1/14. An unusual procedure for the treatment of simultaneous pericardial and pleural effusions.BACKGROUND: Symptomatic posterior pericardial effusion (PE) represents a diagnostic challenge since it is not easy to quantify by echocardiography. In addition, this type of effusion is normally treated by surgery because of the difficulty in drainage. CASE: A 59-year-old male presented a symptomatic circumferential PE following mitral valve substitution. Two days after a successful percutaneous subcostal pericardiocentesis, he reported severe dyspnea with hypotension and pulsus paradoxus. At chest x-rays, he showed a left pleural effusion; echocardiography, also performed from the left posterior axillary line, showed a large posterior PE and a large pleural effusion separated by a membrane. A needle was inserted at the fourth intercostal space 2 cm medially to the left posterior axillary line and advanced into the pleural and then into the pericardial cavity under echocardiographic guidance. Serous-hemorrhagic fluid was drained from the pericardial (800 cc) cavity and, after retraction, from the left pleural cavities (600 cc), with consequent hemodynamic improvement. CONCLUSION: Pleuro-pericardiocentesis may represent a valid alternative to surgery for the treatment of cardiac tamponade due to posterior pericardial effusions, in the peculiar situation characterized by the simultaneous presence of a left pleural effusion. This procedure should be performed by qualified physicians under echographic guidance.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. melioidosis complicated by pericarditis.A case of acute and recrudescent melioidosis complicated by pericarditis and pericardial effusion is described. The potential for the appearance of future cases in the united states and the necessity for physicians to remain aware of this potential diagnosis are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. Early detection of cardiac disease masquerading as acute bronchospasm: The role of bedside limited echocardiography by the emergency physician.We report two cases in which the patients experienced dyspnea, cough, and acute bronchospasm. Pulmonary pathology was initially suspected. Failure to respond to an initial trial of inhaled bronchodilator prompted the use of bedside limited echocardiography by the emergency physician. The potential role of limited echocardiography by the emergency physician as a triage tool in facilitating early diagnosis and emergent therapy, reducing time to final discharge, and enhancing interaction between the pediatric emergency physician and cardiology consultants is highlighted.- - - - - - - - - - ranking = 7keywords = physician (Clic here for more details about this article) |
4/14. cardiac tamponade complicating postpericardiotomy syndrome.We present 2 children who developed postpericardiotomy syndrome (PPS) and the rare complication of cardiac tamponade after cardiac surgery, each requiring life-saving pericardiocentesis in the emergency department (ED). Each child presented with vomiting as a chief complaint, an initial sign that has not been reported previously. As the frequency of orthotopic heart transplants and other cardiac surgeries among children increases, it is likely that ED physicians will encounter PPS and cardiac tamponade with greater frequency, and it is imperative that it be recognized promptly and treated appropriately. We review PPS, cardiac tamponade, and the proper performance of a pericardiocentesis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. Deaths due to hunger strike: post-mortem findings.hunger strike is described as voluntary refusal of food and/or fluids. Prolonged starvation may produce many adverse events including even death in rare circumstances. Here, we present three fatal cases (all males, 25-38 years) died from hunger strike. In all corpses, obvious muscle wasting with reduced subcutaneous and internal fat deposits, and atrophy in some organs were demonstrated at autopsy. The extraordinary long starvation period before death could presumably be linked to the thiamine uptake in this period, which had been discontinued by all subjects before the death occurred. Prolonged caloric deficiency with subsequent complications such as multiple organ failure, severe sepsis and ventricular fibrillation could account as major causes of death in these subjects. The competence of the physicians working with hunger strikers about the processes and potential problems is of great importance since they have to acknowledge about them to their patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. Pericardial involvement as an atypical manifestation of giant cell arteritis: report of a clinical case and literature review.PURPOSE: pericardial effusion has been known to be a rare manifestation of giant cell arteritis. During the last six decades, only 24 cases have been cited in the literature. In this report, we describe the case of a patient presenting with nonspecific symptoms and development of pericardial effusion. PROCEDURES AND FINDINGS: A 71-year-old woman was admitted to the hospital with low-grade fever, exertion breathlessness, atypical diffuse muscular pain, and weight loss over a period of about 5 weeks. pericardial effusion and giant cell arteritis were diagnosed by echocardiography and left temporal artery biopsy, respectively. Treatment with corticosteroids resulted in remarkable improvement of symptoms and complete remission of pericardial effusion. One year after admission, the patient remained in a stable good condition, under low steroid maintenance dosage. CONCLUSIONS: The diversity of clinical manifestations (such as pericardial effusion) in such a potentially severe disease should alert the physician to prompt diagnosis and treatment in view of impending irreparable vascular damages, even in cases in which the initial presentation is quite uncommon.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. Emergent signs of cancer. Recognizing them early in the office or ER.Primary care physicians have a crucial role in recognition of potentially emergent conditions in patients with known or suspected cancer. This task presents a significant challenge because the initial manifestations of these conditions are usually nonspecific. In most cases, therapy is far more effective when diagnosis is made at the earliest possible point. Thus, physicians should become familiar with conditions commonly seen in cancer patients, such as superior vena cava syndrome, malignant pericardial effusion, spinal-epidural metastasis, and altered mentation from brain metastases, metabolic encephalopathy, or hypoglycemia.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/14. Pericardial constriction as a late complication of coronary bypass surgery.A 55-year-old man had progressive dyspnea, recurrent atrial arrhythmias, and severe right heart failure following coronary bypass surgery. His condition improved only slightly with the usual decongestive therapy. When transferred for further studies 5 months after the operation, he had typical clinical and hemodynamic findings of constrictive pericarditis. review of chest films following the bypass operation revealed a large pericardial effusion or hematoma, the incomplete resolution of which probably caused the pericardial constriction confirmed at thoracotomy. The man was treated by pericardiectomy. A recent report on the incidence of overt tamponade soon after bypass surgery suggests that a significant volume of pericardial fluid accumulates in the early postoperative course in many instances and that late constriction may not be a rare complication. In treating patients who have circulatory congestion after such operations, it is important that the physician consider constrictive pericarditis and not assume that the clinical findings are the consquence of myocardial failure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. Cardiac injuries caused by blunt chest trauma in children.Two illustrative cases with different features of cardiac injury caused by blunt chest trauma are described. The first patient had mild and obscure symptoms, detected on physical examination, and required observation only. The second patient had acute pericardial tamponade, necessitating surgical treatment. We present the different medical procedures that should be taken into consideration in management of such cases, although continuous monitoring, repeated physical examination, electrocardiograms, chest x-rays, and echocardiography proved sufficient in managing our two children. It is important that physicians who provide care to children suffering from blunt chest trauma have increased awareness of possible cardiac injuries.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Ovarian adenocarcinoma complicated by malignant pericarditis.Neoplastic pericarditis is a rare complication of gynecologic malignancies. However, as illustrated in the case presented, the physician involved in the care of patients with cancer should be aware of this possible life-threatening complication. The case report is followed by a brief review of the pertinent clinical, pathophysiologic, and therapeutic aspects of this condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |