Spinal cord ischemia: an evaluation of pharmacologic agents in minimizing paraplegia after aortic occlusion.

Superoxide dismutase (SOD), barbiturates, and hypothermic crystalloid were evaluated for their effectiveness in minimizing ischemic damage to the spinal cord at 40 minutes of aortic occlusion. Forty-two dogs underwent proximal and distal thoracic aortic occlusion for 40 minutes with infusion of test agents into the occluded segment. The dogs were divided into six groups. Group 1 (n = 6) served as control. Group 2 (n = 6) received hypothermic crystalloid. Group 3 (n = 6) animals received thiopental. Group 4 (n = 7) received SOD. Group 5 (n = 9) received hypothermic crystalloid and thiopental. Group 6 (n = 8) received hypothermic crystalloid, thiopental and SOD. The animals were observed for neurologic deficit for 72 hours. In group 1, six of six dogs showed complete paralysis. Five of six dogs from group 2, five of six dogs from group 3, and five of seven dogs from group 4 showed complete paraplegia. The remaining dogs in these groups showed varying degrees of recovery. Four of nine dogs in group 5 had complete paraplegia, three dogs showed varying degrees of recovery, and two dogs had no neurologic deficit. In group 6, one dog had complete paraplegia, three had partial recovery, and four had no neurologic deficit. Group 6 was the only group that showed significantly less late neurologic impairment than the control group. We concluded that although cold perfusion, barbiturates, and SOD are not protective when used alone, they are effective when all are used in combination. The combination of cold perfusion, barbiturates, and SOD significantly decreases neurologic deficit after 40 minutes of aortic occlusion.

Acute aortic rupture from cross clamp injury.

We report a case of transmural disruption and perforation of the abdominal aorta secondary to clamp injury. The literature is reviewed in reference to the traumatic effects of vascular clamps. Steps are outlined to reduce the risk of this injury.

Ocular manifestations of carotid artery atheroma.

Although carotid endarterectomy (CE) is recommended in appropriate patients with bifurcation atheroma for the prevention of stroke, these patients are also at risk for visual loss, either temporary or permanent. The presentations of patients undergoing 512 consecutive CEs were reviewed to determine the preoperative frequency and risks of ocular disturbances. Visual symptoms occurred in 131 patients (25%). Temporary, monocular blindness (amaurosis fugax, AF) was reported by 99 patients (19%). Concomitant neurologic symptoms were present in 33 (33%) of the patients with AF, and carotid artery stenoses of greater than 75% diameter were documented in 82 (83%) of these patients. No visual deficits were observed following operation. Permanent visual loss ranging from scotoma to complete blindness was documented in 32 patients (6.2%). The permanent deficits were due to retinal artery occlusions (RAO) in 20 patients (4%), ischemic optic neuropathy (ION) in eight patients (1.5%), and homonymous hemianopsia (HH) in four patients (0.7%). Visual loss occurred without any warning in 27 of these 32 cases (84%). The five cases with warning had multiple episodes of AF and then sustained RAO and blindness. Neurologic symptoms occurred concomitantly but not prior to visual symptoms in 7 of the 12 patients (58%) with ION and HH. Stenoses greater than 75% were present in 22 of 32 cases (69%) and in every case of ION. Operation had no effect on the visual deficit. Permanent visual loss occurred in a significant number of patients with carotid atheroma (6.2%). Warning in the form of visual prodroma is uncommon in these patients (16%).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute thrombosis of abdominal aortic aneurysm subsequent to Heimlich maneuver: a case report.

We report a case of acute thrombosis of an abdominal aortic aneurysm secondary to a correctly applied and successful Heimlich maneuver. Although the Heimlich maneuver is generally safe and effective, this possible catastrophic consequence needs to be recognized.

Case report: late rupture of a thrombosed abdominal aortic aneurysm.

A patient with a thrombosed aortic aneurysm, proved by angiography, died of aortic rupture 5 1/2 months after thrombosis. To our knowledge, this is the first reported case of late rupture of a thrombosed aortic aneurysm. This occurrence raises questions about the long-term safety of nonresective treatment of aortic aneurysms.