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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Symptoms of infection in the elderly may be absent, vague or atypical. Infection should be suspected when an elderly patient presents with a decline in well-being or with non-specific symptoms such as falls, dizziness, confusion, anorexia or weakness. Common infections include bacterial pneumonia, urinary tract infection, intra-abdominal infections, gram-negative bacteremia and infection of decubitus ulcers. Antibiotic therapy is not recommended for asymptomatic bacteriuria or locally infected decubitus ulcers. Drug dosages should be adjusted for the age-associated decline in renal function and for hepatic or renal insufficiency. The trend in antibiotic therapy is evolving toward the use of third-generation cephalosporins instead of aminoglycosides to avoid the side effects of nephrotoxicity and ototoxicity. Pneumococcal, influenza and tetanus/diphtheria immunizations help prevent morbidity and mortality.
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PMID:Common infections in the elderly. 848 May 62

Our objective is to validate the ability of 3 appropriately placed accelerometers to determine body position during ambulatory electrocardiographic (ECG) monitoring and to demonstrate the clinical applicability of this method. During ambulatory (Holter) monitoring, the ability to know a patient's position (lying down, sitting, standing, or changing from one position to another) is important in the evaluation of common symptoms such as dizziness, palpitations, and syncope. Changes in body position are also known to alter the electrical axis of the heart, resulting in artifactual changes in QRS amplitude and ST-segment morphology. We have developed an ambulatory patient-monitoring instrument that, through the use of microfabricated accelerometers, can simultaneously record body-position information and 2 channels of ECG data. The accelerometers measure the effects of gravity and dynamic acceleration, allowing determination of a patient's orientation and movements. The accelerometer and ECG signals are input to a portable recorder and are filtered and digitized. Algorithms were developed to automatically determine body position. Ten healthy volunteers wore the device for 1 hour and followed a protocol of standing, sitting, walking, lying supine, and lying in the left and right lateral decubitus positions. An observer manually recorded times of position changes. Data were recorded and analyzed using software designed with MATLAB. The ability of the accelerometers and computer algorithms to determine body position was analyzed in terms of the sensitivity and specificity for each body position. The sensitivities for sitting, standing, walking, lying supine, lying right, and lying left were 98.8%, 99.2%, 95.5%, 99.1%, 98.9%, and 94.8%, respectively. The specificities were 99.7%, 99.4%, 99.6%, 99.0%, 99.8%, and 99.9%, respectively. The use of microfabricated accelerometers is a clinically feasible method to determine body position and can be applied to future studies correlating body position with ECG or other physiologic data.
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PMID:Accelerometer-based body-position sensing for ambulatory electrocardiographic monitoring. 1456 5

We report the case of a 21-year-old female referred to our institution complaining of dizziness when standing up, which improved in the dorsal decubitus position and at rest, after a few minutes. The symptom, which had lasted for years, was not accompanied by vertigo, syncope, or neurological changes, but was gradually getting worse. Transthoracic echocardiogram showed a hyperechoic mass in the middle-apical region of the left ventricular posterior wall and normal pericardium. The cardiac nuclear magnetic resonance allowed the diagnosis of the left ventricular tumor suggestive of lipoma. Surgery was performed and the tumor was resected. The patient recovered well and is currently asymptomatic.
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PMID:Left ventricular lipoma. 1504 56

The authors report a 64-year-old man who developed persistent direction fixed nystagmus after a canalith repositioning maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV). The patient was initially diagnosed with right HC-BPPV given that the Dix-Hallpike test showed geotropic horizontal nystagmus that was more pronounced on the right side, although the roll test did not show any positional nystagmus. The patient was treated with a canalith repositioning maneuver (Lempert maneuver). The next day, the patient experienced a different character of dizziness, and left-beating spontaneous nystagmus regardless of head position was observed. After a forced prolonged left decubitus and frequent head shaking, his symptoms and nystagmus resolved. This condition, referred to as canalith jam, can be a complication after the repositioning maneuver in patients with BPPV. Atypical positional tests suggest that abnormal canal anatomy could be the underlying cause of canalith jam.
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PMID:Persistent Direction-Fixed Nystagmus Following Canalith Repositioning Maneuver for Horizontal Canal BPPV: A Case of Canalith Jam. 2491 12

Arrhythmias are the most common cardiac complication during gestational period and may occur in women with or without known structural heart disease. Premature extra beats and sustained tachyarrhythmias are the most common arrhythmias in pregnancy. Symptomatic episodes occur in 20-44% of pregnant women, usually as palpitations, dizziness, or syncope. We searched on Pubmed for ventricular premature complexes (VPC) in pregnant women and found no case reporting increased incidence of this arrhythmia while supine. The aim of this study is to report a case of a pregnant woman without previous structural heart disease that presented a great number of VPC when supine. The arrhythmogenesis increase during pregnancy is multifactorial. In the reported case, we believe that augmented venous return was the most important pathophysiologic process. When the patient changes to left lateral decubitus, there could be a sudden release of the inferior vena cava, causing an abrupt augmentation of venous return to the right heart chambers and increasing the risk of arrhythmias. Obstetricians and primary care physicians should be aware of palpitations and related patient complains while they are asleep or supine.
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PMID:Supine Frequent Ventricular Extrasystoles in a Pregnant Woman without Structural Heart Disease. 2764