CJEM Articles: John Opie
Displaying 1-2 of 2 results
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January
2004
6
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Akbar Panju, Eric Stanton, Gordon H. Guyatt, John Opie, Lauren Griffith, Matthew J. McQueen, P.J. Devereaux, Stephen A. Hill
Objective: To determine the ability of troponin I (TnI) measurement to predict the likelihood of a serious cardiac outcome over the subsequent 72 hours in patients presenting to the emergency department (ED) with symptoms suggestive of an acute coronary syndrome.
Methods: This prospective observational study enrolled consecutive patients presenting to 2 urban tertiary care hospital EDs over a 5-week period. Eligible patients included those for whom a TnI test was ordered within 24 hours of arrival and in whom no serious cardiac outcome occurred before the test result was available. Patients were followed for 72 hours and serious cardiac outcomes documented; these included cardiovascular death, myocardial infarction, congestive heart failure, serious arrhythmia and refractory pain. We calculated likelihood ratios (LRs) to describe the association of the TnI result with serious cardiac outcomes.
Results: Of the 352 enrolled patients, 20 had a serious cardiac outcome within 72 hours of ED presentation. The derived LRs (and 95% confidence interval [CI]) were 0.5 (0.3-0.9) for TnI values <0.5 µg/L, 1.6 (0.4-6.5) for TnI values from 0.5 to 2.0 µg/L, 5.8 (1.7-19.5) for TnI values from >2.0 to 10.0 µg/L and 14.4 (4.8-42.9) for TnI values >10.0 µg/L.
Conclusions: TnI values >2.0 µg/L are associated with an increased probability of serious cardiac outcomes within 72 hours. TnI values between 0.5 and 2.0 µg/L are weakly positive predictors. TnI values <0.5 µg/L have LRs in the range of 0.5 and thus are weakly negative predictors, not substantially decreasing the likelihood of serious cardiac outcomes, particularly in patients with a moderate or high pretest probability.
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March
2002
4
2
Andrew Worster, Farouk Mookadam, John Opie, Sangita Sharma
We report an unusual case of a 27-year-old male with an acute presentation of choriocarcinoma. The patient presented with unstable vital signs, severe anemia and a widened arterial pulse pressure following a several day history of testicular pain. He was subsequently diagnosed as having testicular choriocarcinoma with multiple hepatic metastases and large hemorrhagic para-aortic lymph nodes. The widened pulse pressure persisted during fluid resuscitation and correction of both the anemia and hypotension, and only narrowed after the initiation of chemotherapy. A literature review indicates that metastatic testicular choriocarcinoma is a rare but aggressive malignancy that often presents with acute symptoms and signs that cause patients to seek emergency care. We summarize the reported cases of "acute" testicular choriocarcinoma presentation and briefly discuss its relationship to widened arterial pulse pressure.
