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

This report describes a 52-year-old black male with the isolated finding of an anomalous superior vena cava draining into the left atrium. The patient presented with dizziness, mild cyanosis, polycythemia and normal cardiac and pulmonary findings. The first major diagnostic clue in this confusing clinical presentation was an unsuccessful lung perfusion scan in which intravenous tracer consistently bypassed the lungs. This appears to be the first adult presenting with this rare anomaly. This condition should be suspected if cyanosis, clubbing, and a "normal" cardiac examination coexist and if the more common pulmonary and hematological causes of this triad have been excluded.
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PMID:Isolated drainage of the superior vena cava into the left atrium in a 52-year-old man: a rare congenital malformation in the adult presenting with cyanosis, polycythemia, and an unsuccessful lung scan. 68 85

To determine whether a better understanding of primary pulmonary hypertension has affected its clinical presentation, natural history, and prognosis, we retrospectively compared patients with primary pulmonary hypertension presenting to our institution during two different periods: 1962 to 1978 (group 1, n = 38) and 1979 to 1989 (group 2, n = 33). Demographic characteristics were similar in both groups. Dyspnea on exertion was the most frequent presenting symptom in both groups. Fatigue, cough, dizziness, right heart failure, and cyanosis were more frequent in group 1. The electrocardiographic, radiographic, and echocardiographic findings did not differ between groups. Hemodynamic measurements revealed severe pulmonary hypertension and a normal pulmonary capillary wedge pressure and cardiac index; these measurements were similar in both groups. Complications related to cardiac catheterization were more frequent in group 1 (32%) than in group 2 (3%). Causes of death were comparable in both groups, the most frequent being progressive right heart failure, sudden death, and death of unknown cause. Patients from both groups received standard treatment with digitalis, diuretics, and vasodilators; however, group 2 had a higher probability of survival than group 1. We conclude that patients with pulmonary hypertension seen in more recent years tend to present at earlier stages of disease, have fewer complications during cardiac catheterization, and probably survive longer than those seen several decades ago. A clear cause for the longer survival could not be identified, although it may be partly related to earlier presentation in the course of disease.
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PMID:Primary pulmonary hypertension, then and now: 28 years of experience. 152 74

A case of thrombosis of a Blalock anastomosis in a woman with Fallot's tetralogy is presented. She had the anastomosis at age 7 years, and had symptoms of dyspnea, dizziness, and a systolic murmur at the time of a miscarriage at age 21. 5 days after starting a 5 mg combination of norethynodrel and mestranol she was hospitalized for acute dyspnea, cyanosis, fainting, and painful hepatosplenomagaly suggestive of failure of the anastomosis. This was documented by angiography and during surgery when an aortic-pulmonary shunt was done. After several relapses the woman was doing well with some cyanosis and Stage 2 dyspnea. The evidence that oral contraceptives may cause some thromboembolic disease, particularly pulmonary, cerebral, and cardial accidents, is discussed.
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PMID:[Thrombosis of a Blalock's anastomosis for Fallot's tetralogy, in the course of a contraceptive treatment (by an anovulatory steroid)]. 498 79

In six patients with clinically unsuspected right atrial thromboemboli the diagnosis was made with two-dimensional echocardiography. Five patients had pulmonary emboli, and one had systemic embolization. Three patients had congestive cardiomyopathy, two with tricuspid regurgitation; of the remaining three, one had cor pulmonale complicated by tricuspid regurgitation, one had thrombophlebitis and one had no discernible cardiac illness. Four patients had dizziness or syncope, four had dyspnea, three had chest pain, three had hypotension and tow had cyanosis. Five patients were treated with thrombolytic or anticoagulant therapy, or a combination of the two. In three patients, surgical removal of the thrombus was undertaken because of recurrent pulmonary emboli or tricuspid regurgitation, or both, and progressive right heart failure. The thromboemboli were removed in all three, but one patient died. On two-dimensional echocardiography, four of the six patients' thromboemboli were snake-like, unattached to the right atrium and prolapsed freely across the tricuspid valve into the right ventricle in diastole and back into the right atrium in systole. The other two patients' thromboemboli were attached to the right atrium and did not prolapse across the tricuspid valve. Our cases, together with a review of other reports, suggest that right atrial thromboemboli: 1) can be accurately diagnosed by two-dimensional echocardiography; and 2) result from two different pathophysiologic mechanisms developing a) in situ, either on a foreign body or secondary to reduced cardiac output, or b) as a result of an embolus from systemic vein thromboses.
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PMID:Right atrial thromboemboli: clinical, echocardiographic and pathophysiologic manifestations. 649 Oct 71

Thirteen of 308 patients (4.2%), who had received right-sided valved extracardiac conduits at the Mayo Clinic from November, 1972, to April, 1977, have required conduit replacement because of obstruction. Patients were 5 to 16 years old at initial operation and 8 to 20 years old at reoperation; the duration of conduit implantation was 27 to 79 months (mean 50). Four patients (31%) were asymptomatic; exertional dyspnea was present in eight (62%) and dizziness was reported in one (8%). Signs of conduit obstruction included increasing intensity of murmurs in 11 (85%), cyanosis in two (15%), and heart failure in one (8%). Peak pressure gradients from the right ventricle to the pulmonary arteries ranged from 50 to 140 mm Hg (mean 87) and correlated well with the degree of conduit obstruction. Catheter pullback allowed accurate localization of stenosis within the conduit, whereas angiography alone did not. The site of major obstruction was in the proximal conduit in five (38%), at the valve in nine (69%), and in the distal conduit or side branches in six (46%); stated differently, major stenosis affected the valve alone in five (38%), the graft alone in four (31%), and both the valve and the graft in four (31%). Valvular changes leading to stenosis included thrombosis, commissural fusion, and calcification, and changes consistent with insufficiency included tears, fusion of cusps to the conduit wall, and, in one case, infective endocarditis. Within the conduit, nonvalvular obstruction was due to formation of a thick fibrous peel (or neointima). Progressive thickening of the peel appeared to be due to organization of thrombus between the peel and conduit and not due to luminal mural thrombus. In one case, the peel formed a flap-valve, causing even further obstruction. Since many patients are asymptomatic, and since late conduit stenosis may develop unpredictably by several mechanisms, long-term follow-up is necessary.
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PMID:Clinicopathological correlates of obstructed right-sided porcine-valved extracardiac conduits. 720 68

Four patients showing classic physical stigmata of traumatic asphyxia were studied. Cervicofacial cyanosis and edema, subconjunctival hemorrhage, and multiple ecchymotic hemorrhage of the face, neck, and upper part of the chest were documented. Admission Glasgow coma scale scores ranged from 8 to 15. All but one had no associated injury. Skin discoloration resolved within 3 weeks. Complete resolution of subconjunctival hemorrhage occurred 1 month later. In our series, sore throat, hoarseness, dizziness, numbness, and headaches were common. Profound lower leg pitting edema, hemoptysis, hemotympanum, and transient visual loss were noted. Chest radiographic findings were normal in all patients. Microscopic hematuria was noted in one patient. Diagnosis is made from the history and characteristic appearance of the patient. Treatment is directed to the associated injury. Oxygen supplement with head elevation to 30 degrees is the mainstay of treatment. If the patient survives the initial insult, the prognosis is excellent.
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PMID:Traumatic asphyxia. 813 32

In an open, controlled study, 44 patients complaining of vertigo, dizziness, or both, caused by vascular vestibular disorders were randomly treated with extract of Ginkgo biloba (EGb 761) 80 mg twice daily or with betahistine dihydrochloride (BI) 16 mg twice daily for 3 months. A complete neuro-otologic and equilibrimetric examination was performed at baseline and after 3 months of treatment, with evaluation of clinical findings. In the first month of therapy, vertigo and dizziness improved in 64.7% of patients treated with BI and in 65% of those who received EGb 761. Compared to baseline, no statistically significant changes were observed in cranial scans for patients with a "central" cranial pattern. Likewise, no changes versus baseline were observed in both groups for the equilibrium score. The comprehensive test battery showed the following findings: EGb 761 induced a slight decrease of saccadic delay and considerably increased saccadic velocities; BI improved saccadic accuracy but did not modify delay; EGb 761 improved smooth pursuit gain at 0.4 Hz 40 degrees/s three times more than BI; both drugs asymmetrically reduced nystagmus maximum velocity at 40 degrees/s; both drugs asymmetrically improved the sinusoidal vestibulo-ocular reflex; BI considerably reduced--whereas EGb 761 considerably improved--visuovestibular ocular reflex. No side effects were recorded during the trial except for transient mild headache and gastric upset in 2 patients receiving EGb 761 and transient cyanosis of nails and lips in 1 patient given BI. These results suggest that EGb 761 and BI operate at different equilibrium receptor sites and show that EGb 761 can considerably improve oculomotor and visuovestibular function.
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PMID:Ginkgo biloba (EGb 761) in the treatment of equilibrium disorders. 1034 50

The diagnosis of major pulmonary embolism should be considered in case of acute respiratory distress, particularly when there is high thromboembolic risk. Although clinical symptoms are not specific, some are suggestive: syncope or dizziness with cyanosis and polypnoea, and especially arterial hypotension and cardiogenic shock. Diagnostic workup should be rapid and straight forward. Transthoracic echography is particularly useful to detect right heart thrombi and right ventricular overload. More information could be provided by helical computed tomography or perfusion lung scan or less commonly now by pulmonary angiography, depending on the patient's clinical condition and the available equipment. The mortality rate can reach 20 to 30%, and up to 65% after resuscitated cardiac arrest. Rapid desobstruction is justified through surgical embolectomy or intravenous thrombolysis favouring short duration protocols (alteplase over 2 h), in spite of the bleeding risk.
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PMID:[Major pulmonary embolism]. 1073 26

On rare occasions benzocaine has produced methemoglobinemia from oral, rectal and dermal exposures. There is disagreement whether this is an idiosyncratic event or a dose-related event. To gain a better perspective on this problem we retrospectively reviewed cases at 4 large regional poison centers of children <18-y of age from 1993-1996. One hundred and eighty-eight benzocaine exposures were reported. Mean and median ingested dosage were 86.8 (+/- 89.5) mg/kg and 50 mg/kg, respectively. Fifty-eight patients (30%) were managed in the emergency department; 8 patients had methemoglobin levels determined. One child had a methemoglobin level of 19%; all others were <1%. One hundred and seventy-three patients (92%) remained asymptomatic. Other symptoms were minor: oral numbness (8), vomiting (3), and 1 each of oral irritation, dizziness and nausea. In this series of accidental ingestions of benzocaine-containing products cyanosis was rare and apparently not dose related. These cases may be safely managed at home with telephone follow up for at least 2 h. If there is evidence of cyanosis, dusky pallor, shortness of breath, or change in mental status direct medical evaluation should be recommended.
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PMID:Multi-center retrospective evaluation of oral benzocaine exposure in children. 1092 90

Dinitrotoluenes (DNTs) are nitroaromatic compounds appearing as pale yellow crystalline solids at room temperature. Dinitrotoluenes exist as a mixture of 2 to 6 isomers, with 2,4-DNT, and 2,6-DNT being the most significant. About 500 persons are estimated to be potentially exposed yearly to 2,4-DNT and 2,6-DNT during the production of munitions and explosives. The main route of human exposure at ammunition facilities is inhalation, but dermal contact and inadvertent ingestion can also be substantial. In factory workers, exposure to DNTs has been linked to many adverse health effects, including cyanosis, vertigo, headache, metallic taste, dyspnea, weakness and lassitude, loss of appetite, nausea, and vomiting. Other symptoms including pain or parasthesia in extremities, abdominal discomfort, tremors, paralysis, chest pain, and unconsciousness have also been reported. The primary targets of DNT toxicity are the hematopoietic system (pallor, cyanosis, anemia, and leukocytosis), the cardiovascular system (ischemic heart disease), the nervous system (muscular weakness, headache, dizziness, nausea, insomnia, and tingling pains in the extremities) and the reproductive system (reduction of sperm counts, alteration of sperm morphology, and aspermatogenesis). An association between DNT exposure and increased risk of hepatocellular carcinomas and subcutaneous tumors in rats, as well as renal tumors in mice, has been established. Epidemiologic studies of DNT toxicity have been limited to small groups of workers who had been occupationally exposed at various ammunitions production facilities. Clearly defining the health effects of DNTs with a high degree of confidence has therefore been difficult because of the multigenic nature of occupational exposure. In an attempt to update the toxicologic profile of the DNTs, we hereby provide a critical review of the environmental and toxicologic pathology of DNTs, with a special emphasis on their potential implications for public health.
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PMID:Environmental toxicology and health effects associated with dinitrotoluene exposure. 1467 15


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