A rare complication of pacemaker implantation.

Lead perforation is a life-threatening rare complication of pacemaker or defibrillator lead implantation. Clinical examination, electrocardiogram, device interrogation, echocardiography, chest x-ray, and chest computed tomography scan can help in the diagnosis. Clinicians should be aware because early diagnosis and treatment are the cornerstones for achieving a better outcome.

Diagnosis of gastrointestinal stromal tumor (GIST) on transurethral resection of the prostate: a case report and review of the literature.

Gastrointesinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract and they show differentiation towards interstitial cells of Cajal (ICC). Herein, we describe a case of a 60-year-old man presenting with symptoms mimicking adenomatous hyperplasia of the prostate that was subjected to repeated transurethral prostatectomies. Histologic and immunohistochemical examination showed a neoplastic process with characteristics consistent with GIST. Imaging studies confirmed a rectal origin of the tumor. Review of the literature revealed 20 cases of GISTs occurring in the prostate gland, either diagnosed as either primary GISTs or, more commonly, as rectal neoplasms extending to this organ. We add our case in this short list, emphasizing on the importance of inclusion of GISTs in the differential diagnosis of every spindle cell lesion encountered in the prostate.

Creating arteriovenous fistula using an automatic anastomotic device.

We describe the use of the Cardica C-Port xA Distal Anastomosis System for performing an automated, arteriovenous fistula in patients on hemodialysis with end stage renal failure.

Latent congenital defect: interrupted aortic arch in an adult--case report and literature review.

Interrupted aortic arch (IAA) is rare congenital cardiac defect defined as a complete loss of luminal and anatomical continuity between ascending and descending segments of the aorta. Usually it is detected in the perinatal period or during the first hours or days of infancy. If not treated surgically, it usually is lethal. Nevertheless, diagnosis can be made in adults but is a very rare entity. Extremely few cases in adults are reported in the pertinent medical literature. We present an asymptomatic 62-year-old patient who was found to have IAA after examination for hypertension. The patient underwent a successful anatomical repair, with an uneventful postoperative course, and follow-up examinations reveal regression of hypertension and excellent health condition.

Bilateral sternobronchial fistula after coronary surgery--are the retained epicardial pacing wires responsible? A case report.

BACKGROUND: Temporary epicardial pacing wires are routinely used during cardiac surgery; they are dependable in controlling postoperative arrhythmias and are associated with low morbitity. CASE REPORT: We report a case of sternobronchial fistula formation induced by the existence of retained epicardial pacing wires in a patient who underwent coronary surgery ten years ago. CONCLUSION: Reported complications of retained epicardial pacing wires are unusual. We present this case in order to include it to the potential complications of the epicardial pacing wires.

Triple valve endocarditis as an unusual complication of bacterial meningitis.

We report a case of Staphylococcus aureus endocarditis with late onset in a 39-year-old male drug abuser, who presented with bacterial meningitis. Despite resolution of the meningitis as the result of appropriate antimicrobial chemotherapy he developed triple valve endocarditis. Some striking features of this case and a comparison with other reported cases of this uncommon presentation of infective endocarditis are discussed.

Use of continuous subcutaneous anesthetic infusion in cardiac surgical patients after median sternotomy.

UNLABELLED: The use of opioid analgesics to control pain after median sternotomy in cardiac surgical patients is worldwide accepted and established. However, opioids have a wide range of possible side effects, concerning prolonged extubation time, gastrointestinal tract dyskinesia and urinary tract disorders mostly retention. All these may lead to a prolonged ICU stay or overall hospitalization time increase. OBJECTIVE: To determine whether a continuous subcutaneous regional anesthetic infusion delivered directly to the sternotomy site would result in decreased levels of postoperative pain and opioid requirements in cardiac surgical patients undergoing median sternotomy. METHOD: The continuous subcutaneous infusion (OnQ Painbuster system) was applied in 37 patients. 3 patients were exempted due to prolonged ICU stay. 29 patients underwent CABG, 5 had AVR, 1 MVR and modified Maze, 1 patient had a 3-valve repair due to endocarditis and another one had reconstruction of the left ventricle. Requirements of opioid analgesics were recorded for 96 hours after operation. Pain was assessed using the visual analog scale and the total postoperative hospital length of stay was also measured. RESULTS: The postoperative pain was significantly diminished (0 - 3 at VAS). The mean postoperative length of stay was 5,8 days, rather improved compared to the average stay of 6,7 days. CONCLUSION: Continuous subcutaneous infusion of ropivacaine directly at the median sternotomy significantly diminishes postoperative pain and the need for opioid analgesic use. Moreover, it seems to reduce overall postoperative length of stay for all cardiac surgical patients.

Surgical treatment of coronary subclavian steal syndrome.

The internal mammary artery is the conduit of choice for cardiac revascularization. Atherosclerotic disease of the coronary arteries may simultaneously involve the subclavian artery. Proximal stenosis in the left subclavian artery may result in recurrent myocardial ischemia in patients with a patent left internal mammary artery (LIMA), due to coronary steal syndrome through the LIMA.