1/34. Morbid hypocalcemia associated with phosphate enema in a six-week-old infant.A 6-week-old premature infant who was born at 29 weeks of gestation presented to the emergency department with a several-hour history of stiffness and increased alarms on his apnea monitor at home. On arrival he was noted to have generalized seizures, apnea, and bradycardia. He was intubated and required cardiopulmonary resuscitation including chest compressions and medications. After stabilization he was transferred to the neonatal intensive care unit for further management. His initial laboratory tests revealed a serum calcium level of 2.4 mg/dL (normal range: 8.4-10.2 mg/dL) and a serum phosphorus level of 28.5 mg/dL (normal range: 2.4-4.5 mg/dL). During the first week of admission, the infant's mother reported that she had administered a full pediatric Fleets enema (CB Fleet Company Inc, Lynchburg, VA) to him. The infant was discharged after 12 days of hospitalization. Anticipatory guidance on the stool patterns and behavior of infants can prevent misconceptions about constipation that are especially prevalent in new parents. Proper management of constipation, should it arise, should be addressed with all parents at early well-child visits to avoid hazardous complications of treatments. hypocalcemia, seizures, premature infants, enema.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/34. Hormonal and cardiovascular reflex assessment in a female patient with pure autonomic failure.We report the case of a 72-year-old female with pure autonomic failure, a rare entity, whose diagnosis of autonomic dysfunction was determined with a series of complementary tests. For approximately 2 years, the patient has been experiencing dizziness and a tendency to fall, a significant weight loss, generalized weakness, dysphagia, intestinal constipation, blurred vision, dry mouth, and changes in her voice. She underwent clinical assessment and laboratory tests (biochemical tests, chest X-ray, digestive endoscopy, colonoscopy, chest computed tomography, abdomen and pelvis computed tomography, abdominal ultrasound, and ambulatory blood pressure monitoring). Measurements of catecholamine and plasmatic renin activity were performed at rest and after physical exercise. Finally the patient underwent physiological and pharmacological autonomic tests that better diagnosed dysautonomia.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
3/34. death due to bioterrorism-related inhalational anthrax: report of 2 patients.On October 9, 2001, a letter containing anthrax spores was mailed from new jersey to washington, DC. The letter was processed at a major postal facility in washington, DC, and opened in the Senate's Hart Office Building on October 15. Between October 19 and October 26, there were 5 cases of inhalational anthrax among postal workers who were employed at that major facility or who handled bulk mail originating from that facility. The cases of 2 postal workers who died of inhalational anthrax are reported here. Both patients had nonspecific prodromal illnesses. One patient developed predominantly gastrointestinal symptoms, including nausea, vomiting, and abdominal pain. The other patient had a "flulike" illness associated with myalgias and malaise. Both patients ultimately developed dyspnea, retrosternal chest pressure, and respiratory failure requiring mechanical ventilation. leukocytosis and hemoconcentration were noted in both cases prior to death. Both patients had evidence of mediastinitis and extensive pulmonary infiltrates late in their course of illness. The durations of illness were 7 days and 5 days from onset of symptoms to death; both patients died within 24 hours of hospitalization. Without a clinician's high index of suspicion, the diagnosis of inhalational anthrax is difficult during nonspecific prodromal illness. Clinicians have an urgent need for prompt communication of vital epidemiologic information that could focus their diagnostic evaluation. Rapid diagnostic assays to distinguish more common infectious processes from agents of bioterrorism also could improve management strategies.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/34. Acute circulatory and respiratory collapse in obstetrical patients: a case report and review of the literature.Venous air embolism is the entrapment of air into the venous system producing signs and symptoms due to obstruction of pulmonary arterial blood flow. We present a healthy, 27-year-old, full-term parturient admitted for postdate induction of labor. Cesarean delivery was required following fetal distress. During delivery, the mother became bradycardic and required advanced cardiac life support for resuscitation. Serial hemoglobin values, electrocardiograms, echocardiograms, and a magnetic resonance image of the head were all normal. No fetal squamous cells were found in the patient's blood. She required 6 days of ventilation, was successfully extubated, and was discharged 14 days after the cesarean delivery. The differential diagnosis in this patient's care centered on a pulmonary embolic event. thromboembolism was unlikely, based upon the patient's rapid clinical improvement without definitive therapy for thrombotic disease or detection of peripheral thrombosis. amniotic fluid embolus was unlikely, although not excluded, by the absence of fetal cells in the maternal circulation and the lack of an accompanying intravascular coagulopathy. Air embolism may occur in up to 50% of women undergoing cesarean delivery. A lethal embolism may follow a bolus of 3 to 5 mL/kg of air. Chief among the many symptoms of air embolism are tachypnea, chest pain, and gasping. The diagnosis may be facilitated by precordial Doppler monitoring, transesophageal echocardiography, or by the identification of air when aspirating from a right heart catheter. Management includes optimum patient positioning, aspiration of air, discontinuation of nitrous oxide, administration of 100% oxygen, and flooding the surgical site with saline to avoid further air entry. Preventive strategies are also discussed.- - - - - - - - - - ranking = 11.314587230805keywords = chest pain, chest (Clic here for more details about this article) |
5/34. Apparent bradycardia-dependent advanced second-degree atrioventricular block.A 65-year-old man with repeated chest discomfort and dizzy spells was transferred by an emergency car. On the way to hospital, his pulse was palpable as regular 4 to 5 beats followed by an unpalpable period of about 4 s. His electrocardiographic monitor showed that 4 to 5 sinus QRS complexes were followed by consecutive 3 to 4 blocked sinus P waves, which occurred repeatedly. When PP intervals gradually shortened during inspiration, sinus impulses were conducted to the ventricles, whereas when PP intervals lengthened during expiration, 3 to 4 sinus impulses were blocked in succession. An attempt was made to explain the mechanism for such apparent bradycardia-dependent atrioventricular block by using the concepts of periodic increases in vagal tone due to respiration and concealed electrotonic conduction of blocked impulses. Such a peculiar form of advanced second-degree atrioventricular block has never been reported before.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
6/34. Ebstein's anomaly, atrial paralysis and atrio-ventricular block: an uncommon association.We report here the case of a 22-year-old female patient with an incomplete Ebstein's anomaly, complete heart block and atrial standstill. Atrial paralysis associated with Ebstein's anomaly is the most important feature, since there is a report of familial Ebstein's anomaly associated with atrial standstill but isolated cases have not been described. The patient presented with atypical chest pain and a symptomatic bradycardia of 37 beats per minute. A VVIR pacemaker was implanted. She has subsequently been symptom free.- - - - - - - - - - ranking = 11.314587230805keywords = chest pain, chest (Clic here for more details about this article) |
7/34. Pertussis pneumonia complicated by a hyponatremic seizure.We present the case of a 6-week-old male infant who had a convulsion due to pertussis pneumonia. He was admitted to our emergency department because of lethargy and hypothermia. He developed a generalized tonic-clonic convulsion, requiring various treatments, including artificial ventilation. A chest CT showed bilateral pneumonia and laboratory data revealed hyponatremia with other features of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Although SIADH has been recognized as a cause of hyponatremia in association with pneumonia, there is little in the literature regarding SIADH caused by pertussis. hyponatremia caused by SIADH must be considered as a differential diagnosis of seizures in pertussis infection of infants.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
8/34. Spontaneous rupture of the diaphragm.A 42-year-old man was brought into the Accident and Emergency Department with epigastric discomfort and severe bradycardia. Computerized tomography of the chest revealed spontaneous rupture of the left hemidiaphragm with herniation of small bowel loops.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/34. Acute cardiac toxicity associated with high-dose intravenous methotrexate therapy: case report and review of the literature.A 36-year-old woman was hospitalized for preoperative chemotherapy for osteosarcoma. She received intravenous fluids for 12 hours for volume expansion, then methotrexate 24 g (12 g/m2) over 6 hours. This was followed by intravenous leucovorin 200 mg over 1 hour. Two hours after the methotrexate infusion the patient developed chest pain and bradycardia. An electrocardiogram revealed sinus pauses, and telemetry recordings indicated a 4-beat run of ventricular tachycardia. A cardiac work-up consisting of cardiac enzyme level determination, two-dimensional echocardiography, and an adenosine technetium-99m tetrofosmin stress test was negative for structural and ischemic heart disease. The patient recovered without treatment and, approximately 2 weeks later, received a second course of methotrexate at half the dose without complication. One month later the patient received treatment with doxorubicin and cisplatin; 2 days later she died unexpectedly at home. Clinicians should be aware that high-dose methotrexate can cause cardiac symptoms and arrhythmias in previously healthy adults. This complication warrants attention and needs additional clinical investigation.- - - - - - - - - - ranking = 11.314587230805keywords = chest pain, chest (Clic here for more details about this article) |
10/34. Negative-pressure pulmonary edema: a rare complication of upper airway obstruction in children.Negative-pressure pulmonary edema is a rare but life-threatening complication of upper airway obstruction. Because negative-pressure pulmonary edema may occur in a large spectrum of pathologies associated with upper airway obstruction, awareness of this condition is crucial during daily clinical practice. We report a case of negative-pressure pulmonary edema during anesthetic recovery to highlight this condition. CASE: A 2-year-old boy was scheduled for orchidopexy under general anesthesia. Shortly after an uneventful operation, the patient presented airway obstruction. Serious oxygen desaturation and bradycardia ensued, during inefficient attempts at positive-pressure ventilation. After emergency intubation, copious pink secretions emerged from the airway. pulmonary edema was confirmed by clinical examination, pulse oximetry, and chest radiography. The finding of pulmonary edema was resolved within 24 hours after mechanical ventilation and positive end-expiratory pressure. The child suffered no sequelae. This report highlights the clinical features of negative-pressure pulmonary edema and serves as a reminder to the pediatrician who must be able to recognize and initiate treatment for conditions that are uncommon but life-threatening.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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