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Alternative approaches to the standard posterolateral incision for thoracotomy have been developed to minimize its postoperative pain and wound related side effects. Muscle-sparing (MS) thoracotomy has been a well-known substitution to the standard posterolateral thoracotomy for this purpose; however it has not been studied in the pediatric age group in detail. We studied retrospectively the patients with thoracotomy for non-cardiac, thoracic surgical procedures. Group 1 included the patients with standard posterolateral thoracotomy for the surgery. The patients with MS thoracotomy composed group 2. The related data were collected retrospectively. The early postoperative morbidities (time requiring for regaining shoulder girdle movement, extubation, intensive care unit stay, and hospital stay) and late musculoskeletal anomalies (scoliosis, elevation of the shoulder, winged scapula, asymmetry of the nipples) were compared between groups. A total of 90 patients were included in the study. Group 1 constituted 50 patients with an average age of 4.24 +/- 2.91 years. Group 2 included 40 patients with an average age of 4.20 +/- 2.92 years. Comparison of the demographics and the baseline characteristics of the patients were not different between groups. In comparison of operative characteristics, there was lesser morbidity in group 2 as re-exploration for bleeding, wound infection, wound healing and fewer intensive care unit and hospital stay days. Late follow-up revealed a significant increase in musculoskeletal deformities in group 1. We conclude that muscle-sparing incision should be preferred to the standard posterolateral thoracotomy in pediatric age.

Cardiac myxomas are highly vascular tumors and there is no consensus on the use of coronary angiography to assess their vascularity. A 64-year-old male patient presented with complaints of exertional dyspnea, fatigue, arthralgia, weight loss, intermittent high fever, and palpitation. He had an 18-month history of stent implantation for the left anterior descending coronary artery. Echocardiography showed a mobile mass in the left atrium with regular contours. Coronary angiography was performed with the initial diagnosis of myxoma and vascular supply of the tumor by the proximal branches of the right coronary artery (RCA) was visualized. Re-evaluation of previous angiograms of the patient showed existence of the same mass, in significantly smaller size, and supply from the RCA. The mass which was 5.5x1x0.5 cm in size was removed by surgical resection and the branches of the RCA supplying the tumor were ligated. Histopathologic examination confirmed the diagnosis. During 20 months of follow-up, the patient was asymptomatic and echocardiographic examinations were normal.

Hypothermia plays an important role in radial artery vasospasm. Normothermic organ bath and verapamil-nitroglycerin solution alone or in combination relieve spasm of radial artery.

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