A 24-year-old housewife with congenital aneurysm of the left atrial appendage underwent a successful operation for its removal. Operation, using cardiopulmonary bypass, is indicated in all patients with atrial aneurysm. The procedure has proved uniformly safe and successful.Aneurysmal dilatation of the left atrium as a consequence of valvular heart disease is common. However, congenital or idiopathic aneurysm of the left atrium is extremely rare. Twenty-six cases verified at necropsy or operation have been reported. The purpose of this report is to present a case of congenital aneurysm of the left atrial appendage. Case reportA 24-year-old housewife was admitted to hospital in April 1976 with attacks of palpitation and atrial fibrillation. At age 10 years she was told that she had an enlarged heart and congenital heart disease was suggested. Attacks of palpitation were experienced for the first time at 18 years. Subsequent attacks of palpitation occurred frequently and lasted longer, and she received treatment with digitalis and DC conversion without any benefit. She was admitted to Hokkaido University Hospital on 10 April 1976 for investigation.The patient was a well-developed woman. On admission her pulse was irregular at 80 beats per minute. The pulses were present in all extremities, and the blood pressure was 126/60 mm mercury. There was no cyanosis or clubbing of digits. On auscultation, the heart sounds were normal, and no murmur was heard. The chest radiograph showed cardiac enlargement (CTR 615%), with a prominent convexity located at the left cardiac border in the position of the left atrial appendage (fig 1). A barium swallow showed no posterior displacement of the oesophagus. The electrocardiogram showed atrial fibrillation only. There was no evidence of ventricular hypertrophy. The echocardiographic scan revealed a large cavity behind the left ventricular wall. Cardiac catheterisation revealed that all intracardiac pressures were within normal limits and there was no evidence of an intracardiac shunt. Cardioangiography demonstrated a huge nonpulsating dilatation of the left atrial appendage from which the contrast medium cleared slowly. The left atrium and the left ventricle were displaced to the right by the dilated left atrial appendage. The diagnosis after cardiac catheterisation was congenital aneurysm of the left atrial appendage.An operation was perfomed on 23 June 1976,

General Hospital* A total of 65 patients who had interlobar invading lung cancer lesions underwent surgical resection. The 5-year survival rate of these cases was 42%. Of the 65 patients, the 52 patients who were treated with complete resection had a significantly higher survival rate than the 13 patients who underwent incomplete resection (52% vs. 0%). Of the 52 patients who were treated with complete resection, the 5-year survival rate of the 28 patients who underwent lobectomy of the invaded lobes (Group A) was significantly higher than that of the remaining 24 patients who underwent partial resection of such lobes (Group B) (74% vs. 27%). In particular, there was a significant difference between these two groups in adenocacinoma, in NO cases, and in N1 cases. Causes of death were compared between Group A and Group B according to nodal involvement. Almost all of the N2 cases in both groups died of distant metastasis. However, in N1 and NO cases, the recurrence rate in the ipsilateral hemithorax and the mortality of Group A were lower than those of Group B. To improve the survival rate of patients with interlober invading lung cancer lesions , bilobectomy or pneumonectomy should be performed. However, in patients 70 years of age or older, pneumonectomy is not recommended, since it did not improve the survival rate of such elderly patients.

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