Compressive neuropathy of the brachial plexus and long thoracic nerve: a rare complication of heparin anticoagulation.

We present a case of a 69-year-old woman who developed brachial plexopathy and long thoracic nerve palsy secondary to compression from a hematoma while receiving heparin therapy for the treatment of a stroke. The patient was treated conservatively with discontinuation of heparin and had complete resolution of her compressive neuropathy. This is the first report of a patient with long thoracic nerve palsy with a brachial plexopathy complicating anticoagulation. We review the literature on hematoma-induced compressive neuropathies and treatment options. Our review concludes by emphasizing the importance of clinical judgment in determining the best therapeutic modality.

Dopamine enhances the phosphaturic effect of PTH during acute respiratory alkalosis.

The phosphaturic response to parathyroid hormone (PTH) is blunted during acute respiratory alkalosis. The objective of the present study was to determine the effect of dopamine on the blunted phosphaturic response to PTH during acute respiratory alkalosis. The phosphaturic response to PTH was determined in thyroparathyroidectomized (TPTX) normocapnic and respiratory alkalotic rats in the absence and presence of the infusion of exogenous dopamine (25 microg/kg/min) or of 3,4-dihydroxyphenylalanine (L-DOPA, 250 microg/kg/min) to increase endogenous dopamine synthesis. In normocapnic rats, PTH infusion (33 U/kg plus 1 U/kg/min) significantly increased the fractional excretion of phosphate (FE(Pi)), from 1.5%+/-0.5% to 28.4%+/-4.0%, (deltaFE(Pi) 26.9%+/-4.1%, n = 11, P<.05); in respiratory alkalotic rats, the increase was from 0.4%+/-0.1% to 11.4%+/-1.7% (deltaFE(Pi) 11.0%+/-1.8%, n = 13, P<.05). However, the phosphaturic response to PTH was attenuated in respiratory alkalotic rats (deltaFE(Pi) 26.9%+/-4.1% vs 11.0%+/-1.9%, P<.05). In normocapnic rats, in the presence of dopamine or L-DOPA infusions, PTH infusion significantly increased the FE(Pi) from 6.1%+/-2.3% to 33.4%+/-8.0% (deltaFE(Pi) 27.3%+/-7.0%, n = 5) and from 3.2%+/-0.6% to 32.5%+/-3.3% (deltaFE(Pi) 29.3%+/-3.2%, n = 7), respectively. In respiratory alkalotic rats, in the presence of dopamine infusion, PTH significantly increased the FE(Pi), from 0.6%+/-0.2% to 19.3%+/-3.3% (deltaFE(Pi) 18.7%+/-3.3%, n = 6); in the presence of L-DOPA infusion it increased from 1.0%+/-0.3% to 20.5%+/-2.8% (deltaFE(Pi) 19.5%+/-2.9%, n = 8, P<.05 as compared with PTH alone). Thus the phosphaturic effect of PTH that was attenuated in respiratory alkalotic rats was enhanced by stimulation of endogenous dopamine synthesis by the infusion of L-DOPA.

Temporal changes in the surgical pathology of prosthetic aortic valves: a study of 157 cases spanning 26 years (1970-1995).

The objective of this study was to identify time-related changes in the types, functional states, and complications of explanted prosthetic aortic valves. All patients having a prosthetic aortic valve replacement at Mayo Clinic Rochester during the years 1970, 1975, 1980, 1985, 1990, and 1995 were identified. By reviewing the medical records and pathologic specimens, 157 valves were classified by type, functional state, complications, and duration of implantation. Among the 157 patients (118 men and 39 women), 48% had mechanical valves, 37% bioprostheses, 14% homografts, and 1% teflon trileaflet. Regurgitation was the most common functional state both overall (69%) and in each year. The mean age of patients at reoperation increased from 53 years in 1970 to 60 years in 1995, during which time the mean duration of implantation increased from 2.7 to 9.2 years. Although mechanical valves represented 70% of explanted aortic prostheses in 1970, they accounted for only 37% in 1995. The percentage of valves failing from structural degeneration decreased, from 58% in 1980 to an average of 36% thereafter, while the percentage for prosthetic aortic endocarditis increased from 0% in 1980 to an average of 19% during 1985, 1990, and 1995. Endocarditis affected men in 19 (83%) of the 23 cases and was caused by staphylococci or streptococci in 18 (78%). The development of newer prosthetic valves, changes in surgeons' preferences for them, and improvements in diagnosis, treatment, and prevention have contributed to temporal fluctuations in the relative frequencies of complications and associated functional states.