A case of chylorrhea arising after median sternotomy for treatment of atrial septal defect was reported. The patient was a 55-year-old male, who had visited our outpatient clinic with a complaint of edema in the bilateral lower legs in June 1990. Under a diagnosis of atrial septal defect, a patch closure was performed in November. On the 5th postoperative day, a full liquid diet was started. Two hours and a half after the food intake, the drainage from a tube inserted into the anterior mediastinum turned milky white. Chylorrhea was diagnosed. The patient was placed in N.P.O. and maintained by an intravenous hyperalimentation. Drainage of 250-350ml/day milky white fluid persisted until the 14th postoperative day, when a 5cm removal of the mediastinal tube resulted in dramatic decrease in drainage. Thus chylorrhea in this case was cured by conservative treatment.

This report documents a case of three-channeled aortic dissection. The diagnosis of dissecting aneurysm was made by chest X-P and CT to 70-year-old man, with a chief complaint of back pain. Aortogram showed aortic aneurysm (DeBakey type IIIb), which had an entry at distal of the beginning of the left subclavian artery. Though we had given a pressure control therapy, the patient died on the 5th day of the admission. At autopsy, a new dissection was found in the chronic dissecting outer wall, forming three channeled dissection and rupture was there. Three-channeled dissection is very rare, only 8 cases including ours have been reported so far. From this case, we learned it very difficult to diagnose and treat it.

Metastasis to the heart is not so rare, but it is not diagnosed easily during patient's lifetime because clinical symptoms are not related to the nature of the tumor. We present a rare case of resection of cardiac metastasis of liposarcoma. A 37-year-old man suffered from dyspnea on effort was given a diagnosis of heart failure. He had already suffered from primary liposarcomas of the right heel which had been resected at age 28 and 32. Echocardiography revealed pericardial effusion and a tumor exiting from the apex. The mass grew rapidly and was excised using a cardiopulmonary bypass. The pathophysiological diagnosis was metastatic liposarcoma to the heart. The surgical margins of tumor were positive and cancer cells were exposed on the epicardial surfaces on some places. Adjuvant chemotherapy was therefore performed for 6 months. The patient was discharged after a good post-operative course and has been in good health for 40 months since the operation. Despite the generally poor prognosis of metastatic liposarcoma to the heart, combination of surgical treatment and chemotherapy yield a long period of survival in this case. It is important not only to establish the therapeutic strategy for metastatic tumor to the heart but also to detect it at an early stage.

There were 16 patients who developed acute renal failure (ARF) follwing cardiovascular operation using extracorporeal circulation. They were treated by either CPD or CAVH because their ARF were resistant to medical treatment. These patients were divided into three groups according to their treatment; 7 patients treated by CPD (Group A), 5 patients treated both CPD and CAVH (Group B), 4 patients treated by CAVH (Group C). The survival rate was 33% in Group A, 20% in Group B, and 0% in Group C. The prognosis of the each group was poor. CPD and CAVH were effective to control the concentration of serum potasium and water removing. But CPD and CAVH were not very effective to control the concentrations of serum creatinine and blood urea nitrogen. There were three patients who developed low proteinemia which was one of the side effects of CPD. Seven of nine patients treated by CAVH, developed bleeding. The side effects of CAVH were seemed to be more severe than those of CPD.