Preoperative complication from coronary dissection was the most important predictor of early postoperative mortality in this series. In such cases, rapid surgical intervention before myocardial infarction develops is vital to saving lives.
A 72-year-old man suffering from congestive heart failure, swelling of the lower limbs and hematuria was transferred from another hospital with a diagnosis of large aneurysms of the abdominal aorta and the left common iliac artery.Iliac arteriovenous fistula (AVF) was definitively diagnosed preoperatively by contrast-enhanced CT and angiogaphy. At operation, an infrarenal abdominal aortic aneurysm of 8 cm and left iliac arterial aneurysm of 12 cm were identified. After proximal and distal aortic clamping, the aneurysm was entered and an AVF orifice of 1 cm communicating with the left common iliac vein was disclosed at the right posterior wall of the left common iliac artery. Venous blood reflux was controlled by inserting an occlusive balloon catheter to the fistula and intraoperative shed blood was aspirated and returned by an autotransfusion system. The AVF was closed from inside the iliac aneurysm by three interrupted 3-0 monofilament mattress sutures with pledgets. The aneurysms were resected and replaced with a bifurcated Dacron prosthetic graft. The patient had an uncomplicated postoperative recovery ; the lower limb edema subsided and heart failure improved rapidly. Preoperative identification of the location of the AVF is mandatory to make surgery safe. Moreover, easy availability or routine use of the devices for controlling undue blood loss such as an autotransfusion system and an occlusive balloon catheter are other important supplementary means to obtain good results of surgical treatment.
We report a case of spontaneous haemothorax in a 19 year old boy with an exostosis of the left second rib. It may have been caused by nontraumatic rupture of markedly dilated pleural vessels, as a result of long-standing friction between the exostosis and the pleura. This is the first report of spontaneous haemothorax, without penetrative injury to the pleura or the diaphragm, in a patient with hereditary multiple exostosis.
The effects of Ryanodine, an inhibitor of salcoplasmic reticulum function, was investigated in isolated hearts of the Wistar rat strain. The cytosolic calcium was measured with the intracellular Ca2+ fluorescent indicator Fura-2. After 3 minutes perfusion of various cardioplegic solution which were added potassium (the concentration; 20 mmol/L) and four Ryanodine groups (1, 4, 10, and 20 nmol/L), these were obtained cardiac arrest. The arrested hearts were kept at 37 degrees C (normothermia) measuring hemodynamic studies. Hemodynamic parameters were heart rate, LVDP, LV dp/dt, coronary flow, and the intracellular calcium fluorescents which were calculated intracellular Ca2+. The significant difference was not noted in LVDP, but comparable improvement was achieved with Ryanodine groups (p < 0.05; 20 nM vs 0 nM). Other cardiac functions were likely same as above. The cytosolic calcium concentration of Ryanodine groups was depressed during cardiac arrest, it was 97.4 +/- 17.2% at the end of cardiac arrest, and it was slowly increased to 161.9 +/- 46.9% after 40 minutes reperfusion. On the other hand, that of the control group was higher than Ryanodine groups at every measuring points about two times. There was significant difference between both groups (p < 0.01). Concequently these phenomena caused that Ca2+ handling in the salcoplasmic reticulum were supressed by Ryanodine and the contractile function was recovered for that reason.
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