Early surgical treatment for coronary artery fistulas is safe and effective. The risk of operative correction appears to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients.

The operation for a ruptured aneurysm of sinus of Valsalva carries a low operative risk and results in excellent long-term survival after surgical treatment.

Streptococcal bacteremia is an uncommon presentation for colorectal malignancy, yet most physicians would probably be aware of the association between Streptococcus bovis infection and such malignancy; however, many physicians may be unaware that other streptococcal species are also associated with colon and rectal cancers. We describe a 62-year-old male with adenocarcinoma of the sigmoid colon with the presentation of infective endocarditis due to infection by Streptococcus viridans, and we also report on the condition's successful treatment.

Coronary artery spasm can severely complicate the postoperative course for patients undergoing off-pump CABG, leading to myocardial ischaemia or infarction, life-threatening arrhythmias, persistent hypotension and even cardiac arrest. Early awareness and diagnosis of CAS with the establishment of appropriate management strategies may prevent its potentially lethal consequences.

Salmonella mycotic aneurysms of the descending thoracic aorta are exceedingly rare. There are few case reports and even fewer reports of long term survival. The case of a 68-year-old female presenting with a mycotic aneurysm of the descending thoracic aorta caused by Salmonella species is described, which involved successful surgical intervention.

Aneurysm of the left atrial appendage is extremely rare, and afflicted patients most commonly present with atrial tachyarrhythmia or thromboembolism. For these patients, resection of the aneurysm is the recommended and preferred therapy. We present the case of a 57-year-old woman who was found incidentally to have a large aneurysm of the left atrial appendage presenting as atrial fibrillation. After surgical intervention with resection of the aneurysm and a Cox maze III procedure, the patient recovered and was discharged in sinus rhythm.

Dear Editor,Haemangioma arising from external jugular veina ns_5465 755..764 Haemangioma arising from blood vessels is very rare and should be differentiated from other vascular tumour. Once haemangioma presents as a lateral neck mass, it should be distinguished from other malignancies.A 67-year-old female was seen at our vascular surgery section with a painless, nodular, 4 cm in diameter, right-sided neck mass of one-year duration. The patient was otherwise asymptomatic, but the lesion gradually increased in size. The neck mass was not obvious at rest but became prominent on straining or Valsalva manoeuvre. The patient felt embarrassed during work because it enlarged on exertion.On physical examination, the mass showed firm in consistency, not pulsatile, and free from superficial and muscular layer. Palpation revealed the mass was along the course of the external jugular vein (EJV) and positive empty sign. Doppler scan confirmed a solid nodule, hypoechoic, well-defined and with involvement of EJV. Pressure exerted by the probe showed that the mass was collapsible.Under general anaesthesia, a mass of 4.7 ¥ 4.2 ¥ 0.6 cm ( Fig. 1) arising from the EJV was isolated by careful dissection. Proximal and distal feeding vessels were ligated. Macroscopically, the tumour was reddish, not encapsulated and not infiltrated beyond the surrounding tissue. Histolopathologic examination showed pictures of thin-wall capillaries with haematoma and focal necrosis and was consistent with haemangioma. The post-operative course was uneventful, and no recurrence was detected after one-year follow-up period.The first description of benign intravascular tumour was given by Masson in 1923. Clinical presentation included subcutaneous nodule with growing in size, with signs of venous thrombosis or varicose LETTERS TO THE EDITOR ANZJSurg.com

The results of this study suggest that the off-pump technique is a safe and efficacious method for myocardial revascularization in elderly patients and that the short-term outcome obtained with this technique are promising. Our data suggest that the off-pump technique is preferable in these patients.