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Results for “Surgical source control”

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PubMed2001

Quality control of resident operative experience: compliance with RRC criteria.

PURPOSE: Process Capability Analysis (PCA) is a quality control tool that can be applied to how resident cases are allocated. PCA measures how close an output is to its target (Cp) and its location (K) in relation to Cp. For resident cases, the statistics of Cp and K measure variability in case numbers, which is useful in planning how a program meets RRC criteria in operative experience on specialty services. METHODS: A review of 6 years of vascular surgery cases (1994-1999) using PG 5 RRC case logs and the departmental quality database as sources was done. PCA was applied to resident case numbers. RRC 1997-1998 National Program Data were used to define quality control limits. The 30th, 50th, and 70th percentiles in vascular procedures served as lower, nominal, and upper control limits, respectively. RESULTS: Cases were grouped into aortic (AO), cerebrovascular (CER), peripheral (PER), and visceral (VSC), to meet RRC definition for major reconstructions. PCA analysis of PG5 RRC submitted data, total cases reported by the graduating residents (n = 20) in their submitted RRC Case logs, and department QA log numbers over 6 years of the period revealed the following mean numbers for AO = 13.7 +/- 4.2 (Cp = 0.279, K = +70.5%), CER = 15.6 +/- 6.4 (Cp = 0.365, K = +78.6%), PER = 23.1 +/- 10.5 (Cp = 0.237, K = +80.1%), VSC = 2.5 +/- 1.5 (Cp = 0.189, K = +175.0%), and total = 55.1 +/- 20.2 (Cp = 0.305, K = +70.5%). CONCLUSIONS: Processes that are in statistical control should have a Cp > 1.0, and a small K: i.e., centered tightly and near the desired nominal limit. By PCA analysis, the vascular surgery service product of PG5 case numbers is not in statistical control, but instead exceeds the defined control limits (RRC 50th percentile levels). The low Cp values demonstrate that specific case numbers may vary from resident to resident. The high positive K percentages imply that more residents have case numbers that meet or exceed RRC 50th percentiles. Sources of potential error and variability may be partially explained by the data of total case volume and resident underreporting. More accurate RRC reporting by residents could account for up to 20% more cases, potentially offsetting individual case allocation differences within a particular resident year.

Aorta↗

PubMed2005

Multi-Resolution FOCUSS: a source imaging technique applied to MEG data.

A variety of techniques are available for imaging magnetoencephalographic (MEG) data to the corresponding cortical structures. Each performs a functional optimization that includes mathematical and physical restrictions on source activity. Unlike other imaging techniques, MR-FOCUSS (Multi-Resolution FOCal Underdetermined System Solution) utilizes a wavelet statistical operator that allows spatial resolution to be chosen appropriately for focal or extended sources. Control of focal imaging properties is achieved by specifying P in an l(P) norm distribution template used to construct the wavelets. In addition, incorporation of a multi-resolution wavelet operator desensitizes the mathematical algorithm to noise, (regularization). Like the FOCUSS imaging technique, an initial estimate of cortical activity is recursively enhanced to obtain the final high resolution imaging results. Studies of model MEG data representing all regions of a realistic cortical model are performed to quantify MR-FOCUSS imaging properties. These modeled data studies included single and multiple dipole sources as well as an extended source model. Thus, MR-FOCUSS is found to be very effective for imaging language processing for pre-surgical planning and provides a high-resolution method to image sequential activation of multiple correlated sources involved in language processing.

Algorithms↗

PubMed2005

The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively--a randomised clinical trial.

AIM: Recent evidence suggests that the provision of energy-containing fluids is safe and may impact positively on markers of recovery. The aims of this study were to assess the tolerance of preoperative carbohydrate fluid administration and to determine its effect on postoperative metabolic and clinical responses. METHODS: Patients admitted to the Royal Infirmary of Edinburgh for major, elective abdominal surgery were recruited to this double-blind, randomised study and received either a placebo drink or carbohydrate (12.6g/100ml) drink (CHOD). Patients consumed 800 ml of their drink on the evening before surgery and 400 ml on the day of surgery 2-3 h before the induction of anaesthesia. Nutritional status was determined using body mass index (BMI) and upper arm anthropometry; all measurements were taken preoperatively, postoperatively and at discharge. Blood glucose and insulin concentrations were also measured preoperatively and on the first post operative day. Length of hospital stay (LOS) and postoperative complications were recorded. RESULTS: Seventy-two patients were recruited and 65 (34 male:31 female) completed this study. Thirty-four patients were randomised to receive the placebo drink (control group) and 31 patients to receive the carbohydrate drink (CHOD group). Groups were well-matched in terms of gender and age. There were no differences between the two groups at baseline for BMI (control: -25.1+/-1.7 kg/m2; CHOD -25.2+/-1.2 kg/m2), upper arm anthropometry or surgical procedure. At discharge loss of muscle mass (arm muscle circumference) was significantly greater in the control group when compared with the CHOD group (control: -1.1+/-0.15 cm; CHOD: -0.5+/-0.16 cm; P<0.05). Baseline insulin (control: 20.7+/-4.9 mU/l; CHOD: 24.6+/-6.2 mU/l) and glucose (control: 6.0+/-1.4 mmol/l; CHOD 5.7+/-1.4 mmol/l) were comparable in the two groups and did not differ postoperatively. No complications were recorded as a result of preoperative fluid consumption. Postoperative morbidity occurred in six patients from each group. Median LOS in the control group was 10 days (IQR=6), and 8 days (IQR=4) in the CHOD group. CONCLUSION: Preoperative consumption of carbohydrate-containing fluids is safe. Provision of a carbohydrate energy source prior to surgery may attenuate depletion of muscle mass after surgery. Further studies are required to determine if this preservation of muscle mass is reflected in improved function and reduced rehabilitation time.

Abdomen↗

PubMed2000

Antibiotic selection for patients with septic shock.

Early recognition of the sepsis syndrome, prompt administration of broad-spectrum antibiotics, surgical intervention when indicated, and aggressive supportive care in intensive care units remain the therapeutic strategies for patients with sepsis. Antibiotic selection is based on many factors including the most probable source of infection, the most likely pathogens, and knowledge of antibiotic susceptibility patterns for community- and hospital-acquired infections. Unfortunately, with this approach, mortality remains unacceptably high. Adjuvant therapies such as antiendotoxin antibodies, cytokine antagonists, and anti-inflammatory agents aimed at blunting the host immune response to bacterial infection have provided little clinical benefit to date. As our understanding of the pathophysiology of sepsis progresses, perhaps newer modalities will improve clinical outcome. At this time, preventive strategies, including optimal vaccine use, effective infection control practices, judicious use and care of intravascular lines and indwelling urinary catheters, and appropriate use of anti-infective agents to prevent microbial resistance should be used to decrease the incidence of infection and subsequent sepsis.

Anti-Bacterial Agents↗

PubMed2005

The numbers needed to treat for neurological disorders.

BACKGROUND: Numerous therapeutic interventions have been developed in the neurosciences. Clinicians need summary measures about efficacy of therapies that derive from the best available evidence, and that can be readily extrapolated to clinical practice. The number needed to treat (NNT) is intuitive and clinically applicable. We provide clinicians with a single source that summarizes important therapies in the main neurological and neurosurgical areas. METHODS: Critically appraised evidence about therapies in the neurosciences was obtained from meta-analyses in all neurosciences groups in the Cochrane library, and from critically appraised topics at the University of Western Ontario. Therapies were included if they were deemed relevant and if outcomes were dichotomous. For each therapy, we obtained absolute risk differences and their 95% confidence intervals (CI), the corresponding NNTs, control and experimental event rates, and the time-frame of the outcome assessment. RESULTS: We assembled a table of NNTs for 87 interventions in ten disease categories, deriving from meta-analyses (70%) or randomized controlled trials (30%), and assessing surgical interventions (7%), procedures (9%) or pharmacological treatments (84%). The NNTs varied widely, ranging from 1 in the use of epidural blood patch for post-dural puncture headache to 4608 for meningococcal vaccination. Preventative interventions had substantially larger NNTs. Time-frames were inappropriately short for many chronic conditions. CONCLUSIONS: Large collections of NNTs provide useful, updateable summaries of therapeutic effects in the neurosciences, an increasingly interventional clinical field.

Canada↗

PubMed1994

Preparing children and families psychologically for day surgery: an evaluation.

The increasing use of ambulatory care settings for children's surgery places more responsibility on parents for psychological preparation of children for surgery and for their post-operative care. This paper describes the evaluation of a pre-admission programme to prepare children between the ages of 3 and 15 years and their families psychologically for day surgery. Seventy-five families comprised the study sample, 23 in the programme group and 53 in the non-intervention group. The programme focused on familiarizing families with the physical and procedural components of day surgery through a videotape of a family in a naturally occurring day surgery situation, a tour, and hospital play. Fewer children and parents in the programme group reported high anxiety levels awaiting surgery. Children and parents with previous surgical experience reported higher levels of pre-surgical anxiety than inexperienced families. Families reported the physicians and day surgery nurse as their primary sources of information and rated the day surgery nurse highest in their satisfaction with information received. Implications for practice, particularly for meeting the needs of young children and out-of-town families, are discussed.

Adaptation, Psychological↗

PubMed2004

Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis.

OBJECTIVE: To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis. DATA SOURCES: Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles. STUDY SELECTION: Randomised controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as randomised controlled trials and were included for data extraction. DATA EXTRACTION: Six studies with 263 participants were analysed. Descriptive and outcome data were extracted. Main outcome measures were infections, complications other than infections, operative interventions, length of hospital stay, and mortality. The meta-analysis was performed with the random effects model. DATA SYNTHESIS: Enteral nutrition was associated with a significantly lower incidence of infections (relative risk 0.45; 95% confidence interval 0.26 to 0.78, P = 0.004), reduced surgical interventions to control pancreatitis (0.48, 0.22 to 1.0, P = 0.05), and a reduced length of hospital stay (mean reduction 2.9 days, 1.6 days to 4.3 days, P < 0.001). There were no significant differences in mortality (relative risk 0.66, 0.32 to 1.37, P = 0.3) or non-infectious complications (0.61, 0.31 to 1.22, P = 0.16) between the two groups of patients. CONCLUSIONS: Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.

Acute Disease↗

PubMed1987

Resuscitation and evaluation of victims of blunt multisystem trauma.

The initial management of hemodynamically unstable polytrauma patients can be challenging. Although there are other possible causes of hypotension, such as tension pneumothorax, CNS injury and hemopericardium, in the vast majority of blunt trauma victims shock is due to blood loss. Whereas the diagnosis of circulatory collapse is clearcut, the rapid identification and control of the bleeding source may not be a straightforward matter. Such patients often have injuries to several body systems and thus have numerous potential sites of hemorrhage. Ideally, the injury pattern should be defined during resuscitation. The use of a trauma team and standardized protocols facilitate patient management. Clearly, airway patency and adequacy of ventilation must have top priority. Cervical spine immobilization should be maintained until a fracture has been ruled out. In concert with respiratory management, other members of the trauma team should secure adequate vascular access, resuscitate the patient and perform a physical examination. Physical findings dictate the order of further diagnostic and therapeutic maneuvers. In unstable patients the potential need for urgent surgical intervention must not be overlooked.

Emergency Medical Services↗

PubMed1995

Breakdown of adenine nucleotides, formation of oxygen free radicals, and early markers of cellular injury in endotoxic shock.

OBJECTIVE: To study the influence of shock on muscle and plasma adenine nucleotide and creatine pools and their metabolites, and to identify early markers of cellular injury in shock. SETTING: Surgical research laboratory, Kuwait and UAE. DESIGN: Experimental study. MATERIAL: 19 New Zealand rabbits. INTERVENTIONS: 15 rabbits were injected with Escherichia coli endotoxin, and an additional 4 rabbits acted as controls. MAIN OUTCOME MEASURES: Blood and muscle energy metabolites, platelet count, arterial blood gas tensions, and arterial pressure were followed until the animals died. RESULTS: Five minutes after injection of endotoxin muscle ATP, creatine phosphate, and total adenine purine concentration decreased. This decrease was later reversed, but again decline to a critical level in the terminal phase. Loss of the muscle creatine pool indicated cellular damage after 3 hours. Plasma hypoxanthine, creatine, and lactate concentrations increased continuously throughout the study. CONCLUSION: Hypoxanthine formation is a possible source of oxygen free radicals in shock. The rise of hypoxanthine, creatine, and lactate concentrations in plasma during septic shock may reflect early high energy nucleotide failure, membrane injury, and anaerobic metabolism, respectively.

Adenine↗

PubMed1993

Reduced levels of acetylcholine receptor expression in chick ciliary ganglion neurons developing in the absence of innervation.

Chick ciliary ganglion neurons receive innervation from a single source, the accessory oculomotor nucleus (AON), and nicotinic ACh receptors (AChRs) mediate chemical synaptic transmission through the ganglion. Previous experiments examining the developmental expression of AChRs in embryonic chick ciliary ganglion neurons in situ have shown that AChR levels increase substantially in the neurons at the time of innervation. Prior to synapse formation, few AChRs are detected in the neurons. In the present experiments, the role of presynaptic inputs in inducing an increase in AChRs was established by examining AChR levels in ciliary ganglion neurons that have been deprived of innervation by surgical ablation of the AON prior to synapse formation. AChR levels were dramatically reduced in neurons of input-deprived ganglia as compared to control innervated neurons at all developmental stages examined from embryonic day (ED) 5 to ED 12 as determined by indirect immunocytochemical labeling of frozen ganglion sections with the anti-AChR monoclonal antibody mAb 35, and light microscopy. In contrast, neuronal somata of input-deprived and control ganglia had equivalent levels of immunolabeling for three other components, a transmembrane glycoprotein of synaptic vesicles, SV2, and two microtubule-associated proteins, MAP 1B and MAP 2, from ED 5 up to ED 10. The results demonstrate that presynaptic inputs specifically increase the levels of AChR expression in developing neurons. In addition, changes in the levels of immunolabeling for AChRs, SV2, MAP 1B, and MAP 2 in neuronal somata after ED 10 demonstrate that other major developmental events also influence the levels of these components in neurons. Declines in the intensity of AChR, SV2, MAP 1B, and MAP 2 immunolabeling within a subset of neuronal somata in both operated and control ganglia at ED 10 and 12 coincide with the period of neuronal cell death. Increases in AChR labeling in the rest of the neuronal population of input-deprived ganglia at ED 12 suggest that, in addition to innervation, synapse formation with the peripheral target tissue influences AChR levels in developing neurons in situ.

Animals↗

PubMed2001

Slow aging during insect reproductive diapause: why butterflies, grasshoppers and flies are like worms.

Diapause is a state of arrested development accompanied by physiology for somatic persistence. Diapause is common in many invertebrates and is familiar to biogerontology in the context of Caenorhabditis elegans dauer. Among insects, diapause may occur in embryos, larvae, pupae or adults. At the adult stage, reproductive diapause arrests development of oogenesis, vitellogenesis, accessory gland activity, and mating behavior. Reproductive diapause has been well studied in monarch butterflies, several grasshoppers, and several Diptera, including Drosophila and Phormia. In monarchs and in grasshoppers, reproductive diapause physiology has been experimentally induced by the surgical removal of the corpora allata, the source of adult juvenile hormone; allatectomy in each case was found to double adult longevity. Among Drosophila, the endemic D. triauraria of Japan, and D. littoralis of Finland over-winter as adults in reproductive diapause. How D. melanogaster winter is poorly understood, but reproductive diapause can be cued by cool temperature. In laboratory studies, the mortality rates of post-diapause D. melanogaster are similar to rates of newly enclosed, young flies. This implies that senescence during diapause is slow or negligible. Slow aging during the diapause period may involve elevated somatic stress resistance as well as reallocation of resources to somatic maintenance. Reproductive diapause in Drosophila is proximally controlled by down regulation of juvenile hormone, a phenotype that is also produced by mutants of the insulin-like receptor InR, homologue of C. elegans daf-2. We propose neuroendocrine control of reproductive diapause in D. melanogaster that includes phenotypic plasticity for rates of senescence.

Aging↗

PubMed2000

Intrapulmonary arteriovenous shunting may be a universal phenomenon in patients with the superior cavopulmonary anastomosis: a radionuclide study.

OBJECTIVE: To evaluate the extent of intrapulmonary right to left shunting in children after bidirectional cavopulmonary anastomosis (BCPA). DESIGN: Prospective study of patients who underwent BCPA in a single centre. PATIENTS: 17 patients with complex cyanotic congenital cardiac malformations who underwent BCPA at 1-45 months of age (median 21 months) were evaluated 15-64 months postoperatively (median 32 months). Five children between 1 and 10 years (median 5 years) with normal or surgically corrected intracardiac anatomy and peripheral pulmonary circulation who required V/Q scanning for other reasons were used as controls. INTERVENTIONS: All patients underwent cardiac catheterisation to exclude angiographically demonstrable venovenous collaterals followed by pulmonary perfusion scanning using (99m)technetium ((99m)Tc) labelled albumen microspheres to quantify the intrapulmonary right to left shunt. MAIN OUTCOME MEASURE: Percentage of intrapulmonary right to left shunt. RESULTS: The mean (SD) level of physiological right to left shunting found in the control group was 5.4 (2.3)%. All patients with BCPA showed the presence of a significantly higher level of intrapulmonary shunting (26.8 (16.9)%, p < 0.001). The degree of shunting was significantly increased in the subgroup of 11 patients with BCPA as the only source of pulmonary blood flow (34.9 (15.8)%), when compared to the six remaining patients with an additional source of pulmonary blood supply (12.0 (2.6)%, p < 0.001). There was a negative correlation between age at BCPA and the shunt percentage found in the patients with a competitive source of pulmonary blood flow (r = -0.63, p < 0. 01). CONCLUSIONS: Intrapulmonary right to left shunting develops in all patients following BCPA. This may be caused by a sustained and inappropriate vasodilatation resulting from absence or decreased levels of a substance that inhibits pulmonary vasodilatation. Augmenting BCPA with an additional source of blood flow containing hepatic factor limits the degree of intrapulmonary arteriovenous shunting and may help provide successful longer term palliation.

Age Factors↗

PubMedDate not supplied

[Shadow optic. An endoscope with optimized ligth].

Modern endoscopes use a single mid-frontal illumination source that yields an unnatural flat image. At the University of Tübingen, in collaboration with Gimmi GmbH (Tuttlingen, Germany), a new concept endoscope has been developed with an additional light source: the shadow optic. With the aid of a secondary light source along the axis of the endoscope, a shadow is obtained which gives an impression of spatial depth. The aim of the study was to assess this new endoscope objectively, focusing on the speed and safety of the surgical act. The shadow optic was used in an experimental setting by 20 probands, each of whom performed five different standardized procedures of increasing difficulty five times, with and without shadow optic in randomized sequence, making a total of 1000 experiments. The procedures consisted in spatial orientation tests, structure-surrounding maneuvers, tissue clamping, needle puncture and suturing. The evaluation criteria were the time required to perform the procedures and the number of predefined errors as determined by electronic control. In each procedure, the time needed to perform the experiments was shorter with the shadow optic, reductions of up to 18% being recorded, and the number of errors was up to 54% lower compared to the experiments conducted with the traditional endoscope. The results of the study demonstrate that, as a result of the more natural spatial view conditions, the procedures were performed faster and with greater precision when the shadow optic was used. The endoscopic imaging with the shadow optic makes for better spatial orientation and a more natural and manageable image.

Endoscopes↗

PubMed1984

[Clinical studies on topical hemostat Avitene in urological surgery].

Avitene (Microfibrillar Collagen Hemostat) is a new absorbable topical hemostatic agent, of which action mechanisms are platelet entrapment and activation of platelet clotting factors. It was used clinically on 11 patients for bleeding during urological surgery; bleeding from renal beds, resectional surfaces of kidney, urethras and floor of the pelvis, prostatic capsule and renal pelvis. The patients were 9 males and 2 females aged from 30 to 71 years old. Avitene was applied directly to the source of bleeding in a dry condition after the treatment of large vessel hemostasis. Pressure was applied to the area, and after 3 to 5 minutes, the excess of this material was removed. Avitene was successful in rapidly controlling bleeding in all the patients. No patient had secondary bleeding and complications attributed to the use of this material. This study indicates that Avitene is very effective as a topical hemostatic agent, particularly in urological surgery.

Adult↗

PubMed2003

Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy.

BACKGROUND: Following pelvic radiotherapy (RT), a proportion of women experience problems related to sexual function, which are multifactorial in origin. The physical components relate to distortion of the perineum and vagina, which may occur as a result of surgery and/or radiotherapy and compromise sexual activity resulting in considerable distress. OBJECTIVES: The aim of this review was to evaluate the evidence for treatment options addressing the physical components of sexual dysfunction arising from pelvic radiotherapy as prevention or treatment of acute or late complications. SEARCH STRATEGY: The concepts used included synonyms for radiation therapy and brachytherapy and synonyms for the spectrum of physical aspects of sexual dysfunction in women. randomized. We searched the Cochrane Controlled Trials Register (CENTRAL), issue 1, 2002, MEDLINE 1966 to 2002, EMBASE 1980 to 2002, CANCERCD 1980 to 2002, Science Citation Index 1991 to 2002, CINAHL 1982 to 2002, as well as sources of grey literature. We also hand searched relevant textbooks and contacted experts in the field. SELECTION CRITERIA: Any study describing the therapeutic trial of a treatment to relieve the physical aspects of female sexual dysfunction which had developed following pelvic radiotherapy was considered. The quality of each study was then assessed by two reviewers independently to determine its suitability for inclusion in statistical analysis. DATA COLLECTION AND ANALYSIS: Thirty-two references met the inclusion criteria for the search but of these only four were suitable to be included for statistical analysis. MAIN RESULTS: The strongest evidence for benefit is the grade IC data in the topical oestrogens and benzydamine sections which describes the treatment of acute radiation vaginal changes. The use of vaginal dilators to prevent the development of vaginal stenosis is supported by grade IIC evidence. The value of hyperbaric oxygen therapy and surgical reconstruction is supported by the much weaker grade IIIC evidence in the form of case series. REVIEWER'S CONCLUSIONS: These findings reflect the quality of published data regarding interventions for this aspect of the management of radiation induced complications. Although there is grade IC evidence, these studies are not recent, the allocation concealment is unclear in the text, and overall there is a variable level of assessment of the response, emphasising the need for more studies to be conducted with improved designs to clarify the investigative process and support the final result.

Brachytherapy↗

PubMedDate not supplied

Operative hemorrhoidectomy versus cryodestruction.

Twenty-six patients were treated for hemorrhoids by a combination of cryodestruction and closed operative hemorrhoidectomy. Patients were able to draw their own conclusions about the efficacies of these treatments. They had no difficulty in distinguishing exactly which area was causing pain. The operative site was a source of greater pain until the second day after the procedure, when the pain resulting from cryodestruction equalled surgical pain; then cryodestruction associated pain continued longer. Cryodestruction was associated with production of a foul discharge. Residual hemorrhoids were present in 50 per cent of patients' cryodestruction sites. Given the choice at the one year follow-up examination, 65 per cent preferred surgical treatment and 35 per cent preferred cryodestruction.

Adult↗

PubMed2006

Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies.

OBJECTIVE: To determine the strength of evidence underlying recommendations for use of statins during the perioperative period to reduce the risk of cardiovascular events. DESIGN: Systematic review of studies with concurrent control groups. DATA SOURCES: Four electronic databases, the references of identified studies, international experts on perioperative medicine, and the authors of the primary studies. Review methods Two reviewers independently extracted data from studies that reported acute coronary syndromes or mortality in patients receiving or not receiving statins during the perioperative period. MAIN OUTCOME MEASURE: Random effects summary odds ratios for death or acute coronary syndrome during the perioperative period. RESULTS: 18 studies--two randomised trials (n=177), 15 cohort studies (n=799,632), and one case-control study (n=480)--assessed whether statins provide perioperative cardiovascular protection; 12 studies enrolled patients undergoing non-cardiac vascular surgery, four enrolled patients undergoing coronary bypass surgery, and two enrolled patients undergoing various surgical procedures. In the randomised trials the summary odds ratio for death or acute coronary syndrome during the perioperative period with statin use was 0.26 (95% confidence interval 0.07 to 0.99) and the summary odds ratio in the cohort studies was 0.70 (0.57 to 0.87). Although the pooled cohort data provided a statistically significant result, statins were not randomly allocated, results in retrospective studies were larger (odds ratio 0.65, 0.50 to 0.84) than those in the prospective cohorts (0.91, 0.65 to 1.27), and dose, duration, and safety of statin use was not reported. CONCLUSION: The evidence base for routine administration of statins to reduce perioperative cardiovascular risk is inadequate.

Case-Control Studies↗

PubMedDate not supplied

Induction of controlled cardiac tamponade in the management of massive unexplained postcardiotomy bleeding. Case report and review of the literature.

Massive unexplained bleeding is a catastrophic complication of open heart surgery. The following paper describes a successful attempt to terminate such a hemorrhage by induction of controlled cardiac tamponade which caused augmentation of mediastinal pressure without hemodynamic decompensation, thereby aiding in hemostasis. This modality has not previously reported. Few events in clinical medicine are so ominous as the major unexplained hemorrhage. Diffuse bleeding from multiple transected small vessels may be controlled by mechanical techniques which apply pressure directly over the bleeding area. However, where the mediastinum is the source of bleeding, application of such a direct pressure with a closed chest, is both technically difficult and potentially risky. Reported attempts to stop bleeding by increasing the mediastinal pressure included the induction of pneumothorax, and the increase of positive end expiratory pressure (PEEP) has been published. To the best of our knowledge, a deliberate induction of controlled cardiac tamponade in order to terminate prolonged unexplained massive postcardiotomy hemorrhage has not been reported so far.

Aged↗