Yoshiharu Hamanaka

High-Output Heart Failure Caused by a Huge Renal Arteriovenous Fistula After Nephrectomy: Report of a Case

Abstract Postnephrectomy renal arteriovenous fistula (AVF) with an aneurysmal lesion is a rare clinical entity that may cause high-output heart failure. In this report, we describe the case of a 68-year-old man who had undergone nephrectomy for renal tuberculosis 43 years previously, in whom an acquired large renal AVF presenting as an aneurysm caused congestive cardiac failure. We also discuss the hemodynamic, hormonogenic (human arterial natriuretic polypeptide; hANP), and radiographic findings before and after surgery for the AVF. The AVF with an aneurysmal lesion was clearly visualized by three-dimensional-computerized tomographic (CT) scanning, and proximal ligation of the renal artery was followed by an uneventful recovery. This procedure can produce good results when a fistula is too large to allow safe embolization and when excision would be hazardous due to inflammation surrounding the fistula.

Thymic metastasis from prostatic carcinoma : report of a case

The thymus is an important organ involved in cell-mediated immunological function, and to our knowledge, there has never been a case of thymic metastasis reported. We recently examined a 65-year-old man who presented at our department with a cough and shortness of breath on exertion. He had a history of prostatic carcinoma for which he had undergone an orchiectomy 11 years previously. Investigations disclosed a mediastinal tumor, 14×9 cm in size, and histological examination of the resected tumor confirmed a diagnosis of thymic metastasis from prostatic carcinoma.

Primary Venous Aneurysm—Case Reports

Venous aneurysm (VA) is a rare vascular lesion. The authors have experi enced 2 cases of VA: a seventy-year-old woman who had a 4 x 4 cm VA at the elbow and a forty-five-year-old woman who had a 1.5 x 1 cm VA in the long saphenous vein. In the second case, intraaneurysmal observation was per formed by angioendoscopy during surgery. Histologic examination of the re sected lesion proved that the basic structure of the venous wall was preserved in both cases, although a marked reduction in each component of wall was ob served. The authors reviewed the reported cases of VA and classified them into type I VA (cystic ectasia) and type II VA (fusiform ectasia). Type I VA is predominant in extremities and internal organs, while type II VA predominates in the cervical region. Their analysis of the reported cases indicated that although VA and varicose veins are both venous ectasias, VA is distinguishable from varicose veins by the following features: no sex difference, occurrence even in children, occurrence anywhere in the body, occurrence as a single lesion, and lack of prolongation of the vein.

Chronic expanding hematoma in the pericardial cavity after cardiac surgery

We report the successful surgical treatment of a rare case of chronic expanding hematoma in the pericardial cavity that developed into a very large mass over a long period. The patient, who had a history of cardiac surgery for a double-outlet right ventricle 14 years previously and for tricuspid regurgitation 8 years ago, noticed a slowly growing mass near the left atrium and ventricle 5 years ago. The mass, which confirmed a diagnosis of chronic expanding hematoma, was resected by left thoracotomy.

Implantable motor-driven artificial heart

An implantable artificial heart was made using a flat-type brushless dc motor, a cylindrical cam, and Harmonic Drive as a reduction gear. A specially designed cylindrical cam makes the one-directional slow revolution into the reciprocating motion, then two sacs inside the driver are pushed alternately by the pusher plates located at both ends of the cam. The percentage systole of the driver is fixed at 50%. The two sacs, blood chambers, are 87 ml (left) and 81 ml (right) in volume and are made of polyurethane rubber. Bjork-Shiley monostrut valves are placed at the inflow and outflow of the sacs.

Thymic carcinoids in multiple endocrine neoplasia-type 1

We report a case of a 45-year-old man with thymic carcinoids in multiple endocrine neoplasm-type 1. Extended total thymectomy was performed through a median sternotomy, and the mediastinal regional lymph nodes and fibroadipose tissue were dissected. Multiple endocrine neoplasm-type 1 related thymic carcinoids are rare and have a poor prognosis. The efficacy of radiotherapy and chemotherapy for prolonging survival is limited, and an aggressive surgical approach with complete excision of the tumor with resection of the peripheral tissues and dissection of the mediastinal lymph nodes seems to be the best available treatment today. We have found that this practice of thymectomy at an early stage in combination with genetic and effective radiological treatment can be effective for multiple endocrine neoplasm-type 1 patients.

Transvenous mitral commissurotomy examined with transesophageal echocardiography

SummaryTransvenous mitral commissurotomy (TMC) was conducted with transesophageal echocardiography (TEE) in two patients with mitral stenosis. It was possible to see clearly not only the intracardiac structures to be examined by TMC, such as the right and left atria, interatrial septum, and mitral valve, but also the instruments used in TMC, such as the catheter, guidewire, and balloon. It was possible to determine the positional relation between the intracardiac structures and instruments. We could observe all procedures other than Brockenbroughs procedure by both TEE and fluoroscopy at the same time. Although safety and reliability cannot be confirmed from just the two present cases, TEE appears to be applicable to TMC.

Surgical repair of Wolff-Parkinson-White syndrome complicated with myocardial bridging

Myocardial bridging causes myocardial ischemia during supraventricular tachycardia. We present a case of Wolff-Parkinson-White syndrome combined with myocardial bridging. The patient complained of angina pectoris during paroxysmal supraventricular tachycardia because of severe constriction of the left anterior descending coronary artery during systole. A myocardial scintigram revealed myocardial ischemia in the anteroseptal wall during paroxysmal supraventricular tachycardia. Myotomy to prevent myocardial bridging and interruption of the accessory conduction pathway was successfully accomplished in a one-stage operation.

Deterioration of ebstein disease after closure of atrial septal defect

We treated a 7-year-old girl in whom the clinical evidence of Ebstein disease was manifest after a surgical closure of an atrial septal defect. This manifestation, which was not evident either in the preoperative catheterization studies or during operative investigation of closure of the atrial septal defect, required further hemodynamic and angiographic evaluation. Tricuspid valve replacement with Hall-Kaster prostheses was carried out.

Post-traumatic diaphragmatic herniation of the liver, examined by positron emission tomography: case report

We present a case of post-traumatic diaphragmatic herniation of the liver, which mimicked an intrathoracic tumor. After an automobile accident, the patient underwent thoracotomies for hemothorax and lung cancer in the right chest. Seven months later, computed tomography (CT) demonstrated a round tumor in the thorax adjacent to the right diaphragm with a higher density than the liver parenchyma. An intrathoracic tumor including a primary or metastatic lung cancer was suspected. However, positron emission tomography (PET) showed that the uptake of fluorine-18-fluorodeoxyglucose (FDG) was identical to that in the liver, and the tumor appeared to be contiguous with the liver. Thus, we suspected liver herniation. Core needle biopsy revealed liver cells without neoplastic tissue. Upon surgical exploration, herniation of the liver was found and repaired. PET was helpful in providing morphological and functional information leading to accurate diagnosis of liver herniation in this unusual case.