Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery.

Background: The purpose of this study was to determine the predictive value of dobutamine stress echocardiography for perioperative cardiac events in patients scheduled for elective major noncardiac vascular surgery.

Methods And Results: Patients (n = 136; mean age, 68 years) unable to exercise underwent a dobutamine stress test before surgery (incremental dobutamine infusion [10-40 micrograms.kg-1.

Isocaloric feeding and medium chain triglycerides fail to improve liver function tests in a patient with Crohn's disease and a high output stoma.

A patient with Crohn's disease complicated by multiple fistulae to the skin and bladder and a high-output stoma following previous multiple short bowel resections developed liver dysfunction during total parenteral nutrition. Isocaloric feeding based on calorimetry and changing from a long chain triglyceride emulsion to a mixture of medium and long chain triglyceride emulsion failed to improve liver function. Surgical removal of the affected small bowel resulted in a rapid improvement of the liver function despite continuation of total parenteral nutrition.

Pyomyositis: an unusual complication of Staphylococcus aureus infection.

Pyomyositis, an unusual complication of Staphylococcus aureus infection. Treatment consists of surgical drainage and antibiotics.

Pancreatitis induced by disodium azodisalicylate.

A patient with Crohn's disease of the colon developed severe abdominal pain after salicylicazosulfapyridine and after disodium azodisalicylate therapy. Raised serum and urinary amylase levels were found after disodium azodisalicylate. Rechallenge with disodium azodisalicylate caused a recurrence of the pain and of the elevated amylase levels.

Blood pressure response of nephrectomized subjects and patients with essential hypertension to ramipril: indirect evidence that inhibition of tissue angiotensin converting enzyme is important.

The kinetics of blood pressure changes and plasma angiotensin converting enzyme (ACE) inhibition in response to ramipril (HOE 498), 10 mg orally, were studied in 6 nephrectomized subjects 12 hours after ultrafiltration and in 10 patients with essential hypertension. Ramipril lowered supine and standing blood pressure in both groups, but the effect was greater in essential hypertension. The maximal blood pressure response followed the effect on plasma ACE after a lag time of 3 to 4 hours in both groups.

Familial cortisol resistance: differential diagnostic and therapeutic aspects.

A 26-yr-old woman presented with hirsutism, male pattern scalp baldness ("geheimratsecken"), and menstrual irregularities. She had no hypertension or other signs and symptoms of Cushing's syndrome. Plasma cortisol levels were greatly elevated and did not suppress normally in response to dexamethasone.