Complications of albendazole treatment in hydatid disease of lung.

We present rupture of lung hydatid cyst in a patient with multiple organ involvement during albendazole treatment. The patient was first provided mechanical ventilation than residue cavity and the other intact cyst was treated surgically. We concluded that albendazole should be used in postoperative period in patients with hydatid disease of the lung to prevent recurrent disease.     

Spontaneous esophageal rupture following severe vomiting in pregnancy

Spontaneous esophageal perforation is an uncommon finding requiring prompt diagnosis and immediate surgery because of its high mortality rate. Esophageal rupture secondary to severe vomiting in pregnancy is extremely rare and only four cases have been published in the literature. We report the case of a 20-year-old female in whom severe vomiting in early pregnancy resulted in esophageal perforation with subcutaneous emphysema. The diagnosis was made 48 h later. The patient had undergone surgical treatment and the postoperative period was uneventful. The unusual cause and the interesting clinical course of esophageal rupture are described.     

New and old cardiovascular risk factors: C-reactive protein, homocysteine, cysteine and von Willebrand factor increase risk, especially in smokers.

BACKGROUND: The relative importance of new risk factors for heart disease singly or in combination is uncertain. We assessed relationships between C-reactive protein, homocysteine, cysteine, von Willebrand factor, activated factor XII and stable heart disease, as well as interaction with established risk factors. METHODS: A case-control study of 260 cases of stable heart disease from the Irish component of the European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) II cohort and 260 age, sex-matched controls. C-reactive protein, homocysteine, cysteine, von Willebrand factor, activated factor XII and conventional risk factors were assayed or recorded. Interaction effects between new and conventional factors were assessed using additive and multiplicative models. RESULTS: C-reactive protein, homocysteine, cysteine and von Willebrand factor were significantly higher in cases than controls. Comparing the top fifth with the bottom four-fifths showed independent associations between heart disease and C-reactive protein [odds ratio (OR) 1.79; 95% confidence interval (CI) 1.12-2.86; P = 0.01], cysteine (OR 2.00; 95% CI 1.25-3.20; P = 0.004), von Willebrand factor (OR, 3.0; 95% CI 1.9-4.8; P < 0.0001). For homocysteine, the association was independent comparing the top tenth to the bottom nine-tenths (OR 1.95; 95% CI 1.02-3.41; P = 0.04). Activated factor XII was not associated with risk. The association between C-reactive protein and disease was U-shaped and a graded association existed between homocysteine, cysteine, von Willebrand factor and disease. C-reactive protein, homocysteine, cysteine and von Willebrand factor considerably increased risk associated with other factors, particularly smoking. CONCLUSIONS: Independent associations exist between stable heart disease and C-reactive protein, homocysteine, cysteine and von Willebrand factor. Strong combined effects were observed between these and conventional risk factors, particularly smoking. Smoking cessation may profoundly reduce risk associated with other risk factors. We found no evidence of a relationship between activated factor XII and disease.     

Anterior and Posterior Pulmonary Cusp Augmentation in the Repair of Tetralogy of Fallot

BackgroundIn this retrospective study, we compared the results from 2 pulmonary valve augmentation techniques in patients undergoing surgical repair of tetralogy of Fallot.MethodsBetween 2015 and 2018, 18 patients had anterior pulmonary valve repair at our institution, and 26 patients had both anterior and posterior pulmonary valve repair.ResultsPatients ranged from 6 months to 30 years of age. The median follow-up period was 8 months in the anterior augmentation group and 5 months in the anterior and posterior augmentation group. Postoperative echocardiograms indicated that only 2 patients (11%) in the anterior augmentation group had moderate or severe pulmonary insufficiency, compared with no patients in the anterior and posterior augmentation group. At follow-up, pulmonary insufficiency was seen in 3 patients (17%) in the anterior augmentation group and no patients in the anterior and posterior augmentation group.ConclusionReconstruction of the native pulmonary valve accompanied by pulmonary cusp augmentation can decrease or even circumvent postoperative pulmonary insufficiency. Both anterior augmentation and anterior and posterior augmentation techniques are easily applied; however, we believe that the anterior and posterior augmentation technique is superior in terms of early postoperative and follow-up pulmonary insufficiency outcomes.     

Breast mass caused by rib tuberculosis abscess.

Tuberculosis involving ribs and presenting with breast mass is a very rare entity and only a few cases have been reported in the literature previously. A 35 year-old patient had a retromammarial abscess revealed by a mass in the medial quadrant of right breast. Midsternal incision for abscess drainage and a partial resection of involved ribs was performed. Histopathologic evaluation revealed rib tuberculosis and secondary abscess formation in the right breast. This unusual manifestation of tuberculosis should be included in differential diagnosis of high-risk patients presenting with a breast mass.