An asymptomatic 14-year-old boy presented with minor chest trauma. Chest X-ray showed opacity in the upper zone of the left lung. Further investigations with magnetic resonance imaging showed it to be a posterior mediastinal mass with a fistula to the lung, along with cystic changes in the left upper lobe of lung. Left upper lobectomy with excision of the mass was performed. Histological examination later showed an oesophageal duplication cyst with a fistula to the left upper lobe of the lung. We present this unusual complication of an oesophageal cyst infiltrating the lung in an asymptomatic child.
SummaryA best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether prophylactic tranexamic acid can safely reduce bleeding without increasing thrombotic complications in patients undergoing cardiac surgery. Altogether 334 papers were found using the reported search, of which 12 represented the best evidence on this topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We conclude that tranexamic acid clearly reduces blood loss, requirement for blood transfusion, and the risk of reoperation for bleeding, and although no study has yet looked directly at vein graft patency with tranexamic acid, no randomized studies have raised concerns over its safety. q
ower extremity compartment syndrome is a rare complication after on-pump coronary artery bypass grafting (CABG). It is associated with fasciotomy wound-related morbidity, occasional amputation, and universal occurrence of permanent foot drop. Compartment syndrome after off-pump CABG has not been reported so far. We report a case of lower limb compartment syndrome after off-pump CABG.
atrial ablation purposes. 3 However, it is a known fact that patients with long-standing AF, giant atria, or both have a much smaller chance to revert back to sinus rhythm after these ablation procedures. 4 Our findings, herein reported, might provide an explanation to understand this fact. As we have described, the morphologic consequences of chronic AF on the normal SN can be synthesized in 3 main features: (1) progressive tissue fibrosis, (2) progressive myocardial cell loss (including P cells), and (3) myocardial cell degeneration (including P cells). These SN morphologic abnormalities must inevitably lead to an impairment of its function. Thus normal sinus rhythm is less likely to be restored in patients with long-standing AF, regardless of the atrial lesion pattern used to interrupt re-entry or the energy source used to create these lesions because their SN is morphologically and functionally abnormal. Conversely, surgical treatment of AF during its early stages, with minimal SN damage, is more likely to be successful.
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