Acute preload effects of furosemide.

Acute preload effects (as reflected by the pulmonary capillary wedge pressure [PCWP]) of an intravenous furosemide bolus were studied in 33 patients. In those patients receiving no vasoactive drug and in those receiving predominantly preload reducing agents, there was an initial rise in PCWP up until 15 minutes followed by a diuresis-induced fall in PCWP below baseline levels at 1 h. Patients who were receiving preload and significant afterload reduction showed an immediate drop in PCWP which was sustained. This trend is independent of underlying pathology or dose of furosemide used. It is postulated that furosemide causes an early deleterious release of endogenous vasoconstrictors which may be blocked by combined preload and afterload reduction.

Acute lung injury at Baragwanath ICU. An eight-month audit and call for consensus for other organ failure in the adult respiratory distress syndrome.

To test the expanded definition of acute lung injury (ALI), we prospectively, over a period of 8 months, studied all adult ICU admissions who fitted the definition. Our study consisted of 83 patients with the adult respiratory distress syndrome (ARDS) and 60 with mild to moderate ALI. Sepsis and trauma were the most common diagnoses on admission. The overall mortality rate was 45 percent for ARDS and 38 percent in the other group. Mortality rose significantly with associated other organ failure, the incidence of which was as follows: hepatic, 39 percent; cardiac, 38 percent; hematologic, 22 percent; renal, 21 percent; neurologic, 5 percent. Sepsis syndrome eventually occurred in 73 percent and septic shock in 38 percent of all cases of ALI. We found the expanded definition a useful grading system and consider this definition of ARDS to be currently the best. There are, however, problems with the determination of lung compliance, the effect of inverse ratio ventilation, and the lack of consensus in defining other organ failure.

Coronary embolism causing myocardial infarction.

Two cases of myocardial infarction due to coronary embolism arising from bacterial endocarditis are reported. The importance of this condition in the differential diagnosis of myocardial infarction from non-atheromatous coronary artery disease is highlighted and the literature on the subject is reviewed.

Urgent heart surgery for an atrial mass: metastatic hepatocellular carcinoma.

Extension of metastatic hepatocellular carcinoma into the right atrium is exceedingly rare and has a very poor prognosis. We report a case of successful surgical excision of hepatic tumor extension into the right atrium that was causing hemodynamic compromise.

Nonepithelial neoplasms arising within vesical diverticula.

Two cases of rare vesical tumors, a paraganglioma and a malignant fibrous histiocytoma, are reported. The occurrence of these tumors within the urinary bladder is rare; their occurrence within bladder diverticula appears unique. The clinical, radiologic, and pathologic findings are summarized.

Laparoscopic pelvic lymphadenectomy during epidural anesthesia.

This report describes the perioperative management of a 70-year-old man undergoing bilateral pelvic lymphadenectomy. Because of concerns regarding this patient's high risk for myocardial ischemia, the four-hour surgical procedure, which included the formation of pneumoperitoneum, was performed during epidural anesthesia with minimal sedation. The anesthetic implications of pneumoperitoneum during regional anesthesia are discussed.

Saline infusion sonohysterogram as initial investigation of the endometrium and uterine cavity.

The results of 54 consecutive saline infusion sonohysterograms (SIS) are presented. Sonohysterogram, in conjunction with Pipelle endometrial sampling, was found to be a reliable and accurate method of initial investigation of the endometrium and uterine cavity with good correlation with other methods of investigation. It was well tolerated in an outpatient setting, saved two out of three of the women from needing a hysteroscopy and curettage, and yielded information beyond that available from hysteroscopy and curettage.

The young 'elderly' primipara revisited.

A 1970 analysis of labour ward data to determine whether primiparas in the 30 to 34 year age group should be considered 'at risk' due to age was repeated in 1997. Control groups were primiparas aged 20 to 23 and multiparas 2 and 3. Incidence of operative delivery, several other obstetric outcomes and the condition of the infant at birth were compared in various age groups. Both studies showed that the 30 to 34 age group was at increased risk of operative delivery