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.

Is postoperative cognitive decline after cardiac surgery associated with plasma beta amyloid 1-42 levels?

BACKGROUND: Postoperative cognitive decline following cardiac surgery is one of the frequently reported complications affecting postoperative outcome, characterized by impairment of memory or concentration. The aetiology is considered multifactorial and the research conducted so far has presented contradictory results. The proposed mechanisms to explain the cognitive decline associated with cardiac surgery include the neurotoxic accumulation of ß-amyloid (Aß) proteins similar to Alzheimer's disease. The comparison of coronary artery bypass grafting procedures concerning postoperative cognitive decline and plasmatic Aß1-42 concentrations has not yet been conducted. METHODS: The research was designed as a controlled clinical study of patients with coronary artery disease undergoing surgical myocardial revascularization with or without the use of a cardiopulmonary bypass machine. All patients completed a battery of neuropsychological tests and plasmatic Aß1-42 concentrations were collected. RESULTS: The neuropsychological test results postoperatively were significantly worse in the cardiopulmonary bypass group and the patients had larger shifts in the Aß1-42 preoperative and postoperative values than the group in which off-pump coronary artery bypass was performed. CONCLUSIONS: The conducted research confirmed the earlier suspected association of plasmatic Aß1-42 concentration to postoperative cognitive decline and the results further showed that there were less changes and lower concentrations in the off-pump coronary artery bypass group, which correlated to less neurocognitive decline. There is a lot of clinical contribution acquired by this research, not only in everyday decision making and using amyloid proteins as biomarkers, but also in the development and application of non-pharmacological and pharmacological neuroprotective strategies.

Urgent Off-Pump Coronary Bypass Grafting in Moyamoya Disease: A Case Report.

Moyamoya disease is a rare progressive cerebrovascular occlusive disease that predominantly occurs in countries in Northeast Asia. We report a 54-year-old male patient with moyamoya and coronary artery disease, on whom urgent off-pump coronary artery bypass grafting was performed after cardiopulmonary reanimation due to ventricular fibrillation. This patient had left main trunk disease, a Pudenz peritoneal catheter (Medtronic, Inc., Minneapolis, MN, USA) for liquor drainage, bilateral internal carotid artery occlusion, diffuse peripheral atherosclerotic artery disease, and chronic renal insufficiency. We prefer off-pump surgery to avoid the risk of intraoperative hypotension and minimize the risk of perioperative cerebral ischemic complications.

Case Report: Surgical Treatment of Two Asymptomatic Myxomas at Two Atypical Locations.

Atypical presentation of myxomas in the two cases described here arise from the fact that both patients were asymptomatic and both showed unexpected echocardiographic findings. Asymptomatic presentation is very rare, and occurs in only about 10% of individuals. Atrial myxomas discovered on incidental echocardiography is also a rare phenomenon, as seen in our cases. Early diagnosis and timely surgical treatment allow these patients to live a completely asymptomatic life.

Giant primary pleomorphic adenoma of the lung presenting as a post-traumatic pulmonary hematoma: a case report.

BACKGROUND: Pleomorphic adenomas, also known as benign mixed tumors, are the most common tumors of glandular origin in the head and neck and although they are generally benign they can undergo malignant transformation. Primary pleomorphic adenomas of the lung are extremely rare tumors with less than 40 cases reported in the literature by now. This is the first case in the literature describing overlapping with a traumatic event and also one of the rare cases describing primary adenoma of the lung reaching this impressive size. CASE PRESENTATION: We report a rare case of a giant primary pleomorphic adenoma of the lung presenting as a post-traumatic pulmonary hematoma. A 38-year-old Caucasian male patient came to the Urgent Trauma Center after being hit in the chest by a bull and, after a number of tests, was diagnosed with primary pleomorphic adenoma of the lung. Operative treatment was performed and the surgical excision was successfully done. CONCLUSIONS: Our conclusion is that the surgical excision is the main treatment for pleomorphic adenoma of the lungs and we recommend lifelong follow-up and regular check-ups. Furthermore, we consider our case an interesting one due to its concurrence with the chest trauma and the dilemma about the optimal approach considering the entity could have been a large interlobular hematoma.

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.

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.

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.