We retrospectively reviewed all patients with a final diagnosis of deep venous thrombosis (DVT) treated at Linkou Chang Gung Memorial Hospital between 1989 and 1995. There were a total of 245 patients with a mean age of 58 years (males 56 and females 59), ranging from 11 to 89 years. The ratio of left to right leg involvement was 2.4 to 1 (166 to 71), however, the right leg was more likely to lead to an acute pulmonary embolism, with a ratio of 3.0 to 1 (9/ 71 to 7/166 patients). Among these patients, 16.3% (40) had cancer. The most frequently involved system was the GI system (16). Adenocarcinoma proved the most common type of malignancy 62.5% (25/40).From this analysis, we found the left leg had a higher likelihood of thrombosis but a DVT of the right leg was more frequently associated with an acute pulmonary embolism. As with previous reports there was a strong relationship between cancer and DVT and the development of a deep venous thrombosis requiring a search for an underlying malignancy in those patients with an unexplained DVT.
SUMMARYAn 18-year-old schizophrenic female was recently treated after overdosing on trihexyphenidyl, thioridazine and an unknown antidepressant. On presentation to a local hospital, she was cyanotic with dilatated pupils and in acute respiratory failure. She was intubated prior to transfer. While in our Emergency Department, she exhibited occasional premature ventricular contractions which later became intermittent torsade de pointes. As this was an anticholinergic overdose we infused sodium bicarbonate in an attempt to increase protein binding, hoping to decrease the concentration of toxic metabolites. We also tried to suppress the dysrhythmia by infusing magnesium. The potassium level was borderline low so a supplemental infusion was initiated. Defibrillation was attempted. To try to shorten the action potential duration by activating the K+ channel, an isuprel infusion was also attempted. All methods failed. The patient fluctuated between an irregular sinus rhythm with prolonged QT interval and pulseless torsade de pointes for almost 24 hours. At all times, she responded appropriately to pain. Finally we attempted blockade of the calcium channel using verapamil with dramatic results. Each single bolus (0.1mg/kg) successfully converted the patient back to sinus rhythm for some 15-20 minutes before the torsade recurred. After the initiation of a continuous verapamil infusion (0.005mg/kg/hr), the patient remained in stable sinus rhythm.Verapamil proved highly effective in this patient with an anticholinergic overdose induced dysrhythmia. (Jpn Heart J 1996; 37: 925-931)
We retrospectively reviewed all of the patients who were treated for cardiac tamponade at Linkou Chang Gung Memorial Hospital between January 1991 and December 1995. There were a total of 112 patients (57 males, 55 females) with a mean age of 51 +/- 14 years (53 +/- 15, 49 +/- 13, respectively). Dyspnea was the most common complaint (85%). The mean blood pressure was 129 +/- 24/78 +/- 17 mmHg, and only 8% had a systolic blood pressure of less than 90 mmHg. Sinus tachycardia was the most frequent electrocardiographic finding (72%, 62/86). Diffuse low voltage was noted in 35% (30/86) of the patients and electrical alternans was seen in 17% (15/86). The mean volume of pericardial effusion was 610 +/- 263 ml. Sixty-five percent of the pericardial effusions were bloody, 31% were serosanguineous, 2% were purulent and 2% were chylous. Overall, 54.5% of the patients had malignant diseases. Of the 61 patients who died, 79% had malignancies. Thirty-five (57%) of these 48 patients had lung cancer. The mean survival time from emergent pericardiocentesis was 3.4 months. In conclusion, non-traumatic cardiac tamponade had a poor prognosis because most patients had malignant etiologies. There is still no definitive treatment for recurrent malignant pericardial effusion-induced cardiac tamponade. Percutaneous pericardiocentesis as clinically required may be the most appropriate treatment, since it is questionable whether such subjects should be subjected to the unnecessary pain and suffering associated with an operative procedure, considering their short mean survival time.
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