Synchronous left ventricular myxoma and malignant fibrous histiocytoma: simultaneous surgical management.

The occurrence of synchronous but unrelated cardiac and soft tissue tumours is extremely rare. Here we describe the case of a 62-year-old man who had a left ventricular myxoma and an unrelated synchronous malignant fibrous histiocytoma. The patient first underwent successful resection of the soft tissue tumour and in the same session emergency resection of the cardiac mass under cardiopulmonary bypass.

Percutaneous coil embolisation of a false aortic aneurysm following coronary surgery and mediastinitis.

A 71-year-old male patient was admitted with methicillin-resistant staphylococcus aureus mediastinitis two months after coronary artery bypass grafting. Treatment with immediate surgical debridement, removal of sternal wires and use of vacuum-assisted closure device was started. Spiral computerised tomography and aortography revealed a false aortic aneurysm at the cannulation site.

Congenital diaphragmatic hernia as a cause of cardiorespiratory failure and visceral obstruction in late pregnancy.

Background: Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, particularly if early surgical intervention is not undertaken.

Case Presentation: A woman at 23 week gestation was admitted with symptoms of respiratory failure and bowel obstruction due to incarceration of viscera through a left posterolateral defect of the diaphragm (Bochdalek's hernia). Surgery (left thoracoabdominal incision) demonstrated compression atelectasis, mediastinal shift, strangulation and gangrene of the herniated viscera which led to segmental resection of the involved portion of large intestine with re-establishment of bowel continuity by end to end anastomosis.

Successful octreotide treatment of chylothorax following coronary artery bypass grafting procedure. A case report and review of the literature.

Chylothorax occurs in 0.25 to 0.50% of cardiac operations performed through thoracotomy incisions and is more unusual after median sternotomy.

Bochdaleck's hernia complicating pregnancy: case report.

Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, particularly if early surgical intervention is not undertaken. We report a case in which a woman presenting at 23 wk's gestation was admitted with symptoms of respiratory failure and bowel obstruction due to incarceration of viscera through a left posterolateral defect of the diaphragm (Bochdalek's hernia). Surgery (left thoracoabdominal incision) demonstrated compression atelectasis, mediastinal shift, strangulation and gangrene of the herniated viscera which led to segmental resection of the involved portion of large intestine with re-establishment of bowel continuity by end to end anastomosis.

Primary mediastinal hemangiopericytoma.

Background: Hemangiopericytoma is a rare mesenchymal neoplasm, accounting for about 1% of vascular tumors The tumor occurs most commonly in the skin, subcutaneous soft tissues, muscles of the extremities, retroperitoneum but rarely in the lung, trachea or mediastinum.

Case Presentation: A rare case of primary mediastinal hemangiopericytoma is presented. A 72-year-old woman was treated by complete surgical resection of the tumor.

An unusual cause of haemoptysis in a young male.

Inflammatory myofibroblastic tumours are reported to occur in a variety of sites, including the head and neck, abdominal organs, central nervous system and urinary tract. They only rarely occur in the lung. We report a case of a 25-year-old male admitted with haemoptysis.

A long-term survivor of Bland-White-Garland syndrome with systemic collateral supply: a case report and review of the literature.

Background: Bland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a rare disease which may result in myocardial infarction, congestive heart failure and sometimes death during the early infantile period.

Case Presentation: A successfully treated case of a 45-year-old mother of 2 children with Bland-White-Garland syndrome and concomitant severe mitral regurgitation is presented. Subsequent therapy consisted of ligation of the anomalous origin of the left coronary artery, anastomosis of the left internal mammary artery to the left anterior descending branch and mitral valve replacement.

Does leukodepletion during elective cardiac surgery really influence the overall clinical outcome?

Aim: We examined the impact of leukocyte filtration during the entire bypass time on postoperative leukocytosis, perioperative hemorrhage and overall clinical outcome in patients undergoing elective cardiac surgery.

Methods: Eighty patients who electively underwent cardiac surgery were randomly allocated to a leukocyte depletion group (n=40) or a control group (n=40). In patients of the leukocyte depletion group an arterial line filter with leukocyte depleting capacity (Pall LG6) was applied instead of a standard arterial line filter.

Beware Swan-Ganz complications. Perioperative management.

Since the introduction of the pulmonary artery catheter (PAC) in 1970 by Swan et al., various complications are recognized with the insertion and the use of Swan-Ganz catheter. We present two different cases with rare but life threatening complications which had been successfully managed.

Bronchogenic cyst infected by Salmonella enteritidis followed gastroenteritis.

Congenital bronchogenic cysts of the lung and mediastinum develop from the ventral foregut during embryogenesis. Bronchogenic cysts are seldom seen in the adults and most are thought to be asymptomatic and free of complications unless they become infected or are large enough to cause pressure on contiguous vital structures such as the tracheal carina, the lung or the esophagus. We present the unique case of a 24-year-old man who developed respiratory symptoms after Salmonella enteritidis infected bronchogenic cyst following Salmonella gastroenteritis.

Multivascular trauma on an adolescent. Perioperative management.

Penetrating vascular injury, in particular at the neck, is a life-threatening trauma not only of the nature and the anatomic proximity of cardiovascular, aerodigestive, glandular and neurologic system but also of the development of early and late complications. The following case report describes our experience with a penetrating wound patient, who was admitted to our emergencies twelve hours after the accident. The only demonstrable objective signs included a large hematoma at the right-side of the neck and distended mediastinum on the chest X-ray.

Effect of prostacyclin PGI2 on cardiopulmonary bypass-induced lung injury.

Lung injury produced by cardiopulmonary bypass (CPB) is clinically characterized as postperfusion pulmonary dysfunction syndrome. The roles of humoral factors, altered perfusion modes and the occurrence of diffuse microembolism have been subjects of a number of studies. This paper presents the effectiveness of a platelet inhibiting drug, PGI2 in preventing occlusive microaggregates in the pulmonary circulation.

Brain damage after profoundly hypothermic circulatory arrest: correlations between neurophysiologic and neuropathologic findings. An experimental study in vertebrates.

Five groups of neonatal pigs were subjected to cardiopulmonary bypass with circulatory arrest periods that varied from 70 to 120 minutes for the investigation of brain changes in induced deep-core hypothermia (15 degrees C) with circulatory arrest. The parameters that were analyzed were (1) microscopy of the brain in animals at 6 hours after bypass procedures and (2) intraoperative monitoring of somatosensory evoked potentials. Microscopic cellular damage appeared in all animals with a circulatory arrest period of more than 70 minutes.

Neuropathological features of profoundly hypothermic circulatory arrest: an experimental study in the pig.

Twenty-four neonatal pigs were exposed to periods of circulatory arrest of between 70 and 120 min under profound hypothermia at 15 degrees C. Brain tissue taken 6h after cardiopulmonary bypass was examined histologically and by electron microscopy for evidence of hypoxic damage. Specimens from control pigs and animals subjected to 70 min arrest showed no morphological changes in the cerebral or cerebellar neurones.

Assessment of neurological injury due to circulatory arrest during profound hypothermia. An experimental study in vertebrates.

To investigate brain changes in induced deep core hypothermia (15 degrees C) with circulatory arrest, five groups of neonatal pigs were subjected to cardiopulmonary bypass (CPB), with circulatory arrest (CA) periods varying from 70-120 min. The parameters analysed were: 1. Histology and electron microscopy of the brain six hours post-CPB, 2.

Prevention of perioperative neurological dysfunction. A six year perspective of cardiac surgery.

Neurological dysfunction following cardiac surgical procedures is now well recognized. In order to minimise this serious complication, we instituted various protocols related to the potential causes of perioperative stroke such as: (1) components and use of the heart-lung machine; (2) air embolization; (3) intrinsic cerebro-vascular disease; (4) atheroemboli from the ascending aorta and (5) clot emboli from the left ventricle. We employed certain methods of operation of the heart-lung machine, air evacuation manoeuvres and a pharmacological brain protection protocol.

Thirteen years evaluation of the Bjork-Shiley isolated mitral valve prosthesis. The Wessex experience.

Between 1973 and 1985, 349 patients had isolated mitral valve replacement by a Bjork-Shiley prosthesis with an overall early (30 day) mortality of 5.1%. Of the 331 survivors, 294 patients have been traced and their clinical outcome was followed for up to 13 years in order to define the long term performance of the mitral Bjork-Shiley models MBRP-standard, MBRC-convexo concave and MMSM-monostrut.

Ten year clinical evaluation of Starr-Edwards 2400 and 1260 aortic valve prostheses.

The long term performance characteristics of the 2400 and 1260 series of Starr-Edwards aortic prostheses were investigated by a follow up study of clinical outcome of 327 patients discharged from hospital with isolated aortic valve replacement. Follow up lasted for up to 10 years and was based on 1616 patient-years. The 2400 series cloth covered tracked valve was implanted in 182 patients from 1974 to 1980 and the 1260 series bare strut silastic ball valve was inserted in 145 patients from 1979 to 1983.

Ten-year clinical evaluation of isolated mitral valve and double-valve replacement with the Starr-Edwards prostheses.

From 1974 through 1983, 689 hospital survivors of Starr-Edwards (SE) valve replacement were identified; 279 (40.4%) patients with complete follow-up had an isolated mitral valve (SE model 6120 or 6400) replacement: 60.6% of these patients were women, 33.

Effect of prostacyclin on the circulatory histamine during cardiopulmonary bypass.

Changes in plasma histamine levels were studied in sixteen dogs under cardiopulmonary bypass (CPB) or bypass with the addition of prostacyclin (PGI2) infusion. In both groups, plasma histamine rose immediately after anaesthetic induction (median above pre-induction: 0.4 ng/ml) and following heparin infusion (median above pre-induction: 0.