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Biomedical subjects

S A Deluca

Publications and source records attributed to S A Deluca.

At least 19 recordsLinked to original sources
PubMed2000

Comparison of troponin T versus creatine kinase-MB in suspected acute coronary syndromes.

Limitations of creatine kinase-MB (CK-MB) have led to alternative biochemical markers, including troponin T (TnT), to detect myocardial necrosis. Limited data are available regarding the predictive value of this new marker in patients with chest pain of uncertain etiology. Therefore, we prospectively compared CK-MB and TnT in a broad population with suspected acute coronary syndromes, including those admitted to a short-stay chest pain unit. CK-MB, quantitative TnT levels, and a rapid bedside assay were performed at 0, 4, 8, and 16 hours. Adverse events, including infarction, recurrent ischemia, coronary surgery, need for catheterization and/or intervention, stroke, congestive heart failure, or death, were identified by chart review and by follow-up phone call at 6 months. Of 707 patients, 104 were excluded for creatinine >2 mg/dl or incomplete data, leaving a total cohort of 603 patients. Coronary Care Unit admissions were 18%, intermediate care admissions were 14%, telemetry admissions is 21%, and admissions to 24-hour short-stay area were 47%. TnT (at 0.1 ng/ml) and CK-MB were positive in a similar proportion of patients (20.4% and 19.7%, respectively); however, the patients identified by TnT and CK-MB were not identical. In-hospital adverse events occurred in 37.1% with no differences in positive predictive value for the markers (p = NS). If CK-MB and TnT were negative, the early adverse event rate was 27%. No cardiac marker was positive by 16 hours in 54.9% of patients with an adverse event. Six-month follow-up was obtained in 576 of the 603 patients (95.5%). One hundred fifty-five late adverse events occurred in 134 patients (23.3%) at an average of 3.3+/-2.5 months after discharge. If both markers were negative, the late event rate was 20.2% and did not increase in patients with positive CK-MB or TnT >0.2 ng/ml. However, the late event rate was substantially higher (52.9%) in those with intermediate TnT levels of 0.1 to 0.2 ng/ml (p = 0.002). Thus, TnT is a suitable alternative to CK-MB in patients with suspected acute coronary syndromes. The rapid bedside assay is comparable to quantitative TnT and may enable early diagnosis and triage. A negative cardiac marker value (TnT or CK-MB) does not necessarily confer a low risk of complication in patients presenting with acute chest pain to an emergency department.

Adult↗
PubMed2000

Prediction of short- and long-term outcomes by troponin T levels in low-risk patients evaluated for acute coronary syndromes.

STUDY OBJECTIVE: Recent reports suggest a short series of cardiac troponin (cTnT) testing effectively identifies patients at risk for cardiac events. However, there are few studies validating this strategy. The purpose of this study was to determine the ability of cTnT levels to predict short- and long-term outcomes in low-risk patients with suspected acute coronary syndromes. METHODS: This prospective longitudinal study was conducted in a 20-bed emergency department observation unit. Patients at low risk for acute coronary ischemia, with a normal creatine kinase-isoenzyme subunit MB (CKMB) index, were admitted to an observation unit for chest pain evaluation. Serum cTnT levels were measured at baseline and at 4, 8, and 16 hours after admission. The main outcome measures were adverse cardiac events (death, acute myocardial infarction, unstable angina, revascularization) during the index visit and within 6 months after discharge. Using manufacturer's recommendations, the cTnT level was considered abnormal if it exceeded 0.2 microg/L. RESULTS: Two hundred sixty-six patients were evaluated. Twenty-one (7.9%) had an adverse event during their index hospitalization. Troponin testing identified only 2 (9.5%) of these patients. Twenty (7.5%) had a cardiac event within 6 months; none were identified by cTnT testing. The sensitivity and specificity were 9.5% and 99.2%, respectively, at the index visit, and 0% and 98.4% at 6 months. The positive and negative predictive values were 50% and 93%, respectively, at the index visit; and 0% and 92% at 6 months. CONCLUSION: Determination of troponin T levels has a low sensitivity and high specificity for predicting outcomes in low-risk patients evaluated for suspected acute coronary syndromes. This study does not support a strategy of relying solely on troponin testing for disposition decisions.

Acute Disease↗
PubMed1995

Radiographic aspects of pneumothorax.

Pneumothorax is a common medical problem of varied etiology. Because pneumothorax has potentially severe acute consequences, it is important that all physicians know its radiographic appearance. Patient complaints are nonspecific, and physical examination findings are often subtle. The chest radiograph is the principal means of detecting and following a pneumothorax. Radiographic diagnosis on an upright film requires the detection of the visceral pleural line. For radiographs obtained with the patient in the supine position, pneumothorax may be manifested by increased lucency over the upper quadrant of the abdomen, an unusually sharp definition of the anterior diaphragmatic surface or a very wide and deep costophrenic angle.

Humans↗
PubMed1995

The radiology of rheumatoid arthritis.

Rheumatoid arthritis is a connective tissue disorder of unknown etiology that can involve any synovial-lined joint in the body. The most frequently involved joints are the small joints of the hands and feet, the wrists, knees and elbows, and the glenohumeral and acromioclavicular joints. The radiographic hallmarks of rheumatoid arthritis are swelling of the soft tissue, osteoporosis, narrowing of the joint spaces and marginal erosions. The unique combination of osteoporosis, marginal erosions and relatively minimal reactive bone formation help distinguish rheumatoid arthritis from other inflammatory arthritides.

Arthritis, Rheumatoid↗
PubMed1993

Perfusion imaging in ischemic heart disease.

Myocardial perfusion imaging with thallium-201 has been used extensively for many years in the evaluation of ischemic heart disease. It is a valuable adjunct to exercise treadmill testing and is especially helpful in evaluating cardiac perfusion in patients who have abnormal resting electrocardiograms, who are unable to exercise, and whose clinical history and exercise test results are discordant. Perfusion imaging is useful for both diagnosis and prognosis in patients with coronary artery disease. In patients unable to exercise, the coronary vasodilators dipyridamole and adenosine may be used in conjunction with thallium imaging. Two recently approved technetium agents, sestamibi and teboroxime, may be used in place of thallium.

Adenosine↗
PubMed1993

Hypertrophic pyloric stenosis.

Hypertrophic pyloric stenosis is a gastrointestinal tract disorder common in infancy. The disorder causes projectile vomiting, weight loss, and fluid and electrolyte abnormalities. The problem can usually be diagnosed by clinical symptoms and manual detection of an enlarged pylorus. When the diagnosis cannot be confirmed by these methods, however, imaging studies are relevant. Until recently, plain radiographs and upper gastrointestinal contrast studies have been used to make the diagnosis, but ultrasonography is becoming the method of choice because it is highly accurate and lacks the ionizing radiation inherent in a radiologic procedure. Surgery provides a safe and effective treatment.

Female↗
PubMed1992

Posterior mediastinal masses in children: ganglioneuroblastoma.

Ganglioneuroblastoma, although a rare neoplasm, is one of the most common causes of posterior mediastinal masses in children. This tumor occurs in children from one to 10 years of age. With intrathoracic involvement, the tumor may remain asymptomatic until it is large. The case reported illustrates a typical presentation of intrathoracic ganglioneuroblastoma.

Child, Preschool↗
PubMed1992

Traumatic rupture of the diaphragm and herniation of the liver.

Injuries that result in a sudden increase in intra-abdominal pressure may cause a diaphragmatic tear and visceral herniation. Right-sided tears are significantly less likely than left-sided tears because of the protective effect of the liver. When diaphragmatic elevation persists in a post-trauma patient, or if unexplained acidosis or hypoxemia develops, herniation of abdominal contents should be suspected. This is particularly true when other signs of severe trauma are present, such as multiple rib fractures, laceration of the liver or spleen, or a history of deceleration injury.

Accidents, Traffic↗
PubMed1991

Idiopathic hemochromatosis.

Hemochromatosis is a rare disorder in which about four times the normal amount of iron is absorbed in the intestine, resulting in the accumulation of iron in the skin, liver, pancreas and heart. Radiographic features may include a small liver on plain abdominal films, increased hepatic density on computed tomographic imaging, and loss of liver signal on magnetic resonance imaging as a result of the strong paramagnetic effect of iron. Management includes phlebotomy and supportive treatment of damaged organs.

Bloodletting↗
PubMed1991

Parathyroid hyperplasia as a cause of recurrent hyperparathyroidism.

Parathyroid hyperplasia is second only to adenoma as the most common cause of hyperparathyroidism. Symptoms are most likely to result from elevated serum calcium levels. Symptoms include nephrocalcinosis and nephrolithiasis. Studies that may help confirm a suspected diagnosis include ultrasonography, computed tomography, radionuclide scanning with thallium and/or technetium, and magnetic resonance imaging. Surgical treatment consists of excision of all but part of one parathyroid gland if all of the glands are enlarged.

Humans↗
PubMed1991

Necrotizing aspiration pneumonia.

Infectious disease is the most common etiology of a cavitary lung process, which can occur with necrotizing pneumonia, lung abscess and septic pulmonary embolism. Other infectious causes of pulmonary cavitation include cavitating fungal or mycobacterial granulomas and superinfection of preexisting spaces. Noninfectious causes of cavitation that should be considered in the differential diagnosis are infarction from thromboembolic disease or vasculitis, necrotic primary or metastatic tumor, rheumatoid nodules and air-filled congenital cysts. The clinical history combined with radiographic features can be helpful in diagnosing the underlying cause of cavitation.

Diagnosis, Differential↗
PubMed1991

Giant cell tumor of bone.

Giant cell tumor is the second most common benign tumor of bone. Plain radiographs may demonstrate distinctive features but can also be misleading. The diagnosis may be aided by the use of other imaging modalities, such as bone scan, computed tomography and angiography. The recurrence rate is high, but some of the newer treatments seem to be associated with better outcomes.

Adult↗
PubMed1990

Coarctation of the aorta.

Coarctation of the aorta is a common cardiovascular disorder with an unknown etiology. In the preductal type, blood flows from a patent ductus into the distal aorta. When the coarctation is juxtaductal or postductal, blood flows to the lower extremities by way of the subclavian arteries and collaterals. Plain films may show the reverse sign in postductal coarctation. Arteriography is the gold standard for making the diagnosis. However, magnetic resonance imaging will probably become an increasingly important diagnostic tool. The treatment of choice is surgery, with complete resection of the stenosed segment.

Aortic Coarctation↗
PubMed1990

Thoracic spine fractures.

Diagnosis of thoracic spine fractures in patients with multiple trauma requires careful evaluation of the chest radiograph. Primary findings, consisting of a fracture line through the vertebral bodies, decreased height of the vertebral body, an increase in the interpediculate distance and misalignment of the vertebral bodies, may all be noted on the anteroposterior supine chest radiograph. Early diagnosis and intervention may prevent a catastrophic neurologic event, such as spinal cord or nerve root damage.

Fractures, Bone↗
PubMed1989

Castleman's disease.

Castleman's disease is characterized by lymph node enlargement. There are two distinct histologic subtypes. Most patients are asymptomatic and under age 30, and a mediastinal or hilar mass is found incidentally on chest radiograph. The pathogenesis is unknown, but a chronic inflammatory process has been suggested by some investigators. Complete surgical excision is the treatment of choice and is generally curative.

Adult↗
PubMed1989

Rounded atelectasis.

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Diagnosis, Differential↗
PubMed1989

Pulmonary hypertension.

Conventional radiography reflects the underlying cause of pulmonary hypertension and may help to distinguish between precapillary and postcapillary etiologies. Adjunctive nuclear medicine studies may aid in identifying chronic pulmonary emboli as a cause of precapillary hypertension.

Chronic Disease↗