[Clinical outcome of intramyocardial dissecting hematoma after acute myocardial infarction].

Objective: To observe the clinical outcome of intramyocardial dissecting hematoma (IDH) after acute myocardial infarction (MI). Methods: The clinical characteristics and outcomes of nine patients with IDH after acute MI in Beijing Anzhen Hospital from 2010 to 2014 were retrospectively assessed, and all the patients were followed up. Results: The mean age of nine IDH patients (7 males, 2 females) was (61±5) years. One patient was diagnosed as right ventricular IDH and died before surgery because of deteriorated cardiac and renal failure. Eight patients were diagnosed as left ventricular IDH, among whom 1 patient died of perioperative bleeding. The other 7 patients survived, among whom 5 cases were treated medically and 2 cases accepted surgical treatment. After 2-6 years of follow-up, the survived patients had no other complications. Conclusion: IDH after acute MI was a rare clinical event with a high mortality, and improvement of recognition of this rare condition may reduce its mortality, especially the right ventricular IDH.

Clinical experience in anesthetic management for children with mucopolysaccharidoses: Report of ten cases.

The mucopolysaccharidoses (MPS) are hereditary disorders. Children with these disorders have multisystem disease and present significant challenges for the anesthesiologist. The establishment and maintenance of an adequate airway represents the most commonly encountered anesthesia-related problem in these patients. We report ten children with MPS who required surgical intervention. One patient died and the others had a good outcome. In this report, we share our experience and discuss the anesthetic risks and management of MPS patients.

Children with mucopolysaccharidoses--three cases report.

The mucopolysaccharidoses (MPS) are a group of inherited disorders of metabolism, with widespread, progressive involvement and derangement of many organs and tissues. Because of their disabling nature, frequent surgical intervention for the abnormality entailed is common, and is associated with a high degree of anesthetic risks perioperatively. One of the major hazards which we find clinically is airway difficulty. Multiple factors are present in the mucopolysaccharidoses to make airway management and trachael intubation potentially hazardous. Aside from generalized infiltration and thickening of the soft tissues, the oropharynx may be obstructed by a large tongue with tonsillar hypertrophy. Also, the friable mucosa covering the nasal and oral pharynx renders these structures easily to bleed and edematous. The neck is typically short and immobile, and the cervical spine and tempromandibular joint may have a limited range of movement. From our experience, we have learned not to overlook the propensity of airway difficulty. The uniqueness of their anatomy and extremely sensitive airway often result in failed intubation and bronchospasm even after successful intubation. Recently, in Mackay Memorial Hospital we have encountered in series three pediatric cases with mucopolysaccharidoses (one Hurler and two Hunter syndromes). In this report we would like to share our experiences and to discuss the anesthetic risks and management of the MPS patients.

Postoperative myocardial infarction in a patient with perioperative ST-depression--a case report.

Often we ignore electrocardiogram (EKG) evidence of ischemia and no adverse events occur. However, once in a while these ischemic episodes will turn into a full-blown myocardial infarction. Therefore, studying perioperative events which tilt the balance over to postoperative myocardial infarction (PMI) can enlighten our knowledge in postoperative myocardial infarction (MI) prevention. We present a case of ST depression in perioperative EKG evolving into postoperative MI. In this paper we attempt to explore various possibilities which could have altered this patient from her ischemic state into an infracted event.