Yasuhiko Tsukamoto

Surgical management of renal cell carcinoma with inferior vena caval and right atrial involvement

A 52-year old man underwent successful surgical removal of renal cell carcinoma with inferior vena caval and right atrial involvement, under cardio-pulmonary bypass. The postoperative progress was uneventful and at this writing he is doing well, with no evidence of metastasis.

A Case of Resected Minute Hepatocellular Carcinoma Detected by Laparoscopy

症例は62歳男性.腹腔鏡検査時, 肝左葉表面より肝外に突出した腫瘤が認められた.しかし超音波検査, computed tomography検査, 血管造影によって腫瘤は同定されず, 腫瘍マーカーも正常であった.腹腔鏡所見によってのみ肝癌と診断され, 肝部分切除が施行された.切除標本において径1.1cmの主腫瘍とその近傍に2個の肝内転移が認められ, 組織学的に肝細胞癌と診断された.肝表面に存在した肝癌の早期発見と診断に腹腔鏡検査が有用であった症例を報告した.

Ventricular septal perforation following acute myocardial infarction in a patient with hypothyroidism —A case report—

A 61-year-old woman with profound hypothyroidism under-went surgery for a ventricular septal perforation 15 days following an acute myocardial infarction, with no preoperative thyroid replacement. Her immediate postoperative course was complicated by a low cardiac output, respiratory suppression and high output renal failure, requiring prolonged hemodynamic and respiratory support. Thyroid replacement (50 μg of thyronine and 100 μg of thyroxine daily) was given in two installments on the 2nd day after the operation. The effect of the inotropic agents increased gradually and the patient was weaned off intra-aortic balloon pumping. A large quantity of diuretics, hydration and hyperalimentation also successfully reduced her elevated BUN and serum creatinine. After full thyroid replacement, she was discharged in good health on the 40th postoperative day.