Immunohistochemical assessment of the nm23, c-erbB-2 and p53 proteins using the above monoclonal antibodies does not have value as an independent prognostic indicator in pulmonary adenocarcinoma.

For surgery of dissecting ascending aortic aneurysms we have employed deep hypothermic circulatory arrest to permit construction of the distal aortic anastomosis in a bloodless field. The cerebral complications of circulatory arrest in deep hypothermia are well recognised. Many methods of cerebral protection have been suggested besides deep hypothermia including retrograde cerebral perfusion, administration of thiopentone and cerebroplegia. We report a supplementary technique that theoretically may provide improved cerebral protection, and present the results in four cases.

More than 30 000 people undergo heart surgery in the UK each year. A significant source of long-term morbidity following sternotomy is the tendency to form abnormal scars. Living with scars can be challenging in a social environment that values physical attractiveness. The physiology of wound healing is a complex, dynamic process that results in restoration of anatomical continuity and function. However, where the reparative processes are disrupted, wound healing can be impaired resulting in two pathological extremes: deficient healing leading to chronic wounds or excessive healing leading to hypertrophic or keloid scars. Current post-sternotomy precautions are, at best, supported by indirect evidence and have several limitations. Psychosocial distress is directly related to patient-perceived scar severity and unrelated to clinicians’ ‘objective’ rating. The potential impact of sternal scar formation should be discussed with patients pre-operatively and appropriate support (social skills training, cognitive behavioural therapy) should be offered during recovery.

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