Autotransplantation of premolars: does surgeon experience matter?

Autotransplantation of premolars is a well-established method to rehabilitate aplasia of premolars. Nevertheless, with the introduction of titanium implants, not all surgical units offer this procedure. The aim of this study was to examine the predictability of autotransplantation of premolars on orthodontic indication as suggested by Andreasen et al., when performed by surgeons with or without prior experience of this procedure. A prospective protocol was implemented in 2001. All patients treated with autotransplantation of premolars during the years 2001-2015 were recalled to evaluate the long-term status of the teeth. The state of root development, need for endodontic treatment, presence of an apical pathology or ankylosis, and tooth loss were recorded. The results were divided into two groups according to the surgeon's experience: senior surgeons with prior training and experience in the procedure and junior surgeons without prior experience. A total of 89 teeth (66 patients) were treated. The mean observation time was 10.1 years (range 1.0-15.1 years). The long-term survival rate was 95%. No statistically significant difference between the results of the two groups of surgeons was found. Autotransplantation of premolars on orthodontic indication could be adopted successfully in the hospital setting regardless of surgeon experience.

Relocation of patients after cardiac surgery: is it worth the effort?

BACKGROUND: Fast-track protocols may facilitate early patient discharge from the site of surgery through the implementation of more expedient pathways. However, costs may merely be shifted towards other parts of the health care system. We aimed to investigate the consequence of patient transfers on overall hospitalisation, follow-up and readmission rate after cardiac surgery. METHODS: A single-centre descriptive cohort study using prospectively entered registry data. The study included 4,515 patients who underwent cardiac surgery at Aarhus University Hospital during the period 1 April 2006 to 31 December 2012. Patients were grouped and analysed based on type of discharge: Directly from site of surgery or after transfer to a regional hospital. The cohort was obtained from the Western Denmark Heart Registry and matched to the Danish National Hospital Register. RESULTS: Median overall length of stay was 9 days (7.0;14.4). Transferred patients had longer length of stay, median difference of 2.0 days, p < 0.001. Time to first outpatient consultation was 41(30;58) days in transferred patients vs. 45(29;74) days, p < 0.001. 18.6% was readmitted within 30 days. Mean time to readmission was 18.4 ± 6.4 days. Median length of readmission was 3(1,6) days. There was no difference in readmissions between groups. Leading cause of readmission was cardiovascular disease with 48%. CONCLUSION: Transfer of patients does not overtly reduce health care costs, but overall LOS and time to first outpatient consultation are substantially longer in patients transferred to secondary hospitals than in patients discharged directly. Readmission rate is high during the month after surgery, but with no difference between groups.

Effects of levosimendan in patients with left ventricular hypertrophy undergoing aortic valve replacement.

BACKGROUND: Left ventricular hypertrophy is associated with adverse outcomes, including death, during cardiac surgery. This may be facilitated by an increased oxygen demand and diastolic dysfunction. Levosimendan augments haemodynamics without further oxygen consumption and improves echocardiographic indices of diastolic dysfunction. This study aimed to describe the haemodynamic effects of short-term pre- and intra-operative levosimendan infusion including advanced echocardiographic measures of diastolic and systolic heart function. METHODS: The study was randomised, double-blinded and placebo-controlled performed at a single-centre university hospital. Patients with left ventricular hypertrophy and ejection fraction > 45% scheduled for single procedure aortic valve replacement were included and randomised to infusion of either levosimendan 0.1 µg/kg/min or placebo from 4 h before anaesthesia to the end of surgery. Outcome measures were echocardiographic indices of left ventricular diastolic function: E/e' (primary endpoint), e', e'/a' and indices of systolic function: longitudinal strain, ejection fraction and s'. Patients were followed until 6 months after surgery. In addition, invasive haemodynamic measures were obtained perioperatively. RESULTS: The trial was prematurely terminated due to an overall high incidence of post-operative atrial fibrillation (15/20, P = 0.002) after inclusion of 20 patients. The relative decrease in perioperative cardiac index was lower (P = 0.016) in the levosimendan group. There was no difference in E/e', and similar results were found for all measures of systolic function. CONCLUSION: Short-term levosimendan caused a transient relative increase in cardiac index, but no effect was seen on the first post-operative day and up to 6 months post-operatively with indices of systolic and diastolic heart function.

Genetic susceptibility and genotype-phenotype association in 588 Danish children with inflammatory bowel disease.

AIM: To investigate the association between known inflammatory bowel disease (IBD)-associated genetic variants and development of paediatric IBD, and specific clinical sub-phenotypes. MATERIAL AND METHODS: In this case-control study we included IBD patients <18 years of age at diagnosis from the Danish National Patient Registry and healthy children <18 years of age were randomly selected from the Danish Central Office of Civil Registration. The latter had filled out a questionnaire regarding health status, and DNA was obtained from blood samples and the buccal mucosa. Patient files were retrieved and clinical information was extracted. DNA was obtained from Guthrie cards from the Danish National Neonatal Screening Biobank (PKU-biobanken) at Statens Serum Institut and from blood samples. RESULTS: A total of 588 IBD patients (244 Crohn's disease (CD), 318 ulcerative colitis (UC) and 26 IBD-unclassified (IBDU)) and 543 healthy controls were included. We found an association between CD and rs22411880 (ATG16L1, odds ratio (OR)=1.7 [1.1-1.7], p=0.003), rs5743289 (NOD2, OR=1.4 [1.1-1.9], p=0.009) and the paediatric specific rs1250550 (ZMIZ1, OR=0.7 [0.5-0.9], p=0.01). None of the investigated 41 SNPs were associated with disease localisation, medical treatment or surgery after correcting for multiple analyses. CONCLUSION: We found an association between CD and three previously published genetic variants and replicated the association with the paediatric specific ZMIZ1 gene. No Bonferroni corrected significant genotype-phenotype associations were found. For future studies aimed at finding predictors for disease course in (paediatric) IBD, it will be worthwhile to include a combination of genetic, clinical and serological markers.

Mesenchymal stem cells in oral reconstructive surgery: a systematic review of the literature.

This study evaluated clinical outcomes following intraoperative use of adult mesenchymal stem cells (MSCs) in various oral reconstructive procedures. PubMed was searched without language restrictions from 2000 to 2011 using the search words stem cell, oral surgery, tissue engineering, sinus lift, bone regeneration and combinations of these. Inclusion criteria were intraoperative use of MSCs in the study design. Reference lists of the articles found were searched for other related studies. Eighteen clinical trials using MSCs for sinus augmentation were found: five case reports on the repair of large bony defects and six studies on ridge augmentation and healing of alveolar sockets after third molar extraction. The findings suggest that MSCs are capable of producing in vivo bone, re-establishing lost tissue and facilitating placement of dental implants. Use of MSCs would reduce patient morbidity because of a less stressful harvesting technique than that of autogenous bone. The majority of clinical trials indicate that MSCs can produce bone in vivo. However, a satisfactory outcome was not seen in all studies, and due to the diversity of study designs, a 'golden approach' cannot be determined. Before use of MSCs can be considered as a first-choice treatment, more predictable outcomes and better long-term prognoses need to be established. Conventional bone grafting remains the gold standard.

High thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients.

OBJECTIVE: Assuming that high thoracic epidural analgesia (HTEA) with the sympathetic block might decrease postoperative blood glucose (BG) level and reduce the need of insulin, the aim was to evaluate the effect of HTEA on the BG level and insulin requirement in patients undergoing cardiac surgery. MATERIALS AND METHODS: Forty-two low-risk patients age 65-79 years scheduled for elective coronary artery bypass grafting with or without aortic valve replacement were randomised to receive HTEA as supplement for general anaesthesia. BG and lactate were measured before and after cardiopulmonary bypass and postoperatively at least every 3 h together with administration of insulin. Postoperative pain was evaluated 30 min, 2, 4 and 6 h after extubation, and before discharge from the intensive care unit. RESULTS: Overall BG levels showed great variation over time (P < 0.001). No statistically significant difference was found in perioperative BG, but postoperative lower BG levels were found in HTEA patients (P = 0.042). The number of patients not receiving insulin in postoperative period was significantly higher in HTEA group (9 vs. 2, P = 0.032). No differences were seen in lactate levels. Patients in the HTEA group had significant lower pain scores (P < 0.001). CONCLUSION: HTEA preserves glucose metabolism better and leads to a lesser degree of 'stress hyperglycaemia' in cardiac surgery patients.

Agreement between cardiac outputs by four-dimensional echocardiography and thermodilution method is poor.

OBJECTIVE: The objective of the study was to determine the agreement of cardiac output (CO) measured by four-dimensional echocardiography (4D echo) to simultaneously obtain CO from pulmonary artery catheter (PAC) using thermodilution technique. MATERIALS AND METHODS: Sixty-three comparable readings from 27 patients scheduled for elective coronary artery bypass were included. All echocardiographic measurements were obtained by one experienced echocardiographer. All echo images were analyzed independently and blinded from PAC-obtained measurements. Analysis was primarily done by Bland and Altman plot. The collected data were further controlled for interobserver bias and image quality. RESULTS: Differences in CO measurements increased with higher CO, hence values were logarithmically transformed. On the logaritmic scale, the 4D echo underestimated CO by 0.37 l/min compared with PAC, indicating that PAC measurements were 1.45 times higher than the 4D echo (95% confidence interval 1.32-1.52) and limits of agreement 0.97-2.14). The interobserver bias of 4D echo measurement analysis was 0.29 l/min (95% confidence interval 0.16-0.42) and limits of agreement -0.8-1.38). No difference was seen in image quality between comparisons with good agreement compared with comparisons with poor agreement. CONCLUSION: The agreement between COs by 4D echo and standard PAC thermodilution technique was poor. 4D echo underestimates CO as compared with PAC. This is most likely caused by the analysis software or low frame rate inherent to the technique.

Differences in phenotype and disease course in adult and paediatric inflammatory bowel disease--a population-based study.

BACKGROUND: Few studies have compared phenotype and disease course in children and adults with inflammatory bowel disease (IBD). AIM: To compare phenotype, treatment and disease course in children (<15 years) and adults (≥18 years) with IBD. METHODS: Two population-based cohorts comprising paediatric (2001-2006) and adult (2003-2004) patients from Copenhagen County and City were studied. RESULTS: Twenty children and 106 adults with ulcerative colitis (UC), and 29 children and 67 adults with Crohn's disease (CD) were included. Median follow-up time was 4.8 years (children) and 5.2 years (adults). Children with UC had more extensive disease compared to adult patients [14 (70%) vs. 20 (19%), P<0.001]. The risks of starting systemic steroid treatment and AZA/MP were higher for paediatric UC patients compared to adult UC patients; hazard ratio (HR): 3.1 (95% CI: 1.8-5.3) and HR: 2.5 (1.3-5-9), respectively. Steroid dependency was more frequent in paediatric than in adult UC patients [9 (45%) vs. 9 (8%), P<0.001]. Mild disease course was less frequent in children with UC compared to adult patients [7 (35%) vs. 76 (72%), P=0.002]. Paediatric and adult CD patients did not differ regarding treatment or disease course. Cumulative 5-year surgery rates for paediatric and adult patients were 5% and 9% for UC (N.S.) and 18% and 21% for CD (N.S.), respectively. CONCLUSIONS: Paediatric UC patients had more extensive disease, were more often treated with systemic steroids and AZA, had a higher frequency of steroid dependency and a more severe disease course compared to adult UC patients. No differences were found when comparing paediatric and adult CD patients.

Sufentanil preserves hemodynamics and left ventricular function in patients with ischemic heart disease.

OBJECTIVE: Sufentanil has been reported to provide stable hemodynamics similar to other opioids. However, it has not been reliably established whether this stability can be attributed only to Sufentanil and translates into fully preserved left ventricular (LV) function. The purpose of this study was to evaluate the effect of Sufentanil on hemodynamics and LV systolic and diastolic function using invasive monitoring and echocardiography in patients with ischemic heart disease. METHODS: Prospective observational study of thirty patients acting as their own control undergoing echocardiographic imaging before and after bolus Sufentanil 1.5-2.0 µg/kg. Full invasive hemodynamic monitoring was established before Sufentanil administration. Global LV systolic function was evaluated with a global longitudinal peak systolic strain (GLPSS) by speckle tracking ultrasound; systolic displacement by tissue tracking (TT) and diastolic function was evaluated using Doppler tissue imaging and pulse wave Doppler. RESULTS: Hemodynamic monitoring showed a minor decline in systolic blood pressure from 159 to 154 mmHg (P=0.046). No changes were observed in the cardiac index, stroke volume index and heart rate. An unchanged TT score index (9.9 vs. 10.2 mm, P=0.428) and GLPSS (14.3 vs. 14.5%, P=0.658) indicated preserved LV global systolic function and unchanged E'/A' (0.95 vs. 0.89, P=0.110) and E/E' ratio (15.4 vs. 14.9, P=0.612) indicated unchanged diastolic function. CONCLUSION: Sufentanil preserves hemodynamic parameters as well as echocardiographic indices of LV systolic and diastolic function in patients with ischemic heart disease (IHD).

Variation in use of peroperative inotropic support therapy in cardiac surgery: time for reflection?

BACKGROUND: There is no well-established evidence-based clinical guidelines on the most appropriate use of peroperative inotropic support in cardiac surgery. We aimed to identify patient- and procedure-related factors associated with the use of peroperative inotropic support and to estimate physician-level variation. METHODS: A population-based study using data from the Western Denmark Heart Registry on 3585 consecutive cardiac surgery cases from three university hospitals. Inotropic support was defined as infusion of inotropic drugs or nor epinephrine at the separation from cardiopulmonary bypass. Poisson's regression modelling was used to determine predictors of inotropic support and to compare use of high-dose inotropic support among experienced cardiac anaesthesiologists. RESULTS: We identified a range of factors that were independently associated with an increased use of inotropic support therapy including pre-operative left ventricular dysfunction, pre-operative renal dysfunction, complex procedures, prior cardiac surgery, emergency surgery, pre-operative pulmonary hypertension, critical pre-operative state, extended extra corporal circulation-time and female gender. Further, we found substantial variation in use of inotropic support both at hospital- and at physician-level. The adjusted odds ratio of high-intensity inotropic support varied significantly at physician level from 2.3 [95% confidence interval (CI) 1.83-2.71] to 0.3 (95% CI 0.15-0.61) when the individual physicians were compared with the rest. CONCLUSION: The use of inotropic support during cardiac surgery is associated with the pre-operative state of the patient, as well as type of surgery. However, the present study indicates that use of peroperative inotropic support is also highly dependent on physician's preferences, indicating the need for an evidence-based approach when initiating inotropic therapy in cardiac surgery.

Cardiac surgery patients present considerable variation in pre-operative hemodynamic variables.

BACKGROUND: It is essential to control hemodynamics in cardiac surgery. Patients are often monitored extensively in order to optimize hemodynamic performance. However, pre-operative values are normally unknown. Furthermore, hemodynamic goals may seem arbitrary and the lack of an evidence-based consensus may lead to both under- and over-treatment. The aim of this study was to evaluate the variables most commonly used for hemodynamic guidance in the post-operative period. METHODS: Ten patients scheduled for elective cardiac surgery were followed with invasive hemodynamic monitoring the night before surgery. All data were recorded automatically and electronically. RESULTS: We found considerable inter-patient differences and intra-patient variation. The greatest intra-patient variation was found in the cardiac index (CI), ranging from 1.9 to 5.3 l/min/m(2). Four patients had periodic CI <2.4 l/min/m(2). Eight patients showed SpO2 values < or =92, four of them in more than 15% of the observations. Six patients had an SvO2 <70% in more than 40% of the observations and two an SvO2 < 64% in more than 20% of the observations. CONCLUSIONS: This study is unique because hemodynamic reference data in cardiac surgery patients have not been published previously. The intra-patient variations were unexpectedly high in most hemodynamic variables and demonstrate the difficulties of using hemodynamic parameters as a guidance for treatment and indicate that goal-oriented therapy using currently accepted values may result in over-treatment in some patients.

Design, synthesis, and pharmacological evaluation of thapsigargin analogues for targeting apoptosis to prostatic cancer cells.

A series of thapsigargin (TG) analogues, containing an amino acid applicable for conjugation to a peptide specifically cleaved by prostate-specific antigen (PSA), has been prepared to develop the drug-moiety of prodrugs for treatment of prostatic cancer. The analogues were synthesized by converting TG into O-8-debutanoylthapsigargin (DBTG) and esterifying O-8 of DBTG with various amino acid linkers. The compounds were evaluated for their ability to elevate the cytosolic Ca(2+) concentration ([Ca(2+)](i)) in TSU-Pr1 cells, their ability to inhibit the rabbit skeletal muscle SERCA pump, and their ability to induce apoptosis in TSU-Pr1 human prostatic cancer cells. The activity of analogues, in which DBTG were esterified with omega-amino acids [HOOC(CH(2))(n)()NH(2), n = 5-7, 10, 11], increased with the linker length. Analogues with 3-[4-(L-leucinoylamino)phenyl]propanoyl, 6-(L-leucinoylamino)hexanoyl, and 12-(L-serinoylamino)dodecanoyl were considerably less active than TG, and analogues with 12-(L-alaninoylamino)dodecanoyl and 12-(L-phenylalaninoylamino)dodecanoyl were almost as active as TG. The 12-(L-leucinoylamino)dodecanoyl gave an analogue equipotent with TG, making this compound promising as the drug-moiety of a PSA sensitive prodrug of TG.

[Identification of a novel termination release factor eRF3b expressing the eRF3 activity in vitro and in vivo]. / Identifikatsiia novogo faktora terminatsii transliatsii eRF3b, obladaiushchego in vitro i in vivo aktivnost'iu eRF3.

Termination of translation in eukaryotes is governed by the ribosome, a termination codon in the mRNA, and two polypeptide chain release factors (eRF1 and eRF3). We have identified a human protein of 628 amino acids, named eRF3b, which is highly homologous to the known human eRF3 henceforth named eRF3a. At the nucleotide and at the amino acid levels the human eRF3a and eRF3b are about 87% identical. The differences in amino acid sequence are concentrated near the amino terminus. The most important difference in the nucleotide sequence is that eRF3b lacks a GGC repeat close to the initiation codon in eRF3a. We have cloned the cDNA encoding the human eRF3b, purified the eRF3b expressed in Escherichia coli, and found that the protein is active in vitro as a potent stimulator of the release factor activity of human eRFl. Like eRF3a, eRF3b exhibits GTPase activity, which is ribosome- and eRFl-dependent. In vivo assays (based on suppression of readthrough induced by three species of suppressor tRNAs: amber, ochre, and opal) show that the human eRF3b is able to enhance the release factor activity of endogenous and overexpressed eRFl with all three stop codons.

The influence of propofol and midazolam/halothane anesthesia on hepatic SvO2 and gastric mucosal pH during cardiopulmonary bypass.

OBJECTIVE: Because propofol is known to reduce vascular resistance, the objective of this study was to compare the indices of hepatosplanchnic circulation and oxygenation during cardiopulmonary bypass (CPB) in patients anesthetized with either propofol or midazolam/halothane. DESIGN: A prospective, randomized, nonblinded study. SETTING: A university hospital. PARTICIPANTS: Twenty patients undergoing cardiac surgery with CPB. INTERVENTIONS: Nine patients were anesthetized with propofol/fentanyl/pancuronium and 11 patients were anesthetized with midazolam/halothane/fentanyl/pancuronium. All patients had a nasogastric tonometer tube and two fiberoptic thermodilution catheters inserted; one in the pulmonary artery and one in the upper right hepatic vein. During bypass, SvO2s were measured from the venous line of the heart-lung machine. MEASUREMENTS AND MAIN RESULTS: Gastric mucosal pH (pHi) was measured prebypass, 30 minutes after the start of CPB, and just before weaning off CPB. Hepatic SvO2 (HSvO2) values were recorded every 5 minutes. The pH gap was less at 30 minutes of hypothermic CPB in the propofol group. In the midazolam/halothane group, the HSvO2 decreased after the start of rewarming, whereas in the propofol group the values remained almost at the prebypass levels. At the end of rewarming, the HSvO2 was almost identical in the two groups. CONCLUSION: Propofol preserved the HSvO2 during CPB and produced a more optimal relationship between the hepatosplanchnic blood flow and oxygen consumption.

Perioperative metoprolol reduces the frequency of atrial fibrillation after thoracotomy for lung resection.

OBJECTIVE: The association of atrial fibrillation with thoracic surgical procedures is well known, but nevertheless its cause is not well defined. Increased sympathetic activity may play a role in the development of atrial fibrillation, and reduced beta-receptor activity may be advantageous. The objective was to evaluate the effect of oral beta-blockade on the frequency of atrial fibrillation and to evaluate some possible causative factors. DESIGN AND SETTING: The study was prospective, randomized, and double-blind, and was conducted at Aarhus University Hospital. PARTICIPANTS: Thirty patients without previous or present cardiovascular history undergoing elective thoracotomy for lung resection. INTERVENTIONS: The patients received either 100 mg of metoprolol or placebo orally before surgery and once daily postoperatively. Anesthesia consisted of a thoracic epidural block combined with general intravenous anesthesia. Epidural morphine was continued postoperatively. MEASUREMENTS AND MAIN RESULTS: Patients were monitored with electrocardiograms (ECGs), capillary pulse oximetry, invasive hemodynamic monitoring, central venous oxygen saturation, arterial blood gases, serum electrolytes, and fluid balances. Atrial fibrillation developed in 23.3% of the patients, 6.7% after metoprolol compared with 40% in the placebo group. Atrial fibrillation developed a mean of 2.9 days postoperatively. The predominant hemodynamic findings were perioperative lower oxygen consumption and postoperative lower cardiac index after metoprolol. Patients developing atrial fibrillation had much higher oxygen consumption and postoperative cardiac index than other patients. CONCLUSION: Perioperative oral beta-blockade can reduce the frequency of atrial fibrillation without serious side effects. Increased sympathetic activity is one of the predominant factors in the cause of this complication.

[Continuous measurements of cardiac output in the perioperative period]. / Kontinuerlig måling af hjertets minutvolumen i den perioperative periode.

Management of critically ill patients is based on knowledge of fundamental physiological variables. Automatized and continuous measurement of these variables is preferable. A new system based upon the thermodilution method has been developed to measure cardiac output automatically and continuously. We evaluated the system in the potentially unstable perioperative period with possible great and rapid changes in cardiac output. Twenty patients, scheduled for open heart or abdominal aortic aneurysm surgery, were included into the study, which was approved by the local ethical committee. The patients were monitored for up to 30 hours. At random intervals five iced bolus thermodilution cardiac output (BCO) determinations were made and compared to the continuous measurements (CCO). Two hundred and thirty-one pairs of data were obtained. The cardiac outputs ranged from 2.5-14.9 l/min. The absolute bias was 0.31 l/min (95% limits of agreement -1.4 l/min to 2.0 l/min). The mean relative error was 4.7% with a standard deviation of the relative error of 15.4%. The linear regression was represented by: CCO = 11.352 x BCO - 0.36. The correlation coefficient R was 0.90 (p < 0.001). In conclusion, the CCO measurement technique is a promising clinical method. The method is straightforward, requires no calibration, is independent of vascular geometry and measures with its limitations volumetric flow. Finally automatic and continuous patient monitoring provides more information and has potential to reveal previously undetected haemodynamic events.

[Atrial fibrillation after coronary artery bypass surgery. The significance of preoperative vagus modulation and ectopic atrial activity]. / Atreiflimren efter koronar bypass-kirurgi. Betydningen af proeoperativ vagusmodulation og ektopisk atrieaktivitet.

To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-hour Holter monitoring was analyzed in 102 patients before coronary artery bypass grafting. Index for vagal tone was calculated as % successive RR-interval differences > 6%. Twenty-nine (28%) of the 102 patients developed atrial fibrillation or flutter. Independent predictors (90% confidence interval) of postoperative atrial fibrillation or flutter were identified by logistic regression analysis: the independent predictors were older age, relative risk 1.07/year (1.02-1.12), vagal index < 10%, relative risk 4.50 (1.40-14.5), > or= 10 ectopic supraventricular beats/24 hour, relative risk 3.03 (1.05-8.72), and one or more event of non-sustained supraventricular tachycardia, relative risk 3.02 (1.11-8.22). Thus, age of the patient, attenuated preoperative cardiac vagal modulation, ectopic supraventricular beats, and paroxysmal non-sustained supraventricular tachycardia are independent risk factors for the development of atrial fibrillation or flutter after coronary artery bypass surgery.

Continuous cardiac output measurements in the perioperative period.

Management of critically ill patients is based on knowledge of fundamental physiologic variables. Automatized and continuous measurement of these variables is preferable. A new system based upon the thermodilution method has been developed to measure cardiac output automatically and continuously. We evaluated the system in the potentially unstable perioperative period with possible great and rapid changes in cardiac output. Twenty patients, scheduled for open heart or abdominal aortic aneurysm surgery, were included in the study, which was approved by the local ethical committee. The patients were monitored up to 30 hours. At random intervals five, iced, bolus thermodilution cardiac output (BCO) determinations were made and compared to the continuous cardiac output measurements (CCO). Two hundred and thirty-one pairs of data were obtained. The cardiac outputs ranged from 2.5-14.9 l.min-1. The absolute bias was 0.31 l.min-1 (95% limits of agreement -14 l.min-1 to 2.0 l.min-1). The mean relative error was 4.7% with a standard deviation of the relative error of 15.4%. The linear regression was represented by: CCO = 1,1352.BCO-0.36. The correlation coefficient R was 0.90 (P < 0.001). In conclusion, the CCO measurement technique is a promising clinical method. The method is straightforward, requires no calibration, is independent of vascular geometry and measures with its limitations volumetric flow. Finally automatic and continuous patient monitoring provides more information and has potential to reveal previously undetected haemodynamic events.