A 41 year old with chest pain and a Nondiagnostic Triage ECG. Thrombolytics prior to transfer for PCI.

Conclusion:Transfer for PCI without thrombolytics is best if PCI at receiving facility can be done in less than 120 minutes from first medical contact, or less than 90 minutes from STEMI diagnosis in first ED.Thrombolytics prior to Transfer to a PCI capable facility, then rescue PCI if no reperfusion for STEMITRANSFER AMI(Cantor et al. 2009).High risk STEMI: BP less than 100, HR greater than 100 Killip class II, III, ST depression of at least 2 mm in precordial leads, ST elevation in right precordial leads (right ventricular MIAll patients get TNK-tPA.80-90% received clopidogrel 300 mg (75 mg for age over 75).Enoxaparin (not for age over 75) or UFH (50-50).  Doses not specified, presumably standard doses.Patients randomized to: 1) Standard Rx:Transfer only if there is persistent ST elevation (less than 50% ST resolution)No transfer if thereis reperfusion (ST resolution)2) Transfer with immediate PCI regardless of reperfusion.Results:Intervention group had PCI a median of 2.8 hours after randomization30-day severe adverse outcomes 17.2% vs. 11.0% (NNT = 16)Conclusion:All high risk STEMI should be immediately transferred after thrombolyticsThrombolytics prior to transfer to a PCI capable facility, thenroutine PCI regardless of reperfusion for STEMICARESS-in-AMI(Di Mario et al. 2008)Patients: High risk STEMI, had at least one high risk feature treated initially at non-PCI hospitalExtensive ST elevation, new LBBB, previous MI, Killip class greater t...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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ConclusionThe GBM algorithm showcased a considerably high discriminatory power for excluding the presence of obstructive CAD, with negative predictive value and positive predictive value of 100% and 38%, respectively.
Source: Academic Radiology - Category: Radiology Source Type: research
Conclusion: In conclusion, Frey's procedure appears to be a less burdensome surgical procedure. Thus, it could be the first option for management of patients with large pancreatic stone. PMID: 31824884 [PubMed]
Source: Annals of Surgical Treatment and Research - Category: Surgery Tags: Ann Surg Treat Res Source Type: research
CONCLUSION: Rehabilitation with PENS improved kinematics in both tasks and decreased EMG activity. This suggests that rehabilitation with PENS may improve muscle function during functional tasks. PMID: 31825893 [PubMed - as supplied by publisher]
Source: Journal of Sport Rehabilitation - Category: Sports Medicine Tags: J Sport Rehabil Source Type: research
CONCLUSIONS: The observed changes in CoM motion at POST2 may be associated with atypical running biomechanics that can translate to greater mediolateral impulses, potentially increasing the risk of injury. This study demonstrates the use of an accelerometer as an effective tool to detect atypical CoM motion for runners due to fatigue, recovery, and musculoskeletal pain in real-world environments. PMID: 31825892 [PubMed - as supplied by publisher]
Source: Journal of Sport Rehabilitation - Category: Sports Medicine Tags: J Sport Rehabil Source Type: research
Cowden syndrome (CS) is a multiple hamartoma syndrome associated with the development of various tumors, including endometrial cancer. However, the histology of CS-associated endometrial cancer remains to be fully described. To our knowledge, this is the first report of a patient with CS having endometrial endometrioid carcinoma with ovarian metastasis demonstrating morula-like features. A 31-yr-old, nulliparous, Japanese woman presented with abnormal genital bleeding. Endometrial biopsy revealed endometrioid carcinoma with an extensive morular formation, partially resembling atypical polypoid adenomyoma (APAM). Moreover, ...
Source: International Journal of Gynecological Pathology - Category: Pathology Tags: PATHOLOGY OF THE CORPUS: CASE REPORT Source Type: research
Primary extrarenal Wilms tumor of the gynecologic tract is extremely rare with scattered case reports occurring in the ovary, uterine corpus and cervix. Only 9 cases of primary ovarian Wilms tumor have been reported to date. Here, we provide an extensive literature review and describe 2 patients with ovarian Wilms tumor: a 36-yr-old female (patient 1) and a 16-yr-old female (patient 2), both presenting with abdominal pain and suspected ovarian torsion. They were each found to have unilateral ovarian masses measuring>15 cm in size which were removed by unilateral salpingo-oophorectomy. Microscopically, the tumors ...
Source: International Journal of Gynecological Pathology - Category: Pathology Tags: PATHOLOGY OF THE UPPER TRACT: CASE REPORTS Source Type: research
We report a case of a primary cervical angiosarcoma in a 43-yr-old woman who presented with heavy vaginal bleeding. Cervical biopsy and subsequent radical hysterectomy showed a malignant vascular tumor which was composed of spindled and epithelioid cells and formed abortive vascular channels. Immunohistochemically, the tumor cells were diffusely positive for CD31, CD34, ERG, and cyclin D1 and focally positive for D2-40. A reverse transcription polymerase chain reaction test for YWHAE-NUTM2 genetic fusion was negative excluding a YWHAE-translocated high-grade endometrial stromal sarcoma. The tumor formed a 5 cm mass ...
Source: International Journal of Gynecological Pathology - Category: Pathology Tags: PATHOLOGY OF THE LOWER TRACT: CASE REPORT Source Type: research
The active ingredient in psychedelic mushrooms is called psilocybin -- and a new study suggests it could safely be used as a therapeutic approach to treat depression when other drugs have failed to work.
Source: CNN.com - Health - Category: Consumer Health News Source Type: news
Conclusions: Findings suggest that veterans with mild and moderate-to-severe TBI are at increased risk of death by drug overdose and firearms, with overdose risk heightened with age. Data indicate that prevention efforts in patients with TBI include targeted means reduction. PMID: 31822136 [PubMed - as supplied by publisher]
Source: Brain Injury - Category: Neurology Tags: Brain Inj Source Type: research
CONCLUSION: Incidence of repeated thrombectomy was low. However, the high number of patients with known origin of stroke etiology raises the question how their monitoring may be optimized. The number of patients with remarkable extracranial pathologies or intracranial endothelial lesions supports current clinical practice to pay attention to final angiographic series. PMID: 31822162 [PubMed - as supplied by publisher]
Source: Interventional Neuroradiology - Category: Radiology Tags: Interv Neuroradiol Source Type: research
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