Transluminal laser catheter angioplasty

The first transluminal laser angioplasty in animals is reported herein. An Argon laser and a specialized coronary arterial catheter with a fiberoptic wave guide were used. Immediate histologic changes consisted of a moderate degree of intimai necrosis and some loss of elastic tissue. At 5 days the intima was repaired, but focal elastic tissue loss persisted.     

Extreme hypocapnia in the critically ill patient

Respiratory alkalosis was the most common acid-base disturbance observed in a computer analysis of 8,607 consecutive arterial blood gas studies collected over an 18 month period in a large intensive care unit.Through a retrospective review of the randomly selected hospital records of 114 patients, we defined four groups based upon arterial carbon dioxide tension (PaCO₂) and mode of ventilation. Group 1, with a PaCO₂ of 15 mm Hg or less, consisted of 25 patients with an over-all mortality of 88 per cent. Group II, with a PaCO₂ of 20 to 25 mm Hg, consisted of 35 patients with a mortality of 77 per cent. Group III, with a PaCO₂ of 25 to 30 mm Hg, consisted of 33 patients with a mortality of 73 per cent, and Group IV, with a PaCO₂ of 35 to 45 mm Hg, consisted of 21 patients with a mortality of 29 per cent (p <0.001). Shock and sepsis were most common in group I patients.These findings suggest that extreme hypocapnia in the critically ill patient has serious prognostic implications and is indicative of the severity of the underlying disease.     

Bacteroides fragilis resistant to the administration of clindamycin.

The susceptibility of Bacteroides fragilis to the administration of clindamycin, and the efficacy of this agent in Bacteroides infections are well documented. Clindamycin-resistant strains of B. fragilis were isolated from two patients with bacteremia at two institutions. Clinically significant resistance to clindamycin therapy has not been noted previously in B. fragilis infections.     

Accidental hypothermia in an alcoholic population

Thirty-nine cases of accidental hypothermia are reviewed. Data indicate that mortality varies with the presence of underlying disease rather than with the degree of hypothermia or the methods of rewarming. In 31 patients with hypothermia alone (average temperature 85 °F) mortality was 6.25 per cent. In eight patients with hypothermia and another primary condition (average temperature 84 °F) mortality was 75 per cent.Intractable cardiac arrhythmia has been reported as the primary cause of death in hypothermia. In these patients, death during hypothermia resulted from pulmonary complications. Ventricular arrhythmias, when they occurred, were responsive to routine measures such as electrical cardioversion and myocardial suppressant drugs. Methods of treatment are discussed.     

Acute cortical necrosis. Case report and review of the literature

Confluent acute cortical necrosis is a rare but catastrophic disease. Described here is one case which was heralded by abruptio placenta and occurred in concert with a disseminated intravascular coagulopathy (DIC). All causes of acute cortical necrosis share one common denominator: a procoagulant factor capable of activating the coagulation mechanism. This aspect of the pathogenesis, the pathophysiology and clinical aspects of acute cortical necrosis are reviewed and contrasted to acute tubular necrosis and irreversible postpartum renal failure. Preparation for an extended period of treatment is emphasized as recovery from acute cortical necrosis is protracted.     

Acute pulmonary edema due to ischemic heart disease without accompanying myocardial infarction: Natural history and clinical profile

The natural history of acute cardiogenic pulmonary edema was studied in a group of patients who did not have acute myocardial infarction, cardiomyopathy, or valvular heart disease. Most of these patients had coronary artery disease. Cardiac catheterization in selected patients showed depressed contractility in some with segmental abnormalities. In the group older than 70 years, this carried a 70 percent two-year mortality rate. It is important to approach patients with this syndrome vigorously, both diagnostically and therapeutically. Acute, reversible segmental ischemia may be responsible for this syndrome and may respond to measures designed to prevent recurrent ischemia.     

Hemoglobin S/C disease in a pregnant woman with crisis and fat embolization syndrome

The complications of painful crisis and megaloblastic anemia are hallmarks of the pregnant patient with hemoglobin S/C disease. We describe here the clinical course in a patient with hemoglobin S/C disease in whom painful crisis and the fat embolization syndrome developed postpartum with severe neurologic abnormalities. Response to exchange blood transfusion was dramatic, and the patient recovered without neurologic impairment.     

Ocular complications in renal transplant recipients

The ocular complications in renal transplant recipients were evaluated in 44 patients and in 22 control patients with renal failure. Of the 44 patients 33 showed some ocular abnormality, but only posterior subcapsular cataracts which occurred in 34 per cent of post-transplant patients could be related to post-transplant corticosteroid therapy. There was no correlation between posterior subcapsular cataracts and either the duration of daily doses or total doses of corticosteroids in patients under 25 years of age in whom the incidence of posterior subcapsular cataracts tended to be higher than in older patients. There appeared to be a significant correlation between the duration of therapy and the total corticosteroid dose and the incidence of posterior subcapsular cataracts in the older age group.     

Calcium metabolism in renal failure

Osteodystrophy is almost universally present in chronic renal failure. Mild, but detectable, abnormalities—especially in parathyroid hormone (PTH) secretion—occur even when the glomerular filtration rate is greater than 30 cc/min. Osteomalacia is common in areas in which vitamin D intake and exposure to sunlight are minimal; when these factors are plentiful, osteitis fibrosa predominates. Osteoporosis is seen with increasing frequency in hemodialyzed patients. Nonosseous complications of secondary hyperparathyroidism include hypercalcemia, metastatic calcification and pruritus. The most important factor in the medical therapy of Osteodystrophy is control of serum phosphate levels. Next, a positive calcium balance must be provided either by giving vitamin D as dihydrotachysterol, raising dialysate calcium or administering calcium orally. Parathyroidectomy is sometimes indicated, especially when the patients are transplant candidates and manifest hypercalcemia. Whether or not transplant is contemplated, patients with persistently high calcium-phosphate products, severe metastatic calcification or rapidly progressive Osteodystrophy should be considered for parathyroidectomy. Newer, experimental vitamin D preparations, such as 1,25-dihydroxycholecalciferol or 1-alpha-hydroxycholecalciferol, should improve the management of patients with renal Osteodystrophy and decrease the need for parathyroidectomies.     

Dynamic intercoronary collateral flow in a patient with variant angina and coronary artery spasm

Intermittent intercoronary collateral flow was observed in a patient with coronary vasospasm associated with variant angina. Collateral flow began almost immediately after total occlusion of the right coronary artery, but did not prevent pain or S-T segment elevation. Some collateral vessels may pre-exist ischemic conditions and flow across these channels may be immediately dependent on the pressure gradient across them.     

Anterior myocardial infarction patterns in the mitral valve prolapse-systolic click syndrome

Two young women with the mitral valve prolapse-systolic click (MVP-SC) syndrome had electrocardiographic and vectorcardiographic evidence of transmural anterior myocardial infarction in the absence of clinical and arteriographic evidence of coronary disease.