To study changes in coronary artery surgery practice the years spanning publication of cardiac mortality data UK.A retrospective analysis prospectively collected from all National Health Service centres undertaking adult northwest England was carried out. Patients undergoing for first time between April 1997 and March 2005 were included. Changes observed, predicted risk adjusted (EuroSCORE) studied. Evidence risk-averse behaviour looked by examining number patients at low (EuroSCORE 0-5),...

To study the ability of logistic EuroSCORE to predict operative risk in contemporary cardiac surgery.Retrospective analysis prospectively collected data.All National Health Service centres undertaking adult surgery northwest England.All patients undergoing between April 2002 and March 2004.The predictive was assessed by analysing how well it discriminates with differing observed using area under receiver operating characteristic (ROC) curve studying is calibrated against in-hospital...

<b>Objective</b> To assess the effects of social deprivation on survival after cardiac surgery and to examine influence potentially modifiable risk factors. <b>Design</b> Analysis prospectively collected data. Prognostic models used additional effect end points. <b>Setting</b> Birmingham north west England. <b>Participants</b> 44 902 adults undergoing surgery, 1997-2007. <b>Main outcome measures</b> Social with census based 2001 Carstairs scores. All cause mortality in hospital at mid-term...

<h3>Abstract</h3> <b>Objective</b> To study the “learning curve” associated with independent practice in coronary artery surgery. <b>Design</b> Retrospective analysis of prospectively collected data. <b>Setting</b> All NHS centres north west England that carry out cardiac surgery adults. <b>Participants</b> 18 913 patients undergoing for first time between April 1997 and March 2003, 5678 whom were operated on by 15 surgeons four years after their consultant appointment. <b>Main outcome...

To develop a multivariate prediction model for in-hospital mortality following aortic valve replacement.Retrospective analysis of prospectively collected data on 4550 consecutive patients undergoing replacement between 1 April 1997 and 31 March 2004 at four hospitals. A logistic regression was undertaken, using the forward stepwise technique, to identify independent risk factors mortality. The area under receiver operating characteristic (ROC) curve calculated assess performance model....

Off-pump coronary artery bypass (OPCAB) surgery is being increasingly reported to show better outcomes compared conventional on grafting. We examined the effect of OPCAB in-hospital mortality and morbidity, while adjusting for patient disease characteristics, in four institutions North West England.Between April 1997 March 2001, 10,941 consecutive patients underwent isolated at these institutions. Of these, 7.7% were performed off-pump. used logistic regression examine morbidity after...

Objective: As little is known about the impact of non-dialysis-dependent renal dysfunction on short-and mid-term outcomes following coronary surgery we have conducted a large multi-centre study comparing patients with no history to those preoperative dysfunction.Methods: Data was prospectively collected 19,625 consecutive undergoing isolated between 1997 and 2003 from four institutions.Sixty-seven had dialysis support prior surgery, were excluded main analysis study.The remaining 19,558...

To compare implications of using the logistic EuroSCORE and a locally derived model when analysing individual surgeon mortality outcomes.Retrospective analysis prospectively collected data.All NHS hospitals undertaking adult cardiac surgery in northwest England.14,637 consecutive patients, April 2002 to March 2005.We have compared predictive ability (uncalibrated), calibrated for contemporary performance regression model. We used each create risk-adjusted funnel plots demonstrate high...

The anatomy of the cervical spine musculature visible on magnetic resonance (MR) images is poorly described in literature. However, correct identification individual muscles clinically important because certain conditions spine, for example whiplash associated disorders, idiopathic neck pain, nerve root avulsion and spondylotic myelopathy, are with different morphological changes specific MR images. Knowledge precise structure crucial when comparisons contralateral side or normal required...

An acetabular prosthesis orientated outside the 'safe zone' is one of key contributing factors in increasing complications after total hip replacement (THR). Although orientation routinely assessed using supine x-rays, standing x-rays have been proposed because a change body position alters pelvic tilt and therefore orientation. This study aimed to assess whether components within can also be standing. Thirty patients (12M, 18F) had lateral antero-posterior taken positions six weeks post...

Heart transplantation for congenital heart disease poses unique problems because of structural anomalies and previous corrective palliative surgery. In the period between May 1985 February 1992 a total 231 orthotopic transplants were performed at our hospital -22 these procedures carried out in patients with disease. The patient's ages ranged from 1 month to 51 years (median 10 years). There 13 paediatric group (under 16 years) 9 adult (16 or older). diagnoses included univentricular...

In order to determine the results of steroid-sparing maintenance immunosuppression in paediatric patients who have undergone orthotopic heart transplantation (OHT), a retrospective study was undertaken 12 children and five infants (median age 3.5 years). Preoperative diagnoses were cardiomyopathy seven congenital disease 10 patients. Immunosuppression induced by cyclosporin, azathioprine, methylprednisolone, antihuman lymphocyte immune globulin. It maintained with cyclosporin azathioprine....

Cardiac complications associated with type A aortic dissections are relatively common before and during the surgical repair. cardiac event occurring a few days after routine recovery is rare though. We describe case of acute occlusion left anterior descending artery by thrombus, 4 repair, salvaged emergency angioplasty stenting. possible explanation for thrombus includes embolisation fragment glue.

A 70-year-old patient presented with ventricular tachycardia and left failure. He was found to have a communication between posterior aneurysm the right atrium. The causal myocardial infarction had been silent. This defect satisfactorily closed at operation from which he made an uneventful recovery. is first report of ventricular-right atrial developing in association ischaemic heart disease highlights role transoesophageal echocardiography diagnosis surgical management such condition.

The unstable pelvic fracture has been described as the 'killing fracture' because of risk significant vascular compromise. ability to correctly classify fractures may therefore be crucial in optimizing patient outcomes. Pelvic classification is difficult and previous research indicated that suboptimal orthopaedic registrars. objective this study was examine efficacy an educational package improving registrars' fractures.A total 35 registrars were recruited study. An used introduce AO teach...

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed whether re-operative or radiotherapy should be given patients with residual microscopic tumour at the bronchial resection margin. Altogether 427 papers were identified using reported search of which 13 represented on this topic. author, journal, date and country publication, patient group studied, study type, relevant outcomes, results weaknesses tabulated. We conclude that for...

Duodenum inversum is a rare congenital anomaly of unknown aetiology characterised by the proximal duodenum travelling posteriorly and superiorly prior to crossing midline. Clinical presentations include epigastric pain, nausea, abdominal distension. It can be associated with duodenitis, acute pancreatitis, peptic ulcer disease functional biliary obstruction. In this case report, we discuss 77-year-old male who presented hematemesis pain secondary for which he had CT scan abdomen demonstrated...