J Emerg Med
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Few studies have evaluated the necessity of immediate stress testing after observation for chest pain. The purpose of this study was to assess the safety of outpatient stress testing after discharge from a chest pain unit. We hypothesized that discharge from a chest pain unit before stress testing is associated with a low rate of short-term adverse outcomes. ⋯ Nine patients (2.6%) were admitted to the hospital and 10 (2.9%) were readmitted to the observation unit for chest pain. We conclude that patients who have negative serial electrocardiograms and enzyme testing in a chest pain unit are at low risk for short-term cardiac events. Appropriately selected patients may be discharged for subsequent outpatient testing.
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This study was conducted to determine if an initial bout of resistance (weight lifting) exercise by untrained women results in any alterations in indicators of acute myocardial infarction (AMI). Untrained women performed 4 resistance exercises at 70% of their 1 repetition maximum. ⋯ Using several criteria for the assessment of AMI, 22-25% of subjects completing the protocol demonstrated increases in CK-MB(2), CK-MB(2)/CK-MB(1) ratio, and relative lymphocyte percentages that were suggestive of AMI. Thus, our data suggest that moderate resistance exercise can significantly alter blood indicators of AMI, emphasizing the need to determine recent exercise history in patients with possible AMI.
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The PFAPA (Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitidis) syndrome is characterized by periodic fever, adenitis, pharyngitis, and aphthous stomatitis. Herein, we present a Turkish child with PFAPA syndrome mimicking familial Mediterranean fever because of a rare presentation. A 9-year-old boy was admitted with recurrent fever, aphthous stomatitis, sore throat, headache, and general body pains, lasting 2 to 3 days since 3.5 years of age. ⋯ At this writing the patient is in the 12th month of follow-up, and there have been no symptoms after the second attack. In conclusion, our patient shows that PFAPA syndrome can be confused with familial Mediterranean fever. We also would like to emphasize that the typical PFAPA syndrome can be easily diagnosed by detailed history-taking and physical findings.
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Case Reports
Combination pharmacotherapy with reduced-dose fibrinolytic and platelet GP IIb/IIIa inhibition.
Combination fibrinolytic and antiplatelet therapy regimens may provide a means of inducing rapid reperfusion in patients requiring myocardial salvage after an acute myocardial infarction (AMI). This article describes case histories and a therapeutic regimen combining reteplase (5 U + 5 U double bolus) and abciximab (0.25 mg/kg bolus + 0.125 microg/kg/min infusion to a maximum of 10 microg/min for 12 h) for AMI patients before percutaneous coronary intervention (PCI). This medication regimen was used in the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) V clinical trial, for the medical treatment of AMI, resulting in decreased reinfarction rates with similar mortality and intracranial hemorrhage rates as compared to standard fibrinolytic therapy.
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We describe a case of intermediate syndrome after chlorpyrifos ingestion in a toddler, despite a continuous pralidoxime infusion. A 16-month-old girl ingested a pesticide containing chlorpyrifos. She was brought to an Emergency Department where she became lethargic and tachycardic, and subsequently developed pulmonary edema requiring mechanical ventilation. ⋯ She was emergently re-intubated. The child's delayed onset of respiratory arrest and flaccid paralysis after an asymptomatic period is consistent with Intermediate Syndrome. This is an unusual case in that it occurred in a young child, was related to chlorpyrifos, and occurred despite continuous and adequate oxime therapy.