Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 1991
Case Reports[Aortobronchial fistulae as late complications following the surgical correction of aortic isthmus stenosis].
Three patients (2 men, aged 39 and 52 years, one woman, aged 47 years) developed hemoptysis 3-19 years after surgical resection of coarctation of the aorta. Digital subtraction angiography in the two men was suspicious of an aortobronchial fistula. An emergency thoracotomy revealed the diagnosis in the woman: she died during the operation of intractable arterial bleeding, the initial operation having been atypical (insertion of a graft extending across the isthmus to the ascending aorta). ⋯ An aneurysm sack at the aortic isthmus was resected and a vascular graft implanted in the 39-year-old man. There have been no further hemoptyses. These cases emphasize the need for including aortobronchial fistula as a cause of hemoptysis.
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Dtsch. Med. Wochenschr. · May 1991
Comparative Study[Prognostic significance of prehospital phase in acute myocardial infarct. Results of the Augsburg Myocardial Infarct Registry, 1985-1988].
Data collected by the Augsburg Infarct Register during 1985-1988 were analysed. There were 3,729 cases of acute myocardial infarct (2,672 men and 1,057 women; mean age 62.8 [25-74] years). Before hospitalization cardiac arrest had occurred in 1,401 persons (38%); resuscitation attempts were made in 494 of them (34%). ⋯ This caused decisive delays. The thrombolysis rate was 24%, if the pre-hospital interval was under 6 hours (mortality rate 6% with, 12% without thrombolysis). The prognosis of acute myocardial infarction could be improved by specific instructions to high-risk patients and their relatives and by widening emergency care provisions.
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Dtsch. Med. Wochenschr. · May 1991
Case Reports[Opening and closing movements of the heart valves in cardiopulmonary resuscitation. Confirmation of the cardiac pump theory ].
Cardiorespiratory arrest occurred in a 64-year-old man with severe triple-vessel coronary artery disease (status after two myocardial infarctions) and heart failure (ejection fraction of 20%). After intubation and starting resuscitation measures, transoesophageal echocardiography (TE) was performed to exclude electromechanical dissociation with ventricular tamponade. During the thoracic compression of closed-chest cardiac massage the aortic valve opened, while the mitral and tricuspid valves closed. ⋯ This is the first time that the wash-out of spontaneous echo-contrast has been reported in these circumstances. It makes it possible, together with the movements of the cardiac valves during thoracic compression, to state precisely the localization and direction of blood flow during closed-chest cardiac massage in man. The observations confirm the correctness of the cardiac pump theory rather than the thoracic pump one.