Facility-based approach for the management of acute ST segment elevation myocardial infarction with cardiogenic shock in a rural medical centre: the Durango model.

Introduction: Cardiogenic shock (CS) complicates 5%-15% of cases of acute myocardial infarction (AMI) with inpatient mortality greater than 40%. The implementation of standardised protocols may improve clinical outcomes in patients with AMI-CS.

Methods And Analysis: The Durango model is a prospective single-centre registry designed to enable early identification of patients with STEMI-CS to facilitate primary reperfusion therapy with a shock team management algorithm in a rural level II heart attack centre.

Coronary artery fistula diagnosed by transesophageal echocardiography.

Coronary artery fistulas have been traditionally diagnosed by angiography. This report describes a congenital and a traumatic coronary artery fistula diagnosed by transesophageal echocardiography. Transesophageal echocardiography was superior to transthoracic echocardiography in both cases and to angiography in one case.

Laser-assisted thermal angioplasty in human peripheral artery occlusions: mechanism of recanalization.

Recanalization of completely occluded superficial femoral or popliteal arteries was attempted in 18 patients with use of an Argon laser-mediated thermal probe. The length of the occluded segments varied between 0.5 and 26.

The role of IVP in blunt trauma.

To investigate the role of the IVP, we studied 139 patients with blunt abdominal trauma and hematuria. Multivariate analysis of clinical parameters was utilized in attempt to predict which patients would have abnormal IVP's and which would eventually require genitourinary operation. Thirty-four patients (25%) demonstrated abnormalities on IVP; however, no combination of clinical findings (including degree of hematuria) could reliably predict which patients would have abnormal IVP's.

Hypogammaglobulinemia in a renal transplant recipient with antiglomerular basement membrane disease.

A thirty-six-year-old woman developed antiglomerular basement membrane disease, necessitating bilateral nephrectomies. Subsequent to cadaveric renal transplant and 8 years of immunosuppressive treatment with prednisone and azathioprine, the patient developed multiple life-threatening infections. Quantitative immunoglobulins revealed IgG = 9, IgA less than 6.

Hyperthermic pelvic isolation-perfusion in the treatment of refractory pelvic cancer.

Hyperthermic isolation-perfusion (I-P) was used to treat 27 patients with refractory pelvic cancer. All patients except one achieved pelvic isolation as manifested by selective pelvic heating and by pharmacologic monitoring. Patient response was good, with rapid pain relief in 75% and tumor control as detected by physical examination, computed tomographic scan, and decline in carcinoembryonic antigen levels.

Digital subtraction ductography.

Digital subtraction techniques used in the examination of eight patients with salivary and nasolacrimal disease are described. Pleomorphic adenoma, ductal stricture, extrinsic masses, parotid-otic fistula, and a radiolucent calculus were demonstrated. The procedures are more easily performed than film techniques, and pathology is better demonstrated by digital ductography than on a film examination.

Digital tomography: description and preliminary clinical experience.

Digital tomography was performed in 30 patients using a new prototype system with a PET-Scope image tube. Twenty-eight exposures are obtained during a single revolution of the x-ray source over the volume of tissue to be imaged. The sum of the radiation produced by the 28 exposures is about equivalent to a single routine exposure of the part imaged.

Development of gallstone pancreatitis. The role of the common channel.

Whether bile reflux through a common channel into the pancreatic duct is a causative factor in the development of gallstone pancreatitis is controversial. To address this issue, we have reviewed a consecutive series of cholecystectomies performed with intraoperative cholangiograms. The cholangiograms and the patients' charts were reviewed independently to determine the incidence of a common channel in patients both with and without pancreatitis and to analyze their clinical courses.

Treatment of tandem lesions of the extracranial carotid artery.

The authors present a patient with bihemispheric transient ischemic attacks attributed to stenosis of the left common carotid origin and stenosis and ulceration of the left cervical internal carotid artery. Because of precarious cerebral blood supply secondary to occlusions of the right common carotid and left vertebral arteries, several measures were undertaken perioperatively to provide protection from cerebral ischemia during vessel occlusion. These included Swan-Ganz catheter monitoring to maximize cardiac output and maintain satisfactory hydration, normocarbia, satisfactory oxygenation, and moderate hypertension and barbiturate infusion.

Angiographic nephrectomy using iodinated contrast agent.

Diatrizoate meglumine and sodium (Renografin-76) was perfused in an obstructed renal artery in 13 dogs. Intense and prolonged accumulation of contrast agent ("contrast staining") was achieved in all animals. Repeat injection was frequently necessary to enhance staining.