Giant esophageal leiomyoma and cardiac compression

Esophageal leiomyoma is rare diseases, it is often asymptomatic, and typically require only close surveillance except if became large and cause symptoms secondary to compression. We report a case with giant leiomyoma presented with chest pain and unstable blood pressure secondary to cardiac compression It is usually managed by thoracotomy and surgical enucleation and possible resection

Thoracic Surgery: Opportunities and Challenges in Saudi Arabia

The cardiothoracic surgery is an essential field of medical sciences in producing cardiothoracic surgeons with higher principles of knowledge, skills and integrity with a profound impact on health care system. Progress in achieving excellence in cardiothoracic surgery and its allied research goals varied over the time and across the countries. Saudi Arabia devoted special attention to fostering higher education on health care system although, the country is facing challenges in the management of cardiopulmonary diseases burden amenable to cardiothoracic surgical treatment. Patients have access to quality cardiothoracic surgical care, but still the state is struggling for enough number of trained thoracic surgeons to provide better health care services in cardiothoracic surgery field. This review article summarizes the opportunities and challenges in this promising surgical discipline

PRIMARY SPONTANEOUS PNEUMOTHORAX: CLINICAL PROFILE, SEASONALITY AND RECURRENCE OF 132 ADULT PATIENTS IN A UNIVERSITY HOSPITAL, KINGDOM OF SAUDI ARABIA

Objectives: The current study aimed to study the presenting features of Primary Spontaneous Pneumothorax (PSP) patients including demographic (gender, age, smoking, height and weight, Body mass index (BMI)), symptoms and seasonality among adult patients in KKUH during the period from 2010 to 2016. To describe the recurrence of PSP and length of hospital stay in patients who were managed surgically in KKUH during the period from 2010 to 2016. Methods: Quantitative, Observational, Retrospective, Case-series study. 132 Patients was studied who were diagnosed with primary spontaneous pneumothorax disease from Jan 2010 to Dec 2016 in King Khalid University Hospital were studied. Data was collected by reviewing the transfer sheet case report form (CRF), and by reviewing variables in medical records of PSP patients. Results: The mean age was 24.62 (S.D ±8.8) years old. 88.6% of patients were males (11.4% females). 59.8% were smokers and 40.2% were non-smoker. The (BMI) average was 19.4 kg/m2. The season of the attack was more in spring and summer accounting a 29.6% for each. 90.9% of the Patients were treated surgically. The average length of hospital stay after surgical management was 6.45 days (S.D ±3.15), recurrent after surgical management was (4.1%). Conclusion: Based on this case series study, majority of primary spontaneous pneumothorax (PSP) patients were male, at young age group, with low body mass index (BMI). Most of the admissions occurred in warm climate (spring/summer). Furthermore, short hospital stays, and low state of recurrence were noted among the patients treated surgically. Key words: (Primary Spontaneous Pneumothorax, variables, seasonality, recurrence

Thoracic Surgery: Opportunities and Challenges in Saudi Arabia

The cardiothoracic surgery is an essential field of medical sciences in producing cardiothoracic surgeons with higher principles of knowledge, skills and integrity with a profound impact on health care system. Progress in achieving excellence in cardiothoracic surgery and its allied research goals varied over the time and across the countries. Saudi Arabia devoted special attention to fostering higher education on health care system although, the country is facing challenges in the management of cardiopulmonary diseases burden amenable to cardiothoracic surgical treatment. Patients have access to quality cardiothoracic surgical care, but still the state is struggling for enough number of trained thoracic surgeons to provide better health care services in cardiothoracic surgery field. This review article summarizes the opportunities and challenges in this promising surgical discipline

Mediastinal Seroma Post Laparoscopic Repair of Type IV Paraesophageal Hernia

Laparoscopic repair of paraesophageal hernia is safe and feasible and can provide comparable results for patients with type IV paraesophageal hernia. We report a rare case of mediastinal seroma in an 80-year-old gentleman who had a giant type IV paraesophageal hernia and was eventually admitted to our hospital for elective laparoscopic repair and recovered very well after surgery with resolution of the atelectatic lungs and air-fluid collection in his chest

Continuous positive airway pressure ventilation during whole lung lavage for treatment of alveolar proteinosis -A case report and review of literature

Pulmonary alveolar proteinosis (PAP) is a rare disease that affects young population usually in the age group of 20-40 years, characterized by the deposition of lipoproteinacious material in the alveoli secondary to abnormal processing of surfactant by macrophages. We report a case of a 15-year-old female who had history of cough with sputum for 3 days along with fever. She was seen in another hospital and was treated as a case of pneumonia where she received antibiotic but with no improvement. Computerized tomography (CT) chest showed diffuse interlobular septal thickening in the background of ground glass opacity giving a picture of crazy paving pattern which was consistent with the diagnosis of PAP. The patient was scheduled to undergo, first right-sided whole lung lavage (WLL) under general anesthesia. Endobronchial intubation using left sided 37 Fr double lumen tube. Continuous positive airway pressure (CPAP) as described in our previously published report was connected to the right lumen of the endobronchial tube. CPAP ventilation was used during the suctioning of lavage fluid phase in order to improve oxygenation. WLL was done using 5 L of warm heparinized saline (500 i.u/litre). The same procedure was repeated on the left side using 6 L of heparinized normal saline solution. In conclusion, anesthesia in alveolar proteinosis for patients undergoing WLL is challenging to the anesthesiologist. It requires meticulous preoperative preparation with antibiotics, mucolytics and chest physiotherapy. Also it requires careful intraoperative monitoring and proper oxygenation especially during the suctioning phase of the lavaged fluid. With this second case report of successful anesthetic management using the modified CPAP system we recommend with confidence the application of CPAP ventilation to improve oxygenation during WLL

Surgical management of retrosternal goiter: Local experience at a university hospital

Background and Objective: Retrosternal goiter (RSG) is a term that has been used to describe a goiter that extends beyond the thoracic inlet. Surgery plays an important role in the treatment of these patients, but whether all or selected patients with RSG should undergo this operation remains controversial. Our aim is to look into the demographics, presentation, and treatment of patients with RSG and essentially to determine the role of surgery in its treatment. Setting and Design: Retrospective study, teaching hospital-based. Methods: Retrospective analysis of 537 thyroidectomies performed at King Khalid University Hospital between 2003 and 2010. The twenty-six patients with RSG were analyzed further, with regard to demographics, presentation, indications, and outcome of surgical treatment. Statistical analysis was performed, where age was expressed as mean and range, and other variables were presented as numbers and percentage. Results: There were 26 patients (4.8%) with RSG out of 537 thyroidectomies, who underwent an operation for removal of RSGs, in a seven-year period. The most common presentation was dyspnea (34.6%) and the surgical procedure predominantly used was total thyroidectomy. The RSGs were removed by collar incision in 96% of the cases. The final histological diagnosis revealed malignancy in 26.9% of the thyroid specimens. There was no mortality and minor complications occurred in nine patients. Conclusions: The presence of an RSG is an indication for surgery owing to the lack of effective medical treatment, the higher incidence of symptoms related to compression, low surgical morbidity, and the risk of malignancy

A novel technique for the reconstruction of resected sternoclavicular joints: A case report with a review of the literature

Sternal metastasis in thyroid cancer is an uncommon occurrence with only a handful of cases of chest wall resections being done. Sternal reconstruction for both primary and secondary tumors has been performed using various techniques and materials such as the mesh, methyl acrylate resin, and steel plates; however, this is a case of papillary thyroid cancer involving the sternum in a 50-year-old woman who had resection of the sternum with reconstruction using titanium bars and clips (STRATOS system) fixed to the clavicles with an underlying Proceed mesh. STRATOS system showed good recovery postoperatively. The functional results were excellent with the patient being able to perform all daily activities unassisted after 1 month and almost complete range of motion with acceptable limitations in power of the shoulder muscles after 2 months. We have reviewed all the English language publications of the subject by doing Medline search for the last 25 years and we present here the surgical management of this pathology with our novel approach by using the titanium steel bars to stabilize both medial aspects of the resected clavicles as a promising therapy for manubrial reconstruction and clavicular fixation