Rosai-Dorfman Disease of Right Atrium Mimicking Myxoma.

Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy, is a rare multisystemic disorder that was first reported by Rosai and Dorfman in 1969. It is a distinct histioproliferative disorder due to overproduction of histiocytes, which accumulate in lymph nodes. The cardiac involvement of this disease is extremely rare, and until now, only 18 cases have been reported. We report the case of a 53-year-old woman with right atrial mass mimicking myxoma, which the histopathologic evaluation revealed to be Rosai-Dorfman disease of the right atrium.

Emergent endovascular stent grafting for saccular arch aneurysm complicated by aorto-esophageal fistula.

Aneurysms of aortic arch are rare but amenable to endovascular therapy. Arch aneurysm presenting with aorto-esophageal fistula and hematemesis is a feared, but relatively rare complication. The extrapolation of the safety and rapidity of emergent endovascular repair for bleeding arch aneurysms has been infrequently reported. A bovine arch anatomy confers distinct advantages for endovascular therapy often avoiding a preceding debranching surgery. However, its endovascular treatment might be complicated by the nonhealing of fistula and potential risk for mediastinitis. Here, we report a case of a bovine aortic arch cystic aneurysm complicated by bleeding aorto-esophageal fistula, which warranted an emergent endovascular therapy. The prevertebral part of LSCA was plugged to interrupt the retrograde filling and a future endoleak. A nonhealing aorto-mediastinal fistula at follow-up was successfully treated by covered esophageal stenting. This report reiterates the importance of multidisciplinary approach with multispecialty collaboration to such complex spectrum of diseases.

Concomitant coronary bypass and below knee amputation in a diabetic patient.

A 57-year-old man presented with unstable angina and uncontrolled diabetes with diabetic foot. It was decided to perform right below knee amputation with coronary revascularization in a single stage. Right below knee amputation was carried out first. The left anterior descending artery, ramus intermedius, and second obtuse marginal branch of the circumflex were bypassed on a beating heart, using saphenous vein grafts. The patient was discharged on the 7th postoperative day after a course of antibiotics.

Surgical correction of Lutembacher's syndrome in a patient with severe pulmonary artery hypertension.

Lutembacher's syndrome is an uncommon combination of a congenital ostium secundum atrial septal defect (ASD) with acquired mitral stenosis (MS). The incidence of this condition is very rare. The symptoms are dependent upon the size of the ASD, severity of the MS, compliance of the right ventricle and pulmonary artery hypertension. We describe a patient with Lutembacher's syndrome with severe pulmonary hypertension who underwent successful surgical repair.

Management of a patient with unstable angina, left main coronary artery disease, and respiratory insufficiency due to eventration of the diaphragm.

The incidence of eventration of diaphragm before cardiac surgery is rare. We describe the management of a patient with eventration of the diaphragm who underwent a coronary artery bypass grafting (CABG) for left main coronary artery disease followed by left diaphragm plication with video-assisted thoracic surgery (VATS) for the postoperative respiratory insufficiency.

Parasitic infections in juveniles of Arapaima gigas (Schinz, 1822) cultivated in the Peruvian Amazon.

The paiche, Arapaima gigas represents a socio-economically important species in the Peruvian Amazon, and actually an intensive production for human consumption has emerged during the last years. Therefore, more studies are required in fish farming development, especially concerning populations of parasites that affect fish production yields. Eighty specimens of paiche collected between September and October of 2011 from semi-intensive fish farm in Loreto State, Peru, were examined for their helminthic parasites. Five species were recorded parasitizing A. gigas: Dawestrema cycloancistrium and Dawestrema cycloancistrioides (Monogenea) on gills, Trichodina sp. (Protozoa) on the skin, Caballerotrema arapaimense (Trematoda) in stomachs and Philometra senticosa (Nematoda) in the swim bladder. Highest prevalence was recorded for D. cycloancistrium (100.0%), D. cycloancistrioides (83.0%) and Trichodina sp. (50.0%) and highest values of mean intensity and mean abundance were recorded for D. cycloancistrium (260) parasites per individual. The results confirm the necessity of constant monitoring of fish, seeking the diagnosis and timely control of infestations with parasites, in order to eradicate the mortality of the host that leads unviable the fish farming intended for human consumption.

Time spent on health related activities associated with chronic illness: a scoping literature review.

BACKGROUND: The management of health care, particularly for people with chronic conditions, combines the activities of health professionals, patients, informal carers and social networks that support them. Understanding the non-professional roles in health management requires information about the health related activities (HRA) that are undertaken by patients and informal carers. This understanding allows management planning that incorporates the capacity of patients and informal carers, as well as identifying the particular skills, knowledge and technical support that are necessary. This review was undertaken to identify how much time people with chronic illness and their informal carers spend on HRA. METHODS: Literature searches of three electronic databases (CINAHL, Medline, and PubMed) and two journals (Time and Society, Sociology of Health and Illness) were carried out in 2011 using the following search terms (and derivatives): chronic illness AND time AND consumer OR carer. The search was aimed at finding studies of time spent on HRA. A scoping literature review method was utilised. RESULTS: Twenty-two peer reviewed articles published between 1990 and 2010 were included for review. The review identified limited but specific studies about time use by people with a chronic illness and/or their carers. While illness work was seen as demanding, few studies combined inquiry about both defined tasks and defined time use. It also identified methodological issues such as consistency of definition and data collection methods, which remain unresolved. CONCLUSIONS: While HRA are seen as demanding by people doing them, few studies have measured actual time taken to carry out a comprehensive range of HRA. The results of this review suggest that both patients with chronic illness and informal carers may be spending 2 hours a day or more on HRA. Illnesses such as diabetes may be associated with higher time use. More empirical research is needed to understand the time demands of self-management, particularly for those affected by chronic illness.

Infestación masiva por Perulernaea gamitanae (Crustacea: Cyclopoida: Lernaeidae) en juveniles de gamitana, cultivados en la Amazonia peruana / Massive infestation by Perulernaea gamitanae (Crustacea: Cyclopoida: Lernaeidae) in juvenile gamitana, cultured in the Peruvian Amazon

The gamitana is a species of socio-economic importance in the Peruvian Amazon, often intensively produced locally for human consumption. Because of this, more studies concerning parasite populations affecting this species' culture are necessary. In this study, a heavy copepod infestation of Perulernaea gamitanae is reported in a managed culture of gamitana. The prevalence of infection was 100% and mortality of the fish population was complete. The average intensity and abundance of the parasite was 268.8 parasites per individual.

La gamitana constituye una especie de importancia socioeconómica en la Amazonia peruana, que ha llevado a su producción intensiva para el consumo humano, pero se requieren más estudios respecto de la población de parásitos que estén afectando su cultivo. En este estudio se identificó una alta infestación por copépodos de la especie Perulernaea gamitanae en un cultivo de gamitana. La prevalencia fue de 100%, con mortalidad de todos los peces. La intensidad media y la abundancia fue, en ambos casos, de 268.8 parásitos por individuo.