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 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Current data concerning epidemiology, clinical picture, pathogenesis, prevention and treatment of Avian influenza H5N1, data of pharmacodynamics and pharmacokinetics of antiviral drugs--neuraminidase inhibitors and M2 channels inhibitors, also the recommendation of WHO for prevention prevalence of infection were discussed in the review. Strategic measures of WHO aims to protect humans from contact with infected poultry, in case of contact, to prevent transmission of this infection from human to human and occurrence of pandemic. Infected birds were the major source of the H5N1 influenza virus among humans in Asia. Mainly humans became infected by eating infected birds, by poor hygiene procedures when cooking infected birds, or by close contact with infected poultry. At present transmission of the H5N1 influenza from human to human by aerosol way hasn't been registered, but ongoing monitoring for identification mutation and adaptation of H5N1 influenza virus to human is needed. Season influenza and avian H5N1 influenza differ by the ways of transmission, clinical picture, severity, pathogenesis, response to treatment. Diagnostic of infection is difficult due to non-specific initial symptoms, in most cases disease begins with disturbance of under respiratory ways and in rare cases--from upper respiratory ways. High viral titre is identified in pharynx but not in nose. Initial symptoms of the H5N1 influenza are: fever greater then 38 degrees Celsius, mild cold, cough and shortness of breath, practically all patient have viral pneumonia, later secondary bacterial infection occurs, mild to severe respiratory distress, diarrhea, vomiting and abdominal pain. Conjunctivitis is rarely diagnosed contrary to season influenza. Sometimes gastrointestinal disorder begins a week early then respiratory symptoms. Complication also includes renal and multi organ failure. The cytokine storm is commonly developed during H5N1 influenza. For treatment and for prevention (under certain conditions) of the H5N1 influenza neuraminidase inhibitors such as oseltamivir (Tamiflu) and zanamivir (Relenza) are recommended. Currently circulatory of the H5N1 strains are fully resistant to an older class of antiviral drugs--the M2 channels inhibitors (amantadine and rimantadine). The knowledge of epidemiology, pathogenesis, clinical picture, treatment of the H5N1 influenza in humans, in spite of progress isn't complete. Future coordination of scientific investigation of the H5N1 influenza in humans should be provided not only in the countries where infection was revealed, but all around the world.
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PMID:[Epidemiology, clinical picture, prevention and treatment of Avian influenza]. 1657 38

A 64-year-old woman presented with severe abdominal pain and was found to have a large fecolith in the sigmoid colon with resulting bowel obstruction. During a therapeutic colonoscopy, she developed severe shortness of breath and hypoxia, and was found to have a tension pneumothorax. We review the potential mechanisms by which pneumothorax may occur following colonoscopy. In addition, the eight previously published cases are reviewed. Pneumothorax, with or without pneumomediastinum, can occur through a variety of mechanisms following colonoscopy. Although rarely reported, this may represent an underappreciated complication and should be fully investigated in the appropriate setting. Colonoscopy, an exceedingly common procedure, will continue to increase with the aging population. As a result, tension pneumothorax can have a profound effect on the patient outcome and therefore physicians, both gastroenterologists and pulmonologists, should be aware of all the potential problems with this procedure.
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PMID:Colonoscopy-associated pneumothorax: a case of tension pneumothorax and review of the literature. 1696 48

A 32-year-old man who had undergone kidney transplantation presented with malaise, severe diarrhoea, nausea and vomiting, productive cough and shortness of breath. A 42-year-old woman with no relevant medical history presented with fever, weight loss and abdominal pain. Both patients had lactic acidosis and hypoglycaemia. Initially, the hyperlactataemia was thought to result from tissue hypoxia (sepsis) but it persisted after correction of the hypovolaemia; therefore, alternative causes were considered. Both patients were found to have T-cell lymphoma with liver infiltration. The male patient died before treatment could be initiated. The lactic acidosis resolved in the female patient following lymphoma treatment, but she died subsequently from the lymphoma. Lymphoreticular malignancies should be considered for cases of lactic acidosis with sufficient oxygen supply, particularly when hypoglycaemia is also present. The lactic acidosis and hypoglycaemia result from increased anaerobic glycolysis in tumour cells. Tumour reduction with chemotherapy can reduce the lactic acidosis.
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PMID:[Two patients with lactic acidosis and hypoglycaemia as initial presentation of a lymphoma]. 1722 91

An 85-year-old woman presented at the emergency ward. She had had shortness of breath for several days and no bowel movements for 3 days. On the day ofhospitalisation she experienced sudden abdominal pain and collapsed as she went to the toilet. She was being treated for multiple conditions, including type-2 diabetes. She appeared to have lactic acidosis. At first, the symptoms were not attributed to metformin because she was receiving a low dose and serum-creatinine concentrations were within the normal range (98 micromol/l). Bowel ischaemia was suspected and surgery was performed but no defects were found. She was subsequently treated for metformin-related lactic acidosis but died shortly thereafter due in part to postoperative complications. Lactic acidosis is a rare side effect of metformin. In this patient, the retrospectively calculated glomerular filtration rate (GFR) was extremely low (23 ml/min). The serum-creatinine concentration was normal because the patient's body weight was low (40 kg). Impaired renal function is a risk factor for metformin-related lactic acidosis. Renal function can appear to be normal when measured by serum-creatinine concentration in older patients with reduced muscle mass, but calculation of GFR often reveals impairment. Metformin is contraindicated in patients with poor renal function. The increasing use of metformin in older patients for the treatment of diabetes mellitus warrants renewed attention to this severe side effect.
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PMID:[Metformin-related lactic acidosis in an 85-year-old woman]. 1772 21

Five-point triage assessment scales currently used in many emergency departments (EDs) across the country have been shown to be accurate and reliable. We have found the system to be highly predictive of outcome (hospital admission, intensive care unit/operating room admission, or death) at either extreme of the scale but much less predictive in the middle triage group. This is problematic because the middle triage acuity group is the largest, in our experience comprising almost half of all patients. Patients triaged to the 2 highest acuity categories (A and B) have admission/ED death rates of 76% and 43%, respectively. In contrast, the 2 lowest acuity categories (D and E) have admission/ED death rates of 1% or less. The middle category (C), however, has an overall admission/ED death rate of 10%, too high to be comfortable with prolonged delays in the ED evaluation of these patients. We studied this group to determine if easily obtainable clinical factors could identify higher-risk patients in this heterogeneous category. Data were obtained from a retrospective, cross-sectional study of all patients seen in 2001 at an urban academic hospital ED. The main outcome measure for multivariate logistic regression models was hospital admission among patients triaged as acuity C. Acuity C patients who were 65 years or older, presenting with weakness or dizziness, shortness of breath, abdominal pain, or a final diagnosis related group diagnosis of psychosis, were more likely to be admitted than patients originally triaged in category B. These findings suggest that a few easily obtainable clinical factors may significantly improve the accuracy of triage and resource allocation among patients assigned with a middle-acuity score.
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PMID:Identifying high-risk patients for triage and resource allocation in the ED. 1787 Apr 84

To assess the associations between job stress and somatic symptoms and to investigate the effect of individual coping on these associations. In July 2006, a cross-sectional study was conducted during a periodic health check-up of 185 Japanese male office workers (21-66 yr old) at a Japanese company. Job stress was measured by job demand, control, and strain (=job demand/control) based on the Job Content Questionnaire (JCQ). Major somatic symptoms studied were headache, dizziness, shoulder stiffness, back pain, shortness of breath, abdominal pain, general fatigue, sleep disturbance, and skin itching. Five kinds of coping were measured using the Job Stress Scale: active coping, escape, support seeking, reconciliation, and emotional suppression. Comorbidities of hypertension, diabetes, obesity, depression, and anxiety were also evaluated. The most frequently cited somatic symptom was general fatigue (66%), followed by shoulder stiffness (63%) and sleep disturbance (53%). Of the five kinds of coping, only "active coping" was significantly and negatively associated with the number of somatic symptoms. The generalized linear models showed that the number of somatic symptoms increased as job strain index (p=0.001) and job demand (p=0.001) became higher, and decreased as active coping (p=0.018) increased, after adjusting for age and comorbidities. There was no statistical interaction among active coping, the number of somatic symptoms, and the three JCQ scales. Reporting somatic symptoms may be a simple indicator of job stress, and active coping could be used to alleviate somatization induced by job stress.
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PMID:The association of the reporting of somatic symptoms with job stress and active coping among Japanese white-collar workers. 1795 68

Acute gastric volvulus associated with congenital diaphragmatic hernia is an unusual surgical emergency. We describe a case of an 11-year-old girl who presented with a 4-day history of abdominal pain, nonproductive retching, cough, and shortness of breath. A chest radiograph revealed a large air-fluid level in left hemithorax and the presence of intestinal loops with marked mediastinal deviation. Nasogastric decompression was unsuccessful. Via a thoracoscopic approach, the large fluid-filled stomach was percutaneously decompressed but could not be reduced. Through a left subcostal incision, a left-sided diaphragmatic defect about 4 x 5 cm was encountered. A large portion of small intestines, ascending and transverse colon, strangulated but viable stomach, and a large spleen herniated through the defect. The contents were reduced, revealing a combined gastric volvulus. Once the diaphragmatic defect was repaired primarily, there was insufficient space in the abdominal cavity to contain all the viscera reduced form the chest. Therefore, we placed an AlloDerm patch on the fascia and closed with a wound V.A.C (Kinetic Concepts Inc, San Antonio, TX). Two weeks later, the wound was definitively closed; she recovered uneventfully and was discharged home 3 days later. To our knowledge, only 26 previous cases of acute gastric volvulus complicating a congenital diaphragmatic hernia in children have been reported in the literature. Our patient represents the 27th case and the first combined type acute gastric volvulus case.
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PMID:Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature. 2808 38

Nonoperative management of splenic injury is standard in hemodynamically stable patients. Splenic artery embolization is a useful adjunct to nonoperative management for patients with ongoing hemorrhage. However, the complications of embolization are not well defined. We report a case of progressive splenomegaly requiring delayed splenectomy after embolization. A 57-year-old hemodynamically stable, blunt trauma patient had a Grade III splenic injury with associated subcapsular hematoma. Nonoperative management was initiated, but his hemoglobin levels progressively declined prompting proximal splenic artery embolization. His hemoglobin levels remained stable postembolization and he was discharged on postinjury day 5. The patient was readmitted 10 days later with increasing abdominal pain and shortness of breath. Repeat CT revealed an enlarged subcapsular fluid collection, but his hemoglobin level remained stable and he was discharged 5 days later. He returned again 2 days later with similar complaints, and CT demonstrated that his subcapsular fluid collection was further enlarged. Repeat hemoglobin level was again stable. The patient requested operative intervention due to intractable pain, and splenectomy was performed without complications. Operative findings included a sterile, contained subcapsular hematoma. Splenic embolization has emerged as an adjunct to nonoperative management of splenic injury; however, the indications for splenic embolization are yet to be defined, and the spectrum and frequency of potential complications are poorly documented. This case report highlights a potentially serious complication that can occur after splenic embolization.
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PMID:Progressive splenomegaly following splenic artery embolization. 1848 4

Diagnosis of myocardial infarction or acute coronary syndrome is difficult, especially in atypical presentation at an emergency department, and sometimes results in serious legal issues. Symptoms of atypical presentation include shortness of breath, dyspnoea on exertion, toothache, abdominal pain, back pain and throat pain. As of now, reports of a headache, especially exertional headache, as the only presentation of acute cardiac ischaemia are rare and only have case reports. We present two patients with a cardiac source of headache and analyse 32 patients with similar situations from MEDLINE search from 1966 to the present. Cardiac cephalalgia is benign in general, but potential risks for death should be considered. If the patient has increased risk of atherosclerosis with exertional headache, anginal headache should be highly suspected and further work-up should be undertaken.
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PMID:Cardiac cephalalgia: case reports and review. 1850 57

Pneumothorax is a potentially life-threatening condition caused by an accumulation of air or gas in the pleural space. This may occur either spontaneously or as a result of disease or injury. The term "catamenial" is derived from the Greek meaning "monthly". Catamenial pneumothorax is a rare complication of endometriosis. A patient with a history of endometriosis presented to the accident and emergency department with increased abdominal pain, shortness of breath and wheeze. She was subsequently found to have a right-sided pneumothorax which was initially aspirated. However, the pneumothorax recurred and required chest drain insertion and admission to a medical ward. Further recovery was uneventful. It is important to maintain a high index of suspicion of catamenial pneumothorax in patients with a history of endometriosis.
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PMID:Catamenial pneumothorax. 1903 19


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