[A Rare Cause of Acute Coronary Occlusion with Inferior ST-Elevation Myocardial Infarction and Out of Hospital Cardiac Arrest]. / Seltene Ursache eines akuten Koronararterienverschlusses mit ST-Hebungsinfarkt der Hinterwand und präklinischer Reanimation.

HISTORY: The 59-year old female was successfully resuscitated after out of hospital cardiac arrest due to ventricular fibrillation. The ECG after return of spontaneous circulation showed elevated ST-segments in the inferior leads. FINDINGS AND DIAGNOSIS: Acute coronary angiography confirmed a complete occlusion of the right coronary artery without collateral flow. However, a few seconds after intracoronary administration of nitroglycerin complete reperfusion was achieved without persistent relevant stenosis. THERAPY AND COURSE: Stenting of the vessel was withheld. After controlled hypothermia and 68 h on respirator therapy the patient was extubated and showed no persistent neurological disorders. On day 6 she received an implantable cardioverter-defibrillator. Two weeks after the index event the patient could be discharged in good condition. Routine intracoronary administration of nitroglycerin before balloon dilatation or stenting is therefore highly recommended, also in the setting of acute coronary syndromes. Because of the high risk of recurrence, patients resuscitated from lethal cardiac arrhythmia, caused by coronary spasm should receive a cardioverter-defibrillator.

[Venous Paravasation After Augmentation of Pedicle Screws - An Underestimated Risk]. / Venöse Paravasate nach Augmentation von Pedikelschrauben ­ ein unterschätztes Risiko.

Cement-augmented pedicle screws can increase the stability of fixators for unstable vertebral fractures in the elderly. Fixators can be inserted quickly and with minimally invasive techniques, reducing surgical risks. From March 2012 until July 2014, we treated 40 patients with percutaneous augmented fixators for unstable vertebral fractures. Average age was 77.5 years. During the six month observation period, no patients died. There were no neurological deficits. On VAS, average pain decreased from 8.5 to 4.1 points postoperatively. The average Cobb angle of 4.1° was improved after surgery. After 6 months, bony consolidation yielded angles of 1 to 4°, average 2.6°. There was often venous extravasation of cement leaking from the augmented vertebrae, even extending to pulmonary embolism. The emboli were usually asymptomatic. We report a case where the patient required resuscitation immediately after cement application because of pulmonary emboli. The patient survived because of the immediately implemented critical care measures. Little has been published about this risk, which is underestimated despite increasing numbers of augmented fixator operations. The risk can be reduced with slower cement injection, smaller cement applicators, and short term positive pressure ventilation with PEEP.

[Pay for performance approach and its possible future influence on revenues in German interventional cardiology units]. / Der "Pay-for-Performance"-Ansatz im Krankenhausstrukturgesetz.

Pay-for-performance in German health care system is still uncommon but--in view of scheduled legislative projects--could gain more influence in future. Beside others, risc adjusted in-hospital mortality and the door-to-ballon-time inpatients with ST-elevation myocardial infarction could become quality- and performance indicators in interventional cardiology units. As a result, process optimization based on these indicators could have an impact on both patient value (as already today) and revenues (from 2017 onwards).