Katsuaki Magishi

Primary Osteosarcoma of the Lung: Report of a Case

Osteosarcoma of the lung without an extrathoracic primary tumor is extremely rare, with only eight cases documented in the literature, to the best of our knowledge. We report a case of primary osteosarcoma of the lung found in an asymptomatic 74-year-old woman. Computed tomography showed a heterogeneous mass beside the aortic arch, and the patient underwent a left upper lobectomy. The pathology results confirmed a diagnosis of primary osteosarcoma.

Cardioprotective effects of normothermic reperfusion with oxygenated potassium cardioplegia: a possible mechanism

Na(+)/K(+) pump activation induced by normothermic reperfusion with high potassium cardioplegia may exert a protective effect on reperfusion-induced myocardial damage. We investigated (1) temperature dependency and extracellular potassium dependency of the Na(+)/K(+) pump current (Ip), (2) effects of high potassium or ouabain during reperfusion on the post-ischemic left ventricular (LV) function. Ip-voltage relation was constructed at 5.0 and 20 mM of KCl (37 degrees C) using a whole-cell clamp technique in guinea pig myocytes. Ip at -40 mV was measured at 37, 27 and 18 degrees C (KCl: 5.0 mM). Isolated rat hearts were Langendorff-perfused and subjected to 20 min of global ischemia (37 degrees C) followed by 35 min of reperfusion (37 degrees C). The post-ischemic recovery of LV developed pressure (%LVDP) was assessed in the four reperfusate groups (4.8 mM KCl, 10 mM KCl, 20 mM KCl, or 4.8 mM KCl plus 50 microM ouabain during the first 10 min of reperfusion). The 4.8 mM KCl and 10.0 mM KCl groups were compared under metabolic inhibition (glucose-free, NaCN, or hypoxia) during reperfusion. The Ip-voltage relation shifted upward when extracellular KCl was increased from 5.0 to 20 mM. Ip was significantly greater at 37 degrees C than at 18 degrees C (114.3+/-17.2 vs. 22.7+/-1.2 pA, respectively). %LVDP was significantly greater at the 10.0 mM KCl group than at the 4.8 mM KCl group (54.9+/-5.5% vs. 34.2+/-5.9%, respectively). Metabolic inhibition abolished the difference between the two groups. Ouabain significantly decreased %LVDP (15.9+/-1.6%). Potassium-induced cardiac arrest during normothermic reperfusion may exert a cardioprotective effect by inducing Na(+)/K(+) pump activation, which may be supported by aerobic metabolism during reoxygenation rather than by energy saving during cardiac arrest.

A Case of Ruptured Aneurysm of the Persistent Sciatic Artery Presenting Acute Lower Limb Ischemia

Only 5 cases of ruptured aneurysm of the persistent sciatic artery have been previously reported to date. We experienced a case of ruptured aneurysm of the persistent sciatic artery presenting acute lower limb ischemia. Physical examination showed a pulsatile mass with a subcutaneous hemorrhage in the left buttock, drop foot and paresthesia of the foot due to limb ischemia. An enhanced computed tomography scan showed a ruptured aneurysm of the left persistent sciatic artery at the level of the greater trochanter. An exclusion of the aneurysm and creation of common iliac to popliteal artery bypass was performed as an emergency operation.

A Case of Localized Abdominal Aortic Dissection Suspected to Have Simultaneously Occurred with an Idiopathic Esophageal Rupture

症例は47歳男性.平成13年2月13日特発性食道破裂の診断で緊急食道破裂部縫合閉鎖が当院外科で施行された.術後腹部CTで腎動脈下大動脈から右総腸骨動脈までの解離が認められた.大動脈の最大径は3.0cm,右総腸骨動脈の最大径は2.5cmで偽腔は開存していた.手術は右後腹膜経路でアプローチ,腎動脈下で大動脈を遮断し瘤壁を切開したところ右前方に偽腔が存在しエントリーまたはりエントリーと思われる交通孔が3ヵ所存在した.腎動脈下大動脈から両側腸骨動脈までY型人工血管で置換を行った.術後経過は良好で術後15日目に退院した.本症例では食道破裂時以外に強い疼痛の既往がないことなどから特発性食道破裂と同時に腹部限局大動脈解離が発症した可能性が考えられた.