1/90. Catheter-based techniques for closure of coronary fistulae.This study details different methodologies of percutaneous closure of arteriosystemic and arteriovenous coronary fistula. Seven patients underwent transcatheter intervention of 10 fistulas, with 7 fistulas successfully closed: 6 with embolic coil devices and 1 with a covered stent obstructing the fistula ostium. The major complication encountered was one death as a result of device recoil into a major epicardial vessel. Percutaneous transcatheter closure of coronary fistulas appears to be simple, facile, and effective. However, device recoil into an undesired arterial segment, while irritating in a noncoronary arterial tree, may be catastrophic when occurring in an epicardial coronary artery.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/90. Treatment of obsessive-compulsive disorder using clomipramine in a very old patient.OBJECTIVE: To describe the effect of the tricyclic drug clomipramine in a very old patient with obsessive-compulsive disorder and Alzheimer dementia. CASE SUMMARY: A 93-year-old woman had a history of obsessive-compulsive disorder since early adulthood. The obsession consisted of remembering names of famous people and the compulsion consisted of excessive list making. With the onset of memory loss secondary to alzheimer disease, she became increasingly anxious and compulsive as a result of a failure to remember. After nine weeks on fluoxetine she became jittery and more confused. After a two-week wash-out period, she was given a nine-week course of clomipramine that was carefully titrated up to a therapeutic concentration. RESULTS: At the completion of clomipramine treatment, the patient no longer felt driven to recall the names of famous people. Her score from the Yale-Brown Obsessive-Compulsive Scale dropped from 29 to 3. Her Folstein Mini-Mental State Examination score increased from 21 to 23. CONCLUSIONS: clomipramine appeared much more effective and better tolerated than fluoxetine in this very old patient despite its potential anticholinergic effect and the coexistence of alzheimer disease.- - - - - - - - - - ranking = 0.031954878323137keywords = drug (Clic here for more details about this article) |
3/90. Antegrade transcatheter closure of coronary artery fistulae using vascular occlusion devices.Two children (a 9 year old boy and a 2.5 year old girl) with coronary artery fistulae communicating with the right ventricle underwent successful transcatheter occlusion using an antegrade technique. A Rashkind double umbrella device was used in one case and an Amplatzer duct occluder in the other.- - - - - - - - - - ranking = 0.66666666666667keywords = closure (Clic here for more details about this article) |
4/90. Aortic dissection with fistula to left atrium: diagnosis by transesophageal echocardiography with successful repair.The aorta-atria fistula is an infrequent complication of aortic dissection, and it is rarely diagnosed before death. A 41-year-old man who 8 years previously had undergone prosthetic aortic valve replacement had an aortic dissection complicated by aorta-left atrial fistula. This patient had acute left heart failure associated with a systolic and diastolic murmur at the lower left sternal border suggesting an aortic prosthetic malfunction. The cardiac diagnosis was made with transesophageal echocardiography and Doppler color flow imaging; it was notable that the cardiac lesions were not detected by transthoracic echocardiography. On the basis of the echocardiographic findings, the patient underwent successful emergency replacement of the dissecting ascending aorta with closure of the aorta-left atrial fistula. Transesophageal echocardiography is the procedure of choice for defining this abnormality. In this case a prompt surgical repair consisting of replacement of the affected segment of the aorta with the prosthesis and closure of the fistula provided optimum resolution of the clinical situation.- - - - - - - - - - ranking = 0.33333333333333keywords = closure (Clic here for more details about this article) |
5/90. Transient nature of interference effects from heterophile antibodies: examples of interference with cardiac marker measurements.Two-site immunoassay methods have become the standard technique for measurement of a wide variety of drugs, hormones, and cell proteins. One limitation of these methods is their susceptibility to interference from heterophilic antibodies present in the sera of some patients. Human anti-murine antibodies represent a common heterophile antibody that can bind to mouse immunoglobulin and as well as to immunoglobulin from other species. While the mechanism of human anti-murine antibody interference has been well characterized, the time course over which this interference occurs and the susceptibility of different immunoassay procedures to human anti-murine antibody interference from patients with human anti-murine antibody have not been as well described. We report on the time course of interference in assays for cardiac markers for two patients with human anti-murine antibodies. We measured creatine kinase MB isoenzyme (CKMB) and troponins I and T using three different vendors' immunoassay procedures. Our results demonstrate that assay interference due to human anti-murine antibody interference is a transient phenomenon. In one of our patients, human anti-murine antibody interference appeared suddenly, peaked approximately 9 days following its appearance, and gradually resolved over the next 3 weeks. In addition, we found that immunoassay methods from different vendors can show highly variable interference effects when human anti-murine antibody-containing specimens are analyzed.- - - - - - - - - - ranking = 0.031954878323137keywords = drug (Clic here for more details about this article) |
6/90. Iatrogenic main pulmonary artery-left atrial fistula in a child.A 14-month-old boy who underwent operation for ventricular septal defect patch closure and debanding of the pulmonary artery presented with arterial desaturation in the early postoperative period. angiography confirmed the echocardiographic findings of hemodynamically significant main pulmonary artery-left atrial fistula. This communication was successfully closed surgically.- - - - - - - - - - ranking = 0.16666666666667keywords = closure (Clic here for more details about this article) |
7/90. Coronary artery-left ventricle fistula complicating balloon angioplasty--a case report.The authors describe a coronary artery fistula complicated balloon angioplasty. The proximal left anterior descending coronary artery was dilated, but a septal branch was occluded by thrombus. angioplasty was used on the septal branch, but a pseudoaneurysm communicating with the left ventricle occurred. Follow-up angiography revealed spontaneous closure of the fistula.- - - - - - - - - - ranking = 0.16666666666667keywords = closure (Clic here for more details about this article) |
8/90. Intra-atrial thrombus after surgical closure of patent foramen ovale.Patent foramen ovale (PFO) represents a potential path for paradoxical embolism and is associated with cryptogenic stroke. It has been suggested that because a PFO represents a repairable lesion (by surgical or transcatheter methods), repair may be the optimal treatment to prevent recurrent stroke. This report describes a patient with recurrent neurologic and peripheral embolic events, which occurred approximately 6 months after the surgical closure of a PFO. The diagnosis of an intra-atrial thrombus with a small residual PFO was made by subsequent transesophageal echocardiography. Thrombus formation at the closure site needs to be considered in a patient with recurrent embolic events after closure of a PFO.- - - - - - - - - - ranking = 1.1666666666667keywords = closure (Clic here for more details about this article) |
9/90. Cardiac displacement after lobectomy in a patient with a congenital complete left-sided pericardial defect.A 74-year-old man underwent left upper lobectomy for a suspected lung cancer. At thoracotomy, the pericardium was found to be completely absent. The heart was fixed in a central position with an artificial patch to prevent displacement. However, the heart became displaced just after closure of the thoracotomy. The thoracotomy was immediately reopened. The anchor points of the patch on the adventitia of the descending aorta had pulled through. The heart was fixed to the surrounding mediastinal tissues with a larger patch using pledget-reinforced mattress sutures. Because simple closure may result in cardiac herniation due to the cardiac pulsations, congenital pericardial defects should be securely repaired when encountered.- - - - - - - - - - ranking = 0.33333333333333keywords = closure (Clic here for more details about this article) |
10/90. Transcatheter occlusion of a large coronary arterial fistula with new detachable platinum microcoils.We report a 17 year old boy with a large fistula from the right coronary artery to the right ventricle. The fistula consisted of two major branches. The smaller branch could be embolised with three detachable platinum microcoils without problems. The high flow of blood in the larger branch, however, prevented conventional occlusion using coils. Interventional occlusion of this branch was achieved in a second attempt. Following creation of an arterio-venous wire-loop, we advanced a balloon catheter into the distal end of the fistula. Under temporary occlusion of the fistula, complete closure was achieved by delivery of 7 detachable platinum microcoils. Thus, even large coronary arterial fistulas can be closed safely with these new platinum detachable microcoils. The procedure, however, requires temporary control of the flow of blood by balloon occlusion.- - - - - - - - - - ranking = 0.16666666666667keywords = closure (Clic here for more details about this article) |
| | Next -> |