Association of IL6 and IL10 with renal dysfunction and the use of haemofiltration during cardiopulmonary bypass.

Objective: Assessment of the effects of haemofiltration during cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG) on the renal function and correlation with interleukin 6 (IL6) and interleukin 10 (IL10) levels.

Methods: Seventy-nine patients scheduled for elective CABG were prospectively randomised into two groups. Group A with a haemofilter attached to arterial line of the CPB circuit and group B without a haemofilter.

Does the choice of risk-adjustment model influence the outcome of surgeon-specific mortality analysis? A retrospective analysis of 14,637 patients under 31 surgeons.

Objectives: To compare implications of using the logistic EuroSCORE and a locally derived model when analysing individual surgeon mortality outcomes.

Design: Retrospective analysis of prospectively collected data.

Setting: All NHS hospitals undertaking adult cardiac surgery in northwest England.

A multi-centre additive and logistic risk model for in-hospital mortality following aortic valve replacement.

Objective: To develop a multivariate prediction model for in-hospital mortality following aortic valve replacement.

Methods: Retrospective analysis of prospectively collected data on 4550 consecutive patients undergoing aortic valve replacement between 1 April 1997 and 31 March 2004 at four hospitals. A multivariate logistic regression analysis was undertaken, using the forward stepwise technique, to identify independent risk factors for in-hospital mortality.

Has the publication of cardiac surgery outcome data been associated with changes in practice in northwest England: an analysis of 25,730 patients undergoing CABG surgery under 30 surgeons over eight years.

Objectives: To study changes in coronary artery surgery practice in the years spanning publication of cardiac surgery mortality data in the UK.

Methods: A retrospective analysis of prospectively collected data from all National Health Service centres undertaking adult cardiac surgery in northwest England was carried out. Patients undergoing coronary artery surgery for the first time between April 1997 and March 2005 were included.

The logistic EuroSCORE in cardiac surgery: how well does it predict operative risk?

Objectives: To study the ability of the logistic EuroSCORE to predict operative risk in contemporary cardiac surgery.

Design: Retrospective analysis of prospectively collected data.

Setting: All National Health Service centres undertaking adult cardiac surgery in northwest England.

Recurrent acute rheumatic fever: a forgotten diagnosis?

The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve.

Repair of post-infarct ventricular septal defect with or without coronary artery bypass grafting in the northwest of England: a 5-year multi-institutional experience.

Objective: To present the 5-year experience of the northwest of England's surgical repair of post myocardial infarction (MI) ventricular septal defects (VSD). Our primary aim was to evaluate the effect of concomitant coronary artery bypass grafting (CABG) on mid-term survival and also to identify prognostic indicators.

Methods: A multi-centre regional observational study involving clinical data from 65 consecutive patients who underwent post MI VSD repair in the northwest of England between April 1997 and March 2002.

Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data.

Objective: As a result of recent failures in clinical governance the government has made a commitment to bring individual surgeons' mortality data into the public domain. We have analysed a database to compare crude mortality after coronary artery bypass surgery with outcomes that were stratified by risk.

Design: Retrospective analysis of prospectively collected data.

Limitations of the Parsonnet score for measuring risk stratified mortality in the north west of England. The North West Regional Cardiac Surgery Audit Steering Group.

Objective: To study the use of the Parsonnet score to predict mortality following adult cardiac surgery.

Design: Prospective study.

Setting: All centres performing adult cardiac surgery in the north west of England.

Overdose of tetracycline for pleurodesis leading to chemical burns of the pleura.

Chemical pleurodesis using tetracycline is an accepted and commonly employed treatment of pneumothorax and pleural effusions. We describe a case of chemical burn of the pleura in a ventilated 41-year-old who came to thoracotomy after 3 days of continuous intrapleural infusion of tetracycline at another hospital. To our knowledge this has not been previously reported although other adverse effects of this procedure are documented.

Good outcomes from cardiac surgery in the over 70s.

Objective: To determine the early mortality and major morbidity associated with cardiac surgery in the elderly.

Design: Retrospective case record review study of 575 patients >/= 70 years old who underwent cardiac surgery at the Manchester Heart Centre between January 1990 and December 1996.

Setting: Regional cardiothoracic centre.

Hypoglycaemia associated with a solitary fibrous tumour of the pleura.

We report the interesting case of an elderly woman who presented with hypoglycaemic episodes and weight loss. She was found to have a solitary fibrous tumour weighing more than 1.7 kg arising from the diaphragmatic pleura, which had been producing insulin-like growth factor II.

The management of stab wounds to the chest: sixteen years' experience.

In a retrospective review of 16 years of admissions to a regional cardiothoracic unit, 76 patients were admitted with stab wounds to the chest. Of these wounds, 75% were managed conservatively with tube drainage and observation and 25% required surgical intervention. 5.

Determinants of early and late mortality in patients with end-stage renal disease undergoing cardiac surgery.

To determine factors influencing early and late mortality associated with cardiovascular surgery in end-stage renal disease, 48 consecutive patients (mean age 56.3 years) were reviewed: 30 underwent coronary and 18 valvular surgery. There were eight early deaths, three in the former and five in the latter group.

Comparison of propafenone to atenolol for the prophylaxis of postcardiotomy supraventricular tachyarrhythmias: a prospective trial.

To compare the efficacy of propafenone to atenolol in the prevention of supraventricular tachyarrhythmias (SVT) following cardiac surgery, 207 consecutive patients were randomly allocated to receive either propafenone 300 mg twice daily (105 patients) or atenolol 50 mg once daily (102 patients) orally for 7 days after operation. Double blinding was achieved using placebos. The end point was the development of a SVT which was symptomatic, recurrent, or lasting over 2 minutes, or the occurrence of adverse effects possibly attributable to the drugs.

Progressive tracheal and superior vena caval compression caused by benign neurofibromatosis.

The case history presented is of a patient with progressive tracheal and superior vena caval compression caused by a benign neurofibroma, a previously unrecognised feature of neurofibromatosis. The patient was successfully treated by surgical decompression.

Early and late results following combined coronary bypass surgery and mitral valve replacement.

To study the effect of various perioperative and operative variables, we analysed the results of 66 consecutive patients undergoing mitral valve replacement (MVR) and coronary artery bypass grafting (CABG). The mean age was 61.2 years (34 males and 32 females), the mean follow-up 54.

Three months treatment with chemotherapy and radiotherapy for small cell lung cancer.

Fifty-five patients with inoperable but limited stage small cell carcinoma of the bronchus and a further 15 patients with contra lateral neck nodes, pleural effusions and marrow involvement were entered into the study and treated. The 3 month treatment regimen comprised 3 courses of etoposide with cyclophosphamide at 2.5 gm-2 followed by methotrexate and radiotherapy, no maintenance treatment was given.

Half-life of digoxin in myocardium after stopping maintenance treatment.

The rate of decline of digoxin level in myocardium was estimated from operative samples of atrial and ventricular tissue from 40 patients undergoing cardiac surgery 1-20 days after maintenance digoxin treatment was stopped. Linear regression of myocardial log concentration-time curves for the group as a whole gave half-lives of 2.9 and 3.

Urinary incontinence in children: treatment with free autogenous muscle transplantation.

Free autogenous muscle transplantation has now been carried out in 13 patients with anal incontinence and 16 patients with urinary incontinence. In anal incontinence the results have been excellent; all patients were improved and 12 out of 13 reached an acceptable level of continence. In 10 patients with urinary incontinence the results were good, with increase of functional bladder capacity and abandonment of nappies during the day.

Neuron-specific enolase as a differential marker in a case of retroperitoneal tumour.

In some cases of retroperitoneal tumour, preoperative investigations fail to conclusively differentiate between neuroblastoma and Wilms' tumour. Diagnostic difficulties can be encountered also intraoperatively, and even the histopathological presentation can be equivocal. According to earlier results, neuron-specific enolase (NSE) in tumour extract can be used as a marker for neuronal tissue and thus offers a new diagnostic criterion differing neuroblastoma from e.