Unplanned admissions after outpatient cardiac catheterization

Increasing numbers of patients are undergoing diagnostic catheterization as outpatients; however, a small proportion of patients requires hospital admission following the procedure. Unplanned admissions after consecutive outpatient cardiac catheterizations performed during 1 year were prospectively reviewed to determine the incidence of and reasons for admission. Among 847 patients undergoing outpatient cardiac catheterization, 130 patients (15%) required hospital admission after the procedure. Admitted patients were divided into four groups: patients undergoing immediate percutaneous transluminal coronary angioplasty (PTCA) (Group 1; 33%), patients with severe cardiac disease requiring urgent intervention (Group 2; 48%), patients suffering complications or hemodynamic instability (Group 3; 15%), and patients whose procedures were completed too late to allow same-day discharge (Group 4; 4%). Patients over 65 were more likely to require admission and women were more likely to be admitted with complications or hemodynamic instability. Findings are compared with results of other outpatient series, and implications regarding appropriate setting for outpatient catheterization are discussed.     

Effects of posture and pneumoperitoneum during anaesthesia on the indices of left ventricular filling

Background. Laparoscopic surgery requires the use of pneumoperitoneum (PP). When combined with positional changes, pneumoperitoneum may cause marked circulatory alterations.
Methods. Eight anaesthetized cardiovascularly healthy patients, scheduled for laparoscopic cholecystectomy, were studied before and during pneumoperitoneum in three different postures (supine, Trendelenburg and reversed Trendelenburg), employing transesophageal echocardiography and pulmonary artery pressure monitoring.
Results. PP significantly increased end-diastolic area (EDA) and pulmonary capillary wedge pressure (PCWP) irrespective of posture. PCWP was significantly influenced by postural changes, whereas EDA was not. Further, changes in EDA and PCWP covaried during the investigation, but showed no linear correlation. Systolic function, measured as end-systolic area (ESA) and fractional area shortening (FAS), was not altered. Diastolic function, as assessed by the velocity rate of the trans-mitral flow during the early filling phase (E) and the atrial contraction (A), showed no change of the E/A ratio, whereas after the induction of PP there was a significant reduction of the E component.
Conclusions. In cardiovascularly healthy patients, the left ventricular volume is increased during pneumoperitoneum. Further, changes in invasive pressure determinations (PCWP) do not correlate linearly with changes in volume indices of left ventricular filling (EDA).     

Successful treatment for squamous cell carcinoma of the female urethra with combined radio- and chemotherapy

We report on two cases of women with locally advanced squamous cell carcinoma of the urethra. Patient 1 also displayed regional lymph node metastasis. Treatment comprised combined radiotherapy to 60 Gy and chemotherapy with 5-fluorouracil and cisplatin. Complete response was obtained in both patients, including the inguinal lymph nodes of Patient 1. Patient 1 experienced recurrent inguinal lymph node metastasis on the contralateral side at 42 months after initial treatment, and the same treatment was performed followed by surgical excision. Both patients remain alive with no evidence of disease, at 12 months after recurrence in Patient 1, and at 27 months after treatment in Patient 2.     

Percutaneous transluminal coronary angioplasty in a patient with paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired chronic hemolytic anemia associated with an unusual susceptibility to hemolytic crisis, infection, and venous thrombosis which would be aggravated by a number of factors including surgery. We report a case of PNH undergoing percutaneous transluminal coronary angioplasty and discuss the corresponding perioperative management.     

Dual origin of the left circumflex coronary artery: A case report

We describe a patient with two separate vessels having different origins supplying the circumflex coronary artery distribution. This represents a previously undescribed coronary artery anomaly.     

Tension-free vaginal tape for the treatment of urodynamic stress incontinence with intrinsic sphincteric deficiency

The purpose of this study was to evaluate the outcome of tension-free vaginal tape (TVT) procedure in women with urodynamic stress incontinence diagnosed as having intrinsic sphincteric deficiency (ISD). The combination of a maximal urethral closure pressure <20 cm H₂O and a Valsalva leak point pressure <60 cm H₂O was considered as diagnostic of ISD. Subjects with detrusor overactivity on preoperative urodynamics were excluded. A total of 35 patients with both low closure pressure and leak point pressure were enrolled. Bladder perforation occurred in three (8.6%) cases. Postoperative urinary voiding difficulties occurred in nine (25.7%) women. Two patients underwent surgical detension of the tape, with complete resolution of urinary retention and no relapse of incontinence. Women with postoperative voiding dysfunction had a significantly lower detrusorial pressure at the peak flow on preoperative urodynamics compared to those who voided efficiently after TVT. The mean (range) follow-up time was 12.5 months (3–36). The objective cure rate for stress incontinence was 91.4%. Two of the three (66%) patients in whom the TVT procedure failed had a fixed urethra. De novo urge incontinence was found in five (14.3%) patients.     

妇产科患者术后使用镇痛泵引发尿路感染的临床探讨

目的 了解留置导尿所致尿路感染的发病率及影响因素。方法 采用前瞻性调查与回顾性调查相结合的方法,对妇产科手术后患者留置尿管而引发泌尿系感染率增高的原因进行调查和分析。结果 使用镇痛泵患者留置导尿后尿路感染率为5.45％,未用镇痛泵者的尿路感染率为0.21％,两者之间差异有高度显著性(P<0.005)。结论 镇痛泵不能滥用,使用时要避免诱发感染的因素。     

脱细胞尿道及其海绵体基质制备的实验研究

目的 探索脱细胞尿道及其海绵体基质的制备方法。方法取健康壮年兔完整尿道及其海绵体组织，以Triton-X100与NH3H2O联合提取法进行脱细胞处理。标本做HE染色，组织学观察分析脱细胞效果。结果脱细胞处理11天后，成功获得脱细胞及其海绵体基质，所得基质外观良好。HE染色观察无细胞存在。弹力纤维排列规整，间隙较大，结构无破坏。结论利用Triton-X100与NH3H2O联合提取法可成功制备完整无细胞尿道及其海绵体基质，为尿道再造修复提供崭新思路。     

Virtual real-time digital processing of hemodynamic data

At present, the majority of cardiac catheterization laboratories acquire and store hemo-dynamic data in analog form. To examine the possibility of performing complex analysis of digital data during the catheterization procedure, we examined whether virtual realtime digital (fast Fourier) analysis improves the accuracy of clinical data. We compared digital filtering of fluid manometry during right heart catheterization with 10-Hz and 250-Hz analog filters. Using the simultaneously acquired micromanometry as the “gold standard,” we found that analog filtering is associated with a greater error and time delay than digital filtering. This study demonstrates that digital hemodynamic data analysis performed during cardiac catheterization can improve the quality of data obtained during right heart catheterization, with the results available within seconds. More extensive use of computers in the cardiac catheterization laboratory may be useful for both clinical and research purposes. © 1992 Wiley-Liss, Inc.