Southern medical journal
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Southern medical journal · Nov 2003
Clinical predictors of 30-day cardiac events in patients with acute coronary syndrome at a community hospital.
We sought to determine predictors of coronary events (cardiac death, acute myocardial infarction, and urgent revascularization) within 30 days after admission. ⋯ Our model incorporating elements from the patient's demographic, medical history, presentation, and ischemic assessment identified 48% of patients presenting with unstable angina and acute coronary syndromes who will suffer a major adverse cardiac event within 30 days of admission. Although the strongest predictor was identified as serum troponin T, other clinical criteria offered improvement in our predictive abilities. Therefore, good initial clinical evaluation in addition to simple tests such as serum cardiac markers and electrocardiography are valuable in risk stratification of patients presenting with acute coronary syndromes and cardiac chest pain. Additional testing may be necessary to improve the positive predictive value of the model. Cardiac enzymes and electrocardiographic changes have the highest negative predictive value for occurrence of major adverse cardiac events. Identification of high-risk patients is essential to direct resources toward these patients and to avoid unnecessary costs and risk to the low-risk population.
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Southern medical journal · Nov 2003
Case ReportsInnominate artery compression of the trachea: an unusual cause of apnea in a 12-year-old boy.
Innominate artery compression of the trachea is a common cause of airway obstruction in infants and young children. The clinical significance of this lesion, even when compression is documented endoscopically or radiographically, is controversial. ⋯ We present a case of a 12-year-old boy with a chief complaint of progressive stridor and apnea who was diagnosed with symptomatic innominate artery compression of the trachea. We reviewed the literature regarding the pathology, diagnosis, and treatment of this condition.
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Atherosclerosis is currently considered to be an inflammatory and thus a systemic disease affecting multiple arterial beds. Recent advances in intravascular imaging have shown multiple sites of atherosclerotic changes in coronary arterial wall. Traditionally, angiography has been used to detect and characterize atherosclerotic plaque in coronary arteries, but recently it has been found that plaques that are not significantly stenotic on angiography cause acute myocardial infarction. ⋯ Intravascular ultrasound can identify multiple plaques that are not seen on coronary angiography. Thermography has shown much promise and is based on the concept that the inflammatory plaques are associated with increased temperature and can also identify "vulnerable patients." Of all these newer modalities, magnetic resonance imaging has shown the most promise in identification and characterization of vulnerable plaques. In this article, we review the newer coronary artery imaging modalities and discuss the limitations of traditional coronary angiography.
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Southern medical journal · Oct 2003
Case ReportsNear-fatal air embolism: fibrin sheath as the portal of air entry.
Complications of central venous catheters occur in less than 1% of all insertions. Of these, pulmonary air embolism is a rare though often fatal complication. ⋯ There has also been speculation that the presence of a fibrin sheath after removal might be a mechanism for air entry. We present a case of a near-fatal pulmonary air embolus with documentation of air in the pulmonary outflow trunk and a residual air-filled fibrin tract seen on computed tomography.
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Southern medical journal · Sep 2003
ReviewAdditional experience with dexmedetomidine in pediatric patients.
This study evaluates the efficacy of dexmedetomidine in clinical scenarios other than sedation during mechanical ventilation. ⋯ These preliminary data suggest that dexmedetomidine may be an effective agent for sedation in spontaneously breathing patients, in the treatment of drug withdrawal, and in the treatment of two common postanesthesia problems.