Aorto-left renal vein fistula caused by a ruptured abdominal aortic aneurysm.

Retroaortic left renal vein is a malformation in which the left renal vein courses dorsal to the abdominal aorta. In patients with abdominal aortic aneurysm, an aorto-left renal vein fistula can form if the left renal vein is sandwiched between the aneurysm wall and lumbar vertebrae. The patient was an 84-year-old man with lower back pain. We performed a contrast-enhanced computed tomography (CT), although renal dysfunction was noted. The CT showed a ruptured juxta-renal abdominal aortic with aorto-left renal vein fistula. This clinical condition can cause severe renal dysfunction, in spite of which an enhanced contrasted CT scan would be extremely informative preoperatively.

The utility of BiClamp(®) for intraoperative air leakage control in video-assisted thoracic surgery for pulmonary lobectomy.

We describe a simple technique of controlling air leakage from the lung parenchyma using BiClamp(®). The device creates appropriate protein coagulation at an air leakage point of the lung parenchyma. The leakage point and adjacent area are grasped with BiClamp(®) forceps and coagulated without tissue carbonization. After the procedure, no air leakage was recognized under airway pressure test of 15-20 cmH(2)O. This method is easy to handle, especially in video-assisted thoracic surgery lobectomy with an economical advantage as "Ecosurgery".

Efficacy of SOFT COAG for intraoperative bleeding in thoracic surgery.

We present and examine two cases of the dramatic hemostasis with SOFT COAG in general thoracic surgery. SOFT COAG is a coagulation mode unique to VIO electrosurgical units (ERBE Elektromedizin GmbH, Germany). This system regulates the temperature rise below boiling point without generating sparks, which is high enough to denature protein. In addition to clinical applications, this coagulation system makes use of a reusable device, Slim line hand switch, which has economically and ecologically major advantages for ecosurgery.

Evaluation of native valve-sparing aortic root reconstruction with direct imaging--reimplantation or remodeling?

BACKGROUND: Aortic root reimplantation and remodeling have been used to preserve the native aortic valve. However, direct observation of valve motions with these techniques has not been performed. METHODS: Mongrel dogs were studied. The beating heart model was created using modified Tyrode's solution. Normal aortic valves and aortic valves preserved with the remodeling or reimplantation procedure were observed with an endoscope, and behavior was recorded on a high-speed video (200 frames/s). The aortic valve orifice area was measured at 11 data points per beat. A predictable maximum valve orifice area was defined as an area encircled by the three commissures. A ratio of each aortic valve orifice area to the predictable maximum valve orifice area was calculated. The control group, the reimplantation group, and the remodeling group were compared. RESULTS: The preserved aortic valve with reimplantation showed bending and asymmetric motion. The ratio of aortic valve orifice area and predictable maximum valve orifice area in the reimplantation group was significantly smaller compared with the control and remodeling groups. CONCLUSIONS: The opening and closing behavior of the aortic valve preserved with the reimplantation procedure was impaired. It was speculated that the remodeling procedure may preserve more physiologic root function compared with the reimplantation procedure.

Omental herniation through the esophageal hiatus mimics mediastinal lipomatous tumor.

A 61-year-old man with a mediastinal abnormal mass on computed tomography is presented. Sagittal sections of magnetic resonance imaging (MRI) clearly indicated the continuity of the fatty mass from the abdomen to the thorax. The diagnosis was an omental herniation through the esophageal hiatus during the operation. First, we returned the omentum into the abdominal cavity, and then repaired the hiatus. The patient had an uneventful postoperative recovery. A herniation of the omentum through the esophageal hiatus is rare; this case is the tenth found in both English and Japanese literatures. The coronal and sagittal planes of MRI were useful in distinguishing the herniation of omentum through the esophageal hiatus from lipomatous tumor. It is our intention of raising awareness about the disease.