An optimal preoperative evaluation is fundamental to the assessment of all patients undergoing cardiac surgery. We report the case of a male patient who underwent elective coronary artery bypass surgery, and intraoperative transesophageal echocardiography (TEE) revealed an unexpected left atrial cavernous hemangioma. The tumor was resected via a transatrial approach, and a definitive diagnosis was made after histological examination. This uncommon intra-atrial tumor (which accounts for approximately 2.8% of all benign cardiac neoplasms) was detected at the time of the operation as no basic echocardiography study had been performed on the patient during the process of diagnosing his coronary heart disease because of a suboptimal cardiological work-up. Most cardiac masses are discovered incidentally by imaging techniques; in this patient, transthoracic echocardiography could have aided in the preoperative study and enabled the cardiac surgeon to plan and perform the adequate surgical procedure beforehand. Intraoperative TEE should be used routinely in all patients undergoing cardiac surgery: the clinical information obtained in certain cases might have a direct impact on surgical decision-making and might therefore positively influence patient's outcome.

& AbstractIntroduction: Pain associated with chronic pancreatitis is often difficult to treat. On many occasions, interventional techniques may be necessary. In recent years, spinal cord stimulation techniques have been used successfully in the treatment of these patients. However, only the use of traditional tonic stimulation based on paresthesias has been published for this purpose. Spinal cord burst stimulation has been shown to be more effective than tonic stimulation, especially in failed back surgery syndrome. Case description: We present the case of an 82-year-old patient with incoercible pain related to chronic pancreatitis for the preceding 5 years. She had shown good short-term results with lidocaine-cortisone blocks and celiac plexus radiofrequency. After a failed trial period with low-frequency conventional tonic stimulation, she was successfully treated with burst stimulation. Results: A sustained pain score reduction of over 50% on the visual analogue scale was seen, as were a decrease in opioid consumption and a high degree of satisfaction with the therapy by our patient. &

Vertebral fractures are very frequent among the population affected by osteoporosis, being pain one of the most distressing associated symptoms. The classic treatment of vertebral fractures is, in principle, conservative. However, in the case of persistent pain, vertebral augmentation techniques and radiofrequency ablation (in the event that vertebral augmentation techniques can’t be applied) have proved to be useful. We present the case of a patient who developed severe pain secondary to an acute T2 and L3 fracture, in addition to a posterior T6 fracture. It was treated successfully with L3 vertebroplasty and facet joints denervation of T1-T2 and later T5-T6, this being justified by the technical impossibility of performing vertebroplasty on said levels. The patient was discharged from the hospital with managed pain relief and more than a 50% reduction in opioids doses. Three months later, she continued experiencing pain relief. Radiofrequency ablation of the medial branch of facet joints can be useful in the treatment of pain associated with vertebral fractures in patients where vertebral augmentation techniques are contraindicated or as a complementary treatment for persistent pain. Key words: Vertebral compression fracture, percutaneous vertebroplasty, radiofrequency ablation, medial branch, facet joints, osteoporosis

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