Chondromyxoid Fibroma of a Rib.

Introduction: Chondromyxoid fibroma (CMF) is an uncommon bone tumor, accounting for <1% of all bone tumors. It generally affects the metaphysis of the long bone of the lower limb and seldom involves the small bones, but the involvement of the flat bones, like ribs, is infrequent. Case Report: A teenage girl complained of pain on the right side of the chest for the past 6 months, dull aching, and persistent without any diurnal variation. The chest X-ray examination showed a nodular, hyperdense lesion on the lateral chest wall near the 5-7th rib on the right side. A computed tomography scan confirmed the lesion from the sixth rib with ground-glass matrix and cortical thinning with a smooth margin, without any soft-tissue involvement. An enblock excision of the lesion was done. Histopathological studies showed a well-circumscribed tumor with reactive bone formation at the periphery with lobules of chondromyxoid tissue separated by spindle cells and stellate-shaped cells suggestive of CMF. At 1-year follow-up, she is asymptomatic without any recurrence. Conclusion: CMFs are rare benign tumors that require histopathological study to differentiate from other benign lesions of the bone. In flat tubular bones like the ribs, enblock resection is the mainstay of treatment.

Management of Thrombosis of the External Iliac Artery during Total Hip Arthroplasty - A Case Report.

Introduction: Vascular injury following total hip arthroplasty (THA) is uncommon but can lead to loss of life or limb. External iliac and common femoral arteries are commonly injured during THA. Case Report: We report a case of thrombosis of the external iliac and femoral artery during THA in a mid-60-year female patient with 15-year-old neglected fracture neck of the femur. Six hours following THA through Harding's approach, a feeble pulse was palpated in the operated limb. Ischemia of the limb led to sciatic nerve palsy and foot drop in the operated limb, which was intact following surgery. Computed tomography angiography confirmed thrombosis of the external iliac and femoral artery. Removal of thrombosis with the use of a Fogarty catheter could save the limb and lead to recovery of foot drop. Early detection of pulselessness and timely intervention in the post-operative period was the cornerstone of this case report. Conclusion: Vascular injury during THA though rare but cannot be ruled out completely. Early diagnosis with a stringent post-operative protocol and timely intervention would be the cornerstone of the management of any vascular injury following THA.

Idiopathic Pericardial Ossification Causing Chronic Constrictive Pericarditis.

BACKGROUND: Chronic constrictive pericarditis (CCP) is usually caused by the fibroinflammatory reaction of the visceral and parietal pericardium that encase the heart. The cause of CCP is various including tuberculosis, trauma, prior surgery, radiation, and malignancy. MATERIAL AND METHODS: We examined the pericardiectomy specimen of a case of CCP in a 17-year-old boy. RESULTS: The histopathology of the pericardium revealed pericardial ossification bony remodeling and hematopoiesis within the intertrabecular marrow spaces. No granulomatous or neoplastic etiology was identified. CONCLUSION: Idiopathic pericardial ossification can cause CCP in pediatric patients.

Diagnosis of absent right superior vena cava with intraoperative transesophageal echocardiography in a child with Holt-Oram syndrome: Anesthetic and perfusion implications.

Holt-Oram syndrome is a rare autosomal disorder with cardiac, vascular, and upper limb anomalies. Previous reports have described anesthetic and perioperative challenges including difficulty in arterial and venous cannulations, airway management and rhythm, and temperature abnormalities. There are no previous reports of absent right superior vena cava (SVC) in children with Holt-Oram syndrome. We present images of a case where the diagnosis of absent right SVC with persistent left SVC was made with intraoperative transesophageal echocardiography and discuss the anesthetic and perfusion implications of such findings.

Acute limb ischemia following iatrogenic femoral artery injury during orchiopexy.

Orchiopexy for undescended testis is a standard procedure in pediatric patients. Intraoperative complications during orchiopexy are rare. Major complications reported include injury to vas deferens or testicular vessels, leading to testicular atrophy. Damage to the femoral artery has not been described in the literature as a complication during orchiopexy. In this report, we describe a case where injury to the right femoral artery leading to acute limb ischemia occurred while performing orchiopexy.

Surgical repair of postcatheterization radial artery pseudoaneurysm.

Radial artery pseudoaneurysm (RAP) at the site of transradial access (TRA) for coronary angiography is rare. A clean puncture, secure bandage, and watchful follow-up are must to prevent complete occlusion and aneurysm formation at the access site. This illustration describes surgical repair as one of the successful strategies to repair a postcatheterization RAP after TRA.

Triple Blow Injury to a Limb: Ipsilateral Hip and Knee Dislocation with Vascular Occlusion.

Ipsilateral hip and knee dislocation (double blow) occurring simultaneously during trauma are rare occurrences that are associated with secondary complications. These are high energy injuries that warrant acute emergency management more so if associated with vascular compromise. We encountered a poly trauma patient having a combined right anterior hip and ipsilateral knee dislocation with vascular occlusion at popliteus level apart from associated segmental radius fracture of the left upper limb. This young patient presented after 22 h being referred form elsewhere making the situation critical to the surgical team. An attempted thrombolysis was done but as gangrenous changes started, we ended up in a below knee amputation. This case highlights a typical scenario in a developing country where facilities involving super specialty services are scarce and even patients are complacent about need for emergent referral. All this adds to surgical dilemma as guidelines are unclear for the best treatment.

Criterions for selection of patients for, and results of, a new technique for construction of the modified Blalock-Taussig shunt.

BACKGROUND: We describe alternative surgical techniques for construction of systemic-to-pulmonary arterial shunts, and propose criterions for their application in selected patients. PATIENTS AND METHODS: We constructed a variety of modified systemic-to-pulmonary arterial shunts, using polytetrafluoroethylene grafts, in 92 selected patients with cyanotic congenital heart disease and anomalies of the aortic arch and systemic veins. Their age ranged from 7 days to 3.6 years, with a mean of 7.08 months. We performed 88 operations through a thoracotomy. Of this cohort, 60 patients underwent a second-stage operation, with 15 receiving a superior cavopulmonary connection, 16 a total cavopulmonary connection, and 29 proceeding to biventricular repair after a mean interval of 15.6 months. We have 21 patients awaiting their second or final stage of palliation. RESULTS: There were five early (5.4%) and six late deaths (6.8%), two of which were related to construction of the shunts. At a mean follow-up of 45.29 months, the increase in diameter of pulmonary trunk and its right and left branches was uniform and significant (p value less than 0.001). Pulmonary arterial distortion requiring correction at the time of second-stage operation was observed in 5 patients (6.1%). Adequate overall palliation was achieved in 98% of the cohort at 8 months, 91% at 12 months, and 58% at 18 months. CONCLUSIONS: Patients with a right- or left-sided aortic arch and right-sided descending thoracic aorta, those with anomalies of systemic venous drainage masking the origin of great arterial branches, and those with disproportionately small subclavian arteries, constitute the ideal candidates for our suggested modification of the construction of a modified Blalock-Taussig shunt. The palliation provided by these shunts was satisfactory, with predictable growth of pulmonary arteries, insignificant distortion in the great majority, and easy take-down.

Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques.

BACKGROUND: This study was designed to compare the outcomes after total versus partial pericardiectomy clinically, echocardiographically, and hemodynamically. METHODS: Three hundred ninety-five patients undergoing pericardiectomy for constrictive pericarditis between January 1985 and December 2004 were studied. Age was 10 months to 71 years (mean, 25.1 +/- 13.4 years). Three hundred thirty-eight patients (85.6%) underwent total pericardiectomy (group I), and 57 patients (14.4%) underwent partial pericardiectomy (group II). RESULTS: Operative and late mortality rates were 7.6% and 4.9%, respectively. Preoperative high right atrial pressure, hyperbilirubinemia, renal dysfunction, atrial fibrillation, pericardial calcification, thoracotomy approach, and partial pericardiectomy were significant risk factors for death. The risk of death was 4.5 times higher (95% confidence interval: 2.05 to 9.75) in patients undergoing partial pericardiectomy. At a mean follow-up of 17.9 +/- 0.3 years (95% confidence interval: 17.3 to 18.6), actuarial survival was 83.8% +/- 0.04% in group I and 73.9% +/- 0.06% in group II (p = 0.004). At their last follow-up, 96.3% survivors of group I and 79.1% survivors of group II were in New York Heart Association class I/II (p < 0.001). CONCLUSIONS: Total pericardiectomy is associated with lower perioperative and late mortality, and confers significant long-term advantage by providing superior hemodynamics that appear to be independent of the etiology of constrictive pericarditis.

One and one-half ventricle repair: results and concerns.

BACKGROUND: The study was designed to assess the long-term results of one and one-half ventricular repair on systemic and pulmonary circulation, right ventricular growth and function, and the prevalence of arrhythmias. METHODS: Eighty-four patients undergoing one and one-half ventricular repair between January 1990 and December 2003 were studied. Age was 4 to 504 months (mean, 47.9 +/- 57.3 months). Sixty-nine survivors underwent serial echocardiography, radionuclide studies, cardiac magnetic resonance imaging, and cardiac catheterization. RESULTS: Operative and late mortality were 10.7% and 8%, respectively. Perioperative and postoperative supraventricular arrhythmias were observed in 14.3% and 15.9% of patients, respectively. Risk factors for supraventricular arrhythmias included systemic ventricular dysfunction, heterotaxy syndrome, and Ebstein's anomaly. Mean late postoperative superior vena caval pressure was 14.2 +/- 1.52 mm Hg and right atrial pressure was 6.6 +/- 0.74 mm Hg. At a median follow-up of 87 months, actuarial survival was 81.9% +/- 0.04%, and 89.8% were in New York Heart Association class I or II. Serial cine-magnetic resonance imaging demonstrated significant growth of tricuspid valve and right ventricular cavity in 45% of patients. CONCLUSIONS: One and one-half ventricular repair can be performed with an acceptable risk. The operation maintains a low pressure in the inferior vena caval tributaries, and reverses the Fontan paradox. Patients with tripartite right ventricles demonstrated a tendency toward enlargement of the pulmonary ventricular chamber commensurable with somatic growth.