Inguinal synovial sarcoma revealed by a limb swelling: A case report.

INTRODUCTION AND IMPORTANCE: Synovial sarcoma is a malignant soft tissue tumor typically found near joints; its occurrence in the inguinal region is very rare. CASE PRESENTATION: We report a 23-years-old who presented with lower limb swelling. Imaging studies revealed a tumor in the groin area, compressing the femoral vein. A trucut biopsy concluded a synovial sarcoma. A complete resection was performed and the patient had adjuvant radiotherapy and chemotherapy with no evidence of reccurrence at 2-years follow-up. CLINICAL DISCUSSION: Synovial sarcoma accounts for approximately 8 to 10 % of all soft tissue sarcomas. It is predominantly localized near the large joints in the limbs, with the inguinal location being extremely rare. Clinical diagnosis of the mass can sometimes be challenging. A needle biopsy, followed by histological analysis, is necessary to establish the diagnosis. MRI is considered the gold standard radiological examination for local staging of the tumor. The main treatment approach for synovial sarcoma is wide-margin resection, involving en-bloc resection of the tumor with clear margins. Vascular resection and reconstruction should be considered for involved vessels. Some authors argue that resection alone is sufficient for treating primary synovial sarcoma. However, adjuvant chemotherapy may be effective in cases where surgery quality is poor, making it a non-standard treatment. Others have highlighted the potential benefits of adjuvant radiotherapy, particularly in high-grade tumors. CONCLUSION: Surgical excision remains the mainstay of treatment. Therefore, it is necessary to be aware of the different clinical presentations, which can sometimes be unusual.

Left sleeve pneumonectomy for a rare lung tumor: A case report.

INTRODUCTION AND IMPORTANCE: Primary adenoid cystic carcinoma (ACC) of the lung is extremely rare. This tumor can be asymptomatic or have non characteristics symptoms, and the diagnosis is often late. The treatment of choice is surgery when it's possible. CASE PRESENTATION: We herein report the case of a young patient with ACC of the left main bronchus. He had dyspnea and chest pain for 6 months. Complete atelectasis of the left lung was found on the chest x-ray. Bronchoscopy showed a tumor obstructing the LMB and invading the carina. The CT scan revealed a 5 cm tumor obstructing the left main bronchus (LMB) with extension to the carina and thoracic trachea. The extension assessment was without abnormalities. The treatment was surgical. A left carinal pneumonectomy by double lateral thoracotomy was performed. The postoperative results were satisfactory. There was no recurrence with a follow-up of 2 years. CLINICAL DISCUSSION: The therapeutic management of ACC is essentially based on surgical resection, which should be as radical as possible. However, complete resection is often difficult given the infiltrating nature of the tumor. CONCLUSION: Sleeve pneumonectomy with carinal resection is a curative option for patients with ACC of the main bronchi and carina that require expertise of the surgeons.

Oxygen delivery monitoring under cardiopulmonary bypass : what implication on postoperative morbidity and mortality ?

INTRODUCTION: The standard control parameters of cardiopulmonary bypass (CPB) currently used in Tunisia are replaced in Western countries by the concept of "goal-directed-perfusion" requiring oxygen delivery (DO2) minimum at 270ml / min / m2. AIM: In this study, we explored the association between the DO2 and the postoperative morbidity and mortality. METHODS: This is a cross-sectional and retrospective observational study including a series of 50 patients operated on for myocardial revascularization under CPB. RESULTS: We noticed a significant correlation between starting DO2i and Creatinine clearance at day 0, Δcreate (day 1-day 0) and ventilation time. There was also a significant correlation between discharge DO2i and daytime urine output, ventilation time, hospital stay and in-hospital mortality. Through a univariable study, we compared the classic parameters of perfusion monitoring during CPB in addition to the starting DO2i with the different postoperative results. It was noted that the starting DO2i figures below the threshold of 270ml / min / m² were significantly correlated with the duration of administration of catecholamines postoperatively, with prolonged ventilation, with the variation in serum creatinine postoperatively and with in-hospital mortality. CONCLUSION: DO2 is a monitoring tool that has proven its advantages for monitoring under CPB.

Surgical management of a simultaneous aortic valve replacement and pneumonectomy.

Combined heart surgery and lung resection remains a controversial issue. The treatment of two major conditions in the same operative time may be attempted in certain cases. We report the case of a 68-year-old man who presented for dyspnea on exertion. The chest computerized tomography scan showed an infiltrating tumor which involved the right interlobar artery. A pneumonectomy was indicated and the preoperative echocardiography detected a calcified aortic valve with severe stenosis and significant pressure gradient. The patient had combined pneumonectomy and aortic valve replacement through median sternotomy and was discharged 18 days after surgery. Cardiac valve replacement is feasible in conjunction with pulmonary resection. However morbidity is increased in case of associated pneumonectomy.

The emergent use of Cardiopulmonary bypass and extracorporeal membrane oxygenator in a child with sickle cell disease.

The use of Cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenator (ECMO) in patients suffering from Sickle cell disease (SCD) needs specific precautions. Whereas, no consensual protocols have been established to clarify therapeutic management. CASE REPORT A 7-year-old boy was admitted to the hospital for surgery of advanced endocarditis.  Major dyspnea, hemodynamic distress and fever were noted on physical examination. Biological tests exploring anaemia revealed Haemoglobin (Hb) S levels of 39.1%. Echocardiography showed important right heart cavities dilation with multiple aortic vegetations. The child was accepted for emergent surgery. Ten minutes after anesthetic induction, serious hemodynamic distress was established. The patient was put on normothermic CPB when he received four packed red-blood-cell. After surgery, he was placed on ECMO support for 2 days than he succumbed. CONCLUSION Urgent cardiac surgery in patients suffering from SCD poses a major therapeutic dilemma. Multiplying case reports and encouraging prospective studies are necessary to define the right place of cardio-pulmonary assistance in treatment protocols for better management.

[Beating heart coronary artery bypass: 100 cases]. / Pontage coronaire à coeur battant : A propos de 100 cas.

BACKGROUND: Coronary artery revascularization with cardiopulmonary bypass has been reported to carry several risks. AIM: Off-pump coronary artery bypass grafting has been proposed to result in a better outcome. The aim of this study is to assess the effect of off-pump cardiopulmonary bypass. METHODS: In a 7-year period, a total of 100 patients undergoing isolated first-time off-pump coronary artery bypass graft were studied. The mean ejection fractions was 48% and the EUROSCORE mean was 4.9. RESULTS: The average number of grafts was 1.55 per patient. The postoperative outcomes were simple for most patients with little use of inotropes after 24 hours (42%), few cases of atrial fibrillation (9.4%), and transfusion (27.3%). Time to extubation was less than 48 hours in most cases (94.7%) and hospital mortality rate was 10.5%. CONCLUSION: The beating heart bypass surgery allows good immediate results including multi-vessel disease and in patients at high risk.