By H. Rasarus. Roanoke College.
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Compare results 1University of Ibadan 400 mg viagra plus, Department of Physiotherapy viagra plus 400mg, Ibadan viagra plus 400 mg, Ni- with National results 400mg viagra plus. All patients should be referred to Southport geria and put on National spinal Injuries database . The huge fnancial burden of treatment is borne by the patient , their 529 families and the society . Direct costs of in-patient and out-patient treatment over the frst year of injury were estimated . Estimated cost included costs of 1Universiti Teknologi Mara , Fisioterapi , Puncak Alam, Malaysia, hospital admission, diagnostic tests and procedures, surgical treat- 2Universiti Malaya Medical Centre, Rehab Medicine, Kuala Lum- ments, physiotherapy, drugs and non-drug items, nursing and cost pur, Malaysia of outpatient visits. The total cost of out-patient treatment patient, there has not been a careful systematic approach to support was N9, 611 975. In this narrative review, we used system- lowed by cost of routine consultations by neurosurgeons (28. Material and Methods: A compre- these costs were on routine specialist consultations by the neurosur- hensive systematic review strategies were conducted from electronic geons. This could be reduced by ensuring consultations on require- search engine from 1946 to 2015 to identify the relevant evidence ments rather than routine. Acknowledgement: Study supported by and literature of potential lower limb muscle strength effect from grant from the Medical Education Partnership Initiative in Nigeria. Dwerryhouse1 clusion: Even though there were numerous quasi-experimental stud- 1 ies, generally they implicated different style and method of research Broadgreen Hospital, Phoenix Cent Re for Rehabilitation, Liver- 2 including sample sizes and protocols. Thus, it is hard to conclude pool, United Kingdom, Cheshire and Merseyside Rehabilitation which protocols can be implicated in the clinical practice. Although Network, Rehabilitation Medicine, Liverpool, United Kingdom all the studies have shown positive changes in muscle fbers, the Introduction/Background: Phoenix Rehabilitation Unit opened Jun evidence still insuffcient. Spinal patients were classed as patient with spi- nal injury including laminectomies, spinal cord compressions and 530 stenosis, resections of meningioma, myelopathies and spinal frac- tures polytrauma. Results: • Male patients 27/38 1Robert Jones and Agnes Hunt Orthopaedic Hospital, Midland 71%. Material and Methods: Analysis of 2 years prospec- eterisation 5%, long-term catheter = 24%, incontinent at times 5%, tive data collection, including 36 consecutive patients admitted to urostomy 2. We put 45 refective markers on the subject’s chest wall and & pulmonary embolism (16. If the medicine failed to fulfll patients’ ex- and Methods: The baclofen of 50μg was administered to 33 patients pectation, then it will lead them to seek another alternative therapy who had severe spasticity due to 26 spinal cord injury, 1 syringomy- such as looking for shaman, get refexology, and or phytotherapy. Results: Subjects were 36, 25 improvement of the spasticity was remarkably admitted in all cases, men and 11 women, mean age 41. Dis- Introduction/Background: The aim was to study the effect of the exoskeleton Ekzoatlet the dynamics of neurological and psycho- cipline of Rehabilitation Medicine. Material and Methods: The object of the study were 10 patients Introduction/Background: Spinal cord injury due to an iatrogenic (8 males and 2 females) aged - from 18 to 32 years with a complete cause can impose signifcant impairment that leads to deterioration in interruption of the spinal cord at the thoracic level and lower para- physical activities and psychosocial disruption. Training distance on 13 year-old girl who underwent a lumbar puncture procedure follow- a fat surface with the help of the exoskeleton held for two weeks, ing confusional mental state in the setting of acute infection involv- 5 times per week. Subsequently, she developed cauda equina survey: evaluation of neurological status with the defnition of digi- syndrome secondary to subarachnoid hematoma at L3/L4 level that tal values of strength and tone, depression test of Beck, electrocar- was later identifed by magnetic resonance imaging of the lumbar diography, ultrasound duplex scanning of the veins and arteries of spine. Because of the prolonged mechanical ventilation in the acute the lower extremities to rule out thrombosis, and the wall-occlusive phase she developed chronic illness polyneuropathy. The subarach- lesions, ultrasound Study knee and ankle joints, and soft tissues of noid hematoma from the lumbar puncture was initially obscured. Results: During the walk performed Holter became wheelchair dependent post acute phase of the disease. With monitoring, monitoring of blood pressure and oxygen saturation intensive therapy and serial functional evaluation, she achieved sig- during the occupation. In carrying out a comprehensive survey of nifcant independence in activities of daily living despite poor neu- patients on the 1st and 14 day, we found no changes of neurologith - rological recovery of the affected muscles. Material and Methods: cal status and signifcant changes in muscle strength and tone the A case report. Conclusion: Thus, on the basis of spinal cord pathology can be delayed due to deteriotation of an acute the study can draw preliminary conclusions about the safety of the medical illness and when other neurological condition such as criti- exoskeleton Ekzoatlet prosthetic walking function in patients with cal illness polyneuropathy is also present. Intensive rehabilitation is essential to provide signifcant functional independence. Orgasmic function is affected Hospital Sungai Buloh, Rehabilitation Medicine, Sungai Buloh, in all patients with impaired and unknown function was 46. Previous studies reported reasonable accuracy of single channel Most patients have preference for oral medication. Saitoh1 method of bladder management was intermittent catheterization 1School of Medicine- Fujita Health University, Department of Re- (75%), voluntary voiding (0. It was habilitation Medicine, Toyoake- Aichi, Japan, 2Fujita Health Uni- found that in 87. Material and Methods: Series of case report highlight- showed reduced laryngeal elevation and weak left pharyngeal con- ing the varying clinical course of patients referred for rehabilita- traction. In high-resolution manometry, the pharyngeal contractile tion with an initial diagnosis of Miller Fisher Syndrome. He could eat gruel in the same position at 191 task-specifc functional activities and high-level mobility. The left pharyngeal contractile pressure measured by high- proved signifcantly and became fully independent by 4 months. Post-extubation, she demonstrated without giving fatigue and pain to the patients. She improved with rehabilitation, with residual bilateral arm weakness during recent review at 10 months. Subsequently, she developed respiratory impair- 1 1 1 1 ment requiring mechanical ventilation. Tekin strated reduced conscious level with clinical features suggestive of 1Gulhane Military Medical Academy - Haydarpasa Research and Bickerstaff brainstem encephalitis. She endured a long rehabilitation Training Hospital, Physical Medicine and Rehabilitation, Istanbul, phase and at 1-year follow-up, was still dependent in daily activi- Turkey ties and mobility. Rehabilitation goals may as- broad category of conditions such as stroke, brain tumor, degen- sume an altered course during the rehabilitation phase; depending on erative conditions, multiple sclerosis, infections etc. Neurobrucellosis is a rare clinical condition, which may manifest as stroke, encephalitis, meningitis, or demyelinating diseases such as multiple sclerosis. On neurological examination, he had 1 1 4/5 motor scores in distal muscle groups of the lower extremities M. Miller 1Medical University of Lodz, Department of Physical Medicine, bilaterally and gait disturbance. All the deep tendon refexes were hyperactive and babins- Lodz, Poland ki’ s sign was positive. It was realized that there was no signifcant signifcantly affect patient’s quality of life. So the patient consulted may have a positive effect on both cognitive and motor function- with neurology service. Material and Methods: The study group con- revealed low glucose (4 mg/dl) and elevated protein at 3550 mg/ sists of 58 patients with multiple sclerosis hospitalized in Neurore- dl. The training was carried out with a constant underlying average Conclusion: Initial clinical manifestations consist of demyelinating load for 30 minutes (2 × 15min) daily for 30 days. The endpoint syndrome in this case so he was diagnosed with multiple sclerosis of the study was aerobic ftness. Herein we want to emphasize that the other etiological fac- ing ability, cognitive function and level of depression. Visual evoked potential funded by Medical University of Lodz; grant number: 502-03/5- are altered relating with a bilateral optic neuritis. Injectable corticosteroids were prescribed associated with motor and pel- 545 vic foor rehabilitation. A 41 year old female was admitted to the acute rehabilitation on an early initiation of aggressive immunosuppressive treatment hospital for autoimmune sensory ganglionopathy related to lupus. She had also suffered from Raynaud’s phenomenon, for which she was taking amlodipine. Orthopedic Introduction/Background: Our aim was to evaluate the effect of a consultation was obtained and eventually the digit was amputated. Material and Meth- causes blood vessels to spasm, restricting blood fow to the fngers. Conclusion: Raynaud’s phenomenon can lead to severe the 6 minutes walking test, the pain visual analogic scale with an ischemia and dry gangrene, for which early conservative manage- assay of C reactive protein and of creatin kinase. However, some cases still require partial perimental group continued to improve till the end of the study. Chen infammation and demyelination of the optic nerve and the spi- 1Guangzhou, Afghanistan, 2The Third Affliated Hospital- Sun nal cord. He came to rehabilitation service for tory cells invasion and spinal cord demyelinating changes. For this reason the study 549 was expanded to left 1st dorsal interoseus muscle showing similar fndings with myotonic discharges. As a result diffculty with gait occurs, which are aggravated when paired with a secondary cognitive task. Khalimova1 to understand what effect it has on gait, and if possible improve- 1Tashkent Medical Academy, Neurology, Tashkent, Uzbekistan ments in dynamic balance can infuence it. Material and Methods: This ex- cal forms of the disease, but also depends on many factors that perimental study included 39 participants with mild to moderate affect the quality of life and disability of patients. For the diagnosis of cognitive impairment in clinical practice and research are more commonly used neuropsychological Introduction/Background: Patients with Parkinson’s disease have research methods. To assess the quality of life in this study was steadily deteriorating motor and cognitive function. Rigidity sets used by the European Quality of Life Questionnaire of 5 questions in mid to late stages which will further reduce the use of function. Analysis of the questionnaire showed that when the left arm and fngers which lead to severe tightness unable to get the “mobility” met in 87. Material and Methods: This is an isolated case of people with a “specifc” or “signifcant” problems of the above report in which we used nerve block with 70% alcohol to radial, components was signifcantly lower (56. When carrying out a regression analysis of tor to relax the elbow and fngers inorder to improve hygiene in motor and non-motor symptoms and quality of life of patients with the palm, elbow (fexor aspect) and the fngers. Conclusion: Nerve blocks with alcoho/Phenol disorders, psychosis, pain, and sleep disorders. We report an elderly lady with severe parkinson’s disease with timely correction of these factors reduces disability in patients. This results from the sham block, at the end of the 1st and 2nd active blocks, and then satisfactory respiratory function of most patients at frst visit and at 5 months follow-up. Results: Improvement was observed across optimistic view that bulbar symptoms (dysarthria) can be managed nearly all measures during the active relative to sham phase eg in with rehabilitation. We speculate that signifcant cognitive changes Mobility, cognition, anxiety and sleep. Minimal Clinically Impor- with less insight in bulbar-onset patients infuence results. He has been diagnosed to have idio- 1 Kumamoto Health Science University, Rehabilitation, Kumamoto, pathic Parkinson’s disease four years earlier. Neurologic examination 2 Japan, Hokkaido University, Functioning and Disability-Faculty revealed a mild motor defcit in the right side of the body. The subject dem- of Health Sciences, Sapporo-Hokkaido, Japan, Chubu Gakuin University, Nursing and Rehabilitation, Seki-Gifu, Japan, 4Ku- onstrated an independent slow walking with frequent falls. A training program to stimulate and Introduction/Background: Most children with spinal muscular at- facilitate the peripheral proprioceptors was set up. This procedure was easy and well tolerated vere muscle weakness hinders nonverbal communication such as by the patient. Results: It seems that balance exercises dedicated to restricted, providing communication support using specialized de- stimulate and facilitate the peripheral proprioceptors have benefcial vices is essential to preserve and develop the cognitive and intel- effects in improving balance among hemiparetic individuals suffering lectual functions. Improvement of each subject from baseline by protocol Material and Methods: The participants comprised patients with Par- step. Patients 2 F/11 2 4 with spinal disease and other neurological diseases were excluded. Electrodiagnostic test performed three 1The First Affliated Hosipital of Nanjing Medical University, De- weeks after onset of the symptoms revealed bilateral severe motor partment of Rehabilitation Medicine, Nanjing, China, 2The Affli- and sensorial conduction defcit of radial nerveat the level of bilat- eral upper arm. Patient was processing respectively for aphasic patients with phonological or referred to neurosurgery clinic for consultation but patient refused semantic processing defcits and to explore the underlying neu- surgery. Material and Methods: Two patients, Zhang with considered in the differential diagnosis. Material and Methods: A 32-year-old male pre- not related with classical language area activation. In addition, for sented with a 5-month history of numbness and tingling over the aphasic patients with phonological defcit, hand action observation backside of the right thigh, lower leg and the sole. His complaints training may facilitate language areas and phonological retrieving. There was a history of stab injury at the backside of the thigh fve months earlier. Yılmaz1 observed but hyperintense vascular structures could be easily inter- 1Gülhane Military Medical Academy, Department of Physical fered with the neuroma. Then we performed ultrasonography and neuroma was easily appreciated, and also normal sciatic nerve was Medicine and Rehabilitation- Turkish Armed Forces Rehabilitation easily differentiated from the surrounding muscular structure in the Center, Ankara, Turkey unaffected side. According to electrophysiological as- Turkey sessment, age higher than 50 years was more prevalent with sural nerve neuropathy. Due to the close proximity of the medi- are also cost-beneft and available tools in screening suspected pa- an nerve and brachial artery, vascular patologies of brachial artery tients to neuropathy, especially predominantly sensory distal poly- may also cause nerve damages. Due to weakness of screening tools in early case of median nerve palsy due to the pseudoaneurysm of brachial detection of motor neuropathic process, routine electrodiagnostic artery. Material and Methods: A 21 years-old man presented with evaluation of such patients, in spite of normal screening, is recom- weakness, numbness and paresthesias of the right hand in the in the mended.
When symptoms do occur 400 mg viagra plus, they are frequently related to mechanical complica- tions of the aneurysm causing compression of adjacent structures viagra plus 400mg. This includes the trachea and esophagus viagra plus 400 mg, and symptoms can include cough 400mg viagra plus, chest pain , hoarseness , and dysphagia . The risk of rupture is ~2–3% yearly for aneurysms <4 cm and rises to 7% per year once the size is greater than >6 cm . Beta blockers are recommended because they decrease contractility of the heart and thus decrease aortic wall stress , potentially slowing aneurys- mal growth . Individuals with thoracic aortic aneurysms should be monitored with chest imaging at least yearly, or sooner if new symptoms develop. Operative repair is indicated if the an- eurysm expands by >1 cm in a year or reaches a diameter of >5. Endovascular stenting for the treatment of thoracic aortic aneurysms is a relatively new procedure with limited long-term results available. The largest study to date included >400 patients with a variety of indications for thoracic endovascular stents. However, if the procedure was done emer- gently, the mortality rate at 30 days was 28%. At 1 year, data were available on only 96 of the original 249 patients with degenerative thoracic aneurysms. Ongoing studies with long-term follow-up are needed before endovascular stenting can be recommended for the treatment of tho- racic aortic aneurysms, although in individuals who are not candidates for surgery, stent- ing should be considered. Furthermore, this artery in the majority of the population arises from the right coronary artery. Thus, a patient who pre- sents as this one does with symptoms consistent with an acute coronary syndrome and V. Wellen’s T waves are deep symmetric T-wave in- versions that are seen in either signiﬁcant left main coronary artery stenosis or proximal left anterior descending artery stenosis. Acute pericarditis is the most common disease of the pericardium and typically pre- sents as a sharp, intense anterior chest pain. It may be referred to the neck, arms, or left shoulder and may be pleuritic in nature. The pain is worse with lying supine and improved with sitting up and leaning forward. A pericardial friction rub is described as high-pitched, grating, or scratching and is heard throughout the cardiac cycle. An echocardiogram should be performed if there is suspicion of a possible effusion. Aspirin or nonsteroidal anti-inﬂammatory drugs in high doses are most commonly used. As this patient is in severe pain, reassurance only is not the best option but would be a possible treatment if panic attack were suspected. The other choices are utilized in the case of unstable angina and acute myocardial infarction and should not be utilized in this patient. Both heparin and reteplase would increase the risk of developing a hemorrhagic pericardial effusion. While all of the diagnoses listed are causes of sudden cardiac death in young indi- viduals, commotio cordis is the likely diagnosis because of the occurrence of the injury in relation to blunt trauma to the chest wall. In contrast to cardiac contusion (contusion cordis), the force of the injury is insufﬁcient to cause cardiac contusion or injury to the ribs or chest wall. If the force were delivered during the upstroke of the T wave (10–30 msec before the peak), ventricular ﬁbrillation would frequently result. A normal S2, the location of the murmur, the absence of radiation to the neck, and being loudest at the lower left sternal border make aortic sclerosis or aortic ste- nosis less likely. Maneuvers such as going from standing to squatting and passively raising the legs decrease the gradient across the outﬂow tract and intensity of the murmur due to in- creased preload. Amyl nitrate causes a decrease in systemic vascular resistance and arte- rial pressure. Right-sided murmurs, except for the pulmonic ejection “click” of pulmonary stenosis, usually in- crease in intensity during inspiration. Of the medications, only the thiazolidinediones improve insulin-mediated glucose uptake in the muscle and adipose tissue. The mechanism of ac- tion of metformin is uncertain, but it appears to work by reducing hepatic gluconeogen- esis and intestinal absorption of glucose. In a large trial of lifestyle modiﬁcations and metformin in the prevention of diabetes (Diabetes Prevention Program), subjects in the lifestyle arm of the trial had a more signiﬁcant reduction in the incidence of diabetes than those assigned to metformin. In resource-poor settings and the developing world, life- style modiﬁcations have also been shown to be more cost-effective than metformin for preventing diabetes. Generally the recipients do well, with survival rates of 76% at 3 years and an average transplant “half-life” of 9. However, certain complica- tions are common with the necessary immunosuppression, including an increased risk of malignancy and infections. Additionally, patients are at risk of rejection of the trans- planted organ that can be acute or chronic. Chronic cardiac transplant rejection mani- fests as coronary artery disease, with characteristic long, diffuse, and concentric stenosis seen on angiography. It is thought that these changes represent chronic rejection of the transplanted organ. Common alternative diagnoses in this setting include exacerbations of congestive heart failure, myocarditis, and pulmonary embolism. This patient has atypical features of his chest pain for angina: lasting for more than minutes at a time, nonexertional. In a young host, without other signiﬁcant risk factors, atherosclerotic coronary artery disease would be less likely, especially if the history is atypical. However, other factors in the management of these patients have been shown to decrease risk. In several disease states, notably severe obstructive lung disease, pericardial tamponade, and superior vena cava obstruction, an accentua- tion of this normal ﬁnding can occur. Indeed, in the most pronounced cases the periph- eral pulse may not be palpable during inspiration. The most common cause of constrictive pericarditis worldwide is tuberculosis, but given the low incidence of tu- berculosis in the United States, constrictive pericarditis is a rare condition in this country. With the increasing ability to cure Hodgkin’s disease with mediastinal irradiation, many cases of constrictive pericarditis in the United States are in patients who received curative radiation therapy 10–20 years prior. Other rare causes of constrictive pericarditis are recurrent acute pericarditis, hemorrhagic pericarditis, prior cardiac surgery, mediastinal irradia- tion, chronic infection, and neoplastic disease. Physiologically, constrictive pericarditis is characterized by the inability of the ventricles to ﬁll because of the noncompliant pericar- dium. In early diastole, the ventricles ﬁll rapidly, but ﬁlling stops abruptly when the elastic limit of the pericardium is reached. The jugular venous pressure is elevated, and the neck veins fail to collapse on inspiration (Kussmaul’s sign). Right heart catheterization would show the “square root sign” characterized by an abrupt y descent followed by a gradual rise in ventricular pressure. This ﬁnding, however, is not pathogno- monic of constrictive pericarditis and can be seen in restrictive cardiomyopathy of any cause. Echocardiogram shows a thickened pericardium, dilatation of the inferior vena cava and hepatic veins, and an abrupt cessation of ventricular ﬁlling in early diastole. Peri- cardial resection is the only deﬁnitive treatment of constrictive pericarditis. Diuresis and sodium restriction are useful in managing volume status preoperatively, and paracentesis may be necessary. Underlying cardiac function is normal; thus, cardiac transplantation is not indicated. Pericardiocentesis is indicated for diagnostic removal of pericardial ﬂuid and cardiac tamponade, which is not present on the patient’s echocardiogram. Mitral valve stenosis may present similarly with anasarca, congestive hepatic failure, and ascites. Examination would be expected to demonstrate a diastolic murmur, and echocardiogram should show a normal pericardium and a thickened immobile mi- tral valve. Mitral valve replacement would be indicated if mitral stenosis were the cause of the patient’s symptoms. Initial management should include high-dose aspirin, heparin, and stabilization of blood pressure. In addition, use of furosemide for the treatment of pulmonary edema is also contraindicated because of the degree of hypotension. Intra- venous ﬂuids should be used with caution as the patient also has evidence of pulmonary edema. The best choice for treatment of this patient’s hypotension is aortic counterpulsa- tion. Aortic counterpulsation requires placement of an intraaortic balloon pump percu- taneously into the femoral artery. The sausage-shaped balloon inﬂates during early diastole, augmenting coronary blood ﬂow, and collapses during early systole, markedly decreasing afterload. In contrast to vasopressors and inotropic agents, aortic counterpul- sation decreases myocardial oxygen consumption. Both dobutamine and norepinephrine can increase myocardial oxygen demand and worsen ischemia. If ﬂuid administration fails to alleviate the hypotension, sympathomimetic agents or aortic counterpulsation can be used. However, care must be taken to avoid excess ﬂuid administration, which would 230 V. A trans- venous pacemaker would be useful if the hypotension were related to heart block or pro- found bradycardia, which can be associated with right coronary artery ischemia. Sudden cardiac death accounts for about 50% of all cardiac deaths, and of these, two-thirds are initial cardiac events or occur in populations with previously known heart disease who are considered to be relatively low risk. A strong parental history of sudden cardiac death as a presenting history of coronary artery disease increases the likelihood of a similar presentation in an offspring. Deﬁbrillation should occur prior to endotracheal intuba- tion or placement of intravenous access. If the time to potential deﬁbrillation is <5 min, the medical team should proceed immediately to deﬁbrillation at 300–360 J if a monophasic deﬁbrillator is used (150 J if a biphasic deﬁbrillator is used). Even if there is return of a perfusable rhythm, there is often a delayed return of pulse because of myo- cardial stunning. In these trials, patients were rapidly cooled to 32–34°C and maintained at these temperatures for the initial 12–24 h. Individuals who re- ceived therapeutic hypothermia were 40–85% more likely to have good neurologic out- comes upon hospital discharge. Time to initial deﬁbrillation of >5 min is associated with no more than a 25–30% survival rate, and survival continues to decrease linearly from 1 to 10 min. Deﬁbrillation within 5 minutes has the greatest likelihood for good neurologic outcomes. Of the medications used in treatment of cardiac arrest due to ventricular ﬁbrillation or pulseless ventricular tachycardia, none have been demonstrated to have any effects on neurologic outcome. Pharmacologic agents used in cardiac stress testing are either vasodilators (adenosine, dipyridamole) or in- otropic agents (dobutamine). When vasodilator agents are used, ischemic myocardium de- velops as normal coronary artery segments dilate in response to the drug, whereas ﬁxed coronary lesions are unable to fully dilate. Alternatively, inotro- pic agents induce stress by causing increased myocardial oxygen demand, and ischemia is diagnosed by the failure to increase blood ﬂow in response to this stress. Using radionucle- ide labeled perfusion agents, images of the heart are taken following the stress-inducing agent and with rest. Reversible ischemia, indicative of coronary artery ischemia, is demon- strated by lack of perfusion with stress, but perfusion is present at rest. In the images de- picted in the ﬁgure, there is no evidence of reperfusion of the affected area upon rest. These images are typical of an old myocardial infarction resulting in scar formation and is de- scribed as a ﬁxed defect. Tissue attenuation due to obesity or breast tissue is a particular problem, especially with the use of thallium. When tissue attenuation occurs, it typically appears as a reversible defect and is a cause of a false-positive stress test. An apical aneurysm may be difﬁcult to ascertain by thallium images, but typically there should be evidence of ballooning of the cardiac apex outward and distortion of the cardiac silhouette, which is not seen here. Aspirin resistance can occur in 5–10% of patients and is more common among those taking lower doses of aspirin. Common alternative diagnoses in this setting include exacerbations of congestive heart failure, myo- carditis, and pulmonary embolism. This patient has atypical features of his chest pain for angina, with it lasting for more than minutes at a time and being nonexertional. In a young host, without other signiﬁcant risk factors, atherosclerotic coronary artery disease would be less likely, especially if the history is atypical. While the exact mechanism is not clear, proximal nonobstructive coronary plaques are usually present. It is associated with other vasospastic disorders such as mi- graine, Raynaud’s phenomenon, and aspirin-induced asthma.
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