No abstract

Overall, CABG rather than PCI was the favoured cost-effective treatment for complex MVCAD in the long term. While the evidence base for the cost-effectiveness of DES compared with CABG is growing, there is a need for more evaluations adopting a societal perspective, and time horizons of a lifetime or 10 or more years.

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All hepatitis B carriers who were HBeAg-positive had high titres of HBsAg; this could not be used as a reliable indicator of the presence of HBeAg, however, because some of the carriers with anti-HBe also had high HBsAg titres. Generally it has been found that many HBsAg carriers have neither HBeAg nor anti-HBe, which reflects the relative insensitivity of immunodiffusion-for example, in our study 2900 of the carriers were e-negative by this test. This number of unclassifiable carriers has made it difficult to evaluate the relation between HBeAg and raised liver enzyme concentrations reported by Maynard et al'6 and Polesky and Hanson."7 By using the more sensitive e-RIA in addition to immunodiffusion we could confirm their observations and show a more precise relation between the presence of HBeAg and raised enzyme concentrations.In acute hepatitis B infections serum liver enzyme concentrations are generally much higher than those in carriers and HBeAg is only transiently present. In chronic asymptomatic carriers persistently, though modestly, raised liver enzyme concentrations appear to be a useful indicator of the presence of e antigen and thus of probable infectivity. Indeed, it is interesting to compare the accuracy of using either immunodiffusion or raised enzyme concentrations to identify the HBeAgpositive carriers. Immunodiffusion identified 12 of the 14 HBeAg-positive sera, whereas 13 were identified by finding raised enzyme concentrations, though at the cost of three anti-HBe sera being incorrectly classified.Testing for the presence of HBeAg is practicable only for specialised laboratories; on the other hand, estimating liver enzyme concentrations is a routine determination in any general hospital. We consider that when assessing the potential infectivity of an indigenous HBsAg carrier in the UK estimating liver enzyme concentrations is a simple and accurate alternative to the specific tests for HBeAg. Haemodynamic effects of buprenorphine after heart surgery Medical_Journal, 1978, 2, 1602-1603 Summary and conclusions The effect of buprenorphine on the cardiovascular system was examined in 11 patients during the period of reduced cardiac reserve after open-heart surgery. Within 10 minutes of giving the full analgesic dose (5 ,_tg/kg) intravenously the mean heart rate had fallen significantly by six beats,'min. Although in two patients the mean arterial pressure fell by 24 mm Hg, there was no overall change in mean arterial pressure, carciiac output, or peripheral resistance. In a further six patients buprenorphine was used successfully as the sole analgesic after open-heart surgery.

The analgesic effcacy, side effects and cost of administration of regimens of intravenous buprenorphine and intravenous morphine were compared in a randomized double‐blind trial performed during the first 24 h after cardiac surgery. Seven patients received buprenorphine by intermittent intravenous injection and six received morphine by continuous infusion. Both these regimens provided good analgesia for the entire 24 h period, with only mild pain at rest and moderate pain on vigorous coughing. Both regimens also produced mild respiratory depression but this was not of clinical importance: the mean arterial pco2 in both groups was less than 45 mmhg after extubation. The major difference between drugs in the clinical setting was the ease of administration. Buprenorphine had no narcotic code restriction and could be given by intermittent intravenous injection, whereas morphine required checking and handling as a restricted drug and administration by continuous intravenous infusion. When labour and material costs were computed, over the first 24 postoperative hours, it cost $19.76 per patient to administer morphine, but only $3.16 to administer buprenorphine. Thus the use of buprenorphine injections for the first 24 h after cardiac surgery produced pain relief and respiratory depression comparable to that produced by a morphine infusion, but with a significant cost saving in terms of labour and materials.