Outcome of travelers who refuse transport after emergency medical services evaluation at an international airport.

Objective: To determine the short-term outcome of patients refusing transport after emergency medical services (EMS) evaluation at an international airport.

Methods: This was a prospective, descriptive, observational study of patients who refused transport after evaluation by Philadelphia Fire Department paramedics at Philadelphia International Airport from July 2003 through March 2004. Paramedics contacted a medical command physician (MCP), who recorded the patient's contact information.

Evaluation of a clinical decision rule for young adult patients with chest pain.

Objectives: The authors sought to validate a clinical decision rule that young adult (younger than 40 years) chest pain patients without known cardiac disease who had either no cardiac risk factors and/or a normal electrocardiogram (ECG) are at low risk (<1%) for acute coronary syndromes (ACS) and 30-day adverse cardiovascular (CV) events.

Methods: A prospective cohort study of patients 24-39 years old who received an ECG for chest pain from July 1999 to March 2002 were included. Cocaine users were excluded.

Impact of a negative evaluation for underlying coronary artery disease on one-year resource utilization for patients admitted with potential acute coronary syndromes.

Unlabelled: Reduction in emergency department (ED) overcrowding is a major Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) initiative. One major source of ED overcrowding is patients waiting for telemetry beds.

Objective: To determine whether, in patients admitted with a potential acute coronary syndrome, a negative evaluation for underlying coronary artery disease would reduce ED and hospital revisits over the subsequent year compared with patients who did not receive an evaluation for underlying coronary artery disease.

Portoenterostomy: an old treatment for a new disease.

Hypothesis: Portoenterostomy may be an effective treatment for patients sustaining a thermal injury to the hepatic duct confluence during laparoscopic cholecystectomy.

Design: Case series.

Setting: A tertiary care referral hospital.

Aortoventricular fistula secondary to blunt trauma: a case report and review of the literature.

An aorto-right ventricular fistula secondary to nonpenetrating trauma is described. Review of the literature is reported. Ascending aortic injuries present as either traumatic pseudoaneurysms or, less commonly, as aortocardiac fistulas.

Renal computed tomography with 3-dimensional angiography and simultaneous measurement of plasma contrast clearance reduce the invasiveness and cost of evaluating living renal donor candidates.

Renal computed tomography (CT), 3-dimensional CT angiography (3D-CTA), and simultaneous measurement of glomerular filtration rate (GFR) by x-ray fluorescence determination of plasma contrast clearance (PCC) are alternatives to intravenous urography (IVU), renal arteriography (RA), and 24-hr urine creatinine clearance (CrCl) for evaluation of renal structure and function in living renal donor (LRD) candidates. To determine if CT, 3D-CTA, and PCC provide data comparable to IVU, RA, and CrCl, both methods were used to evaluate 23 LRD candidates. Costs were also compared.

A new method to obtain a tissue diagnosis of proximal bile duct tumors.

Klatskin tumors often pose a challenge for diagnosis and treatment. Most of these neoplasms are diagnosed clinically because of the difficulty in obtaining tissue that will provide histologic proof of the disease. When a non-operative course is sought, exhaustive attempts should be made to obtain a tissue diagnosis because of the potential for a false-positive clinical diagnosis.

Common bile duct obstruction by free floating tumor.

Unlabelled: Tumors usually spread by local invasion or by vascular or lymphatic metastases. We report six patients in whom tumor cells were shed into the common bile duct with resulting obstruction. The three men and three women had jaundice and upper abdominal discomfort.

Case report 732. Gout presenting as a large pseudo tumor (tophus) in the proximal end of the tibia.

A case of a large, lytic, tophaceous defect in the upper end of the tibia has been reported in a 44-year-old man as a solitary lesion. The term "gouty tophus" should not be confused with the geode or subchondral bone cyst.

Iatrogenic femoral arteriovenous fistula.

Twelve iatrogenic femoral arteriovenous fistulas are reported, 11 of which arose from the superficial or deep femoral arteries. All but two occurred in association with cardiac angiographic procedures. It appears that the femoral crease was used as a landmark to establish the cutaneous entry point for vascular puncture and resulted in an excessively distal puncture site.

CT of thoracic aortic aneurysms.

Aneurysms of the thoracic aorta are most often the result of arteriosclerotic disease. Other causes include degeneration of the medial layer of the aortic wall, either idiopathically or due to genetic disorders such as Marfan syndrome; aortic dissection; trauma; syphilis and other bacterial infection; noninfective aortitis; and congenital anomaly. We review normal anatomy of the aorta and discuss our technique and interpretation of computed tomography (CT) in the evaluation of the thoracic aorta.

Effect of contrast media on prostaglandin synthesis in vivo.

Since systemic reactions to contrast media (CM) in patients often resemble pathophysiologic conditions associated with prostaglandin metabolites prostacyclin (PGI2), and thromboxane B2 (TXB2), plasma levels of these mediators are likely to provide an index of CM pathogenesis. In this study, patients undergoing peripheral arteriography were injected either with a hyperosmolal CM sodium diatrizoate or with a newer low osmolal CM, iohexol. Arterial blood samples were collected before and after the procedure.

CT diagnosis of idiopathic aneurysms of the thoracic systemic veins.

Three patients with idiopathic aneurysms of the superior vena cava, left innominate vein, and inferior vena cava are presented. The advantages of CT over other diagnostic modalities are discussed.

Computed tomographic demonstration of anomalous inferior vena cava with azygos continuation.

A case of anomalous inferior vena cava with azygos continuation first diagnosed by computed tomography (CT) and later confirmed by venography is presented. In addition to identifying the dilated azygos vein in the chest, CT can determine the direction of flow in the vein by means of a bolus contrast medium injection. Once this is established, a search for the etiology of the dilated vein can be directed to the appropriate anatomic area.

Esophageal carcinoma presenting as a primary renal tumor.

A patient with esophageal carcinoma presenting with hematuria is described. Initial studies confirmed the presence of a renal mass that was thought to be a primary renal neoplasm. Further studies to evaluate anemia before a renal operation led to the discovery of an unsuspected esophageal carcinoma.

Visualization of the gallbladder wall at excretory urography: implication for infusion tomography of the gallbladder.

Visualization of the gallbladder wall during intravenous infusion of diatrizoate has been equated with cholecystopathy. However, a large control group of patients without biliary tract symptoms has not been studied. The authors examined a group of 2,867 such patients who underwent excretory urography; the results suggest that visualization of the normal gallbladder wall occurs frequently enough to severely limit the usefulness of infusion tomography of the gallbladder in the diagnosis of cholecystopathy.