Emergency portable cardiopulmonary bypass for abrupt left main occlusion during coronary angioplasty. Excellent long-term survival.

A 53-year-old man had total occlusion of the left main coronary artery with subsequent cardiac arrest during attempted angioplasty of the circumflex coronary artery. Conventional resuscitation was unsuccessful. However, emergent portable cardiopulmonary bypass support in the catheterization laboratory contributed to excellent long-term survival. Portable cardiopulmonary bypass support is a valuable resuscitative tool readily available in the catheterization laboratory setting.

Postoperative pericarditis following thymectomy for myasthenia gravis. A prospective study.

Eight consecutive patients who underwent thymectomy for the treatment of myasthenia gravis were evaluated prospectively for the development of postoperative pericarditis. In four of the eight patients (50 percent) pericarditis developed within 48 hours after thymectomy. All four had a three-component pericardial friction rub, two of the four patients had a new postoperative pericardial effusion by echocardiography, and in two typical ECG diffuse concave ST segment elevation and evolutionary ST and T wave changes developed. In the four patients with postoperative pericarditis, a malignant thymoma adherent to the pericardium was found in two, while two patients had a normal thymus histology with no adherence to the pericardium. Thus, postoperative pericarditis was found in both of the patients with a thymoma and in two of six patients without a thymoma. This study demonstrates that a high incidence of pericarditis occurs following thymectomy for the treatment of myasthenia gravis.

Repolarization variant vs acute pericarditis. A prospective electrocardiographic and echocardiographic evaluation.

Patients with ECG nonischemic ST segment elevation were prospectively studied to determine the accuracy of the initial ECG diagnoses. Evaluations were made of 131 consecutive patients by serial clinical, ECG, and echocardiography to establish a diagnosis. Eighty-six (66 percent) had an initial ECG interpretation of repolarization variant. Only three of the 86 (3 percent) subsequently met clinical criteria for acute pericarditis. Analysis of the mean frontal ST segment vector and PR segment depression revealed no significant differences between the 119 patients with final clinical diagnosis of repolarization variant and the 12 with clinical acute pericarditis. The diagnostic reliability of the initial ECG alone as a means of confirming acute pericarditis is low (9/45, 20 percent) but in the detection of repolarization variant is extremely high (83/86, 97 percent).

Tuberculous arthritis of 33 years' duration with destruction of the wrist joint.

We have described an unusual case of tuberculous arthritis with a 33-year history of symptomatic disease and destruction of the left wrist joint. This case emphasizes the chronicity and destructive potential of untreated tuberculous arthritis.