Floating Tumor of the Aortic Arch: A Case Report.

BACKGROUND: Neoplasms of the aortic arch are rare tumors presenting a diagnostic challenge, regardless of whether they are benign or malignant. The most effective treatment method is surgical resection of the tumor. CASE PRESENTATION: This case presents a 62-year-old woman with cerebrovascular ischemia and right-sided hemiparesis. Further medical treatment showed a CT scan of a floating mass in the aortic arch. The patient underwent surgery after the initial diagnosis. CONCLUSION: In most patients, these types of tumors are detected after a peripheral arterial embolism. Surgical resection of the tumor is the most effective treatment method. The symptoms and presentation of this patient can be beneficial for future diagnosis of this type of tumor.

Rare Case of Multiple Aneurysms with Rupture of the Deep Femoral Artery Aneurysm.

Profunda femoris artery aneurysms (PFAA) are very rare and easily overlooked. Currently, around 100 PFAA and 20 ruptured PFAA have been described in the literature. This is a report on a case of ruptured PFAA with thoracoabdominal aortic aneurysm. A ligation of the profunda femoris artery (PFA) and a femoropopliteal supragenicular bypass with vascular prosthesis were performed in the surgical treatment, which showed good results on the further follow-ups. A month after the procedure the patient had a rupture of the thoracoabdominal aortic aneurysm with fatal result. Therefore, it is recommended to perform a search for another aneurysm, especially on the aortoiliac segment, in every diagnosed PFAA case.

First quadricuspid aortic valve to be reported in Croatia.

Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. Even in the era of a transthoracic and transesophageal ultrasound the occurrence is sometimes missed. Aortic incompetence occurs usually in 5th or 6th decade of life requiring surgical intervention. We report on a 70-year-old woman who presented with exertional dyspnea. In a diagnostic setting transthoracic ultrasound, helical computed tomography scan of the chest and coronary angiography including aortography were performed. Unusual aortic valve anatomy was not described as it was not expected. Finally, the diagnosis of this congenital malformation was established intraoperatively.

The outcome of surgical treatment in patients with penetrating chest wounds.

The aim of this paper is to present the treatment evaluation of the chest penetrating wounds in our hospital during the Patriotic war in Croatia. Due to the war situation, all the patients were treated with the aggressive surgery--thoracotomy. We compared the treatment outcome of these patients with those treated after the war who were treated with the standard procedure, meaning that the thoracotomy was performed only if the indications were clear and most of the minor chest wounds were treated with the thoracic drain. The compared parameters were: age, gender, thoracotomy percentage in comparison to total number of wounded, incidence of multiple wounds needing surgery, total follow up period, infection incidence, period of hospital treatment, blood transfusions, spirometry finding minimum one year after the hospital treatment. None of the parameters showed any significant statistical difference suggesting that one treatment was better than the other.

Abdominal angina caused by kinking of the superior mesenteric artery.

Abdominal angina followed by an active vascular intervention constitutes an infrequent sequence of events. The limited experience in the active management of this, potentially lethal, condition prompted us to present the case of a 54 year old man with an exceedingly rare etiology of mesenteric ischemia. The underlying cause was kinking of the superior mesenteric artery in combination with ostial stenosis of the celiac trunk. The initial management strategy included an interventional radiological procedure because patient initially declined the surgical treatment. The second intervention was a surgical revascularization of the diseased segment of the abdominal vasculature. The surgical treatment led to complete resolution of his symptoms.

Pulmonary embolism caused by a migrated gunshot projectile.

Pulmonary embolism caused by a foreign body is an exceedingly rare event. We report on a 62 year old woman who suffered a gun shot injury to her left knee with concomitant vascular lacerations. The bullet migrated through the venous system into the pulmonary circulation causing a pulmonary embolism. The projectile remained stationary for ten years. Taking into consideration that she is virtually asymptomatic and that regular follow up examinations showed no further migration of the foreign body, we opted for a conservative venue of management.

A successful early gore-tex reconstruction of an abdominal wall defect in a neonate with Cantrell pentalogy: a case report and literature review.

A surgical technique, materials used for abdominal wall reconstruction, and postoperative care are important for patient outcomes. We report the first case of neonate with Cantrell's pentalogy surviving early reconstruction of abdominal, diaphragmal and pericardial defects. Several recent investigations suggest that intraabdominal pressure monitoring may improve outcomes in this patient category.

Live Dirofilaria immitis found during coronary artery bypass grafting procedure.

Dirofilaria immitis is a parasite transmitted by mosquito bites, where the most common primary hosts are dogs, cats and some wild animals. Humans become accidental hosts after being bitten by an infected mosquito and the number of such infections has rapidly increased during the last decade. We present a patient in which a live D. immitis has been found during myocardial revascularization. To the best of our knowledge, live D. immitis found in the substernal area during open heart surgery has never before been described. D. immitis in humans most often cause pulmonary nodules known as 'coin lesions' which are benign and asymptomatic, but it is very important for thoracic surgery that they are considered in the differential diagnosis of pulmonary nodules. Video assisted thoracic surgery has been proven as the best method for diagnosing and treating pulmonary dirofilariasis.

Surgical treatment of patients with penetrating chest injuries sustained in war.

AIM: To show our experience in treatment of patients with penetrating chest injuries sustained during the Homeland War in Croatia METHODS: It was a retrospective study based on the records of the Department of Surgery of the University Hospital of Osijek (Croatia). All patients surgically treated during the wartime period (1991.-1995.) were analysed with respect to death rate, causes of injuries, frequency of injuries of thoracic organs and frequency of combined injuries of thorax and abdomen. Most of our patients were treated with thoracotomy as opposed to the common protocol (thoracostomy) applied in usual treatments. RESULTS: The study includes 157 patients with penetrating chest wounds, 111 (70.7%) of which were from metal fragments of bursting artillery, 37 (23.6%) of the wounded were exposed to gunshot bullets, and 9 (5.7%) had stab injuries. Lung injuries had 134 (85.4%) patients, and 15 (9.6%) had injuries of the heart. Chest injuries combined with injuries of abdominal organs happened in 30 (19%) cases. The abdominal organs in question were the liver, spleen, stomach, and colon, in eight (26.6%), seven (23.3%), four (13.3%), and three (10.0%) cases, respectively. Thoracotomy was performed in 144 (91.7%) cases, 13 (8.3%) of the patients underwent thoracostomy, and 134 (85.3%) patients stayed alive. CONCLUSIONS: It points out that, in our case due to organizational problems, aggressive surgical procedure of patients with penetrating chest and multiple injuries sustained in war was the good choice.