From January 1968 to July 1983, 38 patients with an intracardiac myxoma underwent surgical excision of the tumor at our Institution. There were 15 males and 23 females, ranging in age from 17 to 68 years (mean 47.7). In all but 2 patients, the presence of an intracardiac myxoma was documented preoperatively by angiographic and/or echocardiographic study. The first 2 patients of this series were referred with the diagnosis of mitral stenosis, and the myxoma was an unexpected surgical finding. In 32 cases (84.2%) the myxoma was located in the left atrium, in 4 (10.5%) in the right atrium and in 2 (5.3%) in the right ventricle. Surgery was performed on an emergency basis in 36 patients. Two patients (5.2%) both with a left atrial myxoma, died after surgery: one died intraoperatively of hemorrhage and the other after one month of bowel infarction. Follow-up of the 36 survivors ranges from 3 months to 14.5 years (average 5.2 yr); all were controlled by means of clinical and echocardiographic investigations, and no evidence of tumor recurrence was detected. Surgery for intracardiac myxoma, which should be undertaken on an emergency basis, carries a low operative risk; excision of the tumor appears to be curative with no recurrences at long-term follow-up; non-invasive tools are of the utmost importance in both the preoperative assessment and follow-up of these patients.

Studies of T-cell subsets (CD3+, CD4+, CD8+, CD8+ CD57+ cells), lymphocyte response to concanavalin A (Con A), phytohaemoagglutinin (PHA) and the alterations of white cell membranes shown by scanning electronic microscope (SEM) in 51 patients who underwent cardiac operation were performed. Out of these 51 unselected patients, for 16, duration of CPB was < or = 110 min (group A), while for the other 35 (group B) it was prolonged (> 110 minutes). Although variations of the lymphocyte subset observed between groups A and B were slightly significant (p < 0.05 before CPB and on postoperative day 7), the T-cell reactivity in group B in comparison to that of group A did not normalize by postoperative day 7 regardless of stimulation with PHA or with Con A. With the use of the SEM, the folded aspect of lymphocyte surface decreased after surgery in about 71% (group A) and 78% (group B) of the observed cells. The outcome of the immunological effects given by our studies could have been due to an elongated CPB even if there need to be taken into consideration multifactorial influences, i.e. biological, pharmacological and hormonal hypotheses, and rapid changes in CPB-micro-environment.

The present report reviews our experience with 12 cases of delayed cardiac tamponade following open heart surgery, which occurred at various times after the seventh postoperative day (average 19 days). In each case the diagnosis was made on clinical grounds, supported by the radiographic findings in all, and confirmed by echocardiography in 4. Pericardial effusion was serous in 5 patients, sero-sanguineous in 3, sanguineous in 3, and purulent in one; it was most frequently caused by a postpericardiotomy syndrome (7 cases). A single pericardiocentesis was curative in 6 instances, while repeat procedures were required in 2 because of recurrence. A repeat median sternotomy was performed in 5 patients associated with pericardiocentesis, and a pericardiectomy in 2. Three patients died within one month from the initial operation; no recurrences have been noted so far in the long-term survivors. According to the results of the present investigation, early clinical recognition is considered the clue to a successful outcome. Sole pericardiocentesis is followed by immediate improvement of the patient's state, and is often curative, but recurrences may require other maneuvers for further fluid evacuation. Awareness of this possible complication may contribute to a decrease in the still high mortality rate associated with this condition.

No abstract

Aul~er den einzelnen der einen wie der anderen Affektion speziell eigentiimlichen Manifestationen, mit allen m5glichen Graddifferenzen, und auBer den verschiedensten Modalit~ten, Mutabilit~ten und Anomalien der entsprechenden Symptomatologie, welehe, nicht so sehr yon der Natur der Affektion als yon der essentiellen Lokalisation in bestimmten SystemeH abh~ngig, nicht selten verschieden interpretierbare klinisehe Bilder vort~uscht, aufler allen diesen Umst~nden kSnnen wirkliche Kombinationen zwischen Syphilis und Lepra vorkommen. Wenn sie sieh manchmal mit eigener Symptomatologie einzeln in einem und demselben Individuum entwickeln, komplizieren und gegenseitig beeinflussen, wird eine pr~zise Differentialdiagnose und eine exakte Interpretation der Pathogenese der einzelnen Symptome ~ul~erst erschwert. Und wenn bei einem und demselben Individuum nicht allein beide Affektionen vorhanden sind, sondern, bei identischer Lokalisation, auch eine wirkliche und eigentiimliche Aufeinanderlegung verschiedener Prozesse stattfindet, yon denen jeder einzelne wahrscheinlich eine Modifikationswirkung erleidet und in gleieher Zeit eine solche auch ausdriickt, dann gestaltet sieh die Arbeit,