Acute coronary syndromes (ACS) may precipitate up to a third of acute heart failure (AHF) cases. We assessed the characteristics, initial management, and survival of AHF patients with (ACS-AHF) and without (nACS-AHF) concomitant ACS.
Data from 620 AHF patients were analyzed in a prospective multicenter study. The ACS-AHF patients (32%) more often presented with de novo AHF (61% vs. 43%; P
Alcohol-free licorice beverages contain glycyrrhizic acid. Excess glycyrrhizic acid is a well-known cause of excess mineralocorticoid syndrome. We report a case of glycyrrhizic acid poisoning in an abstinent alcoholic complicated by severe pulmonary edema following excessive hydration with intravenous normal saline.
With the increasing amount of people traveling to high altitude regions, the number of people at risk of acquiring altitude illness increases. Altitude illness entails three syndromes; acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema. These syndromes are potentially lethal acquired medical conditions that in most cases are preventable. Health care providers need to inform travelers of the risks associated with mountaineering and the prophylactic measures available as well as identify underlying conditions that require specific considerations. This article provides a summary of the pathophysiology, symptoms and treatment of altitude illness and aims to be an orientation for general practitioners.
Men and mammals (excluding the indigenous mountain species) who are born at high altitude, or who ascend to live there for a long period, have to undergo acclimatization which affects virtually every system in the body. Since chronic hypoxia is the most important adverse factor in the mountain environment, the lung plays a major part in the process and shows many alterations in structure and function. However, we remain ignorant about many aspects of acclimatization of the lung to hypoxia especially at the ultrastructural level with respect to those cells whose normal function is not yet established. An account of what is known is given in this paper.
Magnetic resonance imaging (MRI) has been used previously to follow noninvasively inflammatory processes in rat acute models of lung inflammation. Here the technique was applied to a model involving repeated intratracheal administration of ovalbumin (OA). Anatomical MRI was performed at different time points with respect to a single or multiple OA challenges in Brown Norway rats actively sensitized to the allergen. Vascular permeability was assessed using dynamic contrast-enhanced MRI (DCE-MRI). Bronchoalveolar lavage (BAL) fluid analysis and histology were performed to validate the MRI data. The time course of MRI signals after a single OA challenge reached a maximum at 48 h and decreased significantly at 96 h. After the second and subsequent challenges, the maximum signal occurred at 6 h with a time-dependent decline over the remainder of the time course. A reduction of the inflammatory response following repeated administration of OA was also detected by BAL fluid analysis. The decrease in vascular permeability assessed by DCE-MRI in repeatedly OA-challenged rats was consistent with the thickening of the vascular wall for vessels of diameter up to 300 microm revealed by histology. Angiogenesis of vessels smaller than 30 microm was also detected histologically. These results suggest that MRI can be used to detect the inflammatory response and vascular remodeling associated with chronic airway inflammation in rat models involving repeated administration of allergen. As the contrast agent used in the DCE-MRI experiments is approved for clinical use, there is potential to translate the approach to patients.
The risk of thromboembolic complications in outpatient surgery is regarded as being low. Thromboembolic prophylaxis is seldom administered as a routine. A retrospective study in our outpatient department, based upon patients readmitted for clinical thromboembolism, showed an incidence of deep vein thrombosis of 0.05% (8/1 691) and of pulmonary embolism 0.0006% (1/1 691). None of the patients received prophylaxis for thrombosis, and all operations were performed under regional anaesthesia of the lower extremity. 50% of the operations were performed using a tourniquet. 2/3 of the patients were women and 2/3 were over the age of 50. Operation time was usually 30-45 minutes. Our study indicates that patients undergoing knee arthroscopy, and operations for varicose veins and hallux valgus are at risk of thromboembolism. Prospective studies of these risk groups are necessary to figure out the need for thrombosis prophylaxis.