Because patients with Swyer-James syndrome have almost always been treated conservatively, few reports exist of pathological findings of the lung in this syndrome. We report a case of this rare disease treated surgically and discuss pathological findings. A 36-year-old woman repeatedly contracted bronchitis and pneumothorax since adolescence, until April 26, 1997, when she reported chest pain and dyspnea. Chest X-ray on admission showed left pulmonary collapse with a slight deviation of the mediastinum toward the right. Chest computed tomography showed an apical bulla and emphysematous change in the left upper lobe. Pulmonary arteriography at age 17 showed hypoplasia of left pulmonary artery branches in the left upper lobe. Based on a diagnosis of Swyer-James syndrome, we conducted left upper lobectomy on May 2, 1997. Pathological examination of the resected left upper lobe showed marked emphysematous change, including an emphysematous bulla with destruction of alveolar structure and peribronchiolar fibrosis. No vascular abnormality was recognized in histology. Emphysematous change secondary to repeated bronchiolitis is believed to have led to her repeated pneumothorax.

A 63-year-old man was transported to the emergency medical center due to blunt chest trauma combined with a fractured left leg caused by a motorcycle accident. He complained of severe dyspnea. Contrast-enhanced computed tomography revealed chronic aortic dissection DeBakey III, mediastinal hematoma of high density just above the diaphragm around the aorta, and an intimal flap-like shadow in the false lumen. Traumatic aortic rupture (TAR) with chronic aortic dissection was suspected. Aortography showed no clear sign of leakage, but a double-contour density was found in the outer wall of the false lumen of the descending aorta just above the diaphragm. He was therefore diagnosed with TAR and underwent an emergency operation. At the operation, rupture in the outer wall of the preexisting false lumen was found and was directly sutured. Acute renal failure developed immediately after surgery, which improved after several hemodialyses. We consider our case rare because no report has been so far made on TAR with chronic dissection.

Preoperative complication from coronary dissection was the most important predictor of early postoperative mortality in this series. In such cases, rapid surgical intervention before myocardial infarction develops is vital to saving lives.

This report describes the case of a 47-year-old man who shot himself in the left side of the chest in an attempted suicide, and was transferred to the hospital. Two gunshot wounds were found in the left side of the chest and the back. CT scans revealed left hemopneumothorax, the accumulation of pericardial blood, and lacerations of the heart and the spleen. Emergency thoracotomy and laparotomy were performed. There was a contusion of the left lung and lacerations of the left ventricular free wall, the diaphragm, and the spleen. The laceration of the heart was repaired by 3 pairs of mattress sutures with felt strips, and covered with fibrin glue and a TachoComb(®) tissue sealing sheet without the use of cardiopulmonary bypass. The patient was discharged on foot on the 18th postoperative day. Such patients can only be saved with an efficient emergency medical-care system including quick transportation, and close cooperation of the hospital staff.

The effectiveness of monitoring somatosensory evoked potentials (SEPs) intraoperatively to detect brain damage early remains controversial. To assess the diagnostic accuracy of this modality, a study was conducted between 1991 and 1994, recording SEPs in 287 consecutive patients undergoing cardiac and aortic surgery using cardiopulmonary bypass (CPB) with moderate hypothermia or deep hypothermic circulatory arrest. From P1 to N2 of the SEPs occurring within 50 ms latency in response to electrical stimulation of the median nerve were recorded over the contralateral postcentral cortex at 5-min intervals using a Neuropack-2 (Nihon Koden, Tokyo, Japan). Normal SEPs were recovered in 247 patients postoperatively; however, 2 of these patients had suffered a cerebral infarction and 1, a transient stroke intraoperatively, demonstrating a false-negative incidence of 1.2%. On the other hand, three different types of abnormal SEPs were recorded postoperatively. P1 and N1 absence, probably caused by a subcortical lesion, was observed in 4 patients; P2 and N2 absence, probably caused by a cortical lesion, was observed in 8 patients; and a flat SEP, representing diffuse damage, was observed in 2 patients. Among these 14 patients with abnormal SEPs, 7 showed no neurologic disturbance at all, demonstrating a false-positive incidence of 50%. Thus, we concluded that when normal SEPs are recovered during weaning from CPB, the incidence of brain damage could be predicted at below 5%. Conversely, when abnormal SEPs are demonstrated, the incidence of brain dysfunction impeding a return to active life is estimated to be about 70%.