[Surgical treatment of acute massive pulmonary embolism: report of two cases].

We experienced two cases of acute massive pulmonary embolism. Both of the patients required emergent surgical procedures under cardiopulmonary bypass after cardiopulmonary resuscitation. Postoperative courses of them were uneventful. In severe cases with acute massive pulmonary thrombosis, there is no time to choose medical treatment alternative to pulmonary embolectomy. The diagnosis should be made promptly, and immediate decision of operation is very important.

[Surgical treatment of the Palmaz-Schatz stent trapped in the left coronary ostium].

A 72-year-old male with failed delivery of the Palmaz-Schatz stent to the coronary dissection following percutaneous transluminal coronary angioplasty (PTCA) was admitted to our hospital. He was very sick and required an emergent surgical procedures. We successfully carried out the bypass grafting to the LAD and removed the stent through the aortotomy. Besides his respiratory care, postoperative course was uneventful.

[An emergent coronary artery bypass grafting to total occlusion of all three coronary arteries in a patient with severe hyperbilirubinemia].

A 69-year-old man was transferred to our hospital because of chest pain and dyspnea. He had been very ill due to acute hepatitis and hyperbilirubinemia. Coronary angiography showed total occlusion of all three coronary arteries. An emergent coronary artery bypass grafting was successfully performed after insertion of IABP. Even though total bilirubin levels rose to 20.5 mg/dl, it gradually decreased without plasmapheresis. He had no hepatic failure and was discharged on foot on the 24th postoperative days.

Dominantly inherited motor and sensory neuropathy with excessive myelin folding complex.

The two patients in a family having the clinical and electrodiagnostic features of hereditary motor and sensory neuropathy (HMSN) are described. The main histological features of sural nerve were segmental demyelination and remyelination with moderate to marked loss of myelinated fibers, and myelin folding complex along all of the large and small myelinated fibers. These features appeared morphologically similar to those observed in HMSN with excessive myelin outfolding, or globular neuropathy. Southern blot analysis suggests that there were neither duplication nor deletion of the peripheral myelin protein-22 gene in the patients. The presented two patients may be a rare form of dominantly inherited HMSN with myelin folding complex.