male and female patients had similar rates of follow-up provocative testing. After adjustment for clinical factors, the odds of undergoing angiography were 1.8 (95% CI: 1.36-2.40) times higher for men than women. Of those undergoing coronary angiography within 30 days, a smaller proportion of women, compared to men, received revascularisation. Within 30 days, three (0.2%) male and one (0.1%) female patient died. Minimal sex differences were observed in the contemporary emergency management of patients presenting with suspected ACS. Thirty-day outcomes were similarly low in men and women despite lower rates of coronary angiography and revascularisation in women. Further research is required to replicate these results in different

  12. Neck/shoulder pain and low back pain among school teachers in China, prevalence and risk factors

    Directory of Open Access Journals (Sweden)

    Yue Pengying

    2012-09-01

    Full Text Available Abstract Background School teachers represent an occupational group among which there appears to be a high prevalence of neck and/or shoulder pain (NSP and low back pain (LBP. Epidemiological data on NSP and LBP in Chinese teachers are limited. The aim of this study was to investigate the prevalence of and risk factors for NSP and LBP among primary, secondary and high school teachers. Methods In a cross-sectional study of teachers from 7 schools, information on participant demographics, work characteristics, occupational factors and musculoskeletal symptoms and pain were collected. Results Among 893 teachers, the prevalence of NSP and LBP was 48.7% and 45.6% respectively. There was significant association between the level and prevalence of NSP and LBP among teachers in different schools. The prevalence of NSP among female teachers was much higher than that for males. Self-reported NSP was associated with physical exercise (OR 0.55, 95% CI 0.35 to 0.86, prolonged standing (1.74, 1.03 to 2.95, sitting (1.76, 1.23 to 2.52 and static posture (2.25, 1.56 to 3.24, and uncomfortable back support (1.77, 1.23 to 2.55. LBP was more consistently associated with twisting posture (1.93, 1.30 to 2.87, uncomfortable back support (1.62, 1.13 to 2.32 and prolonged sitting (1.42, 1.00 to 2.02 and static posture (1.60, 1.11 to 2.31. Conclusions NSP and LBP are common among teachers. There were strong associations with different individual, ergonomic, and occupational factors.

  13. Chest X-Ray

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    Full Text Available ... I’d like to talk with you about chest radiography also known as chest x-rays. Chest x-rays are the most ... far outweighs any risk. For more information about chest x-rays, visit Radiology Info dot org. Thank you for your time! ...

  14. Use of observation followed by outpatient stress testing in chest pain patients with prior coronary artery disease history: An evaluation of prognostic utility.

    Science.gov (United States)

    Khalil, Yasser; Schwartz, Melvin H; Pandey, Prasant S; Abdul Latif, Maida S; Matsumura, Martin E

    2015-06-01

    To determine the outcomes of patients with chest pain (CP) and prior history of coronary artery disease (CAD) managed with observation followed by outpatient stress myocardial perfusion imaging (MPI). Retrospective analysis of patients with CP managed with observation followed by outpatient stress MPI, comparing cardiovascular (CV) event rates stratified by CAD history. 375 patients were included: 111 with and 264 without a CAD history. All patients underwent outpatient stress MPI within 72 h of observation. MPI identified patients at risk for CV events. However, while patients with negative MPI and without a CAD history had very low rates of short- and long-term CAD events (0.8%, 0.8%, and 1.3% at 30 days, 1 year, and 3 years, respectively), event rates of those with a negative test but a CAD history were significantly higher (2.6%, 5.3%, and 6.6% at 30 days, 1 year and 3 years, respectively; p = 0.044 and p = 0.034 compared to CAD- patients at 1 year and 3 years, respectively). In a multivariable logistic regression model, a positive MPI proved to be an independent predictor of long-term CV events in patients with CP and prior CAD. Observation followed by stress MPI can effectively risk stratify CP patients with prior CAD for CV risk. These patients are at increased risk of CV events even after a low-risk stress MPI study. Patients presenting with CP and managed with a strategy of observation followed by a negative stress MPI warrant close short- and long-term monitoring for recurrent events.

  15. Chest x-ray

    Science.gov (United States)

    ... pain from a chest injury (with a possible rib fracture or lung complication) or from heart problems Coughing ... arteries Evidence of heart failure In the bones: Fractures or other problems of the ribs and spine Osteoporosis

  16. Detection of pulmonary metastatic nodules: usefulness of low-dose multidetector CT in comparison with chest radiograph

    International Nuclear Information System (INIS)

    Kim, Ki Nam; Lee, Ki Nam; Yang, Doo Kyung; Lee, Soo Keol

    2006-01-01

    We wanted to evaluate the usefulness of low-dose multidetector CT for the detection and follow-up of pulmonary metastatic nodules in patients suffering with malignancy. We retrospectively reviewed the conventional chest radiographs and low-dose multidetector CT (low-dose CT) scans of 81 patients who had been under the diagnosis of malignancy. We reviewed the detection of pulmonary nodules and we counted the number of nodules detected by each method. The nodules were confirmed by surgical operation and by the radiologic criteria. The accuracy, sensitivity, specificity and positive and negative predictive values of each method for detecting metastatic nodules were compared with χ 2 tests. Low-dose CT depicted more nodules than did chest radiograph, and the indeterminate nodules seen on chest radiograph may be clearly benign on low-dose CT (eg. calcified granulomas or bony lesions). The accuracy of low-dose CT (75.3%) was significantly higher than that of chest radiograph (49.4%) for the detection for metastatic nodules (ρ < 0.05). Low-dose CT may provide better information than does chest radiograph for diagnosing pulmonary metastasis

  17. Trajectories of acute low back pain: a latent class growth analysis.

    Science.gov (United States)

    Downie, Aron S; Hancock, Mark J; Rzewuska, Magdalena; Williams, Christopher M; Lin, Chung-Wei Christine; Maher, Christopher G

    2016-01-01

    Characterising the clinical course of back pain by mean pain scores over time may not adequately reflect the complexity of the clinical course of acute low back pain. We analysed pain scores over 12 weeks for 1585 patients with acute low back pain presenting to primary care to identify distinct pain trajectory groups and baseline patient characteristics associated with membership of each cluster. This was a secondary analysis of the PACE trial that evaluated paracetamol for acute low back pain. Latent class growth analysis determined a 5 cluster model, which comprised 567 (35.8%) patients who recovered by week 2 (cluster 1, rapid pain recovery); 543 (34.3%) patients who recovered by week 12 (cluster 2, pain recovery by week 12); 222 (14.0%) patients whose pain reduced but did not recover (cluster 3, incomplete pain recovery); 167 (10.5%) patients whose pain initially decreased but then increased by week 12 (cluster 4, fluctuating pain); and 86 (5.4%) patients who experienced high-level pain for the whole 12 weeks (cluster 5, persistent high pain). Patients with longer pain duration were more likely to experience delayed recovery or nonrecovery. Belief in greater risk of persistence was associated with nonrecovery, but not delayed recovery. Higher pain intensity, longer duration, and workers' compensation were associated with persistent high pain, whereas older age and increased number of episodes were associated with fluctuating pain. Identification of discrete pain trajectory groups offers the potential to better manage acute low back pain.

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

    International Nuclear Information System (INIS)

    Yamabe, Hiroshi; Fujiwara, Sei; Rin, Kouten; Ando, Makoto; Yokoyama, Mitsuhiro; Sakamoto, Takaaki; Ishida, Toshiharu; Itagane, Hiroshi; Mori, Takao

    2000-01-01

    Resting 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 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 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 123 I-BMIPP. A positive 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 123 I-BMIPP scintigraphy was valuable in detecting advanced coronary lesions in angina patients associated with a high incidence of subsequent intervention therapy. (author)

  19. POSTUR KERJA DAN RISIKO LOW BACK PAIN PADA PEKERJA PASIRAN

    Directory of Open Access Journals (Sweden)

    Denny Nurkertamanda

    2017-10-01

    participants. The purpose of research is to find potential risks of low back pain based on angle trunk when workers work sent down the sand by enggrong. Angle trunk which is predicted covering: 1 angle trunk flexion, 2 angle trunk bending, and 3 angle trunk twisting. Work posture data was taken using Microsoft KinectTM 3D camera and analyzed by using Siemen Jack 3D Static Strength Prediction Program (3DSSPP software to predict angle trunk. The result of the analysis of the 6 work postures showed that worker's frequently employed posture had the average angle trunk flexion of 61.10 ± 10.090, angle trunk bending of 19.80 ± 6.740 and angle trunk twisting of 20.00 ± 9.030. The average angle trunk flexion at 87.28% of maximal angle is a major cause risk low back pain. So that it can be summed up the potential for low back pain on sand workers. Intervention ergonomics need to prevent and reduce potential risks happened low back pain on sand workers.

  20. Yoga treatment for chronic non-specific low back pain.

    Science.gov (United States)

    Wieland, L Susan; Skoetz, Nicole; Pilkington, Karen; Vempati, Ramaprabhu; D'Adamo, Christopher R; Berman, Brian M

    2017-01-12

    Non-specific low back pain is a common, potentially disabling condition usually treated with self-care and non-prescription medication. For chronic low back pain, current guidelines state that exercise therapy may be beneficial. Yoga is a mind-body exercise sometimes used for non-specific low back pain. To assess the effects of yoga for treating chronic non-specific low back pain, compared to no specific treatment, a minimal intervention (e.g. education), or another active treatment, with a focus on pain, function, and adverse events. We searched CENTRAL, MEDLINE, Embase, five other databases and four trials registers to 11 March 2016 without restriction of language or publication status. We screened reference lists and contacted experts in the field to identify additional studies. We included randomized controlled trials of yoga treatment in people with chronic non-specific low back pain. We included studies comparing yoga to any other intervention or to no intervention. We also included studies comparing yoga as an adjunct to other therapies, versus those other therapies alone. Two authors independently screened and selected studies, extracted outcome data, and assessed risk of bias. We contacted study authors to obtain missing or unclear information. We evaluated the overall certainty of evidence using the GRADE approach. We included 12 trials (1080 participants) carried out in the USA (seven trials), India (three trials), and the UK (two trials). Studies were unfunded (one trial), funded by a yoga institution (one trial), funded by non-profit or government sources (seven trials), or did not report on funding (three trials). Most trials used Iyengar, Hatha, or Viniyoga forms of yoga. The trials compared yoga to no intervention or a non-exercise intervention such as education (seven trials), an exercise intervention (three trials), or both exercise and non-exercise interventions (two trials). All trials were at high risk of performance and detection bias because

  1. Yoga treatment for chronic non-specific low back pain

    Science.gov (United States)

    Wieland, L. Susan; Skoetz, Nicole; Pilkington, Karen; Vempati, Ramaprabhu; D’Adamo, Christopher R; Berman, Brian M

    2017-01-01

    Background Non-specific low back pain is a common, potentially disabling condition usually treated with self-care and non-prescription medication. For chronic low back pain, current guidelines state that exercise therapy may be beneficial. Yoga is a mind-body exercise sometimes used for non-specific low back pain. Objectives To assess the effects of yoga for treating chronic non-specific low back pain, compared to no specific treatment, a minimal intervention (e.g. education), or another active treatment, with a focus on pain, function, and adverse events. Search methods We searched CENTRAL, MEDLINE, Embase, five other databases and four trials registers to 11 March 2016 without restriction of language or publication status. We screened reference lists and contacted experts in the field to identify additional studies. Selection criteria We included randomized controlled trials of yoga treatment in people with chronic non-specific low back pain. We included studies comparing yoga to any other intervention or to no intervention. We also included studies comparing yoga as an adjunct to other therapies, versus those other therapies alone. Data collection and analysis Two authors independently screened and selected studies, extracted outcome data, and assessed risk of bias. We contacted study authors to obtain missing or unclear information. We evaluated the overall certainty of evidence using the GRADE approach. Main results We included 12 trials (1080 participants) carried out in the USA (seven trials), India (three trials), and the UK (two trials). Studies were unfunded (one trial), funded by a yoga institution (one trial), funded by non-profit or government sources (seven trials), or did not report on funding (three trials). Most trials used Iyengar, Hatha, or Viniyoga forms of yoga. The trials compared yoga to no intervention or a non-exercise intervention such as education (seven trials), an exercise intervention (three trials), or both exercise and non

  2. Non-Invasive Mechanic Ventilation Using in Flail Chest, Caused By Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Serdar Onat

    2008-01-01

    Full Text Available A 75-year-old woman admitted our faculty emergency room with shortness of breath, and chest pain after traffic accident’s second hour. She was diagnosed as bilateral multipl rib fractures, left clavicula fracture, and left flail chest by phsical and radiological examinations. She was transfered to Chest Surgery Depatment’s intensive care unit. The patient was undergone non-invasive mask mechanic ventilation support, because of the decreasing of blood oxygen saturation and increasing of arteriel blood partial carbondioxide pressure. The treatment of non-invasive mechanic ventilation was succesfull for ventilation support. With this report, we would like to attentioned that non-invasive mechanic ventilation for blunt chest trauma patients could be used succesfully and could be used instead of endotracheal invasive mechanic ventilation.

  3. Low back pain during pregnancy

    Directory of Open Access Journals (Sweden)

    Maria Emília Coelho Costa Carvalho

    2017-05-01

    Full Text Available Objective: Low back pain is a common complaint among pregnant women. It is estimated that about 50% of pregnant women complain of some form of back pain at some point in pregnancy or during the postpartum period. The aim of this study was to evaluate the frequency of low back pain during pregnancy and its characteristics. Methods: Cross-sectional study with low-risk pregnant women. After approval by the Human Research Ethics Committee and receiving written informed consent, we included pregnant women over 18 years of age and excluded those with psychiatric disorders, previous lumbar pathologies, and receiving treatment for low back pain. Results: We interviewed 97 pregnant women. The frequency of low back pain was 68%. The mean age was 26.2 years and the median gestational age was 30 weeks. Fifty-eight pregnant women declared themselves as brown (58%. Most (88.6% were married or living in common-law marriage, 56 (57.7% worked outside the home, and 71 (73.2% had completed high school. Low back pain was more frequent during the second trimester of pregnancy (43.9%, referred to as a “burning” sensation in 37.8% of patients, with intermittent frequency in 96.9% of the women. The symptoms got worse at night (71.2%. Resting reduced low back pain in 43.9% of pregnant women, while the standing position for a long time worsened it in 27.2% of patients. Conclusion: Low back pain is common in pregnant women, has specific characteristics, and is more frequent in the second trimester of pregnancy. This indicates the need for prevention strategies that enable better quality of life for pregnant women. Resumo: Objetivo: A lombalgia é uma queixa comum entre grávidas. Estima-se que cerca de 50% das gestantes queixam-se de algum tipo de dor lombar em algum momento da gravidez ou durante o puerpério. O objetivo deste estudo foi avaliar a frequência da lombalgia na gestação e suas características. Método: Estudo de corte transversal com gestantes de

  4. Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm).

    Science.gov (United States)

    Rodriguez, Robert M; Hendey, Gregory W; Mower, William R

    2017-01-01

    Chest imaging plays a prominent role in blunt trauma patient evaluation, but indiscriminate imaging is expensive, may delay care, and unnecessarily exposes patients to potentially harmful ionizing radiation. To improve diagnostic chest imaging utilization, we conducted 3 prospective multicenter studies over 12years to derive and validate decision instruments (DIs) to guide the use of chest x-ray (CXR) and chest computed tomography (CT). The first DI, NEXUS Chest x-ray, consists of seven criteria (Age >60years; rapid deceleration mechanism; chest pain; intoxication; altered mental status; distracting painful injury; and chest wall tenderness) and exhibits a sensitivity of 99.0% (95% confidence interval [CI] 98.2-99.4%) and a specificity of 13.3% (95% CI, 12.6%-14.0%) for detecting clinically significant injuries. We developed two NEXUS Chest CT DIs, which are both highly reliable in detecting clinically major injuries (sensitivity of 99.2%; 95% CI 95.4-100%). Designed primarily to focus on detecting major injuries, the NEXUS Chest CT-Major DI consists of six criteria (abnormal CXR; distracting injury; chest wall tenderness; sternal tenderness; thoracic spine tenderness; and scapular tenderness) and exhibits higher specificity (37.9%; 95% CI 35.8-40.1%). Designed to reliability detect both major and minor injuries (sensitivity 95.4%; 95% CI 93.6-96.9%) with resulting lower specificity (25.5%; 95% CI 23.5-27.5%), the NEXUS CT-All rule consists of seven elements (the six NEXUS CT-Major criteria plus rapid deceleration mechanism). The purpose of this review is to synthesize the three DIs into a novel, cohesive summary algorithm with practical implementation recommendations to guide selective chest imaging in adult blunt trauma patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Radiation risk assessment in neonatal radiographic examinations of the chest and abdomen: a clinical and Monte Carlo dosimetry study

    Science.gov (United States)

    Makri, T.; Yakoumakis, E.; Papadopoulou, D.; Gialousis, G.; Theodoropoulos, V.; Sandilos, P.; Georgiou, E.

    2006-10-01

    Seeking to assess the radiation risk associated with radiological examinations in neonatal intensive care units, thermo-luminescence dosimetry was used for the measurement of entrance surface dose (ESD) in 44 AP chest and 28 AP combined chest-abdominal exposures of a sample of 60 neonates. The mean values of ESD were found to be equal to 44 ± 16 µGy and 43 ± 19 µGy, respectively. The MCNP-4C2 code with a mathematical phantom simulating a neonate and appropriate x-ray energy spectra were employed for the simulation of the AP chest and AP combined chest-abdominal exposures. Equivalent organ dose per unit ESD and energy imparted per unit ESD calculations are presented in tabular form. Combined with ESD measurements, these calculations yield an effective dose of 10.2 ± 3.7 µSv, regardless of sex, and an imparted energy of 18.5 ± 6.7 µJ for the chest radiograph. The corresponding results for the combined chest-abdominal examination are 14.7 ± 7.6 µSv (males)/17.2 ± 7.6 µSv (females) and 29.7 ± 13.2 µJ. The calculated total risk per radiograph was low, ranging between 1.7 and 2.9 per million neonates, per film, and being slightly higher for females. Results of this study are in good agreement with previous studies, especially in view of the diversity met in the calculation methods.

  6. Radiation risk assessment in neonatal radiographic examinations of the chest and abdomen: a clinical and Monte Carlo dosimetry study

    International Nuclear Information System (INIS)

    Makri, T; Yakoumakis, E; Papadopoulou, D; Gialousis, G; Theodoropoulos, V; Sandilos, P; Georgiou, E

    2006-01-01

    Seeking to assess the radiation risk associated with radiological examinations in neonatal intensive care units, thermo-luminescence dosimetry was used for the measurement of entrance surface dose (ESD) in 44 AP chest and 28 AP combined chest-abdominal exposures of a sample of 60 neonates. The mean values of ESD were found to be equal to 44 ± 16 μGy and 43 ± 19 μGy, respectively. The MCNP-4C2 code with a mathematical phantom simulating a neonate and appropriate x-ray energy spectra were employed for the simulation of the AP chest and AP combined chest-abdominal exposures. Equivalent organ dose per unit ESD and energy imparted per unit ESD calculations are presented in tabular form. Combined with ESD measurements, these calculations yield an effective dose of 10.2 ± 3.7 μSv, regardless of sex, and an imparted energy of 18.5 ± 6.7 μJ for the chest radiograph. The corresponding results for the combined chest-abdominal examination are 14.7 ± 7.6 μSv (males)/17.2 ± 7.6 μSv (females) and 29.7 ± 13.2 μJ. The calculated total risk per radiograph was low, ranging between 1.7 and 2.9 per million neonates, per film, and being slightly higher for females. Results of this study are in good agreement with previous studies, especially in view of the diversity met in the calculation methods

  7. High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: Results of a prospective cohort study

    NARCIS (Netherlands)

    Hoogendoorn, W.E.; Bongers, P.M.; Vet, H.C.W. de; Ariëns, G.A.M.; Mechelen, W. van; Bouter, L.M.

    2002-01-01

    Objective: To determine whether physical and psychosocial load at work influence sickness absence due to low back pain. Methods: The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for

  8. High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study

    NARCIS (Netherlands)

    Hoogendoorn, W.E.; Bongers, P.M.; de Vet, H.C.W.; Ariens, G.A.M.; van Mechelen, W.; Bouter, L.M.

    2002-01-01

    Objective: To determine whether physical and psychosocial load at work influence sickness absence due to low back pain. Methods: The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for

  9. High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain : results of a prospective cohort study

    NARCIS (Netherlands)

    Hoogendoorn, W E; Bongers, P M; de Vet, H C W; Ariëns, G A M; van Mechelen, W; Bouter, L M

    OBJECTIVE: To determine whether physical and psychosocial load at work influence sickness absence due to low back pain. METHODS: The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for

  10. Developing risk factors for post traumatic empyema in patients with chest trauma

    Institute of Scientific and Technical Information of China (English)

    Mara del Pilar Quiroga; Jos Daniel Charry; Nicols Becerra; Juan Camilo Garcia; Eliana Karina Muoz; Rodrigo Lara

    2015-01-01

    Objective:To establish the risk factors associated to development of empyema posttraumatic in patients with chest trauma managed with closed thoracostomy. Methods: It was a descriptive and observational study of patients with chest trauma who were admitted between January 2013 and May 2014. The variables were evaluated and the results according to management with closed thoracostomy in patients with thoracic trauma was determined. Univariate analysis was performed and measures of central tendency were calculated. Results: In total 240 patients were analyzed. Among them, 10.4% (25) developed posttraumatic empyema. In patients who developed empyema, the mean age was 34.2 years, and the mean injury severity score was 20.6. It was identified as a risk factor closed chest trauma in 68%(17) and 84%coagulated hemothorax trauma. Empyema management thoracoscopy was in 100%of cases. Conclusions: The posttraumatic empyema is a complication that occurs in patients with thoracic trauma. One of the most important risk factors is coagulated hemothorax which could be identified and treated in time to avoid comorbidities during hospital stay.

  11. specific low back pain

    African Journals Online (AJOL)

    2015-09-01

    Sep 1, 2015 ... SPECIFIC LOW BACK PAIN: IMPLICATION FOR DIRECT HEALTH. CARE COST ... abundant evidence suggesting the benefits of therapeu- tic exercise on pain and ... Exercise and behavioural therapies in chronic pain. 174.

  12. Behavioural treatment for chronic low-back pain.

    Science.gov (United States)

    Henschke, Nicholas; Ostelo, Raymond Wjg; van Tulder, Maurits W; Vlaeyen, Johan Ws; Morley, Stephen; Assendelft, Willem Jj; Main, Chris J

    2010-07-07

    Behavioural treatment is commonly used in the management of chronic low-back pain (CLBP) to reduce disability through modification of maladaptive pain behaviours and cognitive processes. Three behavioural approaches are generally distinguished: operant, cognitive, and respondent; but are often combined as a treatment package. To determine the effects of behavioural therapy for CLBP and the most effective behavioural approach. The Cochrane Back Review Group Trials Register, CENTRAL, MEDLINE, EMBASE, and PsycINFO were searched up to February 2009. Reference lists and citations of identified trials and relevant systematic reviews were screened. Randomised trials on behavioural treatments for non-specific CLBP were included. Two review authors independently assessed the risk of bias in each study and extracted the data. If sufficient homogeneity existed among studies in the pre-defined comparisons, a meta-analysis was performed. We determined the quality of the evidence for each comparison with the GRADE approach. We included 30 randomised trials (3438 participants) in this review, up 11 from the previous version. Fourteen trials (47%) had low risk of bias. For most comparisons, there was only low or very low quality evidence to support the results. There was moderate quality evidence that:i) operant therapy was more effective than waiting list (SMD -0.43; 95%CI -0.75 to -0.11) for short-term pain relief;ii) little or no difference exists between operant, cognitive, or combined behavioural therapy for short- to intermediate-term pain relief;iii) behavioural treatment was more effective than usual care for short-term pain relief (MD -5.18; 95%CI -9.79 to -0.57), but there were no differences in the intermediate- to long-term, or on functional status;iv) there was little or no difference between behavioural treatment and group exercise for pain relief or depressive symptoms over the intermediate- to long-term;v) adding behavioural therapy to inpatient rehabilitation was

  13. Low back pain among school teachers in Botswana, prevalence and risk factors.

    Science.gov (United States)

    Erick, Patience N; Smith, Derek R

    2014-10-30

    Although low back pain (LBP) represents a common occupational problem, few epidemiological studies have investigated the prevalence and risk factors for LBP among school teachers, particularly in Africa. School teachers are known to represent an occupational group among which there appears to be a high prevalence of LBP. The objective of this study was, therefore, to conduct one of the first epidemiological investigations of LBP among teachers in Botswana. A cross-sectional study was conducted among teachers in Botswana using self-administered questionnaires which were distributed to 3100 randomly selected school teachers and collected over a five-month period between July and November 2012. The questionnaire included low back pain information, demographic data, lifestyle, work-related characteristics and psychosocial factors. Data were analysed using Chi-squared and logistic regression models. The 12 month prevalence and LBP disability and associated risk factors were also analysed. A total of 1747 teachers returned completed questionnaires, yielding a response rate of 56.3%. The 12-month prevalence of LBP was 55.7%, with 67.1% of them reporting minimal disability. The results of logistic regression analysis revealed that female gender [OR: 1.51, 95% CI: 1.14-2.00] and previous back injury [OR: 9.67, 95% CI: 4.94-18.93] were positively correlated to LBP. Awkward arm position [OR: 1.81, 95% CI: 1.24-2.62] and high psychological job demands [OR: 1.40, 95% CI: 1.02-1.93] were also significantly associated with LBP. Regular physical exercise was negatively associated with LBP [OR: 0.63, 95% CI: 0.43-0.93]. Female gender [OR: 2.67, 95% CI: 1.52-3.99] and previous back injury [OR: 3.01, 95% CI: 1.92-4.74] were also positively associated with LBP disability. The prevalence of LBP appears to be high among school teachers in Botswana. A wide variety of LBP risk factors were identified in this study. Female gender and previous injury were both associated with LBP presence

  14. Making Sense of Low Back Pain and Pain-Related Fear.

    Science.gov (United States)

    Bunzli, Samantha; Smith, Anne; Schütze, Robert; Lin, Ivan; O'Sullivan, Peter

    2017-09-01

    Synopsis Pain-related fear is implicated in the transition from acute to chronic low back pain and the persistence of disabling low back pain, making it a key target for physical therapy intervention. The current understanding of pain-related fear is that it is a psychopathological problem, whereby people who catastrophize about the meaning of pain become trapped in a vicious cycle of avoidance behavior, pain, and disability, as recognized in the fear-avoidance model. However, there is evidence that pain-related fear can also be seen as a common-sense response to deal with low back pain, for example, when one is told that one's back is vulnerable, degenerating, or damaged. In this instance, avoidance is a common-sense response to protect a "damaged" back. While the fear-avoidance model proposes that when someone first develops low back pain, the confrontation of normal activity in the absence of catastrophizing leads to recovery, the pathway to recovery for individuals trapped in the fear-avoidance cycle is less clear. Understanding pain-related fear from a common-sense perspective enables physical therapists to offer individuals with low back pain and high fear a pathway to recovery by altering how they make sense of their pain. Drawing on a body of published work exploring the lived experience of pain-related fear in people with low back pain, this clinical commentary illustrates how Leventhal's common-sense model may assist physical therapists to understand the broader sense-making processes involved in the fear-avoidance cycle, and how they can be altered to facilitate fear reduction by applying strategies established in the behavioral medicine literature. J Orthop Sports Phys Ther 2017;47(9):628-636. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7434.

  15. 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

  16. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review

    DEFF Research Database (Denmark)

    Bartels, Mette Damkjær; Nielsen, PE; Sleight, P

    2006-01-01

    Prompted by a case where a patient (with no risk factors, and single vessel disease) developed angina pectoris after previous blunt chest trauma, we searched Medline for blunt chest trauma and myocardial ischaemia. We found 77 cases describing AMI after blunt chest trauma, but only one reporting...... angina pectoris. We focused on the age and sex distribution, type of trauma, the angiography findings and the time interval between the trauma and the angiography. The age distribution was atypical, compared to AMI in general; 82% of the patients with AMI after blunt chest trauma were less than 45 years......, which strongly suggested a causal relation between the trauma and subsequent occlusion. AMI should therefore be considered in patients suffering from chest pain after blunt chest trauma. Because traumatic AMI might often be the result of an intimal tear or dissection, thrombolytic therapy might worsen...

  17. Neuropathic low back pain in clinical practice.

    Science.gov (United States)

    Baron, R; Binder, A; Attal, N; Casale, R; Dickenson, A H; Treede, R-D

    2016-07-01

    Low back pain (LBP) is one of the most common chronic pain conditions. This paper reviews the available literature on the role of neuropathic mechanisms in chronic LBP and discusses implications for its clinical management, with a particular focus on pharmacological treatments. Literature searches were performed in PubMed, key pain congresses and ProQuest Dialog to identify published evidence on neuropathic back pain and its management. All titles were assessed for relevant literature. Chronic LBP comprises both nociceptive and neuropathic components, however, the neuropathic component appears under-recognized and undertreated. Neuropathic pain (NP) is challenging to manage. Many patients with chronic LBP have pain that is refractory to existing treatments. Typically, less than half of patients experience clinically meaningful analgesia with oral pharmacotherapies; these are also associated with risks of adverse effects. Paracetamol and NSAIDs, although widely used for LBP, are unlikely to ameliorate the neuropathic component and data on the use of NP medications such as antidepressants and gabapentin/pregabalin are limited. While there is an unmet need for improved treatment options, recent data have shown tapentadol to have efficacy in the neuropathic component of LBP, and studies suggest that the capsaicin 8% patch and lidocaine 5% medicated plaster, topical analgesics available for the treatment of peripheral NP, may be a valuable additional approach for the management of neuropathic LBP. Chronic LBP often has an under-recognized neuropathic component, which can be challenging to manage, and requires improved understanding and better diagnosis and treatment. WHAT DOES THIS REVIEW ADD?: Increased recognition and improved understanding of the neuropathic component of low back pain raises the potential for the development of mechanism-based therapies. Open and retrospective studies suggest that agents like tapentadol and topical analgesics - such as the capsaicin

  18. Coronary artery dissection following chest trauma

    Directory of Open Access Journals (Sweden)

    Manoj K Agarwala

    2016-01-01

    Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

  19. Patient Nonadherence to Guideline-Recommended Care in Acute Low Back Pain.

    Science.gov (United States)

    Bier, Jasper D; Kamper, Steven J; Verhagen, Arianne P; Maher, Christopher G; Williams, Christopher M

    2017-12-01

    To describe the magnitude of patient-reported nonadherence with guideline-recommended care for acute low back pain. Secondary analysis of data from participants enrolled in the Paracetamol for Acute Low Back Pain study trial, a randomized controlled trial evaluating the effectiveness of paracetamol for acute low back pain. Primary care, general practitioner. Data from participants with acute low back pain (N=1643). Guideline-recommended care, including reassurance, simple analgesia, and the advice to stay active and avoid bed rest. Also, advice against additional treatments and referral for imaging. Proportion of nonadherence with guideline-recommended care. Nonadherence was defined as (1) failure to consume the advised paracetamol dose, or (2) receipt of additional health care, tests, or medication during the trial treatment period (4wk). Multivariable logistic regression analysis was performed to determine the factors associated with nonadherence. In the first week of treatment, 39.7% of participants were classified as nonadherent. Over the 4-week treatment period, 70.0% were nonadherent, and 57.5% did not complete the advised paracetamol regimen. Higher perceived risk of persistent pain, lower level of disability, and not claiming workers' compensation were associated with nonadherence, with odds ratios ranging from .46 to 1.05. Adherence to guideline-recommended care for acute low back pain was poor. Most participants do not complete the advised paracetamol regimen. Higher perceived risk of persistence of complaints, lower baseline disability, and participants not claiming workers' compensation were independently associated with nonadherence. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. Whole-Body Vibrations Associated With Alpine Skiing: A Risk Factor for Low Back Pain?

    Directory of Open Access Journals (Sweden)

    Matej Supej

    2018-03-01

    Full Text Available Alpine skiing, both recreational and competitive, is associated with high rates of injury. Numerous studies have shown that occupational exposure to whole-body vibrations is strongly related to lower back pain and some suggest that, in particular, vibrations of lower frequencies could lead to overuse injuries of the back in connection with alpine ski racing. However, it is not yet known which forms of skiing involve stronger vibrations and whether these exceed safety thresholds set by existing standards and directives. Therefore, this study was designed to examine whole-body vibrations connected with different types of skiing and the associated potential risk of developing low back pain. Eight highly skilled ski instructors, all former competitive ski racers and equipped with five accelerometers and a Global Satellite Navigation System to measure vibrations and speed, respectively, performed six different forms of skiing: straight running, plowing, snow-plow swinging, basic swinging, short swinging, and carved turns. To estimate exposure to periodic, random and transient vibrations the power spectrum density (PSD and standard ISO 2631-1:1997 parameters [i.e., the weighted root-mean-square acceleration (RMS, crest factor, maximum transient vibration value and the fourth-power vibration dose value (VDV] were calculated. Ground reaction forces were estimated from data provided by accelerometers attached to the pelvis. The major novel findings were that all of the forms of skiing tested produced whole-body vibrations, with highest PSD values of 1.5–8 Hz. Intensified PSD between 8.5 and 35 Hz was observed only when skidding was involved. The RMS values for 10 min of short swinging or carved turns, as well as all 10-min equivalent VDV values exceeded the limits set by European Directive 2002/44/EC for health and safety. Thus, whole-body vibrations, particularly in connection with high ground reaction forces, contribute to a high risk for low back

  1. Automated aortic calcium scoring on low-dose chest computed tomography

    International Nuclear Information System (INIS)

    Isgum, Ivana; Rutten, Annemarieke; Prokop, Mathias; Staring, Marius; Klein, Stefan; Pluim, Josien P. W.; Viergever, Max A.; Ginneken, Bram van

    2010-01-01

    Purpose: Thoracic computed tomography (CT) scans provide information about cardiovascular risk status. These scans are non-ECG synchronized, thus precise quantification of coronary calcifications is difficult. Aortic calcium scoring is less sensitive to cardiac motion, so it is an alternative to coronary calcium scoring as an indicator of cardiovascular risk. The authors developed and evaluated a computer-aided system for automatic detection and quantification of aortic calcifications in low-dose noncontrast-enhanced chest CT. Methods: The system was trained and tested on scans from participants of a lung cancer screening trial. A total of 433 low-dose, non-ECG-synchronized, noncontrast-enhanced 16 detector row examinations of the chest was randomly divided into 340 training and 93 test data sets. A first observer manually identified aortic calcifications on training and test scans. A second observer did the same on the test scans only. First, a multiatlas-based segmentation method was developed to delineate the aorta. Segmented volume was thresholded and potential calcifications (candidate objects) were extracted by three-dimensional connected component labeling. Due to image resolution and noise, in rare cases extracted candidate objects were connected to the spine. They were separated into a part outside and parts inside the aorta, and only the latter was further analyzed. All candidate objects were represented by 63 features describing their size, position, and texture. Subsequently, a two-stage classification with a selection of features and k-nearest neighbor classifiers was performed. Based on the detected aortic calcifications, total calcium volume score was determined for each subject. Results: The computer system correctly detected, on the average, 945 mm 3 out of 965 mm 3 (97.9%) calcified plaque volume in the aorta with an average of 64 mm 3 of false positive volume per scan. Spearman rank correlation coefficient was ρ=0.960 between the system and the

  2. Botulinum toxin injections for low-back pain and sciatica.

    Science.gov (United States)

    Waseem, Zeeshan; Boulias, Chris; Gordon, Allan; Ismail, Farooq; Sheean, Geoffrey; Furlan, Andrea D

    2011-01-19

    Adequate relief from low-back pain (LBP) is not always possible. Emerging evidence suggests a role for botulinum neurotoxin (BoNT) injections in treating pain disorders. Proponents of BoNT suggest its properties can decrease muscle spasms, ischemia and inflammatory markers, thereby reducing pain. To determine the effects of botulinum toxin injections in adults with LBP. We searched CENTRAL (The Cochrane Library 2009, issue 3) and MEDLINE, EMBASE, and CINAHL to August 2009; screened references from included studies; consulted with content experts and Allergan. We included published and unpublished randomised controlled trials without language restrictions We included randomised trials that evaluated BoNT serotypes versus other treatments in patients with non-specific LBP of any duration. Two review authors selected the studies, assessed the risk of bias using the Cochrane Back Review Group criteria, and extracted the data using standardized forms. We performed a qualitative analysis due to lack of data. We excluded evidence from nineteen studies due to non-randomisation, incomplete or unpublished data. We included three randomised trials (N =123 patients). Only one study included patients with chronic non-specific LBP; the other two examined unique subpopulations. Only one of the three trials had a low risk of bias and demonstrated that BoNT injections reduced pain at three and eight weeks and improved function at eight weeks better than saline injections. The second trial showed that BoNT injections were better than injections of corticosteroid plus lidocaine or placebo in patients with sciatica attributed to piriformis syndrome. The third trial concluded that BoNT injections were better than traditional acupuncture in patients with third lumbar transverse process syndrome. Both studies with high risk of bias had several key limitations. Heterogeneity of the studies prevented meta-analysis. There is low quality evidence that BoNT injections improved pain, function

  3. 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.

  4. Comparison of chest radiography, chest digital tomosynthesis and low dose MDCT to detect small ground-glass opacity nodules: an anthropomorphic chest phantom study

    International Nuclear Information System (INIS)

    Doo, Kyung Won; Kang, Eun-Young; Yong, Hwan Seok; Ham, Soo-Youn; Lee, Ki Yeol; Choo, Ji Yung

    2014-01-01

    The purpose of this study was to evaluate the diagnostic performance of chest radiography (CXR), chest digital tomosynthesis (DT) and low dose multidetector computed tomography (LDCT) for the detection of small pulmonary ground-glass opacity (GGO) nodules, using an anthropomorphic chest phantom. Artificial pulmonary nodules were placed in a phantom and a total of 40 samples of different nodule settings underwent CXR, DT and LDCT. The images were randomly read by three experienced chest radiologists. Free-response receiver-operating characteristics (FROC) were used. The figures of merit for the FROC curves averaged for the three observers were 0.41, 0.37 and 0.76 for CXR, DT and LDCT, respectively. FROC analyses revealed significantly better performance of LDCT over CXR or DT for the detection of GGO nodules (P < 0.05). The difference in detectability between CXR and DT was not statistically significant (P = 0.73). The diagnostic performance of DT for the detection of pulmonary small GGO nodules was not significantly different from that of CXR, but LDCT performed significantly better than both CXR and DT. DT is not a suitable alternative to CT for small GGO nodule detection, and LDCT remains the method of choice for this purpose. (orig.)

  5. Comparison of chest radiography, chest digital tomosynthesis and low dose MDCT to detect small ground-glass opacity nodules: an anthropomorphic chest phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Doo, Kyung Won; Kang, Eun-Young; Yong, Hwan Seok [Korea University Guro Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Ham, Soo-Youn [Korea University Anam Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Lee, Ki Yeol; Choo, Ji Yung [Korea University Ansan Hospital, Korea University College of Medicine, Department of Radiology, Ansan (Korea, Republic of)

    2014-12-15

    The purpose of this study was to evaluate the diagnostic performance of chest radiography (CXR), chest digital tomosynthesis (DT) and low dose multidetector computed tomography (LDCT) for the detection of small pulmonary ground-glass opacity (GGO) nodules, using an anthropomorphic chest phantom. Artificial pulmonary nodules were placed in a phantom and a total of 40 samples of different nodule settings underwent CXR, DT and LDCT. The images were randomly read by three experienced chest radiologists. Free-response receiver-operating characteristics (FROC) were used. The figures of merit for the FROC curves averaged for the three observers were 0.41, 0.37 and 0.76 for CXR, DT and LDCT, respectively. FROC analyses revealed significantly better performance of LDCT over CXR or DT for the detection of GGO nodules (P < 0.05). The difference in detectability between CXR and DT was not statistically significant (P = 0.73). The diagnostic performance of DT for the detection of pulmonary small GGO nodules was not significantly different from that of CXR, but LDCT performed significantly better than both CXR and DT. DT is not a suitable alternative to CT for small GGO nodule detection, and LDCT remains the method of choice for this purpose. (orig.)

  6. Low-Back Pain Patients Learn to Adapt Motor Behavior with Adverse Secondary Consequences

    NARCIS (Netherlands)

    van Dieën, Jaap H.; Flor, Herta; Hodges, Paul W.

    2017-01-01

    ABSTRACT: We hypothesize that changes in motor behavior in individuals with low-back pain are adaptations aimed at minimizing the real or perceived risk of further pain. Through reinforcement learning, pain and subsequent adaptions result in less dynamic motor behavior, leading to increased loading

  7. An empirical assessment of boarding and quality of care: delays in care among chest pain, pneumonia, and cellulitis patients.

    Science.gov (United States)

    Liu, Shan W; Chang, Yuchiao; Weissman, Joel S; Griffey, Richard T; Thomas, James; Nergui, Suvd; Hamedani, Azita G; Camargo, Carlos A; Singer, Sara

    2011-12-01

    As hospital crowding has increased, more patients have ended up boarding in the emergency department (ED) awaiting their inpatient beds. To the best of our knowledge, no study has compared the quality of care of boarded and nonboarded patients. This study sought to examine whether being a boarded patient and boarding longer were associated with more delays, medication errors, and adverse events among ED patients admitted with chest pain, pneumonia, or cellulitis. This study was a retrospective cohort design in which data collection was accomplished via medical record review from two urban teaching hospitals. Patients admitted with chest pain, pneumonia, or cellulitis between August 2004 and January 2005 were eligible for inclusion. Our outcomes measures were: 1) delays in administration of home medications, cardiac enzyme tests, partial thromboplastin time (PTT), and antibiotics; 2) medication errors; and 3) adverse events or near misses. Primary independent variables were boarded status, boarding time, and boarded time interval. Multiple logistic regression models controlling for patient, ED, and hospital characteristics were used. A total of 1,431 patient charts were included: 811 with chest pain, 387 with pneumonia, and 233 with cellulitis. Boarding time was associated with an increased odds of home medication delays (adjusted odds ratio [AOR] = 1.07, 95% confidence interval [CI] = 1.05 to 1.10), as were boarded time intervals of 12, 18, and 24 hours. Boarding time also was associated with lower odds of having a late cardiac enzyme test (AOR = 0.93, 95% CI = 0.88 to 0.97). Boarding was associated with home medication delays, but fewer cardiac enzyme test delays. Boarding was not associated with delayed PTT checks, antibiotic administration, medication errors, or adverse events/near misses. These findings likely reflect the inherent resources of the ED and the inpatient units. © 2011 by the Society for Academic Emergency Medicine.

  8. Differences in Pain Processing Between Patients with Chronic Low Back Pain, Recurrent Low Back Pain, and Fibromyalgia.

    Science.gov (United States)

    Goubert, Dorien; Danneels, Lieven; Graven-Nielsen, Thomas; Descheemaeker, Filip; Meeus, Mira

    2017-05-01

    The impairment in musculoskeletal structures in patients with low back pain (LBP) is often disproportionate to their complaint. Therefore, the need arises for exploration of alternative mechanisms contributing to the origin and maintenance of non-specific LBP. The recent focus has been on central nervous system phenomena in LBP and the pathophysiological mechanisms underlying the various symptoms and characteristics of chronic pain. Knowledge concerning changes in pain processing in LBP remains ambiguous, partly due to the diversity in the LBP population. The purpose of this study is to compare quantitative sensory assessment in different groups of LBP patients with regard to chronicity. Recurrent low back pain (RLBP), mild chronic low back pain (CLBP), and severe CLBP are compared on the one hand with healthy controls (HC), and on the other hand with fibromyalgia (FM) patients, in which abnormal pain processing has previously been reported. Cross-sectional study. Department of Rehabilitation Sciences, Ghent University, Belgium. Twenty-three RLBP, 15 mild CLBP, 16 severe CLBP, 26 FM, and 21 HC participated in this study. Quantitative sensory testing was conducted by manual pressure algometry and computer-controlled cuff algometry. A manual algometer was used to evaluate hyperalgesia as well as temporal summation of pain and a cuff algometer was used to evaluate deep tissue hyperalgesia, the efficacy of the conditioned pain modulation and spatial summation of pain. Pressure pain thresholds by manual algometry were significantly lower in FM compared to HC, RLBP, and severe CLBP. Temporal summation of pain was significantly higher in FM compared to HC and RLBP. Pain tolerance thresholds assessed by cuff algometry were significantly lower in FM compared to HC and RLBP and also in severe CLBP compared to RLBP. No significant differences between groups were found for spatial summation or conditioned pain modulation. No psychosocial issues were taken into account for this

  9. Are low back pain and low physical capacity risk indicators for dropout among recently qualified eldercare workers? A follow-up study.

    Science.gov (United States)

    Faber, Anne; Giver, Hanne; Strøyer, Jesper; Hannerz, Harald

    2010-12-01

    A high job turnover and dropout among eldercare workers has led to a significant shortage of qualified manpower in the Danish eldercare sector. The predictive effect of some non-work-related causes for leaving the eldercare sector 2 years after qualification, physical capacity, duration, and severity of previous low back pain, was investigated. A 2-year prospective cohort study of all the Danish eldercare workers, who finished their education during 2004 (n = 6347). Questionnaire data from 2004 were followed up by register data on attachment to labour market, educational status, and association to trade from Statistics Denmark in 2006. Data on physical capacity, duration, and severity of low back pain the last 12 months among the female participants were analysed by multinomial logistic regression to estimate odds-ratios for being either in the eldercare sector, in other health- and welfare sectors, in all other sectors, under education, or outside labour market, 2 years after qualification. Disability due to and duration of low back pain were significant predictors for dropout from the eldercare sector 2 years after qualification. Low physical capacity was not. Data on duration of low back pain suggest a trend towards a dose-response relationship: The longer the duration of low back pain, the higher odds for dropout. Low back pain and disability due to low back pain during the last year of education were independent predictors for dropout from the eldercare sector 2 years after qualification. However, low self-rated physical capacity did not predict job dropout or turnover.

  10. Prevalence of esophageal disorders in patients with recurrent chest pain.

    Science.gov (United States)

    Manterola, C; Barroso, M S; Losada, H; Muñoz, S; Vial, M

    2004-01-01

    The objective of this study is to determine the prevalence of esophageal disorders (ED) associated with recurrent chest pain (RCP) and the utility of esophageal functional tests (EFT) in the study of these patients. The cross-sectional study was conducted at Hospital Clínico de La Frontera, Chile. One hundred and twenty-three patients with RCP were studied using esophageal manometry, edrophonium stimulation and 24-h pH monitoring. The performance of EFT was considered acceptable when they were capable of finding ED. To state the probability that RCP had an esophageal origin, patients were classified according to whether their pain had a probable, possible or unlikely esophageal origin. The prevalence of ED was determined according to diagnoses obtained after applying EFT and a multivariate analysis was performed to examine the association between the esophageal origin of RCP and ED. Rates of correct diagnosis of 65.9%, 56.9% and 31.7% was verified for 24-h pH monitoring, esophageal manometry and edrophonium stimulation, respectively. In 38.2% of patients with RCP, the pain was probably of esophageal origin, in 42.3% there was a possible esophageal origin and in 19.5% an unlikely esophageal origin. A 44.7% prevalence of GERD, 26.8% of GERD with secondary esophageal motor dysfunction and 8.9% of pure esophageal motor dysfunction were verified. The multivariate analysis allowed us to verify the association between the probability of esophageal origin of RCP, the variables RCP duration, esophagitis and dysphagia coexistence (P= 0.037, P= 0.030 and P= 0.024, respectively), and a statistically significant association between ED and dysphagia coexistence (P= 0.028). A high prevalence of ED was identified in patients with RCP.

  11. Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax.

    Science.gov (United States)

    Kulvatunyou, N; Erickson, L; Vijayasekaran, A; Gries, L; Joseph, B; Friese, R F; O'Keeffe, T; Tang, A L; Wynne, J L; Rhee, P

    2014-01-01

    Small pigtail catheters appear to work as well as the traditional large-bore chest tubes in patients with traumatic pneumothorax, but it is not known whether the smaller pigtail catheters are associated with less tube-site pain. This study was conducted to compare tube-site pain following pigtail catheter or chest tube insertion in patients with uncomplicated traumatic pneumothorax. This prospective randomized trial compared 14-Fr pigtail catheters and 28-Fr chest tubes in patients with traumatic pneumothorax presenting to a level I trauma centre from July 2010 to February 2012. Patients who required emergency tube placement, those who refused and those who could not respond to pain assessment were excluded. Primary outcomes were tube-site pain, as assessed by a numerical rating scale, and total pain medication use. Secondary outcomes included the success rate of pneumothorax resolution and insertion-related complications. Forty patients were enrolled. Baseline characteristics of 20 patients in the pigtail catheter group were similar to those of 20 patients in the chest tube group. No patient had a flail chest or haemothorax. Pain scores related to chest wall trauma were similar in the two groups. Patients with a pigtail catheter had significantly lower mean(s.d.) tube-site pain scores than those with a chest tube, at baseline after tube insertion (3.2(0.6) versus 7.7(0.6); P pneumothorax, use of a 14-Fr pigtail catheter is associated with reduced pain at the site of insertion, with no other clinically important differences noted compared with chest tubes. NCT01537289 (http://clinicaltrials.gov). © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  12. Risk Perception of Nonspecific Low Back Pain among Nurses: A Qualitative Approach

    Directory of Open Access Journals (Sweden)

    Sedigheh Abedini

    2014-12-01

    Full Text Available Background:Low back pain (LBP is a common medical problem among nurses. A better understanding of nurses’ experiences about LBP may help to develop preventative approaches. The study aimed to explore risk perceptions of nonspecific LBP among nurses in Bandar Abbas City, southern Iran. Methods: This qualitative study conducted as directed content analysis in 2013. Private semi-structured interviews were conducted with a convenience sample of 30 nurses with minimum of 1-year working experience in hospital. The interview questions were based on perceived severity and vulnerability structures of Protection Motivation Theory. All interviews were transcribed and analyzed using thematic analysis. Results: Perceived Severity had the following sub-themes: developing disorders in one’s own life and profession, psychical and mental consequences, conflicts and problems in family life, and financial problems. Two sub-themes (problems and limitations in hospital’s working system, nature of nursing profession were identified in relation to perceived vulnerability. Conclusion: Nurses reflected their concerns about the impact of LBP on their job security and their considerations about how their back pain might be interpreted by their employers and co-workers. Importance of transparent medical diagnostic procedure and clinical evidence to justify degree of LBP and its burden on the nurses’ performance was also addressed.

  13. Yoga Treatment for Chronic Non-Specific Low Back Pain (2017).

    Science.gov (United States)

    Whitehead, Alison; Gould Fogerite, Susan

    Wieland LS, Skoetz N, Pilkington K, Vempati R, D׳Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain.Cochrane Database Syst Rev2017, Issue 1. Art. No.: CD010671. DOI: 10.1002/14651858.CD010671.pub2. Non-specific low back pain is a common, potentially disabling condition usually treated with self-care and non-prescription medication. For chronic low back pain, current guidelines state that exercise therapy may be beneficial. Yoga is a mind-body exercise sometimes used for non-specific low back pain. To assess the effects of yoga for treating chronic non-specific low back pain, compared to no specific treatment, a minimal intervention (e.g., education), or another active treatment, with a focus on pain, function, and adverse events. We searched CENTRAL, MEDLINE, Embase, five other databases, and four trials registers to 11 March 2016 without restriction of language or publication status. We screened reference lists and contacted experts in the field to identify additional studies. We included randomized controlled trials of yoga treatment in people with chronic non-specific low back pain. We included studies comparing yoga to any other intervention or to no intervention. We also included studies comparing yoga as an adjunct to other therapies, versus those other therapies alone. Two authors independently screened and selected studies, extracted outcome data, and assessed risk of bias. We contacted study authors to obtain missing or unclear information. We evaluated the overall certainty of evidence using the GRADE approach. We included 12 trials (1080 participants) carried out in the USA (seven trials), India (three trials), and the UK (two trials). Studies were unfunded (one trial), funded by a yoga institution (one trial), funded by non-profit or government sources (seven trials), or did not report on funding (three trials). Most trials used Iyengar, Hatha, or Viniyoga forms of yoga. The trials compared yoga to no intervention or a non

  14. Cardiointegram: detection of coronary artery disease in males with chest pain and a normal resting electrocardiogram

    International Nuclear Information System (INIS)

    Teichholz, L.E.; Steinmetz, M.Y.; Escher, D.; Herman, M.V.; Naimi, S.; Mahony, D.V.; Ellestad, M.H.

    1986-01-01

    The cardiointegram is a non-invasive technique for the analysis of the electrical signals of the heart obtained by a transformation of the voltage vs. time format by a series of integrations. This multicenter study compares the results of the cardiointegram with coronary arteriography in 140 male patients with chest pain and a normal resting electrocardiogram. The cardiointegram was determined on two resting complexes of Leads I, II, V4, V5 and V6 and called abnormal if greater than or equal to four of ten complexes were abnormal, i.e., fell outside of a previously determined template of normality. The sensitivity was 73% and specificity was 78% for the diagnosis of occlusive coronary artery disease. When greater than or equal to five of ten abnormal complexes were used as the cut-off for an abnormal test and ''equivocal'' results (four of ten abnormal, n = 18) were excluded from analysis there was a sensitivity of 69% and specificity of 88%. Thirty-seven of 38 patients (97%) with an abnormal cardiointegram and a positive exercise stress test had coronary artery disease. Thus, the cardiointegram appears to be a useful non-invasive test for the detection of coronary artery disease in males with chest pain and a normal resting electrocardiogram in whom the diagnosis of coronary artery disease is being considered

  15. Neurophysiological Pain-education for Patients with Chronic Low Back Pain - A Systematic Review and Meta-analysis

    DEFF Research Database (Denmark)

    Tegner, Heidi; Frederiksen, Pernille; Esbensen, Bente Appel

    2018-01-01

    OBJECTIVE: To evaluate the effect of Neurophysiological Pain-Education (NPE) for patients with Chronic Low Back Pain (CLBP). METHODS: A systematic search was performed in six electronic databases. Eligible RCTs were those with at least 50 % of patients with CLBP and in which NPE was compared...... with no intervention or usual care. Methodological quality was assessed independently by two of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability and behavioral attitudes. Effect was estimated as weighted mean...

  16. Acute non-specific low back pain in primary care

    African Journals Online (AJOL)

    Treatment of non-specific low back pain typically results in a significant improvement ... and the potential benefits and risks associated with drug treatment, have been ... South African Family Practice 2014; 56(6):10-14. Open Access article ...

  17. Pain-to-hospital times, cardiovascular risk factors, and early intrahospital mortality in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Brković E

    2015-02-01

    Full Text Available Eliana Brković,1 Katarina Novak,2,3 Livia Puljak3 1Department of Psychiatry, 2Department of Internal Medicine, Division of Cardiology, 3Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Background: The aim of the study was to analyze the most recent trends in myocardial infarction (MI care, the number of patients treated for MI and their outcomes, cardiovascular disease risk factors, and pain-to-hospital times in MI patients. Subjects and methods: For 778 patients treated for acute MI at the Coronary Care Unit (CCU of University Hospital Split, Croatia the following data were acquired: outcome during hospitalization (survived, deceased, cardiovascular risk factors (hypertension, diabetes, dyslipidemia, previous MI, smoking, and pain-to-CCU time. Results: Among 778 patients treated for acute MI, there were 291 (37% women and 487 (63% men. Forty-five patients (6% died during hospitalization, mostly due to cardiogenic shock. An association was found between early intrahospital mortality and the following risk factors: age >70 years, female sex, previous MI, and smoking. Median pain-to-call time was 2 hours, and median time from the onset of pain to arrival into the CCU was 4 hours. There were 59 (7.6% patients admitted to the CCU within recommended 90 minutes. Diabetic comorbidity was not associated with early death or with longer time from pain to emergency calls. Conclusion: Some of the risk factors associated with adverse outcomes in MI are modifiable. Prehospital delay of 4 hours observed in patients who suffered an MI is too long, and more effort should be devoted to investments in health care and education of the general public regarding chest pain symptoms. Keywords: prehospital delay, ischemic heart disease

  18. Assessment of coronary flow reserve by sestamibi imaging in patients with typical chest pain and normal coronary arteries

    Energy Technology Data Exchange (ETDEWEB)

    Storto, Giovanni; Sorrentino, Anna R.; Pellegrino, Teresa; Liuzzi, Raffaele; Cuocolo, Alberto [University Federico II, Department of Biomorphological and Functional Sciences, Institute of Biostructures and Bioimages of the National Council of Research, Naples (Italy); Petretta, Mario [University Federico II, Department of Internal Medicine, Cardiovascular and Immunological Sciences, Naples (Italy)

    2007-08-15

    We assessed coronary flow reserve (CFR) by sestamibi imaging in patients with typical chest pain, positive exercise stress test and normal coronary vessels. Thirty-five patients with typical chest pain and normal angiogram and 12 control subjects with atypical chest pain underwent dipyridamole/rest {sup 99m}Tc-sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress to rest MBF. Rest MBF and CFR were corrected for rate-pressure product (RPP) and expressed as normalised MBF (MBF{sub n}) and normalised CFR (CFR{sub n}). Coronary vascular resistances (CVR) were calculated as the ratio between mean arterial pressure and estimated MBF. At rest, estimated MBF and MBF{sub n} were lower in controls than in patients (0.98 {+-} 0.4 vs 1.30 {+-} 0.3 counts/pixel/s and 1.14 {+-} 0.5 vs 1.64 {+-} 0.6 counts/pixel/s, respectively, both p < 0.02). Stress MBF was not different between controls and patients (2.34 {+-} 0.8 vs 2.01 {+-} 0.7 counts/pixel/s, p=NS). Estimated CFR was 2.40 {+-} 0.3 in controls and 1.54 {+-} 0.3 in patients (p < 0.0001). After correction for the RPP, CFR{sub n} was still higher in controls than in patients (2.1 {+-} 0.5 vs 1.29 {+-} 0.5, p < 0.0001). At baseline, CVR values were lower (p < 0.01) in patients than in controls. Dipyridamole-induced changes in CVR were greater (p < 0.0001) in controls (-63%) than in patients (-35%). In the overall study population, a significant correlation between dipyridamole-induced changes in CVR and CFR was observed (r = -0.88, p < 0.0001). SPECT might represent a useful non-invasive method for assessing coronary vascular function in patients with angina and a normal coronary angiogram. (orig.)

  19. Prevalence and Risk Factor of Neck Pain in Elderly Korean Community Residents

    Science.gov (United States)

    Son, Kyeong Min; Cho, Nam H.; Lim, Seung Hun

    2013-01-01

    Neck pain is a common musculoskeletal condition, which causes substantial medical cost. In Korea, prevalence of neck pain in community based population, especially in elderly subjects, has scarcely been reported. We evaluated the prevalence, the severity and the risk factors of neck pain in elderly Korean community residents. Data for neck pain were collected for 1,655 subjects from a rural farming community. The point, 6-months and cumulative lifetime prevalence of neck pain was obtained in addition to the measurement of the severity of neck pain. The mean age of the study subjects was 61 yr and 57% were females. The lifetime prevalence of neck pain was 20.8% with women having a higher prevalence. The prevalence did not increase with age, and the majority of individuals had low-intensity/low-disability pain. Subjects with neck pain had a significantly worse SF-12 score in all domains except for mental health. The prevalence of neck pain was significantly associated with female gender, obesity and smoking. This is the first large-scale Korean study estimating the prevalence of neck pain in elderly population. Although the majority of individuals had low-intensity/low-disability pain, subjects with neck pain had a significantly worse SF-12 score indicating that neck pain has significant health impact. PMID:23678258

  20. 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.

  1. Predictive risk factors for persistent postherniotomy pain

    DEFF Research Database (Denmark)

    Aasvang, Eske K; Gmaehle, Eliza; Hansen, Jeanette B

    2010-01-01

    BACKGROUND: Persistent postherniotomy pain (PPP) affects everyday activities in 5-10% of patients. Identification of predisposing factors may help to identify the risk groups and guide anesthetic or surgical procedures in reducing risk for PPP. METHODS: A prospective study was conducted in 464...... patients undergoing open or laparoscopic transabdominal preperitoneal elective groin hernia repair. Primary outcome was identification of risk factors for substantial pain-related functional impairment at 6 months postoperatively assessed by the validated Activity Assessment Scale (AAS). Data on potential...... risk factors for PPP were collected preoperatively (pain from the groin hernia, preoperative AAS score, pain from other body regions, and psychometric assessment). Pain scores were collected on days 7 and 30 postoperatively. Sensory functions including pain response to tonic heat stimulation were...

  2. Outpatient Management of Children With World Health Organization Chest Indrawing Pneumonia: Implementation Risks and Proposed Solutions.

    Science.gov (United States)

    McCollum, Eric D; Ginsburg, Amy Sarah

    2017-10-16

    This Viewpoints article details our recommendation for the World Health Organization Integrated Management of Childhood Illness guidelines to consider additional referral or daily monitoring criteria for children with chest indrawing pneumonia in low-resource settings. We review chest indrawing physiology in children and relate this to the risk of adverse pneumonia outcomes. We believe there is sufficient evidence to support referring or daily monitoring of children with chest indrawing pneumonia and signs of severe respiratory distress, oxygen saturation <93% (when not at high altitude), moderate malnutrition, or an unknown human immunodeficiency virus (HIV) status in an HIV-endemic setting. Pulse oximetry screening should be routine and performed at the earliest point in the patient care pathway as possible. If outpatient clinics lack capacity to conduct pulse oximetry, nutritional assessment, or HIV testing, then we recommend considering referral to complete the evaluation. When referral is not possible, careful daily monitoring should be performed. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  3. Spinal Manipulation for Low-Back Pain

    Science.gov (United States)

    ... V W X Y Z Spinal Manipulation for Low-Back Pain Share: On This Page Introduction Key Points About ... will help ensure coordinated and safe care. About Low-Back Pain Back pain is one of the most common ...

  4. Is low back pain in youth associated with weight at birth?

    DEFF Research Database (Denmark)

    Hestbæk, Lise; Leboeuf-Yde, Charlotte; Kyvik, Kirsten Ohm

    2003-01-01

    INTRODUCTION: Low back pain has been associated with an increased risk of several diseases and with poor general health. Also low birth weight has been associated with an increased susceptibility to various diseases as well as with poor general health. Thus, low birth weight could be a common fac...

  5. Cost-effectiveness and radiological risk associated with mass chest screening

    International Nuclear Information System (INIS)

    Stieve, F.E.

    1987-01-01

    This report presents in summary the cost effectiveness and radiological risks associated with mass chest tuberculosis screening in major European countries. The state of tuberculosis in west Europe, the cost effectiveness of mass screening, international standards regarding radiation doses as well as the need for quality control are addressed

  6. Patients with low back pain differ from those who also have leg pain or signs of nerve root involvement

    DEFF Research Database (Denmark)

    Kongsted, Alice; Kent, Peter; Albert, Hanne

    2012-01-01

    ABSTRACT: BACKGROUND: Leg pain associated with low back pain (LBP) is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The location of leg pain relative to the knee and the presence of a positive straight leg raise test have been...... only, 2) LBP and pain above the knee, 3) LBP and pain below the knee, and 4) LBP and signs of nerve root involvement. METHODS: Analysis of routine clinical data from an outpatient department. Based on patient reported data and clinical findings, patients were allocated to the QTF subgroups...

  7. A brief cognitive-behavioral 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.; Voshaar, R. C. Oude; Beek, A. M.; van Zijderveld, G. A.; Visser, S.; Speckens, A. E. M.; Batelaan, N.; van Balkom, A. J. L. M.

    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

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

    NARCIS (Netherlands)

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

    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

  9. 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

  10. Prognosis of acute low back pain: design of a prospective inception cohort study

    Directory of Open Access Journals (Sweden)

    York John

    2006-06-01

    Full Text Available Abstract Background Clinical guidelines generally portray acute low back pain as a benign and self-limiting condition. However, evidence about the clinical course of acute low back pain is contradictory and the risk of subsequently developing chronic low back pain remains uncertain. There are few high quality prognosis studies and none that have measured pain, disability and return to work over a 12 month period. This study aims to provide the first estimates of the one year prognosis of acute low back pain (pain of less than 2 weeks duration in patients consulting primary care practitioners. A secondary aim is to identify factors that are associated with the prognosis of low back pain. Methods/Design The study is a prospective inception cohort study. Consecutive patients consulting general medical practitioners, physiotherapists and chiropractors in the Sydney metropolitan region will complete a baseline questionnaire regarding their back pain. Subsequently these patients will be followed up by telephone 6 weeks, 3 months and 12 months after the initial consultation. Patients will be considered to have recovered from the episode of back pain if they have no pain and no limitation of activity, and have returned to pre-injury work status. Life tables will be generated to determine the one year prognosis of acute low back pain. Prognostic factors will be assessed using Cox regression. Discussion This study will provide the first estimates of the one year prognosis of acute low back pain in a representative sample of primary care patients.

  11. Is objectively measured sitting at work associated with low-back pain?

    DEFF Research Database (Denmark)

    Korshøj, Mette; Hallman, David M; Mathiassen, Svend Erik

    2018-01-01

    Objectives Low-back pain (LBP) is a substantial health challenge due to the risk for long-term sickness absence and early retirement. Several biomechanical exposures at work, including sitting, have been suggested to increase the risk for LBP. The objectives of this study were to determine (i...... and low BMI showing a negative and positive association, respectively. Conclusion Sitting was not independently associated with peak LBP intensity, suggesting other exposures are more powerful risk factors for LBP....

  12. Low vitamin D and the risk of developing chronic widespread pain: results from the European male ageing study.

    Science.gov (United States)

    McCabe, Paul S; Pye, Stephen R; Beth, John Mc; Lee, David M; Tajar, Abdelouahid; Bartfai, Gyorgy; Boonen, Steven; Bouillon, Roger; Casanueva, Felipe; Finn, Joseph D; Forti, Gianni; Giwercman, Aleksander; Huhtaniemi, Ilpo T; Kula, Krzysztof; Pendleton, Neil; Punab, Margus; Vanderschueren, Dirk; Wu, Frederick C; O'Neill, Terence W

    2016-01-16

    The association between low levels of vitamin D and the occurrence of chronic widespread pain (CWP) remains unclear. The aim of our analysis was to determine the relationship between low vitamin D levels and the risk of developing CWP in a population sample of middle age and elderly men. Three thousand three hundred sixty nine men aged 40-79 were recruited from 8 European centres for a longitudinal study of male ageing, the European Male Ageing Study. At baseline participants underwent assessment of lifestyle, health factors, physical characteristics and gave a fasting blood sample. The occurrence of pain was assessed at baseline and follow up (a mean of 4.3 years later) by shading painful sites on a body manikin. The presence of CWP was determined using the ACR criteria for fibromyalgia. Serum 25-hydroxyvitamin D (25-(OH) D) was assessed by radioimmunoassay. Logistic regression was used to determine the relationship between baseline vitamin D levels and the new occurrence of CWP. Two thousand three hundred thirteen men, mean age 58.8 years (SD = 10.6), had complete pain and vitamin data available and contributed to this analysis. 151 (6.5%) developed new CWP at follow up and 577 (24.9%) were pain free at both time points, the comparator group. After adjustment for age and centre, physical performance and number of comorbidities, compared to those in upper quintile of 25-(OH) D ( ≥36.3 ng/mL), those in the lowest quintile (BMI (OR = 1.67; 95% CI = 0.93-3.02) or depression (OR = 1.77; 95% CI = 0.98-3.21), however rendered the association non-significant. Low vitamin D is linked with the new occurrence of CWP, although this may be explained by underlying adverse health factors, particularly obesity and depression.

  13. [Occupational low back pain in nursing workers: massage versus pain].

    Science.gov (United States)

    Borges, Talita Pavarini; Kurebayashi, Leonice Fumiko Sato; Silva, Maria Júlia Paes da

    2014-08-01

    To assess the efficacy of massage for decreasing occupational low back pain in workers of a Nursing team in an Emergency Room. A randomized controlled trial, using a socio-demographic/morbidity questionnaire and a Pain Numeric Scale. Forty-five subjects were randomly allocated for intervention (G1 - Massage by acupressure), placebo group (G2 - application of Garlium Arseneid Laser 904 nm turned off) and control (G3 - no intervention). The main triggering factor, as well as the worsening of pain, was the patient manipulation, both with a prevalence of 34.9%. The main treatment for low back pain before this research was the use of medication, with a prevalence of 44.2%. In accordance with a variance analysis, only G1 presented a significant statistical difference, with a better result after 12 sessions. Massage presented an enormous effect (d = 4.59), corresponding to 86% of reduction in the pain level. Massage was effective to decrease occupational low back pain of those Nursing workers.

  14. Digitizing pediatric chest radiographs: comparison of low-cost, commercial off-the-shelf technologies

    International Nuclear Information System (INIS)

    Ruess, L.; Shiels, K.C.; Cho, K.H.; O'Connor, S.C.; Uyehara, C.F.T.; Person, D.A.; Whitton, R.K.

    2001-01-01

    Objective: To compare low-cost, off-the-shelf technology for digitizing pediatric chest radiographs. Materials and methods: Forty pediatric chest radiographs (hard copy), each with a single abnormality, were digitized using a commercial film digitizer and two low-cost methods: a digital camera and a flatbed scanner. A stratified, randomized, block design was used where 20 readers evaluated 40 different images to determine the ability to accurately detect the abnormality. Readers then rated all 160 images (40 images x 4 methods) for conspicuity of the abnormality and overall image quality. Results: Abnormalities were correctly identified on 82.3 % of hard copy images, 82.9 % of flatbed scanner images, 74.3 % of film digitizer images, and 69.7 % of digital camera images (p flatbed scanner > film digitizer > digital camera images. Conclusion: A low-cost flatbed scanner yielded digital pediatric chest images which were significantly superior to digital camera images While flatbed scanner images were interpreted with the equivalent diagnostic accuracy of hard copy images, they were rated lower for image quality and lesion conspicuity. (orig.)

  15. INCIDENCE AND RISK FACTORS FOR CHRONIC PELVIC PAIN AFTER HYSTEROSCOPIC STERILIZATION

    Science.gov (United States)

    YUNKER, Amanda C.; RITCH, Jessica M. B.; ROBINSON, Erica F.; GOLISH, Cara T.

    2014-01-01

    Objective To investigate the incidence and pre-operative risk factors for developing pelvic pain after hysteroscopic sterilization using the Essure™ micro-inserts Design Retrospective cohort study (Canadian Task Force classification II-2). Setting University Medical Center Patients A total of 458 patients who underwent hysteroscopic sterilization with Essure™ between January 1, 2005 and June 30, 2012. Results The incidence of acute pelvic pain after hysteroscopic sterilization was 8.1%, and the incidence of persistent pain after 3 months post-procedure was 4.2%. The range of presentation with pain was 1 to 469 days, with a mean time of 56 days. Of the patients that developed chronic pelvic pain after the procedure, 75% presented within 130 days of the procedure. Patients with previous diagnoses of any chronic pain (chronic pelvic pain, chronic low back pain, chronic headache, and fibromyalgia) were more likely to report both acute pain (OR 6.81, 95% CI 2.95,15.73) and chronic pain (OR 6.15, 95% CI 2.10,18.10) after hysteroscopic sterilization. Conclusions Pelvic pain may develop after hysteroscopic sterilization. Patients with preexisting chronic pain diagnoses may be at increased risk of developing pelvic pain after the procedure. Fifty percent of new pelvic pain after Essure™ placement will resolve by 3 months. PMID:24952343

  16. The Association Between Body Mass Index and the Prevalence, Severity, and Frequency of Low Back Pain: Data From the Osteoarthritis Initiative.

    Science.gov (United States)

    Su, Charles A; Kusin, David J; Li, Samuel Q; Ahn, Uri M; Ahn, Nicholas U

    2018-02-16

    Cross-sectional study. To determine whether there is an association between body mass index (BMI) and the prevalence, severity, and frequency of low back pain and identify other potential patient risk factors for the development of low back pain. Many studies have implicated that a high BMI is a risk factor for low back pain. However, few studies have examined the association between increased BMI and the prevalence, severity, and frequency of low back pain. Data from the Osteoarthritis Initiative, a multicenter, prospective study of knee osteoarthritis, were used to conduct this study, which included 4796 patients. BMI was categorized according to the World Health Organization classification and the prevalence, severity, and frequency of low back pain were assessed. Logistic regression was performed to identify additional patient risk factors associated with low back pain. The prevalence of low back pain was found to be significantly higher in patients with an elevated BMI compared to those with normal or underweight BMI and demonstrated a stepwise increase with each BMI category. Approximately 47.4% of patients with normal or underweight BMI complained of low back pain compared with 72.8% of morbidly obese patients (P frequency or severity of low back pain episodes. Osteoarthritis of the back and depression were patient variables found to be associated with all three measures (prevalence, severity, and frequency) of low back pain. Elevated BMI is strongly associated with an increased prevalence of low back pain. Depression and osteoarthritis of the back are associated with the prevalence, severity, and frequency of low back pain. 3.

  17. A brief cognitive-behavioral 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.M.; 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 aim

  18. Lateral topography for reducing effective dose in low-dose chest CT.

    Science.gov (United States)

    Bang, Dong-Ho; Lim, Daekeon; Hwang, Wi-Sub; Park, Seong-Hoon; Jeong, Ok-man; Kang, Kyung Wook; Kang, Hohyung

    2013-06-01

    The purposes of this study were to assess radiation exposure during low-dose chest CT by using lateral topography and to compare the lateral topographic findings with findings obtained with anteroposterior topography alone and anteroposterior and lateral topography combined. From November 2011 to February 2012, 210 male subjects were enrolled in the study. Age, weight, and height of the men were recorded. All subjects were placed into one of three subgroups based on the type of topographic image obtained: anteroposterior topography, lateral topography, and both anteroposterior and lateral topography. Imaging was performed with a 128-MDCT scanner. CT, except for topography, was the same for all subjects. A radiologist analyzed each image, recorded scan length, checked for any insufficiencies in the FOV, and calculated the effective radiation dose. One-way analysis of variance and multiple comparisons were used to compare the effective radiation exposure and scan length between groups. The mean scan length in the anteroposterior topography group was significantly greater than that of the lateral topography group and the combined anteroposterior and lateral topography group (p topography group (0.735 ± 0.033 mSv) was significantly lower than that for the anteroposterior topography group (0.763 ± 0.038 mSv) and the combined anteroposterior and lateral topography group (0.773 ± 0.038) (p < 0.001). Lateral topographic low-dose CT was associated with a lower effective radiation dose and scan length than either anteroposterior topographic low-dose chest CT or low-dose chest CT with both anteroposterior and lateral topograms.

  19. Prevalence and Diagnostic Performance of Isolated and Combined NEXUS Chest CT Decision Criteria.

    Science.gov (United States)

    Raja, Ali S; Mower, William R; Nishijima, Daniel K; Hendey, Gregory W; Baumann, Brigitte M; Medak, Anthony J; Rodriguez, Robert M

    2016-08-01

    The use of chest computed tomography (CT) to evaluate emergency department patients with adult blunt trauma is rising. The NEXUS Chest CT decision instruments are highly sensitive identifiers of adult blunt trauma patients with thoracic injuries. However, many patients without injury exhibit one of more of the criteria so cannot be classified "low risk." We sought to determine screening performance of both individual and combined NEXUS Chest CT criteria as predictors of thoracic injury to inform chest CT imaging decisions in "non-low-risk" patients. This was a secondary analysis of data on patients in the derivation and validation cohorts of the prospective, observational NEXUS Chest CT study, performed September 2011 to May 2014 in 11 Level I trauma centers. Institutional review board approval was obtained at all study sites. Adult blunt trauma patients receiving chest CT were included. The primary outcome was injury and major clinical injury prevalence and screening performance in patients with combinations of one, two, or three of seven individual NEXUS Chest CT criteria. Across the 11 study sites, rates of chest CT performance ranged from 15.5% to 77.2% (median = 43.6%). We found injuries in 1,493/5,169 patients (28.9%) who had chest CT; 269 patients (5.2%) had major clinical injury (e.g., pneumothorax requiring chest tube). With sensitivity of 73.7 (95% confidence interval [CI] = 68.1 to 78.6) and specificity of 83.9 (95% CI = 83.6 to 84.2) for major clinical injury, abnormal chest-x-ray (CXR) was the single most important screening criterion. When patients had only abnormal CXR, injury and major clinical injury prevalences were 60.7% (95% CI = 52.2% to 68.6%) and 12.9% (95% CI = 8.3% to 19.4%), respectively. Injury and major clinical injury prevalences when any other single criterion alone (other than abnormal CXR) was present were 16.8% (95% CI = 15.2% to 18.6%) and 1.1% (95% CI = 0.1% to 1.8%), respectively. Injury and major clinical injury prevalences

  20. Differences in pain processing between patients with chronic low back pain, recurrent low back pain and fibromyalgia

    OpenAIRE

    Goubert, Dorien; Danneels, Lieven; Graven-Nielsen, Thomas; Descheemaeker, Filip; Coppieters, Iris; Meeus, Mira

    2017-01-01

    Background: The impairment in musculoskeletal structures in patients with low back pain (LBP) is often disproportionate to their complaint. Therefore, the need arises for exploration of alternative mechanisms contributing to the origin and maintenance of non-specific LBP. The recent focus has been on central nervous system phenomena in LBP and the pathophysiological mechanisms underlying the various symptoms and characteristics of chronic pain. Knowledge concerning changes in pain processing ...

  1. Pharmacotherapy for chronic non-specific low back pain: current and future options.

    Science.gov (United States)

    Koes, Bart W; Backes, Daan; Bindels, Patrick J E

    2018-04-01

    Low back pain is associated with a large burden-of-illness. It is responsible for the most years lived with disability as compared with any other medical condition. A comprehensive overview of the evidence on pharmacological treatment options for chronic low back pain is lacking. This review evaluates the evidence for the benefits and risks of currently available pharmacological treatments for chronic low back pain. Areas covered: The authors focus on the recent (Cochrane) systematic reviews and meta-analyses of randomized clinical trials covering paracetamol (acetaminophen), NSAIDs, muscle relaxants, antidepressants, anticonvulsants, opioids, and other (new) drugs. Expert opinion: The overall impression of the efficacy of pharmacological treatments for patients with chronic low back pain is rather sobering. The effects on pain reduction and improvement of function are commonly small to moderate and short lasting when compared to placebo. At the same time, the various types of drugs are not without side-effects. This holds especially true for serious side-effects associated with (prolonged) use of strong opioids. Future studies on patients with chronic back pain should aim to identify subgroups of patients with good response to specific pharmacological treatment to facilitate personalized care.

  2. Low back pain at school: unique risk deriving from unsatisfactory grade in maths and school-type recommendation.

    Science.gov (United States)

    Erne, Cordula; Elfering, Achim

    2011-12-01

    Psychosocial stress and pain may relate to educational selection. At the end of primary school (International Standard Classification of Education: ISCED level 1) children are recommended for one of three performance-based lower secondary level types of school (ISCED level 2). The study examines the association of educational selection and other risk factors with pain in the upper back (UBP), lower back pain (LBP), peripheral (limb) pain (PP), and abdominal pain (AP). Teacher reports of unsatisfactory grades in mathematics, and official school-type recommendation are included as objective psychosocial risk factors. One hundred and ninety-two schoolchildren, aged between 10 and 13 from 11 classes of 7 schools in Switzerland participated in the cross-sectional study. In logistic regression analysis, predictor variables included age, sex, BMI, participation in sport, physical mobility, weight of satchel, hours of daily TV, video, and computer use, pupils' back pain reported by the mother and father, psychosocial strain, unsatisfactory grade in mathematics, and school-type recommendation. Analysis of pain drawings was highly reliable and revealed high prevalence rates of musculoskeletal pain in the last 4 weeks (UBP 15.3%, LBP 13:8%, PP 33.9%, AP 20.1%). Psychosocial risk factors were uniquely significant predictors of UBP (psychosocial strain), LBP (psychosocial strain, unsatisfactory grade in mathematics, school-type recommendation), and AP (school-type recommendation). In conclusion, selection in terms of educational school system was uniquely associated with LBP in schoolchildren. Stress caused by educational selection should be addressed in primary prevention of musculoskeletal pain in schoolchildren.

  3. Chronic low back pain: possibilities for prevention and treatment

    Directory of Open Access Journals (Sweden)

    P. R. Kamchatnov

    2013-01-01

    Full Text Available Low back pain (LBP is a very common syndrome that is associated with the extremely high rate of temporary disability and the development of chronic pain syndrome. In addition to structural changes in the locomotor system, psychological and social factors contribute to the development and maintenance of chronic pain. Drug therapy for chronic LBP frequently gives rise to complications. A physician’s important task in this situation is to prevent pain chronization and to reduce the risk of side effects of treatment. One of the ways to solve this task is to use the vitamin B complex (milgamma along with analgesics and myorelaxants. The review considers the possible effects of combination therapy in patients with LBP and discusses whether it should be used.

  4. Performance of highly sensitive cardiac troponin T assay to detect ischaemia at PET-CT in low-risk patients with acute coronary syndrome: a prospective observational study.

    Science.gov (United States)

    Morawiec, Beata; Fournier, Stephane; Tapponnier, Maxime; Prior, John O; Monney, Pierre; Dunet, Vincent; Lauriers, Nathalie; Recordon, Frederique; Trana, Catalina; Iglesias, Juan-Fernando; Kawecki, Damian; Boulat, Olivier; Bardy, Daniel; Lamsidri, Sabine; Eeckhout, Eric; Hugli, Olivier; Muller, Olivier

    2017-07-10

    Highly sensitive troponin T (hs-TnT) assay has improved clinical decision-making for patients admitted with chest pain. However, this assay's performance in detecting myocardial ischaemia in a lowrisk population has been poorly documented. To assess hs-TnT assay's performance to detect myocardial ischaemia at positron emission tomography/CT (PET-CT) in low-risk patients admitted with chest pain. Patients admitted for chest pain with a nonconclusive ECG and negative standard cardiac troponin T results at admission and after 6 hours were prospectively enrolled. Their hs-TnT samples were at T0, T2 and T6. Physicians were blinded to hs-TnT results. All patients underwent a PET-CT at rest and during adenosine-induced stress. All patients with a positive PET-CT result underwent a coronary angiography. Forty-eight patients were included. Six had ischaemia at PET-CT. All of them had ≥1 significant stenosis at coronary angiography. Areas under the curve (95% CI) for predicting significant ischaemia at PET-CT using hs-TnT were 0.764 (0.515 to 1.000) at T0, 0.812(0.616 to 1.000) at T2 and 0.813(0.638 to 0.989) at T6. The receiver operating characteristicbased optimal cut-off value for hs-TnT at T0, T2 and T6 needed to exclude significant ischaemia at PET-CT was <4 ng/L. Using this value, sensitivity, specificity, positive and negative predictive values of hs-TnT to predict significant ischaemia were 83%/38%/16%/94% at T0, 100%/40%/19%/100% at T2 and 100%/43%/20%/100% at T6, respectively. Our findings suggest that in low-risk patients, using the hs-TnT assay with a cut-off value of 4 ng/L demonstrates excellent negative predictive value to exclude myocardial ischaemia detection at PET-CT, at the expense of weak specificity and positive predictive value. ClinicalTrials.gov Identifier: NCT01374607. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly

  5. Occupational low back pain in nursing workers: massage versus pain

    Directory of Open Access Journals (Sweden)

    Talita Pavarini Borges

    2014-08-01

    Full Text Available Objective: To assess the efficacy of massage for decreasing occupational low back pain in workers of a Nursing team in an Emergency Room. Method: A randomized controlled trial, using a socio-demographic/morbidity questionnaire and a Pain Numeric Scale. Forty-five subjects were randomly allocated for intervention (G1 – Massage by acupressure, placebo group (G2 – application of Garlium Arseneid Laser 904nm turned off and control (G3 – no intervention. Results: The main triggering factor, as well as the worsening of pain, was the patient manipulation, both with a prevalence of 34.9%. The main treatment for low back pain before this research was the use of medication, with a prevalence of 44.2%. In accordance with a variance analysis, only G1 presented a significant statistical difference, with a better result after 12 sessions. Massage presented an enormous effect (d = 4.59, corresponding to 86% of reduction in the pain level. Conclusion: Massage was effective to decrease occupational low back pain of those Nursing workers.

  6. Physical and psychosocial ergonomic risk factors for low back pain in automobile manufacturing workers.

    Science.gov (United States)

    Vandergrift, Jonathan L; Gold, Judith E; Hanlon, Alexandra; Punnett, Laura

    2012-01-01

    To examine the association between ergonomic physical and psychosocial exposures and the risk of prevalent and incident low back pain (LBP) in a longitudinal cohort of automobile manufacturing workers. Ergonomic exposure intensity and LBP presence were determined through questionnaires at baseline (n=1181) and to workers in the same job 1 year later (n=505). Models were constructed using log-binomial regression with special attention to interactions between ergonomic exposures. Awkward back posture (prevalence ratio (PR) 1.12, 95% CI 1.07 to 1.17), hand force (PR 1.06, 95% CI 1.02 to 1.10), physical effort (PR 1.10, 95% CI 1.04 to 1.16) and whole body vibration (PR 1.04, 95% CI 1.01 to 1.08) were each associated cross-sectionally with LBP. Awkward back posture (RR 1.13, 95% CI 0.98 to 1.31) and hand force (RR 1.07, 95% CI 0.93 to 1.22) also predicted incident LBP, although estimates were statistically less precise. Neither job control, psychological demands, nor job strain was independently related to risk of incident LBP. Among participants reporting high physical ergonomic exposures and moderate to high job control, increasing job demands was associated with a reduced LBP risk (RR 0.72, 95% CI 0.52 to 1.00). Among participants reporting high physical exposures and low job control, psychological demands was associated with an increased LBP risk (RR 1.30, 95% CI 1.02 to 1.66). Psychosocial workplace interventions for LBP should prioritise jobs in which there are high physical ergonomic exposures. Future studies of LBP should examine the interactions between physical ergonomic risk factors.

  7. Back pain and low back pain

    International Nuclear Information System (INIS)

    Cotta, H.; Niethard, F.U.

    1983-01-01

    In patients with back pain there is only a poor correlation between clinical and radiological symptoms. Therefore the interpretation of radiological findings is only possible with respect to the natural history of the disease. Indication for radiological examination is given for early diagnosis and treatment of malinformation of the spine; diagnosis and treatment of functional disturbances of the spine with back- and low back pain and diagnosis and treatment of diseases which affect the stability of the vertebrae. (orig.)

  8. The prevalence of angina symptoms and association with cardiovascular risk factors, among rural, urban and rural to urban migrant populations in Peru

    Directory of Open Access Journals (Sweden)

    Gilman Robert H

    2010-10-01

    Full Text Available Abstract Background Rural-to-urban migration in low- and middle-income countries causes an increase in individual cardiovascular risk. Cost-effective interventions at early stages of the natural history of coronary disease such as angina may stem an epidemic of premature coronary deaths in these countries. However, there are few data on the prevalence of angina in developing countries, whilst the understanding the aetiology of angina is complicated by the difficulty in measuring it across differing populations. Methods The PERU MIGRANT study was designed to investigate differences between rural-to-urban migrant and non-migrant groups in specific cardiovascular disease risk factors. Mass-migration seen in Peru from 1980s onwards was largely driven by politically motivated violence resulting in less 'healthy migrant' selection bias. The Rose angina questionnaire was used to record chest pain, which was classified definite, possible and non-exertional. Mental health was measured using the General Health Questionnaire (GHQ-12. Mantel-Haenszel odds ratios (adjusted for age, sex, cardiovascular disease risk factors and mental health were used to assess the risk of chest pain in the migrant and urban groups compared to the rural group, and further to assess the relationship (age and sex-adjusted between risk factors, mental health and chest pain. Results Compared to the urban group, rural dwellers had a greatly increased likelihood of possible/definite angina (multi-adjusted OR 2.82 (1.68- 4.73. Urban and migrant groups had higher levels of risk factors (e.g. smoking - 20.1% urban, 5.5% rural. No diabetes was seen in the rural dwellers who complained of possible/definite angina. Rural dwellers had a higher prevalence of mood disorder and the presence of a mood disorder was associated with possible/definite angina in all three groups, but not consistently with non-exertional chest pain. Conclusion Rural groups had a higher prevalence of angina as

  9. Pain during mammography: Possible risk factors and ways to alleviate pain

    International Nuclear Information System (INIS)

    Davey, Belinda

    2007-01-01

    This article reviews the literature surrounding the issue of pain experienced during mammography. This is an important topic since many women may refuse screening mammograms due to the possibility of a painful examination. It is a difficult area to research since the experience of pain is by nature subjective and the manner by which data have been collected has varied with many different pain assessment instruments being utilised. Accordingly there is wide variation in the degree of pain felt from only slight pain to some women finding it acutely painful. To discover why some women find it so painful certain risk factors that have been associated with painful mammography are explored. There are many of these risk factors but this article concentrates on three main areas: biological, psychological and staff-related. Once the reasons why some women experience such acute pain, ways to ease this may be found. Methods to alleviate painful mammography are suggested and discussed. The article concludes that there is a wide variance in the data collection techniques which could account for the wide variance in the reported pain. More research is required using a validated pain measurement to establish the extent of pain and to establish the effect of this on future compliance

  10. Relationship between workload and low back pain in assembly line workers

    Directory of Open Access Journals (Sweden)

    Reza Kalantari

    2016-06-01

    Full Text Available Introduction: Work pressure and excessive workload can jeopardize and impair the people’s health. One of these impairments is musculoskeletal disorders. Among these disorders, low back pain is the most common and most costly problem. The purpose of this study was to investigate the relationship between workload and prevalence of low back pain in assembly line workers of a car manufacturing factory. Methods: This cross-sectional study was conducted on 69 workers working in the assembly line of a factory. Data collection tools included three questionnaires: demographic questionnaire, NASA Task Load Index (NASA-TLX and Cornell Musculoskeletal Discomfort Questionnaire (CMDQ. Data were analyzed by descriptive and inferential (T-test and One-way ANOVA statistics. Results: Of the workers, 72.5% were female. The average total workload was 71.42% and the prevalence of musculoskeletal disorders in low back was 43.37%. The results of the analysis of relationship between workload and the prevalence of low back pain showed a significant relationship between physical/ mental workload and the incidence of low back pain (P<0.05. Conclusion: The more is the workload on the person, the greater is the risk of low back pain. Measures such as increasing the number of workers to distribute the workload, slowing the work pace, having work-rest periods for workers, improving psychological conditions of work, etc. can be useful in this regard.

  11. Knee Pain and Low Back Pain Additively Disturb Sleep in the General Population: A Cross-Sectional Analysis of the Nagahama Study.

    Directory of Open Access Journals (Sweden)

    Kimihiko Murase

    Full Text Available Association of knee and low back pain with sleep disturbance is poorly understood. We aimed to clarify the independent and combined effects of these orthopedic symptoms on sleep in a large-scale general population.Cross-sectional data about sleep and knee/low back pain were collected for 9,611 community residents (53±14 years old by a structured questionnaire. Sleep duration less than 6 h/d was defined as short sleep. Sleep quality and the presence of knee and low back pain were evaluated by dichotomous questions. Subjects who complained about knee or low back pains were graded by tertiles of a numerical response scale (NRS score and a Roland-Morris disability questionnaire (RDQ score respectively. Multivariate regression analyses were performed to determine the correlates of short sleep duration and poor sleep quality.Frequency of participants who complained of the orthopedic symptoms was as follows; knee pain, 29.0%; low back pain, 42.0% and both knee and low back pain 17.6%. Both knee and low back pain were significantly and independently associated with short sleep duration (knee pain: odds ratio (OR = 1.19, p<0.01; low back pain: OR = 1.13, p = 0.01 and poor sleep quality (knee pain: OR = 1.22, p<0.01; low back pain; OR = 1.57, p<0.01. The group in the highest tertile of the NRS or RDQ score had the highest risk for short sleep duration and poor sleep quality except for the relationship between the highest tertile of the RDQ score and short sleep duration.(the highest tertile of the NRS: OR for short sleep duration = 1.31, p<0.01; OR for poor sleep quality = 1.47, p<0.01; the highest tertile of the RDQ: OR for short sleep duration = 1.11, p = 0.12; OR for poor sleep quality = 1.81, p<0.01 Further, coincident knee and low back pain raised the odds ratios for short sleep duration (either of knee or low back pain: OR = 1.10, p = 0.06; both knee and low back pain: OR = 1.40, p<0.01 and poor sleep quality (either of knee or low back pain: OR

  12. Effectiveness of Low-Level Laser Therapy in Reducing Orthodontic Pain: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Deana, Naira Figueiredo; Zaror, Carlos; Sandoval, Paulo

    2017-01-01

    Objectives To assess the effectiveness of low-level laser therapy (LLLT) in reducing orthodontic pain after the application of orthodontic force (OF). Methods A systematic search was conducted in the MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science, and EBSCOhost databases. The study included randomized clinical trials (RCT) which analysed the effectiveness of LLLT in reducing orthodontic pain assessed at 24 and 72 hrs after the application of OF. The risk of bias of the eligible trials was assessed using the Cochrane Collaboration's risk of bias tool. Standard mean difference was calculated and pooled by meta-analysis using random effect models. Results Of 467 identified articles, 20 RCT were finally included. In the risk of bias assessments, 13 studies presented a high risk, 5 an unclear risk, and 2 a low risk. The meta-analysis showed that in patients treated with laser versus placebo there was a difference in favour of LLLT in spontaneous pain 24 and 72 hrs after the installation of light archwires and spontaneous pain and chewing pain 24 and 72 hrs after the installation of elastomeric separators. Conclusions LLLT proved to be effective in promoting a reduction in spontaneous and chewing pain after the application of OF; however, the poor quality of the evidence requires these results to be treated with caution. PMID:29089818

  13. Persistent postsurgical pain: risk factors and prevention

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Jensen, Troels Staehelin; Woolf, Clifford J.

    2006-01-01

    therapy for postoperative pain should be investigated, since the intensity of acute postoperative pain correlates with the risk of developing a persistent pain state. Finally, the role of genetic factors should be studied, since only a proportion of patients with intraoperative nerve damage develop...... chronic pain. Based on information about the molecular mechanisms that affect changes to the peripheral and central nervous system in neuropathic pain, several opportunities exist for multimodal pharmacological intervention. Here, we outline strategies for identification of patients at risk...

  14. Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis.

    Science.gov (United States)

    Zhou, Dong; Deng, Xu-Feng; Liu, Quan-Xing; Chen, Qian; Min, Jia-Xin; Dai, Ji-Gang

    2016-05-27

    In this meta-analysis, we conducted a pooled analysis of clinical studies comparing the efficacy of single chest tube versus double chest tube after a lobectomy. According to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of the PubMed, Embase, Cochrane Library and Web of Science databases to identify articles to include in our meta-analysis. A literature search was performed using relevant keywords. A meta-analysis was performed using RevMan© software. Five studies, published between 2003 and 2014, including 630 patients (314 patients with a single chest tube and 316 patients with a double chest tube), met the selection criteria. From the available data, the patients using a single tube demonstrated significantly decreased postoperative pain [weighted mean difference [WMD] -0.60; 95 % confidence intervals [CIs] -0.68-- 0.52; P tube after a pulmonary lobectomy. However, there were no significant differences in postoperative complications [OR 0.91; 95 % CIs 0.57-1.44; P = 0.67] and re-drainage rates [OR 0.81; 95 % CIs 0.42-1.58; P = 0.54]. Our results showed that a single-drain method is effective, reducing postoperative pain, hospitalization times and duration of drainage in patients who undergo a lobectomy. Moreover, the single-drain method does not increase the occurrence of postoperative complications and re-drainage rates.

  15. Low Yield of Chest Radiography in General Inpatients and Outpatients with "Positive PPD" Results in a Country with Low Prevalence of TB.

    Science.gov (United States)

    Eisenberg, Ronald L; Heidinger, Benedikt H

    2017-07-01

    The purpose of this study was to assess the frequency and spectrum of abnormalities on routine screening chest radiographs among inpatients and outpatients with "positive purified protein derivative (PPD)" in a large tertiary care academic medical center in a country with low prevalence of tuberculosis (TB). The reports of all chest radiographs of general inpatients and outpatients referred for positive PPD (2010-2014) were evaluated for the frequency of evidence of active or latent TB and the spectrum of imaging findings. The results of additional chest radiographs and computed tomography scans were recorded, as were additional relevant clinical histories and symptoms. Of the 2518 patients who underwent chest radiography for positive PPD, the radiographs were normal in 91.3%. The vast majority of the abnormal radiographs demonstrated findings consistent with old tuberculous disease. There were three cases (0.1%) of active TB, all of which were either recent immigrants from an endemic area or had other relevant histories or clinical symptoms suggestive of the disease. Universal chest radiography in general inpatient and outpatient populations referred for positive PPD is of low yield for detecting active disease in a country with low prevalence of TB. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  16. Ejection fraction response to exercise in patients with chest pain and normal coronary arteriograms

    International Nuclear Information System (INIS)

    Gibbons, R.L.; Lee, K.L.; Cobb, F.; Jones, R.H.

    1981-01-01

    In this study we describe the ejection fraction response to upright exercise using first-pass radionuclide angiocardiography in a group of 60 patients with chest pain, normal coronary ateriograms and normal resting ventricular function. A wide range of resting function (heart rate and ejection fraction) and exercise function (heart rate, ejection fraction, peak work load and estimated peak oxygen uptake) were measured. The ejection fraction response to exercise demonstrated wide variation, ranging from a decrease of 23% to an increase of 24%. Six of 22 clinical and radionuclide angiocardiographic variables (resting ejection fraction, peak work load, age, sex, body surface area and the change in end-diastolic volume index with exercise) were significant univariate predictors of the ejection fraction response to exercise. Multivariable analysis identified resting ejection fraction, the change in end-diastolic volume index with exercise and either sex or peak work load as variables that provided significant independent predictive information. These observations indicate that the ejection fraction response to exercise is a complex response that is influenced by multiple physiologic variables. The wide variation in this population suggests that the ejection fraction response to exercise is not a reliable test for the diagnosis of coronary artery disease because of its low specificity

  17. Participatory ergonomic intervention for prevention of low back pain: assembly line redesign case.

    Science.gov (United States)

    Bernardes, João Marcos; Wanderck, Claudia; Moro, Antônio Renato Pereira

    2012-01-01

    This paper gives an overview of a participatory ergonomic intervention aimed at reducing low back pain cases in the dispatch department of a catalogue and e-commerce retail company. Based on the findings of the ergonomic analysis and design committee, the company's own employees redesigned the assembly line's layout. As a result of these changes two job tasks that involved manual material handling of boxes, identified by the revised NIOSH equation as posing an increased risk for lifting-related low back pain, were totally eliminated, and the employees responsible for moving boxes from the end of the assembly line to pallets on the ground were given more control over their jobs, and these jobs were also enriched with a new, less heavy task. These results demonstrate that participatory ergonomic interventions are a viable and effective strategy to reduce the exposure to work-related physical and psychosocial risk factors for low back pain.

  18. Study of chronic pain and its associated risk factors among Japanese industry workers: the Quality of Working Life Influenced by Chronic pain (QWLIC) study.

    Science.gov (United States)

    Yamada, Keiko; Wakaizumi, Kenta; Fukai, Kyosuke; Iso, Hiroyasu; Sobue, Tomotaka; Shibata, Masahiko; Matsudaira, Ko

    2017-10-05

    This study was performed to identify the prevalence, influence, and risk factors associated with chronic pain among Japanese industry workers. We investigated 2,544 participants working at a manufacturing company A, a manufacturing company B, and 16 branch shops of a retail chain company C. The participants responded to self-administered questionnaires related to pain. Furthermore, data obtained from the lifestyle interview sheet of an annual health screening examination and those obtained from the questionnaires were merged. We analyzed the association between lifestyles, psychosocial factors, and chronic pain. Age- and sex-adjusted odds ratios were calculated with a 95% confidence interval using the logistic regression model. Of 2,544 participants, 1,914 (1,224 men and 690 women) completed the questionnaire, and the response rate was 75.2%. The prevalence of chronic pain over 3 months was 42.7% and that of chronic pain with work disability was 11.3%. A higher proportion of obesity, smoking habit, insomnia, psychological stress, depressive state, workaholic nature, low social support from supervisors and coworkers, high job demand, low job control, and job dissatisfaction was observed in workers with chronic pain than in workers without pain. Several risk factors of chronic pain in Japanese industry workers were found. Obesity, smoking habits, sleep disorders, workplace environment, and mental state should be taken into account as risk factors associated with chronic pain issues and general occupational health.

  19. Physical risk factors for neck pain

    NARCIS (Netherlands)

    Ariëns, Geertje A M; Van Mechelen, Willem; Bongers, Paulien M.; Bouter, Lex M.; Van Der Wal, Gerrit

    2000-01-01

    To identify physical risk factors for neck pain, a systematic review of the literature was carried out. Based on methodological quality and study design, 4 levels of evidence were defined to establish the strength of evidence for the relationship between risk factors and neck pain. Altogether, 22

  20. Do Psychological Factors Increase the Risk for Low Back Pain Among Nurses? A Comparing According to Cross-sectional and Prospective Analysis

    Directory of Open Access Journals (Sweden)

    Farideh Sadeghian

    2014-03-01

    Conclusion: Results indicate that risk factors for prevalence of back pain at baseline and 1-year follow-up are different. At baseline, the risk factors are age, belief that work causes pain, and somatization tendency, and at follow-up, expectation of pain is the major risk factor.

  1. Thoracic Trauma: Which Chest Tube When and Where?

    Science.gov (United States)

    Molnar, Tamas F

    2017-02-01

    Clinical suspicion of hemo/pneumothorax: when in doubt, drain the chest. Stable chest trauma with hemo/pneumothorax: drain and wait. Unstable patient with dislocated trachea must be approached with drain in hand and scalpel ready. Massive hemo/pneumothorax may be controlled by drainage alone. The surgeon should not hesitate to open the chest if too much blood drains over a short period. The chest drainage procedure does not end with the last stitch; the second half of the match is still ahead. The drained patient is in need of physiotherapy and proper pain relief with an extended pleural space: control the suction system. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Competing effects of pain and fear of pain on postural control in low back pain?

    NARCIS (Netherlands)

    Mazaheri, M.; Heidari, E.; Mostmand, J.; Negahban, H.; van Dieen, J.H.

    2014-01-01

    STUDY DESIGN. A cross-sectional, observational study. OBJECTIVE. To determine whether pain and fear of pain have competing effects on postural sway in patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA. Competing effects of pain and pain-related fear on postural control can be proposed as

  3. A giant cardiac hydatid cyst presenting with chest pain and ventricular tachycardia in a pregnant woman undergoing cesarean section

    Directory of Open Access Journals (Sweden)

    Mehmet Yaman

    2016-09-01

    Full Text Available Cyst hydatid disease is an infectious disease caused by development of the larval form of Echinococcus granulosus in humans. Cardiac involvement of this disease is a rare condition, and if present, it is most commonly located in the left ventricle. Interventricular septal involvement is observed only in 4% of these cases. Herein, we report a case of cyst hydatid located at interventricular septum causing chest pain and ventricular tachycardia during cesarean section.

  4. Pain-related guilt in low back pain.

    Science.gov (United States)

    Serbic, Danijela; Pincus, Tamar

    2014-12-01

    Identifying mechanisms that mediate recovery is imperative to improve outcomes in low back pain (LBP). Qualitative studies suggest that guilt may be such a mechanism, but research on this concept is scarce, and reliable instruments to measure pain-related guilt are not available. We addressed this gap by developing and testing a Pain-related Guilt Scale (PGS) for people with LBP. Two samples of participants with LBP completed the scale and provided data on rates of depression, anxiety, pain intensity, and disability. Three factors were identified using exploratory factor analysis (n=137): "Social guilt," (4 items) relating to letting down family and friends; "Managing condition/pain guilt," (5 items) relating to failing to overcome and control pain; and "Verification of pain guilt," (3 items) relating to the absence of objective evidence and diagnosis. This factor structure was confirmed using confirmatory factor analysis (n=288), demonstrating an adequate to good fit with the data (AGFI=0.913, RMSEA=0.061). The PGS subscales positively correlated with depression, anxiety, pain intensity, and disability. After controlling for depression and anxiety the majority of relationships between the PGS subscales and disability and pain intensity remained significant, suggesting that guilt shared unique variance with disability and pain intensity independent of depression and anxiety. High levels of guilt were reported by over 40% of participants. The findings suggest that pain-related guilt is common and is associated with clinical outcomes. Prospective research is needed to examine the role of guilt as a predictor, moderator, and mediator of patients' outcomes.

  5. Herbal medicine for low-back pain.

    Science.gov (United States)

    Oltean, Hanna; Robbins, Chris; van Tulder, Maurits W; Berman, Brian M; Bombardier, Claire; Gagnier, Joel J

    2014-12-23

    Low-back pain (LBP) is a common condition and imposes a substantial economic burden upon people living in industrialized societies. A large proportion of people with chronic LBP use complementary and alternative medicine (CAM), visit CAM practitioners, or both. Several herbal medicines have been purported for use in treating people with LBP. This is an update of a Cochrane Review first published in 2006. To determine the effectiveness of herbal medicine for non-specific LBP. We searched the following electronic databases up to September 2014: MEDLINE, EMBASE, CENTRAL, CINAHL, Clinical Trials.gov, World Health Organization International Clinical Trials Registry Portal and PubMed; checked reference lists in review articles, guidelines and retrieved trials; and personally contacted individuals with expertise in this area. We included randomized controlled trials (RCTs) examining adults (over 18 years of age) suffering from acute, sub-acute, or chronic non-specific LBP. The interventions were herbal medicines which we defined as plants used for medicinal purposes in any form. Primary outcome measures were pain and function. A library scientist with the Cochrane Back Review Group conducted the database searches. One review author contacted content experts and acquired relevant citations. We downloaded full references and abstracts of the identified studies and retrieved a hard copy of each study for final inclusion decisions. Two review authors assessed risk of bias, GRADE criteria (GRADE 2004), and CONSORT compliance and a random subset were compared to assessments by a third individual. Two review authors assessed clinical relevance and resolved any disagreements by consensus. We included 14 RCTs (2050 participants) in this review. One trial on Solidago chilensis M. (Brazilian arnica) (20 participants) found very low quality evidence of reduction in perception of pain and improved flexibility with application of Brazilian arnica-containing gel twice daily as compared

  6. Lifting index of the niosh lifting equation and low back pain

    Directory of Open Access Journals (Sweden)

    Eliana Remor Teixeira

    2011-09-01

    Full Text Available The purpose of this study is to assess the relationship of the Lifting Index obtained through the application of the NIOSH Lifting Equation and the incidence of low back pain among forty-eight workers involved in manual lifting tasks. It was applied the equation in eleven tasks and the workers were interviewed. The most unfavorable conditions presented themselves in the lifting destination. The variables that most contributed to the inadequate values of the Lifting Index were: the horizontal location, the lifting frequency and the vertical distance, beyond the high weight of the load. The incidence of low back pain in the last twelve months was 19%, whereas the incidence of work-related low back pain in the same period was 10%. In 72.7% of the tasks evaluated the Composite Lifting Index was more than three, which are considered as high ergonomic risk.

  7. Non-Cardiac Chest Pain

    Science.gov (United States)

    ... such as achalasia. This is particularly important since achalasia is a treatable disorder. A number of studies continue to be done to better understand the mechanism(s) of pain in NCCP. Furthermore, new treatment agents are being investigated. A recent study suggested ...

  8. 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.

  9. Low back pain in school-age children: risk factors, clinical features and diagnostic managment.

    Science.gov (United States)

    Boćkowski, L; Sobaniec, W; Kułak, W; Smigielska-Kuzia, J; Sendrowski, K; Roszkowska, M

    2007-01-01

    Low back pain (LBP) is common in adult population, and it is becoming a serious health concern in adolescents. On surveys, about every fifth child in the school-age reports LBP. The study objective was to analysis the natural history, risk factors, clinical symptoms, causes and diagnostic management in school-age children hospitalized with LBP. The study group consisted of 36 patients at the age between 10 and 18 years, 22 girls and 14 boys suffering from LBP hospitalized in our Department of Pediatric Neurology and Rehabilitation in years 2000-2004. The mean age of clinical onset of LBP in our group was 14.7 years, earlier in girls, later in boys. We find the family history of LBP in 50% children. Most frequent factors associated with LBP were: spina bifida (16.7%) and incorrect posture (13.9%). Half of patients pointed the factor initialising LBP: rapid, incoordinated move (39%) or heavy load rise (11%). 58% of patients present the symptoms of ischialgia. Diagnostic imaging showed disc protrusion in 11 children (31%) 6 in computed tomography, 4 in magnetic resonance imaging and 1 in X-Ray examination only. Other causes of LBP included: spondylolysis in 2 patients, Scheuermann disease in one case and juvenile reumatoid arthritis in one case. Some school-age children suffering on low back pain, particulary with sciatic neuralgia symptoms seek medical care in hospital. Althought the main causes are mechanical, associated with lack of physical activity or strenous exercise, serious diagnostic managment is strongly recommended.

  10. Thallium-201 myocardial perfusion scintigraphy to evaluate patients with chest pain (preliminary study)

    International Nuclear Information System (INIS)

    Mahfouz, M.; Elhaddad, S.; Elghoneimy, I.; Elmesidy, S.; Haggag, F.; Sbdou, S.; Dayem, K.A.; Ezzeldiy, H.

    1985-01-01

    201 Tl perfusion scintigraphy for the diagnosis of coronary artery disease was carried out in 25 patients of mean age years, presenting with chest pain. Scintiscan were obtained at rest and after exercise and were compared with ECG studies at rest and after exercise. In all patients with previous myocardial infarctions, perfusion defects were present at rest, two of these patients showed abnormal stress scintigraphy consistent with a new ischemic response which was not detected by the stress ECG. In 3 out of the 8 patients with normal ECG, in 2 out of the 4 patients with response suggesting ischemia and in 4 out of the 7 patients with definite ECG proof of ischemia infarction was detected by 201 Tl. In all the previous, resting and exercise ECG failed to show evidence of infarction.1 fig.,2 tab

  11. Traction for low-back pain with or without sciatica.

    Science.gov (United States)

    Wegner, Inge; Widyahening, Indah S; van Tulder, Maurits W; Blomberg, Stefan E I; de Vet, Henrica Cw; Brønfort, Gert; Bouter, Lex M; van der Heijden, Geert J

    2013-08-19

    Traction has been used to treat low-back pain (LBP), often in combination with other treatments. We included both manual and machine-delivered traction in this review. This is an update of a Cochrane review first published in 1995, and previously updated in 2006. To assess the effects of traction compared to placebo, sham traction, reference treatments and no treatment in people with LBP. We searched the Cochrane Back Review Group Specialized Register, the Cochrane Central Register of Controlled Trials (2012, Issue 8), MEDLINE (January 2006 to August 2012), EMBASE (January 2006 to August 2012), CINAHL (January 2006 to August 2012), and reference lists of articles and personal files. The review authors are not aware of any important new randomized controlled trial (RCTs) on this topic since the date of the last search. RCTs involving traction to treat acute (less than four weeks' duration), subacute (four to 12 weeks' duration) or chronic (more than 12 weeks' duration) non-specific LBP with or without sciatica. Two review authors independently performed study selection, risk of bias assessment and data extraction. As there were insufficient data for statistical pooling, we performed a descriptive analysis. We did not find any case series that identified adverse effects, therefore we evaluated adverse effects that were reported in the included studies. We included 32 RCTs involving 2762 participants in this review. We considered 16 trials, representing 57% of all participants, to have a low risk of bias based on the Cochrane Back Review Group's 'Risk of bias' tool.For people with mixed symptom patterns (acute, subacute and chronic LBP with and without sciatica), there was low- to moderate-quality evidence that traction may make little or no difference in pain intensity, functional status, global improvement or return to work when compared to placebo, sham traction or no treatment. Similarly, when comparing the combination of physiotherapy plus traction with

  12. Non-invasive coronary angiography for patients with acute atypical chest pain discharged after negative screening including maximal negative treadmill stress test. A prospective study.

    Science.gov (United States)

    Bonello, L; Armero, S; Jacquier, A; Com, O; Sarran, A; Sbragia, P; Panuel, M; Arques, S; Paganelli, F

    2009-05-01

    Among patients admitted in the emergency department for acute atypical chest pain those with an acute coronary syndrome (ACS) who are mistakenly discharged home have high mortality. A recent retrospective study has demonstrated that multislice computed tomography (MSCT) coronary angiography could improve triage of these patients. We aimed to prospectively confirm these data on patients with a negative screening including maximal treadmill stress. 30 patients discharged from the emergency department after negative screening for an ACS were included. All patients underwent MSCT angiography of the coronary artery. Patients with coronary atheroma on MSCT had an invasive coronary angiography to confirm these findings. Seven patients (23%) had obstructive coronary artery disease on MSCT. Invasive coronary angiography (ICA) confirmed the diagnosis in all patients. In patients with no previously known coronary artery disease admitted to the emergency department with atypical acute chest pain and discharged after negative screening, including maximal treadmill stress test, MSCT coronary angiography is useful for the diagnosis of obstructive coronary artery disease.

  13. Prolotherapy: An Effective Treatment for Low Back Pain?

    Science.gov (United States)

    ... pain? Is prolotherapy an effective treatment for chronic low back pain? Answers from Brent A. Bauer, M.D. Prolotherapy is ... reduced pain. Studies of prolotherapy in people with low back pain have had mixed results. A combination of prolotherapy ...

  14. 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

    NARCIS (Netherlands)

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

    2010-01-01

    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

  15. Prevalence of Low Back Pain Among Traffic Wardens in Lagos State ...

    African Journals Online (AJOL)

    to determine the prevalence of low back pain and its associated risk factors among traffic wardens. ... in regulating traffic also has a significant influence on the severity of LBP. ... wardens in Lagos State, who assume a standing position for.

  16. Assessment and exercise in low back pain. With special reference to the management of pain and disability following first time lumbar disc surgery.

    Science.gov (United States)

    Manniche, C

    1995-09-01

    Eight articles including 555 low back pain patients have been published. They included the following topics: 1) A ratio interval rating scale (Low Back Pain Rating Scale (RS)) was introduced. The possibility of registering the actual status in low back pain patients including; Back Pain, Sciatica, Functional Disability and Physical Impairment was studied. Methods of evaluating index-scales developed in the field of psychometry were applied in the validation process of RS. RS was found to be both valid and user friendly. 2) Using Low Back Pain Rating Scale the general outcome following first-time lumbar disc surgery was analysed through a survey. The results showed that more than half of the patients still suffered from considerable Back Pain, Sciatica, and Functional Disabilities. Approximately 25% of the patients risked reduced work capabilities, and many receive pensions. 3) By means of a comprehensive statistical analysis of 18 studied preoperative demographic and physical findings, sex, hypoalgesia, smoking and Finneson-index were found to have prognostic value. 4) Attempts at influencing the results obtained from lumbar disc surgery have been tested in 3 randomized trials, including back training and peroperative glucocorticoid administration. 5) Three randomized trials including patients suffering from chronic low back pain (with or without previous lumbar disc surgery) attempted to convey which elements of a training programme provide patients with the greatest effect and the least risk of side-effects. It was concluded that Low Back Pain Rating Scale is a useable assessment instrument in both clinical trials and as a daily quality control instrument of back patients. There is a need of increased patient scrutiny in patient selection prior to lumbar disc surgery. Postoperative rehabilitation should include intensive back training, which has been shown to be of value in behavioural support and restoration of functional deficits. This has resulted in increased

  17. Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.

    Science.gov (United States)

    Beygui, Farzin; Castren, Maaret; Brunetti, Natale Daniele; Rosell-Ortiz, Fernando; Christ, Michael; Zeymer, Uwe; Huber, Kurt; Folke, Fredrik; Svensson, Leif; Bueno, Hector; Van't Hof, Arnoud; Nikolaou, Nikolaos; Nibbe, Lutz; Charpentier, Sandrine; Swahn, Eva; Tubaro, Marco; Goldstein, Patrick

    2015-08-27

    Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts' opinions, for all emergency medical services' health providers involved in the pre-hospital management of acute cardiovascular care. © The European Society of Cardiology 2015.

  18. Spine Day 2012: spinal pain in Swiss school children- epidemiology and risk factors.

    Science.gov (United States)

    Wirth, Brigitte; Knecht, Christina; Humphreys, Kim

    2013-10-05

    The key to a better understanding of the immense problem of spinal pain seems to be to investigate its development in adolescents. Based on the data of Spine Day 2012 (an annual action day where Swiss school children were examined by chiropractors on a voluntary basis for back problems), the aim of the present study was to gain systematic epidemiologic data on adolescent spinal pain in Switzerland and to explore risk factors per gender and per spinal area. Data (questionnaires and physical examinations) of 836 school children were descriptively analyzed for prevalence, recurrence and severity of spinal pain. Of those, 434 data sets were included in risk factor analysis. Using logistic regression analysis, psycho-social parameters (presence of parental back pain, parental smoking, media consumption, type of school bag) and physical parameters (trunk symmetry, posture, mobility, coordination, BMI) were analyzed per gender and per spinal area. Prevalence of spinal pain was higher for female gender in all areas apart from the neck. With age, a steep increase in prevalence was observed for low back pain (LBP) and for multiple pain sites. The increasing impact of spinal pain on quality of life with age was reflected in an increase in recurrence, but not in severity of spinal pain. Besides age and gender, parental back pain (Odds ratio (OR)=3.26, p=0.011) and trunk asymmetry (OR=3.36, p=0.027) emerged as risk factors for spinal pain in girls. Parental smoking seemed to increase the risk for both genders (boys: OR=2.39, p=0.020; girls: OR=2.19, p=0.051). Risk factor analysis per spinal area resulted in trunk asymmetry as risk factor for LBP (OR=3.15, p=0.015), while parental smoking increased the risk for thoracic spinal pain (TSP) (OR=2.83, p=0.036) and neck pain (OR=2.23, p=0.038). The risk for TSP was further enhanced by a higher BMI (OR=1.15, p=0.027). This study supports the view of adolescent spinal pain as a bio-psycho-social problem that should be investigated per

  19. The forgotten view: Chest X-ray - Lateral view

    Directory of Open Access Journals (Sweden)

    Abraham M. Ittyachen

    2017-01-01

    Full Text Available With CT (computed tomography chest gaining more importance as a diagnostic tool, chest X-ray especially the lateral view is taken less commonly nowadays. Besides CT chest is also proven to be superior to chest X-ray in patients with major blunt trauma. We are presenting a 68-year old male who was partially treated from outside for a left sided pneumonia. He came to our hospital because of persisting chest pain. Chest X-ray, frontal view (postero-anterior was almost normal except for a mild opacity in the left lower zone. CT scan of the chest revealed a fluid collection posteriorly enclosed within enhancing pleura. Chest X-ray, left lateral view showed a corresponding posterior pleural based opacity. We are presenting this case to highlight the importance of the lateral view of the chest X-ray. In selected cases there is still a role for the lateral view. With the three dimensional visualization provided by the CT, the lateral view of the chest may be easier to understand. Consequent to the initial diagnosis by CT further follow up can be done with the chest X-ray. In a limited way this mitigates unnecessary expenditure and more importantly prevents the patient from exposure to harmful radiation in the form of repeated CT.

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

    International Nuclear Information System (INIS)

    Kosuda, Shigeru; Momiyama, Yukihiko; Ohsuzu, Fumitaka; Kusano, Shoichi; Ichihara, Kiyoshi

    1999-01-01

    To evaluate the potential cost-effectiveness of exercise 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 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 4 yen/patient in the CAG group, 30.2 x 10 4 yen/patient in the follow-up group, and 71.0 x 10 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 4 yen/patient, as compared to the CAG group. In conclusion, the exercise 201 Tl myocardial SPECT strategy for patients with chest pain has the potential to reduce health care costs in Japan. (author)

  1. 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....

  2. Pain on Functional Movement Screen Tests and Injury Risk.

    Science.gov (United States)

    Bushman, Timothy T; Grier, Tyson L; Canham-Chervak, Michelle C; Anderson, Morgan K; North, William J; Jones, Bruce H

    2015-11-01

    The Functional Movement Screen (FMS) is a tool intended to evaluate limitations or asymmetries of movement to detect individuals at risk for exercise- and sports-related injury. The purpose was to determine the association and predictive value of specific FMS tests with injury risk in physically active men. Soldiers aged 18-57 years completed the FMS (n = 2,476). Demographic and fitness data were collected by survey. Medical record data for any, overuse, and traumatic injury 6 months after the assessment were obtained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated along with receiver operator characteristics to determine area under the curve (AUC). Risks, risk ratios, odds ratios (ORs), and 95% confidence intervals were calculated to assess injury risks. Multivariate logistic regression identified that pain on 5 of the 7 tests was associated with greater risk for any injury (OR = 1.50-3.51): deep squat, hurdle step, in-line lunge, trunk stability push-up, and rotary stability. However, FMS registered low sensitivity, PPV, and AUC for all 7 tests for the 3 injury types (2-24% sensitivity, 16-74% PPV, and 50-58% AUC). Although the presence of pain was associated with a higher risk of injury on 5 tests, a low sensitivity, PPV, and AUC were displayed. Therefore, caution is advised when implementing the FMS as a screening tool in an Army or similarly active population as it could lead to prevention and treatment resources being directed toward individuals who are not at greater risk for injury.

  3. Individual Participant Data Meta-Analysis of Mechanical Workplace Risk Factors and Low Back Pain

    Science.gov (United States)

    Shannon, Harry S.; Wells, Richard P.; Walter, Stephen D.; Cole, Donald C.; Côté, Pierre; Frank, John; Hogg-Johnson, Sheilah; Langlois, Lacey E.

    2012-01-01

    Objectives. We used individual participant data from multiple studies to conduct a comprehensive meta-analysis of mechanical exposures in the workplace and low back pain. Methods. We conducted a systematic literature search and contacted an author of each study to request their individual participant data. Because outcome definitions and exposure measures were not uniform across studies, we conducted 2 substudies: (1) to identify sets of outcome definitions that could be combined in a meta-analysis and (2) to develop methods to translate mechanical exposure onto a common metric. We used generalized estimating equation regression to analyze the data. Results. The odds ratios (ORs) for posture exposures ranged from 1.1 to 2.0. Force exposure ORs ranged from 1.4 to 2.1. The magnitudes of the ORs differed according to the definition of low back pain, and heterogeneity was associated with both study-level and individual-level characteristics. Conclusions. We found small to moderate ORs for the association of mechanical exposures and low back pain, although the relationships were complex. The presence of individual-level OR modifiers in such an area can be best understood by conducting a meta-analysis of individual participant data. PMID:22390445

  4. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report.

    Science.gov (United States)

    Idris, Baig M; Hefny, Ashraf F

    2016-01-01

    Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. A 63- year- old man presented to the Emergency Department complaining of left lateral chest pain due to a fall on his chest at home. On examination, he was hemodynamically stable. An urgent chest X-ray showed evidence of left sided pneumothorax. CT scan of the chest showed pneumothorax of more than 30% of the left hemithorax (around 600ml of air) with multiple left ribs fracture. Patient refused tube thoracostomy and was admitted to surgical department for close observation. The patient was managed conservatively without chest tube insertion. A repeat CT scan of the chest has shown complete resolution of the pneumothorax. The clinical spectrum of pneumothorax varies from asymptomatic to life threatening tension pneumothorax. In stable patients, conservative management can be safe and effective for small pneumothorax. To the best of our knowledge, this is the second reported case in the English literature with large pneumothorax which resolved spontaneously without chest drain. Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Prevalence and risk factors for low back pain among professional cooks working in school lunch services.

    Science.gov (United States)

    Nagasu, Miwako; Sakai, Kazuhiro; Ito, Akiyoshi; Tomita, Shigeru; Temmyo, Yoshiomi; Ueno, Mitsuo; Miyagi, Shigeji

    2007-07-24

    The prevalence of self-reported low back pain among professional cooks was estimated to examine the effects of daily life conditions, job-related factors, and psychological factors on this disorder. Data was collected using a mailed self-administered questionnaire. Of 7100 cooks, 5835 (82%) replied to the questionnaire, including 1010 men and 4825 women. The mean age was 41.4 for men and 47.5 for women. The prevalence of low back pain during a 1-month period was 72.2% among men and 74.7% among women, with no significant differences between groups. By logistic regression analyses, factors significantly associated with the prevalence of low back pain in 1 month were female gender (prevalence ratio [PR] 1.32; 95% CI, 1.03-1.68), current smoking (PR 1.57; 95% CI, 1.24-1.98), and past smoking (PR 1.35; 95% CI, 1.01-1.79). As for job-related factors, the number of cooked lunches per person (PR 1.28; 95% CI, 1.05-1.56), breaks in the morning session (PR 1.33; 95% CI, 1.13-1.56), kitchen environment (PR 1.09; 95%, CI, 1.03-1.15), and height of cooking equipment (PR 1.13; 95% CI, 1.08-1.19) were associated with the prevalence of low back pain. As for psychological factors, job satisfaction (PR 1.22; 95% CI, 1.03-1.45), stress at work (PR 1.68; 95% CI, 1.42-1.99), financial constraints (PR 1.23; 95% CI, 1.03-1.47), health-related stress (PR 1.31; 95% CI, 1.08-1.59) and worries about the future (PR 1.24; 95% CI, 1.01-1.52) were similarly associated. Daily life conditions, job-related factors, and psychological factors are associated with the occurrence of low back pain. It is important to take comprehensive preventive measures to address a range of work and life conditions that can be improved to decrease the incidence of low back pain for professional cooks.

  6. Breast Pain

    Science.gov (United States)

    ... result in the development of breast cysts. Breast trauma, prior breast surgery or other factors localized to the breast can lead to breast pain. Breast pain may also start outside the breast — in the chest wall, muscles, joints or heart, for example — and ...

  7. Low back pain among personal care workers in an old age home: work-related and individual factors.

    Science.gov (United States)

    Yeung, Simon S; Yuan, Jun

    2011-08-01

    This cross-sectional study explored the work-related and individual factors that contributed to the occurrence of low back pain and affected activities of 36 personal care workers at an old age home in Hong Kong. The study was divided into four parts: (1) a questionnaire documenting workload exposure factors; (2) a musculoskeletal symptoms survey documenting the prevalence of low back pain in this group of workers; (3) a worksite evaluation focusing on personal care workers' work postures and the work environment; and (4) an evaluation of physical fitness and lifting capacities of personal care workers. Univariate followed by multiple logistic regression analyses were used to identify the risk factors associated with low back pain that affected work activities. The results revealed that low back pain was associated with the perceived physical demands of cleaning tasks (odds ratio [OR] = 7.28, 95% confidence interval [CI] = 1.35-39.35, p stress at work (OR = 49.80, CI = 0.70-3541.79, p = .072). The results of the current study indicated that the work environment contributed to low back pain at work. Workers perceived that exertion in workplaces has a role in assessing workplace risk. To avoid progression of low back pain in the workplace, work adjustment or modification should be considered when workers report high levels of perceived exertion at work. Copyright 2011, SLACK Incorporated.

  8. Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.

    NARCIS (Netherlands)

    Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.

    2004-01-01

    The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40

  9. Estimation of breast dose and cancer risk in chest and abdomen CT procedures

    International Nuclear Information System (INIS)

    Eltahir, Suha Abubaker Ali

    2013-05-01

    The use of CT in medical diagnosis delivers radiation doses to patents that are higher than those from other radiological procedures. Lack of optimized protocols be an additional source of increased dose in developing countries. The aims of this study are first, to measure patient doses during CT chest and abdomen procedures, second, to estimate the radiation dose to the breast, and third to quantify the radiation risks during the procedures. Patient doses from two common CT examinations were obtained from four hospitals in Khartoum.The patient doses were estimated using measurement of CT dose indexes (CTDI), exposure-related parameters, and the IMPACT spreadsheet based on NRPB conversion factors. A large variation of mean organ doses among hospitals was observed for similar CT examinations. These variations largely originated from different CT scanning protocols used in different hospitals and scanner type. The largest range was found for CT of the chest, for which the dose varied from 2.3 to 47 (average 24.7) mSv and for abdomen CT, it was 1.6 to 18.8 (average 10.2) mSv. Radiation dose to the breast ranged from 1.6 to 32.9 mSv for the chest and 1.1 to 13.2 mSv for the abdomen. The radiation risk per procedure was high. The obtained values were mostly higher than the values of organ doses reported from the other studies. It was concluded that current clinical chest and abdomen protocols result in variable radiation doses to the breast. The magnitude of exposure may have implications for imaging strategies.(Author)

  10. Early predictors of the long-term outcome of low back pain - results of a 22-year prospective cohort study from general practice

    DEFF Research Database (Denmark)

    Lonnberg, F.; Pedersen, P.; Siersma, V.

    2010-01-01

    , use of painkillers for low back pain, use of health care providers, impairments due to low back pain and unfitness for work caused by low back pain. The influence of the predictors was assessed by relative risks. RESULTS: After 22 years, four out of five patients still experienced low back pain....... The perception of poor working conditions correlates with recurrent low back pain, intake of painkillers and limitations to daily life. CONCLUSION: Compared with pain history and clinical findings, the perception of workload is a better predictor of the long-term outcome of low back pain Udgivelsesdato: 2010/8/3...

  11. Exercise therapy for chronic nonspecific low-back pain

    NARCIS (Netherlands)

    van Middelkoop, Marienke; Rubinstein, Sidney M; Verhagen, Arianne P; Ostelo, Raymond W; Koes, Bart W; van Tulder, Maurits W

    Exercise therapy is the most widely used type of conservative treatment for low back pain. Systematic reviews have shown that exercise therapy is effective for chronic but not for acute low back pain. During the past 5 years, many additional trials have been published on chronic low back pain. This

  12. Sex differences of troponin test performance in chest pain patients.

    Science.gov (United States)

    Slagman, Anna; Searle, Julia; Vollert, Jörn O; Storchmann, Harald; Büschenfelde, Dirk Meyer Zum; von Recum, Johannes; Vlasny, Daniela; Ale-Abaei, Angela; Koch, Matthias; Müller, Christian; Müller, Reinhold; Somasundaram, Rajan; Möckel, Martin

    2015-01-01

    Current guidelines recommend troponin as the preferred biomarker to diagnose acute myocardial infarction (AMI) irrespective of the patient's sex. Recent reports have shown that sex-specific cut-offs should be considered but studies investigating sex-differences in the diagnostic accuracy of cardiac troponins are sparse. To evaluate whether the diagnostic performance of cardiac troponin at admission (cTn) under routine conditions is influenced by patient's sex. Between 15th of February 2009 and 15th of February 2010, women (n=1648) and men (n=2305) who presented to the emergency department with chest pain (n=3954) were enrolled. The diagnostic performance of the routine, contemporary sensitive cTn assays (TnI; Stratus® CS, Siemens and TnT; Roche Diagnostics) at baseline for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) was analyzed. NSTEMI was diagnosed in 7.3% (n=287) of all patients. Men were more likely to be diagnosed with NSTEMI (8.8%; n=202) as compared to women (5.2%; n=85; psex, with a lower sensitivity and NPV in women. The definition and implementation of sex-specific cut-off values for cTn into clinical routine seems to be highly recommendable. Copyright © 2015. Published by Elsevier Ireland Ltd.

  13. Risk factors for sickness absence due to low back pain and prognostic factors for return to work in a cohort of shipyard workers

    NARCIS (Netherlands)

    E.C. Alexopoulos (Evangelos); E.C. Konstantinou (Eleni); G. Bakoyannis (Giorgos); D. Tanagra (Dimitra); A. Burdorf (Alex)

    2008-01-01

    textabstractThe purpose of this study was to determine risk factors for the occurrence of sickness absence due to low back pain (LBP) and to evaluate prognostic factors for return to work. A longitudinal study with 1-year follow-up was conducted among 853 shipyard workers. The cohort was drawn

  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

    pain: appendicitis; renal colic; perforated duodenal ulcer ; acute cholecystitis; small bowel obstruction; and non-specific abdominal pain, This...psychoneurotic disorder; g) epigastric lesions (cholelithiasis, peptic ulcer , etc.). Musculoskeletal pain and costochrondritis denote muscle, rib, or cartilage...hyperventilation syndrome; f) psychoneurotic disorder; g) epigastric lesions (cholelithiasis, peptic ulcer , etc.). Musculoskeletal pain and the

  15. Low back pain in military recruits in relation to social background and previous low back pain. A cross-sectional and prospective observational survey

    DEFF Research Database (Denmark)

    Hestbæk, Lise; Larsen, K.; Weidich, F.

    2005-01-01

    back pain in the development of low back pain in military recruits. METHODS: During a three-month period, Danish military recruits with different social backgrounds live and work under the same conditions. Thus, there is an opportunity to investigate the influence of social background......BACKGROUND: Traditionally, studies on the etiology of low back pain have been carried out in adult populations. However, since low back pain often appears early in life, more research on young populations is needed. This study focuses on the importance of social background factors and previous low...... on the development of low back pain, when persons are removed from their usual environment and submitted to a number of new stressors. In addition, the importance of the recruits' previous low back pain history in relation to low back pain during military service was studied. This was done by means of questionnaires...

  16. Do functional tests predict low back pain?

    Science.gov (United States)

    Takala, E P; Viikari-Juntura, E

    2000-08-15

    A cohort of 307 nonsymptomatic workers and another cohort of 123 workers with previous episodes of low back pain were followed up for 2 years. The outcomes were measured by symptoms, medical consultations, and sick leaves due to low back disorders. To study the predictive value of a set of tests measuring the physical performance of the back in a working population. The hypothesis was that subjects with poor functional capacity are liable to back disorders. Reduced functional performance has been associated with back pain. There are few data to show whether reduced functional capacity is a cause or a consequence of pain. Mobility of the trunk in forward and side bending, maximal isokinetic trunk extension, flexion and lifting strength, and static endurance of back extension were measured. Standing balance and foot reaction time were recorded with a force plate. Clinical tests for the provocation of back or leg pain were performed. Gender, workload, age, and anthropometrics were managed as potential confounders in the analysis. Marked overlapping was seen in the measures of the subjects with different outcomes. Among the nonsymptomatic subjects, low performance in tests of mobility and standing balance was associated with future back disorders. Among workers with previous episodes of back pain, low isokinetic extension strength, poor standing balance, and positive clinical signs predicted future pain. Some associations were found between the functional tests and future low back pain. The wide variation in the results questions the value of the tests in health examinations (e.g., in screening or surveillance of low back disorders).

  17. 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

  18. Ketamine for chronic pain: risks and benefits

    Science.gov (United States)

    Niesters, Marieke; Martini, Christian; Dahan, Albert

    2014-01-01

    The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites. Current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4–14 days) show long-term analgesic effects up to 3 months following infusion. The side effects of ketamine noted in clinical studies include psychedelic symptoms (hallucinations, memory defects, panic attacks), nausea/vomiting, somnolence, cardiovascular stimulation and, in a minority of patients, hepatoxicity. The recreational use of ketamine is increasing and comes with a variety of additional risks ranging from bladder and renal complications to persistent psychotypical behaviour and memory defects. Blind extrapolation of these risks to clinical patients is difficult because of the variable, high and recurrent exposure to the drug in ketamine abusers and the high frequency of abuse of other illicit substances in this population. In clinical settings, ketamine is well tolerated, especially when benzodiazepines are used to tame the psychotropic side effects. Irrespective, close monitoring of patients receiving ketamine is mandatory, particularly aimed at CNS, haemodynamic, renal and hepatic symptoms as well as abuse. Further research is required to assess whether the benefits outweigh the risks and costs. Until definite proof is obtained ketamine administration should be restricted to patients with therapy-resistant severe neuropathic pain. PMID:23432384

  19. What is adolescent low back pain? Current definitions used to define the adolescent with low back pain

    Directory of Open Access Journals (Sweden)

    Steven Milanese

    2010-05-01

    Full Text Available Steven Milanese, Karen Grimmer-SomersCentre for Allied Health Evidence, University of South Australia, Adelaide, South AustraliaAbstract: Adolescent low back pain (ALBP is a common form of adolescent morbidity which remains poorly understood. When attempting a meta-analysis of observational studies into ALBP, in an effort to better understand associated risk factors, it is important that the studies involved are homogenic, particularly in terms of the dependent and independent variables. Our preliminary reading highlighted the potential for lack of homogeneity in descriptors used for ALBP. This review identified 39 studies of ALBP prevalence which fulfilled the inclusion criteria, ie, English language, involving adolescents (aged 10 to 19 years, pain localized to lumbar region, and not involving specific subgroups such as athletes and dancers. Descriptions for ALBP used in the literature were categorized into three categories: general ALBP, chronic/recurrent ALBP, and severe/disabling ALBP. Whilst the comparison of period prevalence rates for each category suggest that the three represent different forms of ALBP, it remains unclear whether they represented different stages on a continuum, or represent separate entities. The optimal period prevalence for ALBP recollection depends on the category of ALBP. For general ALBP the optimal period prevalence appears to be up to 12 months, with average lifetime prevalence rates similar to 1-year prevalence rates, suggesting an influence of memory decay on pain recall.Keywords: lumbar pain, teenager, adolescent

  20. Theeffectivenessofginger compress on non-specific low back pain ...

    African Journals Online (AJOL)

    Theeffectivenessofginger compress on non-specific low back pain. ... for a total of ten sessions and control group (n=7) did not received any treatment. ... in pain relief and reduces functional disability in patients with non-specific low back pain.

  1. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging.

    Science.gov (United States)

    Pathik, Bhupesh; Raman, Betty; Mohd Amin, Nor Hanim; Mahadavan, Devan; Rajendran, Sharmalar; McGavigan, Andrew D; Grover, Suchi; Smith, Emma; Mazhar, Jawad; Bridgman, Cameron; Ganesan, Anand N; Selvanayagam, Joseph B

    2016-10-01

    Troponin-positive chest pain patients with unobstructed coronaries represent a clinical dilemma. Cardiovascular magnetic resonance (CMR) imaging has an increasingly prominent role in the assessment of these patients; however, its utility in addition to expert clinical judgement is unclear. We sought to determine the incremental diagnostic value of CMR and the heterogeneity in diagnoses by experienced cardiologists when presented with blinded clinical and investigative data in this population. A total of 125 consecutive patients presenting to a tertiary centre between 2010 and 2014 with cardiac chest pain, elevated troponin (>29 ng/L), and unobstructed coronaries were enrolled and underwent CMR. A panel of three experienced cardiologists unaware of the CMR diagnosis and blinded to each other's assessment provided a diagnosis based on clinical and investigative findings. A consensus panel diagnosis was defined as two or more cardiologists sharing the same clinical diagnosis. Findings were classified into acute myocarditis, Takotsubo cardiomyopathy, acute myocardial infarction (AMI), or indeterminate. CMR provided a diagnosis in 87% of patients. Consensus panel diagnosis and CMR were concordant in 65/125 (52%) patients. There was an only moderate level of agreement between the three cardiologists (k = 0.47, P < 0.05) and a poor level of agreement between the consensus panel and CMR (k = 0.38, P < 0.05) with the most disagreement seen in patients with AMI diagnosed on CMR. The clinical diagnosis of patients with non-obstructive coronaries and positive troponin remains a challenge. The concordance between CMR and clinical diagnosis is poor. CMR provides a diagnosis in majority of these patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  2. Gender Differences in Somatic Symptoms and Current Suicidal Risk in Outpatients with Major Depressive Disorder.

    Science.gov (United States)

    Jeon, Hong Jin; Woo, Jong-Min; Kim, Hyo-Jin; Fava, Maurizio; Mischoulon, David; Cho, Seong Jin; Chang, Sung Man; Park, Doo-Heum; Kim, Jong Woo; Yoo, Ikki; Heo, Jung-Yoon; Hong, Jin Pyo

    2016-11-01

    Although somatic symptoms are common complaints of patients with major depressive disorder (MDD), their associations with suicide are still unclear. A total of 811 MDD outpatients of aged between 18 to 64 years were enrolled nationwide in Korea with the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Depression and Somatic Symptom Scale (DSSS). On stepwise regression analysis, current suicidality scores were most strongly associated with chest pain in men, and neck or shoulder pain in women. Severe chest pain was associated with higher current suicidality scores in men than in women, whereas severe neck or shoulder pain showed no significant differences between the genders. In conclusion, MDD patients of both sexes with suicidal ideation showed significantly more frequent and severe somatic symptoms than those without. Current suicidal risk was associated with chest pain in men, and neck or shoulder pain in women. We suggest that clinicians pay attention to patients' somatic symptoms in real world practice.

  3. Ketamine infusion for sickle cell pain crisis refractory to opioids: a case report and review of literature.

    Science.gov (United States)

    Uprety, Dipesh; Baber, Aurangzeb; Foy, Maria

    2014-05-01

    This article reports a rare case of the use of low-dose ketamine infusion as an adjuvant to opioids to treat pain in sickle cell disease. A 31-year-old African-American male with history of sickle cell disease presented to the emergency department with complaints of chest tightness, multiple joint pain, and headache for 1 week. His vital signs and physical examination were unremarkable. His admission lab included hemoglobin of 8.4 g/dl, reticulocyte count of 16.3%, bilirubin of 1.7 mg/dl, and LDH of 1,267 U/l. Chest X-ray showed middle and lower lobe opacity and interstitial thickening. He was treated for acute pain crisis and community-acquired pneumonia with intravenous fluids, supplemental oxygen, and intravenous levofloxacin. He was placed on fentanyl patient-controlled analgesia (PCA), oxycodone, ketorolac, and methadone with co-analgesic gabapentin and venlafaxine. Over the course of his hospitalization, his chest pain resolved, but the joint pains continued. He was then transferred to the ICU and was discharged a day later after 7 days of ketamine infusion. Ketamine is a noncompetitive antagonist at the N-methyl-D-aspartate (NMDA) receptor. This property has been shown to modulate opioid tolerance and opioid-induced hyperalgesia. There have been a very few published reports on the use of low-dose ketamine in sickle cell pain management. A PubMed search revealed four published articles (Table 1). Fourteen out of the 17 cases (82.35%) who received ketamine infusion showed improvement in self-reported pain intensity and significant reduction in opioid dosage. Only one patient (5.9%) developed serious side effect leading to discontinuation of the drug. A low-dose ketamine can be an option for pain control in sickle cell disease. Randomized trial is required to establish this benefit of ketamine over currently available therapies.

  4. Comparison of chest compression quality between the modified chest compression method with the use of smartphone application and the standardized traditional chest compression method during CPR.

    Science.gov (United States)

    Park, Sang-Sub

    2014-01-01

    The purpose of this study is to grasp difference in quality of chest compression accuracy between the modified chest compression method with the use of smartphone application and the standardized traditional chest compression method. Participants were progressed 64 people except 6 absentees among 70 people who agreed to participation with completing the CPR curriculum. In the classification of group in participants, the modified chest compression method was called as smartphone group (33 people). The standardized chest compression method was called as traditional group (31 people). The common equipments in both groups were used Manikin for practice and Manikin for evaluation. In the meantime, the smartphone group for application was utilized Android and iOS Operating System (OS) of 2 smartphone products (G, i). The measurement period was conducted from September 25th to 26th, 2012. Data analysis was used SPSS WIN 12.0 program. As a result of research, the proper compression depth (mm) was shown the proper compression depth (p< 0.01) in traditional group (53.77 mm) compared to smartphone group (48.35 mm). Even the proper chest compression (%) was formed suitably (p< 0.05) in traditional group (73.96%) more than smartphone group (60.51%). As for the awareness of chest compression accuracy, the traditional group (3.83 points) had the higher awareness of chest compression accuracy (p< 0.001) than the smartphone group (2.32 points). In the questionnaire that was additionally carried out 1 question only in smartphone group, the modified chest compression method with the use of smartphone had the high negative reason in rescuer for occurrence of hand back pain (48.5%) and unstable posture (21.2%).

  5. Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study.

    Science.gov (United States)

    Langdorf, Mark I; Medak, Anthony J; Hendey, Gregory W; Nishijima, Daniel K; Mower, William R; Raja, Ali S; Baumann, Brigitte M; Anglin, Deirdre R; Anderson, Craig L; Lotfipour, Shahram; Reed, Karin E; Zuabi, Nadia; Khan, Nooreen A; Bithell, Chelsey A; Rowther, Armaan A; Villar, Julian; Rodriguez, Robert M

    2015-12-01

    Chest computed tomography (CT) diagnoses more injuries than chest radiography, so-called occult injuries. Wide availability of chest CT has driven substantial increase in emergency department use, although the incidence and clinical significance of chest CT findings have not been fully described. We determine the frequency, severity, and clinical import of occult injury, as determined by changes in management. These data will better inform clinical decisions, need for chest CT, and odds of intervention. Our sample included prospective data (2009 to 2013) on 5,912 patients at 10 Level I trauma center EDs with both chest radiography and chest CT at physician discretion. These patients were 40.6% of 14,553 enrolled in the parent study who had either chest radiography or chest CT. Occult injuries were pneumothorax, hemothorax, sternal or greater than 2 rib fractures, pulmonary contusion, thoracic spine or scapula fracture, and diaphragm or great vessel injury found on chest CT but not on preceding chest radiography. A priori, we categorized thoracic injuries as major (having invasive procedures), minor (observation or inpatient pain control >24 hours), or of no clinical significance. Primary outcome was prevalence and proportion of occult injury with major interventions of chest tube, mechanical ventilation, or surgery. Secondary outcome was minor interventions of admission rate or observation hours because of occult injury. Two thousand forty-eight patients (34.6%) had chest injury on chest radiography or chest CT, whereas 1,454 of these patients (71.0%, 24.6% of all patients) had occult injury. Of these, in 954 patients (46.6% of injured, 16.1% of total), chest CT found injuries not observed on immediately preceding chest radiography. In 500 more patients (24.4% of injured patients, 8.5% of all patients), chest radiography found some injury, but chest CT found occult injury. Chest radiography found all injuries in only 29.0% of injured patients. Two hundred and two

  6. Threshold of musculoskeletal pain intensity for increased risk of long-term sickness absence among female healthcare workers in eldercare.

    Directory of Open Access Journals (Sweden)

    Lars L Andersen

    Full Text Available PURPOSE: Musculoskeletal disorders increase the risk for absenteeism and work disability. However, the threshold when musculoskeletal pain intensity significantly increases the risk of sickness absence among different occupations is unknown. This study estimates the risk for long-term sickness absence (LTSA from different pain intensities in the low back, neck/shoulder and knees among female healthcare workers in eldercare. METHODS: Prospective cohort study among 8,732 Danish female healthcare workers responding to a questionnaire in 2004-2005, and subsequently followed for one year in a national register of social transfer payments (DREAM. Using Cox regression hazard ratio (HR analysis we modeled risk estimates of pain intensities on a scale from 0-9 (reference 0, where 0 is no pain and 9 is worst imaginable pain in the low back, neck/shoulders and knees during the last three months for onset of LTSA (receiving sickness absence compensation for at least eight consecutive weeks during one-year follow-up. RESULTS: During follow-up, the 12-month prevalence of LTSA was 6.3%. With adjustment for age, BMI, smoking and leisure physical activity, the thresholds of pain intensities significantly increasing risk of LTSA for the low back (HR 1.44 [95%CI 1.07-1.93], neck/shoulders (HR 1.47 [95%CI 1.10-1.96] and knees (HR 1.43 [95%CI 1.06-1.93] were 5, 4 and 3 (scale 0-9, respectively, referencing pain intensity of 0. CONCLUSION: The threshold of pain intensity significantly increasing the risk for LTSA among female healthcare workers varies across body regions, with knee pain having the lowest threshold. This knowledge may be used in the prevention of LTSA among health care workers.

  7. Lumbopelvic Core Stabilization Exercise and Pain Modulation Among Individuals with Chronic Nonspecific Low Back Pain.

    Science.gov (United States)

    Paungmali, Aatit; Joseph, Leonard H; Sitilertpisan, Patraporn; Pirunsan, Ubon; Uthaikhup, Sureeporn

    2017-11-01

    Lumbopelvic stabilization training (LPST) may provide therapeutic benefits on pain modulation in chronic nonspecific low back pain conditions. This study aimed to examine the effects of LPST on pain threshold and pain intensity in comparison with the passive automated cycling intervention and control intervention among patients with chronic nonspecific low back pain. A within-subject, repeated-measures, crossover randomized controlled design was conducted among 25 participants (7 males and 18 females) with chronic nonspecific low back pain. All the participants received 3 different types of experimental interventions, which included LPST, the passive automated cycling intervention, and the control intervention randomly, with 48 hours between the sessions. The pressure pain threshold (PPT), hot-cold pain threshold, and pain intensity were estimated before and after the interventions. Repeated-measures analysis of variance showed that LPST provided therapeutic effects as it improved the PPT beyond the placebo and control interventions (P pain intensity under the LPST condition was significantly better than that under the passive automated cycling intervention and controlled intervention (P pain threshold under the LPST condition also showed a significant trend of improvement beyond the control (P pain threshold were evident. Lumbopelvic stabilization training may provide therapeutic effects by inducing pain modulation through an improvement in the pain threshold and reduction in pain intensity. LPST may be considered as part of the management programs for treatment of chronic low back pain. © 2017 World Institute of Pain.

  8. Lombalgia ocupacional Occupational low back pain

    Directory of Open Access Journals (Sweden)

    Milton Helfenstein Junior

    2010-01-01

    Full Text Available A lombalgia ocupacional apresenta etiologia multifatorial, elevada prevalência e incidência. Caracterizada por quadro de dor de variada duração e intensidade, a dor lombar pode levar à incapacidade laborativa e à invalidez. A lombalgia acarreta sofrimento aos trabalhadores, custos às empresas, aos sistemas previdenciário e assistencial de saúde. Os autores, pela relevância do tema, elaboraram este artigo de revisão bibliográfica dando ênfase ao embasamento teorico-conceitual e à experiência de especialistas.The occupational low back pain presents multifactorial aetiology, important prevalence and incidence. Characterized by pain of varying duration and intensity, low back pain may lead to disability. Low back pain causes suffering to workers, implies costs to companies, to the social security and health assistance system. Because of the theme's relevance, the authors have elaborated this review of literature with emphasis on a theoretical and conceptual basis, as well as experience of experts.

  9. Evaluation of a low-dose neonatal chest radiographic system

    International Nuclear Information System (INIS)

    Burton, E.M.; Kirks, D.R.; Strife, J.L.; Henry, G.C.; Kereiakes, J.G.

    1988-01-01

    A new low-dose chest radiographic system for use in the neonatal nursery was evaluated. This test system, composed of a Du Pont Kevlar fiber-front cassette, Quanta fast-detail screen, Cronex 4L film (wide latitude), and additional yttrium filtration (0.1 mm), reduced the radiation dose in neonatal chest radiography by 69% (0.9 vs 2.9 mrad [0.009 vs 0.029 mGy]) as compared with a conventional system without added yttrium filtration; the thyroid dose was reduced by 76% (0.9 vs 3.7 mrad [0.009 vs 0.037 mGy]). The cumulative dose reduction was achieved through a combination of factors, including (1) beam hardening by the added yttrium filter, (2) increased X-ray transmission through the Kevlar cassette, and (3) a fast film-screen combination. Scatter radiation at distances of 1 and 6 ft. (0.3 and 1.8 m) was negligible for both systems. Image sharpness was compared for the conventional system with and without added yttrium filtration and for the Kevlar system with yttrium. Although sharpness of bony detail was unchanged by adding yttrium filtration to the conventional system, a decrease in sharpness was noted with the Kevlar system. Because image sharpness was affected in the test system, we are not using the Kevlar-Cronex 4L system for mobile chest radiography in the neonatal intensive care unit, despite dose reductions. However, further study is recommended to determine if there is a slower film-screen combination with yttrium filtration that will not degrade image sharpness

  10. Prevalence and risk factors for low back pain among professional cooks working in school lunch services

    Directory of Open Access Journals (Sweden)

    Temmyo Yoshiomi

    2007-07-01

    Full Text Available Abstract Background The prevalence of self-reported low back pain among professional cooks was estimated to examine the effects of daily life conditions, job-related factors, and psychological factors on this disorder. Methods Data was collected using a mailed self-administered questionnaire. Results Of 7100 cooks, 5835 (82% replied to the questionnaire, including 1010 men and 4825 women. The mean age was 41.4 for men and 47.5 for women. The prevalence of low back pain during a 1-month period was 72.2% among men and 74.7% among women, with no significant differences between groups. By logistic regression analyses, factors significantly associated with the prevalence of low back pain in 1 month were female gender (prevalence ratio [PR] 1.32; 95% CI, 1.03–1.68, current smoking (PR 1.57; 95% CI, 1.24–1.98, and past smoking (PR 1.35; 95% CI, 1.01–1.79. As for job-related factors, the number of cooked lunches per person (PR 1.28; 95% CI, 1.05–1.56, breaks in the morning session (PR 1.33; 95% CI, 1.13–1.56, kitchen environment (PR 1.09; 95%, CI, 1.03–1.15, and height of cooking equipment (PR 1.13; 95% CI, 1.08–1.19 were associated with the prevalence of low back pain. As for psychological factors, job satisfaction (PR 1.22; 95% CI, 1.03–1.45, stress at work (PR 1.68; 95% CI, 1.42–1.99, financial constraints (PR 1.23; 95% CI, 1.03–1.47, health-related stress (PR 1.31; 95% CI, 1.08–1.59 and worries about the future (PR 1.24; 95% CI, 1.01–1.52 were similarly associated. Conclusion Daily life conditions, job-related factors, and psychological factors are associated with the occurrence of low back pain. It is important to take comprehensive preventive measures to address a range of work and life conditions that can be improved to decrease the incidence of low back pain for professional cooks.

  11. The most physically active Danish adolescents are at increased risk for developing spinal pain

    DEFF Research Database (Denmark)

    Aartun, Ellen; Boyle, Eleanor; Hartvigsen, Jan

    2016-01-01

    BACKGROUND: The overall aim of this study was to determine to what extent objectively measured physical activity in a school-based sample aged 11-13 years predicted incident cases of spinal pain (neck pain, mid back pain or low back pain) over the following 2 years. METHODS: Data were collected...... was defined as a report of pain in at least one spinal area at follow-up. Physical activity was measured objectively using the Actigraph GT3X Triaxial Activity Monitor for 1 week. RESULTS: Objectively measured sedentary activity, moderate-to-vigorous physical activity and vigorous physical activity were...... generally not predictive of the 2-year incidence of spinal pain. However, 10% of participants with the highest proportion of the day spent in vigorous physical activity were at increased risk of reporting spinal pain at follow-up with a relative risk (RR) of 1.44 (95% CI 1.09 to 1.91). For the overall...

  12. Psychological risk and protective factors for disability in chronic low back pain - a longitudinal analysis in primary care.

    Science.gov (United States)

    Jegan, Nikita Roman A; Brugger, Markus; Viniol, Annika; Strauch, Konstantin; Barth, Jürgen; Baum, Erika; Leonhardt, Corinna; Becker, Annette

    2017-03-20

    Utilizing psychological resources when dealing with chronic low back pain might aid the prevention of disability. The observational study at hand examined the longitudinal impact of resilience and coping resources on disability in addition to established risk factors. Four hundred eighty four patients with chronic low back pain (>3 months) were recruited in primary care practices and followed up for one year. Resilience, coping, depression, somatization, pain and demographic variables were measured at baseline. At follow-up (participation rate 89%), data on disability was collected. We first calculated bivariate correlations of all the predictors with each other and with follow-up disability. We then used a multiple regression to evaluate the impact of all the predictors on disability together. More than half of the followed up sample showed a high degree of disability at baseline (53.7%) and had suffered for more than 10 years from pain (50.4%). Besides gender all of the predictors were bivariately associated with follow-up disability. However in the main analysis (multiple regression), disability at follow up was only predicted by baseline disability, age and somatization. There was no relationship between resilience and disability, nor between coping resources and disability. Although it is known that there are cross-sectional relationships between resilience/coping resources and disability we were not able to replicate it in the multiple regression. This can have several reasons: a) the majority of patients in our sample were much more disabled and suffered for a longer time than in other studies. Therefore our results might be limited to this specific population and resilience and coping resources might still have a protective influence in acute or subacute populations. b) We used a rather broad operationalization of resilience. There is emerging evidence that focusing on more concrete sub facets like (pain) self-efficacy and acceptance might be more

  13. Comparison of central and intraesophageal factors between gastroesophageal reflux disease (GERD) patients and those with GERD-related noncardiac chest pain.

    Science.gov (United States)

    Shapiro, M; Simantov, R; Yair, M; Leitman, M; Blatt, A; Scapa, E; Broide, E

    2012-01-01

    Gastroesophageal reflux disease (GERD) causes a wide range of symptoms. Some patients present with typical symptoms such as heartburn and regurgitation and others with atypical symptoms such as chest pain. The mechanism responsible for the varying clinical presentation of GERD is still not fully elucidated. The aim of this study was to prospectively evaluate differences in central and local intraesophageal factors between patients with typical GERD symptoms and those with noncardiac chest pain (NCCP). Patients presenting with typical and atypical symptoms suspicious of GERD underwent upper endoscopy and 24-hour pH monitoring with four sensors, each positioned at a different esophageal level. All patients completed GERD symptom, Hospital Anxiety and Depression Scale, and Symptom Stress Rating questionnaires. From January 2006 to December 2009, 50 patients were recruited, 29 with typical symptoms, and 21 with NCCP. Patients with proven GERD and NCCP had higher proximal extension of acid during reflux episodes than patients with typical symptoms. They were found to be older, had a shorter history of symptom onset, worse anxiety scores, and more endoscopic findings compatible with gastritis. Proximal extension of acid during the reflux episodes in patients with GERD presenting with NCCP may play a role in symptom generation. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  14. Is a history of work-related low back injury associated with prevalent low back pain and depression in the general population?

    Directory of Open Access Journals (Sweden)

    Cassidy J David

    2008-02-01

    may be an important risk factor for future episodes of low back pain and disability in the general population.

  15. Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures.

    Science.gov (United States)

    Chapman, Brandon C; Overbey, Douglas M; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T; French, Andrew; Johnson, Jeffrey L; Burlew, Clay C; Barnett, Carlton; Moore, Ernest E; Pieracci, Fredric M

    2016-12-01

    Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student's t-test and chi-square analysis were used for comparison. We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

  16. [Low back pain during pregnancy. Multidisciplinary approach].

    Science.gov (United States)

    Gallo-Padilla, D; Gallo-Padilla, C; Gallo-Vallejo, F J; Gallo-Vallejo, J L

    2016-09-01

    After explaining that low back pain is considered the most common pregnancy complication, its pathogenesis, risk factors and the clinical characteristics of the very painful symptoms of this condition are described. As for its approach, it is stressed that it must be multidisciplinary, introducing very important preventive measures, including proper postural hygiene. For its treatment, the methods may be based on non-surgical or pharmacological interventions of a conservative non-invasive nature. Thus, physiotherapy, osteopathic manipulation, multimodal intervention (exercise and education), exercises performed in water environment, acupuncture, etc., have proven to be effective. Finally, it is emphasised that given the significant impact on their quality of life, different health professionals must be proactive and treat the lumbar disease in pregnant women. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Risk stratification of patients suspected of coronary artery disease

    DEFF Research Database (Denmark)

    Jensen, Jesper M; Voss, Mette; Hansen, Vibeke Bøgelund

    2012-01-01

    To compare the performance of five risk models (Diamond-Forrester, the updated Diamond-Forrester, Morise, Duke, and a new model designated COronary Risk SCORE (CORSCORE) in predicting significant coronary artery disease (CAD) in patients with chest pain suggestive of stable angina pectoris....

  18. Identification of pain indicators for infants at risk for neurological impairment: A Delphi consensus study

    Directory of Open Access Journals (Sweden)

    Camfield Carol

    2006-02-01

    Full Text Available Abstract Background A number of infant pain measures have been developed over the past 15 years incorporating behavioural and physiologic indicators; however, no reliable or valid measure exists for infants who are at risk for neurological impairments (NI. The objective of this study was to establish consensus about which behavioural, physiologic and contextual indicators best characterize pain in infants at high, moderate and low levels of risk for NI. Methods A 39- item, self-administered electronic survey that included infant physiologic, behavioral and contextual pain indicators was used in a two round Delphi consensus exercise. Fourteen pediatric pain experts were polled individually and anonymously on the importance and usefulness of the pain indicators for the 3 differing levels of risk for NI. Results The strength of agreement between expert raters was moderate in Round 1 and fair in Round 2. In general, pain indicators with the highest concordance for all three groups were brow bulge, facial grimace, eye squeeze, and inconsolability. Increased heart rate from baseline in the moderate and severe groups demonstrated high concordance. In the severe risk group, fluctuations in heart rate and reduced oxygen saturation were also highly rated. Conclusion These data constitute the first step in contributing to the development and validation of a pain measure for infants at risk for NI. In future research, we will integrate these findings with the opinions of (a health care providers about the importance and usefulness of infant pain indicators and (b the pain responses of infants at mild, moderate and high risk for NI.

  19. Meta-analysis: exercise therapy for nonspecific low back pain.

    Science.gov (United States)

    Hayden, Jill A; van Tulder, Maurits W; Malmivaara, Antti V; Koes, Bart W

    2005-05-03

    Exercise therapy is widely used as an intervention in low back pain. To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments. MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes. Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up. 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, -1.3 to 1.4 points]). Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent

  20. Limitations associated with managing chronic low back pain.

    Science.gov (United States)

    Beland, Paul

    2016-04-20

    Non-specific chronic low back pain is an occupational hazard for nurses. It may result in persistent and disabling pain for some people. There are many techniques for investigating, assessing and treating chronic low back pain. However, research to support some of these interventions and the assumptions that underlie them is limited. Interventions that may be beneficial are not always available to those who need them. Changes to service provision are required to rectify this situation and provide effective treatment for patients with non-specific chronic low back pain.

  1. Spouse criticism and hostility during marital interaction: effects on pain intensity and behaviors among individuals with chronic low back pain.

    Science.gov (United States)

    Burns, John W; Post, Kristina M; Smith, David A; Porter, Laura S; Buvanendran, Asokumar; Fras, Anne Marie; Keefe, Francis J

    2017-10-30

    Individuals with chronic pain may experience negative responses from spouse, family, and friends. Responses such as overt criticism and hostility may be associated with worsening pain and function for chronic pain sufferers. We used a laboratory procedure to evaluate whether variability in spouse criticism/hostility exhibited toward chronic low back pain (CLBP) patients during a conflictual discussion predicted variability in patient pain and function during a subsequent pain-induction task. Chronic low back pain patients (n = 71) and their spouses (n = 71) participated in a 10-minute discussion followed by the patient undergoing a 10-minute structured pain behavior task (SPBT). Spouse criticism/hostility perceived by patients and patient Beck Depression Inventory-II (BDI) scores correlated significantly and positively with pain intensity during the SPBT, whereas perceived spouse hostility, patient BDI scores, and spouse trait hostility correlated significantly and positively with observed pain behaviors during the SPBT. Spouse criticism/hostility coded by raters from video recordings interacted significantly with patient BDI scores, such that observed spouse criticism/hostility was related significantly and positively with pain behaviors only for patients with high BDI scores. Patient sex interacted significantly with observed spouse criticism/hostility, such that observed spouse criticism/hostility was related significantly and positively with pain behaviors only for female patients. Results support the hypothesis that spouse criticism and hostility-actually expressed or perceived-may worsen CLBP patient symptoms. Further, women patients and patients high in depressive symptoms appeared most vulnerable to spouse criticism/hostility. Thus, negative marital communication patterns may be appropriate targets for intervention, especially among these 2 at risk groups.

  2. Digital chest radiography

    DEFF Research Database (Denmark)

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

    ,3 mAs and SID SID of 180 centimetres using a phantom and lithium fluoride thermo luminescence dosimeter (TLD). Dose to risk organs mamma, thyroid and colon are measured at different collimations with one-centimetre steps. TLD results are used to estimate dose reduction for different collimations...... at the conference. Conclusion: Collimation improvement in basic chest radiography can reduce the radiation to female patients at chest x-ray examinations....

  3. Low back pain during pregnancy and Kinesio tape application.

    Science.gov (United States)

    Reyhan, Aycan Çakmak; Dereli, Elif Elçin; Çolak, Tuğba Kuru

    2017-01-01

    Low back pain is a common problem during pregnancy. Although the pain usually occurs in the third trimester, it might be seen in the first trimester, too. There are various types of applications for the treatment of low back pain during pregnancy. However, there is a lack of evidence for the effectiveness of each method. If there is not an obvious deficit, bed rest, exercise, conventional physiotherapy, using protective principles for the lumbar area are recommended, since the main and the only complaint is low back pain. It is aimed in the current review to investigate the use of Kinesio tape in the low back pain seen during pregnancy and to review the literature related to this subject. There are only a few studies investigating the effect of Kinesio tape during pregnancy in the literature and they mostly did not aim to study the low back pain, further evidence and studies are needed to investigate the use of Kinesio tape for the low back pain seen during pregnancy as there is not evidence strong enough. Kinesiotape application aims to increase circulation and mobility, and regarding these gains decreased pain and increased performance are expected.

  4. Comparison of mental distress in patients with low back pain and a population-based control group measured by Symptoms Check List

    DEFF Research Database (Denmark)

    Christensen, Jan; Fisker, Annette; Mortensen, Erik Lykke

    2015-01-01

    . The objective of this study was to compare mental symptoms and distress as measured by the Symptoms Check List-90 in sick-listed or at risk of being sick-listed patients with low back pain with a population-based control group. METHODS: Mental distress was compared in a group of patients with low back pain (n......=770) and a randomly selected population-based reference group (n=909). Established Danish cut-off values for mental distress were used to evaluate the mental distress status in the low back pain and control group and logistic regression was used to calculate odds ratios for the Global Severity Index......PURPOSE: Mental distress is common in persons experiencing low back pain and who are sick-listed or at risk of being sick-listed. It is, however, not known how mental distress measured by the Symptoms Check List-90 differs between patients with low back pain and the general population...

  5. Psychosocial work characteristics and psychological strain in relation to low-back pain

    NARCIS (Netherlands)

    Hoogendoorn, W.E.; Bongers, P.M.; Vet, H.C.W. de; Houtman, I.L.D.; Ariëns, G.A.M.

    2001-01-01

    This study investigated the relationship between psychosocial work characteristics and low-back pain and the potential intermediate role of psychological strain variables in this relationship. The research was part of a prospective cohort study of risk factors for musculoskeletal symptoms. The study

  6. B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST-segment elevation.

    Science.gov (United States)

    Bassan, Roberto; Potsch, Alfredo; Maisel, Alan; Tura, Bernardo; Villacorta, Humberto; Nogueira, Mônica Viegas; Campos, Augusta; Gamarski, Roberto; Masetto, Antonio Cláudio; Moutinho, Marco Aurélio

    2005-02-01

    This study was undertaken to determine the diagnostic value of admission B-type natriuretic peptide (BNP) for acute myocardial infarction (AMI) in patients with acute chest pain and no ST-segment elevation. A prospective study with 631 consecutive patients was conducted in the emergency department. Non-ST elevation AMI was present in 72 patients and their median admission BNP level was significantly higher than in unstable angina and non-acute coronary syndrome patients. Sensitivity of admission BNP for AMI (cut-off value of 100 pg/mL) was significantly higher than creatine kinase-MB (CKMB) and troponin-I on admission (70.8 vs. 45.8 vs. 50.7%, respectively, P<0.0001) and specificity was 68.9%. Simultaneous use of these markers significantly improved sensitivity to 87.3% and the negative predictive value to 97.3%. In multiple logistic regression analysis, admission BNP was a significant independent predictor of AMI, even when CKMB and troponin-I were present in the model. BNP is a useful adjunct to standard cardiac markers in patients presenting to the emergency department with chest pain and no ST-segment elevation, particularly if initial CKMB and/or troponin-I are non-diagnostic.

  7. Questionnaire for low back pain in the garment industry workers.

    Science.gov (United States)

    Bindra, Supreet; Sinha, A G K; Benjamin, A I

    2013-05-01

    Low back pain affects up to 90% of the world's population at some point in their lives. Until date no questionnaire has been designed for back pain in the garment industry workers. Therefore, the objective of this study is to design a questionnaire to determine the prevalence, risk factors, impact, health care service utilization and back pain features in the garment industry workers and gain preliminary experience of its use. The content validity and reliability of the questionnaire was established. Items showing acceptable internal consistency and moderate to high test re-test reliability were retained in the questionnaire. Items showing unacceptable internal consistency, low test re-test reliability or poor differentiation were reworded, redrafted and re-tested on the workers. It took 20 min to complete one interview schedule. Environmental factors such as the absence of the garment industry owner/supervisor or co-workers at the time of the interview and interview during leisure hours need to be standardized. Thus, final questionnaire is ready for use after necessary amendments and will be used on the larger sample size in the main study.

  8. Low Dose Vaporized Cannabis Significantly Improves Neuropathic Pain

    Science.gov (United States)

    Wilsey, Barth; Marcotte, Thomas D.; Deutsch, Reena; Gouaux, Ben; Sakai, Staci; Donaghe, Haylee

    2013-01-01

    We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling either medium dose (3.53%), low dose (1.29%), or placebo cannabis with the primary outcome being VAS pain intensity. Psychoactive side-effects, and neuropsychological performance were also evaluated. Mixed effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the two active dose groups’ results (p>0.7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo vs. low dose, 2.9 for placebo vs. medium dose, and 25 for medium vs. low dose. As these NNT are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being, for all intents and purposes, as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well-tolerated, and neuropsychological effects were of limited duration and readily reversible within 1–2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. PMID:23237736

  9. Antidepressants for non-specific low back pain

    NARCIS (Netherlands)

    Urquhart, D. M.; Hoving, J. L.; Assendelft, W. W. J. J.; Roland, M.; van Tulder, M. W.

    2008-01-01

    BACKGROUND: Antidepressants are commonly used in the management of low-back pain. However, their use is controversial. OBJECTIVES: The aim of this review was to determine whether antidepressants are more effective than placebo for the treatment of non-specific low-back pain. SEARCH STRATEGY:

  10. Prolonged pain and disability are common after rib fractures.

    Science.gov (United States)

    Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John

    2013-05-01

    The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks. This study was a prospective observation of 203 patients with rib fractures at a level 1 trauma center. Chest wall pain was evaluated by the McGill Pain Questionnaire (MPQ) pain rating index (PRI) and present pain intensity (PPI). Prolonged pain was defined as a PRI of 8 or more at 2 months after injury. Prolonged disability was defined as a decrease in 1 or more levels of work or functional status at 2 months after injury. Predictors of prolonged pain and disability were determined by multivariate analysis. One hundred forty-five male patients and 58 female patients with a mean injury severity score (ISS) of 20 (range, 1 to 59) had a mean of 5.4 rib fractures (range, 1 to 29). Forty-four (22%) patients had bilateral fractures, 15 (7%) had flail chest, and 92 (45%) had associated injury. One hundred eighty-seven patients were followed 2 months or more. One hundred ten (59%) patients had prolonged chest wall pain and 142 (76%) had prolonged disability. Among 111 patients with isolated rib fractures, 67 (64%) had prolonged chest wall pain and 69 (66%) had prolonged disability. MPQ PPI was predictive of prolonged pain (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4 to 2.5), and prolonged disability (OR, 2.2; 95% CI, 1.5 to 3.4). The presence of significant associated injuries was predictive of prolonged disability (OR, 5.9; 95% CI, 1.4 to 29). Prolonged chest wall pain is common, and the contribution of rib fractures to disability is greater than traditionally expected. Further investigation into more effective therapies that prevent prolonged pain and disability after rib fractures is needed. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Low back pain and yoga.

    Science.gov (United States)

    Singh, Supreet

    2014-12-01

    ABSTRACT 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 chronic low back pain, one of the most common reasons to visit one's primary care doctor. Complementary approaches, including yoga, will be addressed.

  12. Ketamine for chronic pain: risks and benefits.

    Science.gov (United States)

    Niesters, Marieke; Martini, Christian; Dahan, Albert

    2014-02-01

    The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites. Current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4-14 days) show long-term analgesic effects up to 3 months following infusion. The side effects of ketamine noted in clinical studies include psychedelic symptoms (hallucinations, memory defects, panic attacks), nausea/vomiting, somnolence, cardiovascular stimulation and, in a minority of patients, hepatoxicity. The recreational use of ketamine is increasing and comes with a variety of additional risks ranging from bladder and renal complications to persistent psychotypical behaviour and memory defects. Blind extrapolation of these risks to clinical patients is difficult because of the variable, high and recurrent exposure to the drug in ketamine abusers and the high frequency of abuse of other illicit substances in this population. In clinical settings, ketamine is well tolerated, especially when benzodiazepines are used to tame the psychotropic side effects. Irrespective, close monitoring of patients receiving ketamine is mandatory, particularly aimed at CNS, haemodynamic, renal and hepatic symptoms as well as abuse. Further research is required to assess whether the benefits outweigh the risks and costs. Until definite proof is obtained ketamine administration should be restricted to patients with therapy-resistant severe neuropathic pain. © 2013 The Authors. British Journal of Clinical Pharmacology © 2013 The British Pharmacological Society.

  13. Low-dose vaporized cannabis significantly improves neuropathic pain.

    Science.gov (United States)

    Wilsey, Barth; Marcotte, Thomas; Deutsch, Reena; Gouaux, Ben; Sakai, Staci; Donaghe, Haylee

    2013-02-01

    We conducted a double-blind, placebo-controlled, crossover study evaluating the analgesic efficacy of vaporized cannabis in subjects, the majority of whom were experiencing neuropathic pain despite traditional treatment. Thirty-nine patients with central and peripheral neuropathic pain underwent a standardized procedure for inhaling medium-dose (3.53%), low-dose (1.29%), or placebo cannabis with the primary outcome being visual analog scale pain intensity. Psychoactive side effects and neuropsychological performance were also evaluated. Mixed-effects regression models demonstrated an analgesic response to vaporized cannabis. There was no significant difference between the 2 active dose groups' results (P > .7). The number needed to treat (NNT) to achieve 30% pain reduction was 3.2 for placebo versus low-dose, 2.9 for placebo versus medium-dose, and 25 for medium- versus low-dose. As these NNTs are comparable to those of traditional neuropathic pain medications, cannabis has analgesic efficacy with the low dose being as effective a pain reliever as the medium dose. Psychoactive effects were minimal and well tolerated, and neuropsychological effects were of limited duration and readily reversible within 1 to 2 hours. Vaporized cannabis, even at low doses, may present an effective option for patients with treatment-resistant neuropathic pain. The analgesia obtained from a low dose of delta-9-tetrahydrocannabinol (1.29%) in patients, most of whom were experiencing neuropathic pain despite conventional treatments, is a clinically significant outcome. In general, the effect sizes on cognitive testing were consistent with this minimal dose. As a result, one might not anticipate a significant impact on daily functioning. Published by Elsevier Inc.

  14. Chest X-Ray (Chest Radiography)

    Science.gov (United States)

    ... Resources Professions Site Index A-Z X-ray (Radiography) - Chest Chest x-ray uses a very small dose ... Radiography? What is a Chest X-ray (Chest Radiography)? The chest x-ray is the most commonly performed diagnostic ...

  15. Brunkow exercises and low back pain

    Directory of Open Access Journals (Sweden)

    Emela Mujić Skikić

    2004-11-01

    Full Text Available Brunkow exercises starting with dynamic contraction of hands and feet with fixed point on the wrist or/and heal. Dynamic contraction from the beginning, transferring through kinetic chain, leads to isometric contraction of the group of muscles, which has to be included in the exercise. Starting positions determine the group of muscles to be trained. The purpose of this study is to investigate influence of Brunkow exercises on spinal motion improvement and pain relief and to evaluate use of Brunkow exercises, as a routine method for lower back pain in Physical Medicine and Rehabilitation Centres. Thirty-four patients with symptoms of low back pain were included in study. Patients received a mean of 14.9 treatments with standard deviation of 8.96. All patients were assessed before and after the treatment for spinal mobility and flexibility as well as pain intensity. All parameters for spinal movements showed statistically significant improvement in patients with low back pain who practiced Brunkow exercise program at the end of treatment in relations to pre-treatment values, with significant difference of p<0.01 for all motions. Pain was reduced on VAS for X=1.,7 with S.D. 1.97. Difference Test was t=6.020 with significant difference p<0.01. Flexibility of spine increased, so average difference in values before and after treatment for Shober test was 0.5 cm with SD 0.65. Difference test was t=3.794 with significant difference p<0.01. Brunkow exercises for low back pain are beneficial treatment for increasing flexibility and mobility of spine and improving the pain.

  16. Functional results after chest wall stabilization with a new screwless fixation device

    OpenAIRE

    Wiese, Mark Nikolaj; Kawel-Boehm, Nadine; Moreno de la Santa, Pablo; Al-Shahrabani, Feras; Toffel, Melanie; Rosenthal, Rachel; Schäfer, Juliane; Tamm, Michael; Bremerich, Jens; Lardinois, Didier

    2017-01-01

    OBJECTIVES This is the experience with the Stratos system in two surgical centres for the management of two types of rib fractures: flail chest and multiple dislocated rib fractures with significant chest wall deformity. METHODS From January 2009 to May 2012, 94 consecutive patients were included. Selected indications were extended anterolateral flail chest (n = 68) and dislocated painful rib fractures (n = 26). The open reduction internal fixation (ORIF) system consists of flexible titanium ...

  17. Prevalence and Risk Factors Associated with Low Back Pain Among Health Care Providers in a District Hospital

    Directory of Open Access Journals (Sweden)

    TS Wong

    2010-07-01

    Full Text Available STUDY DESIGN: A cross-sectional study among health care providers working at one hospital. OBJECTIVE: To investigate the prevalence, the consequences and the risk factors associated with low back pain (LBP among hospital staff. MATERIALS AND METHODS: The study sample consisted of 931 health care providers who answered a pre-established questionnaire including 30 items in two languages. RESULTS: The cumulative life-prevalence of LBP was 72.5% and the yearly prevalence was 56.9%. Chronic LBP prevalence was noted 5.1% of the cases. Treatment was sought in 34.1% of LBP sufferers and 7.3% required sick leave or absence from work due to LBP. Risk factors associated with LBP were professional categories, bad body posture, lifting objects or patients and the increased levels of lifting, levels of job satisfaction and stressful job demands. CONCLUSION: There was a high prevalence of LBP among hospital staff, resulting in significant medical and socio-professional consequences. Many risk factors were identified that would necessitate multidisciplinary involvement to reduce the LBP incidence and related costs.

  18. A rare cause of postpartum low back pain: pregnancy- and lactation-associated osteoporosis.

    Science.gov (United States)

    Terzi, Rabia; Terzi, Hasan; Özer, Tülay; Kale, Ahmet

    2014-01-01

    Pregnancy- and lactation-associated osteoporosis (PLO) is a rare form of osteoporosis. It results in severe low back pain in the last trimester of pregnancy and in the postpartum period, decreases in height, and fragility fractures, particularly in the vertebra. The current case report presents a 32-year-old patient who presented with back and low back pain that began in the last trimester of the pregnancy and worsened at two months postpartum and who was diagnosed with pregnancy- and lactation-associated osteoporosis after exclusion of other causes; the findings are discussed in view of the current literature. PLO is a rare clinical condition causing significant disability. PLO must be kept in mind in the differential diagnosis in patients presenting with low back pain during or after pregnancy. The patients must be evaluated for the risk factors of PLO, and an appropriate therapy must be initiated.

  19. A Rare Cause of Postpartum Low Back Pain: Pregnancy- and Lactation-Associated Osteoporosis

    Directory of Open Access Journals (Sweden)

    Rabia Terzi

    2014-01-01

    Full Text Available Pregnancy- and lactation-associated osteoporosis (PLO is a rare form of osteoporosis. It results in severe low back pain in the last trimester of pregnancy and in the postpartum period, decreases in height, and fragility fractures, particularly in the vertebra. The current case report presents a 32-year-old patient who presented with back and low back pain that began in the last trimester of the pregnancy and worsened at two months postpartum and who was diagnosed with pregnancy- and lactation-associated osteoporosis after exclusion of other causes; the findings are discussed in view of the current literature. PLO is a rare clinical condition causing significant disability. PLO must be kept in mind in the differential diagnosis in patients presenting with low back pain during or after pregnancy. The patients must be evaluated for the risk factors of PLO, and an appropriate therapy must be initiated.

  20. Prevalence of Low Back Pain Among Traffic Wardens in Lagos State ...

    African Journals Online (AJOL)

    ... of low back pain and its associated risk factors among traffic wardens. The study design was a cross-sectional descriptive survey. All subjects were evaluated using a 32-item questionnaire to collect information on the demographic characteristics, years of involvement in working as a traffic warden, history of LBP in the last ...

  1. Frequency and interrelations of risk factors for chronic low back pain in a primary care setting.

    Directory of Open Access Journals (Sweden)

    Marie-Martine Lefevre-Colau

    Full Text Available INTRODUCTION: Many risk factors have been identified for chronic low back pain (cLBP, but only one study evaluated their interrelations. We aimed to investigate the frequency of cLBP risk factors and their interrelations in patients consulting their general practitioners (GPs for cLBP. METHODS: A cross-sectional, descriptive, national survey was performed. 3000 GPs randomly selected were asked to include at least one patient consulting for cLBP. Demographic, clinical characteristics and the presence of cLBP risk factors were recorded. The frequency of each cLBP risk factor was calculated and multiple correspondence analysis (MCA was performed to study their interrelations. RESULTS: A total of 2068 GPs (68.9% included at least 1 patient, for 4522 questionnaires analyzed. In the whole sample of patients, the 2 risk factors most commonly observed were history of recurrent LBP (72.1% and initial limitation of activities of daily living (66.4%. For working patients, common professional risk factors were beliefs, that LBP was due to maintaining a specific posture at work (79.0% and frequent heavy lifting at work (65.5%. On MCA, we identified 3 risk-factor dimensions (axes for working and nonworking patients. The main dimension for working patients involved professional risk factors and among these factors, patients' job satisfaction and job recognition largely contribute to this dimension. DISCUSSION: Our results shed in light for the first time the interrelation and the respective contribution of several previously identified cLBP risk factors. They suggest that risk factors representing a "work-related" dimension are the most important cLBP risk factors in the working population.

  2. Is obesity a risk factor for low back pain? An example of using the evidence to answer a clinical question

    Directory of Open Access Journals (Sweden)

    Mirtz Timothy A

    2005-04-01

    Full Text Available Abstract Background Obesity as a causal factor for low back pain has been controversial with no definitive answer to this date. The objective of this study was to determine whether obesity is associated with low back pain. In addition this paper aims to provide a step-by-step guide for chiropractors and osteopaths on how to ask and answer a clinical question using the literature. Methods A literature review using the MEDLINE search engine using the keywords "obesity", "low back pain", "body mass index" "BMI" and "osteoarthritis" from years 1990 to 2004 was utilised. The method employed is similar to that utilised by evidence-based practice advocates. Results The available data at this time is controversial with no clear-cut evidence connecting low back pain with obesity. Conclusion There is a lack of a clear dose-response relationship between body mass index (BMI and low back pain. Further, studies on the relationship between obesity and related lumbar osteoarthritis, knee pain, and disc herniation are also problematic.There is little doubt that future studies with controlled variables are needed to determine the existence of an unambiguous link, if any.

  3. The predictive ability of the STarT Back Tool was limited in people with chronic low back pain: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Michelle Kendell

    2018-04-01

    Full Text Available Questions: In people with chronic non-specific low back pain (LBP, what is the predictive and discriminative validity of the STarT Back Tool (SBT for pain intensity, self-reported LBP-related disability, and global self-perceived change at 1-year follow-up? What is the profile of the SBT risk subgroups with respect to demographic variables, pain intensity, self-reported LBP-related disability, and psychological measures? Design: Prospective cohort study. Participants: A total of 290 adults with dominant axial LBP of ≥ 3 months’ duration recruited from the general community, and private physiotherapy, psychology, and pain-management clinics in Western Australia. Outcome measures: The 1-year follow-up measures were pain intensity, LBP-related disability, and global self-perceived change. Results: Outcomes were collected on 264 participants. The SBT categorised 82 participants (28% as low risk, 116 (40% as medium risk, and 92 (32% as high risk. The risk subgroups differed significantly (p < 0.05 on baseline pain, disability, and psychological scores. The SBT’s predictive ability was strongest for disability: RR was 2.30 (95% CI 1.28 to 4.10 in the medium-risk group and 2.86 (95% CI 1.60 to 5.11 in the high-risk group. The SBT’s predictive ability was weaker for pain: RR was 1.25 (95% CI 1.04 to 1.51 in the medium-risk group and 1.26 (95% CI 1.03 to 1.52 in the high-risk group. For the SBT total score, the AUC was 0.71 (95% CI 0.64 to 0.77 for disability and 0.63 (95% CI 0.55 to 0.71 for pain. Conclusion: This was the first large study to investigate the SBT in a population exclusively with chronic LBP. The SBT provided an acceptable indication of 1-year disability, had poor predictive and discriminative ability for future pain, and was unable to predict or discriminate global perceived change. In this cohort with chronic non-specific LBP, the SBT’s predictive and discriminative abilities were restricted to disability at 1

  4. Adolescent low back pain among secondary school students in ...

    African Journals Online (AJOL)

    Adolescent low back pain among secondary school students in Ibadan, Nigeria. BOA Adegoke, AC Odole, AA Adeyinka. Abstract. Background: Adolescent low back pain (ALBP) can be considered a signal or precursor of a serious organic disease or telltale sign of future incidence of low back pain in adulthood. Published ...

  5. COMT Diplotype Amplifies Effect of Stress on Risk of Temporomandibular Pain.

    Science.gov (United States)

    Slade, G D; Sanders, A E; Ohrbach, R; Bair, E; Maixner, W; Greenspan, J D; Fillingim, R B; Smith, S; Diatchenko, L

    2015-09-01

    When measured once, psychological stress predicts development of painful temporomandibular disorder (TMD). However, a single measurement fails to characterize the dynamic nature of stress over time. Moreover, effects of stress on pain likely vary according to biological susceptibility. We hypothesized that temporal escalation in stress exacerbates risk for TMD, and the effect is amplified by allelic variants in a gene, catechol-O-methyltransferase (COMT), regulating catechol neurotransmitter catabolism. We used data from the Orofacial Pain: Prospective Evaluation and Risk Assessment prospective cohort study of 2,707 community-dwelling adults with no lifetime history of TMD on enrollment. At baseline and quarterly periods thereafter, the Perceived Stress Scale (PSS) measured psychological stress. Genotyped DNA from blood samples determined COMT diplotypes. During follow-up of 0.25 to 5.2 y, 248 adults developed examiner-verified incident TMD. PSS scores at baseline were 20% greater (P stress escalation was limited to incident cases with COMT diplotypes coding for low-activity COMT, signifying impaired catabolism of catecholamines. Cox regression models confirmed significant effects on TMD hazard of both baseline PSS (P stress showed that a postbaseline increase of 1.0 standard deviation in PSS more than doubled risk of TMD incidence in subjects with low-activity COMT diplotypes (hazard ratio = 2.35; 95% confidence limits: 1.66, 3.32), an effect not found in subjects with high-activity COMT diplotypes (hazard ratio = 1.42; 95% confidence limits: 0.96, 2.09). Findings provide novel insights into dynamic effects of psychological stress on TMD pain, highlighting that effects are most pronounced in individuals whose genetic susceptibility increases responsiveness to catecholamine neurotransmitters. © International & American Associations for Dental Research 2015.

  6. Psychogenic Low-Back Pain and Hysterical Paralysis in Adolescence.

    Science.gov (United States)

    Kanchiku, Tsukasa; Suzuki, Hidenori; Imajo, Yasuaki; Yoshida, Yuichiro; Nishida, Norihiro; Taguchi, Toshihiko

    2017-10-01

    A retrospective review. The purpose of this study was to investigate the clinical outcomes in adolescents diagnosed with psychogenic low-back pain and hysterical paralysis and to evaluate the efficacy of differential diagnosis methods. The incidence of low-back pain in adolescence is similar to that in adults, but the causes of low-back pain are difficult to determine in most cases. For these patients, a definitive diagnosis of psychogenic low-back pain and hysterical paralysis as well as adequate treatment are clinically important to avoid unnecessary surgical treatment. Eleven patients (3 males and 8 females; mean age, 16.5 years; range, 13-19 y) diagnosed with psychogenic low-back pain and hysterical paralysis were followed up for 2-10.25 years (mean, 4.67 y). Nonorganic signs were observed in almost all patients. For the purpose of excluding organic disorders, the thiopentone pain study was used in patients who complained mainly of pain, and motor evoked potentials using transcranial magnetic stimulation were measured in patients experiencing primarily muscle weakness. The psychiatric diagnosis was neurosis in 9 patients, whereas it was psychosomatic disorder in 2 patients. Conservative treatment, such as physiotherapy, was performed, and at the final follow-up evaluation, outcomes were regarded as excellent in 7 patients and good in 4 patients. The prognosis of psychogenic low-back pain and hysterical paralysis in adolescence is relatively good. However, it is important to understand the characteristics of psychogenic low-back pain and hysterical paralysis in childhood and young adulthood and to perform accurate diagnosis by screening for nonorganic signs and excluding organic disorders by using the thiopentone pain study and motor evoked potentials obtained using transcranial magnetic stimulation.

  7. Comparison of pain intensity, emotional status and disability level in patients with chronic neck and low back pain.

    Science.gov (United States)

    Altuğ, Filiz; Kavlak, Erdoğan; Kurtca, Mine Pekesen; Ünal, Ayşe; Cavlak, Uğur

    2015-01-01

    This study was planned to compare of pain, emotional status and disability level in patients with chronic neck pain and low back pain. In this study, fifty patients with chronic low back pain (Group I) and fifty patients with chronic neck pain (Group II) at least 6 months were evaluated. A Visual Analog Scale was used to describe pain intensity. To determine emotional status of the subjects, the Beck Depression Scale was used The Oswestry Disability Index and the Neck Disability Index were used to evaluate disability level. The mean age of the patients with low back pain and neck pain were 39.70 ± 9.71 years, 45.44 ± 10.39 years, respectively. It was not found a significant difference between in low back pain (Group I) and neck pain (Group II) in results of pain intensity (p= 0.286) and pain duration (p= 0.382). It was found a significant difference between group I and group II in results of emotional status (p= 0.000) and disability level (p= 0.000). The emotional status and disability level scores were found highest in patient's with low back pain. Chronic low back pain is affect in patients than chronic neck pain as a emotional status and disability level.

  8. Low back pain in pregnant women attending antenatal clinic: The Aminu Kano teaching hospital experience.

    Science.gov (United States)

    Usman, Mustapha Ibrahim; Abubakar, Muhammad Kabir; Muhammad, Shamsuddeen; Rabiu, Ayyuba; Garba, Ibrahim

    2017-01-01

    The profound physiologic effects of pregnancy affect the musculoskeletal system. Pregnant women are at increased risks of low back/pelvic girdle pains. To determine the incidence of low back/pelvic girdle pains among pregnant women. This was a cross-sectional study conducted from May 1 to June 30, 2016, among consenting pregnant women at Aminu Kano Teaching Hospital. Ethical approval was obtained from the Hospital Ethics Committee. Information was obtained in a questionnaire on consecutive pregnant women. Data obtained were analyzed using SPSS version 18 (SPSS Inc., Chicago, Illinois, USA, 2012). Fisher's exact test was used for categorical data, and P ≤ 0.05 was considered statistically significant. A total of 309 pregnant women were recruited from May 1 to June 30, 2016. The mean age ± standard deviation was 28.4 ± 5.86 years. The incidence of low back pains (LBPs) and pelvic girdle pains among the pregnant women was 106 (34.3%) and 178 (57.6%), respectively. The pain was severe among 26 (9.2%) pregnant women, which warranted analgesic usage. Pain radiation was reported in> 50% of cases. There was an incidental finding of urinary incontinence in 36 (12.6%) cases. Low back/pelvic girdle pain was not associated with body mass index (BMI) (P = 0.390). The incidence of LBPs and pelvic girdle pains was high and found to be 34.3% and 57.6%, respectively. Analgesics were used especially among those with severe pains. There was an incidental finding of urinary incontinence among pregnant women with complaints of low back/pelvic girdle pains. There was no statistically significant association between LBPs and maternal BMI.

  9. [Implementationof a low FODMAP dietforfunctional abdominal pain].

    Science.gov (United States)

    Baranguán Castro, María Luisa; Ros Arnal, Ignacio; García Romero, Ruth; Rodríguez Martínez, Gerardo; Ubalde Sainz, Eduardo

    2018-04-20

    The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. A table was designed in which foods were classified according to their FODMAP content, as well as a 'Symptoms and Stools Diary'. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41-3.33] versus 2 [IQR: 1.33-6.33] daily episodes, P=.024), less pain severity compared to baseline (1.41cm [IQR: 0.32-5.23] versus 4.63cm [IQR: 2.51-6.39] measured by 10-cm Visual Analogue Scale, P=.035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods. Copyright © 2018. Publicado por Elsevier España, S.L.U.

  10. Low-grade extraskeletal osteosarcoma of the chest wall: case report and review of literature

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    Chetaille Bruno

    2010-11-01

    Full Text Available Abstract Background Low-grade extraskeletal osteosarcomas (ESOS are extremely rare. Case presentation We present the first case of low-grade ESOS of the chest wall, which occurred in a 30-year-old man. Because of initial misdiagnosis and patient's refusal of surgery, the diagnosis was done after a 4-year history of a slowly growing mass in soft tissues, leading to a huge (30-cm diameter calcified mass locally extended over the left chest wall. Final diagnosis was helped by molecular analysis of MDM2 and CDK4 oncogenes. Unfortunately, at this time, no surgical treatment was possible due to loco-regional extension, and despite chemotherapy, the patient died one year after diagnosis, five years after the first symptoms. Conclusion We describe the clinical, radiological and bio-pathological features of this unique case, and review the literature concerning low-grade ESOS. Our case highlights the diagnostic difficulties for such very rare tumours and the interest of molecular analysis in ambiguous cases.

  11. Low-grade extraskeletal osteosarcoma of the chest wall: case report and review of literature.

    Science.gov (United States)

    Sabatier, Renaud; Bouvier, Corinne; de Pinieux, Gonzague; Sarran, Anthony; Brenot-Rossi, Isabelle; Pedeutour, Florence; Chetaille, Bruno; Viens, Patrice; Weiller, Pierre-Jean; Bertucci, François

    2010-11-24

    Low-grade extraskeletal osteosarcomas (ESOS) are extremely rare. We present the first case of low-grade ESOS of the chest wall, which occurred in a 30-year-old man. Because of initial misdiagnosis and patient's refusal of surgery, the diagnosis was done after a 4-year history of a slowly growing mass in soft tissues, leading to a huge (30-cm diameter) calcified mass locally extended over the left chest wall. Final diagnosis was helped by molecular analysis of MDM2 and CDK4 oncogenes. Unfortunately, at this time, no surgical treatment was possible due to loco-regional extension, and despite chemotherapy, the patient died one year after diagnosis, five years after the first symptoms. We describe the clinical, radiological and bio-pathological features of this unique case, and review the literature concerning low-grade ESOS. Our case highlights the diagnostic difficulties for such very rare tumours and the interest of molecular analysis in ambiguous cases.

  12. Usefulness of the Pain Tracking Technique in Acute Mechanical Low Back Pain

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    Tania Bravo Acosta

    2015-01-01

    Full Text Available Objective. To evaluate the usefulness of the pain tracking technique in acute mechanical low back pain. Method. We performed an experimental prospective (longitudinal explanatory study between January 2011 and September 2012. The sample was randomly divided into two groups. Patients were assessed at the start and end of the treatment using the visual analogue scale and the Waddell test. Treatment consisted in applying the pain tracking technique to the study group and interferential current therapy to the control group. At the end of treatment, cryotherapy was applied for 10 minutes. The Wilcoxon signed-rank test and the Mann Whitney test were used. They were performed with a predetermined significance level of p≤0.05. Results. Pain was triggered by prolonged static posture and intense physical labor and intensified through trunk movements and when sitting and standing. The greatest relief was reported in lateral decubitus position and in William’s position. The majority of the patients had contracture. Pain and disability were modified with the rehabilitation treatment in both groups. Conclusions. Both the pain tracking and interferential current techniques combined with cryotherapy are useful treatments for acute mechanical low back pain. The onset of analgesia is faster when using the pain tracking technique.

  13. Multi-detector row computed tomography and blunt chest trauma

    International Nuclear Information System (INIS)

    Scaglione, Mariano; Pinto, Antonio; Pedrosa, Ivan; Sparano, Amelia; Romano, Luigia

    2008-01-01

    Blunt chest trauma is a significant source of morbidity and mortality in industrialized countries. The clinical presentation of trauma patients varies widely from one individual to another and ranges from minor reports of pain to shock. Knowledge of the mechanism of injury, the time of injury, estimates of motor vehicle accident velocity and deceleration, and evidence of associated injury to other systems are all salient features to provide for an adequate assessment of chest trauma. Multi-detector row computed tomography (MDCT) scanning and MDCT-angiography are being used more frequently in the diagnosis of patients with chest trauma. The high sensitivity of MDCT has increased the recognized spectrum of injuries. This new technology can be regarded as an extremely valuable adjunct to physical examination to recognize suspected and unsuspected blunt chest trauma

  14. Low back pain tied to spinal endometriosis.

    Science.gov (United States)

    Dongxu, Zhao; Fei, Yin; Xing, Xiao; Bo-Yin, Zhang; Qingsan, Zhu

    2014-05-01

    Case report. We present a case of endometriosis of lumbar vertebrae. The literatures are reviewed with endometriosis of spine. Endometriosis is a common condition, which is defined as endometrial tissue lying outside the endometrial cavity. It is usually found within the peritoneal cavity, predominantly within the pelvis, commonly on the uterosacral ligaments. It can also be found in other sites such as umbilicus, abdominal scars, nasal passages and pleural cavity. But it is very rarely seen in the spine, with no report of endometriosis found in the lumbar vertebrae. A 33-year-old woman presented with severe low back pain. She had the low back pain periodically for 3 years, and the pain was associated with menstruation. Radiographs showed a lesion in the posterior L3 body. After surgery, tissue biopsy indicated the presence of endometrial tissue in the lesion and thus confirmed endometriosis. Most cases of spine endometriosis that have been reported are usually found inside spinal canal, endorachis or spinal cord. But spinal vertebrae can also be involved in endometriosis. Although endometriosis is a rare possible cause of periodical low back pain in women of childbearing age, we suggest that if a woman suffering from periodical low back pain is encountered, do not ignore the possibility of endometriosis in the spine.

  15. Prevalence and risk factors of vitamin D deficiency in patients with widespread musculoskeletal pain

    Directory of Open Access Journals (Sweden)

    Muharrem Çidem

    2013-12-01

    Full Text Available Objective: Vitamin D deficiency is a worldwide common health problems. Vitamin D deficiency in adults has been associated with proximal muscle weakness, skeletal mineralization defect, and an increased risk of falling. Patients with vitamin D deficiency commonly complain of widespread pain in the body. The aim of this study was to examine the prevalence and risk factors of 25-hydroxyvitamin D deficiency in patients complaining of widespread musculoskeletal pain. Methods: In this cross-sectional study, 8457 patients with widespread musculoskeletal pain (7772 females, 685 males, aged 46.7 (range 20-100 years were included. Serum 25-hydroxyvitamin D was measured with ELISA method. Patients were classified into two groups: 1 Patients with vitamin D deficiency (20 ng/ml. Results: Prevalence of vitamin D deficiency was found to be 71.7%. A binary logistic regression model showed that low 25(OHVit D level was associated with gender, age and month in which 25(OH hypovitaminosis was determined. The risk of low 25(OH Vit D was found to be 2.15 times higher in female patients and 1.52 times higher on March and 1.55 times higher on April. Conclusion: This study indicates that Vitamin D deficiency should be taken into consideration in patients with widespread musculoskeletal pain, and some precautions such as sunbathe during summer should be recommended patients having risk of vitamin D deficiency. J Clin Exp Invest 2013; 4 (4: 48-491

  16. Load Handling and Repetitive Movements Are Associated with Chronic Low Back Pain among Jute Mill Workers in India

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    S. Goswami

    2016-01-01

    Full Text Available Introduction. WHO recognizes low back pain as one of the most important ergonomic stressors. Therefore, the present study was designed to find out the magnitude of the problem among jute mill workers in India and identify possible associations. Methodology. This cross-sectional workplace based study was conducted among eight (8 selected jute mills of India. Subjects with self-reported back pain for at least last 12 weeks were included and n=717 male jute mill workers actively engaged in work entered the study and completed all assessments. Results. Among all participants 55% (n=392 had current chronic low back pain. Age was an important association with subjects in the age group of 40–59 years more likely to have pain (p=0.02, OR 1.44. Regarding ergonomic risk factors lifting of load of more than 20 kg (p=0.04, OR 1.42 and repetitive movements of limbs (p=0.03, OR 0.67 were significant associations of chronic low back pain. Conclusion. This study identified a significant prevalence of current chronic low back pain among jute mill workers. Regarding ergonomic risk factors the present study has identified two significant associations: lifting of load above 20 kg and repetitive movements of limbs. Therefore, this study has identified need for workplace interventions in this occupational group employing approximately 3,50,000 workers in India.

  17. Load Handling and Repetitive Movements Are Associated with Chronic Low Back Pain among Jute Mill Workers in India

    Science.gov (United States)

    Goswami, S.; Dasgupta, S.; Samanta, A.; Talukdar, G.; Chanda, A.; Ray Karmakar, P.; Bhattacharya, D.

    2016-01-01

    Introduction. WHO recognizes low back pain as one of the most important ergonomic stressors. Therefore, the present study was designed to find out the magnitude of the problem among jute mill workers in India and identify possible associations. Methodology. This cross-sectional workplace based study was conducted among eight (8) selected jute mills of India. Subjects with self-reported back pain for at least last 12 weeks were included and n = 717 male jute mill workers actively engaged in work entered the study and completed all assessments. Results. Among all participants 55% (n = 392) had current chronic low back pain. Age was an important association with subjects in the age group of 40–59 years more likely to have pain (p = 0.02, OR 1.44). Regarding ergonomic risk factors lifting of load of more than 20 kg (p = 0.04, OR 1.42) and repetitive movements of limbs (p = 0.03, OR 0.67) were significant associations of chronic low back pain. Conclusion. This study identified a significant prevalence of current chronic low back pain among jute mill workers. Regarding ergonomic risk factors the present study has identified two significant associations: lifting of load above 20 kg and repetitive movements of limbs. Therefore, this study has identified need for workplace interventions in this occupational group employing approximately 3,50,000 workers in India. PMID:27563463

  18. Routine chest and abdominal high-pitch CT: An alternative low dose protocol with preserved image quality

    International Nuclear Information System (INIS)

    Amacker, Nadja A.; Mader, Caecilia; Alkadhi, Hatem; Leschka, Sebastian; Frauenfelder, Thomas

    2012-01-01

    Objective: To investigate the radiation dose and image quality of the high-pitch dual source computer tomography (DSCT) for routine chest and abdominal scans. Methods: 130 consecutive patients (62 female, 68 male, median age 55 years) were included. All patients underwent 128-slice high-pitch DSCT (chest n = 99; abdomen n = 84) at a pitch of 3.2. Two observers independently rated image quality using a 4-point score (1: excellent to 4: non-diagnostic). Image noise was measured and operational radiation dose quantities were recorded. An additional group of 132 patients (chest, n = 80; abdomen n = 52) scanned with standard-pitch CT matched for age, gender, and body mass index (BMI) served as control group. Results: Interobserver agreement for image quality rating was good (k = 0.74). Subjective image quality of high-pitch CT was diagnostic in all patients (median score chest; 2, median score abdomen: 2). Image noise of high-pitch CT was comparable to standard-pitch for the chest (p = 0.32) but increased in the abdomen (p < 0.0001). For high-pitch CT radiation dose was 4.4 ± 0.9 mSv (chest) and 6.5 ± 1.2 mSv (abdomen). These values were significantly lower compared to standard-pitch CT (chest: 5.5 ± 1.2 mSv; abdomen: 11.3 ± 3.8 mSv). Conclusion: Based on the technical background high-pitch dual source CT may serve as an alternative scan mode for low radiation dose routine chest and abdominal CT.

  19. Physical activity associate low back pain and intervention program: Review

    Science.gov (United States)

    Ibrahim, Muhamad Aizat Mat; Hasbollah, Hasif Rafidee; Ibrahim, Mohd Asrul Hery; Marican, Nor Dalila; Halim, Muhd Hafzal Abdul; Rashid, Ahmad Faezi Ab.; Yasin, Nurul Hafizah Mohd

    2017-10-01

    The person who have low back pain often report impaired disability to performance daily activities which passive movement of daily life. The effects of low back pain on daily function of patients can describe as a patients level of disability or reduction in physical function it interferes with the movement of patients for running a daily lives. Therefore, the aim of this study was to conduct a review to examine the relationship between physical activity and low back pain. Besides that, the suggestion prevention program to patient who has low back pain. This systematic review study was used internet to find databases and search engines. Data were collected using Wiley online library, Bioline International, SAGE, Science Direct, NCBI, ProQuest, Biomed central, American Diabetes Association, PLOS One and Springer. The search was performed using keywords of "physical activity", "low back pain", "back pain", "activity level" and "intervention". The study was reviewed the resources and the results were classified in different section The results were classified based on several sections including years of reporting, who were reporting, the origins of articles and their health criteria about physical activity and low back pain. There are positive associate physical activity and low back pain from the systematic review. Future intervention treatment can reduce associate physical activity to low back pain.

  20. Reporting of coronary artery calcification on chest CT studies in breast cancer patients at high risk of cancer therapy related cardiac events

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    William J. Phillips

    2018-03-01

    Full Text Available Background: The identification of coronary artery calcification (CAC detected coincidentally on chest CT exams could assist in cardiovascular risk assessment but may not be reported consistently on clinical studies. Cardiovascular risk factor stratification is important to predict short term cardiac events during cancer therapy and long term cardiac event free survival in cancer patients. We sought to determine the prevalence of CAC and clinical reporting rates in a cohort of cancer patients at high risk of cancer therapy related cardiac events. Methods: 408 Breast cancer patients who were referred to a cardiac oncology clinic were screened. Inclusion criteria included having had a CT chest and the absence of known coronary disease. Among those screened 263 patients were included in the study. Results: CAC was identified in 70 patients (26%. CAC was reported in 18% of studies. The reporting rates of CAC increased with the extent of coronary calcification (p < 0.01 and increased during the period of the study (p < 0.05. Conclusions: CAC was commonly detected on chest CT studies in this observational study of breast cancer patients at high risk of cardiac oncology events. The presence of CAC was often not reported clinically but reporting rates have increased over time. Recent SCCT/STR guidelines recommend reporting the presence of CAC on routine chest CT scans in recognition of the importance of CAC as a predictor of cardiovascular events. Reporting of CAC on chest CTs may help to further risk stratify breast cancer patients and improve cardiovascular outcomes in this vulnerable population. Keywords: Cardiac oncology, Coronary calcification and chest CT

  1. Lumbar CT findings of patients with low back pain

    International Nuclear Information System (INIS)

    Lee, Yong Chul; Kim, Yang Soo; Kim, Kyun Sang

    1986-01-01

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  2. Lumbar CT findings of patients with low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yong Chul; Kim, Yang Soo; Kim, Kyun Sang [Chung-Ang University, Seoul (Korea, Republic of)

    1986-04-15

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  3. Severity of exercise-induced ischemia with chest pain and recovery from ischemia after the disappearance of chest pain

    International Nuclear Information System (INIS)

    Akutsu, Yasushi; Shinozuka, Akira; Kodama, Yusuke; Li, Hui-Ling; Yamanaka, Hideyuki; Katagiri, Takashi

    2004-01-01

    The severity of exercise-induced painful ischemia and its recovery after the disappearance of pain are unknown. The aim of this study was to investigate the difference in severity of ischemia at both exercise and postexercise between painful ischemia and painless ischemia. After injections of technetium-99m tetrofosmin at peak ergometer exercise and thallium-201 at 3 minutes postexercise, dual-isotope single photon emission tomography was performed in 78 patients with angiographically proven ischemic heart disease. The extent of ischemic areas (the number of areas), the depth of ischemia in the ischemic area (the severity score of ischemia) and the extension of ischemia toward long axis of the left ventricle (the number of left ventricular levels with ischemic areas in apical, middle, and basal levels) at both exercise and postexercise were compared on the basis of the presence of pain and a history of diabetes mellitus (DM). The symptoms improved within 3 minutes postexercise in all painful ischemia patients. Of 59 patients with reversible ischemia, except for 4 painful ischemia patients with DM, the extent and depth of ischemia at postexercise were more severe in 14 painful ischemia patients without DM and 13 painless ischemia patients with DM than 28 painless ischemia patients without DM (extent; 2.9±1.7 areas, 3.5±2.8 areas versus 1.4±1.8 areas, P=0.005, depth; 3.8±3.1 scores, 5.8±5.4 scores versus 1.9±3.0 scores, P=0.0084, respectively) despite a comparable severity of ischemia at peak exercise (extent; 5.4±2.6 areas, 6.0±2.4 areas versus 4.3±3.3 areas, depth; 9.3±5.7 scores, 10.7±7.3 scores and 7.5±8.1 scores, all NS). The extension of ischemia toward long-axis of the left ventricle at both peak exercise and postexercise was more severe in the former 2 groups than the latter group (peak exercise; 2.4±0.6 levels, 2.5±0.7 levels versus 1.9 ±0.8 levels, P=0.0263, postexercise: 1.8±0.7 levels, 1.5±0.9 levels versus 0.8±0.8 levels, P=0

  4. Acute Low Back Pain? Do Not Blame the Weather-A Case-Crossover Study.

    Science.gov (United States)

    Beilken, Keira; Hancock, Mark J; Maher, Chris G; Li, Qiang; Steffens, Daniel

    2017-06-01

    To investigate the influence of various weather parameters on the risk of developing a low back pain (LBP) episode. Case-crossover study. Primary care clinics in Sydney, Australia. 981 participants with a new episode of acute LBP. Weather parameters were obtained from the Australian Bureau of Meteorology. Odds ratios (OR) and 95% confidence intervals (95% CI) were derived comparing two exposure variables in the case window-(1) the average of the weather variable for the day prior to pain onset and (2) the change in the weather variable from 2 days prior to 1 day prior to pain onset-with exposures in two control windows (1 week and 1 month before the case window). The weather parameters of precipitation, humidity, wind speed, wind gust, wind direction, and air pressure were not associated with the onset of acute LBP. For one of the four analyses, higher temperature slightly increased the odds of pain onset. Common weather parameters that had been previously linked to musculoskeletal pain, such as precipitation, humidity, wind speed, wind gust, wind direction, and air pressure, do not increase the risk of onset for LBP. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  5. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis.

    Science.gov (United States)

    Battle, Ceri E; Hutchings, Hayley; Evans, Phillip A

    2012-01-01

    The risk factors for mortality following blunt chest wall trauma have neither been well established or summarised. To summarise the risk factors for mortality in blunt chest wall trauma patients based on available evidence in the literature. A systematic review of English and non-English articles using MEDLINE, EMBASE and the Cochrane Library from their introduction until May 2010. Additional studies were identified by hand-searching bibliographies and contacting relevant clinical experts. Grey literature was sought by searching abstracts from all Emergency Medicine conferences. Broad search terms and inclusion criteria were used to reduce the number of missed studies. A two step study selection process was used. All published and unpublished observational studies were included if they investigated estimates of association between a risk factor and mortality for blunt chest wall trauma patients. A two step data extraction process using pre-defined data fields, including study quality indicators. Each study was appraised using a previously designed quality assessment tool and the STROBE checklist. Where sufficient data were available, odds ratios with 95% confidence intervals were calculated using Mantel-Haenszel method for the risk factors investigated. The I(2) statistic was calculated for combined studies in order to assess heterogeneity. Age, number of rib fractures, presence of pre-existing disease and pneumonia were found to be related to mortality in 29 identified studies. Combined odds ratio of 1.98 (1.86-2.11, 95% CI), 2.02 (1.89-2.15, 95% CI), 2.43 (1.03-5.72, 95% CI) and 5.24 (3.51-7.82) for mortality were calculated for blunt chest wall trauma patients aged 65 years or more, with three or more rib fractures, pre-existing conditions and pneumonia respectively. The risk factors for mortality in patients sustaining blunt chest wall trauma were a patient age of 65 years or more, three or more rib fractures and the presence of pre-existing disease especially

  6. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain.

    Science.gov (United States)

    Kamper, Steven J; Apeldoorn, Andreas T; Chiarotto, Alessandro; Smeets, Rob J E M; Ostelo, Raymond W J G; Guzman, Jaime; van Tulder, Maurits W

    2014-09-02

    Low back pain (LBP) is responsible for considerable personal suffering worldwide. Those with persistent disabling symptoms also contribute to substantial costs to society via healthcare expenditure and reduced work productivity. While there are many treatment options, none are universally endorsed. The idea that chronic LBP is a condition best understood with reference to an interaction of physical, psychological and social influences, the 'biopsychosocial model', has received increasing acceptance. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds. To review the evidence on the effectiveness of MBR for patients with chronic LBP. The focus was on comparisons with usual care and with physical treatments measuring outcomes of pain, disability and work status, particularly in the long term. We searched the CENTRAL, MEDLINE, EMBASE, PsycINFO and CINAHL databases in January and March 2014 together with carrying out handsearches of the reference lists of included and related studies, forward citation tracking of included studies and screening of studies excluded in the previous version of this review. All studies identified in the searches were screened independently by two review authors; disagreements regarding inclusion were resolved by consensus. The inclusion criteria were published randomised controlled trials (RCTs) that included adults with non-specific LBP of longer than 12 weeks duration; the index intervention targeted at least two of physical, psychological and social or work-related factors; and the index intervention was delivered by clinicians from at least two different professional backgrounds. Two review authors extracted and checked information to describe the included studies, assessed risk of bias and performed the analyses. We used the Cochrane risk of bias tool to describe the

  7. Individual and work-related risk factors for musculoskeletal pain: a cross-sectional study among Estonian computer users.

    Science.gov (United States)

    Oha, Kristel; Animägi, Liina; Pääsuke, Mati; Coggon, David; Merisalu, Eda

    2014-05-28

    Occupational use of computers has increased rapidly over recent decades, and has been linked with various musculoskeletal disorders, which are now the most commonly diagnosed occupational diseases in Estonia. The aim of this study was to assess the prevalence of musculoskeletal pain (MSP) by anatomical region during the past 12 months and to investigate its association with personal characteristics and work-related risk factors among Estonian office workers using computers. In a cross-sectional survey, the questionnaires were sent to the 415 computer users. Data were collected by self-administered questionnaire from 202 computer users at two universities in Estonia. The questionnaire asked about MSP at different anatomical sites, and potential individual and work related risk factors. Associations with risk factors were assessed by logistic regression. Most respondents (77%) reported MSP in at least one anatomical region during the past 12 months. Most prevalent was pain in the neck (51%), followed by low back pain (42%), wrist/hand pain (35%) and shoulder pain (30%). Older age, right-handedness, not currently smoking, emotional exhaustion, belief that musculoskeletal problems are commonly caused by work, and low job security were the statistically significant risk factors for MSP in different anatomical sites. A high prevalence of MSP in the neck, low back, wrist/arm and shoulder was observed among Estonian computer users. Psychosocial risk factors were broadly consistent with those reported from elsewhere. While computer users should be aware of ergonomic techniques that can make their work easier and more comfortable, presenting computer use as a serious health hazard may modify health beliefs in a way that is unhelpful.

  8. Back pain in space and post-flight spine injury: Mechanisms and countermeasure development

    Science.gov (United States)

    Sayson, Jojo V.; Lotz, Jeffrey; Parazynski, Scott; Hargens, Alan R.

    2013-05-01

    During spaceflight many astronauts experience moderate to severe lumbar pain and deconditioning of paraspinal muscles. There is also a significant incidence of herniated nucleus pulposus (HNP) in astronauts post-flight being most prevalent in cervical discs. Relief of in-flight lumbar back pain is facilitated by assuming a knee-to-chest position. The pathogenesis of lumbar back pain during spaceflight is most likely discogenic and somatic referred (from the sinuvertebral nerves) due to supra-physiologic swelling of the lumbar intervertebral discs (IVDs) due to removal of gravitational compressive loads in microgravity. The knee-to-chest position may reduce lumbar back pain by redistributing stresses through compressive loading to the IVDs, possibly reducing disc volume by fluid outflow across IVD endplates. IVD stress redistribution may reduce Type IV mechanoreceptor nerve impulse propagation in the annulus fibrosus and vertebral endplate resulting in centrally mediated pain inhibition during spinal flexion. Countermeasures for lumbar back pain may include in-flight use of: (1) an axial compression harness to prevent excessive IVD expansion and spinal column elongation; (2) the use of an adjustable pulley exercise developed to prevent atrophy of spine muscle stabilisers; and (3) other exercises that provide Earth-like annular stress with low-load repetitive active spine rotation movements. The overall objective of these countermeasures is to promote IVD health and to prevent degenerative changes that may lead to HNPs post-flight. In response to "NASA's Critical Path Roadmap Risks and Questions" regarding disc injury and higher incidence of HNPs after space flight (Integrated Research Plan Gap-B4), future studies will incorporate pre- and post-flight imaging of International Space Station long-duration crew members to investigate mechanisms of lumbar back pain as well as degeneration and damage to spinal structures. Quantitative results on morphological, biochemical

  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)

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

    2015-01-01

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

  10. 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

  11. 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

    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

  12. [Rehabilitation for the patients with low-back pain].

    Science.gov (United States)

    Shirado, Osamu; Watanabe, Yasuyuki; Kawase, Masafumi

    2005-03-01

    The first choice for the treatment of low-back pain should be physical therapy, or rehabilitation. These are mainly divided into two modalities; passive and active modality. The former includes bed rest, hot pack, massage, and brace. The latter includes therapeutic exercise. The modality used should be dependent of the stages in each patient. Bed rest is indicated in the acute stage within a week after the occurrence low-back pain. The rest longer than a week is basically contraindicated, because of disuse syndrome such as muscle weakness, osteoporosis, and soft tissue contracture. Therapeutic exercise is the mainstay in the chronic stage. It includes trunk muscles strengthening exercise and stretching. Lumbar stabilization exercise has currently drawn attention for the treatment of low-back pain. Patient education such as back-school also plays an important role to manage low-back pain.

  13. Clinical evaluation of adenosine and exercise stress 99Tcm-MIBI myocardial imaging in detection of myocardial ischemia in patients with untypical chest pain

    International Nuclear Information System (INIS)

    Tian Yueqin; He Zuoxiang; Wang Qi; Hu Fenghuan; Yang Weixian; Qiao Shubing; Liu Xiujie

    2005-01-01

    Objective: To evaluate the value of adenosine and exercise stress 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial imaging for the diagnosis of myocardial ischemia in patients with untypical chest pain. Methods: Two groups included. Group 1: 67 cases of adenosine 99 Tc m -MIBI myocardial imaging. Group 2: 81 cases of exercise stress 99 Tc m -MIBI myocardial imaging. All of the patients had coronary angiography (CAG). The results of them were compared. Results: 23 out of 67 patients in group 1 had significant coronary stenosis after CAG, 16 showed reversible perfusion abnormalities in adenosine imaging. 41 of 44 patients with normal CAG showed normal adenosine imaging. The sensitivity, specificity and accuracy of adenosine imaging for coronary artery disease detection were 70%, 93% and 85%, respectively. Group 2: 22 out of 31 patients with significant coronany stenosis after CAG showed reversible perfusion abnormalities, 48 of 50 patients with normal CAG showed normal exercise imaging. The sensitivity, specificity and accuracy of exercise imaging for coronary artery disease detection were 71%, 96% and 86%, respectively. Conclusion: Reversible perfusion abnormalities found both in adenosine and exercise stress 99 Tc m -MIBI myocardial imaging were the key point for diagnosis of myocardial ischemia in patients with untypical chest pain. (authors)

  14. Managing low back pain second edition

    International Nuclear Information System (INIS)

    Kirkaldy-Willis, W.H.

    1988-01-01

    This book contains 26 chapters. Some of the titles are: Magnetic resonance imaging of the lumbar spine; Diagnostic techniques; The site and nature of the lesion; The anatomy of the lumbosacral spine; The perception of pain; Differential diagnosis of low back pain; and A comprehensive outline of treatment

  15. MRI of the Chest

    Medline Plus

    Full Text Available ... a risk, depending on their nature and the strength of the MRI magnet. Many implanted devices will ... abnormalities where Chest CT is a preferred imaging test. MR imaging can assess blood flow without risking ...

  16. The interactions between pain, pain-related fear of movement and productivity

    DEFF Research Database (Denmark)

    Sell, L; Lund, H L; Holtermann, A

    2014-01-01

    BACKGROUND: Employees with physically heavy work have an increased risk of musculoskeletal disorders leading to reduced work ability. AIMS: To investigate if a high level of musculoskeletal pain or pain-related fear of movement was associated with low productivity among employees with physically....... CONCLUSIONS: Despite the fact that musculoskeletal pain increases the risk of reduced work ability significantly, musculoskeletal pain and pain-related fear of movement were associated with low productivity only among employees with good work ability....... heavy work and differing work ability levels. METHODS: The study was conducted at a Danish production site and employees with physically heavy work in the production line were included in the study. Work ability was assessed with the Work Ability Index (WAI), pain-related fear of movement with the Tampa...

  17. Identifying risk factors for first-episode neck pain: A systematic review.

    Science.gov (United States)

    Kim, Rebecca; Wiest, Colin; Clark, Kelly; Cook, Chad; Horn, Maggie

    2018-02-01

    Neck pain affects 15.1% of the United States' general population every 3 months, and ranks fourth in global disability. Because of the tendency for neck pain to become a chronic issue, it is important to identify risk factors that could encourage prevention and early diagnosis. The purpose of this systematic review was to identify risk factors for a first episode of neck pain. Three databases were searched with key words such as "neck pain" and "first incidence." Risk factors from the resulting articles were reported as either a physical or psychosocial risk factor and ranked by the strength of their odds/risk/hazard ratio: empowering leadership, high perceived social climate, leisure physical activity, and cervical extensor endurance. Most risk factors found for neck pain were related to psychosocial characteristics, rather than physical characteristics. A number of these risk factors were mediating factors, suggesting that a prevention-based program may be useful in modifying the existence of the risk factors before the occurrence of neck pain. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Imaging-guided hyperstimulation analgesia in low back pain

    Directory of Open Access Journals (Sweden)

    Gorenberg M

    2013-06-01

    Full Text Available Miguel Gorenberg,1,2 Kobi Schwartz31Department of Nuclear Medicine, B'nai Zion Medical Center, Haifa, Israel; 2The Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; 3Department of Physical Therapy, B'nai Zion Medical Center, Haifa, IsraelAbstract: Low back pain in patients with myofascial pain syndrome is characterized by painful active myofascial trigger points (ATPs in muscles. This article reviews a novel, noninvasive modality that combines simultaneous imaging and treatment, thus taking advantage of the electrodermal information available from imaged ATPs to deliver localized neurostimulation, to stimulate peripheral nerve endings (Aδ fibers and in turn, to release endogenous endorphins. "Hyperstimulation analgesia" with localized, intense, low-rate electrical pulses applied to painful ATPs was found to be effective in 95% patients with chronic nonspecific low back pain, in a clinical validation study.Keywords: myofascial, noninvasive, electrical, impedance

  19. Diffuse Subcutaneous Emphysema and Pneumomediastinum Secondary to a Minor Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Maximilian Andreas Storz

    2017-01-01

    Full Text Available Full medical evaluation is paramount for all trauma patients. Minor traumas are often overlooked, as they are thought to bear low injury potential. In this case report, we describe the case of a 48-year-old man presenting to our Emergency Department with mild to moderate right-sided shoulder and scapular pain following a fall from his own height ten days previously. Clinical and paraclinical investigations (CT revealed diffuse right shoulder pain, with crepitations on palpation of the neck, right shoulder, and right lateral chest wall. Computed tomography (CT demonstrated right-sided costal fractures (ribs 7 to 9, with diffuse subcutaneous emphysema and pneumomediastinum due to laceration of the visceral and parietal pleura and the adjacent lung parenchyma. In addition, a small ipsilateral pneumothorax was found. Surprisingly, the clinical status was only minimally affected by mild to moderate pain and minor functional impairment.

  20. Evaluation of Low Back and Neck Pain and Disability of Interns at Physiotherapy and Rehabilitation Department of Afyon Kocatepe University

    Directory of Open Access Journals (Sweden)

    Horata Emel Taşvuran

    2017-01-01

    Full Text Available Repetitive tasks, high force, direct pressure, and awkward joint and prolonged constrained posture are cited as prime risk factors, making particularly younger adult physiotherapists vulnerable to musculoskeletal injury. Fourth-grade students (interns perform clinical practice at Afyon Kocatepe University Hospital. They apply hydrotherapy, electrotherapy, robotic therapy, virtual reality therapy and exercise therapy to patients (inpatient and outpatient at both orthopaedic and neurology units approximately twelve months. Because we think they are under the risk of low back and neck disorders therefore aim of the present study is to evaluate recent low back and neck pain and disability of them. 50.6% participants had recent low back pain; 52.9% participants reported mild and moderate low back disability. 21.8% participants had recent neck pain; 16% participants showed mild, moderate and severe neck disability. The difference between units related to low back and neck pain or disability wasn’t significant statistically (p>0.05. Most participants announced that they used the body biomechanics correctly (84.1% and took care of ergonomic conditions (91.5%. In conclusion, it is vital to identify prevalence of low back and neck pain among physiotherapy students and take necessary precautions to prevent further problems.