Clinical results of femoropopliteal bypass using externally supported (EXS) Dacron grafts: with a comparison of above- and below-knee anastomosis.

As of the end of September 1989, 52 EXS Dacron grafts had been implanted for femoropopliteal bypass operations. The distal ends of 27 grafts were anastomosed to above-knee popliteal arteries and those of 25 grafts to below-knee popliteal arteries. The cumulative patency rate of above-knee grafts was 71.3% at 54 months, and that of below-knee grafts was 78.8% at 48 months (n.s.). Kinking and stenosis of the arteriosclerotic proximal and/or mid popliteal artery when the knee was bent were angiographically remarkable. These changes may explain why some femoropopliteal grafts occlude with time and why the late results of above-knee grafts are not much better than those of below-knee grafts.

Recovery of an impalement and transfixion chest injury by a reinforced steel bar.

A 36-year-old man was admitted to our hospital because of impalement injury due to a downwards fall upon some reinforced steel rods. An emergency operation was performed using percutaneous cardiopulmonary support (PCPS). The steel rods were taken out in the operating room. The heart, great vessels, vertebrae, and spinal cord were not involved in the impalement wounds. We performed a bronchoplasty of the torn and separated right main bronchus, and repaired the impaled left lung without any pulmonary resection. He recuperated without sequelae.

[Lung cancer surgery in a patient with idiopathic thrombocytopenic purpura (ITP)].

A 59-year-old woman was hospitalized due to an abnormal chest X-ray film. Chest X-ray examination revealed an irregular opacity in the right S6 area. Adenocarcinoma was diagnosed by bronchoscopic exfoliative cytology. Preoperative hematology tests showed a low platelet count and further investigation suggested the presence of idiopathic thrombocytopenic purpura. Preoperative high-dose immunoglobulin therapy (400 mg/kg/day for five days) and platelet transfusion allowed the operation to be performed successfully (resection of the inferior lobe of the right lung and removal of regional lymphnodes). High-dose immunoglobulin therapy is thought to be a very useful method with few adverse effects for the rapid increase of platelet count to prevent massive hemorrhage.

[A desmoid tumor of the chest wall].

Desmoid tumors develop in the muscle or aponeurosis, but rarely in the chest wall. We report a patient with desmoid tumor in the chest wall. A 30-year-old female visited our hospital due to an abnormal shadow in the chest detected at a health examination. No definite diagnosis could be made by chest CT, MRI, or Ga scintigraphy, and finally a biopsy demonstrated desmoid tumor. The left anterior chest and posterolateral chest (lung apex) were opened, and tumors were resected together with the chest wall. No radiotherapy was performed. No recurrence has been observed for 1.5 years after operation. This tumor does not yield distant metastasis, but its recurrence rate is very high. Therefore, we intend to follow this patient for a long period.

Bilateral ruptured isolated internal iliac artery aneurysms--report of a case and review of the literature.

We present herein, a rare case of a 78-year-old man who experienced rupture of an isolated internal iliac artery aneurysm on 2 separate occasions. He underwent successful embolization with ligation of the right aneurysm at our institution, where only 2 such cases have ever been seen. Embolization with ligation proved very effective in clotting the intraaneurysmal blood in this case and would appear to be the treatment of choice for very large aneurysms. A review of the English and Japanese literature follows this case report.