1/7. back pain: a case study.Musculoskeletal complaints, especially back pain without trauma, are frequent health problems seen by nurse practitioners in community emergency centers and office settings. back pain can be a symptom of serious health problems. This article presents the case of a Caucasian male in his early sixties who reported sudden onset of back pain after pushing a heavy object. Careful clinical assessment led the nurse practitioner with the collaborating physician to pursue diagnostic tests, which revealed thoracic and abdominal aortic aneurysms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Clinical case of the month. chest pain, diaphoresis, and dyspnea in a hypertensive 53-year-old man.Aortic dissection is a life-threatening condition requiring urgent diagnosis and treatment. The initial challenge for the physician lies in distinguishing aortic dissection from more common conditions such as myocardial infarction that also are characterized by chest pain. Subsequent management depends on imaging techniques that define whether just the descending aorta is affected or its more proximal portions as well. mortality and morbidity are high, especially when the ascending aorta is involved.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Spontaneous hemothorax. Report of 6 cases and review of the literature.We present 6 cases of spontaneous hemothorax and comprehensively review the medical literature on this subject. We categorize the reported causes and offer a rational diagnostic approach to patients with nontraumatic hemothorax. We recommend specific treatments for specific etiologies, and emphasize the importance of well-established surgical principles for the treatment of hemothorax. Our suggestions should enable physicians to accurately diagnose and expeditiously treat patients with spontaneous hemothorax.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. cocaine-associated dissection of the thoracic aorta.patients present to emergency departments with a variety of complications related to cocaine abuse. Emergency physicians must be aware of the life- and limb-threatening complications to avoid undue mortality and morbidity. We present the case of a patient with aortic dissection who developed the acute onset of abdominal pain 5 minutes after subcutaneous cocaine use. Four previous reports of cocaine-associated aortic dissection are reported in the literature. These cases and other reports of intra-abdominal vascular injuries related to cocaine use are reviewed. cocaine's mechanism of action as it relates to aortic dissection and some of the pharmacologic agents available for treatment are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Descending necrotising mediastinitis: a report of misdiagnosis as thoracic aortic dissection.Descending necrotising mediastinitis is an uncommon disease in the emergency department. Early recognition is important for a good prognosis for this fatal condition. This report describes a case of a healthy 79 year old woman who was seen in the urgent care centre with the initial presentation of chest pain. Misdiagnosis was made because of the mis-reading of a flap-like artefact over the ascending aorta and difficulty interpreting subtle change of mediastinal soft tissue infiltration. The patient was then treated as dissecting aneurysm over ascending aorta until her condition deteriorated. Although aggressive treatment comprising thoracotomy, cervical incision and drainage, and antibiotics were begun, the response was poor. Emergency physicians should be familiar with this rare but highly lethal disease. Correlation should be made in a patient complaining about chest pain, especially combined with fever, sore throat, dysphagia, or neck swelling.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Dysphagia aortica: a neglected symptom of aortoesophageal fistula.Aortoesophageal fistula, secondary to thoracic aortic aneurysm, is an uncommon cause of gastrointestinal bleeding that is uniformly fatal without surgical intervention. Typical symptoms are midthoracic pain and/or dysphagia followed by a usually short, albeit unpredictable, symptom-free interval and by a 'herald' haemorrhage, which is observed in 80% of patients before fatal exsanguinations. Dysphagia is present in 45% of patients, sometimes for several weeks, before the first bleeding occurs. However, dysphagia aortica is rarely considered in the differential diagnosis of dysphagia and lack of awareness, as well as symptom's underevaluation, both contribute to a significant diagnostic and therapeutic delay. We present a case of a 77-year-old woman who died for a bleeding AEF consequent to a thoracic aortic aneurysm and whose main symptom during the past 2 months was dysphagia, which was not taken seriously into consideration by her general practitioner. This case report emphasises that primary care physicians should be alerted to evaluate carefully the alarming symptoms like dysphagia -- especially in elderly patients -- before life threatening complications occur, as they are the ones who could suspect early the diagnosis and make a proper referral.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Acute dissecting aortic aneurysm in an operational environment.Acute dissecting thoracic aortic aneurysm is a rare cause of chest pain in young adults. patients require prompt surgical treatment to reduce the high risk of early mortality. This report describes the case of a young Army officer who developed a dissecting aortic aneurysm in Mogadishu, somalia, during Operation Continue hope. Moving the patient from an isolated hostile country to a location where definitive surgical treatment could be quickly performed presented a significant challenge. Military physicians who may be deployed to isolated locations should be familiar with this unusual cause of chest pain and be prepared to rapidly evacuate patients to facilities that can treat them.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |