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Objective: The incidence of surgically treated thoracic disc herniations in the U.S. is estimated to be 1:116,338 [1]. The disease poses 2 main challenges: 1) Surgical removal and 2) early and correct diagnosis. It is without doubt that herniated thoracic discs can be difficult to remove; Equally difficult is often enough attributing the correct symptoms to the disease that lead to the diagnosis, because there is a great variability and supposedly low specificity of the clinical symptoms, especially concerning pain related symptoms, which are often attributed to muscular or joint related causes.The series published so far are comparatively small (up to a maximum of 200) to give a good and valid overview of the symptoms that the disease can cause.The aim of this study was therefore to verify and falsify the previously published data that were obtained with small series on the basis of a much larger series. Methods: We used our practice's own database that was designed to included only patients with thoracic disc herniations since the senior author focused on this disease about 25 years ago. The patient's symptoms were initially recorded descriptively on the basis of the medical record. Then the patients were contacted and the development of symptoms after surgery and new symptoms were recorded. Results: 664 patients were included in the study. Mean follow-up period was 57.89 months. 151 (22.74%) patients reported neurological motor deficits, 313 (47.13%) reported neurological sensory deficits, 542 (81.62%) thoracic back pain, 125 (18.82%) bladder and rectal dysfunction and 46 (6.92%) atypical symptoms. 137 (20%) of the patients were completely symptom-free. The rate of improvement/ symptom stability was about 90% for neurological symptoms, pain-improvement 40%, 65% improvement in bladder and rectal dysfunction, and 80% improvement in atypical symptoms. Conclusion: The results of this largest series to date of patients who were operated on for a thoracic disc herniation show that not only neurological but also algetic symptoms are dominating in patients harboring this disease. The postoperative results primarily help to advise the patient on their prognosis.

Contrast-enhanced chest computed tomography (CT) is not considered part of the evaluation of myocardial infarction. However, acute myocardial infarction has been detected on contrast-enhanced chest CT as areas of decreased myocardial enhancement in patients evaluated for other indications, such as pulmonary embolism and aortic dissection. We present a case of acute myocardial infarction on a nongated chest CT in a 67-year-old male who presented with atypical chest pain and initial nondiagnostic electrocardiogram. This case highlights that acute myocardial infarction may be detectable on contrast-enhanced CT. When evaluating contrast-enhanced chest CT's for other etiologies of chest pain, radiologists should look for potential myocardial perfusion abnormalities that can provide clues to the presence of myocardial infarction.

Patients with acute nonspecific chest pain and low probability for coronary disease remain an important clinical management dilemma. We focus on evidence for imaging, in an integrated decision-making setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment., (Copyright © 2020 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background: Herniation of intraabdominal contents into the pericardial cavity is exceptionally rare, and when seen, it is most often the result of trauma, postsurgical complication, or genetic defect. There have been only a few case reports describing spontaneous bowel herniation into the pericardium in minimally invasive cardiac procedures like cardiac ablation, pacemaker placement, and minimally invasive coronary artery bypass graft., Case Report: We report the case of a 65-year-old man who presented to an urgent care center complaining of abdominal and chest pain. This patient had recently undergone a laparoscopic hybrid maze procedure and ultimately had an incarcerated loop of small bowel herniate into the pericardial sac. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present this case to increase awareness among emergency physicians of the diagnosis of a pericardial hernia in patients presenting with gastrointestinal or cardiorespiratory symptoms after surgical procedures involving the diaphragm., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Intrinsic functional properties of high density lipoproteins (HDL) are considered to be physiologically important for atheroprotection. We compared the HDL anti-inflammatory capacity between patients with acute myocardial infarction (MI) and patients with non-cardiac chest pain, and prospectively determined the association of new major adverse cardiovascular events (MACE) with this metric of HDL function., Methods: A prospective study was carried out in 93 patients referred for acute chest pain (65 patients with acute MI). The HDL anti-inflammatory capacity was determined as the ability to suppress tumor necrosis factor-α-induced vascular cell adhesion molecule-1 mRNA expression in endothelial cells in vitro., Results: Acute MI at admission was associated with impaired HDL anti-inflammatory capacity (p=0.001), even after adjustment for HDL cholesterol and apolipoprotein A-I (p=0.003). Twenty nine MACE were ascertained during a median follow-up of 1210 (910-1679) days. New MACE was associated with impaired HDL anti-inflammatory capacity (hazard ratio: 1.80 (1.17-2.77) per SD change, p=0.007) in age, sex, HDL cholesterol and apolipoprotein-AI adjusted analysis., Conclusions: The ability of HDL to attenuate endothelial inflammation is impaired in acute MI, and this metric of HDL function may serve as a predictor of new MACE, even independent of HDL cholesterol and apolipoprotein A-I., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: The cholesterol esterifying enzyme, lecithin:cholesterol acyltransferase (LCAT), plays a key role in HDL maturation and remodeling. Myeloperoxidase (MPO) may compromise LCAT enzymatic activity. We tested the extent to which plasma LCAT activity is altered in acute myocardial infarction (MI) in conjunction with abnormal MPO levels. We also assessed the impact of LCAT and MPO on newly developed major adverse cardiovascular events (MACE)., Methods: Two-hundred one consecutive patients referred for acute chest pain of whom 134 had MI (95 with ST-elevation) participated. Forty-five new MACE were ascertained during 1203 (range 13-1745) days of follow-up among 185 patients. Plasma LCAT activity was measured using an exogenous substrate assay. MPO mass was assayed by chemiluminescent microparticle immunoassay., Results: Plasma LCAT activity was decreased by 15%, coinciding with 7-fold increased MPO levels in acute MI patients vs. patients with non-cardiac chest pain (p < 0.001 for both; correlation: r = -0.343, p < 0.001). MI at admission was associated independently with both lower plasma LCAT activity and higher MPO (age- and sex-adjusted odds ratio per 1 SD increment: 0.46 (95% CI, 0.31-0.68), p < 0.001 and 7.58 (95% CI, 3.34-17.11), p < 0.001, respectively). In an analysis with LCAT and MPO together these associations were modestly attenuated. MPO mass (hazard ratio: 1.59 (95% CI, 1.15-2.19), p = 0.004), but not LCAT activity (hazard ratio: 0.87 (95% CI, 0.65-1.19), p = 0.39), predicted newly manifest MACE., Conclusion: In acute MI patients, plasma LCAT activity is decreased coinciding with increased MPO levels. Higher MPO but not lower LCAT activity prospectively predicts adverse cardiac outcome., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) mass predicts future cardiovascular events in the non-acute setting. We tested the extent to which Lp-PLA2 is elevated in patients with acute coronary syndrome., Methods: A total of 231 consecutive patients referred for acute chest pain participated. Of this number, 144 were diagnosed with myocardial infarction (MI; 100 were classified as MI with ST-elevation (STEMI) and 44 as MI without ST-elevation (non-STEMI)). Eighty-seven patients had non-cardiac chest pain. Plasma Lp-PLA2 mass was measured using turbidimetric immunoassay., Results: Lp-PLA2 mass was not different between MI patients and patients with non-cardiac chest pain (231±72 μg/l vs.243±88 μg/l, p=0.29), and did not relate to MI in age- and sex-adjusted logistic regression analysis (odds ratio per SD increment, 0.92 (95% CI, 0.69-1.23), p=0.58). However, Lp-PLA2 mass was elevated in STEMI compared to non-STEMI patients (246±73 vs. 198±58 ng/ml, p<0.001), and independently predicted STEMI (odds ratio, 2.35 (95% CI, 1.46-3.79), p<0.001). Among MI patients maximal creatine kinase was correlated positively with Lp-PLA2 (r=0.183, p=0.034)., Conclusions: In the acute setting, plasma Lp-PLA2 mass is not elevated in MI patients, although Lp-PLA2 mass appears to relate to the severity of myocardial damage., (Copyright © 2013 Elsevier B.V. All rights reserved.)