Internal medicine
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Patient 1 (82 years old) had recurrent weakness and numbness in the left upper extremity, Patient 2 (71 years old) had transient dysarthria, and Patient 3 (70 years old) had transient apraxia of speech. Transient ischemic attack (TIA) was suspected; however, all three women had a history of head trauma before the symptom onset, and magnetic resonance imaging revealed subdural hematomas near the responsible lesions associated with sulcal hyperintensity (SHI) in the cerebral sulcus near the hematoma. Patients 1 and 2 improved spontaneously, whereas Patient 3 improved with antiseizure medication. Subdural hematomas associated with SHI may have transient focal neurological deficits that manifest through a mechanism unlike TIA.
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Objective Triple-vessel disease (TVD) is a well-established prognostic factor for patients with acute myocardial infarction (AMI). However, there is a paucity of literature regarding the risk factors for in-hospital death in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and TVD. In this retrospective study, we examined the determinants of in-hospital death in patients with NSTEMI and TVD who underwent percutaneous coronary intervention (PCI) for culprit lesions. ⋯ In the multivariate logistic regression analysis, in-hospital death was inversely associated with the SBP at admission (odds ratio [OR] 0.984, 95% confidence interval [CI] 0.970-0.999, p<0.035) and eGFR (OR 0.966, 95% CI 0.939-0.994, p=0.019) and was associated with cardiopulmonary arrest (CPA) before PCI (OR 8.448, 95%CI 1.863-38.309, p=0.006). Conclusion In-hospital death was associated with CPA before PCI and inversely associated with the SBP at admission and eGFR in patients with NSTEMI and TVD who underwent PCI for the culprit lesion. It may be important to recognize these high-risk features in order to improve the clinical outcomes of patients with NSTEMI and TVD.
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Objectives The present study evaluated the usefulness of machine learning (ML) models with the coronary artery calcification score (CACS) and clinical parameters for predicting major adverse cardiac events (MACEs). Methods The Nationwide Gender-specific Atherosclerosis Determinants Estimation and Ischemic Cardiovascular Disease Prospective Cohort study (NADESICO) of 1,187 patients with suspected coronary artery disease (CAD) 50-74 years old was used to build a MACE prediction model. The ML random forest (RF) model was compared with a logistic regression analysis. ⋯ Conclusion The ML-RF model improved the long-term prediction of MACEs compared to the logistic regression model. However, the selected variables in the internal dataset were not highly predictive of the external dataset. Further investigations are required to validate the usefulness of this model.
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Angiosarcoma is a rare malignancy that can arise from chronic pyothorax. We herein report a 75-year-old Japanese man with a history of tuberculosis who presented with left-sided chest pain that had persisted for 4 months. ⋯ Chemotherapy with paclitaxel (80 mg/m2 weekly) was ineffective and was discontinued after 3 months. Our findings emphasize that physicians should inform patients with chronic tuberculous pyothorax about malignant complications for which chest pain is the initial symptom, in addition to highlighting the need for careful follow-up.