case of severe and recurrent painless thyroiditis requiring thyroidectomy

To report a case of severe and recurrent painless thyroiditis requiring thyroidectomy. A 47-year-old man who presented with severe thyrotoxicosis was found to have extremely low radioactive iodine uptake, negative TSH receptor antibodies, and normal C-reactive protein; these findings suggested a diagnosis of painless thyroiditis. Due to the severity and recurrence of thyrotoxicosis, surgical resection of the thyroid gland was performed to prevent a thyrotoxic storm. Histological examination revealed typical lymphoid infiltration of the thyroid gland. This case illustrates that a patient with painless thyroiditis was successfully treated with surgery

Bicuspid Aortic Valve and Coronary Artery Stenosis in the Cardiac CT

No abstract available.

Amiodarone-induced thyrotoxicosis with thyroid papillary Cancer in multinodular goiter: case report

To report a case of amiodarone-induced thyrotoxicosis [AIT] concomitant with thyroid cancer in multinodular goiter [MNG]. A 61-year-old man treated with amiodarone for 5 years presented with mild sweating. He was found to have AIT simultaneously with thyroid papillary cancer and MNG. Administration of amiodarone was stopped, and he was treated with methimazole for AIT. Five weeks after the initial treatment, thyroid function normalized. Total thyroidectomy was considered to enable use of amiodarone again. This case showed that thyrotoxicosis, MNG and amiodarone may contribute to thyroid carcinogenesis. Amiodarone should be carefully commenced in cases with MNG

Surgical Management for the Patients of Mediastinal Malignancy Involving Cardiac Structures with Circulatory Impairments / 日本心臓血管外科学会雑誌

Malignant disease in the mediastinum often involves cardiac structures such as the cardiac chamber and great vessels, and causes circulatory impairments that limit therapeutic options and longevity. In the present study, we evaluated curative or palliative surgical management for 6 cases of such malignancy in the mediastinum with circulatory impairment who were operated on between January 2001 and February 2004 (4 men and 2 women aged 17 to 72 years). Procedures included tumor resection with cardiopulmonary bypass (CPB) for mitral strangulation due to left atrial myxosarcoma; pericardiectomy without CPB for constrictive pericarditis due to invasive thymoma; radical nephrectomy for renal cell carcinoma with right atrial tumor thrombus using CPB; two pericardial fenestrations with or without partial tumor resection for cardiac tamponade due to pericarditis carcinomatosis caused by malignant lymphoma or lung cancer; and right ventricular metastatic lesion resection with outflow tract reconstruction for the recurrence of renal cell carcinoma using CPB. The follow-up ranged from 4 days to 30 months. Procedure-related death occurred in the patient with invasive thymoma due to heart failure on postoperative day 4. Five operative survivors had improved quality of life and received other therapeutic options. Although the patient with malignant lymphoma died of sepsis during chemotherapy at three weeks, the remaining 4 patients were discharged from the hospital postoperatively but 3 died during follow-up due to the progression of malignant disease. The cause of death were local recurrence at 20 months after operation in the patient with myxosarcoma, liver metastasis at 13 months in the renal cell carcinoma patient, and carcinomatous cachexia at 8 months in the patient with metastatic lung cancer. The patient with recurrence of renal cell carcinoma is doing well without any symptoms of tumor progression at 30 months after metastatic lesion rsection. Despite poor prognosis of the patients of mediastinal malignancy, surgical management for circulatory impairments can be indicated with acceptable risk to lengthen survival and improve the quality of life.

Late Renal Cell Carcinoma Metastasis to the Right Ventricle without Caval Involvement / 日本心臓血管外科学会雑誌

A 72-year-old woman was admitted to our hospital because of a mass in the right ventricle. She has a history of renal cell carcinoma of the left kidney, which was completely removed by nephrectomy in 1996. Echocardiography, CT and MRI showed a large tumor in the right ventricle without any inferior vena cava involvement. A biopsy performed on that tumor confirmed that the tumor was a metastasic tumor in the right ventricle from the renal cell carcinoma. The tumor grew quickly, and almost completely obstructed the right ventricular outflow tract. On February 24, 2004; an operation was performed to remove the tumor, which protruded from the ventricular septum and occupied the right ventricular cavity from the attachment of the tricuspid valve to the right ventricular outflow tract close to the pulmonary valve. A transannular patch was placed in order to dilate the right ventricular outflow tract. Histopathology diagnosed that the tumor was a metastasis from the renal cell carcinoma. The postoperative course was uneventful. Interleukin-2 was administered postoperatively. Echocardiography performed eight months after the surgery showed that although the tumor in the right ventricle had grown, it had not produced stenosis of the right ventricular outflow tract. The patient died as a result of the recurrent tumor blocking the right ventricular outflow tract 11.5 months after the surgery.

A Case of an Elderly Patient Suffering from Acute Type A Aortic Dissection Who Received Conservative Treatment 3 Years after Aortic Valve Replacement / 日本心臓血管外科学会雑誌

An 87-year-old man who had a history of aortic valve replacement (Carbomedics n 23) due to severe aortic valve regurgitation 3 years previously was admitted to our hospital suffering from syncope. The ascending aorta was 40mm in diameter at the time. At the time of admission, the patient's ECG showed elevation of the ST segments in leads V₁-V₃ and depression in leads V₅, V₆, II, III and _aV_F. Emergency coronary angiography performed for suspected acute myocardial infarction showed a type A acute aortic dissection extending to the ostium of the left coronary artery. However, because of his age and stable condition without cardiac tamponade, we treated this patient with conservative therapy including antihypertensive medication. He experienced no major complication and was discharged 31 days after admission. It is concluded that the occurrence of acute aortic dissection after aortic valve replacement is not common, but for a patient with a dilated aortic root at the time of aortic valve replacement, strict postoperative care is necessary. An operation is the first choice of treatment for acute type A aortic dissection, but in this case the patient's overall condition had to be considered.

A Myxosarcoma of the Left Atrium of Which Extension in the Left Atrium Was Diagnosed by Transesophageal Echocardiography / 日本心臓血管外科学会雑誌

A 60-year-old woman was admitted because of dyspnea and a cough. Computed tomography and transthoracic echocardiography showed a tumor in the left atrium. However, transesophageal echocardiography alone could show the tumor and its extension in the interior wall of the left atrium. Peripheral blood chemistry showed a high CA125 level. The first operation was carried out in order to perform a complete resection of the tumor which was 3.5×4.0×2.0cm, but the interior wall of the left atrium seemed normal. The CA125 level returned to within a normal range 80 days after the first operation. Histopathology showed the tumor had myxomatous changes and ring structure formations, but malignancy was also suspected. Transthoracic echocardiography performed 14 months after the first surgery showed a recurrence of the tumor, and subsequent transesophageal echocardiography showed the tumor and its invasion in the interior wall of the left atrium. A second operation was performed to resect the tumor, which had invaded a part of the left atrial interior wall. The histopathology showed the tumor was myxoid but had mitoses and foci of necroses. This tumor was consistent with a myxosarcoma. The patient died as a result of a recurrent tumor blocking the left atrium 20 months after the first surgery.

Suppressive effect of myocardial edema of single-dose crystalloid cardioplegia at immature period / 日本心臓血管外科学会雑誌

The objective of this study was to investigate the edema suppresive effect of single-dose crystalloid cardioplegia against immature myocardium. 50 puppies (3-21-day-old) were separated into 4 groups by the method of myocardial preservation, group A: preservation at 30°C, group B: topical cooling used only, group C: topical cooling with cardioplegia (St. Thomas Hospital solution: 4°C, pH 7.8, 350 mOsm/<i>l</i>), group D: topical cooling with oxygenated cardioplegia, and gravimetric water content of myocardium (%) was measured at control, 5, 30, 60, 90, 120, 150, and 180 min after aortic clamp. All hearts had elevated myocardial water content with linear change pattern, although which in groups A and B was consecutively increased while which in groups C and D was increased immediately after aortic clamp followed by slow increase thereafter. Increase of myocardial water content from 5 min after aortic clamp in group B at 90 min was significantly higher (<i>p</i><0.01) than those in groups C and D, at 180 min that in group A was higher than that in group C and that in group B was higher than those in groups C and D (<i>p</i><0.05, <i>p</i><0.01, <i>p</i><0.01, respectively). This study has shown that evolution of myocardial edema was suppressed by the administration of cardioplegia, while myocardial water content was seemingly higher because coronary vascular dilatation resulted in increase of intravascular water. We could not find the effect of the topical cooling only or oxygenated cardioplegia.