Primary undifferentiated high-grade pleomorphic cardiac sarcoma in the left atrium with atypical presentation.

A woman in her 60s had 4 months of malaise, fatigue, dyspnoea, night sweats and grade 3 clubbing. She had a pansystolic murmur and signs of congestive heart failure. Multimodal imaging with a transthoracic echocardiogram, transoesophageal echocardiogram and CT was carried out to diagnose and reconstruct the mass for surgical planning. A 2×2.8 cm circular dense mass was found in the left atrium with vegetations on the mitral valve. Positron emission tomography and cardiac MRI confirmed the mass's hypermetabolic activity and malignant features. Mitral valve replacement and surgical resection were performed. She was diagnosed with grade 3 undifferentiated cardiac sarcoma and referred to the sarcoma multidisciplinary team for further management given sarcoma's rarity and complexity. The poor prognosis of sarcoma was evident as her symptoms recurred 2 months postoperatively.

Multiarterial coronary grafting using the radial artery as a second arterial graft: how far does the survival benefit extend?

OBJECTIVES: Despite the 10-year results of the Arterial Revascularization Trial, the controversy regarding the survival benefit of multiarterial grafting (MAG) remains. Our goal was to present our long-term survival data in this propensity-matched observational study. METHODS: A primary unmatched population of 4303 patients with first-time isolated coronary artery bypass grafts operated on between 2000 and 2018 were included. A total of 1187 post-matched patients were compared with matched controls. Multivariate logistic regression and Cox proportional hazard analyses were undertaken to assess the contribution of MAG and other covariates to the long-term survival of unmatched and propensity-matched populations. RESULTS: MAG was associated with increased median survival in both the unmatched and the matched groups; difference: 962 and 1459 days, log-rank tests; P = 0.029 and 0.0004, respectively. MAG was associated with a reduced hazard of death in the unmatched as well as in the matched groups: hazard ratio [95% confidence interval (CI)]: 0.72 (0.62-0.83); P < 0.0001 and 0.75 (0.64-0.88); P ≤ 0.0001, respectively. In the matched group, the prosurvival factors were low logistic EuroSCORE, obesity, no intra-aortic balloon pump, an ejection fraction >30%, age 50-69 years, operation by an experienced surgeon, with and without diabetes, on-pump surgery and 3 distal anastomoses. In a cohort of 242 late-presenting patients with reinfarction or recurrent angina, both MAG and control populations were associated with reduced median survival; median (95% CI): MAG: 3026 (1138-3503); control: 3035 (2134-3991), log-rank P = 0.217 with superior patency of the left internal mammary artery but no difference between radial artery and saphenous vein grafts. CONCLUSIONS: Multiarterial revascularization, especially using the radial artery as a second arterial conduit, is associated with a significant survival benefit and a lack of in-hospital morbidity.

Influence of selenomethionine and omega-3 fatty acid on serum mineral profile and nutrient utilization of broiler chicken.

AIM: This study was conducted to investigate the effect of selenomethionine and omega-3 fatty acid on serum mineral profile and nutrient utilization of broiler chicken. MATERIALS AND METHODS: The present study was a 2×3 factorial arrangement of two levels of selenomethionine (0 and 0.3 ppm) and three levels of omega-3 fatty acid (0, 0.5 and 1%). Day-old Vencobb broiler chicks (n=180), were randomly assigned in six treatment groups. The experiment lasted for 42 days. Treatment groups followed of: Group I was a control. Group II, III, IV, V and VI were supplemented with 0 ppm selenomethionine with 0.5% omega-3 fatty acid, 0 ppm selenomethionine with 1% omega-3 fatty acid, 0.3 ppm selenomethionine with 0% omega-3 fatty acid, 0.3 ppm selenomethionine with 0.5% omega-3 fatty acid and 0.3 ppm selenomethionine with 1% omega-3 fatty acid, respectively. Linseed oil was used as a source of omega-3 fatty acid while sel-plex is used for selenomethionine supplementation. RESULTS: Significant (p<0.05) interaction exist between selenomethionine and omega-3 fatty acid for serum zinc and iron concentration whereas, it was non-significant for serum calcium and copper. Significantly (p<0.05) increased concentration of selenium, zinc, iron and phosphorus was observed in birds fed 0.3 ppm selenomethionine whereas, significantly (p<0.05) increased zinc and iron was observed in birds fed 0.5% omega-3 fatty acid. There was significant (p<0.05) interaction exist between selenomethionine and omega-3 fatty acid for calcium and phosphorus retention percentage. The maximum retention of calcium and phosphorus was recorded in birds supplemented with 0.3 ppm selenomethionine in combination with 0.5% omega-3 fatty acid. There was marked interaction between selenomethionine and omega-3 fatty acid for hemoglobin (Hb), total erythrocytic count, total leukocytic count and platelets (p<0.05) however, it was non-significant for mean corpuscular volume, mean corpuscular Hb, MCH concentration and differential leukocyte count. Dietary selenomethionine significantly (p<0.05) increased the platelet count. Hb concentration was significantly (p<0.05) higher in birds fed 0.5% omega-3 fatty acid whereas, 1% omega-3 fatty acid in the diet drastically increased (p<0.05) the platelet count. CONCLUSION: Supplementation of selenomethionine and omega-3 fatty acid improves the nutrient utilization and mineral retention, which subsequently enhance the bone mineralization. Supplementation also helps in combating the stress.

Influence of post hatch dietary supplementation of fat on performance, carcass cuts and biochemical profile in Ven Cobb broiler.

AIM: The present experiment was conducted to study the effect of post hatch dietary fat supplementation on performance of broiler chicken. MATERIALS AND METHODS: A total of 120 day-old Ven Cobb broiler chicks were randomly assigned to 4 treatment groups of 30 chicks in each (three replicates of 10 birds/treatment). The trial lasted for 35 days. The experimental design was a completely randomized design. Four types of diet were formulated for 1(st) week: T1, T2, T3 and T4 contained control diet with no added fat, 2.5, 5 and 7.5% fat, respectively. After 1(st) week post-hatch period chicks were fed ad libitum with the normal basal diet as per Bureau of Indian Standard recommendations till completion of the experiment (8-35 days). RESULTS: Significantly higher (p<0.05) body weight and improved feed conversion ratio (FCR) was recorded in birds fed 5% dietary fat at the end of the experiment whereas, feed intake was not significantly affected. Significantly (p<0.05) higher dressed weight was observed due to 5% fat supplementation than other groups whereas, it was not significant for other carcass cuts. No significant differences were observed in moisture, protein and lipid content of breast and thigh muscle of broiler due to supplemented fat whereas, 2.5% dietary fat significantly (p<0.05) increase the serum HI titer on day 28(th). In biochemical profile, higher serum albumin (g/dl) was recorded due to 5% fat supplementation whereas other biochemical components did not show any significance difference among treatments. CONCLUSION: It may be concluded that supplementation of fat in broilers diet improves the overall FCR, dressing percentage and gain more body weight.

Pock forming ability of fowl pox virus isolated from layer chicken and its adaptation in chicken embryo fibroblast cell culture.

AIM: The objective of the present study was to examine pock forming ability of field strain and vaccine strain of fowl pox virus (FPV) in chorioallantoic membrane (CAM) of embryonated chicken eggs and its adaptation in chicken embryo fibroblast (CEF) cell culture. MATERIALS AND METHODS: Dry scabs were collected from 25 affected birds in glycerin-saline and preserved at 4°C until processed. Virus was isolated in 10-day-old embryonated chicken eggs by dropped CAM method. The identity of the virus is confirmed by clinical findings of affected birds, pock morphology and histopathology of infected CAM. In addition one field isolate and vaccine strain of FPV was adapted to CEF cell culture. CEF cell culture was prepared from 9-day-old embryonated chicken eggs. RESULT: Clinical symptoms observed in affected birds include pox lesion on comb, wattle, eyelids and legs, no internal lesions were observed. All field isolates produced similar findings in CAM. Pocks produced by field isolates ranged from 3 mm to 5 mm at the third passage while initial passages edematous thickening and necrosis of CAM was observed. Pocks formed by lyophilized strain were ranges from 0.5 mm to 2.5 mm in diameter scattered all over the membrane at the first passage. Intra-cytoplasmic inclusion bodies are found on histopathology of CAM. At third passage level, the CEF inoculated with FPV showed characteristic cytopathic effect (CPE) included aggregation of cells, syncytia and plaque formation. CONCLUSION: FPV field isolates and vaccine strain produced distinct pock lesions on CAMs. Infected CAM showed intracytoplasmic inclusion bodies. The CEF inoculated with FPV field isolate as well as a vaccine strain showed characteristic CPE at third passage level.

Pseudoaneurysm of the left ventricle following apical approach TAVI.

Symptomatic severe aortic stenosis carries a two year survival of only 50%. However many patients are unsuitable for conventional aortic valve replacement as they are considered too high risk due to significant co-morbidities. Transcatheter Aortic Valve Implantation (TAVI) offers a viable alternative for this high risk patient group, either by the femoral or apical route. This article reports a case of a pseudoaneurysm of the left ventricle following an apical approach TAVI in an elderly lady with severe aortic stenosis. To our knowledge pseduoaneuryms of the left ventricle have been reported infrequently in the literature and has yet to be established as a recognised complication of TAVI.

Beating-heart mitral valve surgery in patients with poor left ventricular function.

BACKGROUND AND AIM OF THE STUDY: Mitral valve surgery in the presence of poor left ventricular (LV) function is associated with higher mortality. One surgeon's (S. K. N.) evolving practice of mitral valve surgery on the beating heart using normothermic cardiopulmonary bypass (CPB) in a cohort of patients is described. METHODS: Between July 2000 and December 2002, 23 patients (13 men, 10 women; mean age 68.6 +/- 4.8 years; range: 54-81 years) with mitral regurgitation and LV ejection fraction <30% undergoing isolated mitral valve repair (n = 4) or replacement (n = 19) were investigated. All patients received maximal drug therapy. Among patients, 17 were in NYHA class III, and six in class IV. RESULTS: The mean duration of follow up was 17 +/- 14 months, and was complete for all survivors. The visual field of the on-pump beating heart was equal to that of conventional valvular surgery, and technical accuracy was not compromised. The mean ICU and hospital stays were 2.4 +/- 1.3 days and 8.9 +/- 2.6 days, respectively. Mean CPB time was 74.3 +/- 14.8 min. Thirty-day mortality was significantly lower (8.7%) when compared to mean Euroscore-predicted mortality for this high-risk group (16.9%; p <0.001). The medium-term one- and two-year survivals were 87% and 78%, respectively. Mean NYHA class was improved, from 3.6 +/- 0.5 preoperatively to 1.9 +/- 0.7 at follow up (p = 0.037). CONCLUSION: On-pump, beating-heart mitral valve surgery is a good option in patients with poor LV function, and is advantageous as conditions for the heart are more physiological with a beating tonus than with cardioplegia.

Remodelamento cirúrgico do coraçäo no tratamento cirúrgico da cardiomiopatia isquêmica / Cardiac surgical remodeling as a surgical treatment for ischemic cardiomyopathy

Objetivo: Apresentamos um grupo de pacientes em fase avançada de miocardiopatia isquêmica, operado com a técnica de remodelamento cirúrgico do coraçäo: revascularizaçäo do miocárdio, anuloplastia mitral/tricúspide, plicatura de VE e procedimento de DOR. Casuística e Métodos: Vinte e sete pacientes com miocardiopatia isquêmica avançada foram submetidos a remodelamento cirúrgico do coraçäo: 22 homens, idade média 57,8 anos, 23 em classes III e IV, fraçäo de ejeçäo média de 15 por cento. Todos os pacientes foram submetidos a CEC e cardioplegia sangüínea quente. Vinte e seis pacientes receberam 74 enxertos (2,7). Anuloplastia mitral foi realizada em 10 casos e mitral + tricúspide em 4. Plicatura do VE foi realizada em 2 pacientes e procedimento de DOR em 18. O tempo médio de pinçamento aórtico foi de 59min e o tempo médio de CEC de145min. Dez pacientes necessitaram de baläo intra-aórtico e 25 receberam drogas inotrópicas no pós-operatório. Resultados: O tempo médio de ventilaçäo foi de 31,7horas e tempo médio de internaçäo na UTI foi de 65,7horas. Três pacientes foram reintubados e 2 reoperados por sangramento. Oito pacientes apresentaramom FA e 1 AVC. O período médio de internaçäo foi de 13 dias. A mortalidade hospitalar foi de 22,3 por cento (6 pacientes); 4 decorrente de baixo débito e 2 de sepse. Num período de acompanhamento médio de 20,7 meses, 19 (70,3 por cento) estavam vivos; 17 em classes I e II, näo tendo sido observado IAM neste período. Dois pacientes foram reinternados por FA, 2 por angina e 3 por ICC. Conclusäo: Remodelamento cirúrgico do coraçäo é uma alternativa cirúrgica para pacientes com cardiomiopatia isquêmica com morbidade aceitável e bons resultados a médio prazo

Ruptura del septum interventricular postinfarto miocardico / Rupture of interventricular septum post-myocardial infarction

Se informan los resultados de la intervencion quirurgica tardia en doce casos de ruptura postinfarto del septum interventricular. En promedio los pacientes fueron intervenidos despues de doce dias de producida la ruptura. Se presentaron dos muertes: una debida a sindrome de bajo gasto cardiaco y otra secundaria un accidente cerebrovascular ppostoperatorio. El manejo inicial se practico con inotropicos, vasodilatadores, diureticos y balon de contrapulsacion intraaortico. E lprocedimiento quirurgico incluyo parche con suturas reforzadas de teflon,aneurismectomia e injertos aortocoronarios cuando fueron necesarios. Se discute la fisiopatologia de la entidad y los resultados obtenidos con intervencion temprana y tardia.

Neumotorax espontaneo / Spontaneous pneumothorax

Se define el pneumotorax espontaneo como entidad clinica; se hace una sintesis historica de la enfermedad desde los tiempos de Hipocrates hasta la descripcion de la pleurectomia parietal por Gaensler en 1956. Se mencional la incidencia y la fisiopatologia de la misma destacando sus dos variedades: primaria y secundaria. Se analizan los metodos diagnosticos basados en la sintomatologia y la signologia predominantes, asi como su posible asociacion con otras entidades patologicas. Se planean los metodos de tratamiento, en numero de siete; se propone un diagrama sobre el manejo de los pacientes afectados por la enfermedad, y por ultimo se comenta la conducta frente a circunstancias especiales. El trabajo se fundamenta en la experiencia del Centro Regional Cardiotoracico de Freeman Hospital, en donde los auores han completado una serie de 200 pleurectomias.