The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study.

Background: Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients' ED management and short-term outcomes.

Methods: This was a sub-analysis of a European EURODEM study.

Pre-hospital management protocols and perceived difficulty in diagnosing acute heart failure.

Aim: To illustrate the pre-hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre-hospital conditions.

Methods And Results: A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit.

Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study.

Objective: Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs).

Methods: We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data.

The impact of emergency medical services in acute heart failure.

Background: Real-life data on the role of emergency medical services (EMS) in acute heart failure (AHF) are scarce. Our aim was to describe prehospital treatment of AHF and to compare patients using EMS with self-presented, non-EMS patients.

Methods: Data were collected retrospectively from three university hospitals in Helsinki metropolitan area between July 1, 2012 and July 31, 2013.

Angiographic 20-year follow-up of 61 consecutive patients with internal thoracic artery grafts.

Objective: To assess the behavior of internal thoracic artery (ITA) grafts versus venous grafts in repeated angiograms up to 20 years.

Summary Background Data: Use of ITA grafts to bypass left anterior descending artery stenosis has been shown to be associated with improved survival in patients undergoing coronary artery bypass grafting.

Methods: Sixty-one consecutive patients who received one or two ITA grafts and who underwent surgery from Oct.

Trends in vascular surgery--an evaluation of operative activity in Finland 1976-1992.

To evaluate trends in vascular surgical activity in Finland, data were gathered from cross-sectional questionnaire surveys during three separate years. The material consisted of 1,658 (1976) and 4,887 (1992) procedures in Finland, and 1,039 (1988) and 1,212 (1992) in the Tampere region. In 1976 there was an annual mean of 350 vascular reconstructions per one million inhabitants, 660 in 1992, and 967 if also endovascular revascularisations were included.

Effect of antiplatelet and anticoagulant therapy on patency of femorotibial bypass grafts.

In a retrospective study, 210 autogenous femorotibial saphenous vein grafts inserted during the 15 years from 1967 to 1982 were followed-up for a mean period of 62.3 +/- 5.7 months.

Polydioxanone in coronary vascular surgery.

We have used polydioxanone (PDS) in 50 patients who underwent coronary artery bypass grafting. The anastomoses consisted of suturing an autologous vein graft to the coronary artery (122 operations), a vein graft to the aorta (63 operations) and the internal mammary artery to the coronary artery (33 operations). The recipient coronary artery was subjected to endarterectomy in 28 instances.

Femorotibial bypass grafting for lower limb ischaemia.

The results of 305 femorotibial bypass grafts performed in 246 patients are presented. Of these operations 246 were primary and 58 secondary or tertiary. A total of 66 diabetic patients were in the series.

Femoral-tibial bypass for limb salvage.

From 1967 to 1982, 305 femoral tibial bypasses were performed. Of these 180 (59%) were performed on limb salvage indication. A reversed autogenous saphenous vein was used in 134 instances, among 46 vein substitutes there were 15 vein allografts, 13 human umbilical cord vein grafts, 12 PTFE grafts and six dacron grafts.

Diagnosis and treatment of spontaneous aorto-caval fistula.

The diagnostic features and operative results of six patients with spontaneous aorto-caval fistula associated with abdominal aortic aneurysm were analyzed. Abdominal pain, pulsatile abdominal mass and haematuria were constant preoperative findings in all patients. Radiological signs of congestive heart failure of various degrees were present in five, abdominal bruit in four and preoperative renal failure in three patients.

Surgical treatment of occlusion of the infrarenal abdominal aorta. Experience with 55 patients.

A series of 55 patients with occlusion of the infrarenal abdominal aorta operated on in the 15-year period 1966-1980 is presented. The type of operation was an extra-anatomic reconstruction in four cases and some type of anatomic repair in 51 cases. The operative mortality was 5.

Treatment of Takayasu's arteritis: an analysis of 29 operated patients.

Over a 25-year period 29 patients underwent 49 vascular procedures due to arterial insufficiency or vascular complications caused by Takayasu's arteritis. In bypass operations 36 grafts were inserted. The 5-year patency rates were 53% when grafts were used for patients with the active disease stage and 88% during the inactive disease stage (p = 0.

Traumatic rupture of the right hemidiaphragm.

Sixteen cases of traumatic disruption of the right hemidiaphragm are presented. Six tears were treated in the acute post-trauma phase and ten were detected from late manifestations. The causal trauma was penetrating in 11 cases and blunt in five.

Hospital cost development in coronary bypass surgery.

The rapid expansion of open-heart surgery together with steadily rising costs of health services has elicited criticism against uncontrollably expanded costs of coronary bypass surgery. However, critical analyses of the cost structures and the attempts for cost containment can only rarely be found in medical literature. This study emphasizes self-evident surgical principles which have led to surprisingly high cost reductions.

Epicardial lipoma.

A case of epicardial lipoma is presented. Coexisting coronary artery disease partly masked the symptoms by pointing to myocardial failure caused by compression from the tumor. An unexpectedly good result was achieved by combining excision of the lipoma with the planned coronary bypass procedure.

Isolated renal artery and combined aortic and renal artery reconstruction for renovascular hypertension. Late results of surgical treatment.

Fifty consecutive patients with renal artery occlusive disease underwent surgery for renovascular hypertension. The etiology was arteriosclerosis; only three patients had fibromuscular hyperplasia. Isolated renal artery stenosis was operated on in 22 patients while 28 patients underwent combined renal and aortoiliac/femoral procedures.

Direct hospital costs in coronary bypass surgery.

The direct hospital costs of 100 coronary artery bypass grafting operations are calculated. The basis of the calculations is the detailed, function-based, market-priced analysis of the files, including the hospital deaths, complication and reoperations of this patient group. The price of a CABG operation proved to lie somewhere between FIM 30,000 and 50,000, the mean value being FIM 46,800.

Coronary bypass surgery in stable angina pectoris. A randomized study of the effects on morbidity, mortality and employment.

The effects of coronary bypass surgery on morbidity, mortality and employment were assessed in a randomized prospective 5-year study. Exercise tolerance showed an immediate, striking improvement, which was maintained throughout the follow-up period. Corresponding patients treated with medical therapy showed no change.