Giant Mediastinal Thymic Cyst.

The authors present a rare case of giant mediastinal cyst which arises from the thymus gland, and goes down in both pleural spaces, especially in the right chest cavity where a dominant part of the cyst was present. The cyst was full with 2.5 liters of transparent fluid, and compressed surrounding structures - heart and both lungs, especially the right one which was partially collapsed. The patient was a 52 years old woman, without any clinical symptoms. Accidentally, on the screened chest X-ray a shading in the distal third of the right chest was detected. The case was well documented with a CT of the chest, and an indication for surgical treatment was made. The surgery was done successfully in general anesthesia according to the small right anterior thoracotomy from which a giant part of the cyst was mobilized, which was in the right pleural cavity, but, also, the thymus with the origin of the cyst in the anterior and superior mediastinum was completely removed. In the end, a part of the cyst which was in the left pleural cavity was removed.

Vascular calcification and atherosclerosis in hemodialysis patients: what can we learn from the routine clinical practice?

BACKGROUND: Hemodialysis (HD) patients are at increased risk for arterial intimal (AIC) and medial calcification (AMC). METHODS: In a cross-sectional study on 153 HD patients we evaluated the presence of AIC and AMC using plain radiography of the pelvis and the presence of atherosclerotic lesions using high-resolution B-mode ultrasonography of the common carotid arteries (CCA). RESULTS: The radiography of the pelvis confirmed the frequent presence of AIC (35.3%) and AMC (35.9%) in our HD patients. Arterial calcification was absent (non calcified-NC) in a minority of patients (28.8%). Patients with AIC had significantly higher prevalence of atherosclerotic plaques on CCA (78.6%) compared with both other groups and a higher number of documented atherosclerotic complications, such as cardiovascular (85.2%), cerebrovascular (33.3%) and peripheral arterial disease (38.9%) in comparison with the NC patients. According to the 1-year calculated data from patient records, there were no significant differences in the specific HD risks, such as the dose of prescribed calcium carbonate and vitamin D3, serum levels of calcium, phosphate, calcium-phosphate product and intact parathyroid hormone. All four bone metabolism markers within the range proposed by K/DOQI guidelines were achieved in 9.3%, 14.5% and 20.4% in the AIC, AMC and NC group, respectively. CONCLUSIONS: Patients with AIC and AMC are frequently found in the HD population. Screening for arterial calcifications in chronic kidney disease patients is suggested even in the early pre-dialysis period. The highest proportion of patients within the guidelines proposed range for bone and mineral metabolism markers was observed in the NC group. A longer period of data analysis is required in order to evaluate the possible role of some traditional and HD-specific risk factors for the development of arterial calcifications. The achievement of the K/DOQI guidelines is an important issue in the prevention of those conditions.