The incidence and impact of implantable cardioverter defibrillator shocks in the last phase of life: An integrated review.

BACKGROUND: Although the implantable cardioverter defibrillator is successful in terminating life threatening arrhythmias, it might give unwanted shocks in the last phase of life if not deactivated in a timely manner. AIMS: This integrated review aimed to provide an overview of studies reporting on implantable cardioverter defibrillator shock incidence and impact in the last phase of life. METHODS AND RESULTS: We systematically searched five electronic databases. Studies reporting on the incidence and/or impact of implantable cardioverter defibrillator shocks in the last month of life were included. Fifteen studies were included. Two American studies published in 1996 and 1998 reported on the incidence of shocks in patients who died non-suddenly: incidences were 24% and 33%, respectively, in the last 24 hours, and 7% and 14%, respectively, in the last hour of life. Six American studies and one Danish study published between 1991-1999 reported on patients dying suddenly: incidences were 41% and 68% in the last 24 hours and 22-66% in the last hour. Four American studies and two Swedish studies published between 2004-2015 did not distinguish the cause of death: incidences were 17-32% in the last month, 3-32% in the last 24 hours, and 8% and 31% in the last hour of life. Three American studies published between 2004-2011 reported that shocks in dying patients are painful and distressing for patients, and distressing for relatives and professional caregivers. CONCLUSION: If the implantable cardioverter defibrillator is not deactivated in a timely manner, a potentially significant proportion of implantable cardioverter defibrillator patients experience painful and distressing shocks in their last phase of life.

[Dorsal recumbency in dogs--a circulatory risk during surgical treatment?]. / Rückenlage des Hundes--ein Kreislaufrisiko bei operativen Eingriffen?

In this study, changes in hemodynamic, blood gas, and metabolic variables recorded during right lateral and dorsal recumbency in beagles anaesthetised with thiopental are presented. Other than reported in human beings, dorsal recumbency in these dogs resulted in an increase (33%) in heart rate, decrease (30%) in systolic, diastolic, and mean systemic arterial pressure, a decrease (17%) in systemic vascular resistance, and a decrease in both right (31%) and left (39%) ventricular work in comparison with lateral recumbency. Furthermore, mixed-venous PO2, oxygen saturation and respiratory quotient were lower in dorsal than in lateral recumbency while O2 consumption and lipolysis were increased in the former. The changes presented may have been caused by beta-adrenergic stimulation in dorsal recumbency. It needs to be studied if capillary perfusion can be maintained adequately during surgery in dorsal recumbency or if this predisposes to cardiovascular shock.

Factors contributing to deficiencies in cell-mediated immunity in esophageal cancer patients.

Based on the previous data which indicated a preoperative decrease in cell-mediated immunity (CMI) is associated with the occurrence of infectious complications following surgery on patients with esophageal cancer, we examined possible factors contributing to a decrease in CMI levels. A multiple linear regression analysis was made on data from 76 patients with esophageal cancer and 53 with gastric cancer as the control. In patients with esophageal cancer, both protein-calorie malnutrition (PCM) and age factor contributed to a decrease in CMI, although the contribution of the latter was weak while the stage of the cancer and the grade of dysphagia showed no such contribution. The PCM and stage of the cancer were contributing factors in patients with gastric cancer. Thus, these results indicate that PCM and old age, and not the presence of malignant tumors, play a significant role in deficiency in CMI in patients with esophageal cancer.

Caesarean section morbidity at district level in Zimbabwe.

The incidence of complications related to Caesarean section was studied among 643 patients operated in four hospitals in Zimbabwe. Major complications were recorded in 15% of the patients and minor complications in 27%. Among these complications, infection morbidity played the leading role. Only 53% of Caesarean section were devoid of complication or need of blood transfusion. It is concluded that in a Third World environment, Caesarean section carries a substantial risk of operative and post-operative complications.

Midline or transverse laparotomy? A random controlled clinical trial. Part II: Influence on postoperative pulmonary complications.

In a series of 579 patients undergoing major laparotomy, the direction of incision (midline or transverse/oblique muscle-cutting) was decided randomly. The severity of postoperative pulmonary complications was expressed by a scoring system which allowed categorization into mild (score 0-3), moderate (score 4-6) and serious (score 7 or more) complications. The important determinants of high scores were found to be male sex, preoperative pulmonary dysfunction, postoperative ventilatory depression, hypovolaemic and septic shock, inhalation of gastric contents and embolism. In no stratum did the direction of incision have any significant effect.

[Postoperative haemorrhage in gastric ulceration and gallstone surgery (author's transl)]. / Postoperative Blutungen in der Magenulkus- und Gallenchirurgie.

5463 operations for gallstone disease were followed eleven times (0,2%) by haemorrhage. 16 intragastric (1,2%) and 11 haemorrhages into the peritoneal cavity (0,8%) could be observed after a total of 1370 operations for gastric or duodenal ulcer. For the most part haemorrhage into the peritoneal cavity frequently occurred within the first 24 hours, whereas the intragastric bleeding appeared later. Both manifestations showed the signs of haemorrhagic shock. While haemorrhage into the peritoneal cavity had to be treated mostly by secondary laparotomy after adequate shock therapy, intragastric haemorrhage could be cured most without surgical treatment.

[Surgery of old age (author's transl)]. / Uber Bedeutung und Spezifik der Alterschirurgie.

The importance of surgery in the aged is based on the increased life expectancy of the population. Besides the multimorbidity of geriatric people psychological and social aspects must be taken into consideration. In old age the danger of shock is increased therefore the indication for urgent surgery permits no delay. In 1975 649 patients over 60 years out of a total of 2532 operations underwent surgical procedures; 349 were urgent cases. Mortality rate below 10%.