Solitary adrenal metastasis in a patient with sigmoid colon cancer; report of a case.

A 73-year-old man had sigmoidectomy for sigmoid colon cancer in December 2001. Although he was followed regularly with chemotherapy, his serum carcinoembryonic antigen (CEA) increased on August 2002. Abdominal computed tomography and magnetic resonance imaging showed a right adrenal mass and no other abnormality. The preoperative diagnosis was a solitary adrenal metastasis from sigmoid colon cancer; the lesion was removed in September 2002. On pathology, adrenal metastasis was confirmed. Although the patient's serum CEA normalized soon thereafter, 12 months after adrenalectomy, the CEA again increased; the patient had local recurrence of the resected adrenal lesion and liver metastasis. Therefore, the patient was given systemic chemotherapy, but his condition deteriorated, and he died 38 months after adrenalectomy. Adrenal metastasis from colorectal cancer is not unusual; however, a solitary metastasis is rarely found and resected surgically. As surgical treatment of the metastatic lesion could improve patients' prognosis to some extent if it is detected early, the possibility of adrenal metastasis should be kept in mind when colorectal cancer patients are followed.

Comparison of Bassini repair and mesh-plug repair for primary inguinal hernia: a retrospective study.

The purpose of this study was to compare the mesh-plug repair with the Bassini repair for the treatment of primary unilateral inguinal hernias. Patients with primary unilateral inguinal hernias who underwent a Bassini repair (n = 118) between January 1992 and May 1996 and a mesh-plug repair (n = 113) between July 1996 and April 1998 were retrospectively reviewed. We recorded information regarding the types of hernia according to Nyhus classification, operation time, complications, postoperative recovery, and recurrence after surgery. The two groups were comparable regarding age, sex, side of hernia, types of hernia, and the follow-up interval. The operation time was 55 +/- 20min for Bassini repair and 54 +/- 18min for mesh-plug repair. There was no incidence of mesh infection in the mesh-plug repair cases. The amount of diclofenac sodium (suppository) was 307 +/- 222mg in the Bassini repair group and 132 +/- 182mg in the mesh-plug repair group (P < 0.0001). The length of hospital stay was 8.2 +/- 2.0 days in the Bassini repair group and 4.3 +/- 2.7 days in the mesh-plug repair group (P < 0.01). Nine patients (7.6%) in the Bassini repair group had recurrence, compared with one patient (0.9%) in the mesh-plug repair group. The recurrence-free survival in the mesh-plug repair group was significantly longer than that in the Bassini repair group (P = 0.03). In conclusion, patients with primary unilateral inguinal hernias who undergo a mesh-plug repair recover more rapidly and have less recurrence in comparison with those who undergo a Bassini repair.

[Three cases of left atrial myxoma].

Three cases of left atrial myxoma are presented. All of them were diagnosed by echocardiography, computed tomography and cardiovascular angiography. At operation, origin of the tumors were found to arise from the vicinity of the fossa ovalis in two cases and the lower atrial septum in the other. Three different operative maneuvers were used in these three cases. In the first case, the left atrium was incised and the tumor was removed submucosally. In the second case, the left and right atrium were incised and the tumor was removed with atrial septum. In the third case, only the right atrium was incised and the tumor was removed with atrial septum. In comparison of these three different maneuvers, we conclude that the second case was most appreciable, because the operator could see whole sight of the left atrial cavity and whole contour of the tumor and remove the tumor completely without destruction. All these patients have done well for periods of follow-up ranging from 10 to 37 months.

[Total anomalous pulmonary venous connection in adult: report of a case].

Total anomalous pulmonary venous connection (TAPVC) is a cardiac disorder that seldom permits survival into adulthood without surgical correction in infancy. We reported a successful total correction in a 47-year-old man with TAPVC. Cardiovascular angiography demonstrated the features of Darling I a type TAPVC. Cardiac catheterization showed Qp/Qs: 5.8, Pp/Ps: 0.31, Rp/Rs: 0.06 and mild pulmonary hypertension. On operation, the posterior wall of left atrium anastomosed to the common pulmonary vein over 4 cm length, ASD (5.0x3.8 cm) was closed with patch, and the communicating vein was ligated. The patient made uneventful postoperative recovery and is well 3 months following surgery.

Modified versus classical Blalock-Taussig shunts for congenital cyanotic heart diseases: a comparison of long-term results.

Between March 1977 and December 1984, 103 Blalock-Taussig shunts were performed on 88 patients. Included in this study were 40 patients who underwent the modified BT shunt and 63 patients who underwent the classical BT shunt. 13 of the modified BT shunts (33 per cent) and 18 of the classical BT shunts (29 per cent) were performed during infancy and 10 of the modified BT shunts (25 per cent) were performed on patients under the age of 3 months. EPTFE grafts of varying sizes were used in the patients who underwent modified BT shunts--4 mm in 14 cases, 5 mm in 15 cases and 6 mm in 11 cases, respectively. The early mortality rate was 11 per cent (3 deaths) in the group who had modified BT shunts and 8 per cent (5 deaths) in the group who had classical BT shunts. Over a follow-up period of 6 years, 6 shunt failures were diagnosed in the modified BTS group by auscultation and/or angiographic study, and during a follow-up period of 8 years, 12 shunt failures were diagnosed in the classical BTS group. The patency rate 3 years after surgery was 88.8 per cent in the modified BTS group and 78.0 per cent in the classical BTS group. The patency rate 5 years after surgery was 88.8 per cent in the modified BTS group and 75 per cent in the classical BTS group.(ABSTRACT TRUNCATED AT 250 WORDS)

Modern trends in the management of aortic aneurysms. Review of 450 cases experienced.

Treatment of various aortic aneurysms in 450 cases experienced during the past 25 years was analysed. One hundred and five patients were treated with survival rate of 80.2% in the thoracic aortic aneurysm group, 65 patients with survival rate of 76.9% in the dissected aneurysm of the aorta group, 175 patients with survival rate of 93.1% in the nonruptured abdominal aortic aneurysm group and 37 patients with survival rate of 75.7% in the ruptured abdominal aortic aneurysm group. From 1981 to the present time, considerable improvement of the operative results has been achieved with refinement of cardiovascular adjunctive techniques and operative procedures with careful management of the patients. Survival rates are now reached to 88.7% in the thoracic aortic aneurysm, 81.0% in the dissected aneurysm, 100% in the nonruptured abdominal aortic aneurysm and 81.2% in the ruptured abdominal aortic aneurysm. From the careful analyses of the results, prompt diagnosis, distinct treatment policy, strict operative indication and better surgical procedure are considered to have contributed to these excellent operative results.

Surgical treatment of aortic dissection: application of Ivalon sponge to the dissected lumen.

With canine disease models for aortic dissection, we performed comparative evaluations of several surgical procedures for the management of this dissection. From these experimental procedures, we developed a new operative technique, the Ivalon sponge occlusion method, designed to promote thrombus formation and to mesh (organize) effectively with the tissue ingrowth of the peripheral dilated, dissected aortic lumen. The details of the technique are described. It has been used successfully in 12 patients with DeBakey type I and type III aortic dissection. Based on our experimental and clinical evaluations, although the results are preliminary, we believe this operative technique is a simple, effective approach for the management of extended aortic dissection.