Prevalence of unrecognized acute myocardial infarction in El-Fayoum governorate

The clinical manifestations of acute ST elevation myocardial infarction [AMI] vary considerably. Since it was first described, many epidemiologic studies have shown that silent, atypical or unrecognized AMIs constitute between 20% and 60% of all AMIs. This study was performed to detect the frequency and causes of the initial unrecognition of AMI in El-Fayoum governorate, describe the historical features of those initially unrecognized patients as well as the misdiagnosis made and the treatment prescribed by the initial physicians who examined the patients. This study included 100 consecutive patients with documented AMI admitted to the intensive care units [ICUs] of El-Fayoum City. Detailed history was obtained from each patient including interrogation about their complaints as well as thee diagnosis made and drugs prescribed by the doctors who first examined the patients. Fourty six of the 100 patients with AMI were initially misdiagnosed and treated as having other medical disorders. Nineteen were misdiagnosed as having musculo-skeletal pain and treated by analgesics, 11 were misdiagnosed as having chest disorders and treated accordingly and 10 were misdiagnosed as having gastrointestinal [GIT] disorders and managed accordingly. The misdiagnoses of having anemia, stroke, hypotension and exhaustion were made in 6 patients. Inspite of the recent advances in the laboratory detection of AMI, the history remains of substantial value in suspecting the diagnosis. Continuous training of practicing physicians to recognize the typical and atypical presentations of AMI as well as its various masquerades is needed

Percutaneous metal mitral commissurotomy: initial experience

Although balloon mitral valvuloplasty [BMV] is the preferred percutaneous treatment for mitral stenosis, the technique has shortcomings such as obstruction of the mitral valve during balloon inflation, incomplete mitral commissural splitting, relatively high incidence of mitral incompetence, and high cost of the balloon set. We used a new metallic percutaneous mitral commissurotome [PMC] in 32 patients with severe mitral stenosis, to assess its advantages, disadvantages and complications. This study describes the device, the technique used, and the immediate results. PMC was successful in 26 cases [81.2%], failed in 3 cases [9.4%], and was partially successful [an increase of mitral valve area [MVA] <50%] in 3 cases [9.4%]. MVA increased from a mean of 1.0 +/- 0.1 cm2 to a mean of 2.3 +/- 0.5 cm2 in the successful cases. We experienced no complications with PMC, and no increase in mitral regurgitation in any patient in the study

Laparoscopic cholecystectomy and deep vein thrombosis, risks and prophylaxis

Intraoperative venous stasis may increase the risk for perioperative deep vein thrombosis and pulmonary embolism. To determine if abdominal insufflations during laparoscopic cholecystectomy causes venous stasis, twenty five patients undergoing this procedure had their common femoral veins examined by a duplex scanner to determine time peak blood velocity, circumference and cross-sectional area of the vein, normal pulsatility percent and compressibility before and after abdominal insufflations, then they were examined again immediately after deflation and the day after surgery. The right common femoral veins were catheterized to measure the femoral venous pressures. The results suggested that abdominal insufflation causes venous stasis during laparoscopic cholecystectomies; and measures shown to reduce intraoperative venous stasis, such as pneumatic compressive stockings, may benefit those patients undergoing such procedures