Pseudoxanthoma elasticum: An unique entity in the coronary surgery.

Pseudoxanthoma elasticum is a rare connective tissue disease which affects the synthesis of the elastic fibres. It is an area of uncertainty for patients affected by this disease requiring surgical revascularization. We present a case report of a 43-year-old gentleman was known to have pseudoxanthoma elasticum syndrome (PXE) and coronary artery disease. He underwent successful off pump LIMA to LAD. Interestingly, this is the first case in UK and second one in the literature managed with an off-pump strategy. The predilection of the histopathological changes in PXE patients, should not prevent the routine use in of the left internal mammary artery as a standard conduit in CABG. Further studies are required to standardize the practice for surgical revascularization in the patients with PXE.

Surgical repair of a giant congenital left atrial aneurysm presenting with respiratory distress in a neonate.

The presentation of congenital left atrial aneurysm is extremely rare in neonates. The neonate may suffer from severe respiratory distress symptoms, and by then, early surgical management is lifesaving.

Pulmonary thromboendarterectomy for pulmonary hypertension linked to thalassemia.

This report supports the feasibility of pulmonary thromboendarterectomy in thalassemic patients, and highlights the need for a comprehensive evaluation of the cause of pulmonary hypertension prior to determining the likelihood of surgical cure.

Comparison of safety and outcomes with two approaches to the mitral valve.

BACKGROUND AND AIM: The efficacy of the superior trans-septal (STS) approach to the mitral valve has been offset by the perceived risks of adverse postoperative events. The aim of this study was to review our experience with using the left atriotomy (LA) and STS approaches in patients undergoing mitral valve surgery. METHODS: Charts of patients who underwent mitral valve surgery by a single surgeon over a period of 20 years were reviewed retrospectively. A total of 319 patients (aged 42.9 ± 16.2 years) were studied. Surgical operations were carried out through the LA approach in 111 patients, and through the STS approach in 208 patients. RESULTS: The two groups were comparable in terms of patients' characteristics, but cardiopulmonary bypass and aortic cross-clamp times were longer in the STS approach group (P = .0005). No technical complications related to either approach occurred. Rates of re-exploration for postoperative bleeding, durations of intensive care unit (ICU) stay, in-hospital days, and mortality were comparable in both approaches. Statistical analyses indicated that a patient was more likely to maintain a preoperative sinus rhythm if the LA approach rather than the STS approach was used (P < .05). On the other hand, when the preoperative heart rhythm was atrial fibrillation, no significant difference in perioperative changes in heart rhythm was observed between the two approaches. CONCLUSIONS: This study confirms that the routine use of the STS approach is not associated with important adverse postoperative outcomes, but is associated with increased incidence of postoperative sinus node dysfunction in patients who were in sinus rhythm preoperatively.

Early calcific degeneration of the St. Jude Medical Epic aortic bioprosthesis.

This report highlights the need for close surveillance of bioprosthetic valves. Unaccountable degeneration of bioprosthetic valves can develop early after implantation and usually requires replacing the failed valve with a mechanical prosthesis.

Dissected saccular aneurysms of the ascending aorta.

This report highlights the need for distinction between saccular and fusiform aortic aneurysms, considering the high risk of rupture of saccular aneurysms. The management of dissected saccular aneurysms involves elective replacement of the dissected aorta while preserving the aortic valve.

Case report: Ectopic Cushing's syndrome in a young male with hidden lung carcinoid tumor.

INTRODUCTION: Ectopic Cushing syndrome is a form of Cushing's in which a tumor outside the pituitary gland produces adrenocorticotropic hormone (ACTH). Small cell carcinoma and carcinoid of the lung comprises half of its cases. The main purpose of this study is to present a case of ectopic Cushing syndrome caused by a hidden lung carcinoid and how to manage it. PRESENTATION OF CASE: Here we present a case of a 26year old young male complains of increased weight and appetite, proximal muscle weakness, easy bruising and appearing of purple striae on his abdomen, with a final diagnosis of ACTH secreting lung carcinoid. DISCUSSION: The diagnosis was made by non-invasive radiological procedures (CT scan and MRI) and serological tests. The management consisted of medical treatment which was not useful, then bilateral adrenalectomy to limit the patient symptoms. The ectopic spot was finally detected and excised surgically through thoracotomy. After six months of follow up there was no recurrence, signs and symptoms of Cushing syndrome begin to disappear. CONCLUSION: Ectopic cushing syndrome is a complicated medical problem especially when it comes to identification of the ectopic spot. The surgical treatment could be curative when the spot is determined.

Multi-sited hydatid cystic disease with muscular involvement in a young female: A case report from Syria.

INTRODUCTION: Hydatidosis is a unique disease caused by a tapeworm called Echinococcus granulosus. Musculoskeletal involvement with hydatid cystic disease accounts for less than 5% of all cases. The main purpose of this study is to present a case of multi-sited hydatid cystic disease and how to manage it. PRESENTATION OF CASE: Here we present a case of 14-year-old girl complained of a gradually enlarging mass on her left shoulder with a final diagnosis of triple-sited hydatid cystic disease including the right lung, the left trapezius muscle and the liver. DISCUSSION: The diagnosis was made by non invasive radiological procedures (CT scan and MRI). The management consisted of aspiration and reinjection of hypertonic solution to the lung cyst followed by complete surgical resection, enucleation of the muscular lesion and conservative management of the liver lesion. After Three months of follow up there was no recurrence at the sites of operation and the liver cyst reduced in size. CONCLUSION: Multi-sited hydatid cysts could be treated through one stage surgery followed by chemotherapy with benzimidazoles.

Pelvic Myxoid Leiomyoma Mass between Vagina and Rectum.

Leiomyomas are the most common pelvic tumors in women. About 20-30% of women older than 35 are affected. Rare conditions of leiomyomas have extrauterine locations. Myxoid degeneration is a rare type of leiomyoma degeneration. We report a case of solid-cystic myxoid leiomyoma in a 53-year-old woman complained of constipation, urinary hesitation, and malodorous vaginal discharge with palpable 17 × 12 cm mass between vagina and rectum. Regarding the inferior location of the mass, a perineal approach was used to enucleate it. This rare location has not been mentioned before. The woman was finally diagnosed by pathologists which was myxoid leiomyoma.