Arch Intern Med
-
Published studies of the blood pressure response to exercise were reviewed to assess the probability of future hypertension in a subject with a "hypertensive" response to exercise. The reviewed data indicate that the sensitivity of a hypertensive response to exercise for future hypertension varied between 16% and 60%, and the specificity between 53% and 95%. ⋯ However, this predictive value is limited, since 38.1% to 89.3% of those with a hypertensive response to exercise did not have hypertension on follow-up, and a normotensive response only marginally reduced the risk of future hypertension. The use of exercise testing as a predictor of hypertension is still in need of experimental development and confirmation.
-
An accurate diagnosis of pulmonary embolism is essential to prevent excessive morbidity and mortality from lack of therapy or inappropriate anticoagulation. Clinical signs and symptoms are reported to be nonspecific, although published studies do not allow calculation of true specificity. Since certain clinical characteristics or groups of findings may be sensitive enough for pulmonary embolism, the diagnosis is unlikely in their absence. ⋯ Scans with less extensive perfusion abnormalities or matching ventilation defects do not reliably exclude pulmonary embolism. Pulmonary angiography is the most definitive procedure for diagnosing pulmonary embolism. Digital subtraction pulmonary angiography and radiolabeled platelet scanning are promising but require more extensive validation before routine use.
-
The adult respiratory distress syndrome (ARDS) is a common syndrome of diffuse lung injury with high mortality. An underlying mechanism is pulmonary microvascular injury leading to increased permeability, pulmonary edema and impaired gas exchange. ⋯ The development of an accurate clinical marker of pulmonary microvascular injury or a technique to measure pulmonary microvascular permeability may allow earlier and more specific diagnosis. We review ARDS with emphasis on recent work concerning the mechanisms of lung injury, diagnosis, and therapy.
-
Hemodialysis or sorbent hemoperfusion has been used in the management of clinical overdose of salicylates or acetaminophen. Hemodialysis offers considerable benefit in severe salicylate poisoning and is preferred to hemoperfusion or peritoneal dialysis, since it more rapidly corrects acid-base and electrolyte abnormalities than does hemoperfusion, and since it is clearly more efficient than is peritoneal dialysis for the removal of salicylates. ⋯ Hemodialysis and hemoperfusion are of questionable benefit in clinical acetaminophen overdose. However, our clinical experience to date with charcoal hemoperfusion in "late" acetaminophen overdose has been associated with a less notable increase in liver enzyme concentrations in comparison with results of retrospective studies of series of patients treated or not treated with sulfhydryl donors.