Early surgical repair should be considered once diagnosis of a spontaneous hemopneumothorax is confirmed, because this provides better long-term results. Video-assisted thoracoscopic surgery as well as minithoracotomy should be considered as surgical options because of the improved quality of life they confer.

No abstract

A 56-year-old male consulted us because of a palpable mass and pain of the left flank 8 and a half years after resection of hepatocellular carcinoma of the left lobe about 3 cm in diameter. Ultrasound examination of the abdomen demonstrated a tumor about 10 cm in diameter showing a mosaic of hyperechoic and hypoechoic areas on the upper pole of the left kidney. By angiography, the tumor was found to be supplied mainly by the inferior adrenal artery. PIVKA-II was increased. Adrenal metastasis of hepatocellular carcinoma was suspected, and adrenalectomy was carried out. No intrahepatic metastasis was noted. The tumor was histopathologically identified as a pseudo-glandular type of moderately differentiated hepatocellular carcinoma with a trabecular pattern similar to the primary lesion. In this patient, a resectable giant metastasis was observed only in the left adrenal gland and no intrahepatic metastasis was demonstrated 8 and a half years after resection of hepatocellular carcinoma. The patient has survived 10 years after the first operation. This case is considered to be important for evaluation of the treatment for distant metastasis of hepatocellular carcinoma.

Few reports of open heart surgery being performed in patients with von Willebrand disease (vWD) have been documented. We describe herein the case of a 5-year-old girl with a ventricular septal defect (VSD) and vWD who underwent patch closure under cardiopulmonary bypass (CPB). The hematological parameters relating to vWD, namely, factor VIII, von Willebrand factor, and factor VIII-related antigen were monitored perioperatively. These laboratory findings were elevated after the termination of CPB, and consistently maintained within the normal range for 4 months postoperatively. The operation was successfully completed without the administration of factor VIII concentrates or homologous blood products.

SUMMARYHemodynamic, morphological and functional observations on the right ventricular outflow tract of tetralogy of Fallot were performed. The classification of the structures of the outflow tract into 3 types (I-localized infundibular hypertrophy, II-valvular stenosis and III-hypoplasia of the pulmonary trunk combined with infundibulovalvular stenosis) might be suitable and practical from the points of hemodynamic and angiocardiographic studies.Morphological, histochemical and electron microscopic findings obtained in this survey revealed characteristic patterns shown in the dystrophied cardiac muscle structures secondary to possible hypertrophy.During the studies, effects of congenital cyanosis or intracardiac pressure on structures of the outflow tract of tetralogy of Fallot were found to be taken into consideration to locate a position as to hypertrophied or dystrophied muscle. Further investigations are necessitated in these points with more distinct presentations of cardiac nerve innervation.