Moaath Alsmady

Hereditary Multiple Exostoses with Pseudoaneurysm

A 16-year-old male patient with hereditary multiple exostoses (HME) was found to have a pseudoaneurysm of the left popliteal artery caused by osteochondroma in the lower femur. The diagnosis was confirmed by ultrasound, magnetic resonance imaging and magnetic resonance angiography without the need to perform an angiogram. The osteochondroma was excised and the popliteal artery was repaired with a saphenous graft. Vascular complications are extremely rare in HME, pseudoaneurysm being the most common and mostly located in the popliteal artery. This complication should be considered in young HME patients with a mass at the knee region. The radiological spectrum of investigations allows the diagnosis of this complication with proper and less invasive management procedures for the patient.

Spontaneous femoral artery pseudoaneurysm in a young patient.

Spontaneous femoral artery pseudoaneurysm is a rare disease and reported cases are very rare. Most of them are related to an underlying pathology of either atherosclerotic disease or connective tissue disease. We present a healthy, 29-year-old man with 2-month history of a painful pulsating mass at the level of the lower right thigh with no previous history of trauma, surgery, or puncture of the femoral artery. An angiogram revealed a right superficial femoral artery pseudoaneurysm. It was treated surgically by resection of the aneurysm and reconstruction with an interpositional saphenous vein graft. We report this case because of the rarity of this condition in a young patient with no underlying pathology.

Effects of experimental acute myocardial infarction on blood cell counts and plasma biochemical values in a nude rat model (Crl:NIH-Fox1RNU)

To determine the clinical pathology parameters in nude rats (Crl:NIH-Fox1RNU) following experimental induction of acute myocardial infarction (AMI), 50 male adult nude rats weighing 250–350 g were used. Complete blood count, total and differential leukocyte counts, plasma total protein, albumin, glucose, urea, creatinine, total bilirubin, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase were determined before (time zero, T0), 1, and 5 days following experimental induction of AMI. Lactate dehydrogenase, creatinine kinase (CK), and creatinine kinase MB fraction (CK-MB) were determined at T0, 6, and 24 h following AMI. There were no significant changes in the hematological parameters at any sampling point. Among all plasma biochemical parameters studied, only CK and CK-MB were significantly elevated 6 h following induction of AMI. These data will aid scientists and researchers in the interpretation and better application of their results when using nude rats for AMI studies.

Cardiac myxoma: clinical characteristics, surgical intervention, intra-operative challenges and outcome:

Objective: The objectives of this retrospective study were to characterize the clinical presentation, diagnostic findings, surgical approaches, intra-operative challenges and complications following the surgical treatment of cardiac myxoma in two of the largest referral hospitals in Jordan. Methods: Medical records of all patients presented to the cardiology department during the period between 1984 and 2016 were reviewed. Criteria for inclusion in the study were: (1) patients who were presented for cardiac evaluation due to symptoms suggestive of a primary cardiac problem, (2) completed medical records, including results of echocardiography suggestive of intra-cardiac occupying mass, (3) the surgical operation was undertaken and intra-operative data was available, (4) a histological diagnosis of myxoma was available and (5) the discharge status and follow-up data were available for at least 2 years after initial surgery. Results: A total of 27 patients fulfilled the criteria for inclusion in the study. The average age was 42 years. Thirteen of the patients were females and 14 patients were males. The most common clinical presentations were dyspnea (29.6%) and murmurs (22.2%). Non-specific signs, such as weight loss, fever, fatigue, arthralgia and anemia, were reported in 10 (37%) patients. Signs related to systemic embolization were reported in 9 (33.3%) of the patients, involving the upper and lower extremities (55.6%), brain ischemia and vision loss (54.4%). Tumors in all patients were successfully resected under cardiopulmonary bypass support. The tumor was pedunculated in 17 (62.9%) of the patients and the size of the tumors varied from 1 to 7 centimeters in diameter. The tumor was located in the left atrium in 21 patients (77.7%), in the right atrium in 4 patients (14.8%), in the right ventricular side of the septum in 1 patient (3.7%) and involving the tricuspid valve in 1 patient (3.7%). The left atrial approach was used in 3 patients, a right atrial approach in 4 patients and a bi-atrial approach in 20 patients. The most common concomitant cardiac pathology was coronary artery disease in 3 patients and an atrial septal defect in one patient. The most common intra-operative challenges were inter-atrial communication (2 patients), large defect in the tricuspid valve leaflet (1 patient) and involvement of the inter-ventricular septum (1 patient). In the post-operative period, 1 patient suffered a stroke. In the post-operative period, the most common complications were stroke (1 patient) and recurrence of the tumor (2 patients). Conclusion: The success rate after surgical removal of cardiac myxoma in this study was substantial and complications were rare.

Outcome of upper limb vascular access for hemodialysis

The aim of this study was to investigate the outcome of vascular access procedures for hemodialysis and factors affecting access survival and complication rates. A retrospective review was carried out on 276 patients who underwent 404 consecutive vascular access operations performed over seven-years. The overall primary failure rate was 9.2%, while the oneand five-year cumulative access patency rates were 63.8% and 40.6%, respectively. Diabetes mellitus status significantly influenced access survival (P = 0.022). Autogenous arteriovenous fistulas (AVFs) are reliable procedures with access sites often available in the upper limb proximally and distally. Patients with diabetes mellitus have significantly worse patency rates of upper limb AVFs.

Spontaneous femoral artery pseudoaneurysm in a young patient

Spontaneous femoral artery pseudoaneurysm is a rare disease and reported cases are very few. Most of them are related to underlying pathology either atherosclerotic disease or connective tissue disease. We present a 29-year-old healthy man with two months history of a painful pulsating mass at the level of the lower right thigh without any previous history of trauma, surgery or puncture of the femoral artery. An angiogram revealed a right superficial femoral artery pseudo-aneurysm. It was treated surgically by resection of the aneurysm, reconstruction with inter-positional saphenous vein graft. We reported this case because of its rare incidence in the young patient with no underlying pathology.

Saphenous vein patch for correction of anomalous origin of the right coronary artery from the left main coronary artery.

Abstract Anomalous origin of the coronary arteries is a rare congenital heart defect that may lead to disturbed life style, myocardial infarction and sudden death. This report describes a young lady with the right coronary artery arising from the left main coronary artery, which was confirmed by coronary angiography and corrected surgically using saphenous vein patch.

Anesthetic Management of Simultaneous Coronary Artery bypass Grafting with Cardiopulmonary bypass and Extended Thymectomy in a Patient with Myasthenia Gravis

A 61-yr-old male having myasthenia gravis MG (Osserman IIB), Hypertension HTN, hyperlipidemia, type II diabetes mellitus DM II, a single pelvic kidney, chronic obstructive pulmonary disease COPD with a positive history of smoking and coronary artery disease, was admitted for uncontrolled myasthenic symptoms, cardiology team was consulted, cardiac catheterization was performed and revealed a three vessel coronary artery disease. All the findings dictated the management, a combined coronary artery bypass graft CABG and an extended thymectomy was performed. Optimization of the patient was achieved preoperatively. Total intravenous anesthesia using propofol and remifentanyl was applied to this patient. Continuous monitoring of the neuromuscular transmission NMT was maintained throughout the perioperative period. Although neither muscle relaxants nor inhalational agents were used in the anesthetic management of this patient; the patient developed postoperative atelectasis and lung collapse; which was managed successfully, and extubation of the trachea was done after ensuring adequate recovery of the NMT and respiratory function. Myasthenic therapy was continued throughout the perioperative period.

Giant Spontaneous Femoral Artery Pseudoaneurysm Treated with Covered Stents: Report of a rare presentation and review of literature.

We report the case of a 62-year-old woman who presented with a one-month history of a pulsatile mass, with no antecedent trauma or intervention. Imaging showed a large pseudoaneurysm (PSA) of the distal portion of the left superficial femoral artery. The PSA was treated successfully with endovascular placement of covered stents.

Chronic total occlusion of left main coronary artery in a young man

Chronic total occlusion of the left main coronary artery is rarely encountered in coronary angiography. Patients are at high risk of death because of its intimate association with massive anterior myocardial infarction. A 29-year-old man with no cardiac risk factors, presented with myocardial infarction and severe mitral regurgitation. Coronary angiography revealed chronic total occlusion of the left main coronary artery. He underwent coronary artery bypass grafting and mitral valve repair.