Reduction of post-surgical pericardial adhesions using a pig model.

BACKGROUND: Post-surgical pericardial adhesions pose an increased risk of complications during redo sternotomies. Adhesive tissue formation is a normal response to tissue injury and involves complex patho-physiological processes including the actions of prostaglandins to cause plasma leakage and fibrin formation. The purpose of this study was to assess the ability of two non-steroidal anti-inflammatory agents (Indomethacin and Rofecoxib) and a barrier (Coseal, a polyethylene glycol) to limit adhesion formation following cardiac surgery in a pig model. METHODS: Forty-four piglets were allocated equally to four treatment groups: Group 1: Control, Group 2: intramuscular Indomethacin, Group 3: oral Rofecoxib and Group 4: Coseal sprayed on the heart. A full median sternotomy was performed on each animal and the heart exposed. Adhesions were induced by rubbing tissues with gauze, applying sutures and leaving blood in the pericardial sac before chest closure. Plasma inflammatory markers including prostaglandin E(2) and thromboxane B(2) were measured preoperatively and on Days 2, 5 and 10 after surgery. Eight animals from each group were slaughtered after 12 weeks and 3 after 25 weeks. Adhesions were assessed macroscopically and microscopically. RESULTS: Compared to the Control group, the extent of adhesions was significantly less in all other groups whilst adhesion density was least in the Indomethacin and Coseal groups. Indomethacin and less so Rofecoxib, inhibited the synthesis of prostaglandin E(2) and thromboxane B(2) but there were no significant changes in other inflammatory markers. CONCLUSIONS: We conclude that systemic Indomethacin, and locally applied Coseal are suitable methods to markedly reduce pericardial and retrosternal adhesions.

Primary solitary mediastinal mass lesions: a review of 37 cases.

BACKGROUND: Primary solitary mass lesions of the mediastinum, although relatively uncommon, encompass an interesting spectrum of pathologies. METHODS: A comprehensive retrospective review was undertaken of all cases of mediastinal lesions that presented to the two major thoracic surgical centres in North Queensland, Australia, over a 7-year period. RESULTS: Thirty-seven mediastinal mass lesions were managed over the period of the review. Over one-quarter of all cases were clinically silent, the pathology having been discovered incidentally during investigation for other reasons. Malignant thymoma was the single most common pathology, being present in 13 (35.1%) cases. A variety of other pathologies were encountered, including thymic cyst, bronchogenic cyst, neurofibroma, parathyroid adenoma, and lymphoma. Expeditious surgical resection of the lesions, once discovered, afforded good medium-term survival, even for those patients with malignant pathology. CONCLUSIONS: Prompt thoracic surgical referral with view to aggressive, early resection optimizes clinical outcome in the short and medium-term for patients presenting with mass lesions of the mediastinum.

Outcomes of coronary artery bypass graft surgery.

This review article summarizes the major studies that have investigated the outcomes of coronary artery bypass graft surgery (CABG). The article includes a review of the literature in the areas of: history of CABG; indications for CABG; and measurement of quality of life following CABG, including prolongation of life, physical functioning (ie, relief from angina and dyspnea, physical activity, as well as complications of surgery and re-hospitalization), psychological functioning, and social functioning. Overall, the literature demonstrates that the outcomes of CABG have historically been measured in terms of mortality and morbidity; however, it has now been well recognized that adjustment to CABG is a multidimensional phenomenon that is not fully explained by medical factors. Therefore, in addition to studying mortality and morbidity outcomes following CABG many recent studies have identified that it is important to investigate various physical, psychological, and social variables that have a significant impact on post-operative adjustment to CABG.

Conservative management of a large oesophageal haematoma as a complication of systemic thrombolysis.

An acute coronary syndrome patient was treated with tissue plasminogen activator to produce thrombolysis. Six hours post-lysis, haematemesis occurred. Computed tomography (CT) revealed a large haematoma around the lower oesophagus and endoscopy showed a tear in the lower end of the oesophagus. This case represents an unusual complication of anticoagulation and thrombolysis associated with the management of acute coronary syndrome. Conservative management was successful.

Platelet function after off pump coronary surgery.

BACKGROUND: Little is known about the impact of off pump coronary artery bypass (OPCAB) on platelet function. Although improved platelet function may decrease bleeding and reduce cerebral and pulmonary damage, there is a concern that changes in platelet function may also accentuate bypass graft occlusion or other thrombotic processes. In this pilot study we used a point-of-care test--Hemostatus (Medtronic, Minneapolis, MN, USA)--to assess changes in platelet function after OPCAB. METHODS: We analyzed data from 11 adult patients undergoing CAB surgery whose platelet function was assessed before and after OPCAB. A Hemostatus test was conducted prior to heparin administration and after protamine reversal. RESULTS: There was a significant improvement in platelet function as measured in both channels 5 and 6 of the Hemostatus test. Blood loss was 598 +/- 244 mL in the first 24 hours. One patient received blood products. CONCLUSION: This pilot study suggests that platelet function is not diminished but instead is improved after OPCAB. This improvement may be due to the release of newer, larger platelets from the bone marrow into the circulation. This finding has important implications for the use of antiplatelet agents perioperatively. Furthermore, more detailed studies in this field are needed.

Angiosarcoma of the right ventricle: a rare encounter.

We report a case of angiosarcoma involving the right ventricle. The patient was seen in our Cardiology Department and subsequently referred to our unit for surgery. He gave a 1-week history of lethargy, chest pain, breathlessness on exertion, fevers, and night sweats. Echocardiography and computed tomography of the chest showed a large pericardial effusion with multiple densities, raising suspicions of a hemorrhagic effusion. Surgical exploration showed an epicardial mass. Histopathology revealed angiosarcoma.