Symphysitis following transrectal biopsy of the prostate

Transrectal ultrasound-guided needle biopsy of the prostate is a widely accepted technique to obtain prostatic tissue for histological examination. Severe complications are rarely seen. We report a case of symphysitis causing hospitalization and severe pain and discomfort of the patient. Possible etiologic factors are traumatic osseous lesions and transport of rectal bacteria to the periosseous region. Especially in small prostates, care should be taken to avoid this condition. Prolonged perioperative antibiotic prophylaxis is mandatory.     

Haemodynamic effects of molsidomine and propranolol in patients with cirrhosis

Propranolol and molsidomine have both been shown to decrease the hepatic venous pressure gradient in patients with cirrhosis. The present study aimed at assessing the effects of the combination of these two drugs on splanchnic and systemic haemodynamics of cirrhotic patients. Fifteen patients with biopsy proven alcoholic cirrhosis had haemodynamic measurements under basal conditions, 60  min after oral administration of 4  mg molsidomine then 15  min after intravenous administration of 15  mg propranolol. As compared with baseline values, molsidomine was found to decrease mean arterial pressure (−7.9%, P <0.01), cardiac output (−7.3%, P <0.01), pulmonary wedged pressure (−45.8%, P <0.05) and hepatic venous pressure gradient (−11.7%, P <0.01). Propranolol decreased heart rate (−21%, P <0.01), further decreased cardiac output (−20.6%, P <0.01) and hepatic venous pressure gradient (−10.5%, P <0.01). As a whole, molsidomine plus propranolol decreased mean arterial pressure (−8%, P <0.01), heart rate (−19%, P <0.01), cardiac output (−26.5%, P <0.01) and hepatic venous pressure gradient (−21%, P <0.01). Pulmonary wedged pressure, liver blood flow and hepatic intrinsic clearance of indocyanine green were not significantly changed by the association of molsidomine and propranolol. We conclude that in patients with cirrhosis, molsidomine and propranolol potentiate their effects on hepatic venous pressure gradient. Such a combination could therefore prove useful in the treatment of portal hypertension.     

Mechanical Support for Postcardiotomy Heart Failure

Cardiac failure remains a life-threatening complication for certain patients undergoing intracardiac repair. Despite improvements in surgical techniques, methods of myocardial protection, and postoperative care, patients are frequently at risk to develop postoperative low output syndrome. Approximately 1% of cardiac surgical patients cannot be weaned from extracorporeal circulation in spite of adequate volume loading, the use of inotropic support, and initiation of intraaortic balloon pumping. In these cases, ventricular assist devices (VAD) can mechanically aid the failing heart and reverse the low output state. The concept of mechanical support for the failing left ventricle was first proposed by Clauss et al. in 1961. By 1968, Kantrowitz and associates had developed and refined the first intraaortic balloon pump (IABP). Through the efforts of Moulopolous and others, this device evolved into the present-day intraaortic balloon pump (IABP). Clinical evidence for the efficacy of left ventricular assist devices (LVAD) remained questionable until 1980, when the National Heart, Blood and Lung Institute evaluated short-term LVADs by comparing various types of mechanical aids. This report focused attention primarily on the failing left ventricle (LV). As the use of inotropic support, intraaortic balloon pumping, and LVADs improved, a small group of patients emerged who could not be separated from extracorporeal circulation due to a failing right ventricle. The failing right ventricle emerged as a unique clinical entity similar to postcardiotomy left ventricular failure that also benefited from mechanical cardiac assistance. Current therapy at major centers incorporating mechanical assist devices is based on the premise that the low output state will allow the failing heart to recover from a reversible injury. The frequent occurrence of postcardiotomy ischemia may be due to several factors such as poor myocardial protection, overdistension of the LV, emboli, coronary spasm or technical problems. Whatever the etiology, the end product of cardiac failure is a demand for oxygen consumption that cannot be met, thus leading to cardiac demise.     

NEONATAL MENINGITIS CAUSED BY SALMONELLA THOMPSON

A case of neonatal meningitis caused by Salmonella Thompson is presented. In spite of adequate antibiotic treatment during 1 month a relapse occurred and treatment had to be continued for 3 months. The final outcome was very favourable and at the age of 2 years the patient appeared quite normal. During the course of the disease the immunoglobulin levels and the Widal test were followed. Evidence of an antibody deficiency syndrome explaining the patient's relapse could not be demonstrated.     

A Technique for Concurrent Repair of Pectus Excavatum and Intracardiac Defects

Pectus excavatum deformity may present problems when median sternotomy is required for repair of intracardiac defects. We have used a partial median sternotomy extending from the manubrium to the level of the second intercostal space with extension into that space. The perichondral sheaths are disconnected from the sternum on the right side after removing the deformed costal cartilages. Exposure is thus provided for the cardiac procedure. Following this, the upper sternal fragments are sutured together and the repair is completed in a manner similar to the Ravitch technique.     

Sinus Dysrhythmia in Kearns-Sayre Syndrome

Kearns-Sayre syndrome is the triad of progressive external ophthalmoplegia, pigmentary retinopathy, and complete AV block. The etiology is unknown, but is thought to be due to a mitochondrial DNA deletion. Reported electrocardiographic abnormalities include first-degree AV block, fascicular blocks, and complete heart block, as well as nonspecific S-T segment changes and T wave abnormalities, but has not included sinus node dysfunction. We report a case with episodes of sinus arrest in an asymptomatic patient with Kearns-Sayre syndrome resulting in pauses lasting up to 6 seconds.     

Effects of ramipril on the neurohormonal response to exercise in patients with mild or moderate congestive heart failure

Static measurements of plasma neurohormones at rest may notbe adequate to detect alterations in cardiovascular controlmechanisms in congestive heart failure (CHF). Therefore, itis of interest to study neurohormonal activation during differentphysiological conditions. Plasnw neurohormones were measuredin 54 patients on diuretic therapy for mild or moderate CHF.Samples were taken at rest and immediately after maximal bicycleexercise, before and after 12 weeks of treatment with ramiprilor placebo. There was a strong correlation between the plasmalevels of each hormone before and after exercise. An inversecorrelation existed at baseline between exercise duration andangiotensin II levels after maximal exercise (r= – 0·30,P=0·03), but not at rest. Plasma levels of angiotensinII, aldosterone, atrial natriuretic peptide (ANP) and noradrenalinewere increased after maximal exercise compared to rest. Plasmaangiotensin converting enzyme activity and ANP were reducedby ramipril compared to placebo, both at rest and after exercise,but levels of angiotensin II, aldosterone and nordrenaline werenot significantly affected Thus, exercise consistently activatesneurohormonal systems in patients with CHF. Patients with thelowest exercise duration had the highest angiotensin II levelsafter exercise. Measurements of plasma neurohormones after maximalexercise provide limited additional value to measurements atrest.