J Emerg Med
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Narcotic bowel syndrome is characterized by chronic or recurrent abdominal pain associated with escalating doses of narcotic pain medications. It may occur in as many as 4% of all patients taking opiates, and yet few physicians are aware that the syndrome exists. ⋯ It is particularly important for emergency physicians to be familiar with this syndrome, as many patients with narcotic bowel syndrome seek evaluation and treatment in the ED. Although the diagnosis is unlikely to be made in the ED, timely referral for evaluation of this syndrome may help patients to receive definitive treatment for their recurrent and chronic pain.
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Case Reports
Life-threatening rupture of a renal angiomyolipoma in a patient taking over-the-counter horse chestnut seed extract.
Alternative medical therapies are increasingly being prescribed due to their good safety profile and perceived limited side effects. They are often unregulated and prescribed over the counter. One such medication is horse chestnut seed extract (HCSE), which is used for the treatment of chronic venous insufficiency and is known to affect blood coagulation. Angiomyolipoma (AML) is a benign fat-containing mesenchymal tumor of the kidney. It is often found incidentally and in most cases can be managed conservatively. Rupture of the kidney with hemorrhage is a well-known complication that may be serious and life-threatening. Known risk factors for hemorrhage include anticoagulation as well as pregnancy, increased size of the lesion, high lesion vascularity, and aneurysm formation within the tumor. ⋯ We demonstrate a potentially life-threatening association between HSCE-containing products and renal AML, highlighting the risk associated with HSCE-induced anticoagulation.
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In the United States, the incidence of traumatic spinal cord injury is estimated to be approximately 40 per one million persons per year. The most common causes of traumatic spinal cord injury are motor vehicle collisions, falls, gunshot wounds, and sports accidents. ⋯ Neurogenic shock should be considered in patients with hypotension of unknown or unclear etiology. A ground-level fall is sufficient to cause traumatic spinal cord injury in elderly patients, and a cervical spine computed tomography scan without clear fracture does not exclude this pathology.
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Case Reports
Thallium-201 for cardiac stress tests: residual radioactivity worries patients and security.
A 47-year-old man presented to the Emergency Department (ED) in duress and stated he was "highly radioactive." There were no reports of nuclear disasters, spills, or mishaps in the local area. ⋯ This case describes an anxious, but otherwise asymptomatic patient presenting to the ED with detection of low-level personal radiation. Documentation should be provided to and carried by individuals receiving radionuclides for a minimum of five to six half-lives of the longest-lasting isotope provided. Patients receiving Tl-201 should understand the potential for security issues; reducing probable tense moments, confusion, and anxiety to themselves, their employers, security officials, and ED staff.
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Infectious intracranial aneurysms constitute a small subgroup of all intracranial aneurysms, but are an important cause of neurologic complaints in patients with infective endocarditis. ⋯ Early consideration of intracranial infectious aneurysm in patients with infective endocarditis and neurologic symptoms is critical. Therapeutic intervention is often effective, and risk of aneurysm rupture is high.