ABSTRACT
We report the findings in a 75-year-old woman who was given diagnosis of rupture of the internal thoracic artery (ITA) and was successfully treated by coil embolization. The patient suddenly felt chest pain, and a chest CT revealed a mediastinal hematoma. She was suspected to have an acute aortic dissection, and therefore transferred to our hospital. Upon careful examination, a CT showed a hematoma in the superior mediastunum and the extravasation of the left internal thoracic artery. Emergency coil embolization was thus performed to stop the bleeding. After the embolization, no further hemorrhaging was observed. The patient was uneventfully discharged in a healthy state 2 weeks later. Rupture of the internal thoracic artery is rare. However, it is important to include this potential disease in the differential diagnosis when encountering a patient presenting with an atraumatic mediastinal hematoma.
ABSTRACT
We describe the case of an 83-year-old woman who underwent surgical repair for abdominal aortic aneurysm with horseshoe kidney. Preoperative computed tomography (CT) scans showed the presence of not only the principal bilateral renal arteries but 2 accessory renal arteries originating from the right common iliac artery. The left accessory renal artery had 2 branches supplying each of the lower poles of the kidneys. We performed open surgery for artificial graft replacement by dividing the isthmus. The isthmus was formed of fibrous connective tissue therefore we dissected the isthmus sharply and sutured edges. A urinary fistula was absent. Since supply to the right renal lower pole via the left accessory artery was negligible, the artery was ligated. We performed this procedure safely and achieved a successful outcome.
ABSTRACT
Combined monitoring of rSO<sub>2</sub> and SSEP is routinely performed during cardiopulmonary bypass (CPB), but it is not sensitive enough to detect focal lesions of the brain. Thus, we assessed whether simultaneous measurement of S-100β is able to enhance diagnostic sensitivity or not. Between September 1999 and February 2000, serial measurement of plasma levels of S-100β and SSEP and rSO<sub>2</sub> monitoring during CPB were simultaneously performed in 26 consecutive patients (19 men and 7 women). Ages ranged from 46 to 85 (mean 67±10 years). Neurological complications developed in 5 (19.2%). Among those patients, hemiplegia developed in 2, and dementia, temporary convulsion, and deep coma in 1 each. Three of them showed abnormally low rSO<sub>2</sub> levels during surgery, but no patient showed abnormal change in SSEP waves after surgery. There was no significant difference in S-100β level 1h after CPB between patients associated with or without neurological complications (1.98±0.48 vs. 1.89±1.65), however, its level 24h after CPB remained significantly higher in patients with neurological complications (1.01±1.14 vs. 0.22±0.24). S-100β level 24h after CPB appears to improve diagnostic sensitivity for detecting such focal brain damage lesions as those in which SSEP or rSO<sub>2</sub> are not efficient enough to make a diagnosis. However, further study is required to evaluate how fast it can differentiate patients with and without brain damage.