RESUMO
The deterioration of hepatorenal function due to worsening congestion is relatively common in acute heart failure and carries an independent adverse prognosis. In some patients, the risk of proarrhythmia is increased due to impaired drug metabolism. We described a patient with acute heart failure, polymorphic ventricular tachycardia (VT), and ventricular fibrillation episodes while receiving loading doses of amiodarone for atrial fibrillation. The occurrence of arrhythmia at the background therapy with a relatively safe antiarrhythmic drug in the settings of moderate cardiac, renal, and borderline liver functional impairment demonstrates that careful evaluation of liver and renal function is mandatory for the prevention of proarrhythmia.
RESUMO
The paper reports successful thrombolysis conducted in 64 years old woman admitted to the clinic with clinical and angiographic data for acute surgical abdomen caused by acute tromboembolia of arteria mesenterica superior (AMS). The therapeutic approach required to undertake lifesaving decision on i.e. surgical vs. invasive treatment in conditions of emergency. Finally, it was decided to undertake invasive treatment with successful restoration of blood flow in the related artery. The patient was discharged from the clinic with considerable clinical improvement on the fifth day of her stay. The case report includes discussion on issues relating the consequence of the diagnostic and interventional procedures in such patients, opportunities for conducting emergency thrombolysis in acute embolia of AMS and preventive measures in patients with high tromboembolic risk.
RESUMO
BACKGROUND: Intraoperative Doppler ultrasonography is a non-invasive method with a great potential for the assessment of perfusion in surgery. This study aimed to determine the accuracy of Doppler ultrasonography in the assessment of blood flow on the top of an Akiyama-fashioned stomach tube for esophagus substitution. A secondary point of interest was the real length gained after construction of the gastric tube. MATERIALS AND METHODS: The Ivor-Lewis two stage gastro-esophagectomy was performed in 22 patients with carcinoma of the lower third of the esophagus. Vascularization of the gastric tube was assessed in every patient by Doppler sonographies after every separate step of stomach mobilization. Control arteriographies were performed at 4 major steps of mobilization to evaluate the accuracy of Doppler measurements. RESULTS: Doppler assessment showed a sensitivity of 50 to 95%, specificity of up to 97% and overall accuracy between 95% and 75% during the separate steps of construction of the gastric tube. An approximate length of 4 cm was gained after the final mobilization and tubularization of the stomach. CONCLUSION: Our clinical trial revealed an excellent agreement between the results of Doppler sonography and arteriography. Doppler sonography proved to be a precise technique for the evaluation of stomach perfusion, especially for the needs of tissue viability assessment of the stomach tube in esophageal surgery.