February 26th 2024
At 3 months following ischemic stroke, lower mean oxygen saturation but not apnea-hypopnea index was associated with functional deficits, according to a French research team.
Stroke Symptoms Common Even Without Stroke Diagnosis
October 11th 2006BIRMINGHAM, Ala. -- In a national sample of the general population, although weighted in favor of African Americans and the so-called stroke belt, about one in five individuals 45 or older has had undiagnosed cerebrovascular symptoms, investigators reported.
Clinical Citations: Recognizing pulmonary embolism in patients with COPD exacerbation
October 1st 2006When a patient with chronic obstructive pulmonary disease (COPD) presents with what appears to be an acute exacerbation, you should consider the possibility of pulmonary embolism (PE). This is the message conveyed by a prospective cohort study in France.
ASNC: Coronary Calcium Score Predicts Vascular Disease in Asymptomatic Type 2 Diabetes
September 12th 2006MONTREAL -- A coronary artery calcium score, obtained via CT, can accurately predict the development of atherosclerotic and ischemic disease in asymptomatic patients with type 2 diabetes, according to a report at the American Society of Nuclear cardiology meeting here.
Clinical Citations: Acute infection: Risk of deep venous thrombosis and pulmonary embolism
September 1st 2006Acute infection has been known to increase the risk of arterial cardiovascular events, but the effects of acute infections on venous thromboembolic disease have not been well established. Using the self- controlled case-series method, British researchers studied data obtained from general practitioners between 1987 and 2004 to investigate whether acute respiratory and urinary tract infections transiently increased the risk of initial incidents of deep venous thrombosis (DVT) in 7278 persons and pulmonary embolism (PE) in 3755.
New Atrial Fibrillation Guidelines Emphasize Stroke Prevention
August 2nd 2006NEW YORK -- Stroke risk trumps age, gender or other history of heart disease in determining which atrial fibrillation patients benefit from anticoagulation, according to revised guidelines issued today by the American College of Cardiology, the American Heart Association, and the European Society of Cardiology.
Case In Point: Peripheral nerve sheath tumor mimicking pulmonary embolism
August 1st 2006We describe a case in which a patient received thrombolytic therapy after he presented with a clinical picture consistent with submassive pulmonary embolism (PE). Two months later, a malignant peripheral nerve sheath tumor was diagnosed, and the patient died with metastatic disease. The filling defect in the left main pulmonary artery originally interpreted as PE was in fact a tumor. This case describes an unusual presentation of a rare disease (malignant peripheral nerve sheath tumor) mimicking a submassive PE.
Today's approach to the treatment of heparin-induced thrombocytopenia
June 1st 2006Abstract: Failure to recognize heparin-induced thrombocytopenia (HIT) can lead to devastating thrombotic events, including pulmonary embolism and stroke. In most cases, the problem develops within 5 to 14 days after a first-time exposure to heparin. HIT can occur with either unfractionated heparin or low molecular weight heparin (LMWH), but the incidence is much lower with LMWH. When HIT is suspected clinically, a functional assay and immunoassay should be performed. However, treatment should not be delayed while waiting for laboratory confirmation. All forms of heparin should be eliminated, and treatment with an alternative anticoagulant should be initiated to prevent new thromboembolic events. Argatroban and lepirudin are the direct thrombin inhibitors that have been approved for the treatment of HIT. Because of the risk of warfarin-induced venous limb gangrene or skin necrosis, warfarin should be avoided in patients with acute HIT until their platelet counts have recovered and they are improving clinically. (J Respir Dis. 2006;27(6):248-259)
Abdominal Aortic Aneurysm With Impending Rupture
April 1st 2006Lower back pain of 7 days' duration prompted a 79-year-old man to seek medical attention. The pain was localized to the left side of the back. Vital signs were stable. During the abdominal examination, a pulsatile mass was noted in the periumbilical region. The patient was admitted to the hospital.
Clinical Citations: Fine-tuning the evaluation of acute pulmonary embolism
March 1st 2006One of the keys to successfully managing acute pulmonary embolism (PE) is to quickly and reliably identify which patients require anticoagulant therapy. A diagnostic algorithm that combines clinical probability, D-dimer results, and CT findings appears to be quite effective in achieving this, according to a multicenter study conducted in the Netherlands.
Consultant Health Guide: Keys to Successful Weight Loss
March 1st 2006Excess weight increases the risk of having a heart attack, stroke, high blood pressure, arthritis, diabetes, depression, fatigue, and certain types of cancer. Losing weight and keeping it off are very difficult for most persons who are overweight. Here are some suggestions to help you lose pounds and keep your weight down.
Top Papers Of The Month: Stroke Prediction That's as Easy as ABCD
March 1st 2006n the first 7 days after a transient ischemic attack (TIA), the risk of a stroke is 10%.1 If half the patients who presented with TIAs were admitted and received an immediate workup within that 7-day window, only 5% of them would have a stroke.1 Thus, many patients would undergo unnecessary tests. Some would have complications, and the costs would be prohibitive. What is needed is a way to identify patients who are at high risk for a stroke in the immediate future--and who require emergent assessment.
Clinical Update: Heparin-induced thrombocytopenia: Highlights of recent studies
December 1st 2005Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening complication that occurs in about 1% to 5% of patients who receive heparin.1 Patients with HIT are at risk for the development of new thrombosis, including pulmonary embolism (PE). The mortality rate among patients with HIT and thrombosis is about 20% to 30%.2-5
The keys to diagnosing interstitial lung disease: Part 2
October 1st 2005Abstract: Many patients with sarcoidosis are asymptomatic at presentation and have bilateral hilar adenopathy on a chest radiograph obtained for other reasons. Symptomatic patients usually present with chronic cough, dyspnea, or noncardiac chest pain. Extrapulmonary organ involvement is not uncommon. Lung biopsy shows well-formed noncaseating granulomas in a bronchovascular distribution. Interstitial lung disease also may result from collagen vascular disease, such as systemic lupus erythematosus and Sjögren syndrome. In patients with acute hypersensitivity pneumonitis, cough, dyspnea, and flu-like symptoms occur within 12 hours of exposure to the inciting antigen, such as pigeon stool or moldy hay. Some patients have a subacute or chronic course, probably as a result of continued exposure to the offending antigen. In acute hypersensitivity pneumonitis, the chest radiograph may show diffuse small nodules, whereas in chronic disease, reticular lines or fibrosis may be seen. (J Respir Dis. 2005;26(10):443-448)