The haemodynamic results suggest that PTA to the femoropopliteal segment is seldom a procedure of choice for critically ischaemic legs with poor run-off. The run-off score is useful in identifying patients who may benefit from PTA.

Hemodynamic response to moderate dobutamine dose in OPCAB during acute normovolemic hemodilutionTo the Editor: Acute normovolemic hemodilution (ANH) is a widespread practice during coronary artery surgery and numerous studies emphasize the safety of a low transfusion trigger in these patients. [1][2][3] During off-pump coronary artery bypass surgery (OPCAB), periods of hemodynamic instability that require inotropic therapy may occur. 4 However, no studies, except experimental, evaluate how hemodilution influences the hemodynamic response to inotropic therapy. 5 Our study compared the hemodynamic response to dobutamine in patients with coronary artery disease (CAD) at two different levels of ANH.After Ethical Board approval, 40 patients with CAD scheduled for OPCAB surgery were randomized to two groups after induction of anesthesia. Anesthesia was induced with midazolam (0.2 mg·kg ). All patients were monitored with pulmonary artery and arterial catheters, 5-lead electrocardiogram, pulse oximeter, capnography and transesophageal echocardiography.In the moderate group ANH was performed up to hemoglobin values of 95 to 105 g·L -1 and, in the severe group, up to hemoglobin values of 75 to 85 g·L -1 . Calculated blood volume to obtain the required level of ANH was replaced with the same volume of 6% hydroxyethylstarch. After ANH, both groups were treated with dobutamine 5 µg·kg -1 ·min -1 for 15 min. Hemodynamic and oxygenation variables were measured using the thermodilution method after induction, 15 min after ANH and 15 min after starting the dobutamine infusion. Nonparametric tests were used for statistical analysis due to the small number of patients.In the moderate ANH group, dobutamine infusion was associated with a significant increase in cardiac index (CI; 2.7 ± 1.1 vs 3.3 ± 1.1 L·min -1 ·m -2 , P < 0.01) and oxygen delivery (DO 2 ; 391 ± 132 vs 444 ± 96 mL·min -1 ·m -2 , P < 0.05), while in the severe ANH group, CI and DO 2 did not change significantly after the administration of dobutamine (Table). Thus, dobutamine could not increase CI to compensate the reduced DO 2 after severe ANH while the moderate ANH group had favourable hemodynamic and oxygenation variables (Table).In conclusion, hemodynamic response to dobutamine is significantly better in moderate compared to severe ANH. Our results suggest OPCAB surgery patients should have hemoglobin values of 100 g·L -1 during ANH. These preliminary results should be evaluated in further studies. Data presented with mean ± standard deviation. ANH = acute normovolemic hemodilution; CI = cardiac index; DO 2 I = oxygen delivery index; VO 2 I = oxygen consumption index; O 2 ER = oxygen extraction rate; HGB = hemoglobin. *Significance within groups in comparison with previous measurement P < 0.05; **significance within groups in comparison with previous measurement P < 0.01; †significance between groups P < 0.05; ‡significance between groups P < 0.01. Perhaps one reason for lack of use of awake fibreoptic intubation is a lack of training or confidence on the part o...

Leukocytoclastic vasculitis is a disease mostly limited to the skin. Extracutaneous manifestations that include visceral involvement are normally self-limiting and not life-threatening. We describe a 44-year-old man with palpable purpura, polyarthritis and microhematuria who developed severe vasculitis of the small and large bowel. Initial laboratory tests confirmed leukocytosis, slightly elevated C-reactive protein and mildly increased erythrocyte sedimentation rate. Skin biopsy revealed histological features typical of leukocytoclastic vasculitis. The search for trigger factors revealed urogenital infection with Ureaplasma urealyticum. Severe abdominal pain followed cutaneous symptoms eight days after admission. Abdominal x-ray showed several air-fluid levels in the lower right abdomen and an abdominal CT scan revealed thickening of the intestinal wall in several segments of jejunum, ileum and colon. C-reactive protein rose from 32 mg/l to 107 mg/l. Methylprednisolone pulse therapy rapidly improved gastrointestinal, cutaneous and articular symptoms. The aim of this report is to show the unpredictability of vasculitic disease and the difficulties in its classification. The report emphasizes the importance of adapting diagnosis and treatment according to disease severity rather than to the type of vasculitis. The specific etiological trigger remains unknown in this case, although a causal relationship with U. urealyticum infection is speculated.

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There is no common pathology in strictures of the external urinary meatus in men and women. These strictures have to be considered in their complexity and history with influential factors like additional diseases and previous surgical interventions. It is necessary to distinguish a simple situation from extensive findings. Successful therapy depends on the exact evaluation and classification of the stricture.