The high-quality cardiothoracic surgery program is primed for mindful effective surgery. The challenge lies in attaining mindful skills and efficiency. Herein is one journey toward high departmental quality over two decades.In 1921, 16 Texas pathologists gathered in Dallas, Texas, to found the Texas Society of Pathologists (TSP). The TSP is now the oldest state pathology society in the USA with continuity traced back to its founding 100 years ago. This article aims to both commemorate the TSP centennial and to provide context for the remarkable success of the society. The article takes a look back and a look forward from 1921. The look back focuses on the development of the field of pathology and the maturation of medicine and pathology in the USA and Texas. The look forward encompasses developments in science, technology, American health care policy, and medicine that have impacted Texas pathologists and influenced proactive initiatives of the TSP. The review of the life and times of the TSP highlights the importance of leaders and leadership in shaping outcomes. Complexities and uncertainties of the contemporary health care scene point to the need for continued strong leadership. The successful past century and hopeful future of the TSP are inextricably linked to the guiding principle of the TSP, which is a focus on continual striving for excellence in medicine.A recent critic levels two new charges against Sir William Osler (1) that in 1912 he was a vice president of the First International Eugenics Congress; and (2) that in 1914 he asserted Canada should remain a "a white man's country." Osler was indeed among the 31 vice presidents of the First International Eugenics Congress, but he did nothing further in this area. Osler indeed asserted that Canada should remain a "white man's country," but his context was the Komagata Maru incident during which most Canadians felt the same way about 376 passengers from the Punjab Province of British India who sought to defy Canadian immigration law. There is little or no indication of racism elsewhere in Osler's deeds and writings, and the idea that race is largely a social construct emerged only after his death. Advocates for racial equality should view Osler not as an adversary but rather as an ally in today's battles for global justice and also for human survival.Primary hyperparathyroidism is rare in pregnancy, with an incidence of 1%. It is associated with maternal, fetal, and neonatal complications. Herein, we present two patients with gestational primary hyperparathyroidism who failed medical management and underwent successful parathyroidectomy. Based on our experience and review of the literature, gestational hyperparathyroidism appears to be a clear indication for early parathyroidectomy in both symptomatic and asymptomatic patients.A 27-year-old woman underwent aspiration and bioresorbable cement injection of a simple bone cyst. During injection, cement was seen on fluoroscopy extravasating into the posterior vein of the ankle. The procedure was immediately stopped, and the patient remained hemodynamically stable. Vascular leakage of bone cement during injection of a bone cyst is rare but can have catastrophic consequences.Cardiopulmonary resuscitation-induced consciousness (CPRIC) is a rare yet confusing event that can cause management issues during resuscitation. The reported incidence of CPRIC is increasing. Being aware of this phenomenon and developing a standardized approach for its management is important to prevent both delay and interruptions during resuscitation efforts. We present a patient who demonstrated purposeful movements suggesting consciousness during cardiopulmonary resuscitation that would repeatedly abate with cessation of chest compressions.Statins are the most widely used class of drug in the United States. They lower blood cholesterol levels by inhibiting 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase. Common side effects include myalgias and a mild increase in liver function tests. Statin-induced necrotizing autoimmune myopathy (SINAM) is a very rare side effect that is independent of the type and duration of statin use. Treatment involves high-dose steroids and immunosuppressants such as azathioprine, methotrexate, or mycophenolate mofetil. Nonresponders and patients with severe weakness can be treated with intravenous immunoglobulin or rituximab. We present a case of SINAM that was successfully treated with intravenous immunoglobulin.A 56-year-old man with end-stage heart failure performed a 4-week, symptom-limited, progressive inpatient cardiac prehabilitation program while confined to the cardiovascular intensive care unit awaiting heart transplantation. Mobility was limited by an acute gout flare and multiple central venous access lines. He received a tailored prescription of intermittent boxing, supervised hallway ambulation, stair training, and golfing on a putting green on four consecutive weekdays and was encouraged to mobilize with nursing on the remaining days. The patient progressed and by the last week demonstrated increased activity tolerance. He had a successful transplant after 40 days in the intensive care unit and was discharged with stamina sufficient to participate in outpatient cardiac rehabilitation, demonstrating the value, safety, and feasibility of an individualized inpatient cardiac prehabilitation program for patients with advanced cardiac disease medically confined to the intensive care unit.Ventricular fibrillation (VF) is a dangerous ventricular arrhythmia that results in pulselessness and sudden cardiac death. We present a 43-year-old woman with peripartum cardiomyopathy with a left ventricular assist device (LVAD) and recalcitrant right-sided heart failure who presented with unsuccessful defibrillator shocks. The patient was asymptomatic while in persistent VF for over 4 hours. Echocardiography showed the heart to be in asystole. We hypothesize that a combination of chronic right heart failure and LVAD kept her asymptomatic. Patients supported with LVAD can survive prolonged periods with VF.Coronavirus disease 2019 (COVID-19) initiates a hypercoagulable state and causes thrombotic complications. A presentation of multiple thromboembolic events without an underlying source should raise suspicion for COVID-19 hypercoagulability. We describe a patient with an ascending aortic thrombus resulting in multiple emboli treated by multiple modalities.Acute and subacute stent thromboses are rare but life-threatening complications of primary coronary intervention and stenting. We present a case of a patient with COVID-19 infection who presented with pneumonia, acute respiratory failure, and non-ST elevation myocardial infarction. https://www.selleckchem.com/products/Everolimus(RAD001).html Reperfusion was achieved with coronary angioplasty and drug-eluting stent placement, and the patient was started on aspirin and clopidogrel. However, 72 hours later, the patient experienced an episode of subacute stent thrombosis. This raises concerns about a possible association between stent thrombosis and increased thrombogenicity and platelet aggregability triggered by COVID-19 infection.Bronchogenic cysts are rare incidental findings, but they can have life-threatening complications. Herein, we report a case of a 44-year-old man who presented with complaints of left-sided chest pain, intermittent dyspnea, and pink-tinged sputum. Computed tomography angiography of the chest revealed a large cystic mediastinal mass in the subcarinal location. During his hospital stay, the patient became hypotensive with jugular venous distention and muffled heart sounds on auscultation. A stat echocardiogram depicted a large pericardial effusion with early diastolic collapse of the right ventricle. Pericardiocentesis was performed for cardiac tamponade, followed by thoracotomy with removal of bronchogenic cyst. Herein, we highlight the relation between bronchogenic cysts and cardiac tamponade and review the surgical treatment options.Worsening symptoms and fluid overload are the hallmarks of heart failure (HF) decompensation, and fluid removal is central to improvement. Despite high-dose loop diuretics, patients with decompensated HF may develop suboptimal diuresis/diuretic resistance. Sequential nephron blockade with a combination of loop and thiazide/thiazide-like diuretics may be insufficient, resulting in poor outcomes. We present a case wherein urine output improved significantly with acetazolamide. Although the diuretic capacity of acetazolamide is weak on its own, it might be efficient in aiding the efficacy of loop diuretics. We discuss the pathophysiological basis and evidence behind its potential role in diuretic resistance. Drawing from current understanding, we propose a stepwise approach to diuresis in such patients.Turner syndrome is a chromosomal disorder that involves multiple organ systems and is typically associated with short stature. A multidisciplinary approach with regular screening and surveillance is key to managing this condition's multiple comorbidities. We present a case of a young girl with Turner syndrome and associated short stature on growth hormone treatment who presented with cystic renal disease found to be autosomal dominant kidney disease. We propose reevaluation of renal screening guidelines in this population due to the potential association of growth hormone and cyst proliferation.Primary hyperparathyroidism presenting with diffuse skeletal involvement, such as discrete osteoclastic bone lesions, is rare. We describe a 35-year-old woman who presented with a left mandibular mass that rapidly enlarged over 3 weeks. Radiological, histological, and biochemical investigations led to the diagnosis of brown tumor secondary to primary hyperparathyroidism. A neck ultrasound revealed a 1.5 × 2.3 × 4.6 cm mass at the lower pole of the left thyroid lobe, suggestive of a parathyroid adenoma. Bone scan showed additional abnormal foci of increased uptake in the maxilla, both femora, skull, and scapula. Brown tumors are treated primarily by correcting the underlying endocrine disorder, and a parathyroidectomy was performed.Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital tumor of the dermal and subcutaneous tissues, often presenting as a papule or a pedunculated or sessile mass at the midline on the head and neck. Although RMH is benign, some cases have reported associations with other congenital and syndromic anomalies. Thus, an accurate diagnosis is important, as an internal or systemic evaluation of the patient may be warranted. We report a case of a solitary RMH on the midline upper chest in a healthy 15-year-old girl.High-oxygen-affinity hemoglobin variants are a rare clinical entity that can present with secondary erythrocytosis. Herein, the author reports a case of a 41-year-old man with a 4-year history of secondary erythrocytosis of unknown etiology. Physical examination was unremarkable except for plethora of the palms. Myeloproliferative neoplasms and common causes of secondary erythrocytosis were ruled out. The P50 oxygen-hemoglobin dissociation curve was left shifted. Hemoglobin electrophoresis was silent; however, globin mass spectrometry revealed a β-globin variant. Globin sequencing confirmed hemoglobin San Diego. This case highlights the fact that rare high-oxygen-affinity variants should be considered in the differential diagnoses of secondary erythrocytosis.