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Background: Cardiac myxomas are commonly located in the left atrium but rarely affect the right side of the heart. We retrospectively analyzed 28 patients receiving surgical treatment for right heart myxomas at our center and aimed to summarize the clinical features and surgical outcomes of right heart myxomas. Methods: Between May 2001 and June 2022, 244 patients with sporadic cardiac myxomas underwent complete surgical resection. Twenty-eight patients (28/244, 11.48%) were right heart myxomas. Among the 28 right heart myxoma cases, 25 underwent median sternotomy and 3 underwent robotic or total thoracoscopic procedures. The clinical features, operative information, and follow-up data of right heart myxoma were comprehensively reviewed, and clinical characteristics between right heart myxoma and left heart myxoma were also compared. Results: A significant difference was noted in sex between right heart myxoma and left heart myxoma (P

Introduction: Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural effusion. Methods: This is a descriptive cross-sectional study conducted in two tertiary care hospitals in Chitwan from March 2018 to May 2018. Ethical approval from the Institutional Review Board was obtained. Convenient sampling was done that included all the patients who met criteria for undiagnosed exudative pleural effusion after diagnostic thoracocentesis. Patients having contraindication to procedure and who refused consent were excluded. Statistical analysis was performed using IBM SPSS Statistics 20 and data are presented as mean (±SD) and frequency (percentage). Results: A total of 14 patients underwent rigid medical thoracoscopy. All 14 patients had unilateral pleural effusion. The overall diagnostic yield was 100%. Malignancy was the most frequent histopathology diagnosis seen in 11 (78.57%) patients, the commonest being metastatic adenocarcinoma in 8 (57.1%). Pleural tuberculosis and acute-on-chronic pleuritis were seen in 2 (14.3%) and 1 (7.1%) patients, respectively. Pleural deposits and hemorrhagic pleural fluid were the two commonest findings, seen in 10 (70.1%) and 9 (64.3%) patients, respectively. Two (14.3%) patients clinically treated as tuberculous pleural effusion was re-diagnosed to have metastatic adenocarcinoma. Common procedure-related minor complications observed were mild to moderate pain and mild bleeding, observed in 3 (21.4%) and 2 (14.3%) patients, respectively. Conclusions: Medical thoracoscopy is a safe, well-tolerated and high yield procedure in undiagnosed exudative pleural effusion. This art of medicine should be promoted in daily medical practice.

We describe a case of microscopic polyangiitis manifested as pleuritis confirmed by thoracoscopic biopsy. An 80-year-old man presented with a three-day history of shortness of breath and cough. Chest radiography revealed patchy opacities in the lower fields of the bilateral lung and right-sided pleural effusion. Thoracentesis revealed lymphocytic pleural exudates. Thoracoscopic biopsy specimens were compatible with fibrotic pleuritis. He developed rapidly progressive glomerulonephritis with elevated myeloperoxidase anti-neutrophil cytoplasmic antibody titer in blood and pleural effusion. Although the patient was resistant to two weekly courses of pulse steroid therapy, he was successfully treated with a five-day course of intravenous immunoglobulin.

Introduction: Diaphragmatic paralysis is produced by interruption in the transmissionof nerve impulses by means of the phrenic nerve or by loss of the muscle contractility.It entails to progressive muscular atrophy and to distension of the cupola. It can appearunilaterally or bilaterally, being this one the most common; however, it is a condition oflow incidence. The causes are tumour invasion of the phrenic nerve, surgical, traumaticand idiopathic lesions and infections, between others. Its surgical correction is necessarywhen respiratory commitment exists. Several techniques and approaches are describedto do repair. Publications about diaphragmatic plication by thoracoscopy by two portsare unknown.Clinical case: It is presented a clinical case of a 50 years old female patient withidiopathic diaphragmatic paralysis, progressive dyspnea with suggestive spirometrydata of severe restrictive pattern. Diaphragmatic plication by thoracoscopic way bytwo ports was carried out satisfactorily. Anatomical and clinical improvements wereconfirmed.Conclusion: Diaphragmatic plication is the surgical technique of choice to repairdiaphragmatic paralysis. The videothoracoscopy by two ports is proposed as a favorableapproach that allows the development of the surgical procedure. Rev.cienc.biomed.2013;4(1):142-146.RESUMENIntroducción: la parálisis diafragmática se produce por interrupción en la transmisiónde los impulsos nerviosos a través del nervio frénico o por pérdida de la contractilidaddel músculo. Conlleva a atrofia muscular progresiva y distensión de la cúpula. Puedepresentarse bilateral o unilateralmente, siendo esta última más común; sin embargo,es una afección de baja incidencia. Las causas son invasión tumoral del nervio frénico,lesiones quirúrgicas, traumáticas, infecciones, idiopáticas, entre otras. Su correcciónquirúrgica es necesaria cuando hay compromiso respiratorio. Varias técnicas y abordajesestán descritos para realizar reparación. No se conocen publicaciones de plicaturasdiagramáticas realizadas por videotoracoscopia por dos puertos.Caso clínico: se presenta caso clínico de paciente femenina de 50 años de edad conparálisis diafragmática idiopática. Disnea progresiva, con datos espirométricos sugestivosde patrón restrictivo severo. Se realizó satisfactoriamente y sin complicaciones plicaturadiafragmática vía toracoscópica por dos puertos. Se comprobó mejoría anatómica yclínica.Conclusión: la plicatura diafragmática es la técnica quirúrgica de elección parala corrección de la parálisis diafragmática. Se propone la videotoracoscopia por dospuertos como abordaje favorable que permite realización del procedimiento operatorio.Rev.cienc.biomed.2013;4(1):142-146

The case of a patient with p rimary pulmonary Hodgkin Lymphoma simulating a mediastinal tumour i s r e p o r t e d f o r i t s r a r i t y a n d t h e d i a g n o s t i c c o n c e r n s e n c o u n t e r e d b y u s .

Gastrointestinal stromal tumor is a rare entity, especially in the esophagus. We report a patient with a stromal tumor of the esophagus who underwent a thoracoscopic enucleation of the tumor. The patient was a 61-year-old man complaining of slight dysphagia. A submucosal tumor of the middle thoracic esophagus was found endoscopically. The tumor was approximately 4.0 cm in diameter measured by endoscopic ultrasonography. On 17 May 2001, thoracoscopic enucleation of the esophageal tumor was performed using a Kodama Di-suction. The Kodama Di-suction was useful for the thoracoscopic enucleation of the submucosal tumor of the esophagus, acting as both a dissector and a sucker. The patient's course was uneventful after surgery. Histopathologically the esophageal tumor revealed a high cellularity, consisting of spindle cells, and the tumor cells were immunohistochemically positive for CD34 and c-kit protein, but not for a-smooth muscle actin or S-100 protein. From these findings, the esophageal submucosal tumor was diagnosed as gastrointestinal stromal tumor, distinguished from leiomyoma. [ABSTRACT FROM AUTHOR]

To evaluate the effect of an open-chest condition on oxygen delivery in anesthetized dogs. Prospective, controlled experimental study. Eight clinically normal adult Walker Hound dogs weighing 25.6–29.2 kg. Eight anesthetized dogs underwent an open-chest operation after the insertion of thoracoscopy cannulae in the lateral chest walls . A Swan Ganz catheter was used to both measure hemodynamic parameters and obtain mixed venous blood samples for blood gas analysis. A dorsal pedal catheter was placed to both measure arterial blood pressure and obtain blood samples for blood gas analysis. Oxygen delivery index and oxygen extraction ratio were calculated. A randomized block anova for repeated measures was used to evaluate the effect of the treatment on hemodynamic and pulmonary parameters. Creation of an open chest did not significantly affect oxygen delivery index (DO2I; p = 0.545). It induced a significant decrease in arterial oxygen partial pressure (PaO2; p = 0.018) and arterial oxygen content (CaO2; p = 0.025). It induced a significant increase in shunt fraction ( p = 0.023), physiologic dead space ( p = 0.015), and alveolar-arterial oxygen difference ( p = 0.019). Arterial partial pressure of carbon dioxide (PaCO2; p = 0.766) and arterial hemoglobin oxygen saturation (SaO2; p = 0.178) were not significantly affected. Diastolic (DPAP; p = 0.050) and mean (MPAP; p = 0.033) pulmonary arterial pressures were significantly increased by opening the chest. Other hemodynamic parameters were not significantly affected. Opening the thoracic cavity is not detrimental to hemodynamic function and oxygen delivery in normal dogs, although impaired gas exchange does occur. Close monitoring of patients is recommended during open-chest thoracoscopy as adverse effects on gas exchange can contribute to hypoxemia. [ABSTRACT FROM AUTHOR]

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Microsurgical approaches for the treatment of pathology located in the ventral thoracic spine using video-assisted thoracic surgery (VATS) allow neurosurgeons to access the disc spaces, vertebral bodies, paravertebral soft tissues, spinal cord, spinal nerves, and sympathetic chain with minimally invasive surgery. This has been associated with substantial clinical benefits including reduced postoperative pain, lower complication rates and shorter recovery times when compared with standard thoracotomy techniques. This article describes the experience at our institution with VATS for discectomy (20 cases), corpectomy and spinal reconstruction (8 cases), thoracic sympathectomy (3 cases), and nerve sheath tumor removal (1 case). The technique can be mastered but requires surgeons to learn the new psychomotor skills needed to perform endoscopic spine surgery. The learning curve is steep. Special training in instructional seminars, surgical skill laboratories, and clinical preceptorships is needed before this surgical approach can be used clinically to treat spinal pathology. VATS has significant advantages compared to standard thoracotomy, including reduced incisional pain and avoidance of the postthoracotomy pain syndrome. If intercostal neuralgia develops postoperatively, it is milder and usually transient compared to the pain associated with standard thoracotomy. Better cosmetic outcomes, earlier mobilization, and faster recovery are added benefits. The surgical techniques are relatively new for neurosurgeons and require dedicated practice to master them. Once the surgical skills are perfected, VATS is feasible for spinal pathology and can be performed safely and effectively. [ABSTRACT FROM AUTHOR]

Congenital tracheoesophageal fistula not associated with esophageal atresia, known as H-type fistula, is an uncommon anomaly. It presents with cough, choking, and cyanosis during feeding and/or recurrent pneumonia. Although symptoms are usually present from birth, diagnosis is difficult. The rarity of this disease, non-specific symptoms, and the limitations of radiological and endoscopic confirmation of the fistula often result in a delay between presentation and diagnosis confirmation. Here we describe the clinical manifestations, assessment methods, and management of 3 newborn infants with H-type tracheoesophageal fistula, together with diagnosis recommendations to prevent unnecessary delays in the management of this condition., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)