科研之友
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摘要
A 67-year-old man presented to the emergency department with chest pain that had begun earlier that day and had progressed over a period of several hours. The pain was substernal and nonradiating, and it did not change with position or food intake. ForewordIn this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.StageA 67-year-old man presented to the emergency department with chest pain, reporting that he had felt well until 10 days before presentation, when nausea, nonbloody emesis, bloating, and epigastric pain developed. At that time, he was evaluated at another hospital, where the results of computed tomography (CT) of the abdomen and pelvis, performed after the administration of intravenous contrast material, and laboratory tests were normal except for an elevated platelet count (491,000 per cubic millimeter). A presumptive diagnosis of gastroesophageal reflux was made, and omeprazole was prescribed but provided no relief of symptoms. Over the course of several hours ...
- 出版日期2013-11-7
