Acquired fourth ventricular outlet obstruction, an uncommon entity, has been conventionally managed by ventriculoperitoneal shunt placements or excision of the obstructing membranes. The role of endoscopic third ventriculostomy is highlighted in the present communication. Three patients presenting with symptoms of raised intracranial pressure were diagnosed to have fourth ventricular outlet ...

Physiologic regulation of fibrinolysis plays an important role in the control of hypercoagulable states and thrombogenesis. Both the hereditary and acquired conditions leading to fibrinolytic deficit result in thrombotic complications leading to arterial and venous occlusive disorders. Several changes in physiologic states such as pregnancy, old age, stress, obesity, and ...

Every year, 540,000 patients enter a hospital for myocardial infarction. Of these, 4% to 13% will be misdiagnosed and 11%-25% of them may die as a result. Missed diagnoses are the most expensive claims against emergency department physicians and account for 20% of all losses paid by them. A sound ...

OBJECTIVE: This study sought to assess the impact of local implementation of clinical practice guidelines on the pattern of care and outcome in patients admitted to the Coronary Care Unit (CCU) with acute myocardial infarction. BACKGROUND: Development of clinical practice guidelines is among the most popular of the methods intended ...

To the authors' knowledge, this case is unique to the emergency medicine literature. Although testicular infarction from epididymitis is rare, it should be considered as a complication of severe or unresolving epididymitis. These patients should be placed on broad spectrum antibiotics, i.e., quinolones; color flow Doppler of the testes should ...

A 39-year-old woman had alcoholic ketoacidosis complicated by reversible life-threatening myocardial dysfunction. This complication occurred a few hours after correction of acidosis in association with severe hypophosphatemia. A marked improvement in clinical, echocardiographic, and hemodynamic features was associated with the normalization of the serum phosphorus level. This case illustrates a ...

BACKGROUND: Non-Q-wave myocardial infarction is usually managed according to an "invasive" strategy (i.e., one of routine coronary angiography followed by myocardial revascularization). METHODS: We randomly assigned 920 patients to either "invasive" management (462 patients) or "conservative" management, defined as medical therapy and noninvasive testing, with subsequent invasive management if indicated ...

Although multiple case reports have demonstrated the capability of transoesophageal echocardiography (TOE) to detect unsuspected cardiac pathology with important therapeutic implications, few studies have examined the effect of real-time interpretation of routine TOE on clinical management of a typical series of cardiac surgery patients. To assess the impact of intraoperative ...

The objective was to determine how patients are selected for invasive investigation after myocardial infarction in Scotland. Cardiologists in Scotland were surveyed by postal questionnaire asking them to detail their approach to four sample clinical scenarios. Complete responses were obtained from 82% of those surveyed. Substantial differences in practice were ...

Intravenous immunoglobulin is used to prevent coronary artery involvement in patients with acute Kawasaki disease. In this issue of the journal, Beiser et al provide a scoring system that is invoked 24 hours after gamma globulin therapy to predict risk for coronary involvement. This instrument would be useful for pediatric ...

Carotid-cavernous and vertebral-venous fistulas are direct arteriovenous fistulas. Their symptoms range from benign to extremely severe ophthalmologic or neurologic complications. Mechanism of symptoms is mostly related to venous drainage. Therapy is widely indicated, as today's endovascular techniques--using mostly detachable balloons and coils--have a high success rate and very few complications.

Neurological, cardiac, and systemic complications during the first days to weeks after ischaemic stroke can cause substantial morbidity and mortality. The reported 30-day case fatality rate for cerebral infarction varies between 10 and 17%. The incidence and effects of the various complications vary with time after stroke: transtentorial herniation and ...

The purpose of this study was to evaluate the outcomes of medical management compared with invasive management for patients with mild or moderate ischemia (non-high-risk) on stress tomographic myocardial perfusion scintigraphy. Of the 1,352 non-high-risk patients, 116 (9%) subsequently were referred for coronary angiography within the first 30 days after ...

A left-sided pleural effusion is an infrequent clinical occurrence compared with bilateral or right-sided effusions. After coronary bypass surgery, a patient presented with dyspnea and an enlarging left pleural effusion erroneously attributed to congestive heart failure and refractory to medical management. Thoracentesis generated a clinical surprise, allowed specific therapy, and ...

Dilutional acidosis is a poorly recognized cause of metabolic acidosis. Indeed, the prevailing view has been that even massive expansion of the extracellular fluid volume with non-bicarbonate-containing solutions would not lead to clinically significant hypobicarbonatemia. We describe the development of marked dilutional acidosis as a complication of management of right ...

A patient underwent a partial right hepatic lobectomy for adenocarcinoma of the colon metastatic to the liver. He was admitted to the surgical intensive care unit in stable condition. Six hours after surgery, the patient experienced sudden and sever hypotension, bradycardia, and systole. Differential diagnoses included acute myocardial infarction, hemorrhage ...

Percutaneous coronary interventions have been performed for 20 years. Despite the success and progress of these interventions, abrupt vessel closure has been a dramatic adverse event of coronary interventions. Closure has frequently led to the major complications of death, myocardial infarction, and emergency coronary artery bypass. Because of the fear ...

Myocardial infarction-remains one of the leading causes of death among adults in the United States despite the significant advances in therapy made during the past three decades. However, a significant reduction in mortality following acute myocardial infarction has been accomplished through an aggressive strategy directed toward early recognition and intervention. ...

Focal deficits, seizures and epilepsy, altered consciousness, and disturbed behaviours can complicate heart diseases and their medical treatment as well as cardiological procedures and cardiac surgery. Neurological complications of common cardiac conditions are discussed. These cardiac conditions are acute myocardial infarction and ischaemic heart disease, atrial fibrillation and cardiac arrhythmias, ...

BACKGROUND: The total expense associated with acute myocardial infarction in the United States is substantial because of the combination of high volume and high cost per case. The aim of this study was to identify potential cost-saving strategies for the management of acute myocardial infarction. METHODS: Information was gathered through ...

Assessment of large cardiac tumors requires careful definition of the extent, cell type, and degree of invasiveness to determine the best operative management. Preoperative magnetic resonance imaging and echocardiography were helpful, but limited in the assessment and management in the case of a 19-year-old pregnant woman with a large (9 ...

Hepatic infarction is a serious complication of liver transplantation, causing significant morbidity and mortality and often requiring retransplantation. Real time ultrasonography with Doppler examination is often the first imaging modality employed to investigate post-operative complications. We report on the sonographic appearances of three patients in whom hepatic infarction followed transplantation ...

Significant medical complications after elective abortion are rare. However, complications do occur, and the emergency physician should always bear this in mind when evaluating a patient with significant illness who has recently undergone an elective abortion. Reported here is a case of postabortion endocarditis, manifesting as a septic coronary artery ...

The objective of this study was to assess the impact of group-based stress management training on emotional well-being, functional status, social activity and chest pain in cardiac patients, within a randomized controlled trial. Fifty acute myocardial infarction and 50 coronary artery bypass patients were randomized to experimental (27 myocardial infarction ...

OBJECTIVE: To trace the evolution of coronary care and the management of acute coronary syndromes. STUDY SELECTION: Landmark articles and selected personal experiences. DATA SYNTHESIS: The evolution of coronary care falls into four major categories and decades: the 1960s during which it was recognized that resuscitation from myocardial infarction through ...

In the general population, endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy is preferable to surgery as therapy for gallstone pancreatitis and acute cholangitis. It is particularly attractive to perform therapeutic. ERCP for symptomatic choledocholithiasis after recent myocardial infarction because of the increased risk of the alternative therapy of cholecystectomy and ...

OBJECTIVE: Acute myocardial infarction is often accompanied by anxiety, but the effect of this emotion on recovery is unclear. The purpose of this study was to determine the association between patient anxiety early after acute myocardial infarction and the incidence of subsequent in-hospital complications. METHODS: We assessed anxiety level within ...

The complications of IE may involve any organ system. Cardiac complications are frequently present, and heart failure remains a leading cause of death. Abscess formation in the surrounding cardiac tissues may result in myocardial or pericardial disease, and cardiac conduction abnormalities may develop. Extracardiac complications, including neurologic, vascular, and renal ...

Coronary heart disease and myocardial infarction are uncommon complications during pregnancy. Women with insulin-dependent diabetes mellitus (IDDM) have a much greater risk of serious coronary heart disease, but few cases of myocardial infarctions occurring during pregnancy have been reported. Significant maternal morbidity has been reported in half of these cases. ...

A percutaneous gastrostomy (PG) was complicated by gastric wall dissection and partial tube malposition. It occurred after tangential puncture along the greater curvature of the stomach which was performed in order to avoid an enlarged left lobe of the liver. To prevent this complication we recommend not using hydrophilic guidewires ...

OBJECTIVE: To examine the incidence and outcome of cardiac catheter complications related to left main coronary artery disease or damage using the CECCC (Confidential Enquiry into Cardiac Catheter Complications) database. SETTING: Coordinating centre for national database. DESIGN: Retrospective analysis of reports to a national multicentre database for cardiac catheter complications. ...

A 68-year-old white man with lung carcinoma underwent removal of the lower lobe of the left lung. Four months later, the patient developed a hemothorax requiring exploratory thoracotomy, evacuation of hemothorax, and decortication. Postoperatively a persistent airspace with prolonged air leak developed. Bronchoscopic application of fibrin glue failed to seal ...

BACKGROUND: Myocardial infarction is a rare event in pregnancy that requires medical stabilization with possible surgical interventions. CASE: A 37-year-old woman developed an anterior wall myocardial infarction secondary to severe coronary artery disease during the early third trimester of pregnancy. The patient was managed with multiple modalities to stabilize her ...

This review will attempt to put together the voluminous studies and concepts that have been published during the past 25 years following the description of the acute respiratory distress syndrome (ARDS) regarding diagnosis and management. The initial discussion will focus on how to clinically diagnose ARDS based recommendations. This also ...

The effective early diagnosis of acute myocardial infarction still rests primarily on the clinical history and the electrocardiogram. ST segment elevation is specific though sometimes short lived and less than ideally sensitive; but with bundle branch block it defines a population that benefits importantly from thrombolysis. Novel electrode configurations can ...

BACKGROUND: The role of the general practitioner in the management of patients with suspected acute myocardial infarction is important and specific. It has been recommended that eligible patients should receive thrombolysis within 90 minutes of alerting medical or ambulance services. The administration of prehospital thrombolysis by general practitioners is controversial. ...

Right latissimus dorsi cardiomyoplasty has recently been shown to provide effective support for the chronic failing heart. A simplified technique to perform this procedure is described here. The use of the pericardial "suspenders" may avoid dangerous lifting of the heart out of its sac position, and allow a more appropriate ...

Inhaled nitric oxide, with a threshold of perhaps only a few parts per million, is a selective pulmonary vasodilator in patients with congenital heart disease and increased pulmonary vascular resistance. Multiple reports suggest that it may be useful in managing postoperative pulmonary hypertension in the cardiac patient, although it is ...

Patients with acute inferior myocardial infarction (IMI), complicated by a more extensive right ventricular infarction (RVI), have an increased risk of both complications and mortality. The critical care nurse plays an important role in 1) the early detection of RVI and 2) the management of the common hemodynamic and conduction ...

Potential safety issues related to early extubation include the effect of changes in anesthetic management on intraoperative hemodynamics, stress responses and awareness, altered management in the control of pain, shivering and ischemia in the early postoperative period, and the risks of reintubation in patients who might require reoperation for bleeding. ...

Coronary artery disease is common in the general population. Dentists must be prepared to treat patients with coronary artery disease in the safest possible manner. This article reviews the dental management of such patients. Specific attention is devoted to medical history, treatment planning, treatment modifications and appropriate measures to be ...

This article presents a young patient affected with non-Hodgkin lymphoma who developed acute myocardial infarction 7 days after treatment with epirubicin (90 mg/m2, day 1), cyclophosphamide (600 mg/m2, day 1), vincristine (2 mg, day 1), prednisolone (100 mg, days 1-5), and ondansetron (3 x 4 mg/day, days 1-2). Six months ...

BACKGROUND: Differences in the management of acute myocardial infarction have been reported among countries, but few studies have investigated this issue in regions of the United States. METHODS: We compared the management of acute myocardial infarction among census regions across the United States, using data from the first Global Utilization ...

OBJECTIVE: To develop an epidemiological database of morbidity in the community as presented to general practitioners and to support epidemiological research in general practice. DESIGN: The project is a sentinel network of 23 general practices in Northern Ireland that report the incidence of a list of selected diseases to a ...

The development of paediatric transoesophageal ultrasound imaging represents an important advance in the diagnosis and management of the patient with congenital heart disease. Although primary diagnostic transoesophageal studies are seldom indicated in infants and unoperated children, they have an important role in the older child, especially where there has been ...

Although substantial advances have been made in the management of cardiovascular disease, it remains the leading cause of death on the United States and many other countries, due to the impact of aging and other changes in patient demographics. Since cardiovascular complications are usually associated with stress, it is not ...

BACKGROUND: Donor management remains one of the most neglected areas of transplantation. A comprehensive donor management regimen has been developed. The results of the application of this strategy form the basis of this report. METHODS: Full hemodynamic data were collected from 150 multiorgan donors between October 1990 and August 1993. ...

Little is known of the outcome of myocardial infarction in patients managed in regional hospitals, where investigational and therapeutic modalities may have limited availability. Policies in place in the Intensive Care Unit of Wimmera Base Hospital for the management of myocardial infarction are designed to ensure that current 'best practice' ...

Myocardial abscess may occur rarely as a complication of myocardial infarction. This case report is the first demonstration of a myocardial abscess at the site of acute myocardial infarction in a 38-year-old man diagnosed by transesophageal echocardiography and color-flow imaging. Transesophageal echocardiography was crucial in the timing of surgery. Three ...

Coronary heart disease is the leading cause of mortality and morbidity in the United States at an estimated cost of $56 billion per year. Current approaches to treatment of coronary artery disease are not likely to reduce mortality and morbidity despite pressure to reduce costs in the changing health care ...