Sternal wound complications after primary isolated myocardial revascularization: the importance of the post-operative variables.

OBJECTIVE: Select pre-, peri-, and post-operative variables, predictive for sternal wound complications (SWC), in a clinical setting. METHODS: We analyzed pre-, peri-, and post-operative data of 3815 patients who underwent a primary isolated bypass grafting. 100 patients (2.6%) had post-operative SWC. Unifactor and multifactor risk analysis, were used for statistical analysis. RESULTS: Unifactor analysis identified age (P=0.05), obesity (P=0.001), lung disease (P=0.001), extracorporeal circulation >100 min (P=0.02), graft choice (P=0.01), post-operative low cardiac output, reoperation, nephrological, pulmonary problems (P<0.001) as risk factors. Multifactor analysis, identified obesity (P=0.005), reoperation (P=0.01), nephrological (P=0.0001), pulmonary problems (P=0.001) and No-IMA-use (P=0.05) as independent predictors. Age <50 years (P=0.04) decreased the risk for SWC. There is, however, an interaction of the graft-use and the pre-operative and post-operative predictors, that can mask the precise effect of the graft-use. CONCLUSION: Reoperation, nephrological and pulmonary problems are strong predictors, obesity and age independent preoperative risk factors for sternal wound complications.

Infiltrating lobular carcinoma of the breast detected by screening.

BACKGROUND: This study was a retrospective analysis of all patients with invasive lobular breast cancer who presented to the University Hospital Nijmegen between 1980 and 1990, with follow-up to December 1992. A comparison was made between the invasive lobular carcinomas detected by breast cancer screening and those detected outside the screening project. METHODS: The total number of patients with breast cancer during this interval was 937, of whom 136 (14.5 per cent) had pure infiltrating lobular carcinoma (ILC). Breast cancer screening identified a total of 158 patients with infiltrating breast carcinoma of whom 20 (12.7 per cent) had ILC. Outside the screening programme a total of 116 patients with ILC were diagnosed during the same interval. RESULTS: The 2- and 5- and 10-year disease-free survival rate in the screen-detected group was 100, 100 and 89 per cent respectively. For the group outside the screening programme this was 88.4, 74.3 and 72.5 per cent respectively (P = 0.04). No patient in the screen-detected group died from breast cancer during follow-up, whereas the 2- and 5- and 10-year breast cancer survival rate for the group detected outside the screening programme was 96.5, 89.1 and 70.6 per cent respectively (P = 0.06). CONCLUSION: Between 10 and 15 per cent of patients with invasive lobular breast cancer can be detected by breast screening. These patients have a favourable outcome compared with those who have ILC detected outside the screening programme.