Delayed presentation of an aspirated capsule endoscope.

Capsule endoscopy has revolutionized the investigation of small intestinal pathology with an increasing repertoire of indications. We present the first reported case of an aspirated capsule presenting after a long asymptomatic period that was removed with no permanent pulmonary sequelae. This report highlights a cohort of patients who could be susceptible to this rare complication. The report also encourages the development of local/national guidelines to investigate misplaced/lost capsules during the procedure.

Phenoxybenzamine treatment can lead to loss of endothelial cell viability.

Phenoxybenzamine, an irreversible alpha-adrenoceptor antagonist, is used as a topical treatment against catecholamine-induced contraction in radial artery bypass grafts. Published data suggest that a wide range of phenoxybenzamine doses may be equally effective. This study aimed to investigate whether lower doses of phenoxybenzamine would benefit grafts by better preserving endothelium. To this end human vascular endothelial cells were isolated from sections of radial artery or saphenous vein, and treated with phenoxybenzamine for 30 min. Cells were then washed free of drug and viability assayed using a resazurin-based toxicology assay or returned to culture for assay at 24 h. Phenoxybenzamine treatment showed a dose-dependent effect on cell viability over several clinically employed concentrations. Concentrations above 0.1 mM led to a loss of viability, which became more pronounced with time. The loss of viability was shown to be independent of the carrier used, as results were identical when phenoxybenzamine was dissolved in dimethylsulphoxide, which alone did not affect viability. Changes in pH alone were also not sufficient to affect viability. In conclusion, phenoxybenzamine treatment is likely to cause damage to graft endothelium if employed at concentrations above 0.1 mM (0.03 mg/ml). Phenoxybenzamine may be safely used at lower doses with no potential loss of endothelial cell viability.

The effect of chronic steroid therapy on outcomes following cardiac surgery: a propensity-matched analysis.

OBJECTIVE: Steroids are beneficial in reducing the inflammatory response accompanying surgery with cardiopulmonary bypass. However, chronic steroid therapy has been implicated as a risk factor for abdominal complications and mortality following surgery. We assessed the impact of chronic steroid therapy had on outcome following cardiac surgery. METHODS: During the period January 1999 to March 2003 there were 98 patients on chronic steroid therapy (Group S) who underwent cardiac surgery at our institution. These patients were matched with a control group of 98 patients who were not on steroids (Group C). A propensity score was used to perform the matching. The C statistic for this model was 0.72. RESULTS: Ninety (93.7%) of the 98 patients in Group S had been on oral prednisolone for a median of 9.5 years (25th and 75th percentile of 5 and 12 years) with a median dose of 5mg (25th and 75th percentile of 4 and 8.75 mg). Preoperative characteristics were well matched between both groups. There was no difference in the post-operative outcome between the two groups with respect to mortality, stroke, renal failure, abdominal complications, wound infections, requirement for inotropic support and myocardial infarction. Patients in Group S were more likely to develop atrial arrhythmias and to require prolonged ventilation, although this did not reach statistical significance. CONCLUSIONS: Chronic steroid therapy was not associated with increased mortality or overall morbidity following cardiac surgery. However, patients on chronic steroids may be at greater risk of developing atrial arrhythmias or of requiring prolonged ventilation.

Ectopic thymoma of the chest wall.

A case of ectopic thymoma arising from the chest wall is reported. A chest wall tumour involving the third and fourth ribs and extending extrapleurally and subpectorally was resected following a histopathological diagnosis of hemangioendothelioma obtained at initial incision biopsy. Pathological examination of the excised mass, revealed appearances consistent with a malignant thymoma. No primary thymic tumour was present in the anterior mediastinum so we conclude that the tumour originated in ectopic thymic tissue. To our knowledge a primary thymoma arising within the chest wall has not been reported.