Harunobu Matsumoto

Surgical Treatment of Retroperitoneal Leiomyosarcoma Invading the Inferior Vena Cava: Report of Three Cases

Abstract.Retroperitoneal leiomyosarcoma is a rare neoplasm for which complete surgical removal provides the only effective treatment, as local recurrence adversely affects prognosis. However, invasion of major vessels may occur, making complete resection difficult. This report describes the cases of three patients who required concomitant resection of parts of the inferior vena cava because of direct tumor invasion. The major vessels should be isolated in preference to the tumor capsule during surgery to prevent sudden exsanguination or incomplete tumor resection. Resection of a recurrent sarcoma or a solitary metastasis can be effective in selected patients.

Is the size of an abdominal aortic aneurysm associated with coagulopathy

Abdominal aortic aneurysm (AAA) volume and intraluminal thrombi were analyzed with respect to the number and function of platelets, blood cells, and coagulation factors. A group of 43 patients who underwent repair of an AAA were enrolled in this study. The maximum diameter and volume of the AAA, and the volume of intraluminal thrombi and lumen were measured by computed tomography with planimetry. The platelet count and platelet function, prothrombin time, activated partial thromboplastin time, fibrinogen, plasminogen, antithrombin 3, fibrin degradation products (FDP), D-dimer, and blood cell counts were measured. Spontaneous platelet aggregation and the FDP, and D-dimer levels were elevated; all other factors remained within the normal range. Intraluminal thrombus volume was strongly correlated with the volume and diameter of the AAA. However, no correlation was observed between the size of the AAA and coagulating factors, including the number and aggregation value of platelets. AAAs are frequently associated with a coagulating disorder. However, its size and thrombus volume are not correlated with coagulation changes. Although an intraluminal thrornbus increases along with fee enlargement of the AAA, the clinical manifestation of bleeding is rarely associated with an AAA. Therefore coagulopathy in patients with an AAA is not fully explained by its morphology.

Delayed Presentation of Injury to the Sinus of Valsalva with Aortic Regurgitation Resulting from Penetrating Cardiac Wounds

Abstract A 39‐year‐old man had attempted to commit suicide using a small knife to penetrate the anterior chest wall. An emergency operation was performed successfully to repair the penetrating cardiac injury of the right ventricular outflow tract without using cardiopulmonary bypass. Two years after the operation, he was complained of dyspnea and a continuous murmur was detected. Echocardiography and cardiac catheterization revealed aorto‐right ventricular fistula in the sinus of valsalva with aortic regurgitation. In operation, the healed laceration of the right coronary cusp and the fistula between aorta and right ventricle were identified. The fistula was closed using a Dacron patch and the aortic valve was replaced with a mechanical valve. Long‐term follow‐up of penetrating thoracic injuries is important for detecting underlying intracardiac lesions. (J Card Surg 2003;18:236‐239)

Primary Bypass Surgery from the Descending Aorta to the Iliac Arteries for a Severely Calcified Aorta: Report of Two Cases

We herein report two patients with end-stage renal failure who complained of disabling claudication due to abdominal aortic atherosclerosis. Both were on chronic hemodialysis for more than 15 years, and their abdominal aorta was densely calcified. We elected to perform a descending aorta to iliac artery bypass in order to avoid hazardous clamping of the calcified aorta. Hemodialyisis was able to be resumed on the first postoperative day. They tolerated the operation well and their symptoms disappeared. This operative procedure is therefore considered to be a useful option for patients with a porcelain aorta who are on chronic hemodialysis.

Acute palmer digital artery occlusion treated using endoscopic ablation of the thoracic sympathetic.

Acute occlusion of the digital arteries frequently causes painful infarction requiring digital amputation. We describe a 55-year-old male patient who presented with acute onset of digital ischemia with impending gangrene on the right hand. Because angiography revealed bypass surgery was not feasible, he underwent thoracoscopic sympathectomy (TS) one week after onset of the symptom, which resulted in rapid pain resolution. He was diagnosed, thereafter, with malignant rheumatoid arthritis and methotrexate was administered. Postoperative angiography revealed that the occluded digital artery had become recanalized. Timely TS is therefore a treatment of choice for acute digital ischemia.