Large pericardial effusion after cardiac surgery: role of echocardiography in diagnosis and management

We performed M-mode and two-dimensional (2-D) echocardiograms prospectively in 140 patients an average of eight days after open heart surgery. Large pericardial effusions occurred in 13 patients; three had complete circumcardiac pericardial effusion, four had local anterior adhesions, five had extensive anterior adhesions (posterior loculated effusion), and one had a large loculated pericardial effusion contiguous to the right atrium. In five patients with tamponade, the effusion was drained, with immediate reversal of symptoms and signs of tamponade. In the other eight patients, who had no deterioration in cardiovascular status, the effusion was not drained; instead, these patients were treated medically with indomethacin and observed with serial echocardiograms, and the effusions eventually disappeared. The most consistent echocardiographic differences between the five patients with and the eight patients without tamponade were that patients with tamponade had larger posterior pericardial effusions, more severe left atrial compression, and more indentation of the right atrial wall. Echocardiography plays an essential role in diagnosis and management of large pericardial effusions after open heart surgery. Patients with large pericardial effusions who are clinically stable need only medical management, including serial echocardiograms, but drainage is indicated if the cardiovascular or respiratory status worsens. Certain echocardiographic findings indicate a high probability of tamponade.

Anterior Cruciate Ligament Injuries in Relay Tricycle Racing

In brief: Each year at Indiana University in Bloomington, there is a relay in which teams of women mount and dismount specially made tricycles in a race against the clock. This paper reports on 11 cases of anterior cruciate ligament injuries in 504 participants. All of these injuries were caused by a twist or fall during the dismount from the tricycle. Seven of the 11 patients chose either arthroscopy or reconstruction of the anterior cruciate ligament. The other four patients elected a conservative approach to treatment. The authors recommend that two tricycles be used by each team to eliminate the need for a dismount.

Self-administered intravenous analgesia during labour. A comparison between pentazocine and pethidine

Pentazocine or pethidine was administered to healthy parturients up to the time of delivery using a self-demand (self-administration on demand) intravenous apparatus, the Cardiff Palliator. Good analgesia was obtained with both drugs. The patients receiving pethidine exhibited side-effects (nausea, vomiting and drowsiness), whereas there were no side-effects among those receiving pentazocine. Apgar and neurobehavioural scores of the babies of mothers in both groups were the same and did not differ from those of a third group of babies, the mothers of whom had received 4-hourly intramuscular pethidine on demand according to the usual hospital routine. The self-administration technique proved a safe and effective means of providing analgesia during labour and delivery, with pentazocine having a decided advantage over pethidine because of its lack of side-effects.

Complications of transurethral resection of bladder tumors: prevention, recognition and treatment

Between 1931 and 1971, 373 patients underwent transurethral resection of bladder tumors for cure or for control of the neoplasms. Complications included perforation of the bladder wall (5 per cent), hemorrhage requiring transfusion (13 per cent), infection (24 per cent) and postoperative mortality (1.3 per cent). Patients in whom perforations occurred had approximately twice as many infections and twice as much hemorrhage as the entire group but there were no postoperative deaths of those with perforations. Morbidity and mortality can be reduced in patients with perforation by 1) using isotonic irrigating fluid, 2) avoiding over-distension of the bladder, 3) maintaining postoperative free drainage through the catheter and 4) diagnosing and treating hyponatremia.

Changes in grade and stage of recurrent bladder tumors

A retrospective study with adequate followup of 5 years of longer of 114 patients who had transurethral resection for cure or control of bladder tumors and in whom there were 1 or more recurrences is reported. There was recurrence of the tumor in a higher grade in 19 per cent of the cases and in a higher stage in 22 per cent. The interval between the treatment of the original tumor and a recurrence in a higher grade or state varied from 0.25 (3 months) to 27 years. When a low grade or low stage tumor recurs in a higher category in less than 3 years more aggressive treatment should be considered.