Fiberoptic examination of the inferior vena cava during circulatory arrest for complete removal of renal cell carcinoma thrombus.

Renal cell carcinoma is known to invade the inferior vena cava and may extend its entire length. Profound hypothermic circulatory arrest has been demonstrated to be a very effective technique to facilitate removal of tumor thrombus from the cava while limiting the amount of blood loss. We describe an innovative method of ensuring complete removal of tumor thrombus from the retrohepatic cava with a fiberoptic bronchoscope introduced through the right atrium during profound hypothermic circulatory arrest. Fiberoptic examination of the cava and hepatic vein orifices under these circumstances will prevent incomplete removal of tumor.

Single-stage repair of thoracic ectopia cordis.

Thoracic ectopia cordis is a rare congenital defect most often seen in association with sternal and congenital heart defects. Surgical correction of these defects is complex and generally requires a staged closure including (1) coverage of the "naked heart," (2) placement of the heart into the thoracic cavity, and (3) sternal or thoracic reconstruction. Survival past the perioperative period is rare, with only 2 reported cases in the English-language literature. As with our case, neither had any discernable intracardiac defect. We present a case report of a patient with thoracic ectopia cordis repaired in a single stage using polytetrafluoroethylene membrane and skin for coverage and closure of the heart and thoracic defect.

Posterior wall gastric leiomyoma: endoscopic tattooing facilitates laparoscopic resection.

OBJECTIVE: To demonstrate the application of tattooing for the intraoperative localization of posterior wall gastric leiomyoma during laparoscopic resection. The preoperative injection of Indian ink in the tumor-bearing area of the posterior gastric wall eliminates the need to perform anterior wall gastrostomy or intraoperative upper endoscopic tumor localization. METHODS: A patient with posterior wall gastric leiomyoma was marked with Indian ink during preoperative upper endoscopy. The dye was visualized intraoperatively facilitating wedge resection of the tumor-bearing area with the Endo GIA. RESULTS: The patient had an uneventful surgery and recovery. Complete excision of the tumor was accomplished. CONCLUSION: The preoperative endoscopic marking of gastric lesions, facilitates the intraoperative localization and resection of these lesions.

Coronary artery bypass grafting. The relationship of surgical volume, hospital location, and outcome.

The relationship between mortality, surgical volume, and location was investigated in the university medical centers (UMCs) in the Greater New York metropolitan area for patients undergoing coronary artery bypass grafting (CABG) in 1986. Three high-volume and five low-volume institutions, with a total of 49 surgeons, performed a total of 3,408 CABG operations. The crude mortality rates were 4% for simple, 14.7% for complex, and 5.3% combined for all UMC CABG operations. The crude mortality rates for CABG operations in high- and low-volume centers were respectively 3.6% and 4.8% for simple and 16.1% and 11.3% for complex operations. No statistically significant differences between urban (N = 6), suburban (N = 2), high-volume (N = 3), or low-volume (N = 5) centers or physicians were found (all p values greater than 0.05). Taken together, these findings suggest that surgical volume and location are not significant factors for predicting outcome for CABG.