ABSTRACT
Background: Atrial myxoma is the most common benign cardiac neoplasm. Most of the case series have focused on the variable clinical presentation of myxoma rather than its gross and microscopic features. The objective of our study was to evaluate prevalence of different morphologic types of myxoma and to correlate with their clinical presentations. Methods: 68 patients were included in the study. The study population was divided into two groups- Group-A (n-18) patients having soft (papillary) tumor in the left atrium, Group B (n=50) patients having solid tumor in the left atrium. Results: 88.3% patients suffered illness more than 12 months. 92% of the solid myxomas were located in the septal wall compared to 55.6% of the papillary myxomas (p = 0.031), while one-third (33.3%) the papillary tumors were found in the left atrial free wall compared to only 4% of the solid myxomas (p = 0.048). Fever, congestive heart failure and dyspnoea were significantly predominant in patients with solid myxomas (72% vs. 44.4%, p = 0.036; 92% vs. 22.2%, p < 0.001 and 88% vs. 55.6%, p = 0.010 respectively). Atrial fibrillation and neurologic manifestations were more frequently encountered in the papillary myxoma group. No statistically significant difference was found between the groups (p>0.05) by postoperative complication during in hospital follow up but one mortality in each group. Conclusion: Our findings lend support to the view that different gross left atrial Myxoma tumor types and tumor location predict presentation.
ABSTRACT
Background: Acute lower extremity ischemia is a common vascular disease and considered limb- and life- threatening. The present study evaluated and compared the outcome of early and late surgical intervention in acute lower limb ischemia due to thromboembolism. Methodology: This non randomized comparative parallel study was conducted at the Department of Cardiovascular Surgery, NICVD, Dhaka, Bangladesh from January 2007 to December 2008 for duration of two year. Total 80 patients were enrolled in this study. The patients were divided into equal two groups, Group A, for early surgical intervention (with in 24 hours) and Group B, late surgical intervention (more than 24 hours). Results: Mean (±SD) age of both Group A and Group B was 51.93 (±11.73) and 47.00 (± 11.01) years. Male and female ratio of the total study population was 1.76:1 Pain and absence of pulse distal to occlusion was common for all. Cold extremity, sensory deficit, motor deficit, diminish vascular flow was the commonest findings of both group. In Group A, 57.5% had superficial femoral artery occlusion, 22.5% had iliac artery and 20.0% popliteal artery occlusion. In Group B, 42.5% had superficial femoral artery occlusion, 32.5% had popliteal artery occlusion and 25.0% had iliac artery occlusion. Fasciotomy was performed in 15.0% patients of Group A and in 22.0% patients of Group B. After Fogarty embolectomy in group A and group B had warm extremity (80.0% vs. 65.0%), pulsation distal to occlusion (90.0% vs. 75.0%), intact sensory function (82.5% vs. 67.5%), intact motor function (80.0% vs. 65.0%), and normal vascular flow by Doppler US (80.0% vs. 65.0%). During postoperative period history of bleeding, infection, reperfusion injury, muscle necrosis and limb amputation were 12.5% vs. 10.0%, 5.0% and 7.5%, 17.5% vs. 35.0%, 15.0% vs. 12.5% and 37.5% vs. 32.5% respectively. Conclusion: Duration of embolism may be the significant factor determining the outcomes of the management of acute arterial embolism in the lower extremities. The 24- hour duration of arterial embolism is a crucial factor influencing the surgical the management and early diagnosis and shifting of patients to specified centre as early as possible to save limb as well as life.