[Ectopic mediastinal parathyroid adenoma].

We experienced 3 surgical cases with ectopic mediastinal parathyroid adenoma. All patients checked elevated serum calcium levels and parathyroid hormone levels above normal range so we diagnosed their illness as primary hyperparathyroidism. Two had treated urinary tract lithiasis for long time, and the other had no symptoms by hypercalcemia. To determine the location of abnormal parathyroid glands, 99mTc-methoxy-isobutyl-isonitrile (MIBI) scintigraphy, chest computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were done, then posterior and anterior mediastinal tumors were revealed. Especially MIBI scintigraphy was very useful as diagnostic procedure for small ectopic parathyroid adenoma. It's considered that large tumor in the posterior mediastinum like case 1 is originated from upper parathyroid gland, and small tumor in the anterior mediastinum like case 2, 3 is originated from lower parathyroid gland. Tumors were resected via small thoracotomy with thoracoscope, cervical incision and partial median sternotomy respectively. Serum calcium and parathyroid hormone levels were normalized immediately. If we can detect the accurate location of small ectopic parathyroid adenoma using some intraoperative method, the tumor is resected by less invasive procedure.

Rupture of infectious aneurysm of the thoracic aorta into the lung after radical esophageal cancer surgery.

A 60-year-old male underwent radical operation for esophageal cancer 45 days prior to complaining of several incidents of hemoptysis. The hemoptysis was found to be caused by infectious aneurysm of the descending thoracic aorta penetrating the lung. The aneurysm was resected and the aortic wall was sutured directly under percutaneous circulatory pulmonary support system. The sutured thoracic aorta was wrapped with the pedicle of an intercostal muscle flap to prevent reinfection. Forty-eight days after the aortic wall suture operation, however, the patient experienced massive hemoptysis and went into shock. Angiography was reveal no arterial lesions, so emergency left lower lobectomy was performed on suspicion of lung vessel rupture. Immediately after the lower lobectomy, recurrence of the aortic wall rupture caused uncontrollable bleeding. The patient died intraoperatively.

Clinical effects of percutaneous cardiopulmonary support in severe heart failure: early results and analysis of complications.

Between January 1993 and December 2001, we employed percutaneous cardiopulmonary support (PCPS) in 35 patients. PCPS was used for postcardiotomy in 25 of these patients who could not be weaned from cardiopulmonary bypass (CPB) because of severe cardiogenic shock. In the other 10 patients, PCPS was used for a non-surgical disease. Twenty-nine patients (82.9%) were weaned from PCPS, and 28 (80.0%) survived. The other 7 patients (20.0%) died due to postoperative complications. The causes of death were multiple organ failure (MOF) due to wound bleeding, low cardiac output syndrome (LOS), myonephropathic metabolic syndrome (MNMS) with severe lower limbs ischemia, cerebrovascular accident (CVA), and sepsis. The first cause for the complications was postoperative sustained severe heart failure. To improve the survival rate, it was necessary to prevent bleeding and begin PCPS at an earlier stage.