Hepatic portal venous gas in a patient with intestinal necrosis.

This report describes a case of hepatic portal venous gas (HPVG) in a patient with intestinal ischaemia and necrosis resulting from an obstructing lesion in the sigmoid colon. CT images demonstrating a large amount of HPVG are presented.

Review of ECMO (extra corporeal membrane oxygenation) support in critically ill adult patients.

Mechanical circulatory support has evolved markedly over recent years. ECMO (extra corporeal membrane oxygenation) is instituted for the management of life threatening pulmonary or cardiac failure (or both), when no other form of treatment has been or is likely to be successful. Most commonly, it is instituted in an emergency or urgent situation after failure of other treatment modalities.

Clinical practice guidelines for improving outcomes in sepsis.

Sepsis is a common medical condition resulting from an infectious stimulus with a variable inflammatory response leading to a spectrum of clinical conditions from mild constitutional symptoms to varying degrees of organ dysfunction and death. The understanding of the patho-physiology of sepsis has lead to better treatment modalities and whilst sepsis is an increasingly more common condition world wide, the mortality from sepsis is nevertheless falling. Treatment algorithms have been promulgated over the years and levels of evidence for these have varied.

Recombinant activated factor VII: current perspectives and Epworth experience.

Recombinant factor VII was first developed for control and prevention of bleeding in haemophilia with antibodies to factor VIII and IX. Its efficacy in these situations is well established. Over recent years, the 'off-label' use of this substance has become more widespread in trauma, surgery and obstetric bleeding.

Acute renal dysfunction after cardiac surgery: still a big problem!

This review will address the issue that renal dysfunction post cardiac surgery, whether pre-existent or developing de novo, is a major contributor to morbidity as well as short- and long-term survival. The ability to recognise diminished renal reserve through estimating glomerular filtration rate, makes clinicians more vigilant to protecting renal function through better haemodynamic post-operative management and avoidance of nephrotoxins. Further the application of the recent consensus classification of acute renal dysfunction allows early recognition of renal impairment and earlier intervention with renal replacement therapy.

Validation of Euroscore model in an Australian patient population.

Background: The purpose of the present paper was to assess the performance of the European system for cardiac operative risk evaluation (EuroSCORE) model in an Australian adult cardiac surgical population.

Methods: The additive and logistic EuroSCORE models were retrospectively applied to predict operative mortality in 2106 consecutive patients undergoing cardiac surgery at St Vincent's Hospital, Melbourne between June 2001 and August 2003, and at Geelong Hospital between June 2001 and April 2004. The entire cohort and a subset of patients undergoing isolated coronary artery bypass graft (CABG) surgery were analysed.