In this report the authors describe a case of a giant pericardial cyst with symptoms of mediastinal compression for which the surgical excision guaranteed a month follow-up of complete remission of the symptomatology. They are typically unilocular, are lined by endothelium or mesothelium, contain clear serous fluid.
Usually, they are more likely to occur in middle-aged adults, most frequently in the third or fourth decade of life, and equally among men and women. The occurrence of pericardial cysts in children is rare. The most common finding on roentgenograms is a round homogeneous radiodense lesion at the cardiophrenic angle, two thirds being found on the right .
These finds are enough to the diagnostic but confirmation may be obtained by two-dimensional echocardiography, computed tomography, or nuclear magnetic resonance NMR . The aim of the present case report is to describe a case of a successful surgical excision of a giant pericardial cyst. CASE REPORT A year-old female presented with a 6-month history of progressive exertional dyspnea, right-sided chest pain, and dry cough was admitted to our service in a good general condition, conscious, eupneic breathing, acyanotic, normal colored, anicteric, and afebrile.
Cardiovascular examinations showed a regular heartbeat with normal heart sounds and without murmurs. Old Marley was as dead as a door-nail. I might have been inclined, myself, to regard a coffin- nail as the deadest piece of ironmongery in the trade. You will therefore permit me to repeat, emphatically, that Marley was as dead as a door-nail.
Scrooge knew he was dead? Of course he did. How could it be otherwise? Scrooge was his sole executor, his sole administrator, his sole assign, his sole residuary legatee, his sole friend, and sole mourner. And even Scrooge was not so dreadfully cut up by the sad event, but that he was an excellent man of business on the very day of the funeral, and solemnised it with an undoubted bargain. There is no doubt that Marley was dead. This must be distinctly understood, or nothing wonderful can come of the story I am going to relate.
There it stood, years afterwards, above the warehouse door: Scrooge and Marley. The firm was known as Scrooge and Marley. Sometimes people new to the business called Scrooge Scrooge, and sometimes Marley, but he answered to both names. It was all the same to him.
But he was a tight-fisted hand at the grind- stone, Scrooge! Hard and sharp as flint, from which no steel had ever struck out generous fire; secret, and self-contained, and solitary as an oyster. The cold within him froze his old features, nipped his pointed nose, shrivelled his cheek, stiffened his gait; made his eyes red, his thin lips blue; and spoke out shrewdly in his grating voice.
A frosty rime was on his head, and on his eyebrows, and his wiry chin. External heat and cold had little influence on Scrooge. No warmth could warm, no wintry weather chill him. No wind that blew was bitterer than he, no falling snow was more intent upon its purpose, no pelting rain less open to entreaty. The heaviest rain, and snow, and hail, and sleet, could boast of the advantage over him in only one respect.
When will you come to see me? It was the very thing he liked. Once upon a time — of all the good days in the year, on Christmas Eve — old Scrooge sat busy in his counting- house. It was cold, bleak, biting weather: foggy withal: and he could hear the people in the court outside, go wheezing up and down, beating their hands upon their breasts, and stamping their feet upon the pavement stones to warm them. The city clocks had only just gone three, but it was quite dark already — it had not been light all day — and candles were flaring in the windows of the neighbouring offices, like ruddy smears upon the palpable brown air.
The fog came pouring in at every chink and keyhole, and was so dense without, that although the court was of the narrowest, the houses opposite were mere phantoms. To see the dingy cloud come drooping down, obscuring everything, one might have thought that Nature lived hard by, and was brewing on a large scale. Wherefore the clerk put on his white comforter, and tried to warm himself at the candle; in which effort, not being a man of a strong imagination, he failed. God save you! What right have you to be merry?
What reason have you to be merry? What reason have you to be morose? Merry Christmas! Out upon merry Christmas! He should! Much good it has ever done you! But I am sure I have always thought of Christmas time, when it has come round — apart from the veneration due to its sacred name and origin, if anything belonging to it can be apart from that — as a good time; a kind, forgiving, charitable, pleasant time: the only time I know of, in the long calendar of the year, when men and women seem by one consent to open their shut-up hearts freely, and to think of people below them as if they really were fellow-passengers to the grave, and not another race of creatures bound on other journeys.
And therefore, uncle, though it has never put a scrap of gold or silver in my pocket, I believe that it has done me good, and will do me good; and I say, God bless it!
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Becoming immediately sensible of the impropriety, he poked the fire, and extinguished the last frail spark for ever. Dine with us tomorrow. He went the whole length of the expression, and said that he would see him in that extremity first. Why give it as a reason for not coming now? We have never had any quarrel, to which I have been a party.
So A Merry Christmas, uncle! His nephew left the room without an angry word, notwithstanding. He stopped at the outer door to bestow the greetings of the season on the clerk, who cold as he was, was warmer than Scrooge; for he returned them cordially. They had books and papers in their hands, and bowed to him. Scrooge, or Mr. It certainly was; for they had been two kindred spirits. Many thousands are in want of common necessaries; hundreds of thousands are in want of common comforts, sir.
"natas" English translation
We choose this time, because it is a time, of all others, when Want is keenly felt, and Abundance rejoices. What shall I put you down for? I help to support the establishments I have mentioned — they cost enough; and those who are badly off must go there. Mine occupies me constantly. Good afternoon, gentlemen! Scrooge returned his labours with an improved opinion of himself, and in a more facetious temper than was usual with him.
Meanwhile the fog and darkness thickened so, that people ran about with flaring links, proffering their services to go before horses in carriages, and conduct them on their way. The ancient tower of a church, whose gruff old bell was always peeping slily down at Scrooge out of a Gothic window in the wall, became invisible, and struck the hours and quarters in the clouds, with tremulous vibrations afterwards as if its teeth were chattering in its frozen head up there. The cold became intense. In the main street at the corner of the court, some labourers were repairing the gas-pipes, and had lighted a great fire in a brazier, round which a party of ragged men and boys were gathered: warming their hands and winking their eyes before the blaze in rapture.
The water-plug being left in solitude, its overflowing sullenly congealed, and turned to misanthropic ice. The brightness of the shops where holly sprigs and berries crackled in the lamp heat of the windows, made pale faces ruddy as they passed. Foggier yet, and colder! Piercing, searching, biting cold. May nothing you dismay! At length the hour of shutting up the counting- house arrived. With an ill-will Scrooge dismounted from his stool, and tacitly admitted the fact to the expectant clerk in the Tank, who instantly snuffed his candle out, and put on his hat. Be here all the earlier next morning.
He lived in chambers which had once belonged to his deceased partner. They were a gloomy suite of rooms, in a lowering pile of building up a yard, where it had so little business to be, that one could scarcely help fancying it must have run there when it was a young house, playing at hide-and-seek with other houses, and forgotten the way out again.
It was old enough now, and dreary enough, for nobody lived in it but Scrooge, the other rooms being all let out as offices. The yard was so dark that even Scrooge, who knew its every stone, was fain to grope with his hands. The fog and frost so hung about the black old gateway of the house, that it seemed as if the Genius of the Weather sat in mournful meditation on the threshold. Now, it is a fact, that there was nothing at all particular about the knocker on the door, except that it was very large.
It is also a fact, that Scrooge had seen it, night and morning, during his whole residence in that place; also that Scrooge had as little of what is called fancy about him as any man in the city of London, even including — which is a bold word — the corporation, aldermen, and livery. It was not in impenetrable shadow as the other objects in the yard were, but had a dismal light about it, like a bad lobster in a dark cellar.
It was not angry or ferocious, but looked at Scrooge as Marley used to look: with ghostly spectacles turned up on its ghostly forehead. The hair was curiously stirred, as if by breath or hot air; and, though the eyes were wide open, they were perfectly motionless. That, and its livid colour, made it horrible; but its horror seemed to be in spite of the face and beyond its control, rather than a part or its own expression.
As Scrooge looked fixedly at this phenomenon, it was a knocker again. To say that he was not startled, or that his blood was not conscious of a terrible sensation to which it had been a stranger from infancy, would be untrue. But he put his hand upon the key he had relinquished, turned it sturdily, walked in, and lighted his candle. The sound resounded through the house like thunder. Scrooge was not a man to be frightened by echoes. He fastened the door, and walked across the hall, and up the stairs; slowly too: trimming his candle as he went.
English to Brazilian Portuguese translator specializing in subtitling and dubbing.
You may talk vaguely about driving a coach-and-six up a good old flight of stairs, or through a bad young Act of Parliament; but I mean to say you might have got a hearse up that staircase, and taken it broadwise, with the splinter- bar towards the wall and the door towards the balustrades: and done it easy. There was plenty of width for that, and room to spare; which is perhaps the reason why Scrooge thought he saw a locomotive hearse going on before him in the gloom. Up Scrooge went, not caring a button for that. Darkness is cheap, and Scrooge liked it.
But before he shut his heavy door, he walked through his rooms to see that all was right. He had just enough recollection of the face to desire to do that. Sitting-room, bedroom, lumber-room.
The Twelve Days of Christmas
All as they should be. Nobody under the table, nobody under the sofa; a small fire in the grate; spoon and basin ready; and the little saucepan of gruel Scrooge had a cold in his head upon the hob. Nobody under the bed; nobody in the closet; nobody in his dressing-gown, which was hanging up in a suspicious attitude against the wall.
Lumber-room as usual. Old fire-guards, old shoes, two fish-baskets, washing-stand on three legs, and a poker. Quite satisfied, he closed his door, and locked himself in; double-locked himself in, which was not his custom. Thus secured against surprise, he took off his cravat; put on his dressing-gown and slippers, and his nightcap; and sat down before the fire to take his gruel.
It was a very low fire indeed; nothing on such a bitter night. He was obliged to sit close to it, and brood over it, before he could extract the least sensation of warmth from such a handful of fuel. The fireplace was an old one, built by some Dutch merchant long ago, and paved all round with quaint Dutch tiles, designed to illustrate the Scriptures. After several turns, he sat down again. As he threw his head back in the chair, his glance happened to rest upon a bell, a disused bell, that hung in the room, and communicated for some purpose now forgotten with a chamber in the highest story of the building.
It was with great astonishment, and with a strange, inexplicable dread, that as he looked, he saw this bell begin to swing. It swung so softly in the outset that it scarcely made a sound; but soon it rang out loudly, and so did every bell in the house. This might have lasted half a minute, or a minute, but it seemed an hour. The bells ceased as they had begun, together. Scrooge then remembered to have heard that ghosts in haunted houses were described as dragging chains. The cellar-door flew open with a booming sound, and then he heard the noise much louder, on the floors below; then coming up the stairs; then coming straight towards his door.
The same face: the very same. Marley in his pigtail, usual waistcoat, tights and boots; the tassels on the latter bristling, like his pigtail, and his coat-skirts, and the hair upon his head. The chain he drew was clasped about his middle.
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It was long, and wound about him like a tail; and it was made for Scrooge observed it closely of cash- boxes, keys, padlocks, ledgers, deeds, and heavy purses wrought in steel. His body was transparent; so that Scrooge, observing him, and looking through his waistcoat, could see the two buttons on his coat behind.
Scrooge had often heard it said that Marley had no bowels, but he had never believed it until now. No, nor did he believe it even now. Though he looked the phantom through and through, and saw it standing before him; though he felt the chilling influence of its death-cold eyes; and marked the very texture of the folded kerchief bound about its head and chin, which wrapper he had not observed before; he was still incredulous, and fought against his senses.
But the ghost sat down on the opposite side of the fireplace, as if he were quite used to it. A slight disorder of the stomach makes them cheats. You may be an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato. To sit, staring at those fixed glazed eyes, in silence for a moment, would play, Scrooge felt, the very deuce with him.
Scrooge could not feel it himself, but this was clearly the case; for though the Ghost sat perfectly motionless, its hair, and skirts, and tassels, were still agitated as by the hot vapour from an oven. Humbug, I tell you!
"natas" in English
But how much greater was his horror, when the phantom taking off the bandage round its head, as if it were too warm to wear indoors, its lower jaw dropped down upon its breast! Scrooge fell upon his knees, and clasped his hands before his face. But why do spirits walk the earth, and why do they come to me? It is doomed to wander through the world — oh, woe is me!
Is its pattern strange to you? It was full as heavy and as long as this, seven Christmas Eves ago. You have laboured on it, since. It is a ponderous chain! Speak comfort to me, Jacob!