Mycotic pseudoaneurysm of the ascending aorta following purulent pericardial effusion diagnosed by multi-slice computed tomography.

Mycotic pseudoaneurysm of the aorta is an uncommon disease, especially in childhood but has a high mortality due to spontaneous rupture. It is caused by endarteritis following bacteraemia or fungaemia. Due to spontaneous rupture, early diagnosis is very important.

Comparison of harmonic scalpel and high-frequency electrocautery in radial artery harvesting.

AIM: We evaluated the effects of the radial artery on the functional outcomes and endothelium when the harvest was made either by harmonic scalpel or by high-frequency electrocautery. METHODS: Between 2002 and 2007, 982 patients with coronary artery diseases were operated for coronary artery revascularization. The radial arteries were harvested for 101 of these patients and divided into two groups depending on the use of the harmonic scalpel (Group A; N=51) and the high-frequency electrocautery (Group B; N=50). Harvesting time, use of hemostatic clips, frequency of spasm, in situ free flow, and endothelial damage were compared between the two groups. RESULTS: Conventional high-frequency electrocautery technique used 8.7+/-3.9 hemostatic clips versus 1.5+/-1 clips (P<0.001). In situ free blood flow was 85+/-5.5 mL/min for Group B versus 114+/-21.7 mL/min for Group A (P<0.006). The endothelial damage of the radial arteries taken down with the harmonic scalpel was significantly less than when taken down with the high-frequency electrocautery (P<0.05). There was no statistically significant difference in terms of harvesting time and spasm between the two groups (P>0.05). CONCLUSION: Ultrasonic dissection with harmonic scalpel of the radial artery is associated with a decreased use of hemostatic clips. Moreover, the harmonic scalpel has a positive effect on endothelial preservation and it was associated with increased free blood flow of the radial artery.

Emergency surgical treatment of a giant unruptured aneurysm of the ascending aorta: the importance of routine chest X-ray.

Chest X-rays can detect aortic aneurysms or other silently developing aortic or cardiac diseases. In the present study, an ascending aortic aneurysm was detected in a 20-year-old woman with a persistent cough presenting to our emergency department. A Bentall procedure was carried out under deep hypothermic circulatory arrest.

Combined coronary arterial bypass graft and thyroidectomy in a patient with giant goiter: how reliable is it?

A 47-year-old male was admitted to our clinic with the complaints of chest pain, limitation of cervical movements, progressive dyspnea, and painless cervical mass. The cervical mass dimensions were approximately 15 x 20 x 25 cm. Laboratory studies revealed a recurrent hyperthyroid state. After the thyroid hormones were maintained in a euthyroid condition, a coronary angiogram was made. It revealed progressive ischemic heart disease. Combined cardiac surgery and total thyroidectomy were performed. The postoperative course was uneventful without any of the problems associated with hyperthyroidism or hypothyroidism. Combined thyroid and cardiac surgery is feasible with little risk for both operations if the perioperative levels of the thyroid hormone are maintained in a euthyroid or hypothyroid state.

Thrombolytic therapy with tissue plasminogen activator for superior vena cava thrombosis in an infant with sepsis.

Superior vena cava syndrome is rare in infants, and rarely responds to conservative treatment. We report a 22-mo-old girl with superior vena cava syndrome due to the use of a central venous line and/or sepsis. Doppler study and computed tomography angiography of the neck showed thrombosis within the superior vena cava and jugular veins. She was admitted to a monitored setting and received recombinant tissue plasminogen activator for 2 d. The clinical features of superior vena cava syndrome disappeared completely 3 d after treatment. No complications were observed and radiological investigations showed blood flow through the thrombus after treatment. Systemic recombinant tissue plasminogen activator may be useful in the treatment of superior vena cava syndrome in children.

Hyperhomocysteinaemia as a risk factor for deep-vein thrombosis.

OBJECTIVE: Several studies have shown a relation between hyperhomocysteinaemia and vascular disease. To assess the risk of deep-vein thrombosis (DVT) associated with hyperhomocysteinaemia, we studied plasma homocysteine levels in patients with deep-vein thrombosis and in normal control subjects. MATERIALS AND METHODS: We measured plasma homocysteine levels in 48 patients with deep-vein thrombosis and in 33 healthy controls matched to the patients according to age and sex. Plasma homocysteine levels were measured with high performance liquid chromatography and fluorescence detection. Hyperhomocysteinaemia was defined as a plasma homocysteine level about 15 micromol/L in both groups. The diagnosis of all patients with deep-vein thrombosis (n=48) was verified by Doppler ultrasonography. RESULTS: Plasma homocysteine levels were found to be increased in the deep-vein thrombosis group compared the control group (p<0.001, t-test). The mean plasma homocysteine level in the patients was 17.1 SD 5.13 micromol/L (range 6.4-31.3), and that in the controls was 9.0 SD 1.27 micromol/L (range 6.0-11.5). The association between elevated homocysteine levels and venous thrombosis was stronger among men than among women. CONCLUSIONS: The increased plasma homocysteine levels we have observed may have a causative role in the development of deep-vein thrombosis.

Subxiphoid pericardiostomy in the management of pericardial effusions: case series analysis of 368 patients.

OBJECTIVE: To assess the effectiveness of subxiphoid pericardiostomy in the treatment and diagnosis of pericardial effusions. METHODS: 368 patients who underwent subxiphoid pericardiostomy and tube drainage for cardiac tamponade, moderate to severe pericardial effusion, or suspicious bacterial aetiology were retrospectively analysed. Biopsies of the pericardium and fluid samples for diagnostic tests were obtained from each patient. RESULTS: The mean age of the patients was 38.4 years, and the male to female ratio was 220:148. The pericardial effusion was classified by echocardiography as severe in 53% of the patients, moderate in 43%, and mild in 4%. The incidence of cardiac tamponade was 25%. Myocardial injury requiring sternotomy occurred as an operative complication in 0.8% of the patients and recurrent effusion necessitating further surgical intervention developed in 10% of patients. Histopathological examination and the polymerase chain reaction of specimens of pericardium and fluid were helpful for establishing a diagnosis in 90% of patients with malignancy and 92% of patients with tuberculous pericarditis. The overall 30 day mortality rate was 0.8%. Patients were followed up for at least one year. Pericardial constriction requiring pericardiectomy developed in 3% of the patients. CONCLUSIONS: Pericardial effusions of various causes can be safely, effectively, and quickly managed with subxiphoid pericardiostomy in both adults and children.

Clinical experience with subxiphoid pericardiostomy in the management of pericardial effusions: a study of 240 cases.

We aimed to assess the effectiveness of subxiphoid pericardiostomy for treating patients with pericardial effusions (PE), and its contribution to defining the aetiology of these effusions. We undertook retrospective analysis of 240 PE patients who underwent subxiphoid pericardiostomy and tube drainage between 1990 and 2000. Echocardiography classified PE as severe in 132 patients, moderate in 99, and mild in nine. The main causes of PE were uraemic, idiopathic and undefined, tuberculous and non-tuberculous pericarditis, malignancy and trauma. Peri-operative myocardial injury requiring sternotomy, and recurrent effusion requiring further surgical intervention, occurred in three and 24 patients, respectively. Histopathological examination assisted the diagnosis in 94% of patients with malignancy, and 96% with tuberculous pericarditis. Overall 30-day mortality was 1.3% and pericardial constriction, requiring pericardiectomy, developed in seven cases. In conclusion, we believe that adults and children with PE can be safely, effectively and quickly managed with subxiphoid pericardiostomy, irrespective of its aetiology.

Comparison of the topical haemostatic agents for the prevention of suture hole bleeding. An experimental study.

OBJECTIVE: using a rabbit vascular graft model we investigated the use of fibrin glue (FG), gelatin-resorcinol-formaldehyde (GRF), and collagen (C) as a means of reducing suture hole bleeding. MATERIALS AND METHODS: twenty-eight rabbits were divided into four groups: fibrin glue, gelatin-resorcinol-formaldehyde, collagen and control. A 1 cm incision was made in the abdominal aortic wall of each animal. Incisions were covered with a polytetrafluoroethylene patch sutured with a 7-0 polypropylene. Fibrin Glue, GRF, and C were applied to cover suture holes in the groups 1, 2 and 3, respectively, but nothing in controls (group 4). The fibrin clot was allowed to achieve strength for 3 minutes before the clamps were reopened. After reopening the clamps, blood was collected from the surgical site using a syringe for a total of 2 min. RESULTS: mean blood loss was significantly lower in the FG, GRF, and C compared with control group (p=0.0022, p=0.0022, and p=0.0017, respectively). The volume of blood lost and the time of haemostasis in the group 1 (FG) was less than those in groups 2 and 3 (GRF and C, respectively) (p=0.001). The haemostasis (defined 2 min later) was achieved only in group 1 (FG) (p=0.00067). CONCLUSIONS: FG, GRF and C all reduce blood loss. Fibrin glue containing factor XIII was the most effective.

Infected cardiac hydatid cyst.

A 24 year old woman presented with chest pain and palpitation. The presence of a semisolid mass-an echinococcal cyst or tumour-in the left ventricular apex was diagnosed by echocardiography, computed tomography, and magnetic resonance imaging. The infected cyst was seen at surgery. The cyst was removed successfully by using cardiopulmonary bypass with cross clamp.

The effect of vascular endothelial growth factor on angiogenesis: an experimental study.

OBJECTIVE: to evaluate the effects of exogenous vascular endothelial growth factor (VEGF) on angiogenesis in a rabbit model of persistent hind limb ischaemia. MATERIALS AND METHODS: ischaemia was induced in the hind limbs of 42 New Zealand white rabbits divided into six groups, each of 7 animals. Group 1a and 1b received intramuscular injections of 1 and 2 mg VEGF/day, respectively, into the ischaemic hind limb for 10 days beginning on postoperative 11th day, and group 1c received IM injections of saline only. Group 2a and 2b received similar regimen of VEGF, but administered intra-arterially. Group 2c served as controls. Perfusion of the ischaemic limb was evaluated by thigh blood pressure and thigh circumference at 10, 25 and 40 days following limb ischaemia in all animals and by digital subtraction angiography, perfusion scans, histological examination of capillary density in 2 animals from each group. RESULTS: thigh pressure index and thigh circumference improved significantly in the VEGF treated animals (Groups 1a,b and 2a,b). Collateral formation, as assessed by angiography, scintigraphy and by histological examination, indicated marked formation of collaterals in the VEGF treated animals as compared with the controls. This was most pronounced in groups receiving the highest dose of VEGF. CONCLUSION: these data suggest that VEGF promotes angiogenesis, that the route of administration is unimportant, but that a dose-response relationship is present in this experimental ischaemic hind limb model.