Postoperative diaphragmatic paralysis after cardiac surgery in children: incidence, diagnosis and surgical management

Background Cardiac surgery for congenital heart disease covers a wide spectrum from simple to complex cardiac and extracardiac malformations. Innovations in pediatric cardiac surgery and perioperative care over the past decades have allowed surgical correction or at least palliation in almost all complex congenital heart defects in the first years of life. Diaphragmatic paralysis （DP） due to phrenic nerve injury after congenital cardiac surgery is an important respiratory complication resulting with respiratory insufficiency, lung infections, prolonged hospital stay time and even death.     

心房黏液瘤15例临床及病理学分析

回顾性分析2001年5月至2008年12月我院共收治的15例心房黏液瘤患者的临床及病理资料。15例患者均有不同程度的活动后胸闷、心悸、气短等酷似二尖瓣病变的肺瘀血症状,其中3例瘤体脱落发生体循环及肺循环的栓塞,1例出现突然昏厥。X线及超声心动图检查均能及时发现黏液瘤。确诊依靠组织病理学检查。本组随访6个月～6年,1例复发。该病一旦确诊,应立即手术治疗,瘤蒂切除要彻底,防止肿瘤复发。     

先天性肺囊性病的诊断和手术治疗

目的总结儿童先天性肺囊性病的诊治经验,探讨手术时机和方式。方法1993年1月至2006年5月,手术治疗52例先天性肺囊性病患儿,男26例,女26例,平均年龄3．5岁,包括新生儿16例。术前诊断主要依靠X线胸片和胸部CT。病种包括：先天性肺囊肿37例,先天性肺大叶气肿6例,肺隔离症10例。肺囊肿行肺叶切除27例、囊肿摘除8例、肺楔形切除2例;肺大叶气肿中5例有呼吸窘迫,均行肺叶切除术。肺隔离症中包括叶内型3例,叶外型7例,均手术切除。结果无手术死亡,近期主要并发症包括反复气胸1例、少量胸腔积液1例、肺炎2例。所有病人均痊愈出院。随访病人中1例肺囊肿复发,术后3年再次行左下肺叶切除术。其余病人均恢复良好,肺功能正常。结论小儿先天性肺囊性病应早诊断、早手术,对有明显压迫症状和呼吸窘迫者应急诊手术。手术是先天性肺囊性病的主要治疗方法,肺叶切除是标准术式,术后肺功能均可恢复。     

Left atrial myxoma: diagnosis, treatment, and cytological observations.

A patient first seen with cardiac cachexia was found to have a large left atrial myxoma. The diagnosis was first suggested by echocardiographic examination. Cure was achieved by surgery. Light and electron microscopic studies indicate a multipotential mesenchymal cell origin of myxomata.     

Giant leiomyosarcoma of the pelvis: diagnosis and surgical management

Leiomyosarcoma most frequently arises in the vretropefitoneum, the intra-abdominal space, and the subcutaneous tissue of the extremities. Primary leiomyosarcoma of bone is a rare malignant neoplasm, most commonly involving bones around the knee.1 Although whether leiomyosarcoma can be considered a true primary bone tumor remains questionable, refinements in immunohistochemical techniques are causing this recognition to slowly gain favor. We report a case of a huge primary leiomyosarcoma of bone in the right pelvis.     

practice: Atrial myxoma as a cause of stroke: case report and discussion

Cardiac myxoma is a source of emboli to the central nervous system and elsewhere in the vascular tree. However, nonspecific systemic symptoms and minor embolic phenomena may be overlooked in the absence of any history of cardiac problems. In this situation, cardiac investigations may not be performed, and diagnosis of this rare condition may be delayed until the onset of more significant embolic disease, such as stroke with functional impairment, as in the case reported here. The clinical presentation of cardiac myxoma is discussed, along with appropriate investigations and treatment, which may prevent such sequelae.     

Cockett综合征的临床诊断和外科处理

目的:探讨Cockett综合征的临床诊断及选择合理的外科处理方法.方法:通过对我院5年内收治的44例Cockett综合征患者进行临床分析和回顾性研究.结果:除保守或未治者,手术或介入治疗全部治愈;在急性血栓型中,有5例患者行取栓及人工血管搭桥术后仍有轻度下肢水肿,其余症状消失,生活质量提高.结论:Cockett综合征的诊断主要依靠临床表现及下肢静脉造影;治疗术式暂无定论,但介入治疗是发展方向,其住院时间短,创伤小,操作简便,安全有效.     

复发性心脏黏液瘤的临床诊治

目的总结复发性心脏黏液瘤的临床特征及诊治经验,提高其诊治水平。方法回顾性分析5例复发性心脏黏液瘤病例资料,并复习相关文献资料,总结其临床诊治经验。结果5例原发黏液瘤均起源于非典型位置,1例存在早期远处种植转移,1例有明显家族史,2例复发时恶变;复发间隔时间为(2.30±2.16)年,均为不同位置或不同腔室复发;复发后均行手术治疗,除1例复发时恶变后死于心力衰竭外,余4例再次手术后效果良好。结论非典型位置起源、多发、多腔室分布、早期远处种植转移和有家族史的心脏黏液瘤较易复发,术后更应加强随访,一旦发现复发,应及早手术治疗。     

A case of left atrial myxoma: Anaesthetic management

Left Atrial Myxomas are notorious for their varied presentations. We describe one such case which initially presented with hemiparesis and seizures and was diagnosed as cerebral infarction and treated accordingly and decompression craniotomy with hinge flap was done for raised ICP and impending brain herniation. The main cause was a left atrial myxoma, which was diagnosed only in follow up. The myxoma has embolised to give rise to cerebral infarction. The LA myxoma was then successfully operated under general anaesthesia and Cardiopulmonary bypass (CPB). not not not not notKey words: Hemiparesis, Cerebral infarction, Left Atrial (LA) Myxoma.