Fine needle aspiration cytology in the diagnosis of mediastinal seminomas.

Fine needle aspiration cytology (FNAC) was employed to diagnose 117 cases of mediastinal tumours from January, 1985 till December, 1994. Six cases were diagnosed as mediastinal seminomas which are rare mediastinal malignant neoplasms. All patients had complete resolution of the mediastinal masses after external beam radiotherapy. Diagnosis of mediastinal masses by FNAC can spare the patients from more invasive diagnostic procedures and help the thoracic surgeons to plan immediate treatment.

The surgical treatment of atrial myxomas. Clinical experience and results in eight patients.

Between 1983 and 1988, eight patients underwent excision of left atrial myxomas at the Institute of Postgraduate Medical Education & Research, Calcutta. There were five females and three males. The presenting symptoms and signs often simulated mitral stenosis or insufficiency, and the diagnosis was confirmed by echocardiography and angiocardiography. One patient presented with features of cerebral embolism. The myxomas were successfully removed under cardiopulmonary bypass in all patients, either by shaving them from the atrial septum, or by excising a portion of normal atrial septum with the tumour. Small tumours were removed through left atriotomy, while a biatrial approach was utilised for large tumours. There was one perioperative death, and another patient died one and half years later, probably due to tumour embolisation in brain. Late functional results have been excellent in all the other patients. Two dimensional echocardiography has proved to be extremely accurate in early diagnosis of myxomas and in the late follow up of patients. The pertinent literature is reviewed.

The amylase-creatinine clearance ratio following cardiopulmonary bypass.

The incidence of unexplained pancreatitis in patients dying after cardiac operations has been recorded as 16%, with evidence to implicate ischemia in the pathogenesis of the pancreatitis. Increased amylase--to--creatinine clearance ratios (ACCR), suggesting pancreatic dysfunction, have been reported in patients following nonpulsatile cardiopulmonary bypass (CPB). Pulsatile CPB is increasingly recognized to be a more physiological form of perfusion, particularly with respect to capillary blood flow. In this study the ACCR has been determined before, during, and after cardiac operations performed with both nonpulsatile and pulsatile CPB. Twenty patients undergoing elective cardiac operations were studied. Ten patients had nonpulsatile CPB (nonpulsatile group) and 10 had pulsatile CPB (pulsatile group). The two groups were comparable as regards perioperative variables and perfusion parameters. In both groups the ACCR was estimated preoperatively, on three occasions during the operation, and daily on the first 5 postoperative days. A significant elevation in ACCR was observed in nine of 10 patients in the nonpulsatile group but in only one of 10 patients in the pulsatile group (p less than 0.001). The significant improvement of ACCR stability following pulsatile CPB may indicate that this form of perfusion will reduce the risk of pancreatitis following cardiac operations performed with CPB.