[A Case of Axillary Nodal Metastasis of Adenocarcinoma of an Unknown Primary Site Effectively Treated with Anti-HER2plus AC plus Paclitaxel Therapy].

A 68-year-old woman who presented with a left axillary mass was admitted. A computed tomography scan showed swelling ofthe left axillary and supraclavicular lymph nodes, but magnetic resonance imaging(MRI)and fluorodeoxyglucose positron emission tomography(FDG-PET)did not reveal these primary sites. Histological findings of the axillary mass revealed a HER2-positive adenocarcinoma. We diagnosed the patient with axillary nodal metastasis ofadenocarcinoma ofan unknown primary site and treated her with neoadjuvant chemotherapy including paclitaxel and trastuzumab followed by doxorubicin and cyclophosphamide. The lesions almost disappeared after 3 courses of chemotherapy and she showed a pathologically complete response(CR)after surgery. The patient has been recurrence-free since the operation owing to treatment with adjuvant trastuzumab.

[Combined Open and Endovascular Repair of Multiple Aortic Aneurysms due to Syphilitic Aortitis].

The patient was a 69-year-old man who presented with low-grade fever and appetite loss. Thoracoabdominal computed tomography revealed multiple aneurysms in the distal arch and descending thoracic and infrarenal aortic regions combined with a right common iliac artery aneurysm. After endovascular stent grafting for a right iliac artery aneurysm, he underwent total arch replacement and open stent grafting for the descending thoracic aneurysms. Pathological microscopic examination revealed an inflammatory infiltrate within the adventitia and destruction of the elastic fibers in the media, which are classical features of syphilitic aortitis. Endovascular aneurysm repair is contraindicated in mycotic infected aneurysms. However, endovascular repair is useful for treating mycotic infected aneurysm, if multiple aneurysms have the possibility of rupture and a high risk of surgery.

[DeBakey type 2 Aortic Dissection Failed to Diagnose by Enhanced Computed Tomography;Report of a Case].

An 81-year-old woman presented with dyspnea and chest pain. A plain chest X-ray revealed widening of the mediastinum and a contrast-enhanced chest computed tomography showed dilatation of the ascending aorta without any specific findings of aortic dissection. Transesophageal echocardiography revealed severe aortic regurgitation (AR). We planned an aortic valve replacement on the 34th day after admission because of the severe AR. During the operation, we found an entry in the intima of the ascending aorta 5 mm above the aortic valve and she was diagnosed with DeBakey type II aortic dissection. Therefore, we decided to perform Bentall's operation and the operation was successful.

[Vacuum-assisted Closure (VAC) Treatment for Sternal Infection in a Patient after Cardiovascular Surgery; Report of a Case].

One year ago, a 42-year-old woman underwent aortic root replacement because of a pseudoaneurysm that developed at the site of an anastomosis after ascending aortic replacement for acute aortic dissection. Six months later, she complained of fever and cough. A computed tomography revealed recurrence of the peudoaneurysm at the proximal anastomosis of the aortic root replacement. After emergency re-do aortic root replacement, she was admitted to intensive care unit (ICU) without sternal closure because of mediastinitis. The mediastinitis was managed by debridement and lavage drainage, followed by vacuum-assisted closure (VAC) treatment. The VAC treatment facilitated wound healing and active rehabilitation using a portable device. Finally, the wound was closed completely using a skin graft. VAC treatment is considered very useful in a case of post-sternotomy madiastinitis.