Characteristics and outcomes of in-hospital cardiac arrest in adults hospitalized with acute coronary syndrome in China

AimsThis retrospective study aims to analyze and explore the clinical characteristics, risk factors, and in-hospital outcomes - including return of spontaneous circulation (ROSC) and survival to discharge - of hospitalized patients admitted with acute coronary syndrome (ACS) suffering cardiac arrest.MethodsACS patients admitted to three tertiary hospitals in Fujian, China, were evaluated retrospectively from January 1, 2012 to December 30, 2016. Data were collected, based on the Utstein Style, for all cases of attempted resuscitation for IHCA. We analyzed patient characteristics, pre-event variables, event variables, and the main outcomes, including ROSC and survival to discharge, and identified the influencing factors on the outcomes.ResultsThe total number of ACS admissions across the three hospitals during this study period was 21,337. Among these admissions, 320 ACS patients experienced IHCA (incidence: 1.50%); 134 (41.9%) patients experienced ROSC; and 68 (21.2%) survived to discharge. The findings indicated that four factors were associated with ROSC, including age <70 years-old, shockable rhythm, duration of resuscitation (≤15 min and 16–30 min), and PCI. Five factors were associated with survival to discharge, including age <70 years-old, shockable rhythm, the duration of resuscitation (≤15 min and 16–30 min), Killip ≤ II, and CCI ≤ 2.ConclusionYounger age, shockable rhythm, and shorter duration of resuscitation were all factors demonstrated to be a predictor of ROSC and survival to hospital discharge.     

Pneumatosis intestinalis and pneumoretroperitoneum post steroid use in a patient with superior mesenteric artery syndrome

Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the small or large intestine. PI can be both asymptomatic and life-threatening. The patient was a 50-year-old man with previous cervical spine abscess and osteomyelitis post debridement 4 years ago, with a heroin abuse history. He presented with abdominal distension ongoing for 4 days and vomiting for 3 times with fluid content. Abdominal computed tomography revealed pneumatosis with pneumoretroperitoneum.A surgeon was contacted and antibiotic treatment was started. The patient was kept on nothing per os and intravenous fluid supply. A drainage tube was inserted into retroperitoneum space on the same day. Tracing back his history, our patient was discharged from the hospital recently with a diagnosis of superior mesenteric artery dyndrome (SMAS), hypersensitivity pneumonitis, and asbestosis with soft tissue pleural plaques and calcified pleural plaques. During the hospitalization period, hydrocortisone dexamethasone and methylprednisolone were prescribed for hypersensitivity pneumonitis. Steroid use and SMAS maybe the cause of PI. Finally, he was discharged 5 days later with a nasojejunal and drainage tubes and was arranged for OPD follow-up. PI can be asymptomatic or life-threatening, and patient management varies based on the clinical condition. Although in this case PI was found in the emergency department, a patient's past history of underlying disease and medication should be reviewed to find the most possible etiology.     

Palpebral emphysema following a dental procedure

Palpebral emphysema is a rare occurrence after a dental procedure. However, it can be associated with severe complications, such as soft tissue infection, pneumomediastinum, pneumothorax, optic nerve ischemia or even blindness. Early diagnosis and prompt management are mandatory for emergency physicians.     

The effect of intravenous gadolinium-DTPA on diffusion-weighted imaging

Introduction Diffusion-weighted imaging (DWI) is usually performed before injection of intravenous paramagnetic contrast medium. Occasionally, it may be necessary to perform or to repeat DWI after such administration. Our purpose was to evaluate the effect of intravenous gadodiamide (Gd [DTPA-BMA]) on DWI.Methods DWI was performed on 88 brain lesions immediately before, immediately after, and 5–10 min following the end of 0.1 mmol/kg Gd [DTPA-BMA] administration. Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of the lesions, and the SNRs of normal brain tissue were calculated on b=0 s/mm² and b=1,000 s/mm² DW images. Apparent diffusion coefficient (ADC) values of the lesions were measured on ADC maps. A paired t-test was used to determine the significance of differences between the values before and after administration of contrast medium.Results The lesions consisted of 23 intraaxial and 11 extraaxial masses, 19 ischemic strokes, 15 intracranial hemorrhages and 20 demyelinating lesions. Images before and after contrast administration were not significantly different regarding SNRs and CNRs on DWI. This statement was also true for strongly enhanced lesions. However, ADC values significantly decreased after contrast medium injection on early post-contrast DWI in normal brain tissue (1%, P<0.049) and (3%, P<0.008) in lesions. By contrast, on late images, ADC values were normalized.Conclusion Contrast medium injection had significant and time-dependent effects on ADC values. Therefore, only pre-contrast and late DW images should be used in quantitative ADC studies.     

Application of a new segmentation tool based on interactive simplex meshes to cardiac images and pulmonary MRI data

RATIONALE AND OBJECTIVES: Medical image segmentation is still very time consuming and is therefore seldom integrated into clinical routine. Various three-dimensional (3D) segmentation approaches could facilitate the work, but they are rarely used in clinical setups because of complex initialization and parametrization of such models. MATERIALS AND METHODS: We developed a new semiautomatic 3D-segmentation tool based on deformable simplex meshes. The user can define attracting points in the original image data. The new deformation algorithm guarantees that the surface model will pass through these interactively set points. The user can directly influence the evolution of the deformable model and gets direct feedback during the segmentation process. RESULTS: The segmentation tool was evaluated for cardiac image data and magnetic resonance imaging lung images. Comparison with manual segmentation showed high accuracy. Time needed for delineation of the various structures could be reduced in some cases. The model was not sensitive to noise in the input data and model initialization. CONCLUSIONS: The tool is suitable for fast interactive segmentation of any kind of 3D or 3D time-resolved medical image data. It enables the clinician to influence a complex 3D-segmentation algorithm and makes this algorithm controllable. The better the quality of the data, the less interaction is required. The tool still works when the processed images have low quality.