Tomizo Hiekata

Surgically treated Swyer-James syndrome

Because patients with Swyer-James syndrome have almost always been treated conservatively, few reports exist of pathological findings of the lung in this syndrome. We report a case of this rare disease treated surgically and discuss pathological findings. A 36-year-old woman repeatedly contracted bronchitis and pneumothorax since adolescence, until April 26, 1997, when she reported chest pain and dyspnea. Chest X-ray on admission showed left pulmonary collapse with a slight deviation of the mediastinum toward the right. Chest computed tomography showed an apical bulla and emphysematous change in the left upper lobe. Pulmonary arteriography at age 17 showed hypoplasia of left pulmonary artery branches in the left upper lobe. Based on a diagnosis of Swyer-James syndrome, we conducted left upper lobectomy on May 2, 1997. Pathological examination of the resected left upper lobe showed marked emphysematous change, including an emphysematous bulla with destruction of alveolar structure and peribronchiolar fibrosis. No vascular abnormality was recognized in histology. Emphysematous change secondary to repeated bronchiolitis is believed to have led to her repeated pneumothorax.

RECURRENT CARDIAC TAMPONADE TREATED USING A PERICARDIO-VENOUS SHUNT

A 49-year-old woman was admitted because of recurrent cardiac tamponade. She had undergone radical mastectomy and radiotherapy for left breast cancer four years previously. In the following two years, she felt short of breath on exertion due to cardiac tamponade. Repeated conservative therapy with diuretics and pericardial drainage were ineffective in terminating pericardial effusion. The therapeutic procedure of a pericardio-venous shunt was then employed and was effective for improving the recurrent symptoms.

An Unusual Obstruction of the Left Renal Vein Caused by “Nutcracker” Phenomenon: Repair by Renocaval Bypass Procedure A Case Report

Compression of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta has been termed the nutcracker phenomenon. Although often asymptomatic, this phenomenon rarely results in hematuria and flank pain. The mechanisms of the compression found in the surgical cases have included a simple compression by the SMA, the fibrous tissue entrapping the LRV, and dorsal ptosis of the left kidney. Previous surgical approaches have thus included division of the fibrous band, renocaval reimplantation or external stenting procedures, and medial nephropexy. The authors report a case of a twenty-eight-year-old woman who had suffered from massive hematuria with resultant anemia and intractable flank pain caused by nutcracker phenomenon, which had resulted in unusual organic obstruction of the lumen of the LRV by intimal adhesion. Renocaval bypass with a prosthetic graft with supplemental nephropexy and resection of periureteral varices were successfully performed. The pathogenesis of the fibrous band and intimal adhesion could be considered to be the results of reactions to the mechanical stress by the SMA. Dorsal renal ptosis may be an additional contributing factor. Conclusion on the indications for excision of the pelviureteral varices awaits further surgical experiences.

Reconstructive Vascular Surgery for Intestinal Angina Associated with Renovascular Hypertension and Intermittent Claudication A Case Report

Calcified atherosclerosis producing occlusion of the suprarenal aorta with involvement of the celiac artery (CA), superior mesenteric artery (SMA), and renal artery is an extremely rare entity. The authors report a case of a fifty-five-year-old woman with this lesion who had suffered from renovascular hypertension, intestinal angina, and intermittent claudi cation of the lower extremities. Reconstructive vascular surgery was successfully performed including an aortic bypass from the lower descending thoracic aorta to the distal abdominal aorta and revascularization of the CA, SMA, and bilateral renal and external iliac arteries simultaneously. Only a few similar cases have been reported in the literature, and all the patients were female. It appears that there is an unusual predilection for females in this particular form of arteriosclerosis.

Aneurysm of the Portal Vein: Case Report and Review of the Literature

The authors present a case of a sixty-nine-year-old woman who had a saccu lar aneurysm of the extrahepatic portal vein measuring 5 cm in diameter. The aneurysm was excised safely without complications. Microscopically, the aneu rysmal wall showed extremely thin portions with media consisting of only a few layers of muscle bundles. Etiology was considered to be congenital. Eighty cases have been reported in the world literatures including 40 cases presented in Japanese. Fatal complications such as rupture and perforation have been reported in 1 case, and portacaval shunt has been recommended as a surgical treatment of choice for symptomatic patients to avoid thrombosis in the aneurysm, rupture, or portal hypertension. On the basis of the experience ob tained from the presented case, however, the authors consider that a large sac cular extrahepatic portal vein aneurysm had better be excised to avoid potentially fatal complications.