Intravenous leiomyomatosis is a rare tumor in which benign smooth muscle cells grow into the pelvic venous channels of female patients. A case of intravenous leiomyomatosis with cardiac extension in a 45-year-old woman is described. The patient was diagnosed with cardiac syncope 3 months after total abdominal hysterectomy and was successfully treated with a two-stage approach consisting of sternotomy followed by laparotomy. The cause, disease, presentation, diagnosis, treatment and recurrence are reviewed.

Percutaneous intra-aortic balloon pump use may carry an increased risk for patients with peripheral vascular disease. To determine the incidence and types of associated complications, the medical records of 144 patients who underwent a total of 153 percutaneous intra-aortic balloon pump insertions were reviewed. Patients were divided into two groups. Group 1 was composed of 20 patients with a history of peripheral vascular disease. Group 2 was composed of 124 patients without such history; they underwent a total of 133 insertions. Nineteen major complications (12%) occurred, 12 in group 1 (60% of 20 insertions) and seven in group 2 (5% of 133 insertions). Major complications were further classified by their nature: embolic, occlusive, and technical. All three types of complications occurred more frequently in group 1. Embolic complications occurred more frequently in patients with aneurysms and proved the most lethal, with two of six deaths in group 1 resulting from this complication.

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The use of computed tomographic (CT) scanning in the diagnosis of ruptured abdominal aortic aneurysm is controversial because the delay created by the procedure, it has been argued, may increase overall mortality. However, if emergency surgery can be avoided in the medically compromised patient, surgical results may improve. To assess the value of CT scanning, we studied the 1983 to 1988 records of 65 hemodynamically stable patients with abdominal aortic aneurysms, who underwent diagnostic CT scanning for acute abdominal or back pain. Twenty-one patients had a history of severe cardiac, renal, or pulmonary disease. The average duration of the examination was 63 minutes; no episodes of hypotension occurred. Subsequently, 17 of 18 patients with ruptured aneurysms had emergency surgery, with 31% morbidity and 29% mortality. Of 44 patients found to have nonruptured aneurysms, 13 had other causes for their pain, nine were not considered surgical candidates, and 24 had elective aneurysmectomies, with 8% morbidity and 0% mortality. In three patients CT scanning excluded the diagnosis of aneurysm. Additional information provided by CT scanning enhanced the safety of the perioperative management of four patients with rupture and 14 without. In conclusion, the delay imposed by obtaining a preoperative CT scan in patients with possible ruptured aneurysm did not adversely affect patient outcome, and the information obtained from it aided significantly in both preoperative and intraoperative management.