1/15. Giant congenital epigastric hernia.Epigastric hernia is rare in children. When it occurs, as in adults, it is usually small. This is a report of a giant, congenital epigastric hernia which was repaired early to prevent complications. Though there was a brief period of postoperative respiratory difficulty, the final outcome was satisfactory. This case is interesting due to its massive size and congenital nature.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/15. Treatment of giant aortic aneurysm with tracheal compression and sternal erosion without circulatory arrest.Treatment of huge aneurysms involving the ascending aorta and the aortic arch with compression of the surrounding structures represents a surgical challenge. The case of a patient affected by respiratory insufficiency and sternal erosion caused by chronic giant aortic aneurysm is reported. The use of a stepwise approach and selective cerebral arterial perfusion ensured successful operative management, avoiding circulatory arrest and enabling an expeditious postoperative recovery.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
3/15. Autotransplantation procedure for giant left atrium repair.BACKGROUND: Giant left atrium has been associated with bronchopulmonary and left ventricular compression [Kawazoe 1983]. CASE REPORT: We present a patient with severe congestive heart failure (CHF), respiratory insufficiency and a giant left atrium (GLA) following two previous mitral valve procedures and tricuspid valve annuloplasty in the distant past. Mitral prosthetic function and ventricular systolic function were felt to be normal leading to a tentative diagnosis of diastolic restriction from left ventricular compression and pericardial constriction. A pericardial decortication procedure through left thoracotomy was initially done but proved ineffective. Subsequently, full evidence of hemodynamic failure due to the giant left atrium and its respiratory complication was recognized and the patient underwent cardiac autotransplantation procedure [Kosak 1987], with the aim to reduce the left atrial dimensions to normal. CONCLUSIONS: Calcification of posterior left atrial wall prevented a completely satisfactory reduction of atrial size and the severity of ventricular adhesions from the previous pericardial procedure resulted in very long cardiopulmonary bypass time with severe bleeding complications. This case provides ample evidence that GLA can cause respiratory failure and needs to be surgically corrected.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
4/15. Excision of a giant hydatid cyst of the lung under thoracic epidural anaesthesia.We present a patient with a large pulmonary hydatid cyst compressing underlying lung, with previous pulmonary tuberculosis, who presented in respiratory failure. After institution of thoracic epidural anaesthesia employing 0.25% bupivacaine, 1% lignocaine and fentanyl, the patient was placed in the sitting position and the hydatid cyst excised and drained after a limited rib resection. An air leak persisted until the 16th postoperative day. A marked improvement in symptoms as well as in spirometly and arterial blood gases occurred, and the patient was discharged on the 20th day. Thoracic epidural anaesthesia may be a safer method than general anaesthesia for removal of a hydatid cyst in a patient with severe respiratory compromise.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
5/15. Course and outcome of a pregnancy with a giant fetal cervical teratoma diagnosed prenatally.We report the course and outcome of a pregnancy involving a giant fetal neck teratoma which was diagnosed at 23 weeks of gestation. Sonographic surveillance of the fetal neck revealed continuing growth of the tumor with development of polyhydramnios. Three-dimensional ultrasound provided additional detailed information on the external extent of the lesion. color Doppler ultrasound showed intense arterial and venous flow with low resistance indices. cesarean section under general anesthesia was planned in close cooperation with the neonatologist, pediatric surgeon and anesthesiologist because the size of the neck mass precluded vaginal delivery. cesarean section was performed at 34 weeks of gestation following preterm rupture of the membranes. Orotracheal intubation was not successful because of compression of the airway and a tracheostomy could not be performed because of the risk of severe fetal hemorrhage from the tumor. The neonate died from respiratory insufficiency 66 min after birth.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
6/15. Giant uterine tumors: two cases with different clinical presentations.BACKGROUND: Giant uterine tumors are uncommon. However, they may be life threatening because of pressure effects on the lungs and other adjacent organs. Proper surgical management and careful perioperative care are essential to assure a good outcome after excision. CASE: Two women with giant uterine leiomyomata (weighing more then 40 kg [88 lb]) are discussed. In one case the leiomyoma led to severe pulmonary hypertension and respiratory failure necessitating an emergency operation. Abdominal hysterectomy and bilateral salpingo-oophorectomy were successfully carried out in both cases, which are among the largest tumors ever removed with survival of the patient. CONCLUSION: Different clinical manifestations can be expected in cases of giant uterine tumors according to which other organs are secondarily affected. Numerous difficulties may be encountered in the evaluation and removal of these tumors. A combined team consisting of gynecologic, general, and plastic surgeons is necessary for a successful outcome.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
7/15. Giant transdiaphragmatic duodenal duplication with an intraspinal neurenteric cyst as part of the split notochord syndrome: report of a case.We report the case of a 6-month-old girl with a giant transdiaphragmatic duodenal duplication connecting to a cervical intraspinal cyst, which compressed the heart and lung, causing severe respiratory distress. We removed the intraspinal neurenteric cyst through a posterior cervical incision at the C6 and C7 level, and the duodenal duplication cyst in the mediastinum was removed through a right thoracotomy. Her respiratory symptoms were completely resolved by these operations.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
8/15. Acute respiratory insufficiency and giant coronary artery aneurysm with fistula.Several causes of acute respiratory insufficiency have been reported in the literature. We describe a case in which it was caused by a rare combination of a giant right coronary artery aneurysm with fistula that occurred in a 56-year-old woman with concomitant congenital hypothyroidism. Diagnostic tools, differential diagnosis, surgical techniques, and follow-up at 1 year are discussed.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
9/15. Emergent bullectomy for acute respiratory failure in ehlers-danlos syndrome.A 49-year-old man with ehlers-danlos syndrome developed acute respiratory failure requiring mechanical ventilation. Chest computed tomography demonstrated giant right bulla extending into the contralateral hemithorax with mediastinal shift. Surgical bullectomy with pleurodesis relieved tension effects and allowed weaning.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
10/15. giant cell arteritis in a patient with acute aortic insufficiency with thyrotoxicosis.Acute aortic insufficiency in the setting of thyrotoxicosis can mask the presentation of vasculitis. We report a case of a 38-year-old woman with a 22 weeks gestation pregnancy who was known to be hyperthyroid for 4 months prior to conception. She presented with thyrotoxicosis and acute respiratory failure. Echocardiogram revealed severe acute aortic regurgitant flow. Following medical treatment for aortic insufficiency and thyrotoxicosis, the patient underwent ascending aorta replacement with aortic valve repair. Pathological exam revealed giant cell arteritis. Both giant cell arteritis and thyrotoxicosis share a common major histocompatibility antigen which may facilitate concomitant disease presentation. Following immunosuppression for giant cell arteritis, valve repair, and treatment for thyrotoxicosis, the patient made a complete recovery. A rise in human chorionic gonadotropin (HCG) during the first trimester of pregnancy is known to have a stimulatory effect on the thyroid gland and may result in hyperthyroidism. Although HCG may have exacerbated the existing hyperthyroidism, in this case it was not causal, as the diagnosis preceded her pregnancy by several months. diagnosis of vasculitis may be overshadowed by the presence of thyrotoxicosis. Significant vascular compromise in the setting of thyrotoxicosis must prompt an evaluation for vasculitis. This may prevent unnecessary surgery with attendant morbidity and mortality.- - - - - - - - - - ranking = 3keywords = giant (Clic here for more details about this article) |
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