Diagnostic and Management Dilemmas in Women Presenting with Acute Coronary Syndromes.

Purpose Of Review: To summarize gender- and sex-specific differences in the presentation, diagnosis, management, and pathophysiology of women presenting with acute coronary syndrome (ACS).

Recent Findings: Sex differences exist in many aspects of ACS that impact the identification, treatment, and outcomes in women. There are delays in the initiation of care, under recognized diagnostic differences based on sex, and inconsistencies in the management of ACS in women compared with men, that ultimately impact outcomes.

Effect of steroids on inflammatory markers and clinical parameters in congenital open heart surgery: a randomised controlled trial.

Background: Cardiopulmonary bypass is associated with systemic inflammatory response. Steroids suppress this response, although the therapeutic evidence remains controversial. We hypothesised that intravenous steroids in children undergoing open-heart surgery would decrease inflammation leading to better early post-operative outcomes.

Subclavian steal syndrome secondary to subclavian artery thrombosis in a patient with homocysteinemia and its successful treatment.

Subclavian steal syndrome (SSS) is a rare condition. It results from subclavian artery (SA) stenosis proximal to the origin of the vertebral artery. It is characterized by cerebral ischaemia with associated symptoms of vertebrobasilar hypoperfusion and/or symptoms of brainstem or arm ischaemia.

How VATS has changed the management of spontaneous pneumothorax in the 21st century.

Objective: To: determine the outcome of patients having undergone Video Assisted Thoracoscopic Surgery (VATS) for spontaneous pneumothrox in terms of hospital stay, complications and recurrence.

Methods: The netrospective study included the review of 39 cases who had presented with spontaneous pneumothorax at the Aga Khan University Hospital, Karachi, Pakistan, between January 2001 to November 2008 and had undergone video assisted thoracoscopic surgery (VATS).

Results: The duration of hospital stay (had a range of 3 to 9 days), and the length of chest tube in place (a range of 2 to 8 days), 2 (5.

Major thoracic vessels and cardiac trauma: case series from a center in a developing country.

Background: Seventy-five percent of all trauma-related deaths are related to thoracic trauma. Very few penetrating cardiac trauma patients arrive to the hospital alive. Due to its high prevalence, an understanding of the pathogenesis, manifestations and management of cardiac trauma by the medical personnel is becoming increasingly important.

Asymptomatic presentation of giant bulla of the left apical and anterior segment of the left upper lobe of the lung with near complete atelectasis of the remaining left lung.

Giant bullae may be found in association with emphysema. They present as pockets of entrapped air which grow as the surrounding lung retracts away. As they do not take part in gas exchange and merely occupy space, their presence leads to severe impediment of mechanical ventilation in the adjacent lung parenchyma.

Giant pseudoaneurysm of the aortic arch and successful surgical repair.

A 50-year-old woman presented with fever, cough, shortness of breath, and left-sided chest pain. Computed tomography with contrast showed a pseudoaneurysm occupying the upper half of the left hemithorax. Surgical repair with a Dacron patch was performed after considering the risk of pseudoaneurysmal rupture.

Congenital diaphragmatic hernia presenting in the sixth decade mimicking pneumonia.

Congenital diaphragmatic hernia presentation in adults is extremely rare. Patients who present with late diaphragmatic hernias complain of a wide variety of symptoms and diagnosis can be difficult. We report a case of a 64 year old male who presented with a six month history of cough, shortness of breath and weight loss.

Outcomes of surgical management of tracheobronchial injuries---a case series from a developing country.

Objective: Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma.

Methods: A retrospective review was performed at the Aga Khan University, Karachi, Pakistan.

Tuberculous pericardial abscess with impending pericardial effusion and cardiac tamponade.

The case of a 59 year male with acute tuberculous pericardial abscess who presented with cough, dyspnoea, haemoptysis, signs of Tamponade and a large Pleural Effusion is reported. Performing Pericardiocentesis did not improve his symptoms hence he was subjected to surgery. Acute tuberculous pericardial abscess was the diagnosis made after histopathology which was successfully managed with sternotomy along with drainage of pus.

Mediastinal seminoma presenting as superior vena cava syndrome and tracheal obstruction.

Malignant germ cell tumours of the mediastinum are rare, presenting mostly in young males. These are bulky tumours, mostly intrathoracic, infiltrating into adjacent structures early in the growth process. Patients may present with symptoms of compression.

Synovial sarcoma of the lung presenting late with compression of mediastinal structures and its successful resection: A case report.

Synovial sarcoma accounts for 5-14% of all soft tissue tumours. We present a case of 35 year-old male who presented with five months history of progressively increasing shortness of breath and cough. On evaluation, there was no air entry on the left side.

Acute traumatic subclavian artery thrombosis and its successful repair via resection and end-to-end anastomosis.

Subclavian artery thrombosis is a rare complication of clavicle fractures. We reported a 20-year-old man who was admitted to the emergency room after a road traffic accident. He was a pedestrian who was initially hit by a bus and after he fell down on the road, he was run over by a car.

Ruptured hydatid cyst presenting as pneumothorax.

Patients with echinococcus infection are mostly asymptomatic. The documented rates of simple pneumothorax in patients with pulmonary hydatidosis ranged from 2.4% - 6.

On pump coronary surgical revascularization in a patient with chronic immune thrombocytopenic purpura.

We performed on-pump coronary artery bypass graft surgery on a 54-year-old female, known case of chronic Idiopathic Thrombocytopenic Purpura (ITP), hypertension and dyslipidaemia who had presented to us with progressive exertional shortness of breath and chest pain. The decision of going on with CABG was made after two weeks of preoperative treatment with prednisolone. Her platelet counts pre-operatively and on the 4th post-operative day were 135 x 10(9)/L and 32 x 10(9)/L.