Search

Congenital bullous emphysema is defined as large bullae involving at least one-third of a hemithorax. We describe the case of a 32-year-old female who presented with increasing shortness of breath. Radiological investigations revealed severe emphysema with hyperexpansion of the right lung and a mediastinal shift to the left. A lung perfusion scan showed reduced perfusion in the right lung. The patient underwent a right pneumonectomy with a diagnosis of congenital bullous emphysema. She was doing well 6 years later.

Heparin resistance (HR) is occasionally encountered in cardiac surgery. The objective of this study is to identify possible factors predisposing patients to heparin resistance. Four hundred patients scheduled for elective cardiac surgery requiring the use of cardiopulmonary bypass (CPB) were enrolled in this study. Data collection included: demographic data, types of preoperative anticoagulant/antiplatelet therapy, preoperative haematological and biochemical laboratory results, medical condition, baseline activated clotting time (ACT) and infusion volume prior to heparinisation. Patients who require 5 mg/kg or more to achieve ACT greater than 400 seconds before CPB were considered to be heparin resistant. All data was tested with a preliminary univariate analysis and factors associated with HR (p valueB /0.05) were entered into a multivariate logistic regression analysis. Factors associated with HR with a p valueB /0.05 are considered predictors for HR. Thirty-two (8.0%) of the 400 patients fulfilled the criteria for HR. Preoperative heparin (p /0.025), low molecular weight heparin (p /0.049), plateletcount ] /300,000/ml (p /0.022) and albumin plasma concentration 5 /35 g/dl 0, /0.044) are significantly associated with HR. HR patients also tend to require more volume replacement prior to CPB to maintain haemodynamic stability p /0.007). Perfusion (2006) 21, 99/103.

Sternoclavicular joint infection is rare and tends to present insidiously in debilitated and immunocompromised patients. Between August 1996 and July 1998, we managed 7 patients with 8 sternoclavicular joint infections. Three were women. Their age ranged from 42 to 63 years. Five of the patients had significant associated medical conditions. Six patients, including 1 with bilateral involvement, underwent surgical resection, which consisted of radical excision of the involved joint, medial third of the clavicle, first and second ribs and adjacent muscular wall, and part of the manubrium. All of them underwent delayed reconstruction with either pectoralis major or latissimus dorsi flaps. There was 1 operative mortality from continuing sepsis from another source. All the surviving patients showed no sign of local recurrent infection and no functional deficits at follow-up. We conclude that infection of the sternoclavicular joint often presents late in debilitated patients. Medical therapy often fails in these cases. Radical excision is effective in eradicating the septic focus, and functional results after reconstruction are excellent.

Giant coronary aneurysm presented initially as acute ventricular septal rupture in a 65-year-old man. At surgery, aneurysms measuring more than 10 cm each were found in the right coronary and left anterior descending arteries. The right coronary artery was bypassed and the aneurysm was plicated. A 2-cm ventricular septal defect was patched. Postoperatively, the patient's condition deteriorated and he succumbed to septic shock.

An unusual case of primary leiomyosarcoma presenting as a cystic mass is reported. An 86-year-old man underwent resection of a large cystic mass measuring 15 cm in diameter, arising from the left lower lobe of the lung. Histology of the resected specimen showed primary pulmonary leiomyosarcoma. The patient made a good recovery.

Delayed pseudoaneurysm of the abdominal aorta is an exceedingly rare but potentially fatal complication following blunt abdominal trauma. A 25-year-old male presented 3 months after a road traffic accident with central abdominal pain. A 4-cm pseudoaneurysm of the infrarenal aorta was detected by computed tomography. Successful surgical repair was performed with an interposition graft and reimplantation of the inferior mesenteric artery.

A 21-year-old woman presented with almost complete extrinsic airway obstruction due to a massive mediastinal tumor. Venovenous extracorporeal membrane oxygenation support for 3 days with concurrent chemotherapy allowed time for tumor shrinkage, ventilation via the endotracheal route, and subsequent successful extubation on the fifth day.