Summary A fatal case of post-myocardial infarction syndrome (PMIS) followed by a rupture of an inferior left ventricular aneurysm is described. Attention is drawn to the growing number of reports of aneurysm in PMIS, and the clinico-pathological significance of this association is discussed.
SUMMARY Background: Lansoprazole is a new proton pump inhibitor which powerfully decreases acid secretion. Methods : We compared the efficacy and short‐term safety of lansoprazole against ranitidine in the healing of gastric ulcer. This was a parallel group, comparative multicentre, prospectively randomized, double‐blind study which included 250 patients with gastric ulcer, 219 of whom had follow‐up endoscopic data. Results: Both lansoprazole 30 mg and 60 mg daily produced significantly more rapid healing of gastric ulcer than ranitidine 300 mg nightly with healing rates after 4 weeks of 78% (P < 0.05), 84% (P < 0.01) and 61%, respectively. After 8 weeks, the corresponding healing rates were 99%, 97% and 91% (P = 0.08). Symptom relief was similar for all treatment groups, but fewer antacids were used by patients receiving lansoprazole. Sixty‐nine patients experienced 91 adverse events; the incidence, pattern and severity was similar across all three treatment groups. Conclusions: Lansoprazole 30 mg and 60 mg once daily had similar efficacy. Both were superior to ranitidine 300 mg nocte in healing gastric ulcer. The short‐term safety profile of lansoprazole was similar to ranitidine. These data indicate that lansoprazole should be used at a dose of 30 mg once daily for the treatment of gastric ulcers.
An in-house audit revealed a theatre utilization time in the day surgery unit of 70%. The reason identified for this poor theatre utilization was patient selection by the clerical staff based on a fixed number of cases per session. A grading system which estimated the anticipated duration of operation time was introduced as the basis for patient selection in the day surgery. A pilot study of 20 patients revealed that the system was both effective and simple to implement. It was therefore adopted. A re-audit of a further 299 patients treated using the grading system revealed that theatre utilization time had increased from 70 to 98%. The number of patients treated per session also increased, thus effectively reducing the waiting list. The grading system can be used in all clinical specialities providing day case surgery and we recommend it.
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