J Emerg Med
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The purpose of this study was to evaluate appendiceal enlargement as a radiographic criterion for the diagnosis of acute appendicitis. We examined medical records and specimens of 190 adults and children who presented to a teaching hospital in New York City with right-lower-quadrant pain and who underwent surgery. ⋯ Yet, radiologic evidence of appendix size often influences the diagnosis and management of patients with acute abdominal pain, including the decision to operate. This tendency to equate an enlarged appendix with appendicitis is shown to lead to an inappropriate diagnosis and jeopardize optimal care of patients with acute abdominal pain.
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Cardiac troponins I and T are proteins integral to the function of cardiac muscle. They are very sensitive markers for the detection of myocardial damage, and the ability to assay their serum levels accurately and quickly have revolutionized the concepts of minor myocardial injury and infarction. ⋯ Rapid, whole blood assays are now available that can be done at the patient's bedside. This review discusses the cardiac troponins, their biochemistry, the assays for them currently available, and their roles in the evaluation of cardiac disease in the Emergency Department (ED).
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Blunt diaphragmatic injury is notoriously difficult to diagnose. There is no gold standard for radiologic diagnosis of this disease entity. This article reports a case of traumatic diaphragmatic rupture in a 7-year-old girl whose injury was identified on hospital day 2. The discussion includes a review of the physiology of this injury and the utility of radiologic modalities in making a timely diagnosis.
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The lumbar puncture (LP) is a relatively simple diagnostic test. However, significant diagnostic ambiguity can arise when trauma from the needle causes bleeding into the subarachnoid space, especially when trying to make the diagnosis of subarachnoid hemorrhage (SAH). The purpose of this article is to assist emergency physicians in distinguishing traumatic LPs from SAH. ⋯ Timing of the LP in relation to the onset of the SAH affects the results of the cerebrospinal fluid (CFS) analysis; the typical findings will change with time. With a few caveats, xanthochromia, the yellow discoloration of the CSF resulting from hemoglobin catabolism, is often critical in making a diagnosis of SAH. A few of the most essential methods for distinguishing traumatic LP from true SAH include: the "three tube test," opening pressure, and inspection for visual xanthochromia.
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Malaria is frequently a deadly disease, particularly in tropical countries of the world where this protozoan infection is endemic. While physicians in tropical countries are familiar with the presentation, those who do not practice in endemic regions of the world may neglect to add tropical diseases to their differential diagnosis of fever. Epidemiologic data from the CDC show the number of cases of malaria being diagnosed in the United States in the last decade has risen sharply. With international travel continuing to rise, there is strong reason to consider malaria as a source of fever.