Kazunari Yamana

Anaplastic Giant Cell Tumor With Mucinous Cystadenocarcinoma of The Ovary Origin of the Giant Cells

The present case is that of a 27 years old woman who had received right oophorectomy for ovarian cancer nine years previously. The histological diagnosis at that time was mucinous cystadenocarcinoma with anaplastic areas. The patient expired ten years after oophorectomy due to widespread metastases of the tumor. Review of the histological slides revealed ovarian giant cell tumor which was considered to be of epithelial origin differing from those appearing in giant cell tumor of bone.

Reoperations for Aneurysmal Disease of the Ascending Aorta, Aortic Arch, and Descending Aorta: Their Causes and Operative Results

Between 1984 and 1993, 20 patients underwent reoperation for the thoracic aorta or ascending aorta and aortic valve. There were 14 male and 6 female patients who ranged in age from 28 to 70 years with a mean of 53.2 years. The mean interval between initial operation and the 2nd operation was 70.4 months. Of the 20 patients, 6 had stigmata of Marfans syndrome. The primary aortic pathology requiring initial operation was annuloaortic ectasia in 10 patients, aortic valvular disease in 5, aortic dissection in 3, and mega aorta syndrome, aortic aneurysm in multiple segments, or aortic arch aneurysm in 1 each. Cause of reoperation was pseudoaneurysm formation at suture lines in the ascending aorta in 6 patients, new or progressive dilatation in the remaining aortic segment in 5, new or persistent aortic dissection in 4, graft infection in 2, and recurrent aortic arch aneurysm in 1. The remaining 2 patients received a planned two-stage operation for multiple aneurysms or mega aorta syndrome. Six patients died early after reoperation, yielding a hospital mortality rate of 30%; however, 3 of the 6 deaths were related to a compromised preoperative clinical condition and 1 to perioperative contamination. Two operative deaths (10%) were related to operative techniques. Results suggest application of separate grafts for coronary artery reattachment, as in the Cabrol or Piehler techniques, or the aortic button technique for aortic root replacement, may help eliminate pseudoaneurysm formation, which is one of the major complications after operations on the ascending aorta. It is also suggested that early diagnosis and prompt operative treatment for recurrent or residual aneurysmal diseases of the aorta may be essential for successful definitive treatment.

Primary Anastomosis for Acute Ascending Aortic Dissection

Abstract Intimal tear resection and primary anastomosis of the aorta were used for the treatment of eight patients with DeBakey I and II type acute aortic dissection. Five patients were of DeBakey I type, and three patients were of the II type. Moderate or severe aortic regurgitation (AR) was observed in six of eight patients. The site of the intimal tear was diagnosed by intraoperative echocardiography, and the adventitia corresponding to the intimal tear was transversely opened under total cardiopulmonary bypass. While resuspension of the aortic valve was performed on only one of six patients, AR disappeared in four, postoperatively. Two of eight patients died early postoperatively. The cause of death was postoperative cardiac tamponade in one patient and cerebral herniation in the remaining one. The other six patients have been observed for a mean period of 27 months. There is no late death, and they show no dilatation of the aortic root and deterioration of AR. We believe that this operative method is a simple and safe emergency procedure for DeBakey I and II type acute aortic dissection.