Recidiva en vena cava inferior de carcinoma suprarrenal

Paciente de 15 meses sometido a resección de masa suprarrenal derecha. Estudio de extensión negativo e histología de tumor adrenocortical. Dos meses después presenta recidiva tumoral en vena cava inferior (VCI) a nivel de venas suprahepáticas que se reseca bajo hipotermia profunda y parada circulatoria (19 min) (Fig. 1). Se extrae una masa friable de 25 × 20 mm que ocluye la VCI, sin evidencia de resto tumoral, aunque se considera resección incompleta al estar infiltradas las paredes de VCI. La histología confirma carcinoma suprarrenal (Fig. 2). A los 5 meses sigue quimioterapia sin datos de nueva invasión de VCI

Dramatic post-cardiotomy outcome, due to severe anaphylactic reaction to protamine

Immunologic reactions to protamine sulfate during cardiac surgery are very rare. The frequency and outcome of such adverse reactions is unclear. We report a case of lethal anaphylactic reaction to protamine that occurred in a non-diabetic patient following the uneventful replacement of the ascending aorta. We also briefly review the mechanisms of this adverse reaction and emit some considerations on the management of this situation

Circumferential dissection with intimal intussusception: an unusual case of acute aortic type A dissection

An unusual case of a type-A aortic dissection with complete circumferential dissection just above the aortic valve with intimointimal intussuseption just distal to the left subclavian artery partially obstructing the descending aorta is described. CT-scan and transesophageal echocardiography together with clinical suspicion led to the correct diagnosis. Intimointimal intussusception is an unusual type of aortic dissection in which a proximal circumferential tear causes dissection with intussusception of the torn intima downstream, which could cause confusion about the appropriate diagnosis ([1]). It is a very infrequent complication of aortic dissection with only a few cases reported in the literature ([2-6]). CT scan and transesophageal echocardiography are the most accurate diagnostic tools ([7-9]). We describe a patient with intimointimal intussusception, diagnosed by CT scan and transesophageal echocardiography

Short-term outcomes of aortic valve neocuspidization for various aortic valve diseases

Objectives: Bioprosthetic valve deterioration remains a major limitation following aortic valve replacement. Favorable results have been reported with an autologous pericardium aortic valve neocuspidization. Methods: Seventy patients (31 women and 39 men) (mean age, 62 ± 12 years) with aortic stenosis (n = 52 [74%]) or aortic regurgitation (n = 18 [26%]) underwent the aortic valve neocuspidization procedure. Thirty-four patients (49%) had a tricuspid valve, 35 (50%) had a bicuspid valve, and 1 (1%) had a monocuspid valve. European System for Cardiac Operative Risk Evaluation and Society of Thoracic Surgeons scores were, respectively, 2.2% ± 2% and 2.0% ± 1.8%. Four patients (6%) had active endocarditis and 2 (3%) had endocarditis sequelae. One patient (1%) had fibroelastoma. A combined procedure was performed in 33 patients (46%). Results: The follow-up period was 24 ± 12 months. One patient (1%) died in hospital and 1 patient (1%) underwent conventional valve replacement for significant aortic regurgitation. Postoperative peak and mean pressure gradients were respectively 14 ± 5 and 8 ± 3 mm Hg. Aortic valve area was 2.5 ± 0.6 cm2. During follow-up, no patients died. Reintervention occurred in 2 patients (3%). At last follow-up, peak pressure gradient was 13 ± 7 mm Hg, mean pressure gradient was 7 ± 4 mm Hg, and aortic valve area was 2.3 ± 0.7 cm2. There was 1 recurrence of moderate aortic stenosis (1%). All patients were in New York Heart Association functional class I (90%) or II (10%). Freedom from major valve-related events was 92.1%, (98.5% for death, 95.2% for reintervention, and 95.2% for endocarditis). Conclusions: In our experience, the midterm outcomes of the aortic valve neocuspidization procedure with autologous glutaraldehyde fixed pericardium were acceptable for survival, operative risk and valve-related complications, for our all-comer patient population with various aortic valve diseases.</p

Cancers de la thyroïde : expérience genevoise

To study the survival of patients with thyroid cancer operated in the same centre from 1978 to 1999