Lee01 - Coulter Counter Registers Talc Particles as...

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DOI 10.1378/chest.119.2.669 2001;119;669-670 Chest Y. C. Gary Lee, Kirk B. Lane and Richard W. Light Leukocytes Coulter Counter Registers Talc Particles as http://chestjournal.chestpubs.org/content/119/2/669.full.html and services can be found online on the World Wide Web at: The online version of this article, along with updated information ISSN:0012-3692 ) http://chestjournal.chestpubs.org/site/misc/reprints.xhtml ( of the copyright holder. may be reproduced or distributed without the prior written permission Northbrook, IL 60062. All rights reserved. No part of this article or PDF by the American College of Chest Physicians, 3300 Dundee Road, 2001 Physicians. It has been published monthly since 1935. Copyright CHEST is the official journal of the American College of Chest © 2001 American College of Chest Physicians by guest on October 5, 2009 chestjournal.chestpubs.org Downloaded from
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wall injury pattern on the ECG resembling that of an acute anterior wall myocardial infarction with reciprocal ST-segment depression in the inferior leads, a very rare situation in patients with sole hypocalcemia (although compounded in this patient, as is frequently the case, by hypomagnesemia and hypokalemia). The myocardial dyskinesia noted by echocardiography and car- diac catheterization is also an expected finding, as are the marked improvements of the ECG abnormalities following replacement of calcium and vitamin D. The ECG hallmark of hypocalcemia remains the prolongation of the QTc interval because of lengthening of the ST segment, which is directly proportional to the degree of hypocalcemia or, as otherwise stated, inversely proportional to the serum calcium level. The exact opposite holds true for hypercalcemia. Considerable controversy still exists concerning other ECG abnormalities. The T waves are normal in . 50% of patients, but decreased T-wave voltage and even negative to deeply negative T waves have been said to occur. 2 It is doubtful, however, that these cases were evaluated as completely as was this patient. Peaked T waves have been reported with ST-segment elevation in patients with combined hypocalcemia and hyperkalemia (often renal dialysis patients). Cardiac arrhythmias are also rarely reported, including torsade de pointes. Reddy et al 3 in 1974 and Khardori et al 4 in 1985 each described a single patient with an acute anteroseptal injury pattern on the ECG with no proven subsequent infarction, which they associ- ated with hypocalcemia. In both instances, the patients involved had complicated coexisting medical problems with associated electrolyte imbalance. It is commonly accepted that hypocalce- mia with its accompanying increase in the QTc interval does not affect the QRS complex, and therefore does not produce an intraventricular conduction defect. It must be remembered that a prolonged QT interval can be associated with other conditions, such as hypokalemia (broad T and U waves), hypoglycemia, diabetic acidosis, alkalosis, beriberi, heart failure, cardiomegaly,
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Lee01 - Coulter Counter Registers Talc Particles as...

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