Radical excision of invasive thymoma with intracardiac extension.

A patient with a low grade malignant thymoma who also had pleural, pericardial and cardiac invasion with intracardiac extension, presented with signs of superior vena cava obstruction, moderate hepatosplenomegaly and a mediastinal mass on a plain chest radiograph. Radical excision requiring cardiopulmonary bypass for the removal of the intracardiac extension into the right atrium was performed. Despite the patient's failure to receive radiotherapy treatment, he was alive one year after surgery. This case is reported because this mode of presentation of intracardiac extension of a thymoma is uncommon and because only this method of radical excision could ensure near-total removal of the mass and prevent early death from cardiovascular complications.

Brain cardiac events in Nigerian patients with cocaine abuse.

Epidemiological evidences indicated that substance abuse disorders are increasingly prevalent among Nigerians. The psychosocial deleterious effects of these drugs appear well recognised, but their medical consequences are less often considered in the region. The potential for these drugs to precipitate life threatening cardiac and brain event needs to be reemphasised. We report the clinical and laboratory findings in 4 Nigerians in whom non-intravenous use (recreational and ritualistic) of cocaine was temporally related to acute myocardial ischaemia, cardiac dysarrhythmias, convulsion and cerebrovascular accident. These findings suggest that the observations--that underlying heart disorders were not sinequanon for the cardiotoxic effects of cocaine; the brain and cardiac consequences were not restricted to parenteral use of the drug; the development of seizures were not prerequisite for cerebrovascular accident and vice versa; and that massive doses of the drug needed not be ingested to produce toxic effects on the heart and brain--may also apply in these Nigerian patients. Perhaps with the increase in user population, it is timely to embark on public enlightenment on the medical dangers of cocaine abuse, as these are no less important than the psychosocial consequences.