The optimal management of effusive pericardial disease remains controversial. Subxiphoid drainage has been criticized for a high recurrence rate while transthoracic procedures (window or pericardiectomy) are more invasive operations with greater potential for morbidity. We compared subxiphoid (SX group) and transthoracic (TT group) drainage in 131 patients (age range from 1 month to 81 years) treated from 1979 to the present. The etiology of effusion included cancer (38), uremia (24), infection (27), radiation (9), and other (33) causes. The two groups had similar age and sex distribution, etiology, and fluid volume. There was no difference in the operative mortality between the two groups (SX 15%, TT 13%, p = NS). Patients undergoing thoracotomy for treatment of effusive pericardial disease had a higher incidence of respiratory complications as defined by the presence of pneumonia, pleural effusion, prolonged ventilation, and need for reintubation (SX 11%, TT 35%, p less than 0.005). This may account, in part, for the longer mean hospital stay in transthoracic group (14.4 vs. 11.4 days). Nine patients were lost to follow-up after hospital discharge. The remaining 104 hospital survivors were followed for between 1 month and 11 years (mean 34 months, cumulative of 297 patient years). Three patients in each group experienced fluid recurrence and all but one were successfully treated by needle aspiration or percutaneous catheter placement. Following discharge, no patient required reoperation for effusive or constrictive pericardial disease or died from tamponade. There were no significant differences in 5-year actuarial survival (SX 54%, TT 49%) or actuarial freedom from recurrence (SX 89%, TT 93%).(ABSTRACT TRUNCATED AT 250 WORDS)
Fif ty-seuen patients suffering from melanotic cerebral metastares are reviewed. The nature and course of the primary lesion, the clinical history of the cerebral metastases and the results of treatment are discussed. Radiotherapy, chemotherapy, surgery and immunotherapy formed the basis o f treatment. CEREBRAL metastasis from melanoma carries an extremely poor prognosis. Beresford (1969) reported a mean survival of 78 days from the onset of symptoms of cerebral metastasis in 37 patients managed conservatively. Of patients coming to autopsy 80% had multiple or diffuse cerebral metastases. In the series of Satran and McDonald (1968) of 34 similar patients there was a 50% mortality within two months of the onset of symptoms, irrespective of treatment. At autopsy 33 patients (97%) had multiple cerebra1 metastases. Gottlieb et a& (1972) reported a mean survival of 52 days from the onset of symptoms in 25 patients who did not respond to treatment for cerebral melanoma. The present article is a survey of 57 cases of cerebral metastasis from melanoma seen in the Melanoma Clinic (now at Sydney Hospital) between 1952 and 1975.The aim of this investigation has been: (i) to characterize the primary lesions and possible differences between them and primary melanomas in general ; (ii) to describe the course of metastatic disease and determine its relevance to subsequent cerebral metastasis ; ( 3 ) to determine the natural history of cerebral metastasis, including its diagnosis and subse-' Presented at the 48th annual general scientific meeting of the Royal Australasian College of Surgeons, Queenstown, 1975. . quent course; and (iv) to determine the effects of treatment of cerebral metastasis, and in particular to compare the results following several different treatment regimes. PATIENTS AND METHODS (i)Patients.-There were 57 patients in the whole series. These were divided into two major groups, Group A, 26 patients who were treated symptomatically; and Group B, 31 patients who received specific treatment for ,their cerebral metastases. Group B was subdivided into Groups BI, B2 and B2a for the purposes of assessment of individual treatment regimes (see Table 3 ) .All data relating to the series were collected from systematic records kept by the Melanoma Unit and confirmed when necessary by reference to hospital records. The data were recorded on a standard pro-forma sheet for each patient. (ii) Primary Zesions.-The characteristics of the primary lesions are summarized in Table I . (iii) Metastases.-Both Groups A and Bwere analysed separately and together to determine the site, character and duration of the lesions before the appearance and subsequent behaviour of metastases other than cerebral. Metastatic disease was considered to be any spread beyond the primary site, and included local recurrences, regional nodal and distant metastases. An analysis of two subgroups within Group B was undertaken to determine whether slowly progressive disease favoured increased survival with cerebral metastasis and
In dogs anesthetized with chloralose-urethan on right heart bypass, left ventricular (LV) performance was assessed at constant LV stroke work before and for up to 2.5 h after crystalloid hemodilution was established. Lowering the hematocrit from 43.3 +/- 1.3% to 13.6 +/- 1.7% (SE) did not significantly change LV end-diastolic pressure (LVEDP) initially. After 80 min LVEDP increased slightly by 1.7 +/- 0.6 cmH2O (P less than 0.05) at a stroke work of 17.3 +/- 2.3 g.m. The value of dP/dt did not change significantly throughout. When LV function curves were generated by increasing cardiac output, the stroke work attained at an LVEDP of 10 cmH2O decreased with hemodilution from 23.9 +/- 3.5 to 20.8 +/- 3.9 g.m (NS). LV wall water content increased with hemodilution, from which it could be calculated that there was an 18.6% increase in LV mass. Thus, despite an increase in LV external girth demonstrated by LV circumferential gauges, it is possible that increased wall thickness due to the water gain resulted in little change or an actual decrease in LV end-diastolic volume. Thus, profound hemodilution can be attained with only slight depression of LV performance.
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