Proceedings (Baylor University. Medical Center)
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Proc (Bayl Univ Med Cent) · Jan 2015
Acute pulmonary embolism masquerading as acute myocardial infarction.
Pulmonary embolism can be extremely difficult to diagnose based on clinical presentation. Many studies have demonstrated certain electrocardiographic patterns commonly seen in pulmonary embolism, but few have described changes consistent with ST segment elevation myocardial infarction. In this report, we describe a patient who presented to the emergency department with electrocardiographic findings consistent with an anteroseptal myocardial infarction and his subsequent clinical course.
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Proc (Bayl Univ Med Cent) · Jan 2015
Vertebral artery dissection after a chiropractor neck manipulation.
The differential diagnosis for ischemic central nervous system infarcts in young patients includes paradoxic emboli through cardiac shunts, vasculitis, and vascular trauma. We report a young woman who developed headache, vomiting, diplopia, dizziness, and ataxia following neck manipulation by her chiropractor. A computed tomography scan of the head revealed an infarct in the inferior half of the left cerebellar hemisphere and compression of the fourth ventricle causing moderate acute obstructive hydrocephalus. ⋯ The patient was treated with mannitol and a ventriculostomy and had an excellent functional recovery. This report illustrates the potential hazards associated with neck trauma, including chiropractic manipulation. The vertebral arteries are at risk for aneurysm formation and/or dissection, which can cause acute stroke.
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Proc (Bayl Univ Med Cent) · Oct 2014
Evaluation of epidural analgesia for open major liver resection surgery from a US inpatient sample.
The aim of this study was to assess the nationwide use of epidural analgesia (EA) and the incidence of postoperative complications in patients undergoing major liver resections (MLR) with and without EA in the United States. The 2001 to 2010 Nationwide Inpatient Sample was queried to identify adult patients undergoing MLR. A 1:1 matched cohort of patients having MLR with and without EA was assembled using propensity-score matching techniques. ⋯ Although use of EA was associated with more blood transfusions (relative risk, 1.36; 95% confidence interval, 1.12-1.65; P = 0.001) and longer hospital stay (median [interquartile range], 6 [5-8] vs 6 [4-8] days), the use of coagulation factors and the incidence of postoperative hemorrhage/hematomas or other postoperative complications were not higher in patients receiving EA. In conclusion, the use of EA for MLR is low, and EA does not seem to influence the incidence of postoperative complications. EA, however, was associated with an increased use of blood transfusions and a longer hospital stay.
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Proc (Bayl Univ Med Cent) · Oct 2014
Lupus myopericarditis as a preceding stressor for takotsubo cardiomyopathy.
We describe herein a 61-year-old African American woman who presented with takotsubo cardiomyopathy preceded by lupus myopericarditis. The case highlights the importance of the association between pericarditis and takotsubo cardiomyopathy. This new stressor adds to the existing evidence that these two entities may coexist and do not have to be mutually exclusive.