Iatrogenic arteriovenous fistula of the internal mammary artery. Transcatheter intravascular coil occlusion.

We encountered a case of right internal mammary artery to innominate vein fistula following subclavian vein catheterization and the projection of the coil spring was projected after transcatheter intravascular coil occlusion. We were worried about both distal thromboembolism from small thrombi forming on a portion of the coil spring and stenosis of the subclavian artery. However, there was no evidence of thromboembolism of the distal artery, and good patency of the right subclavian artery was shown by an angiogram performed six months later. The patient has been receiving heparin therapy during hemodialysis, which should help prevent thromboembolism of the distal artery.

Surgical and conservative management of esophageal perforation.

A series of patients with esophageal injuries was reviewed to evaluate the role of conservative management of these injuries. Between 1962 and 1978, we treated 108 esophageal injuries. In 74 percent of the cases, the injury was probably iatrogenic. Foreign bodies were the most frequent cause of noniatrogenic esophageal injury. Sixty-eight patients underwent surgery, while the remaining 40 patients received conservative treatment. Of 11 deaths in the series, eight occurred among the surgically treated group. Methods of treatment are discussed, and illustrative cases presented.

Iatrogenic and nurisgenic effects of prolonged immobilization of the ill aged.

The kinesio, phychopathologic and psychosocial effects of prolonged immobilization of the ill aged are outlined. The iatrogenic (physician-induced) and nurisgenic (nurse-induced) factors related to such functional disabilities are described. Illustrative case histories are given. The syndrome is reversible. Thus physicians and nurses have a continued responsibility to support a sustained rehabilitation program for these patients. The biochemical effects of prolonged inactivity indicate that immobilization of the elderly patient results in adverse physical and psychologic phenomena.

Main stem bronchial occlusion in a neonate.

In recent years it has become evident that partial obstruction of bronchi can be acquired postnatally secondary to mechanical trauma caused during prolonged endotracheal intubation. In the presented case, a complete obstruction of the right main stem bronchus developed during the neonatal period despite a relatively short time of intubation. The etiological background is discussed.

The doctor/patient relationship in geriatric care.

Information derived from the relationship of the primary care physician with an older patient provides the best possible way to eliminate or minimize many ethical conflicts that arise in the care of the very old. The conscientious physician can seek information regarding the patient's personal value scheme and his or her expectations and utilize the breadth of available technology to best serve the patient. Many of the issues raised in this article are discussed in much greater detail in subsequent articles. The discussions of the issues they encompass are intended to inform and to stimulate. There is legitimate reason for optimism that, with education and thoughtful review, physicians will be able to improve the manner in which we care for older individuals.

[Long-term survival of patients treated for small cell bronchial cancers]. / Survie à long terme des malades traités pour cancers bronchiques à petites cellules.

Three to 15% of the whole population of patients with small cell lung carcinoma are long-term survivors. In a view of preventing iatrogenic sequellae and obtaining a better definition of therapeutic indications, the prognostic factors in this population will be defined.

Inadequate skin preparation as a cause of intravenous catheter-related infection in the dog.

Eight-eight dogs admitted to the intensive care unit of the University of Pennsylvania School of Veterinary Medicine were studied to determine the frequency of intravenous catheter-related infection. Dogs were randomly assigned to 1 of 2 groups. In group 2, the skin was scrubbed with an iodine soap before final rinsing with alcohol and tincture of iodine. After withdrawal of each catheter, its tip was examined by bacteriologic culture, and the limb was examined for signs of phlebitis. Bacteria were isolated from 24 (48.9%) catheter tips in group 1 and from 6 (15.4%) in group 2 (P less than 0.005). Phlebitis was evident in 6 dogs in group 1, and in 1 dog in group 2. One death occurred in group 1, from causes possibly associated with catheter infection. These data suggest that catheter-related infection may be wide-spread in the dog and that it can be reduced by meticulous skin preparation.

False-positive lung imaging: inadvertent injection into a pulmonary artery catheter.

A case of a ventilation-perfusion mismatch seen post-operatively in a patient with chest pain is reported. There was absence of perfusion to the right lung, with relatively normal ventilation. The study was initially interpreted as indicating a high probability of pulmonary embolus. It was then discovered that the injection had been inadvertently made into a Swan-Ganz catheter, with its tip in the left main pulmonary artery. The mismatch was therefore iatrogenic and not related to pulmonary embolus. The false-positive lung imaging which resulted has not been previously reported in the literature.

[Iatrogenic tissue damage and its treatment (author's transl)]. / Iatrogen bedingte Gewebeschäden und ihre Behandlung

Modern medicine with its manifold therapeutic possibilites brings many side effects which might result in tissue damage. 8 cases of iatrogenic tissue damage seen over a period of 5 years are presented and discussed. Measures for correction and reconstruction are proposed.

[Treatment of coronary artery vasospasm during coronary arteriography]. / Traitement du spasme artériel coronaire pendant l'artériographie coronaire.

Coronary spasm was first demonstrated by Gensini in 1962, and the diagnostic value of spontaneous spasm during coronary angiography is now generally accepted. In its absence, provocation tests with ergonovine or its derivatives form part of routine hemodynamic investigation for confirming the spastic nature of atypical chest pain or pain suggestive of Prinzmetal angina. The coronary spasm so induced gives rise to reduced coronary flow, an increase in coronary resistance and myocardial ischemia as shown by an increased lactate extraction in coronary sinus blood; therefore, once it is documented, it must be treated in order to avoid myocardial necrosis or ventricular arrhythmias. Three groups of drugs of drugs are used to counteract spontaneous or provoked spasm: alpha-blockers, especially phentolamine, nitrate derivatives, trinitroglycerine or isosorbide dinitrate, and calcium inhibitors nifedipine or diltiazem, which have a direct antispastic effect. The hemodynamic and pharmacological actions of these three groups of drugs depend on whether they are given orally, intravenously or by intracoronary injection. Twenty six coronary spasms were observed in 23 patients out of a total of 780 coronary angiographies (3,3 per cent) performed between June 1980 and June 1981: 12 spasms were spontaneous (1,5 per cent), 6 provoked by the catheter (0,8 per cent) and 8 by methylergometrine. There were no complications. Five coronary spasms were also observed during 70 coronary angioplasties (7,1 per cent). The spasm was relieved in all cases by intravenous injection of 1,5 to 3 mg of trinitrin (Lenitral). Calcium inhibitors, especially nifedipine, have been used successfully by Hugenholtz and Bertrand who consider that nifedipine has a slower action and the coronary dilatation obtained is never as great with the nitrate derivatives. Trinitrin remains the treatment of choice for the rapid relief of provoked spasm.

Urethral stricture after transurethral resection.

After 101 transurethral resections, iatrogenic postoperative urethral strictures have occurred in 10 cases due to pathologic changes in the bladder and bladder neck. Urethral stricture after transurethral resection (TUR) thus has represented the most common postoperative complication. No morbidity increase of urethral strictures after TUR could be demonstrated in one of the analysed groups. Fifty per cent of the incidence rate of strictures was localized in the pars pendulans urethrae. Factors causing the stricture have been demonstrated, and the incidence rate of strictures was reduced when these factors were taken into consideration. Preference is given either to conservative or surgical therapy depending on the localization of the stricture, even though endoscopic methods are used more frequently now in the treatment of stenoses of the urethra.