A rare complication of laparoscopic surgery: iatrogenic arteriovenous fistula with high-output cardiac failure.

SUMMARY: The authors report a 19-year-old man with cardiomegaly and high-output cardiac failure resulting from a hemodynamically significant arteriovenous fistula that was diagnosed 18 months after laparoscopic surgery for an inguinal hernia. The diagnosis was established on clinical examination and by ultrasonography and was confirmed by cardiac catheterization and angiography. The fistula was closed surgically by direct venous suture and reconstruction of the iliac artery with a polytetrafluoroethylene patch. The surgical repair achieved complete closure of the fistula with rapid normalization of cardiac size and function within 8 days.

Haemodynamic changes in patients undergoing high-risk PTCA under protection of transfemoral heart- lung machine support with centrifugal pumps.

Patients with a high risk for myocardial revascularization by cardiological or surgical means can be supported during high-risk PTCA with mechanical circulatory support (supp HR-PTCA). Between November 1994 and June 1997 we performed 28 supp HR-PTCA's under protection of a heart-lung machine (HLM) with femoro - femoral cannulation under regional anesthesia. We approached 2.8+/-1.5 stenoses and 1.7+/-0.6 vessels per patient. Primary success rate was 95 percent of the treated vessels. During unloading, pulmonary artery mean pressure fell to 42+/-29% of the starting value, and LVEDP was decreased to 36+/-42%. Mechanical unloading also resulted in a significant reduction of left ventricular volumes (unloaded LVEDVI and LVESVI represent 76.8% and 76.6% of pre-unloaded values, respectively, p<0.05). All patients except one survived the procedure and could be discharged from the hospital. Femoro-femoral cardio-pulmonary bypass under regional anesthesia provides sufficient protection for high risk PTCA procedures and enables high risk patients to benefit from coronary revascularization.

Coastal Laboratories and Environmental Management Agencies: Building Better Bridges.

This essay will explore how coastal (i.e., marine and Great Lakes) laboratories can be more effective in facilitating collaborations between research and management communities, thereby promoting sounder environmental policies and more effective environmental management.

Turbidity maximum of the northern chesapeake bay.

The turbidity maximum near the head of the Chesapeake Bay is produced primarily by the local resuspension of bottom sediments, and by the estuarine "sediment trap" which is formed in the upper reaches of the estuarine circulation regime by the net nontidal circulation.