Metastatic atrial sarcoma extending from the lung into the left atrium via a pulmonary vein

Lung tumours are the leading metastatic cancers that spread to the heart through direct invasion, and rarely extend into the chambers of the left side of the heart via pulmonary veins. A case of primary lung sarcoma involving a patient who presented with dyspnea and fatigue is reported. This sarcoma extended from the lung into the left atrium via (a/the) pulmonary vein. Chemotherapy and radiotherapy were recommended. Surgery was not considered due to high risk and the advanced stage of the tumour.     

Sequential radial artery for coronary artery bypass grafting: Five-year follow-up and evaluation with multi-detector row computed tomography

This study was undertaken to compare early postoperative results, programmed multi-detector row computed tomography coronary angiographic patency and midterm results of revascularization by sequential radial artery grafting with those of single radial artery grafting during a five-year period. Patients were grouped as those with sequential radial artery grafts (Group A, n = 27) and single radial artery grafts (Group B, n = 26). Multi-detector row computed tomography coronary angiography was scheduled at 1 and 5 years postoperatively. Each distal anastomosis was accepted as nonfunctional if a radial artery graft was occluded proximally or there was a critical stenosis. One sequential radial artery graft and two single radial artery grafts failed in the 1-year period (p > 0.05). In the 5-year period, three radial artery grafts failed in each group (p > 0.05). In Group A, there was no mortality in the five-year period, but in Group B, one patient died four years after the operation due to cardiac problems (p > 0.05). In addition to one death in Group B, there were three percutaneous interventions and two myocardial infarctions among the 26 patients during the five-year follow-up. In group A, among 27 patients, there were 4 percutaneous interventions and one myocardial infarction (p > 0.05). Although the sample size is relatively small to be conclusive, these data suggest that sequential radial artery grafting may be considered as a method of choice for maximizing arterial graft survival and patency. Noninvasive control of sequential and single radial artery grafts with multi-detector row computed tomography is feasible with no discomfort for the patient and excellent visualization of grafts.     

Association of inflammation with atrial fibrillation in hyperthyroidism

Objectives The aim of this study was to evaluate the relationship between inflammation and development of atrial fibrillation (AF) in patients with hyperthyroidism. Methods A total of 65 patients with newly diagnosed hyperthyroidism, 35 of whom were in sinus rhythm and 30 of whom in AF. Thirty five age- and gender-matched patients in a control group were included in the study. Factors associated with the development of AF were evaluated by multivariate regression analysis. Results Factors associated with AF in multivariate analysis included high sensitivity C reactive protein [(HsCRP); odds ratio (OR): 11.19; 95% confidence interval (95% CI): 1.80-69.53; P = 0.003], free T4 (OR: 8.76; 95% CI: 2.09–36.7; P = 0.003), and left atrial diameter (OR: 1.25; 95% CI: 1.06–1.47; P = 0.008). Conclusions The results of the present study suggest that high sensitivity C reactive protein, an indicator of inflammation, free T4 and left atrial diameter are associated with the development AF in patients with hyperthyroidism.     

Embolization Therapy for Traumatic Splenic Lacerations

Purpose

This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma.

Methods

A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes.

Results

Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16–80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies.

Conclusions

Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.     

Can cardiac surgery be performed safely on patients with haematological malignancies

Introduction: Surgical strategy in patients with haematological malignancies must be planned and carried out with the specific aim of decreasing postoperative complications. The aim of this study was to present our experience on patients previously diagnosed with haematological malignancies who subsequently underwent cardiac surgery. We include data to assist other surgeons predict factors affecting postoperative morbidity and mortality in this group of patients. Methods: Fifteen patients diagnosed with haematological malignancies who had cardiac surgery were retrospectively analysed. Eight patients had chronic lymphocytic leukaemia, six had non-Hodgkin's lymphoma and the rest had chronic myelocytic leukaemia. Coronary artery bypass graft surgery was performed on all of them. Results: There were no hospital mortalities. The average follow-up period was 35 ± 11 (23-56) months. Three patients required early postoperative re-operation because of excessive bleeding. No mortalities were seen in the early postoperative period. There were five (33%) deaths during the late follow-up period. Three patients were lost due to intracranial bleeding (confirmed by autopsy) in the 16th, 23rd and 38th months after surgery. The remaining two patients had sudden death in the eighth and 55th months from nondetectable causes. Conclusion: Cardiac surgery can be performed with acceptable early postoperative outcomes in patients with haematological malignancies. Intracranial bleeding is an important factor contributing to late mortality and patient selection and risk stratification are crucial to improving surgical benefits.     

Tracheal intubation in morbidly obese patients: a comparison of the Intubating Laryngeal Mask Airway™ and Laryngeal Mask Airway CTrach™

The aim of this study was to evaluate the efficacy of the Intubating Laryngeal Mask Airway? (ILMA) and Laryngeal Mask Airway CTrach? (LMA CTrach) in facilitating tracheal intubation in morbidly obese patients. Eighty patients (body mass index > 40kg.m^?2) were randomly allocated to the ILMA or the LMA CTrach. The median (IQR [range]) total time taken for tracheal intubation was shorter with the ILMA than with the LMA CTrach (78 (63–105 [40–265]) s vs 128 (98–221 [60–423]) s, respectively; p < 0.001). Significantly more manoeuvres were applied for the satisfactory ventilation and viewing of the glottis with the LMA CTrach (25% vs 55% with the ILMA; p = 0.006). During the postoperative period, there was more sore throat with the LMA CTrach (p < 0.02). We conclude that the ILMA results in shorter intubation times with fewer manoeuvres and sore throat compared with the LMA CTrach in the morbidly obese.     

Anticholinesterase poisoning in Turkey--clinical, laboratory and radiologic evaluation of 269 cases

A retrospective study was conducted on 269 patients with anticholinesterase poisoning who had been admitted to the Internal Medicine and Pediatric Clinics over the past 10 years. Their ages ranged from 17 d to 62 years. In adults, suicide was the most common means of intoxication. Miosis was the most frequent symptom and was seen in 80.66% of the patients. Hyperglycaemia, hypoglycaemia, hypokalaemia, hyperkalaemia, hyperchloraemia, hypochloraemia and hyponatraemia were among the electrolytic and haematologic disorders (hyperglycaemia 48.00%, hypoglycaemia 6.40%). There were also electrocardiographic abnormalities. Asthma, although usually a late complication, was also noted at the beginning of treatment. Mortality rates were 8.98% for children and 9.6% for adults. Since hypoglycaemia was found in all the patients who died, it was accepted as an ominous prognostic sign. We think that anticholinesterase poisoning is an important health problem in our country. It is much less common in developed than semi-developed countries, and a complete understanding of it is essential for the emergency physician.