Coronary artery aneurysm is a rare entity and is being seen more frequently with the increasing use of stents during PTCA. Proximal ligation and plication of the aneurysm with coronary artery bypass grafting in the present series provided good results. With this case series, we seek to establish an optimal surgical therapy for this rare entity.

Purpose On-pump beating-heart coronary artery bypass grafting represents a merger of standard on and off-pump techniques and is thought to benefit patients by coupling the dual absence of cardioplegic arrest (conventional coronary surgery), with the hemodynamic instability during manipulation seen in off-pump surgery. However, the clinical benefits are still under discussion. We improvised on the standard on-pump beating-heart surgeries by introducing use of Bintermittent^bypass as and when required. Methods This study involved 108 patients. BIntermittent^on-pump-beating heart coronary artery bypass grafting was done using suction stabilizer and placing aortic and venous cannula, electively in all patients (group 1) who were supported by pump intermittently (n = 54). Retrospective data of patients who underwent off-pump surgery electively by the same surgeon (group 2, n = 54) was collected. Results There was a significant advantage in the number of grafts performed for the lateral surface (circumflex branches) using the new technique compared to conventional technique (68vs22). Similarly, significant advantage was also noted in terms of total number of grafts along with shorter operating times. There were no mortalities in the new group compared to the off-pump group and blood loss was also lesser. Conclusions BIntermittent^on-pump coronary revascularization is a technically reliable method of coronary revascularization taking advantage of the off-pump and conventional on-pump techniques while considerably eliminating the disadvantages of both. It has shown its superiority in safety, number of grafts, blood loss, operating time and perioperative course.

SUMMARYWe present a young patient with occasional chest pain and an incidentally found posterior mediastinal mass on radiology which was confirmed as mature teratoma on histopathology. The gross specimen received in the department of pathology was globular measuring 9.0×7.0×5.5 cm and varying in consistency from soft cystic to firm. Cut surface showed numerous hair entangled in pultaceous material. Representative sections were taken and stained with H&E stain. Histopathology revealed haphazardly distributed mature derivatives of all the three germ layers comprising of epidermis, pilo sebaceous units, nerve bundles (ectodermal), cartilage, bone, salivary gland clusters, blood vessels, muscle bundles, fibrous tissue infiltrated by foreign body giant cells, lymphoid follicles (mesodermal) and pseudostratified columnar epithelium (mesodermal), thus establishing the diagnosis of mature teratoma. BACKGROUND

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Cardiac hydatidosis is a rare presentation of echinococcus granulosus infestation. We report the case of 57-year-old man who presented with syncope due to ventricular tachycardia and was managed with antiarrhythmic drugs for an acute episode. Echocardiography and cardiac magnetic resonance imaging suggested a 1 cm right ventricular hydatid cyst. In view of the control of arrhythmia on antiarrhythmic drugs and the small size of the cyst, the patient was treated with albendazole 400 mg twice a day for 4 weeks. He was asymptomatic with normal liver function during follow-up, and repeat echocardiography after 1 year revealed disappearance of the intramyocardial lesion.

Thromboelastographic parameters show a reliable correlation with increased blood loss in off-pump coronary artery bypass grafting, and predict patients with an increased chance of blood requirement as well as those at risk of a hypercoagulable state.

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