ABSTRACT
Two patients with early postoperative spasm of a left internal mammary artery bypass graft are described. To our knowledge, this entity has not been reported previously. Both patients were characterized by vasomotor collapse secondary to intractable spasm responsive only to local application of vasodilator agents. Although the mechanism of graft spasm is not clear, prophylactic nifedipine therapy in appropriate dose may be of some value. The profound hemodynamic effect of internal mammary artery spasm in the immediate postoperative period may allow no time for anything other than emergency reoperation to assess the nature of the problem and treat it appropriately.
Subject(s)
Coronary Artery Bypass , Coronary Vasospasm/etiology , Mammary Arteries/transplantation , Postoperative Complications/etiology , Thoracic Arteries/transplantation , Aged , Emergencies , Humans , Male , Mammary Arteries/physiopathology , Middle Aged , Postoperative Complications/surgery , Reoperation , Time FactorsABSTRACT
A 56-year-old man developed procainamide-induced agranulocytosis. Bone marrow aspiration showed the absence of myeloid elements beyond the promyelocyte stage. Procainamide at therapeutic concentrations in vitro depressed bone marrow granulocyte-macrophage colonies (CFUc) while CFUc growth was normal in the absence of drug. Following the patient's recovery, CFUc growth was no longer suppressed by procainamide in vitro. The observations in this patient showing reversible sensitivity to drug contrast with those on other patients with drug-induced agranulocytosis that show persistent marrow injury or drug sensitivity despite clinical recovery.
Subject(s)
Agranulocytosis/pathology , Bone Marrow/pathology , Procainamide/adverse effects , Agranulocytosis/chemically induced , Colony-Forming Units Assay , Colony-Stimulating Factors/pharmacology , Granulocytes/pathology , Hematopoietic Stem Cells/pathology , Humans , Macrophages/pathology , Male , Middle AgedABSTRACT
Two patients developed paraplegia associated with the use of the intraaortic balloon pump. In one patient, transient spinal ischemic episodes ceased after removal of the intraaortic balloon and the second patient apparently sustained spinal cord infarction. Possible etiologic mechanisms include vascular occlusion due to balloon position, arterial spasm, thromboembolic phenomena, hypotension, hypoxia and arterial dissection.
