Acute left anterior descending artery occlusion in a hemophiliac A patient during recombinant factor VIII infusion: treatment with coronary angioplasty.

Acute myocardial infarction in association with the replacement of recombinant factor VIII in hemophiliacs has not been documented. We describe the use of PTCA in a hemophiliac A patient who developed acute myocardial infarction during factor VIII replacement. Because surgery in hemophiliac A patients remains hazardous, PTCA seems to be an attractive alternative.

Paradoxical embolism-report of a case involving four organ systems.

Paradoxical embolism through a patent foramen ovale (PFO) can involve multiple organs simultaneously. The most commonly involved sites are the cerebrum and the extremities. Paradoxical embolism to coronary arteries or upper extremities is relatively uncommon.

Vasoseal hemostasis following coronary interventions with abciximab.

Femoral arteriotomy management using a collagen vascular hemostasis device (VasoSeal, Datascope Corporation, Montvale, New Jersey) was studied in 50 consecutive patients following interventional coronary procedures performed with abciximab (ReoPro, Eli Lilly and Company, Indianapolis, Indiana). Low-dose weight-adjusted or no heparin was employed. The first 25 patients were permitted to sit up after 6 hours with ambulation the following day.

Normal electrocardiogram with total occlusion of the left anterior descending coronary artery.

Total occlusion of the left anterior descending coronary artery is usually characterized by ST-segment elevation in the anterior leads of the surface electrocardiogram. We report a case of a patient who had a persistently normal electrocardiogram throughout his hospitalization despite the angiographic findings of total occlusion of the left anterior descending coronary artery and no collateral vessels. Percutaneous transluminal coronary angioplasty with stent placement was performed successfully.

Acute profound thrombocytopenia without bleeding complications after abciximab administration.

Abciximab (c7E3) is the Fab fragment of the chimeric monoclonal antibody directed against glycoprotein IIb/IIIa found on the surface of platelets. It is the first FDA-approved platelet receptor glycoprotein inhibitor. Severe thrombocytopenia (defined as platelet count < 50 x 109/L) on first administration is a rare complication, occurring in only 1.

Dorsalis pedis artery aneurysm: case report and literature review.

The presentation, diagnostic evaluation, and treatment of a patient with a dorsalis pedis artery aneurysm is discussed, and the literature is reviewed on this rare entity.

Hepatocellular injury in a patient receiving rosiglitazone. A case report.

Background: Rosiglitazone maleate (Avandia, SmithKline Beecham, Philadelphia, Pennsylvania) is a new oral hypoglycemic agent approved for the treatment of type 2 diabetes. It acts primarily by increasing insulin sensitivity. In controlled trials, there has been no evidence of rosiglitazone-induced hepatocellular injury.

Abciximab readministration: A single-operator community-hospital experience.

Abciximab, a monoclonal antibody to the platelet glycoprotein IIb/IIIa receptor, reduces ischemic complications of coronary interventions after first administration. In this study, We sought to determine whether readministration of abciximab is associated with equal efficacy and safety. We retrospectively reviewed the charts of 35 patients who received two doses of abciximab at separate intervals.

Molecular advances in cardiac and cardiovascular disease.

Recent advances in the field of molecular biology have led to a better understanding of the pathological mechanisms of cardiovascular disease. The impact of these findings will shape the future of treatment modalities for cardiovascular disorders. Postulated targets and biological rationale of new techniques are being developed in a race towards molecular therapies for vascular diseases.

Massive spontaneous hemoperitoneum of unknown etiology: a case report.

Massive spontaneous hemoperitoneum has been infrequently presented in the literature. Only very seldom has this phenomenon been described without eventual discovery of an inciting event. We discuss a case of massive spontaneous hemoperitoneum in a 21-year-old healthy white male presenting with nausea, abdominal pain, and mild distention.

The dynamics of education: making a match.

The education process when applied to the renal population offers challenges to the health educator. Complexity of information, the numerous and often changing diet restrictions, along with the learning abilities of clients present potential obstacles to the education process. Selecting materials that match the client's learning abilities can enhance learning outcomes.

Vasoseal hemostasis following coronary interventions with Abciximab.

Femoral arteriotomy management using a collagen vascular hemostasis device (VasoSeal) was studied in 50 consecutive patients following interventional coronary procedures performed with Abciximab (ReoPro). Low dose weight adjusted or no heparin was employed. The first 25 patients were permitted to sit up after 6 hours with ambulation the following day.

Lipoproteins and coagulation.

A broad range of molecular and cellular interactions contribute to various pathophysiological alterations in haemostasis. Recent studies have shown strong links between lipoproteins and coagulation factors. Findings suggest that lipoproteins play an important role in the fibrinolytic and thrombogenic mechanisms that influence the risks of patients in acute coronary syndromes.

Effect of temperature on pressure-volume hysteresis of excised lungs.

The objective of this study was to determine if the effect of temperature on excised lung pressure-volume (P-V) hysteresis during various P-V maneuvers would be consistent with predicted effects based on the recruitment-derecruitment (R-D) model of lung P-V hysteresis. Three sets of P-V curves were recorded for excised rat lungs at (1) 24 degrees C, (2) either 42 degrees or 45 degrees C, and (3) 24 degrees C. After full inflation of the lung, deflation-inflation (D-I) cycles were performed between total lung capacity (30 cmH2O) and successively decreasing end-expiratory pressures (EEPs).

Self-paced learning stations for tuberculosis respirator training: report of a pilot program.

Background: In response to the Centers for Disease Control and Prevention's recently issued "Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Facilities, 1994," during May 1994 we implemented and evaluated a pilot tuberculosis respirator training program that used four self-directed learning stations, through which participants proceeded at their own pace. Employee tuberculin skin testing was included in the training program.

Methods: The time required to train each employee was recorded.

Lipoproteins in heart disease.

Most lipids are carried in the circulation by lipoproteins. Lipoproteins and their associated proteins, called apolipoproteins, are currently being studied in an effort to further our understanding of atherosclerotic cardiovascular disease. Lipoprotein assembly, secretion, transportation, modification and clearance are essential elements of healthy lipid metabolism.

Two techniques of creating periumbilical incisions during laparoscopic surgery.

Insertion of a periumbilical port is an integral part of laparoscopic surgery. It is often difficult to avoid bevelling of the skin when the semicircular periumbilical incision is made. We used two simple techniques for creating a uniform periumbilical incision.

Method of salvaging long-term dialysis catheters.

Hemodialysis is an important component of chronic renal replacement therapy, which is increasingly being provided with indwelling venous catheters. Catheter malfunction is commonly dealt with using Urokinase instillation or endovascular catheter stripping. We describe the application of a simple technique that allows the indwelling dialysis catheter to be replaced in a subcutaneous tunnel following manipulation for flow problems.

Slip knot for tying monofilament nylon sutures.

The integrity of the suture and the knot is important during the early phase of laparotomy wound healing. When monofilament suture is used, the initial anchoring knot can have varying configuration. We present a simple and rapid technique of placing this anchoring knot with a modified "slip knot.

Computer-assisted antimicrobial surveillance in a community teaching hospital.

A computer-assisted, pharmacy-managed antimicrobial surveillance service is described. Rising drug costs and inappropriate use of antimicrobial drugs led to the January 1994 implementation of an antimicrobial surveillance program at a 369-bed community teaching hospital. A computer interface between the pharmacy and microbiology laboratory data-bases was established that allows pharmacists quick access to culture and susceptibility test results and provides timely reports identifying patients for whom intervention may be necessary.

The utility of the CCK DISIDA scan in the treatment of occult biliary tract disease.

The vast majority of biliary tract disease is correlated with calculi, and the diagnosis of biliary disease is made simpler when calculi are detected. There are good screening studies for the detection of calculi; however, a reproducible objective test for biliary tract disease in the absence of gallstones has been lacking. Occult biliary tract disease should be considered when symptoms typical of biliary tract disease are present, gallstones cannot be demonstrated, and other diseases have been ruled out.

Percutaneous endoscopic gastrostomy: a community hospital experience.

Percutaneous endoscopic gastrostomy (PEG) is a well established procedure for establishing a feeding port in patients unable to take oral nutrition. As these patients are often elderly with multiple ailments, mortality due to comorbidities is common. This retrospective study reviewed the experience with PEG in a community hospital, with particular attention paid to morbidity and mortality rates.

Uterine artery ligation in the control of postcesarean hemorrhage.

The technique is described for devascularizing the post-cesarean section uterus with bilateral mass ligation of the ascending branches of the uterine arteries and veins. This 30-year clinical experience with 265 patients includes the results and complications. Ten patients required additional therapy.