Androgenic anabolic steroids are commonly abused by athletes and body-builders to help develope lean body mass and muscular strength to enhance their performance. However, at doses which are much higher than recommended therapeutic dosage, abuse of these drugs is commonly associated with cardiovascular side-effects that can lead to acute myocardial infarction and sudden death. We report here three cases of acute myocardial infarction in local young bodybuilders who were using Stanazolol, an androgenic anabolic steroid, and discuss the pathophysiological mechanisms behind the observed cardiovascular side effects.

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Introduction Chest drain insertion after surgical patent ductus arteriosus (PDA) ligation creates significant morbidity in terms of pain, pleural space infection, reduced mobility as well as prolonged hospital stay. We investigated the safety and efficacy of performing drainless thoracotomy closure following PDA ligation in a paediatric population. Materials and Methods Retrospective analysis of data collected from 13 paediatric patients undergoing PDA ligation at RIPAS hospital by a single surgeon over a period of five years (2001 to 2006) was performed. All continuous data were presented as mean ± standard deviation. Results PDA ligation was performed via a left thoracotomy in 13 paediatric patients with a mean age of 2.24 ± 2.03 years (ten females and three males). Mean duration of the procedures was 67 ± 12 minutes. There was minimal blood loss and no transfusions were required. Postoperatively, ten patients required only oral paracetamol for pain relief. Two patients required additional non steroidal anti-inflammatory drugs (NSAIDs). One patient had one dose of pethidine immediately post-operatively. Post-operative chest radiographs confirmed full expansion of the left lung except in one patient who had a small apical pneumothorax. Two other patients developed mild surgical emphysema despite full expansion of the left lung. All three complications resolved spontaneously after a day. Median post-operative stay was two days. There were no cases of left recurrent nerve injury and no mortality. Conclusion Routine chest drainage is not necessary following uncomplicated surgical PDA ligation and patients recovered more quickly and were discharged earlier.

Introduction: Excessive manipulation of the aorta in conventional on-pump coronary artery bypass (ONCAB) is associated with postoperative neurological complications. We assessed the results of a protocol of 'minimal-aortic manipulation' in off-pump-CABG (OPCAB) using Guidant Heartstring aortic-seal with selective epiaortic scanning. Materials and Methods: A protocol of 'minimal-aortic manipulation OPCAB' using Heartstring aortic-seals was introduced in patients undergoing OPCAB from January 2005. Data were prospectively collected for one year. Intra-operative epiaortic scanning was selectively used. Mean graft flow and pulsatility index (PI) were routinely measured. Results: Sixty-nine Heartstring aortic-seals were used in 31 patients (23 Male; 8 Female). Mean age and left ventricular ejection fraction (LVEF) were 62.5 ± 10.8 years and 57.8 ± 14.2% respectively. Five patients had intra-operative epiaortic scanning performed. Left internal thoracic artery (LITA) to left anterior descending (LAD) artery was achieved in 100% with mean LITA graft flow and PI of 32.09 ± 19.48 ml/min and 3.26 ± 1.74 respectively. Mean flow and PI in radial artery graft (RAG) and saphenous venous graft (SVG) were 20.47 ± 5.37 ml/min; 1.97 ± 0.31 and 22.84 ± 16.88 ml/min; 3.93 ± 2.83 respectively. There were no postoperative neurological complications or death. Conclusions: Routine use of Heartstring aortic-seals with selective epiaortic scanning in a protocol driven 'minimal-aortic manipulation OPCAB' is safe. The avoidance of partial aorta cross-clamping may translate to a reduction in post-operative neurological complications.

Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; diagnosis ; drug therapy ; Tuberculosis, Pulmonary ; diagnosis ; Uterine Cervical Neoplasms ; drug therapy

Dysphagia is considered a warning symptom that requires exclusion of significant pathology such as oesophageal cancer, especially in elderly patients. Benign neoplasms of the oesophagus are rare. We report the case of a 69-year-old lady who presented with a five years history of infrequent intermittent dysphagia that had rapidly progressed over one month. This was associated with globus sensation, weight loss, intermittent episodes of stridor and aspiration pneumonia. Investigations revealed a large oesophageal lipoma in the proximal oesophagus extending down to the lower oesophagus. This was successfully resected via a left cervical approach. She remained well two years after the surgery.