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ObjectivesTo describe contemporary characteristics and diagnoses in prehospital patients with chest pain and to identify factors suitable for the early recognition of high-risk and low-risk conditions.DesignProspective observational cohort study.SettingTwo centre study in a Swedish county emergency medical services (EMS) organisation.ParticipantsUnselected inclusion of 2917 patients with chest pain contacting the EMS due to chest pain during 2018.Primary outcome measuresLow-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.ResultsOf included EMS missions, 68% concerned patients with a low-risk condition without medical need of acute hospital treatment in hindsight. Sixteen per cent concerned patients with a high-risk condition in need of rapid transport to hospital care. Numerous variables with significant association with low-risk or high-risk conditions were found. In total high-risk and low-risk prediction models shared six predictive variables of which ST-depression on ECG and age were most important. Previously known risk factors such as history of acute coronary syndrome, diabetes and hypertension had no predictive value in the multivariate analyses. Some aspects of the symptoms such as pain intensity, pain in the right arm and paleness did on the other hand appear to be helpful. The area under the curve (AUC) for prediction of low-risk candidates was 0.786 and for high-risk candidates 0.796. The addition of troponin in a subset increased the AUC to >0.8 for both.ConclusionsA majority of patients with chest pain cared for by the EMS suffer from a low-risk condition and have no prognostic reason for acute hospital care given their diagnosis on hospital discharge. A smaller proportion has a high-risk condition and is in need of prompt specialist care. Building models with good accuracy for prehospital identification of these groups is possible. The use of risk stratification models could make a more personalised care possible with increased patient safety.

Background Currently, there is no formally accepted pharmacological treatment for COVID-19. Materials and methods We included COVID-19 outpatients of a Peruvian primary care center from Lima, Peru, who were treated between April 30 - September 30, 2020, with hydroxychloroquine and azithromycin. Logistic regression was applied to determine factors associated with case-fatality rate. Results A total of 1265 COVID-19 patients with an average age of 44.5 years were studied. Women represented 50.1% of patients, with an overall 5.9 symptom days, SpO2 97%, temperature of 37.3 °C, 41% with at least one comorbidity and 96.1% one symptom or sign. No patient treated within the first 72 h of illness died. The factors associated with higher case fatality rate were age (OR = 1.06; 95% CI 1.01–1.11, p = 0.021), SpO2 (OR = 0.87; 95% CI 0.79–0.96, p = 0.005) and treatment onset (OR = 1.16; 95% CI 1.06–1.27, p = 0.002), being the latter the only associated in the multivariate analysis (OR = 1.18; 95% CI 1.05–1.32, p = 0.005). 0.6% of our patients died. Conclusions The case fatality rate in COVID-19 outpatients treated with hydroxychloroquine/azithromycin was associated with the number of days of illness on which treatment was started.

Introduction: Bilateral breast reduction surgery is the surgical treatment of bilateral breast hypertrophy. This is one of the most common breast surgery requested by women, and performed by plastic surgeons. The reasons that patients want this surgery are to re-size sagging breasts aesthetically, and to get rid of somatic symptoms such as shoulder, chest, back, and neck pain. We believe that the objective positive effects of breast reduction surgery exist beside aesthetic. In our study, our aim is to elicit positive effects of surgery on lungs, if there are, by making pulmonary function test and carbon monoxide diffusion test before surgery and after 6 months of surgery. Materials and Methods: Thirty patients agreed to participate in the study. Study is completed with 19 patients. Pulmonary function test and carbon monoxide diffusion test were made to all patients in preoperative and 6 months of postoperative period. Lung roentgenogram of all patients was performed and height, weight, body mass index were measured. Saturation level was measured. Results: There was a meaningful increase in FEV1 and FVC values in the postoperative period in comparison with pulmonary function test performed in preoperative period. DLCO in postoperative period decreased meaningfully as compared to the preoperative period. Conclusion: Breast reduction surgery seems to have positive effects on pulmonary function test values and relaxes patients clinically. Patients with big breasts should be evaluated from this perspective if they apply chest diseases clinic with shortness of breath. © 2017, Ankara University. All rights reserved.

Very old (aged ≥80 years) adults constitute an increasing proportion of the global population. Currently, this subgroup of patients represents an important percentage of patients admitted to the intensive care unit. Community-acquired pneumonia (CAP) frequently affects very old adults. However, there are no specific recommendations for the management of critically ill very old CAP patients. Multiple morbidities, polypharmacy, immunosenescence and frailty contribute to an increased risk of pneumonia in this population. CAP in critically ill very old patients is associated with higher short- and long-term mortality; however, because of its uncommon presentation, diagnosis can be very difficult. Management of critically ill very old CAP patients should be guided by their baseline characteristics, clinical presentation and risk factors for multidrug-resistant pathogens. Hospitalisation in intermediate care may be a good option for critical ill very old CAP patients who do not require invasive procedures and for whom intensive care is questionable in terms of benefit. Publication was funded by Ciber de Enfermedades Respiratorias (CibeRes CB06/06/0028) and the 2009 Support to Research Groups in Catalonia 911, IDIBAPS (CERCA Programme/Generalitat de Catalunya). C. Cillóniz is the recipient of a postdoctoral grant (Strategic Plan for Research and Innovation in Health-PERIS 2016–2020), SEPAR fellowship 2008 and the Fondo de Investigación Sanitaria (grant PI19/00207). Funding information for this article has been deposited with the Crossref Funder Registry

The case is presented of a 41 year-old male patient with chest pain, asthenia and adynamia. The imaging studies showed a mass in the anterior mediastinum, which according to the pathology report, was a thymoma. Also, the patient also had haemolytic anaemia and autoimmune hypothyroidism, and with no associated myasthenia gravis. © 2016 Published by Elsevier Españ a.

Podría decirse que una de las pocas cualidades comunes a todos los seres humanos es la capacidad de apreciar la belleza. Si bien, es cierto que el objeto considerado como bello cambia de una persona a otra, la admiración y profunda emoción que experimenta un espectador en trance, es la misma. En ocasiones, esta experiencia puede llevar una persona hasta el borde mismo de la existencia. Una condición muy rara, conocida como síndrome estético, y en algunos casos, síndrome de Stendhal, comprende un cuadro clínico en el que la presencia de una magnífica y bella pieza de arte o arquitectura, produce síntomas disautonómicos como taquicardia, diaforesis, dolor torácico y pérdida de la consciencia. Presentamos aquí una revisión clínica e histórica de esta condición. It could be argued that one of the few unifying qualities all human beings share is the ability to appreciate beauty. While the object of beauty may change from one person to another, the awe and the thrill experienced by an enthralled beholder remains the same. Sometimes, this experience can be so overwhelming it can bring someone to the edge of existence. A very rare condition, known as aesthetic syndrome and, more commonly, Stendhal syndrome, entails a clinical phenomenon in which the presence of a beautiful piece of work or architecture causes dysautonomic symptoms such as tachycardia, diaphoresis, chest pains and loss of consciousness. We present an historical and clinical review of this condition. © 2018, Associacao Arquivos de Neuro-Psiquiatria. All rights reserved.

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Birt-Hogg-Dube (BHD) syndrome is an unusual disorder characterized by the triad of cutaneous lesions, renal tumors and lung cysts. In cases with BHD syndrome, the frequency of recurrent pneumothorax is increased due to presence of multiple lung cysts. It is important to evaluate the BHD syndrome in differential diagnosis of recurrent pneumothorax especially with multiple lung cysts predominating in the lung base. In these patients, the presence of accompanying kidney and other tumors should be investigated. Herein, we report a case of BHD syndrome presenting with recurrent pneumothorax. © 2018 by Turkish Thoracic Society.

Ufuk, Furkan/0000-0002-8614-5387; Ufuk, Furkan/0000-0002-8614-5387 WOS:000459432000025 PubMed: 30629460 Objective: We aimed to determine the diagnostic performance of the contrast-enhanced and unenhanced combined pulmonary arterial MRI and magnetic resonance venography techniques in the diagnosis of venous thromboembolism (VTE). Methods: 44 patients who underwent CT pulmonary angiography (CTPA) for suspected PE constituted the study population. Patients underwent combined pulmonary and lower extremity MRI, and Doppler ultrasonography within 72 h after CTPA. Combined MRI included two sequences: unenhanced steady-state free precession (SSFP) and contrast-enhanced three-dimensional (3D) gradient echo (GRE). The presence of emboli in pulmonary arteries and thrombi in lower extremity veins on 3D-GRE and SSFP sequences was recorded. Results: CTPA showed a total of 244 emboli in 33 (75%) patients whereas contrast-enhanced 3D-GRE MRI showed deep vein thrombosis (DVT) in 34 (77%) subjects. Sensitivities for SSFP vs 3D-GRE MRI respectively in PE detection were 87.9 vs 100% on a per-patient basis, and 53.7 vs 73% on a per-embolus basis. Of 34 patients with established DVT, 31 (91%) were detected by Doppler ultrasound and 29 (85%) were detected by SSFP technique respectively. Conclusion: Both contrast-enhanced and unenhanced combined MRI of acute PE and DVT are feasible one-stop-shopping techniques in patients with suspected thromboembolism. Advances in knowledge: Pulmonary VTE is a common disease with high mortality. Non-invasive techniques withhigh accuracy are required for the assessment of VTE. CT-related radiation and contrast material risks cause concerns. MRI is a radiation-free technique evaluating the vessels with and without contrast. Combined contrast enhancedor unenhanced pulmonary and lower extremity MRI is feasible in patients with suspected thromboembolism.

WOS: 000414152700007, PubMed ID: 28248408, Background: The association between mortality and localization of central thrombus in hemodynamically stable patients with pulmonary embolism (PE) is unclear. Sufficient data are not available to help clinicians to select between low molecular weight heparin (LMWH), unfractionated heparin (UFH) and thrombolytics for the management of central thrombus. The present study aims to investigate whether central thrombus in the pulmonary artery affects 30-day mortality rate, and to compare the outcomes of different treatment approaches in patients with central thrombus. Methods: This multi-central, prospective, observational study included 874 hemodynamically stable patients with PE confirmed by multidetector computed tomography scan. The localization of the emboli was evaluated and categorized as central (saddle or at least one main pulmonary artery), lobar or distal. The primary study outcome was 30-day all-cause mortality. Results: Localization of the emboli was central in 319 (36.5%) patients, lobar in 264 (30.2%) and distal in 291 (33.2%) patients. Seventy-four (8.5%) patients died during the 30-day follow-up period. All-cause mortality rate was 11.9%, 6.8% and 6.2% in patients with central, lobar, and distal emboli, respectively (p < 0.001). Multivariate analysis did not show that hemodynamically stable central thrombus was an independent predictor of mortality. Additionally, mortality rate was not significantly different between UFH, LMWH and thrombolytic therapy groups. Conclusions: The present study showed that central thrombus was not an independent predictor of mortality in hemodynamically stable PE patients. LMWH and UFH were similarly effective in the treatment of this patient group.

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Emphysematous aortitis is a form of septic aortitis. It is a rare disease with a high mortality rate, necessitating prompt diagnosis and aggressive treatment. We present the computed tomography features of emphysematous aortitis leading to esophageal rupture and esophageal-pleural fistula in a 76-year-old female with rheumatoid arthritis. © SAGE Publications.

Objectives: The early diagnosis and treatment of patients with acute coronary syndrome in the emergency department is crucial. This study examined the data involving sociodemographic and clinical features of patients diagnosed with acute coronary syndrome. Methods: The study participants included subjects recruited over a four year period with the diagnosis of acute coronary syndrome in the emergency department. Patients' gender, age, complaints, histories, diagnoses, and results were obtained and evaluated. Results: Most of the subjects in the study were males with histories of consisting of hypertension, coronary artery disease, and diabetes mellitus. The mean age of subjects was 52.4±9.4 years, and the most common time patients registered were between either 05:00-08:00 or 17:00-20:00. Most visits occurred during the weekends and the month of December. The most common complaint was chest pain (72.6%), and the subjects average duration at the emergency department was 2.5±2.4 hours. The most common diagnosis for both genders was UA, and it was found that the diagnosis of non-ST elevation MI increased as patients age increased. The diagnosis of UA was more prevelant in females when compared to males (p

Chagas disease is a complex zoonotic pathology caused by the kinetoplastid Trypanosoma cruzi. This parasite presents remarkable genetic variability and has been grouped into six discrete typing units (DTUs). The association between the DTUs and clinical outcome remains unknown. Chagas disease and co-infection with HIV/AIDS has been reported widely in Brazil and Argentina. Herein, we present the molecular analyses from a Chagas disease patient with HIV/AIDS co-infection in Colombia who presented severe cardiomyopathy, pleural effusion, and central nervous system involvement. A mixed infection by T. cruzi genotypes was detected. We suggest including T. cruzi in the list of opportunistic pathogens for the management of HIV patients in Colombia. The epidemiological implications of this finding are discussed. © 2014 The Authors.

Objective: Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic measurement used for evaluating right ventricular systolic function. While established reference values of TAPSE exist for the adult population, only a limited number of studies have attempted to evaluate reference values for the pediatric population. The aim of the present study was to determine the reference values for TAPSE in healthy children in Turkey. Methods: A total of 765 healthy children aged between 0 and 18 years, all of whom were referred to our clinic with cardiac murmurs, were evaluated prospectively. Patients with no cardiac pathologies or other disorders were excluded from the study. The measurement of TAPSE was obtained using a 2D-guided M-mode technique with echocardiography, and the relationship between age and surface area with TAPSE was investigated. The statistical analysis was carried out using the SPSS 20.0 software package (SPSS Inc., Chicago, IL, USA, 2012). Results: The mean TAPSE value was found to be 19.56 +/- 5.54 mm, and no significant difference was identified between male and female children. TAPSE values showed a positive correlation with increasing age and surface area. The mean TAPSE value was 9.09 +/- 1.36 mm in newborns and 25.91 +/- 3.60 mm in the 13-18 years age group. A negative correlation was seen between TAPSE and heart rate. Conclusion: In the present study, the reference values for TAPSE in healthy Turkish children were presented in percentile tables and the corresponding z-scores were determined. These reference values may be useful in daily practice for the evaluation of right ventricular systolic function in children.

For the treatment of patients with cystic fibrosis, recombinant human deoxyribonuclease I is widely used. Deoxyribonuclease I has a positive effect on lung function and the number of hospitalizations. Deoxyribonuclease I is currently administered by nebulization, which is an inefficient administration method. For expensive drugs, such as deoxyribonuclease I, dry powder inhalation would be advantageous due to increased deposition efficiency, patient mobility and compliance. Furthermore, a significant cost reduction may be obtained. The current status of deoxyribonuclease I in the management of cystic fibrosis was investigated and special attention given to the developments in delivery systems, such as dry powder inhalation. It is estimated that if dry powder inhalation of deoxyribonuclease I could be used, a reduction in the cost-effectiveness ratio of approximately 40% can be obtained as compared with nebulization.

Gastric perforation into the pericardium is an extremely rare but lethal condition. Only a few case reports have been described in the literature. It is difficult to diagnose these patients with clinical evaluation. Accurate and immediate diagnosis of the intestinal perforation is vital. Herein, we present a 56-year old female patient with gastric perforation into the pericardium due to benign gastric ulcer diagnosed with computed tomography (CT). We also emphasized the imaging findings in the diagnosis of intestinal perforation into the pericardium. (C) 2017 Elsevier Inc. All rights reserved.

A 14-year-old right-hand dominant female lacrosse player presented with a complaint of right shoulder and upper posterior thorax pain of 8 days’ duration. She had been playing lacrosse at the attack wing and midfielder positions and experienced insidious pain after a game. She had no history of trauma to that shoulder during that game and had not experienced an injury in the past. Six days after the pain developed, she woke up one night with a sudden increase in the pain, which brought her to tears and caused slight difficulty with breathing. The pain was located anteriorly just lateral to the right sternoclavicular joint and posteriorly in the paraspinal muscles in the upper thoracic region. Physical examination suggested a first-rib stress fracture, which was subsequently confirmed by chest and shoulder radiographs.

Rationale The majority of patients suspected of pulmonary embolism (PE) undergoes imaging tests, but PE will only be confirmed in a minority of patients. Consequently, there is a need for non-invasive, safe assessment aimed to accurately exclude PE. Exhaled breath molecular profiling by electronic nose (eNose) provides a metabolomic fingerprint (breathomics) and may be able to fulfill these criteria. Hypothesis We hypothesized that breath fingerprinting by eNose differentiates between confirmed and absent PE in patients with suspected acute PE, and that this differentiation is most pronounced in patients without relevant comorbidities. Methods Patients with suspected PE were prospectively enrolled in this proof-of-principle study. PE was suspected in case of sudden onset/worsening of dyspnea and/or pleuritic chest pain combined with a high clinical probability according to clinical decision rule (CDR: Wells) or D-dimer >500 ug/L. Confirmed PE and non-PE were defined by the presence and absence of filling defects in the pulmonary artery tree on CT. Breath samples were taken within 2 hours of presentation. Patients inhaled through a filter and exhaled into a Tedlar bag. Breath was analyzed using the Cyranose 320 eNose (Smiths Detection, Pasadena, USA) resulting in breathprints. After principal component reduction breathprints were compared using discriminant analysis, and ROC curves were constructed. Results 40 patients with suspected PE; 20 patients with PE (age 52±15 yrs, 13 males) and 20 patients in whom PE was excluded (48±19 yrs, 8 males). Half of the patients (7 PE, 13 non-PE) had comorbidities known to significantly influence the breathprint (4 diabetes, 12 cancer, 2 renal insufficiency, 4 heart failure). Breathprints of PE and non-PE patients were modestly separated (accuracy 70%, p=0.045). The separation was more pronounced in the non-comorbid group (accuracy 85%, 17/20 correctly classified, p=0.008, PPV 0.86, NPV 0.83), and absent in the comorbid group (accuracy 65%, p=0.78). The ROC curves showed an AUC of 0.81 and 0.55, respectively. Combining the probabilities of PE diagnosis based on breathprints and CDR into one algorithm, the AUC in the non-comorbid group reached 0.90, in the comorbid group 0.51 (fig.1). (Figure presented) ROC curves for the predictive value of electronic nose (eNose) breathprints, Wells score and the combination of eNose breathprints and Wells score for diagnosing pulmonary embolism in subjects (A) without and (B) with comorbidity. Conclusion In this proof-of-principle study, breathomics assessment in patients with suspected PE and no comorbidities provides accurate discrimination between patients with and without PE. A large trainingset of non-comorbid PE patients should be build to avoid masking of the signal by other diseases, and this reference standard should be tested in a newly recruited external validation set, followed by a diagnostic management study.

Myocardial bridging (MB) is defined as the intramural course of a major epicardial coronary artery, and is mostly confined to the left ventricle and the left anterior descending coronary artery (LAD). MB is a common congenital abnormality of a coronary artery, and is usually thought to be a benign anatomical variant. Although rare, previous studies have reported that patients with MB may suffer from myocardial ischemia, myocardial infarction (Ml), arrhythmias, and even sudden death. Therefore, the diagnosis and treatment of MB are both important. Since MB is congenital, its disappearance is unlikely. We here report a very rare case of disappearance of MB after inferior Ml. © 2014 Türk Kardiyoloji Derne?i.

Clinical definitions of melioidosis and inhalation-acquired melioidosis (Burkholderia pseudomallei infection) are described together with the evidence used to develop these definitions. Such definitions support accurate public health reporting, preparedness planning for deliberate B. pseudomallei release, design of experimental models, and categorization of naturally acquired melioidosis.

A coronary artery fistula consists of a communication between a coronary artery and a cardiac chamber, a great artery or the vena cava. It is the most common congenital anomaly that can affect coronary perfusion. However, coronary fistulas to one of the cardiac chambers and coexisting apical myocardial hypertophy are infrequent anomalies, and usually are found unexpectedly. Herein, we report a case in which all three major coronary arteries emptied into the left ventricle with apical hypertrophy, through multiple microfistulas. © 2013 .

Coronary artery perforation (CAP) is a rare but feared complication of percutaneous coronary intervention. With the advent of new devices and technologies, interventionalists attempt more complex lesions, including more calcified or tortuous vessels and chronic total occlusions, which increases the incidence of CAP. A short literature review, in addition to four cases of CAP, is presented in this report. Resumo: As perfurações das artérias coronárias são raras, mas complicações temidas nas intervenções coronarianas percutâneas. Com o advento de novos dispositivos e tecnologias, a tentativa de intervenção em lesões mais complexas, incluindo os vasos mais calcificados ou tortuosos ou oclusões crónicas, leva a maior incidência de perfurações de artérias coronárias. Uma breve revisão da literatura, além de quatro casos de perfurações de artérias coronárias foi apresentada no presente trabalho. Keywords: Coronary artery perforation, Complication, Percutaneous coronary intervention, Palavras-chave: Perfurações de artérias coronárias, Complicação, Intervenção coronária percutânea

To the EditorEosinophilic myocarditis is a relatively rare condition and usually results from myocardial damage as a result of drugs or parasites. It is generally associated with increased peripheral eosinophil count.1 The clinical presentation of patients with myocarditis is variable, ranging from

Hydatid disease can be seen anywhere in the body and presents with a variety of clinical symptoms and imaging features according to its location. In this article, computed tomography features of a giant hepatic hydatid cyst extending into the right atrium and causing pulmonary embolism are presented. © 2012 Elsevier Inc.

Background: A 28-year-old male smoker (6 pack-years) presented with complaints of dyspnea, cough and chest pain. Physical examination was unremarkable except for decreased respiratory sounds within anterior mid-lung zones bilaterally. Laboratory findings were within normal limits.

We present a rare case of cystic bronchioloalveolar cacinoma (BAC) which was complicated by spontaneous pneumothorax. Descriptions about the mechanism of cysts and complications of pneumothorax in BAC are few in the literature. Check-valve mechanism is one of these factors which may be responsible for the cystic lesions and spontaneous pneumothorax in cystic BAC. Narrowing of the respiratory bronchioles by the tumor cells should be a cause of the check-valve mechanism. In our case, high resolution CT (HRCT) showed that some of the cysts have a connection with the airways, which was confirmed by pathology. This case is original because the connection between the airways and cysts was supported by not only pathology specimens but also HRCT.

Background and Objectives: The extent of congruence between one's symptom experience and preconceived ideas about the nature of myocardial infarction symptoms (ie, symptom congruence) can influence when acute myocardial infarction (AMI) patients seek medical care. Lengthy delays impede timely receipt of medical interventions and result in greater morbidity and mortality. However, little is known about the factors that contribute to symptom congruence. Hence, the purpose of this study was to examine how AMI patients' symptom experiences and patients' demographic and clinical characteristics contribute to symptom congruence. Participants and Methods: Secondary data analyses were performed on interview data that were collected from 135 AMI patients. Hierarchical multiple regression analyses were used to examine how specific symptom attributes and demographic and clinical characteristics contribute to symptom congruence. Chest pain/discomfort and other symptom variables (type and location) were included in step 1 of the analysis, whereas symptom severity and demographic and clinical factors were included in step 2. In a second analysis, quality descriptors of discomfort replaced chest pain/discomfort in step 1. Results: Although chest pain/discomfort, and quality descriptors of heaviness and cutting were significant in step 1 of their respective analyses, all became nonsignificant when the variables in step 2 were added to the analyses. Severe discomfort (β = .29, P < .001), history of AMI (β = .21, P < .01), and male sex (β = .17, P < .05) were significant predictors of symptom congruence in the first analysis. Only severe discomfort (β = .23, P < .01) and history of AMI (β = .17, P < .05) were predictive of symptom congruence in the second analysis. Conclusions: Although the location and quality of discomfort were important components of symptom congruence, symptom severity outweighed their importance. Nonsevere symptoms were less likely to meet the expectations of AMI symptoms by those experiencing this event. Those without a previous history of AMI also experienced lower levels of symptom congruence. Implications pertaining to these findings are discussed. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Sarkoidoz, idiyopatik granülomatöz bir hastalıktır. Genellikle akciğer tutulumu vardır. Tanısı, granülomatöz inflamasyonun bilinen diğer nedenlerinin dışlanması gerekliliği yüzünden zor olabilir. Çok merkezli çalışmamızda sarkoidozun klinik görünümleri ve tanısal yaklaşımlarının değerlendirilmesi amaçlandı. Çalışma protokolü internet üzerinden araştırmacılara gönderildi ve yeni tanı almış sarkoidoz olgularına ait bilgilerini göndermeleri istendi (klinik, radyolojik ve tanısal). İki yıl içinde 293 hasta verisi toplandı. Solunumsal yakınmalar, hastaların %73.3’ünde bulundu ve öksürük en sık yakınmaydı (%53.2), dispne (%40.3) ikinci sıklıktaydı. Konstitüsyonel yakınmalar hastaların yarısında görüldü. En sık olanı yorgunluktu (%38.6). En yaygın bulgu eritema nodozum (%17.1) idi. En sık akciğer radyogramı bulgusu bilateral hiler lenfadenomegali (%78.8) idi. Radyolojik evrelemede hastaların çoğunluğunun Evre I ve Evre II olduğu bulundu (sırasıyla %51.9 ve %31.7). Histolojik doğrulama 265 (%90.4) hastada gerçekleşmişti. Bronkoskopilerin üçte biri normal iken, mukozal hiperemi (%19.8) ve bronş duvarının dışarıdan basısı (%16.8) yaygın anormal bulgular idi. Sık kullanılan örnekleme yöntemleri arasında yer alan mediastinoskopide tanı başarısı %100 idi. En sık kullanılan tanı yöntemi olan transbronşiyal biyopsinin başarı oranı %48.8 idi. Sarkoidoza çok yönlü yaklaşım, sık ve seyrek rastlanan bulguları göz önünde bulundurularak ayırıcı tanı listelerinde yer alması, olası tutulmuş alanlara yönelik tanısal incelemelerin organizasyonu ve birarada çalışan ekip üyelerinin konunun uzmanı olması sayesinde iyileştirilir., Sarcoidosis is an idiopathic granulomatous disease. It usually affects the lung. The diagnosis may be problematic since the known causes of granulomatous inflammation must be excluded. This multicenter study aimed to evaluate the clinical presentations and diagnostic approaches of sarcoidosis. The study protocol was sent via internet, and the participants were asked to send the information (clinical, radiological and diagnostic) on newly diagnosed sarcoidosis cases. 293 patients were enrolled within two years. Pulmonary symptoms were found in 73.3% of the patients, and cough was the most common one (53.2%), followed by dyspnea (40.3%). Constitutional symptoms were occured in half of the patients. The most common one was fatigue (38.6%). The most common physical sign was eritema nodosum (17.1%). The most common chest radiograhical sign was bilateral hilar lymphadenomegaly (78.8%). Staging according to chest X-ray has revealed that most of the patients were in Stage I and Stage II (51.9% and 31.7%, respectively). Sarcoidosis was confirmed histopathologically in 265 (90.4%) patients. Although one-third of the bronchoscopy was revealed normal, mucosal hyperemi (19.8%) and external compression of the bronchial wall (16.8%) were common abnormal findings. The 100% success rate was obtained in mediastinoscopy among the frequently used sampling methods. Transbronchial biopsy was the most frequently used method with 48.8% success rate. Considering sarcoidosis with its most common and also rare findings in the differential diagnosis, organizing the related procedures according to the possibly effected areas, and the expertise of the team would favour multimodality diagnosis.

Objective: Recognizing reasons for prehospital delay after symptoms of acute coronary syndrome (ACS) is established in developed countries yet evidence from Latin America is limited. We aimed to assess ACS symptom recognition, health care-seeking behavior, and confidence in local health care facilities to take care of ACS by gender in a sample of Peruvians. Methods: A community-based interview survey in a peri-urban area in Lima, Peru. The 24-item study instrument included vignettes and questions assessing identification of urgent and emergent ACS symptoms, anticipated help-seeking behaviors, and confidence in local health care facilities. Results: In the study population (90 people; 45.6% men; mean age, 43.5 years), women were 4 times less likely to correctly attribute symptoms of chest pain to the heart (OR 0.23; 95% CI: 0.063‐0.87; P 0.03). Women were much more likely to respond that a man would “Seek help” (OR 4.54; 95% CI: 1.21‐16.90; P 0.024) and that “Yes,” a woman would be less likely to seek help for chest pain symptoms (OR 3.26; 95% CI: 1.13‐9.41 P 0.029) after adjusting for age, education level, age at migration, and history of chest pain. Women were less likely than men to think that their local Health Care Post would help them if they had a heart attack (2.1% vs. 14.6%; P 0.04), and only 18.7% of women believed that their local emergency room would help them. Conclusions: Our findings suggest women are less likely to seek help for chest pain and women and men in a peri-urban area in Peru are not confident in their local health care facility to treat urgent or emergent ACS symptoms.

Capecitabine, a fluoropyrimidine derivative, is an orally administered drug that delivers 5-fluorouracil (5-FU) selectively to the tumour. The drug has demonstrated activity in metastatic colorectal cancer. We describe a male patient receiving capecitabine therapy with typical chest pain and electrocardiographic changes consistent with STsegment elevation myocardial infarction. Capecitabine-induced cardiotoxicity may develop in patients who have had a previous episode of 5-FU-induced cardiotoxicity. Capecitabine-induced cardiotoxicity is a rare condition that may lead to diagnostic and therapeutic dilemmas. (Neth Heart J 2009;17:277-80.19789694)

OBJECTIVE: This study is designed to investigate the role of written information, and the value of its timing, provided to Emergency Department (ED) patients regarding cardiac enzyme tests (CET), on their personal concerns about their health status and their discussions with the emergency physicians as to their normal health status post-test. MATERIALS AND METHODS: This is a prospective randomized controlled study. All consecutive patients used for this study were admitted to the university-based ED within the 6-month study period with the presenting chief complaint of atypical chest pain, which was considered as the presumptive diagnosis. CET was ordered to rule out acute coronary syndromes, and these patients were enrolled into the study groups. RESULTS: The study sample included 523 patients whose CET were ordered and who were therefore eligible for the study. Three groups were similar in terms of persuasion and anxiety scores. Groups, which were informed about the test by leaflet had lower anxiety and persuasion scores. The lowest anxiety scores were found especially in the group in which the information was given before CET was drawn (P

Coronary revascularization procedures (coronary artery bypass graft - CABG surgery, percutaneous coronary intervention - PCI) are widely used in patients with coronary artery disease (CAD). By assessing myocardial perfusion, single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) aids the diagnosis of CAD and patient risk stratification, providing useful information regarding the decision about revascularization and is well suited to assess patients after intervention. Saphenous vein graft occlusion rates range between 8% (early) and 45% (11.5 years after CABG surgery), while the 10-year occlusion rate for arterial conduits such as the internal mammary artery is about 20%. PCI restenosis rates without stenting range between 20%-65% during the first 6 months of follow-up, while coronary stenting has been shown to reduce restenosis rates of about 20%. Chest pain and exercise electrocardiography are largely unhelpful in identifying patients at risk after revascularization procedures. MPI is of proven value to assess patients post intervention. Information gained from post-intervention myocardial SPECT is crucial to differentiate patients with angina from those with exo-cardiac chest pain syndromes, to assess peri-intervention myocardial damage/acute vessel closure, to predict-detect restenosis after PCI and graft occlusion/stenosis after CABG surgery, to detect CAD progression in non-revascularized vessels, to assess left ventricular function (gated-SPECT), to evaluate the effects of intervention if required for occupational reasons and to predict long-term prognosis. With respect to detecting graft patency, MPI has an 80-96% sensitivity and 61-88% specificity, while regarding restenosis after PCI, sensitivity and specificity range between 74-94% and 67-88%, respectively. Despite the large amount of published data demonstrating the value of myocardial perfusion SPECT imaging in patients after CABG surgery or PCI, there is still debate on whether or not these tests should be performed routinely. © 2008 Bentham Science Publishers Ltd. 5 1 9 16

Primary tumors of the heart are rare; the most common cardiac tumor is atrial myxoma. Sudden death may occur in patients with atrial myxoma, tumor embolization, or obstruction of blood flow at the mitral or tricuspid valve. This report describes an unusual cause of sudden death and the autopsy findings for a 73-year-old man with left atrial myxoma. ©2007 Health Communications Inc.

Background Computed tomography–guided high-level percutaneous cordotomy has been used unilaterally or bilaterally for the treatment of localized intractable pain in malignancies. Case Description A 57-year-old man was admitted to the hospital with the complaint of intractable pain involving the left side of the chest, axillary region, and shoulder. He was operated for small cell lung cancer on the left side in December 2003 and received radiotherapy and chemotherapy. His neurological examination was normal. Magnetic resonance imaging of the thorax revealed contrast-enhancing lesions on the left side extending to mediastinum and pleura. His pain was relieved completely after the first cordotomy procedure, and he was discharged from the hospital on the second postoperative day. The patient was readmitted to the hospital with the complaint of severe unilateral chest pain like the initial pain on the right side 4 days after cordotomy. The CT-guided bilateral high-level percutaneous cordotomy was performed with a 15-day interval. Conclusion The CT-guided bilateral high-level percutaneous cordotomy can be used in the treatment of intractable upper trunk pain in patients with cancer without pulmonary dysfunction.

Objectives: To assess cost-effectiveness of high sensitivity troponin (hs-cTn) assays for the management of adults presenting with acute chest pain at the emergency department. Methods: An economic model was constructed to estimate lifetime costs and QALYs of five hs-cTn strategies (differing according to manufacturer, timing of the test, number of tests and cutoff point for a positive test result) compared to standard troponin (sTn) testing at presentation and at 10-12 hours, which was considered the reference standard. In the base case, it was assumed that sTn testing had perfect accuracy for diagnosing AMI and only patients with a positive test for sTn were at increased risk for adverse events and would benefit from immediate treatment. In a secondary analysis, a proportion of patients with a positive hs-cTn test and a negative sTn test were at increased risk for adverse events and would benefit from immediate treatment. Results: Base case: Strategies considered cost-effective depending upon ICER thresholds were Abbott ARCHITECT hs-cTnI 99th centile (thresholds £103,194). Secondary analysis: Strategies considered cost-effective were Abbott ARCHITECT hs-cTnI 99th centile ( £14,992). STn was dominated. Sensitivity/subgroup analyses: Main drivers are: the difference in outcomes between treated and untreated patients, and treatment costs for patients testing false-positive. Hs-cTn testing is more cost-effective in younger age, pre-existing coronary artery disease, and symptom onset

Objectifs: Le but de cette etude etait d'evaluer les effets secondaires cardiovasculaires d'une solution a 4% de cocaine en presence d'adrenaline durant la chirurgie septale. Methodes: Cette etude inclut 60 patients ayant subi une chirurgie septale elective avec anesthesie locale. Les nez ont ete decongestionnes avec des cotonnoides imbibes de 5 mL d'une solution de cocaine a 4% laisses en place dans le nez pour 15 minutes. Par la suite, 10 mL d'anesthesique local (xylocaine 2% et adrenaline 1:100,000) ont ete infiltres dans la muqueuse septale. La chirurgie ne commence que 15 minutes plus tard. Au debut de l'intervention, un electrocardiogramme et les signes vitaux incluant la pression arterielle et le rythme cardiaque sont enregistres. Ces memes mesures sont repetees avant l'infiltration d'anesthesique local, avant le debut de l'intervention chirurgicale proprement dite, et, finalement, a la fin de l'intervention. Les quatre series de mesure et les electrocardiogrammes ont ete examines. Les pressions systoliques et diastoliques ainsi que les parametres du QT, les intervales RR, et les rythmes cardiaques ont ete compares par analyse de variance. Resultats: Nous n'avons pas trouve de differences statistiquement significatives entre les quatre groupes de mesure. Aucun des patients n'a developpe de tachycardie, d'hypertension, d'hypotension, ou de douleur retrosternale. Les traces electrocardiographiques n'ont revele aucune tachycardie sinusale, elevation, ou depression du segment ST ou bloc de branche. Conclusions: Cette etude montre que l'utilisation concomitante de cocaine et d'adrenaline en concentration et volume appropries chez des patients bien selectionnes est securitaire au point de vue des effets cardiovasculaires.

Bu çalışma, 04-06 Aralık 2008 tarihleri arasında Innsbruck[Avusturya]’da düzenlenen 4. Workshop on Integrated Cardiovascular Repair (ICR)’da bildiri olarak sunulmuştur. A 69-year-old man was referred to our hospital with a diagnosis of non-ST elevation myocardial infarction. A selective left coronary angiography revealed a fistula connecting the left main coronary artery with the pulmonary artery in addition to severe left main coronary artery disease. The patient subsequently underwent ligation of fistulae and coronary bypass grafting. The combination of a fistula and severe artery disease seen in this patient is unusual because fistulas originating from the left main coronary artery drain into the pulmonary artery in patients with severe left main coronary artery disease. Innsbruck Med University, Dept Cardiac Surgery Innsbruck Med University, Dept Cardiology

A single coronary artery is a very rare type of coronary artery anomaly that may present in various forms. A patient is presented in whom the right coronary artery coursed as the terminal branch of the left circumflex artery. This is the second case of this anomaly in the literature. ©2007 Pulsus Group Inc. All rights reserved.

Descending necrotising mediastinitis rarely develops and this variety of mediastinitis is a highly lethal disease. A case is reported of descending necrotising mediastinitis caused by an odontogenic infection. The importance is emphasised of prompt diagnosis and aggressive surgical mediastinal drainage for the survival of these patients. Most acute mediastinal infections result from oesophageal perforation, either secondary to oesophagoscopy or tumour erosion. Mediastinitis occasionally develops as descending necrotising mediastinitis originating from the complications of cervical or odontogenic infections. Descending necrotising mediastinitis usually has a fulminant course, leading commonly to sepsis and death.

ObjectiveWe assessed in a randomized study the feasibility and efficacy of awake video-assisted thoracoscopic bullectomy with pleural abrasion to treat spontaneous pneumothorax.MethodsBetween January 2001 and June 2005, a total of 43 patients with primary spontaneous pneumothorax were randomly assigned by computer to undergo video-assisted thoracoscopic bullectomy and pleural abrasion under sole thoracic epidural anesthesia or general anesthesia with single-lung ventilation (control group). Primary outcome measures included technical feasibility and patient satisfaction with anesthesia as scored into 4 grades (from 1, unsatisfactory, to 4, excellent). Secondary outcome measures included global operating room time, assessment of thoracic pain by visual analog pain scale, number of nursing care calls, hospital stay, and recurrences within 12 months.ResultsIn the awake group, technical feasibility was scored as excellent, good, and satisfactory in 8, 7, and 6 patients, respectively. Intergroup comparisons (awake versus control) showed that global operating room time (78.0 ± 20.0 vs 105.0 ± 15.0 minutes, P < .0001), perioperative visual analog pain scale score (2.0 ± 3.0 vs 3.5 ± 2.0, P = .005), nursing care calls (2.0 ± 1 vs 3.0 ± 3.0, P = .017), hospital stay (2.0 ± 1.0 days vs 3.0 ± 1.0 days, P < .0001), and overall costs (€2540 ± €352 vs €3550 ± €435, P < .0001) were significantly better in the awake group. In the awake group, 5 patients (23.8%) could be discharged within the first 24 postoperative hours. One patient in the awake group and 2 patients in the control group had recurrences within 12 months (difference not significant).ConclusionIn our study, awake video-assisted thoracoscopic bullectomy with pleural abrasion proved easily feasible and resulted in shorter hospital stays and reduced procedure-related costs while providing equivalent outcome to procedures performed under general anesthesia.