1/231. A new, safer lasing technique for laser-facilitated coronary angioplasty.in vitro studies during cold pulsed-wave laser angioplasty have demonstrated production of gas bubbles within the target tissue, creation of shock wave and formation of multi-layer dissections accompanied by an increase in the plaque and vessel wall temperature. These processes account for certain complications of coronary lasing, including acute vessel closure, dissections, spasm, and even perforation. The traditional lasing technique in which a large number of pulses is continually emitted across the lesion, may in fact contribute to the development and acceleration of the above mentioned processes. To overcome the shortcomings we have developed a new, safe lasing technique that consists of multiple trains of a small number of pulses each. Between laser sessions the laser catheter is retracted into the guiding catheter and nitroglycerin is injected intracoronary, thus providing time for dispersion of produced gas bubbles, cooling of the target artery, and adequate coronary vasodilatation. This new technique results in a significant reduction of laser associated complications.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
2/231. inhalation of nitric oxide as a life-saving therapy in a patient after pulmonary embolectomy.We describe a 54-yr-old man with cardiogenic shock caused by acute right heart failure after pulmonary embolectomy. inhalation of nitric oxide led to immediate improvement in respiratory and haemodynamic variables. Inhaled nitric oxide can be used to reduce acute right heart failure until conventional therapy can provide successful haemodynamic stability.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
3/231. splenic infarction complicating ligation of a gastroduodenal artery aneurysm.BACKGROUND: Aneurysms of visceral arteries are rare, but may lead to dramatic situations of intraabdominal or retroperitoneal hemorrhage in case of rupture. CASE REPORT: We report the case of a 72-year-old patient who developed a hemorrhagic shock following a total hip replacement due to the rupture of an aneurysm of the gastroduodenal artery. angiography also demonstrated a high-grade stenosis of the celiac trunk. The ruptured aneurysm was ligated as a live-saving procedure, but due to the stenosis in the celiac trunk the patient developed a splenic infarction followed by partial tissue liquefication. This was treated conservatively and after 3 months, the computed tomography showed an atrophic residual spleen. SUMMARY: Diagnostic and therapeutic approaches to visceral vascular aneurysms are discussed including the potential complications of splenic infarction.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
4/231. Postoperative toxic shock syndrome caused by a highly virulent methicillin-resistant staphylococcus aureus strain.We report on a rare fatal case of postoperative toxic shock syndrome caused by infection with a highly virulent methicillin-resistant staphylococcus aureus strain, designated Sak-1, which was found to be characteristic in its increased production of toxic shock syndrome toxin 1 in human whole blood (about 30-fold more than produced in Tod Hewitt broth). The strain also produced a high level of toxic shock syndrome toxin 1 in the circulating blood of mice experimentally infected with the strain.- - - - - - - - - - ranking = 75.695314052337keywords = toxic shock syndrome, shock syndrome, toxic shock, shock (Clic here for more details about this article) |
5/231. Septic shock after liver transplantation for Caroli's disease: clinical improvement after treatment with C1-esterase inhibitor.The extent of complement and contact activation is related to outcome in sepsis. A low functional index of their main blocker C1-esterase inhibitor (C1-INH) is considered as a relative deficiency of C1-INH and might contribute to the development of fatal complications in the intensive care unit. The first results of therapeutic intervention with C1-INH concentrate in septic shock are promising. We report on our experience of C1-INH concentrate administration in a young woman with Caroli's disease as ultimate rescue therapy for septic shock with capillary leakage syndrome after combined liver and kidney transplantation. No focus of infection was detectable and thus surgical intervention was not indicated. Antibiotic therapy at that time included vancomycin, tobramycin, meropenem and fluconazol. Hemodynamic stabilization occurred within hours after administration of C1-INH concentrate. Simultaneously a reduction in vasopressor medication was possible and negative fluid balance was achieved.- - - - - - - - - - ranking = 6.2698896001418keywords = shock, septic shock (Clic here for more details about this article) |
6/231. Cardiogenic shock due to coronary narrowings one day after a MAZE III procedure.A MAZE III procedure was performed on a patient with a small body surface area. On the first postoperative day, the patient developed severe dysfunction of the left ventricle, due to significant narrowings of the right and circumflex coronary arteries in the areas that were cryoablated during the MAZE III procedure. The coronary narrowings were treated by percutaneous transluminal coronary angioplasty (PTCA). At discharge the coronary anatomy was normal again with an almost normal left ventricular function.- - - - - - - - - - ranking = 4keywords = shock (Clic here for more details about this article) |
7/231. A rare case: surviving acute left main coronary artery occlusion in Kawasaki's disease.We present a case of cardiogenic shock due to acute thrombotic occlusion of the left main coronary artery in Kawasaki's aneurysmal coronary artery disease. The patient was treated with PTCA as a bridge to CABG. Because of a persistent low-output syndrome, orthotopic heart transplantation was successfully performed three days later. The patient is alive and well one year after the event.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
8/231. Postoperative pulmonary edema after cervical spine surgery--a case report.Injury of the cervical spine may cause serious complications and neurological sequelae. Recently, a patient with C1-2 spinal cord compression developed pulmonary edema postoperatively associated with unstable hemodynamics, which might result from overzealous fluid administration in order to correct neurogenic shock during anesthesia. Therefore, early recognition and timely use of vasoconstrictors, together with judicious fluid replacement are important in the anesthetic management of patients with cervical spine injury undergoing surgery. In addition, the placement of pulmonary artery catheter is crucial for assessing the cardiac function and fluid status.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
9/231. Symmetrical peripheral gangrene: a new presentation of an old disease.This report concerns two cases and a review of the literature on the subject of symmetrical peripheral gangrene. Symmetrical peripheral gangrene is defined as symmetrical distal ischemic damage in two or more sites in the absence of major vascular occlusive disease. It occurs in patients who are septic and have disseminated intravascular coagulation and in nonseptic patients who have cardiogenic or hypovolemic shock. The syndrome is devastating and rare, and controlled studies of its etiology and management are lacking. Recommendations are presented for its prevention and treatment. Cooperative multicenter studies may be necessary to obtain valid data about its prevention and management.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
10/231. Surgical management of ventricular septal defect complicating myocardial infarction.In an 18 month period six patients were treated by operation for ventricular septal defect occurring as a complication of acute myocardial infarction. Each septal defect occurred within one week of the myocardial infarct but the interval from infarction to operation ranged from 8 days to 7 months. All patients had intractable cardiac failure and two were in cardiogenic shock at the time of operation. Preoperatively right and left heart catheterisation with left ventriculography and biplane coronary arteriography was performed in every case. At operation the principle of "total correction" of all the cardiac defects was followed so that in addition to closure of the septal defect each patient required one or more additional operative procedures such as resection of left ventricular infarct or aneurysm, mitral valve replacement or coronary artery vein bypass grafts. All six patients survived operation but one died four weeks postoperatively from perforation of an acute peptic ulcer. In one patient the ventricular septal defect recurred and was successfully closed four months later. The surviving patients remain well at follow-up.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
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