Descending mediastinitis managed by sternotomy, taurolidine and delayed closure.

Descending necrotizing mediastinitis is a rare complication of upper respiratory infections. A quick diagnosis and prompt and complete surgical drainage is important for a successful outcome. A 74-year-old man with descending necrotizing mediastinitis needed a sternotomy, multiple washouts, and delayed sternal closure.

Thymic cyst causing superior venacava syndrome relieved by mediastinoscopy--a rare presentation.

Superior venacava obstruction is most often caused by intrathoracic malignant masses. The commonest cause of benign superior venacava obstruction is fibrosing mediastinitis. A thymic cyst causing marked superior venacava obstruction is very rare and has not been reported. We hereby present a case of a 40-year-old man with such a finding who presented with chest pain and facial congestion. Evaluation revealed a mediastinal mass causing marked superior venacaval obstruction. He underwent a mediastinoscopy, which showed a cyst. It was drained following which there was complete resolution of symptoms post-operatively. Histopathology of the lesion confirmed a thymic cyst.

Comparative study of single- and double-patch techniques for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection.

OBJECTIVE: The correction of sinus venosus atrial septal defect with a partial anomalous pulmonary venous connection to the superior vena cava has been associated with obstruction to the venous return and sinus node dysfunction. We present our follow-up of 2 approaches of managing the lesion and compare their postoperative results. METHODS: Forty patients underwent operation between March 1999 and January 2005, of whom 37 patients (aged 3-50 years) are on follow-up. These patients were divided into 2 groups: single-patch repair (group A, 18 patients) and double-patch repair (group B, 19 patients). Echocardiography and electrocardiography were performed 7 days after surgery and during the subsequent follow-up. RESULTS: The mean duration of follow-up was 22.56 months. There were no postoperative deaths or residual defects. Six patients in group A and 2 patients in group B had turbulence and a significant superior vena cava-right atrium pressure gradient of more than 6 mm Hg. Nine patients in group A had a significant gradient causing turbulence across the right superior pulmonary vein at the level of the patch, whereas no patients in group B had turbulence across the pulmonary vein. Four patients in group A and no patients in group B had postoperative rhythm abnormalities on late follow-up. There was no other complication. CONCLUSIONS: Partial anomalous pulmonary venous connection can be safely managed with multiple techniques with low morbidity. The double-patch technique is technically reproducible and offers better results in terms of superior vena cava narrowing and gradient across the pulmonary vein without any increase in complications.

Supracardiac total anomalous pulmonary venous connection with a supramitral ring: a rare, surgically correctable anomaly.

Total anomalous pulmonary venous connection is rarely associated with a supramitral ring. This condition should be suspected in any infant having total anomalous pulmonary venous connection with obstruction to the pulmonary venous return. Preoperative echocardiography is usually successful in detecting the lesion. The Shumaker and King repair for total anomalous pulmonary venous connection is most appropriate for such composite lesions as it enables the surgeon to identify the membrane and excise it easily and completely. We report one such case.

Evidence of an Eicosanoid Contribution to IL-1 Induction of IL-6 in Human Articular Chondrocytes.

It has been demonstrated previously that interleukin-1 (IL-1) induces articular cartilage explants and chondrocytes in culture to produce elevated levels of inflammatory mediators such as interleukin-6 (IL-6) and prostaglandins. Previous studies have also demonstrated a relationship between IL-6 secretion and the ability of IL-1 to modulate proteoglycan synthesis by chondrocytes. In this study we have utilized an alginate culture system in an effort to investigate a role for eicosanoids in IL-1 induction of IL-6 expression in human articular chondrocytes. IL-1 treatment of chondrocytes cultured in alginate resulted in increased synthesis of IL-6 and prostaglandins, but not leukotrienes. Cyclo-oxygenase inhibitor, indomethacin (5 &mgr;g ml(minus sign1)), was able to inhibit prostaglandin synthesis to below basal levels with no significant effect on the levels of IL-6 released by chondrocytes in response to IL-1. When chondrocytes were treated with 5 &mgr;g ml(minus sign1) indomethacin and 10 &mgr;M of the general lipoxygenase inhibitor, nordihydroguiaretic acid (NDGA), an approximate 50% decrease in IL-1-induced IL-6 expression was observed. Alone, levels of NDGA specific for lipoxygenase inhibition (10 &mgr;M) did not affect IL-1-induced IL-6 expression, but higher levels of NDGA (50 &mgr;M) which inhibited both prostaglandin and leukotriene biosynthesis reduced IL-1-induced IL-6 expression to the same extent as that observed with 5 &mgr;g ml(minus sign1) indomethacin and 10 &mgr;M NDGA. This inhibition of IL-6 expression by NDGA and indomethacin was dose responsive and also reversible with the addition of exogenous prostaglandin E(2) (PGE(2)) or leukotriene B(4) (LTB(4)). Although IL-1-induced IL-6 expression was only affected when both prostaglandin and leukotriene biosynthesis were inhibited, elevated levels of PGE(2) but not leukotriene B(4), C(4), D(4), or E(4) were observed in the culture medium of IL-1-treated chondrocytes. These findings may indicate that cyclo-oxygenase products such as PGE(2) normally contribute to IL-1 induction of IL-6 expression in chondrocytes, and under conditions when cyclo-oxygenase is inhibited, lipoxygenase products alternatively contribute to this response.