Lung ultrasound in diagnosing and monitoring pulmonary interstitial fluid.

Chronic heart failure is a complex clinical syndrome often characterised by recurrent episodes of acute decompensation. This is acknowledged as a major public health problem, leading to a steadily increasing number of hospitalisations in developed countries. In decompensated heart failure, the redistribution of fluids into the pulmonary vascular bed leads to respiratory failure, a common cause of presentation to the emergency department. The ability to diagnose, quantify and monitor pulmonary congestion is particularly important in managing the disease. Lung ultrasound (US) is a relatively new method that has gained a growing acceptance as a bedside diagnostic tool to assess pulmonary interstitial fluid and alveolar oedema. The latest developments in lung US are not because of technological advance but are based on new applications and discovering the meanings of specific sonographic artefacts designated as B-lines. Real-time sonography of the lung targeted to detection of B-lines allows bedside diagnosis of respiratory failure due to impairment of cardiac function, as well as quantification and monitoring of pulmonary interstitial fluid. Lung US saves time and cost, provides immediate information to the clinician and relies on very easy-to-acquire and highly reproducible data.

Thyrotoxic periodic paralysis and intravenous propranolol in the emergency setting.

A 27-year-old male of Malaysian descent presented to the Emergency Department (ED) with rapidly progressive flaccid paralysis that quickly compromised his respiratory effort. The patient was found to have a serum potassium of 1.9 meq/L, and was diagnosed as having an acute paralytic episode secondary to thyrotoxic periodic paralysis. The paralytic attack was aborted with a combination of potassium replacement and parenteral propranolol in large doses. We report the use of a rarely described, yet possibly more effective, therapy for an acute attack of thyrotoxic periodic paralysis.

Comparative knowledge and practice of emergency physicians, cardiologists, and primary care practitioners regarding drug therapy for acute myocardial infarction.

OBJECTIVES: This study assesses the knowledge and practice of emergency physicians regarding the treatment of acute myocardial infarction (AMI) and compares the results with previously published data on cardiologists and primary care practitioners. BACKGROUND: Debate surrounding the respective roles of emergency physicians, primary care practitioners, and specialists figures prominently in discussions regarding the nation's evolving health-care system. Data are lacking about the comparative knowledge and practice of emergency physicians, cardiologists, and primary care practitioners regarding conditions commonly treated by all three groups, eg, AMI. METHODS: A survey of 1,045 emergency physicians, nationally, was conducted in 1995 regarding five short-term pharmacologic interventions employed for many years in the standard treatment of AMI. The emergency physicians were questioned about the effect on survival of each intervention and the likelihood that they would prescribe each intervention. The findings were then compared with previously published data on the knowledge and practice of cardiologists and primary care practitioners obtained in New York and Texas in 1993. Identical clinical queries and eligibility criteria were employed in all groups. RESULTS: The responding emergency physicians' knowledge was similar or significantly greater than that of responding cardiologists for the effect on survival of most of the short-term interventions, and their practice patterns were similar or significantly better than responding cardiologists for all interventions studied. Emergency physicians and cardiologists had significantly better knowledge and practice in this area compared with responding primary care practitioners. CONCLUSIONS: For the management of AMI, emergency physicians, on average, have a similar or greater awareness of the effects on survival and similar or better practice patterns regarding most acute pharmacologic interventions when compared with those of cardiologists; both groups, on average, have a superior knowledge and practice when compared with primary care practitioners. These results illustrate the importance of emergency medicine and support further consideration of an expanding role for the emergency physician in the nation's evolving health-care system.

Effects of acetyl strophanthidin on duration of atrial fibrillation in the neurally-intact and blockaded dog.

Although the inotropic and dromotropic effects of cardiac glycosides in atrial fibrillation (AF) are well recognized, their action on AF itself is not clear. Accordingly, to determine whether cardiac glycosides prolong AF, the duration of electrically induced AF, atrioventricular conduction, and left ventricular function were assessed for 30 minutes before and for 30 minutes following intravenous administration of acetyl strophanthidin (AS), 20 micrograms/kg, in neurally intact, beta-blocked, and beta-blocked and vagotomized dogs. In the intact dog, AS, 20 micrograms/kg, increased peak dp/dt by 132 +/- 35 mmHg.sec-1, p less than 0.05, and slowed ventricular response by 16 +/- 7 min-1, p less than 0.05, but had a variable effect on AF duration. While the increased left ventricular peak dp/dt persisted for 15 minutes after AS, an increased duration of AF was evident only at 20 minutes, when the effects of AS on left ventricular (LV) inotropy were no longer apparent. Moreover, the subset of dogs that did not demonstrate prolongation of average duration of AF after AS had a greater increment of peak dp/dt than those that showed prolongation, 237 +/- 52 versus 53 +/- 31 mmHg.sec-1, p less than 0.05. An additional 20 micrograms/kg, which produced ventricular extrasystoles, prolonged AF duration when compared to both control and 30-minute measurements. Acetyl strophanthidin, 20 micrograms/kg, had a variable effect on duration of AF with beta-blockade but prolonged duration by 114 +/- 34%, p less than 0.05, with both vagotomy and beta-blockade.(ABSTRACT TRUNCATED AT 250 WORDS)

Prostatic tissue in a benign cystic teratoma of the ovary.

A case of benign cystic teratoma of the ovary with two unusual features is reported. Besides the usual components of skin and its appendages, glia, cartilage, fat, smooth muscle and respiratory epithelium, the tumor contained prostatic tissue. Double Barr bodies were found in 15% of tumor cells. Since tissue differentiation in a teratoma is thought to follow similar rules to those of the fetus and since differentiation of prostate depends on testosterone, a source for this hormone had to be found. Several possibilities are discussed. The presence of double Barr bodies is consistent with parthenogenic origin of the teratoma before the first meiotic division or heteropyknosis of a solitary X chromosome in the tumor cells.