Staged thrombolysis and percutaneous transluminal coronary angioplasty for unstable and postinfarction angina.

The precise timing of intravenous thrombolysis and coronary angioplasty continues to be evaluated for patients who have coronary thrombosis and unstable angina or postinfarction angina. Coronary angioplasty is effective for these patients but is associated with thromboembolic coronary occlusion in 24% to 29% of cases. After adjunctive intravenous thrombolysis and oral antiplatelet therapy to improve the success rate and to decrease the risk of acute occlusion, deferred angioplasty was successful in three patients with intracoronary thrombus and unstable angina or postinfarction angina. Staged thrombolysis and deferred angioplasty is feasible for selected patients with these acute coronary syndromes.

Aortic dissection with fistula to right atrium. Noninvasive diagnosis by two-dimensional and Doppler echocardiography with successful repair. Case report and review of the literature.

Aortic dissection with rupture into the right atrium is rare, and a high index of suspicion is required for its clinical recognition. The diagnosis should be considered in a patient with chest pain or dyspnea who at presentation has a widened pulse pressure, a continuous murmur, and evidence of right ventricular volume overload, especially when there is a history of a previous cardiac operation. Two-dimensional and Doppler echocardiography can establish the diagnosis and permit early surgical repair of the dissection and fistula.

Polymicrobial cholangitis and Kaposi's sarcoma in blood product transfusion-related acquired immune deficiency syndrome.

Before presenting to the Mayo Clinic, a 24-year-old white woman had received 35 transfusions of blood products over a 72-hour period in February 1981. Two and one half years later, the diagnosis of polymicrobial cholangitis (Cryptosporidium, Candida albicans, and Klebsiella pneumoniae) was established. Further evaluation demonstrated profound helper T lymphocyte suppression, disseminated Mycobacterium avium-intracellular infection with mycobacteremia, and Kaposi's sarcoma of lymphoid tissue, confirming a diagnosis of acquired immune deficiency syndrome (AIDS). This case represents an unusual infectious complication of AIDS. Additionally, this is believed to be the first report of Kaposi's sarcoma occurring in a patient with AIDS associated with blood product transfusion.