A survey of the practice of thoracic epidural analgesia in the United Kingdom.

A postal survey of the practice of thoracic epidural analgesia was sent to 275 hospitals in the United Kingdom. Responses were received from 70% of hospitals. Informed consent is rarely adequately obtained, with only 28% of respondents mentioning even the most common complications.

Bullectomy for chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is a progressive, disabling condition which leads to poor quality of life and limited survival. Over the years, a variety of surgical procedures have been used to achieve symptomatic improvement in selected patients. This article gives a historical account of these interventions and looks at current surgical options, both for primary treatment and management of complications.

Myocardial ischaemia after coronary artery bypass grafting: early vs late extubation.

The technique of early extubation after coronary artery bypass grafting is increasing in popularity, but its safety and effect on myocardial ischaemia remain to be established. In a randomized, prospective study, patients undergoing routine elective coronary artery bypass grafting were managed with either early or late tracheal extubation. The incidence and severity of electrocardiographic myocardial ischaemia were compared.

Cardiac tamponade.

Cardiac tamponade is a cardiological emergency requiring prompt treatment in order to avoid a fatal outcome. It can complicate a number of medical conditions and it is important, therefore, that all practitioners are aware of its presentation, diagnosis and management. These are outlined.

Gastroesophageal reflux and tracheobronchial contamination after cardiac surgery: should a nasogastric tube be routine?

Nasogastric (NG) tubes are routinely used in patients undergoing cardiac surgery. This randomized study was designed to assess gastroesophageal reflux (GER) without a NG tube (control) compared with a NG tube managed either by gravity drainage (gravity) or continuous low-grade suction (suction). Antimony pH probes were placed in the lower esophagus and trachea after induction of anesthesia in 51 patients, and pH was recorded every 5 s until the time of tracheal extubation.

Experience with cardiac tamponade following open heart surgery.

Cardiac tamponade following open heart surgery is well described, although, fortunately, uncommon. Unlike more classical "primary" tamponade, the clinical features are not specific, and this can delay diagnosis. In practice, the threshold for investigation must be low, and echocardiography has been invaluable in the detection and localization of pericardial collections.

Early experience of directional coronary atherectomy: clinical results, complications and histopathological findings.

Objective: To report the early experience, clinical results and histopathologic findings of Directional Coronary Atherectomy from a UK centre experienced in coronary angioplasty.

Design: Prospective study of the first 45 Directional Coronary Atherectomy (DCA) procedures using the Simpson coronary atherectomy device.

Results: Forty-five procedures were performed in 33 male and 5 female patients (mean age, 55.

Traumatic mitral valve rupture during the Hillsborough football disaster: case report.

Ninety-five spectators died from crush injuries and asphyxiation at the Hillsborough football ground in Sheffield, England on April 15, 1989. Survivors suffered a spectrum of compression injuries to the chest, including documented cardiac injuries although these were not permanent. We report the case of one survivor who developed an isolated traumatic mitral valve rupture during the crush, and may require mitral valve replacement at a later date.

The management of heart failure: a matter of definition?

The term heart failure has become a label for more than one clinical entity. For many years heart failure has been used to denote patients with various heart diseases who have begun to suffer from fluid retention, pulmonary venous hypertension, or systemic venous hypertension, either alone or in combination. More recently, the term heart failure has been applied to the combination of effort intolerance and reduced left ventricular contractility due to ischemic heart disease or other myocardial disease.

Accelerometer-based adaptive-rate pacing: a multicenter study. European EXCEL Study Group.

Unlabelled: A new adaptive rate pacemaker, using an accelerometer to detect body motion as an indicator of metabolic demand, was evaluated in 13 centers located in five countries. During the study, 55 patients with a broad range of indications were implanted with the EXCEL VR single chamber pacemaker. One month evaluations were completed on a subgroup of 37 patients.

Filtration of shed mediastinal blood.

Re-infusion of shed blood carries the risk of re-infusing cellular debris. All re-infusion devices have some sort of integral filtration which is variably supplemented with a second intravenous filter. Using electron microscopy we have observed what debris is collected by secondary filtration.

Videothoracoscopic surgery.

Although thoracoscopy has been used for diagnostic and minor therapeutic procedures for many years, there have been few reports of its use in performing major intrathoracic procedures which have traditionally required formal thoracotomy. We report our initial experience in this field. Fifty patients (M:F = 1.

Can supplementation of diet with omega-3 polyunsaturated fatty acids reduce coronary angioplasty restenosis rate?

The objective of this blinded, randomized, prospective study was to assess whether supplementation of normal diet with omega-3 polyunsaturated fatty acids can reduce angiographically defined restenosis following coronary angioplasty. The study included all patients undergoing coronary angioplasty in this institution between January 1988 and January 1989. One hundred and twenty patients enrolled, 60 in each treatment group.

Family history as an independent risk factor of coronary artery disease.

The relationship between family history of ischaemic heart disease and the presence of coronary heart disease was studied in 387 patients undergoing routine coronary arteriography prior to valve replacement. One hundred and seven patients (27.6%) had a family history of ischaemic heart disease.

Selective decontamination of the digestive tract in cardiac surgical patients.

Objective: To test the hypothesis that selective decontamination of the digestive tract improves outcome in cardiac surgical patients.

Design: Prospective, consecutive, controlled trial over two 4-month periods.

Setting: Eight-bed, open-plan postcardiac surgery ICU.

Pain following thoracotomy. A randomised, double-blind comparison of lumbar versus thoracic epidural fentanyl.

Fifty-eight patients scheduled for elective thoracotomy were randomly allocated to receive fentanyl by either the thoracic or the lumbar epidural route for postoperative analgesia. The infusion rate was adjusted to optimise analgesia. Dose adjustment, pain assessment and the incidence of side effects were monitored by a blinded observer at set times over the 24 hour study period.