A case report of a normal aorta misdiagnosed as type A dissection by modern multidetector computed tomography.

Computed tomography (CT) is generally considered the investigation of choice to exclude acute aortic syndrome. We report an important potentially disastrous misdiagnosis using a modern 32 slice multidetector CT system.

Anaesthesia for patients with cardiac disease. Preoperative management.

Patients with cardiac disease have an increased risk of mortality and morbidity from anaesthesia and surgery. Adequate recognition of cardiac disease and its pathophysiological consequences will lead to appropriate preoperative management, which can greatly reduce these risks to the patient.

Effect of abdominal distension on central and regional hemodynamics in neonatal lambs.

Elevations of intraabdominal pressure (IAP) can occur during surgical repair of gastroschisis and omphalocele and lead to ischemia of abdominal organs. We examined the effect of elevated IAP on central hemodynamics and regional abdominal organ blood flow, measured by radiolabeled microspheres, in 11 pentobarbital-anesthetized neonatal lambs. Stepwise increases in IAP were obtained by inflating a large bag placed intraperitoneally with air to pressures of 15, 20, and 25 mm Hg. Measurements were made at 30 min of elevated IAP and 30 min after deflating the bag. Mean aortic pressure was not significantly altered at an IAP of 15 mm Hg (78 +/- 4 mm HG) (+/- SE) or 20 mm HG (76 +/- 4 mm Hg) compared to baseline (81 +/- 4 mm Hg), but was decreased at the highest IAP (68 +/- 5 mm Hg). Stepwise decreases in blood flow to all abdominal organs, except adrenal gland, occurred with elevated IAP, and blood flows to these organs (except spleen) returned to or above baseline on bag deflation. At IAP of 15, 20, and 25 mm Hg, cardiac output was reduced by 14, 21, and 35%, respectively. Similar percent reductions of renal blood flow occurred. However, regional gastrointestinal blood flow decreased by a greater extent (35, 50, and 54% at each respective IAP). Hepatic arterial blood flow more than doubled at each IAP, but this was not sufficient to maintain total liver blood flow, or presumably total oxygen delivery to liver.(ABSTRACT TRUNCATED AT 250 WORDS)

Ischaemia following selfadministered intra-arterial injection of methylphenidate and diamorphine. A case report of treatment with intra-arterial urokinase and review.

A patient presented with a painful, oedematous, cyanosed hand having injected a solution of diamorphine and methylphenidate into his radial artery. Treatment was started with heparin and vasodilators. Benefit from this was limited and a course of intra-arterial urokinase was instituted. This gave almost total resolution of the injury. The mechanisms producing ischaemia following intra-arterial injection of drugs of abuse and possible treatment are discussed.

Suxamethonium: a new look at pretreatment.

Fifty patients were pretreated with either suxamethonium 10 mg or gallamine 20 mg before an injection of suxamethonium 1 mg kg-1. The effect of the pretreatment upon neuromuscular transmission was monitored by recording the mechanical response of the adductor pollicis muscle to indirect stimulation, using a 2-Hz train-of-four stimulus repeated every 12 s. The pretreatment injection of suxamethonium caused fasciculation in one-quarter of the patients studied. Significant neuromuscular blockade occurred during pretreatment in 16 of the 25 patients investigated. Pretreatment with gallamine 20 mg predictably decreased the efficacy of the intubating injection of suxamethonium, making intubation more difficult. The frequency of muscle pain was similar in both groups.