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Complications of catheter cerebral arteriography: analysis of 5,000 procedures. II. Relation of complication rates to clinical and arteriographic diagnoses.

Clinical (prearteriographic) and arteriographic diagnoses were grouped into six categories each for analysis of central nervous system and systemic complications of 5,000 catheter cerebral arteriograms. Within each category, there was no significant difference in complication rate between clinical and arteriographic diagnoses. The highest complication rates (1.2%-1.9%) were in patients with cerebrovascular occlusive disease, posttraumatic or postoperative conditions, and subarachnoid hemorrhage. Significantly lower complication rates (0.2%-0.5%) were found in patients with tumor, seizure or headache, and patients with normal arteriographic findings.

Adult

[The risks involved in the heart catheter examination. A retrospective evaluation of the complications after 700 examinations. II. Complications (author's transl)].

The author reviewed the complications of 700 heart catheterizations in infants and children performed between 1970 and 1978 with a frequency of 55 to 113 investigations per year. Arrhythmias occurred on 70 occasions (10%), death within 24 hours: 14 (2%), extravasation of contrast media: 11 (1,6%), perforation by catheter: 6 (0,9%), cyanotic spells 5 (0,7%), myocardial ischemia: 4 (0,6%), respiratory arrest: 4 (0,6%), convulsions: 2 (0,3%), wound infection: 2 (0,3%), icterus 2 (0.3%), lung atelactasis: 1 (0,15%), bacterial endocarditis: 1 (0,15%), pyrexia: 1 (0,15%), exanthema: 1 (0,15%), pulmonary edema: 1 (0,15%), meningitis purulenta and hepatitis as possible complications: 1 (0,15%) each. The mortality figue of 2% lies well within the range of rates reported by Ho and ass. (1972): 1,5%, Stanger and ass. (1974): 3,0%, Rowe (1978): 0,95%, and Graham (1978): 2,9%. Mortality mainly occurs in sick neonates and infants with complex cardiac malformations. It could be lowered by a more aggressive approach to diagnostic work-up of suspected cardiac disease, as well as by using more sophisticated catheterization techniques and material and by introducing intensive care principles on the infant ward. Catheter related mortality (e. g. by perforation, severe arrhythmia) could be reduced to zero during the last three years. Myocardial staining by contrast media and electrocardiographic alterations suggesting myocardial ischemia occurred comparatively often but were never followed by serious or long lasting sequelae. Their occurrence was not related to the diagnosis or to the age of the patient. Respiratory arrest and convulsions could only be observed in sick infants. The seizures were not directly related to angiocardiography. All other complications were incidental events. Arrhythmias and vascular complications are discussed in separate papers.

Atrial Fibrillation

[Urological and nephrological complications after general surgery. Urological complications. Kidney and ureter].

Urologic complications can result from abdominal, gynecologic, and retroperitoneal operations. As a result, surgical treatment of colonic tumors, genital tumors, the vertebral column, the lymphatic system, and the aortoiliacal vessels assumes a greater importance. Immediate therapy is possible as a result of intraoperative diagnosis. The postoperative diagnosis may become manifest as early or late symptoms. Certain criteria for avoiding such complications are mentioned. Following diagnosis of a urologic complication, immediate therapy seems to produce the best results and the shortest period of hospitalization.

Abdomen

[Participation of vaccinia virus in the pathogenesis of different clinical forms of postvaccinal complications. I. Frequency of vaccinia virus detection in the vaccinted who have usual and complicated reactions to vaccination].

The virological examination of 1365 samples taken from 469 children vaccinated against smallpox revealed considerable differences in the frequency and the time of vaccinia virus detection in different clinical forms of postvaccinal pathology as compared with uncomplicated vaccinal process. During the postvaccinal period taking its normal course vaccinia virus was isolated from 7.3% of children only from the pharynx till day 8 following vaccination. In generalized and creeping vaccinia the virus was isolated from 71.4% of children, in postvaccinal encephalitis from 57.1% of children, in vaccinal angina frove-mentioned complications vaccinia virus was detected in the samples obtained from the patients till days 24, 35, 15 and 24 respectively. The etiopathogenetic role of vaccinia virus in a number of postvaccinal complications is discussed.

Child, Preschool

[pH changes and the K+ and Na+ concentration in the blood of the coronary vein in experimental myocardial infarct complicated and not complicated by ventricular fibrillation].

It was found that following occlusion of the coronary artery in dogs, the rate of increase in K+ concentration in blood plasma draining directly from the focus of ischemia is greater in cases complicated by ventricular fibrillation. Fibrillation always occurs against the background of a decrease in pH and an increase in the K+ level in blood plasma draining from the focus of ischemia. It is suggested that inhibition of the development of disorders of acid-base and ion equilibrium in the myocardium would be an effective means of preventing ventricular fibrillation in the acute stage of myocardial infarction.

Acid-Base Imbalance

[The risks involved in the heart catheter examination. A retrospective evaluation of the complications after 700 examinations. IV. Vascular complications (author's transl)].

The review of 700 heart catheterizations in infants and children revealed arterial occlusion in 30 instances after 175 catheterizations (17,1%), but 29 of them after 88 arteriotomies (32,9%) and only 1 after 87 percutaneous arterial catheterizations (1,1%). In two cases thrombectomy of the femoral artery was necessary, brachial artery occlusion was never felt to indicate surgical intervention. Since percutaneous sheath catheterization is used in combination with systemic heparinization no obvious occlusion occurred after about 80 investigations. This may be due to a minimum of intimal damage by the sheath and prohibition of thrombus growth at the site of puncture. Occlusive thrombosis of the femoral vein has been assessed clinically and sometimes angiographically in 7 cases out of 468 (0,4%). In two older children the vein was explored and thrombectomy performed. All other were cyanotic infants; in two of them femoral vein occlusion became manifest as late as two days after investigation by venous cutdown. Thrombosis of inferior vena cava has never been observed neither early nor late. Venous bleeding occurred in 6 infants after vessel disruption and 1 arterial hematoma in a boy because of incomplete compression of puncture site. In 4 instances the catheter could not be inserted because the vessels were too small or too spastic. One time a spring guide entered a small artery in the groin or small pelvic region. Forceful withdrawal stripped the arter. -- This study reveals that the most frequent complication, i. e. arterial occlusion, after adoption of modern techniques does not occur more frequently than in institutions with a larger number of catheterizations per year.

Arterial Occlusive Diseases

Osteosarcoma complicating Paget's disease of the spine with neurologic complications.

An osteosarcoma with neurologic manifestations complicated Paget's disease of the lumbar spine in a 63-year-old man. Initially without demonstrable metastasis, the patient was treated by decompressive laminectomy followed by radiation and adjuvant chemotherapy (COMPADRI-1 regimen). While such treatment may not be curative, there are significant palliative benefits.

Diagnosis, Differential