Quality of Post-Discharge Follow-Up in Patients Admitted to TJUH with Intermediate High Risk Pulmonary Embolism

Our institution has developed a multidisciplinary pulmonary embolism response team (PERT) to help in the management of patients with intermediate high risk pulmonary embolism While the PERT focus is on acute inpatient management, it is important that PERT patients have close follow-up to monitor for known future complications including thromboembolic pulmonary hypertension (CTEPH) and chronic pulmonary embolism syndrome CTEPH, in particular, is a potentially treatable disease with significant morbidity if left untreated Therefore, an underappreciated and important aspect of the PERT team should be the coordinated follow-up and long term care of these patients We wanted to better understand how consistently our patients with intermediate high risk PE had pulmonary and/or vascular medicine (JATS) outpatient follow-up with repeat TTE performed at 3 month

An intraductal papillary mucinous tumor... of the biliary tract

Les papillomatoses des voies biliaires sont des tumeurs rares dont le principal risque est celui de la récidive et de la transformation maligne. Nous rapportons l'observation d'une femme présentant une forme de papillomatose biliaire inhabituelle sous la forme d'une tumeur biliaire productrice de mucines et s'apparentant aux tumeurs intra-canalaires papillaires et mucineuses pancréatiques

Monotherapy with labetalol compared with propranolol. Differential effects by race

The antihypertensive effect of oral labetalol and propranolol were evaluated in 65 black and 75 white patients with mild to moderate hypertension (standing diastolic blood pressure (StDBP) of 90-115 mmHg) in a double-blind multicenter clinical trial. Following a 4-week placebo phase, labetalol (n = 70) or propranolol (n = 70) was randomly assigned. During a 5-week titration phase, labetalol could be increased from 100 mg BID to 600 mg BID to achieve a StDBP of less than 90 mmHg and a decrement of greater than or equal to 10 mmHg. Propranolol could be titrated from 40 to 240 mg BID. A 3-month maintenance phase was followed by an optional 8-month maintenance phase. Hydrochlorothiazide (HCTZ) could be added at any time during the maintenance phase. Supine and standing blood pressures were measured at each visit. Statistical analysis revealed significant (ANOVA, p less than 0.05) treatment by race effects. Therefore, the treatment groups were stratified retrospectively by race. This study demonstrated that labetalol is equally effective in white and black patients, whereas, propranolol is significantly (p less than 0.05) more effective in white than in black patients. Moreover, labetalol is significantly more effective than propranolol in lowering the standing systolic/diastolic blood pressure of black patients (p less than 0.02/p less than 0.001). These blood-pressure effects were accompanied by a significantly greater (p less than 0.04) reduction in heart rate with propranolol. Furthermore, significantly more (p less than 0.05) black patients treated with propranolol compared to those treated with labetalol required the addition of a diuretic for control of their blood pressure

Impact probable du volcanisme sur le décès des Hominidés de Dmanissi

International audienceLes restes humains découverts à ce jour sur le site Pléistocène inférieur de Dmanissi (Géorgie) sont abondants, bien conservés, sans trace de prédation ou de transport. Ils ont été retrouvés sur une surface réduite et correspondent au minimum à cinq individus d’Homo georgicus, d’âges répartis régulièrement entre l’adolescent et le « vieillard » de plus de 40 ans. Ces caractéristiques font penser à un groupe familial décédé subitement. Les granulométries et analyses chimiques d’une trentaine d’échantillons de la cendre volcanique de la couche VI, englobant la plupart de ces restes humains, démontrent l’unicité de cette cendre et sa position primaire. Ce téphra ne pouvant correspondre à une nuée ardente, il est probable que les Hominidés de Dmanissi ont été surpris et asphyxiés, il y a 1 810 000 ans, par des retombées de cendres volcaniques