Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jul 2001
[Leading symptoms of chest pain in the emergency room. Using cardiac markers for risk stratification].
The acute coronary syndrome (ACS)--acute infarction or unstable angina pectoris--requires special monitoring and differentiated treatment. A prospective trial was undertaken to determine (1) clinical characteristics of patients with chest pain; (2) value of cardiac markers troponin T, myoglobin and CK-MB mass in differentiating cardiac and noncardiac chest pain; (3) the proportion of patients with ACS in whom these markers provided helpful additional information on admission and afterwards. ⋯ In the assessment of patients with acute chest pain clinical judgement plays the predominant role. In the mostly elderly and male patients with ACS (31% of the cohort) feeling of pressure or stabbing chest pain were most prominent (91%). Cardiac markers troponin T, CK-MB mass and myoglobin were helpful in the differential diagnosis of chest pain, even when the ECG was unremarkable or nonspecific. At the time of admission myoglobin was the most significant marker for acute myocardial infarction or unstable angina.
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Nosocomial infections are an important problem in modern hospitals. The prevalence in German intensive care units is 15.3%. Hand washing or hand disinfection is believed to be the most important means of preventing nosocomial infections. We wished to answer the following questions: 1. How good is the compliance of hand hygiene on intensive care units? 2. Is compliance associated with the patient/nurse-ratio? ⋯ The compliance of hand disinfection is similar to other study results, but on some intensive care units there was considerable room for improvement. In this study the compliance of hand hygiene is more of a constant factor in individual intensive care units than associated with the patient/nurse-ratio.
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Dtsch. Med. Wochenschr. · Jun 2001
Case Reports[Multiple paradoxical emboli in patent foramen ovale].
A 38-year-old man was admitted because of angina pectoris with concomitant dyspnoea. Three months previously he had suffered an ischaemic stroke of the right middle cerebral artery and was treated in a neurological department. At that time, no aetiologic diagnosis was possible. There was no history of other diseases. Pulse rate was 100 beats per minute with a blood pressure of 140/60 mm Hg. The left calf had a 4 cm greater circumference without any symptoms. The rest of the physical examination in the markedly overweight patient was normal. ⋯ In patients with PFO, paradoxical embolism remains a challenging diagnosis that can be made highly probable by documentation of venous thromboses, pulmonary embolism, missing evidence of atherosclerosis in the vessels of the embolized organ and exclusion of other cardiovascular sources of emboli and prothrombotic coagulation disorders. Interventional closure of a patent foramen ovale appears to be the treatment of choice in proven paradoxical embolism.