الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The pericardium and pericardial fluid minimize friction and energy loss during cardiac motion. On the other hand, the normal pericardium and its external attachments maintain cardiac position within mediastinum in the presence of gravitational or other forces that could impair cardiac filling or function .The pericardium serves as a barrier protecting the heart from inflammation or malignancy in adjacent structures. Pericardial effusions may develop rapidly (acute) or more gradually (subacute or chronic). The normal pericardium can stretch to accommodate increases in pericardial volume, with the amount of stretch related to how quickly the effusion develops (e.g. the ability to stretch more with slowly developing effusions). However, regardless of how quickly an effusion develops, intrapericardial pressure from the accumulating fluid increases once the pericardium has been stretched to its limit. With ongoing accumulation of pericardial fluid into a closed space, the intrapericardial pressure begins to increase. When the intrapericardial pressure becomes high enough to impede cardiac filling, cardiac function becomes impaired and cardiac tamponade can be considered to be present (Shabetai, 2004). The symptoms produced by a pericardial effusion depend on the speed with which the effusion is formed, as well as the size of the effusion. Many small to moderate effusions formed over a long period of time will be relatively asymptomatic. However even small effusions which have occurred rapidly may compromise the circulation and cause tamponade (Gowda et al., 2003). Summary and conclusion 86 Treatment depends on the underlying cause and the severity of the heart impairment. Pericardial effusion due to a viral infection usually goes away within a few weeks without treatment. Some pericardial effusions remain small and never need treatment. If the pericardial effusion is due to a condition such as lupus, treatment with anti-inflammatory medications may help. Oxygen therapy will help to relieve symptoms in patients whose circulation is compromised by a pericardial effusion. Patients with dehydration and hypovolaemia may temporarily improve with intravenous fluids improving ventricular filling (Becit et al., 2005). This study included twenty patients from January 2010 to December 2012 with the following inclusion and exclusion criteria. All patient full filing inclusion and exclusion criteria were subjected to the following steps: preoperative assessment (including history, general physical examination, laboratory assessment, radiological examination, electrocardiography and echocardiography), surgical approaches (includibng subxiphoid tube pericardiostomy, pericardio-pleural window and thoracoscopic pericardial window) and postoperative assessment. Our results showed that there is no significance in age and gender between the three groups. The study includes 9 males (45%) and 11 females (55%). Statistically significant improvement in the mean arterial pressure was shown postoperatively between groups I and II with mean arterial pressure preoperatively and no significance between the 3 groups was found. Statistically significant Summary and conclusion 87 improvement in the urine output was shown postoperatively between group II and III with urine output preoperatively and no significance between the 3 groups was found. All the patients had dyspnea. Preoperatively, dyspnea showed improvement in functional class according to NYHA. This improvement was proportionate to the amount of drained fluid. There is no statistical significance between the three groups in improving dyspnea preoperatively and postoperatively. There is highly statistically significance between the three groups in the operative time, with the least range of time to subxiphoid tube pericardiostomy (10 to 30 minutes) and the greatest time for thoracotomy (80 to 180 minute). During surgical drainage, there is no statistically significance between the three groups in the intraoperative complications. There is a statistically significance between the three groups in the hospital stay time, with the least range of time to VATS (2 to 5 days) and the greatest time for thoracotomy (4 to 21 days). There is no statistically significant difference between the three groups in the wound infection. During follow up period after discharging, there is no significant difference as recurrence in patients of the three groups as there was recurrence in 2 patients managed by VATS (50%), 2 patients manged by subxiphoid tube pericardiotomy (28.6%) and one patient (16.7%) managed by thoracotomy. Summary and conclusion 88 We concluded that subxiphoid drainage should be the preferred approach if a patient’s life expectancy is likely to be extremely limited due to major co-morbidities because it is simpler and faster. However, patients without extensive metastasis should be considered for the VATS procedure. Subxiphoid drainage with local anaesthesia therefore remains the method of choice under these circumstances.