Retrograde flow of the left internal thoracic artery (LITA) secondary to proximal left subclavian artery occlusion or severe stenosis in patients who underwent coronary artery bypass grafting (CABG) using a LITA graft can result in myocardial ischemia. This phenomenon is termed as “coronary subclavian steal syndrome (CSSS)”. We report on a successful case of axillo-axillary crossover grafting in a patient with CSSS who suffered cardiogenic shock. A 70-year-old woman had undergone CABG using a LITA graft 10 years previously. The patient developed cardiogenic shock. Emergency angiography revealed retrograde flow of the LITA from the left coronary artery and occlusion of the proximal left subclavian artery. We performed axillo-axillary crossover grafting because anginal pains recurred due to CSSS. The pains disappeared after the operation. This technique appears to be useful in patients with CSSS who suffer cardiogenic shock.

A 58-year-old woman was referred to our department with subacute onset dyspnea on effort. A transthoracic echocardiogram revealed mobile left atrial mass originating from the intra-atrial septum, and almost obstructing the left atrial outflow in diastole. From continuous doppler recordings of the tricuspid valve, a systolic pulmonary artery pressure of 114mmHg was estimated. The tumor was exposed through a left atriotomy after bicaval cannulation for cardiopulmonary bypass (CPB). We performed complete excision of the tumor with the endocardium of the intra-atrial septum, to which it was attached. The defect was closed directly with running sutures. The CPB was weaned off uneventfully, however, there was moderate mitral regurgitation shown by transesophageal echocardiogram. Repeat cardioplegic arrest was induced and the mitral valve was exposed again, and mitral valvoplasty was performed. The mitral incompetence was probably due to an extreme tension of the mitral annulus after closure of the resulting intra-atrial defect.

We report an extremely rare case of primary squamous cell carcinoma of the stomach. A 69-year-old man was admitted to our hospital with a 2-month history of dysphagia and tarry stools. Endoscopic examination revealed a cauliflower-shaped protruding mass along the lesser curvature of the gastric cardia. Biopsy of the lesion revealed squamous cell carcinoma of the stomach. Computed tomography revealed a thickened stomach wall and a mass protruding into the gastric lumen. Total gastrectomy with splenectomy, distal pancreatectomy, and Roux-en-Y reconstruction was performed, together with a lower thoracic esophagectomy via a left thoracotomy. Histopathological examination of the specimen revealed well-differentiated squamous cell carcinoma of the stomach. Postoperative follow-up was uneventful for the first 18 months. However, multiple liver metastases and para-aortic lymph node metastasis developed subsequently. Despite systemic combination chemotherapy, the patient died because of progression of the recurrent tumors. Here, we review the characteristics of 56 cases of gastric squamous cell carcinoma reported in Japan.
Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Cardia ; Deglutition Disorders ; Drug Therapy, Combination ; Esophagectomy ; Follow-Up Studies ; Gastrectomy ; Humans ; Japan* ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Pancreatectomy ; Splenectomy ; Stomach Neoplasms ; Stomach* ; Thoracotomy