Cardiac arrhythmias

Supraventricular dysrhythmias (SVDs) present the most frequent medical complication after thoracic surgery and have been associated with prolonged hospital stays. The reported incidence of SVDs in the thoracic surgery patient population ranges from 10% to 40%, with factors such as age and extent of surgery markedly influencing the incidence. This article focuses on new issues leading to improved understanding of the pathophysiology and mechanisms of SVDs after surgery. New approaches directed at prophylaxis and acute therapy of SVDs are discussed, as are recommendations to prevent thromboembolic events due to atrial dysrhythmias following thoracic surgery.     

Cardiac transplantation

The authors performed a clinical and serologic follow-up study after 4.2 +/- 1.2 years in 44 patients with clinical signs of neuroborreliosis and specific intrathecal antibody production. All patients had been treated with ceftriaxone 2 g/day for 10 days. Although neurologic deficits decreased significantly, more than half the patients had unspecific complaints resembling a chronic fatigue syndrome and showed persisting positive immunoglobulin M serum titers for Borrelia in the Western blot analysis.     

Cardiac rehabilitation

Cardiac rehabilitation is provided for people following diagnosis of a range of cardiac pathologies and to aid recovery after cardiac surgery. The programmes provided cost an estimated 34 m Pounds a year. However, there is wide variation within the programmes and many do not conform to current guidance. Drawn from the NHS Centre for Reviews and Dissemination's latest Effective Health Care bulletin, this article summarises the literature on the effectiveness of cardiac rehabilitation. Its principal findings are that services do not always target all the appropriate client groups and do not always employ the most effective approaches.     

Cardiac rehabilitation

Cardiac rehabilitation as a multifactorial intervention has been shown to improve functional capacity, emotional well-being, return to work rate and longevity. Cardiac rehabilitation is cost effective, and in many aspects represents causal therapy. The meta-analyses do not include studies where pharmacological lipid lowering was used. The use of generally accepted and recommended medical treatment strategies in the EuroAspire study has been below the expected rate, Therefore, cardiac rehabilitation programmes should educate the patient and emphasize the need to apply the appropriate medical regimen in addition to the non-pharmacological treatment modalities of cardiac rehabilitation to achieve maximal benefit. Cardiac rehabilitation has an important role in assuring the application of the available knowledge, to avoid cardiac complications and progression of disease, and improve cardiorespiratory fitness and survival. Cardiac rehabilitation should therefore be an integral part of cardiological management after a cardiac event.     

Cardiac hemangioendothelioma

BACKGROUND: Deep musculoaponeurotic fibromatoses are rare soft tissue neoplasms with a propensity for local recurrence. METHODS: A retrospective analysis was carried out of the factors contributing to local disease control in 75 patients treated between 1963 and 1993. RESULTS: Multivariate analysis identified the type of surgical excision (P < 0.001) and involvement of pathological resection margins (P < 0.02) as significant factors contributing to local recurrence. After a median follow up of 47 months (range 24 months to 29 years) 31 (49 per cent) of the 63 patients who had an 'adequate' surgical resection developed local recurrence. The median time before development of local recurrence was 83.4 (range 8-129) months in patients with clear pathological resection margins. This was significantly shortened to 13.1 (range 2-35) months in those with positive margins (P < 0.001). CONCLUSION: Adequate surgical extirpation is the most important determinant in local disease control. Treatment of local recurrence ranged from observation during periods of disease stabilization to multimodality treatment for aggressive disease.