Canadian Journal of General Internal Medicine最新文献

{"title":"Giant Calcified Left Ventricular Aneurysm with Calcified Thrombus Following Remote Myocardial Infarction","authors":"Max Deschner, E. Deschner, P. Teefy, A. Glanz","doi":"10.22374/cjgim.v17i1.556","DOIUrl":"https://doi.org/10.22374/cjgim.v17i1.556","url":null,"abstract":"In this case study, we provide angiographic and computed tomography images demonstrating a large cal-cified left ventricular (LV) aneurysm and associated calcified thrombus—unique, and now rare, sequelae of ST-elevation myocardial infarction (MI) that are rarely seen in the era of percutaneous coronary intervention (PCI). We discuss here the epidemiology, natural history, workup, and recommended management for LV aneurysms and thrombi with reference to clinical guidelines. Our patient’s calcified LV aneurysm and thrombus were discovered at the time of cardiac catheterization undertaken for a 2-month history of stable angina. He suffered an anterior MI 17 years ago and took aspirin only. He remained asymptomatic until presentation. Angiography also demonstrated severe triple-vessel coronary artery disease including left anterior descending artery occlusion. Our patient underwent stenting of the left circumflex and first diagonal and staged PCI to the right coronary artery, which led to functionally complete revascularization.\u0000RésuméDans cette étude de cas, nous présentons des images angiographiques et des coupes tomographiques d’un gros anévrisme calcifié du ventricule gauche (VG) et d’un thrombus calcifié qui y est associé – des séquelles uniques, mais maintenant rares, de l’infarctus du myocarde (IM) avec susdécalage du segment ST qui sont rarement constatées à l’ère de l’intervention coronarienne percutanée (ICP). Nous nous penchons sur l’épidémiologie, l’histoire naturelle, le processus d’évaluation et la prise en charge recommandée des anévrismes et des thrombus du VG en nous appuyant sur les lignes directrices cliniques. L’anévrisme et le thrombus calcifiés du VG de notre patient ont été découverts lors d’un cathétérisme cardiaque effectué pour une angine de poitrine stable depuis deux mois. Il a déjà subi un IM il y a 17 ans et ne prend que des aspirines. Il est demeuré asymptomatique jusqu’à la consultation. L’angiographie montre également la présence d’une coronaropathie tritronculaire grave, dont une occlusion de l’artère descendante antérieure gauche. Notre patient a subi une implantation d’endoprothèses dans l’artère auriculoventriculaire et la première branche diagonale et une ICP différée de l’artère coronaire droite, ce qui a mené à une revascularisation complète fonctionnelle.","PeriodicalId":9379,"journal":{"name":"Canadian Journal of General Internal Medicine","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73111922","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":"Perioperative Assessment and Management of Patients with Heart Failure","authors":"M. Gewarges, C. Frankfurter, M. McDonald","doi":"10.22374/cjgim.v17isp1.604","DOIUrl":"https://doi.org/10.22374/cjgim.v17isp1.604","url":null,"abstract":"In noncardiac surgery, a preexisting diagnosis of heart failure (HF) serves as a significant risk factor for major adverse cardiac events. Among elderly patients, this risk is heightened, where the risk of operative mortality and hospital readmission for the same operative procedure has been found to be greater in HF patients than it is for patients with coronary artery disease. In this review, we summarize the requisite preoperative evaluation and management of HF patients undergoing noncardiac surgery and highlight the important perioperative monitoring and management considerations.\u0000RésuméEn chirurgie non cardiaque, un diagnostic préexistant d’insuffisance cardiaque constitue un facteur de risque important d’évènements cardiaques indésirables majeurs. Chez les patients âgés, ce risque est accru, car on constate que le risque de mortalité opératoire et de réadmission à l’hôpital pour la même intervention chirurgicale est plus élevé chez les patients atteints d’insuffisance cardiaque que chez ceux atteints d’une coronaropathie. Dans cet article de synthèse, nous résumons l’évaluation et la prise en charge préopératoires requises pour les patients atteints d’insuffisance cardiaque qui subissent une intervention chirurgicale non cardiaque et nous soulignons les aspects importants de la surveillance et de la prise en charge périopératoires.","PeriodicalId":9379,"journal":{"name":"Canadian Journal of General Internal Medicine","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79641125","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":"The Top Five Papers of 2020 for General Internists","authors":"G. Huard, Olivier St-Laurent","doi":"10.22374/cjgim.v17i1.539","DOIUrl":"https://doi.org/10.22374/cjgim.v17i1.539","url":null,"abstract":"The Canadian Society of Internal Medicine (CSIM) held an annual session to present the “Top 5 papers” influencing the practice of general internists. We reviewed major journal publications from January 2020 to November 2020 to come up with approximately 10 articles we considered practice changing trials for general internists. Out of those papers, we decided to present the five we considered were most relevant by addressing frequent pathologies seen in practice, were methodologically well conducted, and had the potential to sustainably modify practice guidelines. The references to the papers that were not retained are presented in the bibliography section for the reader’s interest. This article aims to present those top five papers of 2020, and to review their strengths and limitations. These articles were also discussed at the CSIM Virtual Educational Activity on October 15, 2020 and in the BaladoCritique podcast.\u0000RésuméLa Société canadienne de médecine interne (SCMI) a tenu une séance annuelle pour présenter les « cinq meil-leurs articles » qui influencent la pratique des internistes généralistes. Nous avons examiné les publications des principales revues publiées entre janvier 2020 et novembre 2020 pour en arriver à proposer environ dix articles que nous avons considérés comme des essais pouvant influencer la pratique des internistes généralistes. Parmi ces articles, nous avons décidé d’en présenter cinq qui, selon nous, sont les plus pertinents en abordant des pathologies fréquemment observées dans la pratique, sont bien menés sur le plan de la méthodologie et ont le potentiel de modifier de façon durable les directives de pratique. Les références des articles qui n’ont pas été retenus figurent dans la bibliographie pour l’intérêt du lecteur. Cet article vise à présenter les cinq meilleurs articles de 2020 et à examiner leurs forces et leurs limites. Ces articles ont également fait l’objet de discussions lors de l’activité éducative virtuelle de la SCMI qui s’est tenue le 15 octobre 2020 et dans un épisode du BaladoCritique.","PeriodicalId":9379,"journal":{"name":"Canadian Journal of General Internal Medicine","volume":"2014 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86689479","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":"Colours in Medicine","authors":"H. M. Baillie","doi":"10.22374/cjgim.v17i1.612","DOIUrl":"https://doi.org/10.22374/cjgim.v17i1.612","url":null,"abstract":"We live in a visual world.  Colour can tell us a lot about the diagnosis, help us in diagnositic stains, and categorise medications. ","PeriodicalId":9379,"journal":{"name":"Canadian Journal of General Internal Medicine","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78698487","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":"Gastric adenocarcinoma presenting as bloody ascites","authors":"F. Zhou, A. Morgenthau, T. Arnason, A. Tran","doi":"10.22374/cjgim.v17i1.562","DOIUrl":"https://doi.org/10.22374/cjgim.v17i1.562","url":null,"abstract":"A 71-year-old male presented to hospital with 3 months of increasing abdominal distention and pain. CT showed large volume ascites and gastric wall thickening in the antrum. He had no history of significant alcohol use or other risk factors for cirrhosis. He underwent paracentesis, and 3 litres of homogenously bloody ascites fluid was removed. Ascites cytology showed discohesive malignant cells. Upper endoscopy showed a 10 cm circumferential gastric mass. Biopsies revealed a diagnosis of gastric adenocarcinoma. The presence of homogenously bloody ascites can be a startling finding to healthcare providers. The differential diagnosis for bloody ascites includes hepatocellular carcinoma or other malignancy, hemorrhagic pancreatitis, perforated ulcers/varices, blunt trauma, and iatrogenic (suggested by recent paracentesis, transjuglar intrahepatic portosystemic shunt, or other procedure). The presence of bloody ascites in an otherwise relatively asymptomatic individual should prompt a search for malignancy. This case highlights a rare presentation of gastric adenocarcinoma as bloody ascites.","PeriodicalId":9379,"journal":{"name":"Canadian Journal of General Internal Medicine","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86992688","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":"Detection of Postoperative Vital Signs Abnormalities on a Surgical Ward using Conventional and Remote Automated Monitoring","authors":"M. McGillion, M. Marcucci, F. Borges, D. Conen, Brenda Coleman, K. Gregus, S. Parvaneh, Amal Bessisow, Ameen Patel, Prathiba Harsha, Carley Ouellette, S. Ofori, D. Sessler, P. Devereaux","doi":"10.22374/cjgim.v17isp1.591","DOIUrl":"https://doi.org/10.22374/cjgim.v17isp1.591","url":null,"abstract":"Background: The true incidence of abnormal vital signs on post-surgical wards may be seriously underestimated based on nurse obtained conventional measurement. We sought to determine the incidence and severity of postoperative tachycardia, bradycardia and hypoxemia detected by continuous remote automated monitoring (RAM) versus the incidence of these vital sign abnormalities detected during routine nursing care.Methods: We conducted a prospective cohort proof-of-concept study of 121 patients aged ≥45 years recov-ering from orthopedic surgery. Eligible patients were at risk of postoperative myocardial injury and had a planned hospital stay ≥48 hours. Philips’ IntelliVue MX40 wearable RAM technology was used to continu-ously monitor patients’ heart rate and pulse oximetry up to 72 hours following surgery. In addition, study personnel obtained vital signs collected during routine nursing care from participants’ medical charts. Clinically meaningful tachycardia, bradycardia and hypoxemia were defined as heart rates >100, <55, and blood oxyhemoglobin saturation (SpO2) of <90% for >15 contiguous minutes, respectively.Results: Continuous RAM identified clinically meaningful episodes of tachycardia in 42 of 121 patients [34.7%] versus 7 patients [5.8%] identified by routine nursing care, for an absolute difference 28.9% (95% confidence interval [CI] 20.8, 37.0; p=0.001). RAM also detected bradycardia in 14 of 121 patients [11.6%] versus 6 patients [5.0%] detected by routine care, for an absolute difference 6.6% (95% CI 2.2, 11.0; p=0.07). RAM detected hypoxemia in 25 of 107 patients [23.3%] compared with 1 patient [0.9%] detected through routine monitoring, for an absolute difference of 22.4% (95% CI 14.5, 30.3; p=0.001).Conclusion: Most clinically meaningful episodes of vital signs abnormalities detected by continuous RAM were missed by nurses through conventional periodic monitoring. Continuous RAM technologies have the potential to improve patient outcomes through early identification of physiological abnormalities on surgical wards.\u0000RésuméContexte: La fréquence réelle des signes vitaux anormaux dans les unités de soins postopératoires peut être grandement sous-estimée sur la base des mesures classiques obtenues par le personnel infirmier. Nous avons cherché à déterminer la fréquence et la gravité de la tachycardie, de la bradycardie et de l’hypoxémie post-opératoires détectées par une surveillance automatisée à distance (SAD) en continu par rapport à la fréquence de ces anomalies des signes vitaux décelées pendant les soins infirmiers courants.Méthodologie: Nous avons mené une étude prospective de validation de concept auprès de 121 patients âgés de 45 ans ou plus se remettant d’une intervention chirurgicale orthopédique. Les patients admissibles présen-tent un risque de lésion myocardique postopératoire et leur séjour prévu à l’hôpital est d’au moins 48 heures. Le moniteur portable IntelliVue MX40 de Philips issu de la technologie de SAD a été utili","PeriodicalId":9379,"journal":{"name":"Canadian Journal of General Internal Medicine","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79948171","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":"Perioperative management of Patients with Obstructive Sleep Apnea","authors":"A. R. Mbadjeu Hondjeu, F. Chung, J. Wong","doi":"10.22374/cjgim.v17isp1.601","DOIUrl":"https://doi.org/10.22374/cjgim.v17isp1.601","url":null,"abstract":"Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing with up to 60% of surgical patients with moderate-to-severe OSA unrecognized at the time of preoperative assessment. OSA is a known modifier of perioperative outcomes, with an increase in difficult airway management and postoper-ative morbidity with early and late serious complications that may occasionally result in death. It is critical to identify at-risk patients during the preoperative period as it allows for risk stratification and mitigation, and postoperative monitoring. In this review, we will discuss the preoperative assessment, and intraoperative and postoperative management of patients with diagnosed or suspected OSA.\u0000RésuméLe syndrome d'apnées obstructives du sommeil (SAOS) est la forme la plus frequente de troubles respira-toires du sommeil avec jusqu'à 60 % des patients chirurgicaux atteints de formes modérée à sévère de SAOS sans diagnostic formel ni traitement spécifique au moment de l'évaluation préopératoire. Le SAOS altère les résultats périopératoires, avec une augmentation de la gestion difficile des voies respiratoires et de la morbidité postopératoire associée à des complications critiques précoces et tardives pouvant parfois entraîner la mort. il est donc essentiel d'identifier les patients à risque pendant la période préopératoire enfin d'appliquer des procédures de modération de risque, ainsi que des précautions et une surveillance adéquates. Dans cette revue, après un aperçu de la physiopathologie du SAOS, nous discuterons de l'évaluation préopératoire, de la prise en charge intraopératoire et postopératoire des patients atteints de SAOS confirmée ou suspectée.","PeriodicalId":9379,"journal":{"name":"Canadian Journal of General Internal Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79342373","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":"Rocky Mountain ACP/AMA Internal Medicine Abstracts","authors":"Rocky Mountain ACP/AMA","doi":"10.22374/cjgim.v17i1.611","DOIUrl":"https://doi.org/10.22374/cjgim.v17i1.611","url":null,"abstract":"Rocky Mountain ACP/AMA Internal Medicine Abstracts","PeriodicalId":9379,"journal":{"name":"Canadian Journal of General Internal Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89981709","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":"Barriers to Implementing Internist Recommendations for Perioperative Anticoagulation Management by Surgical Teams","authors":"Kristin Flemons, M. Bosch, G. Marcil, R. Kachra, K. Zarnke, L. Skeith, S. Ruzycki","doi":"10.22374/cjgim.v17i1.525","DOIUrl":"https://doi.org/10.22374/cjgim.v17i1.525","url":null,"abstract":"Introduction: In our center, half of all recommendations made by an internist about perioperative anticoagulation management are not followed by surgical team members. We aimed to understand the barriers to implementing perioperative anticoagulation recommendations.Methods: This was a prespecified analysis of interviews with surgical team members about individual- and systems-level drivers of missed perioperative anticoagulation recommendations. Interviews and analysis were guided by the Theoretical Domains Framework and the Consolidation Framework for Implementation Research.Results: We interviewed 16 surgical team members and 2 internists. Surgical team members intentionally did not follow recommendations about perioperative anticoagulation management when they felt that the bleeding risk outweighed the risk of thrombosis. This assessment of risk was driven by emotion and previous experience, even among participants who were familiar with perioperative literature.Conclusions: Development of study outcomes and guideline recommendations for perioperative anticoagulation management should include surgical team members in order to address the acceptability of these recom-mendations and increase adoption.\u0000RésuméIntroduction : Dans notre centre, la moitié des recommandations formulées par un interniste concernant la prise en charge de l’anticoagulation périopératoire ne sont pas suivies par les membres de l’équipe chirurgicale. Nous avons cherché à comprendre les obstacles à l’application des recommandations relatives à l’antico-agulation périopératoire.\u0000Méthodologie : Il s’agit d’une analyse prédéterminée d’entrevues menées auprès des membres de l’équipe chirurgicale au sujet des facteurs individuels et systémiques de l’insuccès des recommandations relatives à l’anticoagulation périopératoire. Les entrevues et l’analyse ont été guidées par le Theoretical Domains Framework et le Consolidation Framework for Implementation Research.Résultats : Nous avons interrogé 16 membres de l’équipe chirurgicale et 2 internistes. Intentionnellement, les membres de l’équipe chirurgicale ne suivent pas les recommandations concernant la prise en charge de l’anti-coagulation périopératoire lorsqu’ils estiment que le risque d’hémorragie l’emporte sur le risque de thrombose. Cette évaluation du risque est dictée par l’émotion et l’expérience antérieure, même parmi les participants qui connaissent bien la documentation du domaine périopératoire.Conclusions : La mise en application des résultats des études et des recommandations formulées par les lignes directrices pour la prise en charge de l’anticoagulation périopératoire devrait comprendre des membres de l’équipe chirurgicale pour aborder l’acceptabilité de ces recommandations et augmenter l’adoption.","PeriodicalId":9379,"journal":{"name":"Canadian Journal of General Internal Medicine","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81206212","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":"Cerebellar Dysfunction with Lung Pathology on Imaging","authors":"Carter Winberg, Alexander Grindal, A. Chakroborty","doi":"10.22374/cjgim.v17i1.527","DOIUrl":"https://doi.org/10.22374/cjgim.v17i1.527","url":null,"abstract":"A patient presented with ataxia with cerebellar dysfunction on examination. After lung imaging revealed a large consolidation, the patient was eventually diagnosed with Legionnaires’ disease during admission. The imaging and case demonstrate how clinicians must include Legionella on their differential diagnosis when there is a combination of respiratory and neurologic pathologies, even when respiratory symptoms are not the presenting concern.\u0000RésuméUn patient présente une ataxie accompagnée d’un dysfonctionnement cérébelleux révélé à l’examen. Après que l’imagerie pulmonaire ait révélé la présence d’une consolidation importante, le patient a finalement reçu un diagnostic de légionellose lors de son admission. L’imagerie et le présent cas montrent aux cliniciens la nécessité d’inclure la légionelle dans leur diagnostic différentiel en présence d’une combinaison de pathologies respiratoires et neurologiques, même lorsque les symptômes respiratoires ne sont pas la principale préoccupation.","PeriodicalId":9379,"journal":{"name":"Canadian Journal of General Internal Medicine","volume":"113 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77079230","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}