Serge Gouin, Jocelyn Gravel, Devendra K. Amre, Sylvie Bergeron
DOI: http://dx.doi.org/10.1016/j.ajem.2004.02.046
Published in issue: May 2005
xThe aim of this study was to compare the performance of the Paediatric Canadian Triage and Acuity Scale (Paed CTAS) to a previous triage tool with respect to the percentage of admissions, the diagnostic and therapeutic interventions, and the mean pediatric risk of admission (PRISA) score in a pediatric tertiary center emergency department. Data were prospectively collected for 4 months before the Paed CTAS introduction (PRE group) and for 4 months after its implementation (Paed CTAS group). Both groups were similar in chief complaints, distribution of triage levels, and mean PRISA score.
Joel S. Holger, Paul A. Satterlee, Stephanie Haugen
DOI: http://dx.doi.org/10.1016/j.ajem.2005.01.001
Published in issue: May 2005
xWe compared propofol (P) and midazolam (M) use in sedation using nurses' (RN's) monitoring times, costs, and visual analog scale (VAS) satisfaction scores. We randomized 40 patients to either P or M groups. The P group received 0.5 mg/kg IV followed by titration to a Ramsay Sedation Scale of 3 or 4. The M group received 1 mg IV every 2 minutes to a Ramsay Sedation Scale of 3 or 4. Time for sedation, procedure, and recovery were compared. VAS scores were measured for the patient, RN, and physician.
Todd L. Allen, Brendan F. Cummins, R. Thomas Bonk, Colleen P. Harker, Diana L. Handrahan, Mark H. Stevens
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.020
Published in issue: May 2005
xThe aim of this study was to estimate the sensitivity, specificity, and positive predictive value (PPV) of computed tomography (CT) without oral contrast for diaphragm injuries (DIs) in blunt abdominal trauma.
Fredric M. Hustey, Stephen W. Meldon, Gerald A. Banet, Lowell W. Gerson, Michelle Blanda, Lawrence M. Lewis
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.021
Published in issue: May 2005
xThe objectives of this study were to determine the prevalence of use of abdominal computed tomography (CT) in older ED patients with acute nontraumatic abdominal pain, describe the most common diagnostic CT findings, and determine the proportion of diagnostic CT results. This was a prospective, observational, multicenter study of 337 patients 60 years or older. History was obtained prospectively; charts were reviewed for radiographic findings, dispositions, diagnoses, and clinical course, and patients were followed up at 2 weeks for additional information.
Robert Y. Lin, Arlene Curry, Vasilios I. Pitsios, James P. Morgan, Huang San Lee, Michael Nelson, Richard E. Westfal
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.030
Published in issue: May 2005
xThe present study describes the cardiovascular responses to epinephrine (Epi) given into the arm, in adult patients with acute allergic reactions, and the differential responses to subcutaneous (SC) and intramuscular (IM) administration. Sixty-three adult patients were treated with Epi administered SC or IM after H1 and H2 receptor blockade. Heart rate and blood pressure (BP) were then measured for 20 minutes. Changes in heart rate and BP variables were analyzed. Pulse pressure and systolic BP showed increases with time.
Kathleen M. Read, Joseph A. Kufera, M. Christine Jackson, Patricia C. Dischinger
DOI: http://dx.doi.org/10.1016/j.ajem.2005.01.002
Published in issue: May 2005
xTo document the population-based incidence of sexual assault in Baltimore, Md, victims' alcohol/drug use, and pre-event circumstances.
Stephen W. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2005.01.003
Published in issue: May 2005
xReperfusion therapy for acute myocardial infarction (AMI) is indicated in the presence of ST elevation (STE) and ischemic symptoms. Previous MI may present with persistent STE or “left ventricular aneurysm” (LVA) morphology that mimics AMI.
Steven J. Weiss, Amy A. Ernst, Robert Derlet, Richard King, Aaron Bair, Todd G. Nick
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.034
Published in issue: May 2005
xWe hypothesize that the number of patients who leave without being seen is correlated with the simple-to-use National Emergency Department Overcrowding Scale (NEDOCS).
Lowell W. Gerson, Carlos A. Camargo Jr., Scott T. Wilber
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.035
Published in issue: May 2005
xThis trial was conducted at 11 EDs to test the effectiveness of distributing fall prevention information to patients 65 years or older. Intervention patients were given 2 brochures and received a reminder call 2 weeks later. All patients were called at 1 month and asked if they made home safety modifications. Three hundred ninety-seven patients were enrolled (118 control, 279 intervention). Seventy-six percent had complete follow up interviews. Nine percent of control and 8% of intervention patients reported a home modification (95% confidence interval on difference, −8.1% to 5.5%).
Gregory S. Hunt, Matthew T. Spencer, Daniel P. Hays
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.042
Published in issue: May 2005
xTo evaluate whether there is a difference in the time of sedation and time to patient disposition in patients undergoing procedural sedation with etomidate and midazolam.
Bruce D. Adams, Kathy Zeiler, Walter O. Jackson, Brian Hughes
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.013
Published in issue: May 2005
xWe compared 2 models of physician leadership for inhospital cardiac arrest teams (CATs): emergency medicine (EM) residents and staff hospitalist physicians.
Albert Sae, Stephen Haverly, Jeffery Uller, Marc Shalit, Geoff Stroh
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.002
Published in issue: May 2005
xEmergency medical service providers frequently encounter patients with low acuity. Because of liability and safety concerns, emergency medical service systems often prohibit privately owned vehicle (POV) transport. Thus, prehospital resources are used with questionable benefit. In Sequoia and Kings Canyon National Parks, our primary objective was to determine the feasibility of POV. We assessed patient compliance, satisfaction, and safety. Our hypothesis was that POV is feasible with online physician medical control.
Deborah L. Zvosec, Stephen W. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.003
Published in issue: May 2005
xγ-Hydroxybutyrate (GHB)-related compounds are most commonly described as depressants, with emphasis on somnolence, obtundation, stupor, and coma (SOSC). We sought to demonstrate the full spectrum of clinical presentations of GHB intoxication, including agitation and other nonsedative effects. Our observational study identified 66 patients with GHB toxicity, 40 of whom manifested agitation; 25 had agitation before or after SOSC, 10 had agitation alternating abruptly with SOSC, and 5 had agitation only.
Frank LoVecchio, J. Shriki, R. Samaddar
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.015
Published in issue: May 2005
xl-Carnitine is a carnitine replacement that has been used in carnitine deficiency states. We conducted a review of patients with acute valproate (VPA) poisoning that had an elevated ammonia level and received l-carnitine to address safety.
Robert H. Birkhahn, Theodore J. Gaeta, Doug Terry, Joseph J. Bove, John Tloczkowski
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.029
Published in issue: May 2005
xThe aim of this study was to determine the hemodynamic response and calculated shock index (SI = heart rate [HR]/systolic blood pressure [SBP]) in early acute blood loss.
W. Franklin Peacock IV, Charles L. Emerman, Marc A. Silver, on behalf of the PROACTION Study Group
DOI: http://dx.doi.org/10.1016/j.ajem.2004.11.002
Published in issue: May 2005
xThe Prospective Randomized Outcomes study of Acutely decompensated Congestive heart failure Treated Initially as Outpatients with Nesiritide (PROACTION) trial evaluated the safety of nesiritide administration in the emergency department in patients with decompensated heart failure. Patients (N = 237) were treated for at least 12 hours with standard care plus either intravenous nesiritide or placebo. Compared to placebo, nesiritide favorably decreased systolic blood pressure (SBP) in patients with elevated baseline SBP, without negatively impacting patients with lower baseline SBP (SBP, >140 mm Hg: nesiritide, −28.7 mm Hg, vs placebo, −8.4 mm Hg [P < .001]; SBP, 101-140 mm Hg: nesiritide, −12.3 mm Hg, vs placebo, −5 mm Hg [P < .017]; SBP, <101 mm Hg: nesiritide, −1.2 mm Hg vs placebo, +16.7 mm Hg [P < .03]).
Marius A. Tijunelis, Elizabeth Fitzsullivan, Sean O. Henderson
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.037
Published in issue: May 2005
xThe impact of noise pollution on both the patient and the care provider has been extensively studied in the neonatal intensive care unit and in other critical care units. Noise pollution makes errors more probable and is one of the risk factors for provider burnout and negative outcomes for patients. The Environmental Protection Agency (EPA) recommends that the acceptable noise level in a hospital should not exceed 40 dB.
Lisa Tilluckdharry, Sumit Tickoo, Yaw Amoateng-Adjepong, Constantine A. Manthous
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.038
Published in issue: May 2005
xWe hypothesized that critically ill patients who remain in the ED for more than 24 hours experience worse outcomes and longer lengths of stay than those transferred to the medical intensive care unit (MICU) within 24 hours.
Raymond G. Hart, Francisco A.S. Fernandas, Joseph E. Kutz
DOI: http://dx.doi.org/10.1016/j.ajem.2003.12.024
Published in issue: May 2005
xThe transthecal digital block is a simple, safe, and effective anesthesia technique that can be used in many digital injuries. It is contraindicated only in cases of infection. The purposes of this article are to (1) discuss the indications for the transthecal digital block, (2) describe the technique, and (3) review the literature. The transthecal technique is used on appropriate patients almost to the exclusion of more traditional digital blocks by many hand surgeons. The advantages of this method are that it requires only a single injection, has a rapid onset of action, and requires only a small amount of anesthetic.
Gillian D. Smith, Raymond G. Hart, Thomas W. Wolff
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.022
Published in issue: May 2005
xFoot conditions are frequently seen in the emergency department. In many cases, although weight bearing is painful, it is not precluded, per se. When a soft dressing does not provide sufficient support, a below knee walking cast may be applied. We present an alternative dressing that may be of benefit in selected foot injuries. The dressing is fashioned with cast padding, foam sheeting and plaster. It is designed and molded to fit like a slipper. The plaster slipper has distinct advantages in that it is comfortable, lighter for the patient, and avoids the problem of ankle stiffness.
Gillian D. Smith, Raymond G. Hart, Tsu-Min Tsai
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.031
Published in issue: May 2005
xPlaster of Paris has been largely superceded for casting in orthopedic departments by synthetic cast materials. Despite its weight, its relative brittleness, its unpopularity with patients, and its messiness in application, plaster of Paris remains the mainstay of casting in the emergency department. This is due to a combination of economic reasons, the belief that synthetic casts leave less room for swelling and its relative ease of application compared to synthetic materials. We present a technique for synthetic cast application that avoids the problems of the rapidly setting cast and therefore allows the time for less experienced hands to produce a well-fitting cast or splint.
Andrew Han Brainard, William Raynovich, Dan Tandberg, Edward J. Bedrick
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.004
Published in issue: May 2005
xThe prehospital electrocardiogram (ECG) is becoming the standard of care of suspected cardiac chest pain. We evaluated the evidence regarding the prehospital ECG and sought to quantify the reduction in time to reperfusion therapy attributable to the prehospital ECG. We conducted a systematic review and analyzed studies that were conducted in emergency medical systems relevant to providers in the United States. The papers were limited to studies that reported original data that compared prehospital ECG to no prehospital ECG groups.
Carl A. Germann, Andrew D. Perron, Timothy W. Sweeney, Mark D. Miller, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2004.01.002
Published in issue: May 2005
xFractures of the tibial plafond, or distal tibial articular surface, are usually associated with a high-force mechanism, which frequently can involve associated injuries and prolonged disability. Because of distracting injury and variations in clinical findings, tibial plafond fractures may be initially missed or misdiagnosed. This review examines the clinical presentation, diagnostic techniques, and management of tibial plafond fractures applicable to the emergency practitioner.
Shameem R. Nazeer, Hillary Dewbre, Adam H. Miller
DOI: http://dx.doi.org/10.1016/j.ajem.2004.11.001
Published in issue: May 2005
xTo determine if emergency center ultrasound (ECUS) can be of value to emergency physicians in the evaluation of possible ascites and accompanying decisions to perform emergent paracentesis.
Serge Landen, Bernard Majerus, Veronique Delugeau
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.016
Published in issue: May 2005
xAlthough laparoscopic adjustable gastric banding has become a widely used surgical modality for the treatment of morbid obesity, the technique and its complications remain fairly unknown to the medical community in general. Late complications occur in 10% to 20% of patients and usually manifest as upper gastrointestinal symptoms such as total food intolerance. However, seemingly unrelated symptoms such as chest pain may be the primary complaint. A rare but important complication to recognize and treat is gastric necrosis due to herniation of the stomach through the band.
Alex Harrison, Stanley Amundson
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.017
Published in issue: May 2005
xThe etiology of dyspnea can often be difficult to rapidly and accurately determine and can delay timely and appropriate therapies. The current literature reveals important diagnostic, prognostic, and therapeutic implications of several currently used biomarkers: sensitive d-dimer, myoglobin, creatine kinase–MB, cardiac troponins, and b-type natriuretic peptide. These biomarkers were found to have a high sensitivity and negative predictive value for rapidly ruling out potential serious etiologies of dyspnea, namely, pulmonary embolism (PE), acute myocardial infarction (AMI), and congestive heart failure (CHF).
Jacob W. Ufberg, Joseph S. Bushra, David J. Karras, Wayne A. Satz, Friedrich Kueppers
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.005
Published in issue: May 2005
xWe prospectively compared the incidence of pulmonary aspiration of gastric contents between patients endotracheally intubated in the prehospital (PH) setting and those intubated in the emergency department (ED). Tracheal aspirates were collected using a standard Leukens trap from all patients as soon as possible after endotracheal intubation. Tracheal aspirates were then tested for the presence of pepsin, a sensitive and specific marker of gastric contents, using a fibrinogen digestion technique.
Lawrence M. Linett
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.007
Published in issue: May 2005
xAortic dissection results from an intimal tear that allows blood to penetrate the wall of the aorta. Patients, typically males over the age of fifty with a history of hypertension, usually present with sudden onset of severe chest pain. An unusual presentation of a dissecting aortic aneurysm as a cause of abdominal pain in a 32-year-old male is discussed. Although a relatively uncommon cause of abdominal pain, it is important to keep this entity on the list of differential diagnoses and adequately rule it out before discharge from the emergency department.
Chih-Hsien Chi, Fong-Gong Wu, Shu-Hui Tsai, Chun-Hsiang Wang, Susan A. Stern
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.006
Published in issue: May 2005
xAn important step during spine immobilization is application of a cervical collar. Clothing or hair covering the neck may impinge on this process. The purpose of this study was to evaluate the effect of clothing and hair covering the neck on immobilization using a cervical collar. Study participants were 18 female volunteers with long hair aged 20 to 28 years. Cervical range of motion (ROM) was tested in 6 directions (flexion, extension, right and left lateral bending, right and left axial rotation) using a cervical ROM (CROM) device.
Rade B. Vukmir
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.032
Published in issue: May 2005
xWe present the case of a child with abdominal cramping found to have radiopaque matter in his gastrointestinal tract on plain radiography. The parents denied ingestion of a foreign substance but specific questioning revealed a visit for dental care the previous day. This may serve to illustrate the benefits of taking a careful goal-directed history as opposed to the often recommended open-ended approach.
Chih-Hsin Hsieh, Gau-Tyan Lin
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.043
Published in issue: May 2005
xThis report presents a case of hydrochloric acid injection in the inguinal area in a suicide attempt, resulting in total occlusion of the external iliac artery, requiring disarticulation of the hip. To the authors' best knowledge, it has not been previously reported in the English medical literature. The accelerated destructive activity of these irritant chemicals and deep tissue damages are emphasized. Early and aggressive debridement with copious saline irrigation and circumspect monitoring are recommended.
Jessica S. Racusin, Marc L. Pollack
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.001
Published in issue: May 2005
xRenal infarction is an uncommon disease that may mimic renal colic in its presentation and if undiagnosed can lead to significant morbidity. Until recently, intravenous pyelogram (IVP) was the diagnostic study of choice in the ED evaluation of suspected renal colic. However, IVP has increasingly been replaced by unenhanced helical computed tomography (CT) scans. The following case illustrates the limitations of performing a structural rather than functional diagnostic test in the evaluation of renal colic.
Joanna C. Law-Courter, Leonard R. Frank, David A. Townes
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.008
Published in issue: May 2005
xPneumoperitoneum, or free intra-abdominal air, usually results from perforation of a hollow viscus, requiring urgent surgical repair. In approximately 10% of cases, however, pneumoperitoneum is not secondary to perforation. These cases of “spontaneous pneumoperitoneum” (SPP) generally follow a more benign course and may not require surgical intervention. Recognized causes of SPP stem from thoracic, abdominal, gynecologic, and iatrogenic etiologies. Gynecologic causes are rare, but SPP has been reported to result from oral-genital sex, sexual intercourse, postpartum knee-to-chest exercises, and after routine pelvic examination.
Katherine M. Hiller, Stephen J. Wolf
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.009
Published in issue: May 2005
xA 31-year-old man without prior medical history presented to the emergency department with 2 days of nausea, vomiting, dyspnea, and abdominal pain. The patient was in moderate respiratory distress with Kussmaul's breathing. He was tachycardic but was not febrile, hypotensive, or hypoxemic. Physical examination was unremarkable except for evidence of dehydration and the abnormal breathing pattern. He was alert and oriented with a normal neurological examination.
Heather M. Prendergast, Judith Jean-Baptiste, Edward P. Sloan, Adam Schlichting
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.010
Published in issue: May 2005
xHeart failure is the leading discharge diagnosis in the Medicare population and approximately 80% to 90% of patients presenting to the emergency department (ED) with heart failure are admitted [1]. Up to 60% of patients discharged with a diagnosis of heart failure are rehospitalized within 6 months of discharge because of recurrent decomposition [2].
Chien-Chang Lee, Tai-Jung Chen, Yuan-Hui Wu, Kuang-Chau Tsai, Ang Yuan
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.011
Published in issue: May 2005
xSpontaneous cervical and mediastinal emphysema is a rare incident in young patients. Most incidents of spontaneous cervical and pneumomediastinum have an identifiable triggering etiology. Excluding the history of surgery and trauma, the leading cause was bronchial asthma, followed by physical exertion, forced swallowing, or any behavior reproducing Valsalva maneuver such as shout or cough [1-3]. The predominant presenting symptoms were dyspnea, dysphagia, and retrosternal pain. In this case report, we describe a young female adolescent with a history of asthma presented with acute shortness of breath, voice change, and stridor, mimicking acute upper airway obstruction.
Shahriar Zehtabchi, Stephan Rinnert, Seth Manoach, Mary B. Lightfine
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.012
Published in issue: May 2005
xFifteen years after the end of the cold war, ethnic, political, and religious conflicts have caused widespread refugee crises [1]. In addition, a billion people live on less than $1 per day [2], and lack adequate food, shelter, sanitation, and medical care. These problems are exacerbated by natural disasters, which take a heavier toll in poor nations that lack resources to respond to such events [3]. To provide relief, humanitarian organizations have used the skills of various professionals, including physicians.
Frank LoVecchio, Jason Knight
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.014
Published in issue: May 2005
xIntravenous injection with pyrethroids is rarely described. We describe minimal toxicity after intravenous injection.
Richard C. Christensen
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.018
Published in issue: May 2005
xSerotonin syndrome is a medication-induced hyperthermic toxidrome that is triggered by excessive serotonergic activity. Despite an increased awareness in recent years of this syndrome, recent reports suggest that it still may be underdiagnosed in the clinical and emergency setting [1]. Characterized by a triad of mental, autonomic, and neurological symptoms, serotonin syndrome can be either fairly benign or potentially lethal [2]. Hence, accurate diagnosis in the emergency department and prompt discontinuation of the causative agents can profoundly impact the clinical course and outcome of this particular toxic syndrome.
David Cheng, Rami Yakobi-shvili, Jose Fernandez
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.019
Published in issue: May 2005
xTelevised major sport championships have been shown to decrease ED patient visits, especially if a local team is involved [1]. Specifically, these events decrease overall visits by 18% and low acuity visits by 30% [2]. The effects of these events on the sex distribution of ED visit have never been studied.
Debra Houry, Melissa White, Kim Corneal
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.024
Published in issue: May 2005
xMotorcycle helmet laws vary greatly in the United States. Currently, all but 3 states require motorcyclists to wear helmets, although some states only apply this mandate to young riders [1]. Some motorcyclists consider laws that mandate helmet use a violation of their personal freedom; others claim that helmets impair their vision and hearing [2] or increase the risk of neck injury despite evidence that these fears are unfounded. Mangus et al [3] reported that persons with a history of motorcycle injury were less likely to use a helmet or protective equipment.
Min-Shan Tsai, Wen-Chu Chiang, Wen-Jone Chen, Pan-Chyr Yang, Ang Yuan
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.025
Published in issue: May 2005
xSpontaneous pneumomediastinum is an uncommon disease defined as a nontraumatic presence of free air in the mediastinum without any apparent precipitating underlying disease [1]. Most cases can be diagnosed by physical examination and chest roentgenogram [2,3]. We report a case of small-amount pneumomediastinum, which was not apparent on physical examination and chest roentgenogram, confirmed by computed tomography.
Steven L. Bernstein
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.026
Published in issue: May 2005
xEmergency department clinical, research, and administrative programs are frequently interdepartmental. Projects that extend beyond the ED require cooperation and commitment of all partners. To garner the support of administrators, it is often necessary to “sell” the merits of the project and demonstrate how it would complement the hospital's mission in a cost-sensitive fashion.
Paul Gennis, Siu Fai Li, Jennifer Provataris, Samina Shahabuddin, Alison Schachtel, Evelyn Lee, Paul Bobby
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.033
Published in issue: May 2005
xWe tested a rubber ring catheter (the Jacobi ring) in the treatment of Bartholin's abscesses and compared it with the Word catheter in a controlled trial.
Nasser Mikhail, Kash Trivedi, Christina Page, Soma Wali, Dennis Cope
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.036
Published in issue: May 2005
xIn nondiabetic individuals, insulin may be an effective and safe treatment of severe hypertriglyceridemia (serum triglyceride levels > 1000 mg/dL, 11.4 mmol/L) complicated by acute pancreatitis. However, its therapeutic value in this setting has not been adequately studied. We report a 38-year-old Hispanic women presented with excruciating abdominal pain secondary to acute pancreatitis complicating profound hypertriglyceridemia (serum triglycerides on presentation = 10560 mg/dL, 120 mmol/L). She was overweight (body mass index, 29.8 kg/m2) and had widespread eruptive xanthomas in her back and buttock areas.
Rawle A. Seupaul, Tyler M. Stepsis, Marla C. Doehring
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.039
Published in issue: May 2005
xRenal vein thrombosis (RVT) is a rare disorder that is found most commonly in adults with nephrotic syndrome and in children as part of an acute illness with prolonged volume loss. Patients with this condition are at risk for significant renal impairment and other arterial and venous thromboembolic complications. We present a case of a young healthy woman who presented to our ED with classic signs and symptoms of pyelonephritis that was subsequently found to have an idiopathic unilateral RVT without acute infection.
Sarise B. Freiman, Jody Holler, Mary Wittler, Lawrence Raymond
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.040
Published in issue: May 2005
xAluminum is a known neurotoxin, associated with cognitive, psychological, and motor abnormalities [1], most publicized in relation to patients with renal insufficiency, “dialysis dementia,” and plasma aluminum concentrations ([Al]b) of 7 to 392 μg/L (mean, 82 ± 56; normal, ≤7) [2,3]. Occupationally exposed workers with seizures, tremor, and cognitive impairment have also been described, usually without accompanying [Al]b values [4-6], except for the report of aluminum welders with high [Al]b levels (81-1728 and 380-1248) who frequently had electroencephalographic (EEG) abnormalities, including epileptiform changes in 7% to 17% [7].
Anthony L.H. Moss
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.041
Published in issue: May 2005
xIt is reassuring to see randomized control studies being undertaken. The paper by Holger et al [1] highlights some of the issues related to wound healing and closure techniques, particularly in relation to the use of glue [2]. I would like to make some comments to add to the debate.
Nikolaos Markou, Iraklis Tsangaris, Dimitris Konstantonis, George Vretzakis, Ioannis Pneumatikos, Nikolaos Katsikoyiannis, Paraskevi Argiropoulou, Panagiotis Prassopoulos
DOI: http://dx.doi.org/10.1016/j.ajem.2005.01.005
Published in issue: May 2005
xRetroperitoneal fasciitis is a rare, potentially lethal complication of colonic perforation. We report a case of colonic perforation with retroperitoneal necrotizing fasciitis, initially presenting as massive subcutaneous emphysema, in an elderly woman undergoing steroid treatment.
DOI: http://dx.doi.org/10.1016/S0735-6757(05)00151-8
Published in issue: May 2005
