Amelioration of hypertrophic cardiomyopathy using nonsurgical septal ablation in a cirrhotic patient prior to liver transplantation.

A 53-year-old male with hepatitis C cirrhosis, who had been refused liver transplantation because of hypertrophic cardiomyopathy (HC), underwent nonsurgical septal ablation using alcohol with resolution of his ventricular outflow obstruction. This patient was able to subsequently undergo a successful deceased donor liver transplantation. This is the first reported case of alcohol induced septal ablation being performed in a cirrhotic patient with HC. Such nonsurgical procedures may be attractive in cirrhotic patients who are refused access to liver transplantation because of high surgical risk.     

Wirbelsäulenstabilisierung bei extraduraler Metastasenkrankheit Indikation und Verläufe bei 32 Patienten

Zweiunddrei?ig Patienten mit Metastasenkrankheit der Wirbels?ule, überwiegend von Mammakarzinomen und Plasmozytomen wurden über 41/2 Jahre operativ dekomprimiert und stabilisiert. Unter Einbeziehung von 5 früh Verstorbenen, betr?gt die mittlere überlebenszeit 9,5 Monate. Bei Entlassung der überlebenden aus station?rer Behandlung waren mit einer Ausnahme alle Patienten gehf?hig. In der Regel kamen Verbundosteosynthesen, bevorzugt der ventrale Zugang, zur Anwendung. Die pr?operative Embolisation war ein unverzichtbarer Bestandteil des Managements. Die operative Behandlung der Wirbels?ulenmetastasen ist eine segensreiche Methode, die in das gesamte Behandlungskonzept der bedauernswerten Patienten frühzeitig integriert werden sollte. Hochgradige Paresen oder Paralysen, insbesondere nach fudroyantem Verlauf, nicht kontrollierte Prim?rtumoren und spezielle Tumoren, z. B. das Bronchialkarzinom sowie gastrointestinale Karzinome, sind auch in der eigenen Serie indikatorisch eher kritisch zu sehen.      

Age dependence of the flow velocity in the basal cerebral arteries--a transcranial Doppler ultrasound study

The age dependence of the blood flow velocities of the middle, anterior, and posterior cerebral arteries measured by the transcranial Doppler method is discussed and compared with the velocity values in the internal carotid artery. A number of 535 patients without neurological deficits but with a previous neurological event were examined. Flow velocities decrease in all examined vessels with increasing age. This is in accordance with cerebral blood flow measurements by Xenon inhalation techniques. The reasons of the decrease and its consequences on the vasospasm in patients suffering from subarachnoidal hemorrhage are discussed.     

Dye laser coagulation of diabetic maculopathy]

Eighty eyes of 48 patients were followed after laser photocoagulation (615 nm) of the macula because of diabetic macular edema. The follow-up time was at least 6 months (average 10.2 months). The morphological status improved in more than 60% of eyes with focal edema but in only 40% of eyes with diffuse macula edema. Improvement of distance visual acuity was obtained in 35% of the eyes, mostly in those with good baseline acuity (greater than or equal to 0.7). The fraction with improved visual acuity decreased to 13% in eyes with a baseline acuity of 0.6 or less. Similar results were found for near visual acuity. The discrepancies between morphological and functional improvement are still unclear.     

Anatomic reconstruction of a rare combination injury of the axis (trans-dental dislocation with hanged-man fracture) by lag screw fixation]

The patient described here suffered from a Hanged-Man-Fracture type Effendi II in combination with a densfracture type Anderson d'Alonzo II. Options of treatment are discussed, the chosen therapy with lag-screw fixation described. The functional result was perfect.     

Intense vasoconstriction in response to aspirate from stented saphenous vein aortocoronary bypass grafts.

OBJECTIVES: We sought to identify soluble vasoconstrictor substances that are released during stent implantation into saphenous vein aortocoronary bypass grafts. BACKGROUND: Atherosclerotic saphenous vein aortocoronary bypass grafts are particularly vulnerable to plaque rupture. Protection devices prevent particulate debris from being embolized. Additional soluble vasoconstrictor substances possibly also contribute to impaired microvascular perfusion. METHODS: Peripheral venous blood (VB) and aspirate (AS) were obtained from 14 patients with a significant stenosis in a saphenous vein graft during stent implantation under protection with a distal balloon occlusion device. In five additional patients, arterial blood (AB) was also taken distal to the stented lesion before intervention. Vasomotor substances in VB, AB, and AS plasma were identified in a bioassay of rat mesenteric arteries with intact (+E) and denuded endothelium (-E). Vasoconstriction was normalized to that induced by potassium chloride depolarization (100%). RESULTS: Venous blood, AB, and AS plasma induced maximum vasoconstriction within six minutes. The AS plasma induced a vasoconstriction of 138 +/- 13% (-E) and 87 +/- 14% (+E); VB, of 70 +/- 14% (-E) and 23 +/- 4% (+E); and AB plasma obtained before intervention, of 49 +/- 9% (-E) and 36 +/- 8% (+E). The vasoconstrictor potency of AS plasma in endothelium-denuded vessels was related to the severity of anginal symptoms, angiographic stenosis severity, plaque volume, and plaque burden as determined by intravascular ultrasound. The AS plasma-induced vasoconstriction was largely attenuated by combined serotonin/5-hydroxytryptamine (5-HT)(2A/2C)- and 5-HT(1A/1B)-receptor blockade and eliminated by additional thromboxane A2 thromboxane-prostanoid (TP)-receptor blockade. CONCLUSIONS: Stent implantation releases, apart from and in addition to particulate debris, soluble vasoconstrictor substances that possibly contribute to impaired microvascular perfusion.