[Pericardial tamponade in rupture of a right coronary artery aneurysm]. / Perikardtamponade bei Ruptur eines Aneurysmas der RCA.

Cardiovascular magnetic resonance is a valid and accurate tool for the assessment of structural and functional disorders of the heart. Through combination of morphologic and functional studies, it is possible to form a quick diagnosis with a noninvasive examination. In this case, MR-imaging shows a pericardial effusion and a 5 x 5 cm large, well-circumscribed hematoma with displacement of the right coronary artery, which was also visible with other examination techniques as an unclear intracardial mass. At operation a large aneurysm of the right coronary artery was exposed, in addition to a hemorrhagic pericardial effusion.

Pharyngeal dysphagia in postesophagectomy patients: correlation with deglutitive biomechanics.

BACKGROUND: Because of the transient nature of pharyngeal phase dysphagia, posttranshiatal esophagectomy patients provide a model for studying the correlation of dysphagic symptoms and aspiration with deglutitive biomechanics. METHODS: We studied 8 transhiatal esophagectomy patients (age range, 51 to 78 years) and 8 normal age-matched controls in upright position using lateral and anteroposterior (AP) projection videofluoroscopy during three 5 mL barium swallows. RESULTS: The maximum upper esophageal sphincter (UES) AP diameter and maximum anterior excursion of the hyoid bone in patients with transhiatal esophagectomy who experienced aspiration (6.2+/-0.6 and 9.0+/-2.0 mm, respectively) were significantly smaller than those of age-matched normal controls (9.4+/-0.7 and 17.0+/-1.0 mm, respectively). Resolution of aspiration was associated with a significant increase in AP diameter of the UES as well as anterior and superior excursion of the hyoid bone (p<0.05). CONCLUSIONS: Dysphagic symptoms and aspiration in posttranshiatal esophagectomy patients are associated with significant abnormalities of deglutitive biomechanics. Improvement in deglutitive biomechanics is associated with resolution of dysphagic symptoms as well as postdeglutitive aspiration in these patients.

Various effects of angiotensin II on amygdaloid neuronal activity in normotensive control and hypertensive transgenic [TGR(mREN-2)27] rats.

The effects of iontophoretically ejected angiotensin II (Ang II) on the firing rate of neurons in the basolateral complex and the central and cortical amygdala were investigated in two strains of urethane anesthetized rats. In normotensive Sprague-Dawley rats, Ang II induced a significant increase in the discharge rate of responsive amygdaloid neurons. In contrast, in the hypertensive transgenic [TGR(mREN-2)27] rats with higher brain Ang II level, Ang II more often caused inhibitory effects on the amygdaloid firing rate in comparison with controls. The distribution of nonresponsive, excited, and inhibited neurons differed significantly in the two rat strains. Moreover, the responsiveness of amygdaloid neurons was significantly higher in transgenic rats in comparison with controls. Both the increase and the decrease in the firing rate caused by Ang II could be blocked either by angiotensin AT(1) or by AT(2) receptor-specific antagonists. In many cases, the Ang II-induced decrease in the firing rate was antagonized by bicuculline, a gamma-aminobutyric acid (GABA(A)) antagonist. The higher responsiveness of amygdaloid neurons in transgenic rats as well as the predominance of inhibitory effects, presumedly mediated by GABAergic interneurons, could change the output of the amygdala and its influence on thirst, kidney, and cardiovascular function or on processes of learning and anxiety.

[Treatment of intraoperative status asthmaticus with ketamine]. / Behandlung eines intraoperativen Status asthmaticus mittels Ketamin.

A case report of an intraoperative asthmatic state that was untreatable by conservative methods is described. These methods include elevation of the patient's chest, ventilation with pure oxygen, and administration of volatile anaesthetics, bronchodilative drugs and corticoids. If the patient does not respond to conventional therapy, the bronchial smooth muscle relaxant effect of ketamine should be used.