Management of cystic fibrosis related diabetes: a survey of UK cystic fibrosis centers.

Introduction: Cystic fibrosis related diabetes (CFRD), a poor prognostic factor in cystic fibrosis (CF), is an increasing problem and guidelines regarding its management have recently been published. However, the evidence base for CFRD screening and diagnosis is not comprehensive and its current management in the UK is unknown. We therefore conducted a questionnaire survey of all recognized UK CF centers to assess clinical practice and determine adherence to these recent recommendations.

Double orifice mitral valve with dysplastic tricuspid valve and intact interatrial septum: a three-dimensional echocardiographic study.

Double orifice mitral valve is a rare congenital heart disease. We present a case in which 3D echocardiography helped clarify the underlying anatomy. The need exists for more extensive use of this technique to allow for surgical and pathological confirmation.

Reduction in mortality and target-lesion revascularisation at 2 years: a comparison between drug-eluting stents and conventional bare-metal stents in the "real world".

Background: Long-term safety of drug-eluting stent (DES) is still a concern. We aimed to assess the impact of DES use on all-cause mortality and target-lesion revascularisation (TLR) in routine clinical practice.

Methods: Retrospective analysis of all patients undergoing percutaneous coronary intervention with stent implantation at our institution between January 2003 and December 2004.

Peroperative cell salvage.

Red cell salvage (RCS) is now an established therapy for patients undergoing surgery with an associated risk of heavy bleeding. It should always be available for such patients. It is, however, only one part of what should be a multifaceted approach to blood conservation and it does not replace the need for good quality surgical haemostasis.

Diadenosine polyphosphates are selective vasoconstrictors in human coronary artery bypass grafts.

Diadenosine polyphosphates (Ap(n)A) are released by degranulating platelets and high, local concentrations may form at sites of platelet activation. Radial artery grafts, now often used alongside the internal mammary artery in coronary artery bypass surgery, are particularly reactive to several vasoconstrictors but the response to Ap(n)A has not been investigated. This study compared the vasoconstrictor activity of Ap(n)A in human radial artery with other vessels commonly used as bypass grafts.

Do beating heart techniques applied to combined valve and graft operations reduce myocardial damage?

We examined the outcomes of combined beating heart CABG and valve surgery (hybrid) and compared these to conventional CABG and valve surgery (conventional). Between April 1997 and March 2006, 388 patients received combined CABG and valve surgery. Patient characteristics and cardiac enzyme release were collected prospectively.

Resection of pulmonary metastases from colorectal carcinoma.

Although pulmonary metastases from colorectal carcinoma (CRC) often represent systemic and uncontrolled tumour growth, in a number of patients lung disease is limited and the patient remains well. When the metastases can be removed, long term survival is a possibility, with 5- and 10-year survivals in the order of 44% and 25%. Chemotherapy, the only alternative treatment only very rarely leads to survival beyond 24 months.

Long-term effect of insulin treatment in cystic fibrosis-related diabetes.

Background: Although insulin treatment confers short-term benefit in cystic fibrosis-related diabetes (CFRD), few studies have compared its long-term effect on the clinical outcome.

Objectives: In this study, we aimed to investigate the long-term impact of insulin treatment on pulmonary function, nutritional status and hospital admissions in patients with CFRD.

Methods: We reviewed pulmonary function, body mass index (BMI) and hospital admissions 5 years before and 3 years after insulin therapy in 42 adult CFRD patients.

Left internal mammary artery use in patients with poor left ventricular ejection fraction: a propensity-matched analysis of mid-term survival.

We aimed to determine whether the use of left internal mammary artery (LIMA) to the left anterior descending (LAD) artery during coronary artery bypass grafting (CABG) confers an improved survival benefit to patients with an impaired preoperative left ventricular ejection fraction (LVEF). Between April 1997 and March 2004, 7198 consecutive patients underwent first time CABG to the LAD. There were 627 patients who had an LVEF <30% and of these, 548 patients (87.

Mid-term survival after cardiac surgery in elderly patients: analysis of predictors for increased mortality.

This study examines and quantifies the potential risk factors for increased mid-term mortality in elderly patients (> or = 75 years old) undergoing cardiac surgery. We undertook a retrospective analysis of 840 consecutive elderly patients who underwent cardiac surgery (CABG and/or Valve) between April 1997 and March 2002. Deaths occurring as a function of time were described using the product limit methodology of Kaplan and Meier.

Is off-pump coronary surgery justified in EuroSCORE high-risk cases? A propensity score analysis.

We aimed to quantify the effect of avoiding cardiopulmonary bypass on outcomes in high-risk patients. Of the 2079 consecutive CABG's performed by three surgeons between April 1997 and September 2002, 389 were classified as high-risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification, with a score of >5. The off-pump group had 196 patients and the on-pump group had 193 patients.

Preoperative beta-blocker therapy in coronary artery bypass surgery: a propensity score analysis of outcomes.

Preoperative beta-blockade in patients undergoing coronary artery bypass grafting (CABG) has recently been shown to be beneficial in improving the early outcomes after surgery. We aimed to quantify the effect of preoperative beta-blockade on outcomes in our own patient population. We performed a retrospective analysis on CABG patients identified from our prospectively collected cardiac surgery database.

Logistic risk model for prolonged ventilation after adult cardiac surgery.

Background: The aim of this study was to develop a multivariate risk prediction model for prolonged ventilation after adult cardiac surgery.

Methods: This is a retrospective analysis of prospectively collected data on 12,662 consecutive patients undergoing adult cardiac surgery between April 1997 and March 2005. Data were randomly split into a development dataset (n = 6,000) and a validation dataset (n = 6,662).

Coincidence of spinal canal stenosis and thoracoabdominal aortic aneurysm.

We report a case in which a thoracoabdominal aneurysm was present in association with previously unknown critical spinal canal stenosis. In spite of using left heart bypass, systemic hypothermia, and controlled cerebrospinal fluid drainage for spinal cord protection, the patient developed paraplegia following aortic aneurysm repair. Computed tomography scan revealed critical stenosis of the spinal canal that was thought to be sufficient to produce spinal cord compression syndromes including paraplegia.

An abnormal finding in an angiogram.

An 80 year old Chinese gentleman was admitted with NSTEACS characterized by anterior T wave inversion and raised Troponin T. His coronary angiogram showed stenosis of the proximal LAD. He underwent PCI to LAD lesion.

Methicillin resistant Staphylococcus aureus infections following cardiac surgery: incidence, impact and identifying adverse outcome traits.

Objective: To assess the incidence and impact of Methicillin-resistant Staphylococcus aureus (MRSA) infections on cardiac surgery outcomes and to identify adverse outcome traits.

Methods: Retrospective analysis of prospectively collected data from cardiac surgical and microbiology databases between April 2000 and March 2005. The overall and yearly incidence of positive MRSA cultures was examined along with the distribution of clinical infections and the associated mortality.

Ambulatory cardiac rhythm monitoring.

Cardiac arrhythmias may cause palpitations, dyspnoea, angina pectoris, dizziness or even syncope and sudden death. This article will review the indications for investigation, the novel devices that are available for investigating patients with suspected cardiac dysrhythmias and the new technology available for analysis and reporting.

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.

Nitric oxide in blood. The nitrosative-oxidative disequilibrium hypothesis on the pathogenesis of cardiovascular disease.

There is growing evidence that altered production and/or spatio-temporal distribution of reactive oxidant species and reactive nitrosative species in blood creates oxidative and/or nitrosative stresses in the failing myocardium and endothelium. This contributes to the abnormal cardiac and vascular phenotypes that characterize cardiovascular disease. These derangements at the system level can now be interpreted at the integrated cellular and molecular levels in terms of effects on signaling elements in the heart and vasculature.

Anaesthesia for oesophagectomy.

Purpose Of Review: To review the current anaesthetic management of patients undergoing transthoracic oesophagectomy.

Recent Findings: Oesophageal adenocarcinoma is increasing rapidly in the West. The perioperative mortality for oesophagectomy remains high.

Small vessel avulsion and acute aortic syndrome: a putative aetiology for initiation and propagation of blunt traumatic aortic injury at the isthmus.

Based on literature, clinical observation and the analysis of material properties of the aorta, we hypothesize that the aortic isthmus is intrinsically susceptible to blunt trauma because it has a higher density of tributary vessels than other elements of the aortic tree, the avulsion of which during trauma, is a contributory factor in the development of an acute aortic syndrome resulting from intra-mural haematoma, localized dissection and ultimately rupture. This hypothesis provides putative explanations for several aspects of the injury profile including: localized peri-isthmus injuries, inside out injury profiles and the concept of initiation versus propagation of blunt traumatic aortic injury.

Temperature changes stimulate contraction in the human radial artery and affect response to vasoconstrictors.

Background: Radial artery conduits are increasingly used in coronary artery bypass grafting as an additional arterial graft to the internal thoracic artery. Their reactive nature remains a concern, often necessitating the routine use of topically applied vasodilators, such as glyceryl trinitrate, papaverine, phenoxybenzamine, or calcium channel antagonists, in theatre. During preparation prior to surgery and grafting, radial artery conduits are exposed to cooling and rewarming.