Hematometra: A Rare Case of Pelvic Pain in Females Identified with Point of Care Ultrasound.

The differential diagnosis for abdominal or pelvic pain in women of child-bearing age that present to the emergency department is broad. A rare cause of abdominal and pelvic pain is hematometra, or a collection of blood products within the uterus. While blood is normally expelled through menses, this process is disrupted in some patients due to congenital or acquired abnormalities.

Timing and Outcomes After Coronary Angiography Following Out-of-Hospital Cardiac Arrest Without Signs of ST-Segment Elevation Myocardial Infarction.

Background: There is broad consensus that resuscitated out-of-hospital cardiac arrest (OHCA) patients with ST-segment elevation myocardial infarction (STEMI) should receive immediate coronary angiography (CAG); however, factors that guide patient selection and optimal timing of CAG for post-arrest patients without evidence of STEMI remain incompletely described.

Objective: We sought to describe the timing of post-arrest CAG in actual practice, patient characteristics associated with decision to perform immediate vs. delayed CAG, and patient outcomes after CAG.

Clinical factors associated with significant coronary lesions following out-of-hospital cardiac arrest.

Objectives: Out-of-hospital cardiac arrest (OHCA) afflicts >350,000 people annually in the United States. While postarrest coronary angiography (CAG) with percutaneous coronary intervention (PCI) has been associated with improved survival in observational cohorts, substantial uncertainty exists regarding patient selection for postarrest CAG. We tested the hypothesis that symptoms consistent with acute coronary syndrome (ACS), including chest discomfort, prior to OHCAs are associated with significant coronary lesions identified on postarrest CAG.

Race Predicts Unsuccessful Healing of Osteochondritis Dissecans in the Pediatric Knee.

The purpose of this study was to evaluate the effect of race, insurance status, and socioeconomic status on successful or unsuccessful healing of osteochondritis dissecans (OCD) lesions in the pediatric knee. The authors retrospectively reviewed patients younger than 18 years who were treated for a knee OCD lesion between 2006 and 2017. Patients were required to have at least 6 months of clinical and radiographic follow-up to be included, unless complete healing was achieved sooner.

Cannabinoids: A Guide for Use in the World of Gastrointestinal Disease.

Cannabinoids have been known as the primary component of cannabis for decades, but the characterization of the endocannabinoid system (ECS) in the 1990s opened the doors for cannabis' use in modern medicine. The 2 main receptors of this system, cannabinoid receptors 1 and 2, are found on cells of various tissues, with significant expression in the gastrointestinal (GI) tract. The characterization of the ECS also heralded the understanding of endocannabinoids, naturally occurring compounds synthesized in the human body.

Full-thickness neorectal prolapse after transanal transabdominal proctosigmoidectomy for low rectal cancer: a cohort study.

Aim: Transanal transabdominal proctosigmoidectomy (TATA) with a coloanal anastomosis is an alternative to abdominoperineal excision of the rectum (APR) for low rectal cancer. Neorectal prolapse is an unusual complication following TATA. This study aimed to determine the incidence of neorectal prolapse after TATA for low rectal cancer.

Is It Necessary to Extend a Multilevel Posterior Cervical Decompression and Fusion to the Upper Thoracic Spine?

Study Design: A retrospective cohort analysis.

Objective: The aim of this study was to determine if there is a difference in the revision rate in patients who undergo a multilevel posterior cervical fusions ending at C7, T1, or T2-T4.

Summary Of Background Data: Multilevel posterior cervical decompression and fusion is a common procedure for patients with cervical spondylotic myelopathy, but there is little literature available to help guide the surgeon in choosing the caudal level of a multilevel posterior cervical fusion.

Bilateral lesions of thalamus and basal ganglia: origin and outcome.

Twenty-seven MRI examinations from 17 children (7 females, 10 males) with bilateral lesions of the basal ganglia and thalamus, presenting over a period of 8 years, were reevaluated, and correlated with the type of cerebral palsy (CP) as well as motor and cognitive impairment. Children were between 1 year 6 months and 17 years old at last examination (mean 5 years 9 months). Brain damage had occurred as a consequence of birth asphyxia in nine patients and of neonatal shock in four patients.

Cardiovascular and adrenal sensitivity to angiotensin II in essential hypertension.

Regulation of aldosterone secretion by sodium chloride is impaired in a group of essential hypertensives: high-salt diet fails to suppress aldosterone in these patients despite low renin values. The mechanism of this impaired regulation of aldosterone has not been clarified so far. We tested the sensitivity of aldosterone secretion and blood pressure to A II in 20 normotensive controls (aged 20-60, MAP 92 +/- 3 mm Hg), in ten normotensives with one or two parents with hypertension, and in 21 patients with essential hypertension (aged 17-65, MAP 119 +/- 4 mm Hg).

[Primary hyperaldosteronism: differentiation between aldosterone-producing adenoma and idiopathic adrenocortical hyperplasia (author's transl)].

The regulation of aldosterone secretion by sodium restricted and enriched diet was assessed in 21 patients with primary aldosteronism for differentiation between unilateral aldosterone-producing adenoma and adrenocortical hyperplasia causing autonomous aldosterone hypersecretion. Compared to 10 patients with idiopathic adrenocortical hyperplasia, urinary aldosterone excretion after 4 days of sodium restricted diet was significantly higher in 11 patients with established adenoma (41.3 +/- 16.

Antihypertensive effects of captopril and saralasin in essential and renal hypertension.

The antihypertensive effect of captopril and its mechanism of action were studied in patients with essential and renal hypertension. In mild essential hypertension (n = 12), during monotherapy with captopril (50 to 450 mg, 4 to 12 weeks) blood pressure was normalized in seven, improved in two and remained unchanged in three patients, plasma levels of active and acid-activatable inactive renin significantly increased and angiotensin II decreased, whereas no consistent changes in urinary kallikrein excretion occurred. In severe renal (n = 14) and essential (n = 9) hypertension, blood pressure was normalized in eight (seven with renal hypertension), improved in seven and unchanged in eight patients, when captopril (50 to 450 mg, 3 to 15 months) was added to the antihypertensive medication.

Characterization of a group of essential hypertensives with impaired regulation of aldosterone.

The pattern of aldosterone excretion during high sodium intake in 100 patients with essential hypertension allowed the differentiation of two groups: in the majority of patients (group A, n = 64) aldosterone excretion was suppressed below 6 micrograms/day similar to the normotensive control group. In a second group (group B, n = 36), aldosterone remained above the control range despite forced sodium loading. In group B, serum potassium was significantly lower than in patients of group A (3.

[Clinical aspects and treatment of the hypertensive emergency (author's transl)].

The term "hypertensive emergency" includes all clinical syndromes which are triggered by a rapid rise in the arterial blood pressure and are improved by medicinal lowering of the blood pressure. Among them are hypertensive encephalopathy, acute rise in blood pressure with left heart failure and acute rise in blood pressure complicated by intracerebral hemorrhage or a dissecting aortic aneurysm. Parenteral application of dihydralazine, diazoxide and clonidine are suitable for immediate lowering of blood pressure medicinally and sodium nitroprusside under clinical supervision.

[Increased cardiovascular arteriosclerosis risk in patients with analgesic nephropathy (author's transl)].

The retrospective investigation of 54 patients with analgesic nephropathy showed the relatively early occurrence of coronary sclerosis and an increased frequency of arteriosclerotic renal artery stenosis. Angina pectoris was found in 14 patients with a mean age of 48 1/2 years. Summation of risk factors is the probable cause of the tendency for arteriosclerosis: hypercholesterolaemia and hypertriglyceridaemia was found in 29 patients, arterial hypertension in 42 patients, which was so severe in half of the patients that combined treatment with two or more drugs was necessary.

Na-K-ATPase in erythrocyte ghosts is not a marker for primary hypertension.

In search for a diagnostic marker for essential hypertension, we investigated the activity of the ouabain sensitive Na-K-ATPase and the ouabain insensitive ATPase in erythrocyte ghosts of 57 patients with essential hypertension, 12 patients with renal hypertension, 6 patients with Cushing's syndrome and 4 patients with primary hyperaldosteronism. Na-K-ATPase-activity was increased in patients with essential hypertension and in patients with renal hypertension compared with controls with a considerable overlap. Na-K-ATPase-activity was increased in all patients with Cushing's syndrome but was not different from the control group in patients with Conn's syndrome.

Sodium-potassium-dependent ATPase activity in erythrocyte ghosts of patients with primary and secondary hypertension.

1. We have investigated the function of the Na+-K+ pump in the erythrocytes of patients with various types of hypertension by measuring the activity of ouabain-sensitive Na+-K+-dependent ATPase and ouabain-insensitive ATPase in the erythrocyte ghosts of these patients. 2.

Regulation of serum-progesterone in patients with essential hypertension.

Increased levels of progesterone in serum have been reported in male patients with essential hypertension (EH). We, therefore, investigated serum progesterone levels in relation to excretion of aldosterone after 4 days of low Na+ intake and 6 days following high Na+ diets, in 11 normotensive controls, 22 male patients with EH and 8 male patients with hypertension of renal origin (RH). In the group of normotensive controls, the concentration of progesterone in serum averaged 228 +/- 90 and 186 +/- 93 (mean +/- SD) pg/ml during low and high regimens of Na+ intake, respectively, despite a fall in the excretion of aldosterone from 22.