Embolization of the Stent to the Right Heart After a Motor Vehicle Accident

Endovascular stent grafts have become increasingly used in the management of arterial trauma, chronic vascular occlusive diseases, and deep vein thrombosis (DVT). Here, we describe a case of stent migration to the right heart due to a motor vehicle accident in a patient with iliac venous stent implanted for venous stenosis. Computed tomography (CT) scan imaging identification of a metallic stent was superior to the standard two‐dimensional transesophageal echocardiography (TEE) techniques without imaging artifact from reverberation. However, real time three‐dimensional (3D) TEE can precisely defined a metallic stent in right heart oriented with shape and direction without consuming time compared to that of CT scanning. The use of 3DTEE can facilitate identification of intracardiac metallic foreign bodies perioperatively in a patient with accident and emergent unstable condition. (Echocardiography 2010;27:587‐589)     

四川省地震灾后黑热病流行动态与防治现状

目的了解地震灾害后黑热病流行动态和防治现状,为制定灾后黑热病防治策略提供依据。方法收集地震前、后各级医疗卫生机构黑热病病历资料和网络直报疫情报告,核实后进行资料处理;了解各受灾黑热病疫区发病和防治措施实施情况。结果全省黑热病病例地震前的2006、2007年分别发病49和78例;地震灾害的2008年发病56例,发病数较地震前有所减少;2009年发病62例;2010年发病65例,其中疫区居民和非疫区流动人群各发病28、37例,分别比2009年下降13.85%和上升19.36%。2010年汶川县居民发病4例,省内和省外非疫区流动人员在当地感染发病9和3例,当地居民和流动人口发病出现回升。结论地震灾后疫区当年居民发病人数有所减少,其后2年局部疫区居民和流动人口发病人数增多,存在黑热病局部暴发风险,应加强相应的防治对策。     

Home Blood Pressure Control After the Great East Japan Earthquake in Patients on Chronic Hemodialysis

At 14:46 on 11 March 2011, northeastern Japan was struck by a major earthquake measuring 9.0 on the Richter scale (the Great East Japan Earthquake). Several reports have suggested a transient blood pressure (BP) increase after a major earthquake, but its impact on BP in chronic dialysis patients has not been reported. In a retrospective review of 25 hemodialysis patients who were residents of Koriyama City, changes in the morning home BP after the earthquake were investigated. Home systolic and diastolic BPs were significantly elevated 1 week after the earthquake (158 ± 16 mm Hg vs. 151 ± 13 mm Hg, P < 0.01, for systolic; 81 ± 13 mm Hg vs. 78 ± 11 mm Hg, P = 0.01, for diastolic). Mean home BP 1 week after the earthquake was unchanged from baseline in patients treated with sympatholytics and/or renin‐angiotensin system (RAS) inhibitors. BP values returned to baseline by 4 weeks after the earthquake, but percent changes in mean BP were significantly greater even 2 weeks, 4 weeks, and 6 weeks after the earthquake in patients not treated with RAS inhibitors than in those treated with RAS inhibitors (2 weeks 7.0% ± 4.5% vs. 0.2% ± 5.0%, P < 0.01; 4 weeks 4.4% ± 5.9% vs. ?1.8% ± 5.3%, P = 0.02; 6 weeks 4.6% ± 4.9% vs. ?1.9% ± 3.9%, P < 0.01). On multiple regression analysis, RAS inhibitor use had an independent relationship with percentage increases in mean BP during the 6 weeks after the earthquake. Home BP was significantly increased after a major earthquake in patients on chronic hemodialysis. Prolonged deterioration of BP control after the earthquake was associated with non‐use of RAS inhibitors.     

Peptic Ulcers After the Hanshin-Awaji Earthquake: Increased Incidence of Bleeding Gastric Ulcers

Objective : Although physical stresses are known to induce peptic ulcers in the upper gastrointestinal tract, it remains controversial whether emotional stress can cause peptic ulcers. Therefore, we examined retrospectively the influence of the Hanshin-Awaji earthquake that occurred in Japan in January 1995 on the occurrence of peptic ulcer disease among noninjured residents. Methods : Sixty-one hospitals, covering 70% of all endoscopy examinations performed in this area, joined the study and were divided into three areas according to the severity of the damage. A comparison was made between a group of 10,831 patients who underwent upper gastrointestinal endoscopy within 2 months after the earthquake and 16,100 who did so in the same hospitals during the corresponding period in 1994. Results : In the most devastated area, in spite of a dramatic decrease in the total number of endoscopies (50.0%), patients with gastric ulcer (GU) were increased in 1995, whereas those with duodenal ulcer were decreased, resulting in a higher ratio of gastric to duodenal ulcers than in 1994 (3.07 vs 1.88). In particular, there was a marked increase in bleeding GU. The mean age of patients with GU was significantly higher in 1995 than in 1994. Conclusion : The Hanshin-Awaji earthquake–induced life event stress not only triggered but also exacerbated GU, particularly in the elderly.     

Night shift work

The deleterious effects of night shift work are discussed in relation to emergency physicians. Much of the early research is drawn from heavy industry sources and must be extrapolated to medical work. Disruption of circadian rhythms and Zeitgebers, caused by adherence to contemporary social schedules, causes recurrent difficulty for physicians who constantly change schedules. Adjustments in both physical surroundings and social structure that can make the effects of traumatic schedule change more tolerable are discussed.     

Night time eating: a review of the literature

This study reviews the published research on night time eating, including the night eating syndrome (NES) and the nocturnal eating/drinking syndrome (NEDS). Studies were identified by a computerized literature search (PubMed, PsycInfo) and by references from the papers obtained. In addition, published abstracts from recent conferences in the areas of eating disorders and obesity were included. Individual studies were reviewed and their results summarized. Wakeful night time eating appears to be a frequent symptom which is more common among the obese. The data suggest an early age of onset with a chronic course in many patients. There appears to be considerable overlap between NES and NEDS. Treatment studies are sparse. The clinical features of these syndromes, their comorbidities, and their prevalence rates remain a matter of debate. It is unclear if the night eating syndrome presents a distinct entity that is of clinical relevance. The current nosologies may not capture the natural clustering of eating and sleep‐related pathology as it occurs in general population samples. Copyright © 2003 John Wiley & Sons, Ltd and Eating Disorders Association.