Josè Vitale

Chronobiology of acute aortic rupture or dissection: A systematic review and a meta-analysis of the literature

Objectives: Identification and quantification higher risk incidence of aortic rupture or dissection (AARD) could be of clinical interest and improve preventive strategies. Background: Several studies and subsequent meta-analyses have shown chronobiologic variations in the timing of occurrence of myocardial infarction, stroke, and pulmonary embolism. Conversely, such evidences are currently lacking for AARD despite a number of studies available dealing with periodicity. Methods: MEDLINE, EMBASE, and Google Scholar databases were searched up to July 2013. Temporal variation in the incidence of AARD was analyzed including all studies analyzing seasonal, monthly, weekly, and circadian aggregations. Two authors independently reviewed and extracted data. Results: Forty-two studies for a total of more than 80 000 patients were included. Our results showed a significantly increased incidence of AARD in Winter (Chi-square 854.92, p < 0.001), with a relative risk (RR) of 1.171 (99% CI 1.169, 1.172), in December (Chi-square 361.03, p < 0.001), RR of 1.142 (99% CI 1.141, 1.143), on Monday (Chi-square 428.09, p < 0.001), RR of 1.214 (99% CI 1.211, 1.216), and in the hours between 6 am and 12 pm (Chi-square 212.02, p < 0.001), RR of 1.585 (99% CI 1.562, 1.609). Subgroup and sensitivity analyses confirmed the results of principal analyses. Conclusions: Our data strongly support the presence of evident rhythmic patterns in the incidence of acute aortic events, characterized by significantly higher risk in Winter, in December, on Monday and between 6 am and 12 pm. Future studies are needed to better clarify the underlying mechanisms and clinical implications.

Accuracy of Nurse-Performed Lung Ultrasound in Patients With Acute Dyspnea: A Prospective Observational Study.

AbstractIn clinical practice lung ultrasound (LUS) is becoming an easy and reliable noninvasive tool for the evaluation of dyspnea. The aim of this study was to assess the accuracy of nurse-performed LUS, in particular, in the diagnosis of acute cardiogenic pulmonary congestion.We prospectively evaluated all the consecutive patients admitted for dyspnea in our Medicine Department between April and July 2014. At admission, serum brain natriuretic peptide (BNP) levels and LUS was performed by trained nurses blinded to clinical and laboratory data. The accuracy of nurse-performed LUS alone and combined with BNP for the diagnosis of acute cardiogenic dyspnea was calculated.Two hundred twenty-six patients (41.6% men, mean age 78.7 ± 12.7 years) were included in the study. Nurse-performed LUS alone had a sensitivity of 95.3% (95% CI: 92.6–98.1%), a specificity of 88.2% (95% CI: 84.0–92.4%), a positive predictive value of 87.9% (95% CI: 83.7–92.2%) and a negative predictive value of 95.5% (95% CI: 92.7–98.2%). The combination of nurse-performed LUS with BNP level (cut-off 400 pg/mL) resulted in a higher sensitivity (98.9%, 95% CI: 97.4–100%), negative predictive value (98.8%, 95% CI: 97.2–100%), and corresponding negative likelihood ratio (0.01, 95% CI: 0.0, 0.07).Nurse-performed LUS had a good accuracy in the diagnosis of acute cardiogenic dyspnea. Use of this technique in combination with BNP seems to be useful in ruling out cardiogenic dyspnea. Other studies are warranted to confirm our preliminary findings and to establish the role of this tool in other settings.

Accuracy of nurse-performed compression ultrasonography in the diagnosis of proximal symptomatic deep vein thrombosis: a prospective cohort study

Compression ultrasonography (CUS) has been recognized as the diagnostic procedure of choice for the investigation of patients with suspected deep vein thrombosis (DVT); the aim of this study was to assess the diagnostic accuracy of nurse‐performed CUS for symptomatic proximal DVT of the lower limb.

Prevalence of isolated left ventricular non-compaction in a Medicine ward

• Isolated left ventricular non-compaction (LVNC) has recently emerged due to widespread use of noninvasive cardiac imaging.

Comparison of the Accuracy of Nurse-Performed and Physician-Performed Lung Ultrasound in the Diagnosis of Cardiogenic Dyspnea

AFFILIATIONS: From the Department of Medicine, Baystate Medical Center (Drs Stefan and Lindenauer) and OptiStatim, LLC (Dr Nathanson). FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest. CORRESPONDENCE TO: Mihaela Stefan, MD, 759 Chestnut St, Springfield, MA, 01199; e-mail: mihaela.Stefan@baystatehealth.org Copyright 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. DOI: http://dx.doi.org/10.1016/j.chest.2016.06.007

Tongue necrosis in giant-cell arteritis

A 77-year-old woman was complaining of pain in the scapular cingulum since 3 months and pain and swelling in both the wrists, with elevated CRP. She began therapy with deflazacort, bisphosphonates and vitamin D. After a month the patient complained of frontal and bitemporal headache. Shortly after, the patient had intense onset pain in the tongue and …

A ''Google Image'' diagnosis of Madelung's disease

Lesson Given the rare nature of Madelungs disease many clinicians will not have seen a patient with it and will not be able to recognise them: subsequently a diagnosis is unlikely to be made.

Hodgkin disease complicated by recurrent cardiac tamponade.

### Learning Point for Clinicians The most frequent causes of spontaneous pericardial tamponade are neoplastic invasion; pericardial involvement by Hodgkin lymphoma is usually asymptomatic unless accompanied by substantial pericardial effusion. Herein, we report an unusual case of recurrent cardiac tamponade in a patient with nodular sclerosis Hodgkin disease (HD) that was successfully treated with repeated pericardiocentesis and chemotherapy with an excellent outcome. A 23-year-old man was recently diagnosed with nodular sclerosis HD, Cotswold stage II-B. While awaiting chemotherapy, he presented with new-onset dyspnea and jugular turgor. On physical examination, he had evidence of pulsus paradoxus and quiet heart; his blood pressure was 83/65 mm Hg. Electrocardiogram showed low QRS voltages with electrical alternans (Figure 1A, arrows). Transthoracic echocardiography revealed severe pericardial effusion with diastolic collapse of the right and …

Hypoplasia of the inferior vena cava and deep vein thrombosis

### Learning Point for Clinicians Hypoplasia of the inferior vena cava (IVC) has been described mainly as an incidental finding associated with a number of congenital malformations; it should be taken into account when otherwise unexplained deep vein thrombosis (DVT) develops in young people; tips for diagnosis are the presence of extensive and bilateral iliac thrombosis and an enlarged shadow of the azygos vein on chest X-rays, computed tomography (CT) and magnetic resonance imaging (MRI). A 61-year-old man presented with spontaneous bilateral ilio-femoral DVT and dyspnea. His past medical history was unremarkable, and there was no familial history for venous …

Ultrasound Elastography is useful to distinguish Acute and Chronic Deep Vein Thrombosis

Essentials Ultrasound elastography uses tissue deformation to assess the relative quantification of its elasticity. Compression and duplex ultrasonography may be unable to correctly determine the thrombus age. Ultrasound elastography may be useful to distinguish between acute and chronic deep vein thrombosis. The exact determination of the thrombus age could have both therapeutic and prognostic implications.