Adventitial cystic disease (ACD) of the veins is a rare phenomenon, and ACD of the femoral vein is particularly difficult to diagnose due to the similarity in symptoms to those of deep vein thrombosis. We report a case of ACD of the femoral vein, which was initially misdiagnosed as deep vein thrombosis, in a 48-year-old woman who presented with a painless swelling in her right lower leg. The extensive cystic involvement of the femoral vein was completely resected and reconstructed with an 8-mm ringed polytetrafluoroethylene vascular graft with good results.

Synovial sarcoma (SS) is one of common malignant soft-tissue tumors and is encountered most commonly in children and young adults. It frequently involves or invades major neurovascular structures and bones, and its local recurrence rate after simple resection has been reported to be as high as up to 80%. Because major nerves and vessels, as well as an adequate amount of bone, must be preserved to restore excellent limb function in cases of SS, a surgical technique entailing a low risk of local recurrence is needed. Based on the findings of recent experimental studies conducted by us using a mouse osteosarcoma model, we developed a novel therapeutic technique for SS, consisting of reduction surgery followed by photodynamic therapy using acridine orange (AO-PDT), with or without X-ray irradiation at 5 Gy. A preliminary study revealed that low-dose X-rays also excite AO like photons. After an initial study on cell cultures, this novel technique was applied to six cases of SS. A follow-up of the subjects to determine the clinical outcome revealed that none of the cases treated by AO-PDT, including the four cases treated by additional 5 Gy irradiation and the two cases not receiving any radiation, showed any evidence of recurrence or local/systemic complications during the follow-up period of 19-51 months after the surgery. Therefore, we believe that AO-PDT with 5 Gy irradiation may be an excellent novel therapeutic modality with reduction surgery to salvage excellent limb function in SS involving major nerves and vessels or bones.

Objectives Early and late outcomes were evaluated in Japanese patients undergoing aortic valve replacement (AVR) with or without aortic annular enlargement (AAE). Propensity matching adjusted for baseline differences in this study. Methods Between January 2001 and July 2014, 589 patients underwent AVR for aortic stenosis. Of these, 58 patients received AVR with AAE (AAE group), and the others received standard AVR without annular enlargement (sAVR group). Of these 589 patients, 116 patients were selected using propensity score matching analysis. We compared early and late outcomes between the two groups. Results Compared with the sAVR group, cardiopulmonary bypass time (177 ± 42 vs. 157 ± 39 minutes) and aortic cross-clamp time (126 ± 32 vs. 110 ± 34 minutes) were significantly longer in the AAE group. However, there were no significant differences between the AAE group and the sAVR group in 30-day mortality (1.7 vs. 3.4%) and in-hospital mortality (1.7 vs. 3.4%). There was no severe patient-prosthesis mismatch after AVR in the AAE group. The overall survival rate and freedom from cardiac events in the AAE group and in the sAVR group at 10 years were 92.4 versus 75.9% (p = 0.477) and 89.5 versus 82.8% (p = 0.076), respectively. No differences were found between the two groups. Conclusions AAE was performed safely in Japanese patients with small aortic annulus. Surgical outcomes of the AAE group were not inferior to those of sAVR. Using this technique, which did not require advanced skills, it was easy to avoid severe patient-prosthesis mismatch.

Synovial sarcoma (SS) is one of common malignant softtissue tumors and is encountered most commonly in children and young adults. It frequently involves or invades major neurovascular structures and bones, and its local recurrence rate after simple resection has been reported to be as high as up to 80%. Because major nerves and vessels, as well as an adequate amount of bone, must be preserved to restore excellent limb function in cases of SS, a surgical technique entailing a low risk of local recurrence is needed. Based on the findings of recent experimental studies conducted by using a mouse osteosarcoma model, we developed a novel therapeutic technique for SS, consisting of reduction surgery followed by photodynamic therapy using acridine orange (AO‐PDT), with or without X‐ray irradiation at 5 Gy. A preliminary study revealed that low‐dose X‐rays also excite AO like photons. After an initial study on cell cultures, this novel technique was applied to six cases of SS. A follow‐up of the subjects to determine the clinical outcome revealed that none of the cases treated by AO‐PDT, including the four cases treated by additional 5 Gy irradiation and the two cases not receiving any radiation, showed any evidence of recurrence or local/systemic complications during the follow‐up period of 19‐51 months after the surgery. Therefore, we believe that AO‐PDT with 5 Gy irradiation may be an excellent novel therapeutic modality with reduction surgery to salvage excellent limb function in SS involving major nerves and vessels or bones.

Synovial sarcoma (SS) is one of common malignant soft-tissue tumors and is encountered most commonly in children and young adults. It frequently involves or invades major neurovascular structures and bones, and its local recurrence rate after simple resection has been reported to be as high as up to 80%. Because major nerves and vessels, as well as an adequate amount of bone, must be preserved to restore excellent limb function in cases of SS, a surgical technique entailing a low risk of local recurrence is needed. Based on the findings of recent experimental studies conducted by us using a mouse osteosarcoma model, we developed a novel therapeutic technique for SS, consisting of reduction surgery followed by photodynamic therapy using acridine orange (AO-PDT), with or without X-ray irradiation at 5 Gy. A preliminary study revealed that low-dose X-rays also excite AO like photons. After an initial study on cell cultures, this novel technique was applied to six cases of SS. A follow-up of the subjects to determine the clinical outcome revealed that none of the cases treated by AO-PDT, including the four cases treated by additional 5 Gy irradiation and the two cases not receiving any radiation, showed any evidence of recurrence or local/systemic complications during the follow-up period of 19-51 months after the surgery. Therefore, we believe that AO-PDT with 5 Gy irradiation may be an excellent novel therapeutic modality with reduction surgery to salvage excellent limb function in SS involving major nerves and vessels or bones.