A 62-year-old man was admitted because of cardiac failure caused by mitral valve regurgitation. After his cardiac and general conditions had been evaluated, he underwent an operation. Some of chordae tendineae of both leaflets were ruptured and both leaflets had deformities. Since his mitral valve could not be repaired, it was replaced with a 29mm Hancock II bioprosthesis. Two weeks after operation, transesophageal echocardiography (TEE) and left ventriculography revealed that one of the three leaflets of the prosthesis was fixed in the closed position, and mild mitral valve stenosis without regurgitation was recognized. But he had no complaints and there were no other major disorders. He was observed every 2 weeks as an outpatient. Six months after operation, TEE showed good opening and closing of all 3 leaflets and showed no major abnormalities, although the cause of the failure was unknown. He is healthy 2 years after operation, but is being observed carefully.

In two cases of thromboangitis obliterans (TAO) a popliteal-posterior tibial-peroneal artery sequential bypass was attempted through a median approach. The 1st case underwent the operation successfully with non-reversed saphenous vein graft. However, only popliteal-peroneal bypass was carried out in the 2nd patient because the posterior tibial artery was severely affected. In surgery of TAO patients, careful assessment of preoperative angiographic findings is important to select the site of distal anastomosis. We found that the posterior tibial artery and the peroneal artery are easily accessible through the medial route in the proximal half of the lower leg and that peroneal artery revascularization was effective for limb salvage.

Two conservatively treated cases of xanthogranulomatous pyelonephritis are reported here. The first case was a 31-year-old diabetic woman. She was referred to our department. Examinations for gross hematuria were made. US, CT and MRI revealed a renal tumor in the upper pole of the left kidney. The second case was an 86-year-old man with ileal conduit. He complained about pain in the right back. A mass of fist size was found. US, CT and MRI revealed right hydronephrosis connected to the subcutaneous tumor on the right back, and DIP revealed no-functioning right kidney. Because both cases showed some signs of inflammation in laboratory findings, we performed biopsy. Either of the two cases were pathologically diagnosed as xanthogranulomatous pyelonephritis. For this reason, Antibiotic therapy was continued. As a result, reduction of the tumors was seen. The prognosis was good.
Two ; Cases ; X-Ray Computed Tomography ; Pyelonephritis, Xanthogranulomatous ; Pyelonephritis

We reviewed the results of 14 patients who underwent the operation of thoracic aneurysms using a centrifugal pump. Nine patients had atherosclerotic aneurysms and 5 had aortic dissections. The autotransfusion system (ATS) was used to keep hemodynamic stability by rapid transfusion. The ATS consisted of a roller pump, a 2, 000ml reservoir and a heat exchanger. Two mg/kg of heparin was given to the patients to keep ACT over 400 seconds. All patients survived. Body temperature increased 0.08±0.59°C during bypass with the ATS, and no patients showed hemodynamic instability after aneurysmotomy under the help of the ATS. We conclude that 1) the centrifugal pump is a useful and safe assisting means for the surgery of thoracic aneurysms, 2) the autotransfusion system has advantages as follows: keeping stable circulation and preventing loss of body temperature during bypass.