A case is described of overwhelming pneumonia in a patient with a history of coughing since three months. Because of hypoxia and hypercapnia that could not be managed by optimal mechanical ventilation, the patient required urgent extracorporeal lung assistance (ECLA, also known as ECMO). Afterwards the diagnosis of full blown AIDS was made. Appropriate antiviral, antibiotic and antimycotic therapy was successfully established. The patient was weaned from ECLA 4 days later, and discharged from hospital after two months.

Antegrade cold blood cardioplegia is equally effective as antegrade crystalloid cardioplegia in a randomized group of patients with preserved left ventricular function who were undergoing elective first coronary artery bypass grafting. Aprotinin administration resulted in lower cardiac troponin I release, whereas electrical defibrillation was related to a higher release irrespective of cardioplegia type. The presence of a main stem lesion resulted in higher cardiac troponin I release in the crystalloid cardioplegia group.

These data indicate that both Na(+)/H(+)-exchange inhibition and aprotinin administration are promising tools for cardioprotection during minimally invasive CABG. A combination of both treatments is able to adequately suppress loss of contractility during early reperfusion as a consequence of reperfusion injury, and results in significantly improved wall thickening at the end of 1 h of reperfusion.

An accurate assessment of patients with potential blunt abdominal trauma should include a safe and reliable method of determining the need for operative intervention because the mortality and morbidity of these injuries are directly dependent on the immediately valid diagnostic work-up. Since peritoneal signs are often subtle, overshadowed by pain from associated injury or masked by head trauma and intoxicants, clinical methods of diagnosis are often unreliable. Since the frequently injured liver and spleen are nowadays more frequently managed nonoperatively, an acute assessment not only of the presence of injury, but also of the nature and extent of the injuries to the intraabdominal organs, raises an increasing demand of both sensitive and specific diagnostic modalities.This article discusses the use of different diagnostic modalities including peritoneal lavage, computed tomography scanning, ultrasound and laparoscopy in the diagnosis and immediate management of blunt abdominal trauma patients, and formulates a trauma protocol for managing these patients.

Impingement of a guide wire is not unusual during complex percutaneous coronary intervention procedures. It is mostly retrieved by endovascular procedures. If not possible, conservative therapy is frequently the next option, leaving the guide wire in place. This case describes the consequence of such an approach 9 months after initial percutaneous coronary intervention. The guide wire migrated through the abdominal cavity and finally perforated the heart. We therefore defend a more aggressive approach if a guide wire is locked in or lost. Surgical retrieval seems to be the best choice. Fixation of the guide wire with a stent is an acceptable alternative in high-risk patients.