Objective:To report our institutional experience with penile refracture, including demographic data, recurrence time, etiology and operative findings in the first and second episodes.Materials and methods:Between January 1982 and September 2017, 281 patients underwent surgical treatment for penile fracture (PF) at our institution. Demographic data, clinical presentation, besides operative findings and follow-up of patients with relapsed PF were retrospectively assessed by reviewing medical records.Results:Of a total of 281 cases of PF operated at our institution, 3 (1.06%) patients experienced two episodes of trauma. Age ranged from 38 – 40 years (mean: 39.3). The recurrence time varied from 45 to 1560 days (mean: 705). Two patients presented the new fracture episode at the same site of the previous lesion, while in the other case the lesion was observed at another site.Conclusion:Recurrent FP is an extremely rare entity. The risk factors for its occurrence are still unknown. Although the lesion of the corpus cavernosum ipsilateral to the scar tissue of the prior FP is more common, contralateral rupture may be present. Nevertheless, prospective studies with larger samples should be conducted.

BackgroundDunnigan type Familial Partial Lipodystrophy (FPLD) is characterized by loss of subcutaneous fat from the limbs and excessive accumulation on the visceral adipose tissue (VAT). Affected individuals have insulin resistance (IR), diabetes, dyslipidemia and early cardiovascular (CV) events, due to their imbalanced distribution of total body fat (TBF). Epicardial adipose tissue (EAT) is correlated with VAT. Hence, EAT could be a new index of cardiac and visceral adiposity with great potential as a marker of CV risk in FPLD.ObjectiveCompare EAT in FPLD patients versus healthy controls. Moreover, we aimed to verify if EFT is related to anthropometrical (ATPM) and Dual-Energy X-ray Absorptiometry (DEXA) measures, as well as laboratory blood findings. We postulated that FPLD patients have enlarged EAT.MethodsThis is an observational, cross-sectional study. Six patients with a confirmed mutation in the LMNA gene for FPLD were enrolled in the study. Six sex, age and BMI-matched healthy controls were also selected. EFT was measured by transthoracic echocardiography (ECHO). All participants had body fat distribution evaluated by ATPM and by DEXA measures. Fasting blood samples were obtained for biochemical profiles and also for leptin measurements.ResultsMedian EFT was significantly higher in the FPLD group than in matched controls (6.0 ± 3.6 mm vs. 0.0 ± 2.04 mm; p = 0.0306). Additionally, FPLD patients had lower leptin values. There was no significant correlation between EAT and ATPM and DEXA measurements, nor laboratory findings.ConclusionsThis study demonstrates, for the first time, that EAT measured by ECHO is increased in FPLD patients, compared to healthy controls. However, it failed to prove a significant relation neither between EAT and DEXA, ATPM or laboratory variables analyzed.

Myxoma; heart atria left; coronary disease. block, left anterior hemiblock, and secondary alterations of ventricular repolarization. Chest radiography showed lung hyperinflation and a normal cardiac silhouette. Transesophageal echocardiography showed a 4.7 x 1.7-cm mobile mass in the left atrium that was non-obstructive at Doppler. Its origin could not be visualized, but there seemed to be a pedicle originated in the right upper pulmonary vein (Fig. 1).Myxomas are the most common type of cardiac tumors, accounting for 50% to 60% of the total in some case series, with an estimated incidence between 0.5 and one case per one million inhabitants-year 1 . The most common symptoms include dyspnea, atypical chest pain, and obstructive and embolic phenomena. Cases of sudden death have already been described, probably related to embolization to the coronary circulation 2 . Concomitant presence of coronary artery disease has been rarely described. The objective of this study is to report the case of a patient with left atrial myxoma and obstructive coronary lesions indicating the need of a coronary artery bypass grafting. Case ReportSixty-seven-year-old male patient with hypertension, dyslipidemia, chronic obstructive pulmonary disease and past history of smoking and acute myocardial infarction in 2000, treated with angioplasty without stenting of the anterior descending and right coronary arteries at the time. During preoperative assessment for an inguinal hernia repair, he underwent a transthoracic echocardiography that evidenced a tumor mass in the left atrium compatible with myxoma, and was referred to our institution for therapeutic management.In the initial assessment, the patient was asymptomatic, with a normal physical examination. Electrocardiogram showed a sinus rhythm with complete left bundle branchWe describe the case of a 67-year-old male patient with obstructive coronary artery disease who, in the preoperative assessment for an inguinal hernia repair, had undergone an echocardiography that showed a large, mobile, nonobstructive tumor in the left atrium, with a pedicle originated in the right superior pulmonary vein. The patient underwent a coronary angiography with left ventriculography that showed severe stenosis in the mid-third of the left anterior descending artery, moderate stenosis in the proximal third of the circumflex artery at the origin of the first marginal branch, and a non-obstructive lesion in the distal third of the right coronary artery. Moderate left ventricular dysfunction was also observed. The patient then underwent resection of the tumor and coronary artery bypass grafting. The histopathological examination revealed a myxoma. Considering the past history of infarction and the patient's age, we decided to perform a preoperative coronary angiography that showed no lesions in the trunk, a severe lesion at the mid-third of the anterior descending artery, a moderate lesion in the circumflex artery at the origin of the first marginal branch, albeit with a thin irregular distal bed, and a non...

Only rarely do myxomas originate from the mitral valve. This is the report of a 49-year-old woman presenting with congestive heart failure. . Rarely do they occur in other areas of the heart and only exceptionally are the valves involved. This is our first case of a myxoma involving the mitral valve and, as far as we know, the 23 rd case reported in the literature. Case ReportA 49-year-old black woman was admitted to the hospital with a history of palpitations on efforts and progressive dyspnea over the previous two years. She reported no other symptoms. She had a history of systemic arterial hypertension for five years and her parents had "cardiac problems". On physical examination she had distended jugular veins at 45 o with increased a wave in the venous jugular pulse. Both the carotid pulse and other arterial pulses were normal. On admission, her blood pressure was 160/120mmHg. Parasternal right ventricular heave was palpable in the lower left parasternal border. An apex impulse with a diameter of less than 2 fingertips was palpable and palpable valvar sounds were present at the apex and at the pulmonic area. Loud S1 and P2, as well as S4 from the RV could be heard. An intense protodiastolic murmur, which was interpreted as a tumor plop, could be heard in the mitral area, where a 2+/6+ proto-meso systolic murmur and a diastolic rumble 3+/6+ were also detected. Lungs were clear and there was mild hepatomegaly, which was not painful on palpation. Lower limbs showed signs of chronic venous insufficiency, with mild bilateral ankle edema.Electrocardiogram showed left atrial enlargement and diffuse abnormalities of the ST-T segments, with flattened T waves. Moderate enlargement of the cardiac silhouette, with left atrial and right ventricular enlargement, and signs of venocapillary pulmonary hypertension were present on chest X-ray. Transthoracic echocardiogram showed a dilated left atrium and a mass could be seen attached to the anterior leaflet of the mitral valve. Transesophageal echocardiogram showed a rounded mass, with regular contours and homogenous appearance, which measured 2.5 x 2.2cm and was attached to the atrial part of the anterior leaflet of the mitral valve ( fig. 1). A peak gradient of 24mmHg and a mean gradient of 14mmHg between the left atrium and ventricle were present. Coronariography showed normal coronaries and a radioluscent mass inside the left atrium projecting itself inside the left ventricle during diastole was seen by ventriculography.The patient underwent surgery with cardiopulmonary bypass 20 days after admission. Left atriotomy showed a purple tumor which measured 2.5 x 3.0cm in its largest diameter, had regular borders and a small peduncle which was attached to the anterior leaflet of the mitral valve in its cephalic and basal portion ( fig. 2). The tumor and its attachment to the mitral valve were excised and a bovine pericardium patch was used to repair the valve. Elongated cells (fusiform) and star-shaped cells in a myxomatous estroma, which are typical of myxomas, were seen by ...

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