Non-invasive imaging diagnosis of left renal vein compression causing hematuria. Part 1. Ultrasonography

Left renal veins of 100 out-patients were examined by transabdominal ultrasonography to evaluate its usefulness in determining left renal vein compression which is causing renal bleeding. Ultrasonography revealed the left renal vein in 86 patients. In 61 of the 86 cases, the internal cavity of left renal vein was opened at least in diastolic phase, but in 23 cases, the internal cavity was closed between the abdominal aorta and the superior mesenteric artery in both systolic and diastolic phases. In the remaining 2 cases, left renal vein was compressed at a point where it intersected the right renal artery. Left renal vein compression was observed in 18 (69%) of the 26 cases which had been classified as idiopathic renal bleeding and in 7 (26%) of the 27 cases which had urinary tract diseases causing hematuria. In 33 cases which did not have hematuria, left renal vein compression was not observed. These results suggest that diagnosis of left renal vein compression causing renal bleeding is possible by transabdominal ultrasonography.     

Risk factors for acute rejection in living donor liver transplantation

The influence of human leukocyte antigen (HLA) compatibility and lymphocytotoxic crossmatch on acute rejection in living donor liver transplantation (LDLT) has not been well examined. We analyzed 100 consecutive adult LDLT cases. The patient and graft survival rates and post-operative complications were assessed. The relation between the incidence of acute rejection and some clinical factors including HLA and lymphocytotoxic matching was also examined. Patients with HLA DR zero mismatching (p = 0.02) or negative T-lymphocytotoxic crossmatch (p = 0.04) had a significantly lower chance of rejection within 6 wk after LDLT. However the results had no influence on the patient survival. Our results demonstrate that in LDLT, a graft from an HLA-DR zero mismatching or negative T-lymphocytotoxic crossmatch might be advantageous because of the decreased probability of early acute rejection.     

Acetabular components without bulk bone graft in revision surgery: A 5- to 13-year follow-up study

Eighty-three consecutive revisions in 74 patients using a porous-coated acetabular component without bulk bone graft were followed up for an average of 9.3 years (range, 5-13 years). A large-diameter cup was implanted in hips with adequate osseous support, and a high hip center technique using a standard- or smaller-diameter cup was selected in hips without sufficient bone stock. Acetabular bone deficiency was segmental in 18 hips, cavitary in 30, and combined segmental and cavitary in 35. Four (5%) cups were revised again; 1 for infection, 1 for dislodgement of the polyethylene liner from the metal shell, and 2 for recurrent dislocation. No acetabular components were categorized as definitely loose at final follow-up. The current satisfactory results encourage the use of this simple technique.     

Arterial embolization as preoperative treatment for pulmonary aspergillosis with hemoptysis

Pulmonary aspergillosis associated with old tuberculosis is generally resistant to treatment. Thus, if patients are treated only with conservative therapy, their condition continues to deteriorate due to repetitive hemoptysis, and may even become critical. Surgical treatment is required for these patients; however, it is extremely difficult to resect the lesion due to severe adhesions to the chest wall and vascular proliferation surrounding the lesion. We performed preoperative arterial embolization, achieving good results in three patients with hemoptysis caused by pulmonary aspergillosis. The feeding arteries were embolized using microcoils and/or gelatin sponges, and a lobectomy was safely carried out in all patients. We concluded that preoperative arterial embolization is a safe and effective technique to prevent massive hemorrhage occurring at the time of surgery. This work was presented at the 11th Annual Meeting of the Japanese Association for Chest Surgery, held in Kyoto, Japan, May 13–14, 1994     

Thoracoscopic closure of a congenital partial pericardial defect

We describe our technique for performing direct thoracoscopic closure of a congenital partial pericardial defect, which was successfully employed in a 15-year-old boy. This is the first such report of a procedure that is noninvasive and may therefore become the treatment of choice for patients with a small congenital pericardial defect.     

Left ventricular fibroma in an aged patient: Report of a case

We report herein the case of a 77-year-old man with a left ventricular tumor originating from the papillary muscle of the left ventricular wall, in whom a successful tumor resection with mitral valve replacement was performed. The pathological diagnosis of the tumor was confirmed as cardiac fibroma. His postoperative course was uneventful and he is currently well with no signs of recurrence 2 years after surgery.     

Callotasis lengthening in patients with brachymetacarpia

Callotasis lengthening is an established method, but few cases of metacarpal lengthening have been reported. The authors performed callotasis lengthening to treat brachymetacarpia in six digits in three patients. The patient age at the time of distraction ranged from 10 to 19 years. The period of application of an external fixator averaged 13.9 weeks (range 10-19 weeks). All the metacarpals achieved the target length, and all patients were satisfied with the esthetic improvement. The length of the metacarpal distraction averaged 15.2 mm (range 10-18 mm). Complete consolidation of the transport gap was achieved for five of six digits. One digit that had a history of previous lengthening required bone graft. The average healing index was 62.3 days/cm. There were no serious complications. In four digits, the range of flexion of the metacarpophalangeal joint was increased after lengthening, and this enabled the patient to use the digit easily in a palmar grasp. Brachymetacarpia is an appropriate indication for callotasis lengthening in congenital deformities of the upper extremities.     

Long-term results after primary repairs of zone 2 flexor tendon lacerations in children younger than age 6 years

In young children, methods of primary flexor tendon repair in the digital canal are controversial. The authors reviewed 12 children younger than age 6 years with zone 2 flexor tendon repairs. The mean follow-up period was 8 years. In all cases, the flexor digitorum profundus tendons were repaired according to the Kessler modified technique and the hands were immobilized by an above-elbow cast. As for postoperative complications, there were no fingers with tendon rupture and two fingers with tendon adhesion. One finger needed tenolysis. The total active motion (TAM) in the interphalangeal joints evaluated with the Strickland formula averaged 155 degrees, and the TAM percentage averaged 89% (range 74%-100%). Eleven patients had an excellent result and one had a good result. The percentage phalangeal length averaged 99% (range 96%-100%). Functional motion and nearly normal growth of the finger can be expected after primary zone 2 flexor tendon repairs in children younger than age 6 years.     

Reoperation for a Starr-Edwards aortic valve implanted 28 years earlier

A 56-year-old man admitted with dyspnea had undergone aortic valve replacement using a Starr-Edwards ball valve to treat aortic regurgitation 28 years earlier. Chest radiography showed moderate cardiomegaly, moderate pulmonary edema, and mild pleural effusion. Echocardiographic examination showed severe mitral regurgitation. The mitral valve was replaced using a St. Jude Medical prosthesis, and the Starr-Edwards aortic valve was replaced using a CarboMedics prosthetic valve. The cloth covering on the Starr-Edwards valve had worn away and pannus had formed. The patient's postoperative course was uneventful, and he was discharged on postoperative day 35.     

Endoscopic Endonasal Skull Base Surgery: Advantages,Limitations, and Our Techniques to Overcome Cerebrospinal Fluid Leakage: Technical Note

In recent years, resections of midline skull base tumors have been conducted using endoscopic endonasal skull base (EESB) approaches. Nevertheless, many surgeons reported that cerebrospinal fluid (CSF) leakage is still a major complication of these approaches. Here, we report the results of our 42 EESB surgeries and discuss the advantages and limits of this approach for resecting various types of tumors, and also report our technique to overcome CSF leakage. All 42 cases involved midline skull base tumors resected using the EESB technique. Dural incisions were closed using nasoseptal flaps and fascia patch inlay sutures. Total removal of the tumor was accomplished in seven pituitary adenomas (33.3%), five craniopharyngiomas (62.5%), five tuberculum sellae meningiomas (83.3%), three clival chordomas (100%), and one suprasellar ependymoma. Residual regions included the cavernous sinus, the outside of the intracranial part of the internal carotid artery, the lower lateral part of the posterior clivus, and the posterior pituitary stalk. Overall incidence of CSF leakage was 7.1%. Even though the versatility of the approach is limited, EESB surgery has many advantages compared to the transcranial approach for managing mid-line skull base lesions. To avoid CSF leakage, surgeons should have skills and techniques for complete closure, including use of the nasoseptal flap and fascia patch inlay techniques.