Systemic lupus erythematosus (SLE) with an associated aortoarteritis presenting as an ischemic stroke is a rarity in the medical literature. We report the case of an 11-year-old male presenting with an acute ischemic ...Systemic lupus erythematosus (SLE) with an associated aortoarteritis presenting as an ischemic stroke is a rarity in the medical literature. We report the case of an 11-year-old male presenting with an acute ischemic stroke meeting the criteria for the diagnosis of SLE and findings consistent with an aortitis on imaging but mimicking the diagnosis of Takayasu’s pulseless arteritis. Blood and imaging investigations revealed the finding of SLE aortitis following an acute stroke presentation. Thus, it is imperative to note that even though it is infrequent, SLE can be associated with a large vessel vasculitis.展开更多
BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied a...BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation(ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio(NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value(NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis(area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female.In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9(range 0.6-46.5) compared with 8.9(0.28-96) in non-survivors(P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55[odds ratio(OR) = 5.20, confidence interval(CI): 1.5-18.3, P = 0.01], older age(OR= 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level(OR = 1.20, CI:1.03-1.40, P = 0.02) were independent predictors of death.CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.展开更多
Aortic dissection is a critical condition requiring immediate assessment and management. Patients with this condition usually present with severe chest pain and high blood pressure. However, because of the variety of ...Aortic dissection is a critical condition requiring immediate assessment and management. Patients with this condition usually present with severe chest pain and high blood pressure. However, because of the variety of presenting symptoms and features, it is a challenge to identify this condition, and patients are frequently misdiagnosed. The potentially critical course of aortic dissection can result in tragedy. We present the case of a 46-year-old woman who initially presented with a light headache and sensory loss in her right upper limb. She had a medical history of hypertension without regular medication, and her blood pressure (BP) was 110/67 mmHg on arrival. Four days later, she was sent to the emergency department again because she experienced transient loss of consciousness lasting for a few minutes. Her BP was 94/57 mmHg in the right arm and 89/54 in the left arm. She was admitted to the hospital, and the pulses in both upper limbs were impalpable on the following day. Chest magnetic resonance imaging (MRI) was arranged, and subsequently, aortic dissection was diagnosed. The case presented with unusual characteristics, which increased the difficulty in immediate correct diagnosis.展开更多
<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">First described in 1908, TAK has now been recognized as a non...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">First described in 1908, TAK has now been recognized as a non-specific inflammatory disease of unknown etiology, predominantly affecting young females. Sometimes, it progresses into relatively rare and potentially fatal scenarios such heart failure.</span><b><span style="font-family:Verdana;"> Case Presentation: </span></b><span style="font-family:Verdana;">Here, we present the case of a 50-year sub-saharan</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">female suffering from acute heart failure related to TAK.</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Despite constitutional symptoms (fever, malaise, weight loss) and more characteristic features such claudication of lower extremities, carotydinia, and pulseless syndrome, diagnosis of TAK was delayed since main presentation was heart failure.</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Immunosuppressive and anticoagulant therapies have induced improvement in cardiac manifestations.</span><b><span style="font-family:Verdana;"> Conclusion: </span></b><span style="font-family:Verdana;">Early diagnosis and proper treatment can protect the patient from dangerous complications such heart failure.</span></span>展开更多
Amiodarone is one of the widely used antiarrhythmic drugs related to class III, used in the treatment of SVT （supraventricular） and ventricular arrhythmias. However, improper use of this drug such as pushing high co...Amiodarone is one of the widely used antiarrhythmic drugs related to class III, used in the treatment of SVT （supraventricular） and ventricular arrhythmias. However, improper use of this drug such as pushing high concentration with rapid injection can increase the rate of adverse effects. The most common adverse effects associated with intravenous amiodarone are hypotension （16%）, heart block or bradycardia （4.9%）, and peripheral phlebitis （8-55%）, this can be treated by diluting the drug and slowing the rate of infusion or discontinuing the drug. In addition, hypotension can be refractory and lead to a fatal outcome and death. Because phlebitis may occur, the drug should be given through a central line when possible. Some literatures refer to the administration of intravenous amiodarone in the treatment of arrhythmias such as in SVT, as ＂given over 10 minute＂ without focusing on the dilution and rate of infusion, therefore many residents give it with rapid direct intravenous injection without dilution and even during less than 10 minutes. From currently daily practice we are reporting two cases of amiodarone improper administration, first case ＂amiodarone-associated refractory hypotension＂ and second case ＂amiodarone-associated death＂.展开更多
目的观察不同初始负荷剂量胺碘酮治疗无脉性室速和室颤的效果。方法选择183例无脉性室速和室颤患者,经常规心肺复苏、使用肾上腺素以及3次电除颤未能转复者,随机分为两组:胺碘酮组(n=125):300mg或150mg胺碘酮溶于40mL葡萄糖液中快速静注...目的观察不同初始负荷剂量胺碘酮治疗无脉性室速和室颤的效果。方法选择183例无脉性室速和室颤患者,经常规心肺复苏、使用肾上腺素以及3次电除颤未能转复者,随机分为两组:胺碘酮组(n=125):300mg或150mg胺碘酮溶于40mL葡萄糖液中快速静注,再予电除颤,按初始剂量,胺碘酮组又分为300mg组(n=64)和150mg组(n=61);对照组(n=58):仅给予常规肾上腺素、CPR及电除颤;记录并比较各组患者的心律转复时间,入院、出院存活人数。结果两种剂量的胺碘酮均能明显缩短心律转复时间[(9.8±1.7)min,(10.5±2.3)min vs (15.6±2.2)min](P<0.05),提高入院存活率(35.9%,32.8% vs 20.7%)(P<0.05),300mg剂量的胺碘酮的效果略优于150mg剂量组,但差异无统计学意义(P>0.05),胺碘酮对于出院存活率无明显改善。结论300mg与150mg剂量的胺碘酮能有效缩短无脉性室速和心室纤颤患者的心律转复时间,但不能提高出院存活率。展开更多
2018年美国心脏病协会(The American Heart Association,AHA)和国际复苏联络委员会(International Liaison Committee on Resuscitation,ILCOR)更新了心肺复苏指南,推荐对胺碘酮和利多卡因治疗电除颤难复律性心室颤动(ventricular fibri...2018年美国心脏病协会(The American Heart Association,AHA)和国际复苏联络委员会(International Liaison Committee on Resuscitation,ILCOR)更新了心肺复苏指南,推荐对胺碘酮和利多卡因治疗电除颤难复律性心室颤动(ventricular fibrillation,VF)或无脉性室性心动过速(pulseless ventricular tachycardia,pVT)。本文总结胺碘酮、利多卡因在心肺复苏中的药理作用及推荐剂量,回顾两者在心肺复苏中的研究进展。展开更多
BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the h...BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.展开更多
文摘Systemic lupus erythematosus (SLE) with an associated aortoarteritis presenting as an ischemic stroke is a rarity in the medical literature. We report the case of an 11-year-old male presenting with an acute ischemic stroke meeting the criteria for the diagnosis of SLE and findings consistent with an aortitis on imaging but mimicking the diagnosis of Takayasu’s pulseless arteritis. Blood and imaging investigations revealed the finding of SLE aortitis following an acute stroke presentation. Thus, it is imperative to note that even though it is infrequent, SLE can be associated with a large vessel vasculitis.
文摘BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation(ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio(NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value(NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis(area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female.In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9(range 0.6-46.5) compared with 8.9(0.28-96) in non-survivors(P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55[odds ratio(OR) = 5.20, confidence interval(CI): 1.5-18.3, P = 0.01], older age(OR= 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level(OR = 1.20, CI:1.03-1.40, P = 0.02) were independent predictors of death.CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.
文摘Aortic dissection is a critical condition requiring immediate assessment and management. Patients with this condition usually present with severe chest pain and high blood pressure. However, because of the variety of presenting symptoms and features, it is a challenge to identify this condition, and patients are frequently misdiagnosed. The potentially critical course of aortic dissection can result in tragedy. We present the case of a 46-year-old woman who initially presented with a light headache and sensory loss in her right upper limb. She had a medical history of hypertension without regular medication, and her blood pressure (BP) was 110/67 mmHg on arrival. Four days later, she was sent to the emergency department again because she experienced transient loss of consciousness lasting for a few minutes. Her BP was 94/57 mmHg in the right arm and 89/54 in the left arm. She was admitted to the hospital, and the pulses in both upper limbs were impalpable on the following day. Chest magnetic resonance imaging (MRI) was arranged, and subsequently, aortic dissection was diagnosed. The case presented with unusual characteristics, which increased the difficulty in immediate correct diagnosis.
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">First described in 1908, TAK has now been recognized as a non-specific inflammatory disease of unknown etiology, predominantly affecting young females. Sometimes, it progresses into relatively rare and potentially fatal scenarios such heart failure.</span><b><span style="font-family:Verdana;"> Case Presentation: </span></b><span style="font-family:Verdana;">Here, we present the case of a 50-year sub-saharan</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">female suffering from acute heart failure related to TAK.</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Despite constitutional symptoms (fever, malaise, weight loss) and more characteristic features such claudication of lower extremities, carotydinia, and pulseless syndrome, diagnosis of TAK was delayed since main presentation was heart failure.</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Immunosuppressive and anticoagulant therapies have induced improvement in cardiac manifestations.</span><b><span style="font-family:Verdana;"> Conclusion: </span></b><span style="font-family:Verdana;">Early diagnosis and proper treatment can protect the patient from dangerous complications such heart failure.</span></span>
文摘Amiodarone is one of the widely used antiarrhythmic drugs related to class III, used in the treatment of SVT （supraventricular） and ventricular arrhythmias. However, improper use of this drug such as pushing high concentration with rapid injection can increase the rate of adverse effects. The most common adverse effects associated with intravenous amiodarone are hypotension （16%）, heart block or bradycardia （4.9%）, and peripheral phlebitis （8-55%）, this can be treated by diluting the drug and slowing the rate of infusion or discontinuing the drug. In addition, hypotension can be refractory and lead to a fatal outcome and death. Because phlebitis may occur, the drug should be given through a central line when possible. Some literatures refer to the administration of intravenous amiodarone in the treatment of arrhythmias such as in SVT, as ＂given over 10 minute＂ without focusing on the dilution and rate of infusion, therefore many residents give it with rapid direct intravenous injection without dilution and even during less than 10 minutes. From currently daily practice we are reporting two cases of amiodarone improper administration, first case ＂amiodarone-associated refractory hypotension＂ and second case ＂amiodarone-associated death＂.
文摘目的观察不同初始负荷剂量胺碘酮治疗无脉性室速和室颤的效果。方法选择183例无脉性室速和室颤患者,经常规心肺复苏、使用肾上腺素以及3次电除颤未能转复者,随机分为两组:胺碘酮组(n=125):300mg或150mg胺碘酮溶于40mL葡萄糖液中快速静注,再予电除颤,按初始剂量,胺碘酮组又分为300mg组(n=64)和150mg组(n=61);对照组(n=58):仅给予常规肾上腺素、CPR及电除颤;记录并比较各组患者的心律转复时间,入院、出院存活人数。结果两种剂量的胺碘酮均能明显缩短心律转复时间[(9.8±1.7)min,(10.5±2.3)min vs (15.6±2.2)min](P<0.05),提高入院存活率(35.9%,32.8% vs 20.7%)(P<0.05),300mg剂量的胺碘酮的效果略优于150mg剂量组,但差异无统计学意义(P>0.05),胺碘酮对于出院存活率无明显改善。结论300mg与150mg剂量的胺碘酮能有效缩短无脉性室速和心室纤颤患者的心律转复时间,但不能提高出院存活率。
文摘BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.
