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Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The Southwest German Interventional Study in Acute Myocardial Infarction (SIAM III) investigated potentially beneficial effects of immediate stenting after thrombolysis as opposed to a more conservative treatment regimen.Background: Treatment of acute myocardial infarction (AMI) by thrombolysis is compromised by Thrombolysis In Myocardial Infarction (TIMI) 3 flow rates of only 60% and high re-occlusion rates of the infarct-related artery (IRA). Older studies showed no benefit of coronary angioplasty after thrombolysis compared with thrombolytic therapy alone. This observation has been challenged by the superiority of primary stenting over balloon angioplasty in AMI.Methods: The SIAM III study was a multicenter, randomized, prospective, controlled trial in patients receiving thrombolysis in AMI (<12 h). Patients of group I were transferred within 6 h after thrombolysis for coronary angiography, including stenting of the IRA. Group II received elective coronary angiography two weeks after thrombolysis with stenting of the IRA.Results: A total of 197 patients were randomized, 163 patients fulfilled the secondary (angiographic) inclusion criteria (82 in group I, 81 in group II). Immediate stenting was associated with a significant reduction of the combined end point after six months (ischemic events, death, reinfarction, target lesion revascularization 25.6% vs. 50.6%, p = 0.001).Conclusions: Immediate stenting after thrombolysis leads to a significant reduction of cardiac events compared with a more conservative approach including delayed stenting after two weeks. [ABSTRACT FROM AUTHOR]

Aims Current data concerning the influence of X-ray contrast media on the incidence of thrombotic complications in interventional cardiology are controversial. The effect of ionic contrast media on acute (≤72h) and subacute (≤30 days) stent thrombosis has not been investigated.Methods Three thousand, nine hundred and ninety consecutive patients underwent coronary stent placement. Group I (n=1808) received non-ionic contrast media while group II (n=2182) was given the ionic Ioxaglate. All patients were treated with a standard regimen of aspirin and ticlopidine for 4 weeks post intervention.Results Both acute and subacute stent occlusion occurred more frequently in patients receiving non-ionic contrast media compared to ionic contrast media (acute stent occlusion: 1·3% in group I vs 0·3% in group II, P=0·001; subacute stent occlusion: 2·4% in group I vs 0·7% in group II, P=0·001). The incidence of the combined clinical end-point of coronary artery bypass grafting, target lesion revascularization, and overall mortality within 12 months was significantly reduced by the use of Ioxaglate (22·9% vs 16·3%,P =0·001).Conclusions Based upon these data, we recommend the use of Ioxaglate in coronary interventions when stent placement is anticipated. [ABSTRACT FROM PUBLISHER]

Intensive care unit patients are at particular risk of respiratory failure after major abdominal surgery. Non-invasive ventilation or application of continuous positive airway pressure through a face mask may stabilise respiratory function and avoid the need for endotracheal re-intubation. However; there are various contraindications to non-invasive ventilation and/or tracheal re-intubation, such as recent oesophageal anastomosis, anastomotic leakage or tracheal stenting for tracheo-oesophageal fistula. A specific management strategy consisting of continuous intratracheal jet ventilation to support spontaneous respiratory function is described in two patients with contraindications to non-invasive ventilation or mask continuous positive airway pressure after major oesophageal surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Initiated by a clinical case of critical endotracheal tube (ETT) obstruction, we aimed to determine factors that potentially contribute to the development of endotracheal tube obstruction by its inflated cuff. Prehospital climate and storage conditions were simulated. Methods Five different disposable ETTs (6.0, 7.0, and 8.0 mm inner diameter) were exposed to ambient outside temperature for 13 months. In addition, every second of these tubes was mechanically stressed by clamping its cuffed end between the covers of a metal emergency case for 10 min. Then, all tubes were heated up to normal body temperature, placed within the cock of a syringe, followed by stepwise inflation of their cuffs to pressures of 3 kPa and ≥12 kPa, respectively. The inner lumen of the ETT was checked with the naked eye for any obstruction caused by the external cuff pressure. Results Neither in tubes that were exposed to ambient temperature (range: -12°C to +44°C) nor in those that were also clamped, visible obstruction by inflated cuffs was detected at any of the two cuff pressure levels. Conclusions We could not demonstrate a critical obstruction of an ETT by its inflated cuff, neither when the cuff was over-inflated to a pressure of 12 kPa or higher, nor in ETTs that had been exposed to unfavorable storage conditions and significant mechanical stress.