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Tariq S. Marroush Amreeta V. Sharma Louis D. Saravolatz Robert Takla Howard S. Rosman 《The American journal of the medical sciences》2018,355(1):88-93
Myocardial infarction (MI) following blunt chest trauma is rare, but potentially fatal. We treated a young patient for acute MI after falling chest-first on ice while playing hockey. Coronary artery bypass grafting (CABG) was performed after percutaneous stenting attempts were unsuccessful. By reviewing the related literature, we found 179 cases, the majority of which affected young males following road accidents. Left anterior descending artery was most frequently affected followed by right coronary artery particularly in their proximal thirds. Prior to the advent of emergent angioplasty for MI, conservative management was frequently pursued, whereas subsequently both stenting and CABG were performed as initial therapy. Several cases required CABG after the failure of stenting attempts. Trauma-associated MI is uncommon but should be suspected to be properly diagnosed and managed; the potential need for CABG requires that a cardiac surgeon be informed at the time of angiography to avoid possible delay in revascularization. 相似文献
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《Journal of clinical epidemiology》2014,67(2):124-132
ObjectivesThe classical diagnostic cross-sectional study has a focus on one disease only. Generalist clinicians, however, are confronted with a wide range of diagnoses. We propose the “comprehensive diagnostic study design” to evaluate diagnostic tests regarding more than one disease outcome.Study Design and SettingWe present the secondary analysis of a data set obtained from patients presenting with chest pain in primary care. Participating clinicians recorded 42 items of the history and physical examination. Diagnostic outcomes were reviewed by an independent panel after 6-month follow-up (n = 710 complete cases). We used Shannon entropy as a measure of uncertainty before and after testing. Four different analytical strategies modeling specific clinical ways of reasoning were evaluated.ResultsAlthough the “global entropy” strategy reduced entropy most, it is unlikely to be of clinical use because of its complexity. “Inductive” and “fixed-set” strategies turned out to be efficient requiring a small amount of data only. The “deductive” procedure resulted in the smallest reduction of entropy.ConclusionWe suggest that the comprehensive diagnostic study design is a feasible and valid option to improve our understanding of the diagnostic process. It is also promising as a justification for clinical recommendations. 相似文献
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Abhinav Koul Victor Ferraris Daniel L Davenport Chandrashekhar Ramaiah 《International surgery》2012,97(1):34-42
Antifibrinolytic agents such as aprotinin and epsilon aminocaproic acid limit postoperative bleeding and blood transfusion in patients undergoing cardiac operations using cardiopulmonary bypass (CPB). Recent evidence suggests that these agents have adverse side effects that influence operative mortality and morbidity. We studied postoperative bleeding, transfusion rates, and operative outcomes in our patients in order to assess the efficacy of these agents during cardiac operations requiring CPB. We reviewed records of 520 patients undergoing a variety of cardiac operations between January 2005 and May 2009. We measured multiple variables including pre-operative risk factors, antifibrinolytic agent used, and outcomes of operation, such as measures of bleeding and blood transfusion, as well as serious operative morbidity and mortality. Postoperative bleeding rates varied significantly between patients receiving aprotinin and those receiving aminocaproic acid (P < 0.05). There was an associated 12% decrease in operative site bleeding in aprotinin-treated patients compared with aminocaproic acid. There was no significant difference in the transfusion rates of packed red blood cells between patients receiving aminocaproic acid or aprotinin (P > 0.05), though individuals in the aprotinin group did receive FFP more frequently than patients in the aminocaproic acid group (P < 0.05). There was no significant difference in morbidity and mortality rates between patients in either drug group (P > 0.05). Our study shows that aprotinin is more effective at controlling operative site bleeding than aminocaproic acid. Reduced operative site bleeding did not portend better outcome or differences in transfusion requirements. Aminocaproic acid remains a safe and cost-effective option for antifibrinolytic prophylaxis because of unavailability of aprotinin. 相似文献
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Sun Jung Rhee Sang Hyun Paik Hwa Kyoon Shin Jai Soung Park Eun Hye Lee 《Korean journal of radiology》2012,13(3):342-344
We report on a 41-year-old woman with a chest wall desmoid tumour who was successfully treated with a computed tomography (CT)-guided steroid injection. She presented with a palpable mass in the right upper chest wall and was treated by surgical excision and postoperative radiation therapy due to recurrence of the mass at the surgical site. At 20 months after the second operation, a recurrent mass was again detected in the anterosuperior portion of the previous surgical site on CT. We performed a CT-guided steroid injection weekly for 4 weeks by applying a mixture of 3 mL of triamcinolone acetonide (40 mg/mL) and 3 mL of 1% Lidocaine, administering 4-6 mL of the mixture, to the lesion. Six months later, CT showed a marked decrease in the size of the mass. 相似文献