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  1. Chest Pain

    MedlinePlus

    ... causes Chest pain can also be caused by: Panic attack. If you have periods of intense fear accompanied ... fear of dying, you may be experiencing a panic attack. Shingles. Caused by a reactivation of the chickenpox ...

  2. Musculoskeletal chest wall pain

    PubMed Central

    Fam, Adel G.; Smythe, Hugh A.

    1985-01-01

    The musculoskeletal structures of the thoracic wall and the neck are a relatively common source of chest pain. Pain arising from these structures is often mistaken for angina pectoris, pleurisy or other serious disorders. In this article the clinical features, pathogenesis and management of the various musculoskeletal chest wall disorders are discussed. The more common causes are costochondritis, traumatic muscle pain, trauma to the chest wall, “fibrositis” syndrome, referred pain, psychogenic regional pain syndrome, and arthritis involving articulations of the sternum, ribs and thoracic spine. Careful analysis of the history, physical findings and results of investigation is essential for precise diagnosis and effective treatment. ImagesFig. 3Fig. 4Fig. 5 PMID:4027804

  3. Angina - when you have chest pain

    MedlinePlus

    ... pain; ACS - chest pain; Heart attack - chest pain; Myocardial infarction - chest pain; MI - chest pain ... AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College ...

  4. Non-Cardiac Chest Pain

    MedlinePlus

    ... No other specific risk factors have been identified. Diagnosis What do I do if I’ve been treated for chest pain, but told I didn’t have a heart attack? Patients suffering from chest pain must have thorough ...

  5. Chest Pain: First Aid

    MedlinePlus

    ... Classification of unstable angina and non-ST elevation myocardial infarction. http://uptodate.com/home. Accessed Dec. 23, 2014. ... AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology ...

  6. [Cardiac causes of chest pain].

    PubMed

    Wächter, C; Markus, B; Schieffer, B

    2017-01-01

    Because of the life-threatening character and a high prevalence in emergency rooms, cardiac causes are important differential diagnoses of acute chest pain with the need for rapid clarification. In this context the working diagnosis "acute coronary syndrome" (ACS) plays a major role. In a synopsis of the clinical presentation, medical history, electrocardiogram and analysis of cardiac biomarkers, ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina pectoris can be specified as entities of ACS. The treatment of ACS consists of an immediate anti-ischemic therapy, anti-thrombotic therapy and invasive coronary diagnostics with subsequent interventional or operative revascularization therapy. The timing of invasive management is essentially determined by the individual patient risk, with the exception of STEMI where interventional revascularization must be undertaken within 120 min of diagnosis. In this context the GRACE 2.0 and TIMI risk score have become established as reliable tools. Another rare but fatal cause of acute chest pain is aortic dissection. An abrupt onset of tearing and sharp chest pains, deficits in pulse as well as the presence of high-risk factors, such as advanced age, arterial hypertension, atherosclerosis, known collagenosis and previous aortic or coronary artery procedures are highly indicative for aortic dissection and additional diagnostic imaging and the highly sensitive D‑dimer should be undertaken. Additionally, inflammatory diseases, such as pericarditis and myocarditis can be associated with chest pains and mimic the character of ACS and should also be considered in the differential diagnostics.

  7. Noncardiac chest pain: current treatment.

    PubMed

    Schey, Ron; Villarreal, Autumn; Fass, Ronnie

    2007-04-01

    Noncardiac chest pain (NCCP) is very common, affecting up to 25% of the adult population in the United States. Treatment for NCCP has markedly evolved in the past decade and is presently focused on gastroesophageal reflux disease (GERD) and visceral hypersensitivity. Aggressive treatment with proton pump inhibitors has become the standard of care for GERD-related NCCP. Pain modulators such as tricyclics, trazodone, and selective serotonin reuptake inhibitors are considered the mainstay of therapy for non-GERD-related NCCP Other therapeutic modalities such as botulinum toxin injections and hypnotherapy have demonstrated promise in small clinical trials.

  8. [Chest pains in the dental environment].

    PubMed

    Garfunkel, A; Galili, D; Findler, M; Zusman, S P; Malamed, S F; Elad, S; Kaufman, E

    2002-01-01

    Chest pain does not necessarily indicate cardiac disease. The most common causes of acute chest pain encountered in dental situations include hyperventilation, pulmonary embolism, angina pectoris and myocardial infarction. Stress and fear often cause rapid breathing or hyperventilation. This usually occurs in young adults and although the hyperventilating patient often complains of chest pain, this is rarely a manifestation of cardiac disease. Pulmonary embolism usually indicates the occlusion of a pulmonary artery causing severe chest pain. The primary clinical manifestation of angina pectoris is chest pain. Although most instances of anginal pain are easily terminated, the dentist must always consider the possibility that the supposed anginal attack is actually a sign of acute myocardial infarction (AMI). AMI is a clinical syndrome caused by a deficient coronary arterial blood supply to a region of myocardium that results in cellular death. There is a high incidence of mortality among AMI with death often occurring within 2 hours of the onset of signs and symptoms. The initial clinical manifestations of all types of chest pain can be similar. Therefore the dentist must develop proficiency in constituting a differential diagnosis and an efficient management protocol. As in most medical situations prevention is the most powerful tool. However, if chest pains do occur, measures such as airway management, oxygen supplementation, coronary artery dilation, analgesis and in extreme cases, cardiopulmonary resuscitation and evacuation to the emergency room, may be necessary.

  9. [Diagnosis and management of esophageal chest pain].

    PubMed

    Hong, Su Jin

    2010-04-01

    Esophageal pain that manifests as heartburn or chest pain, is a prevalent problem. Esophageal chest pain is most often caused by gastroesophageal reflux disease (GERD), but can also result from inflammatory processes, infections involving the esophagus, and contractions of the esophageal muscle. The mechanisms and pathways of esophageal chest pain are poorly understood. Vagal and spinal afferent pathways carry sensory information from the esophagus. Recently, esophageal hypersensitivity is identified as an important factor in the development of esophageal pain. A number of techniques are available to evaluate esophageal chest pain such as endoscopy and/or proton-pump inhibitor trial, esophageal manometry, a combined impedance-pH study, and esophageal ultrasound imaging. Proton pump inhibitors (PPIs) have the huge success in the treatment of GERD. Other drugs such as imipramine, trazadone, sertraline, tricyclics, and theophylline have been introduced for the control of esophageal chest pain in partial responders to PPI and the patients with esophageal hypersensitivity. Novel drugs which act on different targets are anticipated to treat esophageal pain in the future.

  10. A Review of Esophageal Chest Pain.

    PubMed

    Coss-Adame, Enrique; Rao, Satish S C

    2015-11-01

    Noncardiac chest pain is a term that encompasses all causes of chest pain after a cardiac source has been excluded. This article focuses on esophageal sources for chest pain. Esophageal chest pain (ECP) is common, affects quality of life, and carries a substantial health care burden. The lack of a systematic approach toward the diagnosis and treatment of ECP has led to significant disability and increased health care costs for this condition. Identifying the underlying cause(s) or mechanism(s) for chest pain is key for its successful management. Common etiologies include gastroesophageal reflux disease, esophageal hypersensitivity, dysmotility, and psychological conditions, including panic disorder and anxiety. However, the pathophysiology of this condition is not yet fully understood. Randomized controlled trials have shown that proton pump inhibitor therapy (either omeprazole, lansoprazole, or rabeprazole) can be effective. Evidence for the use of antidepressants and the adenosine receptor antagonist theophylline is fair. Psychological treatments, notably cognitive behavioral therapy, may be useful in select patients. Surgery is not recommended. There remains a large unmet need for identifying the phenotype and prevalence of pathophysiologic mechanisms of ECP as well as for well-designed multicenter clinical trials of current and novel therapies.

  11. Evaluation and treatment of musculoskeletal chest pain.

    PubMed

    Ayloo, Amba; Cvengros, Teresa; Marella, Srimannarayana

    2013-12-01

    This article summarizes the evaluation and treatment of musculoskeletal causes of chest pain. Conditions such as costochondritis, rib pain caused by stress fractures, slipping rib syndrome, chest wall muscle injuries, fibromyalgia, and herpes zoster are discussed, with emphasis on evaluation and treatment of these and other disorders. Many of these conditions can be diagnosed by the primary care clinician in the office by history and physical examination. Treatment is also discussed, including description of manual therapy and exercises as needed for some of the conditions.

  12. Esophageal hypersensitivity in noncardiac chest pain.

    PubMed

    Min, Yang Won; Rhee, Poong-Lyul

    2016-09-01

    Noncardiac chest pain (NCCP) is an often-encountered clinical problem. Although many patients suffer from persistent or recurrent chest pain, treatment remains a challenge owing to its various possible etiologies. Gastroesophageal reflux disease (GERD) is the most common cause of NCCP. In GERD-related NCCP, proton pump inhibitor treatment appears to be effective. However, the pathophysiology remains to be fully elucidated in NCCP patients without GERD. Treatment for non-GERD-related NCCP has been aimed at esophageal motility disorders and visceral hypersensitivity. As there is growing evidence that esophageal visceral hypersensitivity plays a role in NCCP, pain modulators have become the mainstay of therapy in patients with non-GERD-related NCCP. However, there is an unmet need for the treatment of esophageal hypersensitivity in NCCP due to modest evidence for the benefit of pain modulators, including antidepressants, in non-GERD-related NCCP. Recent studies have demonstrated that esophageal mast cell infiltration and impaired mucosal integrity are related to visceral hypersensitivity in patients with NCCP. Thus, esophageal mast cell stabilization and restoration of esophageal mucosal integrity could be considered potential therapeutic targets in selected NCCP patients with hypersensitivity. However, further observations are necessary to shed light on esophageal hypersensitivity in NCCP.

  13. Computer Assisted Diagnosis of Chest Pain. Preliminary Manual

    DTIC Science & Technology

    1984-04-27

    addition, chest pain has been reported to be one of the most frequent causes of medical evacuation from submarines. The Naval Submarine Medical...having potentially fatal outcomes. In addition, chest pain has been reported to be one of the most frequent causes of medical evacuation from submarines...serious causes of acute chest pain . The 5 illnesses which are considered by the conputer are MY0CARD1AL INFARCTION, ANGINA, NON-SPECIFIC CNEST PAIN

  14. Acute Chest Pain: Emergency Evaluation and Management

    PubMed Central

    Walker, David M. C.

    1982-01-01

    Since cardiovascular and pulmonary disorders have significant morbidity and mortality, triage of patients who complain of chest pain is paramount. The less sophisticated the triage system, the more important the protocol should be to have these patients evaluated immediately. History and physical are still the most important diagnostic tools; information should be gathered from all available sources. Advanced cardiac life support training is most useful. Eight diagnostic classifications are described, together with the distinctions of onset, duration, location, radiation, precipitating and relieving factors, character and associated symptoms. The protocol for initial management is outlined, emphasizing coincident management wherever possible. Imagesp2005-a PMID:21286539

  15. Socioeconomic variations in responses to chest pain: qualitative study

    PubMed Central

    Richards, Helen Mary; Reid, Margaret Elspeth; Watt, Graham Charles Murray

    2002-01-01

    Objective To explore and explain socioeconomic variations in perceptions of and behavioural responses to chest pain. Design Qualitative interviews. Setting Community based study in Glasgow, Scotland. Participants 30 respondents (15 men and 15 women) from a socioeconomically deprived area of Glasgow and 30 respondents (15 men and 15 women) from an affluent area of Glasgow. Outcome measures Participants' reports of their perceptions of and actions in response to chest pain. Results Residents of the deprived area reported greater perceived vulnerability to heart disease, stemming from greater exposure to heart disease in family members and greater identification with high risk groups and stereotypes of cardiac patients. This greater perceived vulnerability was not associated with more frequent reporting of presenting to a general practitioner. People from the deprived area reported greater exposure to ill health, which allowed them to normalise their chest pain, led to confusion with other conditions, and gave rise to a belief that they were overusing medical services. These factors were associated with a reported tendency not to present with chest pain. Anxiety about presenting among respondents in the deprived area was heightened by self blame and fear that they would be chastised by their general practitioner for their risk behaviours. Conclusions Important socioeconomic variations in responses to chest pain may contribute to the known inequities in uptake of secondary cardiology services. Primary care professionals and health promoters should be aware of the ways in which perceptions of symptoms and illness behaviour are shaped by social and cultural factors. What is already known on this topicSocioeconomic variations in rates of angiography and revascularisation existAmong socioeconomically deprived patients with a diagnosis of angina, barriers to accessing services include fear, denial, low expectations, and diagnostic confusionWhat this study adds

  16. An atypical cause of atypical chest pain

    PubMed Central

    Zaheen, Ahmad; Siemieniuk, Reed A; Gudgeon, Patrick

    2014-01-01

    The present report describes a case involving a 57-year-old HIV-positive man who presented with acute retrosternal chest pain accompanied by 24 h of fever. Septic arthritis of the manubriosternal joint was diagnosed based on magnetic resonance imaging findings in addition to Staphylococcus aureus bacteremia. To the authors’ knowledge, the present case is only the 12th reported case of manubriosternal septic arthritis, and the first in an HIV-positive patient. Early diagnosis and treatment can circumvent the need for surgical intervention. Based on the present case report and review of the literature, the authors summarize the epidemiology, appropriate imaging and suggestions for antibiotic therapy for this rare presentation. PMID:25371686

  17. Sexual, Physical, Verbal/Emotional Abuse and Unexplained Chest Pain

    ERIC Educational Resources Information Center

    Eslick, Guy D.; Koloski, Natasha A.; Talley, Nicholas J.

    2011-01-01

    Objectives: Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained…

  18. Coping in Chest Pain Patients with and without Psychiatric Disorders.

    ERIC Educational Resources Information Center

    Vitaliano, Peter P.; And Others

    1989-01-01

    Examined relations between psychiatric disorder and coronary heart disease (CHD) in 77 patients with chest pain, and compared coping profiles of chest pain patients with and without psychiatric disorders and CHD. Psychiatric patients with no medical disease were also studied. Results are discussed in the context of illness behavior and…

  19. Medic - Chest Pain: A Decision Support Program for the Management of Acute Chest Pain (User’s Manual)

    DTIC Science & Technology

    1989-10-05

    musculoskeletal chest pain; b) pleurisy ; c) pulmonary erbolus; d) mediastinal emphysema a) Musculoskeletal chest pain and the pain of costochondritis denote muscle...includes mild A-22 analgesics/anti-inflammatory drugs, heat therapy, and rest. b) Pleurisy denotes inflammation of the pleura. It may be seen in the...setting of bronchitis or pneumonia. The symptoms of both assist in differentiating pleurisy fru pneumothorax. In the absence of signs of pneumonia or

  20. Cervical angina: an overlooked source of noncardiac chest pain.

    PubMed

    Sussman, Walter I; Makovitch, Steven A; Merchant, Shabbir Hussain I; Phadke, Jayant

    2015-01-01

    Cervical angina has been widely reported as a cause of chest pain but remains underrecognized. This series demonstrates the varied clinical presentation of patients with cervical angina, the delay in diagnosis, and the extensive cardiac examinations patients with this condition typically undergo prior to a definitive diagnosis. Recognition of this condition in patients with acute chest pain requires a high index of suspicion and an awareness of the common presenting features and clinical findings of cervical angina.

  1. Role of multidetector computed tomography in the diagnosis and management of patients attending the rapid access chest pain clinic, The Scottish computed tomography of the heart (SCOT-HEART) trial: study protocol for randomized controlled trial

    PubMed Central

    2012-01-01

    Background Rapid access chest pain clinics have facilitated the early diagnosis and treatment of patients with coronary heart disease and angina. Despite this important service provision, coronary heart disease continues to be under-diagnosed and many patients are left untreated and at risk. Recent advances in imaging technology have now led to the widespread use of noninvasive computed tomography, which can be used to measure coronary artery calcium scores and perform coronary angiography in one examination. However, this technology has not been robustly evaluated in its application to the clinic. Methods/design The SCOT-HEART study is an open parallel group prospective multicentre randomized controlled trial of 4,138 patients attending the rapid access chest pain clinic for evaluation of suspected cardiac chest pain. Following clinical consultation, participants will be approached and randomized 1:1 to receive standard care or standard care plus ≥64-multidetector computed tomography coronary angiography and coronary calcium score. Randomization will be conducted using a web-based system to ensure allocation concealment and will incorporate minimization. The primary endpoint of the study will be the proportion of patients diagnosed with angina pectoris secondary to coronary heart disease at 6 weeks. Secondary endpoints will include the assessment of subsequent symptoms, diagnosis, investigation and treatment. In addition, long-term health outcomes, safety endpoints, such as radiation dose, and health economic endpoints will be assessed. Assuming a clinic rate of 27.0% for the diagnosis of angina pectoris due to coronary heart disease, we will need to recruit 2,069 patients per group to detect an absolute increase of 4.0% in the rate of diagnosis at 80% power and a two-sided P value of 0.05. The SCOT-HEART study is currently recruiting participants and expects to report in 2014. Discussion This is the first study to look at the implementation of computed

  2. CPDX (Chest Pain Diagnostic Program) - A Decision Support System for the Management of Acute Chest Pain (User’s Manual)

    DTIC Science & Technology

    1988-02-25

    chest pain and/or dyspnea are present. a. Musculoskeletal pain b. Pleurisy c. Pulmonary embolus d. Spontaneous mediastinal emphysema a...Treatment includes mild analgesics, heat therapy, and, perhaps, rest. b) Pleurisy denotes inflammation of the pleura. It is seen in the setting of...bronchitis or pneumonia; the symptoms of both assist in differentiating pleurisy from pneumothorax. Chest discomfort is pleuristic. Unless there are

  3. Noncardiac Chest Pain in Children and Adolescents: A Biopsychosocial Conceptualization

    ERIC Educational Resources Information Center

    McDonnell, Cassandra J.; White, Kamila S.; Grady, R. Mark

    2012-01-01

    Pediatric NCCP may be characterized by recurrent pain accompanied by emotional distress and functional impairment. This paper reviews and critiques literature on pediatric noncardiac chest pain (NCCP) and introduces a theoretical conceptualization to guide future study of NCCP in children and adolescents. A developmentally informed biopsychosocial…

  4. Dual-source CT for chest pain assessment

    PubMed Central

    Nikolaou, Konstantin; Becker, Alexander; Leber, Alexander W.; Rist, Carsten; Wintersperger, Bernd J.; Reiser, Maximilian F.; Becker, Christoph R.

    2007-01-01

    Comprehensive CT angiography protocols offering a simultaneous evaluation of pulmonary embolism, coronary stenoses and aortic disease are gaining attractiveness with recent CT technology. The aim of this study was to assess the diagnostic accuracy of a specific dual-source CT protocol for chest pain assessment. One hundred nine patients suffering from acute chest pain were examined on a dual-source CT scanner with ECG gating at a temporal resolution of 83 ms using a body-weight-adapted contrast material injection regimen. The images were evaluated for the cause of chest pain, and the coronary findings were correlated to invasive coronary angiography in 29 patients (27%). The files of patients with negative CT examinations were reviewed for further diagnoses. Technical limitations were insufficient contrast opacification in six and artifacts from respiration in three patients. The most frequent diagnoses were coronary stenoses, valvular and myocardial disease, pulmonary embolism, aortic aneurysm and dissection. Overall sensitivity for the identification of the cause of chest pain was 98%. Correlation to invasive coronary angiography showed 100% sensitivity and negative predictive value for coronary stenoses. Dual-source CT offers a comprehensive, robust and fast chest pain assessment. PMID:18034246

  5. Computer Assisted Diagnosis of Chest Pain. Adjunctive Treatment Protocols

    DTIC Science & Technology

    1984-07-30

    or dyspnea is present. a. Musculöskeletal pain b. Pleurisy c. Pulmonary embolus d. Spontaneous mediastinal emphysema a) Musculoskeletal chest...analgesics, heat therapy, and, perhaps, rest. b) Pleurisy denotes inflammation of the pleura. It is seen in the setting of bronchitis or pneumonia...the symptoms of both assist in differentiating pleurisy from pneumothorax. Chest discomfort is pleuritic. unless there are signs of pneumonia, lung

  6. Spontaneous pneumomediastinum: an important differential in acute chest pain

    PubMed Central

    Hogan, Francesca; McCullough, Chris; Rahman, Asif

    2014-01-01

    A 38-year-old man presented with pleuritic chest pain that was present on waking and localised to the left costal margin with no radiation. He was otherwise asymptomatic and denied preceding trauma, heavy lifting, coughing or recent vomiting. Observations and examination were unremarkable; however, a chest radiograph showed a pneumomediastinum. Spontaneous pneumomediastinum (SPM) is a rare condition that tends to follow a benign clinical course. A CT of the chest is generally only indicated if the chest X-ray fails to show an SPM in patients for whom there is a high index of clinical suspicion. A contrast-enhanced swallow study is only indicated if there is suspicion of an oesophageal tear or rupture. Evidence suggests that patients with SPM can be managed conservatively and observed for 24 h. PMID:25432910

  7. Chest Wall Pain as the Presenting Symptom of Leptomeningeal Carcinomatosis

    PubMed Central

    Sim, Kyoung Bo; Lee, Ho Jun; Park, Jin-Woo; Ryu, Gi Hyeong; Chang, Jihea; Kwon, Bum Sun

    2014-01-01

    Leptomeningeal metastasis (LMM), also referred to as leptomeningeal carcinomatosis, results from diffuse infiltration of the leptomeninges by malignant cells originating from extra-meningeal primary tumors. It occurs in approximately 5%-10% of patients with solid tumor. Among solid tumors, the most common types leading to infiltration of the leptomeninges are breast cancer, lung cancer, and melanoma. Patients with LMM may present various signs and symptoms. Herein, we report a rare case with initial presentation of isolated chest wall pain. Computed tomography of the chest with contrast revealed a 2.5-cm nodule over the left upper lung. Biopsy confirmed the diagnosis of adenocarcinoma. Later, cerebrospinal fluid cytology exam also confirmed leptomeningeal seeding. It is rare for leptomeningeal carcinomatosis patients to present with chest wall pain. Therefore, a high index of suspicion is mandatory for accurate and prompt diagnosis. PMID:25566489

  8. The Electrocardiogram of an ER Patient With Chest Pain

    PubMed Central

    Panneerselvam, Arunkumar; Ananthakrishna, Rajiv; Bhat, Prabhavathi; Nanjappa, Manjunath C

    2011-01-01

    The electrocardiogram (ECG) is an essential investigation in the evaluation of chest pain in the emergency room (ER). Correct interpretation of the ECG findings, determines the diagnosis and management strategy. This ECG spot diagnosis will improve the skills of the residents and physicians working in ER.

  9. Illness perceptions, negative emotions, and pain in patients with noncardiac chest pain.

    PubMed

    Israel, Jared I; White, Kamila S; Gervino, Ernest V

    2015-03-01

    Illness-specific cognitions are associated with outcomes in numerous health conditions, however, little is known about their role in noncardiac chest pain (NCCP). NCCP is prevalent, impairing, and associated with elevated health care utilization. Our objective was to investigate the relations between illness perceptions, emotion, and pain in a sample of 196 adult patients diagnosed with NCCP. We found that negative illness perceptions were associated with greater anxiety, depression, chest pain, and pain-related life interference while controlling for the effects of demographic and pain-related variables. These results expand current NCCP theory and may inform future treatment development.

  10. Pain in the chest in a user of cocaine

    SciTech Connect

    Wiener, M.D.; Putnam, C.E.

    1987-10-16

    A 21-year-old man presented with pleuritic substernal chest pain of one hour's duration. The pain was exacerbated in a supine position and did not radiate. Questioning revealed that he was a recreational user of cocaine and had inhaled free-based cocaine via a pipe the previous evening and as recently as two hours before admission to the hospital. Physical examination demonstrated an anxious young man with a respiratory rate of 26 breaths per minute and shallow. He was afebrile with normal heart rate and blood pressure. His sternum was tender to palpation, and auscultation revealed precordial crepitus synchronous with systole. His electrocardiogram showed sinus rhythm at a rate of 62 beats per minute. Posteroanterior and lateral roentgenograms of the chest were obtained. A diagnosis of spontaneous pneumomediastinum was made.

  11. Chest Pain: The Need to Consider Less Frequent Diagnosis

    PubMed Central

    Morais, Anabela; Carvalho, Sofia; Cunha, Joana; Lima, Ana R.; Moreira, J. Ilídio; Faria, Trigo

    2016-01-01

    Chest pain is one of the most frequent patient's complaints. The commonest underlying causes are well known, but, sometimes, in some clinical scenarios, it is necessary to consider other diagnoses. We report a case of a 68-year-old Caucasian male, chronically hypertensive, who complained of recurrent episodes of chest pain and fever with elevated acute phase reactants. The first investigation was negative for some of the most likely diagnosis and he quickly improved with anti-inflammatory drugs. Over a few months, his symptoms continued to recur periodically, his hypertension was aggravated, and he developed headaches and lower limbs claudication. After a temporal artery biopsy that was negative for vasculitis, he underwent a positron emission tomography suggestive of Takayasu Arteritis. Takayasu Arteritis is a rare chronic granulomatous vasculitis of the aorta and its first-order branches affecting mostly females up to 50 years old. Chest pain is experienced by >40% of the patients and results from the inflammation of the aorta, pulmonary artery, or coronaries. PMID:27034853

  12. Monsters do exist: an unusual case of chest pain.

    PubMed

    Thomas, Mari Lluon

    2014-01-21

    A 19-year-old man presented to the emergency department with a 3-week history of chest pain. Despite normal examination, bloods and observations of his chest X-ray revealed a large opacity in the middle and lower right zone. Further imaging revealed a multicystic mediastinal teratoma. He was admitted under the respiratory physicians who arranged further investigations and discussed his case with the lung and testicular multidisciplinary team. He was started on neoadjuvant chemotherapy with a plan for future definitive surgical resection. Four months later he suddenly deteriorated due to airway compression from the tumour. He underwent an emergency thoracotomy and tumour resection. He is currently doing well and is thought to have a good prognosis following complete resection of his tumour. This case report summarises this rare diagnosis and emphasises the need for careful evaluation of patients despite their initial well appearance, especially in patients who are reattending.

  13. Acute right ventricular myocarditis presenting with chest pain and syncope

    PubMed Central

    Mancio, Jennifer; Bettencourt, Nuno; Oliveira, Marco; Pires-Morais, Gustavo; Ribeiro, Vasco Gama

    2013-01-01

    Myocarditis is assumed to involve both ventricles equally. Right ventricular predominant involvement is rarely described. A case of acute viral right ventricular myocarditis presenting with chest pain and syncope, grade 3 atrioventricular block, right ventricular dilatation and free wall hypokinesia is reported. Cardiac MRI showed late enhancement of the right ventricular free wall without involvement of the left ventricle. Anti-Coxsackie A9 virus neutralising IgM-type antibodies titre was elevated. This case emphasises that manifestations of myocarditis can be limited to the right ventricle and should be considered in the differential diagnosis of right ventricular enlargement. PMID:24096068

  14. It's Not Your Heart: Group Treatment for Non-Cardiac Chest Pain

    ERIC Educational Resources Information Center

    Hess, Sherry M.

    2011-01-01

    This article presents a brief group psychoeducational treatment for non-cardiac chest pain, supplemented with a composite case study. Patients present to emergency rooms for chest pain they believe is a heart attack symptom. When cardiac testing is negative, this pain is usually a panic symptom, often occurring with a cluster of other panic…

  15. Failure of a negative exercise test to reassure patients with chest pain.

    PubMed

    Channer, K S; James, M A; Papouchado, M; Rees, J R

    1987-04-01

    Seventy-two patients with chest pain and negative exercise tests were observed. Twenty-one (29 per cent) became pain free but 51 (71 per cent) continued to complain of chest pain. Patients with persistent pain were significantly more anxious and depressed at presentation and later compared with those who had become pain free. Anxiety and particularly depression, at presentation and later, were significantly associated with severe symptoms. Patients with chest pain associated with neurosis and depression are not reassured by physiological stress testing because their physical symptoms are a feature of underlying psychiatric disease.

  16. Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria

    PubMed Central

    2016-01-01

    Background Chest pain is a common clinical syndrome. However, there is a paucity of African studies describing the causes, prevalence, aetiology, and disposition of patients with chest pain presenting in the emergency department (ED). Aim The aim of this retrospective descriptive study was to determine the prevalence, causes, demographics, and disposition of all adult patients with the main complaint of chest pain presenting at the ED of a regional hospital in South Africa. Methods Records of all patients 18 years and older presenting with the complaint of chest pain from 1 December 2011 through 10 April 2012 were assessed. A data collection sheet capturing patient demographics and disposition from the ED was used. The diagnosis was subdivided into groups: cardiovascular, respiratory, gastrointestinal, musculoskeletal, psychiatric/psychogenic, other, and unknown. Results Of the 312 patients presenting with chest pain, 210 patient files were retrieved. The prevalence of non-traumatic chest pain was 1.66%. Respiratory disease was the most common cause (36.19%), with pneumonia the most common diagnosis (24.40%). Logistic regression showed diagnoses of acute cardiovascular disease or respiratory disease, older age, and transport by ambulance as being associated with admission. Conclusion The main cause of acute chest pain was found to be respiratory disease, followed by musculoskeletal disorders. In the African context, the aetiology of acute chest pain differs from that in first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain. PMID:27380782

  17. Exercise radionuclide ventriculographic responses in hypertensive patients with chest pain

    SciTech Connect

    Wasserman, A.G.; Katz, R.J.; Varghese, P.J.; Leiboff, R.H.; Bren, G.G.; Schlesselman, S.; Varma, V.M.; Reba, R.C.; Ross, A.M.

    1984-11-15

    The effectiveness of exercise-treadmill testing in diagnosing coronary-artery disease in hypertensive patients is limited by a high rate of false positivity. Exercise radionuclide ventriculography, however, relies on different criteria (ejection fraction and wall motion), and we have evaluated this procedure in 37 hypertensive and 109 normotensive patients with chest pain, using coronary arteriography as an indicator of coronary disease. In the hypertensive cohort there was no difference in the ejection fraction at rest between the 17 patients with coronary disease and the 20 without it. Neither group had a significant mean (+/- S.E.M.) change in ejection fraction from rest to exercise (-1.9 +/- 2 and 1.4 +/- 1%, respectively). A wall-motion abnormality developed during exercise in 5 of the 17 hypertensive patients with coronary disease (29%) and in 4 of the 20 without it (20%) (P = not significant). In the normotensive cohort, however, the peak-exercise ejection fractions were significantly different. The 71 patients with coronary disease had a mean decrease of 3.6 +/- 1%, in contrast to the patients without coronary disease, who had an increase of +/- 1% (P < 0.001). An exercise-induced wall-motion abnormality was seen in 35 of the 71 patients with coronary disease (48%), as compared with 3 of the 38 without it (8%) (P < 0.001). We conclude that exercise radionuclide ventriculography is inadequate as a screening test for coronary atherosclerosis in hypertensive patients with chest pain. 28 references, 2 figures, 3 tables.

  18. Prognosis with chest pain and normal thallium-201 exercise scintigrams

    SciTech Connect

    Pamelia, F.X.; Gibson, R.S.; Watson, D.D.; Craddock, G.B.; Sirowatka, J.; Beller, G.A.

    1985-04-01

    The goal of this study was to determine the prognostic value of a normal exercise thallium-201 (TI-201) scintigram by quantitative criteria in a consecutive series of 349 patients with chest pain. Follow- up was obtained in 345 patients (99%) from 8 to 45 months (mean 34 +/- 7). Of these, 60% were men, 26% had typical angina, 21% had chest pain during exercise testing, 29% were unable to achieve 85% or more of maximal predicted heart rate, and in 9% ischemic ST depression (1.0 mm or greater) developed during exercise. At the time of exercise testing, 45% of patients were taking nitrates and 38% were receiving a beta- blocking drug. During the follow-up period, there were 5 cardiac deaths (0.51%/year), of which 2 were sudden, 6 patients had a nonfatal myocardial infarction (MI) (0.61%/year). Two of the 5 patients who died and 1 who had MI had angiographically normal coronary arteries. The event rate was significantly higher (p less than 0.01) in patients referred for early catheterization (5 of 53; 9%) compared with the rate for those not undergoing early angiography (6 of 298; 2%). However, the event rate was similar in those who underwent catheterization with angiographically normal coronary arteries and in those who had significant coronary artery disease.

  19. Predicting Chest Wall Pain From Lung Stereotactic Body Radiotherapy for Different Fractionation Schemes

    SciTech Connect

    Woody, Neil M.; Videtic, Gregory M.M.; Stephans, Kevin L.; Djemil, Toufik; Kim, Yongbok; Xia Ping

    2012-05-01

    Purpose: Recent studies with two fractionation schemes predicted that the volume of chest wall receiving >30 Gy (V30) correlated with chest wall pain after stereotactic body radiation therapy (SBRT) to the lung. This study developed a predictive model of chest wall pain incorporating radiobiologic effects, using clinical data from four distinct SBRT fractionation schemes. Methods and Materials: 102 SBRT patients were treated with four different fractionations: 60 Gy in three fractions, 50 Gy in five fractions, 48 Gy in four fractions, and 50 Gy in 10 fractions. To account for radiobiologic effects, a modified equivalent uniform dose (mEUD) model calculated the dose to the chest wall with volume weighting. For comparison, V30 and maximum point dose were also reported. Using univariable logistic regression, the association of radiation dose and clinical variables with chest wall pain was assessed by uncertainty coefficient (U) and C statistic (C) of receiver operator curve. The significant associations from the univariable model were verified with a multivariable model. Results: 106 lesions in 102 patients with a mean age of 72 were included, with a mean of 25.5 (range, 12-55) months of follow-up. Twenty patients reported chest wall pain at a mean time of 8.1 (95% confidence interval, 6.3-9.8) months after treatment. The mEUD models, V30, and maximum point dose were significant predictors of chest wall pain (p < 0.0005). mEUD improved prediction of chest wall pain compared with V30 (C = 0.79 vs. 0.77 and U = 0.16 vs. 0.11). The mEUD with moderate weighting (a = 5) better predicted chest wall pain than did mEUD without weighting (a = 1) (C = 0.79 vs. 0.77 and U = 0.16 vs. 0.14). Body mass index (BMI) was significantly associated with chest wall pain (p = 0.008). On multivariable analysis, mEUD and BMI remained significant predictors of chest wall pain (p = 0.0003 and 0.03, respectively). Conclusion: mEUD with moderate weighting better predicted chest wall pain than

  20. Chest Pain in the Setting of Altered Mental Status.

    PubMed

    Tjoeng, Yuen Lie; Mickley, Megan; Prentiss, Kimball

    2017-03-01

    We report on a young adult female presenting with altered mental status and chest pain. Timely review of her electronic medical record revealed a history of panhypopituitarism with poor medication adherence, although this was unknown at the time of her initial evaluation.The patient required hormone replacement and significant fluid resuscitation, followed by definitive treatment with a pericardiocentesis. She was discharged home on hospital day 4, with normalization of her diminished left ventricular ejection fraction at her 1-month follow-up.Although panhypopituitarism and cardiac tamponade are rare diagnoses, we highlight the management of severe hypothyroidism, the importance of early administration of hydrocortisone for panhypopituitarism, and the need for aggressive volume expansion to maintain preload in cardiac tamponade.

  1. A rare cause of chest pain in a cancer patient

    PubMed Central

    Welaya, Karim; Yousuf, Kabir; del Pilar Morales, Maria

    2016-01-01

    It is well known that cancer and hypercoagulability go hand in hand. Most thromboembolism is venous in nature although arterial thrombosis can occur. Arterial thrombosis secondary to malignancy is usually seen in the lower extremities; however, it can also be seen elsewhere. This is a case of bronchogenic carcinoma with no history of typical atherosclerotic risk factors including smoking, diabetes mellitus, hypertension, or hyperlipidemia presented with chest pain and was found to have an acute ST segment elevation myocardial infection. Coronary angiography showed a large thrombus in the left anterior descending artery in the absence of any atherosclerotic lesions. Malignancy is considered to be the major contributing factor for this myocardial infarction in the absence of both atherosclerotic risk factors and atherosclerotic lesions in the coronary angiography. We will focus on the relationship between cancer and thrombosis with special emphasis on arterial thromboembolism with subsequent development of myocardial infarction. PMID:27124166

  2. Plasma fibrinopeptide A and beta-thromboglobulin in patients with chest pain.

    PubMed

    Douglas, J T; Lowe, G D; Forbes, C D; Prentice, C R

    1983-08-30

    Plasma levels of beta-thromboglobulin (BTG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in 48 patients within 3 days of admission to hospital for acute chest pain. Twenty-one patients had a confirmed myocardial infarction (MI); 15 had unstable angina without infarction; and 12 had chest pain due to noncardiac causes. FPA and BTG were also measured in 23 control hospital patients of similar age. Mean plasma BTG levels were not significantly different in the 4 groups. Mean plasma FPA levels were significantly higher in all 3 groups with acute chest pain when compared to the control subjects (p less than 0.01), but there were no significant differences between the 3 groups. Increased FPA levels in patients with acute chest pain are not specific for myocardial infarction, nor for ischaemic chest pain.

  3. Diagnostic values of chest pain history, ECG, troponin and clinical gestalt in patients with chest pain and potential acute coronary syndrome assessed in the emergency department.

    PubMed

    Mokhtari, Arash; Dryver, Eric; Söderholm, Martin; Ekelund, Ulf

    2015-01-01

    In the assessment of chest pain patients with suspected acute coronary syndrome (ACS) in the emergency department (ED), physicians rely on global diagnostic impressions ('gestalt'). The aim of this study was to determine the diagnostic value of the ED physician's overall assessment of ACS likelihood, and the values of the main diagnostic modalities underlying this assessment, namely the chest pain history, the ECG and the initial troponin result. 1,151 consecutive ED chest pain patients were prospectively included. The ED physician's interpretation of the chest pain history, the ECG, and the global likelihood of ACS were recorded on special forms. The discharge diagnoses were retrieved from the medical records. A chart review was carried out to determine whether patients with a non-ACS diagnosis at the index visit had ACS or suffered cardiac death within 30 days. The gestalt was better than its components both at ruling in ("Obvious ACS", LR 29) and at ruling out ("No Suspicion of ACS", LR 0.01) ACS. In the "Strong suspicion of ACS" group, 60% of the patients did not have ACS. A positive TnT (LR 24.9) and an ischemic ECG (LR 8.3) were strong predictors of ACS and seemed superior to pain history for ruling in ACS. In patients with a normal TnT and non-ischemic ECG, chest pain history typical of AMI was not a significant predictor of AMI (LR 1.9) while pain history typical of unstable angina (UA) was a moderate predictor of UA (LR 4.7). Clinical gestalt was better than its components both at ruling in and at ruling out ACS, but overestimated the likelihood of ACS when cases were assessed as strong suspicion of ACS. Among the components of the gestalt, TnT and ECG were superior to the chest pain history for ruling in ACS, while pain history was superior for ruling out ACS.

  4. Non-Coronary Patients with Severe Chest Pain Show More Irrational Beliefs Compared to Patients with Mild Pain

    PubMed Central

    Bahremand, Mostafa; Saeidi, Mozhgan

    2015-01-01

    Background Despite providing insufficient medical evidence of the existence of a real cardiac condition, patients with non-coronary chest pain still interpret their pain incorrectly. The present study, therefore, sought to compare the irrational beliefs in non-coronary patients with mild chest pain against those with severe chest pain. Methods A cross-sectional design was used. The statistical population comprised non-coronary patients who presented to the Heart Emergency Center of Kermanshah city, Iran. Using a matching method, 96 participants were selected and studied in two groups of 48. The instruments used were the Comorbidity Index, Brief Pain Index, and the Jones Irrational Beliefs Test (short-form). The multivariate analysis of variance, chi-square test, and t-test were used for data analysis. Results Controlling for the effects of age and comorbid conditions, the severity of three types of irrational beliefs, including emotional irresponsibility (P<0.001), hopelessness changes (P<0.001), and problem avoiding (P=0.002) was higher among patients with severe chest pain (according to effect level). However, in terms of demand for approval, no difference was seen between the two groups (P=0.180). Conclusion Non-coronary patients with severe chest pain showed a greater number of irrational beliefs in comparison to patients with mild pain. Irrational beliefs are common mental occurrences in patients with non-coronary chest pain, and they should be attended to by health professionals, especially in severe non-coronary chest pain. Further investigation to determine the association between irrational beliefs and non-coronary chest pain is necessary. PMID:26217482

  5. The Importance of Esophageal and Gastric Diseases as Causes of Chest Pain

    PubMed Central

    Shin, Eun Jung; Kim, Nam Su; Lee, Young Ho; Nam, Eun Woo

    2015-01-01

    Purpose Pediatric chest pain is considered to be idiopathic or caused by benign diseases. This study was to find out how much upper gastrointestinal (UGI) diseases are major causes of chest pain in pediatric patients. Methods The records of 75 children (42 boys and 33 girls, aged 3-17 years old) who have presented with mainly chest pain from January 1995 to March 2015 were retrospectively reviewed. Chest X-ray and electrocardiography (ECG) were performed in all aptients. Further cardiologic and gastrointestinal (GI) evaluations were performed in indicated patients. Results Chest pain was most common in the children of 6 and 9 to 14 years old. Esopha-gogastric diseases were unexpectedly the most common direct causes of the chest pain, the next are idiopathic, cardiac diseases, chest trauma, respiratory disease, and psychosomatic disease. Even though 21 showed abnormal ECG findings and 7 showed abnormalities on echocardiography, cardiac diseases were determined to be the direct causes only in 9. UGI endoscopy was performed in 57 cases, and esophago-gastric diseases which thereafter were thought to be causative diseases were 48 cases. The mean age of the children with esophago-gastric diseases were different with marginal significance from that of the other children with chest pain not related with esophago-gastric diseases. All the 48 children diagnosed with treated with GI medicines based on the diagnosis, and 37 cases (77.1%) subsequently showed clinical improvement. Conclusion Diagnostic approaches to find out esophageal and gastric diseases in children with chest pain are important as well as cardiac and respiratory investigations. PMID:26770901

  6. Obesity Increases the Risk of Chest Wall Pain From Thoracic Stereotactic Body Radiation Therapy

    SciTech Connect

    Welsh, James; Thomas, Jimmy; Shah, Deep; Allen, Pamela K.; Wei, Xiong; Mitchell, Kevin; Gao, Song; Balter, Peter; Komaki, Ritsuko; Chang, Joe Y.

    2011-09-01

    Purpose: Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. Patients and Methods: We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0. Results: Of 360 patients in the database, 265 (268 tumors) had tumors within <2.5 cm of the chest wall; 104 (39%) developed skin toxicity (any grade); 14 (5%) developed acute pain (any grade), and 45 (17%) developed chronic pain (Grade 1 in 22 cases [49%] and Grade 2 or 3 in 23 cases [51%]). Both skin toxicity and chest wall pain were associated with the V{sub 30}, or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI {>=}29 had almost twice the risk of chronic pain (p = 0.03). Among patients with BMI >29, diabetes mellitus was a significant contributing factor to the development of chest pain. Conclusion: Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.

  7. Inflammation and Rupture of a Congenital Pericardial Cyst Manifesting Itself as an Acute Chest Pain Syndrome

    PubMed Central

    Cheong, Benjamin Y.C.; Lufschanowski, Roberto

    2016-01-01

    We present the case of a 63-year-old woman with a remote history of supraventricular tachycardia and hyperlipidemia, who presented with recurrent episodes of acute-onset chest pain. An electrocardiogram showed no evidence of acute coronary syndrome. A chest radiograph revealed a prominent right-sided heart border. A suspected congenital pericardial cyst was identified on a computed tomographic chest scan, and stranding was noted around the cyst. The patient was treated with nonsteroidal anti-inflammatory drugs, and the pain initially abated. Another flare-up was treated similarly. Cardiac magnetic resonance imaging was then performed after symptoms had resolved, and no evidence of the cyst was seen. The suspected cause of the patient's chest pain was acute inflammation of a congenital pericardial cyst with subsequent rupture and resolution of symptoms. PMID:28100978

  8. Non-cardiac, non-oesophageal chest pain: the relevance of psychological factors

    PubMed Central

    Ho, K; Kang, J; Yeo, B; Ng, W

    1998-01-01

    Background—No cause has been determined for chest pain that is neither cardiac nor oesophageal in origin. 
Aims—To compare the prevalence of lifetime psychiatric disorders and current psychological distress in three consecutive series of patients with chronic chest or abdominal pain. 
Patients—Thirty nine patients with non-cardiac chest pain and no abnormality on oesophagogastroduodenoscopy, oesophageal manometry, and 24 hour pH monitoring; 22 patients with non-cardiac chest pain having endoscopic abnormality, oesophageal dysmotility, and/or pathological reflux; and 36 patients with biliary colic. 
Methods—The Diagnostic Interview Schedule and the 28 item General Health Questionnaire were administered to all patients. 
Results—Patients with non-cardiac chest pain and no upper gastrointestinal disease had a higher proportion of panic disorder (15%), obsessive-compulsive disorder (21%), and major depressive episodes (28%) than patients with gallstone disease (0%, p<0.02; 3%, p<0.02; and 8%, p<0.05, respectively). In contrast, there were no differences between patients with non-cardiac chest pain and upper gastrointestinal disease and patients with gallstone disease in any of the DSM-111 defined lifetime psychiatric diagnoses. Using the General Health Questionnaire, 49% of patients with non-cardiac chest pain without upper gastrointestinal disease scored above the cut off point (that is, more than 4), which was considered indicative of non-psychotic psychiatric disturbance, whereas only 14% of patients with gallstones did so (p<0.005). The proportions of such cases were however similar between patients with non-cardiac chest pain and upper gastrointestinal disease (27%) and patients with gallstones. 
Conclusions—Psychological factors may play a role in the pathogenesis of chest pain that is neither cardiac nor oesophagogastric in origin. Keywords: chest pain;  oesophageal manometry;  gastro-oesophageal reflux disease;  oesophageal p

  9. Validation of the North American Chest Pain Rule in Prediction of Very Low-Risk Chest Pain; a Diagnostic Accuracy Study

    PubMed Central

    Valadkhani, Somayeh; Jalili, Mohammad; Hesari, Elham; Mirfazaelian, Hadi

    2017-01-01

    Introduction: Acute coronary syndrome accounts for more than 15% of the chest pains. Recently, Hess et al. developed North American Chest Pain Rule (NACPR) to identify very low-risk patients who can be safely discharged from emergency department (ED). The present study aimed to validate this rule in EDs of two academic hospitals. Methods: A prospective diagnostic accuracy study was conducted on consecutive patients 24 years of age and older presenting to the ED with the chief complaint of acute chest pain, during March 2013 to June 2013. Chest pain characteristics, cardiac history, electrocardiogram findings, and cardiac biomarker measurement of patients were collected and screening performance characteristics of NACPR with 95% confidence interval were calculated using SPSS 21. Results: From 400 eligible patients with completed follow up, 69 (17.25 %) developed myocardial infarction, 121 (30.25%) underwent coronary revascularization, and 4 (2%) died because of cardiac or unidentifiable causes. By using NACPR, 34 (8.50%) of all the patients could be considered very low- risk and discharged after a brief ED assessment. Among these patients, none developed above-mentioned adverse outcomes within 30 days. Sensitivity, specificity, positive prediction value, and negative prediction value of the rule were 100% (95% CI: 87.35 - 100.00), 45.35 (95% CI: 40.19 - 50.61), 14.52 (95% CI: 10.40 – 19.85), and 100 (95% CI: 97.18 - 100.00), respectively. Conclusions: The present multicenter study showed that NACPR is a good screening tool for early discharge of patients with very low-risk chest pain from ED. PMID:28286818

  10. Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain.

    PubMed

    White, Kamila S; McDonnell, Cassandra J; Gervino, Ernest V

    2011-12-01

    The aim of this study was to examine independent and combined influences of alexithymia and anxiety sensitivity on chest pain and life interference in patients with non-cardiac chest pain (NCCP). Theories of NCCP posit a central role for emotion in the experience of chest pain, however, studies have not examined how alexithymia characterized by a difficulty identifying or verbalizing emotions, may influence this relationship. This study examined 231 patients (56% females, M age=50 years) with chest pain seeking cardiac evaluation, who showed no abnormalities during exercise tolerance testing. Forty percent (40%) scored at or above the moderate range of alexithymia. Whereas health care utilization was associated with elevated alexithymia among men, health care utilization was associated with elevated anxiety sensitivity among women. Hierarchical regression analyses revealed that alexithymia and anxiety sensitivity were both uniquely and independently associated with pain severity and life interference due to pain. Alexithymia-pain links were stronger for men compared to women. Secondary analyses conducted with a subsample suggest that alexithymia may be increasingly stable over time (i.e., 18-month follow-up). Findings are largely congruent with theoretical models of NCCP showing that personality and emotional factors are important in this medically unexplained syndrome.

  11. Morbidity of "DSM-IV" Axis I Disorders in Patients with Noncardiac Chest Pain: Psychiatric Morbidity Linked with Increased Pain and Health Care Utilization

    ERIC Educational Resources Information Center

    White, Kamila S.; Raffa, Susan D.; Jakle, Katherine R.; Stoddard, Jill A.; Barlow, David H.; Brown, Timothy A.; Covino, Nicholas A.; Ullman, Edward; Gervino, Ernest V.

    2008-01-01

    The present study examined current and lifetime psychiatric morbidity, chest pain, and health care utilization in 229 patients with noncardiac chest pain (NCCP), angina-like pain in the absence of cardiac etiology. Diagnostic interview findings based on the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; "DSM-IV"; American…

  12. Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: the Nambour Short Low-Intermediate Chest pain project.

    PubMed

    George, Terry; Ashover, Sarah; Cullen, Louise; Larsen, Peter; Gibson, Jason; Bilesky, Jennifer; Coverdale, Steven; Parsonage, William

    2013-08-01

    Emergency physicians can feel pressured by opposing forces of clinical reality and the need to publish successful key performance indicators in an environment of increasing demands and cost containment. This is particularly relevant to management of patients with undifferentiated chest pain and possible acute coronary syndrome. Unreliability of clinical assessment and high risk of adverse outcomes for all concerned exist, yet national guidelines are at odds with efforts to reduce ED crowding and access block. We report findings from the Nambour Short Low-Intermediate Chest pain risk trial, which safely introduced an accelerated diagnostic protocol with reduced ED length of stay and high patient acceptability. Over a 7-month period, there were no major adverse cardiac events by 30 days in 19% of undifferentiated chest pain presentations with possible acute coronary syndrome discharged after normal sensitive cardiac troponin taken 2 h after presentation and scheduled to return for outpatient exercise stress test.

  13. Thallium myocardial scanning in the emergency department evaluation of chest pain

    SciTech Connect

    Mace, S.E.

    1989-05-01

    Chest pain is a common complaint of patients seen in the emergency department. The causes are legion, and range from the non-life threatening to the potentially catastrophic. Thallium heart scanning was done prospectively in 20 patients with a ''classic'' history for myocardial infarction (eight patients) or atypical chest pain and/or associated symptoms plus an abnormal ECG (12 patients) to discern a subset of patients from whom thallium scintography may be indicated in the emergency department. Although further investigation is needed, our preliminary study suggests that myocardial scanning with thallium can be a safe, fairly rapid, and useful objective parameter in the emergency department detection of suspected myocardial infarction, and in differential diagnosis of chest pain when other data such as the history, physical examination, ECG, or enzymes are inconclusive.

  14. Undisclosed cocaine use and chest pain in emergency departments of Spain

    PubMed Central

    Burillo-Putze, Guillermo; López, Beatriz; León, Juan María Borreguero; Sánchez, Miquel Sánchez; González, Martin García; Rodriguez, Alberto Domínguez; Afonso, Eva Vallbona; Sosa, Alejandro Jiménez; Mirò, Oscar

    2009-01-01

    Aims Illicit cocaine consumption in Spain is one of the highest in Europe. Our objective was to study the incidence of undisclosed cocaine consumption in patients attending in two Spanish Emergency Departments for chest pain. Methods We analysed urine samples from consenting consecutive patients attending ED for chest pain to determine the presence of cocaine, and other drugs, by semiquantative tests with fluorescence polarization immunoassay (FPIA). Results Of 140 cases, 15.7 presented positive test for drugs, and cocaine was present in 6.4%. All cocaine-positive patients were younger (p < 0.001); none was admitted to Hospital (p = 0.08). No significant differences in ED stay or need for hospitalization were found between cocaine-positive and negative patients. Conclusion This finding in chest pain patients who consented to urine analysis suggests that the true incidence of cocaine use leading to such ED visits may be higher. PMID:19254377

  15. Dronabinol increases pain threshold in patients with functional chest pain: a pilot double-blind placebo-controlled trial.

    PubMed

    Malik, Z; Bayman, L; Valestin, J; Rizvi-Toner, A; Hashmi, S; Schey, R

    2016-01-29

    Noncardiac chest pain is associated with poor quality of life and high care expenditure. The majority of noncardiac chest pain is either gastresophageal reflux disease related or due to esophageal motility disorders, and the rest are considered functional chest pain (FCP) due to central and peripheral hypersensitivity. Current treatment of FCP improves 40-50% of patients. Cannabinoid receptors 1 (CB1 ) and 2 (CB2 ) modulate release of neurotransmitters; CB1 is located in the esophageal epithelium and reduces excitatory enteric transmission and potentially could reduce esophageal hypersensitivity. We performed a prospective study to evaluate its effects on pain threshold, frequency, and intensity in FCP. Subjects with FCP received dronabinol (5 mg, twice daily; n = 7; average age, 44 years; mean body mass index, 26.7) or placebo (n = 6; average age, 42 years; mean body mass index, 25.9) for 28 days (4 weeks). Chest pain, general health, and anxiety/depression questionnaires were assessed at baseline and at 4 weeks. Subjects underwent an esophageal balloon distention test prior to treatment and on last day of the study. Dronabinol increased pain thresholds significantly (3.0 vs. 1.0; P = 0.03) and reduced pain intensity and odynophagia compared to placebo (0.18 vs. 0.01 and 0.12 vs. 0.01, respectively, P = 0.04). Depression and anxiety scores did not differ between the groups at baseline or after treatment. No significant adverse effects were observed. In this novel study, dronabinol increased pain threshold and reduced frequency and intensity of pain in FCP. Further, large scale studies are needed to substantiate these findings.

  16. Rest myocardial perfusion imaging in a patient with atypical chest pain and a nondiagnostic electrocardiogram.

    PubMed

    Grube, Heinrich; Rosenblatt, Jeffrey

    2010-02-01

    ACC/AHA guidelines assign a class I indication for use of myocardial perfusion imaging (MPI) for the evaluation of chest pain in patients with acute coronary syndromes and a nondiagnostic ECG. However, MPI is not a widely used modality for the evaluation of patients who present to the ER with chest pain and an intermediate pretest probability for coronary artery disease.We report a case in which resting MPI was pivotal in diagnosing acute myocardial infarction and expedited the appropriate reperfusion strategy.

  17. Comparison of Fentanyl and Morphine in the Prehospital Treatment of Ischemic Type Chest Pain.

    PubMed

    Weldon, Erin R; Ariano, Robert E; Grierson, Robert A

    2016-01-01

    In the treatment of acute coronary syndromes, reduction of sympathetic stress and catecholamine release is an important therapeutic goal. One method used to achieve this goal is pain reduction through the systemic administration of analgesia. Historically, morphine has been the analgesic of choice in ischemic cardiac pain. This randomized double-blind controlled trial seeks to prove the utility of fentanyl as an alternate first-line analgesic for ischemic-type chest pain in the prehospital setting. Successive patients who were treated for suspected ischemic chest pain in the emergency medical services system were considered eligible. Once chest pain was confirmed, patients received oxygen, aspirin, and nitroglycerin therapy. If the ischemic-type chest pain continued the patient was randomized in a double-blinded fashion to treatment with either morphine or fentanyl. Pain scale scores, necessity for additional dosing, and rate of adverse events between the groups were assessed every 5 minutes and were compared using t-testing, Fisher's Exact test, or Analysis of Variance (ANOVA) where appropriate. The primary outcome of the study was incidence of hypotension and the secondary outcome was pain reduction as measured by the visual analog score and numeric rating score. A total of 207 patients were randomized with 187 patients included in the final analysis. Of the 187 patients, 99 were in the morphine group and 88 in the fentanyl group. No statistically significant difference between the two groups with respect to hypotension was found (morphine 5.1% vs. fentanyl 0%, p = 0.06). Baseline characteristics, necessity for additional dosing, and other adverse events between the two groups were not statistically different. There were no significant differences between the changes in visual analog scores and numeric rating scale scores for pain between the two groups (p = 0.16 and p = 0.15, respectively). This study supports that fentanyl and morphine are comparable in

  18. Stress Tests for Chest Pain: When You Need an Imaging Test -- and When You Don't

    MedlinePlus

    ... Patient Resources Stress Tests for Chest Pain Stress Tests for Chest Pain When you need an imaging test—and when you don’t DOWNLOAD PDF If ... that suggests you might have heart disease, a test that stresses the heart can help you and ...

  19. One Year Medical Outcomes and ED Recidivism Following ED Observation for Cocaine-Associated Chest Pain

    PubMed Central

    Cunningham, Rebecca; Walton, Maureen A.; Weber, Jim Edward; O'Broin, Samantha; Tripathi, Shanti P; Maio, Ronald F.; Booth, Brenda M.

    2010-01-01

    Chest pain is the most common complaint among cocaine users who present to the ED seeking care and many hospital resources are applied to stratify cocaine users in regard to future cardiac morbidity and mortality. Little is known about the longitudinal cardiac and non cardiac medical outcomes of cocaine users who have been stratified to an ED observation period following their ED visit. Objectives to examine one-year cardiac outcomes in a low-intermediate risk sample of patients with cocaine- associated chest pain in an urban ED, as well as to examine ED recidivism one year for cardiac and non-cardiac complaints. Methods Prospective consecutive cohort study of patients (18–60 years) who presented to an urban Level 1 ED with cocaine-associated chest pain and were risk stratified to low-intermediate cardiac risk. Exclusion criteria: EKG suggestive of AMI, elevated serum cardiac markers, history of AMI or CABG, hemodynamic instability, unstable angina. Baseline interviews using validated measures of health functioning, and substance use were conducted during CPOU stay, and 3, 6, and 12 months. ED utilization during the study year was abstracted from medical chart. Zero-Inflated Poisson regression analyses were conducted to predict recurrent ED visits. Results 219 participants (73% participation) were enrolled, 65% returned to the ED post index visit; 23% returned for chest pain, of these 66% had a positive cocaine urine screen. No patient had an AMI within the one year follow up period. Patients with continued cocaine use were more likely to have a recurrent ED visit (p<0.001) but these repeat visits were most often related to musculoskeletal pain (21%), and injury (30%) rather than potential cardiac complaints. Conclusions Patients with cocaine-associated chest pain who are low to intermediate cardiac risk and complete a CPOU protocol have less then 1% rate of MI in the subsequent 12-months. PMID:18824277

  20. Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease

    PubMed Central

    das Virgens, Cláudio Marcelo Bittencourt; Lemos Jr, Laudenor; Noya-Rabelo, Márcia; Carvalhal, Manuela Campelo; Cerqueira Junior, Antônio Maurício dos Santos; Lopes, Fernanda Oliveira de Andrade; de Sá, Nicole Cruz; Suerdieck, Jéssica Gonzalez; de Souza, Thiago Menezes Barbosa; Correia, Vitor Calixto de Almeida; Sodré, Gabriella Sant'Ana; da Silva, André Barcelos; Alexandre, Felipe Kalil Beirão; Ferreira, Felipe Rodrigues Marques; Correia, Luís Cláudio Lemos

    2017-01-01

    AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease (CAD) in patients with acute chest pain. METHODS We studied individuals who were consecutively admitted to our Chest Pain Unit. At admission, investigators performed a standardized interview and recorded 14 chest pain features. Based on these features, a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability, both numerically and categorically. As the reference standard for testing the accuracy of gestalt, angiography was required to rule-in CAD, while either angiography or non-invasive test could be used to rule-out. In order to assess reproducibility, a second cardiologist did the same procedure. RESULTS In a sample of 330 patients, the prevalence of obstructive CAD was 48%. Gestalt’s numerical probability was associated with CAD, but the area under the curve of 0.61 (95%CI: 0.55-0.67) indicated low level of accuracy. Accordingly, categorical definition of typical chest pain had a sensitivity of 48% (95%CI: 40%-55%) and specificity of 66% (95%CI: 59%-73%), yielding a negligible positive likelihood ratio of 1.4 (95%CI: 0.65-2.0) and negative likelihood ratio of 0.79 (95%CI: 0.62-1.02). Agreement between the two cardiologists was poor in the numerical classification (95% limits of agreement = -71% to 51%) and categorical definition of typical pain (Kappa = 0.29; 95%CI: 0.21-0.37). CONCLUSION Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.

  1. Pleuritic chest pain from portal hypertensive gastropathy in ESRD patient with autosomal dominant polycystic kidney disease misdiagnosed as pericarditis.

    PubMed Central

    Onuigbo, Macaulay Amechi Chukwukadibia; Agbasi, Nneoma; Achebe, Jennifer; Odenigbo, Charles; Oguejiofor, Fidelis

    2016-01-01

    Portal hypertensive gastropathy (PHG) is a gastric mucosal lesion complicating portal hypertension, with higher prevalence in decompensated cirrhosis. PHG can sometimes complicate autosomal dominant polycystic kidney disease (ADPKD) due to the presence of multiple liver cysts. Besides, PHG is known to present as chest pain, with or without hematemesis. Other causes of chest pain in ADPKD include referred chest pain from progressively enlarging kidney cysts, and rare pericardial cysts. Chest pain, especially if pleuritic, in end-stage renal disease (ESRD) patients, is often ascribed to uremic pericarditis. We present recurrent pleuritic chest pain in a 24-year old ESRD patient with ADPKD that was initially misdiagnosed as uremic pericarditis. It was ultimately shown to represent symptomatic PHG with excellent therapeutic response to proton pump inhibitors. PMID:27069969

  2. Women and Chest Pain: Recognizing the Different Faces of Angina in the Emergency Department

    PubMed Central

    Safdar, Basmah; D’Onofrio, Gail

    2016-01-01

    Emergency departments (ED) in the United States see over eight million cases of chest pain annually. While a cardinal symptom of acute coronary syndrome (ACS), multiple emergent and non-emergent causes can attribute to chest pain. This case-based perspective describes the different sex-specific causes of angina seen in ED patients. Once coronary artery disease (CAD) is ruled out with standard protocols, microvascular dysfunction is perhaps the most prevalent but under-diagnosed cause of non-CAD related angina in ED patients. Additional causes include coronary artery spasm, coronary artery dissection, coronary artery endothelial dysfunction and myocardial bridging. Non-CAD related angina is associated with persistent chest pain causing poor function, quality of life, and recidivism. Clinicians should consider additional diagnostics to routinely screen for non-CAD related causes of angina in patients with recurrent chest pain. Future work is needed to better define the epidemiological, clinical, biological, and genetic correlates of microvascular dysfunction in these patients. PMID:27354848

  3. Effect of Coronary Computed Tomography Angiography Disease Burden on the Incidence of Recurrent Chest Pain

    PubMed Central

    Ahmadian, Homayoun R.; Thomas, Dustin M.; Shaw, David J.; Barnwell, Megan L.; Jones, Ronald L.; McDonough, Ryan J.; Prentice, Ryan L.; Lin, Charles K.; Slim, Ahmad M.

    2014-01-01

    Introduction. The purpose of this study is to investigate chest pain evaluations after initial coronary computed tomography angiography (CCTA) based upon coronary artery disease (CAD) burden. Methods. CCTA results of 1,518 patients were grouped based on the CCTA results into no CAD, nonobstructive CAD (<50% maximal diameter stenosis), or obstructive CAD (≥50% stenosis). Chest pain evaluation after initial CCTA and rates of major adverse cardiovascular events (MACE) defined as the incidence of all-cause mortality, nonfatal MI, ischemic stroke, and late revascularization (>90 days following CCTA) were evaluated. Results. MACE rates were higher with obstructive CAD compared to nonobstructive CAD and no CAD (8.9% versus 0.7%, P < 0.001; 8.9 versus 1.6%, P < 0.001). One hundred seventy-four patients (11.5%) underwent evaluation for chest pain after index CCTA with rates significantly higher with obstructive CAD compared to both nonobstructive CAD and no CAD (7.5% versus 13.9% versus 17.8%, P < 0.001). The incidence of repeat testing was more frequent in patients with obstructive CAD (no CAD 36.5% versus nonobstructive CAD 54.9% versus obstructive CAD 67.7%, P = 0.015). Conclusion. Absence of obstructive disease on CCTA is associated with lower rates of subsequent evaluations for chest pain and repeat testing with low MACE event rates over a 22-month followup. PMID:27355033

  4. Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring

    PubMed Central

    Syed, Shahbaz; Gatien, Mathieu; Perry, Jeffrey J.; Chaudry, Hina; Kim, Soo-Min; Kwong, Kenneth; Mukarram, Muhammad; Thiruganasambandamoorthy, Venkatesh

    2017-01-01

    BACKGROUND: Most patients with chest pain in the emergency department are assigned to cardiac monitoring for several hours, blocking access for patients in greater need. We sought to validate a previously derived decision rule for safe removal of patients from cardiac monitoring after initial evaluation in the emergency department. METHODS: We prospectively enrolled adults (age ≥ 18 yr) who presented with chest pain and were assigned to cardiac monitoring at 2 academic emergency departments over 18 months. We collected standardized baseline characteristics, findings from clinical evaluations and predictors for the Ottawa Chest Pain Cardiac Monitoring Rule: whether the patient is currently free of chest pain, and whether the electrocardiogram is normal or shows only nonspecific changes. The outcome was an arrhythmia requiring intervention in the emergency department or within 8 hours of presentation to the emergency department. We calculated diagnostic characteristics for the clinical prediction rule. RESULTS: We included 796 patients (mean age 63.8 yr, 55.8% male, 8.9% admitted to hospital). Fifteen patients (1.9%) had an arrhythmia, and the rule performed with the following characteristics: sensitivity 100% (95% confidence interval [CI] 78.2%–100%) and specificity 36.4% (95% CI 33.0%–39.6%). Application of the Ottawa Chest Pain Cardiac Monitoring Rule would have allowed 284 out of 796 patients (35.7%) to be safely removed from cardiac monitoring. INTERPRETATION: We successfully validated the decision rule for safe removal of a large subset of patients with chest pain from cardiac monitoring after initial evaluation in the emergency department. Implementation of this simple yet highly sensitive rule will allow for improved use of health care resources. PMID:28246315

  5. Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain

    PubMed Central

    Sørensen, Jan; Vach, Werner; Christensen, Henrik Wulff; Høilund-Carlsen, Poul Flemming; Hartvigsen, Jan

    2016-01-01

    Aims To assess whether primary sector healthcare in the form of chiropractic care is cost-effective compared with self-management in patients with musculoskeletal chest pain, that is, a subgroup of patients with non-specific chest pain. Methods and results 115 adults aged 18–75 years with acute, non-specific chest pain of musculoskeletal origin were recruited from a cardiology department in Denmark. After ruling out acute coronary syndrome and receiving usual care, patients with musculoskeletal chest pain were randomised to 4 weeks of community-based chiropractic care (n=59) or to a single information session aimed at encouraging self-management as complementary to usual care (n=56). Data on resource use were obtained from Danish national registries and valued from a societal perspective. Patient cost and health-related quality-adjusted life years (QALYs; based on EuroQol five-dimension questionnaire (EQ-5D) and Short Form 36-item Health Survey (SF-36)) were compared in cost-effectiveness analyses over 12 months from baseline. Mean costs were €2183 lower for the group with chiropractic care, but not statistically significant (95% CI −4410.5 to 43.0). The incremental cost-effectiveness ratio suggested that chiropractic care was cost-effective with a probability of 97%, given a threshold value of €30 000 per QALY gained. In both groups, there was an increase in the health-related quality of life, and the mean increases were similar over the 12-month evaluation period. The mean differences in QALYs between the groups were negligible. Conclusions Chiropractic care was more cost-effective than self-management. Therefore, chiropractic care can be seen as a good example of a targeted primary care approach for a subgroup of patients with non-specific chest pain. Trial registration number NCT00462241. PMID:27175285

  6. Human esophageal response during chest pain induced by swallowing cold liquids.

    PubMed

    Meyer, G W; Castell, D O

    1981-11-06

    Normal persons often note chest or back pain during rapid ingestion of cold liquids, commonly believed to result from cold-induced "spasm" of esophageal muscle. We studied the effects of swallowing cold liquids on esophageal function in five normal subjects, aged 20 to 44 years, by comparing their response to cold ice cream (-5 degrees C) and room temperature ice cream mix (20 degrees C). Decreased peristaltic amplitude was seen during cold ice cream ingestion, primarily in the midesophagus. When seven subjects rapidly ingested ice cream until chest pain was produced and maintained for at least 60 s, complete absence of motor activity in the distal esophagus occurred, with slow return to normal during the ensuing five minutes. Our studies indicate that ingestion of cold liquids significantly depresses peristaltic amplitudes and frequency of peristalsis in normal persons, and pain is associated with complete absence of motor activity in the body of the esophagus, rather than esophageal "spasm" as commonly believed.

  7. Another cause of chest pain: Staphylococcus aureus sternal osteomyelitis in an otherwise healthy adult

    PubMed Central

    Vacek, Thomas P; Rehman, Shahnaz; Yu, Shipeng; Moza, Ankush; Assaly, Ragheb

    2014-01-01

    Chest pain requires a detailed differential diagnosis with good history-taking skills to differentiate between cardiogenic and noncardiogenic causes. Moreover, when other symptoms such as fever and elevated white blood cell count are involved, it may be necessary to consider causes that include infectious sources. A 53-year-old female with no significant past medical history returned to the hospital with recurrent complaints of chest pain that was constant, substernal, reproducible, and exacerbated with inspiration and expiration. The chest pain was thought to be noncardiogenic, as electrocardiography did not demonstrate changes, and cardiac enzymes were found to be negative for signs of ischemia. The patient’s blood cultures were analyzed from a previous admission and were shown to be positive for Staphylococcus aureus. The patient was started empirically on vancomycin, which was later switched to ceftriaxone as the bacteria were more sensitive to this antibiotic. A transthoracic echocardiogram did not demonstrate any vegetation or signs of endocarditis. There was a small right pleural effusion discovered on X-ray. Therefore, computed tomography as well as magnetic resonance imaging of the chest were performed, and showed osteomyelitis of the chest. The patient was continued on intravenous ceftriaxone for a total of 6 weeks. Tests for HIV, hepatitis A, B, and C were all found to be negative. The patient had no history of childhood illness, recurrent infections, or previous trauma to the chest, and had had no recent respiratory infections, pneumonia, or any underlying lung condition. Hence, her condition was thought to be a case of primary sternal osteomyelitis without known cause. PMID:25246811

  8. The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study.

    PubMed

    Bruce, J; Drury, N; Poobalan, A S; Jeffrey, R R; Smith, W C S; Chambers, W A

    2003-07-01

    Chronic pain after surgery is recognised as an important post-operative complication; recent studies have shown up to 30% of patients reporting persistent pain following mastectomy and inguinal hernia repair. No large-scale studies have investigated the epidemiology of chronic pain at two operative sites following coronary artery bypass grafting (CABG). This paper reports the follow-up of a cohort of 1348 patients who underwent cardiac surgery between 1996 and 2000 at one cardiothoracic unit in northeast Scotland. Chronic pain was defined as pain in the location of surgery, different from that suffered pre-operatively, arising post-operatively and persisting beyond 3 months. The survey questionnaire consisted of the short-form-36 (SF-36), Rose angina questionnaire, McGill pain questionnaire and the University of California and San Francisco (UCSF) pain service questionnaire. Of the 1080 responders, 130 reported chronic chest pain, 100 chronic post-saphenectomy pain and 194 reported pain at both surgical sites. The cumulative prevalence of post-cardiac surgery pain was 39.3% (CI(95) 36.4-42.2%) and mean time of 28 months since surgery (SD 15.3 months). Patients who reported pain at both sites had lower quality of life scores across all eight health domains compared to patients with pain at one site only and those who were pain-free. Prevalence of chronic pain decreased with age, from 55% in those aged under 60 years to 34% in patients over 70 years. Patients with pre-operative angina and those who were overweight or obese (BMI>/=25) at the time of surgery were more likely to report chronic pain. Chronic pain following median sternotomy and saphenous vein harvesting is more common than hitherto reported and that patients undergoing CABG should be warned of this possibility.

  9. Unusual chest wall pain caused by thoracic disc herniation in a professional baseball pitcher

    PubMed Central

    Kato, Kinshi; Yabuki, Shoji; Otani, Koji; Nikaido, Takuya; Otoshi, Ken-ichi; Watanabe, Kazuyuki; Kikuchi, Shin-ichi; Konno, Shin-ichi

    2016-01-01

    Abstract Symptomatic thoracic disc herniation is clinically rare. There are few cases of disc herniation of the thoracic spine in top athletes described in the literature. We herein present a rare case of chest wall pain due to thoracic disc herniation in a professional baseball pitcher. A 30-year-old, left-handed pitcher complained of left-sided chest wall pain in the region of his lower ribs during a game. Neurological examination revealed hypoesthesia of the left side of the chest at the level of the lower thoracic spine. Magnetic resonance imaging (MRI) of the thoracic spine showed a left-sided paramedian disc herniation at the T9-T10 level. The player was initially prescribed rest, administration of pregabalin (150 mg twice a day), and subsequent physical rehabilitation. He was able to resume full training and pitching without medication 6 months after the onset. A follow-up MRI of the thoracic spine showed a reduction in the size of the herniated disc compared to the initial findings. Though relatively rare, thoracic disc herniation should be considered in cases of chest wall pain in athletes. PMID:26983590

  10. Conditioned Pain Modulation and Situational Pain Catastrophizing as Preoperative Predictors of Pain following Chest Wall Surgery: A Prospective Observational Cohort Study

    PubMed Central

    Grosen, Kasper; Vase, Lene; Pilegaard, Hans K.; Pfeiffer-Jensen, Mogens; Drewes, Asbjørn M.

    2014-01-01

    Background Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency. Methods Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2–5. Pain was reevaluated at six months postoperatively. Results Patients reporting persistent pain at six months follow-up (n = 15) were not significantly different from pain-free patients (n = 16) concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3) or level of catastrophizing (Z = 0.4, P = 1.0). In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007) whereas conditioned pain modulation predicted morphine consumption (β = −0.005, P = 0.001). Conclusions Preoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute postoperative

  11. Influence of the normal personality dimension of neuroticism on chest pain symptoms and coronary artery disease.

    PubMed

    Costa, P T

    1987-12-28

    For at least the last 200 years it has been suspected that somatic manifestations of psychological distress play a role in the medical recognition and treatment of coronary artery disease (CAD). The cardiovascular system is intricately linked to the experience of emotion, and these links may explain how and when neuroticism can cloud the diagnosis of cardiovascular disease. A possible source of anginal symptoms in the absence of angiographically documented CAD is high standing on the personality dimension of neuroticism, which is a broad dimension of individual differences in the tendency to experience negative, distressing emotions and to possess associated behavioral and cognitive traits. A brief review of the clinical cardiologic literature on chest pain is presented, with special attention to distinguishing true angina pectoris from pseudoangina and related syndromes. After a brief description of the major dimensions of normal personality, especially the domain of neuroticism, empirical evidence is reviewed on 1,191 adult men and women who 10 years earlier had made chest pain or discomfort reports part of the National Health and Nutrition Examination Survey. The findings illustrate neuroticism's links to illness and disease. When the mean initial neuroticism levels of the chest pain groups were compared, significantly higher initial levels of neuroticism were found for those who reported any pain or discomfort. As hypothesized, logistic regression results on myocardial infarction death indicated no increased risk due to neuroticism. Neuroticism was related to increased somatic complaints, including chest pain or angina-like complaints, but was not causally or etiologically related to objective signs or pathophysiologic evidence of disease, especially CAD.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. First Clinical Judgment by Primary Care Physicians Distinguishes Well Between Nonorganic and Organic Causes of Abdominal or Chest Pain

    PubMed Central

    Martina, Benedict; Bucheli, Bruno; Stotz, Martin; Battegay, Edouard; Gyr, Niklaus

    1997-01-01

    OBJECTIVE To evaluate the accuracy of a preliminary diagnosis based solely on patient history and physical examination in medical outpatients with abdominal or chest pain. DESIGN Prospective observational study. setting General medical outpatient clinic in a university teaching hospital. participants One hundred ninety new, consecutive patients with a mean age of 44 years (SD = 14 years, range 30–58 years) with a main complaint of abdominal or chest pain. measurements and main results The preliminary diagnosis, established on the basis of patient history and physical examination, was compared with a final diagnosis, obtained after workup at completion of the chart. A nonorganic cause was established in 66 (59%) of 112 patients with abdominal pain and in 65 (83%) of 78 with chest pain. The preliminary diagnosis of “nonorganic” versus “organic” causes was correct in 79% of patients with abdominal pain and in 88% of patients with chest pain. An “undoubted” preliminary diagnosis predicted a correct assessment in all patients with abdominal pain and in all but one patient with chest pain. Overall, only 4 patients (3%) were initially incorrectly diagnosed as having a nonorganic cause of pain rather than an organic cause. In addition, final nonorganic diagnosis (n = 131) was compared with long-term follow-up by obtaining information from patients and, if necessary, from treating physicians. Follow-up information, obtained for 71% of these patients after a mean of 29 months (range 18–56 months) identified three other patients that had been misdiagnosed as having abdominal pain of nonorganic causes. Compared with follow-up, the diagnostic accuracy for nonorganic abdominal and chest pain at chart completion was 93% and 98%, respectively. conclusions A preliminary diagnosis of nonorganic versus organic abdominal or chest pain based on patient history and physical examination proved remarkably reliable. Accuracy was almost complete in patients with an

  13. Chest pain with myocardial ischemia in a child: should we think about coronary slow flow phenomenon?

    PubMed

    Kocabaş, Abdullah; Kardelen, Fırat; Akçurin, Gayaz; Ertuğ, Halil

    2013-10-01

    The coronary slow flow phenomenon (CSFP) is an angiographic finding characterized by delayed opacification of epicardial coronary arteries in the absence of stenotic lesion. Herein, we present a 13-year-old boy with recurrent chest pain who was diagnosed with acute ST-segment elevation myocardial infarction associated with CSFP, which has not been reported previously in the pediatric age group. Coronary angiography revealed only the presence of slow flow in the left anterior descending (LAD) coronary artery. Myocardial perfusion scintigraphy revealed a reversible perfusion defect in the LAD territory, which regressed partially at rest and showed complete improvement after dipyridamole infusion. All the symptoms, electrocardiogram abnormalities and cardiac markers returned to normal after dipyridamole treatment during the follow-up. We conclude that CSFP should be kept in mind in the differential diagnosis of chest pain with myocardial ischemia in the pediatric age group.

  14. Acute chest pain after bench press exercise in a healthy young adult

    PubMed Central

    Smereck, Janet A; Papafilippaki, Argyro; Sudarshan, Sawali

    2016-01-01

    Bench press exercise, which involves repetitive lifting of weights to full arm extension while lying supine on a narrow bench, has been associated with complications ranging in acuity from simple pectoral muscle strain, to aortic and coronary artery dissection. A 39-year-old man, physically fit and previously asymptomatic, presented with acute chest pain following bench press exercise. Diagnostic evaluation led to the discovery of critical multivessel coronary occlusive disease, and subsequently, highly elevated levels of lipoprotein (a). Judicious use of ancillary testing may identify the presence of “high-risk” conditions in a seemingly “low-risk” patient. Emergency department evaluation of the young adult with acute chest pain must take into consideration an extended spectrum of potential etiologies, so as to best guide appropriate management. PMID:27703399

  15. [Chest pain with ischemic electrocardiographic changes: mitral valve prolapse in pediatrics. Case report].

    PubMed

    Matamala-Morillo, Miguel Ángel; Rodríguez-González, Moisés; Segado-Arenas, Antonio

    2015-01-01

    Chest pain is rare and usually benign in pediatrics. Cardiac etiology is even rarer. However, it is a symptom associated with ischemic heart disease and it imposes great social alarm, even in health care workers. Therefore, it is necessary to know the most common causes of this symptom in children, as well as serious diseases that can cause it, which require prompt medical attention. We report a case of chest pain associated with ischemic electrocardiographic changes in a patient with mitral valve prolapse and MASS phenotype (mitral valve prolapse, aortic root enlargement, and skeletal and skin alterations), we review the mitral valve prolapse and stress the importance of knowing it in the pediatric setting.

  16. Chest pain, dyspnoea and elevated D-dimer in a recent air traveller.

    PubMed

    Lima, Joaquim Santos; Sandler, Belinda; McWilliams, Eric

    2011-08-17

    A previously asymptomatic 69-year-old lady, who recently travelled on a 4 h flight, presented with acute left-sided pleuritic pain, dyspnoea and calf pain. Blood gases revealed hypoxaemia and D-dimer was significantly elevated. She also had low-grade fever, leukocytosis and a small left-sided pleural effusion on chest x-ray. The working diagnosis was pulmonary embolism and chest infection and she received low molecular weight heparin and antibiotics. A subsequent CT pulmonary angiogram ruled out pulmonary embolism but revealed an abnormal finding in the ascending aorta, suggestive of a penetrating aortic ulcer. Urgent transoesophageal echocardiography was consistent with an intramural haematoma and the patient underwent emergency aortic root replacement with imminent aortic rupture confirmed at surgery. This case highlights the fact that acute aortic syndromes may have atypical presentations and also emphasises the fact that D-dimer levels are elevated in aortic syndromes.

  17. [Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin.

    PubMed

    Beygui, Farzin; Castren, Maaret; Brunetti, Natale Daniele; Rosell-Ortiz, Fernando; Christ, Michael; Zeymer, Uwe; Huber, Kurt; Folke, Fredrik; Svensson, Leif; Bueno, Hector; Van't Hof, Arnoud; Nikolaou, Nikolaos; Nibbe, Lutz; Charpentier, Sandrine; Swahn, Eva; Tubaro, Marco; Goldstein, Patrick

    2017-01-01

    Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts' opinions, for all emergency medical services' health providers involved in the pre-hospital management of acute cardiovascular care.

  18. Cardiac computed tomography for the evaluation of the acute chest pain syndrome: state of the art.

    PubMed

    Schlett, Christopher L; Hoffmann, Udo; Geisler, Tobias; Nikolaou, Konstantin; Bamberg, Fabian

    2015-03-01

    Coronary computed tomography angiography (CCTA) is recommended for the triage of acute chest pain in patients with a low-to-intermediate likelihood for acute coronary syndrome. Absence of coronary artery disease (CAD) confirmed by CCTA allows rapid emergency department discharge. This article shows that CCTA-based triage is as safe as traditional triage, reduces the hospital length of stay, and may provide cost-effective or even cost-saving care.

  19. Role of Quantitative Wall Motion Analysis in Patients with Acute Chest Pain at Emergency Department

    PubMed Central

    Kim, Kyung-Hee; Park, Jin-Sik

    2017-01-01

    Background Evaluation of acute chest pain in emergency department (ED), using limited resource and time, is still very difficult despite recent development of many diagnostic tools. In this study, we tried to determine the applicability of new semi-automated cardiac function analysis tool, velocity vector imaging (VVI), in the evaluation of the patients with acute chest pain in ED. Methods We prospectively enrolled 48 patients, who visited ED with acute chest pain, and store images to analyze VVI from July 2005 to July 2007. Results In 677 of 768 segments (88%), the analysis by VVI was feasible among 48 patients. Peak systolic radial velocity (Vpeak) and strain significantly decreased according to visual regional wall motion abnormality (Vpeak, 3.50 ± 1.34 cm/s for normal vs. 3.46 ± 1.52 cm/s for hypokinesia, 2.51 ± 1.26 for akinesia, p < 0.01; peak systolic radial strain -31.74 ± 9.15% fornormal, -24.33 ± 6.28% for hypokinesia, -20.30 ± 7.78% for akinesia, p < 0.01). However, the velocity vectors at the time of mitral valve opening (MVO) were directed outward in the visually normal myocardium, inward velocity vectors were revealed in the visually akinetic area (VMVO, -0.85 ± 1.65 cm/s for normal vs. 0.10 ± 1.46 cm/s for akinesia, p < 0.001). At coronary angiography, VMVO clearly increased in the ischemic area (VMVO, -0.88+1.56 cm/s for normal vs. 0.70 + 2.04 cm/s for ischemic area, p < 0.01). Conclusion Regional wall motion assessment using VVI showed could be used to detect significant ischemia in the patient with acute chest pain at ED.

  20. A woman with recurrent chest pain and ST-segment elevation.

    PubMed

    Omar, Hesham R; Mangar, Devanand; Camporesi, Enrico M

    2016-05-01

    A 32-year-old female presents with recurrent episodes of unprovoked chest pain associated with inferior ST-segment elevation and reciprocal ST-segment depression. Coronary angiography during one of these episodes revealed coronary artery spasm that spontaneously resolved followed by resolution of these electrocardiographic changes. There was no atherosclerotic occlusive disease. Her cardiac markers were normal and echocardiogram showed no regional wall motion abnormalities. Electrocariogram and angiography findings are shown in Fig. 1.

  1. The Challenge of Triaging Chest Pain Patients: The Bernese University Hospital Experience

    PubMed Central

    Rohacek, Martin; Bertolotti, Amina; Grützmüller, Nadine; Simmen, Urs; Marty, Hans; Zimmermann, Heinz; Exadaktylos, Aristomenis; Spyridon, Arampatzis

    2012-01-01

    Accurate diagnosis of the causes of chest pain and dyspnea remain challenging. In this preliminary observational study with a 5-year follow-up, we attempted to find a simplified approach to selecting patients with chest pain needing immediate care based on the initial evaluation in ED. During a 24-month period were randomly selected 301 patients and a conditional inference tree (CIT) was used as the basis of the prognostic rule. Common diagnoses were musculoskeletal chest pain (27%), ACS (19%) and panic attack (12%). Using variables of ACS symptoms we estimated the likelihood of ACS based on a CIT to be high at 91% (32), low at 4% (198) and intermediate at 20.5–40% in (71) patients. Coronary catheterization was performed within 24 hours in 91% of the patients with ACS. A culprit lesion was found in 79%. Follow-up (median 4.2 years) information was available for 70% of the patients. Of the 164 patients without ACS who were followed up, 5 were treated with revascularization for stable angina pectoris, 2 were treated with revascularization for myocardial infarction, and 25 died. Although a simple triage decision tree could theoretically help to efficient select patients needing immediate care we need also to be vigilant for those presenting with atypical symptoms. PMID:22114740

  2. Recurrent chest pain after treatment of spontaneous coronary artery dissection: An enigma.

    PubMed

    Bhatt, Dheeraj D; Kachru, Ranjan; Gupta, Sanjay; Kaul, Upendra

    2015-12-01

    Spontaneous coronary artery dissection (SCAD) is a rare entity. It has been described in various settings like pregnancy, collagen vascular diseases, cocaine abuse, heavy exercise, variant angina, eosinophilic arteritis, or fibro muscular dysplasia. It is also easy to miss a dissection during angiography, as the typical radiolucent lumen seen in coronary angiography may be absent in many cases. In this report, we describe the case of a 35-year-old female who presented with acute ST elevation myocardial infarction due to spontaneous coronary dissection. She had been having episodic chest pain for one year and had been seen by two different cardiologists but was thought to have non-cardiac symptoms. Even during the index hospitalization, she underwent coronary angiography three times before coronary dissection could be identified as the cause of her symptoms. She underwent coronary artery bypass graft surgery uneventfully. However, even after myocardial revascularization, she has had multiple episodes of chest pain requiring hospitalization. However, we have not been able to find a specific cause for it and the cause of her recurrent chest pain remains an enigma. This case highlights the problems, which arise while managing a case of SCAD. More research is needed to find the exact etiology and long-term prognosis of this condition.

  3. Poor prognosis of patients presenting with symptomatic myocardial infarction but without chest pain

    PubMed Central

    Dorsch, M; Lawrance, R; Sapsford, R; Durham, N; Oldham, J; Greenwood, D; Jackson, B; Morrell, C; Robinson, M; Hall, A

    2001-01-01

    OBJECTIVE—To describe the clinical features, prognosis, and treatment of patients presenting with atypical forms of acute myocardial infarction.
DESIGN—Consecutive cases of possible acute myocardial infarction were sought from coronary care registers, biochemistry records, and hospital management systems. Case notes were reviewed and predefined epidemiological and clinical variables were abstracted.
SETTING—20 adjacent hospitals in the former Yorkshire region.
PATIENTS—3684 consecutive cases of possible acute myocardial infarction admitted in a three month period were identified, of whom 2096 had a first episode of confirmed acute myocardial infarction.
RESULTS—20.2% of all patients admitted with an eventual diagnosis of acute myocardial infarction presented with symptoms other than chest pain. Compared with the group presenting with chest pain, these patients were older (76.6 v 69.1 years, p < 0.001), were more often women (54.6% v 35.3%, p < 0.001), and were more likely to have a history of heart failure (18.6% v 6.9%, p < 0.001). They had a higher 30 and 365 day mortality (49.2% and 61.0%, respectively) compared with patients presenting with chest pain (17.9% and 26.2%). In a Cox regression analysis the hazard ratio for presentation without chest pain was 1.60 (95% confidence interval 1.30 to 1.97) (p < 0.001) adjusted for age, heart rate, blood pressure, left ventricular impairment, and infarction with ST segment elevation as covariates. Importantly, they were also less likely to receive treatments with a proven ability to improve prognosis.
CONCLUSIONS—Atypical presentation of myocardial infarction without chest pain is common and associated with increased mortality. This may result in part from a failure to use beneficial treatment strategies.


Keywords: acute myocardial infarction; atypical presentation PMID:11602537

  4. Chest Pain

    MedlinePlus

    ... yourself? About Stephen J. Schueler, M.D News Advertising How It Works FAQ for Consumers FAQ for Physicians Testimonials Site Map Terms of Use Contact Us FreeMD is provided for information purposes only and should not be used as a ...

  5. Chest pain

    MedlinePlus

    ... RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; ... Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, ...

  6. Whole-Chest 64-MDCT of Emergency Department Patients with Nonspecific Chest Pain: Radiation Dose and Coronary Artery Image Quality with Prospective ECG Triggering Versus Retrospective ECG Gating

    PubMed Central

    Shuman, William P.; Branch, Kelley R.; May, Janet M.; Mitsumori, Lee M.; Strote, Jared N.; Warren, Bill H.; Dubinsky, Theodore J.; Lockhart, David W.; Caldwell, James H.

    2012-01-01

    Objective The purpose of this study was to compare the patient radiation dose and coronary artery image quality of long-z-axis whole-chest 64-MDCT performed with retrospective ECG gating with those of CT performed with prospective ECG triggering in the evaluation of emergency department patients with nonspecific chest pain. Subjects and Methods Consecutively registered emergency department patients with nonspecific low-to-moderate-risk chest pain underwent whole-chest CT with retrospective gating (n = 41) or prospective triggering (n = 31). Effective patient radiation doses were estimated and compared by use of unpaired Student's t tests. Two reviewers independently scored the quality of images of the coronary arteries, and the scores were compared by use of ordinal logistic regression. Results Age, heart rate, body mass index, and z-axis coverage were not statistically different between the two groups. For retrospective gating, the mean effective radiation dose was 31.8 ± 5.1 mSv; for prospective triggering, the mean effective radiation dose was 9.2 ± 2.2 mSv (prospective triggering 71% lower, p < 0.001). Two of 512 segments imaged with retrospective gating were nonevaluable (0.4%), and two of 394 segments imaged with prospective triggering were nonevaluable (0.5%). Prospectively triggered images were 2.2 (95% CI, 1.1–4.5) times as likely as retrospectively gated images to receive a high image quality score for each segment after adjustment for segment differences (p < 0.05). Conclusion For long-z-axis whole-chest 64-MDCT of emergency department patients with nonspecific chest pain, use of prospective ECG triggering may result in substantially lower patient radiation doses and better coronary artery image quality than is achieved with retrospective ECG gating. PMID:19457832

  7. Acute non-traumatic gastrothorax: presentation of a case with chest pain and atypical radiologic findings.

    PubMed

    Singh, Deepwant; Mackeith, Pieter; Gopal, Dipesh Pravin

    2016-03-23

    A previously well 71-year-old woman presented to the Emergency Department with acute-onset left-sided chest pain. She was haemodynamically stable with unremarkable systemic examination. Her electrocardiogram and troponin were within normal limits and her chest radiograph showed a raised left hemi-diaphragm. Two hours after admission, this woman became acutely breathless, and suffered a pulseless electrical activity cardiac arrest. After cardiopulmonary resuscitation, there was a return of spontaneous circulation and regained consciousness. A repeat clinical assessment revealed a new left-sided dullness to percussion with contralateral percussive resonance on respiratory examination. CXR revealed a left pan-hemi-thoracic opacity whilst better definition using CT-pulmonary angiography (CTPA) indicated an acute tension gastrothorax secondary to a large left-sided diaphragmatic hernia. Nasogastric (NG) tube insertion was used to decompress the stomach and the patient underwent uncomplicated emergency laparoscopic hernia reduction. She remained well at 1-year follow-up.

  8. Patients with acute chest pain - experiences of emergency calls and pre-hospital care.

    PubMed

    Forslund, Kerstin; Kihlgren, Mona; Ostman, Ingela; Sørlie, Venke

    2005-01-01

    Acute chest pain is a common reason why people call an emergency medical dispatch (EMD) centre. We examined how patients with acute chest pain experience the emergency call and their pre-hospital care. A qualitative design was used with a phenomenological-hermeneutic approach. Thirteen patients were interviewed, three women and 10 men. The patients were grateful that their lives had been saved and in general were satisfied with their pre-hospital contact. Sometimes they felt that it took too long for the emergency operators to answer and to understand the urgency. They were in a life-threatening situation and their feeling of vulnerability and dependency was great. Time seemed to stand still while they were waiting for help during their traumatic experience. The situation was fraught with pain, fear and an experience of loneliness. A sense of individualized care is important to strengthen trust and confidence between the patient and the pre-hospital personnel. Patients were aware of what number to call to reach the EMD centre, but were uncertain about when to call. More lives can be saved if people do not hesitate to call for help.

  9. Exercise-provoked esophageal motility disorder in patients with recurrent chest pain

    PubMed Central

    Budzyński, Jacek

    2010-01-01

    AIM: To investigate the relationship between exercise-provoked esophageal motility disorders and the prognosis for patients with chest pain. METHODS: The study involved 63 subjects with recurrent angina-like chest pain non-responsive to empirical therapy with proton pump inhibitor (PPI). In all, a coronary artery angiography, panendoscopy, 24-h esophageal pH-metry and manometry, as well as a treadmill stress test with simultaneous esophageal pH-metry and manometry monitoring, were performed. Thirty-five subjects had no significant coronary artery lesions, and 28 had more than 50% coronary artery narrowing. In patients with hypertensive esophageal motility disorders, a calcium antagonist was recommended. The average follow-up period was 977 ± 249 d. RESULTS: The prevalence of esophageal disorders, such as gastroesophageal reflux or diffuse esophageal spasm, was similar in patients both with and without significant coronary artery narrowing. Exercise prompted esophageal motility disorders, such as a decrease in the percentage of peristaltic and effective contractions and their amplitude, as well as an increase in the percentage of simultaneous and non-effective contractions. In 14 (22%) patients the percentage of simultaneous contractions during the treadmill stress test exceeded the value of 55%. Using Kaplan-Meier analysis and the proportional hazard Cox regression model, it was shown that the administration of a calcium channel antagonist in patients with such an esophageal motility disorder significantly decreased the risk of hospitalization as a result of a suspicion of acute coronary syndrome after the 2.7-year follow-up period. CONCLUSION: In patients with chest pain non-responsive to PPIs, a diagnosis of exercise-provoked esophageal spasm may have the effect of lowering the risk of the next hospitalization. PMID:20845510

  10. Dual Prosthetic Heart Valve Presented with Chest Pain: A Case Report of Coronary Thromboembolism

    PubMed Central

    Siwamogsatham, Sarawut

    2015-01-01

    Coronary embolism from a prosthetic heart valve is a rare but remarkable cause of acute coronary syndrome. There is no definite management of an entity like this. Here we report a case of 54-year-old male with a history of rheumatic heart disease with dual prosthetic heart valve and atrial fibrillation who developed chest pain from acute myocardial infarction. The laboratory values showed inadequate anticoagulation. Cardiac catheterization and thrombectomy with the aspiration catheter were chosen to be the treatment for this patient, and it showed satisfactory outcome. PMID:25785203

  11. A 64-Year-Old Woman with Chest Pain, Limb Weakness, and Endometrial Cancer

    PubMed Central

    Kherad, Omar; Petriccioli, Nicole; Lobrinus, Johannes Alexander; Guerne, Pierre-André A.

    2017-01-01

    Necrotizing autoimmune myopathy (NAM) is a rare subgroup of idiopathic inflammatory myopathies (IIM). This pathology usually affects proximal limb muscles and in some cases the myocardium. Patients usually display proximal limb weakness. Muscular biopsy is required to confirm the diagnosis. We report the case of a 64-year-old woman with an atypical first presentation of NAM, manifested by chest pain in the context of metastatic endometrial cancer. The diagnosis of NAM was however made when she returned a second time with proximal limb weakness. A treatment with prednisone was then initiated, to which rituximab was rapidly associated, beside a specific chemotherapy. PMID:28373922

  12. Chest pain in the emergency room-an interesting case presentation.

    PubMed

    Turner, Michael C

    2016-12-01

    A 61-year-old woman presented to the emergency room with atypical chest pain, non-diagnostic electrocardiogram, and an initial troponin level that was normal. A coronary computed tomography angio (CCTA) was performed, and on initial review, it appeared to be normal. Subsequent review including evaluation of functional data from the retrospective scan identified a distal left anterior descending occlusion and an apical wall-motion abnormality with no other evidence of heart disease. This case illustrates the complementary contribution of anatomic and functional data and serves to remind us that on rare occasions, what looks "normal" is not always normal.

  13. Esophageal Mast Cell Infiltration in a 32-Year-Old Woman with Noncardiac Chest Pain.

    PubMed

    Lee, Keol; Kwon, Hee Jin; Kim, In Young; Yoo, Kwai Han; Lee, Seulkee; Min, Yang Won; Rhee, Poong-Lyul

    2016-01-01

    Noncardiac chest pain (NCCP) is one of the most common esophageal symptoms and lacks a clearly defined mechanism. The most common cause of NCCP is gastroesophageal reflux disease (GERD). One of the accepted mechanisms of NCCP in a patient without GERD has been altered visceral sensitivity. Mast cells may play a role in visceral hypersensitivity in irritable bowel syndrome. In this case, a patient with NCCP and dysphagia who was unresponsive to proton pump inhibitor treatment had an increased esophageal mast cell infiltration and responded to 14 days of antihistamine and antileukotriene treatment. We suggest that there may be a relationship between esophageal symptoms such as NCCP and esophageal mast cell infiltration.

  14. Investigation of non-cardiac chest pain — which oesophageal test?

    PubMed Central

    Lee, R J E; Collins, B J; Spence, R A J; Crookes, P F; Campbell, N P S; Adgey, A A J

    1986-01-01

    Five different tests were used to evaluate oesophageal function in 22 patients who presented to a cardiac unit with acute chest pain but whose cardiological investigations were negative. Eight patients had an abnormality on oesophagoscopy, 10 had an abnormal pH monitoring study, six had a positive acid infusion test, 10 had an abnormal manometric study and six had an abnormal oseophageal transit scintiscan. Concordance for the three tests of gastro-oesophageal reflux disease was low at 28%, and for the two tests of oesophageal motility only 55%. Only two patients had normal results in all five tests. PMID:3739062

  15. Clinical Evaluation Versus Undetectable High-Sensitivity Troponin for Assessment of Patients With Acute Chest Pain.

    PubMed

    Sanchis, Juan; García-Blas, Sergio; Carratalá, Arturo; Valero, Ernesto; Mollar, Anna; Miñana, Gema; Ruiz, Vicente; Balaguer, Jose Vicente; Roqué, Mercé; Bosch, Xavier; Núñez, Julio

    2016-12-01

    Decision-making in acute chest pain remains challenging despite normal (below ninety-ninth percentile) high-sensitivity troponin (hs-cTn). Some studies suggest that undetectable hs-cTn, far below the ninety-ninth percentile, might rule out acute coronary syndrome. We investigated clinical data in comparison to undetectable hs-cTnT. The study comprised 682 patients (November 2010 to September 2011) presenting at the emergency department with chest pain and normal hs-cTnT (<14 ng/l). The main end point was major adverse cardiac events (MACE: death, myocardial infarction, readmission for unstable angina, or revascularization) at a 4-year median follow-up; secondary end point was 30-day MACE. A clinical score was built by assigning points according to hazard ratios of the independent predictive variables: 1 point (male and effort-related pain) and 2 points (recurrent pain and prior ischemic heart disease). The negative predictive values of the clinical score and undetectable hs-cTnT (<5 ng/l), were tested. A total of 72 (10.6%) patients suffered long-term MACE. The C-statistics of the clinical score for long-term (0.75) and 30-day (0.88) MACE were higher than with the TIMI(Thrombolysis In Myocardial Infarction) risk (0.68, 0.77) or GRACE(Global Registry of Acute Coronary Events) (0.50, 0.47) scores. Likewise, the negative predictive values of score = 0 (97.5%, 100%) and ≤1 point (95.9%, 100%) were higher than using undetectable hs-cTnT (91.9%, 98.1%). Both clinical scores of 0 and ≤1 better classified patients at risk of MACE (p = 0.0001, log-rank test) than hs-cTnT <5 ng/l (p = 0.06). In conclusion, clinical data can guide decision-making and perform at least equally well as undetectable hs-cTnT, in patients presenting at the emergency department with chest pain and normal hs-cTnT.

  16. Value of noninvasive assessment of patients with atypical chest pain and suspected coronary spasm using ergonovine infusion and thallium-201 scintigraphy.

    PubMed

    DiCarlo, L A; Botvinick, E H; Canhasi, B S; Schwartz, A S; Chatterjee, K

    1984-10-01

    Twenty-six patients with known benign coronary anatomic characteristics and atypical chest pain syndromes were evaluated for the possibility of coronary spasm. Incremental intravenous ergonovine maleate infusions were administered, and thallium-201 scintigraphy was performed at the peak dosage and during recovery in the coronary care unit. With ergonovine therapy, 4 patients (16%) had chest pain associated with electrocardiographic (ECG) or scintigraphic changes. Nine patients (35%) had chest pain without associated ECG or scintigraphic changes, and 13 patients did not have chest pain in response to ergonovine administration, although 2 (8%) had ergonovine-induced scintigraphic defects. All 4 patients with ergonovine-induced chest pain and associated ECG or scintigraphic abnormalities had resolution or reduction of chest pain after medical treatment. However, 7 of the 9 patients with ergonovine-induced chest pain in the absence of ECG or scintigraphic abnormalities continued to have symptoms despite medical treatment a mean of 18 months later. In this limited study of a select group, bedside ergonovine provocation appeared safe. Many patients had chest pain, but few showed ECG or scintigraphic evidence of ischemia. Perfusion scintigraphy appears to have potential complementary value for the identification of an ischemic cardiac cause of atypical chest pain and provides a rationale for appropriate therapy.

  17. Spontaneous Intramural Oesophageal Haematoma in a Patient with Uncontrolled Hypertension: An Unusual Chest Pain Aetiology

    PubMed Central

    Cooray, Samantha; Caruana, Clifford; Davies, Andrew R.

    2017-01-01

    Introduction. Spontaneous intramural oesophageal haematoma is a rare condition that usually occurs secondary to an acute or chronic coagulation disorder. The presenting complaint is often with retrosternal chest pain and most patients are initially investigated to exclude more common causes in the differential diagnosis, such as acute coronary syndromes. Severe life-threatening bleeding or perforation seldom, if ever, arises. Case Presentation. We present a case of spontaneous oesophageal haematoma which appears to have developed gradually in a 69-year-old female with uncontrolled hypertension and antiplatelet medication use. The diagnosis was made on computed tomography imaging and was further evaluated with upper gastrointestinal endoscopy. Management was conservative and a follow-up endoscopy two weeks later showed almost complete resolution of the lesion. Discussion. Spontaneous oesophageal haematomas are very rare and usually result in the separation of the mucosal layer from the underlying muscle, presenting with chest pain, haematemesis, and dysphagia. Usually the diagnosis is one of exclusion, based on computed tomography imaging and endoscopy. Conservative management is almost always successful. PMID:28316858

  18. Clinical experience with a decision support computer program using Bayes' theorem to diagnose chest pain patients.

    PubMed

    Aase, O

    1999-01-01

    A decision support computer program (DSP) was used by the emergency room physician as a diagnostic tool on patients admitted with acute chest pain to guide the referral of these patients either to the Coronary Care Unit (CCU) or general ward. The DSP used Bayes' theorem on 38 anamnestic and clinical variables to classify patients into one of nine diagnoses. During a six months trial period 32 physicians used the DSP to diagnose 493 patients admitted with acute chest pain. The physicians referred the patients to CCU or general ward based on their clinical judgements, the ECG findings and the diagnostic estimates given by the DSP. The program correctly diagnosed 150 (84%) of 178 patients with acute myocardial infarction and 63 of 112 patients with unstable angina. However, acute ischemic heart disease (acute myocardial infarction or unstable angina) was correctly classified by the DSP for 259 (89%) of 290 patients. By using the DSP, the number of patients unnecessarily referred to CCU was reduced from 35% to 19% and the number of patients in need of CCU observation misallocated to general ward was reduced from 13% to 10%. Thus, use of the DSP in the emergency room on easily available anamnestic and clinical variables may improve referrals to the CCU, optimize therapy and resource use.

  19. [Medico-legal features of early discharge in acute myocardial infarction and chest pain].

    PubMed

    Montisci, M; Ruscazio, M; Snenghi, R; Nalin, S; Montisci, R; Iliceto, S; Ferrara, S D

    2001-06-01

    The authors' aim is to outline some of the main medico-legal problems in cardiology, especially those regarding the premature hospital discharge of patients with undefined chest pain and/or with acute myocardial infarction. After a brief overview on the etiology and clinical definition of chest pain and myocardial infarction, premature hospital discharge is defined and the incidental medico-legal risks that physicians operating in such situations are exposed to are pointed out. Next, the profiles regarding both the positive and negative views of professional medical responsibility are described. In the negative frame, the authors outline the most frequent civil and penal aspects of the unpremeditated responsibility. Then the physician's error, in both qualitative (generic or specific guilt) and quantitative (degree) terms, is considered; particularly, negligence, imprudence and inexperience, as qualitatively accepted meanings of generic guilt, are dealt with by adopting illustrative cases settled in the light of the right legal interpretation. The phases of the diagnostic or prognostic error are evaluated, and clinical protocols, as a reference parameter for the identification of error, are considered. Lastly, the problem of causality, essential condition for the judgment about the professional responsibility, and the problem of the patient's consent, including an evaluation of the legal capability or incapability about the declaration of consent, are examined closely.

  20. Acute chest pain: the role of MR imaging and MR angiography.

    PubMed

    Hunold, Peter; Bischoff, Peter; Barkhausen, Jörg; Vogt, Florian M

    2012-12-01

    MR imaging (MRI) and MR angiography (MRA) have gained a high level of diagnostic accuracy in cardiovascular disease. MRI in cardiac disease has been established as the non-invasive standard of reference in many pathologies. However, in acute chest pain the situation is somewhat special since many of the patients presenting in the emergency department suffer from potentially life-threatening disease including acute coronary syndrome, pulmonary embolism, and acute aortic syndrome. Those patients need a fast and definitive evaluation under continuous monitoring of vital parameters. Due to those requirements MRI seems to be less suitable compared to X-ray coronary angiography and multislice computed tomography angiography (CTA). However, MRI allows for a comprehensive assessment of all clinically stable patients providing unique information on the cardiovascular system including ischemia, inflammation and function. Furthermore, MRI and MRA are considered the method of choice in patients with contraindications to CTA and for regular follow-up in known aortic disease. This review addresses specific features of MRI and MRA for different cardiovascular conditions presenting with acute chest pain.

  1. Esophageal mucosal mast cell infiltration and changes in segmental smooth muscle contraction in noncardiac chest pain.

    PubMed

    Park, S W; Lee, H; Lee, H J; Chung, H; Park, J C; Shin, S K; Lee, S K; Lee, Y C

    2015-01-01

    Mast cells release potent mediators that alter enteric nerve and smooth muscle functions and may contribute to the pathogenesis of functional gastrointestinal disorders. The goal of this study was to determine if mucosal mast cell infiltration was associated with smooth muscle segmental changes in esophageal contraction. All patients with noncardiac chest pain (NCCP) were divided into two groups consisting of patients with non-erosive reflux disease or functional chest pain (FCP) according to the results of ambulatory 24 hours esophageal pH monitoring and high-resolution manometry. Pressure-volume (PV) was calculated by multiplying the length of the esophageal segment, duration of the contraction, and mean pressure over the entire space-time box (P mean). Quantification of mast cells was performed in five consecutive nonoverlapping immunostained sections. Spearman correlation analysis showed that the distal segment PV correlated with the mast cell count in all of the patients combined and in patients with FCP with correlation coefficients of 0.509 and 0.436, respectively (P = 0.004 and P = 0.042). Similar findings were observed for the segmental ratio of distal to proximal smooth muscle PV in all patients and in patients with FCP (correlation coefficients 0.566; P = 0.001 and correlation coefficients 0.525; P = 0.012, respectively). Mucosal mast cell infiltration was associated with distal esophageal contraction as a key pathophysiologic factor of NCCP.

  2. Value of tomographic thallium-201 imaging in patients with chest pain following coronary artery bypass grafting

    SciTech Connect

    Starling, M.R.; Walsh, R.A.; Dehmer, G.J.; Lasher, J.C.; Blumhardt, R.

    1987-02-01

    To determine whether thallium-201 washout profile analysis can detect regional myocardial ischemia caused by coronary artery bypass graft occlusion or progression of disease in nonbypassed coronary arteries, 19 consecutive patients with chest pain following bypass grafting were evaluated with coronary arteriography and thallium-201 scintigraphy. Twenty of the 55 coronary artery regions were perfused by an occluded bypass graft or a significantly stenosed (greater than or equal to 70% diameter narrowing) nonbypassed coronary artery, while 35 coronary regions were perfused by patent bypass grafts or insignificantly diseased coronary arteries. The tomographic thallium-201 washout profile results correlated with the bypass graft and coronary arteriographic findings. The sensitivity of tomographic thallium-201 washout profile abnormalities for arteriographic abnormalities was 75%, while the specificity was 86%. The authors conclude that tomographic thallium-201 washout profile analysis may be very useful in the evaluation of patients with chest pain following coronary artery bypass grafting by detecting regional myocardial ischemia caused by occlusion of specific bypass grafts or progression of disease in nonbypassed coronary arteries.

  3. Cardiointegram: detection of coronary artery disease in males with chest pain and a normal resting electrocardiogram

    SciTech Connect

    Teichholz, L.E.; Steinmetz, M.Y.; Escher, D.; Herman, M.V.; Naimi, S.; Mahony, D.V.; Ellestad, M.H.

    1986-07-01

    The cardiointegram is a non-invasive technique for the analysis of the electrical signals of the heart obtained by a transformation of the voltage vs. time format by a series of integrations. This multicenter study compares the results of the cardiointegram with coronary arteriography in 140 male patients with chest pain and a normal resting electrocardiogram. The cardiointegram was determined on two resting complexes of Leads I, II, V4, V5 and V6 and called abnormal if greater than or equal to four of ten complexes were abnormal, i.e., fell outside of a previously determined template of normality. The sensitivity was 73% and specificity was 78% for the diagnosis of occlusive coronary artery disease. When greater than or equal to five of ten abnormal complexes were used as the cut-off for an abnormal test and ''equivocal'' results (four of ten abnormal, n = 18) were excluded from analysis there was a sensitivity of 69% and specificity of 88%. Thirty-seven of 38 patients (97%) with an abnormal cardiointegram and a positive exercise stress test had coronary artery disease. Thus, the cardiointegram appears to be a useful non-invasive test for the detection of coronary artery disease in males with chest pain and a normal resting electrocardiogram in whom the diagnosis of coronary artery disease is being considered.

  4. Diagnostic indicators of non-cardiovascular chest pain: a systematic review and meta-analysis

    PubMed Central

    2013-01-01

    Background Non-cardiovascular chest pain (NCCP) has a high healthcare cost, but insufficient guidelines exist for its diagnostic investigation. The objective of the present work was to identify important diagnostic indicators and their accuracy for specific and non-specific conditions underlying NCCP. Methods A systematic review and meta-analysis were performed. In May 2012, six databases were searched. Hand and bibliography searches were also conducted. Studies evaluating a diagnostic test against a reference test in patients with NCCP were included. Exclusion criteria were having <30 patients per group, and evaluating diagnostic tests for acute cardiovascular disease. Diagnostic accuracy is given in likelihood ratios (LR): very good (LR+ >10, LR- <0.1); good (LR + 5 to 10, LR- 0.1 to 0.2); fair (LR + 2 to 5, LR- 0.2 to 0.5); or poor (LR + 1 to 2, LR- 0.5 to 1). Joined meta-analysis of the diagnostic test sensitivity and specificity was performed by applying a hierarchical Bayesian model. Results Out of 6,316 records, 260 were reviewed in full text, and 28 were included: 20 investigating gastroesophageal reflux disorders (GERD), 3 musculoskeletal chest pain, and 5 psychiatric conditions. Study quality was good in 15 studies and moderate in 13. GERD diagnosis was more likely with typical GERD symptoms (LR + 2.70 and 2.75, LR- 0.42 and 0.78) than atypical GERD symptoms (LR + 0.49, LR- 2.71). GERD was also more likely with a positive response to a proton pump inhibitor (PPI) test (LR + 5.48, 7.13, and 8.56; LR- 0.24, 0.25, and 0.28); the posterior mean sensitivity and specificity of six studies were 0.89 (95% credible interval, 0.28 to 1) and 0.88 (95% credible interval, 0.26 to 1), respectively. Panic and anxiety screening scores can identify individuals requiring further testing for anxiety or panic disorders. Clinical findings in musculoskeletal pain either had a fair to moderate LR + and a poor LR- or vice versa. Conclusions In

  5. Angina-like chest pain and syncope as the clinical presentation of left ventricular endomyocardial fibrosis: a case report.

    PubMed

    Bestetti, Reinaldo B; Corbucci, Helio A R; Fornitano, Luis D; Godoy, Moacyr F; Cury, Patricia M; Villafanha, Daniel; Santana, Domingos A; Soares, Marcelo J F; Braile, Domingo M

    2005-01-01

    A 47-year-old woman complained of angina-like chest pain, near-syncope, and syncopal episodes of 17 years' duration. Physical examination was unremarkable. A 12-lead resting ECG showed symmetrically inverted T waves in the inferior and anterolateral leads. A graded treadmill exercise stress test precipitated angina-like chest pain accompanied by a near-syncopal episode associated with a systemic arterial pressure of 60/40 mm Hg. Echocardiography disclosed left ventricular apical obliteration. Left ventriculogram showed a typical "ace of heart'' shadow as well as filling defects and apical obliteration. Endomyocardial biopsy of the left ventricle diagnosed left ventricular endomyocardial fibrosis. Thus, angina-like chest pain and near-syncopal episodes should be added to the list of clinical manifestations of pure left ventricular endomyocardial fibrosis.

  6. Treatment Efficacy for Non-Cardiovascular Chest Pain: A Systematic Review and Meta-Analysis

    PubMed Central

    Burgstaller, Jakob M.; Jenni, Boris F.; Steurer, Johann; Held, Ulrike; Wertli, Maria M.

    2014-01-01

    Background Non-cardiovascular chest pain (NCCP) leads to impaired quality of life and is associated with a high disease burden. Upon ruling out cardiovascular disease, only vague recommendations exist for further treatment. Objectives To summarize treatment efficacy for patients presenting with NCCP. Methods Systematic review and meta-analysis. In July 2013, Medline, Web of Knowledge, Embase, EBSCOhost, Cochrane Reviews and Trials, and Scopus were searched. Hand and bibliography searches were also conducted. Randomized controlled trials (RCTs) evaluating non-surgical treatments in patients with NCCP were included. Exclusion criteria were poor study quality and small sample size (<10 patients per group). Results Thirty eligible RCT’s were included. Most studies assessed PPI efficacy for gastroesophageal reflux disorders (GERD, n = 10). Two RCTs included musculoskeletal chest pain, seven psychotropic drugs, and eleven various psychological interventions. Study quality was high in five RCTs and acceptable in 25. PPI treatment in patients with GERD (5 RCTs, 192 patients) was more effective than placebo [pooled OR 11.7 (95% CI 5.5 to 25.0, heterogeneity I2 = 6.1%)]. The pooled OR in GERD negative patients (4 RCTs, 156 patients) was 0.8 (95% CI 0.2 to 2.8, heterogeneity I2 = 50.4%). In musculoskeletal NCCP (2 RCTs, 229 patients) manual therapy was more effective than usual care but not than home exercise [pooled mean difference 0.5 (95% CI −0.3 to 1.3, heterogeneity I2 = 46.2%)]. The findings for cognitive behavioral treatment, serotonin reuptake inhibitors, tricyclic antidepressants were mixed. Most evidence was available for cognitive behavioral treatment interventions. Limitations Only a small number of studies were available. Conclusions Timely diagnostic evaluation and treatment of the disease underlying NCCP is important. For patients with suspected GERD, high-dose treatment with PPI is effective. Only limited evidence was available for most

  7. Meteorological factors and the time of onset of chest pain in acute myocardial infarction

    NASA Astrophysics Data System (ADS)

    Thompson, David R.; Pohl, Jurgen E.; Tse, Yiu-Yu S.; Hiorns, Robert W.

    1996-09-01

    Analysis of the time of onset of chest pain in 2254 patients with a myocardial infarction admitted to a coronary care unit in Leicester during a 10-year period shows an association with temperature and humidity. During both the most cold and humid times of the year, the relationship is a strong one. A generalized linear model with a log link was used to fit the data and the backward elimination selection procedure suggested a humid, cold day might help to trigger the occurrence of myocardial infarction. In addition, cold weather was found to have a stronger effect on the male population while those men aged between 50 and 70 years were more sensitive to the effect of high humidity.

  8. Esophageal Mast Cell Infiltration in a 32-Year-Old Woman with Noncardiac Chest Pain

    PubMed Central

    Lee, Keol; Kwon, Hee Jin; Kim, In Young; Yoo, Kwai Han; Lee, Seulkee; Min, Yang Won; Rhee, Poong-Lyul

    2016-01-01

    Noncardiac chest pain (NCCP) is one of the most common esophageal symptoms and lacks a clearly defined mechanism. The most common cause of NCCP is gastroesophageal reflux disease (GERD). One of the accepted mechanisms of NCCP in a patient without GERD has been altered visceral sensitivity. Mast cells may play a role in visceral hypersensitivity in irritable bowel syndrome. In this case, a patient with NCCP and dysphagia who was unresponsive to proton pump inhibitor treatment had an increased esophageal mast cell infiltration and responded to 14 days of antihistamine and antileukotriene treatment. We suggest that there may be a relationship between esophageal symptoms such as NCCP and esophageal mast cell infiltration. PMID:26087786

  9. Chest Pain with Normal Thallium-201 Myocardial Perfusion Image – Is It Really Normal?

    PubMed Central

    Liu, Pang-Yen; Lin, Wen-Yu; Lin, Li-Fan; Lin, Chin-Sheng; Lin, Wei-Shiang; Cheng, Shu-Meng; Yang, Shih-Ping; Liou, Jun-Ting

    2016-01-01

    Background Thallium-201 myocardial perfusion image (MPI) is commonly used to detect coronary artery disease in patients with chest pain. Although a normal thallium-201 MPI result is generally considered to be a good prognosis and further coronary angiogram is not recommended, there are still a few patients who suffer from unexpected acute coronary events. The aim of this study was to investigate the clinical prognosis in patients with normal thallium-201 MPI. Methods From January 2006 to August 2012, a total 22,003 patients undergoing thallium-201 MPI in one tertiary center were screened. Of these, 8092 patients had normal results and were investigated retrospectively. During follow-up, 54 patients underwent coronary angiogram because of refractory typical angina pectoris or unexpected acute coronary events. These 54 patients were divided into 2 groups: group I consisted of 26 (48.1%) patients with angiography-proven significant coronary artery stenosis, and group II consisted of 28 (51.9%) patients without significant stenosis. Results Patients in group I had a higher prevalence of prior coronary stenting and electrocardiographic features of ST depression compared with patients in group II. The multivariate analysis demonstrated that both prior coronary stenting and ST depression were risk predictors of unexpected acute coronary events in the patients with normal thallium-201 MPI [odds ratio (OR), 5.93; 95% confidence interval (CI): 1.03-34.06, p = 0.05 and OR, 7.10; 95% CI: 1.28-39.51, p = 0.03,respectively]. Conclusions Although there is a low incidence of unexpected acute coronary events in patients with chest pain and normal thallium-201 MPI, physicians should be aware of the potentials risk in certain patients in this specific population. PMID:27274174

  10. Outcomes of Patients With Cocaine Induced Chest Pain in An Inner City Hospital

    PubMed Central

    Atoui, Moustapha; Fida, Nadia; Nayudu, Suresh Kumar; Glandt, Mariela; Chilimuri, Sridhar

    2011-01-01

    Background Cocaine induced chest pain is a major reason for admission in Safety Net Hospitals in the United States. The majority of patients admitted undergo extensive work-up leading to enormous economic burden. We hypothesize that in individuals with low risk, cocaine does not further increase adverse cardiovascular outcomes. Methods We conducted a retrospective chart review of all patients admitted with chest pain to our hospital between 07/01/09 and 06/30/10. We excluded patients with modifiable risk factors for coronary artery disease (CAD). The study population was divided into cocaine and non-cocaine group based on urine drug screen. We analyzed data including demographic, laboratory, cardiac testing, detection of CAD, length of stay and mortality rates. Results A total of 426 individuals matched our inclusion and exclusion criteria and were considered to have no known modifiable cardiac risk factors; 54 in cocaine group and 372 in non-cocaine group. Based on physician discretion, 41(76%) in the cocaine group and 239(64%) in the non-cocaine group underwent various modalities of cardiac testing. Cardiac testing was positive in 6(2.5%) patients in non-cocaine group and none in the cocaine group (p=0.597). There was no significant difference between length of stay and in-hospital mortality between the two groups. Conclusions In individuals at low risk for CAD, cocaine use resulted in higher rate of cardiac testing. However, there is no difference in prevalence of CAD and in-hospital mortality between the two groups. We conclude that cocaine does not increase adverse outcomes in patients with low risk for CAD.

  11. Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule

    PubMed Central

    Haasenritter, Jörg; Donner-Banzhoff, Norbert; Bösner, Stefan

    2015-01-01

    Background The Marburg Heart Score (MHS) is a simple, valid, and robust clinical decision rule assisting GPs in ruling out coronary heart disease (CHD) in patients presenting with chest pain. Aim To investigate whether using the rule adds to the GP’s clinical judgement. Design and setting A comparative diagnostic accuracy study was conducted using data from 832 consecutive patients with chest pain in general practice. Method Three diagnostic strategies were defined using the MHS: diagnosis based solely on the MHS; using the MHS as a triage test; and GP’s clinical judgement aided by the MHS. Their accuracy was compared with the GPs’ unaided clinical judgement. Results Sensitivity and specificity of the GPs’ unaided clinical judgement was 82.9% (95% confidence interval [CI] = 72.4 to 89.9) and 61.0% (95% CI = 56.7 to 65.2), respectively. In comparison, the sensitivity of the MHS was higher (difference 8.5%, 95% CI = −2.4 to 19.6) and the specificity was similar (difference −0.4%, 95% CI = −5.3 to 4.5); the sensitivity of the triage was similar (difference −1.5%, 95% CI = −9.8 to 7.0) and the specificity was higher (difference 11.6%, 95% CI = 7.8 to 15.4); and both the sensitivity and specificity of the aided clinical judgement were higher (difference 8.0%, 95% CI = −6.9 to 23.0 and 5.8%, 95% CI = −1.6 to 13.2, respectively). Conclusion Using the Marburg Heart Score for initial triage can improve the clinical diagnosis of CHD in general practice. PMID:26500322

  12. Serratus Anterior Plane Block to Address Post-thoracotomy and Chest Tube-related Pain: A Report on 3 Cases.

    PubMed

    Chu, George M; Jarvis, G Craig

    2017-03-16

    In this case report, the serratus anterior plane block was used in conjunction with multilevel continuous thoracic paravertebral blocks (TPVB) and general anesthesia in 3 thoracotomy cases. All blocks were accompanied by use of catheters that allowed continuous local anesthetic infusions and intermittent local anesthetic bolus injections to address postoperative pain. In all 3 patients, the serratus anterior plane block provided analgesia for chest tube-related pain that was not provided by the TPVB alone.

  13. Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department

    PubMed Central

    Sawyer, Kelly N.; Shah, Payal; Qu, Lihua; Kurz, Michael C.; Clark, Carol L.; Swor, Robert A.

    2015-01-01

    Introduction Undifferentiated chest pain in the emergency department (ED) is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT) for pulmonary embolism or dissection followed by a cardiac stress test (TRAD). An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods. Methods This was a retrospective observational study of adult patients presenting to a large, community ED for acute chest pain who had non-diagnostic electrocardiograms (ECGs) and normal biomarkers. We collected demographics, ED length of stay, hospital costs, and estimated radiation exposures. We evaluated 30-day return visits for major adverse cardiac events. Results A total of 829 patients underwent TRAD, and 642 patients had TRO. Patients undergoing TRO tended to be younger (mean 52.3 vs 56.5 years) and were more likely to be male (42.4% vs. 30.4%). TRO patients tended to have a shorter ED length of stay (mean 14.45 vs. 21.86 hours), to incur less cost (median $449.83 vs. $1147.70), and to be exposed to less radiation (median 7.18 vs. 16.6mSv). No patient in either group had a related 30-day revisit. Conclusion Use of TRO is feasible for assessment of chest pain in the ED. Both TRAD and TRO safely evaluated patients. Prospective studies investigating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation. PMID:26587090

  14. Application of lidocaine jelly on chest tubes to reduce pain caused by drainage catheter after coronary artery bypass surgery.

    PubMed

    Kang, Hyun; Chung, Yoon Sang; Choe, Ju Won; Woo, Young Cheol; Kim, Sang Wook; Park, Soon J; Hong, Joonhwa

    2014-10-01

    The objective of this study was to assess the effect of lidocaine jelly application to chest tubes on the intensity and duration of overall pain, chest tube site pain and the required analgesics for postoperative pain relief in coronary artery bypass graft (CABG) patients. For patients in group L, we applied sterile 2% lidocaine jelly on the chest tubes just before insertion, and for patients in group C, we applied normal saline. Overall visual analogue scale (VAS), maximal pain area with their VAS were documented postoperatively, and the frequency that button of patient-controlled analgesia was pressed (FPB) and total fentanyl consumption were assessed. The number of patients who complained that tube site was the most painful site was significantly higher in group C than in group L (85% vs. 30% at extubation, P<0.001). The overall VAS score was significantly higher in group C than in group L (39.14±12.49 vs. 27.74±13.76 at extubation, P=0.006). After all of the tubes were removed, the VAS score decreased more in group C (5.74±4.77, P<0.001) than in group L (3.05±2.48, P<0.001). FPB and total fentanyl consumption were significantly higher in group C than in group L (73.00, 59.00-78.00 vs. 34.00, 31.00-39.25, P<0.001; 2,214.65±37.01 vs. 1,720.19±361.63, P<0.001, respectively). Lidocaine jelly application is a very simple way to reduce postoperative pain by reducing chest tube site pain after CABG. (Clinical Trials Registry No. ACTRN 12611001215910).

  15. New Guidelines for the Management of Chest Pain: Lessons From a Recent Audit in Tauranga, New Zealand

    PubMed Central

    Chapman, Andrew R; Leslie, Stephen J; Sage, Derek K

    2012-01-01

    Background Protocol based care is known to improve the outcomes of patients admitted with recent onset chest pain. The aim of this clinical review was to investigate chest pain management, using newly published guidance from NICE, in the emergency department of a regional hospital in New Zealand. Methods All admissions with chest pain during the period of September-October 2010 were identified retrospectively (n = 599), and a sufficiently powered random sample (n = 120) taken. Relevant data was identified from patient notes, including basic demographics and specific management details. Results One hundred and eighteen patients were analysed (M = 65, F = 53), 99.2% received an ECG on admission, yet only 59.3% of patients had documented evidence of a repeat ECG, with admissions during the day less likely to receive one compared to those admitted overnight (51.5% vs 69.2%, P = 0.04). Younger patients (< 39 years) appeared less likely to receive aspirin than older patients (38.9% vs 80.0%, P = 0.06), 21.3% of patients failed to receive 300 mg aspirin, and 45.6% of patients received oxygen despite normal saturations. Conclusions Despite good performance in a number of areas, this clinical review has highlighted that some standards, such as repeat ECGs, administration of aspirin therapy and appropriate use of oxygen are not being met in all patients with chest pain. A chest pain management pathway is to be implemented for all relevant admissions, to ensure that essential aspects of care are not missed. Timely dissemination and implementation of new clinical guidelines remains a challenge in clinical practice.

  16. Protocol Adherence in Prehospital Medical Care Provided for Patients with Chest Pain and Loss of Consciousness; a Brief Report

    PubMed Central

    Mehrara, Mostafa; Tavakoli, Nader; Fathi, Marzieh; Mahshidfar, Babak; Zare, Mohammad Amin; Asadi, Azita; Hosseinzadeh, Saeedeh; Safdarian, Mehdi

    2017-01-01

    Introduction: Although many protocols are available in the field of the prehospital medical care (PMC), there is still a notable gap between protocol based directions and applied clinical practice. This study measures the rate of protocol adherence in PMC provided for patients with chest pain and loss of consciousness (LOC). Method: In this cross-sectional study, 10 educated research assistants audited the situation of provided PMC for non-traumatic chest pain and LOC patients, presenting to the emergency department of a tertiary level teaching hospital, compare to national recommendations in these regards. Results: 101 cases with the mean age of 56.7 ± 12.3 years (30-78) were audited (55.4% male). 61 (60.3%) patients had chest pain and 40 (39.7%) cases had LOC. Protocol adherence rates for cardiac monitoring (62.3%), O2 therapy (32.8%), nitroglycerin administration (60.7%), and aspirin administration (52.5%) in prehospital care of patients with chest pain were fair to poor. Protocol adherence rates for correct patient positioning (25%), O2 therapy (75%), cardiac monitoring (25%), pupils examination (25%), bedside glucometery (50%), and assessing for naloxone administration (55%) in prehospital care of patients with LOC were fair to poor. Conclusion: There were more than 20% protocol violation regarding prehospital care of chest pain patients regarding cardiac monitoring, O2 therapy, and nitroglycerin and aspirin administration. There were same situation regarding O2 therapy, positioning, cardiac monitoring, pupils examination, bedside glucometery, and assessing for naloxone administration of LOC patients in prehospital setting. PMID:28286847

  17. Acute chest pain in emergency room. Preliminary findings with 40-64-slice CT ECG-gated of the whole chest.

    PubMed

    Coche, E

    2007-01-01

    ECG-gated MDCT of the entire chest represents the latest technical advance in the diagnostic work-up of atypical chest pain. The authors report their preliminary experience with the use of 40 and 64-slice CT in the emergency room and recommend to study only patients with moderate likelihood of coronary artery disease. ECG-gated MDCT of the entire chest will be preferentially performed on 64-slice MDCT rather than 40-slice MDCT because it enable to reduce the scan time (18 seconds versus 28 seconds acquisition time), the volume of contrast medium (82 mL + 15 mL versus 97 mL + 15 mL of highly concentrated contrast agent for a patient of 70 kgs) and radiation exposure (17 mSv versus 19 mSv). Approximately 1500 to 2000 of images are produced and need to be analysed on a dedicated workstation by a radiologist expert in cardiac and thoracic disorders. At the present time, only a few studies exist in the literature showing some promising results but further large clinical studies are needed before to implement such sophisticated protocol in emergency room.

  18. Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial

    PubMed Central

    Hollander, Judd E; Schaffer, Jason T; Kline, Jeffrey A; Torres, Carlos A; Diercks, Deborah B; Jones, Russell; Owen, Kelly P; Meisel, Zachary F; Demers, Michel; Leblanc, Annie; Shah, Nilay D; Inselman, Jonathan; Herrin, Jeph; Castaneda-Guarderas, Ana; Montori, Victor M

    2016-01-01

    Objective To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. Design Multicenter pragmatic parallel randomized controlled trial. Setting Six emergency departments in the United States. Participants 898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain. Interventions Patients were randomly assigned (1:1) by an electronic, web based system to shared decision making facilitated by a decision aid or to usual care. The primary outcome, selected by patient and caregiver advisers, was patient knowledge of their risk for acute coronary syndrome and options for care; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30 day rate of major adverse cardiac events. Results Compared with the usual care arm, patients in the decision aid arm had greater knowledge of their risk for acute coronary syndrome and options for care (questions correct: decision aid, 4.2 v usual care, 3.6; mean difference 0.66, 95% confidence interval 0.46 to 0.86), were more involved in the decision (observing patient involvement scores: decision aid, 18.3 v usual care, 7.9; 10.3, 9.1 to 11.5), and less frequently decided with their clinician to be admitted for cardiac testing (decision aid, 37% v usual care, 52%; absolute difference 15%; P<0.001). There were no major adverse cardiac events due to the intervention. Conclusions Use of a decision aid in patients at low risk for acute coronary syndrome increased patient knowledge about their risk, increased

  19. Diagnostic evaluation of the MRP-8/14 for the emergency assessment of chest pain.

    PubMed

    Vora, Amit N; Bonaca, Marc P; Ruff, Christian T; Jarolim, Petr; Murphy, Sabina; Croce, Kevin; Sabatine, Marc S; Simon, Daniel I; Morrow, David A

    2012-08-01

    Elevated levels of myeloid-related protein (MRP)-8/14 (S100A8/A9) are associated with first cardiovascular events in healthy individuals and worse prognosis in patients with acute coronary syndrome (ACS). The diagnostic utility of MRP-8/14 in patients presenting to the emergency room with symptoms concerning for ACS is uncertain. MRP-8/14 was measured in serial serum and plasma samples in a single center prospective cohort-study of patients presenting to the emergency room with non-traumatic chest pain concerning for ACS. Final diagnosis was adjudicated by an endpoint committee. Of patients with baseline MRP-8/14 results (n = 411), the median concentration in serum was 1.57 μg/ml (25th, 75th: 0.87, 2.68) and in plasma was 0.41 μg/ml (<0.4, 1.15) with only moderate correlation between serum and plasma (ρ = 0.40). A final diagnosis of MI was made in 106 (26%). Peak serum MRP-8/14 was higher in patients presenting with MI (p < 0.001). However, the overall diagnostic performance of MRP-8/14 was poor: sensitivity 28% (95% CI 20-38), specificity 82% (78-86), positive predictive value 36% (26-47), and negative predictive value 77% (72-81). The area under the ROC curve for diagnosis of MI with MRP-8/14 was 0.55 (95% CI 0.51-0.60) compared with 0.95 for cTnI. The diagnostic performance was not improved in early-presenters, patients with negative initial cTnI, or using later MRP-8/14 samples. Patients presenting with MI had elevated levels of serum MRP-8/14 compared to patients with non-cardiac chest pain. However, overall diagnostic performance of MRP-8/14 was poor and neither plasma nor serum MRP-8/14 offered diagnostic utility comparable to cardiac troponin.

  20. [Is a more efficient operative strategy feasible for the emergency management of the patient with acute chest pain?].

    PubMed

    Cassin, M; Badano, L P; Solinas, L; Macor, F; Burelli, C; Antonini-Canterin, F; Cappelletti, P; Rubin, D; Tropeano, P; Deganuto, L; Nicolosi, G L

    2000-02-01

    Patients with acute chest pain are a common problem and a difficult challenge for clinicians. In the United States more than 5 million patients are examined in the emergency department on a yearly basis, at a cost of 6 billion dollars. In the CHEPER registry the prevalence of patients with chest pain in the Emergency Department was 5.3%. Similarly, in 1997 at our institution the prevalence was 4.8%. Only 50% of the patients are subsequently found to have cardiac ischemia as the cause of their symptoms and 50-60% of them showed a non-diagnostic electrocardiogram (ECG). Twenty-five-50% of chest pain patients are not appropriately admitted to the hospital and despite this conservative approach, acute myocardial infarction is misdiagnosed up to 8% of patients with acute chest pain who are released from the emergency department without further evaluation, accounting for approximately 20% of emergency department malpractice in the United States. Important diagnostic information is covered by the patient's medical history, physical examination, and ECG, but often this approach is inadequate for a definitive diagnosis. Creatine kinase (CK) and CK isoenzyme--cardiac muscle subunit (CK-MB)--are traditionally obtained in the emergency department in patients admitted for suspected acute coronary syndrome. Mass measurements of CK-MB have improved sensitivity and specificity, and to date this is the gold standard test for diagnosis of acute myocardial infarction. CK-MB, however, is not a perfect marker because it is not totally cardiac specific and does not identify patients with unstable angina and minimal myocardial damage. There are no controlled clinical impact trials showing that these tests are effective in deciding whether to discharge or to appropriately admit the patient with suspected acute coronary syndrome. Relevant investigative interest has recently been focused on new markers for myocardial injury, including myoglobin, cardiac troponins T and I. Myoglobin, a

  1. Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain

    SciTech Connect

    Brown, K.A.; Boucher, C.A.; Okada, R.D.; Guiney, T.E.; Newell, J.B.; Strauss, H.W.; Pohost, G.M.

    1983-04-01

    Accurate prognostic information is important in determining optimal management of patients presenting for evaluation of chest pain. In this study, the ability of exercise thallium-201 myocardial imaging to predict future cardiac events (cardiovascular death or nonfatal myocardial infarction) was correlated with clinical, coronary and left ventricular angiographic and exercise electrocardiographic data in 139 consecutive, nonsurgically managed patients followed-up over a 3 to 5 year period (mean follow-up, 3.7 +/- 0.9), using a logistic regression analysis. Among patients without prior myocardial infarction (100 of 139), the number of myocardial segments with transient thallium-201 defects was the only statistically significant predictor of future cardiac events when all patient variables were evaluated. Among patients with myocardial infarction before evaluation (39 of 139), angiographic ejection fraction was the only significant predictor of future cardiac events when all variables were considered. This study suggests an approach to evaluate the risk of future cardiac events in patients with possible ischemic heart disease.

  2. Atrial pacing and thallium-201 scintigraphy in patients with chest pain: correlation with coronary anatomy

    SciTech Connect

    Stratmann, H.G.; Mark, A.L.; Walter, K.E.; Williams, G.A.

    1989-04-01

    Atrial pacing and thallium-201 scintigraphy were performed in 72 patients referred for evaluation of chest pain. Coronary artery disease (CAD) was present in 63 patients, as documented by cardiac catheterization performed at the same time or within 2 months of atrial pacing. Nine patients had no or insignificant (less than 50% stenosis) CAD. The sensitivity of pacing-induced angina for CAD was 51%, and was 49% for ST depression. Specificities were 89% and 78%, respectively. A reversible perfusion defect was seen in 54% of patients with CAD (specificity 89%), and a fixed defect in 29% (specificity 100%). The sensitivity of an abnormal thallium-201 scan (one or more reversible or fixed defects) was 79% (p less than 0.05 compared to angina or ST depression). Combined sensitivity of ST depression and/or an abnormal thallium-201 scan was 87%. There were no significant changes in any of these sensitivities as the number of vessels with CAD increased. Thallium-201 scintigraphy correctly identified 11 of 19 (58%) patients with single-vessel disease as having CAD in only one vessel, but underestimated the extent of disease in all but a few patients with multivessel disease. The sensitivity of perfusion imaging to identify lesions in specific vessels ranged from 27% (circumflex) to 57% (right coronary artery). Specificities were 100% for circumflex, 78% for anterior descending, and 83% for right coronary artery lesions.

  3. The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals

    PubMed Central

    Chien, Ning; Wang, Tzung-Dau; Chang, Yeun-Chung; Lin, Po-Chih; Tseng, Yao-Hui; Lee, Yee-Fan; Ko, Wei-Chun; Lee, Bai-Chin; Lee, Wen-Jeng

    2016-01-01

    Coronary computed tomographic angiography (CCTA) has been widely available since 2004. After that, the diagnostic accuracy of CCTA has been extensively validated with invasive coronary angiography for detection of coronary arterial stenosis. In this paper, we reviewed the updated evidence of the role of CCTA in both scenarios including acute chest pain and screening in asymptomatic adults. Several large-scale studies have been conducted to evaluate the diagnostic value of CCTA in the context of acute chest pain patients. CCTA could play a role in delivering more efficient care. For risk stratification of asymptomatic patients using CCTA, latest studies have revealed incremental benefits. Future studies evaluating the totality of plaque characteristics may be useful for determining the role of noncalcified plaque for risk stratification in asymptomatic individuals. PMID:27122947

  4. Effects of the dual chest banding using elastic bands on the shoulder pain of scapular dyskinesis patient with winging and elevated scapular

    PubMed Central

    Yoo, Won-Gyu

    2016-01-01

    [Purpose] The purpose of this study was to investigate the effect of dual chest banding using elastic bands on the shoulder pain of a scapular dyskinesis patient with winging and an elevated scapula. [Subject] The subject was a 40-year-old male scapular dyskinesis patient with winging, an elevated scapula, and shoulder pain. [Methods] This study developed a method of dual chest banding using elastic bands, and the subject applied this method for 1 month [Results] After applying dual chest banding for one month, the scapular position and scapular winging were improved when compared to the initial conditions. The upper trapezius pressure pain threshold was increased. [Conclusion] The present study suggests that dual chest banding provides a mechanical effect and increases proprioception and therefore reduces abnormal scapular mobility. The present study suggests that dual chest banding using elastic bands could be applied to patients with scapular dyskinesis in the clinic. PMID:27064764

  5. Using the Electronic Medical Record to Reduce Unnecessary Ordering of Coagulation Studies for Patients with Chest Pain

    PubMed Central

    Hinson, Jeremiah S.; Mistry, Binoy; Hsieh, Yu-Hsiang; Risko, Nicholas; Scordino, David; Paziana, Karolina; Peterson, Susan; Omron, Rodney

    2017-01-01

    Introduction Our goal was to reduce ordering of coagulation studies in the emergency department (ED) that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR). Methods We used a pre and post quasi-experimental study design to evaluate the impact of an EMR-based intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies. Coagulation order frequency was measured via detailed review of randomly sampled encounters during two-month periods before and after intervention. We classified existing orders as clinically indicated or non-value added. Order frequencies were calculated as percentages, and we assessed differences between groups by chi-square analysis. Results Pre-intervention, 73.8% (76/103) of patients with chest pain had coagulation studies ordered, of which 67.1% (51/76) were non-value added. Post-intervention, 38.5% (40/104) of patients with chest pain had coagulation studies ordered, of which 60% (24/40) were non-value added. There was an absolute reduction of 35.3% (95% confidence interval [CI]: 22.7%, 48.0%) in the total ordering of coagulation studies and 26.4% (95% CI: 13.8%, 39.0%) in non-value added order placement. Conclusion Simple EMR-based interactive prompts can serve as effective deterrents to indiscriminate ordering of diagnostic studies. PMID:28210363

  6. Utility of ambulatory 24-hour esophageal pH and motility monitoring in noncardiac chest pain: report of 90 patients and review of the literature.

    PubMed

    Lacima, Gloria; Grande, Luis; Pera, Manuel; Francino, Antonio; Ros, Emilio

    2003-05-01

    It is unclear whether prolonged motility monitoring improves the diagnostic yield of standard esophageal tests in patients with noncardiac chest pain. Our aim was to assess the diagnostic value of ambulatory 24-hr pH and pressure monitoring in patients with noncardiac chest pain. Stationary manometry, edrophonium testing, and ambulatory pH and motility studies were performed in 90 consecutive patients with recurrent chest pain and normal coronary angiograms. Normality limits of ambulatory 24-hr motility were established in 30 healthy controls. The diagnoses of specific esophageal motility disorders (nutcracker esophagus and diffuse esophageal spasm) by stationary and ambulatory manometry were discordant in 48% of the patients. Edrophonium testing was positive in 9 patients, but correlated poorly with esophageal diagnoses. During ambulatory studies, 144 chest pain events occurred in 42 patients, and 72 (50%) were related to esophageal dysfunction. Strict temporal associations of events with esophageal dysfunction in relation to ambulatory 24-hr pH/motility scores permitted four patient categorizations: true positives (event-related and abnormal tests), N = 15; true negatives (event-unrelated and abnormal tests), N = 10; reduced esophageal pain threshold (event-related and normal tests), N = 4; and indeterminate origin (event-unrelated and normal tests), N = 13. Overall, 19 patients (21%) had a probable esophageal cause for chest pain (14 esophageal motility disorder, 4 acid reflux, 1 both). In conclusion, ambulatory manometry increases the diagnostic yield of standard esophageal testing in noncardiac chest pain, but the gain is small. Causes of chest pain other than high esophageal pressures and acid reflux must still be sought in most patients with chest pain of unknown origin after a negative cardiac work-up.

  7. An example of extreme cardiology: chest pain on the high seas and helicoptered medical evacuations: the French Navy experience.

    PubMed

    Vinsonneau, Ulric; Cavel, Christiane; Bombert, Christophe; Lely, Laurent; Paleiron, Nicolas; Vergez-Larrouget, Claude; Cornily, Jean-Christophe; Castellant, Philippe; Gilard, Martine; Paule, Paule; Bronstein, Jean-Ariel

    2012-10-01

    Medicalized high sea rescue is very different from prehospital medical evacuation. It requires specifically trained medical teams because the difficulties are marine, aerial, and medically related. The French Navy provides medical evacuations by helicopter on the Atlantic coast, up to 320 km offshore and under all weather conditions. The epidemiology of acute chest pain in the high seas has been poorly described. Therefore, in this retrospective study, we aimed to assess the prevalence and constraints found in the management of these emergencies. From January 1, 2000, to April 30, 2009, 286 medical evacuations by helicopter were performed, 132 of which were due to traumatological emergencies, and 154 to medical emergencies. Acute chest pain, with 36 missions, was the leading cause of medical evacuation. All evacuated patients were men who were either professional sailors or ferry passengers. The median age was 48 years (range, 26-79). The most common prehospital diagnosis was coronary chest pain in 23 patients (64%), including 11 patients with acute coronary syndrome with ST-segment elevation. Thirty-two patients were airlifted by helicopter. All patients benefited from monitoring, electrocardiogram, peripheral venous catheter, and medical management as soon as the technical conditions allowed it.

  8. Prognostic value of atrial pacing and thallium-201 scintigraphy in patients with stable chest pain

    SciTech Connect

    Stratmann, H.G.; Mark, A.L.; Walter, K.E.; Williams, G.A. )

    1989-11-01

    The value of atrial pacing and thallium-201 scintigraphy for assessing risk of subsequent cardiac events was examined in 210 patients with stable chest pain. Follow-up information was complete in 195 patients (mean age 61 years). Over an average follow-up of 19 months, cardiac events occurred in 38 patients--unstable angina in 20, nonfatal acute myocardial infarction in 6 and death from cardiac causes in 12. A history of previous myocardial infarction, diabetes mellitus, systemic hypertension or peripheral vascular disease at the time of pacing was not associated with an increased frequency of subsequent cardiac events. Six of 38 patients with later cardiac events had a history of congestive heart failure, compared with 8 of 157 without cardiac events (p less than 0.05). Neither pacing-induced angina, ST depression, nor the presence of a fixed perfusion defect was significantly more frequent in patients with cardiac events as a whole compared with patients without such events. Reversible defects and abnormal scans (reversible or fixed defects) were present, respectively, in 19 and 31 of 38 patients with cardiac events, compared with 42 and 79 patients, respectively, of the 157 patients without cardiac events (both p less than 0.01). In patients who developed unstable angina, a reversible defect was seen in 13 and an abnormal scan in 16 (both p less than 0.01 compared with patients without cardiac events). In 12 patients who died from a primary cardiac event, fixed defects were present in 8 and an abnormal scan in 11 (p less than 0.05 and p less than 0.01, respectively, compared with patients without cardiac events).

  9. Low Incidence of Chest Wall Pain with a Risk-Adapted Lung Stereotactic Body Radiation Therapy Approach Using Three or Five Fractions Based on Chest Wall Dosimetry

    PubMed Central

    Lewis, John H.; Baldini, Elizabeth H.; Chen, Aileen B.; Colson, Yolonda L.; Hacker, Fred L.; Hermann, Gretchen; Kozono, David; Mannarino, Edward; Molodowitch, Christina; Wee, Jon O.; Sher, David J.; Killoran, Joseph H.

    2014-01-01

    Purpose To examine the frequency and potential of dose-volume predictors for chest wall (CW) toxicity (pain and/or rib fracture) for patients receiving lung stereotactic body radiotherapy (SBRT) using treatment planning methods to minimize CW dose and a risk-adapted fractionation scheme. Methods We reviewed data from 72 treatment plans, from 69 lung SBRT patients with at least one year of follow-up or CW toxicity, who were treated at our center between 2010 and 2013. Treatment plans were optimized to reduce CW dose and patients received a risk-adapted fractionation of 18 Gy×3 fractions (54 Gy total) if the CW V30 was less than 30 mL or 10–12 Gy×5 fractions (50–60 Gy total) otherwise. The association between CW toxicity and patient characteristics, treatment parameters and dose metrics, including biologically equivalent dose, were analyzed using logistic regression. Results With a median follow-up of 20 months, 6 (8.3%) patients developed CW pain including three (4.2%) grade 1, two (2.8%) grade 2 and one (1.4%) grade 3. Five (6.9%) patients developed rib fractures, one of which was symptomatic. No significant associations between CW toxicity and patient and dosimetric variables were identified on univariate nor multivariate analysis. Conclusions Optimization of treatment plans to reduce CW dose and a risk-adapted fractionation strategy of three or five fractions based on the CW V30 resulted in a low incidence of CW toxicity. Under these conditions, none of the patient characteristics or dose metrics we examined appeared to be predictive of CW pain. PMID:24728448

  10. Clinical risk stratification in the emergency department predicts long-term cardiovascular outcomes in a population-based cohort presenting with acute chest pain: primary results of the Olmsted county chest pain study.

    PubMed

    Farkouh, Michael E; Aneja, Ashish; Reeder, Guy S; Smars, Peter A; Bansilal, Sameer; Lennon, Ryan J; Wiste, Heather J; Razzouk, Louai; Traverse, Kay; Holmes, David R; Mathew, Verghese

    2009-09-01

    The long-term cardiovascular outcomes of a population-based cohort presenting to the emergency department (ED) with chest pain and classified with a clinical risk stratification algorithm are not well documented. The Olmsted County Chest Pain Study is a community-based study that included all consecutive patients presenting with chest pain consistent with unstable angina presenting to all EDs in Olmsted County, Minnesota. Patients were classified according to the Agency for Health Care Policy and Research (AHCPR) criteria. Patients with ST elevation myocardial infarction and chest pain of noncardiac origin were excluded. Main outcome measures were major adverse cardiovascular and cerebrovascular events (MACCE) at 30 days and at a median follow-up of 7.3 years, and mortality through a median of 16.6 years.The 2271 patients were classified as follows: 436 (19.2%) as high risk, 1557 (68.6%) as intermediate risk, and 278 (12.2%) as low risk. Thirty-day MACCE occurred in 11.5% in the high-risk group, 6.2% in the intermediate-risk group, and 2.5% in the low-risk group (p < 0.001). At 7.3 years, significantly more MACCE were recorded in the intermediate-risk (hazard ratio [HR], 1.91; 95% confidence intervals [CI], 1.33-2.75) and high-risk groups (HR, 2.45; 95% CI, 1.67-3.58). Intermediate- and high-risk patients demonstrated a 1.38-fold (95% CI, 0.95-2.01; p = 0.09) and a 1.68-fold (95% CI, 1.13-2.50; p = 0.011) higher mortality, respectively, compared to low-risk patients at 16.6 years. At 7.3 and at 16.6 years of follow-up, biomarkers were not incrementally predictive of cardiovascular risk.In conclusion, a widely applicable rapid clinical algorithm using AHCPR criteria can reliably predict long-term mortality and cardiovascular outcomes. This algorithm, when applied in the ED, affords an excellent opportunity to identify patients who might benefit from a more aggressive cardiovascular risk factor management strategy.

  11. The acceptability and feasibility of an anxiety reduction intervention for emergency department patients with non-cardiac chest pain

    PubMed Central

    Webster, Rosie; Thompson, Andrew Robert; Norman, Paul; Goodacre, Steve

    2017-01-01

    Abstract Despite good physical prognosis, patients who receive a diagnosis of non-cardiac chest pain (NCCP) may experience persistent pain and distress. While cognitive-behavioural interventions have been found to be effective for this group, they are difficult to deliver in busy emergency department (ED) settings. Addressing the acceptability and relevance of self-help interventions is an important initial step in addressing this need. This study sought to examine the acceptability and relevance of an evidence-based self-help intervention for ED patients with persistent NCCP and anxiety. Patient (interviews: N = 11) and specialist chest pain nurse (focus group: N = 4) views on acceptability and feasibility were examined. Data were analysed using thematic analysis. Patients and nurses reported that there was a need for the intervention, as stress and anxiety are common among patients with NCCP, and provision of psychosocial support is currently lacking. Both patients and nurses reported that the intervention was relevant, acceptable, and potentially useful. Some changes to the intervention were suggested. Nurses reported that the intervention could be used within the existing staff resources available in an ED setting. This study represents an important first step towards developing a brief self-help intervention for ED patients with NCCP and anxiety. Further research should seek to determine the efficacy of the intervention in a pilot trial. PMID:26924523

  12. Pain and efficacy of local anesthetics for central venous access

    PubMed Central

    Culp, William C; Yousaf, Mohammed; Lowry, Benjamin; McCowan, Timothy C; Culp, William C

    2008-01-01

    Purpose To compare pain during injection and efficacy of analgesia of local anesthetics during central venous line placement. Methods Sixty-two patients were studied in a randomized, double-blinded prospective fashion. Patients received 1% lidocaine (L), buffered 1% lidocaine (LB), or 2% chloroprocaine (CP) injected around the internal jugular vein for procedural analgesia for central venous access. Patients reported pain via a standard linear visual analog scale, with 0 representing no pain and 10 being the worst pain imaginable. Results Overall patient perception of pain was better with CP and L than LB with mean scores of CP 2.4, L 2.6, LB 4.2. Pain with injection mean scores were CP 2.1, L 2.5, LB 3.2. Pain with catheter placement scores were CP 2.5, L 1.7, LB 3.4. Operator assessment of overall pain values were CP 1.9, L 2.2, LB 3.4. LB consistently scored the worst, though compared with CP, this only reached statistical significance in overall patient pain and pain at catheter insertion compared with L. Conclusion Though chloroprocaine scored better than lidocaine in 3 of 4 parameters, this trend did not achieve statistical significance. Adding sodium bicarbonate to lidocaine isn’t justified in routine practice, nor is routine replacement of lidocaine with chloroprocaine. PMID:22915859

  13. Usefulness of Age and Gender in the Early Triage of Patients with Acute Chest Pain Having Cardiac Computed Tomographic Angiography

    PubMed Central

    Bamberg, Fabian; Truong, Quynh A.; Blankstein, Ron; Nasir, Khurram; Lee, Hang; Rogers, Ian S.; Achenbach, Stephan; Brady, Thomas J.; Nagurney, John T.; Reiser, Maximilian F.; Hoffmann, Udo

    2009-01-01

    To identify age- and gender- specific sub-populations of patients with acute chest pain in whom coronary CT angiography (CTA) yields the highest diagnostic benefit. Subjects with acute chest pain and an inconclusive initial evaluation (non-diagnostic electrocardiogram, negative cardiac biomarkers) underwent contrast-enhanced 64-slice CT coronary angiography as part of an observational cohort study. Independent investigators determined the presence of significant coronary stenosis (>50% luminal narrowing) and the occurrence of acute coronary syndrome (ACS) during index hospitalization. We determined diagnostic accuracy and impact on pretest probability of ACS using Bayes' theorem. Among 368 patients (52.7±12 age, 61% males), 8% had ACS. Presence of significant coronary stenosis by CT and the occurrence of ACS increased with age for both men and women (p<0.001). Cardiac CTA was highly sensitive and specific in women younger than 65 years of age (sensitivity: 100% and specificity >87%) and men younger than 55 years of age (sensitivity: 100% in <45 and 80% in 45-54 years old men; specificity: >88.2%). Moreover, in these patients coronary CTA led to restratification from low to high (for a positive CTA) or from low to very low risk (for a negative CTA). In contrast, a negative CTA result did not result in restratification to low risk category in women >65 and men >55 years of age. In conclusion, this analysis provides initial evidence that men <55 and women <65 might benefit more from cardiac CTA than elderly patients. Thus, age and gender may serve as simple criteria to appropriately select patients who may derive the greatest diagnostic benefit from coronary CTA in the setting of acute chest pain. PMID:19840556

  14. Psychological distress as a crucial determinant for quality of life in patients with noncardiac chest pain in Central China

    PubMed Central

    Zhang, Lei; Tu, Lei; Chen, Jie; Bai, Tao; Song, Jun; Xiang, Xuelian; Wang, Ruiyun; Hou, Xiaohua

    2016-01-01

    Abstract Increased psychiatric comorbidity, predominantly anxiety and depressive symptoms, and lower quality of life (QoL) are associated with noncardiac chest pain (NCCP). We aimed to investigate the roles of anxiety and depression in the impaired QoL of NCCP patients in Central China. In this hospital-based cross-sectional study, 200 consecutive patients who complained of chest pain with normal coronary angiography were enrolled in the Department of Cardiology and Gastroenterology, Union Hospital, Wuhan, China. Meanwhile, 100 healthy controls, with age and sex-matched, were recruited. Upper gastrointestinal endoscopy was undergone and a standardized symptom questionnaire was completed in NCCP patients. Levels of anxiety and depression and QoL were assessed using locally translated and validated versions of the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short Form Health Survey (SF-36), respectively. The NCCP patients had poorer physical and mental QoL compared with the controls, and nearly half of them had anxiety (49.7%) and depression (40.1%). Those with anxiety and/or depression had lower physical (PCS) and mental (MCS) component summary score compared with those without anxiety and depression. Increased levels of anxiety and depression were associated with lower PCS (r = −0.469 and −0.523 respectively, P < 0.001) and MCS (r = −0.474 and −0.440, respectively, P < 0.001). The chest pain, heartburn, and anxiety were independent factors influence on both PCS and MCS. Moreover, psychological distress, besides directly acting on the QoL, may also mediate indirectly effects of physical symptoms on both the physical and mental QoL. We demonstrated that anxiety and depression are important determinants for the QoL of NCCP patients. Therefore, interventions should emphasize on identifying and treating the psychological impact in NCCP. PMID:27861354

  15. A 15-year-old boy with anterior chest pain, progressive dyspnea, and subcutaneous emphysema of the neck.

    PubMed

    Scichilone, Nicola; Buttacavoli, Maria; Camarda, Gaetana; Marchese, Margherita; Bellia, Maria; Spatafora, Mario

    2009-01-01

    We describe the case of an adolescent who was admitted to the hospital because of sudden occurrence of chest pain, dyspnea and subcutaneous emphysema. On admission, physical examination revealed subcutaneous crepitations in the superior part of the rib cage, and auscultation of the chest showed widespread wheezing. The radiological assessment confirmed the diagnosis of pneumomediastinum and pneumothorax. A follow-up CT scan performed one week after the admission showed almost complete resolution of the radiological alterations. At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather. Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander. Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made. Although pneumomediastinum may be a complication of various respiratory diseases, including asthma, it has never been reported as the first presentation of underlying bronchial asthma. Herein, the physiopathological mechanisms, the diagnostic procedures and treatment of pneumomediastinum in asthma are discussed. We suggest that the diagnosis of asthma should be considered in the differential diagnosis of pneumomediastinum in adolescence.

  16. Radiographic evaluation of the patient with chest pain of suspected myocardial origin

    SciTech Connect

    Green, C.E.; Satler, L.F.; Elliott, L.P.

    1984-11-01

    The evaluation of the patient with suspected angina pectoris is discussed and an approach presented which makes use of radiologic tests in conjunction with exercise testing to quickly and efficiently determine the likelihood and severity of coronary artery disease. The relative merits and limitations of chest radiography, cardiac fluoroscopy, nuclear medicine, and coronary arteriography are discussed.

  17. Should we establish chest pain observation units in the UK? A systematic review and critical appraisal of the literature

    PubMed Central

    Goodacre, S.

    2000-01-01

    Objectives—The chest pain observation unit (CPOU) has been developed in the United States to allow rigorous assessment of patients presenting with chest pain, thus expediting their discharge if assessment is negative. This review aims to examine the evidence for effectiveness and economic efficiency of the CPOU and to explore whether data from the United States can be extrapolated to the UK. Method—Search of the literature using Medline and critical appraisal of the validity of the data. Results—Five studies comparing outcomes of CPOU care with routine practice showed no significant difference in objective measures including mortality or missed pathology. Eleven studies described outcomes of a cohort of CPOU patients. Follow up was comprehensive and demonstrated no clinically significant evidence of missed pathology. Nine studies comparing CPOU costs with routine care demonstrated impressive cost savings that were more modest when randomised comparisons were made. Conclusion—CPOU care is safe and costs are well defined. There is no strong evidence that a CPOU will improve outcomes if routine practice is good. Cost savings have been shown when compared with routine care in the United States but may not be reproduced the UK. PMID:10658981

  18. How goal disturbance, coping and chest pain relate to quality of life: A study among patients waiting for PTCA.

    PubMed

    Echteld, M A; van Elderen, T M; van der Kamp, L J

    2001-01-01

    This article describes psychological correlates of quality of life (QOL) in patients on a waiting list for percutaneous transluminal coronary angioplasty (PTCA). Variables were selected based on a theoretical model describing psychological correlates of QOL in PTCA patients. This model was based on self-regulation and stress-coping theories. The variables in the model are stress appraisal, coping, coping resources, and general and disease-specific QOL variables. Respondents were 122 patients on a 3-month waiting list for a PTCA. Results indicated that PTCA patients had a poorer QOL than matched healthy controls. Using a path analysis approach to regression analysis, it appeared that goal disturbance, avoidant coping, approach coping, and chest pain were related to QOL. More specifically, chest pain and goal disturbance were only related to health-related QOL and negative affect. Both approach and avoidant coping were related to QOL variables. Results could be explained adequately using self-regulation theory. Recommendations for future research and for form and content of rehabilitation programmes were made.

  19. The Effect of Computerized Provider Order Entry (CPOE) on Ordering Patterns for Chest Pain Patients in the Emergency Department

    PubMed Central

    Adam, Terrence J.; Waitman, Russ; Jones, Ian; Aronsky, Dominik

    2011-01-01

    This study addressed the effect of CPOE implementation on chest pain ordering patterns for patients in the emergency department. Retrospective order data was collected to assess the implementation. 300 randomly selected, time matched patients with a chief complaint of chest pain were selected in a before/after study. Patient demographics, treatment and disposition data were collected on clinical orders. Order volume, completeness and completion times were assessed before and after implementation. Overall order volume increased significantly from 11.6 pre-CPOE to 19.9 post-implementation (p<.01). Order documentation deficiencies were noted pre-implementation with 35.6% containing all order elements. Order completion times were unchanged; however, laboratory completion times increased for admitted patients post-implementation. Order volume increased after CPOE implementation, likely due to improved ED-based admission order capture for admitted patients. Order completeness improved significantly including standing order documentation. Overall, CPOE implementation is associated with improved clinical documentation with limited effect on clinical testing turn-around times. PMID:22195053

  20. ET-1 and ecNOS gene polymorphisms andsusceptibility to acute chest syndrome and painful vaso-occlusive crises in children with sickle cell anemia.

    PubMed

    Chaar, Vicky; Tarer, Vanessa; Etienne-Julan, Maryse; Diara, Jean Pierre; Elion, Jacques; Romana, Marc

    2006-09-01

    The association of endothelin 1 (ET-1) and endothelial constitutive nitric oxide synthase (ecNOS) gene polymorphisms (G5665T and T8002C, VNTR and T-786C respectively) with the occurrence of acute chest syndrome and painful vaso-occlusive crises was evaluated in homozygous SS children. This retrospective study reveals that ET-1 T8002 and ecNOS C-786 alleles are associated with, respectively, an increased and a decreased risk of acute chest syndrome.

  1. Chest pain and bilateral atrioventricular valve prolapse with normal coronary arteries in isolated corrected transposition of the great vessels. Clinical, angiographic and metabolic features.

    PubMed

    Cowley, M J; Coghlan, H C; Mantle, J A; Soto, B

    1977-09-01

    A man evaluated for disabling chest pain was found to have isolated anatomically corrected transposition of the great vessels. Angiography demonstrated right and left atrioventricular (A-V) valve prolapse and normal coronary arteries. Atrial pacing produced chest pain, ischemic electrocardiographic changes, abnormal myocardial lactate metabolism and marked elevation of the left ventricular end-diastolic pressure; all of these changes returned to normal on termination of pacing. The association of corrected transposition and bilateral A-V valve prolapse and the possible causes of myocardial ischemia in this patient are discussed.

  2. Acute Chest Pain and Broad Complex Tachycardia. A Non-typical Case of Pre-excited Atrial Fibrillation

    PubMed Central

    Arias, Ramon Suarez; Villanueva, Nuria Perez; Cubero, Gustavo Iglesias; Lopez, Jose Rubin

    2011-01-01

    Wolff-Parkinson-White syndrome is a common condition in the emergency department. A case is presented of a 76-year-old patient with acute chest pain and broad complex tachycardia. Despite the fact that previous and post cardioversion ECG tracings in sinus rhythm showed no signs of pre-excitation, the characteristic pattern of pre-excited atrial fibrillation (AF) is recognized and after successful DC cardioversion the patient is referred for catheter ablation of the accessory pathway. This case illustrates a non-typical presentation of the WPW syndrome, with an older patient than usual with slight signs of pre-excitation. We highlight the need for high grades of suspicion for the early recognition of pre-excited AF when attending patients with tachycardia and the obligation to know the distinctive aspects of its management for this potentially life-threatening arrhythmia.

  3. Stress Cardiac Magnetic Resonance Imaging With Observation Unit Care Reduces Cost for Patients With Emergent Chest Pain: A Randomized Trial

    PubMed Central

    Miller, Chadwick D.; Hwang, Wenke; Hoekstra, James W.; Case, Doug; Lefebvre, Cedric; Blumstein, Howard; Hiestand, Brian; Diercks, Deborah B.; Hamilton, Craig A.; Harper, Erin N.; Hundley, W. Gregory

    2013-01-01

    Study objective We determine whether imaging with cardiac magnetic resonance imaging (MRI) in an observation unit would reduce medical costs among patients with emergent non-low-risk chest pain who otherwise would be managed with an inpatient care strategy. Methods Emergency department patients (n=110) at intermediate or high probability for acute coronary syndrome without electrocardiographic or biomarker evidence of a myocardial infarction provided consent and were randomized to stress cardiac MRI in an observation unit versus standard inpatient care. The primary outcome was direct hospital cost calculated as the sum of hospital and provider costs. Estimated median cost differences (Hodges-Lehmann) and distribution-free 95% confidence intervals (Moses) were used to compare groups. Results There were 110 participants with 53 randomized to cardiac MRI and 57 to inpatient care; 8 of 110 (7%) experienced acute coronary syndrome. In the MRI pathway, 49 of 53 underwent stress cardiac MRI, 11 of 53 were admitted, 1 left against medical advice, 41 were discharged, and 2 had acute coronary syndrome. In the inpatient care pathway, 39 of 57 patients initially received stress testing, 54 of 57 were admitted, 3 left against medical advice, and 6 had acute coronary syndrome. At 30 days, no subjects in either group experienced acute coronary syndrome after discharge. The cardiac MRI group had a reduced median hospitalization cost (Hodges-Lehmann estimate $588; 95% confidence interval $336 to $811); 79% were managed without hospital admission. Conclusion Compared with inpatient care, an observation unit strategy involving stress cardiac MRI reduced incident cost without any cases of missed acute coronary syndrome in patients with emergent chest pain. PMID:20554078

  4. Role of Mixed Reflux and Hypomotility with Delayed Reflux Clearance in Patients with Non-cardiac Chest Pain

    PubMed Central

    Ribolsi, Mentore; Balestrieri, Paola; Biasutto, Dario; Emerenziani, Sara; Cicala, Michele

    2016-01-01

    Background/Aims Gastroesophageal reflux disease (GERD) is the most common cause of non-cardiac chest pain (NCCP). Currently available data reveal a weak relationship between NCCP and dysmotility. Moreover, it is unclear why some refluxes are perceived as heartburn and others as NCCP. We aimed to evaluate the role of the reflux pattern and the esophageal motility in patients with NCCP. Methods Forty-eight patients with NCCP (Group 1) and 50 only typical GERD symptoms (Group 2) were included and underwent high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring. Results Impaired peristalsis was found in 60% of patients with NCCP and in 24% of patients with typical symptoms (P < 0.05). In patients belonging to Group 1, the majority of reflux episodes associated with chest pain were acid and mixed. The proportion of mixed refluxes was higher than that in Group 2. In Group 1, the reflux clearing time at 5, 9, and 15 cm, measured in reflux episodes associated to NCCP was longer than in reflux episodes associated to typical symptoms (mean ± 95% CI: 27.2 ± 5.6, 23.3 ± 4.4, and 14.6 ± 2.3 seconds vs 18.3 ± 3.5, 13.3 ± 2.2, and 11.1 ± 1.8 seconds; P < 0.01). Conclusions The presence of gas in the refluxate seems to be associated with NCCP. The impaired motility observed in NCCP patients may play a relevant role in delaying reflux clearing, hence increasing the time of contact between refluxate and esophageal mucosa. PMID:27095707

  5. Dose-Volume Parameters Predict for the Development of Chest Wall Pain After Stereotactic Body Radiation for Lung Cancer

    SciTech Connect

    Mutter, Robert W.; Liu Fan; Abreu, Andres; Yorke, Ellen; Jackson, Andrew; Rosenzweig, Kenneth E.

    2012-04-01

    Purpose: Chest wall (CW) pain has recently been recognized as an important adverse effect of stereotactic body radiation therapy (SBRT) for non-small-cell lung cancer (NSCLC). We developed a dose-volume model to predict the development of this toxicity. Methods and Materials: A total of 126 patients with primary, clinically node-negative NSCLC received three to five fractions of SBRT to doses of 40-60 Gy and were prospectively followed. The dose-absolute volume histograms of two different definitions of the CW as an organ at risk (CW3cm and CW2cm) were examined for all 126 patients. Results: With a median follow-up of 16 months, the 2-year estimated actuarial incidence of Grade {>=} 2 CW pain was 39%. The median time to onset of Grade {>=} 2 CW pain (National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0) was 9 months. There was no predictive advantage for biologically corrected dose over physical dose. Neither fraction number (p = 0.07) nor prescription dose (p = 0.07) were significantly correlated with the development of Grade {>=} 2 CW pain. Cox Proportional Hazards analysis identified significant correlation with a broad range of dose-volume combinations, with the CW volume receiving 30 Gy (V30) as one of the strongest predictors (p < 0.001). CW2cm consistently enabled better prediction of CW toxicity. When a physical dose of 30 Gy was received by more than 70 cm{sup 3} of CW2cm, there was a significant correlation with Grade {>=} 2 CW pain (p = 0.004). Conclusions: CW toxicity after SBRT is common and long-term follow-up is needed to identify affected patients. A volume of CW {>=} 70 cm{sup 3} receiving 30 Gy is significantly correlated with Grade {>=} 2 CW pain. We are currently applying this constraint at our institution for patients receiving thoracic SBRT. An actuarial atlas of our data is provided as an electronic supplement to facilitate data-sharing and meta-analysis relating to CW pain.

  6. Gangrenous intrathoracic appendicitis, a rare cause of right-sided chest pain: report of a case.

    PubMed

    Schellhaas, Elisabeth; Döbler, Oliver; Kroesen, Anton-J; Buhr, Heinz-J; Hotz, Hubert G

    2010-09-01

    Diaphragmatic hernias are becoming increasingly common due to radiofrequency ablation of malignant liver tumors. Most patients eventually present with symptoms caused by bowel obstruction. A 54-year-old woman with pleuritic pain and fever had a right-sided enterothorax probably caused by hemihepatectomy several years before. The patient was diagnosed with perforated gangrenous intrathoracic appendicitis during an emergency laparotomy for suspected incarceration of her diaphragmatic hernia. She was treated with an appendectomy and suturing of her right hemidiaphragm. An acquired diaphragmatic hernia should therefore be surgically repaired as soon as it is diagnosed in order to avoid complications.

  7. Computed Tomography-Derived Parameters of Myocardial Morphology and Function in Black and White Patients With Acute Chest Pain.

    PubMed

    Takx, Richard A P; Vliegenthart, Rozemarijn; Schoepf, U Joseph; Abro, Joseph A; Nance, John W; Ebersberger, Ullrich; Bamberg, Fabian; Carr, Christine M; Apfaltrer, Paul

    2016-02-01

    Blacks have higher mortality and hospitalization rates because of congestive heart failure compared with white counterparts. Differences in cardiac structure and function may contribute to the racial disparity in cardiovascular outcomes. Our aim was to compare computed tomography (CT)-derived cardiac measurements between black patients with acute chest pain and age- and gender-matched white patients. We performed a retrospective analysis under an institutional review board waiver and in Health Insurance Portability and Accountability Act compliance. We investigated patients who underwent cardiac dual-source CT for acute chest pain. Myocardial mass, left ventricular (LV) ejection fraction, LV end-systolic volume, and LV end-diastolic volume were quantified using an automated analysis algorithm. Septal wall thickness and cardiac chamber diameters were manually measured. Measurements were compared by independent t test and linear regression. The study population consisted of 300 patients (150 black-mean age 54 ± 12 years; 46% men; 150 white-mean age 55 ± 11 years; 46% men). Myocardial mass was larger for blacks compared with white (176.1 ± 58.4 vs 155.9 ± 51.7 g, p = 0.002), which remained significant after adjusting for age, gender, body mass index, and hypertension. Septal wall thickness was slightly greater (11.9 ± 2.7 vs 11.2 ± 3.1 mm, p = 0.036). The LV inner diameter was moderately larger in black patients in systole (32.3 ± 9.0 vs 30.1 ± 5.4 ml, p = 0.010) and in diastole (50.1 ± 7.8 vs 48.9 ± 5.2 ml, p = 0.137), as well as LV end-diastolic volume (134.5 ± 42.7 vs 128.2 ± 30.6 ml, p = 0.143). Ejection fraction was nonsignificantly lower in blacks (67.1 ± 13.5% vs 69.0 ± 9.6%, p = 0.169). In conclusion, CT-derived myocardial mass was larger in blacks compared with whites, whereas LV functional parameters were generally not statistically different, suggesting that LV mass might be a possible contributing factor to the higher rate of cardiac events

  8. Diagnostic value of atrial pacing and thallium-201 scintigraphy for the assessment of patients with chest pain

    SciTech Connect

    Stratmann, H.G.; Mark, A.L.; Walter, K.E.; Williams, G.A.

    1989-04-01

    Atrial pacing was performed either alone (n = 23) or in combination with thallium-201 scintigraphy (n = 113) in 136 patients referred for evaluation of chest pain. The presence of coronary artery disease (CAD) was excluded by cardiac catheterization in 12 patients and confirmed in 124. Both pacing-induced ST depression and angina had sensitivities of 48% for CAD; specificities were 75% and 83%, respectively. An abnormal thallium-201 scan (one or more reversible and/or fixed perfusion defects) was seen in 72% of patients with CAD (specificity 83%). Reversible perfusion defects were present in 47% of patients with CAD (specificity 83%), and fixed defects in 36% (specificity 100%). Pacing was associated with either ST depression or an abnormal perfusion scan in 81% of patients (specificity 67%). There were no significant differences in the results of atria pacing or thallium-201 scintigraphy in patients with or without a history of myocardial infarction, or in those with or without previous coronary artery bypass surgery. Pacing-induced ST depression, or both ST depression and a reversible perfusion defect occurred significantly less frequently in patients with peripheral vascular disease than in those without this diagnosis (p less than .05). With only one exception, there were no significant differences in the sensitivities of any indicators of ischemia (ST depression, angina, or perfusion scans), either individually or in combination, as the peak pacing rate or double product achieved increased.

  9. Oesophageal manometry during eating in the investigation of patients with chest pain or dysphagia.

    PubMed Central

    Howard, P J; Pryde, A; Heading, R C

    1989-01-01

    Dysphagia is a frequent cause of referral for oesophageal manometry although the motor response to eating is not routinely studied. We examined symptoms and oesophageal motor patterns in response to eating bread in 30 patients with either gastro-oesophageal reflux (n = 20), or normal oesophageal function tests (n = 10). No patient experienced symptoms while swallowing water but one complained of heartburn and one developed symptomatic oesophageal 'spasm' during eating. In eight further patients, pain or dysphagia which occurred with swallowing bread was associated with aperistalsis. Comparing asymptomatic and symptomatic periods, there was a slight increase in mean swallow frequency from 7.5 (0.79) (SEM) to 9.0 (1.17) swallows per minute (NS; n = 10). The mean number of aperistalsis swallows increased from 4.5 (0.96) per minute to 6.2 (1.30) (p less than 0.01; n = 10). Aperistalsis during symptoms was mainly caused by non-conducted swallows rather than synchronous contractions (mean 5.8 (1.45) per minute compared with 1.2 (0.44]. Aperistalsis can be produced by rapid swallowing in the normal oesophagus through 'deglutitive inhibition'. These results suggest that some patients experience dysphagia associated with aperistalsis perhaps as a response to increased frequency of swallowing. Functional abnormalities of this nature will not be detected by conventional oesophageal manometry. PMID:2806985

  10. Noninvasive strategies for the estimation of cardiac risk in stable chest pain patients. The Economics of Noninvasive Diagnosis (END) Study Group.

    PubMed

    Shaw, L J; Hachamovitch, R; Heller, G V; Marwick, T H; Travin, M I; Iskandrian, A E; Kesler, K; Lauer, M S; Hendel, R; Borges-Neto, S; Lewin, H C; Berman, D S; Miller, D

    2000-07-01

    Effective allocation of medical resources in stable chest pain patients requires the accurate diagnosis of coronary artery disease and the stratification of future cardiac risk. We studied the relative predictive value for cardiac death of 3 commonly applied noninvasive strategies, clinical assessment, stress electrocardiography, and myocardial perfusion tomography, in a large, multicenter population of stable angina patients. The multicenter observational series comprised 7 community and academic medical centers and 8,411 stable chest pain patients. All patients underwent pretest clinical screening followed by stress (exercise 84% or pharmacologic 16%) electrocardiography and myocardial perfusion tomography. Risk-adjusted multivariable Cox proportional hazards models were developed to predict cardiac death. Kaplan-Meier rates of time to cardiac catheterization were also computed. Cardiac mortality was 3% during the 2.5 +/- 1.5 years of follow-up. The number of infarcted vascular territories and pretest clinical risk factors were strong predictors of cardiac mortality, whereas the number of ischemic vascular territories gained increasing importance when determining post-test resource use requirements (i.e., the decision to perform cardiac catheterization). Exertional ST-segment depression in a population with a high frequency of electrocardiographic abnormalities at rest was not a significant differentiator of cardiac death risk. Stable chest pain patients are accurately identified as being at high risk for near-term cardiac events by both physicians' screening clinical evaluation and by the results of stress myocardial perfusion imaging. Disease management strategies for stable chest pain patients aimed at risk reduction should incorporate knowledge of relevant end points in treatment and guideline development.

  11. Feasibility of an automatic computer-assisted algorithm for the detection of significant coronary artery disease in patients presenting with acute chest pain.

    PubMed

    Kang, Ki-woon; Chang, Hyuk-jae; Shim, Hackjoon; Kim, Young-jin; Choi, Byoung-wook; Yang, Woo-in; Shim, Jee-young; Ha, Jongwon; Chung, Namsik

    2012-04-01

    Automatic computer-assisted detection (auto-CAD) of significant coronary artery disease (CAD) in coronary computed tomography angiography (cCTA) has been shown to have relatively high accuracy. However, to date, scarce data are available regarding the performance of auto-CAD in the setting of acute chest pain. This study sought to demonstrate the feasibility of an auto-CAD algorithm for cCTA in patients presenting with acute chest pain. We retrospectively investigated 398 consecutive patients (229 male, mean age 50±21 years) who had acute chest pain and underwent cCTA between Apr 2007 and Jan 2011 in the emergency department (ED). All cCTA data were analyzed using an auto-CAD algorithm for the detection of >50% CAD on cCTA. The accuracy of auto-CAD was compared with the formal radiology report. In 380 of 398 patients (18 were excluded due to failure of data processing), per-patient analysis of auto-CAD revealed the following: sensitivity 94%, specificity 63%, positive predictive value (PPV) 76%, and negative predictive value (NPV) 89%. After the exclusion of 37 cases that were interpreted as invalid by the auto-CAD algorithm, the NPV was further increased up to 97%, considering the false-negative cases in the formal radiology report, and was confirmed by subsequent invasive angiogram during the index visit. We successfully demonstrated the high accuracy of an auto-CAD algorithm, compared with the formal radiology report, for the detection of >50% CAD on cCTA in the setting of acute chest pain. The auto-CAD algorithm can be used to facilitate the decision-making process in the ED.

  12. Feasibility and Safety of Evaluating Patients with Prior Coronary Artery Disease Using an Accelerated Diagnostic Algorithm in a Chest Pain Unit

    PubMed Central

    Goldkorn, Ronen; Goitein, Orly; Ben-Zekery, Sagit; Shlomo, Nir; Narodetsky, Michael; Livne, Moran; Sabbag, Avi; Asher, Elad; Matetzky, Shlomi

    2016-01-01

    An accelerated diagnostic protocol for evaluating low-risk patients with acute chest pain in a cardiologist-based chest pain unit (CPU) is widely employed today. However, limited data exist regarding the feasibility of such an algorithm for patients with a history of prior coronary artery disease (CAD). The aim of the current study was to assess the feasibility and safety of evaluating patients with a history of prior CAD using an accelerated diagnostic protocol. We evaluated 1,220 consecutive patients presenting with acute chest pain and hospitalized in our CPU. Patients were stratified according to whether they had a history of prior CAD or not. The primary composite outcome was defined as a composite of readmission due to chest pain, acute coronary syndrome, coronary revascularization, or death during a 60-day follow-up period. Overall, 268 (22%) patients had a history of prior CAD. Non-invasive evaluation was performed in 1,112 (91%) patients. While patients with a history of prior CAD had more comorbidities, the two study groups were similar regarding hospitalization rates (9% vs. 13%, p = 0.08), coronary angiography (13% vs. 11%, p = 0.41), and revascularization (6.5% vs. 5.7%, p = 0.8) performed during CPU evaluation. At 60-days the primary endpoint was observed in 12 (1.6%) and 6 (3.2%) patients without and with a history of prior CAD, respectively (p = 0.836). No mortalities were recorded. To conclude, Patients with a history of prior CAD can be expeditiously and safely evaluated using an accelerated diagnostic protocol in a CPU with outcomes not differing from patients without such a history. PMID:27669521

  13. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Antacids and diagnosis in patients with atypical chest pain.

    PubMed

    Teece, Stewart; Crawford, Ian

    2003-03-01

    A short cut review was carried out to establish whether antacids can be used as a diagnostic test in atypical chest pain. Altogether 374 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

  14. Impact of Fractionation and Dose in a Multivariate Model for Radiation-Induced Chest Wall Pain

    SciTech Connect

    Din, Shaun U.; Williams, Eric L.; Jackson, Andrew; Rosenzweig, Kenneth E.; Wu, Abraham J.; Foster, Amanda; Yorke, Ellen D.; Rimner, Andreas

    2015-10-01

    Purpose: To determine the role of patient/tumor characteristics, radiation dose, and fractionation using the linear-quadratic (LQ) model to predict stereotactic body radiation therapy–induced grade ≥2 chest wall pain (CWP2) in a larger series and develop clinically useful constraints for patients treated with different fraction numbers. Methods and Materials: A total of 316 lung tumors in 295 patients were treated with stereotactic body radiation therapy in 3 to 5 fractions to 39 to 60 Gy. Absolute dose–absolute volume chest wall (CW) histograms were acquired. The raw dose-volume histograms (α/β = ∞ Gy) were converted via the LQ model to equivalent doses in 2-Gy fractions (normalized total dose, NTD) with α/β from 0 to 25 Gy in 0.1-Gy steps. The Cox proportional hazards (CPH) model was used in univariate and multivariate models to identify and assess CWP2 exposed to a given physical and NTD. Results: The median follow-up was 15.4 months, and the median time to development of CWP2 was 7.4 months. On a univariate CPH model, prescription dose, prescription dose per fraction, number of fractions, D83cc, distance of tumor to CW, and body mass index were all statistically significant for the development of CWP2. Linear-quadratic correction improved the CPH model significance over the physical dose. The best-fit α/β was 2.1 Gy, and the physical dose (α/β = ∞ Gy) was outside the upper 95% confidence limit. With α/β = 2.1 Gy, V{sub NTD99Gy} was most significant, with median V{sub NTD99Gy} = 31.5 cm{sup 3} (hazard ratio 3.87, P<.001). Conclusion: There were several predictive factors for the development of CWP2. The LQ-adjusted doses using the best-fit α/β = 2.1 Gy is a better predictor of CWP2 than the physical dose. To aid dosimetrists, we have calculated the physical dose equivalent corresponding to V{sub NTD99Gy} = 31.5 cm{sup 3} for the 3- to 5-fraction groups.

  15. Who gets admitted to the Chest Pain Unit (CPU) and how do we manage them? Improving the use of the CPU in Waikato DHB, New Zealand.

    PubMed

    Jade, Judith; Huggan, Paul; Stephenson, Douglas

    2015-01-01

    Chest pain is a commonly encountered presentation in the emergency department (ED). The chest pain unit at Waikato DHB is designed for patients with likely stable angina, who are at low risk of acute coronary syndrome (ACS), with a normal ECG and Troponin T, who have a history which is highly suggestive of coronary artery disease (CAD). Two issues were identified with patient care on the unit (1) the number of inappropriate admissions and (2) the number of inappropriate exercise tolerance tests. A baseline study showed that 73% of admissions did not fulfil the criteria and the majority of patients (72%) had an exercise tolerance test (ETT) irrespective of clinical picture. We delivered educational presentations to key stakeholders and the implementation of a new fast track chest pain pathway for discharging patients directly from the ED. There was an improvement in the number of patients inappropriately admitted, which fell to 61%. However, the number of inappropriate ETTs did not decrease, and were still performed on 76.9% of patients.

  16. Impact of an Abbreviated Cardiac Enzyme Protocol to Aid Rapid Discharge of Patients with Cocaine-associated Chest Pain in the Clinical Decision Unit

    PubMed Central

    Guirgis, Faheem W.; Gray-Eurom, Kelly; Mayfield, Teri L.; Imbt, David M.; Kalynych, Colleen J.; Kraemer, Dale F.; Godwin, Steven A.

    2014-01-01

    Introduction In 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9–12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain. Methods We conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU) for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB), and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge. Results There were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103) and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0–5.1%; 95% CI, 0–3.6%). Conclusion Application of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain. PMID:24672608

  17. Computer-Based Exercises in Anemia and Chest Pain Diagnosis: An Interim Evaluation of the PlanAlyzer Project

    PubMed Central

    Lyon, Harold C.; Healy, James C.; Bell, James R.; O'Donnell, Joseph F.; Hirai, Frank; Moore-West, Margaret; Cornwell, Gibbons G.; Brooks, W. Blair; Spackman, Kent A.; Beck, J. Robert

    1990-01-01

    PlanAlyzer is a microcomputer-based, self-paced, case-based, event-driven system for medical education. Aimed at the second year medical student, PlanAlyzer presents cases, elicits and critiques a student's approach to the diagnosis of two common medical disorders: anemias and chest pain. PlanAlyzer uses text, hypertext, images and critiquing theory. Students were randomized, one half becoming the experimental group who received the interactive PlanAlyzer cases in anemia, the other half becoming the controls who received the exact same content material in a text format. Later in each year there was a crossover, the controls becoming the experimentals for a similar intervention with the cardiology PlanAlyzer cases. Preliminary results at the end of the first two trials shows that the programs have achieved most of the proposed instructional objectives, plus some significant efficiency and economy gains. 96 faculty hours of classroom time were saved by using PlanAlyzer in their place, while, maintaining high student achievement. In terms of student proficiency and efficiency, the 176 students in the trial were able to accomplish the project's instructional objectives, and the experimentals accomplished this in less time than the controls. The research suggests additional inquiry in several areas: better evaluation instruments to measure the problem solving skills PlanAlyzer was designed to teach; use of hypertext PlanAlyzer cases to find if such a mode results in performance and/or efficiency differences; through the addition of interactive video, broaden PlanAlyzer to include additional behaviors subsumed under the topic of clinical problem solving, such as patient management strategies and the role of patients' affective behavior and non-verbal cues in the data gathering process.

  18. Diagnostic and Therapeutic Usefulness of Coronary Computed Tomography Angiography in Out-Clinic Patients Referred for Chest Pain.

    PubMed

    Bom, Michiel J; van der Zee, Petrus M; Cornel, Jan H; van der Zant, Friso M; Knol, Remco J J

    2015-07-01

    Coronary computed tomography angiography (CCTA) is widely used to exclude coronary artery disease (CAD) in patients with low-to-intermediate pretest probability (PTP) of obstructive CAD. The aim of our study was to investigate the reclassification by CCTA and the implications of CCTA results on management because limited studies exist on these subjects; 1,560 patients with chest pain without a history of CAD and with low or intermediate PTP of CAD referred for CCTA from the out-patient clinic were prospectively included. PTP was defined by the Duke Clinical Score as either low (<15%), low-intermediate (15% to 50%), or high-intermediate (50% to 85%). Distribution of CCTA results among the categories of PTP of CAD and the influence of CCTA results on management were analyzed. CCTA revealed obstructive CAD in 7%, 15%, and 23% of cases, in patients with low, low-intermediate, and high-intermediate PTP, respectively; 855 of 1,031 patients (83%) with intermediate PTP of CAD showed no obstructive CAD on CCTA and were consequently reclassified. Management changes after CCTA occurred in 689 patients (44%). In 633 patients (41%), medication was altered and 135 (9%) were referred for invasive coronary angiography. Treatment with statin was initiated in 442 (28%) and stopped in 71 patients (5%). Aspirin was initiated in 192 (12%) and stopped in 139 patients (9%). In conclusion, in a routine clinical cohort, CCTA resulted in reclassification in most patients. Furthermore, our study suggests that the Duke Clinical Score overestimates the probability of obstructive CAD compared with CCTA findings. Finally, CCTA results have implications on patient management, with medication changes in 41% of patients.

  19. Comparison of epicardial fat volume by computed tomography in black versus white patients with acute chest pain.

    PubMed

    Apfaltrer, Paul; Schindler, Andreas; Schoepf, U Joseph; Nance, John W; Tricarico, Francesco; Ebersberger, Ullrich; McQuiston, Andrew D; Meyer, Mathias; Henzler, Thomas; Schoenberg, Stefan O; Bamberg, Fabian; Vliegenthart, Rozemarijn

    2014-02-01

    Disparities in the risk of coronary artery disease (CAD) between races may be influenced by differences in the thoracic adipose tissue. We compared computed tomography (CT)-derived volumes of epicardial adipose tissue (EAT), mediastinal adipose tissue (MAT), and pericoronary fat thickness (PFT) and correlations with CAD between black and white patients. This institutional review board-approved Health Insurance Portability and Accountability Act-compliant study included 372 age- and gender-matched black versus white patients (186 black, 54 ± 11 years, 50% men; 186 white, 54 ± 11 years, 50% men) who underwent CT for chest pain evaluation. EAT, MAT, and PFT were measured. The amount of coronary calcium was quantified as calcium score. CAD was defined as ≥50% coronary artery narrowing. EAT and MAT volumes were significantly lower in black than white patients (59 [twenty-fifth to seventy-fifth percentile 39 to 84] vs 97 [67 to 132] cm(3) and 44 [27 to 77] vs 87 [52 to 157] cm(3), for both p <0.001). Mean PFT in black patients was slightly lower than white patients (17.2 ± 3.2 vs 18.1 ± 3.4 mm, p <0.01). The relation between race and extent of adipose tissue remained significant after adjustment for cardiovascular risk factors. Significant correlations were observed between EAT and MAT volumes and calcium score in black and white patients (r = 0.19 to 0.26, p <0.01). For both races, the level of thoracic fat measurements was higher in present versus absent coronary calcification. A greater amount of thoracic fat was found with obstructive CAD only in white patients. In conclusion, CT-derived measurements of thoracic fat differ between symptomatic black and white patients, suggesting a differential relation between thoracic adipose tissue and CAD pathophysiology by race.

  20. Angina (Chest Pain)

    MedlinePlus

    ... Women This content was last reviewed July 2015. Heart Attack • Home • About Heart Attacks Acute Coronary Syndrome (ACS) ... Recovery FAQs • Heart Attack Tools & Resources • Support Network Heart Attack Tools & Resources What Is a Heart Attack? How ...

  1. Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain

    PubMed Central

    Bedetti, Gigliola; Pasanisi, Emilio Maria; Pizzi, Carmine; Turchetti, Giuseppe; Loré, Cosimo

    2008-01-01

    Background Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients. Methods We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA) after positive troponin I or T (cTn-I or cTnT) (strategy 1); after positive exercise electrocardiography (ex-ECG) (strategy 2); after positive exercise echocardiography (ex-Echo) (strategy 3); after positive pharmacologic stress echocardiography (PhSE) (strategy 4); after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc) (strategy 5) and direct CA (strategy 6). Results The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer) and $29.673 for CA ($29.999 including cost of extra risk of cancer). The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator), the relative cost of ex-Echo is 1.5×, of a ex-SPECT-Tc is 3.1×, of a ex-ECG is 3.5×, of cTnI is ×3.8, of cTnT is ×3.9 and of a CA is 56.3×. Conclusion Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void. PMID:18510723

  2. Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain

    PubMed Central

    Fagring, Annika Janson; Kjellgren, Karin I; Rosengren, Annika; Lissner, Lauren; Manhem, Karin; Welin, Catharina

    2008-01-01

    Background Unexplained chest pain (UCP) is a common reason for emergency hospital admission and generates considerable health-care costs for society. Even though prior research indicates that psychological problems and impaired quality of life are common among UCP patients, there is lack of knowledge comparing UCP patients with a reference group from the general population. The aim of this study was to analyse differences between men and women with UCP and a reference group in terms of psychosocial factors as depression, anxiety, stress, social interaction and health-related quality of life (HRQOL). Methods A self-administered questionnaire about psychosocial factors was completed by 127 men and 104 women with acute UCP admitted consecutively to the Emergency Department (ED) or as in-patients on a medical ward. A reference group from the general population, 490 men and 579 women, participants in the INTERGENE study and free of clinical heart disease, were selected. Results The UCP patients were more likely to be immigrants, have a sedentary lifestyle, report stress at work and have symptoms of depression and trait-anxiety compared with the reference group. After adjustment for differences in age, smoking, hypertension and diabetes, these factors were still significantly more common among patients with UCP. In a stepwise multivariate model with mutual adjustment for psychosocial factors, being an immigrant was associated with a more than twofold risk in both sexes. Stress at work was associated with an almost fourfold increase in risk among men, whereas there was no independent impact for women. In contrast, depression only emerged as an independent risk factor in women. Trait-anxiety and a low level of social interaction were not independently associated with risk in either men or women. Patients with UCP were two to five times more likely to have low scores for HRQOL. Conclusion Both men and women with UCP had higher depression scores than referents, but an

  3. Assessing coronary artery disease in patients with anginal chest pain and left bundle branch block: an emerging role for a new parameter of cardiopulmonary exercise testing.

    PubMed

    Dominguez-Rodriguez, Alberto; Abreu-Gonzalez, Pedro; Gomez, Maria Angeles; Garcia-Baute, Maria del Carmen; Arroyo-Ucar, Eduardo; Avanzas, Pablo; Lara-Padron, Antonio

    2012-12-01

    Cardiopulmonary exercise testing (CPET) is used in cardiology to grade the severity of heart failure and to assess its prognosis. However, it is unknown whether CPET may be a useful technique to rule out coronary artery disease (CAD) in patients with anginal chest pain and left bundle branch block (LBBB). The aim of this investigation was to evaluate the diagnostic accuracy of CPET to identify CAD in these patients. A cohort of 90 patients with anginal chest pain, 45 with LBBB (group A) and 45 non-LBBB (group B), were studied with CPET and a single-photon emission computed tomographic myocardial perfusion study during the same period. The following variables of CPET were analyzed: peak oxygen uptake (VO2), VO2 at anaerobic threshold, and time to reach the anaerobic threshold (TAT). Group A values were lower compared with group B in peak VO2 (23 ± 6.2 vs. 28 ± 7.6 mLO2 · kg · min; P = 0.002), VO2 at anaerobic threshold (16.1 ± 3.6 vs. 18.9 ± 4.1 mLO2 · kg · min; P =0.001), and TAT (2.7 ± 0.96 vs. 4.4 ± 2.1 min; P < 0.001). Group A showed higher perfusion abnormalities in myocardial perfusion study than group B [27 (60%) vs. 12 (26.7%); P = 0.003]. Multivariate analysis showed that TAT (odds ratio = 1.59; 95% confidence interval, 1.06-2.39; P = 0.02) was the only independent predictor of CAD, after controlling for other factors. Receiver operator characteristic analysis showed an area under the curve of 0.78 for TAT (95% confidence interval, 0.68-0.86; P < 0.0001). In conclusion, our findings suggest that a new functional parameter such as TAT significantly predicts CAD in patients with anginal chest pain and LBBB.

  4. SEARCH 8Es: A novel point of care ultrasound protocol for patients with chest pain, dyspnea or symptomatic hypotension in the emergency department

    PubMed Central

    Ahn, Jung Hwan; Jeon, Jin; Toh, Hong-Chuen; Noble, Vicki Elizabeth; Kim, Jun Su; Kim, Young Sik; Do, Han Ho; Ha, Young Rock

    2017-01-01

    Objective This study was conducted to evaluate a problem-oriented focused torso bedside ultrasound protocol termed “Sonographic Evaluation of Aetiology for Respiratory difficulty, Chest pain, and/or Hypotension” (SEARCH 8Es) for its ability to narrow differential diagnoses and increase physicians’ diagnostic confidence, and its diagnostic accuracy, for patients presenting with dyspnea, chest pain, or symptomatic hypotension. Methods This single-center prospective observational study was conducted over 12 months in an emergency department and included 308 patients (184 men and 124 women; mean age, 67.7 ± 19.1 years) with emergent cardiopulmonary symptoms. The paired t-test was used to compare the number of differential diagnoses and physician’s level of confidence before and after SEARCH 8Es. The overall accuracy of the SEARCH 8Es protocol in differentiating 13 diagnostic entities was evaluated based on concordance (kappa coefficient) with the diagnosis made by the inpatient specialists. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results SEARCH 8Es narrows the number of differential diagnoses (2.5 ± 1.5 vs. 1.4 ± 0.7; p < 0.001) and improves physicians’ diagnostic confidence (2.8 ± 0.8 vs. 4.3 ± 0.9; p < 0.001) significantly. The overall kappa coefficient value was 0.870 (p < 0.001), with the overall sensitivity, specificity, positive predictive value, and negative predictive value at 90.9%, 99.0%, 89.7%, and 99.0%, respectively. Conclusion The SEARCH 8Es protocol helps emergency physicians to narrow the differential diagnoses, increase diagnostic confidence and provide accurate assessment of patients with dyspnea, chest pain, or symptomatic hypotension. PMID:28355246

  5. Accuracy of a neural diagnostic tree for the identification of acute coronary syndrome in patients with chest pain and no ST-segment elevation.

    PubMed

    Bassan, Roberto; Pimenta, Lucia; Scofano, Marcelo; Soares, José Francisco

    2004-06-01

    Identifying acute coronary syndrome is a difficult task in the emergency department because symptoms may be atypical and the electrocardiogram has low sensitivity. In this prospective cohort study done in a tertiary community emergency hospital, we developed and tested a neural diagnostic tree in 566 consecutive patients with chest pain and no ST-segment elevation for the diagnosis of acute coronary syndrome. Multivariate regression and recursive partitioning analysis allowed the construction of decision rules and of a neural tree for the diagnosis of acute myocardial infarction and acute coronary syndrome. Predictive variables of acute coronary syndrome were: age > or =60 years (odds ratio [OR] = 2.3; P = 0.0016), previous history of coronary artery disease (OR = 2.9; P = 0.0008), diabetes (OR = 2.8; P = 0.0240), definite/probable angina-type chest pain (OR = 17.3; P = 0.0000) and ischemic electrocardiogram (ECG) changes on admission (OR = 3.5; P = 0.0002). The receiver operating characteristic curve of possible diagnostic decision rules of the regression model disclosed a C-index of 0.904 (95% confidence interval = 0.878 to 0.930) for acute coronary syndrome and 0.803 (95% confidence interval 0.757 to 0.849) for acute myocardial infarction. For both disorders, sensitivities of the neural tree were 99% and 93%, respectively, and negative predictive values were both 98%. Negative likelihood ratios were 0.02 and 0.1, respectively. It is concluded that this simple and easy-to-use neural diagnostic tree was very accurate in the identification of non-ST segment elevation chest pain patients without acute coronary syndrome. Patients identified as low probability of disease could receive immediate stress testing and be discharged if the test is negative.

  6. Health-related quality of life in gastroesophageal reflux patients with noncardiac chest pain: Emphasis on the role of psychological distress

    PubMed Central

    Zhang, Lei; Tu, Lei; Chen, Jie; Song, Jun; Bai, Tao; Xiang, Xue-Lian; Wang, Rui-Yun; Hou, Xiao-Hua

    2017-01-01

    AIM To investigate the effects of depression and anxiety on health-related quality of life (QoL) in gastroesophageal reflux disease (GERD) patients and those suffering from cardiac (CCP) and noncardiac (NCCP) chest pain in Wuhan, China. METHODS In this cross-sectional study, a total of 358 consecutive patients with GERD were enrolled in Wuhan, China, of which 176 subjects had complaints of chest pain. Those with chest pain underwent coronary angiography and were divided into a CCP group (52 cases) and NCCP group (124 cases). Validated GERD questionnaires were completed, and the 36-item Short-Form Health Survey and Hospital Anxiety/Depression Scale were used for evaluation of QoL and psychological symptoms, respectively. RESULTS There were similar ratios and levels of depression and anxiety in GERD with NCCP and CCP. However, the QoL was obviously lower in GERD with CCP than NCCP (48.34 ± 17.68 vs 60.21 ± 20.27, P < 0.01). In the GERD-NCCP group, rather than the GERD-CCP group, the physical and mental QoL were much poorer in subjects with depression and/or anxiety than those without anxiety or depression. Anxiety and depression had strong negative correlations with both physical and mental health in GERD-NCCP (all P < 0.01), but only a weak relationship with mental components of QoL in GERD-CCP. CONCLUSION High levels of anxiety and depression may be more related to the poorer QoL in GERD patients with NCCP than those with CCP. This highlights the importance of evaluation and management of psychological impact for improving QoL in GERD-NCCP patients. PMID:28104988

  7. Do guidelines on first impression make sense? Implementation of a chest pain guideline in primary care: a systematic evaluation of acceptance and feasibility

    PubMed Central

    2011-01-01

    Background Most guidelines concentrate on investigations, treatment, and monitoring instead of patient history and clinical examination. We developed a guideline that dealt with the different aetiologies of chest pain by emphasizing the patient's history and physical signs. The objective of this study was to evaluate the guideline's acceptance and feasibility in the context of a practice test. Methods The evaluation study was nested in a diagnostic cross-sectional study with 56 General Practitioners (GPs) and 862 consecutively recruited patients with chest pain. The evaluation of the guideline was conducted in a mixed method design on a sub-sample of 17 GPs and 282 patients. Physicians' evaluation of the guideline was assessed via standardized questionnaires and case record forms. Additionally, practice nursing staff and selected patients were asked for their evaluation of specific guideline modules. Quantitative data was analyzed descriptively for frequencies, means, and standard deviations. In addition, two focus groups with a total of 10 GPs were held to gain further insights in the guideline implementation process. The data analysis and interpretation followed the standards of the qualitative content analysis. Results The overall evaluation of the GPs participating in the evaluation study regarding the recommendations made in the chest pain guideline was positive. A total of 14 GPs were convinced that there was a need for this kind of guideline and perceived the guideline recommendations as useful. While the long version was partially criticized for a perceived lack of clarity, the short version of the chest pain guideline and the heart score were especially appreciated by the GPs. However, change of clinical behaviour as consequence of the guideline was inconsistent. While on a concrete patient related level, GPs indicated to have behaved as the guideline recommended, the feedback on a more general level was heterogeneous. Several suggestions to improve

  8. The UPBEAT Nurse-Delivered Personalized Care Intervention for People with Coronary Heart Disease Who Report Current Chest Pain and Depression: A Randomised Controlled Pilot Study

    PubMed Central

    Barley, Elizabeth A.; Walters, Paul; Haddad, Mark; Phillips, Rachel; Achilla, Evanthia; McCrone, Paul; Van Marwijk, Harm; Mann, Anthony; Tylee, Andre

    2014-01-01

    Background Depression is common in people with coronary heart disease (CHD) and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression. Methods Multi-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC) or treatment as usual (TAU) for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables. Result 1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years) were randomized. PC participants (n = 41) identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%), high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up). Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03). Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9) and illness perceptions (mean scale increase of 7.8 vs 2.5) had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000. Conclusions Trial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU

  9. Chest Wall Volume Receiving >30 Gy Predicts Risk of Severe Pain and/or Rib Fracture After Lung Stereotactic Body Radiotherapy

    SciTech Connect

    Dunlap, Neal E.; Cai, Jing; Biedermann, Gregory B.; Yang, Wensha; Benedict, Stanley H.; Sheng Ke; Schefter, Tracey E.; Kavanagh, Brian D.; Larner, James M.

    2010-03-01

    Purpose: To identify the dose-volume parameters that predict the risk of chest wall (CW) pain and/or rib fracture after lung stereotactic body radiotherapy. Methods and Materials: From a combined, larger multi-institution experience, 60 consecutive patients treated with three to five fractions of stereotactic body radiotherapy for primary or metastatic peripheral lung lesions were reviewed. CW pain was assessed using the Common Toxicity Criteria for pain. Peripheral lung lesions were defined as those located within 2.5 cm of the CW. A minimal point dose of 20 Gy to the CW was required. The CW volume receiving >=20, >=30, >=40, >=50, and >=60 Gy was determined and related to the risk of CW toxicity. Results: Of the 60 patients, 17 experienced Grade 3 CW pain and five rib fractures. The median interval to the onset of severe pain and/or fracture was 7.1 months. The risk of CW toxicity was fitted to the median effective concentration dose-response model. The CW volume receiving 30 Gy best predicted the risk of severe CW pain and/or rib fracture (R{sup 2} = 0.9552). A volume threshold of 30 cm{sup 3} was observed before severe pain and/or rib fracture was reported. A 30% risk of developing severe CW toxicity correlated with a CW volume of 35 cm{sup 3} receiving 30 Gy. Conclusion: The development of CW toxicity is clinically relevant, and the CW should be considered an organ at risk in treatment planning. The CW volume receiving 30 Gy in three to five fractions should be limited to <30 cm{sup 3}, if possible, to reduce the risk of toxicity without compromising tumor coverage.

  10. Chest MRI

    MedlinePlus

    ... Topics Aneurysm Chest CT Scan Chest X Ray Pleurisy and Other Pleural Disorders Pulmonary Hypertension Send a ... X Ray Clinical Trials Implantable Cardioverter Defibrillators Pacemaker Pleurisy and Other Pleural Disorders Pulmonary Hypertension Rate This ...

  11. Chest radiology

    SciTech Connect

    Austin, J.H.M.

    1982-01-01

    This review of chest radiology reexamines normal findings on plain chest radiographs, and presents a new plain film view for detecting metastases in the lungs, and describes new findings on acute and chronic inflammatory diseases. Various chest radiologic procedures are examined. (KRM)

  12. Prevalence and prognosis of non-specific chest pain among patients hospitalized for suspected acute coronary syndrome - a systematic literature search

    PubMed Central

    2012-01-01

    Background The term non-specific chest pain (NSCP) is applied to hospitalized patients in order to designate that they neither have an acute coronary syndrome (ACS) nor display evidence of a coronary ischemia. The number of NSCP patients is increasing and comprehensive guidelines specifying their optimal management have not yet been introduced. The objective of this review was to explore the prevalence and prognosis of NSCP versus ACS among patients recruited in consecutive series hospitalized for chest pain suspected to be ACS. Methods This is a systematic literature search where three databases were searched from 1990 to 14 November 2011. In addition, one database was searched for Epub ahead of print per 24 March 2012. Three inclusion criteria were applied: 1. documentation of an unselected consecutive series of patients admitted for chest pain, where this review is based upon two groups of patients defined as follows: a) 'ACS/high-risk' and b) NSCP; 2. at least 100 cases with NSCP; and 3. follow-up of hospital readmissions and mortality for at least six months. Results A total of 2,204 citations were screened after removal of duplicates. Out of 80 full text articles assessed for eligibility 12 studies were included, comprising 24,829 patients (inter-study range 250 to 13,762), with 11,008 (44%) categorized as NSCP and 13,821 (56%) as 'ACS/high-risk'. The mean one-year total mortality rate among patients with NSCP in nine studies was 3.2% (inter-study range 1.4% to 8.1%), with the highest mortality among patients with pre-existing coronary heart disease (CHD). The mean one-year mortality rate among 'ACS/high-risk' patients was 18.0% (inter-study range 14.0% to 19.9%) in four studies with available data. In six studies the mean one-year readmission rate for patients with NSCP was 17.5% (inter-study range 2.5% to 40%). Conclusions Patients with NSCP represent a large, heterogeneous and important group. Due to co-existing CHD in nearly 40% of these patients, their

  13. Comparison Between Soluble ST2 and High-Sensitivity Troponin I in Predicting Short-Term Mortality for Patients Presenting to the Emergency Department With Chest Pain

    PubMed Central

    Marino, Rossella; Magrini, Laura; Orsini, Francesca; Russo, Veronica; Cardelli, Patrizia; Salerno, Gerardo; Hur, Mina

    2017-01-01

    Background High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain. Methods Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed. Results The incidence of ACS was 37%; 33 patients were diagnosed with ST elevation myocardial infarction (STEMI), and 25 were diagnosed with non-ST elevation myocardial infarction (NSTEMI). Compared with the no acute coronary syndrome (NO ACS) group, the median level of hs-cTnI was higher in ACS patients: 7.22 (5.24-14) pg/mL vs 68 (15.33-163.50) pg/mL (P<0.0001). In all patients, the sST2 level at arrival showed higher independent predictive power than hs-cTnI (odds ratio [OR] 20.13, P<0.0001 and OR 2.61, P<0.0008, respectively). sST2 at ED arrival showed a greater prognostic value for cardiovascular events in STEMI (area under the curve [AUC] 0.80, P<0.001) than NSTEMI patients (AUC 0.72, P<0.05). Overall, 51% of the STEMI patients with an sST2 value>35 ng/mL at ED arrival died during the 30-day follow-up. Conclusions sST2 has a greater prognostic value for 30-day cardiac mortality after discharge in patients presenting to the ED for chest pain compared with hs-cTnI. In STEMI patients, an sST2 value >35 ng/mL at ED arrival showed the highest predictive power for short-term mortality. PMID:28029000

  14. [Rabeprazole test and comparison of the effectiveness of course treatment with rabeprazole in patients with gastroesophageal reflux disease and non-coronary chest pain].

    PubMed

    Maev, I V; Iurenev, G L; Burkov, S G; V'iuchnova, E S

    2007-01-01

    Proton pump inhibitors (PPI) are efficient for ex juvantibus diagnostics of non-coronary chest pain (NCCP) of gastroesophageal reflux origin as well as for its course treatment. The aim of this randomized cross-over study was to compare the efficiency of rabeprasol and omeprasol as means of both diagnostics and long-term treatment. In rabeprasol group the symptoms disappeared more quickly, and the maximum effect was achieved by day three, while in omeprasol group the best results were achieved only by day six (p < or = 0.05). The sensitivity and specificity of rabeprasol test was 81.6% and 80.6%, respectively, while those of omeprasol test were 73.5% and 77.4%, respectively. By the end of the 12th week of treatment pain syndrome had been completely or partly coped with in 92% of rabeprasol patients, and 76% of omeprazol patients (p < 0.05). Thus, response to rabeprasol takes place twice as quick as response to omeprasol, which makes it possible to shorten the time of NCCP diagnostics. Furthermore, rabeprasol test is more sensitive and specific. Course treatment with high doses of PPI increase the number of patients with eliminated pain syndrome, and rabeprasol here is more efficient than omeprasol.

  15. A Young Man Presenting with Pleuritic Chest Pain and Fever after Electrophysiological Study and Implantable Cardioverter-Defibrillator Placement: Diagnostic Difficulties and Value of Bedside Thoracic Sonography

    PubMed Central

    Faraone, Antonio; Fortini, Alberto

    2015-01-01

    We describe the case of a 23-year-old man presenting with recurrent pleuritic chest pain and prolonged fever after electrophysiology testing and placement of an implantable cardioverter-defibrillator because of a suspected arrhythmogenic right ventricular dysplasia. The clinical suspicion was initially directed toward pneumonia with pleural effusion and later toward an infection of the cardiac device complicated by septic pulmonary embolism. The definitive diagnosis of pulmonary embolism and infarction was suggested by a point-of-care thoracic sonography, performed at the bedside by a clinician caring for the patient, and then confirmed by contrast enhanced computed tomography, which also showed thrombosis of the left iliofemoral vein, site of percutaneous puncture for cardiac catheterization. Prolonged fever was attributable to a concomitant Epstein-Barr virus primary infection that acted as confounding factor. The present report confirms the value of bedside thoracic sonography in the diagnostic evaluation of patients with nonspecific respiratory symptoms. PMID:26576159

  16. Accuracy of dual-source CT to identify significant coronary artery disease in patients with uncontrolled hypertension presenting with chest pain: comparison with coronary angiography.

    PubMed

    Marwan, Mohamed; Pflederer, Tobias; Schepis, Tiziano; Seltmann, Martin; Klinghammer, Lutz; Muschiol, Gerd; Ropers, Dieter; Daniel, Werner G; Achenbach, Stephan

    2012-06-01

    It has been previously reported that the sensitivity and specificity of multislice CT for detecting significant CAD (coronary artery disease) is high. Chest pain is a common presentation in patients with uncontrolled hypertension. We investigated the sensitivity and specificity of dual-source CT to detect and rule out significant CAD in patients presenting with uncontrolled hypertension accompanied by chest pain. 260 consecutive patients presenting with acute chest pain in the context of stage 2 hypertension (systolic pressure ≥160 and/or diastolic pressure ≥100) were enrolled in the study. After admission, control of blood pressure and risk stratification, 82 patients were excluded due to renal insufficiency, prior coronary revascularisation or refused participation in the study. 90 further patients with low pre-test probability of CAD were also excluded. 88 remaining patients were subjected to CT coronary angiography using dual-source CT (Definition, Siemens Medical Solutions, Forchheim, Germany) within 24 h before invasive coronary angiography. A contrast-enhanced volume dataset was acquired (120 kV, 400 mAs/rot, collimation 2 × 64 × 0.6 mm, retrospective ECG gating). Data sets were evaluated concerning the presence or absence of significant coronary stenoses and validated against invasive coronary angiography. A significant stenosis was assumed if the diameter reduction was ≥50%. 88 patients (mean age 66 ± 11 years, mean heart rate 61 ± 9 bpm) were evaluated regarding the presence or absence of significant CAD (at least one stenosis ≥50% diameter reduction). Mean systolic blood pressure on presentation was 203 ± 20 mmHg and mean diastolic blood pressure was 103 ± 13 mmHg. On a per patient basis, the sensitivity and specificity for dual-source CT to detect significant CAD in vessels >1.5 mm diameter was 100% (36/36, 95% CI 90-100) and 90% (47/52, 95% CI 79-97), respectively with a negative predictive value (NPV) of 100% (47/47, 95% CI 92-100) and a

  17. A Young Man Presenting with Pleuritic Chest Pain and Fever after Electrophysiological Study and Implantable Cardioverter-Defibrillator Placement: Diagnostic Difficulties and Value of Bedside Thoracic Sonography.

    PubMed

    Faraone, Antonio; Fortini, Alberto

    2015-01-01

    We describe the case of a 23-year-old man presenting with recurrent pleuritic chest pain and prolonged fever after electrophysiology testing and placement of an implantable cardioverter-defibrillator because of a suspected arrhythmogenic right ventricular dysplasia. The clinical suspicion was initially directed toward pneumonia with pleural effusion and later toward an infection of the cardiac device complicated by septic pulmonary embolism. The definitive diagnosis of pulmonary embolism and infarction was suggested by a point-of-care thoracic sonography, performed at the bedside by a clinician caring for the patient, and then confirmed by contrast enhanced computed tomography, which also showed thrombosis of the left iliofemoral vein, site of percutaneous puncture for cardiac catheterization. Prolonged fever was attributable to a concomitant Epstein-Barr virus primary infection that acted as confounding factor. The present report confirms the value of bedside thoracic sonography in the diagnostic evaluation of patients with nonspecific respiratory symptoms.

  18. Clinically integrated multi-organ point-of-care ultrasound for undifferentiated respiratory difficulty, chest pain, or shock: a critical analytic review.

    PubMed

    Ha, Young-Rock; Toh, Hong-Chuen

    2016-01-01

    Rapid and accurate diagnosis and treatment are paramount in the management of the critically ill. Critical care ultrasound has been widely used as an adjunct to standard clinical examination, an invaluable extension of physical examination to guide clinical decision-making at bedside. Recently, there is growing interest in the use of multi-organ point-of-care ultrasound (MOPOCUS) for the management of the critically ill, especially in the early phase of resuscitation. This article will review the role and utility of symptom-based and sign-oriented MOPOCUS in patients with undifferentiated respiratory difficulty, chest pain, or shock and how it can be performed in a timely, effective, and efficient manner.

  19. Access to rehabilitation: patient perceptions of inequalities in access to specialty pain rehabilitation from a gender and intersectional perspective

    PubMed Central

    Wiklund, Maria; Fjellman-Wiklund, Anncristine; Stålnacke, Britt-Marie; Hammarström, Anne; Lehti, Arja

    2016-01-01

    Background Long-term musculoskeletal pain is common, particularly among women. Pain conditions are a concern in primary health care, and people with severe and complex pain are referred to specialty health care. There is gender bias in access, counselling, assessment, and treatment of long-term pain. Objective This study explores patient accounts and perceptions about important (social) factors for accessing specialised pain rehabilitation from gender and intersectional equality perspectives. We aimed to identify potential biases and inequalities in accessing rehabilitation resources at a specialised rehabilitation clinic. Design Individual semi-structured interviews were conducted with 10 adults after an assessment or completion of a specialised rehabilitation programme in northern Sweden. Qualitative content analysis was used to explore patients’ perceptions of important factors for accessing rehabilitation. Results One main theme was formulated as Access to rehab – not a given. Three categories of perceived inequality were demonstrated: power of gender, power of social status, and power of diagnosis. Participants perceived rehabilitation as a resource that is not equally available, but dependent on factors such as gender, socio-economic status, ability to work, ethnicity, or age, and more subtle aspects of social status and habitus (e.g. appearance, fitness, and weight). The character of diagnosis received (medical versus psychiatric or social) was also noted. Conclusions It is crucial that professionals are aware of how potential inequalities related to gender, social status, and diagnosis, and their intersections, can be created, perceived, and have influence on the processes of assessment and treatment. Reduction of social determinants of health and biases remain important within global, national, and local contexts. PMID:27569592

  20. Automated Computer-Assisted Diagnosis of Obstructive Coronary Artery Disease in Emergency Department Patients Undergoing 256-Slice Coronary Computed Tomography Angiography for Acute Chest Pain.

    PubMed

    Hashoul, Sharbell; Gaspar, Tamar; Halon, David A; Lewis, Basil S; Shenkar, Yuval; Jaffe, Ronen; Peled, Nathan; Rubinshtein, Ronen

    2015-10-01

    A 256-slice coronary computed tomography angiography (CCTA) is an accurate method for detection and exclusion of obstructive coronary artery disease (OBS-CAD). However, accurate image interpretation requires expertise and may not be available at all hours. The purpose of this study was to evaluate the usefulness of a fully automated computer-assisted diagnosis (COMP-DIAG) tool for exclusion of OBS-CAD in patients in the emergency department (ED) presenting with chest pain. Three hundred sixty-nine patients in ED without known coronary disease underwent 256-slice CCTA as part of the assessment of chest pain of uncertain origin. COMP-DIAG (CorAnalyzer II) automatically reported presence or exclusion of OBS-CAD (>50% stenosis, ≥1 vessel). Performance characteristics of COMP-DIAG for exclusion and detection of OBS-CAD were determined using expert reading as the reference standard. Seventeen (5%) studies were unassessable by COMP-DIAG software, and 352 patients (1,056 vessels) were therefore available for analysis. COMP-DIAG identified 33% of assessable studies as having OBS-CAD, but the prevalence of OBS-CAD on CCTA was only 18% (66 of 352 patients) by standard expert reading. However, COMP-DIAG correctly identified 61 of the 66 patients (93%) with OBS-CAD with 21 vessels (2%) with OBS-CAD misclassified as negative. In conclusion, compared to expert reading, automated computer-assisted diagnosis using the CorAnalyzer showed high sensitivity but only moderate specificity for detection of obstructive coronary disease in patients in ED who underwent 256-slice CCTA. The high negative predictive value of this computer-assisted algorithm may be useful in the ED setting.

  1. Access to opioids: a global pain management crisis.

    PubMed

    Buitrago, Rosa

    2013-03-01

    The lack of availability of opioids in many countries has created a pain management crisis. Because the Single Convention on Narcotic Drugs requires governments to report annual opioid statistics, there is a need for methods to calculate individual nations' opioid needs. Ways to address this need are discussed.

  2. Serum 25(OH)D Is a 2-Year Predictor of All-Cause Mortality, Cardiac Death and Sudden Cardiac Death in Chest Pain Patients from Northern Argentina

    PubMed Central

    Naesgaard, Patrycja A.; León De La Fuente, Ricardo A.; Nilsen, Stein Tore; Woie, Leik; Aarsland, Torbjoern; Brede, Cato; Staines, Harry; Nilsen, Dennis W. T.

    2012-01-01

    Background Several studies have shown an association between vitamin D deficiency and cardiovascular risk. Vitamin D status is assessed by determination of 25-hydroxyvitamin D [25(OH)D] in serum. Methods We assessed the prognostic utility of 25(OH)D in 982 chest-pain patients with suspected acute coronary syndrome (ACS) from Salta, Northern Argentina. 2-year follow-up data including all-cause mortality, cardiac death and sudden cardiac death were analyzed in quartiles of 25(OH)D, applying univariate and multivariate analysis. Results There were statistically significant changes in seasonal 25(OH)D levels. At follow-up, 119 patients had died. The mean 25(OH)D levels were significantly lower among patients dying than in long-term survivors, both in the total population and in patients with a troponin T (TnT) release (n = 388). When comparing 25(OH)D in the highest quartile to the lowest quartile in a multivariable Cox regression model for all-cause mortality, the hazard ratio (HR) for cardiac death and sudden cardiac death in the total population was 0.37 (95% CI, 0.19–0.73), p = 0.004, 0.23 (95% CI, 0.08–0.67), p = 0.007, and 0.32 (95% CI, 0.11–0.94), p = 0.038, respectively. In patients with TnT release, the respective HR was 0.24 (95% CI, 0.10–0.54), p = 0.001, 0.18 (95% CI, 0.05–0.60), p = 0.006 and 0.25 (95% CI, 0.07–0.89), p = 0.033. 25(OH)D had no prognostic value in patients with no TnT release. Conclusion Vitamin D was shown to be a useful biomarker for prediction of mortality when obtained at admission in chest pain patients with suspected ACS. Trial registration ClinicalTrials.gov NCT01377402 PMID:22970121

  3. Ranolazine versus placebo in patients with ischemic cardiomyopathy and persistent chest pain or dyspnea despite optimal medical and revascularization therapy: randomized, double-blind crossover pilot study

    PubMed Central

    Shammas, Nicolas W; Shammas, Gail A; Keyes, Kathleen; Duske, Shawna; Kelly, Ryan; Jerin, Michael

    2015-01-01

    Background Patients with ischemic cardiomyopathy (ICM) may continue to experience persistent chest pain and/or dyspnea despite pharmacologic therapy and revascularization. We hypothesized that ranolazine would reduce anginal symptoms or dyspnea in optimally treated ICM patients. Methods In this randomized, double-blind, crossover-design pilot study, 28 patients with ICM (ejection fraction less or equal 40%) were included after providing informed consent. A total of 24 patients completed both placebo and ranolazine treatments and were analyzed. All patients were on treatment with a beta blocker, an angiotensin-converting enzyme inhibitor (or angiotensin receptor blocker), and at least one additional antianginal drug. After randomization, patients received up to 1,000 mg ranolazine orally twice a day, as tolerated, versus placebo. The primary end point was change in angina as assessed by the Seattle Angina Questionnaire (SAQ), or in dyspnea as assessed by the Rose Dyspnea Scale (RDS). Change in the RDS and SAQ score from baseline was compared, for ranolazine and placebo, using the Wilcoxon signed rank test or paired t-test. Results Patients had the following demographic and clinical variables: mean age of 71.5 years; male (82.1%); prior coronary bypass surgery (67.9%); prior coronary percutaneous intervention (85.7%); prior myocardial infarction (82.1%); diabetes (67.9%); and mean ejection fraction of 33.1%. No statistical difference was seen between baseline RDS score and that after placebo or ranolazine (n=20) (P≥0.05). There was however, an improvement in anginal frequency (8/10 patients) (P=0.058), quality of life (8/10 patients) (P=0.048), and mean score of all components of the SAQ questionnaire (n=10) (P=0.047) with ranolazine compared with placebo. Conclusion In optimally treated ICM patients with continued chest pain or dyspnea, ranolazine possibly had a positive impact on quality of life, a reduction in anginal frequency, and an overall improvement in the

  4. The 2017 International Joint Working Group recommendations of the Indian College of Cardiology, the Academic College of Emergency Experts, and INDUSEM on the management of low-risk chest pain in emergency departments across India.

    PubMed

    Chauhan, Vivek; Shah, Pavitra Kotini; Galwankar, Sagar; Sammon, Maura; Hosad, Prabhakar; Beeresha; Erickson, Timothy B; Gaieski, David F; Grover, Joydeep; Hegde, Anupama V; Hoek, Terry Vanden; Jarwani, Bhavesh; Kataria, Himanshu; LaBresh, Kenneth A; Manjunath, Cholenahally Nanjappa; Nagamani, A C; Patel, Anjali; Patel, Ketan; Ramesh, D; Rangaraj, R; Shamanur, Narendra; Sridhar, L; Srinivasa, K H; Tyagi, Shweta

    2017-01-01

    There have been no published recommendations for the management of low-risk chest pain in emergency departments (EDs) across India. This is despite the fact that chest pain continues to be one of the most common presenting complaints in EDs. Risk stratification of patients utilizing an accelerated diagnostic protocol has been shown to decrease hospitalizations by approximately 40% with a low 30-day risk of major adverse cardiac events. The experts group of academic leaders from the Indian College of Cardiology and Academic College of Emergency Experts in India partnered with academic experts in emergency medicine and cardiology from leading institutions in the UK and USA collaborated to study the scientific evidence and make recommendations to guide emergency physicians working in EDs across India.

  5. The 2017 International Joint Working Group recommendations of the Indian College of Cardiology, the Academic College of Emergency Experts, and INDUSEM on the management of low-risk chest pain in emergency departments across India

    PubMed Central

    Chauhan, Vivek; Shah, Pavitra Kotini; Galwankar, Sagar; Sammon, Maura; Hosad, Prabhakar; Beeresha; Erickson, Timothy B.; Gaieski, David F.; Grover, Joydeep; Hegde, Anupama V.; Hoek, Terry Vanden; Jarwani, Bhavesh; Kataria, Himanshu; LaBresh, Kenneth A.; Manjunath, Cholenahally Nanjappa; Nagamani, A. C.; Patel, Anjali; Patel, Ketan; Ramesh, D.; Rangaraj, R.; Shamanur, Narendra; Sridhar, L.; Srinivasa, K. H.; Tyagi, Shweta

    2017-01-01

    There have been no published recommendations for the management of low-risk chest pain in emergency departments (EDs) across India. This is despite the fact that chest pain continues to be one of the most common presenting complaints in EDs. Risk stratification of patients utilizing an accelerated diagnostic protocol has been shown to decrease hospitalizations by approximately 40% with a low 30-day risk of major adverse cardiac events. The experts group of academic leaders from the Indian College of Cardiology and Academic College of Emergency Experts in India partnered with academic experts in emergency medicine and cardiology from leading institutions in the UK and USA collaborated to study the scientific evidence and make recommendations to guide emergency physicians working in EDs across India. PMID:28367012

  6. Chest trauma.

    PubMed

    Budassi, S A

    1978-09-01

    For any patient with obvious or suspected chest trauma, one must first assure an adequate airway and adequate ventilation. One should never hesitate to administer oxygen to a victim with a chest injury. The nurse should be concerned with adequate circulation--this may mean the administration of intravenous fluids, specifically volume expanders, via large-bore cannulae. Any obvious open chest wound should be sealed, and any fractures should be splinted. These patients should be rapidly transported to the nearest Emergency Department capable of handling this type of injury. The majority of patients who arrive in the Emergency Department following blunt or penetrating trauma should be considered to be in critical condition until proven otherwise. On presentation, it is essential to recognize those signs, symptoms, and laboratory values that identify the patient's condition as life-threatening. Simple recognition of these signs and symptoms and early appropriate intervention may alter an otherwise fatal outcome.

  7. Behavioral approaches to anxiety and pain management for pediatric venous access.

    PubMed

    Cohen, Lindsey L

    2008-11-01

    Pediatric venous access causes unnecessary anxiety and pain in children and, in turn, can have detrimental consequences. Behavioral approaches to pediatric venous access distress management can be organized temporally. Specifically, preparation before the procedure includes providing children with sensory and procedural information in an age-appropriate manner and providing training in coping skills. It is important to consider the timing, format, and content of the approach to provide optimal preparation for the unique circumstances of the individual patient. In addition to the child patient, preparing parents and teaching them which specific behaviors might be most helpful to their child should prove valuable to both patient and parents. During the procedure, there are benefits to providing secure and comfortable positioning. In addition, researchers recommend that adults encourage children to cope and actively engage children in distracting activities. For infants, there is support for the distress-mitigation properties of swaddling, skin-to-skin contact, breastfeeding, and sucrose. After venous access, distraction and encouragement of coping should speed recovery. In sum, research in behavioral approaches to pediatric pain management has provided recommendations for minimizing children's anxiety and pain associated with venous access.

  8. Superiority of quantitative exercise thallium-201 variables in determining long-term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization

    SciTech Connect

    Kaul, S.; Finkelstein, D.M.; Homma, S.; Leavitt, M.; Okada, R.D.; Boucher, C.A.

    1988-07-01

    The purpose of this study was to determine the prognostic utility of quantitative exercise thallium-201 imaging and compare it with that of cardiac catheterization in ambulatory patients. Accordingly, long-term (4 to 9 years) follow-up was obtained in 293 patients who underwent both tests for the evaluation of chest pain: 89 had undergone coronary artery bypass graft surgery within 3 months of testing and were excluded from analysis, 119 experienced no cardiac events and 91 had an event (death in 20, nonfatal myocardial infarction in 21 and coronary artery bypass operations performed greater than 3 months after cardiac catheterization in 50). When all variables were analyzed using Cox regression analysis, the quantitatively assessed lung/heart ratio of thallium-201 activity was the most important predictor of a future cardiac event (chi 2 = 40.21). Other significant predictors were the number of diseased vessels (chi 2 = 17.11), patient gender (chi 2 = 9.43) and change in heart rate from rest to exercise (chi 2 = 4.19). Whereas the number of diseased vessels was an important independent predictor of cardiac events, it did not add significantly to the overall ability of the exercise thallium-201 test to predict events. Furthermore, information obtained from thallium-201 imaging alone was marginally superior to that obtained from cardiac catheterization alone (p = 0.04) and significantly superior to that obtained from exercise testing alone (p = 0.02) in determining the occurrence of events. In addition, unlike the exercise thallium-201 test, which could predict the occurrence of all categories of events, catheterization data were not able to predict the occurrence of nonfatal myocardial infarction. The exclusion of bypass surgery and previous myocardial infarction did not alter the results.

  9. Chest X-Ray

    MedlinePlus

    ... by Image/Video Gallery Your radiologist explains chest x-ray. Transcript Welcome to Radiology Info dot org! Hello, ... you about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed ...

  10. Significant efficiency findings while controlling for the frequent confounders of CAI research in the PlanAlyzer project's computer-based, self-paced, case-based programs in anemia and chest pain diagnosis.

    PubMed

    Lyon, H C; Healy, J C; Bell, J R; O'Donnell, J F; Shultz, E K; Wigton, R S; Hirai, F; Beck, J R

    1991-04-01

    Richard E. Clark in his widely published comprehensive studies and meta-analyses of the literature on computer assisted instruction (CAI) has decried the lack of carefully controlled research, challenging almost every study which shows the computer-based intervention to result in significant post-test proficiency gains over a non-computer-based intervention. We report on a randomized study in a medical school setting where the usual confounders found by Clark to plague most research, were carefully controlled. PlanAlyzer is a microcomputer-based, self-paced, case-based, event-driven system for medical education which was developed and used in carefully controlled trials in a second year medical school curriculum to test the hypothesis that students with access to the interactive programs could integrate their didactic knowledge more effectively and/or efficiently than with access only to traditional textual "nonintelligent" materials. PlanAlyzer presents cases, elicits and critiques a student's approach to the diagnosis of two common medical disorders: anemias and chest pain. PlanAlyzer uses text, hypertext, images and critiquing theory. Students were randomized, one half becoming the experimental group who received the interactive PlanAlyzer cases in anemia, the other half becoming the controls who received the exact same content material in a text format. Later in each year there was a crossover, the controls becoming the experimentals for a similar intervention with the cardiology PlanAlyzer cases. Preliminary results at the end of the first two full trials shows that the programs have achieved most of the proposed instructional objectives, plus some significant efficiency and economy gains. 96 faculty hours of classroom time were saved by using PlanAlyzer in their place, while maintaining high student achievement. In terms of student proficiency and efficiency, the 328 students in the trials over two years were able to accomplish the project's instructional

  11. Drug induced chest pain—rare but important

    PubMed Central

    Davey, P.; Lalloo, D.

    2000-01-01

    Pericarditis, usually viral in origin, is an infrequent cause of chest pain. Pericarditis due to drug allergy is even less frequent and is thus rarely considered in the differential diagnosis. A case is reported of a woman who presented with severe chest pain, caused by minocycline induced pericarditis. Such allergy may be more common than reported. It is suggested that drug induced pericarditis should be included in the differential diagnosis of acute chest pain.


Keywords: chest pain; pericarditis; minocycline; drug allergy PMID:10878205

  12. Automated assessment of pain in rats using a voluntarily accessed static weight-bearing test

    PubMed Central

    Kim, Hung Tae; Uchimoto, Kazuhiro; Duellman, Tyler; Yang, Jay

    2015-01-01

    The weight-bearing test is one method to assess pain in rodent animal models; however, the acceptance of this convenient method is limited by the low throughput data acquisition and necessity of confining the rodents to a small chamber. New methods We developed novel data acquisition hardware and software, data analysis software, and a conditioning protocol for an automated high throughput static weight-bearing assessment of pain. With this device, the rats voluntarily enter the weighing chamber, precluding the necessity to restrain the animals and thereby removing the potential stress-induced confounds as well as operator selection bias during data collection. We name this device the Voluntarily Accessed Static Incapacitance Chamber (VASIC). Results Control rats subjected to the VASIC device provided hundreds of weight-bearing data points in a single behavioral assay. Chronic constriction injury (CCI) surgery and paw pad injection of complete Freund's adjuvant (CFA) or carrageenan in rats generated hundreds of weight-bearing data during a 30 minute recording session. Rats subjected to CCI, CFA, or carrageenan demonstrated the expected bias in weight distribution favoring the un-operated leg, and the analgesic effect of i.p. morphine was demonstrated. In comparison with existing methods, brief water restriction encouraged the rats to enter the weighing chamber to access water, and an infrared detector confirmed the rat position with feet properly positioned on the footplates, triggering data collection. This allowed hands-off measurement of weight distribution data reducing operator selection bias. Conclusion The VASIC device should enhance the hands-free parallel collection of unbiased weight-bearing data in a high throughput manner, allowing further testing of this behavioral measure as an effective assessment of pain in rodents. PMID:26143745

  13. Chest tube insertion

    MedlinePlus

    Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy; Pericardial drain ... When your chest tube is inserted, you will lie on your side or sit partly upright, with one arm over your head. Sometimes, ...

  14. CT angiography - chest

    MedlinePlus

    Computed tomography angiography - thorax; CTA - lungs; Pulmonary embolism - CTA chest; Thoracic aortic aneurysm - CTA chest; Venous thromboembolism - CTA lung; Blood clot - CTA lung; Embolus - CTA lung; CT ...

  15. Toward a Next Generation of Widely Accessible Spatial Interfaces: Mobile VR Environments for Patients with Persistent Pain

    PubMed Central

    Schroeder, David; Korsakov, Fedor; Jolton, Joseph; Keefe, Francis J.; Haley, Alex; Keefe, Daniel F.

    2015-01-01

    We present a series of multi-modal spatial interfaces and virtual environments that can be implemented with widely accessible virtual reality (VR) technologies. The results demonstrate and evaluate the new degree to which rich virtual experiences involving motion sensing, physiological inputs, stereoscopic imagery, sound, and haptic feedback can now be created using low-cost (e.g., mobile phone based) VR environments. Adapting spatial interfaces to these new platforms can open up exciting new application areas for VR. This is demonstrated through a series of prototype systems aimed at delivering in-home VR therapies to patients suffering from persistent pain conditions (e.g. arthritis pain, cancer pain). A rich spatial interface and visual aesthetic is particularly important for the success of these applications; thus an interdisciplinary team with expertise in technology, design, meditation, and the psychology of pain worked together to iteratively develop and evaluate the current prototypes. PMID:24807994

  16. Phantom Pain

    MedlinePlus

    ... be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts extremely fine, sterilized ... and Stroke. http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm. Accessed Sept. 16, 2014. ...

  17. Findings from an evaluation of PlanAlyzer's double cross-over trials of computer-based, self-paced, case-based programs in anemia and chest pain diagnosis.

    PubMed Central

    Lyon, H. C.; Healy, J. C.; Bell, J. R.; O'Donnell, J. F.; Shultz, E. K.; Wigton, R. S.; Hirai, F.; Beck, J. R.

    1991-01-01

    We report on three years of research trials of the PlanAlyzer I Project--a carefully controlled research study using a microcomputer-based, self-paced, case-based, event-driven system for medical education. PlanAlyzer presents cases, elicits and critiques a second year student's approach to the diagnosis of anemias and chest pain. PlanAlyzer uses text, hypertext, images and critiquing theory. Students were randomized, one half becoming the experimental group who received the interactive PlanAlyzer cases in anemia, the other half becoming the controls who received the exact same content material in a text format. Later in each year there was a crossover, the controls becoming the experimentals for a similar intervention with the cardiology PlanAlyzer cases. Results at the end of the first two years of trials show that the programs have achieved some significant efficiency and economy gains. 96 faculty hours of classroom time were saved by using PlanAlyzer in their place, with no loss in student achievement. In terms of student proficiency and efficiency, combining the anemia and cardiology trials, the 328 students in the two years of full scale trials were able to accomplish the project's instructional objectives. The experimentals accomplished this in 43% less time than the controls. On the average, for both the anemia and chest pain programs, this amounted to students spending 7.5 hours longer on the 30 text cases than on the same 30 computer cases to achieve the same level of mastery. There have been no significant proficiency differences (as measured by current post-tests) between the experimental and control groups.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1807738

  18. Clinical utility of far-infrared therapy for improvement of vascular access blood flow and pain control in hemodialysis patients

    PubMed Central

    Choi, Soo Jeong; Cho, Eun Hee; Jo, Hye Min; Min, Changwook; Ji, Young Sok; Park, Moo Yong; Kim, Jin Kuk; Hwang, Seung Duk

    2015-01-01

    Background Maintenance of a well-functioning vascular access and minimal needling pain are important goals for achieving adequate dialysis and improving the quality of life in hemodialysis (HD) patients. Far-infrared (FIR) therapy may improve endothelial function and increase access blood flow (Qa) and patency in HD patients. The aim of this study was to evaluate effects of FIR therapy on Qa and patency, and needling pain in HD patients. Methods This prospective clinical trial enrolled 25 outpatients who maintained HD with arteriovenous fistula. The other 25 patients were matched as control with age, sex, and diabetes. FIR therapy was administered for 40 minutes during HD 3 times/wk and continued for 12 months. The Qa was measured by the ultrasound dilution method, whereas pain was measured by a numeric rating scale at baseline, then once per month. Results One patient was transferred to another facility, and 7 patients stopped FIR therapy because of an increased body temperature and discomfort. FIR therapy improved the needling pain score from 4 to 2 after 1 year. FIR therapy increased the Qa by 3 months and maintained this change until 1 year, whereas control patients showed the decrease in Qa. The 1-year unassisted patency with FIR therapy was not significantly different from control. Conclusion FIR therapy improved needling pain. Although FIR therapy improved Qa, the unassisted patency was not different compared with the control. A larger and multicenter study is needed to evaluate the effect of FIR therapy. PMID:27069856

  19. Lower limb gigantism, lymphedema, and painful varicosities following a thigh vascular access graft.

    PubMed

    Thompson, Michael; Mathuram Thiyagarajan, Umasankar; Akoh, Jacob A

    2014-07-01

    Prosthetic arteriovenous grafts (AVGs) are associated with greater morbidity than autogenous arteriovenous fistulas (AVFs), but their use is indicated when AVF formation is not possible. This report adds to the literature a case of lower limb gigantism, painful varicosities, and lymphedema following long-term use of AVG in the upper thigh. The patient's past medical history included renal transplantation on the same side well before the AVG was inserted and right leg deep vein thrombosis. Suspicion of AVG thrombosis was excluded by Doppler ultrasound, which demonstrated an access flow of 1700 mL/min. A computed tomography (CT) scan of the abdomen and pelvis did not identify the cause of her symptoms. Whereas functional incompetence of the iliac vein valve might be responsible for the varicosities, the extent of hypertrophy in this case raises the suspicion of lymphatic blockage possibly secondary to groin dissection undertaken at the time of graft insertion, in addition to the previous dissection at the time of transplantation. This case highlights the need for minimal groin dissection during AVG insertion, particularly in patients with a history of previous abdominopelvic surgery.

  20. Postoperative Pain Management in Children, Parental English Proficiency, and Access to Interpretation

    PubMed Central

    Jimenez, Nathalia; Jackson, Douglass L.; Zhou, Chuan; Ayala, Nelly C.; Ebel, Beth E.

    2014-01-01

    BACKGROUND AND OBJECTIVE Patients with limited English proficiency (LEP) are at risk for undertreated pain. The goal of this study was to examine the association between parental language proficiency, interpreted care, and postsurgical pediatric pain management. METHODS This was a retrospective matched cohort study among children <18 years of age. Children of LEP and English-proficient (EP) parents were matched according to age group, surgical procedure, and admission date. Mean number of daily pain assessments and mean daily pain scores were compared between language groups. We also compared the association between pain scores and type of medication given (opioid versus nonopioid). Within the LEP group, similar analyses compared pain assessment and treatment of children whose families received ≥2 professional interpretations per day versus those who received lower rates of interpretation. RESULTS A total of 474 children (237 LEP and 237 EP) were included in the study. Children of LEP parents had fewer pain assessments (mean: 7 [95% confidence interval: 2–13] vs 9 [95% confidence interval: 4–15]; P = .012), and higher levels of pain recorded before receiving opioid analgesics, compared with children of EP parents (P = .003). Within the LEP group, children with ≥2 interpretations per day had lower pain scores after medication administration (P < .05) and were more likely to receive opioids at pain levels similar to those of EP families. CONCLUSIONS Children of LEP parents received fewer pain assessments and were less likely to receive opioid analgesics for similar levels of pain compared with children of EP parents. More frequent use of professional interpreters when assessing pain may aid in reducing the gap in pain management between LEP and EP pediatric patients. PMID:24435597

  1. B-type natriuretic peptide and high sensitive C-reactive protein predict 2-year all cause mortality in chest pain patients: a prospective observational study from Salta, Argentina

    PubMed Central

    2011-01-01

    Background Several mechanisms are involved in the pathophysiology of the Acute Coronary Syndrome (ACS). We have addressed whether B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) in admission samples may improve risk stratification in chest pain patients with suspected ACS. Methods We included 982 patients consecutively admitted with chest pain and suspected ACS at nine hospitals in Salta, Northern Argentina. Total and cardiac mortality were recorded during a 2-year follow up period. Patients were divided into quartiles according to BNP and hsCRP levels, respectively, and inter quartile differences in mortality were statistically evaluated applying univariate and multivariate analyses. Results 119 patients died, and the BNP and hsCRP levels were significantly higher among these patients than in survivors. In a multivariable Cox regression model for total death and cardiac death in all patients, the hazard ratio (HR) in the highest quartile (Q4) as compared to the lowest quartile (Q1) of BNP was 2.32 (95% confidence interval (CI), 1.24-4.35), p = 0.009 and 3.34 (95% CI, 1.26-8.85), p = 0.015, respectively. In the TnT positive patients (TnT > 0.01 ng/mL), the HR for total death and cardiac death in Q4 as compared to Q1 was 2.12 (95% CI, 1.07-4.18), p = 0.031 and 3.42 (95% CI, 1.13-10.32), p = 0.029, respectively. The HR for total death for hsCRP in Q4 as compared to Q1 was 1.97 (95% CI, 1.17-3.32), p = 0.011, but this biomarker did not predict cardiac death (p = 0.21). No prognostic impact of these two biomarkers was found in the TnT negative patients. Conclusion BNP and hsCRP may act as clinically useful biomarkers when obtained at admission in a population with suspected ACS. Trial Registration ClinicalTrials.gov Identifier: NCT01377402. PMID:21958326

  2. Ventricular premature beats on Holter monitoring in patients admitted with chest pain, in whom acute myocardial infarction is not confirmed. The prognostic value and relationship to scars or ischemia on thallium-201 scintigraphy

    SciTech Connect

    Madsen, J.K.; Sorensen, J.N.; Kromann-Andersen, B.; Kjeldgaard, K.M.; Christoffersen, K.; van Duijvendijk, K.; Reiber, J.H.

    1987-05-01

    Ambulatory 24-h Holter monitoring was carried out in 198 patients who had been admitted because of suspected acute myocardial infarction (AMI) due to chest pain, but in whom AMI was not confirmed. During a follow-up period of 12-24 months (median 14 months) 16 cardiac events (i.e., nonfatal AMI or cardiac death) occurred. Ventricular premature beats (VPBs) were found in 65.2% of the patients, complex VPBs in 28.8%. Pairs of VPBs which were seen in 10.0% of the patients were the only important type of VPBs significantly related to an impaired prognosis. Thallium-201 scintigraphy was performed in 144 of the patients. VPBs were significantly related to scar formation (i.e., to permanent defects, but not to ischemia, specifically, to transient defects). It is concluded that ventricular arrhythmias in this patient category indicate presence of chronic ischemic heart disease, and that pairs of VPBs seem to identify patients at risk for cardiac events.

  3. Thoracic Trauma: Which Chest Tube When and Where?

    PubMed

    Molnar, Tamas F

    2017-02-01

    Clinical suspicion of hemo/pneumothorax: when in doubt, drain the chest. Stable chest trauma with hemo/pneumothorax: drain and wait. Unstable patient with dislocated trachea must be approached with drain in hand and scalpel ready. Massive hemo/pneumothorax may be controlled by drainage alone. The surgeon should not hesitate to open the chest if too much blood drains over a short period. The chest drainage procedure does not end with the last stitch; the second half of the match is still ahead. The drained patient is in need of physiotherapy and proper pain relief with an extended pleural space: control the suction system.

  4. Colon in the Chest: An Incidental Dextrocardia

    PubMed Central

    Abd Elrazek, Abd Elrazek; Shehab, Abdullah; Elnour, Asim A.; Al Nuaimi, Saif K.; Baghdady, Shazly

    2015-01-01

    Abstract Diaphragmatic injury is an uncommon traumatic injury (<1%). Although most diaphragmatic injuries can be obvious (eg, herniation of abdominal contents on chest radiograph), some injuries may be subtle and imaging studies can be nondiagnostic in many situations. Patients with diaphragmatic hernia either traumatic or nontraumatic may initially have no symptoms or signs to suggest an injury to the diaphragm. Here, we report a case of a 75-year-old woman diagnosed with irritable bowel syndrome –associated dominant constipation, presented with shortness of breath, cough, expectoration, tachycardia, and chest pain. Dextrocardia was an incidental finding, diagnosed by electrocardiography, chest radiograph, and CT chest. Parts of the colon, small intestine, and stomach were within the thorax in the left side due to left diaphragmatic hernia of a nontraumatic cause. Acquired incidental dextrocardia was the main problem due to displacement of the heart to contralateral side by the GI (gastrointestinal) viscera (left diaphragmatic hernia). The patient was prepared for the laparoscopic surgical repair, using a polyethylene mesh 20 cm to close the defect, and the patient recovered with accepted general condition. However, 5 days postoperative, the patient passed away suddenly due to unexplained cardiac arrest. Intrathoracic herniation of abdominal viscera should be considered in patients presented with sudden chest pain concomitant with a history of increased intra-abdominal pressure. PMID:25674744

  5. Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours

    PubMed Central

    2012-01-01

    Background Coordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP. Methods Fourteen consumers with a history of CLBP from three rural sites in WA participated. Maximum variation sampling was employed to ensure a range of experiences were captured. An interviewer, blinded to quantitative pain history data, conducted semi-structured telephone interviews using a standardised schedule to explore individuals’ access to information and services for CLBP, and self-management behaviours. Interviews were digitally recorded and transcribed verbatim. Inductive analysis techniques were used to derive and refine key themes. Results Five key themes were identified that affected individuals’ experiences of managing CLBP in a rural setting, including: 1) poor access to information and services in rural settings; 2) inadequate knowledge and skills among local practitioners; 3) feelings of isolation and frustration; 4) psychological burden associated with CLBP; and 5) competing lifestyle demands hindering effective self-management for CLBP. Conclusions Consumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as

  6. Back Pain

    MedlinePlus

    ... specific points on the body. Some people with low back pain report that acupuncture helps relieve their symptoms. Massage. ... Accessed May 29, 2015. Adult acute and subacute low back pain. Bloomington, Minn.: Institute for Clinical Systems Improvement. http:// ...

  7. Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures

    PubMed Central

    Chapman, Brandon C.; Overbey, Douglas M.; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T.; French, Andrew; Johnson, Jeffrey L.; Burlew, Clay C.; Barnett, Carlton; Moore, Ernest E.; Pieracci, Fredric M.

    2016-01-01

    Background Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. Objectives The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Methods Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student’s t-test and chi-square analysis were used for comparison. Results We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. Conclusions The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes. PMID:28144607

  8. Chest X-Ray (Chest Radiography)

    MedlinePlus

    ... x-rays. top of page What does the equipment look like? The equipment typically used for chest x-rays consists of ... tube is positioned about six feet away. The equipment may also be arranged with the x-ray ...

  9. Neck pain

    MedlinePlus

    ... neck. If neck pain involves compression of your nerves, you may feel numbness, tingling, or weakness in your arm or ... When to Contact a Medical Professional ... fever and headache, and your neck is so stiff that you cannot touch your chin to your chest. This may be ...

  10. A case series of patients using medicinal marihuana for management of chronic pain under the Canadian Marihuana Medical Access Regulations.

    PubMed

    Lynch, Mary E; Young, Judee; Clark, Alexander J

    2006-11-01

    The Canadian Marihuana Medical Access Regulations (MMAR) program allows Health Canada to grant access to marihuana for medical use to those who are suffering from grave and debilitating illnesses. This is a report on a case series of 30 patients followed at a tertiary care pain management center in Nova Scotia who have used medicinal marihuana for 1-5 years under the MMAR program. Patients completed a follow-up questionnaire containing demographic and dosing information, a series of 11-point numerical symptom relief rating scales, a side effect checklist, and a subjective measure of improvement in function. Doses of marihuana ranged from less than 1 to 5g per day via the smoked or oral route of administration. Ninety-three percent of patients reported moderate or greater pain relief. Side effects were reported by 76% of patients, the most common of which were increased appetite and a sense of well-being, weight gain, and slowed thoughts. Limitations of the study include self-selection bias, small size, and lack of a control group. The need for further study using controlled trials is discussed along with an overview of the MMAR program.

  11. Value of the Gastroesophageal Reflux Disease Questionnaire (GerdQ) in predicting the proton pump inhibitor response in coronary artery disease patients with gastroesophageal reflux-related chest pain.

    PubMed

    He, S; Liu, Y; Chen, Y; Tang, Y; Xu, J; Tang, C

    2016-05-01

    Chest pain experienced by patients with coronary artery disease can be partly due to gastroesophageal reflux-induced chest pain (GERP). Empirical proton pump inhibitor (PPI) therapy has been recommended as an initial clinical approach for treating GERP. However, PPI use may lead to some health problems. The Gastroesophageal Reflux Disease Questionnaire (GerdQ) may represent a noninvasive and cost-effective approach for avoiding PPI misuse and for identifying the appropriate patients for the PPI trial test. The aim of this pilot study was to prospectively evaluate the association between GerdQ scores and PPI response in patients with coronary artery disease (CAD) and GERP to determine whether the GerdQ predicts the PPI response in patients with CAD and GERP and to further validate the clinical application value of the GerdQ. A total of 154 consecutive patients with potential GERP were recruited to complete a GerdQ with subsequent PPI therapy. Based on the PPI trial result, patients were divided into a PPI-positive response group and a PPI-negative response group. The difference in the GerdQ scores between the two groups was assessed. The receiver operating characteristic (ROC) curve of GerdQ score was drawn according to the PPI response as the gold standard. The ability of GerdQ to predict the PPI response was assessed. A total of 96 patients completed the entire study; 62 patients (64.6%) were assigned to the PPI-positive response group, and 34 patients (35.4%) to the PPI-negative response group. The GerdQ score of the PPI-positive response group (8.11 ± 3.315) was significantly higher than that of the PPI-negative response group (4.41 ± 2.743), and the difference was statistically significant (t = 5.863, P = 0.000). The ROC curve was drawn according to a PPI response assessment result with a score above 2 as the gold standard. The area under curve was 0.806. When the critical value of GerdQ score was 7.5, Youden index was up to 0.514, the diagnostic sensitivity

  12. Chest CT Scan

    MedlinePlus

    ... inside the scanner. For some diagnoses, a contrast dye, often iodine-based, may be injected into a ... your arm before the imaging test. This contrast dye highlights areas inside your chest and creates clearer ...

  13. Chest tube insertion - slideshow

    MedlinePlus

    ... Health Topics Chest Injuries and Disorders Collapsed Lung Critical Care Lung Diseases Pleural Disorders A.D.A. ... Duplication for commercial use must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map ...

  14. Chest Injuries and Disorders

    MedlinePlus

    ... your neck and your abdomen. It includes the ribs and breastbone. Inside your chest are several organs, ... and collapsed lung Pleural disorders Esophagus disorders Broken ribs Thoracic aortic aneurysms Disorders of the mediastinum, the ...

  15. Chest x-ray

    MedlinePlus

    ... also be done if you have signs of tuberculosis , lung cancer , or other chest or lung diseases . ... the blood vessels Pneumonia Scarring of lung tissue Tuberculosis In the heart: Problems with the size or ...

  16. Chest Pain in Infants and Children

    MedlinePlus

    ... symptoms.Start OverDiagnosisThese symptoms may be caused by PLEURISY, an inflammation of the lining around the lung. ... or she can determine what is causing the pleurisy. Often, an anti-inflammatory drug will help relieve ...

  17. Gastroesophageal reflux disease in noncardiac chest pain.

    PubMed

    Faybush, Elisa M; Fass, Ronnie

    2004-03-01

    After a cardiac source has been excluded, the most likely cause of NCCP is GERD. Clinical history often cannot make the diagnosis of GERD-related NCCP. The PPI test is a simple, highly sensitive, and cost-effective tool that should be the first diagnostic test used in evaluating these patients. Patients with GERD-related NCCP require long-term therapy with a PPI,commonly double the standard dose. The introduction of the wireless pH system and the multi-channel intraluminal impedance will help us to further understand the role of GERD in NCCP. Treatment of NCCP has dramatically improved since the introduction of the PPI class of drugs.However, better therapeutic modalities should be sought out to further improve our current treatment of GERD-related NCCP.

  18. Accessibility

    EPA Pesticide Factsheets

    Federal laws, including Section 508 of the Rehabilitation Act, mandate that people with disabilities have access to the same information that someone without a disability would have. 508 standards cover electronic and information technology (EIT) products.

  19. Chest X-Ray

    MedlinePlus Videos and Cool Tools

    ... Site Index A-Z Spotlight Recently posted: Anal Cancer Facet Joint Block Video: Lung Cancer Screening Video: Upper GI Tract X-ray Video: ... of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray requires no special preparation. ...

  20. Regional cancer pain syndromes.

    PubMed

    Chang, Victor T; Janjan, Nora; Jain, Subash; Chau, Chi

    2006-12-01

    Cancer pain often presents in a body region. This review summarizes articles from 1999-2004 relevant to cancer pain syndromes in the head and neck, chest, back, abdomen, pelvis, and limbs. Although the evidence is limited, progress is being made in further development of the evidence base to support and guide current practice.

  1. Mitral valve plasty for mitral regurgitation after blunt chest trauma.

    PubMed

    Kumagai, H; Hamanaka, Y; Hirai, S; Mitsui, N; Kobayashi, T

    2001-06-01

    A 21 year-old woman was admitted to our hospital because of chest and back pain after blunt chest trauma. On admission, consciousness was clear and a physical examination showed labored breathing. Her vital signs were stable, but her breathing gradually worsened, and artificial respiration was started. The chest roentgenogram and a subsequent chest computed tomographic scans revealed contusions, hemothorax of the left lung and multiple rib fractures. A transthoracic echocardiography (TTE) revealed normal left ventricular wall motion and mild mitral regurgitation (MR). TTE was carried out repeatedly, and revealed gradually progressive MR and prolapse of the posterior medial leaflet, although there was no congestive heart failure. After her general condition had recovered, surgery was performed. Intraoperative transesophageal echocardiography (TEE) revealed torn chordae at the posterior medial leaflet. The leaflet where the chorda was torn was cut and plicated, and posterior mitral annuloplasty was performed using a prosthetic ring. One month later following discharge, the MR had disappeared on TTE.

  2. An unusual case of flail chest: surgical repair using Marlex mesh

    PubMed Central

    Heriot, A. G.; Wells, F. C.

    1997-01-01

    The case history is presented of a patient with neurofibromatosis with a chest wall defect present from birth. Abnormal rib development had resulted in a flail segment with painful paradoxical movement and unsightly costal cartilage protrusion. Chest wall reconstruction using Marlex mesh resulted in an excellent cosmetic and functional repair. 


 PMID:9176546

  3. The intersection between asthma and acute chest syndrome in children with sickle-cell anaemia.

    PubMed

    DeBaun, Michael R; Strunk, Robert C

    2016-06-18

    Acute chest syndrome is a frequent cause of acute lung disease in children with sickle-cell disease. Asthma is common in children with sickle-cell disease and is associated with increased incidence of vaso-occlusive pain events, acute chest syndrome episodes, and earlier death. Risk factors for asthma exacerbation and an acute chest syndrome episode are similar, and both can present with shortness of breath, chest pain, cough, and wheezing. Despite overlapping risk factors and symptoms, an acute exacerbation of asthma or an episode of acute chest syndrome are two distinct entities that need disease-specific management strategies. Although understanding has increased about asthma as a comorbidity in sickle-cell disease and its effects on morbidity, substantial gaps remain in knowledge about best management.

  4. The intersection between asthma and acute chest syndrome in children with sickle-cell anaemia

    PubMed Central

    DeBaun, Michael R; Strunk, Robert C

    2016-01-01

    Acute chest syndrome is a frequent cause of acute lung disease in children with sickle-cell disease. Asthma is common in children with sickle-cell disease and is associated with increased incidence of vaso-occlusive pain events, acute chest syndrome episodes, and earlier death. Risk factors for asthma exacerbation and an acute chest syndrome episode are similar, and both can present with shortness of breath, chest pain, cough, and wheezing. Despite overlapping risk factors and symptoms, an acute exacerbation of asthma or an episode of acute chest syndrome are two distinct entities that need disease-specific management strategies. Although understanding has increased about asthma as a comorbidity in sickle-cell disease and its effects on morbidity, substantial gaps remain in knowledge about best management. PMID:27353685

  5. A Community-acquired Lung Abscess Attributable to Streptococcus pneumoniae which Extended Directly into the Chest Wall

    PubMed Central

    Ko, Yuki; Tobino, Kazunori; Yasuda, Yuichiro; Sueyasu, Takuto; Nishizawa, Saori; Yoshimine, Kouhei; Munechika, Miyuki; Asaji, Mina; Yamaji, Yoshikazu; Tsuruno, Kosuke; Miyajima, Hiroyuki; Mukasa, Yosuke; Ebi, Noriyuki

    2017-01-01

    We herein report the case of 75-year-old Japanese female with a community-acquired lung abscess attributable to Streptococcus pneumoniae (S. penumoniae) which extended into the chest wall. The patient was admitted to our hospital with a painful mass on the left anterior chest wall. A contrast-enhanced chest computed tomography scan showed a lung abscess in the left upper lobe which extended into the chest wall. Surgical debridement of the chest wall abscess and percutaneous transthoracic tube drainage of the lung abscess were performed. A culture of the drainage specimen yielded S. pneumoniae. The patient showed a remarkable improvement after the initiation of intravenous antibiotic therapy. PMID:28049987

  6. Cost-effectiveness of initial stress cardiovascular MR, stress SPECT or stress echocardiography as a gate-keeper test, compared with upfront invasive coronary angiography in the investigation and management of patients with stable chest pain: mid-term outcomes from the CECaT randomised controlled trial

    PubMed Central

    Thom, Howard; West, Nicholas E J; Hughes, Vikki; Dyer, Matthew; Buxton, Martin; Sharples, Linda D; Jackson, Christopher H; Crean, Andrew M

    2014-01-01

    Objectives To compare outcomes and cost-effectiveness of various initial imaging strategies in the management of stable chest pain in a long-term prospective randomised trial. Setting Regional cardiothoracic referral centre in the east of England. Participants 898 patients (69% man) entered the study with 869 alive at 2 years of follow-up. Patients were included if they presented for assessment of stable chest pain with a positive exercise test and no prior history of ischaemic heart disease. Exclusion criteria were recent infarction, unstable symptoms or any contraindication to stress MRI. Primary outcome measures The primary outcomes of this follow-up study were survival up to a minimum of 2 years post-treatment, quality-adjusted survival and cost-utility of each strategy. Results 898 patients were randomised. Compared with angiography, mortality was marginally higher in the groups randomised to cardiac MR (HR 2.6, 95% CI 1.1 to 6.2), but similar in the single photon emission CT-methoxyisobutylisonitrile (SPECT-MIBI; HR 1.0, 95% CI 0.4 to 2.9) and ECHO groups (HR 1.6, 95% CI 0.6 to 4.0). Although SPECT-MIBI was marginally superior to other non-invasive tests there were no other significant differences between the groups in mortality, quality-adjusted survival or costs. Conclusions Non-invasive cardiac imaging can be used safely as the initial diagnostic test to diagnose coronary artery disease without adverse effects on patient outcomes or increased costs, relative to angiography. These results should be interpreted in the context of recent advances in imaging technology. Trial registration ISRCTN 47108462, UKCRN 3696. PMID:24508847

  7. [A case of huge abscess extended from anterior neck to left lung and lateral chest wall].

    PubMed

    Ikeya, T; Tsuda, M; Hara, H; Koyama, S; Sugiyama, S; Misaki, T

    1997-11-01

    62-year-old woman admitted our hospital with pain of left upper extremity from the left chest and dysphasia. Chest X-ray showed the huge mass shadow in the left lung field. Diabetes mellitus and inflammatory reaction such as high fervor, leukocytosis, CRP and ESR accentuation were recognized. Conservative therapy was done at first, but mass shadow on X-ray increased, and swelling appeared from the neck to the left lateral chest wall. And the same site appeared like subcutaneous emphysema. Computed Tomography showed mass shadow which was enlarged and spread in lung parenchyma and left chest wall with bubble image. Incision and open drainage was performed for the left chest wall but origin bacteria was detected in neither anaerobic nor aerobic culture of pus. Inflammation and mass shadow of left upper lung field have decreased gradually. The patient discharged without bronchoalveolar fistula. Abscess extending from the neck or chest wall with diabetes mellitus is very rare.

  8. Evaluating a Human Rights-Based Advocacy Approach to Expanding Access to Pain Medicines and Palliative Care: Global Advocacy and Case Studies from India, Kenya, and Ukraine.

    PubMed

    Lohman, Diederik; Amon, Joseph J

    2015-12-10

    Palliative care has been defined as care that is person-centered and attentive to physical symptoms and psychological, social, and existential distress in patients with severe or life-threatening illness. The identification of access to palliative care and pain treatment as a human rights issue first emerged among palliative care advocates, physicians, and lawyers in the 1990s, with a basis in the right to health and the right to be free from cruel, inhuman, and degrading treatment. Using a case study approach, we evaluate the results of a human rights-based advocacy approach on access to pain medicine and palliative care in India, Kenya, and Ukraine. In each country, human rights advocacy helped raise awareness of the issue, identify structural barriers to care, define government obligations, and contribute to the reform of laws, policies, and practices impeding the availability of palliative care services. In addition, advocacy efforts stimulated civil society engagement and high-level political leadership that fostered the implementation of human rights-based palliative care programs. Globally, access to palliative care was increasingly recognized by human rights bodies and within global health and drug policy organizations as a government obligation central to the right to health.

  9. Back Pain at Work: Preventing Pain and Injury

    MedlinePlus

    ... pain are steps in the right direction. References Low back pain fact sheet. National Institute of Neurological Disorders and ... backpain/detail_backpain.htm. Accessed March 30, 2016. Low back pain. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos. ...

  10. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: Impact of a Regional Rapid Access Clinic on Access to Care

    SciTech Connect

    Wu, Jackson S.Y.; Kerba, Marc; Wong, Rebecca K.S.; Mckimmon, Erin; Eigl, Bernhard; Hagen, Neil A.

    2010-10-01

    Purpose: External beam radiotherapy (RT) is commonly indicated for the palliation of symptomatic bone metastases, but there is evidence of underutilization of this treatment modality in palliative care for cancer populations. This study was conducted to investigate factors that influenced the use of palliative RT services at a regional comprehensive cancer center. Methods and Materials: A cohort of patients with radiographically confirmed bone metastases and first-time users of palliative RT between 2003 and 2005 was retrospectively reviewed from the time of initial diagnosis of bone metastases to death or last follow-up. Type of radiation treatment service provider used (rapid access or routine access) and patient-, tumor-, and treatment-related factors were analyzed for their influences on the number of treatment courses given over the duration of disease. Results: A total of 887 patients received 1,354 courses of palliative RT for bone metastases at a median interval of 4.0 months between courses. Thirty-three percent of patients required more than one RT course. Increased age and travel distance reduced the likelihood and number of treatment courses, while service through a rapid access clinic was independently associated with an increase in subsequent use of palliative RT. Conclusions: A rapid access service model for palliative RT facilitated access to RT. Travel distance and other factors remained substantial barriers to use of palliative RT services. The pattern of practice suggests an unmet need for symptom control in patients with bone metastases.

  11. High Pain Tolerance Tied to 'Silent' Heart Attack Risk

    MedlinePlus

    ... 162666.html High Pain Tolerance Tied to 'Silent' Heart Attack Risk Unusual symptoms include upper back or jaw ... be at increased risk of having a "silent" heart attack, a new study hints. Chest pain is one ...

  12. Male chest enhancement: pectoral implants.

    PubMed

    Benito-Ruiz, J; Raigosa, J M; Manzano-Surroca, M; Salvador, L

    2008-01-01

    The authors present their experience with the pectoral muscle implant for male chest enhancement in 21 patients. The markings and technique are thoroughly described. The implants used were manufactured and custom made. The candidates for implants comprised three groups: group 1 (18 patients seeking chest enhancement), group 2 (1 patient with muscular atrophy), and group 3 (2 patients with muscular injuries). Because of the satisfying results obtained, including significant enhancement of the chest contour and no major complications, this technique is used for an increasing number of male cosmetic surgeries.

  13. Chest drainage systems in use

    PubMed Central

    Zisis, Charalambos; Tsirgogianni, Katerina; Lazaridis, George; Lampaki, Sofia; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Rapti, Aggeliki; Trakada, Georgia; Karapantzos, Ilias; Karapantzou, Chrysanthi; Zissimopoulos, Athanasios; Zarogoulidis, Konstantinos

    2015-01-01

    A chest tube is a flexible plastic tube that is inserted through the chest wall and into the pleural space or mediastinum. It is used to remove air in the case of pneumothorax or fluid such as in the case of pleural effusion, blood, chyle, or pus when empyema occurs from the intrathoracic space. It is also known as a Bülau drain or an intercostal catheter. Insertion of chest tubes is widely performed by radiologists, pulmonary physicians and thoracic surgeons. Large catheters or small catheters are used based on each situation that the medical doctor encounters. In the current review we will focus on the chest drain systems that are in use. PMID:25815304

  14. American College of Chest Physicians

    MedlinePlus

    ... April 10, 2017 CHEST Foundation and Foundation for Sarcoidosis Research campaign aims to raise awareness of little-known condition, sarcoidosis To coincide with National Sarcoidosis Awareness Month in ...

  15. The role of rib infarcts in the acute chest syndrome of sickle cell diseases.

    PubMed

    Rucknagel, D L

    2001-01-01

    The acute chest syndrome is a generic term for pulmonary complications of sickle cell diseases with heterogeneous etiologies that include pneumonia, vaso-occlusion of pulmonary arterioles, rib infarction, and fat embolism syndrome. My review summarizes these etiologies, the evidence, and pathophysiology supporting the hypothesis that infarction of segments of ribs by the same vaso-occlusive process responsible for the acute episodes of pain (characteristic of the sickle cell diseases) is often involved in the acute chest structure. Inflammation associated with the infarct then causes splinting, hypoventilation, and hypoxia and further vaso-occlusion. The relationship with adult respiratory distress syndrome and fat embolism is also discussed. Use of the incentive spirometer combined with effective analgesia when chest pain is present is advocated for prevention of the pulmonary infiltrates. Newer understanding of the role of nitric oxide in regulating oxygen transport and its relationship to blood transfusions used in therapy of the acute chest syndrome are discussed.

  16. Heimlich valve for chest drainage.

    PubMed

    Heimlich, H J

    1983-01-01

    The Heimlich chest drainage valve was developed so that the process of draining the pleural cavity could be accomplished in a safe, relatively simple, and efficient manner. Replacing the cumbersome underwater drainage bottle system, the Heimlich valve connects to chest tubing and allows fluid and air to pass in one direction only. The valve, which functions in any position, need never be clamped, and regulated suction can be attached to it if necessary. The valve drains into a plastic bag that can be held at any level, allowing the patient undergoing chest drainage to be ambulatory simply by carrying the bag. The construction and function of the valve is easily understood by medical and nursing staffs. It is presterilized, stored in a sterile package, and readily utilized on emergency vehicles and in the operating room.

  17. [Chest ultrasonography in pleurapulmonary disease].

    PubMed

    Gallego Gómez, M P; García Benedito, P; Pereira Boo, D; Sánchez Pérez, M

    2014-01-01

    Although the initial diagnosis and follow-up of pleuropulmonary disease are normally done with plain chest films and the gold standard for chest disease is computed tomography, diverse studies have established the usefulness of chest ultrasonography in the diagnosis of different pleuropulmonary diseases like pleural effusion and lung consolidation, among others. In this article, we show the different ultrasonographic patterns for pleuropulmonary disease. The availability of ultrasonography in different areas (ICU, recovery areas) makes this technique especially important for critical patients because it obviates the need to transfer the patient. Moreover, ultrasonography is noninvasive and easy to repeat. On the other hand, it enables the direct visualization of pleuropulmonary disease that is necessary for interventional procedures.

  18. Factors Associated With Chest Wall Toxicity After Accelerated Partial Breast Irradiation Using High-Dose-Rate Brachytherapy

    SciTech Connect

    Brown, Sheree; Vicini, Frank; Vanapalli, Jyotsna R.; Whitaker, Thomas J.; Pope, D. Keith; Lyden, Maureen; Bruggeman, Lisa; Haile, Kenneth L.; McLaughlin, Mark P.

    2012-07-01

    Purpose: The purpose of this analysis was to evaluate dose-volume relationships associated with a higher probability for developing chest wall toxicity (pain) after accelerated partial breast irradiation (APBI) by using both single-lumen and multilumen brachytherapy. Methods and Materials: Rib dose data were available for 89 patients treated with APBI and were correlated with the development of chest wall/rib pain at any point after treatment. Ribs were contoured on computed tomography planning scans, and rib dose-volume histograms (DVH) along with histograms for other structures were constructed. Rib DVH data for all patients were sampled at all volumes {>=}0.008 cubic centimeter (cc) (for maximum dose related to pain) and at volumes of 0.5, 1, 2, and 3 cc for analysis. Rib pain was evaluated at each follow-up visit. Patient responses were marked as yes or no. No attempt was made to grade responses. Eighty-nine responses were available for this analysis. Results: Nineteen patients (21.3%) complained of transient chest wall/rib pain at any point in follow-up. Analysis showed a direct correlation between total dose received and volume of rib irradiated with the probability of developing rib/chest wall pain at any point after follow-up. The median maximum dose at volumes {>=}0.008 cc of rib in patients who experienced chest wall pain was 132% of the prescribed dose versus 95% of the prescribed dose in those patients who did not experience pain (p = 0.0035). Conclusions: Although the incidence of chest wall/rib pain is quite low with APBI brachytherapy, attempts should be made to keep the volume of rib irradiated at a minimum and the maximum dose received by the chest wall as low as reasonably achievable.

  19. Reconstruction of chest wall defects.

    PubMed

    Hasse, J

    1991-12-01

    A series of 61 consecutive procedures of chest wall resection and reconstruction in 58 patients during the period between August, 1986 and December, 1990 is reported. The ages ranged between 6-77 years. The chest wall resection was indicated for malignant affections in 54 cases. Among these, there were 24 patients with bronchial carcinoma invading the chest wall, 17 patients with primary or metastatic sarcoma, 11 patients with recurrent breast cancer and 3 with cancer metastases of varying origin. Pulmonary resection included pneumonectomy in 8 cases, lobectomy in 19, segmental and wedge resections in 26. In the majority of resections, the reconstruction was accomplished without implants. In cases with full thickness removal of the chest wall, the plane of the rib cage and/or the sternum was reconstructed using Vicryl mesh (n = 7), PTFE soft tissue patch (n = 11), marlex-mesh (n = 1), or methyl-methacrylate (n = 3). There was one case of hospital mortality, 6 weeks postoperatively, due to neurological failure from an independent preoperatively undiagnosed brain tumor. There were 4 reoperations: one early and one late (4 months) infection, one case of limited superficial necrosis of a flap and one with chronic lymphous drainage from a large myocutaneous flap. In no instance was primary postoperative ventilation therapy necessary. Mechanical ventilation was instituted only on day 8 in the patient who accounts for the mortality in this series. In the presence of primary infection, the greater omentum was used for the restoration of the integument.

  20. Device Assists Cardiac Chest Compression

    NASA Technical Reports Server (NTRS)

    Eichstadt, Frank T.

    1995-01-01

    Portable device facilitates effective and prolonged cardiac resuscitation by chest compression. Developed originally for use in absence of gravitation, also useful in terrestrial environments and situations (confined spaces, water rescue, medical transport) not conducive to standard manual cardiopulmonary resuscitation (CPR) techniques.

  1. Interpretations of the chest roentgenogram

    SciTech Connect

    Landay, M.J.

    1986-01-01

    Sixteen brief chapters cover basic principles, techniques, and normal appearance of the lungs, hili, mediastinum, pleura, thoracic cage, and extrathoracic structures as seen in chest radiographs. Common pathologic findings are described and copiously illustrated. Four brief concluding chapters highlight findings in the neck, intensive care radiographs with special reference to tubes and catheters, clues to indicate site of disease, and a brief summary.

  2. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Latin America and the Caribbean: a report from the Global Opioid Policy Initiative (GOPI).

    PubMed

    Cleary, J; De Lima, L; Eisenchlas, J; Radbruch, L; Torode, J; Cherny, N I

    2013-12-01

    The nations of the Caribbean, Central America and South America form a heterogeneous region with substantial variability in economic, social and palliative care development. Palliative care provision is at varied stages of development throughout the region. The consumption of opioids in Latin America and the Caribbean is variable with moderate levels of consumption by international standards (1-10 mg morphine equivalents/capita/year) observed in Argentine, Brazil, Chile, Colombia, Cuba, Mexico, Costa Rica, Uruguay and most of the Caribbean but relatively low levels of consumption in other countries particularly Guatemala, Honduras and Bolivia. Data for Latin American and Caribbean is reported on the availability and accessibility of opioids for the management of cancer pain in 24 of the 33 countries surveyed. The results of this survey are relevant to 560 million of the region's 595 million people (94%). Opioid availability continues to be low throughout most of Latin America and the Caribbean. While formularies in this region generally include all recommended morphine formulations, access is significantly impaired by widespread over-regulation that continues to be pervasive across the region.

  3. Pain management in neonates.

    PubMed

    Carbajal, Ricardo; Gall, Olivier; Annequin, Daniel

    2004-05-01

    treatment to ensure that all staff are familiar with the effects of the drugs being used and to guarantee access and safe administration of pain treatment to all neonates.

  4. [The management of chest injuries].

    PubMed

    Reshad, K; Hirata, T; Itoi, K; Takahashi, Y; Muro, K

    1989-10-01

    The mortality from chest injuries is so high due to severe physiologic imbalance that an immediate and accurate diagnosis of the injured organ and prompt treatment can salvage the patient from the strategy. This study comprises 1329 injured cases including 145 patients with crushed chests. The cause of injury was traffic accident in 537 cases (40.5%), fall or degradation in 332 cases (25%). There was a correlation between the cause of injury and age, as that traffic accident was a major one in young aged and fall in elders. Treatment against crushed patients included 150 surgical operations, 206 plaster bandages, 56 drainage of thoracic, peritoneal and cranial cavities. Thoracotomies performed in patients with flail chest (2), lung contusion (4), rupture of the bronchi and diaphragm (each 1) and for evacuation of clotted hemothorax in 3 patients. The prognosis of all these patients was good. Lastly we conclude that since the prognosis of injured patients depends on how fast the patient can be carried to the hospital and how quickly the physician or surgeon can evaluate the trauma and institute a prompt treatment, the education of the primary staff is the most important.

  5. Chest wall reconstruction after extended resection

    PubMed Central

    Seder, Christopher W.

    2016-01-01

    Extensive chest wall resection and reconstruction is a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeons, plastic surgeons, neurosurgeons, and radiation oncologists. The primary goals of any chest wall reconstruction is to obliterate dead space, restore chest wall rigidity, preserve pulmonary mechanics, protect intrathoracic organs, provide soft tissue coverage, minimize deformity, and allow patients to receive adjuvant radiotherapy. Successful chest wall reconstruction requires the re-establishment of skeletal stability to prevent chest wall hernias, avoids thoracoplasty-like contraction of the operated side, protects underlying viscera, and maintain a cosmetically-acceptable appearance. After skeletal stability is established, full tissue coverage can be achieved using direct closure, skin grafts, local advancement flaps, pedicled myocutaneous flaps, or free flaps. This review examines the indications for chest wall reconstruction and describes techniques for establishment of chest wall rigidity and soft tissue coverage. PMID:27942408

  6. [Chest ultrasound in the diagnosis of pulmonary embolism in a pregnant patient - a case report].

    PubMed

    Małek, Grzegorz; Drygalska, Alicja; Kober, Jarosław; Wawrzyńska, Liliana; Debski, Romuald; Dabrowski, Marek; Torbicki, Adam

    2009-01-01

    Pregnancy is a risk factor for both pulmonary embolism (PE), and an incorrect diagnostic assessment in cases of suspected PE with potentially dangerous consequences for the mother and foetus. The major concern is ionising radiation utilized by diagnostic tests and its potential negative effect on foetal safety. This paper presents diagnostic difficulties encountered in a 31-year-old patient at 20 weeks of gestation who was admitted to hospital with non-specific chest pain and suspected PE as a complication of right lower limb venous thrombosis. The case study reminds of chest ultrasound as a useful tool in the diagnosis of PE. The official clinical practice guidelines do not recommend the use of chest ultrasound for diagnosing of PE due to lack of a sufficient number of published studies. This case report may encourage further, prospective studies in the hope to define whether and when chest ultrasound might find its place in the diagnostic strategy of PE, especially in pregnant women.

  7. Pneumocephalus Following Thoracic Surgery with Posterior Chest Wall Resection.

    PubMed

    Müller, Ina; Tönnies, Mario; Pfannschmidt, Joachim; Kaiser, Dirk

    2015-12-01

    Pneumocephalus can be seen after head injury with fracture of the skull-base or in cerebral neoplasm, infection, or after intracranial or spinal surgery. We report on a 69-year-old male patient with pneumocephalus after right-sided lobectomy and en bloc resection of the chest wall for non-small-cell lung cancer. Postoperatively, the patient showed a reduced vigilance level with no response to pain stimuli and anisocoria. The CCT scan revealed an extensive pneumocephalus; following which, the patient underwent neurosurgery with laminectomy and ligature of the transected nerve roots. After operation the patient returned to his baseline mental status.

  8. Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion

    PubMed Central

    Alkhankan, Emad; Nusair, Ahmad; Mazagri, Rida

    2016-01-01

    Pleural pigtail catheter placement is associated with many complications including pneumothorax, hemorrhage, and chest pain. Air embolism is a known but rare complication of pleural pigtail catheter insertion and has a high risk of occurrence with positive pressure ventilation. In this case report, we present a 50-year-old male with bilateral pneumonia who developed a pneumothorax while on mechanical ventilation with continuous positive airway pressure mode. During the placement of the pleural pigtail catheter to correct the pneumothorax, the patient developed a sudden left sided body weakness and became unresponsive. An air embolism was identified in the right main cerebral artery, which was fatal. PMID:27630781

  9. [Chest modelling and automotive accidents].

    PubMed

    Trosseille, Xavier

    2011-11-01

    Automobile development is increasingly based on mathematical modeling. Accurate models of the human body are now available and serve to develop new means of protection. These models used to consist of rigid, articulated bodies but are now made of several million finite elements. They are now capable of predicting some risks of injury. To develop these models, sophisticated tests were conducted on human cadavers. For example, chest modeling started with material characterization and led to complete validation in the automobile environment. Model personalization, based on medical imaging, will permit studies of the behavior and tolerances of the entire population.

  10. Construction of a multimodal CT-video chest model

    NASA Astrophysics Data System (ADS)

    Byrnes, Patrick D.; Higgins, William E.

    2014-03-01

    Bronchoscopy enables a number of minimally invasive chest procedures for diseases such as lung cancer and asthma. For example, using the bronchoscope's continuous video stream as a guide, a physician can navigate through the lung airways to examine general airway health, collect tissue samples, or administer a disease treatment. In addition, physicians can now use new image-guided intervention (IGI) systems, which draw upon both three-dimensional (3D) multi-detector computed tomography (MDCT) chest scans and bronchoscopic video, to assist with bronchoscope navigation. Unfortunately, little use is made of the acquired video stream, a potentially invaluable source of information. In addition, little effort has been made to link the bronchoscopic video stream to the detailed anatomical information given by a patient's 3D MDCT chest scan. We propose a method for constructing a multimodal CT-video model of the chest. After automatically computing a patient's 3D MDCT-based airway-tree model, the method next parses the available video data to generate a positional linkage between a sparse set of key video frames and airway path locations. Next, a fusion/mapping of the video's color mucosal information and MDCT-based endoluminal surfaces is performed. This results in the final multimodal CT-video chest model. The data structure constituting the model provides a history of those airway locations visited during bronchoscopy. It also provides for quick visual access to relevant sections of the airway wall by condensing large portions of endoscopic video into representative frames containing important structural and textural information. When examined with a set of interactive visualization tools, the resulting fused data structure provides a rich multimodal data source. We demonstrate the potential of the multimodal model with both phantom and human data.

  11. [Delayed hemothorax due to blunt chest trauma].

    PubMed

    Saito, Gaku; Sakaizawa, Takao; Takasuna, Keiichiro; Eguchi, Takashi; Kobayashi, Nobutaka; Hyougotani, Akira; Hamanaka, Kazutoshi; Shiina, Takayuki; Kurai, Makoto; Kondo, Ryouichi; Yoshida, Kazuo; Amano, Jun

    2010-03-01

    We report 2 cases of delayed hemothorax due to blunt chest trauma. A 48-year-old man who fell down and got a blow at the right chest had a checkup with a 1st aid outpatient. By the X-rays at the time of the 1st examination, the hemothorax was not noted. The next day, He has been transported to our hospital for atypical absence. Hemothorax was suggested by computed tomography (CT) and chest drainage was enforced. A 79-year-old man got a blow at the anterior chest by traffic accident and had a checkup in the 1st hospital. The abnormality was not recognized in the chest CT at that time. For the left hemiparesis, he was transported to our hospital the next day. Hemothorax was suggested by CT and chest drainage was enforced.

  12. Hydatid disease of the chest

    PubMed Central

    Xanthakis, D.; Efthimiadis, M.; Papadakis, G.; Primikirios, N.; Chassapakis, G.; Roussaki, A.; Veranis, N.; Akrivakis, A.; Aligizakis, C. J.

    1972-01-01

    Ninety-one cases of hydatid disease of the chest are reported. Eighty-eight were involving the lung, two the chest wall, and one the mediastinum. All the patients were treated surgically. Conservative operations (simple removal of the parasite and closure of the remaining cavity) were performed in 78 patients, 37 unruptured and 41 ruptured cysts. Late postoperative complications occurred in eleven. In 10 patients, recurrent haemoptysis was the main symptom due to residual cavity in four, bronchiectatic changes in two, and unknown aetiology in four. In one patient, recurrence of multiple cysts occurred in the affected lobe. Radical operations were carried out in 10 patients, including segmental resection in four and lobectomy in six. Conservative operations were performed in all cases of unruptured cysts, with the exception of a giant cyst in which resection was the operation of choice. For ruptured cysts with mild infection conservative operation was also performed. Resection was necessary only in patients with ruptured cysts with suppuration, bronchiectatic changes, and giant cysts replacing a whole lobe. There was no mortality. We believe that conservative operation is the treatment of choice for hydatid disease of the lung. Indications for resection are very limited. Images

  13. Diagnosis and Management of Deployed Adults with Chest Pain.

    DTIC Science & Technology

    1983-01-31

    138 .70 197 POSITIVE PREDICTIVE VALUE= 49 .45 108 D. BWH Males, < 60 years old, no prior angina or MI n f 159 ) MODEL MI NO MI MI 30 1 31 TRUTH NO...PERFORMANCE OF RECURSIVE PARTITIONING MODEL WITH THE EKG E. BWR Males and Females, < .0 years old, no prior angina or MI MJDEL MI NO MI MI 43 2 45 TRUTH NO MI...infarctions that were missed by this model, 11 (55%) were in subgroup J, which is relevant only to patients with a prior his- tory of angina . Table 1

  14. Heartburn or Chest Pain: When Is It Heart Attack?

    MedlinePlus

    Diseases and Conditions Heartburn Severe heartburn and heart attack can be hard to tell apart. Understand how they typically differ, and learn when to get immediate help. By Mayo Clinic Staff You' ...

  15. Relevant surgical anatomy of the chest wall.

    PubMed

    Naidu, Babu V; Rajesh, Pala B

    2010-11-01

    The chest wall, like other regional anatomy, is a remarkable fusion of form and function. Principal functions are the protection of internal viscera and an expandable cylinder facilitating variable gas flow into the lungs. Knowledge of the anatomy of the whole cylinder (ribs, sternum, vertebra, diaphragm, intercostal spaces, and extrathoracic muscles) is therefore not only important in the local environment of a specific chest wall resection but also in its relation to overall function. An understanding of chest wall kinematics might help define the loss of function after resection and the effects of various chest wall substitutes. Therefore, this article is not an exhaustive anatomic description but a focused summary and discussion.

  16. Chest wall hypoplasia--principles and treatment.

    PubMed

    Mayer, Oscar Henry

    2015-01-01

    The chest is a dynamic structure. For normal movement it relies on a coordinated movement of the multiple bones, joints and muscles of the respiratory system. While muscle weakness can have clear impact on respiration by decreasing respiratory motion, so can conditions that cause chest wall hypoplasia and produce an immobile chest wall. These conditions, such as Jarcho-Levin and Jeune syndrome, present significantly different challenges than those faced with early onset scoliosis in which chest wall mechanics and thoracic volume may be much closer to normal. Because of this difference more aggressive approaches to clinical and surgical management are necessary.

  17. Groin pain

    MedlinePlus

    Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg: This problem often occurs in people who play sports such as ...

  18. The Global Opioid Policy Initiative (GOPI) project to evaluate the availability and accessibility of opioids for the management of cancer pain in Africa, Asia, Latin America and the Caribbean, and the Middle East: introduction and methodology.

    PubMed

    Cherny, N I; Cleary, J; Scholten, W; Radbruch, L; Torode, J

    2013-12-01

    Opioid analgesics are critical to the effective relief of cancer pain. Effective treatment is predicated on sound assessments, individually tailored analgesic therapy, and the availability and accessibility of the required medications. In some countries, pain relief is hampered by the lack of availability or barriers to the accessibility of opioid analgesics. As the follow-up to a successful project to evaluate the availability and accessibility of opioids and regulatory barriers in Europe, the European Society for Medical Oncology (ESMO) and the European Association for Palliative Care (EAPC) undertook to expand their research to those parts of the world where data were lacking regarding these aspects of care, in particular Africa, Asia, the Middle East, Latin America and the Caribbean, and the states of India. This project has been undertaken in collaboration with the Union for International Cancer Control (UICC), the Pain and Policy Studies Group (PPSG) of the University of Wisconsin, and the World Health Organization (WHO), together with a consortium of 17 international oncology and palliative care societies. This article describes the study methodology.

  19. Analgesic efficacy of lidocaine and multimodal analgesia for chest tube removal: A randomized trial study1

    PubMed Central

    Pinheiro, Valdecy Ferreira de Oliveira; da Costa, José Madson Vidal; Cascudo, Marcelo Matos; Pinheiro, Ênio de Oliveira; Fernandes, Maria Angela Ferreira; de Araujo, Ivonete Batista

    2015-01-01

    Objective: to assess the analgesic efficacy of subcutaneous lidocaine and multimodal analgesia for chest tube removal following heart surgery. Methods: sixty volunteers were randomly allocated in two groups; 30 participants in the experimental group were given 1% subcutaneous lidocaine, and 30 controls were given a multimodal analgesia regime comprising systemic anti-inflammatory agents and opioids. The intensity and quality of pain and trait and state anxiety were assessed. The association between independent variables and final outcome was assessed by means of the Chi-squared test with Yates' correction and Fisher's exact test. Results: the groups did not exhibit significant difference with respect to the intensity of pain upon chest tube removal (p= 0.47). The most frequent descriptors of pain reported by the participants were pressing, sharp, pricking, burning and unbearable. Conclusion: the present study suggests that the analgesic effect of the subcutaneous administration of 1% lidocaine combined with multimodal analgesia is most efficacious. PMID:26625989

  20. Non-invasive quick diagnosis of cardiovascular problems from visible and invisible abnormal changes with increased cardiac troponin I appearing on cardiovascular representation areas of the eyebrows, left upper lip, etc. of the face & hands: beneficial manual stimulation of hands for acute anginal chest pain, and important factors in safe, effective treatment.

    PubMed

    Omura, Yoshiaki; Jones, Marilyn K; Duvvi, Harsha; Shimotsuura, Yasuhiro; Ohki, Motomu; Rodriques, Aaron

    2014-01-01

    Our previous study indicated that there are at least 7 cardiovascular representation areas on the face, including the "Eyebrows", both sides of the "Nose", "Lelt Upper Lip" and the "Outside of the corner of both sides of the mouth," in addition to 2 areas in each hand. When there are cardiovascular problems, some of the heart representation areas of these areas often show the following changes: 1) Most distinctive visible changes such as the initial whitening with or without long white hair, then hair loss and complete disappearance of the hairs of the heart representation area of "Eyebrows" 2) Invisible biochemical changes that happen in heart representation areas at the "Left Upper Lips", 3) "Nose" below eye level as well as 4) "3rd segment of Middle Finger of Hands." Most distinctive visible & invisible changes are found in heart representation areas on the "Eyebrow", located nearest to the midline of face, where the color of the hairs becomes white compared with the rest of the Eyebrow. Then the cardiovascular problem advances, and hair starts disappearing. When there are no hairs at the heart representation areas of the Eyebrow, usually Cardiac Troponin I is increased to a very serious, abnormal high value. Most of the cardiovascular representation areas of the face show, regardless of presence or absence of visible change. When there is a cardiovascular problem, not only simple Bi-Digital O-Ring Test can detect without using any instrument in several minutes but also, corresponding biochemical changes of abnormally increased Cardiac Troponin I level can often be detected non-invasively from these Organ Representation Areas of Face & Hands, although changes in Eyebrows, L-Upper Lip & 3rd segment of middle fingers are clinically the most reliable changes & easy to identify the locations. Manual Stimulation of Hand's heart representation areas often eliminated acute anginal chest pain before medical help became available. Important factors for safe, effective

  1. [Wooden chests for the midwife's equipment].

    PubMed

    Carlén-Nilsson, C

    1993-01-01

    In the museum of medical history in Lund there are several wooden chests containing partly identical instruments apparently belonging to a midwife. The instruments dated from before 1900, e.g. lancets and horn cups for blood-letting, a pewter enema syringe, a wooden stethoscope, a "tobacco pipe" and glass bottles. The use of the tobacco pipe was first puzzling, but it appeared to be a breast reliver. What do we know about the date of the chests? One chest has belonged to Kjersti Nilsdotter, a midwife educated in Lund 1872-1873. Her certificate was in the chest. From Ronnie Hunt, Minnesota we have got information about another chest of the same type. That belonged to Nelly Gustafsson, a midwife educated in Lund probably about 1870. She emigrated to USA and was a practising midwife in Lindstrom, Minnesota from about 1900.

  2. [A case of postcardiac injury syndrome with repeated pleuritis after blunt chest trauma].

    PubMed

    Namba, Ryoichi; Yamamoto, Yusuke; Nawa, Takeshi; Endo, Katuyuki

    2009-12-01

    A 59-year-old man suffered blunt injury to the left chest during a fall in August 2004. He had 5 repeated episodes of back and left chest pain in three years since August 2005. Since these symptoms were accompanied by left pleural effusion and serum inflammatory reaction, the tentative diagnosis was pleuritis. Although examinations of pleural effusion showed exudation with marked augmentation of inflammatory cells, there were no findings that suggested the cause of repetitive pleuritis. All symptoms were relieved within one or two weeks following administration of non-steroid anti-inflammatory drugs. Surgical thoracoscopy was carried out to investigate the cause of repeated pleuritis, and an acquired deficit of the left pericardium was noted. We considered this case to be postcardiac injury syndrome causing repeated pleuritis following blunt chest injury.

  3. Free gracilis flap for chest wall reconstruction in male patient with Poland syndrome after implant failure

    PubMed Central

    Cherubino, Mario; Maggiulli, Francesca; Pellegatta, Igor; Valdatta, Luigi

    2016-01-01

    Poland's syndrome (PS) is a congenital monolateral deformity that may involve breast, chest wall, and upper limb with different degrees of clinical expressions. In some cases, the problem is mainly cosmetic, and the reconstruction should be performed to achieve minimal scarring and donor site morbidity. The authors describe a case report of a male patient with PS who developed a severe capsular contraction after 25 years implant reconstruction, who was treated after explantation using free gracilis flap (FGF). In this patient, only the pectoralis major muscle was missing. An FGF was performed to reconstruct the anterior axillary fold and the soft tissue defect. There was no flap loss, the patient had a clearly improved appearance of the chest wall, and the pain syndrome was solved. In this case report, we demonstrate our experience with the use of an FGF for chest wall reconstruction in male patients with PS after prosthesis explantation. PMID:27833290

  4. Chronic Pain

    MedlinePlus

    ... a problem you need to take care of. Chronic pain is different. The pain signals go on for ... there is no clear cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis Pain ...

  5. Abdominal pain

    MedlinePlus

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

  6. Flank pain

    MedlinePlus

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  7. Heel pain

    MedlinePlus

    Pain - heel ... Heel pain is most often the result of overuse. However, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: Swelling and pain in the Achilles tendon ...

  8. Impacts to the chest of PMHSs - Influence of impact location and load distribution on chest response.

    PubMed

    Holmqvist, Kristian; Svensson, Mats Y; Davidsson, Johan; Gutsche, Andreas; Tomasch, Ernst; Darok, Mario; Ravnik, Dean

    2016-02-01

    The chest response of the human body has been studied for several load conditions, but is not well known in the case of steering wheel rim-to-chest impact in heavy goods vehicle frontal collisions. The aim of this study was to determine the response of the human chest in a set of simulated steering wheel impacts. PMHS tests were carried out and analysed. The steering wheel load pattern was represented by a rigid pendulum with a straight bar-shaped front. A crash test dummy chest calibration pendulum was utilised for comparison. In this study, a set of rigid bar impacts were directed at various heights of the chest, spanning approximately 120mm around the fourth intercostal space. The impact energy was set below a level estimated to cause rib fracture. The analysed results consist of responses, evaluated with respect to differences in the impacting shape and impact heights on compression and viscous criteria chest injury responses. The results showed that the bar impacts consistently produced lesser scaled chest compressions than the hub; the Middle bar responses were around 90% of the hub responses. A superior bar impact provided lesser chest compression; the average response was 86% of the Middle bar response. For inferior bar impacts, the chest compression response was 116% of the chest compression in the middle. The damping properties of the chest caused the compression to decrease in the high speed bar impacts to 88% of that in low speed impacts. From the analysis it could be concluded that the bar impact shape provides lower chest criteria responses compared to the hub. Further, the bar responses are dependent on the impact location of the chest. Inertial and viscous effects of the upper body affect the responses. The results can be used to assess the responses of human substitutes such as anthropomorphic test devices and finite element human body models, which will benefit the development process of heavy goods vehicle safety systems.

  9. [Lateral chest X-rays. Radiographic anatomy].

    PubMed

    García Villafañe, C; Pedrosa, C S

    2014-01-01

    Lateral chest views constitute an essential part of chest X-ray examinations, so it is fundamental to know the anatomy on these images and to be able to detect the variations manifested on these images in different diseases. The aim of this article is to review the normal anatomy and main normal variants seen on lateral chest views. For teaching purposes, we divide the thorax into different spaces and analyze each in an orderly way, especially emphasizing the anatomic details that are most helpful for locating lesions that have already been detected in the posteroanterior view or for detecting lesions that can be missed in the posteroanterior view.

  10. Diagnostic Yield of Recommendations for Chest CT Examination Prompted by Outpatient Chest Radiographic Findings

    PubMed Central

    Harvey, H. Benjamin; Gilman, Matthew D.; Wu, Carol C.; Cushing, Matthew S.; Halpern, Elkan F.; Zhao, Jing; Pandharipande, Pari V.; Shepard, Jo-Anne O.

    2015-01-01

    Purpose To evaluate the diagnostic yield of recommended chest computed tomography (CT) prompted by abnormalities detected on outpatient chest radiographic images. Materials and Methods This HIPAA-compliant study had institutional review board approval; informed consent was waived. Reports of all outpatient chest radiographic examinations performed at a large academic center during 2008 (n = 29 138) were queried to identify studies that included a recommendation for a chest CT imaging. The radiology information system was queried for these patients to determine if a chest CT examination was obtained within 1 year of the index radiographic examination that contained the recommendation. For chest CT examinations obtained within 1 year of the index chest radiographic examination and that met inclusion criteria, chest CT images were reviewed to determine if there was an abnormality that corresponded to the chest radiographic finding that prompted the recommendation. All corresponding abnormalities were categorized as clinically relevant or not clinically relevant, based on whether further work-up or treatment was warranted. Groups were compared by using t test and Fisher exact test with a Bonferroni correction applied for multiple comparisons. Results There were 4.5% (1316 of 29138 [95% confidence interval {CI}: 4.3%, 4.8%]) of outpatient chest radiographic examinations that contained a recommendation for chest CT examination, and increasing patient age (P < .001) and positive smoking history (P = .001) were associated with increased likelihood of a recommendation for chest CT examination. Of patients within this subset who met inclusion criteria, 65.4% (691 of 1057 [95% CI: 62.4%, 68.2%) underwent a chest CT examination within the year after the index chest radiographic examination. Clinically relevant corresponding abnormalities were present on chest CT images in 41.4% (286 of 691 [95% CI: 37.7%, 45.2%]) of cases, nonclinically relevant corresponding abnormalities in

  11. Aspergillosis - chest x-ray (image)

    MedlinePlus

    ... usually occurs in immunocompromised individuals. Here, a chest x-ray shows that the fungus has invaded the lung ... are usually seen as black areas on an x-ray. The cloudiness on the left side of this ...

  12. Tuberculosis, advanced - chest x-rays (image)

    MedlinePlus

    Tuberculosis is an infectious disease that causes inflammation, the formation of tubercules and other growths within tissue, ... death. These chest x-rays show advanced pulmonary tuberculosis. There are multiple light areas (opacities) of varying ...

  13. Fluoroscopic chest tube insertion and patient care.

    PubMed Central

    Collins, J. D.; Shaver, M. L.; Disher, A. C.; Miller, T. Q.

    1992-01-01

    Catheters and chest tubes may be placed under fluoroscopic control to reduce pleural effusions. This procedure has been adopted as a routine procedure at the UCLA School of Medicine in Los Angeles, California to improve patient care. This technique was modified for the placement of large chest tubes, which can be placed by a radiologist without multiple attempts or complications. Our experience with 2234 patients who underwent this procedure between 1977 and 1990 is described. PMID:1404463

  14. Chest discomfort associated with liposomal amphotericin B: report of three cases and review of the literature.

    PubMed

    Johnson, M D; Drew, R H; Perfect, J R

    1998-01-01

    Liposomal formulations of amphotericin B are designed to maintain therapeutic efficacy of amphotericin B deoxycholate while reducing its associated toxicities. In three patients chest discomfort occurred during planned 1-hour infusions of liposomal amphotericin B (AmBisome) 3 mg/kg/day during an open-label trial. The first patient experienced chest tightness and difficulty breathing and the second had dyspnea and acute hypoxia, both within 10 minutes of the start of the infusion. The third patient complained of chest pain 5 minutes after the start of two infusions. All symptoms resolved on terminating therapy. Two patients were later rechallenged with slower infusions and tolerated the drug well. A review of the English-language literature revealed only two other case reports of infusion-related chest or pulmonary reactions with the drug, although similar reactions were noted in several reports of clinical trials. Further review of the literature revealed reports of chest and pulmonary adverse events with other liposomal formulations of amphotericin B, liposomal daunorubicin, liposomal doxorubicin, and liposomes. The pathophysiology of such reactions remains unclear, and premedication with diphenhydramine did not completely prevent this reaction in one of our patients. We recommend infusing liposomal amphotericin B over at least 2 hours with careful monitoring for adverse reactions.

  15. Rare Case of Posterior Reversible Leukoencephalopathy Syndrome Secondary to Acute Chest Syndrome

    PubMed Central

    Klein, Daniel; El-Sherif, Yasir

    2016-01-01

    We present a case of 29/m with a history of sickle cell disease who presented to the emergency department with sudden onset of chest, trunk, extremity, and back pain, consistent in quality and severity with the patient's usual pain crises. Soon after admission to the medical unit for acute chest syndrome (ACS), the patient developed sudden onset of hypertension associated with left sided hemiplegia, lethargy, dysarthria, aphasia, and left sided facial droop. Neuroimaging revealed that on MRI Brain there was multifocal extensive signal abnormality and a small focal areas of hemorrhage compatible with posterior reversible leukoencephalopathy syndrome (PRES). Patient was treated with levetiracetam and phenytoin and improved soon afterwards, with resolution seen on follow-up MRI two months later. PMID:27957377

  16. Chest wall reconstruction using iliac bone allografts and muscle flaps.

    PubMed

    Garcia-Tutor, Emilio; Yeste, Luis; Murillo, Julio; Aubá, Cristina; Sanjulian, Mikel; Torre, Wenceslao

    2004-01-01

    Technically we can divide full-thickness thoracic reconstruction into 2 parts: providing a rigid support and ensuring well-vascularized coverage. Since 1986, the authors' center has had ample experience with bone banks and the use of cryopreserved bone grafts, which led them to consider the possibility of using these grafts for full-thickness chest wall reconstruction. They describe 3 patients in whom resection of the tumor and reconstruction of the thorax were carried out using iliac bone allografts covered with muscle flaps (1 pectoralis major and 2 rectus abdominis). None of the patients experienced breathing difficulties, pain, or instability after 14 months, 18 months, and 11 years of follow-up. The result of the reconstruction was excellent in all 3 patients in terms of function and aesthetics. The advantage of allografts compared with synthetic materials is their potential integration; they can become part of the host patient's living tissue.

  17. 46 CFR 196.37-47 - Portable magazine chests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Portable magazine chests. 196.37-47 Section 196.37-47... Markings for Fire and Emergency Equipment, etc. § 196.37-47 Portable magazine chests. (a) Portable magazine chests shall be marked in letters at least 3 inches high: PORTABLE MAGAZINE CHEST — FLAMMABLE —...

  18. [Characteristics of postoperative period in children with funnel chest deformity after thoracoplasty].

    PubMed

    Mishina, T P; Isalabdulaeva, P A; Magomedov, A D; Makhachev, S M

    2010-01-01

    The efficiency of postoperative analgesia using the epidural infusion of bupivacaine (0.2 mg/kg/hr) in 42 children and with opioid analgesics (1 mg per year of life) was studied in 17 children after Paltia thoracoplasty for funnel chest deformity. Analysis of hemodynamic and external respiratory parameters and visual pain scores demonstrated the high postoperative efficiency of analgesia using the epidural infusion of bupivacaine. By causing respiratory depression, opioid analgesics did not deteriorate alveolar ventilation during active postoperative management.

  19. An 81-year-old man with an abnormal right-sided heart shadow on chest radiograph.

    PubMed

    Shah, Rahman; Khan, M Rehan; Fan, Tai-Hwang M; Ruff, Genina; Ramanathan, Kodangudi B

    2015-02-01

    An 81-year-old man presented with a 1-week history of dry cough. He also complained of mild dyspnea, wheezing, and low-grade fever. He denied hemoptysis, fever, rashes, or chest pain. The patient's medical history included coronary artery bypass surgery, hypertension, gastroesophageal reflux disease, and COPD. The patient was a retired welder and an ex-smoker.

  20. Cryoanalgesia in interventional pain management.

    PubMed

    Trescot, Andrea M

    2003-07-01

    Cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term pain relief in interventional pain management settings. Modern cryoanalgesia traces its roots to Cooper et al who developed in 1961, a device that used liquid nitrogen in a hollow tube that was insulated at the tip and achieved a temperature of - 190 degrees C. Lloyd et al proposed that cryoanalgesia was superior to other methods of peripheral nerve destruction, including alcohol neurolysis, phenol neurolysis, or surgical lesions. The application of cold to tissues creates a conduction block, similar to the effect of local anesthetics. Long-term pain relief from nerve freezing occurs because ice crystals create vascular damage to the vasonervorum, which produces severe endoneural edema. Cryoanalgesia disrupts the nerve structure and creates wallerian degeneration, but leaves the myelin sheath and endoneurium intact. Clinical applications of cryoanalgesia extend from its use in craniofacial pain secondary to trigeminal neuralgia, posterior auricular neuralgia, and glossopharyngeal neuralgia; chest wall pain with multiple conditions including post-thoracotomy neuromas, persistent pain after rib fractures, and post herpetic neuralgia in thoracic distribution; abdominal and pelvic pain secondary to ilioinguinal, iliohypogastric, genitofemoral, subgastric neuralgia; pudendal neuralgia; low back pain and lower extremity pain secondary to lumbar facet joint pathology, pseudosciatica, pain involving intraspinous ligament or supragluteal nerve, sacroiliac joint pain, cluneal neuralgia, obturator neuritis, and various types of peripheral neuropathy; and upper extremity pain secondary to suprascapular neuritis and other conditions of peripheral neuritis. This review describes historical concepts, physics and equipment, various clinical aspects, along with technical features, indications and contraindications, with clinical description of multiple conditions

  1. Radiation of anginal pain to the legs.

    PubMed Central

    Kolettis, M T; Kalogeropoulos, C K; Tzannetis, G C; Vitakis, S K; Xaplanteris, P P; Novas, I A

    1986-01-01

    Pain radiated from the chest to one or both legs (17 cases), or from the legs to the chest (two cases) in 19 patients with angina or acute myocardial infarction. The leg pain was assumed to be related to the angina pectoris when both were of a similar character and occurred together, when the leg pain occurred at rest, and when there were normal peripheral pulses in the leg. Pain was felt in the left leg by 10 patients, the right leg by two patients, and in both legs by seven. Three patients experienced pain in the thigh(s), six in the shin(s), and 10 had pain in both. In six patients the pain extended down to the inner two to four toes. The pain was always felt in front of the legs. This distribution accords with the suggestion that some sensory cardiac nerve fibres occur in the lumbar sympathetic ganglia and that pain is projected into the corresponding dermatomes. PMID:3942655

  2. Transaction Cost Analysis of In-Clinic Versus Telehealth Consultations for Chronic Pain: Preliminary Evidence for Rapid and Affordable Access to Interdisciplinary Collaborative Consultation

    PubMed Central

    Theodore, Brian R.; Whittington, Jan; Towle, Cara; Tauben, David J.; Endicott-Popovsky, Barbara; Cahana, Alex; Doorenbos, Ardith Z.

    2015-01-01

    Objectives With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Methods Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient’s case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Results Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. Conclusions U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits. PMID:25616057

  3. Cancer pain

    SciTech Connect

    Swerdlow, M.; Ventafridda, V.

    1987-01-01

    This book contains 13 chapters. Some of the chapter titles are: Importance of the Problem; Neurophysiology and Biochemistry of Pain; Assessment of Pain in Patients with Cancer; Drug Therapy; Chemotherapy and Radiotherapy for Cancer Pain; Sympton Control as it Relates to Pain Control; and Palliative Surgery in Cancer Pain Treatment.

  4. Cancer Pain Management: Basic Information for the Young Pain Physicians

    PubMed Central

    Rana, SPS; Gupta, Rahul; Chaudhary, Prakash; Khurana, Deepa; Mishra, Seema; Bhatnagar, Sushma

    2011-01-01

    Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk–benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain. PMID:21976852

  5. Use of a titanium alloy (Chest Way) in the surgical stabilization of flail chest.

    PubMed

    Nakagawa, Tomoki; Matsuzaki, Tomohiko; Aruga, Naohiro; Imamura, Naoko; Hamanaka, Rurika; Ikoma, Yoichiro; Masuda, Ryota; Iwazaki, Masayuki

    2016-09-01

    To avoid the complications of internal pneumatic stabilization for flail chest, we performed stabilization of the chest wall with a metal bar using the Nuss procedure. Here, we used a highly elastic lightweight biocompatible titanium alloy Chest Way (Solve Corporation, Kanagawa, Japan), enabling magnetic resonance imaging. The patient was a 37-year-old man who sustained injuries in a car crash. Gradually increasing subcutaneous emphysema was present. Bilateral pleural drainage and tracheal intubation were conducted on the scene, and a peripheral venous line was established. The patient was then transferred to our hospital by helicopter. A titanium alloy Chest Way was inserted to manage his flail chest accompanied by multiple rib fractures on the left side. Two days later, artificial respiration was no longer required.

  6. Foetal pain?

    PubMed

    Derbyshire, Stuart W G

    2010-10-01

    The majority of commentary on foetal pain has looked at the maturation of neural pathways to decide a lower age limit for foetal pain. This approach is sensible because there must be a minimal necessary neural development that makes pain possible. Very broadly, it is generally agreed that the minimal necessary neural pathways for pain are in place by 24 weeks gestation. Arguments remain, however, as to the possibility of foetal pain before or after 24 weeks. Some argue that the foetus can feel pain earlier than 24 weeks because pain can be supported by subcortical structures. Others argue that the foetus cannot feel pain at any stage because it is maintained in a state of sedation in the womb and lacks further neural and conceptual development necessary for pain. Much of this argument rests on the definition of terms such as 'wakefulness' and 'pain'. If a behavioural and neural reaction to a noxious stimulus is considered sufficient for pain, then pain is possible from 24 weeks and probably much earlier. If a conceptual subjectivity is considered necessary for pain, however, then pain is not possible at any gestational age. Regardless of how pain is defined, it is clear that pain for conceptual beings is qualitatively different than pain for non-conceptual beings. It is therefore a mistake to draw an equivalence between foetal pain and pain in the older infant or adult.

  7. Pain after laparoscopic antireflux surgery

    PubMed Central

    Szczebiot, L; Peyser, PM

    2014-01-01

    Introduction The benefits of antireflux surgery are well established. Laparoscopic techniques have been shown to be generally safe and effective. The aim of this paper was to review the subject of pain following laparoscopic antireflux surgery. Methods A systematic review of the literature was conducted using the PubMed database to identify all studies reporting pain after laparoscopic antireflux surgery. Publications were included for the main analysis if they contained at least 30 patients. Operations in children, Collis gastroplasty procedures, endoluminal fundoplication and surgery for paraoesophageal hernias were excluded. The frequency of postoperative pain was calculated and the causes/management were reviewed. An algorithm for the investigation of patients with pain following laparoscopic fundoplication was constructed. Results A total of 17 studies were included in the main analysis. Abdominal pain and chest pain following laparoscopic fundoplication were reported in 24.0% and 19.5% of patients respectively. Pain was mild or moderate in the majority and severe in 4%. Frequency of pain was not associated with operation type. The authors include their experience in managing patients with persistent, severe epigastric pain following laparoscopic anterior fundoplication. Conclusions Pain following laparoscopic antireflux surgery occurs in over 20% of patients. Some have an obvious complication or a diagnosis made through routine investigation. Most have mild to moderate pain with minimal effect on quality of life. In a smaller proportion of patients, pain is severe, persistent and can be disabling. In this group, diagnosis is more difficult but systematic investigation can be rewarding, and can enable appropriate and successful treatment. PMID:24780664

  8. Neck Pain

    MedlinePlus

    ... injuries and conditions that cause pain and restrict motion. Neck pain causes include: Muscle strains. Overuse, such ... body then forms bone spurs that affect joint motion and cause pain. Nerve compression. Herniated disks or ...

  9. Ankle pain

    MedlinePlus

    Pain - ankle ... Ankle pain is often due to an ankle sprain. An ankle sprain is an injury to the ligaments, which ... the joint. In addition to ankle sprains, ankle pain can be caused by: Damage or swelling of ...

  10. Knee pain

    MedlinePlus

    Pain - knee ... Knee pain can have different causes. Being overweight puts you at greater risk for knee problems. Overusing your knee can trigger knee problems that cause pain. If you have a history of arthritis, it ...

  11. Elbow pain

    MedlinePlus

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  12. Eye pain

    MedlinePlus

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  13. Wrist pain

    MedlinePlus

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  14. Foot pain

    MedlinePlus

    Pain - foot ... Foot pain may be due to: Aging Being on your feet for long periods of time Being overweight A ... sports activity Trauma The following can cause foot pain: Arthritis and gout . Common in the big toe, ...

  15. Hip pain

    MedlinePlus

    ... pain involves any pain in or around the hip joint. You may not feel pain from your hip ... 2012:chap 48. Read More Hip fracture surgery Hip joint replacement Patient Instructions Hip fracture - discharge Hip or ...

  16. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

  17. VAC® for external fixation of flail chest.

    PubMed

    Winge, Rikke; Berg, Jais O; Albret, Rikke; Krag, Christen

    2012-05-29

    A large aterior chest wall defect following tumor resection was reconstructed with a Gore-Tex® membrane and a combined musculocutaneous rectus femoris and tensor fasciae latae free flap. Subsequent paradoxical respiration impeded weaning from the ventilator. Appliance of Vacuum Assisted Closure® (VAC®) resulted in immediate chest wall stability and a decrease in the patient's need for respiratory support. Shortly thereafter, the VAC® was discontinued and the patient was discharged from the intensive care unit (ICU). This case report is the first to describe the successful use of VAC® as an adjuvant to a one-stage procedure for large thoracic wall reconstruction, allowing sufficient temporary external fixation to eliminate paradoxical respiration and plausibly shorten the stay in the ICU. No adverse effects on flap healing or haemodynamics were recorded. It is likely that external VAC® can improve thoracic stability and pulmonary function in a patient with flail chest and decrease the need for mechanical ventilation.

  18. Prephonatory chest wall posturing in stutterers.

    PubMed

    Baken, R J; McManus, D A; Cavallo, S A

    1983-09-01

    The possibility that prephonatory chest wall posturing is abnormal in stutterers was explored by observing rib cage and abdominal hemicircumference changes during the interval between the presentation of a stimulus and the production of/alpha/by a group of stutterers (N = 5). It was found that the patterns of chest wall adjustment for phonation were qualitatively identical in the stutterers and in a comparable group of normal men studied previously. There was, however, a significant difference in the way in which lung volume changed during the execution of the chest wall adjustment. This was considered to be indicative of delayed glottal closure among the stutterers rather than representative of a primary ventilatory disturbance.

  19. Tele-pharmacy in remote medical practice: the Royal Flying Doctor Service Medical Chest Program.

    PubMed

    Margolis, S A; Ypinazar, V A

    2008-01-01

    In recent times remote medical practice has been developed into a unique discipline in its own right with telehealth one of the eight defining key features. Since 1942, the telemedicine consultation service provided by the Royal Flying Doctor Service in Australia has been supported by a tele-pharmacy program known as the Medical Chest Program. The contents of the chest comprise more than 85 items, including medications and equipment which can be prescribed during a telehealth consultation to cover both emergency care and definitive treatment for less serious conditions. By 2006 there were 3500 medical chests placed throughout Australia. Specifically, the state of Queensland had 21 470 telehealth consultations from 1 July 2005 to 30 June 2006, resulting in the prescription of at least one medical chest item in 2938 (13.7%) consultations. Queensland data regarding medication indicate that antibiotics (26%), analgesics (23%) and gastrointestinal medications (12%) were the most common categories of dispensed medications, and that the most common clinical diagnostic categories for the consultation resulting in dispensed medications were respiratory (17%), skin (15%) and abdominal conditions (13%). In summary, the RFDS medical chest program continues to be a successful large scale provider of medications to those living in remote Australia, enabling early access to medications for both emergencies and definitive care, while minimising the need for mail-order pharmacy or patient travel. This model of care may provide an important template for those designing service delivery models in other remote jurisdictions.

  20. The usefulness of Wi-Fi based digital chest drainage system in the post-operative care of pneumothorax

    PubMed Central

    Cho, Hyun Min; Hong, Yoon Joo; Byun, Chun Sung

    2016-01-01

    Background Chest drainage systems are usually composed of chest tube and underwater-seal bottle. But this conventional system may restrict patients doing exercise and give clinicians obscure data about when to remove tubes because there is no objective indicator. Recently developed digital chest drainage systems may facilitate interpretation of the grade of air leak and make it easy for clinicians to decide when to remove chest tubes. In addition, with combination of wireless internet devices, monitoring and managing of drainage system distant from the patient is possible. Methods Sixty patients of primary pneumothorax were included in a prospective randomized study and divided into two groups. Group I (study) consisted of digital chest drainage system while in group II (control), conventional underwater-seal chest bottle system was used. Data was collected from January, 2012 to September, 2013 in Eulji University Hospital, Daejeon, Korea. Results There was no difference in age, sex, smoking history and postoperative pain between two groups. But the average length of drainage was 2.2 days in group I and 3.1 days in group II (P<0.006). And more, about 90% of the patients in group I was satisfied with using new device for convenience. Conclusions Digital system was beneficial on reducing the length of tube drainage by real time monitoring. It also had advantage in portability, loudness and gave more satisfaction than conventional system. Moreover, internet based digital drainage system will be a good method in thoracic telemedicine area in the near future. PMID:27076934

  1. Hashimoto's thyroiditis and acute chest syndrome revealing sickle cell anemia in a 32 years female patient.

    PubMed

    Igala, Marielle; Nsame, Daniela; Ova, Jennie Dorothée Guelongo Okouango; Cherkaoui, Siham; Oukkach, Bouchra; Quessar, Asmae

    2015-01-01

    Sickle cell anemia results from a single amino acid substitution in the gene encoding the β-globin subunit. Polymerization of deoxygenated sickle hemoglobin leads to decreased deformability of red blood cells. Hashimoto's thyroiditis is a common thyroid disease now recognized as an auto-immune thyroid disorder, it is usually thought to be haemolytic autoimmune anemia. We report the case of a 32 years old women admitted for chest pain and haemolysis anemia in which Hashimoto's thyroiditis and sickle cell anemia were found. In our observation the patient is a young woman whose examination did not show signs of goitre but the analysis of thyroid function tests performed before an auto-immune hemolytic anemia (confirmed by a high level of unconjugated bilirubin and a Coombs test positive for IgG) has found thyroid stimulating hormone (TSH) and positive thyroid antibody at rates in excess of 4.5 times their normal value. In the same period, as the hemolytic anemia, and before the atypical chest pain and anguish they generated in the patient, the search for hemoglobinopathies was made despite the absence of a family history of haematological disease or painful attacks in childhood. Patient electrophoresis's led to research similar cases in the family. The mother was the first to be analyzed with ultimately diagnosed with sickle cell trait have previously been ignored. This case would be a form with few symptoms because the patient does not describe painful crises in childhood or adolescence.

  2. ASIC3: a lactic acid sensor for cardiac pain.

    PubMed

    Immke, D C; McCleskey, E W

    2001-10-05

    Angina, the prototypic vasoocclusive pain, is a radiating chest pain that occurs when heart muscle gets insufficient blood because of coronary artery disease. Other examples of vasoocclusive pain include the acute pain of heart attack and the intermittent pains that accompany sickle cell anemia and peripheral artery disease. All these conditions cause ischemia - insufficient oxygen delivery for local metabolic demand - and this releases lactic acid as cells switch to anaerobic metabolism. Recent discoveries demonstrate that sensory neurons innervating the heart are richly endowed with an ion channel that is opened by, and perfectly tuned for, the lactic acid released by muscle ischemia.

  3. Shoulder pain

    MedlinePlus

    Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

  4. Pelvic Pain

    MedlinePlus

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  5. Salmonella typhimurium abscess of the chest wall

    PubMed Central

    Tonziello, Gilda; Valentinotti, Romina; Arbore, Enrico; Cassetti, Paolo; Luzzati, Roberto

    2013-01-01

    Patient: Male, 73 Final Diagnosis: Salmonella typhimurium abscess of the chest wall Symptoms: — Medication: Ciprofloxacin Clinical Procedure:— Specialty: Infectious Diseases Objective: Unusual clinical course Background: Non-typhoid Salmonella extra-intestinal infections usually develop in infants and in adult patients with pre-existing predisposing conditions. Blood stream infections and urinary tract infections are the most common clinical presentations, but other sites of infection may be involved as well. Case Report: We describe a case of invasive salmonellosis caused by Salmonella typhimurium involving the chest wall in a 73-year-old man. The patient had suffered from gastroenteritis followed by left basal pneumonia with pleural effusion 7 weeks before. The CT scan of the chest wall showed a pericostal abscess with shirt-stud morphology near the left last cartilaginous arch. The abscess was surgically drained and patient was cured after a 40-day ciprofloxacin treatment. Conclusions: A review of the literature on extra-intestinal non-typhoid salmonellosis shows that pleuropulmonary and soft-tissue infections are uncommon. We argue that non-typhoid Salmonella might be considered as a possible cause of chest wall abscess in individuals with recent history of gastroenteritis complicated by pneumonia and pleural effusion. PMID:24298305

  6. When to Remove a Chest Tube.

    PubMed

    Novoa, Nuria M; Jiménez, Marcelo F; Varela, Gonzalo

    2017-02-01

    Despite the increasing knowledge about the pleural physiology after lung resection, most practices around chest tube removal are dictated by personal preferences and experience. This article discusses recently published data on the topic and suggests opportunities for further investigation and future improvements.

  7. Coccidioidomycosis - chest x-ray (image)

    MedlinePlus

    This chest x-ray shows the affects of a fungal infection, coccidioidomycosis. In the middle of the left lung (seen on the ... defined borders. Other diseases that may explain these x-ray findings include lung abscesses, chronic pulmonary tuberculosis, chronic ...

  8. Adenocarcinoma - chest x-ray (image)

    MedlinePlus

    This chest x-ray shows adenocarcinoma of the lung. There is a rounded light spot in the right upper lung (left side ... density. Diseases that may cause this type of x-ray result would be tuberculous or fungal granuloma, and ...

  9. Unsupervised segmentation of lungs from chest radiographs

    NASA Astrophysics Data System (ADS)

    Ghosh, Payel; Antani, Sameer K.; Long, L. Rodney; Thoma, George R.

    2012-03-01

    This paper describes our preliminary investigations for deriving and characterizing coarse-level textural regions present in the lung field on chest radiographs using unsupervised grow-cut (UGC), a cellular automaton based unsupervised segmentation technique. The segmentation has been performed on a publicly available data set of chest radiographs. The algorithm is useful for this application because it automatically converges to a natural segmentation of the image from random seed points using low-level image features such as pixel intensity values and texture features. Our goal is to develop a portable screening system for early detection of lung diseases for use in remote areas in developing countries. This involves developing automated algorithms for screening x-rays as normal/abnormal with a high degree of sensitivity, and identifying lung disease patterns on chest x-rays. Automatically deriving and quantitatively characterizing abnormal regions present in the lung field is the first step toward this goal. Therefore, region-based features such as geometrical and pixel-value measurements were derived from the segmented lung fields. In the future, feature selection and classification will be performed to identify pathological conditions such as pulmonary tuberculosis on chest radiographs. Shape-based features will also be incorporated to account for occlusions of the lung field and by other anatomical structures such as the heart and diaphragm.

  10. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study.

    PubMed

    Peitzmeier, Sarah; Gardner, Ivy; Weinand, Jamie; Corbet, Alexandra; Acevedo, Kimberlynn

    2017-01-01

    Chest binding involves the compression of chest tissue for masculine gender expression among people assigned a female sex at birth, particularly transgender and gender non-conforming individuals. There are no peer-reviewed studies that directly assess the health impacts of chest binding, yet transgender community resources commonly discuss symptoms such as pain and scarring. A cross-sectional 32-item survey was administered online to an anonymous, non-random sample of adults who were assigned a female sex at birth and had had experience of binding (n = 1800). Multivariate regression models were used to identify practices associated with self-reported health outcomes. Of participants, 51.5% reported daily binding. Over 97% reported at least one of 28 negative outcomes attributed to binding. Frequency (days/week) was consistently associated with negative outcomes (22/28 outcomes). Compression methods associated with symptoms were commercial binders (20/28), elastic bandages (14/28) and duct tape or plastic wrap (13/28). Larger chest size was primarily associated with dermatological problems. Binding is a frequent activity for many transmasculine individuals, despite associated symptoms. Study findings offer evidence of how binding practices may enhance or reduce risk. Clinicians caring for transmasculine patients should assess binding practices and help patients manage risk.

  11. Algorithm of chest wall keloid treatment

    PubMed Central

    Long, Xiao; Zhang, Mingzi; Wang, Yang; Zhao, Ru; Wang, Youbin; Wang, Xiaojun

    2016-01-01

    Abstract Keloids are common in the Asian population. Multiple or huge keloids can appear on the chest wall because of its tendency to develop acne, sebaceous cyst, etc. It is difficult to find an ideal treatment for keloids in this area due to the limit of local soft tissues and higher recurrence rate. This study aims at establishing an individualized protocol that could be easily applied according to the size and number of chest wall keloids. A total of 445 patients received various methods (4 protocols) of treatment in our department from September 2006 to September 2012 according to the size and number of their chest wall keloids. All of the patients received adjuvant radiotherapy in our hospital. Patient and Observer Scar Assessment Scale (POSAS) was used to assess the treatment effect by both doctors and patients. With mean follow-up time of 13 months (range: 6–18 months), 362 patients participated in the assessment of POSAS with doctors. Both the doctors and the patients themselves used POSAS to evaluate the treatment effect. The recurrence rate was 0.83%. There was an obvious significant difference (P < 0.001) between the before-surgery score and the after-surgery score from both doctors and patients, indicating that both doctors and patients were satisfied with the treatment effect. Our preliminary clinical result indicates that good clinical results could be achieved by choosing the proper method in this algorithm for Chinese patients with chest wall keloids. This algorithm could play a guiding role for surgeons when dealing with chest wall keloid treatment. PMID:27583896

  12. Bone suppression technique for chest radiographs

    NASA Astrophysics Data System (ADS)

    Huo, Zhimin; Xu, Fan; Zhang, Jane; Zhao, Hui; Hobbs, Susan K.; Wandtke, John C.; Sykes, Anne-Marie; Paul, Narinder; Foos, David

    2014-03-01

    High-contrast bone structures are a major noise contributor in chest radiographic images. A signal of interest in a chest radiograph could be either partially or completely obscured or "overshadowed" by the highly contrasted bone structures in its surrounding. Thus, removing the bone structures, especially the posterior rib and clavicle structures, is highly desirable to increase the visibility of soft tissue density. We developed an innovative technology that offers a solution to suppress bone structures, including posterior ribs and clavicles, on conventional and portable chest X-ray images. The bone-suppression image processing technology includes five major steps: 1) lung segmentation, 2) rib and clavicle structure detection, 3) rib and clavicle edge detection, 4) rib and clavicle profile estimation, and 5) suppression based on the estimated profiles. The bone-suppression software outputs an image with both the rib and clavicle structures suppressed. The rib suppression performance was evaluated on 491 images. On average, 83.06% (±6.59%) of the rib structures on a standard chest image were suppressed based on the comparison of computer-identified rib areas against hand-drawn rib areas, which is equivalent to about an average of one rib that is still visible on a rib-suppressed image based on a visual assessment. Reader studies were performed to evaluate reader performance in detecting lung nodules and pneumothoraces with and without a bone-suppression companion view. Results from reader studies indicated that the bone-suppression technology significantly improved radiologists' performance in the detection of CT-confirmed possible nodules and pneumothoraces on chest radiographs. The results also showed that radiologists were more confident in making diagnoses regarding the presence or absence of an abnormality after rib-suppressed companion views were presented

  13. Quality assessment of digital X-ray chest images using an anthropomorphic chest phantom

    NASA Astrophysics Data System (ADS)

    Vodovatov, A. V.; Kamishanskaya, I. G.; Drozdov, A. A.; Bernhardsson, C.

    2017-02-01

    The current study is focused on determining the optimal tube voltage for the conventional X-ray digital chest screening examinations, using a visual grading analysis method. Chest images of an anthropomorphic phantom were acquired in posterior-anterior projection on four digital X-ray units with different detector types. X-ray images obtained with an anthropomorphic phantom were accepted by the radiologists as corresponding to a normal human anatomy, hence allowing using phantoms in image quality trials without limitations.

  14. Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis)

    PubMed Central

    Kumar, Kartik; Mandleywala, Swati N.; Gannon, Michael P.; Estes, Nathan Anthony Mark; Weinstock, Jonathan

    2017-01-01

    Objective: Commotio cordis, sudden death with chest impact, occurs clinically despite chest wall protectors worn in sports. In an experimental model of commotio cordis, commercially available chest wall protectors failed to prevent ventricular fibrillation (VF). The goal of the current investigation was to develop a chest wall protector effective in the prevention of commotio cordis. Design: In the Tufts experimental model of commotio cordis the ability of chest protectors to prevent VF was assessed. Impacts were delivered with a 40-mph lacrosse ball, timed to the vulnerable period for VF. Intervention: A chest wall protector or no chest wall protector (control) was randomly assigned to be placed over the chest. Four iterative series of 2 to 4 different chest wall material combinations were assessed. Materials included 3 different foams (Accelleron [Unequal Technologies, Glen Mills, PA], closed cell high density foam; Airilon [Unequal Technologies, Glen Mills, PA], closed cell low density soft foam; and an open cell memory foam) that were adhered to a layer of TriDur (Unequal Technologies, Glen Mills, PA), a flexible elastomeric coated aramid that was bonded to a semirigid polypropylene polymer (ImpacShield, Unequal Technologies, Glen Mills, PA). Main Outcome Measure: Induction of VF by chest wall impact was the primary outcome. Results: Of 80 impacts without chest protectors, 43 (54%) resulted in VF. Ventricular fibrillation with chest protectors ranged from a high of 60% to a low of 5%. Of 12 chest protectors assessed, only 3 significantly lowered the risk of VF compared with impacts without chest protectors. These 3 chest protectors were combinations of Accelleron, Airilon, TriDur, and ImpacShield of different thicknesses. Protection increased linearly with the thicker combinations. Conclusions: Effective protection against VF with chest wall protection can be achieved in an experimental model of commotio cordis. Clinical Relevance: Chest protector designs

  15. Tube thoracostomy; chest tube implantation and follow up

    PubMed Central

    Kuhajda, Ivan; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Huang, Haidong; Li, Qiang; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Papaiwannou, Antonis; Lampaki, Sofia; Papaiwannou, Antonis; Zaric, Bojan; Branislav, Perin; Porpodis, Konstantinos

    2014-01-01

    Pneumothorax is an urgent medical situation that requires urgent treatment. We can divide this entity based on the etiology to primary and secondary. Chest tube implantation can be performed either in the upper chest wall or lower. Both thoracic surgeons and pulmonary physicians can place a chest tube with minimal invasive techniques. In our current work, we will demonstrate chest tube implantation to locations, methodology and tools. PMID:25337405

  16. Diffuse Subcutaneous Emphysema and Pneumomediastinum Secondary to a Minor Blunt Chest Trauma

    PubMed Central

    Heymann, Eric P.; Exadaktylos, Aristomenis K.

    2017-01-01

    Full medical evaluation is paramount for all trauma patients. Minor traumas are often overlooked, as they are thought to bear low injury potential. In this case report, we describe the case of a 48-year-old man presenting to our Emergency Department with mild to moderate right-sided shoulder and scapular pain following a fall from his own height ten days previously. Clinical and paraclinical investigations (CT) revealed diffuse right shoulder pain, with crepitations on palpation of the neck, right shoulder, and right lateral chest wall. Computed tomography (CT) demonstrated right-sided costal fractures (ribs 7 to 9), with diffuse subcutaneous emphysema and pneumomediastinum due to laceration of the visceral and parietal pleura and the adjacent lung parenchyma. In addition, a small ipsilateral pneumothorax was found. Surprisingly, the clinical status was only minimally affected by mild to moderate pain and minor functional impairment. PMID:28392950

  17. 20 CFR 718.102 - Chest roentgenograms (X-rays).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Chest roentgenograms (X-rays). 718.102... roentgenograms (X-rays). (a) A chest roentgenogram (X-ray) shall be of suitable quality for proper classification...-rays as described in Appendix A. (b) A chest X-ray to establish the existence of pneumoconiosis...

  18. 20 CFR 718.102 - Chest roentgenograms (X-rays).

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Chest roentgenograms (X-rays). 718.102... roentgenograms (X-rays). (a) A chest roentgenogram (X-ray) shall be of suitable quality for proper classification...-rays as described in Appendix A. (b) A chest X-ray to establish the existence of pneumoconiosis...

  19. 46 CFR 97.37-47 - Portable magazine chests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Portable magazine chests. 97.37-47 Section 97.37-47... OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 97.37-47 Portable magazine chests. (a) Portable magazine chests shall be marked in letters at least 3 inches high: “PORTABLE MAGAZINE...

  20. 46 CFR 78.47-70 - Portable magazine chests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 3 2010-10-01 2010-10-01 false Portable magazine chests. 78.47-70 Section 78.47-70... Fire and Emergency Equipment, Etc. § 78.47-70 Portable magazine chests. (a) Portable magazine chest shall be marked in letters of at least 3 inches high “PORTABLE MAGAZINE CHEST—FLAMMABLE—KEEP LIGHTS...

  1. 46 CFR 169.743 - Portable magazine chests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Portable magazine chests. 169.743 Section 169.743... Vessel Control, Miscellaneous Systems, and Equipment Markings § 169.743 Portable magazine chests. Portable magazine chests must be marked in letters at least 3 inches high: “PORTABLE MAGAZINE...

  2. 46 CFR 108.651 - Portable magazine chests.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Portable magazine chests. 108.651 Section 108.651... AND EQUIPMENT Equipment Markings and Instructions § 108.651 Portable magazine chests. Each portable magazine chest must be marked: “PORTABLE MAGAZINE CHEST—FLAMMABLE—KEEP LIGHTS AND FIRE AWAY” in letters...

  3. 42 CFR 37.41 - Chest radiograph specifications-film.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Chest radiograph specifications-film. 37.41 Section... Specifications for Performing Chest Radiographic Examinations § 37.41 Chest radiograph specifications—film. (a... posteroanterior projection at full inspiration on a film being no less than 14 by 17 inches and no greater than...

  4. Chest radiographic manifestations of scrub typhus

    PubMed Central

    Abhilash, KPP; Mannam, PR; Rajendran, K; John, RA; Ramasami, P

    2016-01-01

    Background and Rationale: Respiratory system involvement in scrub typhus is seen in 20–72% of patients. In endemic areas, good understanding and familiarity with the various radiologic findings of scrub typhus are essential in identifying pulmonary complications. Materials and Methods: Patients admitted to a tertiary care center with scrub typhus between October 2012 and September 2013 and had a chest X ray done were included in the analysis. Details and radiographic findings were noted and factors associated with abnormal X-rays were analyzed. Results: The study cohort contained 398 patients. Common presenting complaints included fever (100%), generalized myalgia (83%), headache (65%), dyspnea (54%), cough (24.3%), and altered sensorium (14%). Almost half of the patients (49.4%) had normal chest radiographs. Common radiological pulmonary abnormalities included pleural effusion (14.6%), acute respiratory distress syndrome (14%), airspace opacity (10.5%), reticulonodular opacities (10.3%), peribronchial thickening (5.8%), and pulmonary edema (2%). Cardiomegaly was noted in 3.5% of patients. Breathlessness, presence of an eschar, platelet counts of <20,000 cells/cumm, and total serum bilirubin >2 mg/dL had the highest odds of having an abnormal chest radiograph. Patients with an abnormal chest X-ray had a higher requirement of noninvasive ventilation (odds ratio [OR]: 13.98; 95% confidence interval CI: 5.89–33.16), invasive ventilation (OR: 18.07; 95% CI: 6.42–50.88), inotropes (OR: 8.76; 95% CI: 4.35–17.62), higher involvement of other organ systems, longer duration of hospital stay (3.18 ± 3 vs. 7.27 ± 5.58 days; P < 0.001), and higher mortality (OR: 4.63; 95% CI: 1.54–13.85). Conclusion: Almost half of the patients with scrub typhus have abnormal chest radiographs. Chest radiography should be included as part of basic evaluation at presentation in patients with scrub typhus, especially in those with breathlessness, eschar, jaundice, and severe

  5. Chronic cutaneous chest wall fistula and gallstone empyema due to retained gallstones.

    PubMed

    Gaster, Richard S; Berger, Aaron J; Ahmadi-Kashani, Mastaneh; Shrager, Joseph B; Lee, Gordon K

    2014-08-14

    We report a case of a 72-year-old man who presented with a persistent pleural effusion and painful abscess in the right lower chest wall 6 months following a laparoscopic cholecystectomy. The patient subsequently developed a chronic cutaneous chest wall fistula requiring a large resection and complex closure. The complication was likely secondary to intraoperative spillage of gallstones. While previous reports describe gallstone spillage in the abdominal cavity as benign, this case illustrates that stones left in the abdominal cavity can potentially lead to significant morbidity. Therefore, stones should be diligently removed from the abdominal cavity when spillage occurs. In addition, it is important that operative notes reflect the occurrence of stone spillage so stones may be suspected when a patient presents with an abdominal or thoracic infection following a cholecystectomy.

  6. Electrocardiographic chest wall mapping in the diagnosis of coronary artery disease.

    PubMed Central

    Salmasi, A M; Nicolaides, A N; Vecht, R J; Hendry, W G; Salmasi, S N; Nicolaides, E P; Kidner, P H; Besterman, E M

    1983-01-01

    Chest wall mapping of ST segment changes, inverted U waves, and Q waves using 16 electrocardiographic electrodes was performed at rest and during and after bicycle ergometry in 150 patients presenting with chest pain suggestive of angina. All patients underwent coronary angiography. The presence or absence of appreciable coronary artery disease (greater than or equal to 50% stenosis) was detected with a sensitivity of 98% and a specificity of 88%. The identification of lesions in individual coronary arteries was also possible with a sensitivity and specificity of 87% and 85% respectively for the territory of the left anterior descending and diagonal artery, 71% and 85% respectively for the right coronary artery, and 85% and 80% respectively for the circumflex artery. This test appears to be a reliable non-invasive screening method for selecting patients for angiography. PMID:6407696

  7. Periodic appearance and disappearance of a chest wall (serratus anterior development) cavernous hemangioma that was finally resected in a child.

    PubMed

    Nakagawa, Tomoki; Watanabe, Hajime; Nakazato, Kenei; Masuda, Daisuke; Ogura, Go; Masuda, Ryota; Nakamura, Naoya; Iwazaki, Masayuki

    2013-08-01

    Primary chest wall tumors occur infrequently; in particular, cavernous hemangioma of the chest wall is an extremely rare disease. We report a case of child with cavernous hemangioma of the chest wall, which was successfully resected. Obvious enlargement of the tumor and the appearance of pain were observed during a 2-year follow-up. In the present case, transcutaneous ultrasonography showed the appearance and disappearance of the mass. This was considered to be caused by the transfer of contents between the shallow and deep parts of the tumor. This may have resulted from serratus anterior muscle movement between the two-layered tumor. Transcutaneous ultrasonography, as well as magnetic resonance imaging, was therefore extremely effective for preoperative diagnosis. Transcutaneous ultrasonography is easily performed, even in children, such as in the present case. Because of its simplicity and usefulness, transcutaneous ultrasonography may be considered as the first-line imaging modality for diagnosis.

  8. Sexual pain.

    PubMed

    Boardman, Lori A; Stockdale, Colleen K

    2009-12-01

    Sexual pain is an underrecognized and poorly treated constellation of disorders that significantly impact affected women and their partners. Recognized as a form of chronic pain, sexual pain disorders are heterogeneous and include dyspareunia (superficial and deep), vaginismus, vulvodynia, vestibulitis, and noncoital sexual pain disorder. Women too often tolerate pain in the belief that this will meet their partners' needs. This article provides a review of the terminology and definition of the condition, theories on the pathophysiology, diagnostic considerations, and recommendations on the management of female sexual pain.

  9. Ultrasound-Guided Trigger Point Injection for Serratus Anterior Muscle Pain Syndrome: Description of Technique and Case Series.

    PubMed

    Vargas-Schaffer, Grisell; Nowakowsky, Michal; Eghtesadi, Marzieh; Cogan, Jennifer

    2015-09-15

    Chronic chest pain is a challenge, and serratus anterior muscle pain syndrome (SAMPS) is often overlooked. We have developed an ultrasound-guided technique for infiltrating local anesthetics and steroids in patients with SAMPS. In 8 patients, the duration of chronic pain was approximately 19 months. Three months after treatment, all patients had experienced a significant reduction in pain. Infiltration for SAMPS confirms the diagnosis and provides adequate pain relief.

  10. The Neuromatrix Theory of Pain and Angina during Exercise Stress Testing: Results from the PIMI Study

    DTIC Science & Technology

    2011-05-27

    America (American Heart Association, 2010). One of the most common clinical manifestations of CAD is that of angina pectoris , defined as chest pain due...to CAD. Angina pectoris is often one of the earliest signs of CAD and carries important prognostic significance. However, though prevalent...modulate the pain signature in the brain and pain expression and behavior (Melzack, 1993). In patients with a history of angina pectoris , the “pain

  11. Proportionality between chest wall resistance and elastance.

    PubMed

    Barnas, G M; Stamenović, D; Fredberg, J J

    1991-02-01

    Fredberg and Stamenovic (J. Appl. Physiol. 67: 2408-2419, 1989) demonstrated a relatively robust phenomenological relationship between resistance (R) and elastance (E) of lung tissue during external forcing. The relationship can be expressed as omega R = eta E, where omega = 2 pi times forcing frequency and eta is hysteresivity; they found eta to be remarkably invariant under a wide range of circumstances. From data gathered in previous experiments, we have tested the adequacy and utility of this phenomenological description for the chest wall (eta w) and its major compartments, the rib cage (eta rc), diaphragm-abdomen (eta d-a), and belly wall (eta bw+). For forcing frequencies and tidal volumes within the normal range of breathing, we found that eta w remained in a relatively narrow range (0.27-0.37) and that neither eta w nor the compartmental eta's changed much with frequency or tidal volume. Compared with eta w, eta rc tended to be slightly low, whereas eta d-a tended to be slightly higher than eta w. However, at higher frequencies (greater than 1 Hz) all eta's increased appreciably with frequency. During various static nonrespiratory maneuvers involving use of respiratory muscles, eta w increased up to twofold. We conclude that in the normal ranges of breathing frequency and tidal volume 1) elastic and dissipative processes within the chest wall appear to be coupled, 2) eta's of the various component parts of the chest wall are well matched, 3) respiratory muscle contraction increases the ratio of cyclic dissipative losses to energy storage, and 4) R of the relaxed chest wall can be estimated from E.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Advances in chest drain management in thoracic disease

    PubMed Central

    George, Robert S.

    2016-01-01

    An adequate chest drainage system aims to drain fluid and air and restore the negative pleural pressure facilitating lung expansion. In thoracic surgery the post-operative use of the conventional underwater seal chest drainage system fulfills these requirements, however they allow great variability amongst practices. In addition they do not offer accurate data and they are often inconvenient to both patients and hospital staff. This article aims to simplify the myths surrounding the management of chest drains following chest surgery, review current experience and explore the advantages of modern digital chest drain systems and address their disease-specific use. PMID:26941971

  13. Surface Chest Motion Decomposition for Cardiovascular Monitoring

    PubMed Central

    Shafiq, Ghufran; Veluvolu, Kalyana C.

    2014-01-01

    Surface chest motion can be easily monitored with a wide variety of sensors such as pressure belts, fiber Bragg gratings and inertial sensors, etc. The current applications of these sensors are mainly restricted to respiratory motion monitoring/analysis due to the technical challenges involved in separation of the cardiac motion from the dominant respiratory motion. The contribution of heart to the surface chest motion is relatively very small as compared to the respiratory motion. Further, the heart motion spectrally overlaps with the respiratory harmonics and their separation becomes even more challenging. In this paper, we approach this source separation problem with independent component analysis (ICA) framework. ICA with reference (ICA-R) yields only desired component with improved separation, but the method is highly sensitive to the reference generation. Several reference generation approaches are developed to solve the problem. Experimental validation of these proposed approaches is performed with chest displacement data and ECG obtained from healthy subjects under normal breathing and post-exercise conditions. The extracted component morphologically matches well with the collected ECG. Results show that the proposed methods perform better than conventional band pass filtering. PMID:24865183

  14. Pain Assessment

    MedlinePlus

    ... acupuncture, chiropractic care, massage or other manual therapies, yoga, herbal and nutritional therapies, or others. This information helps the health care provider understand the nature of the pain or the potential benefits of treatment. The goals of the comprehensive pain ...

  15. Anal Pain

    MedlinePlus

    ... change in bowel habit or rectal bleeding. A hemorrhoid that develops quickly or is particularly painful may ... your doctor. The blood clot of a thrombosed hemorrhoid, although painful, can't break loose and travel, ...

  16. Period Pain

    MedlinePlus

    ... You may also have other symptoms, such as lower back pain, nausea, diarrhea, and headaches. Period pain is not ... Taking a hot bath Doing relaxation techniques, including yoga and meditation You might also try taking over- ...

  17. Finger pain

    MedlinePlus

    Pain - finger ... Nearly everyone has had finger pain at some time. You may have: Tenderness Burning Stiffness Numbness Tingling Coldness Swelling Change in skin color Redness Many conditions, such ...

  18. Back Pain

    MedlinePlus

    ... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...

  19. Breast Pain

    MedlinePlus

    ... before your period and sometimes continuing through your menstrual cycle. The pain may be moderate or severe, and ... breasts. Throughout the month, not related to your menstrual cycle. Postmenopausal women sometimes have breast pain, but breast ...

  20. Hip Pain

    MedlinePlus

    ... clues about the underlying cause. Problems within the hip joint itself tend to result in pain on the ... tendons and other soft tissues that surround your hip joint. Hip pain can sometimes be caused by diseases ...

  1. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain.

  2. Pain management in video assisted thoracic surgery: evaluation of localised partial rib resection. A new technique.

    PubMed

    Richardson, J; Sabanathan, S

    1995-10-01

    We undertook a re-evaluation of acute and chronic pain generation following Video Assisted Thoracic Surgery (VATS) with regard to chest wall trauma produced by the instruments and their ports. From intercostal space (ICS) measurements made on 40 patients, it was confirmed that both the camera and the staple gun port diameters are too large for insertion without trauma. An instrument was produced (the "Sari" Punch, Bolton Surgical Services, Sheffield, England) which cleanly excises an elipse of the superior aspect of a rib, prior to the introduction of the ports. At the same time, the recommended orbit of the instruments about the surgical focus was abandoned in favour of an alignment along one ICS so that only one nerve was potentially traumatised. These modifications were then combined with balanced, pre-emptive and continuous paravertebral analgesia and the efficacy of this approach was evaluated in nine patients undergoing VATS. Operation of the rib punch was easy in all patients and was carried out without clinical or radiological trauma to the rib. Insertion of the ports was easy and access was good to all intrathoracic structures. Postoperative analgesia was good and the mean hospital stay was 2.7 days (range 2-4). Follow-up two months later confirmed a satisfactory surgical procedure and no patients complained of chest wall pain or numbness. We conclude that pain generation with VATS must be seriously considered if the technique is to become truly successful. Balanced, pre-emptive, paravertebral analgesia will protect the central nervous system while the removal of an elipse of rib and alignment of the instruments along one ICS will reduce the likelihood of peripheral nerve trauma.

  3. Redirection of cutaneous sensation from the hand to the chest skin of human amputees with targeted reinnervation

    PubMed Central

    Kuiken, Todd A.; Marasco, Paul D.; Lock, Blair A.; Harden, R. Norman; Dewald, Julius P. A.

    2007-01-01

    Amputees cannot feel what they touch with their artificial hands, which severely limits usefulness of those hands. We have developed a technique that transfers remaining arm nerves to residual chest muscles after an amputation. This technique allows some sensory nerves from the amputated limb to reinnervate overlying chest skin. When this reinnervated skin is touched, the amputees perceive that they are being touched on their missing limb. We found that touch thresholds of the reinnervated chest skin fall within near-normal ranges, indicating the regeneration of large-fiber afferents. The perceptual identity of the limb and chest was maintained separately even though they shared a common skin surface. A cutaneous expression of proprioception also occurred in one reinnervated individual. Experiments with peltier temperature probes and surface electrical stimulation of the reinnervated skin indicate the regeneration of small diameter temperature and pain afferents. The perception of an amputated limb arising from stimulation of reinnervated chest skin may allow useful sensory feedback from prosthetic devices and provides insight into the mechanisms of neural plasticity and peripheral regeneration in humans. PMID:18048339

  4. Redirection of cutaneous sensation from the hand to the chest skin of human amputees with targeted reinnervation.

    PubMed

    Kuiken, Todd A; Marasco, Paul D; Lock, Blair A; Harden, R Norman; Dewald, Julius P A

    2007-12-11

    Amputees cannot feel what they touch with their artificial hands, which severely limits usefulness of those hands. We have developed a technique that transfers remaining arm nerves to residual chest muscles after an amputation. This technique allows some sensory nerves from the amputated limb to reinnervate overlying chest skin. When this reinnervated skin is touched, the amputees perceive that they are being touched on their missing limb. We found that touch thresholds of the reinnervated chest skin fall within near-normal ranges, indicating the regeneration of large-fiber afferents. The perceptual identity of the limb and chest was maintained separately even though they shared a common skin surface. A cutaneous expression of proprioception also occurred in one reinnervated individual. Experiments with peltier temperature probes and surface electrical stimulation of the reinnervated skin indicate the regeneration of small diameter temperature and pain afferents. The perception of an amputated limb arising from stimulation of reinnervated chest skin may allow useful sensory feedback from prosthetic devices and provides insight into the mechanisms of neural plasticity and peripheral regeneration in humans.

  5. Chest physiotherapy in preterm infants with lung diseases

    PubMed Central

    2010-01-01

    Background In neonatology the role of chest physiotherapy is still uncertain because of the controversial outcomes. Methods The aim of this study was to test the applicability in preterm infants of 'reflex rolling', from the Vojta method, in preterm neonates with lung pathology, with particular attention to the effects on blood gases and oxygen saturation, on the spontaneous breathing, on the onset of stress or pain. The study included 34 preterm newborns with mean gestational age of 30.5 (1.6) weeks - mean (DS) - and birth weight of 1430 (423) g - mean (DS) -, who suffered from hyaline membrane disease, under treatment with nasal CPAP (continuous positive airways pressure), or from pneumonia, under treatment with oxygen-therapy. The neonates underwent phase 1 of 'reflex rolling' according to Vojta method three times daily. Respiratory rate, SatO2, transcutaneous PtcCO2 e PtcO2 were monitored; in order to evaluate the onset of stress or pain following the stimulations, the NIPS score and the PIPP score were recorded; cerebral ultrasound scans were performed on postnatal days 1-3-5-7, and then weekly. Results In this population the first phase of Vojta's 'reflex rolling' caused an increase of PtcO2 and SatO2 values. No negative effects on PtcCO2 and respiratory rate were observed, NIPS and PIPP stress scores remained unmodified during the treatment; in no patient the intraventricular haemorrhage worsened in time and none of the infants developed periventricular leucomalacia. Conclusions Our experience, using the Vojta method, allows to affirm that this method is safe for preterm neonates, but further investigations are necessary to confirm its positive effects and to evaluate long-term respiratory outcomes. PMID:20868518

  6. Painful consequences of anger suppression.

    PubMed

    Quartana, Phillip J; Burns, John W

    2007-05-01

    The authors experimentally examined the effects of anger suppression on pain perception. On the basis of ironic process theory, they proposed that efforts to suppress experiential or expressive components of anger may paradoxically enhance cognitive accessibility of anger-related thoughts and feelings, thereby contaminating perception of succeeding pain in an anger-congruent manner. Participants were randomly assigned to nonsuppression or experiential or expressive suppression conditions during mental arithmetic with or without harassment. A cold-pressor task followed. Results revealed that participants instructed to suppress experiential or expressive components of emotion during harassment not only reported the greatest pain levels, but also rated the anger-specific dimensions of pain uniquely strong. Results suggest that attempts to suppress anger may amplify pain sensitivity by ironically augmenting perception of the irritating and frustrating qualities of pain.

  7. Temporomandibular pain

    PubMed Central

    Prasad, S Raghavendra; Kumar, N Ravi; Shruthi, HR; Kalavathi, SD

    2016-01-01

    Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view. PMID:27601822

  8. Spontaneous massive hemothorax secondary to chest wall chondrosarcoma: a case report.

    PubMed

    Rad, Mohammad Ghasemi; Mahmodlou, Rahim; Mohammadi, Afshin; Mladkova, Nikol; Noorozinia, Farahnaz

    2011-01-01

    We present the case of a 30-year-old man with no past history of disease or recent trauma, who was seen in the emergency room after developing sharp pain in the left hemithorax. Chest roentgenogram showed costopherenic angle blunting and an oval mass in the left mediastinum. A computed tomographic scan showed extrapleural mass with coarse calcifications and pleural effusion, confirmed by magnetic resonance imaging. The tumor was biopsied and removed during thoracotomy. The pathology reported revealed chondrosarcoma, which is a rare cause for a spontaneous massive hemothorax. Invasion of the intercostals vessels by the tumor was the probable cause of hemothorax in this patient.

  9. Pharmacological and other treatment modalities for esophageal pain.

    PubMed

    Hoff, Dag Arne Lihaug; Brock, Christina; Farmer, Adam D; Dickman, Ram; Ruffle, James K; Shaker, Anisa; Drewes, Asbjørn M

    2016-09-01

    Treatment of esophageal pain remains a major challenge for the clinician. Although many patients have heartburn and may respond to proton pump inhibitors, there in an unmet need for other treatment modalities in patients where there are no obvious pathological findings. Although analgesics are the mainstay in esophageal pain treatment, many patients are nonresponders to these drugs. The current concise review focuses on other systems affecting pain processing, where better understanding may serve as a framework for therapy. These are the parasympathetic nervous system, exercise, and personality profiles. Finally, treatment with analgesics for functional chest pain remains a challenge, and an overview of treatment with antidepressive drugs is provided.

  10. Predictors and social consequences of daily pain expectancy among adults with chronic pain.

    PubMed

    Mun, Chung Jung; Thummala, Kirti; Davis, Mary C; Karoly, Paul; Tennen, Howard; Zautra, Alex J

    2017-03-21

    Previous research suggests that for people living with chronic pain, pain expectancy can undermine access to adaptive resources and functioning. We tested and replicated the unique effect of pain expectancy on subsequent pain through 2 daily diary studies. We also extended previous findings by examining cognitive and affective antecedents of pain expectancy and the consequences of pain expectancy for daily social enjoyment and stress. In study 1, 231 individuals with rheumatoid arthritis completed 30 end-of-day diaries. Results of multilevel structural equation model showed that controlling for today's pain, pain expectancy predicted next day pain. In study 2, diary assessments of affective, cognitive, and social factors were collected during the morning, afternoon, and evening for 21 days from a sample of 220 individuals with fibromyalgia. Results showed that both positive affect and the extent to which pain interfered with daily activities in the afternoon predicted evening pain expectancy in the expected direction. However, negative affect and pain coping efficacy were not associated with pain expectancy. Consistent with study 1, more than usual evening pain expectancy was related to greater next morning pain. We also found that next morning pain predicted next afternoon social enjoyment but not social stress. The findings of these 2 studies point to the importance of promoting positive affect and reducing pain expectancy as a way of decreasing the detrimental effect of chronic pain on enjoyable social experiences.

  11. Abdominal Pain (Stomach Pain), Short-Term

    MedlinePlus

    ... myhealthfinder Immunization Schedules Nutrient Shortfall Questionnaire Abdominal Pain (Stomach Pain), Short-termJust about everyone has had a " ... time or another. But sudden severe abdominal pain (stomach pain), also called acute pain, shouldn't be ...

  12. Influence of culture on pain comorbidity in women with and without temporomandibular disorder-pain.

    PubMed

    Al-Harthy, M; Michelotti, A; List, T; Ohrbach, R

    2017-02-28

    Evidence on cultural differences in prevalence and impact of common chronic pain conditions, comparing individuals with temporomandibular disorders (TMD) versus individuals without TMD, is limited. The aim was to assess cross-cultural comorbid pain conditions in women with chronic TMD pain. Consecutive women patients (n = 122) with the index condition of chronic TMD pain diagnosed per the research diagnostic criteria for TMD and TMD-free controls (n = 121) matched for age were recruited in Saudi Arabia, Italy and Sweden. Self-report questionnaires assessed back, chest, stomach and head pain for prevalence, pain intensity and interference with daily activities. Logistic regression was used for binary variables, and ancova was used for parametric data analysis, adjusting for age and education. Back pain was the only comorbid condition with a different prevalence across cultures; Swedes reported a lower prevalence compared to Saudis (P < 0·01). Saudis reported higher prevalence of work reduced >50% due to back pain compared to Italians or Swedes (P < 0·01). Headache was the most common comorbid condition in all three cultures. The total number of comorbid conditions did not differ cross-culturally but were reported more by TMD-pain cases than TMD-free controls (P < 0·01). For both back and head pain, higher average pain intensities (P < 0·01) and interference with daily activities (P < 0·01) were reported by TMD-pain cases, compared to TMD-free controls. Among TMD-pain cases, Italians reported the highest pain-related disability (P < 0·01). Culture influences the associated comorbidity of common pain conditions. The cultural influence on pain expression is reflected in different patterns of physical representation.

  13. Segmentation of ribs in digital chest radiographs

    NASA Astrophysics Data System (ADS)

    Cong, Lin; Guo, Wei; Li, Qiang

    2016-03-01

    Ribs and clavicles in posterior-anterior (PA) digital chest radiographs often overlap with lung abnormalities such as nodules, and cause missing of these abnormalities, it is therefore necessary to remove or reduce the ribs in chest radiographs. The purpose of this study was to develop a fully automated algorithm to segment ribs within lung area in digital radiography (DR) for removal of the ribs. The rib segmentation algorithm consists of three steps. Firstly, a radiograph was pre-processed for contrast adjustment and noise removal; second, generalized Hough transform was employed to localize the lower boundary of the ribs. In the third step, a novel bilateral dynamic programming algorithm was used to accurately segment the upper and lower boundaries of ribs simultaneously. The width of the ribs and the smoothness of the rib boundaries were incorporated in the cost function of the bilateral dynamic programming for obtaining consistent results for the upper and lower boundaries. Our database consisted of 93 DR images, including, respectively, 23 and 70 images acquired with a DR system from Shanghai United-Imaging Healthcare Co. and from GE Healthcare Co. The rib localization algorithm achieved a sensitivity of 98.2% with 0.1 false positives per image. The accuracy of the detected ribs was further evaluated subjectively in 3 levels: "1", good; "2", acceptable; "3", poor. The percentages of good, acceptable, and poor segmentation results were 91.1%, 7.2%, and 1.7%, respectively. Our algorithm can obtain good segmentation results for ribs in chest radiography and would be useful for rib reduction in our future study.

  14. Chest CT Features of North American Paragonimiasis

    PubMed Central

    Henry, Travis S.; Lane, Michael A.; Weil, Gary J.; Bailey, Thomas C.; Bhalla, Sanjeev

    2013-01-01

    OBJECTIVE The purpose of this study was to characterize the chest CT findings of North American paragonimiasis due to Paragonimus kellicotti in the largest (to our knowledge) case series reported to date and to compare the findings with those reported for paragonimiasis infections in other regions. MATERIALS AND METHODS A retrospective review was performed of chest CT examinations of eight patients with North American paragonimiasis treated at our institution between 2006 and 2010. Findings were characterized by site of involvement, including lungs and pleura, heart and pericardium, lymph nodes, and upper abdomen. RESULTS The most common chest CT findings in this case series were pleural effusions and internal mammary and cardiophrenic lymphadenopathy. Pulmonary parenchymal findings included peripheral lung nodules of 1–3.5 cm in size with surrounding ground-glass opacity; many nodules had a linear track to the pleural surface that may correspond to the worm’s burrow tunnel. Pericardial involvement (5/8 patients) and omental inflammation (5/7 patients), which are uncommon in Asian paragonimiasis, were common in this series. CONCLUSION Pleural and pulmonary features of North American paragonimiasis are generally similar to those reported from Asia. The presence of a track between a pulmonary nodule and the pleura may help distinguish paragonimiasis from mimickers, including chronic eosinophilic pneumonia, tuberculosis, fungal infection, or malignancy. Pericarditis, lymphadenopathy, and omental inflammation were more common in our series than in reports on paragonimiasis from other regions. These differences may be related to the infecting parasite species or to the fact that radiologic examinations in the present series were performed relatively early in the course of infection. PMID:22528896

  15. Image processing of digital chest ionograms.

    PubMed

    Yarwood, J R; Moores, B M

    1988-10-01

    A number of image-processing techniques have been applied to a digital ionographic chest image in order to evaluate their possible effects on this type of image. In order to quantify any effect, a simulated lesion was superimposed on the image at a variety of locations representing different types of structural detail. Visualization of these lesions was evaluated by a number of observers both pre- and post-processing operations. The operations employed included grey-scale transformations, histogram operations, edge-enhancement and smoothing functions. The resulting effects of these operations on the visualization of the simulated lesions are discussed.

  16. Pitfalls and variants in pediatric chest imaging.

    PubMed

    García Asensio, D; Fernández Martín, M

    2016-05-01

    Most pitfalls in the interpretation of pediatric chest imaging are closely related with the technique used and the characteristics of pediatric patients. To obtain a quality image that will enable the correct diagnosis, it is very important to use an appropriate technique. It is important to know how technical factors influence the image and to be aware of the possible artifacts that can result from poor patient cooperation. Moreover, radiologists need to be familiar with the normal anatomy in children, with the classic radiologic findings, and with the anatomic and developmental variants to avoid misinterpreting normal findings as pathological.

  17. Usefulness of low dose chest CT for initial evaluation of blunt chest trauma

    PubMed Central

    Kim, Sung Jung; Bista, Anjali Basnyat; Min, Young Gi; Kim, Eun Young; Park, Kyung Joo; Kang, Doo Kyoung; Sun, Joo Sung

    2017-01-01

    Abstract We aimed to compare the diagnostic performance and inter-observer consistency between low dose chest CT (LDCT) and standard dose chest CT (SDCT) in the patients with blunt chest trauma. A total of 69 patients who met criteria indicative of blunt chest trauma (77% of male; age range, 16–85) were enrolled. All patients underwent LDCT without intravenous (IV) contrast and SDCT with IV contrast using parameters as following: LDCT, 40 mAs with automatic tube current modulation (ATCM) and 100 kVp (BMI <25, n = 51) or 120 kVp (BMI>25, n = 18); SDCT, 180 mAs with ATCM and 120 kVp. Transverse, coronal, sagittal images were reconstructed with 3-mm slice thickness without gap and provided for evaluation of 3 observers. Reference standard images (transverse, coronal, sagittal) were reconstructed using SDCT data with 1-mm slice thickness without gap. Reference standard was established by 2 experienced thoracic radiologists by consensus. Three observers independently evaluated each data set of LDCT and SDCT. Multiple-reader receiver operating characteristic analysis for comparing areas under the ROC curves demonstrated that there was no significant difference of diagnostic performance between LDCT and SDCT for the diagnosis of pulmonary injury, skeletal trauma, mediastinal injury, and chest wall injury (P > 0.05). The intraclass correlation coefficient was measured for inter-observer consistency and revealed that there was good inter-observer consistency in each examination of LDCT and SDCT for evaluation of blunt chest injury (0.8601–1.000). Aortic and upper abdominal injury could not be appropriately compared as LDCT was performed without using contrast materials and this was limitation of this study. The effective radiation dose of LDCT (average DLP = 1.52 mSv⋅mGy−1 cm−1) was significantly lower than those of SDCT (7.21 mSv mGy−1 cm−1). There is a great potential benefit to use of LDCT for initial evaluation of blunt chest trauma

  18. Low back pain - chronic

    MedlinePlus

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause of ...

  19. Neuropathic pain

    PubMed Central

    Colloca, Luana; Ludman, Taylor; Bouhassira, Didier; Baron, Ralf; Dickenson, Anthony H.; Yarnitsky, David; Freeman, Roy; Truini, Andrea; Attal, Nadine; Finnerup, Nanna B.; Eccleston, Christopher; Kalso, Eija; Bennett, David L.; Dworkin, Robert H.; Raja, Srinivasa N.

    2017-01-01

    Neuropathic pain is caused by a lesion or disease of the somatosensory system, including peripheral fibres (Aβ, Aδ and C fibres) and central neurons, and affects 7–10% of the general population. Multiple causes of neuropathic pain have been described and its incidence is likely to increase owing to the ageing global population, increased incidence of diabetes mellitus and improved survival from cancer after chemotherapy. Indeed, imbalances between excitatory and inhibitory somatosensory signalling, alterations in ion channels and variability in the way that pain messages are modulated in the central nervous system all have been implicated in neuropathic pain. The burden of chronic neuropathic pain seems to be related to the complexity of neuropathic symptoms, poor outcomes and difficult treatment decisions. Importantly, quality of life is impaired in patients with neuropathic pain owing to increased drug prescriptions and visits to health care providers, as well as the morbidity from the pain itself and the inciting disease. Despite challenges, progress in the understanding of the pathophysiology of neuropathic pain is spurring the development of new diagnostic procedures and personalized interventions, which emphasize the need for a multidisciplinary approach to the management of neuropathic pain. PMID:28205574

  20. Central pain.

    PubMed

    Singh, Supreet

    2014-12-01

    Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topic addressed in this issue is central pain, a neuropathic pain syndrome caused by a lesion in the brain or spinal cord that sensitizes one's perception of pain. It is a debilitating condition caused by various diseases such as multiple sclerosis, strokes, spinal cord injuries, or brain tumors. Varied symptoms and the use of pharmacological medicines and nonpharmacological therapies will be addressed.

  1. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    PubMed Central

    Matos, António P.; Mascarenhas, Vasco; Herédia, Vasco

    2014-01-01

    Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall. PMID:25295188

  2. Multidetector computer tomography: evaluation of blunt chest trauma in adults.

    PubMed

    Palas, João; Matos, António P; Mascarenhas, Vasco; Herédia, Vasco; Ramalho, Miguel

    2014-01-01

    Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  3. Measuring chest circumference change during respiration with an electromagnetic biosensor.

    PubMed

    Padasdao, Bryson; Shahhaidar, Ehsaneh; Boric-Lubecke, Olga

    2013-01-01

    In this paper, an off-the-shelf DC motor is modified into a chest belt and used to successfully measure circumference change on a mechanical chest model, while simultaneously harvesting significant power. Chest circumference change can provide information on tidal volume, which is vital in assessing lung function. The chest circumference change is calculated from the motor's voltage output. Calculated values are within 0.95mm of measured circumference changes, with a standard deviation of 0.37mm. The wearable motor can also harvest at least 29.4µW during normal breathing.

  4. Digital tomosynthesis of the chest: current and emerging applications.

    PubMed

    Chou, Shinn-Huey S; Kicska, Greg A; Pipavath, Sudhakar N; Reddy, Gautham P

    2014-01-01

    Digital tomosynthesis (DTS) of the chest is a technique whose basic components are similar to those of digital radiography, but that also provides some of the benefits of computed tomography (CT). The major advantages of DTS over conventional chest radiography are improved visibility of the pulmonary parenchyma and depiction of abnormalities such as pulmonary nodules. Calcifications, vessels, airways, and chest wall abnormalities are also much more readily visualized at DTS than at chest radiography. DTS could potentially be combined with chest radiography to follow up known nodules, confirm or rule out suspected nodules seen at radiography, or evaluate individuals who are at high risk for lung cancer or pulmonary metastases. DTS generates coronal "slices" through the chest whose resolution is superior to that of coronal reconstructed CT images, but it is limited by its suboptimal depth resolution and susceptibility to motion; consequently, potential pitfalls in recognizing lesions adjacent to the pleura, diaphragm, central vessels, and mediastinum can occur. However, the radiation dose and projected cost of chest DTS are lower than those of standard chest CT. Besides pulmonary nodule detection, specific applications of DTS that are under investigation include evaluation of pulmonary tuberculous and nontuberculous mycobacterial disease, cystic fibrosis, interstitial lung disease, and asbestos-related thoracic diseases. A basic understanding of chest DTS and of the emerging applications of this technique can prove useful to the radiologist. Online supplemental material is available for this article.

  5. Does anterior trunk pain predict a different course of recovery in chronic low back pain?

    PubMed

    Panagopoulos, John; Hancock, Mark J; Kongsted, Alice; Hush, Julia; Kent, Peter

    2014-05-01

    Patient characteristics associated with the course and severity of low back pain (LBP) and disability have been the focus of extensive research, however, known characteristics do not explain much of the variance in outcomes. The relationship between anterior trunk pain (ATP) and LBP has not been explored, though mechanisms for visceral referred pain have been described. Study objectives were: (1) determine prevalence of ATP in chronic LBP patients, (2) determine whether ATP is associated with increased pain and disability in these patients, and (3) evaluate whether ATP predicts the course of pain and disability in these patients. In this study, spinal outpatient department patients mapped the distribution of their pain and patients describing pain in their chest, abdomen or groin were classified with ATP. Generalized estimating equations were performed to investigate the relationship between ATP and LBP outcomes. A total of 2974 patients were included and 19.6% of patients reported ATP. At all time points, there were significant differences in absolute pain intensity and disability in those with ATP compared with those without. The presence of ATP did not affect the clinical course of LBP outcomes. The results of this study suggest that patients who present with LBP and ATP have higher pain and disability levels than patients with localised LBP. Visceral referred pain mechanisms may help to explain some of this difference.

  6. Large hiatal hernia at chest radiography in a woman with cardiorespiratory symptoms.

    PubMed

    Torres, Daniele; Parrinello, Gaspare; Cardillo, Mauro; Pomilla, Marina; Trapanese, Caterina; Michele, Bellanca; Lupo, Umberto; Schimmenti, Caterina; Cuttitta, Francesco; Pietrantoni, Rossella; Vogiatzis, Danai; Licata, Giuseppe

    2012-11-01

    Hiatal hernia (HH) is a frequent entity. Rarely, it may exert a wide spectrum of clinical presentations mimicking acute cardiovascular events such as angina-like chest pain until manifestations of cardiac compression that can include postprandial syncope, exercise intolerance, respiratory function, recurrent acute heart failure, and hemodynamic collapse. A 69-year-old woman presented to the emergency department complaining of fatigue on exertion, cough, and episodes of restrosternal pain with less than 1 hour of duration. Her medical history only included some episodes of bronchitis and no history of hypertension. The 12-lead electrocardiogram demonstrated sinus rhythm with right bundle-branch block. Laboratory tests, including cardiac troponin I, were within normal reference values. Chest radiography showed no significant pulmonary alterations and revealed in mediastinum a huge abnormal shadow overlapping the right heart compatible with a gastric bubble.The gastroscopy confirmed a large HH. A 2-dimensional transthoracic echocardiogram, using all standard and modified apical and parasternal views, revealed an echolucent mass, compatible with HH, compressing the right atrium. Also, it showed an altered left ventricular relaxation and a mild increase of pulmonary artery pressure (35 mm Hg). Spirometry showed a mild obstruction of the small airways, whereas coronary angiography showed normal coronary arteries. We concluded that the patient's symptomatology was related to the compressive effects of the large hiatal ernia, a neglected cause of cardiorespiratory symptoms. The surgical repair of HH was indicated.

  7. Effects of chest resistance exercise and chest expansion exercise on stroke patients’ respiratory function and trunk control ability

    PubMed Central

    Song, Gui bin; Park, Eun cho

    2015-01-01

    [Purpose] The purpose of this study was to examine the efficiency of chest resistance and chest expansion exercises for improving respiratory function and trunk control ability in patients with stroke. [Subjects] Forty patients with stroke were randomly allocated into a chest resistance exercise group (CREG, n = 20) and a chest expansion exercise group (CEEG, n = 20). [Methods] CREG patients underwent chest resistance exercises, and diaphragmatic resistance exercises by way of the proprioceptive neuromuscular facilitation. CEEG patients underwent respiratory exercises with chest expansion in various positions. Both groups received 30 minutes of training per day, five times per week, for eight weeks. [Results] Both the CERG and CEEG groups showed significant changes in FVC, FEV1, and TIS after the intervention. TIS was significantly increased in the CREG compared to the CEEG after the intervention. [Conclusion] Both chest resistance and chest expansion exercises were effective for improving respiratory function and trunk control ability in stroke patients; however, chest resistance exercise is more efficient for increasing trunk control ability. PMID:26180292

  8. Pectoralis Muscle Flap Repair Reduces Paradoxical Motion of the Chest Wall in Complex Sternal Wound Dehiscence

    PubMed Central

    Zeitani, Jacob; Russo, Marco; Pompeo, Eugenio; Sergiacomi, Gian Luigi; Chiariello, Luigi

    2016-01-01

    Background The aim of the study was to test the hypothesis that in patients with chronic complex sternum dehiscence, the use of muscle flap repair minimizes the occurrence of paradoxical motion of the chest wall (CWPM) when compared to sternal rewiring, eventually leading to better respiratory function and clinical outcomes during follow-up. Methods In a propensity score matching analysis, out of 94 patients who underwent sternal reconstruction, 20 patients were selected: 10 patients underwent sternal reconstruction with bilateral pectoralis muscle flaps (group 1) and 10 underwent sternal rewiring (group 2). Eligibility criteria included the presence of hemisternum diastases associated with multiple (≥3) bone fractures and radiologic evidence of synchronous chest wall motion (CWSM). We compared radiologically assessed (volumetric computed tomography) ventilatory mechanic indices such as single lung and global vital capacity (VC), diaphragm excursion, synchronous and paradoxical chest wall motion. Results Follow-up was 100% complete (mean 85±24 months). CWPM was inversely correlated with single lung VC (Spearman R=−0.72, p=0.0003), global VC (R=−0.51, p=0.02) and diaphragm excursion (R=−0.80, p=0.0003), whereas it proved directly correlated with dyspnea grade (Spearman R=0.51, p=0.02) and pain (R=0.59, p=0.005). Mean CWPM and single lung VC were both better in group 1, whereas there was no difference in CWSM, diaphragm excursion and global VC. Conclusion Our study suggests that in patients with complex chronic sternal dehiscence, pectoralis muscle flap reconstruction guarantees lower CWPM and greater single-lung VC when compared with sternal rewiring and it is associated with better clinical outcomes with less pain and dyspnea. PMID:27733997

  9. [Facial pain].

    PubMed

    Makhinov, K A; Barinov, A N; Zhestikova, M G; Mingazova, L R; Parkhomenko, E V

    2015-01-01

    Diagnosis and treatment of facial pain is a problem for physicians of different specialties (neurologists, dentists, surgeons, oculists, otolaryngologists and psychiatrists). A classification of this pathology is far from ideal and an interdisciplinary comprehensive approach is needed. Current approaches to etiotropic, symptomatic and pathogenetic treatment of patients with most frequent variants of orofacial pain are presented.

  10. [Heel pain].

    PubMed

    Cizmár, I; Svizenská, I; Pilný, J; Repko, M; Ira, D

    2005-01-01

    Heel pain is quite frequent clinical symptom in our population. Successful therapy derives from the problem aetiology. The most frequent source of pain is the mechanical basis, both on dorsal and plantar side of calcaneum. Therapy includes a variety of procedures, from routine measures to surgical intervention.

  11. Interventional Analgesic Management of Lung Cancer Pain

    PubMed Central

    Hochberg, Uri; Elgueta, Maria Francisca; Perez, Jordi

    2017-01-01

    Lung cancer is one of the four most prevalent cancers worldwide. Comprehensive patient care includes not only adherence to clinical guidelines to control and when possible cure the disease but also appropriate symptom control. Pain is one of the most prevalent symptoms in patients diagnosed with lung cancer; it can arise from local invasion of chest structures or metastatic disease invading bones, nerves, or other anatomical structures potentially painful. Pain can also be a consequence of therapeutic approaches like surgery, chemotherapy, or radiotherapy. Conventional medical management of cancer pain includes prescription of opioids and coadjuvants at doses sufficient to control the symptoms without causing severe drug effects. When an adequate pharmacological medical management fails to provide satisfactory analgesia or when it causes limiting side effects, interventional cancer pain techniques may be considered. Interventional pain management is devoted to the use of invasive techniques such as joint injections, nerve blocks and/or neurolysis, neuromodulation, and cement augmentation techniques to provide diagnosis and treatment of pain syndromes resistant to conventional medical management. Advantages of interventional approaches include better analgesic outcomes without experiencing drug-related side effects and potential for opioid reduction thus avoiding central side effects. This review will describe various pain syndromes frequently described in lung cancer patients and those interventional techniques potentially indicated for those cases. PMID:28261561

  12. Effective dose to patients from chest examinations with tomosynthesis.

    PubMed

    Båth, Magnus; Svalkvist, Angelica; von Wrangel, Alexa; Rismyhr-Olsson, Heidi; Cederblad, Ake

    2010-01-01

    Chest tomosynthesis, which refers to the principle of collecting low-dose projections of the chest at different angles and using these projections to reconstruct section images of the chest, is an imaging technique recently introduced to health care. The main purpose of the present work was to determine the average effective dose to patients from clinical use of chest tomosynthesis. Exposure data for two chest radiography laboratories with tomosynthesis option (Definium 8000 with VolumeRAD option, GE Healthcare, Chalfont St. Giles, UK) were registered for 20 patients with a weight between 60 and 80 kg (average weight of 70.2 kg). The recorded data were used in the Monte Carlo program PCXMC 2.0 (STUK-Radiation and Nuclear Safety Authority, Helsinki, Finland) to determine the average effective dose for each projection. The effective dose for the chest tomosynthesis examination, including a scout view and the tomosynthesis acquisition, was finally obtained by adding the effective doses from all projections. Using the weighting factors given in ICRP 103, the average effective dose for the examination was found to be 0.13 mSv, whereas the average effective dose for the conventional two-view chest radiography examination was 0.05 mSv. A conversion factor of 0.26 mSv Gy(-1) cm(-2) was found suitable for determining the effective dose from a VolumeRAD chest tomosynthesis examination from the total registered kerma-area product. In conclusion, the effective dose to a standard-sized patient (170 cm/70 kg) from a VolumeRAD chest tomosynthesis examination is ~2 % of an average chest CT and only two to three times the effective dose from the conventional two-view chest radiography examination.

  13. Cardiac Troponin I is Increased in Patients with Polytrauma and Chest or Head Trauma. Results of A Retrospective Case-Control Study

    PubMed Central

    Buonocore, Ruggero; Mitaritonno, Michele; Cervellin, Gianfranco

    2016-01-01

    Summary Background We performed a retrospective case-control study to assess the values of cardiac troponin I (cTnI) in a large number of patients admitted to the emergency department (ED) with different types of trauma. Methods The study population consisted of all patients aged 18 years or older admitted to the local ED with all types of traumas over a 1-year period. Results of cTnI were compared with those of 125 consecutive blood donors and 25 non-cardiac chest pain ED patients. Results The final study population consisted of 380 trauma patients, 10 with isolated abdominal trauma, 99 with isolated trauma of the limbs, 49 with isolated chest trauma, 145 with isolated head trauma and 77 with polytrauma. The concentration of cTnI did not differ among the three study populations, but the frequency of measurable values was substantially higher in patients with trauma (63%) than in blood donors and non-cardiac chest pain ED patients (both 20%). The frequency of cTnI values above the 99th percentile of the reference range was significantly higher in trauma patients (20%) than in blood donors (0%) and noncardiac chest pain ED patients (8%). Increased cTnI values were more frequent after head trauma (21%), chest trauma (27%) and polytrauma (29%) compared to patients with abdominal (0%) or limbs trauma (8%). Conclusions These results suggest that the measurement of cardiac troponin may be advisable to identify potential cardiac involvement in trauma patients, especially in those with polytrauma and head or chest trauma. PMID:28356878

  14. Management of chest trauma in children.

    PubMed

    Tovar, Juan A; Vazquez, Juan J

    2013-06-01

    Chest trauma in children is caused by high-energy blows, due in general to traffic accidents, that involve several other body regions. They occur mainly in the first decade of life and can be penetrating but are more often non-penetrating. Rib fractures and lung contusions, sometimes associated with pneumothorax or haemothorax, are the more usual injuries, but tracheobronchial rupture, cardiac, oesophageal or diaphragmatic injuries may also occur. These injuries are treated with supportive respiratory and haemodynamic measures, drainage of air or blood from the pleural space and, at times, surgical repair of the injured organ(s). Ruptures of the airway may be difficult to treat and occasionally require suture, anastomosis or resection. Oesophageal injuries can be treated conservatively with antibiotics, drainage and parenteral nutrition. Diaphragmatic tears should be repaired operatively. Overall mortality ranges from 6 to 20%. Mortality is high but this is mainly due to the associated presence of extra-thoracic trauma, and particularly to head injuries.

  15. Necrobiotic xanthogranuloma of the chest wall.

    PubMed

    Smith, H Garth; Sargent, Larry A; Lundgrin, Daryl B

    2006-01-27

    Necrobiotic xanthogranuloma is a rare disease that usually presents with indurated yellow red nodules or plaques in the dermis or subdermal tissues. The pathogenesis of this disease is unknown and the limited number of cases has made long-term studies difficult. We report the case of a 61-year-old woman seen in our office for a 5 x 5-cm lesion of her chest wall. Biopsies established a diagnosis of necrobiotic xanthogranuloma. The patient received 4 months of intralesional steroid injections without change in the lesion. The patient was also treated with colchicine for several months without improvement. Therefore, the lesion was surgically excised and the area was reconstructed with local advancement skin flaps. The patient has been followed for 2 years with no evidence of recurrence.

  16. The effect of cold application and lavender oil inhalation in cardiac surgery patients undergoing chest tube removal

    PubMed Central

    Hasanzadeh, Farzaneh; Kashouk, Narges Mohammadi; Amini, Shahram; Asili, Javad; Emami, Seyed Ahmad; Vashani, Hamidreza Behnam; Sahebkar, Amirhossein

    2016-01-01

    Post-surgical chest tube removal (CTR) is associated with a significant pain and discomfort for patients. Current treatment strategies for reducing CTR-associated pain and anxiety are limited and partially efficacious. To determine the effects of cold application, inhalation of lavender essential oil, and their combination on pain and anxiety during CTR was investigated. This randomized controlled open-label trial was conducted with 80 patients in the cardiac surgery intensive care unit who had a chest tube for duration of at least 24 hours after coronary artery bypass grafting (CABG). Patients were randomized (n=20 in each group) to receive cold application, aromatherapy with lavender oil, cold application in combination with lavender oil inhalation, or none of the above interventions (control group). The intensity and quality of pain and anxiety were evaluated using the visual analogue scale, short form and modified-McGill pain questionnaire (SFM-MPQ) and the Spielberger situational anxiety level inventory (STAII) scale, respectively. Patients in all treatment groups had significantly lower pain intensity and anxiety compared with the control group immediately, 5, 10 and 15 min after CTR. There was no statistically significant difference in the SFM-MPQ total scores between the intervention groups. With respect to anxiety score, there was a significantly reduced anxiety level immediately after CTR in the aromatherapy and cold-aromatherapy combination groups versus the cold application group. The present results suggested the efficacy of cold application and aromatherapy with lavender oil in reducing pain and anxiety associated with post-CABG CTR. PMID:27047319

  17. 46 CFR 194.10-20 - Magazine chest construction.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... lid shall have a minimum thickness of 1/8 inch. (b) Permanent sun shields shall be provided for sides... distance of 11/2 inches. Sun shields may be omitted when chests are installed “on deck protected,” shielded from direct exposure to the sun. (c) Chests shall be limited to a gross capacity of 100 cubic feet....

  18. 46 CFR 194.10-20 - Magazine chest construction.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... lid shall have a minimum thickness of 1/8 inch. (b) Permanent sun shields shall be provided for sides... distance of 11/2 inches. Sun shields may be omitted when chests are installed “on deck protected,” shielded from direct exposure to the sun. (c) Chests shall be limited to a gross capacity of 100 cubic feet....

  19. 46 CFR 194.10-20 - Magazine chest construction.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... lid shall have a minimum thickness of 1/8 inch. (b) Permanent sun shields shall be provided for sides... distance of 11/2 inches. Sun shields may be omitted when chests are installed “on deck protected,” shielded from direct exposure to the sun. (c) Chests shall be limited to a gross capacity of 100 cubic feet....

  20. 46 CFR 194.10-20 - Magazine chest construction.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... lid shall have a minimum thickness of 1/8 inch. (b) Permanent sun shields shall be provided for sides... distance of 11/2 inches. Sun shields may be omitted when chests are installed “on deck protected,” shielded from direct exposure to the sun. (c) Chests shall be limited to a gross capacity of 100 cubic feet....

  1. Penetrating cardiac injuries in blunt chest wall trauma.

    PubMed

    Kanchan, Tanuj; Menezes, Ritesh G; Sirohi, Parmendra

    2012-08-01

    The present photocase illustrates the possible mechanism of direct cardiac injuries from broken sharp jagged fractured ends of ribs in blunt force trauma to the chest in run over traffic mishaps. We propose that the projecting fractured ends of the ribs penetrate the underlying thoracic organs due to the transient phenomenon of deformation of chest cavity under pressure in run over traffic mishaps.

  2. Management of chest drainage tubes after lung surgery.

    PubMed

    Satoh, Yukitoshi

    2016-06-01

    Since chest tubes have been routinely used to drain the pleural space, particularly after lung surgery, the management of chest tubes is considered to be essential for the thoracic surgeon. The pleural drainage system requires effective drainage, suction, and water-sealing. Another key point of chest tube management is that a water seal is considered to be superior to suction for most air leaks. Nowadays, the most common pleural drainage device attached to the chest tube is the three-bottle system. An electronic chest drainage system has been developed that is effective in standardizing the postoperative management of chest tubes. More liberal use of digital drainage devices in the postoperative management of the pleural space is warranted. The removal of chest tubes is a common procedure occurring almost daily in hospitals throughout the world. Extraction of the tube is usually done at the end of full inspiration or at the end of full expiration. The tube removal technique is not as important as how it is done and the preparation for the procedure. The management of chest tubes must be based on careful observation, the patient's characteristics, and the operative procedures that had been performed.

  3. Use of chest sonography in acute-care radiology().

    PubMed

    De Luca, C; Valentino, M; Rimondi, M R; Branchini, M; Baleni, M Casadio; Barozzi, L

    2008-12-01

    Diagnosis of acute lung disease is a daily challenge for radiologists working in acute-care areas. It is generally based on the results of chest radiography performed under technically unfavorable conditions. Computed tomography (CT) is undoubtedly more accurate in these cases, but it cannot always be performed on critically ill patients who need continuous care.The use of thoracic ultrasonography (US) has recently been proposed for the study of acute lung disease. It can be carried out rapidly at the bedside and does not require any particularly sophisticated equipment. This report analyzes our experience with chest sonography as a supplement to chest radiography in an Emergency Radiology Unit. We performed chest sonography - as an adjunct to chest radiography - on 168 patients with acute chest pathology. Static and dynamic US signs were analyzed in light of radiographic findings and, when possible, CT. The use of chest US improved the authors' ability to provide confident diagnoses of acute disease of the chest and lungs.

  4. Interpretation of the neonatal chest X-ray.

    PubMed

    Barnes, N; Pilling, D W

    1999-11-01

    Most neonatal X-rays are seen initially by a paediatrician without formal training in interpretation of chest X-rays. This article aims to help improve the information obtained from these X-rays which are often complex. Many factors affect accurate interpretation of the neonatal chest X-ray, including good quality radiographs, appropriate viewing conditions and thorough education.

  5. Quantitative evaluation of correlation of dose and FDG-PET uptake value with clinical chest wall complications in patients with lung cancer treated with stereotactic body radiation therapy.

    PubMed

    Algan, O; Confer, M; Algan, S; Matthiesen, C; Herman, T; Ahmad, S; Ali, I

    2015-01-01

    The aim of this study was to investigate quantitatively the dosimetric factors that increase the risk of clinical complications of rib fractures or chest wall pain after stereotactic body radiation therapy (SBRT) to the lung. The correlations of clinical complications with standard-uptake values (SUV) and FDG-PET activity distributions from post-treatment PET-imaging were studied. Mean and maximum doses from treatment plans, FDG-PET activity values on post-SBRT PET scans and the presence of clinical complications were determined in fifteen patients undergoing 16 SBRT treatments for lung cancer. SBRT treatments were delivered in 3 to 5 fractions using 5 to 7 fields to prescription doses in the range from 39.0 to 60.0 Gy. The dose and FDG-PET activity values were extracted from regions of interest in the chest wall that matched anatomically. Quantitative evaluation of the correlation between dose deposition and FDG-PET activity was performed by calculating the Pearson correlation coefficient using pixel-by-pixel analysis of dose and FDG-PET activity maps in selected regions of interest associated with clinical complications. Overall, three of fifteen patients developed rib fractures with chest wall pain, and two patients developed pain symptoms without fracture. The mean dose to the rib cage in patients with fractures was 37.53 Gy compared to 33.35 Gy in patients without fractures. Increased chest wall activity as determined by FDG-uptake was noted in patients who developed rib fractures. Enhanced activity from PET-images correlated strongly with high doses deposited to the chest wall which could be predicted by a linear relationship. The local enhanced activity was associated with the development of clinical complications such as chest wall inflammation and rib fracture. This study demonstrates that rib fractures and chest wall pain can occur after SBRT treatments to the lung and is associated with increased activity on subsequent PET scans. The FDG-PET activity

  6. Psychogenic Dyspnea and Therapeutic Chest Radiograph

    ERIC Educational Resources Information Center

    Kaufman, Kenneth R.; Endres, Jennifer K.; Kaufman, Nathaniel D.

    2007-01-01

    Conversion disorders, the physical expression of unresolved psychological pain, can be associated with mourning. This case report is third in a series of articles by the authors on childhood mourning reflecting the effects of multiple losses (K. R. Kaufman & N. D. Kaufman, 2005; K. R. Kaufman & N. D. Kaufman, 2006). In this case report, perception…

  7. Multidisciplinary Oncoplastic Approach Reduces Infection in Chest Wall Resection and Reconstruction for Malignant Chest Wall Tumors

    PubMed Central

    Malahias, Marco N.; Balasubramanian, Balapathiran; Djearaman, Madava G.; Naidu, Babu; Grainger, Melvin F.; Kalkat, Maninder

    2016-01-01

    Background: Management of complex thoracic defects post tumor extipiration is challenging because of the nature of pathology, the radical approach, and the insertion of prosthetic material required for biomechanical stability. Wound complications pose a significant problem that can have detrimental effect on patient outcome. The authors outline an institutional experience of a multidisciplinary thoracic oncoplastic approach to improve outcomes. Methods: Prospectively collected data from 71 consecutive patients treated with chest wall resection and reconstruction were analyzed (2009–2015). The demographic data, comorbidities, operative details, and outcomes with special focus on wound infection were recorded. All patients were managed in a multidisciplinary approach to optimize perioperative surgical planning. Results: Pathology included sarcoma (78%), locally advanced breast cancer (15%), and desmoids (6%), with age ranging from 17 to 82 years (median, 42 years) and preponderance of female patients (n = 44). Chest wall defects were located anterior and anterolateral (77.5%), posterior (8.4%), and apical axillary (10%) with skeletal defect size ranging from 56 to 600 cm2 (mean, 154 cm2). Bony reconstruction was performed using polyprolene mesh, methyl methacrylate prosthesis, and titanium plates. Soft tissue reconstructions depended on size, location, and flap availability and were achieved using regional, distant, and free tissue flaps. The postoperative follow-up ranged from 5 to 70 months (median, 32 months). All flaps survived with good functional and aesthetic outcome, whereas 2 patients experienced surgical site infection (2.8%). Conclusions: Multidisciplinary thoracic oncoplastic maximizes outcome for patients with large resection of chest wall tumors with reduction in surgical site infection and wound complications particularly in association with rigid skeletal chest wall reconstruction. PMID:27536488

  8. [Musculoskeletal pain].

    PubMed

    Casser, H-R; Schaible, H-G

    2015-10-01

    Among the clinically relevant pain conditions, pain in the musculoskeletal system is most frequent. This article reports extensive epidemiological data on musculoskeletal system pain in Germany and worldwide. Since back pain is most frequent, the diagnostics and therapeutic algorithms of acute, recurring, and chronic lower back pain in Germany will be particularly addressed. The importance of the physiologic-organic, the cognitive-emotional, the behavioral, and the social level to diagnostics and treatment will be discussed. We will also focus on osteoarthritic pain and address its epidemiology, clinical importance, and significance for the health care system. This article will list some reasons why the musculoskeletal system in particular is frequently the site of chronic pain. The authors believe that these reasons are to be sought in the complex structures of the musculoskeletal system; in the particular sensitivity of the deep somatic nociceptive system for long-term sensitization processes, as well as the ensuing nervous system reactions; and in the interactions between the nervous and immune systems. The article will give some insights into the research carried out on this topic in Germany.

  9. Fetal pain?

    PubMed

    Vanhatalo, S; van Nieuwenhuizen, O

    2000-05-01

    During the last few years a vivid debate, both scientifically and emotionally, has risen in the medical literature as to whether a fetus is able to feel pain during abortion or intrauterine surgery. This debate has mainly been inspired by the demonstration of various hormonal or motor reactions to noxious stimuli at very early stages of fetal development. The aims of this paper are to review the literature on development of the pain system in the fetus, and to speculate about the relationship between "sensing" as opposed to "feeling" pain and the number of reactions associated with painful stimuli. While a cortical processing of pain theoretically becomes possible after development of the thalamo-cortical connections in the 26th week of gestation, noxious stimuli may trigger complex reflex reactions much earlier. However, more important than possible painfulness is the fact that the noxious stimuli, by triggering stress responses, most likely affect the development of an individual at very early stages. Hence, it is not reasonable to speculate on the possible emotional experiences of pain in fetuses or premature babies. A clinically relevant aim is rather to avoid and/or treat any possibly noxious stimuli, and thereby prevent their potential adverse effects on the subsequent development.

  10. Diffuse optical tomography in the presence of a chest wall

    NASA Astrophysics Data System (ADS)

    Ban, Han Y.; Busch, David R.; Pathak, Saurav; Moscatelli, Frank A.; Machida, Manabu; Schotland, John C.; Markel, Vadim A.; Yodh, Arjun G.

    2013-02-01

    Diffuse optical tomography (DOT) has been employed to derive spatial maps of physiologically important chromophores in the human breast, but the fidelity of these images is often compromised by boundary effects such as those due to the chest wall. We explore the image quality in fast, data-intensive analytic and algebraic linear DOT reconstructions of phantoms with subcentimeter target features and large absorptive regions mimicking the chest wall. Experiments demonstrate that the chest wall phantom can introduce severe image artifacts. We then show how these artifacts can be mitigated by exclusion of data affected by the chest wall. We also introduce and demonstrate a linear algebraic reconstruction method well suited for very large data sets in the presence of a chest wall.

  11. Chest wall reconstruction in a pediatric patient with ectopia cordis.

    PubMed

    Mohan, Raja; Peralta, Mat; Perez, Ramiro; Rosenkranz, Eliot R; Panthaki, Zubin J

    2010-08-01

    Ectopia cordis is defined as a congenital malposition of the heart outside of the thoracic cavity. It is a rare condition, and complete ectopia cordis can be a fatal condition. Successful surgical reconstruction of this defect has been reported but is uncommon. The general approach to reconstructing the chest wall involves repositioning the heart and providing adequate coverage of the chest wall defect. We describe our experience with a patient who had complete thoracic ectopia cordis treated with staged chest wall reconstruction. The first stage involved temporary closure with synthetic material, and the second stage involved definitive reconstruction with autologous bone and cartilage grafts supported with plates. The patient has been active and without complaints since the second stage and is awaiting tracheal decannulation. There have been a few descriptions of how to approach chest wall reconstruction in patients with ectopia cordis. The 2 stage method described can be considered to repair the chest wall defect in complete thoracic ectopia cordis.

  12. A rare cause of misdiagnosis in chest X-ray

    PubMed Central

    Ortiz-Mendoza, Carlos Manuel

    2016-01-01

    Chest X-ray is a usual tool for family physicians; however, unexpected findings in chest X-ray are a frequent challenge. We present a rare case of pulmonary hilar nodule misdiagnosis in a chest X-ray. An 84-year-old woman was sent with a diagnosis of a right pulmonary hilum nodule. She had a history of chronic obstructive pulmonary disease; so in a chest X-ray, her family physician discovered a “nodule” in her right lung hilum. Her physical exam was not relevant. In our hospital, a thoracic computed tomography (CT) scan verified the mass in the right pulmonary hilum; nevertheless, in a coronal CT scan, the “hilum lump” was the tortuous descending aorta that created an angle. This case illustrates how anatomical changes associated with vascular aging may cause this exceptional pitfall in chest X-ray. PMID:28217605

  13. The role of postoperative chest radiography in pediatric tracheotomy.

    PubMed

    Greenberg, J S; Sulek, M; de Jong, A; Friedman, E M

    2001-07-30

    A postoperative chest radiograph has traditionally been obtained after tracheotomies to evaluate for the presence of a pneumothorax and to assess tube position. Several recent studies in adults have questioned the usefulness of routine postoperative chest radiography in uncomplicated cases, but the role of post-operative chest radiography in pediatric patients has not been previously reviewed. We performed this study to examine the clinical utility of post-tracheotomy chest radiography in pediatric patients and determine if this routine practice impacts patient management enough to merit continued usage. A retrospective review was performed of 200 consecutive pediatric patients who underwent tracheotomies by the otolaryngology service in a tertiary care pediatric hospital from January 1994 to June 1999. All patients received postoperative chest radiographs. Five of 200 patients had a new postoperative radiographic finding, with three requiring interventions. Two patients required chest tube placement for pneumothorax, and one patient required tracheostomy tube change for repositioning. Fifty-one patients, including both pneumothoraces, exhibited clinical signs of pneumothorax (decreased breath sounds or oxygen saturation) in the immediate postoperative period. Chest X-ray ruled out a pneumothorax in the remaining 49 patients. The majority of these 51 patients were less than 2 years old (94%, P=0.002) or weighed less than 17 kg (89%, P=0.004). Postoperative chest X-rays yielded clinically relevant information in 168 patients that fell into one or more of four high risk categories: age less than 2, weight less than 17 kg, emergent procedures, or concomitant central line placement. Avoiding chest X-rays in the remaining 32 patients would have resulted in potential savings of $5000, which does not reflect the actuarial cost of a missed complication. Since the majority of our patients (84%) fell into a high-risk category, we feel it would be prudent to continue

  14. What a Pain! Kids and Growing Pains

    MedlinePlus

    ... What Happens in the Operating Room? What a Pain! Kids and Growing Pains KidsHealth > For Kids > What a Pain! Kids and ... something doctors call growing pains . What Are Growing Pains? Growing pains aren't a disease. You probably ...

  15. What a Pain! Kids and Growing Pains

    MedlinePlus

    ... dientes Video: Getting an X-ray What a Pain! Kids and Growing Pains KidsHealth > For Kids > What a Pain! Kids and ... something doctors call growing pains . What Are Growing Pains? Growing pains aren't a disease. You probably ...

  16. Breast size, bra fit and thoracic pain in young women: a correlational study

    PubMed Central

    Wood, Katherine; Cameron, Melainie; Fitzgerald, Kylie

    2008-01-01

    Introduction A single sample study was undertaken to determine the strength and direction of correlations between: a) breast size and thoracic spine or posterior chest wall pain; b) bra fit and thoracic spine or posterior chest wall pain and; c) breast size and bra fit, in thirty nulliparous women (18–26 years), with thoracic spine or posterior chest wall pain, who wore bras during daytime. Measures Pain (Short Form McGill Pain Questionnaire), bra size (Triumph International), bra fit (Triumph International). Results Most (80%) women wore incorrectly sized bras: 70% wore bras that were too small, 10% wore bras that were too large. Breast size was negatively correlated with both bra size (r = -0.78) and bra fit (r = -0.50). These results together indicate that large breasted women were particularly likely to be wearing incorrectly sized and fitted bras. Negligible relationships were found between pain and bra fit, and breast size and pain. Menstrual cycle stage was moderately positively correlated with bra fit (r = 0.32). Conclusion In young, nulliparous women, thoracic pain appears unrelated to breast size. Bra fit is moderately related to stage of menstrual cycle suggesting that this research may be somewhat confounded by hormonal changes or reproductive stage. Further research is needed to clarify whether there is a relationship between breast size or bra fit and thoracic pain in women during times of hormonal change. PMID:18339205

  17. Chronic Pelvic Pain

    MedlinePlus

    ... Events Advocacy For Patients About ACOG Chronic Pelvic Pain Home For Patients Search FAQs Chronic Pelvic Pain ... Pain FAQ099, August 2011 PDF Format Chronic Pelvic Pain Gynecologic Problems What is chronic pelvic pain? What ...

  18. Chronic pain - resources

    MedlinePlus

    Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association -- theacpa.org National Fibromyalgia and Chronic Pain Association -- www.fmcpaware.org National ...

  19. CPDX (Chest Pain Diagnostic) - A Decision Support System for the Management of Acute Chest Pain Version 3.0. Programmer’s Manual

    DTIC Science & Technology

    1989-10-23

    the past such as high blood 2ipressure, angina, pericarditis , pneumonia, pneumothorax, pulmonary 2,embolism, and asthma. 3,PREVIOUS MAJOR SURGERY...other sections of these protocols. a) pulmonary embolus b) pericarditis c) aortic dissection d) acute pancreatitis e) spontaneous mediastinal...anticoagulation. Since anticoagulation camat be accanplished safely aboard ship MECCVAC should be arranged. b) Pericarditis is characterized by mild to

  20. Pain Management

    MedlinePlus

    ... analgesia, identify new targets for analgesic drugs, and test the efficacy and adverse reactions of newly developed or currently used drugs to treat pain. Researchers are currently using these technologies to discover the mechanisms by which drugs such ...

  1. Urination - painful

    MedlinePlus

    ... and vagina Other causes of painful urination include: Interstitial cystitis Prostate infection ( prostatitis ) Radiation cystitis - damage to the ... Editorial team. Related MedlinePlus Health Topics Bladder ... Cystitis Prostate Diseases Sexually Transmitted Diseases Urinary Tract Infections ...

  2. Joint pain

    MedlinePlus

    ... that may be done include: CBC or blood differential C-reactive protein Joint x-ray Sedimentation rate ... chap 256. Schaible H-G. Joint pain: basic mechanisms. In: McMahon SB, Koltzenburg M, Tracey I, Turk ...

  3. Testicle pain

    MedlinePlus

    ... be caused by a hernia or kidney stone. Testicular cancer is almost always painless. But any testicle lump ... Read More Abdominal pain Scrotum Testes Testicle lump Testicular cancer Testicular torsion Review Date 8/31/2015 Updated ...

  4. Chronic Pain

    MedlinePlus

    ... Strategy Current Research Research Funded by NINDS Basic Neuroscience Clinical Research Translational Research Research at NINDS Focus ... pain has done. Scientists believe that advances in neuroscience will lead to more and better treatments for ...

  5. [Abdominal pain].

    PubMed

    Gschossmann, J M; Holtmann, G; Netzer, P; Essig, M; Balsiger, B M; Scheurer, U

    2005-10-01

    Abdominal pain can result from a variety of different intra- and extra-abdominal disorders. Given the wide variety of etiological triggers for this pain, the primary task during the first stage of the diagnostic work-up is to determine as soon as possible the underlying cause and the degree of emergency. The aim of this evaluation is to adapt the therapeutic measures which are necessary for a causal treatment to the individual situation. Contrary to somatic causes of abdominal pain, the availability of such a causal therapy for functional bowel disorders is still very limited. Given this dilemma, the therapeutic focus of abdominal pain associated with these functional syndromes has to be placed on symptom-oriented treatment.

  6. Fetal pain.

    PubMed

    Rokyta, Richard

    2008-12-01

    The fetus reacts to nociceptive stimulations through different motor, autonomic, vegetative, hormonal, and metabolic changes relatively early in the gestation period. With respect to the fact that the modulatory system does not yet exist, the first reactions are purely reflexive and without connection to the type of stimulus. While the fetal nervous system is able to react through protective reflexes to potentially harmful stimuli, there is no accurate evidence concerning pain sensations in this early period. Cortical processes occur only after thalamocortical connections and pathways have been completed at the 26th gestational week. Harmful (painful) stimuli, especially in fetuses have an adverse effect on the development of humans regardless of the processes in brain. Moreover, pain activates a number of subcortical mechanisms and a wide spectrum of stress responses influence the maturation of thalamocortical pathways and other cortical activation which are very important in pain processing.

  7. Breast pain

    MedlinePlus

    ... chocolate in your diet helps reduce breast pain. Vitamin E, thiamine, magnesium, and evening primrose oil are not harmful, but most studies have not shown any benefit. Talk to your health care provider before starting ...

  8. 38-year-old woman with recurrent abdominal pain, but no fever

    PubMed Central

    Iwata, Kentaro; Toma, Tomoko; Yachie, Akihiro

    2012-01-01

    A 38-year-old woman presented with 2 days history of left-flank pain. She had similar episodes of abdominal pain as well as chest pain several times, but symptoms disappeared spontaneously. Each time she developed pain, there was no fever. After ruling out common causes of recurrent abdominal pain, familial Mediterranean fever (FMF) was considered as a potential diagnosis. Genetic tests revealed multiple heterozygote mutations, which may be associated with FMF. Patients with Mediterranean fever mutations may present with atypical presentations without fever, like in this case. Astute clinical suspicion is required to make an accurate diagnosis. PMID:22505824

  9. Neonatal pain

    PubMed Central

    Walker, Suellen M

    2014-01-01

    Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

  10. Neonatal pain.

    PubMed

    Walker, Suellen M

    2014-01-01

    Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback.

  11. Measurement of chest wall displacement based on terahertz wave

    NASA Astrophysics Data System (ADS)

    Li, Hui; Lv, Hao; Jiao, Teng; Lu, Guohua; Li, Sheng; Li, Zhao; Liu, Miao; Jing, Xijing; Wang, Jianqi

    2015-02-01

    Measurement of chest wall displacement is an important approach for measuring mechanics of chest wall, which has considerable significance for assessing respiratory system and diagnosing pulmonary diseases. However, existing optical methods for measuring chest wall displacement are inconvenient for some specific patients such as the female patients and the patients with bandaged chest. In this letter, we proposed a method for measuring chest wall displacement based on terahertz wave and established corresponding mathematic model and set up a terahertz measurement system. The main advantages of this method are that it can measure the chest wall displacement of the subjects without taking off clothes or arranging any markers. To validate this method and assess the performance of the terahertz system, in vitro, the displacement of a water module driven by a linear guide rail was measured by the terahertz system and compared with the actual displacement of the water module. The results showed that the waveforms measured with two methods have a good agreement, and the relative error is less than 5% and sufficiently good for measurement demands. In vivo, the synchronous experiment was performed on five human volunteers with the terahertz system and a respiratory belt transducer. The results demonstrate that this method has good performance and promising prospects for measuring chest wall displacement.

  12. Surgical management of the radiated chest wall

    SciTech Connect

    Arnold, P.G.; Pairolero, P.C.

    1986-04-01

    Fifty consecutive patients with radiation-related problems of the chest wall were treated between 1976 and 1984. There were 40 women and 10 men with an average age of 54 years (range 26 to 78 years). Twenty-three patients had radiation ulcers alone, 20 had recurrent cancer, and 7 had infected median sternotomy wounds. Thirty-six had skeletal resections and 44 had soft-tissue resections. The skeleton was reconstructed with Prolene mesh in 12 patients and with autogenous rib in 3. Sixty-three muscles were transposed in 43 patients. Twelve omental transpositions were performed (8 for primary treatment and 4 for salvage of a failed muscle flap). Hospitalization averaged 20.2 days. There was one operative death (at 29 days). Partial flap necrosis occurred in 10 patients. Mesh was removed in three patients. There were 14 late deaths, most from recurrent tumor. The remaining patients had well-healed wounds and a generally improved quality of life. We conclude that aggressive resection and reliable reconstruction are critical considerations in the surgical management of this perplexing clinical problem.

  13. Newer imaging methods in chest radiography.

    PubMed

    Wandtke, J C

    1990-01-01

    In recent years the application of computers to chest radiography has resulted in a wide variety of innovative research. Major research efforts have resulted in the development of new types of x-ray detectors, such as storage phosphor technology, for use with computers. Storage phosphor imaging is one of the most promising new techniques, and almost 100 systems have been installed worldwide. Radiologists are quickly evaluating the image quality provided by this new detector system, which has the potential to improve image quality. It has wide latitude and is coupled with a computer to perform image processing. Another promising technology, originally studied in the form of scan equalization radiography, is now commercially available in the form of advanced multiple-beam equalization radiography. This film technique uses computers to modulate the x-ray exposure to take maximum advantage of the imaging capabilities of radiographic film. Digital solid-state detectors have been studied in conjunction with computerized image enhancement systems. These currently show improvement in nodule detection and quantification of the calcium content of a lesion. Application of large image intensifiers to a digital image system is being studied, but there are currently limitations on spatial resolution.

  14. Chest conduction properties and ECG equalization.

    PubMed

    Delle Cave, G; Fabricatore, G; Nolfe, G; Petrosino, M; Pizzuti, G P

    2000-01-01

    In common practice of detecting and recording biomedical signals, it is often implicitly assumed that the propagation, through the whole circuit human body-electrodes recording devices, is frequency and voltage independent. As a consequence, clinicians are not aware that recorded signals do not correspond faithfully to the original electrical activity of organs under investigation. We have studied the transmission of electrical signals in human body at various voltages and frequencies to understand if and to which extent the most diffused stimulating and recording techniques used in medicine are affected by global body conduction properties. Our results show that, in order to obtain a more faithful detection of electrical activity produced or evoked by human organs (e.g. EGG, electromyography, etc.), it is convenient to 'equalize'' recorded signals. To this purpose, two equalization techniques are proposed, based, respectively, on a simple hardware filtering during acquisition, or FFT post-processing of the acquired signals. As an application, we have studied the transmission of electrical signal in human chest and have compared equalized high frequency ECG signals with raw (original) recordings.

  15. Penetrating chest wound of the foetus.

    PubMed

    Wandaogo, Albert; Tapsoba, Toussaint Wendlamita; Ouédraogo, Isso; Béré, Bernadette; Ouédraogo, S F; Bandré, E

    2016-01-01

    Traumas of the foetus caused by stabbings are rare but actually life-threatening for both the foetus and the mother. We report a case of penetrating chest wound on a baby taken from the obstetrics unit to the paediatric surgical department. His mother was assaulted by his father, a mentally sick person with no appropriate follow-up. The foetus did not show any sign of vital distress. Surgical exploration of the wound has revealed a section of the 10 th rib, a laceration of the pleura and a tearing of the diaphragm. A phrenorraphy and a pleural drainage were performed. The new-born and its mother were released from hospital after 5 days and the clinical control and X-ray checks 6 months later showed nothing abnormal. We insisted a medical, psychiatric follow-up be initiated for the father. As regards pregnant women with penetrating wounds, the mortality rate of the foetus is 80%. The odds are good for our newborn due to the mild injuries and good professional collaboration of the medical staff. Penetrating transuterine wounds of the foetus can be very serious. The health care needed should include many fields due to the mother and the foetus' lesions extreme polymorphism. In our case, it could have prevented by a good psychiatric followed up of the offender.

  16. Primitive chest wall neuroectodermal tumor in a pediatric patient.

    PubMed

    Liu, Zhengcheng; Zou, Wei; Ma, Guodong; Pan, Yanqing

    2011-10-01

    A 13-year-old boy with a primitive neuroectodermal tumor of the chest wall is presented. After four cycles of chemotherapy, a computed tomography scan of his chest showed a larger mass invading the left upper lobe of the lung. He underwent resection of the left chest wall from the left fourth to sixth ribs, including the tumor, combined with left upper lobectomy and lymph node dissection. A diagnosis of primitive neuroectodermal tumor was confirmed histopathologically and immunohistochemically. After surgery, four cycles of chemotherapy with ifosfamide and etoposide were given. One year after treatment, the patient is currently doing well without evidence of recurrence.

  17. [Clinical use of pain measurement techniques].

    PubMed

    Arendt-Nielsen, Lars

    2002-03-25

    The increased knowledge about pain has lead to the suggestion of a mechanism-based classification of pain, and hence mechanism-based therapy. The implementation of this classification is unlikely to occur in the near future, but the concept as such emphasises the importance of a better understanding of the origin of pain before treatment is initiated. The basis for developing and applying such an approach in the future is accessibility to pain assessment techniques, which are able to measure and quantify patients' responses to pain. Experimental clinical research includes a number of techniques to assess the excitability of the pain system and the manifestations related to central sensitisation and neuroplasticity. This can now be applied for mechanism-based diagnosis and related targeted treatment. As the new generation analgesics with new sites of action are developed, a mechanisms-based approach could, it is hoped, lead to more rational management of pain in the future.

  18. Orofacial pain emerging as a dental specialty.

    PubMed

    Rosenbaum, R S; Friction, J R; Okeson, J P

    2001-01-01

    The emerging field of orofacial pain was considered by the American Dental Association for full status as a new dental specialty. While the recognition of orofacial pain as a specialty was denied, the American Academy of Orofacial Pain plans to continue its efforts. Many recent advances in the neuroscience of orofacial pain have led to treatments that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited, leaving many patients to suffer. Dentists are generally supportive of the efforts to develop oral pain treatment into a specialty because the field will provide benefits for both dentists and their patients. A recent survey of 805 individuals who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control--despite having the pain for more than five years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, president of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." Development of the field of orofacial pain into a dental specialty has been moved primarily by the fact that historically, patients with complex chronic orofacial pain disorders have not been treated well by any discipline of healthcare. Recent studies of chronic orofacial pain patients have found that these patients have a higher number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (see Figure 1). Complex pain patients and the clinicians who see them are often confused about who they should consult for relief of the pain. Treatment for those patients within the existing structure of

  19. The effects of chest expansion resistance exercise on chest expansion and maximal respiratory pressure in elderly with inspiratory muscle weakness

    PubMed Central

    Kim, Chang-Beom; Yang, Jin-Mo; Choi, Jong-Duk

    2015-01-01

    [Purpose] The aim of this study was to examine the effect of chest expansion resistance exercises (CERE) on chest expansion, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) in elderly people with inspiratory muscle weakness. [Subjects] Thirty elderly people with inspiratory muscle weakness (MIP < 80% of the predicted value) were randomly and equally assigned to a chest expansion resistance exercise (CERE) group, core conditioning exercise (CCE) group, and control group. [Methods] The intervention was applied to the CERE group and CCE group five times per week, 30 minutes each time, for six weeks. A tapeline was used to measure upper and lower chest expansion. MIP and MEP before and after the intervention were measured and compared. [Results] There was significant improvement in upper and lower chest expansion and MIP after the intervention in both the CERE group and the CCE group, whereas the control group did not show any significant difference. MEP did not significantly change in any of the three groups after the intervention. [Conclusion] The CERE group underwent greater changes than the CCE group, which proves that the CERE is more effective for improving elderly people’s chest expansion capacity and MIP in elderly people. Therefore, application of the CERE by therapists is recommended if the environment and conditions are appropriate for enhancement of chest expansion capacity and MIP in elderly people. PMID:25995570

  20. No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study

    PubMed Central

    Farquhar, Jaclyn; Almahrabi, Yahya; Slobogean, Gerard; Slobogean, Bronwyn; Garraway, Naisan; Simons, Richard K.; Hameed, S. Morad

    2016-01-01

    Background Chest wall trauma is a common cause of morbidity and mortality. Recent technological advances and scientific publications have created a renewed interest in surgical fixation of flail chest. However, definitive data supporting surgical fixation are lacking, and its virtues have not been evaluated against modern, comprehensive management protocols. Methods Consecutive patients undergoing rib fracture fixation with rib-specific locking plates at 2 regional trauma centres between July 2010 and August 2012 were matched to historical controls with similar injury patterns and severity who were managed nonoperatively with modern, multidisciplinary protocols. We compared short- and long-term outcomes between these cohorts. Results Our patient cohorts were well matched for age, sex, injury severity scores and abbreviated injury scores. The nonoperatively managed group had significantly better outcomes than the surgical group in terms of ventilator days (3.1 v. 6.1, p = 0.012), length of stay in the intensive care unit (3.7 v. 7.4 d, p = 0.009), total hospital length of stay (16.0 v. 21.9 d, p = 0.044) and rates of pneumonia (22% v. 63%, p = 0.004). There were no significant differences in long-term outcomes, such as chest pain or dyspnea. Conclusion Although considerable enthusiasm surrounds surgical fixation of flail chest injuries, our analysis does not immediately validate its universal implementation, but rather encourages the use of modern, multidisciplinary, nonoperative strategies. The role of rib fracture fixation in the modern era of chest wall trauma management should ultimately be defined by prospective, randomized trials. PMID:27438051

  1. Low back pain - acute

    MedlinePlus

    Backache; Low back pain; Lumbar pain; Pain - back; Acute back pain; Back pain - new; Back pain - short-term; Back strain - new ... lower back supports most of your body's weight. Low back pain is the number two reason that Americans see ...

  2. Home Delivery of Pain Therapy to Elderly Patients.

    ERIC Educational Resources Information Center

    Dietrich, Coralie

    Chronic pain occurs most frequently in the elderly. Unfortunately, most pain clinics are located in large urban areas and are not readily accessible to the rural elderly. Recent advances in behavioral medicine have provided pain relief techniques that can be used by a wide variety of professional and paraprofessional workers who do not have…

  3. Chest wall reconstruction with methacrylate prosthesis in Poland syndrome.

    PubMed

    Arango Tomás, Elisabet; Baamonde Laborda, Carlos; Algar Algar, Javier; Salvatierra Velázquez, Angel

    2013-10-01

    Poland syndrome is a rare congenital malformation. This syndrome was described in 1841 by Alfred Poland at Guy's Hospital in London. It is characterized by hypoplasia of the breast and nipple, subcutaneous tissue shortages, lack of the costosternal portion of the pectoralis major muscle and associated alterations of the fingers on the same side. Corrective treatment of the chest and soft tissue abnormalities in Poland syndrome varies according to different authors. We report the case of a 17-year-old adolescent who underwent chest wall reconstruction with a methyl methacrylate prosthesis. This surgical procedure is recommended for large anterior chest wall defects, and it prevents paradoxical movement. Moreover it provides for individual remodeling of the defect depending on the shape of the patient's chest.

  4. DETAIL VIEW OF STEAM CHEST FOR LOW PRESSURE STAGE ENGINE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    DETAIL VIEW OF STEAM CHEST FOR LOW PRESSURE STAGE ENGINE OF UNIT #3. - Burnsville Natural Gas Pumping Station, Saratoga Avenue between Little Kanawha River & C&O Railroad line, Burnsville, Braxton County, WV

  5. Detail view of steam chest for low pressure stage of ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Detail view of steam chest for low pressure stage of unit 40. - Burnsville Natural Gas Pumping Station, Saratoga Avenue between Little Kanawha River & C&O Railroad line, Burnsville, Braxton County, WV

  6. Detail view of steam chest and valve mechanisms for high ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Detail view of steam chest and valve mechanisms for high pressure stage of unit 40. - Burnsville Natural Gas Pumping Station, Saratoga Avenue between Little Kanawha River & C&O Railroad line, Burnsville, Braxton County, WV

  7. Detail view of steam chest for low pressure stage engine ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Detail view of steam chest for low pressure stage engine of unit 43. - Burnsville Natural Gas Pumping Station, Saratoga Avenue between Little Kanawha River & C&O Railroad line, Burnsville, Braxton County, WV

  8. [Development of breathing chest radiography: study of exposure timing].

    PubMed

    Tanaka, Rie; Sanada, Shigeru; Kobayashi, Takeshi; Suzuki, Masayuki; Matsui, Takeshi; Inoue, Hitoshi

    2003-08-01

    The flat-panel detector (FPD) has been introduced into clinical practice. A modified FPD, which has the ability to obtain dynamic chest radiographs, was introduced into our hospital, and clinical testing is ongoing. Both the inspiratory and expiratory phases have to be included in dynamic chest radiographs. The purpose of this study was to investigate the most appropriate chest radiography signal for observation of the respiratory process. We prepared ten protocol patterns that differed in terms of respiratory phase at X-ray exposure, exposure duration, and signal multiplicity. We also performed preliminary experiments and administered several questionnaires to ten volunteers. The volunteers breathed according to vocal and visual signals, and their respiratory waves were recorded by spirometer. The most appropriate protocol was similar to the method used for conventional chest radiography.

  9. The Role of Inspiratory Muscle Training in Sickle Cell Anemia Related Pulmonary Damage due to Recurrent Acute Chest Syndrome Attacks

    PubMed Central

    Camcıoğlu, Burcu; Boşnak-Güçlü, Meral; Karadallı, Müşerrefe Nur; Akı, Şahika Zeynep; Türköz-Sucak, Gülsan

    2015-01-01

    Background. The sickling of red blood cells causes a constellation of musculoskeletal, cardiovascular, and pulmonary manifestations. A 32-year-old gentleman with sickle cell anemia (SCA) had been suffering from recurrent acute chest syndrome (ACS). Aim. To examine the effects of inspiratory muscle training (IMT) on pulmonary functions, respiratory and peripheral muscle strength, functional exercise capacity, and quality of life in this patient with SCA. Methods. Functional exercise capacity was evaluated using six-minute walk test, respiratory muscle strength using mouth pressure device, hand grip strength using hand-held dynamometer, pain using Visual Analogue Scale, fatigue using Fatigue Severity Scale, dyspnea using Modified Medical Research Council Scale, and health related quality of life using European Organization for Research and Treatment of Cancer QOL measurement. Results. A significant improvement has been demonstrated in respiratory muscle strength, functional exercise capacity, pain, fatigue, dyspnea, and quality of life. There was no admission to emergency department due to acute chest syndrome in the following 12 months after commencing regular erythrocytapheresis. Conclusion. This is the first report demonstrating the beneficial effects of inspiratory muscle training on functional exercise capacity, respiratory muscle strength, pain, fatigue, dyspnea, and quality of life in a patient with recurrent ACS. PMID:26060589

  10. Chest wall mechanics in sustained microgravity

    NASA Technical Reports Server (NTRS)

    Wantier, M.; Estenne, M.; Verbanck, S.; Prisk, G. K.; Paiva, M.; West, J. B. (Principal Investigator)

    1998-01-01

    We assessed the effects of sustained weightlessness on chest wall mechanics in five astronauts who were studied before, during, and after the 10-day Spacelab D-2 mission (n = 3) and the 180-day Euromir-95 mission (n = 2). We measured flow and pressure at the mouth and rib cage and abdominal volumes during resting breathing and during a relaxation maneuver from midinspiratory capacity to functional residual capacity. Microgravity produced marked and consistent changes (Delta) in the contribution of the abdomen to tidal volume [DeltaVab/(DeltaVab + DeltaVrc), where Vab is abdominal volume and Vrc is rib cage volume], which increased from 30.7 +/- 3. 5 (SE)% at 1 G head-to-foot acceleration to 58.3 +/- 5.7% at 0 G head-to-foot acceleration (P < 0.005). Values of DeltaVab/(DeltaVab + DeltaVrc) did not change significantly during the 180 days of the Euromir mission, but in the two subjects DeltaVab/(DeltaVab + DeltaVrc) was greater on postflight day 1 than on subsequent postflight days or preflight. In the two subjects who produced satisfactory relaxation maneuvers, the slope of the Konno-Mead plot decreased in microgravity; this decrease was entirely accounted for by an increase in abdominal compliance because rib cage compliance did not change. These alterations are similar to those previously reported during short periods of weightlessness inside aircrafts flying parabolic trajectories. They are also qualitatively similar to those observed on going from upright to supine posture; however, in contrast to microgravity, such postural change reduces rib cage compliance.

  11. Chest surgical disorders in ancient Egypt: evidence of advanced knowledge.

    PubMed

    Jungraithmayr, Wolfgang; Weder, Walter

    2012-03-01

    The ancient Egyptians laid the foundation for the development of the earliest recorded systems of medical treatment. Many specialties such as gynecology, neurosurgery, ophthalmology, and chest disorders were subject to diagnosis, which were followed by an appropriate treatment. Here, we elucidate the remarkable level of their knowledge and understanding of anatomy and physiology in the field of chest medicine. Furthermore, we look at how ancient Egyptian physicians came to a diagnosis and treatment based on the thoracic cases in the Edwin Smith papyrus.

  12. Role of Cross Sectional Imaging in Isolated Chest Wall Tuberculosis

    PubMed Central

    Sanyal, Shantiranjan; Sharma, Barun K.; Prakash, Arjun; Dhingani, Dhabal D.; Bora, Karobi

    2017-01-01

    Introduction Isolated chest wall tuberculosis though a rare entity, the incidence of it has been on rise among immunocompromised population making it an important challenging diagnosis for the physicians. Its clinical presentation may resemble pyogenic chest wall abscess or chest wall soft tissue tumour. Sometimes it is difficult to detect clinically or on plain radiograph. Aim The present study was conducted with an aim to evaluate the common sites and varying appearances of isolated chest wall tuberculosis. Materials and Methods A hospital based cross-sectional retrospective study was conducted in Assam Medical College and Hospital, a tertiary care centre in North East India. The study group comprise of 21 patients (n=15 male and n=6 females) with isolated chest wall tuberculosis without associated pulmonary or spinal involvement who were subjected to Computed Tomography/Magnetic Resonance Imaging (CT/MRI) of the thorax following initial Ultrasonogram (USG) evaluation of the local site. Pathological correlation was done from imaging guided sampling of the aspirate or surgery. Results Variable sites of involvement were seen in the chest wall in our patients (n=21), with chest wall abscess formation being the most common presentation and rib being the most common bony site affected in the thoracic cage. Bony sclerosis was noted in 11 patients (52.4%), periosteal reaction in 10 patients (47.6%) and sequestration in five patients (23.8%). CT/MRI not only localized the exact site and extent of the abscesses which facilitated guided aspirations, but also helped in detecting typical bony lesions thereby, differentiating from pyogenic osteomyelitis besides ruling out associated pulmonary or pleural involvement in such patients. Conclusion Cross-sectional imaging plays an important role by giving a wholesome picture of both soft tissue and bony pathology. It is important to have adequate understanding of the radiologic manifestations of the chest wall involvement and

  13. Cash's textbook of chest, heart and vascular disorders for physiotherapists

    SciTech Connect

    Downie, P.A.; Innocenti, D.M.; Jackson, S.E.

    1987-01-01

    This book includes a chapter on chest radiographs. A very high proportion of the patients treated by physiotherapy will have had a chest radiograph (x-ray) either because their primary disease is pulmonary or there is some long standing heart or lung illness which should be taken into account during the management of an acute problem. The chapter outlines the principles involved in reading the radiograph.

  14. Pulmonary embolism findings on chest radiographs and multislice spiral CT.

    PubMed

    Coche, Emmanuel; Verschuren, Franck; Hainaut, Philippe; Goncette, Louis

    2004-07-01

    Multislice spiral CT is becoming an increasingly important tool for diagnosing pulmonary embolism. However, in many instances, a chest radiograph is usually performed as a first-line examination. Many parenchymal, vascular, and other ancillary findings may be observed on both imaging modalities with a highly detailed depiction of abnormalities on multislice CT. A comprehensive review of chest radiograph findings is presented with side-by-side correlations of CT images reformatted mainly in the frontal plane.

  15. Chest Wall Dissemination of Nocardiosis after Percutaneous Transthoracic Needle Biopsy

    SciTech Connect

    Shimamoto, Hiroshi Inaba, Yoshitaka; Yamaura, Hidekazu; Sato, Yozo; Kamiya, Mika; Miyazaki, Masaya; Arai, Yasuaki; Horio, Yoshitsugu

    2007-07-15

    We described a case of chest wall dissemination after percutaneous transthoracic needle biopsy. A 65-year-old man had a lung nodule which was suspected to be lung carcinoma. He underwent percutaneous transthoracic needle biopsy using an 18G semiautomated biopsy needle and pathologic diagnosis showed organizing pneumonia. Two months after the biopsy, chest wall dissemination occurred. Implantation of carcinoma along the biopsy route was suspected, but the mass was actually due to pulmonary nocardiosis.

  16. Outpatient Management of Postbiopsy Pneumothorax with Small-Caliber Chest Tubes: Factors Affecting the Need for Prolonged Drainage and Additional Interventions

    SciTech Connect

    Gupta, Sanjay Hicks, Marshall E.; Wallace, Michael J.; Ahrar, Kamran; Madoff, David C.; Murthy, Ravi

    2008-03-15

    The aim of this study was to evaluate the efficacy of outpatient management of postbiopsy pneumothoraces with small-caliber chest tubes and to assess the factors that influence the need for prolonged drainage or additional interventions.We evaluated the medical records of patients who were treated with small-caliber chest tubes attached to Heimlich valves for pneumothoraces resulting from image-guided transthoracic needle biopsy to determine the hospital admission rates, the number of days the catheters were left in place, and the need for further interventions. We also evaluated the patient, lesion, and biopsy technique characteristics to determine their influence on the need for prolonged catheter drainage or additional interventions. Of the 191 patients included in our study, 178 (93.2%) were treated as outpatients. Ten patients (5.2%) were admitted for chest tube-related problems, either for underwater suction (n = 8) or for pain control (n = 2). No further interventions were required in 146 patients (76.4%), with successful removal of the chest tubes the day after the biopsy procedure. Prolonged catheter drainage (mean, 4.3 days) was required in 44 patients (23%). Nineteen patients (9.9%) underwent additional interventions for management of pneumothorax. Presence of emphysema was noted more frequently in patients who required additional interventions or prolonged chest tube drainage than in those who did not (51.1% vs. 24.7%; p = 0.001).We conclude that use of the Heimlich valve allows safe and successful outpatient treatment of most patients requiring chest tube placement for postbiopsy pneumothorax. Additional interventions or prolonged chest tube drainage are needed more frequently in patients with emphysema in the needle path.

  17. A case report on a full-thickness chest wall reconstruction with polypropylene mesh and stainless steel mesh concurrently using a transverse rectus abdominis myocutaneous flap.

    PubMed

    Yoshino, Naoyuki; Yamauchi, Shigeo; Akimoto, Masataka; Hisayoshi, Takao; Koizumi, Kiyoshi; Shimizu, Kazuo

    2006-12-01

    A full-thickness chest wall resection requires subsequent chest wall reconstruction. A chest wall resection and reconstruction was performed using a transverse rectus abdominis myocutaneous (TRAM) flap, together with polypropylene mesh (Marlex mesh) and stainless steel mesh (SSM). A 71-year-old man was diagnosed as having recurrent lung cancer in the chest wall, and underwent surgical resection. Marlex mesh was sutured to the posterior wall of the surgical defect. A portion of the SSM was adjusted to the size of the defect and cut out. Its edges were folded to make the portion into a plate. This SSM plate was placed anteriorly to the Marlex mesh and sutured to the ribs. The Marlex mesh was folded back on the SSM plate by 2 cm and fixed. After the above procedures, a left-sided TRAM flap was raised through a subcutaneous tunnel up to the defect and sutured to the region. The patient was discharged from hospital 19 days postoperatively. The wound was fine and he had no flail chest or dyspnea, and carcinomatous pain resolved.

  18. Chest wall segmentation in automated 3D breast ultrasound scans.

    PubMed

    Tan, Tao; Platel, Bram; Mann, Ritse M; Huisman, Henkjan; Karssemeijer, Nico

    2013-12-01

    In this paper, we present an automatic method to segment the chest wall in automated 3D breast ultrasound images. Determining the location of the chest wall in automated 3D breast ultrasound images is necessary in computer-aided detection systems to remove automatically detected cancer candidates beyond the chest wall and it can be of great help for inter- and intra-modal image registration. We show that the visible part of the chest wall in an automated 3D breast ultrasound image can be accurately modeled by a cylinder. We fit the surface of our cylinder model to a set of automatically detected rib-surface points. The detection of the rib-surface points is done by a classifier using features representing local image intensity patterns and presence of rib shadows. Due to attenuation of the ultrasound signal, a clear shadow is visible behind the ribs. Evaluation of our segmentation method is done by computing the distance of manually annotated rib points to the surface of the automatically detected chest wall. We examined the performance on images obtained with the two most common 3D breast ultrasound devices in the market. In a dataset of 142 images, the average mean distance of the annotated points to the segmented chest wall was 5.59 ± 3.08 mm.

  19. Evaluation of a Noise Reduction Procedure for Chest Radiography

    PubMed Central

    Fukui, Ryohei; Ishii, Rie; Kodani, Kazuhiko; Kanasaki, Yoshiko; Suyama, Hisashi; Watanabe, Masanari; Nakamoto, Masaki; Fukuoka, Yasushi

    2013-01-01

    Background The aim of this study was to evaluate the usefulness of noise reduction procedure (NRP), a function in the new image processing for chest radiography. Methods A CXDI-50G Portable Digital Radiography System (Canon) was used for X-ray detection. Image noise was analyzed with a noise power spectrum (NPS) and a burger phantom was used for evaluation of density resolution. The usefulness of NRP was evaluated by chest phantom images and clinical chest radiography. We employed the Bureau of Radiological Health Method for scoring chest images while carrying out our observations. Results NPS through the use of NRP was improved compared with conventional image processing (CIP). The results in image quality showed high-density resolution through the use of NRP, so that chest radiography examination can be performed with a low dose of radiation. Scores were significantly higher than for CIP. Conclusion In this study, use of NRP led to a high evaluation in these so we are able to confirm the usefulness of NRP for clinical chest radiography. PMID:24574577

  20. Patient doses and image quality in digital chest radiology.

    PubMed

    Salát, D; Nikodemová, D

    2008-01-01

    Chest X-ray examination is one of the most frequently required procedures used in clinical practice. For studying the image quality of different X-ray digital systems and for the control of patient doses during chest radiological examinations, the standard anthropomorphic lung/chest phantom RSD 330 has been used and exposed in different digital modalities available in Slovakia. To compare different techniques of chest examination, a special software has been developed that enables researchers to compare digital imaging and communications in medicine header images from different digital modalities, using a special viewer. In this paper, this special software has been used for an anonymous correspondent audit for testing image quality evaluation by comparing various parameters of chest imaging, evaluated by 84 Slovak radiologists. The results of the comparison have shown that the majority of the participating radiologists felt that the highest image quality is reached with a flat panel, assessed by the entrance surface dose value, which is approximately 75% lower than the diagnostic reference level of chest examination given in the Slovak legislation. Besides the results of the audit, the possibilities of using the software for optimisation, education and training of medical students, radiological assistants, physicists and radiologists in the field of digital radiology will be described.

  1. Selective management of flail chest and pulmonary contusion.

    PubMed

    Richardson, J D; Adams, L; Flint, L M

    1982-10-01

    Four hundred and twenty-seven patients with severe blunt chest trauma were treated resulting in (1) flail chest, (2) pulmonary contusions, (3) pneumothorax, (4) hemothorax, or (5) multiple rib fracture. The need for endotracheal intubation and mechanical ventilation was determined selectively by standard clinical criteria. Avoidance of fluid overload and vigorous pulmonary toilet was attempted in all patients. Three hundred and twenty-eight patients were treated by nonintubation; 318 patients (96.6%) had a successful outcome, while ten required intubation. Only one patient died. The 99 patients who required intubation and mechanical ventilation had a high mortality because of associated shock and head injury; however, the total mortality for the entire group of patients was 6.5%, with only 1.4% mortality caused by pulmonary injury. The incidence of pneumonia was high (51%), but there was only a 4% incidence of tracheostomy complications. Flail chest and pulmonary contusion without flail chest occurred in 95 and 135 patients, respectively. Half of the flail chest patients were intubated, but 69.5% were intubated less than three days. Twenty per cent of the patients with pulmonary contusion required mechanical ventilation, usually for less than three days. This study demonstrates that patients with severe blunt chest trauma can be managed safely by selective intubation and mechanical, ventilation and that the incidence of complications associated with controlled mechanical ventilation can be greatly reduced.

  2. Mobile devices as adjunctive pain management tools.

    PubMed

    Wiederhold, Brenda K; Gao, Kenneth; Kong, Lingjun; Wiederhold, Mark D

    2014-06-01

    Approximately 108 million people in North America and Europe suffer from chronic pain. Virtual reality (VR) is a promising method for pain management in a clinical setting due to the distracting properties of an immersive virtual environment. In this study, we demonstrated the potential use of mobile phones as a means of delivering an easily accessible, immersive experience. Thirty-one patients tested VR pain distraction. Objective measurements of heart rate correlated to decreased anxiety, while, subjectively, patients also reported reduced levels of discomfort. The positive results of this study indicate that mobile phones can provide an immersive experience sufficient to deliver pain management distraction. Because mobile devices are widely available, the potential for developing pain management programs that are accessible has become a realistic possibility.

  3. Myofascial pain from pectoralis major following trans-axillary surgery.

    PubMed

    Cummings, Mike

    2003-09-01

    This is the first reported description, to the author's knowledge, of myofascial pain occurring at a surgical drain site. The patient consulted a medical acupuncturist after suffering five months of continuous chest and arm pain associated with 'tingling' in the forearm and hand. She had undergone trans-axillary resection of the first left rib following a left axillary vein thrombosis 18 months previously. Her symptoms had been principally attributed to nerve traction at surgery or nerve root entrapment from scar tissue. However, the drain passed through the free border of pectoralis major, and the myofascial trigger point that appeared to develop as a result of the muscle trauma, or the pain at that site, presented as a chronic and complex post-surgical pain problem. The pain and tingling resolved completely after two sessions of dry needling at a single myofascial trigger point in the free border of the left pectoralis major muscle.

  4. Arteriovenous Access

    PubMed Central

    MacRae, Jennifer M.; Dipchand, Christine; Oliver, Matthew; Moist, Louise; Yilmaz, Serdar; Lok, Charmaine; Leung, Kelvin; Clark, Edward; Hiremath, Swapnil; Kappel, Joanne; Kiaii, Mercedeh; Luscombe, Rick; Miller, Lisa M.

    2016-01-01

    Complications of vascular access lead to morbidity and may reduce quality of life. In this module, we review both infectious and noninfectious arteriovenous access complications including neuropathy, aneurysm, and high-output access. For the challenging patients who have developed many complications and are now nearing their last vascular access, we highlight some potentially novel approaches. PMID:28270919

  5. Pulmonary artery location during microgravity activity: Potential impact for chest-mounted Doppler during space travel

    NASA Technical Reports Server (NTRS)

    Hadley, A. T., III; Conkin, J.; Waligora, J. M.; Horrigan, D. J., Jr.

    1984-01-01

    Doppler, or ultrasonic, monitoring for pain manifestations of decompression sickness (the bends) is accomplished by placing a sensor on the chest over the pulmonary artery and listening for bubbles. Difficulties have arisen because the technician notes that the pulmonary artery seems to move with subject movement in a one-g field and because the sensor output is influenced by only slight degrees of sensor movement. This study used two subjects and mapped the position of the pulmonary artery in one-g, microgravity, and two-g environments using ultrasound. The results showed that the pulmonary artery is fixed in location in microgravity and not affected by subject position change. The optimal position corresponded to where the Doppler signal is best heard with the subject in a supine position in a one-g environment. The impact of this result is that a proposed multiple sensor array on the chest proposed for microgravity use may not be necessary to monitor an astronaut during extravehicular activities. Instead, a single sensor of approximately 1 inch diameter and mounted in the position described above may suffice.

  6. Abdominal Pain

    MedlinePlus

    ... call your doctor. In Spanish— Dolor abdominal en niños menores de 12 años What is recurrent abdominal ... Functional abdominal pain (FAP) typically affects kids ages 4-12, and is quite common, affecting up to ...

  7. [Elbow pain].

    PubMed

    Viikari-Juntura, Eira; Miintyselkii, Pekka; Havulinna, Jouni

    2010-01-01

    Pain and disability in the elbow are not as common as in the neck, shoulder or wrist, for example. The elbow may, however, present disorders that may in a prolonged state be difficult and cause significant loss of working capacity. These include epicondylitis, osteoarthritis and entrapment of the ulnar nerve.

  8. Achilles Pain.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…

  9. The prevalence and management of pain in patients with AIDS: a review of 134 cases.

    PubMed

    Lebovits, A H; Lefkowitz, M; McCarthy, D; Simon, R; Wilpon, H; Jung, R; Fried, E

    1989-09-01

    In light of the lack of any prior systematic evaluations of the prevalence and types of pain syndromes and treatments found in patients with AIDS, a chart review study was undertaken to evaluate this issue. Fifty-two of 96 charts reviewed (54%) had at least one note on nonprocedural pain or analgesic prescription. Although chest pain was the most prevalent pain location (22%), presumably because of the high incidence of Pneumocystis carinii pneumonia, other possible AIDS-related entities, such as peripheral neuropathy and thrombophlebitis, were also found. No specific AIDS syndromes could be identified that were related to a higher incidence of pain. Nearly one-third of patients with pain received codeine (31%), others received acetaminophen (27%), and 17% of patients received acetaminophen and oxycodone HCl. Specific pain management interventions must be evaluated and applied to control the nontrivial occurrence of pain in patients who have AIDS symptoms that may be overlooked by the physician given the overwhelming disease process.

  10. 42 CFR 37.60 - Submitting required chest radiograph classification and miner identification documents.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Submitting required chest radiograph classification... OF COAL MINERS Chest Radiographic Examinations Specifications for Interpretation, Classification, and Submission of Chest Radiographs § 37.60 Submitting required chest radiograph classification and...

  11. Employees with Chronic Pain

    MedlinePlus

    ... Home | Accommodation and Compliance Series: Employees with Chronic Pain By Beth Loy, Ph.D. Preface Introduction Information ... at http://AskJAN.org/soar. Information about Chronic Pain How prevalent is chronic pain? Chronic pain has ...

  12. Complex Regional Pain Syndrome

    MedlinePlus

    Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. ... in skin temperature, color, or texture Intense burning pain Extreme skin sensitivity Swelling and stiffness in affected ...

  13. When Sex Is Painful

    MedlinePlus

    ... AQ FREQUENTLY ASKED QUESTIONS GYNECOLOGIC PROBLEMS FAQ020 When Sex Is Painful • How common is painful sex? • What causes pain during sex? • Where is pain during sex felt? • When should ...

  14. Biopsychosocial Approach to Assessing and Managing Patients with Chronic Pain.

    PubMed

    Cheatle, Martin D

    2016-01-01

    Chronic pain affects nearly one-third of the American population. Chronic pain can lead to a variety of problems for a pain sufferer, including developing secondary medical problems, depression, functional and vocational disability, opioid abuse and suicide. Current pain care models are deficient in providing a necessary comprehensive approach. Most patients with chronic pain are managed by primary care clinicians who are typically ill prepared to effectively and efficiently manage these cases. A biopsychosocial approach to evaluate and treat chronic pain is clinically and economically efficacious, but unique delivery systems are required to meet the challenge of access to specialty care.

  15. Noninvasive and Nonocclusive Blood Pressure Estimation Via a Chest Sensor.

    PubMed

    Solà, Josep; Proença, Martin; Ferrario, Damien; Porchet, Jacques-André; Falhi, Abdessamad; Grossenbacher, Olivier; Allemann, Yves; Rimoldi, Stefano F; Sartori, Claudio

    2013-12-01

    The clinical demand for a device to monitor blood pressure (BP) in ambulatory scenarios with minimal use of inflation cuffs is increasing. Based on the so-called pulse wave velocity (PWV) principle, this paper introduces and evaluates a novel concept of BP monitor that can be fully integrated within a chest sensor. After a preliminary calibration, the sensor provides nonocclusive beat-by-beat estimations of mean arterial pressure (MAP) by measuring the pulse transit time (PTT) of arterial pressure pulses travelling from the ascending aorta toward the subcutaneous vasculature of the chest. In a cohort of 15 healthy male subjects, a total of 462 simultaneous readings consisting of reference MAP and chest PTT were acquired. Each subject was recorded at three different days: D, D+3, and D+14. Overall, the implemented protocol induced MAP values to range from 80 ± 6 mmHg in baseline, to 107 ± 9 mmHg during isometric handgrip maneuvers. Agreement between reference and chest-sensor MAP values was tested by using intraclass correlation coefficient (ICC = 0.78) and Bland-Altman analysis (mean error = 0.7 mmHg, standard deviation = 5.1 mmHg). The cumulative percentage of MAP values provided by the chest sensor falling within a range of ±5 mmHg compared to reference MAP readings was of 70%, within ±10 mmHg was of 91%, and within ±15 mmHg was of 98%. These results point at the fact that the chest sensor complies with the British Hypertension Society requirements of Grade A BP monitors, when applied to MAP readings. Grade A performance was maintained even two weeks after having performed the initial subject-dependent calibration. In conclusion, this paper introduces a sensor and a calibration strategy to perform MAP measurements at the chest. The encouraging performance of the presented technique paves the way toward an ambulatory compliant, continuous, and nonocclusive BP monitoring system.

  16. Neck pain

    PubMed Central

    2008-01-01

    Introduction Non-specific neck pain has a postural or mechanical basis and affects about two thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration–deceleration of the neck, such as in road traffic or sporting accidents. Up to 40% of people continue to report symptoms 15 years after the accident, although this varies between countries. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for people with non-specific neck pain without severe neurological deficit? What are the effects of treatments for acute whiplash injury? What are the effects of treatments for chronic whiplash injury? What are the effects of treatments for neck pain with radiculopathy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of the evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, biofeedback, drug treatments (analgesics, antidepressants, epidural steroid injections, muscle relaxants, non-steroidal anti-inflammatory drugs [NSAIDs]), early mobilisation, early return to normal activity, exercise, heat or cold, manipulation (alone or plus exercise), mobilisation, multimodal treatment, patient education, percutaneous radiofrequency neurotomy

  17. Chest Wall Toxicity After Stereotactic Body Radiotherapy for Malignant Lesions of the Lung and Liver

    SciTech Connect

    Andolino, David L.; Forquer, Jeffrey A.; Henderson, Mark A.; Barriger, Robert B.; Shapiro, Ronald H.; Brabham, Jeffrey G.; Johnstone, Peter A.S.; Cardenes, Higinia R.; Fakiris, Achilles J.

    2011-07-01

    Purpose: To quantify the frequency of rib fracture and chest wall (CW) pain and identify the dose-volume parameters that predict CW toxicity after stereotactic body radiotherapy (SBRT). Methods and Materials: The records of patients treated with SBRT between 2000 and 2008 were reviewed, and toxicity was scored according to Common Terminology Criteria for Adverse Events v3.0 for pain and rib fracture. Dosimetric data for CW and rib were analyzed and related to the frequency of toxicity. The risks of CW toxicity were then further characterized according to the median effective concentration (EC{sub 50}) dose-response model. Results: A total of 347 lesions were treated with a median follow-up of 19 months. Frequency of Grade I and higher CW pain and/or fracture for CW vs. non-CW lesions was 21% vs. 4%, respectively (p < 0.0001). A dose of 50 Gy was the cutoff for maximum dose (Dmax) to CW and rib above which there was a significant increase in the frequency of any grade pain and fracture (p = 0.03 and p = 0.025, respectively). Volume of CW receiving 15 Gy - 40 Gy was highly predictive of toxicity (R{sup 2} > 0.9). According to the EC{sub 50} model, 5 cc and 15 cc of CW receiving 40 Gy predict a 10% and 30% risk of CW toxicity, respectively. Conclusion: Adequate tumor coverage remains the primary objective when treating lung or liver lesions with SBRT. To minimize toxicity when treating lesions in close proximity to the CW, Dmax of the CW and/or ribs should remain <50 Gy, and <5 cc of CW should receive {>=}40 Gy.

  18. A Small Randomized Controlled Pilot Trial Comparing Mobile and Traditional Pain Coping Skills Training Protocols for Cancer Patients with Pain

    PubMed Central

    Westbrook, Kelly W.; Kimmick, Gretchen G.; Shelby, Rebecca A.; Abernethy, Amy P.; Keefe, Francis J.

    2016-01-01

    Psychosocial pain management interventions are efficacious for cancer pain but are underutilized. Recent advances in mobile health (mHealth) technologies provide new opportunities to decrease barriers to access psychosocial pain management interventions. The objective of this study was to gain information about the accessibility and efficacy of mobile pain coping skills training (mPCST) intervention delivered to cancer patients with pain compared to traditional in-person pain coping skills training intervention. This study randomly assigned participants (N = 30) to receive either mobile health pain coping skills training intervention delivered via Skype or traditional pain coping skills training delivered face-to-face (PCST-trad). This pilot trial suggests that mPCST is feasible, presents low burden to patients, may lead to high patient engagement, and appears to be acceptable to patients. Cancer patients with pain in the mPCST group reported decreases in pain severity and physical symptoms as well as increases in self-efficacy for pain management that were comparable to changes in the PCST-trad group (p's < 0.05). These findings suggest that mPCST, which is a highly accessible intervention, may provide benefits similar to an in-person intervention and shows promise for being feasible, acceptable, and engaging to cancer patients with pain. PMID:27891252

  19. Effect of the chest wall on breast lesion reconstruction

    PubMed Central

    Ardeshirpour, Yasaman; Huang, Minming; Zhu, Quing

    2009-01-01

    The chest wall underneath the breast tissue affects near-infrared (NIR) diffusive waves measured with reflection geometry. With the assistance of a co-registered ultrasound, the depth and the tilting angle of the chest wall can be determined and are used to model the breast as a two-layer medium. Finite element method (FEM) is suitable for modeling complex boundary conditions and is adapted to model the breast tissue and chest wall. Four parameters of bulk absorption and reduced scattering coefficients of these two layers are estimated and used for imaging reconstruction. Using a two-layer model, we have systematically investigated the effect of the chest wall on breast lesion reconstruction. Results have shown that chest-wall depth, titling angle, and difference between optical properties of two layers of lesion and reference sites affect the lesion reconstruction differently. Our analysis will be valuable and informative to researchers who are using reflectance geometry for breast imaging. The analysis can also provide guidelines for imaging operators to minimize image artifacts and to produce the best reconstruction results. PMID:19725717

  20. Computer-assisted diagnosis of chest radiographs for pneumoconioses

    NASA Astrophysics Data System (ADS)

    Soliz, Peter; Pattichis, Marios S.; Ramachandran, Janakiramanan; James, David S.

    2001-07-01

    A Computer-assisted Chest Radiograph Reader System (CARRS) was developed for the detection of pathological features in lungs presenting with pneumoconioses. CARRS applies novel techniques in automatic image segmentation, incorporates neural network-based pattern classification, and integrates these into a graphical user interface. The three aspects of CARRS are described: Chest radiograph digitization and display, rib and parenchyma characterization, and classification. The quantization of the chest radiograph film was optimized to maximize the information content of the digital images. Entropy was used as the benchmark for optimizing the quantization. From the rib-segmented images, regions of interest were selected by the pulmonologist. A feature vector composed of image characteristics such as entropy, textural statistics, etc. was calculated. A laterally primed adaptive resonance theory (LAPART) neural network was used as the classifier. LAPART classification accuracy averaged 86.8 %. Truth was determined by the two pulmonologists. The CARRS has demonstrated potential as a screening device. Today, 90% or more of the chest radiographs seen by the pulmonologist are normal. A computer-based system that can screen 50% or more of the chest radiographs represents a large savings in time and dollars.

  1. Factors influencing quality of chest compression depth in nursing students.

    PubMed

    Roh, Young Sook; Lim, Eun Ju

    2013-12-01

    The purpose of the study was to identify factors influencing quality of chest compression depth in nursing students. A convenience sample of 102 female nursing students enrolled in a cardiopulmonary resuscitation skills training session. Each student performed 3 min of chest compression skills on a Resusci Anne SkillReporter manikin for measurements of both depth and rate. Nursing students with correct compression depth (50-60 mm) had higher body weight (t = -2.02, P = 0.046) and body mass index (t = -2.19, P = 0.031) compared with students in the incorrect depth group. Mean chest compression depth was shallower in underweight nursing students compared with normal weight or overweight students (F = 8.89, P < 0.001). Body weight was a significant factor influencing quality of chest compression depth (F = 4.25, P = 0.003). Educational intervention targeting underweight nursing students might need to enhance the quality of chest compression skills.

  2. Factors Associated with ICU Admission following Blunt Chest Trauma

    PubMed Central

    Etteri, Massimiliano; Cantaluppi, Francesca; Pina, Paolo; Guanziroli, Massimo; Bianchi, AnnaMaria; Casazza, Giovanni

    2016-01-01

    Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF) and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1%) were admitted to intensive care unit (ICU) within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p = 0.0018) and the severity of trauma score (p < 0.0002) were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure. PMID:28044070

  3. Pain Management: Post-Amputation Pain

    MedlinePlus

    Pain Management Post-Amputation Pain Volume 8 · Issue 2 · March/April 1998 Text size Larger text Smaller text Java Required Print page Save and share ... by G. Edward Jeffries, MD, FACS Post-Amputation Pain Post-amputation pain is one of the most ...

  4. A Pain Research Agenda for the 21st Century

    PubMed Central

    Gereau, Robert W.; Sluka, Kathleen A.; Maixner, William; Savage, Seddon R.; Price, Theodore J.; Murinson, Beth B.; Sullivan, Mark D.; Fillingim, Roger B.

    2015-01-01

    Chronic pain represents an immense clinical problem. With tens of millions of people in the United States alone suffering from the burden of debilitating chronic pain, there is a moral obligation to reduce this burden by improving the understanding of pain and treatment mechanisms, developing new therapies, optimizing and testing existing therapies, and improving access to evidence-based pain care. Here, we present a goal-oriented research agenda describing the American Pain Society’s vision for pain research aimed at tackling the most pressing issues in the field. Perspective This article presents the American Pain Society’s view of some of the most important research questions that need to be addressed to advance pain science and to improve care of patients with chronic pain. PMID:25419990

  5. Delayed pneumothorax after central venous access: a potential hazard.

    PubMed

    Tyburski, J G; Joseph, A L; Thomas, G A; Saxe, J M; Lucas, C E

    1993-09-01

    Percutaneous central venous catheter access is common-place in surgical patients. Though several major complications of this procedure have been described, pneumothorax is the most common. Pneumothorax is routinely assessed by a chest X-ray within 2 hours after catheter placement. During a recent 6-month interval, the authors identified five patients with delayed onset and diagnosis of pneumothorax following percutaneous central venous access. All immediate post-insertion chest X-rays were normal; however, subsequent chest X-ray showed evidence of pneumothoraxes. The pneumothorax contributed to the death of one patient on positive pressure ventilation. A review of the literature revealed a total of 18 patients in the English literature with this complication. Although the incidence of delayed pneumothorax is low, it is, in some instances, life threatening, particularly in patients on positive pressure ventilation. A high index of suspicion is required to diagnosis and treat this reversible condition.

  6. Undertreatment of caner pain.

    PubMed

    Wang, Cheng-Hsu; Lee, Shiu-Yu C

    2015-06-01

    Pain is a burdensome symptom that can commonly exist chronically along the cancer trajectory. Uncontrolled pain will impact on cancer patients' quality of life, even further negatively affect cancer survivors' employment. Based on systemic reviews of studies for past 10 years, the paper reported that although there is enormous advancement on the knowledge of cancer pain and pain management, studies still documented undertreatment of cancer pain globally. Additionally, pain distress a significant portion of cancer survivors. The pain in cancer survivors distinct from the pain related with cancer, instead emphasize on pain related with cancer treatment, such as neuropathic pain, muscular syndrome. Evidence-based pain management with common pain problems in cancer survivors is lacking. Further studies are needed to understand the pain in cancer survivors and to develop effective strategies in helping cancer survivors to manage their pain.

  7. Measuring pain in the context of homelessness

    PubMed Central

    Matter, Rebecca; Kline, Susan; Cook, Karon F.; Amtmann, Dagmar

    2009-01-01

    Purpose The primary objective of this study was to inform the development of measures of pain impact appropriate for all respondents, including homeless individuals, so that they can be used in clinical research and practice. The secondary objective was to increase understanding about the unique experience of homeless people with pain. Methods Seventeen homeless individuals with chronic health conditions (often associated with pain) participated in cognitive interviews to test the functioning of 56 pain measurement items and provided information about their experience living with and accessing treatment for pain. Results The most common problems identified with items were that they lacked clarity or were irrelevant in the context of homelessness. Items that were unclear, irrelevant and/or had other identified problems made it difficult for participants to respond. Participants also described multiple ways in which their pain was exacerbated by conditions of homelessness and identified barriers to accessing appropriate treatment. Conclusions Results suggested that the majority of items were problematic for the homeless and require substantial modifications to make the pain impact bank relevant to this population. Additional recommendations include involving homeless in future item bank development, conducting research on the topic of pain and homelessness, and using cognitive interviewing in other types of health disparities research. PMID:19582592

  8. Ventilation distribution and chest wall mechanics in microgravity

    NASA Technical Reports Server (NTRS)

    Paiva, M.; Wantier, M.; Verbanck, S.; Engel, L. A.; Prisk, G. K.; Guy, H. J. B.; West, J. B.

    1997-01-01

    The effect of gravity on lung ventilation distribution and the mechanisms of the chest wall were investigated. The following tests were performed with the respiratory monitoring system of the Anthorack, flown onboard Spacelab D2 mission: single breath washout (SBW), multiple breath washout (MBW) and argon rebreathing (ARB). In order to study chest wall mechanisms in microgravity, a respiratory inductive plethysmograph was used. The SBW tests did not reach statistical significance, while the ARB tests showed that gravity independent inhomogeneity of specific ventilation is larger than gravity dependent inhomogeneity. In which concerns the chest wall mechanisms, the analysis on the four astronauts during the normal respirations of the relaxation maneuver showed a 40 percent increase on the abdominal contribution to respiration.

  9. The futility of universal pre-employment chest radiographs.

    PubMed Central

    Lohiya, Ghan-Shyam; Tan-Figueroa, Lilia; Lohiya, Piyush; Bui, De

    2006-01-01

    In a developmental center, a preemployment chest x-ray was required for all job applicants. We scrutinized the pros and cons of this practice through a review of the medical literature and our experience, and discussion with our colleagues. We concluded that such chest x-ray caused unwarranted radiation exposure, did not produce compliance with the tuberculosis laws, gave a false sense of security regarding workers' compensation risk management, was contrary to established occupational medicine practice guidelines, and was unnecessary and wasteful. We discontinued such chest x-rays. The purpose of the pre-employment examination should remain narrowly job related. Even long-established procedures require periodic utilization review. PMID:17225852

  10. Lung nodules detection in chest radiography: image components analysis

    NASA Astrophysics Data System (ADS)

    Luo, Tao; Mou, Xuanqin; Yang, Ying; Yan, Hao

    2009-02-01

    We aimed to evaluate the effect of different components of chest image on performances of both human observer and channelized Fisher-Hotelling model (CFH) in nodule detection task. Irrelevant and relevant components were separated from clinical chest radiography by employing Principal Component Analysis (PCA) methods. Human observer performance was evaluated in two-alternative forced-choice (2AFC) on original clinical images and anatomical structure only images obtained by PCA methods. Channelized Fisher-Hotelling model with Laguerre-Gauss basis function was evaluated to predict human performance. We show that relevant component is the primary factor influencing on nodule detection in chest radiography. There is obvious difference of detectability between human observer and CFH model for nodule detection in images only containing anatomical structure. CFH model should be used more carefully.

  11. System for definition of the central-chest vasculature

    NASA Astrophysics Data System (ADS)

    Taeprasartsit, Pinyo; Higgins, William E.

    2009-02-01

    Accurate definition of the central-chest vasculature from three-dimensional (3D) multi-detector CT (MDCT) images is important for pulmonary applications. For instance, the aorta and pulmonary artery help in automatic definition of the Mountain lymph-node stations for lung-cancer staging. This work presents a system for defining major vascular structures in the central chest. The system provides automatic methods for extracting the aorta and pulmonary artery and semi-automatic methods for extracting the other major central chest arteries/veins, such as the superior vena cava and azygos vein. Automatic aorta and pulmonary artery extraction are performed by model fitting and selection. The system also extracts certain vascular structure information to validate outputs. A semi-automatic method extracts vasculature by finding the medial axes between provided important sites. Results of the system are applied to lymph-node station definition and guidance of bronchoscopic biopsy.

  12. Mechanical chest compression: an alternative in helicopter emergency medical services?

    PubMed

    Gässler, Holger; Kümmerle, Simone; Ventzke, Marc-Michael; Lampl, Lorenz; Helm, Matthias

    2015-09-01

    Mechanical chest compression devices are mentioned in the current guidelines of the European Resuscitation Council (ERC) as an alternative in long-lasting cardiopulmonary resuscitations (CPR) or during transport with ongoing CPR. We compared manual chest compression with mechanical devices in a rescue-helicopter-based scenario using a resuscitation manikin. Manual chest compression was compared with the mechanical devices LUCAS™ 2, AutoPulse™ and animax mono (10 series each) using the resuscitation manikin AmbuMan MegaCode Wireless, which was intubated endotracheally and controlled ventilated during the entire scenario. The scenario comprised the installation of each device, transport and loading phases, as well as a 10-min phase inside the helicopter (type BK 117). We investigated practicability as well as measured compression quality. All mechanical devices could be used readily in a BK 117 helicopter. The LUCAS 2 group was the only one that fulfilled all recommendations of the ERC (frequency 102 ± 0.1 min(-1), compression depth 54 ± 3 mm, hands-off time 2.5 ± 1.6 %). Performing adequate manual chest compression was barely possible (fraction of correct compressions 21 ± 15 %). In all four groups, the total hands-off time was <10 %. Performing manual chest compressions during rescue-helicopter transport is barely possible, and only of poor quality. If rescuers are experienced, mechanical chest compression devices could be good alternatives in this situation. We found that the LUCAS 2 system complied with all recommendations of ERC guidelines, and all three tested devices worked consistently during the entire scenario.

  13. Mechanically induced sudden death in chest wall impact (commotio cordis).

    PubMed

    Link, Mark S

    2003-01-01

    Sudden death due to nonpenetrating chest wall impact in the absence of injury to the ribs, sternum and heart is known as commotio cordis. Although once thought rare, an increasing number of these events have been reported. Indeed, a significant percentage of deaths on the athletic field are due to chest wall impact. Commotio cordis is most frequently observed in young individuals (age 4-18 years), but may also occur in adults. Sudden death is instantaneous or preceded by several seconds of lightheadedness after the chest wall blow. Victims are most often found in ventricular fibrillation, and successful resuscitation is more difficult than expected given the young age, excellent health of the victims, and the absence of structural heart disease. Autopsy examination is notable for the lack of any significant cardiac or thoracic abnormalities. In an experimental model of commotio cordis utilizing anesthetized juvenile swine, ventricular fibrillation can be produced by a 30 mph baseball strike if the strike occurred during the vulnerable period of repolarization, on the upslope of the T-wave. Energy of the impact object was also found to be a critical variable with 40 mph baseballs more likely to cause ventricular fibrillation than velocities less or greater than 40 mph. In addition, more rigid impact objects and blows directly over the center of the chest were more likely to cause ventricular fibrillation. Peak left ventricular pressure generated by the chest wall blow correlated with the risk of ventricular fibrillation. Activation of the K(+)(ATP) channel is a likely cause of the ventricular fibrillation produced by chest wall blows. Successful resuscitation is attainable with early defibrillation.

  14. Tube Thoracostomy (Chest Tube) Removal in Traumatic Patients: What Do We Know? What Can We Do?

    PubMed Central

    Paydar, Shahram; Ghahramani, Zahra; Ghoddusi Johari, Hamed; Khezri, Samad; Ziaeian, Bizhan; Ghayyoumi, Mohammad Ali; Fallahi, Mohammad Javad; Niakan, Mohammad Hadi; Sabetian, Golnar; Abbasi, Hamid Reza; Bolandparvaz, Shahram

    2015-01-01

    Chest tube (CT) or tube thoracostomy placement is often indicated following traumatic injuries. Premature movement of the chest tube leads to increased hospital complications and costs for patients. Placement of a chest tube is indicated in drainage of blood, bile, pus, drain air, and other fluids. Although there is a general agreement for the placement of a chest tube, there is little consensus on the subsequent management. Chest tube removal in trauma patients increases morbidity and hospital expense if not done at the right time. A review of relevant literature showed that the best answers to some questions about time and decision-making have been long sought. Issues discussed in this manuscript include chest tube removal conditions, the need for chest radiography before and after chest tuberemoval, the need to clamp the chest tube prior to removal, and drainage rate and acceptability prior to removal. PMID:27162900

  15. Definitions and Types of Pain

    MedlinePlus

    ... Therapy Pain Management Recommendations References April 15, 2017 Definitions and Types of Pain Defining Pain Pain is ... there are many mechanisms involved in nociception. More definitions ... Classifying Pain Pain can be "acute" or "chronic." ...

  16. Web Accessibility and Accessibility Instruction

    ERIC Educational Resources Information Center

    Green, Ravonne A.; Huprich, Julia

    2009-01-01

    Section 508 of the Americans with Disabilities Act (ADA) mandates that programs and services be accessible to people with disabilities. While schools of library and information science (SLIS*) and university libraries should model accessible Web sites, this may not be the case. This article examines previous studies about the Web accessibility of…

  17. Do all Critical Aortic Stenosis with Chest Pain Need Aortic Valve Replacement? A Case Report

    PubMed Central

    Sharma, Munish; Mascarenhas, Daniel A.N.

    2016-01-01

    Aortic valve replacement (AVR) remains the cornerstone of treatment for symptomatic critical aortic stenosis (AS). It is a Class I indication that symptomatic patients with critical AS undergo either surgical or transcatheter aortic valve replacement (TAVR). We present a patient with critical AS and new angina that was managed successfully with percutaneous coronary intervention (PCI) of the Right coronary artery. Physicians should consider that not all patients with critical AS and angina necessarily require AVR. Concomitant pathology leading to the symptoms should be carefully ruled out. This leads to a less invasive, cost effective care plan especially in patients with advanced age and comorbidities for which any type of surgical valvular intervention may pose high risk. PMID:27994841

  18. A path forward for chest pain care: what are the expectations of each team member?

    PubMed

    Bahr, R D

    1997-01-01

    It would be impossible to expect that an immediate solution to the heart attack problem in the United States can come out of this multidisciplinary conference. A more practical goal would be the conferees coming together, seeing better what needs to be done, and using interpretative abilities to put together a logical approach which would unite both the community hospital and the community by the first step on the learning curve. Future progress will come about from the multidisciplinary team with research studies and a commitment to solving this problem on a local level. Acting locally and thinking globally will enable us to move forth and find the expectations of each member of the team. The challenge will find us many times in the years ahead.

  19. An 11-year and 10-month-old girl with purpura and chest pain.

    PubMed

    Chen, Pei-Hsuan; Chiang, Bor-Luen; Lu, Meng-Yao; Yang, Yao-Hsu

    2014-10-01

    Mucosa-associated lymphoid tissue lymphoma (MALToma) is a type of B-cell lymphoma. Case reports of childhood thymic MALToma and its association with vasculitis are rarely found in the related literature. Herein, we present a report of an 11-year and 10-month-old girl who was initially diagnosed with cutaneous vasculitis characterized by nonthrombocytopenic palpable purpura, positive antinuclear antibody and anti-SSA (Ro) antibody. Eight months later, a thymic mediastinal mass was found. Surgical excision was performed and results of pathological analysis revealed an extranodal marginal zone CD20(+) B-cell MALToma. Benign response to the chemotherapeutic regimen of Berlin-Frankfurt-Münster group NHL-BFM 90 R2 without relapse was noted in 2 years of follow-up. For the first time, our case demonstrated some clinical evidence of the association between vasculitis and childhood MALToma.

  20. A 47-year-old stem cell transplant recipient with fever, cough and chest pain

    PubMed Central

    Salh, Omar S; Nadhem, Omar N; Thakore, Sanket R; Halloush, Ruba A; Khasawneh, Faisal A

    2015-01-01

    Infections and malignancies are among the most serious complications that follow organ or stem cell transplantation. They may have a mild course, and nonspecific and overlapping manifestations. The present article describes a case of symptomatic nodular pulmonary disease that complicated hematopoietic stem cell transplantation. It was diagnosed to be post-transplant lymphoproliferative disorder, a potential sequela of immunosuppression and a very difficult entity to treat in profoundly immunosuppressed patients. PMID:26057372

  1. Experiences of Living with Pain after a Spinal Cord Injury

    DTIC Science & Technology

    2013-09-01

    treatments & clinical trials, access to pain management, education, social environment, and pain impact). The impact that pain has on an individual’s life...to treatments, access to pain treatment and information, and social environment. We are making progress towards an integrated model for living with...None 11 M 68 C7 Non-Vet A Pregabalin, Cymbalta 12 F 38 T1 Veteran A Dilaudid, Morphine 13 M 54 C5 Non-Vet D None 14 M 29 C7 Non-Vet B Pregabalin 15 M

  2. Central Neuropathic Pain Syndromes.

    PubMed

    Watson, James C; Sandroni, Paola

    2016-03-01

    Chronic pain is common in patients with neurologic complications of a central nervous system insult such as stroke. The pain is most commonly musculoskeletal or related to obligatory overuse of neurologically unaffected limbs. However, neuropathic pain can result directly from the central nervous system injury. Impaired sensory discrimination can make it challenging to differentiate central neuropathic pain from other pain types or spasticity. Central neuropathic pain may also begin months to years after the injury, further obscuring recognition of its association with a past neurologic injury. This review focuses on unique clinical features that help distinguish central neuropathic pain. The most common clinical central pain syndromes-central poststroke pain, multiple sclerosis-related pain, and spinal cord injury-related pain-are reviewed in detail. Recent progress in understanding of the pathogenesis of central neuropathic pain is reviewed, and pharmacological, surgical, and neuromodulatory treatments of this notoriously difficult to treat pain syndrome are discussed.

  3. Palmoplantar pustules and osteoarticular pain in a 42-year-old woman.

    PubMed

    Zuo, Rena C; Schwartz, Daniella M; Lee, Chyi-Chia Richard; Anadkat, Milan J; Cowen, Edward W; Naik, Haley B

    2015-03-01

    Key teaching points • Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is characterized by distinctive osteoarticular manifestations and a spectrum of neutrophilic dermatoses. • The most common dermatologic manifestations include palmoplantar pustulosis, acne conglobata, and acne fulminans. • SAPHO syndrome should be considered in patients presenting osteoarticular pain, particularly involving the anterior chest wall and/or spine, and neutrophilic skin lesions.

  4. Neuropathic Pain After Lung Surgery

    ClinicalTrials.gov

    2016-11-08

    Chronic Neuropathic Pain, Postoperative; Chronic Pain, Postoperative; Chronic Chemotherapy-induced Neuropathic Pain; Chronic Chemotherapy-induced Pain; Chronic Chemotherapy-induced Peripheral Neuropathy

  5. Pain and pain management in haemophilia

    PubMed Central

    Auerswald, Günter; Dolan, Gerry; Duffy, Anne; Hermans, Cedric; Jiménez-Yuste, Victor; Ljung, Rolf; Morfini, Massimo; Lambert, Thierry; Šalek, Silva Zupančić

    2016-01-01

    Joint pain is common in haemophilia and may be acute or chronic. Effective pain management in haemophilia is essential to reduce the burden that pain imposes on patients. However, the choice of appropriate pain-relieving measures is challenging, as there is a complex interplay of factors affecting pain perception. This can manifest as differences in patients’ experiences and response to pain, which require an individualized approach to pain management. Prophylaxis with factor replacement reduces the likelihood of bleeds and bleed-related pain, whereas on-demand therapy ensures rapid bleed resolution and pain relief. Although use of replacement or bypassing therapy is often the first intervention for pain, additional pain relief strategies may be required. There is an array of analgesic options, but consideration should be paid to the adverse effects of each class. Nevertheless, a combination of medications that act at different points in the pain pathway may be beneficial. Nonpharmacological measures may also help patients and include active coping strategies; rest, ice, compression, and elevation; complementary therapies; and physiotherapy. Joint aspiration may also reduce acute joint pain, and joint steroid injections may alleviate chronic pain. In the longer term, increasing use of prophylaxis or performing surgery may be necessary to reduce the burden of pain caused by the degenerative effects of repeated bleeds. Whichever treatment option is chosen, it is important to monitor pain and adjust patient management accordingly. Beyond specific pain management approaches, ongoing collaboration between multidisciplinary teams, which should include physiotherapists and pain specialists, may improve outcomes for patients. PMID:27439216

  6. Chinese Treasure Chest: An Integrated Exploratory Chinese Language & Culture Program.

    ERIC Educational Resources Information Center

    Jensen, Inge-Lise; Verg-in, Yen-ti

    This publication describes the Chinese Treasure Chest project, an exploratory Chinese language and culture program developed by two elementary school teachers in the Aleutians East Borough (Alaska) School District. The project centers on the use of a large box of materials and a program plan designed to introduce elementary students in…

  7. Automatic image hanging protocol for chest radiographs in PACS.

    PubMed

    Luo, Hui; Hao, Wei; Foos, David H; Cornelius, Craig W

    2006-04-01

    Chest radiography is one of the most widely used techniques in diagnostic imaging. It comprises at least one-third of all diagnostic radiographic procedures in hospitals. However, in the picture archive and communication system, images are often stored with the projection and orientation unknown or mislabeled, which causes inefficiency for radiologists' interpretation. To address this problem, an automatic hanging protocol for chest radiographs is presented. The method targets the most effective region in a chest radiograph, and extracts a set of size-, rotation-, and translation-invariant features from it. Then, a well-trained classifier is used to recognize the projection. The orientation of the radiograph is later identified by locating the neck, heart, and abdomen positions in the radiographs. Initial experiments are performed on the radiographs collected from daily routine chest exams in hospitals and show promising results. Using the presented protocol, 98.2% of all cases could be hung correctly on projection view (without protocol, 62%), and 96.1% had correct orientation (without protocol, 75%). A workflow study on the protocol also demonstrates a significant improvement in efficiency for image display.

  8. Coal worker's lungs - chest x-ray (image)

    MedlinePlus

    This chest x-ray shows coal worker's lungs. There are diffuse, small, light areas on both sides (1 to 3 mm) in ... the lungs. Diseases that may result in an x-ray like this include: simple coal workers pneumoconiosis (CWP) - ...

  9. 42 CFR 37.41 - Chest radiograph specifications-film.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Chest radiograph specifications-film. 37.41 Section... specifications—film. (a) Miners must be disrobed from the waist up at the time the radiograph is given. The... single posteroanterior projection at full inspiration on a film being no less than 14 by 17 inches and...

  10. Lung mass, right upper lung - chest x-ray (image)

    MedlinePlus

    ... chest x-ray of a person with a lung mass. This is a front view, where the lungs are the two dark areas and the heart ... ray shows a mass in the right upper lung, indicated with the arrow (seen on the left ...

  11. Giant intramuscular haemangioma of the chest wall with osteolytic change.

    PubMed

    Matsuoka, Katsunari; Ueda, Mitsuhiro; Miyamoto, Yoshihiro

    2012-05-01

    Intramuscular haemangioma of the chest wall is very rare, and only few cases associated with rib destruction has been reported. Here, we describe a 37-year old woman with a giant intramuscular haemangioma arising in the left back and associated with rib destruction.

  12. Galactorrhea and hyperprolactinemia associated with chest wall injury.

    PubMed

    Morley, J E; Dawson, M; Hodgkinson, H; Kalk, W J

    1977-11-01

    A 48 year old premenopausal woman presented with galactorrhea and amenorrhea associated with chest wall burns. Basal serum prolactin levels were raised, and were further elevated by the administration of L-dopa, chlorpromazine and TRH. Intercostal nerve block and bromocryptine treatment reduced prolactin levels to normal, but did not noticably reduce milk secretion.

  13. Recent and Future Developments in Chest Wall Reconstruction.

    PubMed

    Ng, Calvin S H

    2015-01-01

    Reconstruction following major chest wall resection can be challenging. Conventional methods of using mesh with or without incorporation of methyl methacrylate are slowly being replaced by chest wall reconstruction prosthetic systems that use titanium plates or bars. The most popular systems in use are the titanium STRATOS bars and MatrixRIB plates, which have different systems for securing to the chest wall. In general, these new approaches are user friendly, are more ergonomic, and may avoid certain complications associated with the more conventional methods of reconstruction. However, the successful implantation of these titanium prosthetic systems requires the operator to be familiar with the limitations and potential pitfalls of the process. Follow-up data are only just emerging on the risk factors for implant failure of these prosthetic systems, as well as certain device-specific complications, with fracture failure being increasingly recognized as a significant problem. In the future, emerging intraoperative real-time imaging and 3-dimensional printing technology, as well as development in biomaterials, will allow chest wall reconstruction to become increasingly personalized.

  14. Organ doses to adult patients for chest CT

    SciTech Connect

    Huda, Walter; Sterzik, Alexander; Tipnis, Sameer; Schoepf, U. Joseph

    2010-02-15

    Purpose: The goal of this study was to estimate organ doses for chest CT examinations using volume computed tomography dose index (CTDI{sub vol}) data as well as accounting for patient weight. Methods: A CT dosimetry spreadsheet (ImPACT CT patient dosimetry calculator) was used to compute organ doses for a 70 kg patient undergoing chest CT examinations, as well as volume computed tomography dose index (CTDI{sub vol}) in a body CT dosimetry phantom at the same CT technique factors. Ratios of organ dose to CTDI{sub vol} (f{sub organ}) were generated as a function of anatomical location in the chest for the breasts, lungs, stomach, red bone marrow, liver, thyroid, liver, and thymus. Values of f{sub organ} were obtained for x-ray tube voltages ranging from 80 to 140 kV for 1, 4, 16, and 64 slice CT scanners from two vendors. For constant CT techniques, we computed ratios of dose in water phantoms of differing diameter. By modeling patients of different weights as equivalent water cylinders of different diameters, we generated factors that permit the estimation of the organ doses in patients weighing between 50 and 100 kg who undergo chest CT examinations relative to the corresponding organ doses received by a 70 kg adult. Results: For a 32 cm long CT scan encompassing the complete lungs, values of f{sub organ} ranged from 1.7 (thymus) to 0.3 (stomach). Organs that are directly in the x-ray beam, and are completely irradiated, generally had f{sub organ} values well above 1 (i.e., breast, lung, heart, and thymus). Organs that are not completely irradiated in a total chest CT scan generally had f{sub organ} values that are less than 1 (e.g., red bone marrow, liver, and stomach). Increasing the x-ray tube voltage from 80 to 140 kV resulted in modest increases in f{sub organ} for the heart (9%) and thymus (8%), but resulted in larger increases for the breast (19%) and red bone marrow (21%). Adult patient chests have been modeled by water cylinders with diameters between

  15. Opioid peptides in peripheral pain control.

    PubMed

    Lesniak, Anna; Lipkowski, Andrzej W

    2011-01-01

    Opioids have a long history of therapeutic use as a remedy for various pain states ranging from mild acute nociceptive pain to unbearable chronic advanced or end-stage disease pain. Analgesia produced by classical opioids is mediated extensively by binding to opioid receptors located in the brain or the spinal cord. Nevertheless, opioid receptors are also expressed outside the CNS in the periphery and may become valuable assets in eliciting analgesia devoid of shortcomings typical for the activation of their central counterparts. The discovery of endogenous opioid peptides that participate in the formation, transmission, modulation and perception of pain signals offers numerous opportunities for the development of new analgesics. Novel peptidic opioid receptor analogs, which show limited access through the blood brain barrier may support pain therapy requiring prolonged use of opioid drugs.

  16. Interventional modalities to treat cancer-related pain.

    PubMed

    Moeschler, Susan M; Rosenberg, Casandra; Trainor, Drew; Rho, Richard H; Mauck, W David

    2014-12-01

    Cancer-related pain is a significant cause of morbidity in those affected by both primary and metastatic disease. Although oral, transdermal, and parenteral opioid medications are an integral part of the World Health Organization's analgesic ladder, their use may be limited by side effects. Fortunately, there are advanced interventional pain management strategies effective in reducing pain in the cancer patient while mitigating the aforementioned side effects. Celiac plexus blocks and neurolysis have been proven effective in treating cancers of the abdominal viscera (ie, pancreas). Transversus abdominis plane blocks, neurolysis, and catheter placement can be used to treat cancer pain associated with the abdominal wall. Peripheral nerve blocks and catheter placement at the brachial and lumbosacral plexus or peripheral nerves treat cancer pain associated with the upper and lower limbs, whereas paravertebral and intercostal blocks treat cancer pain associated with the chest wall and ribs. Finally, alternate drug delivery methods such as intrathecal drug delivery systems concentrate medication at central opioid receptors without affecting the peripheral receptors implicated in unwanted side effects. This article provides an overview of these interventions, including indications, contraindications, and potential complications of advanced interventional pain management options available for the treatment of intractable cancer-related pain.

  17. High-ratio grid considerations in mobile chest radiography

    SciTech Connect

    Scott, Alexander W.; Gauntt, David M.; Yester, Michael V.; Barnes, Gary T.

    2012-06-15

    Purpose: Grids are often not used in mobile chest radiography, and when used, they have a low ratio and are often inaccurately aligned. Recently, a mobile radiography automatic grid alignment system (MRAGA) was developed that accurately and automatically aligns the focal spot with the grid. The objective of this study is to investigate high-ratio grid tradeoffs in mobile chest radiography at fixed patient dose when the focal spot lies on the focal axis of the grid. Methods: The chest phantoms (medium and large) used in this study were modifications of the ANSI (American National Standards Institute) chest phantom and consisted of layers of Lucite Trade-Mark-Sign , aluminum, and air. For the large chest phantom, the amount of Lucite and aluminum was increased by 50% over the medium phantom. Further modifications included a mediastinum insert and the addition of contrast targets in the lung and mediastinum regions. Five high-ratio grids were evaluated and compared to the nongrid results at x-ray tube potentials of 80, 90, 100, and 110 kVp for both phantoms. The grids investigated were from two manufacturers: 12:1 and 15:1 aluminum interspace grids from one and 10:1, 13:1, and 15:1 fiber interspace grids from another. MRAGA was employed to align the focal spot with the grid. All exposures for a given kVp and phantom size were made using the same current-time product (CTP). The phantom images were acquired using computed radiography, and contrast-to-noise ratios (CNR) and CNR improvement factors (k{sub CNR}) were determined from the resultant images. The noise in the targets and the contrast between the targets and their backgrounds were calculated using a local detrending correction, and the CNR was calculated as the ratio of the target contrast to the background noise. k{sub CNR} was defined as the ratio of the CNR imaged with the grid divided by the CNR imaged without a grid. Results: The CNR values obtained with a high-ratio grid were 4%-65% higher than those

  18. Overcoming barriers to pain relief in the Caribbean.

    PubMed

    Macpherson, Cheryl; Aarons, Derrick

    2009-12-01

    This paper examines pain and pain relief in the Caribbean, where pain is widely perceived as an unavoidable part of life, and where unnecessary suffering results from untreated and under treated pain. Barriers to pain relief in the Caribbean include patient and family attitudes, inadequate knowledge among health professionals and unduly restrictive regulations on the medical use of opioids. Similar barriers exist all over the world. This paper urges medical, nursing and public health professionals, and educators to examine attitudes towards pain and pain relief and to work towards making effective pain relief and palliation more accessible. It recommends that i) health professionals and officials be better educated about pain, palliation and opioids, ii) regulatory restrictions be updated in light of clinical and scientific evidence, iii) opioid procurement policies be adjusted to facilitate increased medical use, iv) medical charts and records be modified to routinely elicit and document patients levels of pain, and v) educational campaigns be developed to inform the public that moderate and severe pain can be safely relieved at the end of life and other stages of life. The professional, respectful, and beneficent response to patients in pain is to provide rapid and aggressive pain relief or to urgently consult a pain or palliative specialist. When a health system hinders such efforts the ethical response is to identify, facilitate and advocate for overcoming barriers to improvement.

  19. Pain in Persons With Postpolio Syndrome: Frequency, Intensity, and Impact

    PubMed Central

    Stoelb, Brenda L.; Carter, Gregory T.; Abresch, Richard T.; Purekal, Sophia; McDonald, Craig M.; Jensen, Mark P.

    2008-01-01

    Objective To describe the frequency, intensity, and impact of pain in persons with postpoliomyelitis syndrome (PPS). Design Retrospective, cross-sectional survey. Setting Community-based survey. Participants Convenience sample of people with PPS. Interventions Not applicable. Main Outcome Measures Overall intensity and duration of pain, pain sites, pain interference, pain treatments, and relief provided by pain treatments. Results A total of 91% (n=57) of the study participants (N=63) reported pain. The most frequently reported pain sites were the shoulders, lower back, legs, and hips. Participants reported pain intensity to be the greatest in the knees, legs, wrists, lower back, and head. Pain interfered most with sleep and with activities requiring a high level of musculoskeletal involvement. Respondents also reported pain problems that were more severe than those of the general population and than those of a sample of people with multiple sclerosis. Many treatments had been tried previously for pain, but continued use of treatments was reported by relatively few participants at the time of the survey. Conclusions The findings indicate that pain is a persistent and common problem in persons with PPS, highlighting the need for effective and accessible pain treatments for this population. PMID:18929021

  20. Medications for back pain

    MedlinePlus

    ... doses of these medicines can help with chronic low back pain , even if the person does not feel sad ... notices pain. Antidepressants most commonly used for chronic low back pain also help you sleep. Antidepressants most often used ...