Cardioscopy and robotic assistance for the diagnosis of intraventricular endocarditis

A 44-year-old male patient with an undefined mass in the left ventricular endocardium was scheduled for minimally invasive cardiac surgery. Ventricular investigation and tissue biopsies were completed with the help of a voice-controlled robotic arm. Pathologic examination revealed non-bacterial thrombotic endocarditis. In addition to videoscopy, robotic assistance allows an easier diagnostic and therapeutic approach of intraventricular pathologies.     

Primary lipoma of the liver

A case of lipoma of the liver is reported in a 57-year-old woman with a 10-month history of non-insulin dependent diabetes mellitus and 3 days with abdominal pain, distention, nausea, and vomiting. On medical examination, the liver was palpable 5 cm below the right costal margin without splenomegaly or ascites. A CT scan revealed a well-defined fat attenuation tumor and an MR demonstrated a well-circumscribed lesion with bright signal intensity. An extended right hepatic lobectomy was performed. The resected specimen measured 28.6 x 18.3 x 8.2 cm and weighed 2,200 g. The yellow and well-circumscribed tumor measured 15 x 9.5 cm and was composed of mature adipose cells pushing the liver tissue at the periphery. The patient was asymptomatic 6 months after surgery.     

Do patients with intraventricular gradients during dobutamine stress echocardiography have intraventricular gradients with exercise testing?

The development of intraventricular gradients during dobutamine stress echocardiography has been widely reported and this finding is commonly associated with symptoms during stress testing. In a previous study, we investigated the incidence of intraventricular gradients during dobutamine stress echocardiography in 46 patients and concluded that they occur frequently (43%). In another study we looked for the same phenomenon in 50 other consecutive patients during exercise stress echocardiography and only found a small gradient in one patient (2%). The purpose of the present study was to look for the development of intraventricular gradients during exercise echocardiography, in patients in whom this phenomenon occurred during dobutamine stress echocardiography. We studied 10 patients who developed a significant intraventricular gradient in a negative or inconclusive dobutamine stress echocardiography study. Five of the patients were male, mean age was 63 +/- 15.9 years (34-79). Three patients had previously undergone coronary angioplasty. The presence of intraventricular gradients was evaluated in all patients by color, pulsed and continuous wave Doppler echocardiography during dobutamine and exercise stress testing. An intraventricular gradient was considered significant when the intraventricular flow velocity increased by more than 1 m/s at the end of systole. The mean intraventricular gradient developed during dobutamine stress echocardiography was 101.7 +/- 68 mmHg (47-270). Only one of these patients developed a small intraventricular gradient during exercise stress echocardiography. CONCLUSION: In a small population of patients who developed significant intraventricular gradients during dobutamine stress echocardiography, this finding was not reproduced with exercise echocardiography.     

Mitral incompetence associated with lipoma infiltrating the mitral valve

A 54 year old man presented with presyncopal symptoms. Echocardiography and subsequently computed tomography showed a mass in the posterior mitral annulus causing incompetence of the valve. At operation a lipoma was found which could not be resected. Mitral incompetence was the result of chordal rupture where the lipoma had engulfed the papillary muscle. The valve was replaced and the patient made an uneventful recovery. This case report shows a potential danger of an otherwise benign lesion.     

Giant intraosseous lipoma of the rib

Lipoma is defined as a benign tumor consisting of a circumscribed mass of adipose tissue. Intraosseous lipomas represent fewer than 0.08% of all primary bone tumors. We present an unusual case of intraosseous lipoma arising from the left 10th and 11th ribs and extending to the subdiaphragmatic area and abdomen. Lipoma of the rib is an extremely rare disorder presenting diagnostic challenges.     

Submucous subserous lipoma of the colon

Conclusions Among lipomas of the colon, mixed submucous-subserous lipomas are rare. The etiology is obscure. Diagnosis is difficult and rarely made without radiologic study of the colon with double-contrast technic and air insufflation. Treatment is always surgical and prognosis is good. Read at the meeting of the American Proctologic Society, San Francisco, California, May 20 to 23, 1963.     

Sclerosed lipoma of the mitral valve

A very rare case of cardiac lipoma located in the mitral valve is presented. Clinical symptoms, diagnostic procedures, differential diagnosis and treatment are discussed, and the relevant literature briefly reviewed. The treatment of choice for these partially asymptomatic tumors is resection, and invasive diagnostic procedures such as transesophageal biopsy should be avoided. However, transesophageal echocardiography and magnetic resonance techniques are considered helpful in differentiating between benign and malignant tumors in order to plan effective surgery.     

Submucous lipoma of the ileocecal valve

Summary Lipoma of the ileocecal valve is a rare condition which must be distinguished from other neoplasms. It should be considered in the differential diagnosis of any acute or chronic abdominal pain of doubtful origin. In symptomatic cases when the diagnosis cannot be made with certainty, excision of the tumor is indicated.     

Pedunculated giant lipoma of the esophagus

A patient with a giant lipoma of the esophagus presented with progressive dysphagia and odynophagia, fever, and recurrent melena. Two years previously, when the symptoms were less pronounced, it had been misdiagnosed as achalasia. After surgical removal of the lipoma, the patient became symptom free.     

Synovial lipoma arborescens of the hip

Summary Lipoma arborescens is a rare intra-articular tumor usually found in the knee joint. The reported lesion involved the inferomedial recess of the right hip synovium, in a 29-year-old male. The clinical findings were nonspecific. Both arthrography and computerized tomography (CT) of the hip disclosed the tumor which, on CT examination, showed an inhomogeneous low density, due to its fat content. The final diagnosis was given by histological examination of the resected mass. No recurrence was observed after one year. The long-term prognosis probably depends more on the underlying disorder of the joint than on the lipoma itself.     

Mitral incompetence associated with lipoma infiltrating the mitral valve.

A 54 year old man presented with presyncopal symptoms. Echocardiography and subsequently computed tomography showed a mass in the posterior mitral annulus causing incompetence of the valve. At operation a lipoma was found which could not be resected. Mitral incompetence was the result of chordal rupture where the lipoma had engulfed the papillary muscle. The valve was replaced and the patient made an uneventful recovery. This case report shows a potential danger of an otherwise benign lesion.     

Survival in patients with intraventricular conduction defects

All 42,000 electrocardiograms taken at the University of Oregon Health Sciences Center from 1969 through 1971 were reviewed; 325 patients (0.77%) had left bundle-branch block (LBBB) or right bundle-branch block (RBBB) with axis deviation (AD). In December 1974, 90% were contacted or found to be dead. The five-year survival rate (actuarial technique) (mean +/- SE) was 45.5 +/- 2.9%. It was significantly worse than that of age- and sex-matched "controls." In most patients the cause of death could not be determined. Survival of 164 LBBB patients (40.7 +/- 4.1%) at five years was not significantly worse than that of 161 RBBB and AD patients (49.5 +/- 4.2%). Those with syncope did no worse in terms of survival than did those without. The five-year survival in coronary artery disease patients was 33.7 +/- 4.4%, in those with primary conduction system disease (20% of patients), it was 50.6 +/- 6.6%. It will be necessary to know the causes of death and of syncope in conduction disease patients before it can be determined whether or not pacemakers can prevent either.     

Successful treatment of cryptococcal meningitis with intraventricular miconazole

A patient with cryptococcal meningitis retractory to amphotericin B was treated primarily with intraventricular miconazole. All parameters of disease improved, and the patient was dischared after four months of therapy. In selected persons with cryptococcosis, it may be possible to successfully utilize intraventricular miconazole in the absence of concurrent intravenous medication.