Gemma Richardson

BACKGROUND: To date, lung or heart-lung transplantation remains the only definitive treatment for most adults with severe primary pulmonary hypertension or Eisenmenger syndrome. Although the hemodynamic derangements and clinical history of adults with severe primary pulmonary hypertension have been well documented, those of adults with Eisenmenger syndrome have not. METHODS: We evaluated hemodynamics and nontransplantation survival of 100 adults with severe pulmonary hypertension (34 +/- 9 years, 73 women and 27 men; 57 with primary pulmonary hypertension, 37 with Eisenmenger syndrome, and six with a previously repaired congenital heart defect) followed up by the lung transplant or adult congenital heart services at Washington University. RESULTS: Despite a trend toward greater pulmonary artery pressures (107 +/- 20 versus 97 +/- 21 mm Hg, p = 0.06), patients with Eisenmenger syndrome had greater systemic cardiac indexes (2.7 +/- 0.6 versus 2.2 +/- 0.8 L/min/m2, p < 0.05) and lower mean right atrial pressures (5 +/- 2 versus 12 +/- 5 mm Hg, p < 0.0001) than patients with primary pulmonary hypertension. Four (11%) patients with Eisenmenger syndrome died and eight (22%) received transplants during the follow-up interval; 13 (23%) patients with primary pulmonary hypertension died, and 31 (54%) received transplants over the same interval. Actuarial survival of patients who did not receive transplants was 97% at 1 year, 89% at 2 years, and 77% at 3 years for patients with Eisenmenger syndrome and 77%, 69%, and 35%, respectively, for patients with primary pulmonary hypertension. Data on hemodynamics from a small number of patients with a previously repaired heart defect and severe pulmonary hypertension were similar to those from patients with primary pulmonary hypertension. CONCLUSIONS: Our data suggest that adults with Eisenmenger syndrome have a more favorable hemodynamic profile and prognosis than adults with primary pulmonary hypertension.

In an important paper contributed several years ago to this Journal 1 Dr. Tarn presented an interpretation of the Battle of Actium radically different from that which had held the field for the past generation—namely that of the late Professor Kromayer. The paper was brilliantly and authoritatively written, and its chief conclusions appear to have been accepted by some scholars. They were subsequently embodied by Tarn in his section on Actium in the Cambridge Ancient History . Kromayer, however, was unconvinced, and in a reply published in Hermes maintained his original thesis and strongly criticised Tarn's. It seems presumptuous to enter the lists after the veteran scholar has made his own defence; but the question is an important one, and something perhaps remains to be said.

Abstract Aims Gastrointestinal stromal tumours (GISTs) are malignant growths that may be managed effectively with radical surgery if diagnosed at an early stage. The majority of GISTs are found in the stomach and many may be managed effectively via a laparoscopic partial gastrectomy (PG). Day case surgery is becoming a more feasible option for patients undergoing laparoscopic PG. This study examined the outcomes of patients who underwent laparoscopic PG as a day case procedure at a UK tertiary centre. Methods The records of patients who underwent a partial gastrectomy to treat extra-luminal gastric GISTs between January 2021 to December 2023 were retrospectively reviewed. The rates of readmission and post-operative complications were noted for the patients were assessed. Patients with tumours near the gastro-oesophageal junction, lesser curve or with a significant intraluminal component were excluded. Results 42 patients aged between 52 - 81 years were ultimately included in this analysis and 31 (73.8%) underwent surgery as a day case procedure. There were no readmissions, peri- or post-operative complications and none of the patients required a conversion from a laparoscopic to an open approach. Conclusions This single centre analysis suggests that laparoscopic day case PG is a safe option for selected patients. Overall this experience suggests that day case surgery should be carefully considered in those deemed likely to be able to recover well post-operatively. Additional larger studies are required to further evaluate the safety of day case laparoscopic PG.