Fatal hemothorax from mycotic celiac artery aneurysm.

We present two cases of ruptured mycotic aneurysms infected with Staphylococcus aureus. Each patient had hemoptysis and in each case there was hemothorax caused by a ruptured mycotic aneurysm of the celiac artery. In case 1, the pathogenesis was transient Staphylococcus aureus septicemia infecting an atherosclerotic plaque with subsequent aneurysm formation and rupture.

Malignant fibrous histiocytoma of the pulmonary vein with prolapse through the mitral valve orifice.

We present the case of a 33 year old white woman with malignant fibrous histiocytoma arising from the pulmonary vein and prolapsing through the mitral valve, causing acute heart failure. The patient underwent emergency cardiothoracic surgery with resection of the tumour while on cardiopulmonary bypass. The patient's heart failure improved immediately following the resection, demonstrating the benefit of palliative surgery.

Massive extravasation of traumatically ruptured buttock silicone prosthesis.

Although requests for gluteal implants are unusual in the United States, the use of silicone implants for buttock cosmesis has been described. Complications of this procedure have rarely been reported. There are no reports of long-term follow-up in these patients.

Small, deep pelvic abscesses: definition and drainage guided with an endovaginal probe.

Four small, deep pelvic abscesses were easily drained transvaginally by using an endovaginal transducer for guidance, support, and continuous monitoring of catheter placement. Collections that could not be drained percutaneously or at surgery were effectively managed with this technique. An inexpensive guide (estimated cost, $1.

A mid-sized hospital's experience in indicator data collection.

A hospital pharmacy department's experience in selection and use of indicators for measuring quality of care is described. At a 410-bed community teaching hospital, indicators were selected that would use data the department was already collecting. For the first indicator, "Patients on total parenteral nutrition (TPN) experiencing acid-base disorders," the goal was for no more than 20% of patients on TPN to have blood pH values outside the normal range, but 35% of patients were found to be outside the range.

Efficacy of intraoperative autotransfusion in primary total hip arthroplasty.

The role of intraoperative autotransfusion in diminishing perioperative transfusion requirements was studied in 64 patients undergoing primary total hip arthroplasty. The total transfusions administered in a 3-day perioperative period were tabulated for the study group (in which intraoperative autotransfusion was utilized) and compared to that of the control group. Despite the use of the Cell Saver autotransfusion device, no significant difference was noted between the total units of blood transfused perioperatively in the two groups.

Mitomycin as adjunct chemotherapy with trabeculectomy.

Preliminary experience is reported in using mitomycin to improve the prognosis in trabeculectomy operations considered otherwise likely not to succeed. The medication is applied intraoperatively during an otherwise standard trabeculectomy procedure. Surgery was considered successful if the pressure was lowered to a predetermined target level, the only vision reduction was believed to be on the basis of cataract development, and there was no progression of cupping or visual field loss.

Local hypothermia to prolong safe tourniquet time.

Local hypothermia was studied as a method to safely prolong tourniquet time for reconstructive procedures of the upper extremity. An ice blanket constructed of flannel cloth and cold gel packs was applied to the limb for 45 minutes preoperatively. Seventy-eight patients were evaluated for complications resulting from hypothermia and prolonged tourniquet application.

Physician care for interscholastic athletes in Michigan.

Between January 1989 and March 1989 the athletic directors of the 711 high schools in the Michigan High School Athletic Association were surveyed as to what sports and levels of competition each school offered and what level of medical care was available. Fifty-seven percent of the surveyed schools returned properly completed forms. Sixty-one percent of the schools responding reported having a physician available for at least one team at some time during the year.

Sudden death caused by coronary artery aneurysms: a late complication of Kawasaki disease.

The authors describe three cases (two blacks and one Latin American) of sudden death caused by late complications of Kawasaki disease (mucocutaneous lymph node syndrome). At autopsy each heart contained multiple coronary artery aneurysms with luminal stenosis caused by intimal hyperplasia and thrombi. Although virtually all fatal cases of Kawasaki disease occur within six months of the onset of symptoms, there have been other reported deaths up to 14 years after the acute illness.

Fatal big cat attacks.

Two cases of fatal attacks by large cats are presented. In the first case, a 30-year-old female zoo worker was attacked by a jaguar that had escaped its cage. In the second case, a 2-year-old girl was fatally injured by her father's pet leopard.

Two siblings with Tel Hashomer camptodactyly and mitral valve prolapse.

A brother and sister with Tel Hashomer camptodactyly and mitral valve prolapse are described. Mitral valve prolapse is heterogenous, but appears to occur more frequently in individuals with connective tissue disorders. The presence of mitral valve prolapse as a component manifestation of Tel Hashomer camptodactyly suggests that abnormal connective tissue is a pleiotropic effect of the mutant allele.

Bateman bipolar hip arthroplasty for femoral neck fractures. A five- to ten-year follow-up study.

Displaced femoral neck fractures in 128 patients were treated with cemented Bateman universal proximal femoral bipolar hemiarthroplasties. The follow-up period ranged from five to ten years. In the surviving 49 cases, the average follow-up period was seven years and five months.

Bipolar implant shoulder arthroplasty. Long-term results.

The bipolar shoulder implant (BSI), designed by the senior author in 1975, has an unfixed metal glenoid cup with a polyethylene liner that articulates with a cemented titanium humeral component. The BSI was inserted in 35 shoulders of 33 patients with severe rheumatoid arthritis (20 cases), degenerative arthritis (ten cases), and posttraumatic lesions (five cases). The follow-up period ranged from 24 to 140 months (average, 63 months).

Unexpected death as a result of infective endocarditis.

Thirteen cases of infective endocarditis (IE) diagnosed for the first time at autopsy or, in those patients with a previous diagnosis of IE, not thought to be active at the time of death, are presented. Of the six patients who died within 24 h of the onset of symptoms, two died of obstruction of a valve orifice, two died of sepsis, one died of sepsis and alcoholic cardiomyopathy, and one died of a coronary artery embolus. Of the five patients with symptoms lasting more than 24 h, three died of sepsis and congestive heart failure.

Endoscopic tattooing of the colon. An experimental study.

Methods of "tattooing" the colon endoscopically were evaluated in a series of studies on dogs. Injections were performed through a sigmoidoscope using a 25-gauge sclerotherapy needle. The first phase showed excellent staining with methylene blue; however, after 24 hours the stain had completely diffused and was no longer visible.

Using helium-oxygen mixtures in the emergency management of acute upper airway obstruction.

Helium (80%)-oxygen (20%) mixtures (He-O2) are less dense and less viscous than room air. Respiratory work to overcome upper airway obstruction from a number of pathologic conditions may be reduced by inhaling He-O2 instead of room air. We present the case of a 23-year-old woman with a history of asthma and tracheal angioedema refractory to conventional antiasthma and even immunosuppressive therapy.