Fine-needle aspiration of the mediastinum: a clinical, radiologic, cytologic, and histologic study of 42 cases.

Forty-two fine-needle aspirates (FNA) of the mediastinum were reviewed from 1984-1995. The clinical, radiologic, pathologic, and cytologic material was studied. Twenty-five males and 17 females had an age range from 10-72 yr and a mean of 41 yr. Common complaints were chest pain, dyspnea, and cough. Thirty-eight tumors were in the anterior/superior mediastinum. Fifty-seven percent were primary neoplasms (Hodgkin's lymphoma, 7; non-Hodgkin's lymphoma, 6; thymoma, 3; germ-cell tumor, 3; thymic carcinoid and angiosarcoma, 1 each; and malignant not otherwise specified, 3). Twenty-four percent were metastatic tumors (carcinoma, 9; and sarcoma, 1). Twelve percent were benign conditions (granulomatous disease, 2; multinodular goiter, 1; extramedullary hematopoesis, 1; and one thymic cyst). Seven percent were inconclusive. FNA yielded adequate tissue for diagnosis in 83% and a correct diagnosis in 86%. There was one false-negative and no false-positive diagnosis. FNA is a useful tool for accurate tissue diagnosis of mediastinal masses.

Surgical therapy for pulmonary hydatidosis.

Surgical treatment of pulmonary hydatidosis varies from one country to another. Whereas some reports describe marsupialization of the residual cavity others favor capitonnage (imbrication) to decrease complications and hospital stay. Post operative complications and hospital stay were compared in a retrospective study of 53 patients treated surgically at the American University Hospital over a period of 10 years. Forty eight cysts were treated by evacuation after chemical sterilization. Fifteen were marsupialized and 33 were imbricated. Five were excised with lung parenchyma, 5 were delivered intact and one cyst was treated by lobectomy. There was no postoperative mortality. There was no statistical difference in the hospital stay or the complication rate between the marsupialized and imbricated cases. Both imbrication and marsupialization are equally effective methods of treatment of pulmonary hydatid cysts. Anatomic resection is rarely required.

Minimally invasive axillary-LAD saphenous vein bypass.

The left internal mammary artery (LIMA) is the arterial conduit of choice for minimally invasive coronary bypass to the left anterior descending (LAD). However, in redo cases when the LIMA is not available, the use of a saphenous vein graft as an extra-anatomic bypass from the axillary artery to the LAD offers a lower risk alternative than conventional reoperative trans-sternal surgery [Knight 1997]. We report on 3 patients who underwent axillary-LAD saphenous vein bypass. At six months, follow-up by Duplex ultrasound showed patent grafts in all three patients.

Intercostal thorascopic harvesting of the internal mammary artery for supercharging a pedicled rectus abdominis flap.

Thorascopic harvesting of the internal mammary artery for supercharging the rectus abdominis pedicled flap for breast reconstruction is presented. The procedure was carried on a woman who had previously undergone a mastectomy and who was obese and a diabetic. The patient underwent a "high" flap delay 2 weeks earlier. At the time of operative transfer and setting, the flap's vascularity was found to be compromised. Instead of turbocharging the deep inferior epigastric pedicle to the irradiated axillary vessels, it was possible to harvest and utilize the internal mammary artery without rib resection for the supercharging, thus saving the flap and reconstruction. The technical aspects, and possible advantages and disadvantages of such a procedure are discussed.

Nodular fasciitis: a case report.

A case of nodular fasciitis, an unusual, but certainly not rare, lesion is presented. The correct histologic diagnosis was made, and conservative surgical therapy was performed. Follow-up examination at 15 months revealed no residual or recurrent lesion.

Straight pin aspiration in young women.

Straight pins are used extensively for securing facial scarves in women and girls in the Middle East. Accidental aspiration often results in the pin lodging in the segmental bronchus with the sharp end pointing cephalad. Flexible bronchoscopy is superior to rigid bronchoscopy in retrieving these pins. We report on five cases successfully treated by fiberoptic bronchoscopy under general anesthesia.

Successful delayed repair of a complete transection of the right mainstem bronchus in a five-year-old girl: case report.

Bronchial transection of a main bronchus is usually recognized and repaired immediately after injury. Delayed repair is uncommon, especially in pediatric patients. We report a case of delayed repair of a transected right mainstem bronchus in a 5-year-old girl, 3 years after the initial injury. The transected lung re-expanded immediately and showed continued growth 3 years later.