Roles of protein C, protein S, and antithrombin III in acute leukemia

Protein C, protein S, and antithrombin III were measured in 35 patients with acute leukemia (13 with AML and 22 with ALL). Low levels of proteins C and S were present in 15 (42.9%) and 20 (57.1%) patients, respectively, and 6 patients had low levels of antithrombin (ATIII). Seven patients also had DIC at presentation. There were no significant differences in the levels of protein C, protein S, and ATIII in patients with or without DIC. Twenty patients were available for re-evaluation at the end of induction therapy. The low levels of protein C and ATIII found at diagnosis had risen to normal levels at the end of the induction therapy, while low =levels of protein S remained in 75% of the patients. One patient with low protein C at presentation developed myocardial infarction on day 15, and another patient died of progressive neuropathy. No other thrombotic manifestations were seen. Whether the low protein C, protein S, or antithrombin levels predispose patients with acute leukemia to thrombosis in the absence of DIC is not known.     

Pronto catheter thrombectomy in acute ST-segment myocardial infarction: a case series

Primary angioplasty has emerged as the treatment of choice in acute ST-elevation myocardial infarction. While the timely restoration of infarct artery patency is central, close attention needs to be paid to microvascular integrity for successful restoration of normal myocardial metabolism. Clearance of thrombus burden is central to restoring normal myocardial metabolism. Available therapies do not efficiently remove thrombus in a timely and simple fashion. Microthrombi can be treated with appropriate pharmacological therapy, whereas larger macrothrombi should be treated with commercially available thrombectomy devices. In these case reports, the use of the Pronto (Vascular Solutions, Inc., Minneapolis, Minnesota) catheter is described as a quick, simple, and timely tool for the management of thrombus in the setting of an acute right coronary artery myocardial infarction.     

Delayed Left Ventricular Free-Wall Rupture after Cardiac Sarcoma Resection

We report the case of a 38-year-old woman who underwent cardiac sarcoma resection and presented later with spontaneous left ventricular free-wall rupture. The original tumor resection required autotransplantation and a transmitral approach, including partial resection of the inner left ventricular wall. Although the patient did well postoperatively, 3 weeks later she developed a large pericardial effusion with tamponade. Intraoperatively, a portion of the left ventricular free wall ruptured and required repair with a Dacron patch. The patient recovered and was discharged from the hospital 3 weeks later. To our knowledge, this is the 1st reported case of spontaneous ventricular rupture after the resection of a cardiac tumor.Key words: Cardiac surgical procedures, cardiac tamponade/etiology, heart neoplasms/complications/surgery, heart rupture/etiology/pathology, heart ventricles/pathology/surgery, neoplasm invasiveness, pericardial effusion/etiology, postoperative complications, sarcoma/pathology/surgeryMalignant primary cardiac tumors are extremely rare, and surgical resection can be challenging. Many of these tumors can be debulked; however, involvement of the ventricular free wall presents a unique challenge of how much tissue to resect safely. Here, we report the case of a 38-year-old woman who experienced spontaneous ventricular free-wall rupture after having undergone resection of a cardiac sarcoma.     

Hydatidiarrhea

Hydatid cysts rarely rupture into the bowel lumen. We describe five patients presenting with passage of hydatid membranes in stool. Early surgical intervention may prevent erosion of such cysts into the hollow viscus.     

Acquired recto-urethral fistula in children: Long-term follow-up

ObjectiveAcquired recto-urethral fistula is an uncommon entity in children and occurs as a consequence of pelvic disorder, including trauma, iatrogenic injury, inflammatory bowel disease, pelvic neoplasm and infection. We have reviewed our experience with treatment of recto-urethral fistula and focussed on the outcome of the repair.Patients and methodsData collected included demographics, cause, procedure type, presentation, operative details and morbidity. Telephonic and personal contact were made to evaluate functional outcome and quality of life.ResultsBetween 1991 and 2008, 17 children with a mean age of 7 years were treated for recto-urethral fistula. Fifteen cases were of iatrogenic origin and two were following road traffic accident. Six underwent repair through the York-Mason approach; the remaining 11 were treated via the transperineal approach with interposition of vascularised tunica vaginalis flap. Operating time, success rate and overall satisfaction score were similar for the two groups.ConclusionBoth approaches used were effective to treat recto-urethral fistula. Successful repair can be achieved with minimal morbidity, short hospital stay, and good postoperative outcome and quality of life.