Surgery today
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It is very unusual for a carcinoma of the breast to coexist with a phyllodes tumor, or for a carcinoma to arise within a fibroadenoma. We present herein an extremely rare case of lobular carcinoma in situ arising in a fibroadenoma, associated with a malignant phyllodes tumor in the opposite breast. A 49-year-old woman was admitted to our hospital with a large mass in the right breast and a small mass in the left breast. ⋯ Microscopic findings of the material excised from the left breast showed the presence of multiple lobular carcinoma in situ within the tumor mass of the fibroadenoma. However, histological examination did not detect any metastasis to the bilateral axillary lymph nodes. To our knowledge this is the only such case ever to be reported in Japan.
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Mesenteric ischemia caused by obstruction of the superior mesenteric artery associated with acute aortic dissection was successfully treated by surgery in a 74-year-old man. The vein graft was effectively bypassed between the right common iliac artery and superior mesenteric artery on the day of onset of acute DeBakey type III b aortic dissection. He is currently well 1 year postoperatively on anti-hypertensive therapy.
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Case Reports
Intrapleural rupture of a pulmonary arteriovenous fistula occurring just beneath the pleura: report of a case.
We report herein a rare case of a 21-year-old man with Rendu-Osler-Weber disease, otherwise known as hemorrhagic teleangiectasia, in whom a spontaneous hemothorax occurred following the rupture of one of multiple pulmonary arteriovenous fistulae (PAVF). An emergency life-saving operation was performed which revealed the ruptured fistula lying just beneath the visceral pleura. This case demonstrates that patients in whom a pulmonary angiogram shows an arteriovenous fistula lying just beneath the visceral pleura should undergo prophylactic surgery to avoid a life-threatening emergency, whenever possible.
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Abdominal wall lifting is a method to produce operative space between the anterior abdominal wall and the intra-abdominal organs during laparoscopic surgery. We devised a hanger lifting procedure for the anterior abdominal wall to avoid complications as well as reduce the costs related to the pneumoperitoneum. ⋯ Though at the beginning we performed laparoscopic cholecystectomy by the pneumoperitoneum, we discarded the insufflator for this operation since starting the new procedure. There was no incidence of conversion to pneumoperitoneum and a fairly good operative view was achieved enabling a smooth laparoscopic cholecystectomy.
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Case Reports
A case of bilateral obturator hernias: image diagnosis and description of a retropubic operative approach.
A case of bilateral obturator hernias which was diagnosed by ultrasonography (US) and computed tomography (CT), and repaired by a retropubic extraperitoneal operative approach under spinal anesthesia is reported herein. A 91-year-old woman presented with lower abdominal and left groin pain consistent with a Howship-Romberg sign. US demonstrated an image of the bowel projecting from the small pelvic space to the left thigh with a to-and-fro movement of the bowel contents. ⋯ No necrosis was observed in the incarcerated bowel and resection was not necessary. A simple hernial sac was found in the right obturator canal. The operation using the retropubic extraperitoneal approach was successful and we believe it to be the most effective procedure for obturator hernias which have been diagnosed early.