Emergency coronary artery bypass grafting for failed angioplasty: risk factors and outcome

It has been suggested that coronary artery bypass grafting (CABG) performed in the setting of emergent failure of percutaneous transluminal coronary angioplasty causes minimal increased risk compared with routine CABG. We reviewed the records of 103 patients undergoing emergency CABG for failed percutaneous transluminal coronary angioplasty (group 1) and compared them with an identical number of consecutive CABG patients from 1987 (group 2). Group 1 had a lower risk profile evidenced by lower mean age (p less than 0.01), fewer diseased vessels (p less than 0.0001), better ventricular function (p less than 0.001), fewer left main lesions (p less than 0.0001), and fewer patients with acute ischemia requiring intravenous administration of nitroglycerin (p less than 0.01). Despite these differences, the group 1 patients had a higher mortality rate (11% versus 1%; p less than 0.01) and a higher rate of perioperative infarctions (new Q wave) (22% versus 6%; p less than 0.01). An analysis of risk factors was performed in the group 1 patients using 36 preoperative and operative variables. Multivariate analysis revealed that left ventricular score (p less than 0.0001), preoperative (after percutaneous transluminal coronary angioplasty) need for inotropic support (p less than 0.005), and age (p less than 0.025) were independent predictors of operative mortality. In conclusion, emergency CABG after failed percutaneous transluminal coronary angioplasty carries a significantly greater risk of operative death and perioperative infarction than elective CABG.     

Pseudo-acute abdomen in familial Mediterranean fever. A case report]

The Authors report a case of familial mediterranean fever with pseudo-acute abdomen recently observed and emphasize how a careful anamnesis can avoid unnecessary surgical intervention.     

Diagnostic usefulness of BAEPs. A clinical case]

We report the clinical case of a patient operated for a right extracerebral haematoma. In the immediate post-operative period, although no clinical signs were present, a BAEP examination (showing the lack of the V) warned of a pathological condition which was ascertained by CT. A second haematoma was observed, contralateral to the first, and immediately removed. In this case, therapy was based on the neuroelectrophysiological findings.     

Polycystic ovaries: MR imaging

To determine the characteristic appearance of polycystic ovaries on magnetic resonance (MR) images, seven women with polycystic ovarian disease (PCOD) underwent MR examination of the pelvis. These MR images were compared with sonograms. Histologic material was available in two patients. Six of the seven women had characteristic, small peripheral cysts, best seen on T2-weighted MR images; these cysts were seen sonographically in only one case. The centers of nine of 14 ovaries were of low intensity with all MR pulse sequences; this low intensity corresponded with low echogenicity in six cases. Histologically, these areas correlated with hypertrophic cellular stroma. Coexisting central teratomas were seen in three ovaries. The ability of MR to display the findings of PCOD better than ultrasound and its ability to demonstrate coexisting pathologic conditions are valuable in imaging the female pelvis.     

Acute tolerance to diazepam in cats; lack of cross-tolerance to phenobarbital and methocarbamol

A rapid, simple method is described for producing acute tolerance to the depressant effects of diazepam on the linguomandibular reflex (LMR) in anesthetized cats. Administration of a single large i.v. dose of diazepam, 2 mg/kg elicits tolerance after 2 hr, as measured by the reduction of response to a subsequent administration of the same dose of diazepam. In diazepam-tolerant cats, there was no tolerance to the LMR depressant effects of phenobarbital or methocarbamol. It is likely that the site of action of diazepam for LMR inhibition differs from phenobarbital and methocarbamol.