Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty of 33 patients (ages 18-67) with acute dissection of the ascending aorta underwent surgical intervention. There were four deaths. There were eight male and five female patients and 15 patients were known to be hypertensive. Severe chest pain, widened mediastinum (demonstrated radiographically), and varying degrees of aortic insufficiency were present in each patient. Heart failure was present in 13 patients, numbness and coolness of an extremity in seven patients, and central nervous system changes were present in three patients. The diagnosis in each instance was confirmed by aortography. Three patients treated nonoperatively died during hospitalization following aortic rupture into the mediastinum and pericardium. The remaining 30 patients were managed by insertion of a woven Dacron((R)) graft sutured distal to the coronary arteries and proximal to the origin of the great vessels. This was accompanied with resuspension of the aortic valve in 24 patients and valve replacement in six patients. Each of the latter six patients had a history of aortic valve disease. The goals of the operation were: 1) correction of the accompanying aortic insufficiency, either by valve replacement or resuspension of the valve and 2) placement of a prosthetic graft into the ascending aorta, thereby obliterating the false lumen and preventing involvement of the coronary arteries or rupture into the mediastinum or the pericardium. Hypertensive patients were managed pre- and postoperatively with nitroprusside and then with propranolol HCI, methyldopa, or hydralazine HCI and hydrochlorothiazide. One late death occurred six months after myocardial infarction and a second late death occurred from a presumed cardiac arrhythmia. One patient had a femorofemoral graft two months after the initial operation and another patient has mild aortic insufficiency. It is concluded that prompt surgical management is mandatory in acute ascending aortic dissection, and in most patients aortic valve competency can be re-established with resuspension of the valve preventing the added morbidity associated with a prosthetic valve. Four patients have been followed for five years and additional follow-up data will better define long-term survival.
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PMID:Acute ascending aortic dissection. 644 83

To determine the incidence and significance of pleural disease in blastomycosis, we reviewed the chest roentgenograms and medical records of 26 consecutive patients with biopsy- or culture-proved Blastomyces dermatitidis infection. Twenty-three of the 26 (88 percent) had radiographic evidence of blastomycotic pleural disease. Pleural reaction that regressed on therapy was mild (less than 1.0 cm thickening on EPA chest film) in 12. More extensive pleural thickening (1.5 to 3.0 cm) was observed in five, while four had effusions, and two had pneumothoraces. The 15 patients with mild or no visible pleural thickening were considered to have minor pleural involvement, while the 11 patients with greater than 1.5 cm pleural reaction, effusions, or pneumothoraces were considered to have major pleural disease. The ages, incidence of serious underlying disorders, and extra-thoracic dissemination were similar in both groups. Chest pain was more frequent in those with major pleural involvement (8/11 vs 4/15, p = 0.02), and their white blood cell count (14,300 +/- 1,200 c/mm3) was significantly higher than that of those with minor pleural involvement (10,600 +/- 1400, p less than 0.05). All of the patients with minor pleural disease responded to amphotericin therapy, but four of 11 (36 percent) with major pleural disease had an unfavorable outcome (relapse = two, death = two) (p = 0.02). In these patients with blastomycosis, pleural involvement was extremely common. Major pleural disease was associated with an adverse prognosis and may be an indication for prolonged therapy.
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PMID:The spectrum and significance of pleural disease in blastomycosis. 647 98