Coracoid fracture with recurrent AC joint separation after Tightrope repair of AC joint dislocation.

We present a case of failure of acromioclavicular joint (ACJ) reduction that was performed with low-profile, double-metallic button technique (Tightrope; Arthrex Inc). The patient presented with coracoid fracture and loss of reduction within eight weeks of surgery.

Influence of the breathing mode on the time course and amplitude of the cyclic inter-atrial pressure reversal in postoperative coronary bypass surgery patients.

The haemodynamic basis for paradoxical embolization in patients with stroke and decompression sickness has not yet been fully elucidated. Therefore right and left atrial pressures were measured simultaneously with peroperatively placed catheters after coronary artery bypass grafting in 17 patients with sinus rhythm and normal left ventricular function. Recordings were made both during spontaneous breathing and positive pressure ventilation.

Delayed restoration of atrial function after conversion of atrial flutter by pacing or electrical cardioversion.

It is often suggested but never proven that atrial function is not affected during atrial flutter, nor after its conversion to normal sinus rhythm. To evaluate this hypothesis, a prospective study was performed in 22 patients (age range 20 to 88 years) with atrial flutter. Diastolic transmitral flow was analyzed with echo-Doppler before and after conversion.

Computer-controlled in vitro model of the human left heart.

The decision for surgical intervention in the treatment of stenosis and for regurgitation of the mitral valve demands an objective and quantitative evaluation of the severity of mitral valve disease. The availability of ultrasound techniques capable of analysing flow velocities across valves and to produce representative images of valve orifices has increased the interest in the hydraulics of cardiac valves. To isolate and study the determinants of transmitral flow, an in vitro model of the human left heart was built.

Transoesophageal echo-Doppler in patients suspected of a cardiac source of peripheral emboli.

The initial results of a controlled and partly blinded study aimed at evaluating the accuracy of transoesophageal echo-Doppler in detecting cardiac sources of peripheral emboli are reported. A total of 120 consecutive patients suspected of acute embolic events were entered. After completion of all investigations, the patients were classified into three groups: patients who had definitely not suffered an embolic event (controls; n = 56); patients in whom the differentiation between local thrombosis, embolic event originating from a diseased infarct-related artery or embolic event from a cardiac source was not possible (questionable cases; n = 24) and patients in whom a cardiac source of a definite embolic event was highly suspected (cardiac emboli; n = 40).

Transesophageal echocardiography: a simple method for monitoring the patency of ventriculoatrial shunts. Technical note.

A new method for evaluating the patency of a ventriculoatrial shunt is described, and early experience with it is reported. Transesophageal echocardiography can demonstrate a cerebrospinal fluid leak in the right atrium through the atrial tip of a shunting device. This capability was an incidental discovery, and since then the accuracy of the technique in evaluating the patency of a ventriculoatrial shunt has been prospectively studied in 20 observations of 16 patients.

Transesophageal echocardiography for insertion of a physiological pacemaker in early pregnancy.

A dual chamber pacemaker was implanted during the first trimester of pregnancy in a patient with second-degree heart block and syncope. Transesophageal echocardiography was used to confirm satisfactory position in the right atrial appendage.

Use of dopexamine hydrochloride in patients with septic shock.

The short and long-term hemodynamic effects of iv dopexamine hydrochloride (DPX) were studied in ten patients with septic shock. In the short-term study, a dose-dependent increase in cardiac index and heart rate, and a dose-dependent decrease in systemic vascular resistance were demonstrated. These effects diminished gradually during the long-term study, suggesting a problem of tolerance.

Renal arterial stenosis as a cause of high output cardiac failure.

A patient is described in whom renal arterial stenosis in a functionally solitary kidney led to arterial hypertension and high output cardiac failure. The pulmonary oedema was resistant to conventional drug therapy but showed prompt regression after percutaneous transluminal angioplasty. This case report demonstrates the usefulness of cardiac output measurement in selected patients presenting with hypertension and pulmonary oedema.

Acute cholinesterase inhibitor poisoning mimicking pulmonary oedema.

In patients poisoned with a cholinesterase inhibitor, the diagnosis may initially be missed especially when no history is available from the patient or his relatives. The predominant respiratory symptoms may suggest pulmonary oedema as illustrated by the two case reports presented here. A high degree of suspicion and a careful clinical examination are necessary to make the correct diagnosis, which eventually can be confirmed by measurement of red cell and serum cholinesterase activity.

Thrombolytic therapy and acute myocardial infarction.

Coronary thrombosis and subsequent time-dependent wavefront cardiac muscle necrosis are the pathophysiological hallmarks of an acute myocardial infarction. Early treatment of the thrombus by intravenous thrombolytic therapy results in a major reduction of mortality by salvage of myocardial muscle and preservation of left ventricular function. Although the benefit of streptokinase has been best documented, second generation thrombolytics (APSAC and rt-PA) are probably superior thrombolytic agents.

The initial clinical evaluation of a transesophageal system with pulsed Doppler, continuous wave Doppler, and color flow imaging based on an annular array technology.

The application of transesophageal echocardiography (TEE) offers access to a great deal of important clinical information regarding cardiovascular anatomy and physiology. Two applications which have not been reported and would appear to be of interest are continuous wave Doppler capabilities and the implementation of higher frequency transducers. A TEE system designed at the Institute of Biomedical Engineering in Trondheim, which is based on an annular array technology, offers these capabilities.

Use of dopexamine hydrochloride in intensive care patients with low-output left ventricular heart failure.

The short- and long-term hemodynamic effects of intravenous dopexamine hydrochloride (Dopacard) were studied in 12 patients with low cardiac output left ventricular heart failure. In the short-term study, a dose of 4 micrograms/kg/min produced a 60% increase in cardiac output (p less than 0.001), a 30% increase in stroke volume (p less than 0.

Creatine determinations as an early marker for the diagnosis of acute myocardial infarction.

In the acute phase of acute myocardial infarction (3-8 h after onset of symptoms) an early transient increase in the creatine concentration of serum, saliva, and especially of urine can be observed. Due to the renal threshold, urine values give a much better discrimination between infarction patients and controls than do serum determination. In some patients secondary peaks of serum and urine creatine concentrations can be seen about 24-36 h after hospital admission.

Cardiac output-changes during hemodialysis with ultrafiltration.

Cardiovascular hemodynamics were studied noninvasively before, during and after hemodialysis with ultrafiltration in 18 patients on chronic hemodialysis. The cardiac output (CO) was determined by a continuous wave Doppler method. Overall, no major CO changes were seen (7.

Cuprophan reuse and intradialytic changes of lung diffusion capacity and blood gases.

The changes in arterial blood gas, pulmonary function tests, leukocyte counts and complement activation were evaluated during first use and subsequent reuse of cuprophan dialyzers. The dialysate buffer was bicarbonate. Reuse of cuprophan dialyzers significantly attenuated the fall in leukocyte counts and the rise in C3a des Arg seen during first use dialysis.

[Hemodynamic aspects of bicarbonate dialysis].

About the comparison of the acetate haemodialysis with the bicarbonate haemodialysis different and partly contradictory data are found in literature. In general the bicarbonate haemodialysis is regarded as that variant of therapy which has a less negative influence on the haemodynamics during the dialysis treatment. On 21 patients comparative examinations were performed with the two variants of therapy.

Comparison between ultrasonic and thermodilution cardiac output measurements in intensive care patients.

The reliability of ultrasonic cardiac output measurement was assessed using a commercial device that combines A-mode aortic root diameter determination and continuous wave (CW) Doppler flow velocity measurement in the ascending aorta. We compared this method with thermodilution (TD) cardiac output in 41 intensive care patients. Aortic root diameter measurement with A-mode was not possible in four (10%) patients.

Ventricular pacing via a Swan Ganz catheter: a new mode of pacemaker therapy.

Hemodynamic monitoring via a Swan Ganz catheter is often required with critically-ill patients. In the further course of the illness emergency temporary pacing might be necessary, most frequently for AV-conduction disturbances or sinus bradycardia. Insertion via the right internal jugular vein has been used in many cases.

Paraquat poisoning.

A fatal case of paraquat poisoning is described. Postmortem concentration of paraquat in different tissues reveals that treatment in this case could not prevent lethal tissue accumulation. Although accumulation was more pronounced in renal tissue, lung toxicity caused death.