Hypotension-induced post-traumatic necrosis of the right colon

Necrosis of the right colon developed after hemorrhagic shock in six young traumatized patients who did not have colon injury. The mean duration of hypotension was 112 minutes, and the mean resuscitation fluid volume required was 22 liters. Signs of right colon necrosis appeared 2 to 7 days after injury (median 2 days). All patients survived right colectomy and ileocolostomy or ileostomy and mucous fistula.The cause of necrosis of the right colon after hemorrhagic shock from major trauma is not clear. Anatomic abnormalities in blood supply to the right colon or a derangement in the physiologic processes of the microcirculation of the right colon must be considered.     

Role of coronary artery bypass surgery after intracoronary streptokinase infusion for myocardial infarction

Intracoronary streptokinase infusion has been shown to improve left ventricular function and reduce hospital mortality in patients with acute myocardial infarction. Adjuvant coronary artery bypass surgery is of value in many of these patients who have recurrent angina, circulatory instability, severe coronary artery occlusive disease, or a high risk of reinfarction. There is little, if any, evidence that immediate coronary artery bypass surgery affects the results adversely—either because of recent myocardial infarction or recent streptokinase infusion, and early operation appears to be a safe and worthwhile modality of treatment in this group of patients with myocardial infarction.     

Permanent triggered antitachycardia pacemakers in the management of recurrent sustained ventricular tachycardia

Permanent pacemakers capable of triggered ventricular stimulation were implanted in 28 patients with a history of sustained ventricular tachycardia or fibrillation. Noninvasive programmed ventricular stimulation was performed on 125 occasions during follow-up periods ranging from 1 to 25 months and was used to assess the efficacy of antiarrhythmic drug therapy, drug or dosage changes and left ventricular endocardial resection. Drug or dosage changes based on noninvasive programmed ventricular stimulation were made in 19 of the 28 patients. In addition, 126 episodes of spontaneous sustained ventricular tachycardia were terminated noninvasively in nine patients. It is concluded that a permanent pacemaker capable of triggered ventricular stimulation is useful in patients with ventricular tachycardia or fibrillation that is difficult to control.     

Coalescent mastoiditis in a case of congenital aural atresia

A case of unilateral congenital aural atresia presenting as acute coalescent mastoiditis with superiosteal abscess in presented. The literature regarding aural atresia and otitic infection is reviewed, and the recommended preoperative evaluation of a patient with coalescent mastoiditis in an atretic ear is outlined.