Prognostic implications of renal dysfunction in patients with stable angina pectoris.

OBJECTIVE: Impaired renal function is emerging as an independent risk factor for cardiovascular (CV) disease. We analysed the prognostic implications of estimated renal function in patients with angina pectoris. DESIGN: Post hoc analysis of the Angina Prognosis Study In Stockholm (APSIS). The estimated creatinine clearance (eCrCl) was calculated according to the Cockcroft-Gault formula in 808 patients. Outcomes were compared for subgroups with CrCl > or =90, 60-89 and<60 mL min(-1). Setting. Hospital-based study with patients referred from primary care and hospital. SUBJECTS: A total of 809 patients (248 women) with clinically diagnosed stable angina pectoris. Intervention. Double-blind treatment with metoprolol or verapamil. RESULTS: One hundred and sixty-four patients (91 women) had an eCrCl below 60 mL min(-1). During a median follow-up of 40 months, 38 patients suffered CV death and 31 patients had a nonfatal myocardial infarction (MI). In a univariate analysis a lower eCrCl was related to a higher risk for CV death or MI amongst men (log rank P = 0.036). A multivariate Cox analysis showed an independent prognostic importance of eCrCl for CV death (P = 0.046) and for CV death or MI (P = 0.042) amongst all patients. When analysed as a continuous variable, a 1 mL min(-1) decrease in eCrCl was associated with a 1.6% (0.1-3.1) increase in the risk for CV death or MI, and a 2.1% (0-4.1) increase in the risk for CV death alone. CONCLUSION: Renal dysfunction was found to be common in patients with stable angina pectoris and estimated creatinine clearances carried significant independent prognostic information regarding CV death and nonfatal MI.

Iatrogenic hypocalcemic tetany.

The treatment of a patient with hypocalcemic tetany secondary to sodium phosphate enemas is reported. The patient presented with a serum calcium level of 5.2 mg/dL and a phosphate level of 17.5 mg/dL. Physical manifestations included tetanic contraction of the muscles of the legs and arms. There was rapid symptomatic resolution with IV calcium. The electrolyte imbalance normalized over the next two days with oral calcium supplementation.

Echocardiographic diagnosis of acute pericardial effusion in penetrating chest trauma.

Pericardial tamponade persists as a diagnostic challenge to the clinician. The immediate diagnosis is particularly difficult when the patient is well compensated hemodynamically. In contrast to the deceptively stable appearance, the patient is at increased risk due to delayed onset, recognition, and therapy. A case of penetrating thoracic trauma is presented in which the concern about pericardial tamponade was considerable. However, the elements of clinical assessment were inconclusive. Two-dimensional echocardiography was employed in the emergency department to detect a pericardial effusion and thus avoid delayed management. Pericardial tamponade and associated vascular injuries were confirmed at surgery.

Controlled comparison of humidified inhalation and peritoneal lavage in rewarming of immersion hypothermia.

Random source dogs were anesthetized and cooled by immersion in ice water to a stable core temperature of 25 degrees C and subsequently rewarmed with either normal saline peritoneal lavage (43 degrees C, 175 ml/kg/h) or warmed humidified inhalation (43 degrees C, 450 ml/kg/min ventilation). The time required for core rewarming to 30 degrees C was 192 +/- 61 minutes for lavage and 331 +/- 96 minutes for inhalation therapy (P less than 0.03). These data suggest that peritoneal lavage is superior to inhalation therapy for core rewarming of rapidly induced immersion hypothermia.