Laparoscopic HCM with an antireflux procedure provides significant symptom relief in patients with sigmoid oesophagus and may be considered as the first-line treatment option in such patients. Oesophagectomy should be reserved for patients with a failed cardiomyotomy.

Pulmonary symptoms as well as radiological and functional abnormalities are common in patients with achalasia. Treatment in the form of pneumatic dilatation or Lap cardiomyotomy improves pulmonary symptoms.

thoracoscopic excision of a bronchogenic cyst should be considered the first-line therapeutic option. Proper preoperative case selection can prevent conversion to thoracotomy due to major pleural adhesions. There should be a low threshold for conversion to thoracotomy if complete excision of the cyst is not possible, because this is the main goal of treatment to prevent recurrence.

Purpose To analyze the outcomes of long segment coronary anastomoses in patients with diffusely diseased coronary arteries and compare them with medically managed patients. Methods We retrospectively studied patients with diffusely diseased coronary arteries who underwent complete revascularization with long segment coronary reconstruction (> 2 cm in length) from February 2015 to November 2016. During the same time, patients who opted medical management for diffuse coronary artery disease were also studied. Results Forty-one patients underwent long segment coronary anastomoses for diffuse coronary artery disease with either left internal thoracic artery (LITA) or saphenous vein conduits. In 15 (36.58%) patients, the anastomosis length was more than 4 cm. In 41 patients, left anterior descending (LAD) artery had long segment anastomosis and in four patients, posterior descending artery (PDA) had long segment anastomosis. Twenty-one patients were operated off-pump and the rest were operated on cardiopulmonary bypass. The post-operative recovery of all the patients was uneventful. There were no procedural complications. There was one mortality due to cerebrovascular accident (2.43%). During the study period, 50 patients with diffuse coronary artery disease were under medical management. In the medically managed group, there were seven death during the follow-up, with mortality rate of 14%. Conclusion Patients with diffuse disease coronary diseases, who are surgically managed, have a better outcome when compared to the medically managed patients with acceptable morbidity and mortality.

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Background Mucormycosis is an invasive fungal infection. It is rare and commonly associated with fatal outcomes. Methods We report two cases of thoracic mucormycosis in immunocompetent patients. First, is an immunocompetent child with mediastinal mass and extension into the pericardium and left atrium. The second is a young woman with a left pulmonary artery pseudoaneurysm. Results The first patient could not be salvaged while the second patient was successfully managed with surgical intervention and systemic antifungal treatment. Conclusion Mucormycosis should be considered as a differential diagnosis in the management of immunocompetent patients in patients with pyrexia of unknown origin and a mediastinal mass. Early and aggressive surgical management along with systemic antifungal treatment improves the survival in this subset of patients.

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