Anidulafungin had demonstrated favorable efficacy versus fluconazole in a randomized trial on invasive Candida infections. Since patient characteristics in the post-approval use of antifungals likely deviate from clinical trials, we surveyed the use of anidulafungin in clinical routine. We performed a retrospective survey of the post-approval use of anidulafungin in 9 Austrian clinical centers. Anidulafungin was used in 129 critically ill patients with severe comorbidities and multiple risk factors. Indications were suspected invasive fungal infections (IFI) (61%), proven candidemia (19%), and at risk for IFI (prophylaxis, 20%). Candida colonization in conjunction with other risk factors prompted treatment in many patients. Predominant pathogens were C. albicans, C. glabrata and C. krusei. Anidulafungin was mostly used for pre-emptive (69%) and first-line treatment (17%) of invasive candidiasis. Treatment response, i.e. complete response/stabilization as determined by investigators (89% in the overall population; 87% for documented candidemia) and survival rates (81% and 75%, respectively) were similar to previous trial data. No breakthrough IFI and few adverse events were reported. Overall, favorable clinical experiences were documented with anidulafungin in the clinical routine setting.

Surgery is analogous to an extreme stress test. It initiates inflammatory, hypercoagulable, stress, and hypoxic states, which may be associated with elevations in troponin levels leading to postoperative myocardial dysfunction and failure [1]. Cardiac surgery, especially, is associated with the inherent risk of myocardial ischemia and myocardial infarction; and consequently, with postoperative heart failure. The degree of permanent postoperative myocardial injury is determined by the severity and duration of ischemia. A progressive pattern of myocardial dysfunction-apart from ongoing ischemia-suggests that additional underlying mechanisms, which are at least partially different from those of myocardial stunning, may also exist [2].

1Department of Anesthesiology and Intensive Care; 2Department of Cardiothoracic Surgery, General Hospital Linz, Austria; 3Department of Cardiology

We investigated the haemodynamic and respiratory effects of one‐lung ventilation and carbon dioxide insufflation in 13 adult patients undergoing video‐assisted thoracoscopy. Cardiorespiratory variables were determined during carbon dioxide insufflation at intrahemithoracic pressures of 5, 10 and 15 mmHg, and after 5 and 15 min of one‐lung ventilation. Carbon dioxide insufflation was associated with a clear deterioration in circulatory function. The cardiac index decreased subsequent to increasing intrathoracic pressures. The mean cardiac index (SD) at pressures of 10 and 15 mmHg was 1.86 (0.39) and 1.52 (0.46), respectively, and may be compared with the reduced venous return consistent with tension pneumothorax. One‐lung ventilation did not affect haemodynamic variables but reduced arterial oxygenation indices (Pao2/FIo2) from 424.29 (160.79) after induction of anaesthesia, to 207.72 (125.50) after 5 min and 172.04 (72.03) after 15 min of one‐lung ventilation, respectively. The oxygenation index was not influenced by intrahemithoracic carbon dioxide insufflation. One‐lung ventilation via a double‐lumen endobronchial tube is safe and convenient for video‐assisted thoracoscopic surgery. It has no further consequences on haemodynamic variables, whereas the compression of the lung by carbon dioxide insufflation may cause circulatory dysfunction.

We report our experience with 31 consecutive children who underwent single-stage repair of complete atrioventricular septal defect between 1984 and December 1991. Ages ranged from 2 months to 2.5 years, mean 11 months. 18 were classified Rastelli type A, 13 type C. 22 patients had Down's syndrome, 12 were Rastelli type C. 1 patch was used in Rastelli type A cases and 2 patches in type C patients, without incision of the atrioventricular valve tissue. In all but 1 case the left superior and inferior valve leaflets were approximated. 5 patients died postoperatively resulting in an overall mortality of 16.1%. In all survivors, good clinical results and sinus rhythm were seen, although all show some degree of mitral incompetence.

Transplantation of the lung has gained increasing importancy during the last years and is now an established therapy for end stage lung disease. After a 3 years period of preparation the first single lung transplantation (SLTX) was performed at the Second Surgical Department of the University of Vienna in November 1989, followed by the first double lung transplantation (DLTX) in April 1990. Until the end of 1990 11 patients underwent SLTX and 6 DLTX. 7 of the 11 SLTX patients and 4 of the 6 DLTX patients are at present alive with significantly improved lung function and therefore markedly improved quality of life.

Lung transplantation has been available as a therapeutic option for patients with end-stage lung disease for only a short period of time. Since this procedure is now being successfully performed with increasing frequency in various transplantation centers, we must now begin to consider transplantation as a therapeutic options in patients with lung diseases unresponsive to medical therapy. Physicians are required to know principles involved for determination of suitable candidates and operative procedures of choice. We report here our experiences of preoperative assessment of patients undergoing lung transplantation. Patient selection, indications, contraindications, choice of operation, appropriate timing for transplantation and preoperative rehabilitation methods are discussed. It is concluded that appropriate recipient selection remains an important determinant for the success of this treatment modality.

At the end of December 1990 11 patients had survived lung transplantation at the 2nd Department of Surgery, University of Vienna. In these patients 7 single lung (SLTX) and four bilateral lung transplantations (DLTX) were performed. The indication for operation in 6 cases was emphysema, in 2 cases mucoviscidosis, in 2 cases pulmonary fibrosis, and in 1 case secundary pulmonary hypertension, following operation of a ductus Botalli.By means of fitness tests, blood-gas analysis, pulmonary function tests and ventilation respectively perfusion scan a marked improvement of the clinical status of the patients following lung transplantation could be shown.