From 1977 to 1988 60 patients were treated for large pericardial effusion. The operation consisted of a small left anterior thoracotomy with formation of a pericardial window. In 28 patients (47%) the etiology was a malignant disease. Eight patients (29%) had malignant cells in the pericardial fluid and 23 patients (82%) had metastases to the pericardium. Seven patients (12%) had purulent pericarditis; in 4 cases Staphylococcus was found. Of the remaining 25 patients, the etiology remained unknown in 13. The 5-year survival rate was 60% among patients with nonmalignant effusions. In patients with malignant effusions only 20% were alive after 2 years. There were no deaths related to the operation. We conclude that large pericardial effusions of unknown etiology can be safely treated with a small left anterior thoracotomy. This access gives optimal possibilities for rapid diagnosis and treatment.

Gamma-glutamyltransferase (GGT), aspartate aminotransferase (ASAT), and erythrocyte mean corpuscular volume (MCV) were used as indicators of continued alcohol abuse in 178 patients with known liver disease studied for 5-49 months after diagnosis. Abstension was checked by interviews and blood alcohol determinations. Persistent alcoholics had significantly higher values for all three tests than abstainers. At values above upper normal limits, GGT was the most sensitive test, but the least specific. A positive predictive value of 80% for continued alcohol consumption was chosen, and the corresponding discriminating levels of the tests were compared. With this specificity GGT was the least sensitive test, and it did not add to the efficiency of ASAT or MCV when the tests were combined. Abstinence could not be predicted by low levels of the tests. It is concluded that these biochemical tests are valuable as indicators of alcohol consumption in patients with liver disease and that ASAT and MCV are equally efficient, whereas GGT is inferior to these.

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During an operation for an ascending aortic aneurysm with implantation of a saphenous vein graft to the left coronary artery into a prosthesis, we occasionally observed air bubbles in the graft after application of fibrin glue to the anastomosis to control bleeding. In an experimental study in a pig, a vascular prosthesis was anastomosed to the descending aorta. The aorta and the prosthesis were transected and reanastomosed. Air bubbles were collected in a glass flask placed at the end of the prosthesis. Fibrin glue was applied with a spray catheter on all anastomoses at varying distances and with different air pressures. Small amounts of air were collected in the glass flask when an air pressure of 3 or 4 bar was used. This study demonstrates that the use of fibrin glue in cardiovascular surgery can introduce air into the vascular system with subsequent air emboli as a possible side-effect.