Influence of complete revascularization on long-term survival after coronary artery bypass surgery.

To evaluate the influence of complete coronary revascularization after coronary artery bypass grafting (CABG) on long-term survival, we reviewed the records, including reports of coronary angiography, of 198 patients (25 women). Coronary artery bypass grafting was performed in the period 1973-1982, when the patients' mean age was 52.5 years. No significant (p < 0.05) difference in survival in the first 15 postoperative years was found between the patients judged to have complete revascularization at coronary angiography 6 months after CABG and the general Danish population. Complete revascularization by extensive grafting should improve survival of patients treated for angina. If the revascularization remains complete at coronary angiography assessment 6 months postoperatively, the 15-year survival rate can be expected to equal that in the general population.

[A 20-year follow-up of Danish coronary artery bypass patients]. / Tyve års opfølgning af danske koronararteriebypass-patienter.

This study describes the influence of complete revascularization on the long term survival of patients following coronary artery bypass surgery. The patient population consists of 100 consecutive patients discharged from our department after undergoing a coronary bypass operation between November 1973 and July 1978. Patients who survived less than 30 days postoperatively are excluded from the study. The patient population consists of 87 males and 13 females. Mean age was 52.2 years at time of surgery. The rate of revascularization was estimated by coronary angiography, performed between one and 34 months postoperatively, in contrast to other similar studies found in the literature, where such estimation was performed peroperatively. Twenty-five of 86 patients were completely revascularized at postoperative angiographic estimation. Long term survival for the patient population and for the group of completely revascularized patients were compared to the expected survival of the Danish background population (comparable age and sex). Long term survival for the patient population as a whole was similar to that found in similar studies. There was an expected increased mortality compared to the Danish background population.

[10-year survival after lung resection for lung cancer]. / Tiårsoverlevelse efter lungeresektion ved lungecancer.

The purpose of the study was to investigate the prognosis for patients treated for lung cancer by operative resection in the Copenhagen area. Ninety-four consecutively operated patients were followed prospectively for ten years. Seventy-one percent of the patients had been operated radically. The five- and ten-year survival for this group was respectively 46 and 27%. All non-radically operated patients were dead after four years. The postoperative mortality and long-term survival correspond to international results. Type of cancer and mode of operation did not affect survival in the radically operated patients.

[Bacterial endocarditis at a county hospital department, 1983-1992. Prognosis in relation to bacteriology, disease localization and treatment]. / Bakteriel endokardit på en landsdelsafdeling, 1983-1992. Prognose i relation til bakteriologi, sygdomslokalisation og behandling.

The case records of 69 patients with a diagnosis of bacterial endocarditis were reviewed. Forty-nine patients had native valve endocarditis (NVE) and 20 patients had prosthetic valve endocarditis (PVE). Among patients with NVE left-sided endocarditis was treated surgically more often than right-sided endocarditis. Involvement of the aortic valve was the most important indicator of death and acute/subacute surgical intervention. The mortality was 29%. No patient with right-sided endocarditis died. The infective agent did not seem to influence outcome or frequency of surgical intervention. Among patients with PVE the most frequently isolated organism was coagulasenegative staphylococci. Surgical intervention occurred most frequently in those with infection with coagulase-negative staphylococci or culture negative endocarditis. The mortality was 25%, identical for early and late cases. The patients who died were all infected with staphylococci. The localization did not seem to influence treatment or outcome. In spite of advances in surgical and medical treatment bacterial endocarditis is still a life-threatening disease with a high mortality.

Fracture of a composite aortic graft. Case report.

Fracture of a valved composite graft was found 3 years after its implantation in the ascending aorta. This appears to be the first reported case of such fracture.

[Acute thoracic injuries. A retrospective study of treatment and results]. / Akutte thoraxtraumer. En retrospektiv opgørelse over behandling og resultat.

One hundred and twelve patients with severe chest trauma, were evaluated retrospectively. Chest tubulation was sufficient treatment in 64% cases, with hemo/pneumothorax, while 36% underwent thoracotomy. It may be life-threatening if tubulation is not performed in patients with chest trauma, treated with respiratory therapy. The overall mortality was 18%. Most often mortality was related to ARDS (adult respiratory distress syndrome) (Pontoppidans' categories, severe and moderate respiratory failure) and the cause was pulmonary failure and/or multiorgan failure. Infections (pneumonia and sepsis) are often related to pulmonary failure and probably influence its progress to ARDS.

[Traumatic rupture of the thoracic aorta]. / Traumatisk ruptur af aorta thoracalis.

A man aged 19 years sustained multiple injuries on account of deceleration. Radiography of the thorax revealed increase in width of the mediastinum. Aortography after 1 1/2 days revealed pseudocoarctation of the aorta corresponding to rupture of the aortic isthmus. This investigation should be undertaken on broad indications in patients with relevant injuries and increase in width of the mediastinum.

Pleurodesis in spontaneous pneumothorax by means of tetracycline. Follow-up evaluation of a method.

The validity of previous recommendation of early thoracoscopy and tetracycline pleurodesis in the management of spontaneous pneumothorax without thoracoscopically visualized true cyst was assessed under non-trial, normal hospital conditions. Among 46 patients treated during a year, seven underwent immediate thoracotomy following finding of large cysts. Of the remaining 39 patients, 11 had recurrence of pneumothorax after a median of 11 (range 2-64) weeks. Repeat thoracoscopy then showed large cyst or bullous emphysema in seven cases. Tetracycline pleurodesis was again performed in the others. In continued observation for at least 2 years there were no further recurrences. The importance of meticulous thoracoscopy is stressed. The demonstrated diagnostic errors do not detract from the value of tetracycline pleurodesis when spontaneous pneumothorax is caused by rupture of only tiny blebs on the surface of an otherwise healthy lung. The procedure is fast, simple and efficacious.

Pneumopericardium after pneumonectomy and lobectomy.

Pneumopericardium is a rare condition, most frequently reported in connection with prolonged artificial ventilation in infants with hyaline membrane disease. No reports of pneumopericardium after pulmonary surgery have been published. Two cases of pneumopericardium are reported, one of tension pneumopericardium after pneumonectomy and artificial ventilation and one that followed radical lobectomy and artificial ventilation. The radiographic findings included pneumopericardium and subcutaneous emphysema and the patient who had had a pneumonectomy had severe symptoms of cardiac tamponade. Prolonged artificial ventilation in patients after pulmonary surgery and in the presence of an intrathoracic air leak may be a hazard. The importance of prompt surgical intervention in cases of tension pneumopericardium is underlined; the treatment of choice is thoracotomy with pericardiotomy.

Cribriform diaphragm: a variant of congenital diaphragmatic herniation. A case report.

Herniation through a "cribriform" diaphragm was incidentally detected in a 65-year-old woman. Liver tissue protruding into the right hemithorax showed signs of strangulation. The defects were surgically corrected. The condition presumably was an extremely rare variant of congenital diaphragmatic hernia.

A broncho-biliary fistula probably due to exacerbation of chronic pancreatitis. A short review of the literature.

Broncho-biliary fistulae are generally secondary to echinococcal abscesses in the liver, less frequently to trauma, penetrating or not. A third group seems to follow biliary tract obstruction, surgical or non surgical. Congenital broncho-biliary fistulae seem to be extremely rare. We present here a case of broncho-biliary fistula probably secondary to an exacerbation of chronic pancreatitis. Liberal surgical drainage, safe closure of the diaphragm and early surgical intervention are mandatory and are emphasized.

Purulent pericarditis in children. Review and case report.

Acute purulent pericarditis is infrequent in children. Only around 200 cases have been reported in the western literature in the past 25 years (1-10). From the Scandinavian countries only two cases have been described (6, 7). Purulent pericarditis is usually a complication of upper respiratory tract infection. Mortality is very high in unrecognized or inadequately treated cases. Early diagnosis and appropriate treatment with adequate surgical drainage and antimicrobial therapy are vitally important for the outcome.

The predictive value of three diagnostic procedures in the evaluation of palpable breast tumours.

In a prospective study of 200 palpable breast tumours of 200 women, the diagnostic specificity and sensitivity of clinical examination, mammography, and fine needle aspiration were compared, alone and in combinations. All tumours were excised and examined histologically, and 38 were malignant. The diagnostic sensitivity of clinical examination was high, 98% (91-99), whereas the specificity was rather low, 48% (36-60). No statistically significant differences were found between the sensitivities or the specificities of the three examinations. When the methods were combined the sensitivity was 100% (96-100) and the specificity was 37% (27-46). Statistically, no improvement of the diagnostic value could be shown. It is concluded that the possibility of distinguishing between malignant and benign palpable breast tumours is not increased by adding mammography and/or fine needle aspiration, but the discovery of two non-palpable malignant tumours by mammography underscores the importance of this method in disclosing subclinical malignant lesions. The study disclosed a statistical possibility of overlooking a few malignant tumours when using these three procedures. Therefore, we advise that all palpable breast tumours should be excised.

Primary pulmonary leiomyosarcoma. Review of the literature and report of a case.

In a review of the literature, 38 cases of pulmonary leiomyosarcoma were found. An additional case with highly progressive course is reported and the diagnostic and therapeutic possibilities are discussed. Prognostic signs are evaluated. The importance of radical surgery is emphasized.

Management of bronchopleural fistula following pneumonectomy.

Bronchopleural fistula developed in 28 (12.5%) of 225 pneumonectomies performed for pulmonary carcinoma of non-small cell types during a 10-year period. The incidence of fistula apparently decreased significantly when chromic catgut was replaced by Dexon for closure of the bronchial stump. The fistula presented as an emergency in nine cases and was subacute in 19. The overall mortality from bronchopleural fistula was 28.6%. Conservative treatment, i.e. bronchoscopic application of silver nitrate to destroy the epithelium in the bronchial stump and induce granulation, achieved closure of fistula in all the surviving patients. In the seven patients with sterile pleural cavity the pleura was not drained. The results justified our principle of conservative management when a bronchopleural fistula does not present as an emergency. In emergency situations, however, or if the pleural fluid is purulent, pleural drainage should be instituted.