[Cardiogenic shock in acute myocardial infarction. Time for a more aggressive therapeutic strategy?]. / Kardiogent shock ved akut myokardieinfarkt. Tid til en mere aggressiv behandlingsindstilling?

Cardiogenic shock following acute myocardial infarction results in the death of most affected individuals. Longitudinal data suggest that in spite of modern pharmacological inotropic support and thrombolytic regimes, survival from cardiogenic shock has not improved during the last several decades. However, recent observational and limited randomized trial data indicate that some of these high risk patients may derive particular benefit from aggressive percutaneous or surgical revascularisation procedures. This review analyses currently available treatment strategies which appear to hold promise for the future.

[Mediastinoscopy in bronchogenic carcinoma]. / Mediastinoskopi ved bronkogent karcinom.

During recent years it has been discussed whether mediastinoscopy could be replaced or supplemented by other diagnostic procedures for detection of mediastinal lymph node metastases in patients with pulmonary cancer. The results of 289 mediastinoscopies were analyzed and correlated to thoracotomy in order to evaluate the procedure. Two hundred and six males and 83 females were included in the study. The mean age was 63 years for men and 58 years for women. Mediastinoscopy was positive (N2 disease) in 113 cases (39%) and negative in 176 cases. The 113 N2 patients were not operated upon. One hundred and seven patients (37%) had thoracotomy performed. 12% of these patients had metastases at the time of thoracotomy. Mediastinoscopy is still the most reliable method in selecting patients with bronchogenic carcinoma for thoracotomy. It is important to make a careful dissection during the mediastinoscopy at both tracheo-bronchial angles as well as at the subcarinal. Eleven percent of the metastatic lymph nodes were found only at the subcarinal or at the contralateral tracheo-bronchial angle. Sixteen (5.5%) of the 289 patients are still alive, with a follow up of more than six years. Only resected patients survived.

[Malignant tracheal tumor--differential diagnosis in bronchial asthma]. / Malign trakeal tumor--differentialdiagnose ved asthma bronchiale.

Primary tumours of the trachea are rare and most of the symptoms relate to obstruction of the air passage leading to inspiratory and expiratory stridor. Unfortunately, the inclusion of malignant tracheal neoplasms in the differential diagnosis of onset of wheeze in adults is even more rare than the tumours themselves. We report a case where a tracheal adenoid cystic carcinoma presented symptoms suggestive of bronchial asthma. It is emphasized that delay by the physician in diagnosing tracheal tumours is the principal problem, and that adult patients who experience onset of stridor and dyspnoe and do not respond to accepted medical treatment deserve systematic radiographic and endoscopic evaluation of the entire air passage.

Cervical involvement of diffuse idiopathic skeletal hyperostosis with dysphagia and rhinolalia.

Osteophytosis in degenerative joint diseases of the cervical spine may result in dysphagia. Recently, diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease has also been identified as a cause of dysphagia. A case of DISH with cervical involvement producing dysphagia and rhinolalia is presented. The symptomatology, radiographic features and treatment of DISH involving the cervical region are discussed. The diagnosis of DISH is exclusively radiographic. Recognition of this disorder, unfamiliar to many clinicians, may avoid an unnecessary biopsy procedure of a suspected pharyngeal tumor. Once the diagnosis of DISH is made, a supplemental barium esophagram should be performed to exclude possible coexisting neoplasms. Endoscopy has a definite risk for inducing an inadvertent esophageal perforation and should be avoided, if at all possible. A conservative therapeutic approach is advocated by the authors.