ABSTRACT
Transesophageal echocardiography (TEE) has increasingly been used in cardiology and cardiac surgery with few reported complications. This study was undertaken to determine whether TEE is associated with an increased incidence of gastroesophageal (GE) bleeding or postoperative GE symptoms of anorexia, dysphagia, or sore throat. Forty-one patients who underwent TEE during cardiac surgery and 40 control patients who underwent cardiac surgery without TEE were prospectively followed. In addition, a retrospective chart review of 200 patients who underwent TEE during cardiac surgery was also performed. The following information was derived from the patient interviews and chart reviews: (1) The development of both frank and occult upper gastrointestinal tract (UGI) bleeding; (2) the patient's preoperative anticoagulation status; and (3) the patient's subjective complaints of anorexia, dysphagia, or sore throat. The incidence of postoperative occult or frank UGI bleeding was not increased in the groups who underwent TEE. Additionally, the incidence of postoperative GE symptoms was comparable in the three groups. These findings are discussed in the context of reported complications associated with UGI endoscopy. Based on this analysis, recommendations for the safe performance of TEE have been provided.
Subject(s)
Echocardiography/adverse effects , Esophagus/injuries , Stomach/injuries , Anorexia/etiology , Anticoagulants/therapeutic use , Cardiac Surgical Procedures , Deglutition Disorders/etiology , Duodenal Ulcer/complications , Echocardiography/methods , Gastrointestinal Hemorrhage/etiology , Humans , Intraoperative Care , Melena/etiology , Occult Blood , Pharyngitis/etiology , Prospective Studies , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
In this report, we present a 53-yr-old man with extensive subcutaneous fat necrosis due to acute pancreatitis presenting as fluctuant collections resembling large multiple abscesses. The diagnosis was suggested by examination of the wound aspirate. Findings included absence of organisms on the gram stain, presence of fat globules on wet mount, and an elevated amylase in the wound aspirate. This dramatic presentation preceded any symptoms or signs of overt pancreatitis.
Subject(s)
Abscess/diagnosis , Fat Necrosis/etiology , Necrosis/etiology , Pancreatitis/complications , Skin Diseases/etiology , Acute Disease , Diagnosis, Differential , Fat Necrosis/diagnosis , Humans , Male , Middle Aged , Skin Diseases/diagnosisABSTRACT
Leukocytes from 200 mentally ill patients and 100 normal controls were analyzed for electrophoretic variants of arylsulfatase A. Four different variant forms were found in 15 subjects. There is a relatively high occurrence of the arylsulfatase A variants in patients with alcoholism. Twenty-one per cent (12/56) of patients with alcoholism have a variant enzyme. Only one of the 100 normal controls has a variant enzyme. (This single subject was considered normal by the criteria of the study, namely, a self-report of no current medical problem or psychiatric history. However, upon further testing, it was found that this subject has neurological and neuropsychological deficits). The hypothesis is presented that chronic alcohol intake and abnormal arylsulfatase A act in concert to elevate sulfatide levels which results in abnormalities of brain function. If this hypothesis is correct, persons in whom abnormal arylsulfatase A is expressed may be at risk to the neuropathological effects of alcohol.
