1/14. Survey of general practitioners' attitudes to management of patients with heart attacks.Out of 305 general practitioners sent a questionnaire asking how they would treat three hypothetical patients with heart attacks 231 (76%) replied. Of these, only 179 were prepared to make an unqualified choice of home or hospital treatment for a middle-aged man with an uncomplicated attack, 70 (39%) saying that they would keep the patient at home. Practitioners qualifying before 1960 were more likely to do this than those qualifying in 1960 or later. If a patient declined hospital treatment 161 (70%) of the practitioners would keep him in bed for a week or less, but the date of the practitioners' qualification significantly affected the time they would advise him to remain off work. Faced with a patient acutely ill after a heart attack, 162 (70%) of the practitioners would arrange his immediate admission to hospital and 51 (22%) would send him to hospital after initial treatment at home. The numbers of partners in the practice, the nature of the premises, and the location of the practice in urban or rural areas affected the practitioners' attitude to the management of severely ill patients but not to the management of patients with uncomplicated attacks.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/14. resuscitation from severe acute hypercapnia. Determinants of tolerance and survival.A 46-year-old man underwent cosmetic facial surgery under general anesthesia. He was ventilated by mask with an oxygen-enriched gas mixture for 4 to 6 h and monitored by pulse oximetry. Despite adequate arterial saturation (SaO2 > 90 percent) throughout the procedure, he remained in a deep coma after termination of anesthesia. Initial arterial blood gas analysis revealed a pH of 6.60 and a PaCO2 of 375 mm Hg. The patient was intubated and placed on mechanical ventilation. As his respiratory acidosis resolved, he regained consciousness quickly and recovered without any neurologic deficits. This case of record extreme hypercapnia and review of the literature demonstrates that survival is possible in acute severe respiratory acidosis as long as tissue anoxia and ischemia are prevented. We discuss the tissue effects of acute hypercapnia and newer aspects of the nature of intracellular pH regulation in critical tissues that afford considerable tolerance to acidosis. The dependence of these mechanisms upon active ion transport underscores the importance of adequate tissue oxygenation and perfusion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/14. Mycotic aneurysms and death in a hemodialysis patient.A patient with newly diagnosed end-stage renal disease (ESRD) received a femoral catheter for hemodialysis (HD). Shortly thereafter he developed fever, and blood cultures grew methicillin-resistant staphylococcus aureus. The catheter was removed and the patient was treated with both vancomycin and rifampin; however, blood culture positivity persisted. The cerebrospinal fluid showed sterile meningitis. Subsequent imaging studies demonstrated aortic valve endocarditis and multiple mycotic aneurysms that appeared to include the intra- and extracranial vessels. The patient eventually died from sepsis. This case illustrates the aggressive and invasive nature of systemic infection with S. aureus and underscores the high morbidity and mortality associated with infections related to HD catheters.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/14. Seeing the invisible: painless aortic dissection in the emergency setting.Acute dissection of the aorta can be one of the most dramatic cardiovascular emergencies. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterised as ripping or tearing in nature. However, a timely diagnosis can be elusive in the event of an atypical presentation. In this report, the authors present two patients with painless aortic dissection who were misdiagnosed during their initial evaluation in the emergency department.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/14. bronchoalveolar lavage in recurrent aspirin-induced adult respiratory distress syndrome.aspirin has been reported to induce the adult respiratory distress syndrome (ARDS) in humans. The mechanism of injury appears to be similar to other forms of experimentally induced high-permeability edema in which leukocytes play an important role. In a patient who suffered two episodes of aspirin-related ARDS, bronchoalveolar lavage showed a significant influx of leukocytes. This represents the first reported bronchoalveolar lavage in aspirin-related ARDS, as well as the first documentation of the nonhydrostatic nature of the edema in a patient with recurrence of this entity.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/14. Unilateral pulmonary edema complicating chest compression and cardiac avulsion.A 16-year-old male passenger involved in an automobile accident was observed at autopsy to have total avulsion of the heart from its vascular connections and severe unilateral pulmonary edema. The nature of the injuries and the circumstances of the accident revealed that this finding was not an indication of survival of even limited duration. The possible pathogenesis of the pulmonary edema in the context of the injuries received by the victim are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/14. adult respiratory distress syndrome secondary to ethylene glycol ingestion.Presented is a case of ethylene glycol poisoning in a 24-year-old man who subsequently developed adult respiratory distress syndrome. The noncardiogenic nature of the patient's pulmonary edema was documented with hemodynamic monitoring, and a successful outcome was achieved with hemodialysis, ethanol, and intermittent mechanical ventilation with positive end-expiratory pressure.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/14. Radiographic contrast media-induced noncardiogenic pulmonary edema: case report and review of the literature.Adverse reactions are a frequent complication of exposure to radiographic contrast media (RCM). These reactions are most often anaphylactoid in nature and are characterized by the occurrence of urticaria, angioedema, bronchospasm, and shock. In patients who have had an anaphylactoid reaction to RCM and in whom reexposure is indicated, various pretreatment protocols have been developed to mitigate the risk for recurrence. We report the case of a 46-year-old man who, while undergoing cardiac catheterization, developed noncardiogenic pulmonary edema. This is the first reported case of the occurrence of noncardiogenic pulmonary edema secondary to RCM documented with Swan-Ganz data. In addition, our patient developed noncardiogenic pulmonary edema despite pretreatment with prednisone and diphenhydramine, administered because of a past history of a similar reaction. Potential mechanisms for such a reaction are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/14. ARDS due to ingestion of denatured rapeseed oil.Among the different etiologies of noncardiogenic acute pulmonary edema is found the administration or ingestion of various substances. We have studied two patients with ARDS secondary to the ingestion of toxic oil. Both patients presented similar roentgenographic findings characterized by interstitial and alveolar infiltration in "butterfly" distribution, pleural effusion, and a normal cardiac silhouette. The two cases also showed a pulmonary compliance either normal or slightly diminished. With the aid of artificial ventilation, they evolved favorably, gaseous exchange and chest x-ray films returning to normal 16 and 22 days after admission.- - - - - - - - - - ranking = 4keywords = nature (Clic here for more details about this article) |
10/14. Noncardiogenic pulmonary edema following injection of methotrexate into the cerebrospinal fluid.The most common pulmonary disorder induced by methotrexate is a gradually developing interstitial pneumonitis. The associated clinical manifestations include slowly progressive dyspnea and nonproductive cough, with extensive radiographic changes. One case has been reported following intrathecal methotrexate administration; the remainder occurred after either intravenous or oral therapy. We report two cases of rapidly developing respiratory distress following the administration of methotrexate into the cerebrospinal fluid. The clinical courses, radiologic findings, and, in one patient, the pathologic nature, are consistent with noncardiogenic pulmonary edema.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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