Cual es su diagnóstico? / What is your diagnosis? Costo-chondritis obscured by x-ray double-exposure

The case of a 64 years old female patient with chest pain, dizziness and abnormal chest x-ray is presented. The different diagnostic possibilities are discussed. The final assessment in the case was a double radiographic exposure of the chest film confusing the clinical picture

Impact of thrombolytic therapy for myocardial infarction in the Bayamón Public Health Care Sector--1993-1995 experience

The study was designed to evaluate the compliance of general management guidelines, determine the effectiveness of Thrombolytic therapy (TTX), determine the complications, statistics and the [quot ]Door to Needle[quot ] time (DTN) in the management of Myocardial Infarction (MI) in the Bayamón public health care sector. METHODS: Retrospective record review and SPSS statistical calculations were performed. RESULTS: 66 cases (49m, 17f) discharged with MI from January 1993 to June 1995 were included. 27 received TTX. 80 were between 30-69 y/o, while 20 from 70-87 y/o. Past hx and habits; smoker 62, ETOH 45. Labs in adm; hypoMG 15, hypoK 11. The Q MI = 63, Non Q = 38. The sinoatrial and ventricular arrhythmias were seldom seen (7.5 SVT, AIVR 3). Intra and atrioventricular block (3). The most frequent cardiac complication was CHF 10 and the non cardiac; BKP 16.5. The mortality was (6.1). The mean stay was 9.34 days. Therapy used; IV NTG 97, ASA 84, beta B 39, TTX 42.2, ACE inhibitors 32. Absence of TTX was usually due to absence of EKG criteria (63). TTX complications; hypotension 10.5. The mean DTN was 1hr 58m,. 91 were discharged home, 23.3 cath, deaths 6. The ER MD assessment of MI was correct in only 29. CONCLUSIONS: The complications of patients with MI in the TTX era are below the ones before TTX. Mortality and morbidity have improved with the use of TTX. The medical therapy guidelines of MI are generally followed in HURRA. Improvement in the DTN is needed. The prolonged DTN and the inconsistency of the admission assessment by the ER personnel establishes the need to develop a training program which would regulate this abnormality

Impact of thrombolytic therapy for myocardial infarction in the Bayamón Public Health Care Sector--1993-1995 experience.

UNLABELLED: The study was designed to evaluate the compliance of general management guidelines, determine the effectiveness of Thrombolytic therapy (TTX), determine the complications, statistics and the "Door to Needle" time (DTN) in the management of Myocardial Infarction (MI) in the Bayamón public health care sector. METHODS: Retrospective record review and SPSS statistical calculations were performed. RESULTS: 66 cases (49m, 17f) discharged with MI from January 1993 to June 1995 were included. 27 received TTX. 80% were between 30-69 y/o, while 20% from 70-87 y/o. Past hx and habits; smoker 62%, ETOH 45%. Labs in adm; hypoMG 15%, hypoK 11%. The Q MI = 63%, Non Q = 38%. The sinoatrial and ventricular arrhythmias were seldom seen (7.5% SVT, AIVR 3%). Intra and atrioventricular block (3%). The most frequent cardiac complication was CHF 10% and the non cardiac; BKP 16.5%. The mortality was (6.1%). The mean stay was 9.34 days. Therapy used; IV NTG 97%, ASA 84%, beta B 39%, TTX 42.2%, ACE inhibitors 32%. Absence of TTX was usually due to absence of EKG criteria (63%). TTX complications; hypotension 10.5%. The mean DTN was 1hr 58m,. 91% were discharged home, 23.3% cath, deaths 6%. The ER MD assessment of MI was correct in only 29%. CONCLUSIONS: The complications of patients with MI in the TTX era are below the ones before TTX. Mortality and morbidity have improved with the use of TTX. The medical therapy guidelines of MI are generally followed in HURRA. Improvement in the DTN is needed. The prolonged DTN and the inconsistency of the admission assessment by the ER personnel establishes the need to develop a training program which would regulate this abnormality.

[What is your diagnosis? Costo-chondritis obscured by x-ray double-exposure]. / Cual es su diagnóstico?

The case of a 64 years old female patient with chest pain, dizziness and abnormal chest x-ray is presented. The different diagnostic possibilities are discussed. The final assessment in the case was a double radiographic exposure of the chest film confusing the clinical picture.

Profile of HIV patients with and without bacterial endocarditis.

Bacterial endocarditis (BE) is a serious medical condition seen in the injecting drug users (IDU) with or without HIV. Studies report a low prevalence of BE in HIV/AIDS patients and the clinical manifestations have been considered non-specific making early diagnosis difficult. The HIV Registry in our Center has recruited 1500 HIV/AIDS cases since May 1992. We decided to review and compare the clinical and epidemiological variables of patients admitted to the Registry with BE (23 pts) and without. Fever, sweats and weight loss were seen most frequent in BE patients as well as meningitis and pneumonia. The majority of the patients were IDU. Staphylococcus aureus was the most common pathogen. The tricuspid valve was the most affected valve. Mild insufficiency was the rule. The mortality in BE patients was higher than in the total group. The triad of IDU, the described constitutional signs and symptoms and coexisting meningitis and/or pneumonia, in the HIV/AIDS patient, should alert the physician to the presence of BE particularly in the outpatient setting were a more aggressive diagnostic approach should probably be attempted.