Percutaneous balloon pericardiotomy by the use of Inoue balloon for the management of recurrent cardiac tamponade in a patient with lung cancer.

A 32-year-old man with lung cancer involving pericarditis carcinomatosa underwent pericardiotomy, using an Inoue balloon dilating catheter, to create a non-surgical pericardial window. The procedure was performed from the thoracic wall to the left pleural effusion and parietal pericardium under local anesthesia. The effects of non-surgical pericardial window had been maintained until this patient died from his primary disease. It is concluded that percutaneous balloon pericardiotomy is helpful in the management of massive pericardial effusions particularly in patients with malignancies and poor clinical condition

[Cough variant asthma improving with avoidance of pet rabbit].

The concept of cough variant asthma (CVA) has been defined recently, but little is known about the relation between CVA and antigen. A case of CVA due to per rabbit was presented here. A 49-year-old man who kept a pet rabbit indoors was admitted our hospital with nocturnal dry cough. Both serum total IgE level and eosinophil count were elevated (IgE 5580 IU/L. Eosinophil 1183/L). According to Sato's criteria, this case was diagnosed to be CVA. After the patient was kept out of contact with the rabbit, his coughing disappeared and never recurred and IgE (RAST) against rabbit decreased. The out come of this case clearly shows that CVA improved due to avoidance of the antigen. These facts suggest that the cause of CVA in this case in due to mainly an immunoglobulin E-mediated allergic reaction.

[Renal cell carcinoma with many transvenous pleural metastases].

A 64-year-old man was admitted to our hospital because of abnormal shadows on chest X-ray films. Malignant mesothelioma was suspected. However a CT scan revealed a large mass in the right kidney and many nodules in the liver and pleura. This suggested that primary renal cell carcinoma had metastasized to the liver and pleura. The patient was treated with transarterial embolization (TAE), alpha and gamma interferon, and UFT, but died of respiratory failure caused by massive bleeding from the pleural metastases. At autopsy, renal cell carcinoma, clear cell subtype, was noted. The many pleural lesions were of the same histologic type, which suggested that they were metastases from the kidney. Renal cell carcinoma frequently metastasizes to the lungs or bones via the arteries. However, many pleural metastases without lung metastasis is rare. We report a case of renal cell carcinoma with many pleural metastases via Batson's venous plexus.