Surgery for Pulmonary Parenchymatous Schistosomiasis (Bilharziomas): A 20-Year Single-Centre Experience.

BACKGROUND: Pulmonary schistosomiasis may complicate urinary or intestinal infestations. Pulmonary pathology is either in the acute or chronic form. The chronic form of the disease may result in granuloma formation. This study presents 20 years of experience in surgical management of pulmonary bilharziomas. METHODS: A retrospective review was undertaken of 17 consecutive patients who had surgery for lung bilharziomas from 1996-2016. Demographics, clinical presentation, underlying lung disease, investigations performed, operative procedure, and outcome were retrieved and reviewed. RESULTS: All patients were males, with ages ranging from 22-52 years (median 33 years). Haemoptysis was the main presentation (53%). Coexisting lung tuberculosis was present in five (29.4%) patients. Indications for surgery were solitary shadows in 12 (70.6%) patients and persistent tuberculous cavities in five (29.4%) patients. Segmentectomy was performed in one (5.9%) patient, lingulectomy in one (5.9%) patient, lobectomy in 14 (82.3%) patients, and bi-lobectomy in one (5.9%) patient. The histologic nature of the infestation was: bilharzial ova with extensive granulomatous reaction and suppuration in eight cases (47%); both tuberculosis and bilharzial ova within a granulomatous tissue reaction in five cases (29.4%); and bilharzial ova within malignant tissue in four cases (23.6%). There was no operative mortality. One (1) patient (5.9%) developed postoperative bronchopleural fistula after left upper lobectomy; surgical repair of the fistula and omental flap buttress was needed after failure of conservative management. CONCLUSION: Pulmonary schistosomiasis is not an uncommon infestation and occurs more frequently in patients with underlying tuberculosis. It may predispose to granulomatous parenchymatous lung masses or even malignancy, which necessitate surgical intervention with a good outcome. However, predisposition of pulmonary schistosomiasis for the development of bronchogenic carcinoma warrants further studies.

Coronary artery bypass grafting experience in the setting of an anomalous origin of the right coronary artery from the left sinus of Valsalva: Midterm results.

BACKGROUND: An anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva with an interarterial course is a rare congenital anomaly. We aimed to assess midterm results after coronary artery bypass grafting (CABG) for the treatment of anomalous RCA arising from the left sinus of Valsalva. METHODS: From 2008 to 2012, 16 patients underwent CABG for treatment of an anomalous origin of the RCA from the left sinus of Valsalva. Details such as risk factors, operative details, and results of multislice coronary angiography follow-up were assessed. RESULTS: The mean age of the patients was 34.8 ± 4.68 years, and most of them were male (15 out of 16, 93.75%). They received a mean of 1.5 ± 0.87 grafts. Closure of the RCA was completed in all patients except one (15 out of 16), who developed ischemic symptoms upon closing the proximal part of the RCA. One in-hospital death occurred. Among the remaining patients, symptoms persisted in 2 out of 15. The mean follow-up time was 63.4 ± 28.6 months. All patients had patent vessels on 5-year follow-up multislice computed tomography scans, except one patient who showed RCA graft occlusion on the 1-year follow-up scan. CONCLUSION: The CABG of the RCA with anomalous origin can be done safely with excellent early and midterm results. Proximal RCA ligation is an essential step to the success of CABG, but intraoperative challenge testing is required to confirm the sufficiency of the internal thoracic artery graft to reperfuse the supplied territory.