[Surgically treated chest wall schwannoma without entering the pleural space utilizing ultrasonography]

We report a case of surgically treated chest wall schwannoma without entering the pleural space utilizing ultrasonography. A 19-year-old woman was admitted for an abnormal shadow on a routine health checkup. Roentgenologic examination of the chest showed a 2 cm left chest wall mass. Chest computed tomography revealed a heterogeneous mass with obtuse angles characteristic of a pleural-based lesion. Under general anesthesia, the patient was placed in the right decubitous position. Chest wall ultrasonography defined a mass in the intercostal space. A 2.5 cm skin incision was made on the tumor. The tumor arising from the intercostal nerve was surgically removed without entering the pleural space. The pathological examination revealed a benign schwannoma. Postoperative course was uneventful and she discharged 2 days later. Six years later the patient is well without recurrence.

[Extremely elderly patient in whom the pacing lead was implanted via the femoral vein]

We report on an extremely elderly patient in whom we were unable to insert a pacing lead via the subclavian or internal jugular vein because of a superior vena cava obstruction; we instead inserted the pacing lead via the femoral vein. The patient was a 98-year-old male. Thirty-nine years previously, pacemaker implantation was performed for complete atrioventricular block. Afterwards, pacemaker replacement and reimplantation had been performed a total of 15 times. The patient was recently admitted because of pacing failure. Pacemaker replacement was performed, but pacing was not possible because of disconnection of the pacing lead. Insertion of a new pacing lead was attempted via both subclavian veins and the right jugular vein but failed; this approach was abandoned and temporary pacing was done. Superior vena cava obstruction was noted on chest computed tomography (CT), and pacing lead insertion through the superior vena cava was deemed unfeasible. Myocardial electrode implantation was also considered, but general anesthesia was deemed problematic because of the patient's extreme age. A pacing lead was inserted via the right femoral vein, and the generator was implanted in the right lower abdomen. Postoperative pacing was satisfactory.

[Stenting in obstruction of superior vena cava; clinical experience with the self-expanding endovascular prosthesis]

From August 1997 to December 2002, 14 consecutive patients with superior vena cava syndrome with the self-expanding endovascular prosthesis. Diagnoses were adenocarcinoma in 6, small cell carcinoma in 4, squamous cell carcinoma in 1, metastatic lung cancer in 2, and invasive thymoma in 1. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured on their admission and perioperative period. Expecting only 1 patient complete symptomatically relieved within 3 days of stent implantation. Superior vena cava pressure or radial pressure of the stent was sufficient to relieve obstruction. Preoperative ANP level were normal, BNP level were increased. Postoperatively both ANP level and BNP level were slightly increased under intravenous dopamine hydrochloride. Implantation of the self-expanding stent endovascular prosthesis for superior vena cava syndrome provides rapid symptomatic relief and improves the patient's quality of life.