The American journal of the medical sciences
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Comparative Study
BODE index and GOLD staging as predictors of 1-year exacerbation risk in chronic obstructive pulmonary disease.
The body mass index/airflow obstruction/dyspnea/exercise capacity (BODE) index and global initiative for chronic obstructive lung disease (GOLD) staging system are validated measures to define disease severity and to predict survival in chronic obstructive pulmonary disease (COPD). We aimed to investigate the influence of BODE classes (score: 0-2, 3-4, 5-7, and 7-10) and GOLD stages (I, II, III, and IV) on the moderate/severe exacerbation occurrence risk in a cohort of 120 mild/very severe stable patients with COPD. ⋯ In summary, our study shows that unidimensional GOLD classification and multidimensional BODE index staging systems seem to have similar clinical utility in predicting exacerbation in ambulatory COPD patients with COPD. However, variables not included in both systems seem to be the main predictors of the exacerbation risk.
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Cocaine inhalation has been linked to the development of pneumomediastinum. The aim of this review was to identify the clinical course and outcome of spontaneous pneumomediastinum caused by cocaine use. ⋯ Cocaine-induced pneumomediastinum is a benign condition. A short observation period with outpatient follow-up is appropriate in the majority of patients. Invasive procedures have a low yield and should be based on a high degree of clinical suspicion for esophageal rupture or bronchial tree laceration.
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Comparative Study
Hyperfibrinolysis, uPA/suPAR system, kynurenines, and the prevalence of cardiovascular disease in patients with chronic renal failure on conservative treatment.
Disturbances of the fibrinolytic system and kynurenine (KYN) pathway of tryptophan (TRP) metabolism have been postulated as important factors in the pathogenesis of cardiovascular disease (CVD). However, no data are yet available on the associations between these 2 systems in relation to CVD prevalence in patients with chronic renal failure (CRF). ⋯ This cross-sectional study has demonstrated that hyperfibrinolysis was associated with uPA/suPAR system, KYNs, oxidative status, and CVD prevalence in patients with CRF.
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Obturator hernia is relatively rare and is a diagnostic challenge in the emergency department because the hernia mass is usually concealed beneath the pectineus muscle. We report the case of a 91-year-old emaciated woman with an incarcerated obturator hernia. The hernia was discovered early in the emergency department by computed tomography and was reduced by emergency laparotomy. ⋯ One of the clinical clues in our patient was small-bowel obstruction of unknown origin, diagnosed by computed tomography. We emphasize that emergency physicians should keep a high index of clinical suspicion for obturator hernia when encountering small-bowel obstruction in emaciated elderly women. Although we cannot shorten the time from onset of symptoms to hospital admission, we can make rapid evaluation and surgical intervention to reduce the morbidity and mortality of obturator hernia.
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Buckwheat is an important crop in China and is also known as an important potent allergen in the population. Here, we report a series of 7 Chinese patients with buckwheat allergy, which has never been reported previously in China. Mean age was 20 years at diagnosis. ⋯ Anaphylaxis might be characterized by severe symptoms. Buckwheat pillow is an important source of exposure to buckwheat in China and other Asian countries. Therefore, public education with effective avoidance measures should be an integral part of the management strategy.