Combined left pneumonectomy and off-pump coronary artery bypass through left thoracotomy.

Concomitant pneumonectomy and coronary artery bypass grafting (CABG) carry a high morbidity and mortality rate. We present the case of a patient operated on for left pneumonectomy and off pump CABG through a left thoracotomy incision in a one-stage procedure with a 1-year disease-free follow-up. To the best of our knowledge, simultaneous surgical management as presented in this patient has not been previously reported.

Retrocaval in situ RIMA for distal marginal arteries grafting.

The length of the in situ right internal mammary artery (RIMA) often restricts its use as a graft to distal marginal arteries. We describe herein a retrocaval supra-azygous extra-pleural passage of the RIMA that allows a significant gain in length. We report our experience in 30 patients with distal marginal lesions or with large hearts.

Congenital lumbar hernia in association with carpus equina varus.

A rare case of congenital lumbar hernia associated with carpus equina varus is described in a week old baby. The treatment is described with limited review of the literature.

Cellular transplantation: new horizons in the surgical management of heart failure.

End-stage heart failure results from the irreversible destruction of cardiomyocytes, which do not have the capacity to regenerate. Transplantation of myogenic cells into the damaged myocardium is an emerging therapeutic alternative in the management of this major public health problem. Experimental and clinical data suggest that cellular transplantation could improve ventricular function in ischaemic or dilated cardiomyopathies. Implantation of allogeneic and autologous cell types has been applied to induce cardiac myogenesis and, recently, other cell types have been tested for the induction of myocardial angiogenesis. The results of cellular transplantation are encouraging although the role of therapeutic angiogenesis remains to be clarified and the full potential of cellular transplantation to be determined

Thoracoscopic IMA takedown.

In recent years, the field of minimally invasive cardiac surgery has grown rapidly beginning with the MIDCAB operation and evolving toward totally endoscopic coronary artery bypass grafting (CABG). It promotes the goal of decreasing surgical trauma while maintaining surgical efficacy. For MIDCAB, a limited anterior thoracotomy or mediastotomy have been proposed to harvest the internal mammary artery (IMA). However, complete graft harvesting of the IMA is difficult under direct vision in these circumstances and may necessitate costal resection and important chest wall retraction. Additionally, it carries the potential risk of kinking or coronary steal syndrome. Thoracoscopic harvesting of the IMA avoids these hazards. It permits complete dissection from the subclavian artery to the sixth inter-costal space (ICS) with section of all collateral branches issuing from the IMA without any traumatic retraction. The technique of IMA takedown described herein has been used regularly by us since 1995. Our current experience shows that it is safe and reproducible after a reasonable period of training. Furthermore, in the objective of performing a totally endoscopic and/or robotic CABG, thoracoscopic IMA takedown would be a prerequisite.

The histopathological effect of metacercariae of the genus Brachylaima on the land snail, Monacha obstructa.

The histopathological changes in the kidney of the land snail Monacha obstructa and the histochemistry of the body wall of the parasite were studied. The histological pictures of the infected kidney showed extensive degree of degeneration in the renal tissue with multiple necrotic foci. Due to the mechanical and feeding effects of the parasite, the renal lamellae were disintegrated. Also, suckers increased the renal damage. In some levels of the kidney, the renal tissue was completely disappeared except the connective tissue of kidney capsule. Also, it was observed that there was a clear space between the parasites and renal tissue probably as a trial of evasion from the Host's reaction. The histochemical study on the metacercarial body wall revealed that it is consisting of three layers arranged as outer, middle and inner layers. Staining with Periodic Acid Schiff proved that the body wall is rich in mucopolysaccharide content. The idea that this parasite can be used as a biocontrol agent is also discussed.