[Left atrial mass]. / Sol atriyum kitlesi.

A 56-year-old woman presented with a complaint of dyspnea on minimal exertion for the past two months and orthopnea of three-day history. She was first examined at another hospital two years before for nonproductive cough, for which computed tomography was performed that showed a right pulmonary mass. The patient refused further evaluation and treatment at that time. Transthoracic echocardiography revealed a large mass filling the entire left atrium via the inferior pulmonary vein and causing mitral flow obstruction during diastole. Computed tomography of the thorax showed a large mass filling the entire right lower lobe, which occluded the right lateral lobe superior segmental bronchus and obliterated the lower lobe segment bronchi. As the patient was severely symptomatic, she underwent right lower and middle lobectomy and left atrial mass resection, based on the decision of the surgery council. The pathological examination of the specimens from both atrial and pulmonary masses revealed pulmonary large cell carcinoma. The patient died due to cardiopulmonary arrest on the postoperative 20th day.

Endovascular stent graft treatment in a patient with splenic artery aneurysm.

Splenic artery aneurysms are rare but important vascular lesions that constitute approximately 60% of all visceral arterial aneurysms. Splenic artery is the third most common localization of intraabdominal aneurysm formation. Rupture is the main complication that occurs in 3%-10% of the cases. We describe a case with a proximal splenic artery aneurysm. To preserve splenic function and reduce the risk of aneurysmal rupture, we used stent-graft to embolize the aneurysm treated percutaneously. The follow up of patient was uneventful after embolization. Endovascular embolization of the splenic artery aneurysm may prevent the need for emergency surgery and also offer an effective alternative surgical treatment.

Short and long term survival of surgical treatment of left ventricular aneurysms: ten years experience.

Although surgical treatment of left ventricular aneurysms has been performed for a long time, it is still a point of debate. In this study, we investigated 159 patients who had undergone surgery for a left ventricular aneurysm in our clinic between 1985 and 1994. Perioperative mortality, long term survival rates, and parameters which probably affect these ratios were evaluated. All of the patients except one were followed by clinical records, mail or phone. Classic linear repair (111 cases), plication (46 cases), and Dor plasty (2 cases) were performed. Revascularisation procedure was also performed in 140 (88%) cases. The average number of distal anastomosis was 2.6. Twenty cases (12.6%) died in the perioperative period. The most important parameter which affected early mortality was the requirement for an intra-aortic balloon pump in the postoperative period. Mean follow-up duration was 47 +/- 35 months. Forty-two late deaths occurred in this period. The overall 5-year survival rate was 71%. Predictors for long term mortality were related to preoperative left ventricular function, presence of congestive heart failure, and poor functional capacity. The type of surgery did not affect short and long term survival. The functional capacity of the survivors was improved. In conclusion, surgical treatment of left ventricular aneurysms with classic linear repair and plication had acceptable short and long term survival rates and improved functional capacity. The most important predictor of survival in either the early or late postoperative period was preoperative left ventricular function.

Report of a case with polymicrobial endocarditis related to multiresistant strains.

We present a patient with polymicrobial endocarditis who had been operated on previously for a mycotic aneurysm and was seen at the cardiology clinic because of palpitations related to effort. A transesophageal echocardiogram revealed a 15-mm vegetation on his aortic valve. Staphylococcus epidermidis and Corynebacterium striatum were isolated from the blood cultures. Both strains were multiresistant (susceptible to 3 antibiotics at most) against chemotherapy in vitro. Microbiological eradication was not achieved from blood cultures even after applying antimicrobial therapy with effective antibiotics as determined with an antibiotic susceptibility test. For this reason, the patient underwent valve replacement. He was discharged from hospital in fairly good health.