An adult case of giant bronchogenic cyst mimicking tension pneumothorax.

Bronchogenic cysts are usually discovered only incidentally in the adult. A giant bronchogenic cyst in a 19-year-old woman presenting with pain and shortness of breath was mistaken for tension pneumothorax and initially treated with tube thoracostomy. Giant bullae were diagnosed by computed tomography. Bullae resection was undertaken, but the remaining lung tissue required pneumonectomy. Pathologic examination of the specimen confirmed bronchogenic cyst.

Histological results of sclerotherapy, phototherapy, and pulsed 980-nm laser irradiation of the dorsal rabbit ear vein.

OBJECTIVE: To compare the histological changes occurring after three different treatment modalities for telangiectasias. MATERIALS AND METHODS: Thirty 16-week-old New Zealand white rabbits weighing 2.4-3.1 kg were enrolled in the study. The rabbits were divided into three groups. The group 1 received sclerotherapy, he group 2 received phototherapy, and group 3 received high-power diode laser treatments. All animals were treated on the right dorsal marginal ear vein. Biopsies were taken on days 1, 2, 7, and 30 post-treatment, and histopathogical evaluation was performed. RESULTS: Clinical and histological thrombosis occurred between days 1 and 7 in all groups. Superficial necrosis, neutrophil infiltration, and recanalization were mostly seen in group 3, whereas thrombosis was prominent in groups 1 and 2. CONCLUSIONS: All of the methods tested appear to have similar mechanisms of action, but had differing clinical and histological results. Phototherapy and laser treatment are non-invasive and do not require an exact, pinpoint technique, in contrast to sclerotherapy. However, sclerotherapy and phototherapy showed better results, especially with regard to recanalization.

Intracoronary shunt versus bulldog clamp in off-pump bypass surgery. Endothelial trauma: shunt versus clamp.

BACKGROUND: During off-pump coronary bypass grafting, local vascular control of the target vessel and a bloodless field are crucial. The aim of this study is to asses the histopathological outcomes of intracoronary shunts and bulldog clamping on the beating heart in a canine model. METHODS: Twelve healthy adult mongrel dogs weighing between 15 to 25 kg were included in the study. Following left thoracotomy, proximal left anterior descending artery segment 1 cm to distal of diagonal branch was marked. Arteriotomy at this site was performed and a shunt was inserted for 10 min in the shunt group. The bulldog clamp was applied 3 cm distal to the mark for 10 min after heparinization in the bulldog group. Thirty days after the procedure, the specimens of left anterior descending artery from both regions were collected and were examined. Vascular damage, presence of intimal hyperplasia, and denudation were noted. RESULTS: Only intimal denudation was found significantly higher in the shunt group (P < 0.05). In this group, only one case had grade 0 endothelial damage. In the bulldog group, all cases had endothelial damage of various grades. CONCLUSION: The proven advantages of temporary intracoronary shunts are well-known, e.g., preserving the ventricular functions. Despite these advantages, our study revealed an ultimate bad result for an off-pump coronary by pass patient: intimal denudation. We conclude that further studies with a larger number of subjects are needed to decide whether routine shunt insertion into coronary arteries during off-pump coronary bypass surgery is appropriate or not.

Sternal closure reinforced with rib heads: a novel technique for prevention and treatment of sternal dehiscence.

BACKGROUND: When a sternotomy cannot be performed at the midline and/or there is infection at the operation site, sternotomy revision can cause problems that increase the mortality and morbidity of the patients. There is no agreement on the best treatment method. In this paper we present a modified wiring technique. METHODS: This technique consisted of wrapping wires twice around each rib head and placing standard circumferential wire sutures, thus providing full stability by decreasing the load on the sternum using only steel wires. The study group included 23 patients with sternal dehiscence because of inappropriate sternotomy (n = 10) and/or mediastinitis (n = 13). Two mediastinal tubes were placed for irrigation in 13 patients with mediastinitis and/or wound infection, and mobilization and interposition of omentum as an axial graft was performed in 2 patients. Irrigation and antibiotherapy were continued for 4 to 6 weeks. RESULTS: Complete wound healing was obtained in all patients. Twenty-two patients treated with this technique survived. One patient died on postoperative 42nd day because of renal insufficiency and multi-organ failure. CONCLUSION: Early and aggressive debridement of infected and necrotic tissue, irrigation, and antibiotics are necessary for successful treatment, but we believe that the most important factor is full stabilization of the sternal tissue with minimal use of foreign stabilization material. Despite the limited number of cases, we suggest that our stabilization technique seems to be successful in achieving full stabilization even in infected and fragile sternal bony tissue in patients with sternal dehiscence and/or inappropriate sternotomy.

Idiopathic asymptomatic main pulmonary artery aneurysm: surgery or conservative management? A case report.

Idiopathic main pulmonary artery aneurysm is a very rare entity and there are no clear guidelines for optimal treatment. Operative treatment is recommended for patients with a risk of rupture, which is not well defined. We present an unusual case of a 53-year-old woman with an idiopathic main pulmonary artery aneurysm. Our case is asymptomatic, without a causative cardiac lesion and/or pulmonary hypertension; therefore, we did not operate on our patient and she was stable at 22-month follow-up.

Treatment modalities in hypertrophic obstructive cardiomyopathy: surgical myectomy versus percutaneous septal ablation.

BACKGROUND: The aim of this study was to compare the results of percutaneous septal myocardial ablation (PSMA) and surgical myectomy (SM) for decreasing the left ventricular outflow tract (LVOT) gradient, septal thickness, ventricular dimensions, and mitral regurgitation (MR) in patients with symptomatic hypertrophic obstructive cardiomyopathy. METHODS: We treated 40 patients (mean age, 24.4 +/- 6.8 years; 34 male and 6 female patients) between June 2002 and April 2006. Twenty-four patients underwent SM, and 16 patients underwent PSMA. All patients were symptomatic despite maximal medical treatment and had an LVOT gradient higher than 65 mm Hg. Their echocardiographic data were recorded before and after the procedure and then compared. The patients were followed up postoperatively for a mean of 13 months. RESULTS: There was no mortality in either group. One year after the procedure, the LVOT gradients for the 2 groups were not statistically different. During the follow-up, moderate MR was found in 4 patients (25%) in the ablation group and in 2 patients (8.3%) in the myectomy group. Exercise capacity and New York Heart Association class improved after PSMA, whereas postoperative MR severity and effort capacity were better in the surgical group. CONCLUSION: The 2 approaches yielded similar results with regard to reducing the LVOT gradient. We conclude that SM is preferable to PSMA in cases with MR.