Partial sternectomy with reconstruction of a giant cell tumor of the sternum, a case report, Saudi, Arabia.

BACKGROUND: Giant cell tumor (GCT) is a relatively common and locally aggressive benign bone tumor that rarely affects the sternum. CASE PRESENTATION: We report a case of giant cell tumor of the sternum in a 28-year-old Saudi with painful swelling at the lower part of the sternum. Subtotal sternectomy and reconstruction with a neosternum using two layers of proline mesh, a methyl methacrylate prosthesis, and bilateral pectoralis muscle advancement flaps were performed. CONCLUSIONS: Giant cell tumor of the sternum is a rare diagnosis. Surgical resection with negative margins is the ideal management. To avoid defects or instability of the chest wall, reconstruction of the chest wall with neosternum should be considered.

Late presentation of a congenital problem; complicated left-sided Bochdalek's hernia in an adult: A case report.

Background: A diaphragmatic hernia is a defect or hole in the diaphragm through which abdominal contents can enter the chest cavity. Diaphragmatic hernias may be congenital (Morgagni hernia, Bochdalek hernia), a hiatal hernia, or acquired (iatrogenic and traumatic). Bochdalek's hernia typically occurs on the left side and rarely occurs in adults. Less than 100 cases of left Bochdalek's hernia in adults have been described in the literature. Most of them are asymptomatic. Case report: We report a complicated left Bochdalek hernia in a 43-year-old adult male who is a smoker. He came to the pulmonary clinic with symptoms and signs of pneumonia of the left lower lobe with persistent dyspeptic symptoms. Chest radiography revealed evidence of a left diaphragmatic hernia, which was confirmed by computed tomography of the chest and abdomen, and subsequently treated by left diaphragmatic repair via limited left thoracotomy. Conclusion: We report a rare case of a left Bochdalek hernia in an adult who underwent an appropriate left thoracotomy. Bochdalek hernias in adults are rare and usually asymptomatic, but when they become symptomatic, surgical intervention is required to avoid complications. BH should be considered in the differential diagnosis when radiographs suggest pneumothorax and should be treated early to avoid complications.

The ARISCAT Risk Index as a Predictor of Pulmonary Complications After Thoracic Surgeries, Almoosa Specialist Hospital, Saudi Arabia.

Background: Pulmonary complications after thoracic surgery are common and are associated with prolonged hospital stay, higher costs, and increased mortality. This study aimed to evaluate the value of The Assess Respiratory risk in Surgical Patients in Catalonia (ARISCAT) risk index in predicting pulmonary complications after thoracic surgery. Methods: This retrospective study was conducted at Almoosa Specialist Hospital, Saudi Arabia, from August 2016 to August 2019 and included 108 patients who underwent thoracic surgery during the study period. Demographic data, ARISCAT risk index score, length of hospital stay, time of chest tube removal, postoperative complications, and time of discharge were recorded. Results: The study involved 108 patients who met the inclusion criteria. Their mean age was 42.5 ± 18.9 years, and most of them were men (67.6%). Comorbid diseases were present in 53.7%, including mainly type 2 diabetes mellitus and hypertension. FEV1% was measured in 58 patients, with a mean of 71.1 ± 7.3%. The mean ARISCAT score was 39.3 ± 12.4 and ranged from 24 to 76, with more than one-third (35.2%) having a high score grade. The most common surgical procedures were thoracotomy in 47.2%, video-assisted thoracoscopic surgery (VATS) in 28.7%, and mediastinoscopy in 17.6%. Postoperative pulmonary complications (PPCs) occurred in 22 patients (20.4%), mainly pneumonia and atelectasis (9.2%). PPCs occurred most frequently during thoracotomy (68.2%), followed by VATS (13.6%), and mediastinoscopy (9.1%). Multinomial logistic regression of significant risk factors showed that lower FEV1% (OR = 0.88 [0.79-0.98]; p=0.017), longer ICU length of stay (OR = 1.53 [1.04-2.25]; p=0.033), a higher ARISCAT score (OR = 1.22 [1.02-1.47]; p=0.040), and a high ARISCAT grade (OR = 2.77 [1.06-7.21]; p=0.037) were significant predictors of the occurrence of postoperative complications. Conclusion: ARISCAT scoring system, lower FEV1% score, and longer ICU stay were significant predictors of postoperative complications. In addition, thoracotomy was also found to be associated with PPCs.

Combined coronary artery bypass grafting and surgical resection of right atrial myxoma complicated with pulmonary embolism / Cirugía combinada de bypass de arteria coronaria y resección quirúrgica de un mixoma auricular derecho complicado por una embolia pulmonar / Chirurgia combinada de bypass da artéria coronária e ressecção cirúrgica de um mixoma auricular direito complicado por uma embolia pulmonar

Although the association between right atrial myxoma and pulmonary embolism is rare, it has been recognized for many years. This condition is fatal unless surgical intervention is performed for resection of right atrial mass and pulmonary embolectomy. A 68 years old diabetic, hypertensive male patient was admitted to our hospital with severedy spnea and chest pain. An echocardiogram and pulmonary CT angiography revealed right atrial mass and pulmonary embolism. Further more, coronary angiography was done and showed a three vessels disease. Complete surgical removal of the right atrial myxoma and parts of the tumor embolectomy from the right pulmonary artery were successfully performed combined with coronary artery bypass grafting to LAD, obtuse marginal and diagonal branches. Histological examination of the primary tumor as well as the embolus confirmed the diagnosis of benign myxoma. The patientwas discharged after 15 days of his successful operation. We report this case, as it is unique because of the rarity of the combined surgery of right atrial myxoma complicated with pulmonary embolism and coronary artery bypass grafting.

Si bien la asociación entre el mixoma auricular derecho y la embolia pulmonar es poco frecuente, se conoce su existencia desde hace años. La condición es fatal salvo si se realiza una intervención quirúrgica para la resección de la masa auricular derecha y una embolectomía pulmonar. Ingresa a nuestro hospital un paciente masculino diabético e hipertenso de 68 años con disnea severa y dolor de pecho. Un ecocardiograma y una angioTac de pulmón revelan un masa auricularderecha y una embolia pulmonar. Además, la coronario angiografia realizada identifica enfermedad en tres vasos. Se realiza con éxito la resección quirúrgica completa del mixoma auricular derecho y parte de la embolectomia tumoral de la arteria pulmonar derecha junto con un bypass de la arteria coronaria a la descendente anterior, la marginal obtusa y las ramas diagonales. El examen histopatológico del tumor primario y de la embolia confirman el diagnóstico de mixoma benigno. El paciente fue dado de alta 15 días después de la exitosa operación. Publicamos este caso ya que es único porque es poco frecuente es combinar la cirugía de un mixoma auricular derecho complicado por una embolia pulmonar con una cirugía de bypass de la arteria coronaria.

Apesar da associação entre mixoma auricular direito e embolia pulmonar ser pouco frequente, sua existência é conhecida há anos. A condição é fatal salvo se realizamos uma intervenção cirúrgica para a resecção da massa auricular direita e uma embolectomia pulmonar. Ingressa ao nosso hospital um paciente masculino diabético e hipertenso de 68 anos com dispnéia severa e dor no peito. Um ecocardiograma e um angioTAC do pulmão revelam uma massa auricular direita e uma embolia pulmonar. Além disso, a coronario angiografia realizada identifica comprometimento de três vasos. Realiza-se com êxito a resecção cirúrgica completa do mixoma auricular direito e parte da embolectomia tumoral da artéria pulmonar direita junto com um bypass da artéria coronária àdescendente anterior, a artéria obtusa marginal e os ramos diagonais. O exame histopatológico do tumor primário e da embolia confirmam o diagnóstico de mixoma benigno. O paciente recebeu alta 15 dias depois da exitosa operação. Publicamos este caso por ser único devido à pouco frequência em combinar a cirurgia de um mixoma auricular direito complicado por uma embolia pulmonar com uma cirurgia de bypass da artéria coronária.

Solitary benign fibrous tumors of the pleura.

Solitary benign fibrous tumors of the pleura are very rare. Seven patients (mean age, 52 years) who presented between 1995 and 2005 were studied retrospectively. They had nonspecific chest symptoms and no history of asbestos exposure or smoking. Chest radiography showed a large opacity occupying most of the affected hemithorax, with clear costophrenic angles. Computed tomography of the chest showed a large well-delineated heterogeneous mass directly related to the lateral chest wall. Needle biopsy suggested the benign nature of the lesion. Surgery was performed through a posterolateral thoracotomy. Five tumors arose from visceral pleura, and 2 from parietal pleura. The mean tumor diameter was 7.5 cm (range, 8-14 cm). Complete surgical excision was carried out in all cases. Histopathology and immunohistochemical staining confirmed the benign nature of the tumors. There was no mortality or major complication. The mean follow-up period was 4 years (range, 1-10 years). All patients remained tumor-free during follow-up. Wide local excision, including pulmonary and pleural resection, is recommended as the best therapeutic option.