Successfully treated infected left ventricular pseudoaneurysm after the Dor operation.

A 65-year-old woman received a bovine pericardial patch repair with a sutureless technique for a left ventricular free-wall rupture. Three months later the Dor operation was performed for a left ventricular aneurysm. She was admitted again with a mycotic aneurysm 15 months after the Dor operation. Computed tomography suggested a rupture of the pseudoaneurysm due to a damaged endoventricular patch. An emergency Dor reoperation was performed with profound hypothermia. Right thoracotomy was performed with insertion of a left vent catheter via the right upper pulmonary vein in order to prevent ventricular distention. Omentopexy was performed to avoid infection of the mediastinum. The patient had an uneventful postoperative course.

Protective effects of antioxidative serotonin derivatives isolated from safflower against postischemic myocardial dysfunction.

N-(p-Coumaroyl)serotonin (C) and N-feruroylserotonin (F) with antioxidative activity are present in safflower oil. The protective effects of C and F were investigated in perfused guinea-pig Langendorff hearts subjected to ischemia and reperfusion. Changes in cellular levels of high phosphorous energy, NO and Ca2+ in the heart together with simultaneous recordings of left ventricular developed pressure (LVDP) were monitored by an nitric oxide (NO) electrode, fluorometry and 31P-NMR. The rate of recovery of LVDP from ischemia by reperfusion was 30.8% in the control, while in the presence of C or F a gradual increase to 63.2 or 61.0% was observed. Changes of transient NO signals (TNO) released from heart tissue in one contraction (LVDP) were observed to be upside-down with respect to transient fura-2-Ca2+ signals (TCa) and transient O2 signals detected with a pO2 electrode. At the final stage of ischemia, the intracellular concentration of Ca2+ ([Ca2+]i) and the release of NO increased with no twitching and remained at a high steady level. The addition of C increased the NO level at the end of ischemia compared with the control, but [Ca2+]i during ischemia decreased. On reperfusion, the increased diastolic level of TCa and TNO returned rapidly to the control level with the recovery of LVDP. By in vitro EPR, C and F were found to directly quench the activity of active radicals. Therefore, it is concluded that the antioxidant effects of two derivatives isolated from safflower play an important role in ischemia-reperfusion hearts in close relation with NO.

Primary liposarcoma of the mediastinum.

Primary mediastinal liposarcomas are extremely rare malignancies that remain asymptomatic until large and, even then, initial symptoms are nonspecific. We report a 48-year-old man followed up for asymptomatic multiple bullae who suffered progressive weight loss and dyspnea on exertion. Radiography and computed tomography of the chest showed a large mass with calcified nodules in the left pleural cavity and giant bullae in the right pleural cavity. Previous computed tomography of the chest showed a small tumor of mediastinal adipose tissue with calcified nodules. Tumor growth was calculated at about 500 times the tumor volume per 3.6 years. We completely resected the mediastinal tumor and conducted a bullectomy through a median sternotomy. The microscopic pathological diagnosis was well-differentiated/sclerosing liposarcoma. The man underwent no postoperative adjunctive irradiation and remains well 8 months after surgery.