Cardiopulmonary Symptoms Research Articles

Abstract 3263: Right Heart Findings on Supine Bicycle Stress Echocardiography are Highly Predictive of Severe Sleep Apnea in Women Presenting with Chest Pain and Shortness of Breath

Background: Chest pain and shortness of breath may be multifactorial, especially in women, and not always indicative of ischemic heart disease. Sleep apnea may contribute to mortality and morbidity in ischemic heart and cerebral vascular patients. Supine bicycle echocardiography is an effective tool to evaluate right heart function at rest and with stress. Objective: To determine if right heart abnormalities driving supine bicycle stress echocardiography are predictive of hemodynamic significant sleep apnea. Methods: 638 consecutive women presenting with chest pain and/or shortness of breath underwent multistage supine bicycle stress echocardiography/Doppler imaging for left ventricular wall motion, ejection fraction (EF), right ventricular (RV) size and function, tricuspid (TR) and mitral (MR) regurgitation, and systolic pressure. Data was also collected on those who underwent sleep studies. ROC analysis was used to evaluate predictive value for severe sleep apnea (RDI ≥ 30). Results: Mean age was 63 ± 13 years, mean BMI 30 ± 7, and 80% post-menopausal. Mean EF was 62 ± 12%. Supine bicycle stress echocardiography/Doppler at peak exercise revealed moderate/severe RV enlargement 26%, RV hypokinesis 26%, and moderate/severe TR 40%. Mean values for exercise tolerance, peak heart rate, and peak systolic blood pressure were 4.3 ± 1.7 METs, 131 ± 23 bpm, and 183 ± 26 mmHg, respectively. Sleep study data was available for 88 women, of whom 45% had an RDI ≥ 30. 83% of sleep study subjects exhibited a combination of moderate/severe TR, moderate/severe RV dilatation, or moderate/severe hypokinetic RV function. The best predictor of severe sleep apnea was RV size ( C = 0.705) at peak exercise. RV function ( C = 0.640) and TR volume ( C = 0.603) at peak exercise were moderate predictors. Epworth score (10.4 ± 4.0; C = NA) or pulmonary pressure (77.5 ± 14.7 mmHg; C = 0.525) alone were only fair predictors. A model containing RV function, RV size, TR, and EF at peak exercise ( C = 0.730) further improved prediction of identification of those with severe sleep apnea. Conclusion: Sleep apnea can present with cardiopulmonary symptoms in advanced stages. Right heart abnormalities during supine bicycle stress echocardiography warrant screening for moderate/severe sleep apnea.

Ethylenevinylalcohol copolymer (Onyx-18) used in endovascular treatment of vein of Galen malformation

Vein of Galen malformations (VGM) are rare congenital arteriovenous fistulas that usually present with heart failure in the neonate. Endovascular treatment options in the past have utilized coils, balloons, and acrylics. We present, for the first time in the literature, a case of an infant with VGM treated initially with staged coil embolizations followed 1 year later by the transarterial and transvenous catheter based injection of Onyx-18 (ethylenevinylalcohol copolymer) in a single treatment session. The fistula was eliminated, and the infant's cardiopulmonary symptoms were improved.

Pulmonary Complications from Cocaine and Cocaine-based Substances: Imaging Manifestations

Cocaine is the illicit drug whose abuse most often results in cardiopulmonary symptoms and emergency treatment. Habitual smoking of alkaloidal cocaine ("freebase," "crack") has replaced nasal insufflation as the most common method of abuse. Smoking of cocaine exposes the lung directly to the volatilized drug as well as to the other combustion products of the smoked mixture, thereby increasing the risk of adverse pulmonary effects. A wide variety of pulmonary complications including interstitial pneumonitis, fibrosis, pulmonary hypertension, alveolar hemorrhage, asthma exacerbation, barotrauma, thermal airway injury, hilar lymphadenopathies, and bullous emphysema may be associated with the inhalation of crack cocaine or of associated substances such as talc, silica, and lactose. Cocaine abuse represents one of the most serious medical and social problems of our time. Radiologists should be familiar with the various pleuropulmonary complications associated with the abuse of illicit drugs in general and of cocaine in particular to ensure correct diagnosis and appropriate treatment planning in patients with respiratory manifestations associated with such abuse.

Surgical Treatment of Chronic Thromboembolic Pulmonary Hypertension

Pulmonary hypertension as the result of chronic pulmonary thromboembolic disease is a serious condition with poor long-term prognosis. The condition is one of the more common cardiovascular diseases affecting Americans, yet it is severely underdiagnosed. Pulmonary thromboendarterectomy is the definitive treatment for chronic pulmonary hyper-tension as the result of thromboembolic disease; however. it is an uncommon procedure, primarily because of lack of recognition on the part of the clinicians. Patients affected by chronic thromboembolic pulmonary hypertension (CTEPH) may present with a variety of debilitating cardiopulmonary symptoms. However, once diagnosed, there is no curative role for medical management, and surgery remains the only option. Palliation therapy with medical management in order to delay surgery carries the risk of prolonging the disease and irreversibly damaging unaffected pulmonary vasculature.

Systemic Lupus Erythematosus Presenting as Acute Lupus Myocarditis

Systemic lupus erythematous (SLE) is an autoimmune inflammatory disease of unknown etiology which affects various parts of body. SLE can involve all parts of the heart including the pericardium, myocardium, endocardium, heart valves and coronary arteries. Cardiopathy of SLE is the third common cause of death in all patients with SLE. Although cardiopulmonary symptoms are common in SLE, symptomatic acute lupus myocarditis is a very rare and fatal complication of SLE. We report here on a 20-year-old female patient with acute myocarditis as a initial manifestation of SLE and rapidly diagnosed using echocardiogram.

Are heat stroke and physical exhaustion underestimated causes of acute hepatic failure?

While cardiopulmonary symptoms are common in patients undergoing classical or, due to physical exercise, exertional heat stroke, the failure of other organs is a rarely described phenomenon. Here we present two cases of acute hepatic failure, one due to classic heat shock, while the other occurred while the patient was doing a marathon-type running. Both cases presented with very high transaminases and significantly elevated international normalized ratio (INR). No other causes for liver failure could be identified but physical exhaustion and hyperthermia.

Menopause and determinants of quality of life in women at midlife and beyond

Determinants of quality of life (QoL) in pre- and postmenopausal women including nonhormonal modulators of QoL in adult women are not well understood; there is an ongoing controversy about the impact of menopause on health-related QoL. We investigated the extent to which diverse mental and physical symptoms are associated with (a) menopausal status; (b) sociodemographic, psychosocial, and lifestyle factors; and (c) menopausal hormone therapy (MHT) in adult women after the German reunification in a region of the former German Democratic Republic. The Study of Health in Pomerania is a cross-sectional, population-based survey. Computer-based structured interviews and self-administered questionnaires were used to capture QoL (Zerssen Symptom List) and sociodemographic parameters, psychosocial, and lifestyle indicators (age, socioeconomic status, abuse, social support, nutrition, body mass index, self-rated health, chronic diseases, and use of MHT) in 1,119 pre- and postmenopausal women with an intact uterus. Analyses suggest that menopausal status was not associated with QoL. MHT was associated with physical, mental, and gastrointestinal symptoms. Age was a significant predictor for cardiopulmonary symptoms and sensory impairment. The relationship between age and both physical and mental complaints was inverse as was the relationship between age and both mood and gastrointestinal symptoms. Age, socioeconomic status, physical and sexual abuse, perceived social support, nutrition, body mass index, self-rated health, chronic diseases, and MHT modulated QoL. Our findings do not support the hypothesis that QoL is reduced after menopause. Differences between pre- and postmenopausal women can be explained by sociodemographic, psychosocial, and lifestyle factors.

Pulmonary Hypertension in Children and Adolescents with Sickle Cell Disease.

Pulmonary hypertension occurs in 20–40% of adults with sickle cell disease and has a poor prognosis; age of onset and prevalence in childhood are not well established. In adults, recurrent acute chest syndrome is associated with chronic sickle cell lung disease and perhaps pulmonary hypertension. Hematologically normal children with obstructive sleep apnea are at risk for pulmonary hypertension. We sought to determine the prevalence of pulmonary hypertension in children and adolescents with sickle cell disease, explore potential association with abnormal pulmonary function or sleep apnea, and identify other clinical or laboratory factors associated with this potentially life-threatening complication. Forty-eight patients (age 5–21 years, median 12 years) consented to participate. Thirty-eight (79%) had Hb SS; five each had Hb SC and S-beta thalassemia (three beta plus and two beta zero) (10.4%). Eleven (22.9%) were on chronic transfusion (seven for stroke, three for abnormal TCD velocity screening, and one for recurrent pain crises); nineteen (39.5%) were on hydroxyurea (ten for recurrent acute chest syndrome and nine for recurrent pain). A detailed history and physical examination were done on all enrolled subjects (history was comprehensive, but specifically included cardiopulmonary symptoms; neurological problems; number of pain crises and acute chest syndrome; blood transfusions; use of hydroxyurea; and a screening for obstructive sleep apnea). If apnea history was suggestive, polysomnography was done. In addition, all study subjects had Doppler echocardiography and pulmonary function tests (PFT). Pulmonary hypertension was defined as an age and body mass index-adjusted tricuspid regurgitant jet velocity (TRV) of greater than 2.5 mm/sec. Among the study group, 31 (64.5%) had pulmonary function tests; 17 (54.8%) had restrictive abnormalities on PFT, three (9.6%) had obstructive changes and 11 (35.4%) had normal PFT. Three patients (6.2%) had a history suggestive of apnea, then polysomnography; one was normal and two had OSA. Four of the 48 patients (8.3%) had PHT (TRV values 2.52, 2.55, 2.61, and 2.91). All had Hb SS. Two were age 17 and 18 years and two were 10 and 11. All were asymptomatic. One had restrictive PFT and none had OSA. There was no correlation between the presence of PHT and pulmonary function abnormalities or sleep apnea. Of the various other clinical and laboratory parameters examined, only an elevated serum indirect bilirubin was associated with PHT; there was a trend toward association with elevated reticulocyte count and low fetal Hb levels. In summary, the prevalence of PHT our pediatric sickle cell population is 8.3%. As reported in adults, there may be an association between PHT and more severe hemolysis. We could find no association with abnormal pulmonary function or obstructive sleep apnea.Characteristics of study patientsPHTNo PHTP ValueFetal Hb(%) (Mean)3.77.9.154Age (Mean)13.5 years12 years.564Reticulocytes (%)13.88.25.087Indirect bilirubin (mg/dl) (Mean)5.42.2.027

Technical Advances of Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension

Pulmonary endarterectomy is the definitive treatment for chronic pulmonary hypertension as the result of thromboembolic disease. Although significant progress has been made over the last decade in recognition, diagnostic modalities, and treatment of this disease, chronic thromboembolic pulmonary hypertension (CTEPH) continues to be severely underdiagnosed and as a consequence pulmonary endarterectomy remains an uncommon procedure. Patients with CTEPH may present with a variety of debilitating cardiopulmonary symptoms. However, once diagnosed, there is no curative role for medical management, and surgery remains the only option. Medical management in these patients is only palliative, and surgery by means of transplantation for this type of pulmonary hypertension is an inappropriate use of resources with less than satisfactory results. In this article we describe the technical advances of pulmonary endarterectomy and the current procedure as it is performed at University of California-San Diego Medical Center.

Sudden cardiac death associates with a large right atrium thrombus in a late survivor of heart transplantation

A fatal circulatory collapse developed acutely in a patient six years after orthotopic heart transplantation. Autopsy revealed a large, fresh thrombus inside the right atrium which obstructed the orifice of the vena cava completely. The grafted coronary artery and pulmonary vessels were patent. There was no rejection or acute infarct in myocardium. Mildly immature organization was seen on the thrombus-adhered wall. Four chamber enlargement and a rapid decline of right ventricular hypokinesia were detected shortly before death although he did not show active cardiopulmonary symptom. Intracardiac thrombus formation is rather uncommon in late survivor. A synergic effect of atrial turbulence and ventricular hypokinesia in the right heart, superimposed by tissue organization, was proposed for thrombus formation. An empty cardiac output was favored for his mortality. These findings provide a strong evidence to suggest anticoagulation in case of complicated or highly risk of embolization such as turbulence or hypokinesia despite of an absence of active cardiopulmonary symptom.

Novel Electrocardiographic Changes Associated With Iatrogenic Pneumothorax

56-year-old woman (height 165 cm, weight 65 kg) was admitted to the hospital because of a 2-day history of epigastric pain and emesis. Two weeks prior to admission, she had a Billroth II with Roux-en-Y procedure for stomach stricture and biliary reflux. Her medical history was significant for 1 episode of atrial fibrillation many years previously, osteoporosis, bilateral hip replacements, and gastric ulcer surgery. Drug therapy at the time of admission included simethicone 80 mg/d, rabeprazole 10 mg/d, and as-needed doses of clonazepam for anxiety and of acetaminophen. At admission, the patient’s blood pressure was 120/70 mm Hg and her heart rate was 90/min and regular. The physical examination was notable for facial and conjunctival pallor. Mucous membranes were dry. The patient’s abdomen was distended and tender to palpation in the upper quadrants. Bowel sounds were decreased. Her extremities were cool and her peripheral pulses were weak. The abdominal surgical wound was healing. The patient denied any cardiopulmonary symptoms and the results of her neurological examinations were normal. The patient’s white blood cell count was slightly elevated at 10.9 x 10 9 /L, and her hemoglobin level

A Report of the Vancouver Forum on the Care of the Live Organ Donor: Lung, Liver, Pancreas, and Intestine Data and Medical Guidelines

An international conference of transplant physicians, surgeons, and allied health professionals was held in Vancouver, Canada, on September 15 and 16, 2005 to address the care of the live lung, liver, pancreas, and intestine organ donor. The Vancouver Forum was convened under the auspices of the Ethics Committee of The Transplantation Society. Forum participants included over 100 leaders in organ transplantation, representing many countries from around the world, including participants from the following continents: Africa, Asia, Australia, Europe, North and South America. The objective of the Vancouver Forum was to develop an international standard of care for the live lung, liver, pancreas and intestinal organ donor. This Vancouver Forum followed a conference convened in Amsterdam on the care of the live kidney donor (1, 2). There were four organ specific work groups at the Vancouver Forum: lung, liver, pancreas and intestine. Each organ work group addressed the following topics in concert and reported their findings in a plenary presentation to all participants:

Unrecognized myocardial infarction: The association with cardiopulmonary symptoms and mortality is mediated via echocardiographic abnormalities of global dysfunction instead of regional dysfunction: The Olmsted County Heart Function Study

There are very few data describing the association of electrocardiogram-based unrecognized myocardial infarction (ECG-UMI) with nonanginal cardiopulmonary symptoms, echocardiographic abnormalities, and mortality in the community. We studied 2042 Olmsted County residents, who were randomly selected and aged > or = 45 years, by a survey questionnaire for symptoms, echocardiogram for structural abnormalities, and a 5-year follow-up for all-cause mortality. Unrecognized myocardial infarctions (n = 81) were diagnosed if ECG-based myocardial infarction (MI) criteria were met without the history of a documented recognized MI. In UMI versus no MI controls, the prevalence (%) of dyspnea on exertion (49 vs 29), orthopnea (6 vs 4), palpitations (20 vs 15), and history of fluid overload (6 vs 1) was significantly higher (P < .05). The associations of exertional dyspnea and history of fluid overload with UMI were independent of age, sex, and pulmonary disease but had a significant reduction in their magnitude after adjusting for global dysfunction (diastolic or systolic dysfunction). All the 4 symptoms were associated with increased risk of mortality (hazard ratios ranging from 2.3 to 9.1, P < .0001), which was meaningfully attenuated by adjusting for ECG-UMI status. Global ventricular dysfunction had a more significant impact on this association than regional ventricular dysfunction (wall motion abnormalities). The increased risk of mortality associated with symptoms is at least in part mediated via ECG-UMI. Structural abnormalities of global dysfunction play a greater role in mediating this risk than regional dysfunction, challenging the current clinical practice of calling an ECG-based MI false positive in symptomatic adults in the absence of wall motion abnormalities.

Menopause and determinants of quality of life in women at midlife and beyond – the Study of Health in Pomerania (SHIP)

Objective: Determinants of quality of life (QoL) in pre- and postmenopausal women including nonhormonal modulators of QoL in adult women are not well understood; there is an ongoing controversy about the impact of menopause on health-related QoL. We investigated the extent to which diverse mental and physical symptoms are associated with (a) menopausal status; (b) sociodemographic, psychosocial, and lifestyle factors; and (c) menopausal hormone therapy (MHT) in adult women after the German reunification in a region of the former German Democratic Republic. Design: The Study of Health in Pomerania is a cross-sectional, population-based survey. Computer-based structured interviews and self-administered questionnaires were used to capture QoL (Zerssen Symptom List) and sociodemographic parameters, psychosocial, and lifestyle indicators (age, socioeconomic status, abuse, social support, nutrition, body mass index, self-rated health, chronic diseases, and use of MHT) in 1,119 pre- and postmenopausal women with an intact uterus. Results: Analyses suggest that menopausal status was not associated with QoL. MHT was associated with physical, mental, and gastrointestinal symptoms. Age was a significant predictor for cardiopulmonary symptoms and sensory impairment. The relationship between age and both physical and mental complaints was inverse as was the relationship between age and both mood and gastrointestinal symptoms. Age, socioeconomic status, physical and sexual abuse, perceived social support, nutrition, body mass index, self-rated health, chronic diseases, and MHT modulated QoL. Conclusions: Our findings do not support the hypothesis that QoL is reduced after menopause. Differences between pre- and postmenopausal women can be explained by sociodemographic, psychosocial, and lifestyle factors.

Long-Term Effect of Bleomycin on Respiratory Function Tests in Pediatric Cancer Patients.

Abstract Chemotherapy and radiotherapy which are used in the management of cancer have acute and chronic adverse effects on various organs. Patients develop pulmonary damage due to mantle zone irradiation and bleomycin in the short or long-term. In this study, after the completion of treatment long-term pulmonary complications of the teatment were investigated in 30 pediatric patients (19 male, 11 female) with cancer aged between 72–229 months. Twelve of the patients used also chemotherapy in addition to 1020–3570 rad. of mantle zone irradiation (median 2177 rad.), whereas the remaining 18 had chemotherapy alone. All of the patients had completed their treatment approximately 3,8 years ago, and the total dose of bleomycin they used was 12–180 mg. (median 69,83). All of the patients underwent physical examination, and complete blood count, chest radiograph and spirometric tests to measure lung volumes were also performed. Additionally, in 20 patients single breath technique to measure the diffusing capacity for carbon monoxide was carried out. Physical examination of cardiopulmonary system revealed normal findings and none of our patients had a cardiopulmonary symptom. Chest radiograph was normal in 25 (83,3%) but it was abnormal in 5 patients. Lung volume measurements were normal in 21 (71%), but were abnormal in 9 (29%) patients. Of these 9 patients 23% had restrictive, 3% had combined and 3% had obstructive disorders. In our study, no correlation could be shown between the impaired respiratory function tests and irradiation and bleomycin doses used. In 3 (10%) out of 20 patients in whom the diffusing capacity test for carbon monoxide was performed, decreases in diffusing capacity for carbon monoxide were found. One of these patients had both high dose bleomycin (156 mg.) and mantle zone irradiation (2160 rad.), whereas the remaining 2 had low dose bleomycin (30–63 mg.) alone and received no radiotherapy. The diffusing capacity test for carbon monoxide which returns to normal values in short -term is less valuable than the measurement of lung volumes for the long-term follow-up evaluation of respiratory functions in these patients. Generally, in our late phase study (3,8 years after the completion of therapy), there was a low rate of impairment in diffusing capacity test for carbon monoxide, but the rate of impairment in lung volumes was much higher. This finding was compatible with most of the related literature. In conclusion, in pediatirc cancer patients respiratory function tests should be performed during the treatment and also after the completion of treatment in order to follow the course of pulmonary function impairment.

Exercise Stress Testing in Subacute Stroke Patients Using a Combined Upper- and Lower-Limb Ergometer

Hill DC, Ethans KD, MacLeod DA, Harrison ER, Matheson JE. Exercise stress testing in subacute stroke patients using a combined upper- and lower-limb ergometer. Objective To assess functional cardiopulmonary exercise tolerance in a subset of patients with residual neurologic deficits after stroke by exercise stress testing using the Power Trainer, a combined upper- and lower-limb ergometer. Design Prospective, observational study using a convenience sample. Setting Clinical locomotor laboratory in a tertiary rehabilitation hospital. Participants Thirty subjects undergoing rehabilitation an average of 7.3 weeks after stroke. Interventions Not applicable. Main Outcome Measures Percentage of age-predicted maximal heart rate (APMHR) achieved and rate-pressure product (RPP). Results Thirty subjects completed stress tests. Twelve of the 30 subjects were taking β-blocker medications. Mean maximum heart rate ± standard deviation achieved was 119±21 beats/min, equal to 75%±11% of APMHR. Ten subjects achieved 85% of APMHR or greater. Those not taking a β-blocker attained 80%±10% of APMHR. The percentage increase in RPP from rest to maximal exercise for the whole group was 117%±44%. Four subjects developed cardiopulmonary signs or symptoms. Exercise prescriptions were provided to patients using the Karvonen formula. Overall subject satisfaction with the Power Trainer was high. Conclusion The Power Trainer can be used safely to assess cardiopulmonary exercise tolerance in a select subset of patients with neurologic impairments secondary to stroke. This information can be extrapolated for proper exercise prescription and may contribute to the investigation of coronary artery disease in this high-risk population.

Prostacyclin for pulmonary hypertension in adults

Primary pulmonary hypertension (PPH) is progressive, resulting in right ventricular failure. Pulmonary hypertension can be idiopathic or associated with other conditions. Prostacyclin is a potent vasodilator and inhibitor of platelet aggregation, and can be given orally, subcutaneously, intravenously or inhaled via a nebuliser. To determine the efficacy of prostacyclin or one of its analogues in idiopathic primary pulmonary hypertension. Electronic searches were carried out with pre-specified terms. Searches were current as of July 2004. Two reviewers selected randomised controlled trials (RCTs) involving adults with pulmonary hypertension for inclusion. Study quality was assessed and data extracted independently by two reviewers. Outcomes were analysed as continuous and dichotomous outcomes. We sub-grouped data where possible by aetiology of PH (PPH, PH secondary to connective tissue disorder or mixed populations). Nine RCTs of mixed duration (3 days-52 weeks), recruiting 1175 participants were included (NYHA functional classes II-IV). Intravenous prostacyclin versus usual care (four studies): There were significant improvements in exercise capacity of around 90 metres, cardiopulmonary haemodynamics and NYHA functional class over 3 days-12 weeks. Effects were consistent in primary and secondary pulmonary hypertension. Oral prostacyclin versus placebo (two studies): Short-term data (3-6 months) indicated that there was a significant improvement in exercise capacity, but data from one study of 52 weeks reported no significant difference at 12 months. No significant differences were observed for any other outcome. Subcutaneous treprostinil versus placebo (two studies, 8-12 weeks):One large study reported a significant median improvement in exercise capacity of around 16 metres. Cardiopulmonary haemodynamics and symptom scores favoured treprostinil. Infusion site pain and withdrawals due to adverse events were more frequent with treprostinil. Inhaled prostacyclin versus placebo (one study, 12 weeks):There was a significant increase in exercise capacity of approximately 36 metres. Treatment led to better symptom scores and functional class status than with placebo. Subgroup analyses reported by individual studies showed a better exercise capacity in participants with PPH, than those participants with PH secondary to other diseases. Side effects and adverse events were common in the studies. There is evidence that intravenous prostacyclin in addition to conventional therapy at tolerable doses optimised by titration, can confer some short-term benefits (up to 12 weeks of treatment) in exercise capacity, NYHA functional class and cardiopulmonary haemodynamics. There is also some evidence that patients with more severe disease based upon NYHA functional class showed a greater response to treatment.

Lack of relationship between hypertension-associated symptoms and blood pressure in hypertensive ED patients

A number of cardiopulmonary and neurological symptoms are presumed to be associated with hypertension. We examined the prevalence of these symptoms in ED patients with elevated blood pressure (BP) and studied the relationship between symptom prevalence and BP value. We enrolled consecutive adult ED patients with sustained BP elevation (systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg). BP values were categorized according to Joint National Committee on Prevention, Evaluation, and Treatment of High Blood Pressure, 6th Report criteria. Elevated BP was noted in 551 (29%) of 1908 patients. Unprompted complaints of hypertension-associated symptoms were noted in 26%, and there was no association between BP category and complaints other than dyspnea. Symptom interviews were conducted in 294 (56%) patients; 68% of this subset noted ≥1 current hypertension-associated symptom with no relationship between symptom prevalence and BP category. We conclude that symptoms putatively associated with hypertension are common among ED patients with elevated BP, and their prevalence appears unrelated to BP value.

Trauma, post-traumatic stress disorder and somatization

In a cross-sectional study, 483 patients (age: 35.8 +/- 13.2 years) of an outpatient psychosomatic university clinic were investigated using a standardized disorder-specific set of tests. 63.1 % of the patients reported to have experienced at least one traumatic event in their life. Test-psychometrically, a posttraumatic stress disorder (PTSD) could be assumed in 10.1 %. Compared to non-traumatized patients, patients with a PTSD reported significantly more frequently somatoform symptoms; even the comparison of traumatized patients with and without PTSD demonstrated a pronounced tendency to somatize in PTSD patients. Neurologic, gastrointestinal and cardiopulmonary symptoms, as well as pain sensations and sexual dysfunctioning were predominantly reported as somatoform complaints. The results emphasize the close connection between somatization and PTSD symptoms; this should be increasingly taken into consideration in the diagnostic process within psychotraumatology.

This Month in ANESTHESIOLOGY

This Month in ANESTHESIOLOGY