The American journal of emergency medicine
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Acute pancreatitis remains a common intraabdominal disease with a complex pathophysiology. The overall outcome has improved, but specific treatment remains elusive. The challenge is the early identification and treatment of patients who will develop severe acute pancreatitis. Therefore, the aim of the present study is to investigate plasma levels of copeptin in the initial phase of predicted severe acute pancreatitis. ⋯ Copeptin plasma concentrations were significantly higher in patients with acute pancreatitis when compared with healthy controls. Copeptin plasma concentrations in severe pancreatitis patients were significantly higher than in mild pancreatitis patients.
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Patients with colorectal cancer (CRC) who present to the emergency department (ED) reportedly have poorer prognoses than other referral sources. The purpose of this study was to compare the clinical presentations and outcomes of patients referred to the hospital from the ED and those referred from non-ED facilities. ⋯ The ED played a pivotal role in the clinical and diagnostic evaluations of patients with CRC at our institution. Emergency department physicians provided timely diagnoses of CRC because the stage at diagnosis and 2-year mortality rate of ED patients were not compromised compared with that of patients referred from non-ED sources. Efforts should be made to reduce the numbers of patients with late presentations and acute complications associated with in-hospital mortality.
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Acute pancreatitis (AP) is a common cause for hospitalization worldwide. Identification of patients at risk for mortality early in the course of AP is an important step in improving outcome. Red cell distribution width (RDW) is reflective of systemic inflammation. The objective of this study was to investigate the association between RDW and mortality in patients with AP. ⋯ Red cell distribution width on admission is a predictor of mortality in patients with AP.
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Case Reports
Epinephrine-induced myocardial infarction in severe anaphylaxis: is nonselective β-blockade a contributory factor?
Epinephrine-induced myocardial ischemia in the setting of anaphylaxis is a rare event and is postulated to be due to coronary artery spasm. We report the case of a 43-year-old woman who presented to the emergency department with an anaphylactic reaction triggered by flucloxacillin. ⋯ Subsequent coronary angiography demonstrated normal coronary arteries. In this case report, we discuss the potential role of prior nonselective β-blockade with propranolol in predisposing such patients to ischemic cardiac events following treatment with epinephrine.
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Acute aortic syndrome is a spectrum of diseases that have similar presentation and clinical background and include aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. Presented here is an 82-year-old woman with a medical history of diabetes, hypertension, nephrectomy, and chronic renal failure who complained of sudden abdominal pain radiating to epigastrium and back. ⋯ Computed tomography demonstrated an aortic penetrating atherosclerotic ulcer that ruptured into the right pleural space resulting in right hemothorax. A percutaneous endostent was placed with subsequent discharge of the patient 10 days after admission.