Droperidol Plus Diphenhydramine for Symptom Improvement in Suspected Cannabinoid Hyperemesis Syndrome: A Prospective Cohort Study.

Background: Cannabinoid Hyperemesis Syndrome (CHS) is characterized by recurrent, paroxysmal episodes of nausea, vomiting, and abdominal discomfort in chronic cannabis users. Optimized CHS treatment data remain limited. Recent prospective evidence have demonstrated haloperidol superiority over ondansetron.

Single-Operator Left atrial appendage Occlusion utilizing Conscious sedation TEE, Lack of Outpatient pre-imaging, and Same-day Expedited discharge (SOLO-CLOSE): A comparison with conventional approach.

Background: Left atrial appendage occlusion (LAAO) with WATCHMAN currently requires preprocedural imaging, general anesthesia, and inpatient overnight admission. We sought to facilitate simplification of LAAO.

Aims: We describe and compare SOLO-CLOSE (single-operator LAA occlusion utilizing conscious sedation TEE, lack of outpatient pre-imaging, and same-day expedited discharge) with the conventional approach (CA).

Guillain-Barré syndrome after aortic, tricuspid, and mitral valve surgery.

Guillain-Barré syndrome incidence within 8 weeks of a surgical procedure appears to be more common than previously thought. GBS following open-heart surgery is exceedingly rare, perhaps underdiagnosed or underreported given surveillance data incidence. Clinicians should be keenly aware of this association and quickly consider a GBS diagnosis.

Rapidly progressive dyspnea in gastrointestinal stromal tumor (GIST) with imatinib cardiac toxicity.

Gastrointestinal stromal tumors (GISTs) are rare and current estimates range from 4,000 to 6,000 number of GIST cases in the USA annually. Imatinib, a tyrosine kinase inhibitor, has shown a survival benefit in GISTs, and the presence of KIT mutation status is predictive of response. The current case discusses rapidly progressive dyspnea and heart failure in an elderly male with metastatic GIST who was started on imatinib.

Idiopathic pulmonary vein thrombosis?

Idiopathic pulmonary vein thrombosis (PVT) is a rare disease which is likely under-diagnosed because of nebulous presentations. Accurate diagnosis is essential to prevent complications.

A case of asymptomatic pancytopenia with clinical features of hemolysis as a presentation of pernicious anemia.

Pernicious anemia is an autoimmune disease with a variety of clinical presentations. We describe a case of pernicious anemia presenting with pancytopenia with hemolytic features. Further workup revealed very low vitamin B12 levels and elevated methylmalonic acid.

Catastrophic chest pain: blinded by cardiopulmonary disease.

A 53-year-old man with a history of diabetic foot ulcer, osteomyelitis, coronary artery disease, hypertension and hyperlipidaemia, presented with chest pain of 3 weeks duration. Eleven days earlier, the patient had had a drug-eluting stent (DES) placed in a branch of the right coronary artery (RCA) after similar chest pain, leading to the findings of a positive nuclear stress test. Since discharge, he was not compliant with taking clopidegrel (Plavix), a concern for in-stent thrombosis with recurrent myocardial ischaemia; but work up was negative and medications were restarted.

Traumatic intracranial hemorrhage correlates with preinjury brain atrophy, but not with antithrombotic agent use: a retrospective study.

Background: The impact of antithrombotic agents (warfarin, clopidogrel, ASA) on traumatic brain injury outcomes is highly controversial. Although cerebral atrophy is speculated as a risk for acute intracranial hemorrhage, there is no objective literature evidence.

Materials And Methods: This is a retrospective, consecutive investigation of patients with signs of external head trauma and age ≥60 years.

Accessory cardiac bronchus.

Accessory cardiac bronchus is a poorly recognized, usually asymptomatic, congenital abnormality of the bronchial tree. Recognition of bronchial anomalies is important since they are associated with clinical complications including recurrent episodes of infection, hemoptysis, and in some cases malignancy.

Over diagnosis of chronic obstructive pulmonary disease in an underserved patient population.

Introduction: While cross-national studies have documented rates of chronic obstructive pulmonary disease (COPD) misdiagnosis among patients in primary care, US studies are scarce. Studies investigating diagnosis among uninsured patients are lacking.

Objective: The purpose of this study is to identify patients who are over diagnosed and thus, mistreated, for COPD in a federally qualified health center.

Giant bullae emphysema.

Bullous lung disease, a variant of the emphysematous process, can come in different forms and presentations, both histologically and radiographically. Giant bulla (GB) is the rarest form of bullous lung disease. Onset of disease to duration to symptoms is unclear.

Hepatic abscess associated with Salmonella serotype B in a chronic alcoholic patient.

Background: Hepatic abscess secondary to Salmonella is extremely rare in the United States and other Western countries.

Methods: A 43-year-old Caucasian man, with a history of chronic alcohol abuse, was admitted to the hospital for intermittent abdominal pain, fever and diarrhea. Clinical, radiological and laboratory results were analyzed.

Risk factors for upper extremity venous thrombosis associated with peripherally inserted central venous catheters.

Purpose: To identify clinically important risk factors associated with upper extremity venous thrombosis following peripherally inserted central venous catheters (PICC).

Methods: A retrospective case control study of 400 consecutive patients with and without upper extremity venous thrombosis post-PICC insertion was performed. Patient data included demographics, body mass index (BMI), ethnicity, site of insertion, size and lumen of catheter, internal length, infusate, and co-morbidities, such as diabetes mellitus, congestive heart failure, and renal failure.

Impact and costs of targeted recruitment of minorities to the National Lung Screening Trial.

Background: To promote results in the National Lung Screening Trial (NLST) that are generalizable across the entire US population, a subset of NLST sites developed dedicated strategies for minority recruitment.

Purpose: To report the effects of targeted strategies on the accrual of underrepresented groups, to describe participant characteristics, and to estimate the costs of targeted enrollment.

Methods: The 2002-2004 Tobacco Use Supplement was used to estimate eligible proportions of racial and ethnic categories.

Streptococcus sanguinis brain abscess as complication of subclinical endocarditis: emphasizing the importance of prompt diagnosis.

A 19-year-old male patient was diagnosed with S. sanguinis brain abscess of unknown etiopathology as a complication of subclinical endocarditis. While viridans streptococci are implicated in dental seeding to the heart, S.

Risks associated with magnetic resonance imaging and cervical collar in comatose, blunt trauma patients with negative comprehensive cervical spine computed tomography and no apparent spinal deficit.

Introduction: In blunt trauma, comatose patients (Glasgow Coma Scale score 3 to 8) with a negative comprehensive cervical spine (CS) computed tomography assessment and no apparent spinal deficit, CS clearance strategies (magnetic resonance imaging [MRI] and prolonged cervical collar use) are controversial.

Methods: We conducted a literature review to delineate risks for coma, CS instability, prolonged cervical collar use, and CS MRI.

Results: Based on our search of the literature, the numbers of functional survivor patients among those who had sustained blunt trauma were as follows: 350 per 1,000 comatose unstable patients (increased intracranial pressure [ICP], hypotension, hypoxia, or early ventilator-associated pneumonia); 150 per 1,000 comatose high-risk patients (age > 45 years or Glasgow Coma Scale score 3 to 5); and 600 per 1,000 comatose stable patients (not unstable or high risk).

The constricted heart.

Often indistinguishable from restrictive cardiomyopathy and hepatic cirrohis, clinical acumen is essential in the recognition and diagnosis of constrictive pericarditis. A thorough medical history should rule out infectious disease exposure. A physical examination may include variable signs such as Kussmaul's sign, pulsus paradoxus, and pericardial knock, while jugular venous distention is of cardinal significance in eliminating liver cirrhosis as the cause of ascites.

Noninvasive ventilation.

Noninvasive positive-pressure ventilation (NPPV) is the delivery of mechanical-assisted breathing without placement of an artificial airway such as an endotracheal tube or tracheostomy. During the first half of 20th century, negative-pressure ventilation (iron lung) provided mechanical ventilatory assistance. By the 1960s, however, invasive (ie, by means of an endotracheal tube) positive-pressure ventilation superseded negative-pressure ventilation as the primarily mode of support for ICU patients because of its superior delivery of support and better airway protection.