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Emergency room

Gabriella Roda, Sebastiano Arnoldi, Michele Dei Cas, Valeria Ottaviano, Eleonora Casagni, Fausto Tregambe, Giacomo Luca Visconti, Fiorenza Farè, Rino Froldi, Veniero Gambaro
A man was found dead in a hotel located near Rome (Italy). The man was still holding a syringe attached to a butterfly needle inserted in his left forearm vein. The syringe contained a cloudy pinkish fluid. In the hotel room the Police found a broken propofol glass vial plus four sealed ones, an opened NaCl plastic vial and six more still sealed, and a number of packed smaller disposable syringes and needles. An opened plastic bottle containing a white crystalline powder labeled as potassium cyanide was also found...
July 1, 2018: Journal of Analytical Toxicology
Heather I Greenwood, Katerina Dodelzon, Janine T Katzen
New emerging breast imaging techniques have shown great promise in breast cancer screening, evaluation of extent of disease, and response to neoadjuvant therapy. Tomosynthesis, allows 3-dimensional imaging of the breast, and increases breast cancer detection. Fast abbreviated MRI has reduced time and costs associated with traditional breast MRI while maintaining cancer detection. Diffusion-weighted imaging is a functional MRI technique that does not require contrast and has shown potential in screening, lesion characterization and also evaluation of treatment response...
August 2018: Surgical Clinics of North America
Hye Jung Park, Min Kwang Byun, Hyung Jung Kim, Chul Min Ahn, Chin Kook Rhee, Kyungjoo Kim, Bo Yeon Kim, Hye Won Bae, Kwang-Ha Yoo
Background: Asthma requires regular follow-up visits and sustained medication use. Although several studies have reported the importance of adherence to medication and compliance with the treatment, none to date have reported the importance of regular follow-up visits. We investigated the effects of regular clinical visits on asthma exacerbation. Methods: We used claims data in the national medical insurance review system provided by the Health Insurance Review and Assessment Service of Korea...
2018: Allergy, Asthma, and Clinical Immunology
Andrew J Shepherd, Megan E Cloud, Yu-Qing Cao, Durga P Mohapatra
Burrowing, or the removal of material from an enclosed tube, is emerging as a prominent means of testing changes in a voluntary behavior in rodent models of various pain states. Here, we report no significant differences between male and female mice in terms of burrowing performance, in a substantially shorter time frame than previous reports. We found that the color of the burrow tube affects the variability of burrowing performance when tested in a lit room, suggesting that light aversion is at least a partial driver of this behavior...
2018: Frontiers in Behavioral Neuroscience
Francesc Simo Alari, Israel Gutierrez
A 72-year-old woman with morbid obesity and history of psychosis attended the emergency room due to abdominal pain. CT scan revealed a mesenteric infiltration surrounding a thickened wall bowel agglomeration; inside, a dense 2 cm foreign body with no pneumoperitoneum or peritoneal effusion. Surgery revealed four contained bowel perforations due to a blister pill pack inside the ileum; consequently, a 30 cm bowel resection was performed. Ingestion was restarted on day 2, a superficial wound infection was evacuated on day 4 and the patient was discharged 6 days after surgery...
July 11, 2018: BMJ Case Reports
Daniel L Davenport, Walker R Ueland, Shyanie Kumar, Margaret Plymale, Andrew C Bernard, J Scott Roth
BACKGROUND: We compared 30-day outcomes in patients undergoing emergent open and laparoscopic repair of perforated peptic ulcers in a large multicenter cohort. METHODS: Prospectively obtained data in the American College of Surgeons National Surgical Quality Improvement Program public use files from 2010 to 2016 were reviewed. Perioperative risks and outcomes were compared in unmatched and propensity-matched groups using parametric/non-parametric statistical tests as appropriate...
July 11, 2018: Surgical Endoscopy
Tomoyuki Naito, Hiroki Hayashi, Takeru Kashiwada, Yoshinobu Saito, Shinji Abe, Kaoru Kubota, Akihiko Gemma
A 41-year-old woman presented complaining of cough and purpura for one month. On her first visit, a blood test demonstrated peripheral blood eosinophilia, but chest radiography showed no abnormalities. However, 2 days after the first visit, she went to the emergency room because of fever and right-sided chest pain. Contrast-enhanced computed tomography of the chest showed pulmonary embolism and air space consolidation. Thrombosis was present in the popliteal vein. Bronchoscopy revealed alveolar hemorrhage and increased eosinophils in the bronchoalveolar lavage fluid, and a skin biopsy demonstrated a perivascular eosinophilic infiltrate...
2018: Respiratory Medicine Case Reports
Nizar Bhulani, Arjun Gupta, Ang Gao, Jenny Li, Chad Guenther, Chul Ahn, Elizabeth Paulk, Stephanie Houck, Muhammad S Beg
Background: Palliative care has been associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied...
June 2018: Journal of Gastrointestinal Oncology
Daniele Morosetti, Eliseo Picchi, Antonello Calcagni, Feliciana Lamacchia, Armando Ugo Cavallo, Alessio Bozzi, Adriano Lacchè, Gianluigi Sergiacomi
We reported the cases of two adult male patients who were admitted to our emergency room with abdominal pain and dyspnea caused by gallstones and pulmonary embolism respectively. During the radiological investigations, as collateral findings, we found two anomalous development of the inferior vena cava. These conditions affect about 4% of population and, although asymptomatic or mildly symptomatic, are associated with thrombotic manifestations as deep vein thrombosis and pulmonary embolism. The prompt recognition of these anomalies is necessary in order to prevent the complications associated with these conditions and to set the best therapy for patients...
August 2018: Radiology Case Reports
Jessica Allia Williams, Orfeu Buxton, Jesse Hinde, Jeremy Bray, Lisa Berkman
BACKGROUND: While a large literature links psychosocial workplace factors with health and health behaviors, there is very little work connecting psychosocial workplace factors to healthcare utilization. METHODS: Survey data were collected from two different employers using computer-assisted telephone interviewing as a part of the Work-Family Health Network (2008-2013): one in the information technology (IT) service industry and one that is responsible for a network of long-term care (LTC) facilities...
November 26, 2017: International Journal of Health Policy and Management
Romy Ni Chleirigh, Simon Gray, Catherine C Mitchell
In 2008, recommendations from the National Confidential Enquiry into Patient Outcome and Death identified large variations in the quality and safety of delivery of systemic anti-cancer therapy. In 49% of cases it was felt there was room for improvement and in 27% of cases treatment actually caused or hastened death. Every hospital with an emergency department and/or specialist oncology beds should therefore have a fully functioning acute oncology service to align acute oncology with urgent care. Many patients will still present via the acute take and therefore acute physicians need to be aware of the role of the acute oncology teams and management of oncology emergencies...
July 2, 2018: British Journal of Hospital Medicine
José Colleti Junior, Tâmara Eleamen Longui, Werther Brunow de Carvalho
OBJECTIVE: To report a case of a patient who required tracheal intubation in a pediatric emergency department due to acute laryngitis and that, after the planned extubation, has successfully used the high-flow nasal cannula, which possibly prevented extubation failure. CASE DESCRIPTION: A male 8-month-old child was admitted to the pediatric emergency room with acute respiratory distress due to a high airway obstruction secondary to severe acute laryngitis. He was immediately intubated and referred to the pediatric intensive care unit...
July 10, 2018: Revista Paulista de Pediatria: Orgão Oficial da Sociedade de Pediatria de São Paulo
Sergey Karamnov, Ethan Y Brovman, Katherine J Greco, Richard D Urman
PURPOSE: Sepsis causes significant morbidity and mortality after cardiac surgery and carries a significant burden on health care costs. There is a general association of increased risk of post-cardiac surgery sepsis in patients with postoperative complications. We sought to investigate significant patient and procedural risk factors and outcomes associated with sepsis after cardiac surgery. MATERIALS AND METHODS: In this retrospective study, we analyzed 531 coronary artery bypass grafting and open heart valve surgery cases that developed postoperative sepsis in the National Surgical Quality Improvement Program database between 2007 and 2014...
July 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Brenda Bursch, Marcy Forgey, Natacha D Emerson, Prabha Siddarth, Deborah M Weisbrot, Richard J Shaw, Julia Doss, Tatiana Falcone, Kyle Hinman, W Curt LaFrance, Rebecca Laptook, Matthew D Willis, Elissa L Deggelman, Rochelle Caplan, Sigita Plioplys
Objectives: Pediatric psychogenic nonepileptic seizures (PNES) is a functional somatic symptom condition with significant health-care service burden. While both family and individual factors play an important role in the development and maintenance of PNES, little is known about what predicts urgent health-care use in families with children who have PNES. The aim of the current study was to explore whether child coping and parental bonding styles influence the decision to seek urgent medical care in these families...
July 9, 2018: Journal of Pediatric Psychology
Erik Xavier Apolo Romero, Patricio Fernando Gálvez Salazar, Jorge Abdón Estrada Chandi, Fabricio González Andrade, Gabriel Alejandro Molina Proaño, Fanny Carolina Mesías Andrade, Juan Carlos Cadena Baquero
Cholecystitis is a common gallbladder pathology characterized by abdominal pain, positive Murphy sign and elevated white blood count. Abdominal ultrasound usually gives a definite diagnosis. Duplication of the gallbladder is a rare congenital anomaly that can either be asymptomatic or and can present with symptoms associated with cholelithiasis, cholecystitis, cholangitis or pancreatitis. Clinically indistinguishable from regular gallbladder pathologies. The management of duplicated gallbladder is similar to that of other gallbladder diseases, if one or both gallbladders cause symptoms, cholecystectomy should be done for both gallbladders...
July 2018: Journal of Surgical Case Reports
Eduardo Kaiser Ururahy Nunes Fonseca, Milena Rocha Peixoto, Francisco de Assis Cavalcante Júnior, Antonio Rahal Júnior, Miguel José Francisco Neto, Marcelo Buarque de Gusmão Funari
Emergencies involving the inguinal region and scrotum are common and can be caused by a plethora of different causes. In most cases, such conditions have nonspecific symptoms and are quite painful. Some inguinoscrotal conditions have high complication rates. Early and accurate diagnosis is therefore imperative. Ultrasound is the method of choice for the initial evaluation of this vast range of conditions, because it is a rapid, ionizing radiation-free, low-cost method. Despite the practicality and accuracy of the method, which make it ideal for use in emergency care, the examiner should be experienced and should be familiarized with the ultrasound findings of the most common inguinoscrotal diseases...
May 2018: Radiologia Brasileira
Joseph A Ladapo, Matthew J Budoff, Pejman Azarmina, David Sharp, Alice Baker, Bruce Maniet, Lee Herman, Mark Monane
PURPOSE: The evaluation of obstructive coronary artery disease (CAD) is inefficient and costly. Previous studies of an age/sex/gene expression score (ASGES) in this diagnostic workup have shown a 96% negative predictive value, as well as an 85% decreased likelihood of cardiac referral among low-score outpatients at 45 days. The objective was to explore the one-year cost implications of ASGES use among symptomatic outpatients. DESIGN: A prospective PRESET Registry (NCT01677156) enrolled stable, nonacute adult patients presenting with symptoms suggestive of obstructive CAD at 21 U...
June 2018: Managed Care
Takehiko Oami, Taku Oshima, Reiko Oku, Kazuya Nakanishi
Background: Thrombolysis for pulmonary embolism and targeted temperature management for cardiac arrest are controversial treatments in pregnancy. Case: A 37-year-old woman at 23 weeks gestation presented with persistent dyspnea. She experienced cardiac arrest soon after arrival at the emergency room. Massive right ventricular dilatation on echocardiography during the transient return of spontaneous circulation suggested pulmonary embolism. We administered recombinant tissue plasminogen activator for suspected pulmonary embolism to successfully resuscitate the patient experiencing refractory cardiac arrest despite heparin infusion...
July 2018: Acute Medicine & Surgery
Michaela V Bonfert, Katharina Badura, Julia Gerstl, Ingo Borggraefe, Florian Heinen, Sebastian Schroeder, Martin Olivieri, Raphael Weinberger, Mirjam N Landgraf, Katharina Vill, Moritz Tacke, Steffen Berweck, Karl Reiter, Florian Hoffmann, Thomas Nicolai, Lucia Gerstl
Objective: Acute childhood stroke is an emergency requiring a high level of awareness among first-line healthcare providers. This survey serves as an indicator of the awareness of, the interest in, and knowledge of childhood stroke of German pediatricians. Methods: Thousand six hundred and ninety-seven physicians of pediatric in- and outpatient facilities in Bavaria, Germany, were invited via email to an online-survey about childhood stroke. Results: The overall participation rate was 14%. Forty-six percent of participants considered a diagnosis of childhood stroke at least once during the past year, and 47% provide care for patients who have suffered childhood stroke...
2018: Frontiers in Pediatrics
Jerry Vockley, Barbara Burton, Gerard T Berry, Nicola Longo, John Phillips, Amarilis Sanchez-Valle, Pranoot Tanpaiboon, Stephanie Grunewald, Elaine Murphy, Alexandra Bowden, Wencong Chen, Chao-Yin Chen, Jason Cataldo, Deborah Marsden, Emil Kakkis
Long-chain fatty acid oxidation disorders (LC-FAOD) are rare disorders characterized by acute crises of energy metabolism and severe energy deficiency that may present with cardiomyopathy, hypoglycemia, and/or rhabdomyolysis, which can lead to frequent hospitalizations and early death. An open-label Phase 2 study evaluated the efficacy of UX007, an investigational odd-carbon medium-chain triglyceride, in 29 subjects with severe LC-FAOD. UX007 was administered over 78 weeks at a target dose of 25-35% total daily caloric intake (mean 27...
July 9, 2018: Journal of Inherited Metabolic Disease
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