RESUMEN
Pulmonary embolism (PE) is a common but life-threatening condition, and diagnosis can be challenging. Diagnosis is even more difficult in those patients with atypical presentations such as the absence of pleuritic chest pain, dyspnoea, tachycardia, or symptoms of deep vein thrombosis. We have delineated shoulder and back pain as an atypical sign of PE. However, the significant amount of misdiagnosis highlights the importance of other rare symptoms of this potentially fatal disease. Therefore, eliciting these rare presenting symptoms can significantly reduce morbidity and mortality. Here, we report the case of a patient who, 13 days after a laparoscopic Nissen fundoplication, presented to the emergency department (ED) with left shoulder and left-sided pleuritic back pain. She was managed in the resuscitation area in the ED and was subsequently diagnosed with a left-sided PE. Her care was taken over by the medical team, and she continued her recovery in the acute medical unit.
RESUMEN
It is well documented that prolonged immobilization and heavy alcohol consumption can independently cause rhabdomyolysis; however, entrapment on a fence following alcohol consumption resulting in rhabdomyolysis without prolonged coma or seizures has not been reported. We report a case of a 25-year-old man who, following alcohol consumption, whilst attempting to climb a fence, became entrapped and desperately had to clinch on the fence with both forearms for over three hours, resulting in rhabdomyolysis. This case report highlights the importance of recognizing the potential complications associated with prolonged immobilization and the subsequent management of rhabdomyolysis.
RESUMEN
This paper provides updated cohort tables of life expectancy for individuals in the United Kingdom. Using 2008-based projections from the UK Office for National Statistics (ONS) cohort and period expectation of life tables (the Ogden tables); predicted future life expectancies were calculated for quintiles of age from 0-90 years in men and women with mortality ratios between 100% and 1000%. Period tables have been included to illustrate the differences between period and cohort life expectancy in men and women at various ages. These tables are not intended to predict specific life expectancy in individuals but may indicate the mean life expectancy of a cohort of similarly affected people in the UK.
Asunto(s)
Esperanza de Vida , Tablas de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Factores Sexuales , Reino Unido/epidemiología , Adulto JovenRESUMEN
OBJECTIVES: To determine the life expectancy and mortality rates in patients with type 2 diabetes mellitus when compared with the UK general population; to measure the years of life lost. DESIGN: Longitudinal and retrospective cohort study. SETTING: The Wirral Peninsula in the northwest of England. PARTICIPANTS: Total of 13,620 patients with type 2 diabetes mellitus on the Wirral Diabetes Register. MAIN OUTCOME MEASURE: All-cause mortality, from 1 January 2000 to 31 December 2007. RESULTS: Over the 8-year period of the study, there were a total of 16,692.5 person-years lived and 3888 deaths; 2041 (52.5%) males and 1847 (47.5%) females with corresponding mean ages at death of 75.6±10.3 years and 80.2±10.2 years, respectively. Although prevalence rates increased linearly (from 1.06% in 2000 to 4.39% in 2007) a decrease in mortality rates (from 117 to 46 per 1000 population) in both sexes was observed. This coincided with a progressive fall in cardiovascular risk factors in this population. A survival time curve of life lived until death showed that males had 8.0 years reduction in life span and females' life span was reduced by 9.6 years when compared with UK general population. In both sexes, life expectancy was reduced by between 2 and 11 years dependent on the age of diagnosis, with males showing a greater degree of reduction. CONCLUSION: Type 2 diabetes mellitus is associated with a significant reduction in life expectancy, more markedly in men, and in those diagnosed before age 70 years. However, annual mortality rates have fallen progressively in our population and may contribute to longer survival and life expectancy in future years.