Chest pain in the presentation of sarcoidosis

The cases of six patients are reported illustrating that chest pain may be a prominent feature of sarcoidosis. It may be severe and be the chief presenting symptom. In the cases described it was mostly retrosternal and had few consistent aggravating factors. In each case there was bilateral hilar lymph node enlargement and it is suggested that htis was chiefly responsible for this relatively uncommon symptom of sarcoidosis. It is also suggested that undue persisting pain may respond to corticosteroid administration.     

Our general chronic pain (centers for treatment chronic pain: therapeutic and organizational work principles)]

Management of chronic pain is now not only medical but a very important social and economic problem. The approaches to its management in specialized pain control centers are discussed basing on the 20-year experience of the first such center in Russia: pain control clinic with therapeutic and diagnostic center "Integrative Medicine" at Research Center of Surgery. The problems of personnel for such pain control centers, cost-effect issues, diagnostic and therapeutic methods including an advanced technique, resonance electropuncture analgesia and therapy, are reviewed.     

A national survey of emergency department chest pain centers in the United States

Although chest pain centers are promoted as improving emergency cardiac care, no data exist on their structure and processes. This national study determines the 1995 prevalence rate for emergency department (ED)-based chest pain centers in the United States and compares organizational differences of EDs with and without such centers. A mail survey was directed to 476 EDs randomly selected from the American Hospital Association's database of metropolitan hospitals (n = 2,309); the response rate was 63%. The prevalence of chest pain centers was 22.5% (95% confidence interval 18% to 27%), which yielded a projection of 520 centers in the United States in 1995. EDs with centers had higher overall patient volumes, greater use of high-technology testing, lower treatment times for thrombolytic therapy, and more advertising (all p <0.05). Hospitals with centers had greater market competition and more beds per annual admissions, cardiac catheterization, and open heart surgery capability (all p <0.05). Logistic regression identified open heart surgery, high-admission volumes, and nonprofit status as independent predictors of hospitals having chest pain centers. Thus, chest pain centers have a moderate prevalence, offer more services and marketing efforts than standard EDs, and tend to be hosted by large nonprofit hospitals.     

Chest pain in patients with normal coronary angiography (syndrome X): new concepts]

Bone is continuously being formed and resorbed. This process is accomplished by the precise coordination of two cell types: osteoblasts and osteoclasts. Osteoclasts are large, multinucleated cells that are derived from the same hematopoietic precursors as macrophages. However, these bone-resorbing cells are difficult to study directly because of their relative inaccessibility. The purification of primary osteoclasts from rabbit bones by their adherent nature provides an opportunity for investigating the molecules in osteoclasts. We have examined the expression of receptor tyrosine kinase by polymerase chain reaction (PCR) and found that Tyro 3 was frequently identified from primary osteoclasts in PCR cloning. Immunohistochemistry revealed that Tyro 3 was expressed on the multinucleated osteoclasts which were positive for tartrate-resistant acid phosphatase (TRAP), but not on mononuclear TRAP-positive cells. The Tyro 3 ligand, Gas6, induced the phosphorylation of Tyro 3 receptors in osteoclasts in two to five min. Gas6 and protein S directly enhanced the bone resorbing activity of mature osteoclasts. This effect of Gas6 was inhibited by the addition of a tyrosine kinase inhibitor, herbimycin A. However, Gas6 did not affect the differentiation of osteoclasts from bone marrow cells. Gas6 and protein S are dependent on vitamin K, a cofactor for the enzyme responsible for carboxylation of glutamic acid residues. The findings in this study are the first to indicate a new biological activity of Gas6 and protein S as a direct regulator of osteoclastic function; they give an insight into the role of these vitamin K-dependent ligands in bone resorption in vivo.     

Physical, emotional, and sexual abuse among pain patients and health care providers: Implications for psychologists in multidisciplinary pain treatment centers.

Surveyed 200 back pain patients and 64 health care providers/staff on their physical, emotional, and sexual abuse histories as victims or perpetrators. Depending on the type of abuse, 27–36% of female patients, 6–23% of male patients, and 33–55% of female providers/staff were abuse victims. From 1–22% of female patients, 3–20% of male patients, and 3–25% of providers/staff were abuse perpetrators, depending on the type of abuse. A startling 94% of abuse perpetrators were also abuse victims. Among those who were both victim and perpetrator, 81% of physical-abuse perpetrators, 60% of sexual-abuse perpetrators, and 41% of emotional-abuse perpetrators were previously or concurrently some type of abuse victim. Implications for health care diagnoses and treatment decisions, caregiving by providers/staff, and the psychologist's role on multidisciplinary treatment teams are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chest wall rhabdomyosarcoma

BACKGROUND: Rhabdomyosarcoma is the most common soft tissue sarcoma in the pediatric age group. The primary tumor site is an important prognostic determinant. Axial lesions are associated with decreased survival and provide a clinical challenge. METHODS: A retrospective analysis of the authors' institutional experience between 1972 and 1996 was performed. Patients were from a data base of 302 consecutive cases. RESULTS: Fifteen consecutive patients with chest wall rhabdomyosarcoma were identified. The median age was 16 years (range, 6 months-25 years). Median follow-up was 6.6 years (range, 10 months-18.5 years). Nine patients presented with a mass, six with pain, two with respiratory distress, and one with ulnar neuropathy. The median lesion size was 7 cm (range, 3-16 cm). A surgical procedure was the initial therapy for 13 of 15 patients. Fourteen patients received radiation therapy with a median dose of 4400 cGy. All but one were included in institutional-based trials using multiagent chemotherapy. At last follow-up, 10 patients were alive and disease free, with a median survival of 123 months (range, 51-221 months). Seven of ten survivors underwent a complete resection as their initial therapy. There was no surgical mortality, and only two patients had treatment-related complications. Of the five patients who died, two underwent complete resection as their initial therapy. All five patients had invasive tumors. Four were > 10 cm, 3 were of alveolar subtype, and 2 were embryonal. CONCLUSIONS: Complete resection of chest wall rhabdomyosarcoma is recommended. However, survival is possible for patients with microscopically positive surgical margins with the addition of chemotherapy and radiation.     

Chest imaging in AIDS

A review of imaging in the acquired immune deficiency syndrome (AIDS) is presented. The imaging features can be conveniently categorized according to whether the presenting complications are infective (bacterial, protozoal, or fungal), bronchiectasis, neoplastic (Kaposi's sarcoma, AIDS-related lymphoma, or lymphoproliferative disease), or a miscellaneous group (non-specific interstitial pneumonitis, persistent generalized lymphadenopathy, or bronchogenic carcinoma).     

Trauma! Chest injuries

Chest trauma can range from broken ribs and knife wounds to collapsed lungs and bruised hearts. This detailed discussion of mechanism of injury, assessment findings, and treatment strategies will help you identify problems and increase your patients' chances for a quick and successful recovery.