Cerebrovascular disease: evaluation with transbrachial intraarterial digital subtraction angiography using a 4-F catheter

Three hundred sixty-one patients underwent intraarterial digital subtraction angiography for definite or probable occlusive vascular disease of the carotid arteries. Examinations were performed with 65-cm-long, 4-F aortic catheters. A transbrachial approach was used. Images were good or excellent in nearly all cases. No postprocedural neurologic deficits or hematomas occurred. Permanent pulse deficit occurred in two patients, and temporary deficit occurred in three patients, an improvement over the frequency found in previous transbrachial series using 6-8-F catheters. While these results establish the efficacy of this technique, they also indicate a possible greater relative safety in men than in women.     

Avian Flu – A Bird's Eye View

Influenza A (H5N1) virus infects a variety of animals, birds and humans. Present ongoing epidemic of this deadly virus in poultry livestock and humans has had major economic and health repercussions. It causes a wide spectrum of clinical features in human beings ranging from mild respiratory tract infection to a fatal pneumonia leading to multi organ system failure. Diagnosis is mainly clinical, aided by lab features like lymphopaenia and non-specific chest X-ray findings. Diagnostic tests are being evolved for rapid and specific diagnosis. Management is mainly symptomatic. Newer and effective antivirals, i.e. amantadine, zanamivir etc are also being tried.Key Words: Avian influenza, Severe acute respitatory syndrome, Influenza A     

Levosimendan in cardiac surgery

OBJECTIVE: Levosimendan is a new calcium sensitizer with inodilatory properties. There is growing clinical experience with levosimendan given to cardiac surgical patients. The aim of this report was to evaluate the effects of perioperative use of levosimendan in surgical patients with high perioperative risk, compromised left ventricular (LV) function, or difficulties in weaning from cardiopulmonary bypass (CPB). DESIGN: Case series. SETTING: Single-institution, university hospital. PARTICIPANTS: Patients undergoing cardiac surgery. MEASUREMENTS AND MAIN RESULTS: Sixteen cardiac surgical patients received levosimendan infusion with a maximum duration of 29 hours. Eight were initiated preoperatively and 8 postoperatively. Coronary artery disease was the main operative indication in 10 of 16 cases, and 75% of the patients were high-risk patients. RESULTS: Continuous levosimendan infusion increased cardiac index significantly in both groups compared with preoperative baseline. Pulmonary capillary wedge pressure and systolic blood pressure did not change significantly. Norepinephrine and epinephrine were the most common concomitant vasoactive medications. Most importantly, weaning from CPB was successful in all patients even after failure to wean the patient with catecholamines. One high-risk patient in the preoperative group and 2 patients in the postoperative group died in the hospital. Another patient died during the 1-year follow-up. CONCLUSION: Levosimendan can be used for postoperative rescue therapy for patients difficult to wean from CPB. Also, elective preoperative initiation of levosimendan seems applicable to patients with high perioperative risk or compromised LV function.