Early postoperative thrombosis of an aortic bioprosthetic valve: should anticoagulation be patient specific?

Optimal antithrombotic recommendations for patients following bioprosthetic aortic valve replacement have yet to be decided. Current guidelines present conflicting opinions and are based on historical studies, which are limited by their design. We review comparative studies investigating differing thromboprophylactic regimes and outcomes for bioprosthetic aortic valve replacement.

Postdischarge complications: what exactly happens when the patient goes home?

Economic implications favouring early discharge have led to an ever increasing demand to send patients home for recuperation. Patients are now routinely released on their fourth postoperative day, thereby making postdischarge complications harder to record and audit. We set about the use of a structured questionnaire to evaluate the incidence of all postdischarge complications requiring therapy within the first six weeks of convalescence.

Salmonella sepsis simulating gastrointestinal ischaemia following cardiopulmonary bypass.

Cardiac surgery is commonly associated with gastrointestinal complications. The incidence of severe abdominal pathology ranges from 0.5% to 3% and is associated with a 30% risk of mortality.

Repair of spontaneous right ventricular rupture following sternal dehiscence. A novel technique.

Spontaneous rupture of the right ventricle during the early postoperative period is a serious and potentially lethal complication. The inherent friability of the ventricular tissue makes repair difficult since myocardium is frequently weakened by infarction, mediastinitis or trauma caused by an unstable sternum or broken sternal wires. We present a novel yet simple technique for repairing the ruptured anterior wall of the right ventricle in a patient three weeks following coronary artery bypass surgery.

Malignant pleural effusion in the presence of trapped lung. Five-year experience of PleurX tunnelled catheters.

Malignant pleural effusions in the presence of trapped lung remain notoriously difficult to treat. Various methods exist ranging from minimally invasive procedures including repeated needle thoracocentesis to the need for a formal surgical procedure such as placement of a pleuroperitoneal shunt and even thoracotomy and decortication. Controversy exists as to what is the optimum treatment for this condition.

Thymic cyst presenting as tachy-brady syndrome.

Tachy-brady syndrome or sick-sinus syndrome as it is also known is a cardiac rhythm disturbance resulting in alternating episodes of bradycardia and tachycardia. Diagnosis can be difficult because of its nonspecific symptoms and elusive findings on electrocardiogram or 24h tape. Thymic cysts are relatively uncommon tumours that are predominantly asymptomatic and located in the anterior mediastinum.

Endometriosis-associated intestinal tumours: a consequence of long-term unopposed oestrogen?

A case of malignant transformation in an extra-ovarian site, 13 years after total abdominal hysterectomy and bilateral salpingo-oophorectomy, is discussed in a patient on long-term oestrogen implants, which highlights the potential risks surrounding the use of long-term oestrogen replacement therapy.

Massive bronchogenic cyst mimicking ischaemic chest pain.

The presentation of the bronchogenic cyst is variable making preoperative diagnosis difficult. The majority are either asymptomatic or discovered incidentally. The most common presenting symptoms are cough, fever and dyspnoea.

Compensatory hyperhidrosis: a consequence of truncal sympathectomy treated by video assisted application of botulinum toxin and reoperation.

Hyperhidrosis is a debilitating condition characterised by sweating that exceeds the need of normal thermoregulation. Surgical management of primary hyperhidrosis by upper dorsal sympathectomy is the treatment of choice for intractable hyperhidrosis, however, paradoxically it may be followed by troublesome compensatory hyperhidrosis in a significant number of patients. The frequency of compensatory hyperhidrosis often reflects the extensiveness of the denervation.

Atorvastatin and myocardial reperfusion injury: new pleiotropic effect implicating multiple prosurvival signaling.

We investigated the potential role of atorvastatin, given at reperfusion, to improve survival of the ischemic/reperfused myocardium by activation of p44/42 MAPK and p38 MAPK with its downstream effector, HSP27. We have previously shown that atorvastatin attenuates lethal reperfusion-induced injury via activation of the phosphatidyl inositol 3-kinase (PI3K) prosurvival signaling pathway. In this study we hypothesize that other prosurvival kinases may also be implicated in this protection.

Heat shock protein 27 protects the heart against myocardial infarction.

Heat shock proteins (hsp) represent a group of chaperones which protects the cells against a diversity of stresses. It has been demonstrated that hsp27 is constitutively present in cells where it plays an important role in different cytoprotective processes which ultimately inhibit cell death. We investigated the response of the isolated perfused mouse heart over expressing hsp27 to the ischaemia/reperfusion injury using infarct size as an end point.