Osteomas are benign slow growing tumors of bone. Tumors are usually asymptomatic until they attain remarkable size and cause asymmetry or dysfunction. In view of few reported cases of giant osteoma of mandible, this article presents a case of giant osteoma of left mandible in a 53-year old male causing dyspnea due to compression of air way space.
Prevention of recurrent stroke in adults with patent foramen ovale represents a therapeutic challenge. Antiplatelet or anticoagulant treatment is widely introduced, but its exact indication is not known. In this pilot study, eight men and three women with previous ischemic cerebral events underwent direct surgical closure of the patent foramen ovale. Mean age was 39.4 (from 30 to 58) years. No coexisting cause of stroke was found after extensive investigations, including blood and coagulation tests, echocardiography, 24-hour three-lead electrocardiographic monitoring, extracranial and transcranial Doppler ultrasonography, and cerebral angiography. Criteria for operation also included at least two of the following: atrial septal aneurysm, multiple cerebral infarcts, a history of multiple cerebral events, and Valsalva strain before stroke. Before operation, one patient had two shunts (1 patent foramen ovale, 1 intrapulmonary shunt). No intraoperative or postoperative complications occurred, but a few hours after operation transient arrhythmias developed in two patients without atrial fibrillation, hemodynamic instability, or embolism. During a median follow-up of 12.2 months, no patient had recurrent stroke. All patients prospectively underwent brain magnetic resonance imaging and contrast echocardiography with simultaneous transcranial Doppler ultrasonography. A residual right-to-left interatrial shunt, smaller than the preoperative one, was observed in only one patient, whereas no lesion was seen on magnetic resonance imaging. Our study suggests that surgical closure of patent foramen ovale in patients with presumed paradoxic embolism is safe, with no recurrent stroke in the first year of follow-up. Further studies are needed to evaluate the long-term prognosis of patients with versus without operation and to define the role of operation as an alternative to prolonged antithrombotic treatment.
Use of topical sodium nitroprusside to relieve perioperative spasm of the internal mammary artery: A word of caution To the Editor: After reading with interest the article by Cooper, Wilkinson, and Angelini I concerning perioperative spasm of the internal mammary artery (IMA), we used sodium nitroprusside topically in two consecutive patients undergoing coronary artery bypass operation to relieve the spasm of the left IMA before closure of the sternotomy. The concentration of sodium nitroprusside used was that proposed by these authors, 2 mg in 4 ml of 5% dextrose in water. We report here the cases of these two consecutive patients, in whom significant drops in the arterial blood.pressure occurred immediately after the sodium nitroprusside was sprayed on the IMA pedicle. CASE I. A 61-year-old man underwent a coronary artery bypass operation with a left IMA graft to the left anterior descending artery and supplemental sequential saphenous vein grafts to the first and second marginal branches of the circumflexartery. The left IMA was dissected on a pedicle with the aid of electrocautery and titanium hemoclips. Papaverine at 6 mg in 0.9% normal saline solution was sprayed on the pedicle after dissection. After completion of proximal anastomoses, the patient was weaned from bypass with satisfactory hemodynamics and was decannulated. The left IMA was noticed to be spastic before closure of the sternotomy, and 2 mg sodium nitroprusside in 4 ml 5% dextrose in water was sprayed on the IMA pedicle. Systolic arterial blood pressure fell to 30 mm Hg within seconds after the vasodilator was sprayed on. This low blood pressure was not responsive to the infusion of fluids and necessitated the use of vasoactive agents. An intravenous injection of 500 f.l.g metaraminol was given. Despite volume infusion and metaraminol treatment, peripheral vascular collapse persisted and epinephrine was infused at a rate of 4 f.l.g/min. The patient's state of peripheral vascular collapse gradually resolved during the next 15 minutes, and the patient was transferred to the intensive care unit with stable hemodynamics. CASE 2. A 57-year-old woman underwent coronary artery bypass operation with a left IMA graft to the left anterior descending artery and a supplemental saphenous vein graft to the first diagonal artery. The left IMA was prepared as described in case I. The IMA was noted to be spastic after decannulation, and 2 mg sodium nitroprusside in 4 ml 5% dextrose in water was therefore sprayed on the IMA pedicle. Arterial blood pressure fell immediately after the vasodilator was sprayed on. Rapid fluid infusion and 500 ug metaraminol by intravenous injection were enough to reverse peripheral vascular collapse. The patient was transferred to the intensive care unit in stable condition. Early postoperative spasm of the IMA is a serious condition that can result in significant morbidity and mortality.v 3 Coo-Letters to the Editor 3 8 7 per, Wilkinson, and Angelini' recommended the topical use of sodium nitroprusside for immediate relief of IMA s...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.