The American journal of medicine
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Multicenter Study
Characterization of ischemic colitis associated with myocardial infarction: an analysis of 23 patients.
The study characterizes the clinical presentation of ischemic colitis (IC) associated with myocardial infarction (MI) and helps determine whether the primary mechanism for this association is thrombus, embolus, or localized nonocclusive mesenteric ischemia (NOMI) associated with systemic hypotension. ⋯ Patients with both IC and MI present as a clinically distinct group from patients with either IC alone or MI alone. They have significantly more complications and worse in-hospital prognoses. They present with a dramatically lower MAP and a higher frequency of hypotension. This last finding suggests that the most common and most important mechanism for IC with MI may be hypotension from cardiogenic shock. Hypotension is the cardinal risk factor for generalized NOMI with acute mesenteric ischemia and may be an important risk factor for localized NOMI with IC. An APACHE II score greater than 15 may be a predictor of mortality from IC after MI.
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Randomized Controlled Trial Multicenter Study
Celecoxib versus naproxen and diclofenac in osteoarthritis patients: SUCCESS-I Study.
To evaluate the efficacy and upper gastrointestinal (UGI) safety of celecoxib, compared with nonspecific nonsteroidal anti-inflammatory drugs (NSAIDs), among patients with osteoarthritis. ⋯ In the treatment of osteoarthritis, celecoxib is as effective as the nonspecific NSAIDs naproxen and diclofenac, but has significantly fewer serious upper gastrointestinal events.
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B-type natriuretic peptide is known to correlate with hemodynamic state, presence and severity of congestive heart failure, and prognosis. Although low-range B-type natriuretic peptide less than 100 pg/mL has a high negative predictive value (90%), and high-range B-type natriuretic peptide greater than 500 pg/mL has a high positive predictive value (87%), there remains some ambiguity in the interpretation of results in the medium range (100-500 pg/mL). We hypothesized that taking into account the history of congestive heart failure along with other clinical variables would be helpful in this range of B-type natriuretic peptide levels. ⋯ Even in the medium range (100-500 pg/mL), when using the history of congestive heart failure and index criteria, B-type natriuretic peptide can be a powerful diagnostic tool in the hands of clinicians in the emergency department.
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Randomized Controlled Trial Multicenter Study Comparative Study
A randomized trial comparing electronic and conventional stethoscopes.
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Multicenter Study
Competency in electrocardiogram interpretation among internal medicine and emergency medicine residents.
Accurate interpretation of the electrocardiogram is critical, yet there are no evidence-based guidelines for assessing competency. Our study evaluated the ability of internal medicine residents and emergency medicine residents to interpret a variety of electrocardiograms. ⋯ Despite improvement in interpretation with clinical experience, overall performance was low. Research is needed to find optimal methods to improve electrocardiogram competency.