The American journal of the medical sciences
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This study is aimed at better defining the prevalence of left ventricular dysfunction, atrial fibrillation, and mitral regurgitation in aged patients with cardiogenic acute pulmonary edema. ⋯ This study emphasizes that emergency departments should have clear-cut policies for diagnosing and treating acute coronary syndromes and tachyarrhythmias, as being potential treatable causes of APE. Once stabilized, patients should be examined for treatable valvular causes. A further study, of acute echocardiography done upon arrival to the emergency department in patients with APE is warranted.
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Patients with type 2 diabetes have higher rates of cardiovascular events. Among African Americans, there is a higher prevalence of both cardiovascular disease and type 2 diabetes. Few studies have examined longitudinally the change in glucose tolerance in younger adult African Americans. ⋯ Conversion to abnormal glucose tolerance is relatively frequent in young adult African Americans. Deterioration in glucose tolerance may be preceded by higher systolic blood pressure and is accompanied by worsening of other cardiovascular risk factors and insulin resistance.
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Case Reports
Osmotic demyelination syndrome after correction of chronic hyponatremia with normal saline.
Rapid correction of severe chronic hyponatremia with hypertonic saline has been known to cause osmotic demyelination syndrome (ODS). Less recognized are the dangers of rapid correction with normal saline. A 60-year-old woman on thiazide diuretics for hypertension presented with profound hyponatremia (94 mmol/L) and hypokalemia (1.9 mmol/L) associated with volume depletion. ⋯ However, she developed progressive obtundation, quadriplegia, and respiratory failure 6 days later. Magnetic resonance imaging of the brain clearly showed typical features of pontine and extrapontine myelinolysis. We suggest that the aggressive KCl supplement would have been the first-line therapy for this patient presenting with chronic hyponatremia and hypokalemia associated with volume depletion.
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Review Case Reports
Bullous skin disease: an unusual allergic reaction to vancomycin.
Severe reactions due to vancomycin are uncommon. We describe a case of vancomycin-induced linear immunoglobulin A bullous disease and review the literature pertinent to this entity. This is a rare subepidermal blistering disorder, with a heterogenous clinical presentation. ⋯ Spontaneous and complete skin healing follows vancomycin withdrawal; rechallenge reproduces the disease with a more rapid and severe onset. Because vancomycin is almost never suspected to be the cause of such manifestations, awareness of this rare autoimmune reaction is crucial. Early diagnosis through direct immunofluorescence of the perilesional skin would avoid unnecessary laboratory investigations and therapeutic measures and would shorten significantly the pain and suffering of these patients.