Pneumomediastinum from a severe asthma attack.

Spontaneous pneumomediastinum is a rare complication of an asthma exacerbation characterized by chest pain, dyspnea, neck swelling, and subcutaneous emphysema. Although the condition is usually benign and treatment is primarily supportive, surgical intervention may be needed if the patient develops hemodynamic or respiratory failure.

Streptococcus pneumoniae-associated pneumonia, meningitis, and endocarditis: a case of Austrian syndrome.

Streptococcus pneumoniae is the leading cause of hospitalization in cases of community-acquired pneumonia and meningitis in adults. It is also an uncommon cause of endocarditis in the antibiotic era. The occurrence of these three entities in one individual is rare, forming a triad termed Austrian syndrome.

Bilateral pleural effusions in congestive heart failure.

The salt-avid state that accounts for the clinical syndrome congestive heart failure (CHF) leads to an initial expansion of intra- and subsequent rise in extravascular volumes that can include the appearance of pleural effusion. Herein, we present a 54-year-old man with a dilated cardiomyopathy who was hospitalized because of his CHF, which included bilateral pleural effusions, right hydrothorax greater than left. The pathophysiology of pleural fluid formation in CHF, previously debated, has now reached consensus, albeit not frequently reviewed. This index case offers such an opportunity.

Fracture risk in men with congestive heart failure risk reduction with spironolactone.

OBJECTIVES: The purpose of this study was to determine whether spironolactone use is associated with fractures in men with congestive heart failure (CHF). BACKGROUND: In rats with aldosteronism, spironolactone preserves skeletal strength. However, in humans, the relationship of spironolactone to fractures is not known. METHODS: The medical records of all male patients with CHF from 1999 to 2005 treated at the Veterans Affairs Medical Center, Memphis, Tennessee, were reviewed (n = 4,735). Odds ratios with 95% confidence intervals of having a fracture associated with spironolactone use were estimated using conditional logistic regression. RESULTS: We identified 167 cases with a single-incident fracture and matched these by age and race to 668 control subjects without fractures. After adjustment for covariates, spironolactone use was inversely associated with total fracture (odds ratio: 0.575; 95% confidence interval: 0.346 to 0.955, p = 0.0324). CONCLUSIONS: The use of spironolactone is inversely associated with fractures in men with CHF.