[A man with a widened mediastinum after trauma].

A 36-year-old male patient with a high energy trauma had a widened mediastinum caused by a traumatic transsection of the aorta.

Guidelines for cardiac management in noncardiac surgery are poorly implemented in clinical practice: results from a peripheral vascular survey in the Netherlands.

Background: The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery recommend an algorithm for a stepwise approach to preoperative cardiac assessment in vascular surgery patients. The authors' main objective was to determine adherence to the ACC/AHA guidelines on perioperative care in daily clinical practice.

Methods: Between May and December 2004, data on 711 consecutive peripheral vascular surgery patients were collected from 11 hospitals in The Netherlands.

Increase of 1-year mortality after perioperative beta-blocker withdrawal in endovascular and vascular surgery patients.

Objectives: To assess the relation between beta-blocker use, underlying cardiac risk, and 1-year outcome in vascular surgery patients, including the effect of beta-blocker withdrawal.

Design: Prospective survey.

Materials: 711 consecutive peripheral vascular surgery patients from 11 hospitals in the Netherlands between May and December 2004.

[Acute disorders of intestinal perfusion; a nonrigid abdomen may still be acute].

Three patients, a man aged 50 years and two women aged 46 and 45 years, with abdominal pains and an undistended abdomen, were found to have acute mesenteric ischaemia. The causes were: unknown, a thrombus in the descending aorta and severe atherosclerosis, respectively. In the male patient, only 30 cm of vital small intestine ultimately remained; in one woman embolectomy sufficed, in the other, resection of a limited portion of the jejunal tract.

Dyspepsia as initial symptom of splanchnic vascular insufficiency.

A patient is reported with an unusual presentation of splanchnic ischaemia, causing gastritis. Although mesenteric ischaemia is well described in the literature, there is little information on gastric ischaemia resulting in gastritis. There was a considerable delay in diagnosis and treatment, adding to a complicated course of events.