Mechanical ventilation after open heart surgery.

One hundred adult patients, undergoing elective open heart surgery over a period of 4 months, were studied to assess the practice of ventilation in the post operative period. The anaesthetic technique employed used moderate doses of morphine, supplemented with halothane and a muscle relaxant. The decision to extubate was based on clinical assessment, and satisfactory blood gases following a 45 minute T-piece trial. The patients were ventilated for an average duration of 8 hours and 2 minutes and 59 out of 100 patients were extubated within 8 hours. Patients undergoing coronary artery bypass graft were ventilated for significantly longer durations (10 hours 28 minutes) (p < 0.05) and had significantly lower arterial oxygen tension (p < 0.01) 30 minutes after extubation, as compared with those undergoing valvular surgery. Also patients whose bypass time exceeded 2 hours had significantly longer extubation times (p < 0.05) as compared with those who had a bypass time less than 1 hour. T piece trial was found to be a satisfactory method of weaning in all the patients.

Eccrine spiradenoma: a report of malignant transformation.

The authors report the case of a 21-year-old man who had malignant transformation within an eccrine spiradenoma involving the big toe. Although benign eccrine spiradenoma is not an uncommon cutaneous adnexal tumour, malignant change in this tumour is rare. To the authors' knowledge only 16 cases have been reported previously. Two histologically distinct components were seen in the tumour: typical eccrine spiradenoma, constituting a small part of the tumour, and carcinoma with areas of transition. The patient was treated by below-knee amputation and superficial inguinal node dissection. There was no evidence of recurrence 2 years after surgery.