Spontaneous rupture of the ascending aorta.

A case of spontaneous non-traumatic rupture of the thoracic aorta in a hypertensive patient is presented. The clinical findings suggested acute aortic dissection, and a large pericardial effusion was detected by echocardiography. The typical angiographic features of aortic dissection were not found. Autopsy revealed a longitudinal intimal tear and a rupture in the postero-lateral aspect of the ascending aorta. No false lumen was seen in the ascending aorta. When acute intrapericardial or intrapleural bleeding develops with no evidence of aortic aneurysm or dissection, spontaneous aortic rupture should be suspected.

Relationship of histologic grade of hepatocellular carcinoma (HCC) to tumor size, and demonstration of tumor cells of multiple different grades in single small HCC.

The histologic features of 65 surgically resected cases of hepatocellular carcinoma (HCC) were studied, and the cellular differentiation was graded from I to IV according to Edmondson-Steiner's classification. HCC cells of 2 or more grades were seen in 31 (47.7%) of the 65 cases. There was no significant difference in the proportion of HCC composed of tumor cells of more than one histologic grade between HCCs with association with liver cirrhosis and without cirrhosis. Among these 31 cases, extremely well-differentiated HCC, corresponding to Edmondson-Steiner's grade I carcinoma, was found in 9 of 11 tumors smaller than 3 cm in diameter, but it was not seen in 20 tumors larger than 3 cm in diameter. In the 34 HCCs with a uniform histologic pattern, all of two minute tumors smaller than 1 cm in diameter consisted of extremely well-differentiated HCC, but there were no cases consisting of extremely well-differentiated HCC in tumors larger than 2 cm in diameter. Taken together, these findings suggest that HCCs originate as relatively well-differentiated tumors, which may be difficult to distinguish from adenomatous regenerative nodules, and become progressively less differentiated at a later stage of their development.

Hepatocellular carcinoma and schistosomiasis japonica. A clinicopathologic study of 59 autopsy cases of hepatocellular carcinoma associated with chronic schistosomiasis japonica.

The association between hepatocellular carcinoma (HCC) and chronic hepatic schistosomiasis (CS) was studied by reviewing, 4,886 autopsies in adults during the past 20 years. In 229 cases of CS, 59 (25.7%) also had HCC. Among cases without CS, 399 (8.5%) had HCC. The incidence of HCC in patients with CS was significantly higher than that of other autopsy cases (p less than 0.01). Serum HBsAg was positive in 25.7% of 35 HCC cases with CS examined for hepatitis B virus (HBV) markers and anti HBs was positive in 10 of the 12 HBsAg-negative cases associated with CS, and in 62.1% of the other HBsAg-negative cases examined. Thus, most of HCC cases, including those associated with CS, probably had HBV infection at one time. Morphological examination revealed varying degrees of non-schistosomal hepatic changes, including macronodular or mixed macro-and micronodular cirrhosis, superimposed on schistosomal fibrosis in about two-thirds of the cases of HCC associated with CS. Although conclusive evidence whether or not schistosomal infection had a direct role in hepatocarcinogenesis could not be obtained, it was predicted that the additional non-schistosomal factors, particularly HBV infection, might play a synergistic role.

Primary anastomosis for acute ascending aortic dissection.

Intimal tear resection and primary anastomosis of the aorta were used for the treatment of eight patients with DeBakey I and II type acute aortic dissection. Five patients were of DeBakey I type, and three patients were of the II type. Moderate or severe aortic regurgitation (AR) was observed in six of eight patients. The site of the intimal tear was diagnosed by intraoperative echocardiography, and the adventitia corresponding to the intimal tear was transversely opened under total cardiopulmonary bypass. While resuspension of the aortic valve was performed on only one of six patients, AR disappeared in four, postoperatively. Two of eight patients died early postoperatively. The cause of death was postoperative cardiac tamponade in one patient and cerebral herniation in the remaining one. The other six patients have been observed for a mean period of 27 months. There is no late death, and they show no dilatation of the aortic root and deterioration of AR. We believe that this operative method is a simple and safe emergency procedure for DeBakey I and II type acute aortic dissection.

[Surgical treatment of acute ascending dissection--a simplified operative method].

Primary anastomosis for acute ascending aortic dissection was performed in 8 patients. Primary anastomosis included resection of the intimal tear where applicable, a circumferential suture line in the ascending aorta at the site of the tear, and wrapping of the anastomosis of the ascending aorta with Dacron vascular prosthesis. The aortic valve was resuspended in 1 of 6 patients associated with aortic regurgitation. In 4 patients, aortic regurgitation disappeared postoperatively. Two patients show minor non-progressive valve regurgitation. Two of 8 patients died early postoperatively. There was no late death and dilatation of the aortic root in the follow-up period of mean 27 months. On the basis of these results, we believe that primary anastomosis is a simpler and safer operative method for acute dissection of the ascending aorta.