Two patients with advanced hepatocellular carcinoma presented severe exertional dyspnea because of extension of a tumor into the right side of the heart. Removable of the tumor thrombus by open-heart surgery ameliorated the symptoms in each case, but their subsequent courses differed considerably. One patient survived for as long as 8 months thanks to successive multi-disciplinary treatments, whereas the other patient died suddenly 1 month after the surgery. The first patient's hepatocellular carcinoma was more differentiated, and the dyspnea was caused by a low cardiac output due to the intracardiac tumor mass, not by pulmonary embolism as in the second patient's case. We conclude that successive multidisciplinary treatments to control the growth of hepatocellular carcinoma is the most important approach and is indispensable for improving the prognosis.
tremor through motion filtering, thus enhancing surgical precision. This tremor elimination and computer motion scaling overcome perhaps the most significant limitation of conventional endoscopic instruments. Although further chronic studies are necessary to fully validate the clinical utility of this robotic instrumentation, the current study provides encouraging preliminary results. Robotic assistance in the microsurgical environment may allow for the development of completely endoscopic CABG.
We report a patient with complete left pericardial defect whose phrenic nerve, split into two portions, passes both ventral and dorsal to the defect. The dorsal part of the phrenic nerve passes over the ventral surface of the pulmonary artery and veins, indicating that the pericardio-pleural foramen has been obliterated. Contrary to the widely accepted embryogenic theory that pericardial defect results from persistence of the pericardiopleural foramen, we consider that the defect in this patient resulted from a tear in the pericardio-pleural membrane immediately lateral to the common cardinal vein.
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