Satoru Kurata

Surgery for abdominal aortic aneurysms associated with malignancy

Of 148 patients treated for abdominal aortic aneurysms (AAA), 33 (22%) also had cancer. According to the classification of Szilagyi, there were 13 patients in group I, 19 in group II, and 1 in group IV. In group I, the mean interval between the cancer and AAA operations was 7 years (range 1–14 years). Aneurysmectomy was performed in 9 patients, wrapping in 2, and no operation in 2. In group II, a two-stage operation was performed in 8 patients, a single-stage operation in 4, only surgery for cancer in 4, and no operation in 3. Of 4 patients undergoing single-stage operations, 3 had colorectal cancer, and there were no postoperative complications such as graft infection or anastomotic breakdown. In group I, 6 of 13 patients died, but there were no cancer deaths. In group II, 9 of 19 patients died, 6 from progressive cancer. The group IV patient also died of cancer. These results suggest that if a patient can tolerate surgery for both diseases, a single-stage operation is preferable.

Mesenteric infarction in Takayasu's arteritis treated by thromboendarterectomy and intestinal resection

A 36-year-old woman with a history of left nephrectomy for renovascular hypertension secondary to arterial occlusive lesion of Takayasus arteritis was re-admitted to our hospital with complaints of postprandial abdominal pain in the sixth post-operative month. On the 14th hospital day, the developing abdominal distension and generalized tenderness suggested a mesenteric vascular occlusion. Following abdominal aortography, emergency surgery was performed. The entire small bowel was edematous and markedly cyanotic with spotted, dark colored areas and the mesentery was pulseless. The patient was sucessfully treated by thromboendarterectomy at the origin of the celiac and superior mesenteric arteries and the necrotic loop of intestine was then resected 7 days later. Takayasus arteritis was diagnosed by histological examination of the resected specimens. Although the occurrence of mesenteric infarction secondary to Takayasus arteritis is rare, the possibility of mesenteric vascular occlusion should be given consideration in the follow-up of patients with Takayasus arteritis.

Internal echo histogram examination has a role in distinguishing malignant tumors from benign masses in the breast

We analyzed the histograms of reflecting ultrasound (US) from the internal areas of the masses of 50 lesions in the breast. The central average of gravity and the ratio between lower and higher width in the histograms were compared as the parameters. Statistical significance were found in both parameters between malignant tumors and benign masses (P<.001, P<.01). Therefore, analysis of histograms based on reflecting US was useful in making differential diagnoses of malignant tumors and benign masses in the breast.

A New Approach for Abdominal Aortic Aneurysm by a Ringed Y Graft

Nonsuture technique with ringed Y graft (RYG) was applied to 5 high-risk patients with abdominal aortic aneurysm (AAA). All showed marked arterio sclerotic changes. In 3 cases, the AAA was located 1 cm below the renal artery branching. Concomitant diseases were: gastric ulcer in 3 cases, chronic bron chitis in 3, moderate renal failure in 2, thoracic aortic aneurysm in 1, and aortic valvular insufficiency in 1. The RYG method was evaluated by comparing age, size of aneurysm, operating time, blood loss, and aorta clamping time with the conventional Y graft (CYG) method (10 cases). Ages and sizes in the RYG group were nearly identical with those in the CYG group. The mean blood loss was 797 ± 86 ml in the RYG group and 1631 ± 754 ml in the CYG group (p < 0.05). Aorta clamping time was 34 ± 2.4 min in the RYG group and 62 ± 4.9 min in the CYG group (p < 0.01). Although the suprarenal aorta was clamped in 3 of 5 cases in the RYG group, proximal anastomosis took only a few minutes, and none of them required protection to the kidney. The authors conclude that RYG can be reliably applied to high-risk patients with AAA.

Depression of host-defence mechanisms following cardiac surgery

The purpose of the present study was to determine the effects of open-heart surgery on host-defence mechanisms, by studying serial changes in serum immunoglobulins, circulating lymphocyte function in patients undergoing open-heart surgery. Serum proteins and immunoglobulins were significantly depressed immediately after operation and these depressions were correlated to the degree of the durations of cardiopulmonary bypass and associated hypothermia. White cell counts in peripheral blood increased significantly after operation. In contrast, total circulating lymphocytes were depressed postoperatively. The depression of circulating lymphocytes was mainly due to a marked decrease in the number of T-cells. Mitogen responses of lymphocytes stimulated by phytohemagglutinin were also depressed postoperatively. The quantitative and qualitative depression of cell-mediated immunity following open-heart surgery was observed. However, these depressions returned to preoperative levels in one week and had no clinical significance.

Operative arteriography: An indicator for infrainguinal bypass

Preceding infrainguinal artery bypass surgery, a complete arteriographic delineation of the recipient artery is not always feasible. For 13 out of 63 patients with occlusion of the infrainguinal arteries, distinct delineation could not be accomplished with preoperative angiography. However, prebypass operative arteriography was successful in 8 of the 13. In 5, we performed bypass surgery on vessels not visualized on the preoperative angiography. In the other 3, bypass was performed on vessels in which the status of the distal circulation had not been well defined, although the popliteal and infrapopliteal arteries were partially visualized on the preoperative angiography. Intraoperative arteriograms—a technique requiring operative exploration of the target vessel—can significantly improve the visualization of the recipient artery and the distal circulation. Therefore, prebypass operative arteriography may become another indicator for arterial bypass surgery.

Leiomyoma of the left posterior tibial artery: A case report

A case of leiomyoma of the left posterior tibial artery is presented. This tumor produced aneurysmal dilatation of the artery and was treated successfully by surgery. This may be the first documented case of a benign smooth muscle tumor, although nearly 100 leiomyosarcomas arising from large arteries and veins have been described in the literature.

Ringed grafting for an abdominal aortic aneurysm in a 92-year-old patient : report of a case

We report herein the case of a 92-year-old man with an abdominal aortic aneurysm who underwent successful surgical resection using a ringed graft. His postoperative course was uneventful, and he was discharged after 42 days, following which he attended the outpatient department twice a month for regular check-ups. He finally died of pneumonia which developed from an upper respiratory tract infection 6 months after his operation. Thus, surgical treatment should always be considered when an aneurysm is detected, even in very aged patients for whom the activities of daily living are possible.

Idiopathic Retroperitoneal Fibrosis

We treated a patient with idiopathic retroperitoneal fibrosis accompanied by right ureteral constriction. Pyelography, ureterography, and abdominal CT scan were pertinent diagnostics. Close collaboration between the surgeon and the urologist is required when attempting to treat such patients.