[Surgical management of non-tuberculous mycobacteriosis and tuberculosis of the lung].

From 1990 to 1999, three patients with non-tuberculous mycobacteriosis and 14 patients of tuberculosis underwent pulmonary resection in the National Sanatorium Ehime Hospital. Of the patients with tuberculosis, two were multiple drug-resistant cases and twelve cases were suspected of lung cancer before diagnostic resection. All three patients with non-tuberculous mycobacteriosis were symptomatic, had chest cavities in the lung, and were sputum-culture positive. There were no operative death in all patients, and one case of post-operative complication. Two patients, one with non-tuberculous mycobacteriosis and another with tuberculosis, failed in sputum negative conversion. The former had been treated for a long time preoperatively. Early resection in patients of pulmonary non-tuberculous mycobacteriosis and of pulmonary multiple drug-resistant tuberculosis is recommended to prevent further progression of pulmonary lesions.

Centipede inflicted postmortem injury.

We here report the first case of postmortem injury caused by a centipede. An old man was found dead in his bedroom. The death was estimated to be due to intracranial hemorrhage and to have occurred two days before the police inspection. A centipede about 12 cm long emerged from a subcutaneous cavity on the victim's forearm. Obviously, the centipede had dug the cavity on the intact skin. A police inspector was bitten by the centipede, so he stepped on the centipede on the floor. The exudate from the insect was identified to be derived from the victim's blood.

Thallium-201 myocardial tomography with intravenous infusion of adenosine triphosphate in diagnosis of coronary artery disease.

OBJECTIVES: The purpose of this study was to evaluate the feasibility, safety and diagnostic accuracy of thallium-201 myocardial tomography with intravenous adenosine triphosphate (ATP) infusion in patients with suspected coronary artery disease. BACKGROUND: Both ATP and adenosine are potent coronary vasodilators with a very short half-life. Several studies have confirmed that the diagnostic accuracy of adenosine thallium-201 scintigraphy is comparable to that with exercise. However, a high incidence of side effects, including atrioventricular (AV) block, has also been reported. Because the appropriate infusion rate for ATP has not yet been determined, this agent has not been tested in combination with myocardial scintigraphy. METHODS: The study group included 253 consecutive patients who underwent thallium-201 myocardial tomography with ATP infusion (0.16 mg/kg body weight per min for 5 min). The occurrence of adverse effects was carefully monitored. Of the 120 patients with coronary angiography, 76 had significant coronary artery disease. Tomographic images were assessed visually and by computer-quantified polar maps, and they were compared with the results of coronary angiography. RESULTS: Although 56% of the patients had some adverse effects, they were transient and mild. In all patients, the ATP infusion protocol could be completed, and no patient required aminophylline; AV block occurred in only 2% of the patients. The sensitivity and specificity were 88% and 80%, respectively, by visual analysis and 91% and 86%, respectively, by computer quantification. CONCLUSIONS: Thallium tomography with ATP is feasible and has a diagnostic value similar to that with adenosine for detecting coronary artery disease. In addition, it may have fewer side effects than adenosine myocardial tomography.

[Assessment of myocardial viability by thallium-201 reinjection imaging with sublingual nitroglycerin].

Although thallium-201 (201Tl) reinjection imaging improves the detection of myocardial viability compared to standard 3-4-hr redistribution (RD) imaging, it still underestimates the extent of viable myocardium. We examined whether 201Tl reinjection SPECT with sublingual nitroglycerin (NTG) had a higher sensitivity for viability detection than reinjection alone. Eighty patients with coronary artery disease were studied, 38 of them with an old myocardial infarction. At the peak of exercise, 111 MBq 201Tl was injected and the initial and the delayed SPECT images were obtained. Then, all patients were divided randomly into two groups, and in each group, SPECT data were obtained again after the injection of 37 MBq 201Tl with (NTG(+) group) or without 0.6 mg of sublingual NTG (NTG(-) group). Among 50 segments showing fixed defects on the delayed image in the NTG(+) group, 21 (42%) were found to be reversible on the reinjection image, as compared to 16 of 51 (31%) in the NTG(-) group. Twenty-two of 44 (50%) segments showing incomplete RD were found to be reversible in the NTG(+) group, while 17 of 42 (41%) segments in the NTG(-) group. Moreover, the ratio of reversible segments seen in the reinjection images was significantly higher in the collateralized regions of the NTG(+) group than in those of the NTG(-) group (20/26 vs. 14/28, p < 0.05). Thus, 201Tl reinjection SPECT with sublingual NTG improves the detection of ischemic but viable myocardium as compared to SPECT with reinjection alone.

[Reoperation for late pseudoaneurysm in the ascending aorta following the modified Bentall procedure--a case report].

We performed reoperation for annuloaortic ectasia (AAE) in a patient with Marfan's syndrome. The initial operation was the modified Bentall procedure, in which the root of the ascending aorta and the aortic valve were replaced with a composite graft with a prosthetic mechanical valve, and the coronary arteries were reconstructed by direct anastomosis to the right coronary ostium or with an interposing graft to the left coronary ostium. At 1 year and 6 months after the initial operation, a pseudoaneurysm developed in the ascending aorta following the reconstructed coronary ostium on the right side was detached. At reoperation, the hole in the composite graft was closed, but the right coronary artery could not be reconstructed. Her postoperative course was uneventful. In addition, Piehler's method is effective for reconstruction of the coronary arteries, especially for patients with AAE in the Marfan's syndrome.

Carcinosarcoma of the lung. Report of a case and review of the literature.

We describe a case of carcinosarcoma of the lung in a 60-year-old female who was admitted with complaints of productive cough and an abnormal shadow in the chest X-ray. Sputum cytology showed both squamous cell carcinoma and adenocarcinoma cells. Malignant nonepithelial cells were identified in the needle biopsy specimen. Right middle and lower lobectomy was performed to reveal a carcinosarcoma by microscopic and immunohistochemical examination. This case was histologically unusual because it presented multiple carcinomatous elements (squamous cell carcinoma and adenocarcinoma). It was classified as peripheral type according to the clinical classification, showing an extremely poor prognosis. The histogenesis and clinical features of this rare tumor are discussed.

Two cases of scimitar variant.

The scimitar sign is characteristic of partial anomalous pulmonary venous drainage into the inferior vena cava (IVC). We encountered two variant cases of scimitar sign. In one case, the scimitar vein entered both the IVC and the left atrium (LA) without any intracardiac shunts. Surgical repair was made by simple ligation of the scimitar vein to correct the left to right shunt. Retrograde balloon occlusion angiography of the scimitar vein was diagnostic. In the other case, the scimitar vein showed a meandering course, and then drained into the LA without any connection with the IVC, and surgical intervention was not required.

[A case of isolated congenital left ventricular diverticulum].

Isolated congenital diverticulum of the left ventricle is a rare malformation. A 2-year-old boy was admitted to our hospital for evaluation of heart murmur. The echocardiogram and MRI showed an extra cavity communicating with the left ventricle. The diagnosis was made by LV angiography. He was diagnosed as having congenital isolated diverticulum of the left ventricle without other cardiac anomalies. He received resection of the diverticulum under cardiopulmonary bypass. Histological examination showed a fibrous diverticulum. Postoperative clinical course was uneventful. We can expect good prognosis after resection of the congenital diverticulum of the left ventricle, if necessary under cardiopulmonary bypass.

[A case report of coronary sinus atrial septal defect].

We experienced an uncommon case of coronary sinus atrial septal defect, which was not associated with a left superior vena cava (LSVC). A 29-year-old woman, who experienced fatigue during moderate exercises, was found to have the atrial septal defect located in the lower part of the septum by echocardiography preoperatively. On operation, the coronary sinus ASD was diagnosed. The ostium of coronary sinus was located in the left atrium. This type is classified as partially unroofed coronary sinus without LSVC. Our case, in the absence of the LSVC, was repaired by simple closure of the coronary sinus ASD, so the coronary veins drained into the left atrium. Postoperative course was uneventful.

[An elder case of common atrium: surgical repair at a 56-year-old man].

A 56-year-old man was admitted to our hospital with dyspnea. The ultrasonographic and hemodynamic features proved complete absence of atrial septum. The data of catheterization showed right to left shunt (59%) and QP/QS value of 1.7 and also, oxygen saturation of pulmonary arterial blood (87%) was almost as same as that of systemic arterial blood (90%). The radical operation was performed of making a new atrial septum with artificial patch. He did not have the cleft of atrioventricular valves and anomalies of systemic venous drainages. We reported a case of common atrium, which was diagnosed for the first time at the age of 56.

[A case of bronchial mucoepidermoid carcinoma in a 8-year-old child treated with right upper sleeve lobectomy].

A 8-year-old boy was admitted to our hospital with complaint of cough and abnormal shadow on chest X-ray. Bronchoscopy and biopsy revealed a bronchial mucoepidermoid carcinoma, which obstructed right main bronchus. Right upper sleeve lobectomy was performed. The histological examination revealed a low grade malignant mucoepidermoid carcinoma. There were no metastases in the mediastinal lymph nodes. He has been healthy with no evidence of recurrence during 4 years after operation.

[A case of an operation for lung cancer after PTCA].

A 64-year-old lung cancer patient combined with angina pectoris was admitted to our hospital. Chest roentgenogram showed a coin lesion in the left upper lobe. Broncho-fiberscopic examination proved adenocarcinoma. Coronary angiography revealed 90% stenosis of the left circumflex artery. Percutaneous transluminal coronary angioplasty (PTCA) was done and resulted in success. Eight days after PTCA, left upper lobectomy for lung cancer was undergone. Postoperative course was uneventful. Compared with coronary artery bypass grafting, PTCA was very useful for the patient having malignant disease combined with angina pectoris because of little surgical stress and no delay of operation.

Cor triatriatum dexter with anomalous pulmonary venous drainage and sinus venosus atrial septal defect.

The atypical location of a membrane in a case of cor triatriatum dexter prompted successful repair of accompanying anomalies, with in situ use of the membrane. The anatomy is described with a review of the literature.