Atrial myxoma presenting with cerebral haemorrhage

Emboli from left atrial myxomas are a recognized cause of cerebral ischaemia. The myxomatous embolus may infiltrate the cerebral arterial wall, resulting in aneurysmal dilatation with a risk of rupture. Myxoma-associated cerebral haemorrhage has been described in patients with progressive neurological dysfunction. We report a new presentation. Our patient, a previously healthy 20 year old girl, developed acute intracerebral haemorrhage for which craniotomy was performed. Histology of evacuated haematoma revealed an intravascular fragment of myxoma. Echocardiography demonstrated a left atrial myxoma which later was uneventfully excised. Early diagnosis of embolic cardiac myxoma requires awareness of the diversity of clinical manifestations, and careful histological analysis of surgical specimens.     

An unusual case of cardiac tamponade

A 29-year-old woman with Ebstein's anomaly on anticoagulant therapy presented with chest pain. A diagnosis of pericarditis was made once a myocardial infarction and pulmonary embolus had been excluded. She was discharged but returned shortly thereafter with fever, tachypnea and tachycardia. A repeat chest film disclosed that the cardiac silhouette had enlarged greatly since prior admission. Despite the absence of pulsus paradoxus, right heart catheterization confirmed the clinical suspicion of pericardial tamponade.     

Leptospira hebdomadis associated with an outbreak of illness in workers on a farm in North Yorkshire.

Four cases of illness attributed to Leptospira hebdomadis occurred on a cattle farm in North Yorkshire. The clinical features were a febrile illness that resembled influenza; in one case there was a lymphocytic meningitis. This infection is probably more common than is recognised at present, and prevention of further cases may be possible if diagnosed promptly.     

Surgical considerations of infection following operations involving the descending thoracic aorta

Infection in the region of aortic repair is a dreaded complication and is well known to occur after abdominal aortic operations when prosthetic grafts communicate with groin incisions. Although the incidence of this complication is now less than 1% in these cases, it has varied from 1.3% to 6.0% and is associated with a mortality rate varying between 25% and 75%. Principles of treatment in such cases include appropriate antibiotic therapy, removal of infected prosthetic grafts, and restoration of distal circulation when necessary to avoid peripheral ischemia. The latter has been necessary in over 50% of cases and has been accomplished (a) rarely by insertion of a new graft, (b) by local reconstruction using autogenous tissue, and (c) more commonly by closing the involved aortic and arterial openings and performing an extra-anatomic bypass. Although little has been written about this problem occurring after operations for lesions of the descending thoracic aorta, such problems are known to occur. This report is concerned with a detailed review of the 9 reported cases treated surgically and 2 cases that the authors treated. Analysis of this material indicates that the principles learned from treating infected operative sites in the abdominal aorta apply to similar lesions occurring in the descending thoracic aorta.

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Résumé L'infection d'une suture de l'aorte est une complication redoutable. Elle peut survenir après une opération sur l'aorte abdominale, lorsque la prothèse descend jusqu'au niveau des incisions inguinales. La fréquence de cette complication est, à l'heure actuelle, inférieure à 1%; mais elle a varié entre 1.3% et 6.0%, avec une mortalité de 25 à 75%. Lorsque cette complication survient, le traitement doit comporter une antibiothérapie adéquate, l'ablation de la prothèse infectée et le rétablissement de la circulation d'aval si nécessaire pour éviter l'ischémie périphérique. Ceci doit être fait dans plus de 50% des cas et peut être réalisé (a) rarement par mise en place d'une nouvelle prothèse, (b) par reconstruction locale utilisant les tissus autologues, (c) plus souvent par un by-pass extra-anatomique après suture de l'aorte et des artères distales à la prothèse. On sait que les mêmes problèmes peuvent survenir après une opération sur l'aorte thoracique descendante, bien que la littérature soit fort discrète à ce sujet. Nous revoyons en détail les 9 cas publiés et 2 cas personnels. Cette analyse montre que les principes thérapeutiques appliqués aux infections des sutures de l'aorte abdominale sont valables pour l'aorte thoracique descendante.

     

Abdominal hemangiopericytoma scintigraphically simulating an accessory spleen

Hemangiopericytoma is a soft tissue tumor composed histologically of pericytes of Zimmerman, which line capillaries. These neoplasms have been observed throughout the body in soft tissue and bone. Presented here is a case of abdominal hemangiopericytoma proven histologically that simulated an accessory spleen on a number of studies including Tc-99m sulfur colloid imaging.