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Purpose To report an iliac venous stent landing technique using only fluoroscopy in patients with May-Thurner syndrome (MTS). Material and Methods Sixty-five patients (69% female) who had self-expanding nitinol stents deployed for symptomatic MTS were retrospectively analyzed. Mean age was 50 years (range 18–80). The cephalic stent right lower corner was deployed to the right of the lumbar vertebra spinous process (SP), but not as far to the right as the right pedicle lateral border. Mode stent diameter and length were 14 mm (range 12–18) and 120 cm (range 60–180), determined by venography, respectively. The anatomical positions of the right common iliac artery, inferior vena cava (IVC), and stent were assessed relative to these bony landmarks on computed tomography venography. Results Position of the proximal right common iliac artery right lateral border lay a mean distance of 12 mm (±8 to the right of the SP and 13 mm (±7) left of the right pedicle lateral border. Mean position of the IVC right lateral wall lay 1 mm (±6) to the right of the right pedicle lateral border. Mean position of the cephalic stent right lower corner was 6 mm (±6) to the left of the right pedicle lateral border and 19 mm (±7) to the right of the SP. The mean space left between the cephalic stent right lower corner and the IVC right lateral wall was 5 mm (±5). Primary patency rate at 1 year was 88%. Conclusions Important vascular structures lie in predictable locations relative to bony landmarks, facilitating accurate venous stent placement using fluoroscopy only.

A 44-year-old woman visited a hospital with microscopic hematuria in June 2009. Computed tomography showed a large bladder diverticulum at right lateral wall and urachal remnant. Cystoscopic examination showed a large diverticulum at the right lateral wall that closes to the dome. She was followed up closely without therapeutic intervention; however, the residual urine increased gradually and frequent bladder diverticulitis developed. She underwent laparoscopic bladder diverticulectomy and excision of the urachal remnant simultaneously without any complications in August 2017. Laparoscopic approach for a large bladder diverticulum and urachal remnant is useful with safe, effective, and minimally invasive.

Solitary neurofibroma of the oropharynx is extremely rare. Imaging explorations may be necessary, but the diagnostic certainty is pathological. We report a case of benign tumour of the oropharynx in a 25-year-old woman who was seen for a consultation with dysphagia, a change in voice and dyspnea in the supine position. The excision was performed under general anaesthesia with orotracheal intubation via the oropharyngeal route. Pathological examination of the surgical specimen revealed neurofibroma. Although rare, solitary neurofibroma of the oropharynx should be considered in any benign tumour in the area.

The patient, 17 years old, was admitted with complaints of bleeding from the vagina, itching and burning sensation in the external genital parts. With external examination, a mass of vesicles and excorings (Herpes) was found on the external parts; During internal examination with Sims' mirrors, a large fresh blood clot was found on the right lateral wall of the vagina near the fornix, at the removal of which a bleeding, rhomboid, torn wound of the vaginal mucosa was opened, approximately 4 ctm. length and 3 ctm. width.

Background: To report the first case of the spontaneous appendicovesical fistulas' (AVF) repair with robot assisted laparoscopy. Case Presentation: A 29-year-old male patient with urgent persistant bacteriuria and dysuria was referred to our clinic. Physical examination and blood tests were normal. He had used various antibiotics due to recurrent UTI for about 20 years. Computed tomography revealed the fistula tract between the distal end of the appendix and right lateral wall of the bladder dome. He was successfully treated with robot-assisted laparoscopic repair. Following this surgery, the patient's complaints were resolved completely. Conclusion: AVF is the rare condition. Robot-assisted laparoscopy repair of AVF is safe and effective treatment option.

Video Objective Laparoscopic Intracapsular Myomectomy helps in avoiding the opening of uterine cavity in infertile women with deep intramural myomas compressing the cavity. Infertile women with deep intramural myomas compressing the cavity, laparoscopic intracapsular myomectomy may be preferred to avoid opening the uterine cavity. Setting Videos of 3 cases will be shown where infertile women needed Myomectomy to optimize fertility results Case A 33 year old woman with 3 deep intramural medium sized myomas compressing the cavity from three sides. Case B 31 year old woman, with large posterior wall intramural myoma compressing the cavity from fundus to isthmus. Case C 28 year old, regular cycles, showing 6cm by 8cm right lateral wall myoma, compressing the cavity. Interventions 3 cases demonstrating our objective are shown. In all the cases you will notice. • we remained in the intracapsular plane • finer fibers of the capsule were also cut so as to make myoma absolutely naked • Intracapsular plane is the most avascular plane • cavity was not opened Conclusion Remaining in “intracapsular plane” while performing laparoscopic myomectomy in cases of deep intramural myomas, in infertile women, should be preferred as it helps in preventing intrauterine damage. Intrauterine damage can be in the form of intrauterine adhesions, avulsion of uterine wall or scar dehiscence in future pregnancy. Haematoma formation, necrosis and secondary infection are the triad of weakening the scar. This triad automatically gets taken care of as intracapsular plane is relatively avascular, one does not need to do the cauterization of the vessels after the myomectomy over the myoma bed. It is obvious that this will avoid the necrosis and secondary infection. We prefer to take 2-3 layers suturing with V-lock to obliterate dead space.

WOS: 000351489300020, PubMed: 25759784, Background: Pleomorphic adenomas (PAs) are the most common type of benign salivary gland tumours and usually originate from the major salivary glands. PA originating from the nasopharynx has rarely been reported in the literature. Case Report: A 62 year-old male presented with right aural fullness and subjective hearing loss. Otoscopic examination revealed an opaque and bulging tympanic membrane. Nasal endoscopic examination revealed a smooth mass arising from the right wall of the nasopharynx, obstructing the opening of the right Eustachian tube. The MRI showed a 1.3x2x1.3 cm sharply outlined and lobar mass in the right lateral wall of the nasopharynx. The tumour was meticulously detached from its attachment site and excised via the transnasal route under endoscopic visualisation. Conclusion: We reported pleomorphic adenoma in the nasopharynx in a patient who presented with serous otitis media that successfully resected with transnasal endoscopic surgery and discussed the treatment methods.

Despite the emergence of new classifications, the best way to measure and differentiate between the most common congenital uterine anomalies remains debatable. The aim of this study was to test the intra- and inter-observer variability of the different three-dimensional ultrasound (3DUS) uterine measurements described to date. Twenty consecutive women underwent 3DUS in a standardized manner. Two observers analysed each volume three times to assess the interostial distance, indentation distance, indentation angle, percentage of indentation, fundal wall thickness, and lateral wall thickness. Intra- and inter-class correlation coefficients (intra- and inter-CC), limits of agreement (LOA) and repeatability coefficients were estimated. For observers 1 and 2, the intra-observer reproducibility was the lowest for the left lateral wall thickness (intra-CC 0.91 [LOA -6.54 to 7.10] and 0.58 [LOA -6.58 to 6.94], respectively) and right lateral wall thickness (intra-CC 0.92 [LOA -5.68 to 4.74] and 0.56 [LOA -6.79 to 5.59], respectively). The inter-observer reproducibility was also the lowest for both these measurements (inter-CC 0.74 [LOA -4.01 to 6.09] and 0.72 [LOA -3.33 to 5.83], respectively). The remaining measurements showed high levels of intra- and inter-observer reproducibility (intra- and inter-CC ≥0.95). It is evident that not all uterine measurements are equally reproducible on 3DUS.

The purpose of this study was to evaluate and compare the diagnostic efficacy of ultrasonography (US) with radiography and multi-detector computed tomography (CT) for the detection of nasal bone fractures. Forty-one patients with a nasal bone fracture who underwent prospective US examinations were included. Plain radiographs and CT images were obtained on the day of trauma. For US examinations, radiologist used a linear array transducer (L17-5 MHz) in 24 patients and hockey-stick probe (L15-7 MHz) in 17. The bony component of the nose was divided into three parts (right and left lateral nasal walls, and midline of nasal bone). Fracture detection by three modalities was subjected to analysis. Furthermore, findings made by each modality were compared with intraoperative findings. Nasal bone fractures were located in the right lateral wall (n = 28), midline of nasal bone (n = 31), or left lateral wall (n = 31). For right and left lateral nasal walls, CT had greater sensitivity and specificity than US or radiography, and better agreed with intraoperative findings. However, for midline fractures of nasal bone, US had higher specificity, positive predictive value, and negative predictive value than CT. Although two US evaluations showed good agreements at all three sites, US findings obtained by the hockey-stick probe showed closer agreement with intraoperative findings for both lateral nasal wall and midline of nasal bone. Although CT showed higher sensitivity and specificity than US or radiography, US found to be helpful for evaluating the midline of nasal bone. Furthermore, for US examinations of the nasal bone, a smaller probe and higher frequency may be required.

Introduction: Using the robotic platform for radical cystectomy offers many advantages, and this procedure is gaining acceptance around the world. However, performing the urinary diversion by this approach requires the development of special skills, and the learning curve is yet to be determined. Combining the robotic and the open approaches may allow the surgeon to maintain the outcomes while developing the technique for the intracorporeal urinary diversion. Materials and Methods: In our present case series of seven patients, most of the patients were having T1 or early T2 disease. We present a video of a male patient, aged 59 years, with a history of recurrent urothelial bladder carcinoma with squamous differentiation (T1G3). CT shows large bladder tumor in right lateral wall. Robotic radical cystectomy and bilateral standard lymph node dissection (Da Vinci Si Surgical System®) were performed in the extended Trendelenburg position. While doing lymph node dissection, we went cranially up to the ...

Paragangliomas of the urinary bladder are very rare. To date, there are no reliable methods for predicting their clinical behavior, so long-term follow-up is required. We describe a paraganglioma of the urinary bladder in a 32-year-old male who presented with painless gross hematuria. Abdominal ultrasonography revealed a protruding mass with hematoma over the right lateral wall of the urinary bladder. The tumor was not completely resected by transurethral resection of bladder tumor (TURBT) due to intermingling with the bladder wall. Follow-up I131-metaiodobenzylguanidine was performed 3 weeks after surgery and suspected incomplete resection lesions were noted. Histologic examination of the tumor indicated paraganglioma of the urinary bladder. We also provide a brief review of the literature for comparison.

A 23-year-old man presented with chronic lower urinary tract symptoms and right flank pain. He had undergone ureterolithotomy a few years ago. Ultrasonography and CT of the abdomen and pelvis showed a right paravesical mass and proximal hydroureteronephrosis. Cystoscopic examination revealed a part of surgical gauze embedded in the right lateral wall of the bladder. The surgical gauze was completely retrieved with grasping forceps without any additional procedures. The patient experienced prompt relief of his symptoms and at follow-up, imaging studies revealed resolution of the pelvic mass and non-obstructed clearance of right-side collecting system. Pelvic gossypiboma with partial intravesical erosion is an unusual presentation and can be managed successfully by cystoscopic manipulation.

An 81-year-old woman presented with symptoms of recurrent urinary tract infections, urge incontinence and nocturia. Cystoscopy performed revealed a whitish plaque lesion on the fundus and right lateral wall of the bladder. The histology of the biopsy confirmed the diagnosis of leukoplakia vesicae of the bladder. The plan is to follow her up with repeat cystoscopy and biopsy in 6 months. The literature search revealed very little information on the pathogenesis and prognosis of this condition due to its rare occurrence. Analysis of the literature signifies the association of chronic irritation due to recurrent urinary tract infections being the commonest cause of leukoplakia vesicae. The recommended long-term follow-up and surveillance based on the literature review is by cystoscopy with or without biopsy.

The aim was to measure detrusor thickness in healthy children, using high frequency ultrasonography, to determine normal values that could be used for the evaluation of pathological bladder conditions. Ultrasound (US) was performed in 62 children (38 boys, 24 girls, 20 months - 18 years, mean 8.4+/-4.5 years) with the absence of clinical or laboratory pathological changes of the urinary tract. The detrusor thickness was measured at the posterior, anterior and lateral bladder walls, and the average thickness was calculated for each bladder wall in every child. The mean detrusor thickness was 1.17+/-0.45 mm (range 0.4-2.8 mm) for the anterior bladder wall, 1.25+/-0.45 mm (range 0.5-3.0 mm) for the posterior bladder wall, 1.18+/-0.44 mm (range 0.4-2.9 mm) for the left lateral wall, and 1.19+/-0.45 mm (range 0.4-2.8 mm) for the right lateral wall. There was a significant correlation of mean detrusor thickness with age. Using high-frequency US transducers it was possible to measure the detrusor thickness of the anterior and posterior bladder walls in all children. The mean normal detrusor thickness is 1.2+/-0.45 mm (range 0.4-3 mm) when the bladder is full. Future studies should evaluate this method in children with functional, neuropathic and anatomical dysfunctions of the lower urinary system.

A 7-year-old male Major Mitchell's cockatoo (Cacatua leadbeateri) was presented with an encrusted beak tumor. Clinical examination demonstrated a bird that was bright and alert and had good pectoral muscle condition. The bird was open-mouth breathing and had a bilateral mucopurulent ocular discharge. A relatively well-demarcated thick crust overlaid the right naris and extended along the right lateral wall of the rhamphotheca. Radiographs of the head demonstrated a diffuse increased radiodensity of the nasal sinuses. A diagnosis of cryptococcosis was made by examining Wright's-stained choanal smears, which demonstrated a mixed overgrowth of gram-negative coccobacilli and occasional aggregates of encapsulated yeast organisms measuring 6–10 μm within 8- to 12-μm nonstaining capsules. The bird was euthanized, and necropsy findings were confined to the nasal and infraorbital sinuses. The sinuses contained a pale, gelatinous substance, which yielded a heavy growth of Cryptococcus neoformans var gattii...

Tracheal bronchus is an aberrant bronchus usually originating from the right lateral wall of the trachea, with an incidence ranging from 0.1% to 5% and usually within 2.0 cm above the carina. The incidence of lung cancer with bronchial anomaly is very rare. There are only nine cases of lung cancer developing from the tracheal bronchus reported in the literature. Histological examination showed squamous cell carcinoma in only three of them, and we present a fourth case who was a 57-year-old man. Interestingly our patient's anomaly included both an absence of the normal right upper bronchus as well as right upper lobe ventilated from the true tracheal bronchus. This is the first documented case in the world of a squamous carcinoma arising from the true tracheal bronchus. Post-surgical histological stage was T2aN0M0 (stage IB). The patient is well 48 months after the operation and has no evidence of recurrence.

We report two patients with ectopic gastric mucosa in the oesophagus in whom emergency contrast medium studies after traumatic endoscopy revealed broad, flat depressions on the right lateral wall of the upper oesophagus that could initially be mistaken for ulcers or even intramural dissections. However, the appearance and location of these lesions is so characteristic of ectopic gastric mucosa that confirmation with endoscopic biopsy specimens probably is not required in asymptomatic patients.

Lymphangioma is a rare benign lesion of the gastrointestinal tract, in which the large intestine is the least commonly involved site. To the authors' knowledge a lymphangioma of the anal canal has not been reported. Described herein is a case of pedunculated polypoid lymphangioma of the right lateral wall on the transitional zone of the anal canal measuring 1.7 x 1.3 x 1 cm in a 40-year-old woman. A pedicle does not exclude the endoscopic diagnosis of lymphangioma. Lymphangioma must be included in the differential diagnosis of polypoid lesions of the anal canal.

We applied transurethral microwave coagulation therapy to urinary bladder diverticulum. The case is 71-year-old female who had two large diverticulums, 11 × 9 × 7 cm in size on the right lateral wall and 5 × 5 × 4 cm in size on the anterior wall. Electrode resection of diverticular neck was performed, and then all of the inside mucosa was coagulated with a microwave energy of 100 watts. This procedure was able to be performed safely to the end without any complications. After the operation, both diverticulums disappeared. It supposed that the transurethral microwave coagulation therapy was a useful procedure for the endoscopic treatment of urinary bladder diverticulum.

Pheochromocytoma of the urinary bladder is an unusual tumor that typically presents with hypertensive crises related to micturition. We report, herein, the case of a 62-year-old woman with bladder pheochromocytoma. The patient presented with a bladder tumor that was incidentally found by computed tomography (CT) without the triad of sustained hypertension, hematuria and postmicturitional syncope. Cystoscopy revealed a yellowish submucosal tumor in the right lateral wall of the bladder. Treatment consisted of transurethral resection in the initial diagnosis of bladder tumor. A definitive diagnosis was made postoperatively upon pathological examination. The patient has been followed up for 12 months and has shown no recurrence.

A 3-year-old male child presented to the casualty with history of unprovoked dog bite over the right lateral wall of nose. He was managed conservatively with antirabies prophylaxis and dressings. He presented after 3 months with a healed wound and the right upper central incisor projecting into the nostril. The Orthopantomogram showed a rotated temporary incisor with the roots of the permanent incisor placed normally. The tooth was extracted intranasally. Among the mutilating dog bite injuries referred to a plastic surgeon, this injury though thought provoking was also comical.

A female patient with a history of recent abortion was transferred in critically ill condition in our hospital. CT imaging on emergency basis depicted an abscess in the right retroperitoneal space that included the head of fetus, along with rupture of the right lateral wall of uterus. Spiral CT enabled prompt diagnosis and therapy of this rare abortion-related complication. Keywords CT-Spiral; Uterus; Complication; Rupture; Obstetrics

A 19-old female with a large cavernous hemangioma located in the right lateral wall of the oropharynx between the superior pole of the palatine tonsil and the vallecula was removed surgically after embolization. The procedure consisted of a horizontal skin incision of the upper neck, mandibular bone dissection and obliteration of the defect with a pedicled sternomastoid muscle. The defect in the cavity was well epithelized 6 weeks postoperatively with minimal scar contraction.

We present a combination of transitional cell carcinoma and a well differentiated squamous cell carcinoma in the right side of the urinary tract of a bilharzial patient. The right renal pelvis and the right ureter demonstrated transitional cell carcinoma, while the right lateral wall of the bladder showed squamous cell carcinoma.

OBJETIVO: Aportar un nuevo caso de leiomioma vesical a la literatura española. MÉTODO: Hallazgo casual en un estudio ecográfico pélvico de una tumoración de 20 mm en la cara lateral derecha de la vejiga de una mujer de 29 años. El cistograma de la urografía intravenosa mostró la presencia de un defecto de repleción en esa misma localización. Se realizó cistoscopia con el hallazgo de una tumoración en la cara lateral derecha de la vejiga, con recubrimiento mucoso de aspecto normal. RESULTADO: Con el diagnóstico de sospecha de leiomioma vesical se realizó resección transuretral de la tumoración, con confirmación anatomopatológica de dicho diagnóstico. En el postoperatorio desarrolló una placa calcárea sobre el área de resección previa, que se trató mediante resección transuretral de ésta y de restos leiomiomatosos y acidificación urinaria posterior. CONCLUSIÓN: Aunque se trata de un tumor raro, en determinadas circunstancias es posible establecer el diagnóstico prequirúrgico con un alto índice de sospecha. Por otra parte, dada la benignidad del proceso, la cirugía conservadora, en esta caso la resección transuretral, ofrece excelentes resultados.

AimsTo describe an unusual presentation of myxoid liposarcoma of oropharynx and a brief review of literature.IntroductionLiposarcomas of head and neck are very rare. Its treatment and prognosis mainly depends on the site and the histologic pattern of the tumor.Case presentationThe present case report describes a 65-year-old male with complaints of dysphagia, dyspnea, and a peculiar complaint of mass in the throat which turned out to be a low-grade myxoid liposarcoma arising from right lateral wall of oropharynx extending intraluminal in the esophagus, compressing posterior wall of trachea. The mass was successfully excised surgically and postoperative period was uneventful and patient was asymptomatic 4 months after surgery.ConclusionMyxoid liposarcoma is a rare tumor in head and neck and surgical excision with adequate margin is the treatment of choice.How to cite this articleMohiyuddin A, Raj S, Merchant S, Arun P. Interesting Clinical Presentation of Myxoid Liposarcoma of Oropharynx. Int J Head and Neck Surg 2013;4(1):57-58.

A tracheal bronchus is an aberrant, accessory or ectopic bronchus arising almost invariably from the right lateral wall of the trachea, causing hypoxaemia, atelectasis, or both, during anaesthesia. We describe two patients with a tracheal bronchus found before anaesthesia. One tracheal bronchus was found by tracheobronchoscopy and the other by chest x-ray. Because of recognition of the anomaly before operation, anaesthesia was uneventful in each patient.

Inflammatory pseudotumors of the bladder are rare in children. We report here the case of an 11-year-old child who presented with lower urinary tract symptoms. Ultrasonography and computed tomography imaging of abdomen showed an intravesical mass/thickening arising from the right lateral wall. Biopsy of the lesion revealed a lesion that showed uniform elongated spindle cells within a background of myxoid stroma. The cells were loosely packed from a smooth muscle lesion, which had a densely packed cellular stroma. The child improved with a course of antibiotics and a repeat imaging showed disappearance of the lesion.

A 70-year-old man with mediastinal lymphadenopathy was referred to our centre for endobronchial ultrasound with transbronchial needle aspiration. During the bronchoscopic examination, two separate anatomical bronchial variances were observed: a supernumerary ‘true’ tracheal bronchus branching off from the distal right lateral wall of the trachea (figure 1A) and a displaced aberrant ‘tracheal’ bronchus arising from the distal lateral wall of the left main stem bronchus (figure 1B). There was a normal right upper lobe bronchus but the upper division truncus of the …

The authors retrospectively reviewed computed tomographic (CT) scans, angiograms, and surgical-pathologic records of 226 patients without and 64 patients with pathologically proved pancreaticobiliary carcinoma to evaluate frequency of depiction, normal range of size, and causes of dilatation of the posterior superior pancreaticoduodenal vein (PSPDV) at CT. Among the patients with pancreaticobiliary carcinoma, CT demonstrated enlarged PSPDVs (diameter, greater than or equal to 8 mm) in seven patients. CT and angiography showed that the portal-superior mesenteric vein (P-SMV) was occluded or stenotic at its confluence in three patients and was normal in four patients. Among the latter four patients, localized tumor invasion was found surgically-pathologically along the right lateral wall of the P-SMV in three. A dilated PSPDV with obliteration of the P-SMV at CT may confirm tumor extension to the P-SMV. In patients with a normal P-SMV at CT, a dilated PSPDV indicates that the tumor has extended beyond the pancreatic parenchyman and occluded other pancreaticoduodenal veins or extended to the wall of the P-SMV.

A tracheal bronchus is an aberrant, accessory or ectopic bronchus arising almost always from the right lateral wall of the trachea at the level less than 2 cm above the carina. An endotracheal or endobronchial tube can obstruct or migrate into a tracheal bronchus, resulting in pulmonary atelectasis, hypoxemia, or both during general anesthesia. We report two patients in whom the anomalous tracheal bronchus had been surgically resected under general anesthesia. The anomaly was identified before surgery in each patient and anesthesia was uneventful.

A tracheal bronchus, an aberrant bronchus arising directly from the trachea, is an infrequent congenital anomaly. The incidence of this anomaly ranges from 0.5 to 5%. It usually originates from the right lateral wall of the trachea at the level

The authors describe a unique case of osteosarcoma associated with atypical mesonephric rests occurring in the right lateral wall of the uterine cervix. The tumor was examined histologically, cytologically, immunohistochemically, and ultrastructurally and was compared with another osteosarcoma that filled an entire uterine cavity. Comparison with other neoplasms of the uterine cervix indicates that the lesion should be classified separately. Previously reported neoplasms associated with mesonephric rests within the cervix are also reviewed.

Two cases of nasopharyngeal cyst, which seemed to arise from the second branchial pouch, are reported. The first case was a 48-year-old female who had an abnormal feeling in the nasopharynx. Examination revealed a cystic mass attached by a peduncle to the right lateral wall of the nasopharynx. Case 2 was a 58-year-old male who developed hearing impairment and fullness of the ear on the right side associated with nasal stuffiness. Flexible fiberscopic examination disclosed a swelling of the right lateral wall of the nasopharynx so that the orifice of the tube could not be seen. These cysts were removed under general anesthesia. Although nasopharyngeal cyst is a rare disease, many cases are congenital. Congenital cyst of the nasopharynx is discussed.

The electrocardiographic effects of 25 chemically produced myocardial lesions in dogs were studied. Eleven of these were restricted to the subepicardial half of the left ventricular wall, 2 were located in the posterior basal portion of the left ventricle, and 12 were located in the right ventricular wall. Eight of the 11 subepicardial left ventricular lesions altered only mid-temporal and terminal portions of the QRS complex. The other 3 lesions were all located near the interventricular septum and altered early as well as later portions of the QRS. The 2 lesions of the posterior basal left ventricular wall altered only mid-temporal and terminal portions of the QRS complex. Right ventricular lesions in the right lateral wall near the base and those near the interventricular septum altered early as well as late portions of the QRS complex. Other right ventricular lesions altered only mid-temporal and terminal portions of the QRS. The significance of these findings may be summarized as follows: (1) Lesions in a variety of locations cannot be recognized by electrocardiographic standards which require abnormalities of the initial portion of the QRS complex. (2) Recognition of the relatively small and variable electrocardiographic effects of subepicardial, posterior basal, and right ventricular lesions may require modification of current clinical electrocardiographic techniques and standards for the diagnosis of myocardial infarction (3) The finding that most subepicardial lesions did not alter initial portions of the QRS is not consistent with reported evidence that activation of only subepicardial portions of the heart contributes to the form of QRS deflections.

Two cases of Tracheal tumor are presented.47 year old male, complaining of intermittent dyspnea getting worse past 6 months, was admitted for removal of the tumor from tracheal wall.Under local anesthesia, patient was placed in supine position, and the Tracheotomy was carried out on 3rd through 6th tracheal Ring.The tumor which was well pedunculated was removed from posterior wall of trachea, and electrocautery was applied at steeled area.Tumor was proved to be adenoid cystic carcinoma histologically. The incision was well closed in usual maneuver.54 year old male was admitted to the Department of Chest Surgery on emergency base of acute dyspnea.Patient had had intermittent dyspnea past 1 year.Patient was prepared in same manner as former patient was done. The tumor, arising from right lateral wall, was removed without any disturbance of Respiration in quick procedure.Recurrence was noted 3 months after operation, and the patient is ready for resection of trachea.Literatures were reviewed together and the management of rescue of airway problems was discussed.

Case 33: Impermeable Deep Stricture. —A man, 38 years of age, was referred to me by Dr. M. W. Thompson, of Chicago. Had a history of successive attacks of gonorrhea extending over a period of years. Symptoms of urinary obstruction had existed for some four or five years, and had increased until the stricture had become surgically impermeable. I performed perineal section without a guide, found the urethra extremely hard and nodular from the perineo-scrotal junction well down into the membranous portion. The stricture practically involved the entire extent of the latter. Considering the rather complicated state of affairs the bladder was reached with considerable rapidity, the operation requiring about eight minutes after the opening of the urethra. A small fibrous tumor was found in the right lateral wall of the urethra in the midst of the stricture tissue. This was about the size of a fat pea and was