A review of the causes of death in 276 patients with sickle-cell disease showed that although the greatest mortality occurred in the first five years of life, roughly one-quarter were aged over 30. Commonest causes of death in the first ten years included acute splenic sequestration, septicaemia, meningitis, aplastic crises, and gastroenteritis. In older patients cerebrovascular accidents and renal failure became common. The acute chest syndrome affected all age groups about equally but appeared to result predominantly from infection in the young and embolism or thrombosis in the old.
IntroductionMost genotypes of sickle-cell disease are associated with a shortened life expectancy, but there is little information on the causes of death or on the pattern of mortality at different ages. Our experience at a major medical centre in the Caribbean over the past 30 years is therefore presented in this retrospective review of the causes of death in 276 patients.
Low systemic vascular resistance (SVR) requiring vasoconstrictor therapy is a recognized complication of cardiopulmonary bypass. We present here a case in which norepinephrine therapy had failed and alternative strategy with a guanylate cyclase inhibitor, methylene blue, was instituted, resulting in a rapid, permanent restoration of hemodynamic stability.Clinical summary. A 72-year-old man with 3-vessel disease and moderate left ventricular function was admitted for coronary artery bypass surgery. Coronary risk factors included hypercholesterolemia, hypertension, prior smoking, and a family history of heart disease. He was on a program of amlodipine, atenolol, enalapril, simvastatin, and aspirin. Medical history included a cerebrovascular accident. His blood pressure was 150/90 mm Hg and he had atrial fibrillation with a pulse rate of 60 beats/min. Baseline blood results were normal apart from a borderline serum creatinine value of 105 µmol/L.Coronary artery bypass grafting was performed under normothermic conditions with intermittent crossclamp fibrillation. The operation was uneventful and total bypass time was 67 minutes. He was transferred to the intensive care unit receiving intravenous glyceryl trinitrate (2 mL/h) and cardiac dopamine (10.9 µg/kg per minute). Four hours after the operation, his blood pressure progressively sagged. The central venous pressure was 10 mm Hg and the hemoglobin level was 8.9 g/dL after a total of 2.5 L of colloid and 1 unit of blood. Blood loss was negligible and oxygen tension was From the
This paper demonstrates the potential of the mock circulation models both for the investigation of muscle wrap performance and for the comparison of extra-aortic muscle with intra-aortic balloon counterpulsation.
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