Electrocardiographic changes in hiatal hernia: a case report

We describe the case of a 78-year-old woman admitted to our department for suspected silent myocardial ischaemia with the evidence of T wave inversion in anterior lead. All the instrumental exams excluded inducible myocardial ischaemia. A gastroscopy showed a moderate hiatal hernia. We postulate that electrocardiogram modification could be attributed to hiatal hernia

Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation.

OBJECTIVES: To identify clinical outcomes and variables associated with 6-month mortality in very elderly patients admitted for nonacidotic acute exacerbation of chronic obstructive pulmonary disease (AECOPD). DESIGN: Prospective cohort study. SETTING: General medicine acute care ward. PARTICIPANTS: Two hundred forty-four elderly patients with COPD (mean age+/-standard deviation 82+/-7, 55.7\% female) admitted to the hospital because of non-acidotic AECOPD. MEASUREMENTS: Cognitive and mood status and physiological variables were measured. Self-reported comorbidities were assessed using the Charlson Comorbidity Index. In-hospital and long-term mortality and clinical outcomes were recorded. RESULTS: At admission, this elderly population with AECOPD had low cognitive performance (mean Mini-Mental State Examination score 21+/-5), no presence of significant depressive symptoms (Geriatric Depression Scale score 4+/-3), good nutritional status (body mass index (BMI) 25.1+/-5.5), moderate comorbidity (Charlson Comorbidity Index 4.0+/-1.9), high functional disability (Barthel Index (BI) 52+/-34), and moderate severity of acute exacerbation (Acute Physiology and Chronic Health Evaluation (APACHE) II score 9.7+/-4.2). Two hundred twenty-five inpatients with AECOPD were successfully discharged, whereas 15 were transferred to the intensive care unit, and four died in the hospital. The 6-month cumulative mortality rate in discharged patients with AECOPD was 20\%. Multivariate Cox analysis shows that lower BMI (beta=-0.16; 95\% confidence interval (CI)=0.73-0.99), higher APACHE II score (beta=0,17; 95\% CI=1.03-1.36), and lower BI at discharge (beta=-0.02; 95\% CI=0.96-0.99) were independently associated with 6-month mortality. CONCLUSION: Malnutrition, severity of exacerbation and disability status could be identified as risk factors associated with 6-month mortality of elderly patients admitted for nonacidotic AECOPD

Zaspół Boerhaavego - trudna diagnostyka różnicowa bólu w klatce piersiowej

Boerhaave’s syndrome is a very rare disease characterised by a spontaneous rupture of the oesophagus. It is often misdiagnosed and there is no consensus as to the best treatment. We describe a case of a 61 year-old man without significant previous medical history presenting in the emergency room with acute chest and back pain. Despite objective and laboratory tests negative for chest pain screening, computed tomography showed the presence of mediastinal air and pneumothorax consistent with oesophagus rupture. Urgent surgical intervention saved the patient. Kardiol Pol 2010; 68, 9: 1040-104