In recent time, it has become more and more probable that patients with severe diffuse coronary artery disease, who are not candidates for aortocoronary bypass surgery or percutaneous transluminal coronary angioplasty procedures, can benefit from transmyocardial laser revascularization (TMR). But the underlying principle of TMR still remains unclear. This study reports on a histological analysis of eight patients, in whom a total of 250 channels had been created, who died after TMR. The TMR channels were created by a C02 laser surrounded by a zone of necrosis with an extent of about 500 Fm. In the hearts of patients who died in the early postoperative period (1 to 7 days postoperative), almost all channels were closed by fibrin clots, erythrocytes, and macrophages. There were no obvious connections between the channels and the ventricular cavity. In specimens from patients, who died 2 or more weeks after the procedure, a granular tissue with high macrophage and monocyte activity was observable. Within this tissue, we observed a developing network of capillaries. Otherwise, the tissue filling the channels did not substantially differ from scar tissue. We failed to observe connections between the ventricular cavity and the new capillaries. Whether these vessels within the closed channels have any impact on myocardial perfusion remains unclear, but it seems unlikely that the clinical effects of TMR are based on the principle of the amphibian heart. (J Card Surg 1996;11:326-331) There are patients with coronary artery disease, who despite severe angina and significantly restricted quality of life cannot be treated by percutaneous transluminal coronary angioplasty (PTCA) or aortocoronary bypass operation. This concerns patients with diffuse sclerosis of the coronary arteries, as well as those with very small coronaries (small vessel disease). Currently, these patients were more and more treated by transmyocardial laser revascularization (TMR).During a TMR procedure, the surgeon drills

Background: Medical emergencies and on-going medical conditions on board may seriously impair seafarers' health and safety, and also negatively impact on future work prospects for seafarers. When a seafarer gets ill or injured on a ship, medical treatment often relies on the competences on his colleagues on board. The aim of this project was to establish a consensus-based minimum standard for medical education for seafarers, in order to ensure competency for adequate management of ill-health on board. Materials and methods: International Maritime Health Foundation (IMHF) conducted a workshop on medical training of seafarers. A research-based approach to gain consensus on core learning outcomes/competences developed by the Tuning Project, has been used. This method was used by Tuning (Medicine) to gain consensus on core learning outcomes for primary medical degrees (Master of Medicine) across Europe. Results: The result of the project is a set of learning outcomes/competences in medical training for merchant seafarers. Conclusions: The project resulted in a set of learning outcomes/competences on medical training of the seafarers that will be submitted to the relevant bodies of International Maritime Organization (IMO) in the process of the development of model courses 1.13, 1.14 and 1.15.

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ZusammenfassungDie heutigen Einsatzmöglichkeiten von Fachkrankenpflegern sind breit. Verschiedene Disziplinen innerhalb und außerhalb des Krankenhauses sind dabei jedem bekannt, der sich gedanklich mit einer Veränderung seines beruflichen Umfelds beschäftigt. Mancher denkt auch über die Landesgrenzen hinaus, bezieht das nähere oder weitere Ausland in die Überlegungen für einen neuen Schritt mit ein. Dieser Artikel macht mit einem weiteren, weitgehend unbekannten Einsatzgebiet vertraut: Haben Sie schon einmal daran gedacht, auf einem Kreuzfahrtschiff zu arbeiten?