Beyond Ortner's syndrome--unusual pulmonary complications of the giant left atrium.

INTRODUCTION: The giant left atrium (GLA) is a complication of severe mitral valve disease and causes morbidity by compressing adjacent intra-thoracic structures. CLINICAL PICTURE: We report 2 cases of unusual pulmonary complications of the GLA. Case 1 developed recurrent collapse of the left lung due to left main bronchus compression. Case 2 was diagnosed with right middle lobe compression and collapse. TREATMENT AND OUTCOME: Case 1 was successfully treated by mitral valve replacement and left atrial reduction surgery. Case 2 was treated conservatively. CONCLUSION: Pulmonary atelectasis may occur in patients with GLA due to bronchopulmonary compression. Surgical management with valve replacement and atrial reduction may be necessary to relieve airway compression.

Smoking cessation programme: the Singapore General Hospital experience.

INTRODUCTION: The National Health Survey in Singapore reported that the prevalence of smoking had decreased from 20 percent in 1984 to 15 percent in 1998. This may be due to the efforts of smoking cessation education established island-wide. In this study, we review the efficacy of the Singapore General Hospital smoking cessation programme and examine the efficacy of different treatment modalities. METHODS: We studied the immediate quit rate and point prevalence abstinence rates at six and 12 months in our telephone survey. Subjects were patients who attended our programme from June 1999 to December 2002. Pharmacotherapeutic aids utilised with counselling sessions were individualised. RESULTS: The study populations for outpatient and inpatient arms were 394 patients and 425 patients, respectively. In the outpatient programme, mean age was 46 years (range of 12 to 80 years), and the ratio between males and females was 8.6. The outpatient immediate quit rate was 33 percent, and the six and 12 month quit rates were both 36 percent. However, in the inpatient programme, mean age was 65 years (range of 15 to 93 years), and the ratio between males and females was 4.9. The six and 12 month quit rates of the inpatient arms were 30 percent and 32 percent, respectively. Although there is no statistically significant difference in the different treatment modalities, the immediate quit rates for bupropion only and counselling only were relatively higher (36 percent and 41 percent, respectively). These were sustained at more than 35 percent at six and 12 months follow-up. We achieved comparable efficacy compared to published data. Counselling, as a sole therapy, can be effective in a select patient group. One-time inpatient counselling achieved a quit rate (32 percent at 12 months) far superior to previously-reported self-quit rate (3 percent and 8 percent at 12 months). CONCLUSION: We strongly recommend that all inpatients who are smokers to be routinely referred for counselling.