New World's old disease: cardiac hydatid disease and surgical principles.

BACKGROUND: Hydatid cyst is a parasitic disease caused by infection with the Echinococcus granulosus tapeworm larva. It is a major public health problem in endemic regions. Cardiac involvement of the disease is rare. METHODS: Between 1985 and 2015, 12 patients were admitted to our clinic with a possible diagnosis of cardiac hydatid disease. Of these patients, six (50%) were male and six (50%) were female. Mean age of the patients was 42.6 years. RESULTS: The most common location of cardiac hydatid disease was left sided (six patients, 50%). Five (41.7%) patients had cysts located in the right heart, whereas one (8.3%) had a cyst in the interventricular septum. Eleven (91.7%) of the patients were operated on via median sternotomy and the remaining one was operated on via a left anterolateral thoracotomy. Ten (83.3%) of the patients were operated on using cardiopulmonary bypass under moderate hypothermia, whereas the remaining two (16.7%) had off-pump surgery. There was no surgical mortality in our series. All patients were discharged with medical therapy (mebendazole or albendazole) for the duration of six months. No recurrences were observed in their follow ups. CONCLUSION: Although cardiac hydatid disease is rare, its prevalence seems to have increased in the last decade. Any patient with suspected cardiac symptoms suggesting mass lesions should be considered for a differential diagnosis of cardiac hydatid disease, especially in developing countries. Definitive treatment is removal of the cyst, combined with medical therapy.

[Evaluation of post-operative flow and diameter changes in brachial and ulnar arteries in coronary artery bypass surgery patients in which the radial artery is used as graft]. / Koroner arter baypas cerrahisinde radiyal arter grefti kullanilan hastalarda ameliyat sonrasi dönemde brakiyal ve ulnar arterlerde meydana gelen akim ve çap degisikliklerinin incelenmesi.

OBJECTIVE: The radial artery is widely used in coronary bypass surgery. In these patients, forearm and hand circulation is provided by the ulnar artery. This study aimed to investigate post-operative changes in flow and diameter in brachial and ulnar arteries in patients undergoing coronary bypass surgery in which the radial artery is used as graft. METHODS: Between September 2007 and September 2008, 20 patients (16 men, 4 women; mean age 57.8 years; range 44 to 70 years) underwent elective coronary bypass surgery at our clinic. The radial artery was used as graft in all cases. Pre-operatively, adequacy of the ulnar artery for forearm circulation was investigated by Allen test and duplex ultrasonography. Basal flow and diameter values of the brachial and ulnar arteries were measured. Control duplex ultrasound measurements were performed at three months post-operatively. Flow and diameter changes in the brachial and ulnar arteries were recorded. RESULTS: Significant increase was shown in ulnar artery flow and diameter values in post-operative measurements. A significant increase was observed in brachial artery diameter, accompanied by a relative decrease in flow value. There were no mortality or ischemic complications in our study. Transient paresthesia as a neurological complication was observed in 4 patients. CONCLUSION: Radial artery use for coronary bypass surgery leads to significant changes in ulnar and brachial arteries. All flow and diameter changes can be detected by color Doppler ultrasonography in the early stages. These adaptation mechanisms show that the radial artery can be safely harvested as graft material.

Comparison of autologous basilic vein transpositions between forearm and upper arm regions.

Arteriovenous fistulas are crucial for hemodialysis performances in patients with end-stage renal disease. In this report, we compare the results of basilic vein transposition in the forearm and upper arm regions. Autologous basilic vein transpositions were used in 20 patients with end-stage renal failure between May 2000 and January 2002. In 10 cases the basilic vein transposition was in the upper arm region for construction of a brachiobasilic fistula (group 1); in the remaining 10 cases it was in the forearm region for creation of a radiobasilic fistula (group 2). The mean age of the patients in group 1 was 53.6 years, and in group 2 it was 47.3. At the end of the follow-up period (mean, 10 months) patency rates in group 1 were 80% and in group 2, 90%. In group 2, early-term thrombosis, which could be treated easily with second intervention and anticoagulation treatment (low-molecular-weight heparin), was the most common complication (10%). For patients who have unsuitable cephalic vein and require long-term hemodialysis, transposition of the basilic vein in the forearm region (under the elbow) can be a good secondary choice for access, as can a brachiobasilic fistula in the upper arm region.

Benign mature cystic teratoma of the anterior mediastinum leading to heart failure: report of a case.

A 12-year-old male child was referred to our clinic for the surgical treatment of an anterior mediastinal mass, suspected to be a thymic cyst, which was considered to potentially lead to cardiac failure. The mass was resected completely with a median sternotomy. The postoperative course was uneventful. A pathological examination revealed a mature cystic teratoma of anterior mediastinum which is a very rare cystic tumor at this location. The incidence, diagnostic procedures, complications, and treatment of mediastinal teratomas are discussed along with a review of the literature.