Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation of patient's disability level and radiographic constriction of the lumbar spinal canal is of interest.

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Retrospective analysis of 4886 adults undergoing coronary arteriography for evaluation of angina between October 1988 and December 1991, revealed coronary artery fistulae in eight patients (all men, aged 36-69 years). No murmur was audible in any of these eight patients. Associated significant coronary artery disease was detected in five patients. The feeder arteries to the fistula were both the left main coronary artery and the left anterior descending artery (LAD) in two, the LAD in six, and the right coronary artery in two patients. The fistula terminated in the pulmonary artery in seven patients and in the right atrium in one patient. Successful operative treatment (coronary artery bypass grafting and ligation of the fistula) was undertaken in four patients with severe obstructive coronary artery disease with satisfactory results. Follow-up for up to 2 years of the three patients with coronary artery fistula and no associated coronary artery disease who did not undergo surgery revealed continuing good prognosis. We conclude that coronary artery fistula in adults is a distinct, though rare (incidence in present series 0.11%) entity, without audible murmur, commonly associated with coronary artery obstructive disease, and that the diagnosis is mostly incidental during routine coronary arteriography.

SummaryWe report a rare case of a cardiac hydatid cyst that was incidentally found during routine work up for a redo-CABG and was picked up on echocardiography and confirmed by magnetic resonance imaging and, after successful removal, further confirmed by histopathology. The report emphasizes the importance of early and urgent surgery for such cardiac hydatid cysts whenever discovered to prevent fatal and unexpected death. Cardiac hydatidosis is a most infrequent type, in comparison with hydatidosis of the liver (65%) and lung (25%).Learning points Hydatidosis or cystic echinococcosis is caused by infection with the metacestode stage of the tapeworm Echinococcus (family Taeniidae). The adult tapeworm is usually found in dogs or other canines; the tapeworm eggs are expelled in the animal's feces and humans become infected after ingestion of the eggs. The initial phase of primary infection is asymptomatic.Cardiac hydatidosis is extremely rare, more commonly the liver and lungs are affected.Morbidity from heart echinococcosis in men is three times higher than that in women. Solitary cysts occur in almost 60% of the cases; the most frequent location is the ventricular myocardium and they are usually subepicardially located, hence they rarely rupture in the pericardial space. The left ventricle is damaged twofold to threefold more frequently than the right one.The diagnosis of echinococcosis in heart can be divided into two steps: detection of the cyst and its identification as echinococcus. It is based on serological reactions, echocardiography, X-ray, computerized tomography, and/or magnetic resonance imaging.The most dangerous complication of cardiac echinococcosis is cyst perforation. After cyst perforation three quarters of the patients die from septic shock or embolic complications.It is very important to understand that chemotherapy may lead to cyst death, and destruction of its wall and result in cyst rupture. Therefore, no germicide must be administered before surgical removal.