Surgical outcomes for congenital lung malformations: 10 years experience at a single center.

OBJECTIVE: To study the surgical outcome of congenital lung malformation and natural history of the disease at Srinagarind Hospital. MATERIAL AND METHOD: Retrospectively review the medical records of 25 patients diagnosed with congenital lung malformation who underwent surgical treatment between January 2001 and December 2011. RESULTS: Twenty-five patients diagnosed with congenital lung malformation underwent surgery: 16 males (64%), 9 females (36%), median age seven months, median body weight 6 kg. Twelve (48%) had congenital cystic adenomatoid malformation congenital cystic adenomatoidmaflormation (CCAM), seven (28%) pulmonary sequestration, four (16%) congenital lobar emphysema, and one a bronchogenic cyst (4%). The most common presenting symptoms were respiratory tract infection (14, 56%), respiratory distress (7, 28%), lung abscess (1, 4%), hemoptysis (1, 40%), and asymptomatic (2, 8%). Post-operative mortality over 30 days was 0. Complications included lung infection, atelectasis, post-operative bleeding, and wound infection. Post-operative follow-up (lasting between 1-8 years) revealed normal tolerance to daily activity without any respiratory problems. CONCLUSION: Surgical treatment for congenital lung malformations had a good result with few complications.

Diagnostic accuracy of coronary CT angiography in patients after coronary bypass surgery: evaluation of grafts and native coronary arteries.

OBJECTIVE: To evaluate the diagnostic accuracy in the assessment of both grafts and native coronary arteries in patients after coronary artery bypass grafts (CABG) by coronary CT angiography (CCTA) in comparison to invasive conventional coronary angiography (CCA). MATERIAL AND METHOD: CCTA was performed in 54 symptomatic post-CABG patients. Two independent, blinded observers assessed all grafts and native coronary arteries for significant stenosis. CCA served as a reference standard One hundred seventy two graft segments, 156 distal coronary run-offs, 314 grafted coronary segments, and 18 non-grafted coronary segments were analyzed RESULTS: The diagnostic accuracy of CCTA for exclusion or detection of significant stenosis in venous grafts and non-grafted segments of native coronary arteries was 100%. Sensitivity, specificity, and positive and negative predictive values were all 100%. Sensitivity, specificity, and positive and negative predictive values to detect significant stenosis were 100%, 98%, 91%, and 100%, respectively, in arterial grafts, 100%, 99%, 75%, and 100%, respectively, in distal runoffs, and 100%, 87%, 99%, and 100%, respectively, in grafted segments of native coronary arteries. CONCLUSION: Non-invasive coronary CT angiography provides high diagnostic accuracy for evaluation of both bypass grafts and native coronary arteries, although, CCTA is more effective in evaluation of bypass grafts as compared to heavily calcified native coronary arteries.

The posterior pericardiotomy. Does it reduce the incidence of postoperative atrial fibrillation after coronary artery bypass grafting?

Atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass graft surgery (CABG). Posterior pericardiotomy (PP) has been reported toreduce pericardial effusion, AF triggel; and reduce the length of hospital stay and hospital costs without significant complications. A total of 20 patients, diagnosed with coronary artery diseases to be treated by an elective or urgent CABG between August and December 2013, were randomly divided into two groups; 10 patients received PP (PP group) and 10 patients did not receive PP (control group). The incidence ofAF was equal (40% in both groups). Early pericardial effusion was slightly higher in the PP group (PP 70%, control 60%; p = 1.00). The incidence of left pleural effusion and pneumonia were higher in the PP group than in the control. Moreover, one patient in the PP group developed perioperative myocardial infarction (MI) that required intensive care with medication. The duration of ICU stay of the PP group was significantly longer than that of the control group. In conclusion, PP did not reduce the incidence of postoperative AF nor did early pericardial effusion. Rather, PP increased post-operative complications such asperioperative MI, left pleural effusion, and pneumonia resulting in the prolonged ICU stay.

Malignant mesothelioma of the pericardium: a report of two different presentations.

Malignant mesothelioma of the pericardium is a rare and fatal condition that clinicians should be aware of due to its variability of clinical manifestation. The diagnosis may be delayed as a result of delayed treatment. Here, we report two cases of malignant pericardial mesothelioma with two different clinical aspects: cardiac tamponade and mimic tuberculous pericarditis. Both patients: may have indirect exposure to asbestos. Despite chemotherapy, both patients died at 2 weeks and 3 months after the diagnosis. Malignant mesothelioma of the pericardium is fatal, has a variety of presentation, and may not be related to asbestosis exposure.

Treatment of pulmonary aspergilloma in Srinagarind Hospital.

BACKGROUND: Controversy still exists concerning the optimum management of aspergilloma. OBJECTIVE: To evaluate clinical data of patients, the indications for surgery, postoperative complications and results of all treatments of pulmonary aspergillosis compare with data from review literature, to find out the optimum management. MATERIAL AND METHOD: The authors retrospectively reviewed medical records of 45 patients at Srinagarind Hospital who had pulmonary aspergilloma between 1993 and 2008. General data, associated diseases, symptoms, organs involvement, treatments, surgical indications, procedures and complications, and outcome were collected for analysis. RESULTS: Associated diseases were found in 33 patients (73.3%). Tuberculosis was the most common underlying causes. Hemoptysis, the most frequent symptom, occurred in 29 patients (64.4%0). If 40 patients, they only had lung lesion although 5 patients had multiple organ-involvement. Surgery was performed in 24 patients (53.3%). Hemoptysis was the most common indication and lobectomy was the most frequent procedure. Postoperative complications occurred in 5 cases (20.80%) and mortality rate after surgery = 4.2%. Embolization was done on 4 patients; none of them re-bled. Clinical outcome improved in 36 cases (80%), did not improved in 6 patients (13.3%), and resulted in 3 patients' death (6. 7%). CONCLUSION: The most common indication for surgery was hemoptysis. Recurrence of hemoptysis was found in all patients who received selective bronchial artery embolization. Surgical resection is the treatment of choice with acceptable postoperative complications and mortality rate.

Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial.

Use of silicone derivative and onion extract had been reported in the prevention of hypertrophic scarring. Our experience showed the preventive use of silicone derivative plus onion extract gel on hypertrophic scars after median sternotomy. In a randomized, double blinded, placebo-controlled study, 60 patients after median sternotomy incisions were separated into two groups. All patients were treated either with silicone derivative plus onion extract gel (Cybele(®) scagel) or placebo gel twice daily for a total treatment period of 12 weeks. During each visit, pain and itching scores were graded by the patients and scar characteristics were observed by surgeons using the Vancouver scar scale. Pain and itch score values from patients' who applied silicone derivative plus onion extract gel was less than another group (P < 0·05). Pigmentation was significantly different between two groups (P < 0·05) and the reduction of scores on vascularity, pliability, height in treated group was not superior to the untreated group. No adverse events were reported by any of the patients. A silicone derivative plus onion extract gel is safe and effective for the preventing the hypertrophic scarring after median sternotomy.

Congenital aortocaval fistula to the superior vena cava: a case report.

Various systemic arteriovenous fistulas have been described. The arteriovenous fistula arising from the ascending aorta and draining separately into the superior vena cava is very uncommon. The authors report a case of congenital aortocaval fistula to the superior vena cava in a 22 year-old woman in whom the fistula was closed successfully.

Pleuropulmonary blastoma in a child presenting with spontaneous pneumothorax.

The authors described a 27-month-old boy with the diagnosis of pleuropulmonary blastoma who presented with spontaneous pneumothorax. The child was admitted to our hospital with the chief complaint of respiratory distress for 8 months. Initial chest X-ray revealed tension pneumothorax on the right side. After chest tube insertion to the right side, a repeated chest X-ray showed minimal pleural effusion and a mass-like lesion at the right lower lung field. Computed tomography (CT) of the chest showed a cavity with intramural mass confined in the right lower lung accompanied with hydropneumothorax. The surgery revealed a cystic and solid mass occupying the right pleural space medially displacing the right lower lung. Total removal of the mass was performed, the histopathologic findings revealed a mixed cystic and solid type of pleuropulmonary blastoma which was composed of primitive blastema with multidirectional differentiation. Combination chemotherapy consisting of vincristine, cyclophosphamide, doxorubicin and dactinomycin was administered two weeks after surgery. The child has been well for almost 6 months since the surgery, without any signs of metastasis or recurrence.