Emergency medicine investigations最新文献

{"title":"Pseudoaneurysm of the Left Ventricle","authors":"V. Firich, P. Angleitner, G. Laufer, D. Wiedemann","doi":"10.29011/2475-5605.000084","DOIUrl":"https://doi.org/10.29011/2475-5605.000084","url":null,"abstract":"Pseudoaneurysm of the left ventricle most often occurs after transmural myocardial infarction but may also follow cardiac operations, trauma, inflammation, or infection. In contrast to patients with true ventricular aneurysm, those with false aneurysm most commonly die of hemorrhage. Review of the reported surgical experience and of our 14 cases confirms that standard chest radiographs with an abnormal cardiac silhouette and rapidly expanding size may alert the physician to this sometimes overlooked diagnosis. Noninvasive tests such as color-flow Doppler echocardiography, 2-dimensional echocardiography, cineangiographic computed tomography, and transesophageal echocardiography allow relatively easy recognition of these apparently rare lesions with increasing frequency. Cardiac catheterization, however, is usually still necessary for a clear picture of the location and anatomy of the aneurysm and the state of the coronary arteries. Finally, a new classification is proposed, consisting of true aneurysm, false aneurysm, pseudo-false aneurysm, and mixed aneurysm. (Texas Heart Institute Journal 1994; 21:296-301)","PeriodicalId":92630,"journal":{"name":"Emergency medicine investigations","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43436356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short Term Outcomes of Laparoscopic Sleeve Gastrectomy for Obesity in Pakistan","authors":"R. Gill, F. Mannan, M. Aslam, M. Jilani, Muhammad Muneeb Khan, A. Khan, Y. Hadi, A. Alvi, A. Shariff","doi":"10.29011/2475-5605.000082","DOIUrl":"https://doi.org/10.29011/2475-5605.000082","url":null,"abstract":"Introduction: Obesity has been established as a major risk factor for a number of non-communicable diseases and over the year’s multiple strategies have been directed at addressing this issue including minimally invasive procedures like laparoscopic sleeve Gastrectomy, specifically with an end goal of weight reduction for the morbidly obese. This procedure has become the preferred choice for both patients and physicians over the past few years. Laparoscopic sleeve Gastrectomy was introduced at our center recently; we have carried out a retrospective review of charts to evaluate this procedure short-term outcome at our center in our local population. Methods: A retrospective Cohort study, based on a record review for the treatment outcome of laparoscopic sleeve gastrectomy, was carried out at the department of surgery, Aga khan University Hospital, Karachi over a three-year period since its inception and analyzed in June 2015 using SPSS version 20. Results: A total of 17 patients fulfilled the inclusion criteria, out of which 12 were females (70.6%). The mean age of study participants was 41.53 years. Only one patient had undergone liposuction previously for weight loss. The most common comorbidities observed were diabetes mellitus (23.6%), hypertension (23.6%) and polycystic ovarian syndrome (17.7%). A statistically significant mean reduction in excess body weight of 28.9±14.90 Kg, CI 21.27-36.59 was observed along with reduction in BMI at 1 year with a mean difference of 11.1±5.38 Kg/m2, CI 21.27-36.60. Results were further analyzed for reduction in percentage excess body weight which showed a mean reduction of 43.6% for the study participants. Co-morbidity improvement was seen as reduction in systolic blood pressures in 9 patients (52%) though these were not found to be significant. Conclusion: Laparoscopic Sleeve Gastrectomy shows great potential for the Indian sub-continent population, especially for patients requiring rapid weight loss for better health outcomes, although long term follow up and out comes will determine the effectiveness of the procedure over extended periods and its role as a first line intervention for obesity.","PeriodicalId":92630,"journal":{"name":"Emergency medicine investigations","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42101216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Utilization Following Pediatric Out-of-Hospital Cardiac Arrest","authors":"E. Michiels, L. Quan, Randall Leja, T. Rea","doi":"10.29011/2475-5605.000080","DOIUrl":"https://doi.org/10.29011/2475-5605.000080","url":null,"abstract":"Background: Understanding longterm health care utilization after survival of a pediatric OHCA (out-of-hospital cardiac arrest) may allow more fully integrated and cost-conscious health care. Objective: To evaluate frequency and type of re-hospitalizations, procedures and hospital charges for pediatric OHCA survivors. Methods: Retrospective cohort study from 1/1/1976 to 12/31/2007 of persons < 19 years who survived OHCA in King County, WA. Results: Patients were female (49.4%) and ≤ 5 years (43.2%). 53% were readmitted in 189 readmission events, most commonly respiratory (30%) and cardiac (21%) related. Those with unfavorable Pediatric Cerebral Performance Category (PCPC) scores at initial discharge were at higher risk for ≥ 3 hospital readmissions compared to those with favorable PCPC scores (RR 5.94 (95% CI 1.50, 23.61)). Unwitnessed compared to witnessed events were associated with an increased risk of ≥ 3 hospital readmissions (RR 2.59 [95% CI 1.26, 5.31]). Upon readmission, half of patients required procedures of which acute, unplanned procedures including intubation, central and arterial line placement were most common. Adjusted to 2017 consumer price index, average charges/hospitalization were $67,005. Over long-term follow-up, the median adjusted total hospital charges/survivor were $123,190 ($11,091-$822,677). Conclusions: This demonstrates that many children who survive OHCA will develop new chronic health conditions requiring hospital readmission and additional procedures. This data should help parents, primary care providers and subspecialists anticipate and address subsequent needs prior to discharge after the arrest. Early coordinated interventions and establishment of effective outpatient services may reduce hospital readmissions and cost.","PeriodicalId":92630,"journal":{"name":"Emergency medicine investigations","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42914063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial Support: A Tool for Empowering Communities in Puerto Rico after a Catastrophic Event","authors":"Joseph O. Prewitt Diaz","doi":"10.29011/2475-5605.000079","DOIUrl":"https://doi.org/10.29011/2475-5605.000079","url":null,"abstract":"Puerto Rico was affected by Hurricane Maria in September 2017, and today, hundreds of thousands of people are experiencing fear, panic attacks, anxiety, and night terrors as a result of that hurricane. A community-based psychosocial support structure to be integrated into the National Disaster Response Plan of Puerto Rico is proposed herein.","PeriodicalId":92630,"journal":{"name":"Emergency medicine investigations","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44943536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual Presentation of an Everest Trekker","authors":"B. Amatya, P. Lakhey, P. Pandey","doi":"10.29011/2475-5605.000058","DOIUrl":"https://doi.org/10.29011/2475-5605.000058","url":null,"abstract":"Gastro-intestinal symptoms including nausea, vomiting, and abdominal pain are common in high altitude areas of Nepal due to Acute Mountain Sickness (AMS) or due to a gastro-intestinal illness. Occasionally complications of common conditions manifest at high altitude and delay in diagnosis could be catastrophic for the patient presenting with these symptoms. We present a rare case of duodenal ulcer perforation at high altitude. Timely evacuation from high altitude, proper diagnosis and prompt treatment are essential for taking care of such patients.","PeriodicalId":92630,"journal":{"name":"Emergency medicine investigations","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45988735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Overview of Pyogenic Liver Abscess","authors":"B. Batabyal","doi":"10.29011/2475-5605.000062","DOIUrl":"https://doi.org/10.29011/2475-5605.000062","url":null,"abstract":"","PeriodicalId":92630,"journal":{"name":"Emergency medicine investigations","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41563452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Case of Emphysematous Cystitis in Non Diabetes Metastatic Lung Cancer Patient Undergoing Chemotherapy","authors":"Marwane Andaloussi Benatiya, G. Rais","doi":"10.29011/2475-5605.000078","DOIUrl":"https://doi.org/10.29011/2475-5605.000078","url":null,"abstract":"Emphysematous cystitis is a rare and severe infection of the bladder wall and/or lumen that causes gas accumulation in the tissues. The gas is mainly produced by gram-negative bacteria such as Echirichia coli or fungal pathogens. Emphysematous cystitis most often occurs in older women with poorly controlled diabetes. Its has fulminating course, and can be fatal if not recognized and treated promptly. We report a case of a 45-year-old male, under chemotherapy for metastatic lung cancer, presented with fever, dysuria, and pneumaturia. Emphysematous cystitis diagnosed by a computed tomography scan.The treatment was based on antibiotics associated with bladder drainage. The purpose of presenting this case report is not only to report an uncommon case of emphysematous cystitis but also to raise awareness among clinicians that this rare entity can occurs in non diabetes patients, during chemotherapy","PeriodicalId":92630,"journal":{"name":"Emergency medicine investigations","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48342319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Cord Injury Patient Treated with Cell-based Therapy and CellSonic VIPP","authors":"A. Hague","doi":"10.15761/gmo.1000133","DOIUrl":"https://doi.org/10.15761/gmo.1000133","url":null,"abstract":"","PeriodicalId":92630,"journal":{"name":"Emergency medicine investigations","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45039875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium Nitroprusside Enhanced CPR and intra-CPR Hypothermia","authors":"A. Tsangaris, T. Matsuura, J. Bartos, Matthew D. Olson, S. McKnite, J. Rees, K. Shekar, D. Yannopoulos","doi":"10.29011/2475-5605.000072","DOIUrl":"https://doi.org/10.29011/2475-5605.000072","url":null,"abstract":"Objective : Therapeutic Hypothermia (TH) is thought to improve neurologically intact survival when applied after Return of Spontaneous Circulation (ROSC) is achieved in patients who suffer a cardiac arrest. Intra-CPR cooling may accelerate the time to reach TH and thus enhance its neurological benefit. Sodium Nitroprusside Enhanced Cardiopulmonary Resuscitation (SNPeCPR) has been shown to accelerate intra-CPR cooling compared to standard CPR. The aim of this study is to assess which method of therapeutic hypothermia is the most efficient in decreasing brain temperature during SNPeCPR. Methods: This study included 24 intubated and anesthetized swine. After induction of Ventricular Fibrillation (VF), animals were randomized to one of the following groups: 500cc cold saline infusion (group A), 500cc cold saline infusion plus surface cooling with ice packs (group B), surface cooling only (group C) or control/no cooling method applied (group D). After 10 minutes of VF, CPR was initiated. One minute after the initiation of CPR, the randomized intervention was initiated and abdominal binding was applied. SNP (2 mg) was administered at minutes 1, 4 and 8. Animals were defibrillated at minute10. Results: Within 4 minutes of CPR, animals that received intravenous cold saline (Group A and Group B) had decreased their brain temperature by 0.5 °C lower compared to the groups that had not (Group C and Group D). Group B presented a superior heat exchange rate from blood to skin compared to group A. Conclusion : It was observed that cold saline infusion during SNPeCPR accelerates cooling of the brain. Ice packs work synergistically by optimizing heat transfer from the blood to the skin. Further studies will assess the potential neurologic benefit of the combination of SNPeCPR with intra-CPR infusion of cold saline.","PeriodicalId":92630,"journal":{"name":"Emergency medicine investigations","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46067020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Disparities in Patients with Congestive Heart Failure Exacerbations in Los Angeles County.","authors":"Vinh Q Lam,&nbsp;Shahrzad Bazargan-Hejazi,&nbsp;Deyu Pan,&nbsp;Stacey A Teruya","doi":"10.29011/2475-5605.000076","DOIUrl":"https://doi.org/10.29011/2475-5605.000076","url":null,"abstract":"<p><strong>Background: </strong>1.1.Congestive Heart Failure (CHF) is a leading cause of death in the USA, with over 500,000 new cases diagnosed each year. While rates of CHF exacerbation across all races and ethnicities decreased from 2005 to 2009, the number of Black patients with CHF exacerbation who present in Los Angeles (L. A.) County Emergency Departments (ED) remained the highest. We examine disparities in CHF exacerbation rates in L. A. County, and in Los Angeles Service Planning Area (SPA) 6, and compare CHF-related outcomes, and the disposition of these patients post-ED visit.</p><p><strong>Methods: </strong>1.2.This is a retrospective analysis using the Office of Statewide Health Planning and Development (OSHPD) Emergency Department, and Ambulatory Surgery Center database from 2005 to 2009. We used the following variables: congestive heart failure, ICD-9 code 428.0, age, gender, race/ethnicity, insurance status, and disposition. Univariate and descriptive statistics identified distributions of the study variables. There were a total of 13,766 in the study population.</p><p><strong>Results: </strong>1.3.SPA 6 had higher hospitalization rates across all races and ethnicities, compared to L.A. County as a whole. Blacks constitute 9.1% of the County population, but represented 32% of patients diagnosed with CHF in the ED. Only about 10% of L. A. County's population resides in SPA 6, yet over 22% of the entire County's CHF patients reside there.</p><p><strong>Conclusions: </strong>1.4.CHF continues to disproportionately affect Black individuals in L.A. County, and younger adults in SPA 6. Our results indicate that residing in this service planning area, in addition to race, can predict greater likelihood of presenting with CHF exacerbation in the ED, and greater likelihood of hospitalization. Future research on the association of CHF exacerbation with different sociodemographic measures among minority, underserved and disadvantaged patients is needed. These can identify and help mitigate inequities and weaknesses in our health care system, which are manifest through stark health disparities among different racial, ethnic and socioeconomic groups.</p>","PeriodicalId":92630,"journal":{"name":"Emergency medicine investigations","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499488/pdf/nihms-1002084.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37391147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}