Pneumopericardium associated with laparoscopy.

This case report describes a rare but potentially serious complication of pneumopericardium occurring during diagnostic laparoscopy. Contributing factors and possible etiologies are discussed.

The value of pulmonary artery and central venous monitoring in patients undergoing abdominal aortic reconstructive surgery: a comparative study of two selected, randomized groups.

One hundred two patients undergoing abdominal aortic reconstructive surgery were prospectively, randomly allocated to two groups, one of which was monitored with a central venous catheter and the other with a pulmonary artery catheter. Patients with uncompensated cardiopulmonary or renal disease were excluded from the study. General anesthesia was administered for the surgical procedure, and the patients were followed through hospital discharge. No statistically significant differences occurred between the two groups with regard to morbidity (perioperative cardiac, pulmonary or renal sequelae), mortality rate, duration of intensive care, postoperative hospital stay, or cost of hospitalization. The one statistically significant difference between groups was the professional fee charged for anesthetic care, which was higher for patients with pulmonary artery catheters than for those with central venous catheters. In conclusion, we prospectively gathered data from most patients presented for abdominal aortic reconstructive surgery. Our data seem to indicate that the choice of central venous catheter or pulmonary artery catheter monitoring makes little difference in outcome after abdominal aortic reconstructive surgery, and that for many patients pulmonary artery catheters are not necessary to give appropriate, adequate care. Because of the size of the sample, however, declarations of epidemiologic significance would be unfounded. Therefore large-scale, multicenter studies addressing such outcomes remain necessary.

Electroconvulsive therapy--induced hemodynamic changes unmask unsuspected coronary artery disease.

Electroconvulsive therapy (ECT) is known to produce increases in heart rate and blood pressure during seizure activity due to sympathetic stimulation and systemic catecholamine surges. These intense, brief hemodynamic changes can adversely affect myocardial oxygen supply and demand. In patients with compromised myocardial circulation, ECT can unmask undiagnosed cardiac disease. In this case report, ECT was performed on a 64-year-old white male with negative cardiac history. The patient awakened complaining of chest pain and ST wave depression was noted on the electrocardiogram. Cardiology consultation and cardiac catheterization were followed by coronary artery bypass surgery for significant coronary artery stenosis prior to resumption of ECT treatments. The physiological changes that occur during ECT are discussed, as well as pitfalls in evaluation of these patients for ECT treatment.

Intraoperative urinary output and postoperative blood urea nitrogen and creatinine levels in patients undergoing aortic reconstructive surgery.

Urinary output has been used as a measure of adequate renal perfusion during anesthesia and surgery. In this study, 40 consecutive patients undergoing elective aortic reconstruction were studied to determine whether intraoperative urinary output was predictive of postoperative renal function as measured by blood urea nitrogen (BUN) and creatinine concentrations on postoperative days 1, 3 and 6, or 7. Pulmonary capillary wedge pressures or central venous pressures were kept at or above preoperative values. All patients received 22.5 g of mannitol IV prior to aortic crossclamping. No significant correlation was noted between either mean intraoperative urine output or lowest hourly urine output and postoperative BUN and creatinine concentrations. Complete interruption of renal blood flow in nine of the 40 patients had no significant effect on the correlations. Consequently, intraoperative urine output does not appear predictive of postoperative renal insufficiency in patients undergoing elective aortic reconstruction.

Argentophilic papillae of Schistosomatium douthitti cercariae (Trematoda: Schistosomatidae).

Argentophilic papillae of cercariae of Schistosomatium douthitti were studied by light microscopy. The basic number of body papillae was 56, excluding 20 at the anterior tip. The average number of tail papillae was 18. Average locations and spatial ranges of body papillae indicate a rather constant pattern. Tail papillae showed greater variability in location. Twenty papillae (10 on each side) at the anterior tip of cercariae were associated with gland duct openings. Two types of papillae were recognized with light microscopy--uniciliated bulbs and pits. The papilla pattern of S. douthitti differs from those of other species of schistosomes derived to date, and its constancy supports the usefulness of papillae in systematic studies.