Left circumflex artery aneurysm with fistula to the coronary sinus.

A giant coronary artery aneurysm with arteriovenous fistula is a unique pathology having few surgical reports. An 82-year-old woman presented with a symptomatic giant left circumflex artery aneurysm with a fistula to the coronary sinus. The left coronary artery was dilated, and an aneurysmal change was visible from the left main trunk to the fistula. Surgery was performed to close the fistula and seclude all parts of the aneurysmal coronary artery. All coronary branches emerging from the aneurysm required bypass grafting. Herein, we present the history of this unusual case and our successful surgical strategy.

[A case of recurrent gastric cancer with improvement of obstructive symptoms caused by carcinomatous peritonitis and prolonged survival by chemotherapy with combined use of Paclitaxel and 5-FU].

A 29-year-old male underwent Cur B surgery including total gastrectomy, pancreaticoduodenectomy, transverse colectomy, and D 2 dissection for scirrhous gastric carcinoma accompanied by duodenal and pancreatic infiltration. Thereafter, the patient suffered from recurrence with development of ileus caused by carcinomatous peritonitis. Ileus tube was inserted, followed by conservative therapy without ingestion. But, as the symptoms aggravated without any alleviation, an emergency surgical procedure was conducted. As disseminated changes were observed in the entire region of the abdominal cavity of the epigastric region, ileus by-pass procedure and ileostomy were performed. Though ileus symptoms were improved, peroral intake was difficult,and the ileus tube had to be left in place. Thereafter, chemotherapy with combined use of paclitaxel and 5-FU was initiated, and peroral intake become possible. The Ileus tube could be removed after improvement of obstructive symptoms. The patient was treated at the outpatient clinic with nutritional help of HPN, but died 14 months after the recurrence.

[A clinical study of endoscopic local coagulation therapy for hepatocellular carcinoma (HCC)].

Eighteen subjects with cases of HCC who underwent endoscopic local coagulation therapy at Hiroshima City Hospital between 1998 and 2004 were studied and compared with 6 cases of HCC patients who underwent laparoscopic partial hepatectomy during the same period. The subjects composed of 10 cases of laparoscopic microwave coagulation therapy (L-MCT), 5 cases of laparoscopic radio frequency ablation therapy (L-RFA), and 3 cases of thoracoscopic microwave coagulation therapy (T-MCT). The operation time was 114 minutes for L-MCT and 92 minutes for L-RFA, both of which were significantly shorter than 208 minutes for resection cases. No complications were developed in any of the cases and the postoperative hospitalization period of the cases was 13.1 days, 8.2 days, and 13.0 days, respectively. Although each case of local recurrence was observed both in L-MCT and L-RFA groups, one case displayed observation difficulty from the liver surface and the other required a daughter nodule. The three-year survival rate was 71.4%, while the five-year survival rate was 53.6%. Endoscopic local coagulation therapy is not too invasive and useful for hepatocellular carcinoma in which percutaneous RFA is difficult. However, it is well indicated when the scope is evident with observation being feasible from the liver surface.