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A patient with dilated cardiomyopathy and heart failure was referred for implantation of a biventricular pacemaker. He had received a VVI pacemaker seven years ago for atrial fibrillation with bradycardia. [...]

A patient with dilated cardiomyopathy and aborted sudden death was admitted for repeated shocks from his Guidant Ventak Prizm dual chamber implantable cardioverter-defibrillator (ICD). Interrogation of stored events over the [...]

A 41 year old previously healthy woman presented with left sided motor deficit. Nuclear magnetic resonance imaging of the brain showed a recent ischaemic lesion of the right thalamus. Transthoracic [...]

A previously healthy 42 year old woman was referred after the discovery of a 3/6 diastolic murmur maximal at the aortic region, with vigorous pulsation of the suprasternal notch. Echocardiography [...]

Hepatopulmonary syndrome (HPS) is a frequent pulmonary complication of patients with end-stage liver diseases. HPS is diagnosed by hypoxemia and pulmonary vascular dilatation and is an independent risk factor of mortality. Orthotopic liver transplantation (OLT) is the only factor that modifies the natural course of HPS. Once patients with HPS have been transplanted, their long-term survival rate is similar to transplanted patients without HPS. Consequently, HPS is an indication of OLT whatever the severity of hypoxemia. However, besides the favorable long-term survival of HPS patients with OLT, a high postoperative mortality (mostly within 6 months) has been suggested. The aim of our study was to analyze the incidence of HPS and postoperative outcome after OLT in 90 consecutive patients. All patients were prospectively included and had blood gas analysis to detect HPS. Patients with hypoxemia had contrast echocardiography to confirm HPS. Nine patients had HPS with a 50 ≤ PaO2≤ 70 mmHg. Among them 3 (33%) died while the mortality rate was 9.2% in the group without HPS (7 over 76 patients). In the HPS patients who survived, the syndrome completely recovered within 6 months. In conclusion, our study shows a high postoperative mortality rate following OLT even though the preoperative PaO2 was >50 mmHg in all HPS patients transplanted.

We investigated the events that take place during the postnatal morphogenesis of the lung of the quokka wallaby, Setonix brachyurus, using the light microscope and both the scanning and transmission electron microscopes. The lung of term, newborn babies (joeys) at 3‐days of postnatal life was at late canalicular stage and comprised large airways and tubules separated by thick mesenchymal interstitium. The tubules were lined by a low cuboidal epithelium but had few portions with true gas exchange barrier where capillaries came into close contact with squamous type of epithelium. By the fifth day postpartum, the lung entered the early saccular stage characterised by large air sacs, thinner septa, a better developed double capillary system and conversion of the cuboidal epithelium into a squamous one of type I cells interrupted by groups of cuboidal type II cells with lamellar bodies. Transitory respiratory bronchioles were recognisable toward the end of this stage. Formation of secondary septa started by Day 15, dividing the saccules into several generations of smaller air spaces. There were alternating and concurrent periods of tissue proliferation and air space expansion, followed by septal thinning. Alveolization started from about 125 days postpartum when the first burst of small sized air spaces bounded by septa with a single capillary layer were encountered. By Day 180 the process of alveolization was completed with only occasional septa showing a double capillary system and by Day 210 postnatally, the lung resembled that of an adult. For the first time in a mammal, the canalicular stage was encountered postnatally during lung development. Anat Rec 262:253–265, 2001. © 2001 Wiley‐Liss, Inc.

Coagulation disorders in traumatic-haemorrhagic shock need not represent a simple coagulation problem. They may also occur as a complex of local and disseminated intravascular consumption, dilution, extravascular loss and depressed synthesis of coagulation factors. In the severely bleeding patient with a haemorrhagic diathesis heparin is contraindicated because it does not normalize coagulability immediately. Therefore, it fails to stop haemorrhage and the shock becomes untreatable. Fresh frozen plasma, however, has proved to be suitable as a simultaneous substitution therapy for the coagulation disorder and the hypovolaemic shock. 25 patients suffering from severe traumatic-hemorrhagic shock associated with coagulation disorders and haemorrhagic diathesis were successfully treated with fresh frozen plasma, after conventional shock therapy had failed over a period of 2 hours. The success was documented clinically and by numerous laboratory tests. Thrombocytopenia has only a secondary responsibility for the haemorrhagic state.

Summary Five cases of severe adverse reactions after intragluteal injection are presented. All patients developed extensive necroses of the muscle and skin after an injection of phenylbutazone, corticosteroid, and vitamin B12 in the buttocks. The surgical management was: conservative demarcation of the necrosis, débridement, and plastic surgical closure (illustrated). Although it was postulated that the drugs injected were responsible, in our opinion these complications are due to accidental intra-arterial injection. The technique of ventrogluteal injection (v. Hochstetter) is demonstrated.