A surgically salvaged case: emergency Root-Commando procedure for infective endocarditis and chronic dissecting aneurysm of the sinus of Valsalva.

The Commando procedure for infective endocarditis is a high-risk intervention. However, infective endocarditis involving the intervalvular fibrosa is fatal in the absence of surgery. A 41-year-old man with no medical history visited a doctor with chest pain and dyspnoea. Ascending aortic dissection and vegetation on the mitral valve were noted on echocardiography, so he was transferred to our hospital. The diagnosis was dissecting aneurysm of the sinus of Valsalva and acute heart failure due to aortic regurgitation, mitral regurgitation and infective endocarditis. We decided on emergency surgery. Intraoperatively, we confirmed abscess extending to the left atrial roof and destruction of the intervalvular fibrosa, so we performed the Root-Commando procedure. The patient was saved and discharged 47 days after transfer to our hospital through the reoperation on postoperative day 30.

[Left Hemothorax without Pericardial Effusion due to Pacing Lead Penetration Through Right Ventricular Wall:Report of a Case].

Cardiac perforation by a pacemaker lead that causes left hemothorax without pericardial effusion is rare and life threatening. So, we report a surgically salvaged case. A 55-year-old man underwent insertion of adevice for cardiac resynchronization therapy and defibrillation. On the second postoperative day, the patient fell into shock state after defecation. Electrocardiogram showed pacing failure and computed tomography (CT) showed left hemothorax without pericardial effusion. A drainage tube was placed in the left pleural cavity, and bleeding was massive and continuous. We then performed emergency surgery for suspected cardiac perforation by the pacemaker lead. The right ventricular lead had penetrated the ventricle, which was surgically repaired.

[Coil Embolization for an Aberrant Left Subclavian Artery Aneurysm with Kommerell's Diverticulum;Report of a Case].

A 67-year-old woman encountered a traffic accident and had chest computed tomography(CT) examination. It revealed a 24 mm Kommerell's diverticulum associated with a right-sided aortic arch and a 15 mm saccular aneurysm of an aberrant left subclavian artery. We performed intra-aneurysmal coil embolization for the left subclavian artery aneurysm after a balloon occlusion test of the left subclavian artery. The postoperative course was uneventful.

Coronary Artery Bypass Grafting in a Patient With Polyarteritis Nodosa.

A 38-year-old man with polyarteritis nodosa presented with exertional chest pain. Coronary angiography revealed 3-vessel coronary artery disease. We performed 2-vessel coronary artery bypass grafting with the saphenous vein because the left internal thoracic artery was in poor condition. Histological examination of the left internal thoracic artery showed a strong effect of polyarteritis nodosa.

[Thoracic Endovascular Aortic Aneurysm Repair in a Young Patient with Descending Aortic Injury;Report of a Case].

A 15-year-old boy was referred to our emergency room due to a penetrating injury of the back. Computed tomography( CT) demonstrated a descending aortic injury at the Th9/10 level, bilateral hemothorax, and spinal cord injury. Although surgical treatment was indicated, multiple organ injury complicated open surgical repair, which required cardiopulmonary bypass with full heparinization. Therefore, the patient was scheduled to undergo thoracic endovascular aortic repair (TEVAR). A 23×33-mm Excluder aortic extension cuff was chosen for the small, 15-mm diameter aorta. The aortic extension was delivered and deployed in the descending aorta. Postoperative CT demonstrated neither endoleak nor collapse of the stent-graft. TEVAR for traumatic aortic aneurysm appears to be safe and effective, and an aortic extension for an abdominal aortic aneurysm may be utilized as an alternative device if the patient is young and the aorta is small.

[Clinicopathological characteristics of ten cases of advanced gastric carcinoma after S-1 combined with cisplatin administered as neoadjuvant chemotherapy].

OBJECTIVE: Although neoadjuvant chemotherapy(NAC)has been recognized as an important option for improving the clinical outcome of patients with advanced gastric carcinoma, convincing evidence that it prolongs life and brings about a good prognosis are both lacking. We retrospectively evaluated the efficacy and safety of NAC in ten patients with advanced gastric cancer. METHODS: A total of ten patients with advanced gastric cancer, who received NAC with the combination of S-1 and cisplatin in our hospital from April 2008 to March 2010, were retrospectively investigated. RESULTS: A total of 5 patients responded to neoadjuvant chemotherapy, and 2 patients showed a complete regression of the primary gastric carcinoma. Four of the 5 patients who responded had solid-type poorly-differentiated adenocarcinoma. CONCLUSION: NAC with the combination of S-1 and cisplatin was suggested to be effective for advanced gastric carcinoma, especially for solid-type poorly differentiated adenocarcinomas(por1).