BACKGROUND: Syncope is one of the most common reasons for emergency department and urgent care clinic visits. The management of syncope continues to be a challenging problem for front-line providers inasmuch as there are a multitude of possible causes for syncope ranging from relatively benign conditions to potentially life-threatening ones. In any event, it is important to identify those syncope patients who are at immediate risk of life-threatening events; these individuals require prompt hospitalization and thorough evaluation.
OBJECTIVE: The greater acceptance of acupuncture by healthcare professionals and the public has increased the importance of addressing public concern about its safety. Of particular concern has been the potential for transmission of infectious disease and organ and tissue injury, as well as the training and professional standards of acupuncture practitioners. This paper, therefore, addresses the following question: What is the frequency and severity of adverse complications and events in acupuncture treatment?
The growing abundance of highly immunogenic vaccines has arrived with a burden of pain, distress, and common adverse reactions that in turn may interfere with parental compliance and aggravate anti-vaccine sentiment. In a study of 150 children in each of 2 age-groups, we found that approximately 20% of the subjects suffered serious distress or worse. During the procedural phase, approximately 90% of the 15-to-18 month old children and 45% of the 4-to-6 year old children showed serious distress or worse.
100 patients with acute myocardial infarction were given 5 mg of sublingual isosorbide dinitrate within 36 hours by the onset of their symptoms. 86 patients did not show any unusual effect after the administration of the drug; their heart rate was only slightly increased and their arterial pressure slightly reduced. 14 patients developed severe systemic arterial hypotension, associated with absolute or relative bradycardia, within 30 minutes of receiving the drug. All the patients complained of fainting and sweating, 1 patient developed a syncope.
Lithium salts have been widely used for several years in the treatment of manic-depressive psychosis. Various side-effects of lithium salts have been described. The present case report present two patients in whom sinus node dysfunction leading to syncope was caused by lithium. One of the cases showed signs of depressed sinus node function even when not on lithium, but no symptoms arose until lithium treatment was commenced. The second case showed no signs of depressed sinus node function when lithium was withdrawn.
We investigated 76 patients with carotid sinus syndrome followed over a time period of 12-40 months (mean 24 months). In 27 patients long-term ECG were recorded over 24 hours continuously. Carotid Doppler sonography was performed in all patients. 14 patients were studied electrophysiologically. The long-term ECG examinations in patients with carotid sinus syndrome showed a significant tendency to nocturnal bradycardia, and normal heart frequency during the day. In 41% of patients extracranial obstruction of internal carotid arteries could be demonstrated.
We have examined 17 patients suffering from recurrent syncope caused by carcinoma of the head and neck. The tumor originated in the mouth in seven, larynx in six, nasopharynx in three and parotid gland in one, and involved cervical lymph nodes at diagnosis in 12. Sixteen patients had previously had radical neck dissections and 12 had had radiation therapy. Recurrent carcinoma was present in 16. Spells resolved spontaneously in four, improved with treatment in 11 and continued in two. The syncope was spontaneous in 15 and induced only by suctioning or carotid sinus massage in two.
A prospective study examined the diagnostic yield and therapeutic efficacy of electrophysiologic studies in patients with SUO. We defined SUO as those syncopal or near-syncopal events remaining unexplained after a standardized, noninvasive evaluation that included a history, physical examination, routine laboratory screening, EEG, nuclear brain scan or CAT scan, 12-lead ECG, chest x-ray, orthostatic vital signs, bedside carotid sinus massage, and at least 24 hours of continuous ECG monitoring.
Because syncope may occur intermittently in patients with carotid sinus hypersensitivity, a knowledge of its natural history is needed as a basis for interpreting the usefulness of therapy. Fifty-six consecutive patients are described (47 men and 9 women; mean age 61 years) with carotid sinus hypersensitivity and syncope in whom 24 hour ambulatory monitoring and intracardiac electrophysiologic study revealed no other cause for the syncope. The mean duration of symptoms was 44 months (range 1 to 480) and the mean number of episodes was 4.0 (range 1 to 20).
In a 64-year-old male, recurrent syncope, hypotension and bradycardia developed repeatedly. The systolic blood pressure fell and could not be measured by auscultation method and the heart rate decreased to under 20 bpm. He recovered from unconsciousness in several minutes. No precipitating cause was apparent for such episodes. Physical examination revealed swollen lymph nodes in the upper cervical regions. Carotid sinus massage caused a fall of systolic blood pressure by 40 mmHg and the P-P interval lengthened to 1.96 sec. The otolaryngeal examination showed neoplasma in the pharynx.