Giant pulmonary cyst simulating tension pneumothorax.

Giant pulmonary cyst is a rare clinico-pathological entity. It was described as a "windy tumor" by John Floyer in 1726. Since that time, there have been numerous reports on this unique manifestation of emphysema by many authors. In this report, we report one such interesting case who was diagnosed as tension pneumothorax.

Surgical management of intrathoracic goiter.

Intrathoracic goiter is a rare clinical entity. This goiter can develop slowly and the patient may be asymptomatic for many years. A significant number of these patients, however, may develop various complications as a result of compression of vital structures or malignancy. In this report, the surgical management of 18 cases of intrathoracic goiter are reviewed. Six of the patients underwent right thoracotomy with resection of the posterior mediastinal goiter. The remaining 12 patients had their tumor removed via median sternotomy. There were no surgical deaths within this series. Although the incidence of intrathoracic tumor is limited, the threat of malignancy and compressive symptoms clearly indicates the need for surgical excision. Our group recommends thoracotomy and median sternotomy for surgical excision.

Carotid endarterectomy in a community hospital.

Despite the popularity of carotid endarterectomy, considerable debate remains regarding the appropriateness of these procedures. Critics of carotid endarterectomy cite the excessive morbidity and mortality associated with these procedures, particularly when performed in a community hospital setting. A retrospective study of 130 procedures, involving 124 patients within a medium size community hospital setting, was conducted. Indications for the procedure, associated comorbidities, and complication rates were reviewed. The incidence of stroke with subsequent mortality was 0.8% within the study group. One patient (0.8%) developed acute coronary insufficiency and underwent coronary artery bypass surgery. Five (4.0%) other patients experienced minor complications. Carotid endarterectomy is a proven prophylactic measure against the prevention of stroke in a selected group of patients. This study reinforces that this procedure may be performed in a community hospital setting with very low morbidity and mortality rates.

Pericardial flap to minimize internal mammary artery anastomotic tension.

A technique is described that decreases tension on the left internal mammary artery anastomosis in patients whose lungs have herniated across the midline.

Correlation of continuous wave Doppler velocities with cardiac catheterization gradients: an experimental model of aortic stenosis.

The purpose of this study was to use a canine preparation of experimental aortic stenosis to compare estimates of pressure gradient derived from continuous wave Doppler ultrasound with gradients measured directly by catheterization. Aortic stenosis was created in six mongrel dogs by placing an elastic band around the aorta. Eighty-eight different pressure gradients, ranging from 5 to 160 mm Hg, were produced by variable tightening of the aortic band. Pressure gradients were measured by micromanometer-tipped catheters placed in the left ventricle and aorta. Doppler spectral signals were simultaneously obtained using a 2.0 MHz nonimaging transducer placed directly on the surface of the ascending aorta. Doppler and pressure recordings were analyzed using a custom-designed software program to measure maximal instantaneous, mean and peak to peak gradients, as well as ejection and acceleration times. Maximal instantaneous Doppler gradient showed an excellent linear correlation with maximal instantaneous catheterization gradient (r = 0.98, SEE = 5.3 mm Hg). The correlation of Doppler-estimated maximal gradient to peak to peak catheterization gradient was also linear (r = 0.97, SEE = 6.2 mm Hg) but resulted in a systematic overestimation of pressure drop (mean overestimation = 9.0 mm Hg). Measurement of the Doppler gradient at mid-systole resulted in a more accurate correlation with the peak to peak catheterization gradient (r = 0.98, SEE = 6.1 mm Hg) and eliminated the problem of overestimation.(ABSTRACT TRUNCATED AT 250 WORDS)