Adrenocortical tumor with left renal vein, vena cava and intrahepatic venous extension.

A 41 year old white female presented with upper respiratory distress and shortness of breath appeared on initial computed tomography (CT) scan to have a large left retroperitoneal mass with left renal vein extension including a mass up to the level of the atrium. This presentation suggested hypernephroma. She proved, however, to have an adrenal cortical carcinoma which displaced the kidney, exhibiting vascular invasion within the gland and non-adherent extension into the vena cava, atrium, common hepatic vein and left renal vein, where some adherence was present. This unusual tumor required extensive surgery for removal, including use of cardiopulmonary bypass, with good results.

Venous bypass of complicated stent placement for recurrent extracranial carotid occlusive disease.

Aim of the study was to to demonstrate a useful solution to carotid angioplasty and stent complications. A 67 year old male had uncomplicated left carotid endarterectomies in 1985 and 1986. A left distal common carotid angioplasty and stent in 1999 was complicated by stenosis. In 2000 a left common carotid bypass from the lower common carotid to the distal internal carotid well above the stent was performed, yielding retrograde filling of the external carotid, distal antegrade filling of the internal carotid, and widely patent vessels in subsequent Doppler studies. He is currently doing well clinically with no recurrent stenosis. In conclusion a second redo carotid operation was deferred in favor of angioplasty and stent, which had complications. Despite prior operations the only difficulty with the reoperation was obtaining control of the distal internal carotid above the stent. The strategy demonstrated here will be useful to correct complications of carotid angioplasty and stenting.

The advantages of the Harmonic Scalpel for the harvesting of radial arteries for coronary artery bypass.

BACKGROUND: Improvements in replacement vessel harvesting techniques and antispasmodic agents since the 1970s have led to a resurgence of interest in the radial artery (RA) as a conduit for coronary revascularization. METHODS: This randomized study compared the Ultra Cision Harmonic Scalpel (HS) (Ethicon Endo-Surgery, Inc., Cincinnati, OH) and the cold steel scalpel (CSS) for harvesting radial arteries to be used in coronary artery bypass grafting (CABG) procedures. Men and non-pregnant women, aged 21 to 79 years, with myocardial ischemia or coronary stenosis who were scheduled to undergo coronary bypass were enrolled in the study. RESULTS: Harvesting of the radial artery by the Harmonic Scalpel required a significantly lower number of clips to control bleeding. There was no significant difference between the times required to harvest the artery with either device. There were no complications, malfunctions, or serious adverse events associated with the use of either device. CONCLUSIONS: The Harmonic Scalpel provides excellent control of bleeding compared to the cold steel scalpel, and its use permits bleeding to be controlled without the need for potentially damaging electrocautery. No clinically significant adverse events were associated with the use of the Harmonic Scalpel.