September 27th 2024
Your daily dose of the clinical news you may have missed.
Colonic Varices: A Rare Cause of Lower GI Bleeding
September 1st 2006A 50-year-old man with alcohol-induced cirrhosis was hospitalized with lower GI bleeding. On examination, he was pale, heart rate was 100 beats per minute, and blood pressure was 100/60 mm Hg. He was anemic (hemoglobin level, 9 g/dL) and thrombocytopenic (platelet count, 112,000/µL).
Anemia: Discerning the Cause in Different Clinical Settings
June 1st 2006A 77-year-old woman who had hadanorexia and weakness for 3 monthswas seen after a syncopal episode. Sheappeared pale but alert. Heart rate was110 beats per minute; respiration rate,22 breaths per minute; and blood pressure,170/70 mm Hg. Her hematologicindices were: hemoglobin level, 4.3 g/dL;mean corpuscular volume (MCV), 60fL; mean corpuscular hemoglobin concentration(MCHC), 29 g/dL; red bloodcell count, 1.6 million/μL; white bloodcell count, 7500/μL; and platelet count,452,000/μL.
Comparing prognosis in patients with pulmonary arterial hypertension
June 1st 2006According to previous reports, patients with pulmonary arterial hypertension (PAH) associated with collagen-vascular disease have a better prognosis than patients who have idiopathic PAH. However, in a study conducted in Korea, Chung and colleagues recently found that the mortality rate was significantly higher in patients with systemic lupus erythematosus and pulmonary hypertension (SLE-PH) than in those with idiopathic PAH.
Guidelines for evaluating pulmonary arterial hypertension
June 1st 2006Pulmonary arterial hypertension (PAH) can be difficult to diagnose because the symptoms are nonspecific and the physical findings are usually subtle (Table). In 2004, the American College of Chest Physicians (ACCP) published clinical practice guidelines for the diagnosis and management of PAH.1 Highlights of the ACCP's recommendations for patient assessment include the following:
Man With Chest Pain After Cocaine Use
May 1st 2006A 53-year-old man presents to the emergency department(ED) with chest pain that started the previous night. Thepain began about 30 minutes after he had smoked marijuanaand inhaled cocaine. He describes the pain as tightnessin the left side of the chest that radiates into theneck; he also has a tingling sensation in both the left sideof the neck and the left arm.
Diagnostic Puzzlers: A patient with progressive dyspnea and right heart failure
May 1st 2006A 64-year-old woman with a history of uncorrected ventricular septal defect was hospitalized with progressive dyspnea and right heart failure. The patient had recently emigrated to the United States, where she received the diagnosis of ventricular septal defect with significant pulmonary arterial hypertension (Eisenmenger syndrome).
Exercise intolerance in severe COPD: A review of assessment and treatment
May 1st 2006Abstract: Exercise intolerance is common in persons with chronic obstructive pulmonary disease and can result from multiple physiologic factors, including dynamic hyperinflation, gas exchange abnormalities, and pulmonary hypertension. In the initial assessment, keep in mind that many patients underestimate the degree of their impairment. The 6-minute walk test is very useful in assessing the degree of exercise intolerance; when more extensive assessment is indicated, cardiopulmonary exercise testing (CPET) is the gold standard. CPET is particularly useful for defining the underlying physiology of exercise limitation and may reveal other causes of dyspnea, such as myocardial ischemia or pulmonary hypertension. Strategies for improving exercise tolerance range from the use of bronchodilators and supplemental oxygen to participation in a pulmonary rehabilitation program. (J Respir Dis. 2006;27(5):208-218)