Recurrent pleuropulmonary blastoma

Pleuropulmonary blastoma [PPB] is an extremely rare intrathoracic neoplasm of early childhood with unfavorable outcome. We present a case of a 4-year old boy who presented with progressive dyspnea due to tension pneumothorax. After chest tube insertion, CT scan showed large multilocutar cystic lesions containing air and solid areas involving the right lower lobe and its related pleura. Thoracotomy was done and the cyst was removed with the pleural solid areas. Histopathological examination confirmed the diagnosis of Pleuropulmonary blastoma type II. Postoperatively, the patient was scheduled to start chemotherapy in a specialized pediatric oncology center to complete the treatment, but due to delay in starting the treatment, the child developed re currenc of thetumor very shortly and taken back to surgery where tobectomy and decortication were performed with excision of the whole malignant tissues. Chemotherapy was started immediately after surgery and the patient is doing very well with no recurrence after three years of resection

Prosthetic valve endocarditis

Background: prosthetic valve endocarditis [PVE] remains a serious complication of cardiac valve replacement. Patients with valve replacement are at constant risk of 0.6-1% per patient-year for PVE. The mortality is high despite major advances in the treatment of infective endocarditis, which includes more effective antimicrobial therapy and more aggressive surgical procedures

Aim of the work: this study is directed to evaluate patients with prosthetic valve endocarditis managed at the Cardiothoracic Surgery Department, Mansoura University. Evaluation included the mode of presentation, methods of diagnosis and results of different management modalities

Patients and Methods: this is a retrospective study. Between 1994 and 2000, 19 patients were admitted at the Department of Cardiothoracic Surgery, Faculty of Medicine, and Mansoura University for suspected prosthetic valve endocarditis [PVE]. All of the patients have been operated on before in the same department. Retrospective analysis of the patient's charts was performed

Results: the mean age of the patients was 26+/-5.1 years [range 17-41 years] and the male to female ratio was 2:1. Eighteen patients [94.74%] had mechanical valve replacement using bileaflet valves and only one patient [5%] had mitral valve repair using prosthetic ring. Of the 18 patients who had received single valve prosthesis, 8 [42.11%] underwent mitral valve replacement, 6. [31.38%] aortic valve replacement, 4 patients [20.05%] had both aortic and mitral valves replaced. In this study, four patients [21.05%] treated medically using9 antibiotics and supportive medical treatment for heart failure. Fifteen patients [78.9%] required valve medical treatment including antibiotic and supportive treatment of average 15 days. The most common indication for surgery was congestive heart failure caused by paravalvular leakage due to the endocarditis. Paravalvular leak involved more than 50% of the valve circumference with prosthesis dehiscence in 2 patients. In 2 patients, there was persistent fever with refractory sepsis and one patient had septic embolism. The mean aortic cross clamp time was 70+/-14.1 minutes [Interval 55-150 minutes]. The mean cardiopulmonary bypass time was 165+/-26.1 minutes [Interval 100-230 minutes]. The mortality in the medically managed patients was 75% [3 patients] compared to 33.3% [3 patients] in the surgically treated group

Conclusion: 1. PVE remains a surgical challenge, but in order to optimize surgical results, early diagnosis and aggressive medical theraou should go hand-in-hand with Carly surgical intervention especially in those patients known to have a poor prognosis for medical cure and who are at risk for surgical morbidity and mortality. 2. Early reoperation, extensive tis sue debridement with annular reconstruction, could improve the results of the treatment of PVE, but strict prevention measures of intraoperative contamination during valve replacement remains the optimal goal to de crease the incidence and dismal outcome of PVE

Serious chest trauma in children requiring emergency thoracotomy

Background: pediatric trauma remains a major health and social problem. Thoracic injuries are the second leading cause of death in children

Aim of the work: to evaluate our experience in diagnosis and management of serious chest trauma in children either blunt or penetrating which required emergency thoracotomy

Patients and methods: this is a retrospective study of all emergency thoracotomies performed for pediatric patients at Mansoura University Emergency Hospital [MUEH] from January 1997 to December 2002. We reviewed the hospital charts of all patients admitted with the diagnosis of chest injuries either blunt or penetrating injury and selected cases needed emergency thoracotomy. Of the pediatric group, only 50 patients [5%] had serious chest injury, either blunt or penetrating and required emergency thoracotomy were included in this study. Hospital charts of this group of patients were reviewed and classified according to the mechanism of trauma into two groups: Group A: Patients with blunt thoracic trauma; 26 patients [52 %]. Group B Patients with penetrating thoracic trauma; 24 patients [48%]

Results: in the blunt group, 20 patients [76.9%] were males and 6 patients [23.1%] were females, with age ranged from 1 to 16 years [mean 10.0+/-6.4]. In penetrating group, 20 patients [83.3%] were males and 4 patients [16.7 %] were females, with age ranged from 6 to 17 years [mean 12.6+/- 3.4]. In the blunt group, the mechanism of injury was: road traffic accidents in 18 patients [69.26] and falling from height in 8 patients [30.8%]. In the penetrating group, the mechanism of injury was: stab injury in 17 patients [70.8%], gunshot injury in 2 patients [8.4%], 4 patients [16.7%] were victims of iatrogenic trauma and one patient [4.2%] was involved in explosion injury. In both groups the most common side of injury was the left side 29 patients [58 %]. Fifteen patients [57.3%] were in the blunt group and 14 patients [58.3] were in the penetrating group. The pediatric trauma score [PTS] of all children was calculated, it was found that 7 patients [26.9%] of the blunt group and 8 patients [33.3%] of the penetrating group had PTS

Conclusion: from this study concludes that: *A high survival rate can be achieved if emergency thoracotomy, when indicated, is done as long as the patients shows vital signs on admission. *Excellent results are predicted when the surgical interference is performed within the first 2 hours of injury. The emergency thoracotomy could be done in the operating room or in the emergency room provided that the good monitoring and ventilation is available, then patients can be transferred after resuscitation to the operating room for definitive repair of the injuries