The American journal of emergency medicine
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Case Reports
Warburg effect associated with transformed lymphoplasmacytic lymphoma to diffuse large B-cell lymphoma.
Warburg effect is a rare metabolic complication in hematologic malignancies, commonly presented with lactic acidosis and hypoglycemia. Mechanism explained by abnormality of mitochondrial oxidative phosphorylation in cancer cells and energy production is mostly dependent on anaerobic respiration or glycolysis pathway to meet large tumor demand. We present a case with history of lymphoplasmacytic lymphoma and Waldenstörm macroglobulinemia, partial response to chemotherapy. ⋯ Warburg effect represents poor prognosis no matter with or without hypoglycemia. Treatment of choice is cytoreduction with early chemotherapy. Our patient died 2 days after Warburg effect occurred.
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The widespread availability of microwave ovens has sparked interest in injuries resulting from their use. ⋯ To our knowledge, this is the first study to investigate microwave oven-related injuries on a national scale. Microwave ovens are an important source of injury in the home in the United States. The large increases in the number and rate of these injuries underscore the need for increased prevention efforts, especially among young children.
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An algorithmic approach to testing utilizing risk stratification and quantitative D-dimer has been considered an acceptable approach to ruling out pulmonary embolism (PE). When D-dimer is elevated, further testing for PE is indicated. ⋯ This case describes a patient who initially had an elevated D-dimer with negative workup for PE who, on repeat visit, had a decreasing D-dimer but was diagnosed with a PE. When evaluating patients after a negative workup for PE after an elevated D-dimer, a decrease in D-dimer cannot be used to rule out PE.
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Special attention to post-cardiac arrest management is important to long-term survival and favorable neurological outcome in patients resuscitated from cardiac arrest. The use of emergent percutaneous coronary intervention in resuscitated patients presenting with ST-segment elevation myocardial infarction has long been considered an appropriate approach for coronary revascularization. Recent evidence suggests that other subsets of patients, namely, post-cardiac arrest patients without ST-segment elevation myocardial infarction, may benefit from immediate percutaneous coronary intervention following resuscitation. These findings could eventually have important implications for the care of resuscitated patients, including transportation of resuscitated patients to appropriate cardiac interventional facilities, access to treatment modalities such as therapeutic hypothermia, and coordinated care with cardiac catheterization laboratories.
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This retrospective study aims to review California Poison Control System data to qualitatively describe reported methyl acetate (MA) exposures and determine if a metabolic acidosis develops. ⋯ These data suggest that minor ingestions of MA may be observed at home, but a prospective study is needed to exclude the risk of home observation.