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Monica Jurcău, Mariana Floria, Bogdan Mazilu, Anca Ouatu and Daniela Maria Tanase


Introduction: We present the case of a young man with multiple atherosclerotic risk factors and a rare cause of angina and supraventricular ectopic beats.

Case presentation: A 35-year-old man with one-year history of stable angina pectoris and supraventricular ectopic beats, without any medication, presented to the emergency room complaining of anterior chest pain that occurs at moderate physical exertion. The rest electrocardiogram, transthoracic echocardiography, and chest X-ray were normal; the exertion stress test was also normal, except for supraventricular ectopic beats (trigeminal rhythm). Due to the intermediate pre-test probability of coronary artery disease, he was evaluated using coronary computed tomography angiography. An anomalous origin of the right coronary artery from the left coronary sinus, with an inter-arterial course and without any atheroma plaques, was observed. During hospitalization the evolution was stable, without complications. The patient was further referred to a cardiac surgery clinic to evaluate the possibility of surgical treatment of this anomaly.

Conclusions: Coronary artery anomalies are very rare; however, they present multiple implications in current practice. The most severe complication of this condition is represented by sudden death in young patients due to malignant ventricular arrhythmias. Imaging diagnostic techniques allow for a rapid, noninvasive diagnosis of this rare cause of angina.

Open access

Rodica Togănel

.10.969. 12. Abu-Harb M, Wyllie J, Hey E, et al. Presentation of obstructive left heart malformations in infancy. Arch Dis Child Fetal Neonatal Ed. 1994;71:F179. doi:10.1136/fn.71.3.F179. 13. Ewer AK, Furmston AT, Middleton LJ, et al. Pulse oximetry as a screening test for congenital heart defects in newborn infants: a test accuracy study with evaluation of acceptability and costeffectiveness. Health Technol Assess. 2012;16(2):v-xiii,1-184. doi: 10.3310/hta16020. 14. Duff FD, McNamara DG. History and physical examination of the cardiovascular

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Ota Hlinomaz, Ladislav Groch, Jan Sitar, Michal Rezek, Jiří Seménka, Martin Novák and Nikolay Penkov

References 1. Huang D, Swanson EA, Lin CP, et al. Optical coherent tomography. Science. 1991;254:1178-1181. 2. Prati F, Regar E, Mintz GS, et al. Imaging of atherosclerosis: optical coherence tomography (OCT). Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Eur Heart J 2010; 31:401-415. 3. Špaček R, Červinka P. Nové

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Zsuzsánna Ágnes Szász, Enikő Székely-Vass, Gyopár Horváth and Mădălina Hozoi


Introduction: Our article underlines the importance of a good professional anamnesis, knowing all the chemical components with which the patient had been exposed to during her active life as a teacher.

Case presentation: A 64-year-old female patient, teacher for 27 years, who had been retired for six years, presented cough with white phlegm and shortness of breath occurring during physical exertion, diffuse thoracic pain, and fatigue. Several lung functional tests were performed, which established the diagnosis of irreversible minor mixed ventilatory dysfunction. In order to establish the etiology of the patient’s symptoms, multiple clinical, laboratory, imaging, and functional investigations were performed including a chest radiograph, pulmonary functional testing, bronchial reversibility testing, a thoracic CT scan, fibrobronchoscopy, alveolar-capillary diffusion capacity measurement, otorhinolaryngology examination, thyroid ultrasound, as well as a cardiological consult. Finally, a positive diagnosis was established: bronchial hyperreactivity syndrome, chalk dust-induced diffuse pulmonary fibrosis.

Conclusion: An essential part of clinical practice is a proper anamnesis, including detailed information on the professional history and exposure, as well as the composition of the dust/particles with which the patient had been in contact with.

Open access

Ioan Ţilea, Elena Andreea Bocicor, Codruţa Maria Gal and Andreea Varga

;52:3792-3800. 8. Clements PJ, Tan M, McLaughlin VV, et al. The pulmonary arterial hypertension quality enhancement research initiative: comparison of patients with idiopathic PAH to patients with systemic sclerosis-associated PAH. Ann Rheum Dis . 2012;71:249-252. 9. Van der Hogen, et al. 2013 ACR/EULAR Classification Criteria for Scleroderma, Arthritis and Rheumatism. 2013,65:2737-2747. 10. Kavanaugh A, Tomar R, Reveille J, et al. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. American College

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Mihai Roman, Radu Prejbeanu, Andrei-Marian Feier, Octav Russu, Adrian Todor, Vlad Predescu, Bogdan Codorean, Tiberiu Bățagă and Radu Fleaca

References 1. Logerstedt D, Grindem H, Lynch A, et al. Single-legged Hop Tests as Predictors of Self-Reported Knee Function After Anterior Cruciate Ligament Reconstruction: The Delaware-Oslo ACL Cohort Study. Am J Sports Med. 2012;40:2348-2356. 2. Tan SH, Lau BP, Khin LW, et al. The Importance of Patient Sex in the Outcomes of Anterior Cruciate Ligament Reconstructions: A Systematic Review and Meta-analysis. Am J Sports Med. 2016;44:242-254. 3. Tegner Y, Lysholm J. Rating systems in the evaluation of knee

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Sandor Viski and Laszlo Olah

;8:1-7. 12. Homburg A-M, Jakobsen M, Enevoldsen E. Transcranial Doppler recordings in raised intracranial pressure. Acta Neurologica Scandinavica. 1993;87:488-493. 13. Hansen HC, Helme K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. J Neurosurg. 1997;87;34-40. 14. Helme K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol. 1966

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Neha Gupta and Chrystal Rutledge

. Definitive diagnosis is usually made by genetic testing. Structural abnormalities of the brain are quite common in PDCD. A case of a patient with a late-onset diagnosis of PDCD with proximal muscle weakness, lactic acidosis and a normal brain magnetic resonance imaging (MRI) with an unusual presentation is presented. Case Report A 20-month-old boy with a past medical history of developmental delay, hypotonia and feeding difficulty, presented to the emergency department (ED) with runny nose, cough, and increased work of breathing for five days. Birth history was

Open access

Piero Portincasa, Emilio Molina-Molina, Gabriella Garruti and David Q.-H. Wang

associated with gallstones. During painful episodes, some non-specific gastrointestinal symptoms may occur. In about 60% of cases, pain radiates to the angle of the right scapula or shoulder, and in less than 10% of cases to the retrosternal area [ 27 , 31 ]. In two-thirds of patients, a colicky pain may be associated with the urgency to walk [ 32 ]. Nausea and vomiting [ 27 , 28 , 32 ], as well as diaphoresis may be related symptoms, while pain is usually not relieved by flatus or bowel movements [ 28 ]. Following a painful attack, physical examination may be normal