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Automated blood pressure (BP) devices are used by many hypertensive patients in Hong Kong, with or without medical advice. At two community clinics, we invited hypertensive patients aged between 40 and 70 years who used such a device to fill in a questionnaire and to have four sets of BP measurements, automated and mercury, at two visits. Of 290 hypertensive patients 120 fulfilled the criteria, and 73 of these agreed to participate. 53 devices measured arm BP, 21 measured forearm BP. The agreement between the mercury sphygmomanometer and the automated devices was poor, with average differences of 9.5 mmHg for systolic and 9.4 mmHg for diastolic and no clear advantage for either site of measurement. As a means of screening for BP >140/90 mmHg the sensitivity of the automated devices was 81% and the specificity was 80%. There were large variations in how often and under what circumstances the devices had been used. One-fifth of the devices had been acquired on medical advice but only 11% of the participants were aware of the three important conditions for operating such devices. Discussion of automated devices, their role and proper use, should now be part of routine hypertensive care.

Objective: Video-assisted thoracic surgery (VATS) has changed the way we manage a number of thoracic conditions. This study presents near over a decade of experience from our institution on management of spontaneous hemopneumothorax (SHP), with particular reference to the use of VATS., Methods: Retrospective review between March 1988 and December 2002 with 793 patients treated for spontaneous pneumothorax, 30 (3.8%) patients had SHP. The clinical features, indications for surgery and outcomes are discussed., Results: All 30 SHP patients were male with mean age of 25 years. Signs of significant hypovolemia occurred in 4 patients, 3 required blood transfusion. Mean initial blood drainage from tube thoracostomy was 594 ml. All SHP patients received surgery (5 thoracotomies, 25 VATS). Active bleeding was identified in 16 patients; 12 from torn apical vascular adhesion band and 4 from vascular bleb. Postoperative complications after thoracotomy include 2 chest infections and 1 air leak, while VATS had 1 chest infection and 1 air leak (P=0.022). Mean postoperative hospital stay following VATS was 3.9 days and thoracotomy 7.5 days (P=0.0021). There is no recurrence of pneumothorax or SHP during mean follow-up of 21 months., Conclusion: SHP can be life threatening and is a cause for patients presenting with unexplained signs of significant hypovolemia. Surgery in the form of VATS should be considered early in the management of SHP, with potentially less postoperative complications and shorter postoperative hospital stay compared with open thoracotomy.

Coronary artery aneurysm requiring surgery is rare. We report a case of a ruptured giant coronary artery aneurysm due to Kawasaki vasculitis which presented with cardiac arrest and was successfully treated by emergency coronary artery bypass grafting. The controversies surrounding the management of this disease are also discussed.

Background: We determined the feasibility, safety, and short-term efficacy of bronchoscopic placement of a one-way endobronchial valve in selected bronchopulmonary segments as an alternative to surgical lung volume reduction., Methods: A total of 21 patients with incapacitating emphysema who underwent this procedure were studied. All patients had placement of the endobronchial valves into the most emphysematous lung segments. We recorded any major complications or deaths attributed to the procedure and analyzed (1) improvements in the spirometric and functional parameters and quality of life and (2) the radiologic changes compared with the baseline data at 30 and 90 days., Results: A total of 20 patients had complete follow-up data. There was no mortality in the group studied. The forced expiratory volume at 1 second, forced expiratory volume at 1 second (percentage of predicted), forced vital capacity, and forced vital capacity (percentage of predicted) all improved significantly at 90 days (0.73 +/- 0.26 L vs 0.92 +/- 0.34 L [P =.009]; 33.3% +/- 11.9% vs 42.2% +/- 15.0% [P =.006]; 1.94 +/- 0.62 L vs 2.25 +/- 0.61 L [P =.015]; and 63.3% +/- 17.6% vs 73.9% +/- 17.1% [P =.012], respectively). The 6-minute walking distance improved at 30 and 90 days (251.6 +/- 100.2 m vs 306.3 +/- 112.3 m and 322.3 +/- 129.7 m; P =.012 and P =.003). The results of the 36-Item Short-Form Health Survey and the St George Respiratory Questionnaire showed significant improvements at 90 days. The Medical Research Council dyspnea grade also improved significantly at 30 and at 90 days (P =.006 and P =.003, respectively)., Conclusions: Endobronchial valve placement is a safe procedure, with significant short-term improvements in functional status, quality of life, and relief of dyspnea in selected patients with emphysema. A larger study with long-term follow-up is therefore warranted.

Acute septic pancarditis is a life threatening but fortunately rare condition. We report a case of this condition in a young 20-year-old female patient with an early complication of mitral valve destruction and a late complication of a left ventricular pseudoaneurysm formation.

The concept of nonresectional LVRS appears to be highly promising. Several strategies and approaches are currently available; however, the investigations to date are still just studies, and there remain many unanswered questions. No doubt new modifications and improvements in design will occur and these devices will continue to evolve. Appropriate patient selection is, as always, the key to good outcome. The studies so far have included only patients who have heterogenous disease; whether or not the procedures can be helpful for patients who have homogenous distribution of emphysema remains to be seen. Radioactive isotope scans are currently being used in an attempt to identify patients who have significant collateral flow, and these scans might eventually be useful in selecting patients who are unlikely to benefit from this approach. The preliminary data remain encouraging and suggest that a larger study with long-term follow-up care is warranted.