Is povidone-iodine pleurodesis as effective, safe and well tolerated as talc pleurodesis for recurrent malignant pleural effusions?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'For patients with malignant pleural effusion is chemical pleurodesis with povidone-iodine as effective, safe and well tolerated as talc pleurodesis for prevention of recurrent malignant pleural effusions?'. A total of 124 papers were found during the search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. At present, medical-grade talc is the most commonly used agent for chemical pleurodesis due to its high success rate, extensive history of clinical use and well-known side-effect profile. However, studies using povidone-iodine seek to establish it as a readily available,low-cost alternative to talc that can be easily administered through an intercostal catheter at the bedside. The summation of available evidence suggests that povidone-iodine is a safe, well-tolerated and equally efficacious agent for pleurodesis in the setting of malignant pleural effusion, when compared to talc.

Preoperative angioembolisation of a mediastinal accessory ectopic spleen: A case report and review of the literature.

A 50-year-old male presented to our institution for embolization of an incidentally detected mediastinal mass prior to surgical resection. The patient had undergone extensive pre-procedural imaging as well as bronchoscopy and mediastinoscopy. Ultimately, resection was required for a definitive diagnosis of congenital ectopic mediastinal accessory spleen. This case represents the first reported incidence of ectopic splenic tissue in this location and illustrates the difficulties in establishing a pre-operative diagnosis with often confounding imaging findings.

Early reduction of acute anterior shoulder dislocations in a ski field setting.

OBJECTIVE: The present study describes the management of suspected shoulder dislocations in ski field clinics. METHODS: Data were collected from two clinics in Queenstown, New Zealand. Suspected anterior shoulder dislocations, with no suspicion of significant fractures and without imaging, underwent attempted reduction. RESULTS: Ninety percent (n = 49) of dislocations were successfully relocated. No short-term complications because of this procedure were observed. CONCLUSION: This short report raises the possibility that early anterior shoulder reduction in a ski field clinic can be safe without imaging, in select cases. Prospective studies including patient centred data are recommended.

What is the prevalence of inspiratory muscle weakness in preoperative cardiac surgery patients? An observational study.

BACKGROUND: In patients undergoing elective cardiac surgery, the prevalence of inspiratory muscle weakness is not well-understood. This information could guide pre-operative therapy. OBJECTIVES: To determine the prevalence of inspiratory muscle weakness in preoperative cardiac surgery patients, and describe relationships between pre-operative factors (including maximal inspiratory pressure, MIP) and post-operative pulmonary complications (PPCs). METHODS: Prospective study of elective cardiac surgery patients. Pre-operative MIP was measured (cmH2O) and PPC data were extracted from medical records (Melbourne Group Score) while age, height, weight, frailty and physical activity levels were captured via questionnaire. Backwards-stepwise logistic regression was used to describe associations. RESULTS: 24 participants were recruited (79% male, age 70 ±â€¯10.7, BMI 26.8 ±â€¯4.14). The prevalence of inspiratory muscle weakness (MIP < 60% predicted) was 25% (n = 6). PPCs were associated with body mass index (BMI) (r = 0.464, p = 0.022). CONCLUSION: The prevalence of pre-operative inspiratory muscle weakness was 25%. BMI may be an important determinant of PPCs in elective cardiac surgery patients.

Infective endocarditis--a twelve year surgical outcome series.

AIM: To review the clinical course and outcome of patients with infective endocarditis proceeding to surgical treatment in the South Island of New Zealand. METHODS: A retrospective review of all cases of infective endocarditis requiring cardiac surgery, excepting homograft replacement between 1989 and June 2001 was performed. All patients treated at both cardiothoracic units over this time frame in the South Island of New Zealand were included. RESULTS: A total of 29 patients, ten females and nineteen males, age range 31-79 years (mean 55) underwent surgery. 27 patients had native valve endocarditis, two infection of prosthetic valves. A variety of causative micro-organisms were isolated, and all patients received aggressive intravenous antibiotic therapy. Heart failure was the predominant indication for surgical intervention. Fifteen patients underwent aortic, nine mitral, three combined and two replacement of infected prosthetic valves. There were five peri-operative deaths (17% mortality) and significant morbidity in a further eleven patients (38%). Of the 23 survivors available to follow-up none have recurrent endocarditis, with an average disease free survival of 35 months. CONCLUSIONS: Patients who require valve surgery for endocarditis have significant peri-operative morbidity and mortality. Long-term outcome in survivors, however, is extremely good with a prognosis similar to those undergoing elective valve replacement surgery. Mycotic cerebral aneurysms are an emerging important cause of early deaths.