Fatal subdural haemorrhage following lumbar spinal drainage during repair of thoraco-abdominal aneurysm

A 63-year-old male patient collapsed and died from a major subdural haemorrhage 5 days after elective repair of a Type III thoraco-abdominal aortic aneurysm. The anaesthetic technique had included the use of a lumbar cerebrospinal fluid drain. The management of the patient is described, and the association between subdural haemorrhage and cerebrospinal fluid drainage is discussed.     

Effects of Measurement Error and Sampling Resolution on Estimates of Atrial Tissue Recovery Parameters

We studied the effect of sampling resolution and measurement error on estimates of tissue recovery parameters using experimental and simulated data. Action potential duration (APD) was estimated from monophasic action potentials recorded at 250 sites (x=3.5 mm) on the endocardium of the canine right atrium (n=8) during control and acetylcholine perfusion. APD distributions were also simulated using a random number generator, then scaled and filtered to physiological values. The following parameters were estimated at increasing APD sampling interval and measurement error: mean APD, standard deviation of APD, mean APD gradient, standard deviation of APD gradient, APD wavelength, and APD correlation length. We found that large errors can result from APDs collected at inadequate sampling intervals and adequate sampling intervals may be 3–6 times less than the Nyquist interval. Large parameter errors also resulted from data with relatively low levels of measurement error. The effect of measurement error was dependent upon the standard deviation of APD, sampling resolution, and APD wavelength. Inadequate sampling resolution was the largest source of error in experimental parameter estimates. Estimates of mean and standard deviation of APD gradient decreased with spacing as estimates of correlation length and wavelength increased. Careful selection of spacing interval, taking into account the spatial complexity of recovery, as well as considerably low measurement errors will produce accurate estimates of gradients, correlation length, and wavelength. © 2000 Biomedical Engineering Society. PAC00: 8719Nn, 8719Hh, 0620Dk     

Laboratory-based calculation of coronary heart disease risk in a hospital diabetic clinic.

AIMS: To develop an estimation of risk of coronary heart disease (CHD) based on the Framingham equation for use in a diabetes clinic, given concerns about the accuracy of the Sheffield risk tables in this setting. METHODS: A computer program using the Framingham equation based on patients' age, sex, systolic blood pressure, smoking history, presence of diabetes and left ventricular hypertrophy was applied to requests for lipid screening of patients attending the diabetes clinics of Birmingham Heartlands Hospital. The calculated risks for the population were compared with those estimated from the Sheffield tables. RESULTS: Of 1060 patients with diabetes mellitus, 215 (20%) had an annual CHD risk > or =3%, which is considered to be the threshold at which lipid-lowering drugs are cost-effective. Only 24 of these 215 patients (11%) were correctly identified by the Sheffield tables, which we conclude have an unacceptably low sensitivity in diabetes mellitus. CONCLUSIONS: A laboratory-based CHD risk calculation system is a practical alternative to the Sheffield system and may have a greater sensitivity in the diabetic clinic.     

COVID-19 and the multidisciplinary care of patients with lung cancer: an evidence-based review and commentary

Delivering lung cancer care during the COVID-19 pandemic has posed significant and ongoing challenges. There is a lack of published COVID-19 and lung cancer evidence-based reviews, including for the whole patient pathway. We searched for COVID-19 and lung cancer publications and brought together a multidisciplinary group of stakeholders to review and comment on the evidence and challenges. A rapid review of the literature was undertaken up to 28 October 2020, producing 144 papers, with 113 full texts screened. We focused on new primary data collection (qualitative or quantitative evidence) and excluded case reports, editorials and commentaries. Following exclusions, 15 published papers were included in the review and are summarised. They included one qualitative paper and 14 quantitative studies (surveys or cohort studies), with a total of 2295 lung cancer patients data included (mean study size 153 patients; range 7–803). Review of current evidence and commentary included awareness and help-seeking; lung cancer screening; primary care assessment and referral; diagnosis and treatment in secondary care, including oncology and surgery; patient experience and palliative care. Cross-cutting themes and challenges were identified using qualitative methods for patients, healthcare professionals and service delivery, with a clear need for continued studies to guide evidence-based decision-making.Subject terms: Lung cancer, Lung cancer     

Strontium-89 chloride for pain palliation in prostatic skeletal malignancy.

In a multi-centre study strontium-89 was shown to be effective in relieving bone pain from prostatic carcinoma in patients who had failed conventional therapies. Of 83 patients assessed at 3 months, following the administration of a dose of at least 1.5 MBq/kg, 75% derived benefit and 22% became pain free. Symptomatic improvement usually occurred within 6 weeks and continued for between 4 and 15 months (mean 6 months). Based on the dose estimation part of this study the recommended dose of strontium-89 is 150 MBq. Toxicity was low, provided platelet levels were above 100 x 10(9) l-1 at the time of treatment. Repeat treatments with strontium-89 may be given at intervals of not less than 3 months. Strontium-89 is administered intravenously on an out-patient basis with no special radiological protection precautions.     

Driving pressure and arterial carbon dioxide tension during high-frequency jet ventilation in postoperative patients

To achieve normocarbia during conventional mechanical ventilation, ventilator settings are determined initially on the basis of body weight. The best ventilator settings for CO2 elimination during high-frequency jet ventilation (HFJV) have not been so clearly defined. A recent study has suggested that eucarbia will be obtained with HFJV when tidal volume (VT) per kg of body weight is kept within a narrow, well-defined range. In the same study, a "bench test" demonstrated that VT was directly proportional to the jet ventilator driving pressure (DP). The goal of our study was to confirm this recommended VT/kg to obtain eucarbia and to determine whether the relation observed between VT and DP in the laboratory was true clinically. We studied 14 patients admitted to the ICU for postoperative support. We determined a good correlation between DP and VT/kg (r = .811, p less than .001) for the group as a whole and a good inverse correlation between DP or VT/kg and PaCO2 for most individual patients; however, there was a poor inverse correlation between DP or VT/kg and PaCO2 for the group as a whole, due to wide patient-to-patient variation in the efficiency of jet ventilation. We conclude that there is no universal formula for setting jet ventilator DP or VT/kg to affect normocarbia in humans.