RESUMO
Primary cardiac undifferentiated pleomorphic sarcoma is rare and is associated with very poor survival. We report a case of a 45-year-old female who presented with dyspnea on effort, in whom an echocardiographic exam showed a large mass in the left atrium and the tumor resection was performed. The pathological diagnosis of the resected tumor was undifferentiated pleomorphic sarcoma which subsequently recurred. The patient needed four re-surgeries, and chemotherapy with Pazopanib was performed. A long-term survival of 5 years after the initial surgery was achieved.
RESUMO
The patient, a 80-year-old man, had undergone aneurysmectomy and graft replacement of the right external iliac artery aneurysm and coil embolization and exclusion of the right internal iliac artery aneurysm in 2007. Computed tomography showed a rupture of the right internal iliac artery aneurysm in 2010. We performed aneurysmectomy and occlusion of the gluteal artery. The patient had a satisfactory postoperative course.
RESUMO
A 58-year-old man was admitted because of enlargement in diameter of the descending thoracic aorta. Six years previously, he had undergone graft replacement of the proximal descending aorta due to a chronic dissecting aneurysm. During that surgery, distal fenestration involving resection of the intimal flap of the distal anastomotic site and graft replacement with distal anastomosis of the true and false lumen were performed. Our preoperative enhanced computed tomography (eCT) revealed a thoracic aortic aneurysm 58mm in diameter at the site of distal fenestration. Graft replacement through left lateral thoracotomy was considered difficult because of previous occurrence of methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) empyema after the previous operation: hence, endovascular repair was done using a handmade stent graft to interrupt blood flow into the false lumen. The postoperative course was uneventful. Postoperative eCT showed the thrombosed false lumen and the shrinkage of the aneurysm from 58 to 38mm in diameter over a period of 18 months.
RESUMO
This is a case report of an expansion of the right internal iliac artery aneurysm after an exclusion operation. A 72-year-old man, had undergone aneurysmectomy and graft replacement of a right external iliac artery aneurysm and a ruptured left iliac artery aneurysm, and exclusion of a right internal iliac artery aneurysm in 1995. Computed tomography showed an expansion of the right internal iliac artery aneurysm in 2003. We performed graft replacement and bypassing to the right external iliac artery. The patient had a satisfactory postoperative course.
RESUMO
We describe two patients who underwent repeat off-pump coronary revascularization by axillocoronary artery bypass grafting. A 63-year-old man (case 1), who had undergone coronary artery bypass grafting (CABG) 13 years previously, was admitted to our hospital with exertional angina. The saphenous vein grafts (SVG) to the left anterior descending artery (LAD), circumflex artery (Cx), and right coronary artery (RCA) all were occluded. The left internal thoracic artery (LITA) also was occluded because it had been injured. Because the patient declined to undergo a redo CABG, percutaneous transluminal coronary angioplasty (PTCA) to the LAD was attempted. However, coronary dissection occurred, and an emergency operation was performed. A 66-year-old man (case 2), who had undergone CABG 12 years previously, was admitted with unstable angina. The LITA to the LAD and the SVG to the RCA were occluded. The SVG to the Cx had 99% stenosis in its mid-portion and was the cause of the angina. PTCA and stenting of this SVG were performed. Two weeks later, an operation was done. In both patients, the left axillary artery was selected as the site of the proximal anastomosis. Both patients underwent off-pump bypass grafting to the LAD from the left axillary artery using a SVG. Both grafts were patent postoperatively. This approach resulted in early symptomatic improvement.
RESUMO
Since 1993, our hospital has been entrusted by the Gifu Prefectural Government with the operation of the home health care system in the region. Hospital healthnurses, keeping in close contact with other medical institutions and self-goverinig bodies, have endeavored to support the health and medical care of home patients.<BR>Initially, there was much to be desired in the way some government offices were addressing to home health care and care coordination for patients when they were discharged from hospital. These inadequacies have largely been corrected and in 1998 a comprehensive home care system came into being.<BR>Our effort to restructure the home care system has been crowned with success in many ways. Formerly there were many cases in which individual organizations rendered services separately, but now hospitals, local medical associations and government offices have come to play on the team, which has made it possible to provide home care effectively and efficiently. Moreover, the hospital staff have become fully aware of the importance of home care.