[Transesophageal echocardiography in cardiogenic shock in acute posterior wall infarct with rupture of the papillary muscles]

A 63-year-old male patient suffered an acute myocardial infarction entirely confined to the posterior wall. As symptoms persisted and cardiogenic shock developed immediate heart catheterization was performed, which demonstrated an occlusion of the left circumflex branch. Right-heart catheterization demonstrated an enlarged v-wave. Thus, acute infarct associated mitral regurgitation was suspected. In the catheterization laboratory transesophageal echocardiography including Doppler- and contrast echocardiography was then performed, which revealed the diagnosis of posterior papillary muscle rupture. The patient proceeded immediately to emergency surgery during which mitral valve replacement with a St. Jude prothesis was performed in addition to venous bypass revascularization of the occluded and a further stenosed coronary artery. The postoperative follow-up was without any complications and the patient recovered satisfactorily from the acute event. This case demonstrates the excellent diagnostic utility of emergency transesophageal echocardiography in the situation of infarct related myocardial rupture, which has to precede the life-saving operation.

[The venous aneurysm]

Venous aneurysms are rare: only 311 cases of venous aneurysms and 56 cases of aneurysms in vein transplants have been reported since 1939 to date. 62% of the patients suffering from venous aneurysms were less than 40 years of age. The most frequently involved vessels were the internal jugular vein (n = 56), the portal vein (n = 28), the v. saphena magna (n = 30) the popliteal vein (n = 23), the azygos vein (n = 22) and the vena cava superior (n = 20). The diameters of the aneurysms were between 1 and 16 cm. Symptoms, if at all noticeable, depend on the localisation of the aneurysm, but they are unspecific in the majority of cases. The most frequent finding was the space- occupying growth seen in 190 patients (52%). Pulmonary embolisms originating from venous aneurysms were seen in 19/311 (6.1%), a rupture of an aneurysm in 4/311 (1.2%) of the venous aneurysms and 5/56 (8.9%) of the aneurysms in transplant veins, respectively. and were fatal in 1 (0.3%) and 2 (3.6%) of the cases, respectively. Of the 205 patients who were operated on, 3 (1.5%) died from intraoperative complications.

["Coral reef" arteriosclerosis: computed tomographic and angiographic findings]

Patients suffering from "coral reef arteriosclerosis" are presented, the lesions being visualised via CT and angiography. This disease is characterised by an almost complete occlusion of the median ventricular aorta due to extreme, irregularly structured calcareous masses in the vascular lumen. The review of the literature points to the possible aetiology and pathogenesis of this disease pattern.

[Local fibrinolytic therapy of vascular occlusions in the pelvic-leg area and the upper extremity]

Seventy-three patients with vascular occlusions in the pelvis or lower limbs and three patients with upper limb lesions were treated by local low dose fibrinolysin, with strict control of any possible bleeding tendencies. Adequate recanalisation was obtained in 56 patients (73.6%). In ten patients, the occlusion recurred while the patient was still in hospital. After four to six months, 37 of the 56 (67%) of the vessels were still patent. In 18 patients, peripheral emboli resulted in some deterioration, but in 15 of these cases this could be treated successfully by operation. The methods and indications of local fibrinolysis therapy and the problems associated with it are discussed.

[Computed tomography of malignant stomach tumors]

Forty-four patients with malignant disease of the stomach (41 carcinomas, three non-Hodgkin lymphomas) and two patients with chronic gastric ulcers were examined by computer tomography before undergoing surgery. The ulcers, the non-Hodgkin lymphoma and the carcinomas stages pT2 to pT4 were easily demonstrated, as well as 66% of carcinomas in stage pT1. In addition to the primary tumour, it was possible to recognise lymph node and organ metastases. Two of the 46 patients were not submitted for surgery because of extensive metastases.