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International Journal of Surgery Case... 2020Rupture of the pericardium complicating blunt thoracic trauma may lead to cardiac luxation if not early recognized and appropriately surgically treated. This condition...
INTRODUCTION
Rupture of the pericardium complicating blunt thoracic trauma may lead to cardiac luxation if not early recognized and appropriately surgically treated. This condition is exceedingly rare and carries a high mortality rate.
CASE PRESENTATION
A 37-year-old man presented with severe multiple injuries following a road traffic crash, including blunt trauma to the thorax and abdomen. He was in a hemodynamically stable condition. The chest radiograph and CT scan revealed a leftward heart herniation through a pericardial tear, there were also non surgical hepatic and splenic lesions. The diagnosis of left cardiac luxation with no associated valvular lesions was made. Surgical exploration via a midline sternotomy revealed a protruding heart herniating into the left pleural cavity through a large tear (15 cm) of the left pericardium. Sutures with Teflon felt pledgets were performed. The postoperative chest radiograph was normal and the postoperative course was uneventful.
DISCUSSION
Post traumatic heart luxation diagnosis is clinically difficult because the scarcity of signs and lack of specificity. Chest X ray can be suggestive, and specific findings can only be detected by computed tomography, which is the most sensitive diagnostic method. Surgical management in this condition is mandatory to avoid fatal complications such as great vessels strangulation. It consists of replacing the heart in the pericardial sac and repairing the pericardial tear.
CONCLUSION
Despite its rare occurrence, trauma surgeons must be aware of cardiac luxation. Any suspicion of such a diagnosis would warrant surgical exploration to avoid fatal complications.
PubMed: 32474377
DOI: 10.1016/j.ijscr.2020.04.095 -
Hernia : the Journal of Hernias and... Apr 2021Morgagni-Larrey congenital diaphragmatic hernia (MLH) is rare in adult patients and surgery is performed infrequently. The evidence regarding the most beneficial...
PURPOSE
Morgagni-Larrey congenital diaphragmatic hernia (MLH) is rare in adult patients and surgery is performed infrequently. The evidence regarding the most beneficial treatment modality is low. Nevertheless, with increasing experience in minimally-invasive surgery, the literature proves the laparoscopic approach as being safely feasible. However, knowledge on the disease as well as treatment options are based on single surgeon's experiences and small case series in the literature.
METHODS
Retrospective single-center analysis on adult patients (≥ 18 years) with MLH from 01/2003 to 06/2019 regarding symptoms, hernia sac contents, surgical technique and perioperative outcome.
RESULTS
4.0% of diaphragmatic hernia repair procedures were performed for MLH (n = 11 patients). 27.3% of these patients were asymptomatic. Dyspnea or gastrointestinal symptoms were frequently observed (both in 45.5% of the patients). Colon transversum (63.6%), omentum majus (45.5%) and/or stomach (27.3%) were the most common hernia sac contents. Correct diagnosis was achieved preoperatively in 10/11 patients by cross-sectional imaging. All procedures were performed by trans-abdominal surgery (laparotomy in four and laparoscopy in seven patients). All hernias were reinforced by mesh after primary closure. No differences were observed in the perioperative outcome between patients who underwent hernia repair by laparotomy versus laparoscopy. Pleural complications requiring drainage were the most common postoperative complications.
CONCLUSION
MLH repair seems to be safely feasible by laparoscopic surgery. The benefit of mesh augmentation in MLH repair is not clear yet. In contrast to the current literature, all patients in this study received mesh augmentation after primary closure of the hernia. This should be evaluated in larger patient cohorts with long-term follow-up.
Topics: Adult; Hernias, Diaphragmatic, Congenital; Herniorrhaphy; Humans; Laparoscopy; Laparotomy; Retrospective Studies; Surgical Mesh
PubMed: 32112200
DOI: 10.1007/s10029-020-02147-0 -
BMC Surgery Jan 2020Pancreatic pseudocyst is a very common benign cystic lesion of the pancreas. It develops in 5-15% of patients with peri-pancreatic fluid collection following acute...
BACKGROUND
Pancreatic pseudocyst is a very common benign cystic lesion of the pancreas. It develops in 5-15% of patients with peri-pancreatic fluid collection following acute pancreatitis. Collection usually occurs within the lesser sac of the omentum (near the pancreatic head and body region). But in 20-22% cases, that may be extra-pancreatic like in the mediastinum, pleura, in the peritoneal cavity including the pelvis. The pancreatic pseudocyst typically contains brownish fluid with necrotic tissue sludge which may get infected giving rise to infected pseudocyst or pancreatic abscess. The present case is an unusual condition of a young alcoholic subject who was finally diagnosed as a case of a pancreatic abscess within hepato-gastric ligament and was managed with operative intervention. To the best of the author's knowledge, it is the first-ever reported case of a pancreatic abscess within the hepato-gastric ligament in the world. Literature was reviewed to explore potential etiopathogenesis and therapeutic strategies of this extremely rare condition.
CASE PRESENTATION
A 38 years old gentleman, chronic alcoholic, having a previous history of acute pancreatitis 3 months back, presented with fever (102 degrees Fahrenheit) and a huge [20 cm (horizontal) X 15 cm (vertical)] severely painful swelling in the epigastric region. The swelling was round-shaped, intra-abdominal, fixed to deeper tissue, tense-cystic, poorly trans-illuminant, non-pulsatile and irreducible. Routine blood tests showed leucocytosis (14,500/mm) with neutrophilia and elevated plasma pancreatic amylase and lipase levels. USG and MDCT scan of the whole abdomen revealed a thick-walled echogenic cystic swelling of size 18 cm × 12 cm in the epigastric region. USG guided aspiration of the cyst revealed mixed purulent brownish fluid. The cyst fluid was negative for mucin stain and contained high amylase level with low CEA level, suggesting infected pancreatic pseudocyst. An open drainage procedure was considered through an upper midline laparotomy. Aspiration of the pus mixed cyst fluid along with tissue debris was done. Through irrigation of the cyst was done with normal saline. The cyst wall was de-roofed leaving a small part adherent to the inferior surface of the left lobe of the liver. Later the cyst fluid culture showed significant growth of Escherichia coli. He was put on IV antibiotics. The patient was discharged in a stable condition after 5 days. The histopathological examination confirmed pancreatic abscess. Six months after the operation, the patient is doing well, remaining asymptomatic and there is no sign of recurrence.
CONCLUSIONS
Due to extreme rarity, pancreatic abscess formation within hepato-gastric ligament may be a diagnostic dilemma and requires a high index of suspicion. Surgeons should be aware of this rare clinical entity for prompt management of potential morbidity.
Topics: Abscess; Acute Disease; Adult; Cysts; Drainage; Humans; Laparotomy; Ligaments; Liver; Male; Pancreas; Pancreatic Pseudocyst; Stomach; Tomography, X-Ray Computed
PubMed: 32000756
DOI: 10.1186/s12893-020-0688-0 -
World Journal of Clinical Cases Dec 2019Cardiac perforation by a transvenous lead is an uncommon but serious complication. Delayed perforation, defined as migration and perforation of an implanted lead at...
BACKGROUND
Cardiac perforation by a transvenous lead is an uncommon but serious complication. Delayed perforation, defined as migration and perforation of an implanted lead at least 1 mo after implantation, is exceedingly rare and prone to underdiagnosis, and its optimal management is currently unclear. We report an uneventful transvenous extraction of an active fixation lead that led to delayed perforation of the right atrium, pericardium, and lung, disclosed 2 mo after implantation.
CASE SUMMARY
A 61-year-old woman with atrial lead perforation was transferred to our center. She had a dual-chamber pacemaker with active fixation leads implanted 8 mo previously. At 2 mo after implantation, she complained of chest pain and hemoptysis. Chest computed tomography revealed atrial lead migration into the lung. No pericardial or pleural effusion was detected. She underwent transvenous lead extraction in the electrophysiology room with surgical backup. The percutaneous subxiphoid pericardial puncture was performed first, and a pigtail catheter was left in the pericardial sac throughout the procedure. Then, a new active fixation lead was implanted at a different site with less tension. After the active screw was retracted, the culprit atrial lead was explanted successfully with simple traction. There were no complications during or after the procedure. The patient recovered well and follow-up was uneventful.
CONCLUSION
Percutaneous management of perforated active fixation lead outside the pericardial sac under surgical backup is safe and effective.
PubMed: 31911915
DOI: 10.12998/wjcc.v7.i24.4327 -
Multimedia Manual of Cardiothoracic... Nov 2019Malignant pleural mesothelioma is a cancer of the mesothelial cells lining the pleural sac. Surgery for malignant pleural mesothelioma should be part of a multimodality...
Malignant pleural mesothelioma is a cancer of the mesothelial cells lining the pleural sac. Surgery for malignant pleural mesothelioma should be part of a multimodality treatment approach and the aim of surgery should be macroscopic complete tumor resection. Lung-sparing operations, such as extended pleurectomy decortication, have gained increasing popularity in the past decade. This video tutorial illustrates the main steps of extended pleurectomy decortication for the treatment of malignant pleural mesothelioma.
Topics: Aged; Dissection; Humans; Lung; Lung Neoplasms; Male; Mesothelioma; Mesothelioma, Malignant; Organ Sparing Treatments; Pleura; Pleural Neoplasms; Thoracic Surgical Procedures; Treatment Outcome
PubMed: 31751008
DOI: 10.1510/mmcts.2019.023 -
Tropical Biomedicine Jun 2019Although the economic importance of Haemophilus parasuis infection causing Glasser's disease is prevalent throughout pig farms in Peninsular Malaysia, there is a dearth...
Although the economic importance of Haemophilus parasuis infection causing Glasser's disease is prevalent throughout pig farms in Peninsular Malaysia, there is a dearth of knowledge on its actual nature. In this study, a multiplex PCR was performed to screen for three major predominant virulent strains of H. parasuis, which are serotypes 4, 5 or 12 and 13. A total of 175 tissues or bodily fluid samples of various parts were collected from diseased animals from October, 2016 to February, 2018; with total of 62.9% positive detection of H. parasuis. The highest detection was found to be in the pericardial sac fibrin (90.9%) followed by pleural fibrin, lung, pleural fluid, tonsil, pericardial sac, peritoneal fluid, abdominal fibrin, joint fluid, brain and pericardium. Serotype 13 was the highest (40/110) followed by serotype 4(37/110), serotype 5(31/110) and 12 samples were nontypable (12/110). The presence of untypable serotype also drives to further identification of other serotypes in Malaysia.
PubMed: 33597410
DOI: No ID Found -
Frontiers in Veterinary Science 2019A 6-year-old neutered male Yorkshire Terrier presented with recurrent pericardial effusion. Although clinical examinations including computed tomography were...
A 6-year-old neutered male Yorkshire Terrier presented with recurrent pericardial effusion. Although clinical examinations including computed tomography were inconclusive, an exploratory thoracotomy revealed multiple small nodules and plaques on the inner surface of the pericardial sac (Day 1). A subtotal pericardiectomy was performed to prevent cardiac tamponade due to the increasing pericardial effusion, and the resected section of the pericardium was histopathologically diagnosed with mesothelioma. After surgery, chemotherapy with intrathoracic carboplatin was commenced. During the course of the treatment, a detailed follow-up ultrasonographic scan was performed to detect early lesions disseminated on the pleura, originating from the primary pericardial mesothelioma. On Day 101, the minute pleural nodules, which were disseminated lesions as predicted, were successfully imaged by ultrasonography. As the clinical stage advanced, the nodules were observed to gradually increase in size and number, implying tumor progression. These observations highlight the feasibility of ultrasonography in detecting minute disseminated lesions at an early stage, monitoring tumor progression, and thereby, predicting the prognosis of canine pericardial mesothelioma.
PubMed: 31058175
DOI: 10.3389/fvets.2019.00121 -
Ideggyogyaszati Szemle Sep 2018In spine surgery, minimally invasive approaches (MIS) are getting accepted and more popular worldwide during the last decades. It is due to the reduced intraoperative... (Review)
Review
In spine surgery, minimally invasive approaches (MIS) are getting accepted and more popular worldwide during the last decades. It is due to the reduced intraoperative blood loss, decreased infection rate, less postoperative pain and earlier discharge from hospital compared to traditional approaches. The present paper puts forward a minimally invasive extrapleural approach to the thoracic spine that is not applied in Hungary. This new approach, in contrast to the standard costotransversectomy, provides direct visual control over the ventral surface of the dural sac. Furthermore, contrary to the transthoracic way, following minimally invasive extrapleural surgery thoracic drainage and intensive care are not necessary. The approach can be applied safely in treatment of ventral or ventrolateral pathologies of the thoracic spine.
Topics: Blood Loss, Surgical; Humans; Hungary; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Orthopedic Procedures; Pain; Pain Measurement; Pleura; Thoracic Vertebrae; Treatment Outcome
PubMed: 30335261
DOI: 10.18071/isz.71.0293 -
Immunity Oct 2018Tissue-resident mast cells are associated with many inflammatory and physiological processes. Although mast cells arise from the yolk sac, the exact ontogeny of adult...
Tissue-resident mast cells are associated with many inflammatory and physiological processes. Although mast cells arise from the yolk sac, the exact ontogeny of adult mast cells remains unclear. Here we have investigated the hematopoietic origin of mast cells using fate-mapping systems. We have shown that early erythro-myeloid progenitors (EMPs), late EMPs, and definitive hematopoietic stem cells (HSCs) each gave rise to mast cells in succession via an intermediate integrin β7 progenitor. From late embryogenesis to adult, early EMP-derived mast cells were largely replaced by late EMP-derived cells in most connective tissues except adipose and pleural cavity. Thus, mast cells with distinct origin displayed tissue-location preferences: early EMP-derived cells were limited to adipose and pleural cavity and late EMP-derived cells dominated most connective tissues, while HSC-derived cells were a main group in mucosa. Therefore, embryonic origin shapes the heterogeneity of adult mast cells, with diverse functions in immunity and development.
Topics: Animals; Cell Lineage; Cells, Cultured; Connective Tissue; Embryo, Mammalian; Erythroid Cells; Hematopoietic Stem Cells; Integrin beta Chains; Mast Cells; Mice, Transgenic; Myeloid Progenitor Cells
PubMed: 30332630
DOI: 10.1016/j.immuni.2018.09.023 -
Journal of Clinical Imaging Science 2018Pancreatic pseudocyst develops as a complication of both acute and chronic pancreatitis. Although the common location of pseudocyst is lesser sac, extension of...
Pancreatic pseudocyst develops as a complication of both acute and chronic pancreatitis. Although the common location of pseudocyst is lesser sac, extension of pseudocyst can occur into mesentery, retroperitoneum, inguinal region, scrotum, liver, spleen, mediastinum, pleura, and lung. Extension of pseudocyst into psoas muscle and lumbar triangle is extremely rare. The development of pseudocyst in lumbar triangle is radiologically equivalent and further extension of Grey Turner's sign seen clinically in acute pancreatitis. This extension occurs due to the destructive nature of pancreatic enzymes. The lumbar triangle is the site of anatomic weakness in the lateral abdominal wall in the lumbar region. We report the case of a 35-year-old alcoholic male patient who presented with abdominal pain followed by distension and swelling in the right lumbar region for 1 week. On computed tomography scan of the abdomen, acute-on-chronic pancreatitis with multiple pseudocysts in the right posterior pararenal space, extending through the right lumbar triangle in the right lateral abdominal wall, right posterior paraspinal muscles, right iliopsoas, right obturator externus, and medial aspect of the right upper thigh, beneath anterior abdominal wall in the upper abdomen and in the right lateral thoracic wall through the right 11 intercostal space, was detected.
PubMed: 30197824
DOI: 10.4103/jcis.JCIS_29_18