Recurrent pleural effusion in a young woman: calcifying fibrous tumour of the pleura.

We present the case of a 23-year-old woman with a long-standing history of recurrent left-sided pleural effusion unrelated to her menstrual cycle. At her last presentation, non-contrast-enhanced chest CT showed a pleural effusion and a lower left hemithorax mass, both large enough to cause complete collapse of the lower lobe and partial collapse of the upper lobe. Thoracoscopic surgery revealed a multilobulated mass originating from the dome of the diaphragm with pleural deposits.

Analysis of aortic area/height ratio in patients with thoracic aortic aneurysm and Type A dissection.

Objectives: Significant proportions of aortic dissections occur at aortic diameters <5.5 cm. By indexing aortic area to height and correlating with absolute aortic diameter, we sought to identify those aneurysm patients with aortic diameters <5.

No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomical lung resection.

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether manual closure of the bronchial stump is safer with lower failure rates than mechanical closure using a stapling device following anatomical lung resection. One hundred and twenty-nine papers were identified using the search below.

Is perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation in adult cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Is perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation (POAF) in adult cardiac surgery? A total of 70 papers were identified using the search as described below. Of these, eight were identified to provide best evidence to answer the clinical question.

Glucocorticoids in adult cardiac surgery; old drugs revisited.

Glucocorticoids can play a pivotal role in modulating different immune responses. The role of glucocorticoids in cardiac surgery is still controversial as many surgeons are concerned about the potential side effects. In this review, we looked at the role of glucocorticoid administration in modulating postoperative inflammatory responses, atrial fibrillation (AF) and intimal hyperplasia and whether glucocorticoid use is associated with a significant increase in undesirable postoperative complication.

Successful graft patency after factor VIIa use for bleeding in coronary artery surgery: an unusual complication of a coronary artery bypass surgery.

There is a growing literature regarding the use of recombinant activated factor VII (rFVIIa) (NovoSeven, NovoNordisk, Copenhagen, Denmark) to control refractory hemorrhage after cardiopulmonary bypass in cardiac surgery. This supporting evidence is mostly documented as case reports on patients, of which only six involve coronary artery grafting. We present our experience of a patient undergoing coronary artery bypass grafting, who suffered an anaphylactic reaction to protamine preventing safe reversal of systemic heparinization.

S100 protein and its relation to cerebral microemboli in on-pump and off-pump coronary artery bypass surgery.

Objectives: S100 protein has been used as a marker for cerebral injury. Studies have reported lower levels in off-pump coronary artery surgery (CABG) compared to on-pump surgery. However, most of these are flawed as S100 from extracerebral sources was included (e.

Spleen size: how well do linear ultrasound measurements correlate with three-dimensional CT volume assessments?

Ultrasound measurement of splenic length is standard practice, but it is not known how well this represents the true size of the spleen. Previous studies, using a combination of measurements from in vivo and resected spleens, were subject to error because of changes in splenic size. The aim of this study was to correlate the dimensions of the spleen measured by ultrasound with the splenic volume measured by helical CT.

A novel approach to reconstructing the distal aortic arch.

Repair of the aortic arch remains one of the greatest challenges in cardiac surgery. This difficulty is compounded by associated descending or thoracoabdominal pathology. Options include single stage repair, two stage procedures and the ingenious elephant trunk operation where a distal trunk is left for reconnection at a subsequent operation or completion by endovascular stenting.

Cardiopulmonary bypass with danaparoid sodium and ancrod in heparin-induced thrombocytopenia.

Heparin is the standard anticoagulant for patients undergoing cardiopulmonary bypass. There are some patients for whom heparin is unsuitable and ancrod (a defibrinogenating enzyme) has been used as an alternative. We present a patient with heparin-induced thrombocytopenia in whom treatment ancrod was ineffective.

Long-term results of coronary artery bypass grafting.

The treatment of ischemic heart disease by coronary artery bypass grafting remains under intense scrutiny. A better understanding of the long-term outcome for particular patient subgroups will allow a more appropriate choice to be made among the options of coronary artery bypass grafting, angioplasty, or continued medical management. Such information would also permit patients to make informed choices when their preferences influence the decision.

Co-morbidity in patients with abdominal aortic aneurysm.

Objectives: Selection for surgery of patients with abdominal aortic aneurysm (AAA) depends on an assessment of risk from operation compared with risk from aneurysm rupture. A study was performed to assess the levels of co-morbidity and to see whether co-morbidity was different in people with a normal aorta after ultrasonographic examination than in those with an aneurysmal aorta.

Setting And Methods: Over a two year period 5392 people (2341 men, 3051 women) aged 65-80 were screened using B-mode linear ultrasound, with maximum measurements taken of transverse, anteroposterior diameters, or both.