The cardiovascular manifestations of influenza: a systematic review.

Influenza accounts for 3 to 5 million cases of severe illness and up to 300,000 deaths annually, presenting a considerable burden to healthcare services. A spectrum of cardiovascular complications has been reported in association with influenza infection. This can occur through direct effects of the virus on the myocardium or through exacerbation of existing cardiovascular disease. Direct myocardial involvement presenting as myocarditis is not uncommon during influenza infection. Clinical presentation may vary from asymptomatic to fulminant myocarditis resulting in cardiogenic shock and death. Cardiovascular mortality is also increased during influenza epidemics in patients with pre-existing coronary artery disease. Rates of myocardial infarction have been shown to increase following influenza outbreaks, whilst decreases in cardiovascular mortality have been demonstrated following influenza vaccination in high risk patients. The purpose of this review is to provide an overview of cardiovascular complications, their presentation, clinical course and the management options available following influenza infection.

Apronectomy combined with laparotomy for morbidly obese endometrial cancer patients.

BACKGROUND: The surgical management of morbidly (BMI >40) and super obese (BMI >50) women with endometrial cancer is challenging. The aim of this study was to describe the short and long term outcomes of apronectomy combined with laparotomy for endometrial cancer staging and tumour debulking. METHODS: A retrospective case note review of morbidly obese patients undergoing combined apronectomy and laparotomy for suspected endometrial cancer between 2007 and 2009 was performed. Short term (operating time, estimated blood loss, complication rates, duration of hospital stay) and long term outcomes (weight profile over 24-month follow up period) were evaluated. RESULTS: Twenty-one patients were identified with a median age of 58 years and a median BMI of 49 (range 37-64). Apronectomy combined with laparotomy took 192 min on average to complete, with a mean estimated blood loss of 497 ml. There were no intra-operative complications. Postoperative complications included anaemia (14% required a blood transfusion), urinary tract infection (5%) and wound complications (wound infection in 29% and partial wound dehiscence in 5%). The median post-operative stay was 9 days. At twenty-four months, one-third of patients were heavier (mean 5 kg, range 2-8 kg) but almost two-thirds of patients were considerably lighter than they had been pre-operatively (mean 13 kg lighter, range 9-17 kg). CONCLUSIONS: Apronectomy combined with laparotomy was safe and well tolerated in this group of patients. Sustained weight loss by two-thirds of the patients over the two-year follow up period may reflect lifestyle changes instigated by individual patients following surgery. Combined apronectomy and laparotomy may provide an alternative to standard surgery for this challenging group of patients.

A prospective evaluation of cardiac function in patients with chronic myeloid leukaemia treated with imatinib.

In vitro studies have suggested that imatinib may be toxic to cardiac myocytes. Though retrospective studies have not shown clinical heart failure, these did not look for subtle cardiac damage. We have carried out a prospective cardiac assessment in 59 chronic myeloid leukaemia (CML) patients treated with imatinib for a median of 3.4 years, using echocardiography and MUGA scanning, with the latter repeated after a further year. We report no evidence of myocardial deterioration, either at baseline or over 12 months of imatinib treatment. Imatinib cardiotoxicity is not an important clinical consideration for CML patients or their advisors.