Differential diagnosis and clinical approach to the patient with acute chest pain

Chest pain syndromes are diverse and often enigmatic. Most chest pain is of a benign nature and poses no serious threat to life. However, when presented with the patient complaining of acute chest pain, the clinician must make decisions concerning management of potentially lethal disease while considering the emotional and financial implications of overtreatment of less serious disorders. In general, life-threatening chest pain syndromes involve some form of vascular compromise (myocardial ischemia, aortic stenosis, dissection of the aorta, pulmonary embolus), and particular emphasis must be placed on detecting these entities. We have reviewed the major causes of chest pain with a perspective on newer methods for distinguishing these entities. The skilled clinician will apply this information in a judicious, systematic manner to afford the most prudent management of the patient.

Fatal acute splenic sequestration at 4 months of age

A patient with homozygous sickle cell anemia is the youngest known to have died from acute splenic sequestration crisis. A cord blood screening program might have prevented this infant's death.

Spontaneous occurrence of localized pulmonary interstitial and endolymphatic emphysema in infancy

Two infants are described with persistent pulmonary interstitial and endolymphatic emphysema of the localized, bullous type, occurring apparently spontaneously. Roentgenographically, the process simulated congenital lobar emphysema in the first patient and bilateral post-infectious pneumatoceles in the second. The histologic features of the lesion were identical to those seen in localized pulmonary interstitial emphysema caused by positive pressure ventilation in newborns with hyaline membrane disease.

Hypobaric hypoxia-induced intrauterine growth retardation

2-week-pregnant New Zealand White rabbits were placed into a hypobaric chamber and maintained at 3,657 m (12,000 ft). Upon delivery (31 +/- 1 days) or at cesarean section (on day 30), all newborns were sacrificed and organ weights were compared to those of control pups maintained at 128 m (420 ft). Significant findings in the hypobaric animals included a diminished birth weight, placental weight, and liver weight per body weight. Placental weight per body weight was similar in both groups. The brain weight per body weight, brain to liver ratio, and right ventricle to left ventricle plus intraventricular septal weight ratio were significantly increased in the hypobaric pups.

The hazard of ingested alkaline disk batteries in children

We have treated eight cases of childhood ingestion of alkaline disk batteries, one resulting in an esophagotracheal fistula. These batteries are capable of rapid tissue destruction on contact with moist membranes. We recommend that packaging include proper warning of this hazard and urge that retained batteries be promptly removed from the esophagus and stomach by endoscopy or laparotomy. If the battery has reached the small intestine, further transit should be monitored carefully by roentgenographic studies until recovery. Perforation is possible after eight-hour retention at a specific site.

Hypertrophic cardiomyopathy is a component of subacute necrotizing encephalomyelopathy

Twelve patients, ranging from the neonatal period through adolescence, with subacute necrotizing encephalomyelopathy (Leigh disease) were studied. Autopsies of these patients demonstrated an associated hypertrophic cardiomyopathy in seven; of these, four had asymmetric septal hypertrophy. In two patients, the cardiac lesion was observed by premortem echocardiograms. The common occurrence of a cardiac lesion emphasizes the probable systemic nature of SNEM and may serve to segregate these patients into two groups. Because of the involvement of the two systems, we suggest that SNEM may have some relation to a variety of other cardioneurologic syndromes.

The solitary renal calyx and papilla in human kidneys

Three cases of unipapillary and unicalyceal kidneys are presented together with a review of 7 isolated cases taken from the literature. This anomaly is rare in humans and usually associated with other significant morphological or functional abnormalities of the urinary system, most frequently absence of the contralateral kidney.