Saddle pulmonary embolism diagnosed by CT angiography: Frequency, clinical features and outcome

SummaryObjectiveTo assess the frequency, clinical presentation and outcome associated with saddle pulmonary embolism (PE) diagnosed by computed tomographic angiography (CTA).PatientsRetrospective review of 546 consecutive patients diagnosed to have acute PE by CTA from 1 September 2002 to 31 December 2003.ResultsFourteen of 546 patients (2.6%) had saddle PE; 10 were men (71%). None of these patients had pre-existing cardiopulmonary disease. Most common presenting symptoms included dyspnea (72%) and syncope (43%). Hypotension was documented in 2 patients (14%). The most common risk factor for PE was obesity (64%). CTA revealed saddle PE and additional filling defects in the main pulmonary arteries in all patients. Echocardiography was performed within 48h of the PE diagnosis in 10 patients and revealed right ventricular dysfunction in 8 (80%). All patients were initially managed in the hospital, median length of stay of 4 days (range, 1–45 days). Standard anticoagulant therapy with heparin and warfarin was administered to all patients. Five patients (36%) received additional therapy; thrombolytic therapy was administered to 1 patient (7%) and 4 patients (29%) received an inferior vena cava filter. None of the patients died during their hospitalization. Four patients (29%) died following their hospitalization after intervals of 1, 5, 6, and 12 months, respectively. Causes of death were known in 3 patients, all of whom died from progressive malignancy.ConclusionSaddle PE in patients without pre-existing cardiopulmonary disease is associated with a relatively low in-hospital mortality rate and may not necessitate aggressive medical management

Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review

<p>Abstract</p> <p>Background</p> <p>Manual therapy is an intervention commonly advocated in the management of dizziness of a suspected cervical origin. Vestibular rehabilitation exercises have been shown to be effective in the treatment of unilateral peripheral vestibular disorders, and have also been suggested in the literature as an adjunct in the treatment of cervicogenic dizziness. The purpose of this systematic review is to evaluate the evidence for manual therapy, in conjunction with or without vestibular rehabilitation, in the management of cervicogenic dizziness.</p> <p>Methods</p> <p>A comprehensive search was conducted in the databases Scopus, Mantis, CINHAL and the Cochrane Library for terms related to manual therapy, vestibular rehabilitation and cervicogenic dizziness. Included studies were assessed using the Maastricht-Amsterdam criteria.</p> <p>Results</p> <p>A total of fifteen articles reporting findings from thirteen unique investigations, including five randomised controlled trials and eight prospective, non-controlled cohort studies were included in this review. The methodological quality of the included studies was generally poor to moderate. All but one study reported improvement in dizziness following either unimodal or multimodal manual therapy interventions. Some studies reported improvements in postural stability, joint positioning, range of motion, muscle tenderness, neck pain and vertebrobasilar artery blood flow velocity.</p> <p>Discussion</p> <p>Although it has been argued that manual therapy combined with vestibular rehabilitation may be superior in the treatment of cervicogenic dizziness, there are currently no observational and experimental studies demonstrating such effects. A rationale for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is presented.</p> <p>Conclusion</p> <p>There is moderate evidence to support the use of manual therapy, in particular spinal mobilisation and manipulation, for cervicogenic dizziness. The evidence for combining manual therapy and vestibular rehabilitation in the management of cervicogenic dizziness is lacking. Further research to elucidate potential synergistic effects of manual therapy and vestibular rehabilitation is strongly recommended.</p

Comportamiento del coque char y residuos orgánicos en el horno alto con altas tasas de inyección

11 pages, 12 figures, 4 tables.[EN] Blast furnace operation with low coke rate, high amount of auxiliary hydrocarbons and use of nut coke causes a change in coke quality requirements. In particular, not burned in the raceway residues of injected substances (char and ash) can influence the coke behaviour. Therefore combustion efficiency of various organic wastes with and without pulverized coal injection (PCI) and coal char has been investigated under the raceway simulation conditions. Mixing of various substances improves their combustion efficiency. Study on coke gasification by carbon dioxide in the presence of char showed that with the increase of char concentration, coke strength reduction becomes smaller. The reactivity of char with CO2 is higher than that of coke. Therefore char is consumed preferentially. In presence of injected char, total pore volume in coke and its wear resistance were increased. Coke reactivity and microstructure in the presence of various kinds of ash has been studied. Many ash spheres were observed on the surface of coke matrix and its size was dependent on ash properties.[ES] La operación del horno alto con una tasa baja de coque, una cantidad elevada de hidrocarburos auxiliares y el empleo de coque calibrado, origina un cambio en las necesidades de calidad del coque. En particular, pueden influir en el comportamiento del coque los residuos inquemados en el raceway (cavidad enfrente a las toberas del horno) de las sustancias que se inyectan {char y cenizas). El char es el residuo de carbón que se origina después que el carbón libera sus sustancias volátiles. Por tanto, se ha investigado la eficiencia de la combustión de varios residuos orgánicos con y sin inyección de carbón pulverizado (ICP) y char, bajo las condiciones de simulación del raceway. La mezcla de varias sustancias mejora la eficiencia a la combustión. El estudio de la gasificación del coque por el dióxido de carbono en la presencia de char, muestra que con el aumento de la concentración del char, la resistencia del coque después de la reducción se hace más pequeña. La reactividad del char con el CO2 es más elevada que conla del coque. Por tanto, el char se consume con preferencia. En presencia del char inyectado aumentan el volumen total de poros del coque y la resistencia al desgaste. Se ha estudiado la reactividad y microestructura del coque con la presencia de distintos tipos de cenizas. Se observaron muchas esferas de ceniza sobre la superficie matriz del coque y el tamaño de las esferas depende de la naturaleza de las cenizas.The authors are grateful to the "European Coal Steel Community" (ECSC) and JFE Steel Corporation for financial support of this work.Peer reviewe