Der Anaesthesist
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Up to now 136 cases of myocardial infarction during pregnancy have been reported, and angiography revealed normal findings in 47%. In these cases coronary spasms have been discussed as the major mechanism of the disease. In isolated cases coronary artery dissection may also present with a normal coronary angiography. ⋯ It was pointed out recently that even in asymptomatic patients, plaques may be present in coronary vessels indicating an early stage of CAD that cannot be diagnosed by angiography. Plaque rupture is often triggered by hypertension and may lead to myocardial infarction, instable angina pectoris, or sudden ischemic death. As IVUS is a new diagnostic tool that allows diagnoses of even early stages of CAD we believe that myocardial infarction during pregnancy is more often caused by plaque rupture than may be expected according to the current literature.
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Case Reports
[Transesophageal echocardiography as intraoperative monitoring for the resection of an intra-atrial tumor].
Fibrolamellar hepatocellular carcinomas (FLHCC) can grow into the inferior vena cava and the right atrium thus rendering it impossible to insert a pulmonary artery catheter or increasing the risk of tumor embolisation. We report of a young patient with intraatrial growth of a FLHCC where intraoperative transesophageal echocardiography (TEE) instead of a pulmonary artery catheter for continuous monitoring of hemodynamics was used. Hemodynamic parameters as well as the surgical result could easily be assessed.
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The aim of the present investigation, initiated by the German Academy of Education in Anaesthesiology (DAAF), was to obtain valid information about education and training strategies of German anaesthetists, in order to highlight weaknesses and strengths for better planning and performance of future efforts in this area. For this reason, a questionnaire with 23 items was distributed to 2000 German anaesthetists during the years 1993-1995 and of these 1290 questionnaires could then be evaluated (response rate 64.5%). The most important means of education and training were classical media such as text books and journals. ⋯ Hospital and department heads are mostly believed to have positive attitudes to education and training. Most respondents were in favour of strict rules for education and training measures, which includes the obligation to prove their certified attendance (as yet not required in Germany). On the other hand, the majority voted against making the continued recognition as a specialist in anaesthesiology dependent on completion of a performance control.