[A case of left lung cancer associated with an aneurysm of the thoracic aorta].

A 61-year-old man was admitted to our hospital because of a left lung cancer. The chest x-ray film showed an irregular mass in the left upper lung field and the ill-defined left upper mediastinal border. A large portion of the aorta seen in the CT section above the aortic arch was understood to be aortic elongation. When a left pneumonectomy was performed, a saccular aneurysm of the distal aortic arch was found and resected under partial aortic clamping. Following the aneurysmectomy mediastinal dissection was performed in the normal way. The patient recovered uneventfully. The pathological specimens showed a pT2N1M0 squamous cell carcinoma with obstructive pneumonia and an arteriosclerotic aneurysm. There was no report of lung cancer associated with aneurysm of the thoracic aorta. In a patient with left lung cancer obliterating the left upper mediastinal border (the "silhouette sign") the aortic arch should be closely examined by MRI and/or angiography.

[Three cases of catamenial pneumothorax].

Three cases of catamenial pneumothorax were presented. A 42-year-old woman with intrapelvic endometriosis had recurrent right-sided pneumothorax with menstruation more than six times. At the operation only a bleb was noted at the apex of the right lung. In a 16-year-old woman who already had been operated on for recurrent right-sided pneumothorax one year ago, left-sided pneumothorax occurred on the day of the beginning of each menstruation four times. A small bleb was noted at the apex. A 29-year-old woman with cesarean section at the age of 25 had recurrent right-sided pneumothorax occurring on the day before the beginning of menstruation three times. Though the operation was performed during her menstrual period, neither air leakage nor any lesions were found. In all cases each lesion was resected and did not prove endometriosis, and partial parietal pleurectomy was performed for pleurodesis. No pneumothorax has recurred.

[A case of medial pneumothorax in the aged].

A 81-year-old man was admitted because of left recurrent pneumothorax with pleural adhesion. A drainage tube was inserted through the left lateral thoracic wall. The lung seemed to be fully expanded in the AP chest X-ray film but his dyspnea was not relieved. The CT examination showed severe medial pneumothorax. He was operated on and recovered uneventfully. It is important to note medial pneumothorax in patients in the supine position and/or with pleural adhesion.

[A successful treatment of Cabrol's procedure for annuloaortic ectasia with an acute aortic dissection (Stanford type A)].

A 67-year-old female who has an Annuloaortic ectasia with an acute aortic dissection was urgently admitted to our hospital. She was also suspected to have developed into an acute cardiac tamponade. An aortic dissection was arised from just above the right coronary artery orific and extended to the innominate artery and the right common carotid artery. In this case Cabrol's procedure with cerebral perfusion technique was considered to be a good indication, but standard Cabrol's procedure provided almost satisfactory results without utilizing a cerebral perfusion technique because disappearance of pressure difference between both hands and the right common carotid artery after reconstruction. Her postoperative course was uneventful and aortography confirmed competence of the prosthetic valve, good patency of the coronary arteries without false aneurysm formation. Cabrol's procedure is a reliable method for Annulo-aortic ectasia especially with an acute aortic dissection of the ascending aorta.

[A successful one stage treatment in angina pectoris and intermittent claudication of both legs].

A successful surgical case of concomitant aorto-coronary bypass grafting and aorto-right iliac, left femoral bypass grafting was presented. A sixty-two years old male admitted to our institution with complaints of angina pectoris and intermittent claudication of both legs who had a history of acute inferior myocardial infarction for which emergency percutaneous coronary balloon dilatation was carried out prior to this admission. In this admission, he was found out to have diabetes mellitus moreover and he hoped to have one staged operation for two different type of the disease. After general anesthesia, at first, aorto-right coronary bypass grafting with saphenous vein graft was carried out under cardio-pulmonary bypass, then aorto-right iliac, left femoral bypass grafting with a dacron bifurcated graft was made only with one time of systemic heparinization. His postoperative course was uneventful and discharged in good condition. We conclude that simultaneous aorto-coronary bypass and revascularization of both legs can be done with minimal risk.

Measurement of regional myocardial blood flow. Application of the electrolytic hydrogen clearance method in man.

To assess myocardial perfusion intraoperatively and to evaluate the adequacy of coronary bypass grafting, we measured regional myocardial blood flow by the electrolytic hydrogen clearance method in 49 patients. Group I comprised 10 patients with nonischemic heart disease and group II, 39 patients with ischemic heart disease undergoing coronary bypass grafting. Group II was subdivided according to the percent stenosis of the coronary arteries supplying the ventricular regions: group IIa, less than 75% stenosis; group IIb, greater than or equal to 75% stenosis. Mean myocardial blood flows were 154 +/- 7, 145 +/- 5, and 98 +/- 9 ml/min/100 gm in groups I, IIa, and IIb, respectively (p less than 0.01, group IIb versus groups I and IIa). Mean blood flows were 161 +/- 19, 159 +/- 12, 78 +/- 12, and 59 +/- 15 ml/min/100 gm in areas of the left anterior descending coronary artery with less than 50%, 75%, 90%, and 99% stenosis in group II. In areas with a totally occluded left anterior descending coronary artery with collaterals, mean flow was 90 +/- 15 ml/min/100 gm. The mean myocardial blood flows were 40 +/- 7 and 100 +/- 14 ml/min/100 gm in areas with anterior Q wave and non-Q wave infarction, respectively (p less than 0.01). After cardiopulmonary bypass, the mean flow increased from 99 +/- 11 to 150 +/- 7 ml/min/100 gm in the grafted areas in group IIb (p less than 0.01), but it did not change in group I or IIa. The electrolytic hydrogen clearance method provided quantitative evaluation of myocardial perfusion and recovery from hypoperfusion by coronary bypass grafting. This method was especially useful in patients undergoing mammary artery grafting.

Intraoperative evaluation of coronary bypass grafts by measuring myocardial blood flow using the electrolytic hydrogen clearance method.

The regional myocardial blood flow (MBF) was measured in 33 patients who underwent coronary bypass graft surgery in order to evaluate the efficiency of coronary bypass grafts in restoring MBF. MBF was measured by the electrolytic hydrogen clearance method during the coronary bypass surgery. The mean prebypass MBF was 161 +/- 19, 162 +/- 12, 80 +/- 12, 43 +/- 14, 104 +/- 18 ml/min/100 g in segments supplied by the left anterior descending coronary artery (LAD) showing less than or equal to 50 per cent, 75 per cent, 90 per cent, 99 per cent, and 100 per cent stenosis with collaterals, respectively. After bypass grafting of the LAD, the mean MBF increased from 70 +/- 13 and 126 +/- 12 ml/min/100 g to 133 +/- 14 and 163 +/- 9 ml/min/100 g in the segments with and without infarction, respectively. The mean postbypass MBF was 149 +/- 10 and 152 +/- 14 ml/min/100 g in the segments supplied by the LAD bypassed with saphenous vein grafts and mammary artery grafts, respectively. Postbypass MBF was dependent upon the magnitude of myocardial infarction. Measurement of MBF by the electrolytic hydrogen clearance method made it possible to quantitatively evaluate myocardial perfusion at the time of operation. It also provided direct information about the effectiveness of myocardial revascularization.