Potential health promotion benefits of lipid testing for all patients presenting with chest pain to an emergency department

Objectives

To establish the prevalence of previously undiagnosed dyslipidaemia in patients presenting to the emergency department (ED) with non‐traumatic chest pain and, more particularly, the prevalence in the subgroup which was discharged home from the ED, the group that traditionally would not have received a lipid test.

Methods

Prospective, observational study of adult patients presenting to an ED with non‐traumatic chest pain as the presenting complaint.

Results

A total of 185 eligible patients underwent lipid testing during their presentation: 96 in the ED and 89 in the wards. Overall 61% (n = 112) of patients had at least one abnormal lipid level. Of patients discharged from the ED, 62% had at least one abnormal lipid level.

Conclusions

A moderate, but useful, increase in detection rates of dyslipidaemia is possible if lipid testing is offered to all patients presenting with chest pain, and not just to those who are admitted to wards for further investigation and management of suspected acute coronary syndromes. Testing of this group should be considered as a health promotion initiative in the ED, with appropriate follow up in the community.     

Comparison of particle penetration with non-spherical polyvinyl alcohol versus trisacryl gelatin microspheres in women undergoing premyomectomy uterine artery embolization

AIM: The purpose of this study was to compare the depth of vascular penetration of non-spherical polyvinyl alcohol (PVA) versus trisacryl gelatin microspheres (MS) in women undergoing uterine artery embolization (UAE) immediately before transabdominal myomectomy. MATERIALS AND METHODS: A total of 17 patients who had been referred for embolization before myomectomy underwent bilateral uterine artery embolization using either 355-500 microm PVA (group A) or 700-900 microm MS (group B). The depth of penetration of the particles was assessed by identifying their presence and location in the resected specimen. RESULTS: Of the 17 women enrolled in this study, 10 were in group A and 6 in group B. One woman underwent embolization using both types of particle and was excluded from the analysis. Embolic particles were significantly (p = 0.048) more frequently located within the fibroid (4/6, 67%) in Group B than Group A (1/10, 10%). Particles were also identified in the perifibroid tissues in 4/6 (67%) in Group B and 4/10 (40%) in Group A, with no statistical difference. There were no procedural complications. CONCLUSION: MS particles (700-900 microm) penetrate significantly deeper into leiomyomata compared with non-spherical PVA (355-500 microm). MS may therefore confer advantages in UAE, as they may more specifically target the fibroid, allowing an earlier end-point to embolization and minimizing ischaemic damage to normal myometrium and ovaries.