Thymic pathology and cardiac myxomas: Coincidence or a closer relationship?

Myxomas are the most common benign cardiac tumors and are located more frequently in the left atrium. In the literature there are cases describing the coexistence of thymic tumors and cardiac myxomas. In the case reported herein, during the resection of a cardiac myxoma, an enlarged thymus gland was encountered and resected. The histological exam revealed a thymic hyperplasia. The aim of this case study is to assess the need of conducting further studies in order to identify a common histological pathway between thymic lesions and cardiac myxomas. The diagnosis of a cardiac myxoma could justify a further workup of the anterior mediastinum in order not to overlook a lesion of thymic origin

Use of continuous subcutaneous anesthetic infusion in cardiac surgical patients after median sternotomy

The use of opioid analgesics to control pain after median sternotomy in cardiac surgical patients is worldwide accepted and established. However, opioids have a wide range of possible side effects, concerning prolonged extubation time, gastrointestinal tract dyskinesia and urinary tract disorders mostly retention. All these may lead to a prolonged ICU stay or overall hospitalization time increase

Acute heart failure caused by a giant hepatocellular metastatic tumor of the right atrium

We present a symptomatic 40-year-old cirrhotic man who presented with sudden onsets of syncope. Echocardiography revealed right ventricular outflow track obstruction caused by a huge right atrial mass. The tumor was surgically excised under cardiopulmonary bypass. Although no primary cancerous lesion in the liver was detected, histopathology revealed that the mass was a metastatic hepatocellular carcinoma. The aim of this report is to show the value of urgent preoperative computed tomography and its contribution in the operative strategy. The importance of urgent surgical treatment with tricuspid valve sparing tumor resection is emphasized even though the prognosis for such patients is dismal. We also discuss the further management options of such rare case

Antegrade cardioplegia as a cause of acute saphenous vein endothelial damage in patients undergoing on pump coronary artery bypass surgery

Background: The administration of antegrade cardioplegia through vein grafts after the completion of each distal anastomosis is a common practice in coronary artery bypass grafting (CABG). However, the cardioplegic solution may disrupt the vein endothelium and contribute to late vein graft atherosclerotic disease. This study aimed at evaluating the possible impact of the cardioplegic solution on vein graft endothelium. Methods: 52 patients (16 women and 36 men) aged 68±8.5 years that underwent on pump coronary revascularization with at least one vein graft were enrolled. Sections of grafts from the greater saphenous vein were obtained prior to and after delivery of potassium antegrade cardioplegic solution through them. These sections were then examined histologically with immunochemical stain and CD 34 index. The endothelial damage and length of vein specimens of both graft sections were evaluated. Results: The endothelial damage of vein specimens appeared to be increased significantly with exposure to antegrade cardioplegia in male and female patients (P from Wilcoxon tests <0.001, for both genders). The increase in the length of vein specimens was significant too (P from Wilcoxon test <0.001 for men and P=0.001 for women). Conclusions: Antegrade cardioplegia delivered through vein grafts causes substantial damage on vein endothelium. This may have an adverse effect on long term graft patency.ΕΙΣΑΓΩΓΗ: Η χορήγηση διαλύματος καρδιοπροστασίας δια των φλεβικών μοσχευμάτων κατά τη διάρκεια της επέμβασης Αορτοστεφανιαίας παράκαμψης αποτελεί συνήθη πρακτική. Ωστόσο, το καρδιοπληγικό διάλυμα είναι πιθανό να προκαλέσει βλάβη στο ενδοθήλιο του φλεβικού μοσχεύματος και με τον τρόπο αυτό να συμβάλλει στην αθηρωματική νόσο των φλεβικών μοσχευμάτων. Σκοπός της παρούσας μελέτης είναι η εκτίμηση της πιθανής επίδρασης του καρδιοπληγικού διαλύματος στο ενδοθήλιο του φλεβικού μοσχεύματος. ΥΛΙΚΟ ΚΑΙ ΜΕΘΟΔΟΣ: 52 ασθενείς, 16 γυναίκες και 36 άνδρες, ηλικίας 68±8.5 ετών, υποβλήθηκαν σε επέμβαση Αορτοστεφανιαίας παράκαμψης με χρήση τουλάχιστον ενός φλεβικού μοσχεύματος και εντάχθηκαν στη μελέτη. Ελήφθησαν τμήματα μείζονος σαφηνούς φλέβας πριν και μετά από τη χορήγηση ορθόδρομης καρδιοπληγίας διά αυτών. Τα τμήματα αυτά εξετάσθηκαν παθολογοανατομικά με ανοσοϊστοχημική χρώση και το δείκτη CD 34. Ακολούθως εκτιμήθηκε η ενδοθηλιακή βλάβη καθώς και το μήκος τόσο των τμημάτων που δεν εκτέθηκαν στο καρδιοπληγικό διάλυμα, όσο και αυτών από τα οποία διήλθε καρδιοπληγία κατά τη διάρκεια της επέμβασης. ΑΠΟΤΕΛΕΣΜΑΤΑ: Η ενδοθηλιακή βλάβη των δειγμάτων των φλεβών φαίνεται να ήταν σημαντικά αυξημένη μετά από έκθεση στο καρδιοπληγικό διάλυμα, τόσο στους άρρενες όσο και στους θήλεις ασθενείς (P from Wilcoxon tests <0.001 και για τα δύο φύλα). Η αύξηση του μήκους του δείγματος του φλεβικού μοσχεύματος ήταν επίσης σημαντική για την εξαγωγή των αποτελεσμάτων (P from Wilcoxon test <0.001 για τους άνδρες και P=0.001 για τις γυναίκες). ΣΥΜΠΕΡΑΣΜΑΤΑ: Η ορθόδρομη καρδιοπληγία που χορηγείται διά των φλεβικών μοσχευμάτων προκαλεί σημαντική βλάβη στο φλεβικό ενδοθήλιο. Αυτό μπορεί να έχει αρνητική επίδραση στην απώτερη βατότητα των φλεβικών μοσχευμάτων

Innovation strategies and ambidexterity within flat organizations : The case study of Alfa Laval

The progress of technology forces companies and organizations to alter their structure and operational procedures in order to stay alive, adapt to current incumbents and gain competitive advantage within their target markets. One of the major key concepts for this procedure is innovation. This was, and still is a timeless and demanding issue along with its consequences; how companies can achieve innovation and seize all benefits given. Innovation has many "faces", methods and models from which it can be approached. This thesis will analyze the basic strategies and types of innovation as well as their outcomes. To strengthen our investigations on the matter Alfa Laval was selected as the study case of this thesis, a company that has successfully been the leader in separation market for more than one centur

Clinical and surgical-pathological staging in early non-small cell lung cancer

Staging is of the utmost importance in the evaluation of a patient with non-small cell lung cancer (NSCLC) because it defines the actual extent of the disease. Accurate staging allows multidisciplinary oncology teams to plan the best surgical or medical treatment and to predict patient prognosis. Based on the recommendation of the International Association for the Study of Lung Cancer (IASLC), a tumor, node, and metastases (TNM) staging system is currently used for NSCLC. Clinical staging (c-TNM) is achieved via non-invasive modalities such as examination of case history, clinical assessment and radiological tests. Pathological staging (p-TNM) is based on histological examination of tissue specimens obtained with the aid of invasive techniques, either non-surgical or during the intervention. This review is a critical evaluation of the roles of current pre-operative staging modalities, both invasive and non-invasive. In particular, it focuses on new techniques and their role in providing accurate confirmation of patient TNM status. It also evaluates the surgical-pathological staging modalities used to obtain the true-pathological staging for NSCLC

Bilateral pneumothorax, lung cavitations, and pleural empyema in a cocaine addict

A case of bilateral pneumothorax, lung cavitations, and pleural empyema in a cocaine user is described. The patient was treated by left tube thoracostomy and right lower lobectomy. The postoperative course was uneventful. Six months later, the patient remains asymptomatic. The pathology examination of the specimen revealed infected bronchiectasis, interstitial desquamative pneumonia, diffuse alveolar damage, subsegmental arterial thrombosis, and consequent areas of pulmonary infarction