Noncardiogenic pulmonary edema complicating massive verapamil overdose.

Noncardiogenic pulmonary edema has not been (to our knowledge) previously reported associated with a verapamil overdose. We describe a 27-year-old woman who developed this complication after an overdose of 15, 120-mg verapamil tablets (total of 1,800 mg). This report illustrates the possibility of serious pulmonary embarrassment in the course of a verapamil overdose and the need to avoid excessive crystalloid administration during the hypotensive period.

Model for trauma outcomes management in patients with multiple trauma.

Critically injured patients with chest trauma generally sustain severe life-threatening injuries. Post-operative care tends to be complex, and all aspects of care from pre-hospital through rehabilitation must be coordinated and communicated to maximize patient outcomes. The Trauma Outcomes Management Model allows clinicians to assess, track, and analyze the relationship among interventions, outcomes, and the cost of care for each phase of the trauma care continuum.

A prospective randomized trial of Novoste right versus Judkins catheters for engagement of the right coronary artery during diagnostic catheterization.

There has been little technical advancement in catheter shape for diagnostic cardiac catheterization since the early reports of Sones and colleagues during the development of the procedure. In order to determine the utility of a new catheter that directly, without torque or rotation, engages the right coronary artery (RCA), one hundred patients were randomized between 6Fr standard RCA Judkins (6Fr R4) (Cordis Corporation, Miami, FL, USA) or 6Fr Novoste RCA catheters (Novoste Corporation, Aguadilla, Puerto Rico). Endpoints included the duration of the various aspects of the procedure and a qualitative and quantitative assessment of angiographic quality.

Manifestations of coronary atherosclerosis in young trauma victims--an autopsy study.

Objectives: The aim of this study was to look at the prevalence of coronary atherosclerosis, its severity and site of involvement in patients < 35 years old who died from noncardiac trauma.

Background: Autopsies performed on casualties of the Korean War revealed coronary artery involvement in 77.3% of the hearts studied, and data after the Vietnam War noted the presence of atherosclerosis in 45% of casualties with severe disease in 5%, suggesting a decline in the prevalence of coronary atherosclerosis in young men.

Is the left main angulated, stenosed, or "bent" by the guiding catheter?

Exact angiographic and identification of significant stenosis of the left main coronary artery is imperative prior to performing elective percutaneous transluminal coronary angioplasty. A patient is presented with an apparent angiographically significant, but physiologically insignificant, left main stenosis. Both angiographic and physiological methods of detecting "false positive and negative" left main stenoses are discussed.

Randomized trial of late elective angioplasty versus conservative management for patients with residual stenoses after thrombolytic treatment of myocardial infarction. Treatment of Post-Thrombolytic Stenoses (TOPS) Study Group.

Background: After thrombolytic therapy for patients with acute myocardial infarction (MI), percutaneous transluminal coronary angioplasty (PTCA) is frequently performed because of the presence of a "significant" infarct vessel stenosis demonstrated at predischarge coronary angiography. Several studies have shown PTCA performed early after thrombolysis to be unnecessary or even harmful. However, PTCA in these trials was generally performed 1-3 days after MI, when the milieu in the infarct artery may be unsuited for PTCA, and the incidence of major ischemic complications was high.

A prospective randomized study of 4.1 French catheters utilizing the percutaneous right brachial approach for the diagnosis of coronary artery disease.

To determine the utility of 4.1 French (F) catheters in diagnosing coronary artery disease, 50 patients were randomized to 4.1F Multipurpose or Judkins catheters utilizing the percutaneous right brachial approach.

Left ventricular diverticulum: case report and review of the literature.

We describe two patients with left ventricular diverticula which were seen during routine left ventriculography. The diverticula were probably incidental findings and asymptomatic. A review of the literature to determine associated cardiac and extra-cardiac abnormalities and related morbidity and mortality with emphasis of potential treatment strategies is presented.

Multicenter evaluation of a new fixed-wire coronary angioplasty catheter system: clinical and angiographic characteristics and results.

Coronary angioplasty is increasingly used as an attempt to revascularize patients with severe coronary artery disease. To determine the efficacy of such treatment, a new fixed wire angioplasty catheter was evaluated by a multicenter group in a non-randomized fashion in 50 patients, average 58 +/- 11 years (+/- 1 SD), 58% men. Forty-four percent had a prior revascularization procedure (28% angioplasty, 16% coronary bypass surgery), 38% had a prior Q-wave myocardial infarction, 43% had grade 4 angina, and 60% multiple vessel disease.

Preliminary experience with 5 and 6 French diagnostic catheters as guiding catheters for coronary angioplasty.

With the reduction in profile of balloon dilation catheters, until recently, it has been the internal dimensions and performance of the guiding catheter that has mandated the use of 7, 8 or 9 French (F) systems for the performance of percutaneous transluminal coronary angioplasty (PTCA). A new 5F catheter design (Sherwood Medical Co., St.

Fluoroquinolones. New miracle drugs?

Fluoroquinolones are the newest antibiotics for treatment of some infections caused by highly resistant bacteria (eg, Pseudomonas aeruginosa). Clinically sound indications for these drugs include resistant infections of the urinary, intestinal, and respiratory tracts; otitis externa; osteomyelitis; foot infections in diabetic patients; and late infections complicating burns. Fluoroquinolone therapy is not indicated in children younger than 12 years old and patients with foreign bodies, abscesses, pelvic inflammatory disease, or infections requiring a prophylactic antibiotic.

Psychotherapy and career counseling: toward an integration for use with college students.

The authors suggest that psychotherapy and career counseling with college students can be identified as potentially concurrent and interactive processes. They seek to increase awareness of this connection and underscore the value of its application when it is appropriate to do so. Selecting a career is a crucial developmental task for young adults and is, to varying degrees, an integral part of their psychosocial adjustment.

Failed elective percutaneous transluminal coronary angioplasty requiring coronary artery bypass surgery. In-hospital and late clinical outcome at 5 years.

This study was performed to define the in-hospital and late clinical outcome at 5 years in 430 patients who had a failed elective percutaneous transluminal coronary angioplasty (PTCA) and underwent coronary artery bypass graft (CABG) surgery during their hospitalization. This group comprised 5.9% of 7,246 patients undergoing elective PTCA.

Outpatient left heart and coronary arteriography. The current practice at the University of Louisville School of Medicine.

The extension of coronary arteriography into the out-patient population provides more rapid assessment and determination of severity of coronary artery disease in a primary care and referred base population. The speed of the procedure and reduced recovery period are reflected in enhanced cost containment and improved patient compliance and satisfaction. Further technological advancement in this rapidly developing technological field continues to provide improved patient care.

Preliminary results utilizing a new percutaneous transluminal coronary angioplasty balloon catheter.

We report our initial experience with a new percutaneous transluminal coronary angioplasty (PTCA) balloon catheter and compare it to a similar over-the-wire system in a retrospective, nonrandomized fashion. There was no statistical difference in pre-PTCA angiographic indices and post-PTCA angiographic and clinical success rates between the two groups. There was a trend toward a decrease in length of fluoroscopy (P = .