Effects of preoperative teaching of the use of a pain scale with patients in the PACU.

Clinical observations have shown that patients arriving in the PACU who had no experience using a pain scale had more difficulty rating their pain in the immediate postoperative period. The purpose of this pilot study was to determine if preoperative instruction on the use of a pain scale would improve the patient's ability to self-report pain in the Phase I PACU. The sample consisted of 50 English speaking, orthopedic patients between the ages of 19 and 75 years.

Noncardiac surgery in children with hypoplastic left heart syndrome.

Background/purpose: Hospital mortality rate among children with hypoplastic left heart syndrome (HLHS) after cardiac repair is well documented, but comparable data after noncardiac, surgical procedures are unknown. The authors hypothesized an increasing number of noncardiac procedures were being performed on children with HLHS, less than 2 years of age, from 1988 to 1997, and that these procedures were associated with a substantial mortality rate.

Methods: A retrospective review of hospital discharge data for 2,457 children less than 2 years of age with HLHS for 1988 through 1997 was performed.

Delayed closure of persistent postpneumonectomy bronchopleural fistula.

A 73-year-old man with a history of postpneumonectomy empyema and a long-term chest tube since 1979 presented with fever, chills, leukocytosis, and purulent fluid from the left tube thoracostomy. CT scan and bronchoscopy demonstrated a right lower lobe pneumonia and a left mainstem dehiscence with direct communication to the left tube thoracostomy. He underwent primary closure of the bronchopleural fistula with latissimus dorsi muscle flap coverage after antibiotic therapy for right lower lobe pneumonia.

Repair of transposition of the great arteries with total anomalous pulmonary venous return.

A 13-year-old Haitian girl presented with complex congenital heart disease consisting of transposition of the great arteries with total anomalous venous return. The patient exhibited clinical findings of long-standing congestive heart failure and cyanosis. She underwent complete repair with resolution of her symptoms.

Allograft mitral valve replacement.

Allograft valves have been used in cardiac valve replacement for over 40 years. Early failures of allograft mitral valve replacement (AMVR) were attributed to inadequate allograft preservation or unsuccessful implantation techniques. Due to an improved understanding of mitral valve function gained from experience in mitral valve reconstruction, improved imaging techniques for preoperative assessment, and improved methods of allograft preservation, there has been a resurgence of interest in AMVR.