Primary malignant melanoma of the esophagus in a young adult.

A 31-year-old white man presented with a 30-day history of dysphagia without weight loss. Esophagogram revealed a lobulated mass at the junction of the middle and lower third of the esophagus. Esophagoscopy showed the presence of a pigmented tumor at that level. Histological examination indicated that the tumor was a primary malignant melanoma. Partial esophagectomy was performed through a right thoracotomy incision, revealing hilar lymph nodes invaded by tumor. One month postoperatively, the patient died from extensive brain metastases.

Liver cell adenoma presenting as acute abdomen.

A 31-year-old female presented with a sudden onset of acute abdominal pain in the right hypochondrium. Two days later, the patient was in shock and suffering from severe intra-abdominal bleeding. Investigations showed that the bleeding originated in the right lobe of the liver. The patient had been taking oral contraceptives for seven years. She underwent a laparotomy and right lobectomy of the liver which was performed successfully for bleeding cell adenoma. The patient made a full recovery.

Perioperative myocardial protection in severe coronary artery and valvular heart diseases with impaired ventricular function.

One hundred patients with severe coronary artery disease, and impaired left ventricular function were studied. Thirteen of these required valve replacements. Eight required repair of a left ventricular aneurysm. In addition, all these patients had three or more coronary artery diseases. The patients underwent aortocoronary bypass using saphenous vein grafts. For myocardial protection, general and topical hypothermia was used during the procedure, along with perfusion of the root of the aorta, with a cardioplegic solution. Additional cardioplegic perfusion was achieved by perfusing the vein graft anastomosed to the left anterior descending coronary artery below the obstruction, or other vein grafts anastomosed to the circumflex artery or the right coronary artery (or its branches if dominant), during total aortic clamping. No mortality occurred in these patients. Only two patients developed perioperative myocardial infarction, but they recovered. The authors believe that this method can offer further myocardial protection during ischemic arrest.

Right ventricular myxoma.

We recently treated a patient with right ventricular myxoma and a clinical picture of pulmonary embolism and tricuspid valve obstruction who had successful removal of the tumor through the tricuspid valve via a right atriotomy.