The Role of Cardiovascular Magnetic Resonance in Cardiac Resynchronization Therapy.

Randomized, controlled trials have shown that cardiac resynchronization therapy (CRT) is beneficial in patients with heart failure, impaired left ventricular (LV) systolic function, and a wide QRS complex. Other studies have shown that targeting the LV pacing site can also improve patient outcomes. Cardiovascular magnetic resonance (CMR) is a radiation-free imaging modality that provides unparalleled spatial resolution.

Hospital Surgical Volumes and Mortality after Coronary Artery Bypass Grafting: Using International Comparisons to Determine a Safe Threshold.

Objective: To estimate a safe minimum hospital volume for hospitals performing coronary artery bypass graft (CABG) surgery.

Data Source: Hospital data on all publicly funded CABG in five European countries, 2007-2009 (106,149 patients).

Design: Hierarchical logistic regression models to estimate the relationship between hospital volume and mortality, allowing for case mix.

The Role of Cardiovascular Magnetic Resonance in Cardiac Resynchronization Therapy.

Randomized, controlled trials have shown that cardiac resynchronization therapy (CRT) is beneficial in patients with heart failure, impaired left ventricular (LV) systolic function, and a wide QRS complex. Other studies have shown that targeting the LV pacing site can also improve patient outcomes. Cardiovascular magnetic resonance (CMR) is a radiation-free imaging modality that provides unparalleled spatial resolution.

Does in utero exposure of antiepileptic drugs lead to failure to reach full cognitive potential?

A clinical scenario of a young female on 800 mg of sodium valproate (VPA) who has recently failed lamotrigine (LTG) and levetiracetam (LEV) and who is currently planning a pregnancy is presented. Currently available data pertaining to the longer-term development of children exposed to antiepileptic drugs (AEDs) are reviewed along with considerations around the methodology and interpretation of such research. There is an accumulation of data highlighting significant risks associated with prenatal exposed to VPA, with the level of risk being mediated by dose.

Primary Cardiac Allograft Dysfunction-Validation of a Clinical Definition.

Background: Heart transplantation is an established treatment for advanced heart failure. Primary allograft dysfunction (PGD) is reported in up to 40% of transplants and is associated with a poor outcome.

Methods: As part of Heart Evaluation and Retrieval for Transplantation study, an investigation of the assessment of donor hearts for transplantation, we proposed a clinical definition for cardiac PGD comprising severely impaired systolic function affecting one or both ventricles accompanied by hypotension, low cardiac output, and high filling pressures occurring in the first 72 hours (in the absence of hyper acute rejection and technical surgical factors, such as cardiac tamponade).

The new EuroSCORE II does not improve prediction of mortality in high-risk patients undergoing cardiac surgery: a collaborative analysis of two European centres.

Objectives: Prediction of operative risk in adult patients undergoing cardiac surgery remains a challenge, particularly in high-risk patients. In Europe, the EuroSCORE is the most commonly used risk-prediction model, but is no longer accurately calibrated to be used in contemporary practice. The new EuroSCORE II was recently published in an attempt to improve risk prediction.

New approach to the endoscopic repair of a CSF leak originating from the lateral recess of the sphenoid sinus.

Difficult access can make identification of a cerebrospinal fluid leak from the lateral wall of the sphenoid sinus very difficult, especially in a well-pneumatized sinus. Access to the sphenoid sinus has become easier with the advancement of minimally invasive endoscopic technology. In this article we describe our approach to a cerebrospinal fluid leak originating from this location, which has not been described previously in the literature.

Panniculitis ossificans traumatica: an unusual presentation.

We describe a patient with panniculitis ossificans traumatica that arose adjacent to the mandible. Panniculitis ossificans traumatica is an unusual form of heterotopic calcification that develops within subcutaneous fat as a result of injury. There have been few reported cases, and we know of none in the maxillofacial region despite the frequency of trauma to this region.

Snoring: referral, investigation and treatment.

Snoring is a common problem and the incidence increases with age. The significance of snoring as a symptom of sleep disordered breathing must not be overlooked in assessing this complaint. This article aims to highlight some of the important aspects in the investigation and management of a snoring patient.

Hindbrain hernia masquerading as postpartum subarachnoid haemorrhage.

A 29-year-old postpartum lady presented with a headache suggestive of subarachnoid haemorrhage. Investigations were negative for sources of haemorrhage, but revealed a hindbrain hernia. Hindbrain hernia should be considered as a cause of headache postpartum, as repeated Valsalva manoeuvres performed during vaginal delivery may further aggravate tonsillar decent.

Failure of retrograde cerebral perfusion to attenuate metabolic changes associated with hypothermic circulatory arrest.

Objectives: Although retrograde cerebral perfusion has become a popular adjunctive technique and may improve cerebral ischemic tolerance during hypothermic circulatory arrest, direct cerebral metabolic benefit has yet to be demonstrated in human subjects. We investigated the post-arrest metabolic phenomena with and without retrograde cerebral perfusion in patients.

Methods: In a prospective randomized trial, 42 patients undergoing aortic surgery requiring hypothermic circulatory arrest were allocated to receive hypothermic circulatory arrest alone (n = 21) or hypothermic circulatory arrest with additional retrograde cerebral perfusion (n = 21).