Evaluation of the Surgical Margin Threshold for Avoiding Recurrence after Partial Nephrectomy in Patients with Renal Cell Carcinoma

Purpose@#An adequate minimal surgical margin for partial nephrectomy (PN) has not yet been conclusively established. Therefore, we aimed to compare PN recurrence rates according to surgical margin status and to establish an adequate minimal surgical margin. @*Materials and Methods@#We retrospectively studied patients with clinically localized renal cell carcinoma who underwent PN between 2005 and 2014. Surgical margin width (SMW) was assessed for all surgical tissues and divided into three groups: SMW <1 mm, SMW ≥1 mm, and positive surgical margin (PSM). The data were analyzed using the Kaplan-Meier method with log-rank tests and multivariate Cox regression models. @*Results@#Of 748 patients (median age, 55 years; interquartile range, 46–64 years; 220 female), 704 (94.2%) and 44 (5.8%) patients had negative and PSMs, respectively. Recurrence-free survival was significantly lower in patients with PSMs (p<0.001) and was not significantly different between SMW ≥1 mm and <1 mm groups (p=0.604). PSM was a significant predictor of recurrence (hazard ratio: 8.03, 95% confidence interval: 2.74–23.56, p<0.001), in contrast to SMW <1 mm (p=0.680). @*Conclusion@#A PSM after PN significantly increases the risk of recurrence. We discovered that even a submillimeter safety surgical margin may be enough to prevent recurrence. To maximize normal renal parenchyma preservation and to avoid cancer recurrence in renal parenchymal tumor patients, PN may be a safe treatment, except for those with a PSM in the final pathology.

Three Cases of Double Hanging in Korea from 2008 to 2018 / 대한법의학회지

Hanging is the most common form of suicide, but the use of a single ligature in a suicide pact is very rare. The authors identified three cases of double hanging through the National Police Agency's Scientific Crime Analysis System over 11 years in Korea, from 2008 to 2018. Of the six deaths, all but one were suicides; one was a victim of murder (suicide after murder). A couple was found hanging by a single ligature over a beam, wherein a man hanged himself using the weight of the woman he had strangled to death. A mother and her daughter used a chest of drawers as a fulcrum off which they hanged themselves, with one on each side of the drawers, using a single rope. Two lovers were found sitting at each end of the rope, using a single ligature, with a tree branch as an abutment. Each of these cases is discussed and reported along with a brief literature review. In a double hanging case, investigators should be cautious in determining the manner of death by distinguishing between a suicide pact from a homicide-suicide.

Sub-brow blepharoplasty for simultaneous correction of dermatochalasis with upper eyelid hooding and sunken eyelids

Periorbital dermatochalasis with upper eyelid hooding, brow ptosis, and sunken eyelids may appear with age. Because classic blepharoplasty is unable to correct all these issues, we developed a single operation, which we present herein, to correct dermatochalasis accompanied by sunken eyelids. This sub-brow approach is used with simultaneous browpexy by fixing the orbital portion of the orbicularis oculi muscle (OOM) to the periosteum immediately above the supraorbital rim using sutures with 3 or 4 points of fixation and correcting sunken eyelids by burying the elevated dermis, fat, and OOM after de-epithelization in the lower flap of the sunken upper eyelid along the submuscular plane. This method enables the correction of sunken eyelids during the same operation without requiring an additional procedure, and offers the advantages of a shortened operation time and decreased cost. The presence of sunken eyelids in patients with dermatochalasis and severe lateral hooding may be corrected by the procedure described herein, thereby achieving periorbital rejuvenation while maintaining the original shape of the eyes.

Anesthetic considerations for a patient with situs inversus totalis undergoing cardiac surgery: A case report

A 58-year-old male patient with situs inversus totalis, a rare congenital malformation characterized by all asymmetric organs being formed as the mirror images of their normal morphologies, underwent mitral valve repair due to mitral valve prolapse. This case was reported to suggest that anesthesiologists should thoroughly understand the anatomy of these types of patients before providing cardiac anesthesia that often requires advanced monitoring and rely on their accurate interpretation. Accordingly, a few key points will be discussed with emphasis on reversing lead placement during electrocardiogram monitoring, using the left internal jugular vein for pulmonary artery catheterization, and firmly comprehending mirror image heart morphology to better conduct transesophageal echocardiography.

Digital Videoscopic Retrograde Intrarenal Surgeries for Renal Stones: Time-to-Maximal Stone Length Ratio Analysis

PURPOSE: To investigate 100 consecutive cases of videoscopic retrograde intrarenal surgery (RIRS) by a single surgeon and to evaluate factors associated with stone-free status and the learning curve thereof. MATERIALS AND METHODS: We analyzed the results of videoscopic RIRS in 100 patients who underwent primary treatment for renal stones from January 2015 to August 2016. Videoscopic RIRS were performed with URF-V and URF-V2 flexible video uteroscopes (Olympus) or a Flex-Xc flexible ureterorenoscope (KARL STORZ). Non-contrast computed tomography was taken at 3 months postoperatively to confirm the absence of stones. The stone characteristics included the location, maximal stone length (MSL), stone heterogeneity index (SHI), and mean stone density (MSD). Fragmentation efficacy was calculated as operative time (min) divided by removed MSL (mm), and was evaluated in the sequential order of operations. RESULTS: The mean age of the total patient was 60.0±14.0 years. The mean MSL was 13.1±6.2 mm. The average MSD was 734.2±327.6 Hounsfield unit (HU) and the SHI was 241.0±120.0 HU. The mean operation time was 65.1±45.7 min considering each renal unit. The stone-free rate at 3 months post-surgery was 87%. The estimated cut-off of the time-to-MSL ratio below 5 min/mm was 50. Multivariate analyses indicated a lower MSD [odds ratio (OR): 0.998; 95% confidence interval (CI): 0.996–0.999; p=0.047) and the last 50 cases (OR: 5.408, 95% CI: 1.337–30.426; p=0.030) as independent predictors of stone-free status after videoscopic RIRS. CONCLUSION: Low MSDs and the last 50 cases were significant predictors of stone-free rate in videoscopic RIRS.

Cosmetic Lateral Canthal Lengthening with 2 Tarsal Bites Made in the Periosteum

Asian eyes may have a narrow palpebral fissure and an upward Mongolian slant that is sometimes perceived as an angry or unfavorable expression. Among the various methods of oculoplastic surgery, lateral canthoplasty can alter the structure of the eyes such that they appear much bigger, thereby conveying a more favorable expression. We performed a lateral canthoplasty in which the lower eyelid tarsus was fixed to the periosteum while the lateral canthus was moved downward and backward. Here, we describe the surgical procedure we used to perform this technique.

Cosmetic Lateral Canthal Lengthening with 2 Tarsal Bites Made in the Periosteum

Asian eyes may have a narrow palpebral fissure and an upward Mongolian slant that is sometimes perceived as an angry or unfavorable expression. Among the various methods of oculoplastic surgery, lateral canthoplasty can alter the structure of the eyes such that they appear much bigger, thereby conveying a more favorable expression. We performed a lateral canthoplasty in which the lower eyelid tarsus was fixed to the periosteum while the lateral canthus was moved downward and backward. Here, we describe the surgical procedure we used to perform this technique.

Basosquamous Carcinoma of the Hand in a Radiologist with Prolonged Radiation Exposure

Basosquamous carcinoma is a rare epithelial neoplasm, mostly occurring on the head and neck area. There are few reports of basosquamous carcinoma on the finger. Here, the authors experienced treatment of basosquamous carcinoma on the finger in a radiologist. Treatment was successful by the wide excision and the cross-finger flap operation with a split-thickness skin graft and K-wire fixation. The rare finger basosquamous carcinoma case in our study is likely to be linked with radiation. Considering of the high reliance of C-arm during hand surgeries, we think that the hand of the surgeons should be more strictly protected.

Split-Rib Cranioplasty Using a Patient-Specific Three-Dimensional Printing Model

No abstract available.

Split-Rib Cranioplasty Using a Patient-Specific Three-Dimensional Printing Model

No abstract available.

Pulmonary aspiration during anesthetic induction in a patient with laparoscopic adjustable gastric band: A case report

Recently, the number of laparoscopic adjustable gastric banding surgery is increasing as is the number of patients with morbid obesity rapidly. However, no anesthetic management including preoperative fasting strategy for patients with laparoscopic adjustable gastric banding exists. Hereby, we report a case of a 22-year-old woman with laparoscopic adjustable gastric banding who suffered pulmonary aspiration during the anesthetic induction for appendectomy, despite a preoperative fasting period longer than 14 h. This case strongly suggests that guidelines for anesthetic management including the appropriate fasting period for patients with laparoscopic adjustable gastric banding are desperately required.

Rare Giant Upper Lip Epidermal Cyst in a Patient Wearing a Denture

Epidermal cysts are intradermal or subcutaneous cystic tumors that frequently occur in the face, scalp, neck, and body trunk. Acquired cases of epidermal cyst commonly occur as a result of various surgical operations, chronic irritation, or trauma, all of which may trigger the occurrence of the invagination of squamous epithelium. A 57-year-old man presented with a palpable mass 7 cm×2 cm in size in the upper lip. The patient had a 3-year history of wearing a denture to restore missing bilateral maxillary central and lateral incisors, accompanied by inflammatory findings on the buccal mucosa due to chronic lip irritation. The resected oval-shaped cyst had a size of 5.5 cm×3.0 cm×2.5 cm, and it was an encapsulated mass with a well-defined margin. The histopathology was typical of epidermal cyst. This case of a rare giant upper lip epidermal cyst in a patient wearing a denture may be of interest to clinicians.

Effect of recruitment maneuver on arterial oxygenation in patients undergoing robot-assisted laparoscopic prostatectomy with intraoperative 15 cmH₂O positive end expiratory pressure / 대한마취과학회지

BACKGROUND: This randomized, controlled study was designed to compare the effects of recruitment maneuvers (RMs) with a 15 cmH₂O positive end-expiratory pressure (PEEP) on the systemic oxygenation and lung compliance of patients with healthy lungs following robot-assisted laparoscopic prostatectomy (RALP). METHODS: Sixty patients undergoing a RALP with an intraoperative 15 cmH₂O PEEP were randomly allocated to an RM or a Control group. The patients in the RM group received a single RM through the application of a continuous positive airway pressure of 40 cmH₂O for 40 s 15 min after being placed in the Trendelenburg position. The arterial oxygen tension (PaO₂, primary endpoint) and the pulmonary dynamic and static compliances (secondary endpoints) were measured 10 min after the anesthetic induction (T1), 10 min after establishment of the pneumoperitoneum (T2), 10 min after establishment of the Trendelenburg position (T3), 10 min after the RM (T4), 60 min after the RM (T5), and 10 min after deflation of the pneumoperitoneum in the supine position (T6). RESULTS: The intergroup comparisons of the PaO₂ showed significantly higher values in the RM group than in the Control group at T4 and T5 (193 ± 35 mmHg vs. 219 ± 33 mmHg, P = 0.015, 188 ± 41 mmHg vs. 214 ± 42 mmHg, P = 0.005, respectively). However, the PaO₂ at T6 was similar in the two groups (211 ± 39 mmHg vs. 224 ± 41 mmHg, P = 0.442). Moreover, there were no statistical differences between the groups in the dynamic and static compliances of the lungs at any time point. CONCLUSIONS: The arterial oxygenation of the patients with a healthy lung function who had undergone a RALP with intraoperative 15 cmH₂O PEEP was improved by a single RM. However, this benefit did not last long, and it did not lead to an amelioration of the lung mechanics.

Can intravenous patient-controlled analgesia be omitted in patients undergoing laparoscopic surgery for colorectal cancer?

PURPOSE: Opioid-based intravenous patient-controlled analgesia (IV-PCA) is a popular method of postoperative analgesia, but many patients suffer from PCA-related complications. We hypothesized that PCA was not essential in patients undergoing major abdominal surgery by minimal invasive approach. METHODS: Between February 2013 and August 2013, 297 patients undergoing laparoscopic surgery for colorectal cancer were included in this retrospective comparative study. The PCA group received conventional opioid-based PCA postoperatively, and the non-PCA group received intravenous anti-inflammatory drugs (Tramadol) as necessary. Patients reported their postoperative pain using a subjective visual analogue scale (VAS). The PCA-related adverse effects and frequency of rescue analgesia were evaluated, and the recovery rates were measured. RESULTS: Patients in the PCA group experienced less postoperative pain on days 4 and 5 after surgery than those in the non-PCA group (mean [SD] VAS: day 4, 6.2 [0.3] vs. 7.0 [0.3], P = 0.010; and day 5, 5.1 [0.2] vs. 5.5 [0.2], P = 0.030, respectively). Fewer patients in the non-PCA group required additional parenteral analgesia (41 of 93 patients vs. 53 of 75 patients, respectively), and none in the non-PCA group required rescue PCA postoperatively. The incidence of postoperative nausea and vomiting was significantly higher in the non-PCA group than in the PCA group (P < 0.001). The mean (range) length of hospital stay was shorter in the non-PCA group (7.9 [6-10] days vs. 8.7 [7-16] days, respectively, P = 0.03). CONCLUSION: Our Results suggest that IV-PCA may not be necessary in selected patients those who underwent minimal invasive surgery for colorectal cancer.

Detrimental complications due to improper antithrombotic management in the preoperative period: report of two cases / 대한마취과학회지

No abstract available.

Forearm extravasation injury during robot-assisted low anterior resection / 대한마취과학회지

No abstract available.

Forearm extravasation injury during robot-assisted low anterior resection / 대한마취과학회지

No abstract available.

Massive hemothorax immediately after removal of central venous catheter: A case report / 대한마취과학회지

Hemothorax is a possible immediate complication of central venous catheterization. We experienced a patient who suffered from massive hemothorax 72 hours after right subclavian venous catheterization. A 29-year-old female patient with Marfan's syndrome underwent the Bentall's operation and aortic arch replacement with an artificial graft, which was performed uneventfully. She recovered favorably in the intensive care unit and was transferred to the general ward on postoperative day 3. Immediately after the removal of the catheter in the general ward, massive hemothorax developed and emergent thoracotomy should have been performed to control bleeding. We report this case to re-emphasize the careful monitoring even after removal of central venous catheter and the need for ultrasound guidance during insertion of central venous catheters.

The adsorption of inspired desflurane due to incorrectly mounted air dryer filter of the heated humidifier: A case report

Heated humidifiers are used to prevent respiratory complications associated with mechanical ventilation with an endotracheal tube. One of the heated humidifiers uses an air dryer filter in order to remove humidity from air before it enters the anesthetic machine. We report a case in which the air dryer filter was unintentionally misconnected to the inspiratory limb of the circuit, which caused insufficient volatile anesthetic concentration during anesthesia induction.

Efficacy of dexamethasone added to ramosetron for preventing postoperative nausea and vomiting in highly susceptible patients following spine surgery / 대한마취과학회지

BACKGROUND: Opioid-based patient controlled analgesia (PCA) provides adequate pain control following spinal surgeries at the expense of increased risk of postoperative nausea and vomiting (PONV). We evaluated the efficacy of dexamethasone added to ramosetron, which is a newly developed five-hydroxytryptamine receptor 3 antagonist with a higher receptor affinity and longer action duration compared to its congeners, on preventing PONV in highly susceptible patients receiving opioid-based IV PCA after spinal surgery. METHODS: One hundred nonsmoking female patients undergoing spinal surgery were randomly allocated to either a ramosetron group (group R) or a ramosetron plus dexamethasone group (group RD)., Normal saline (1 ml) or 5 mg of dexamethasone was injected before anesthetic induction, while at the end of the surgery, ramosetron (0.3 mg) was administered to all patients and fentanyl-based IV PCA was continued for 48 hrs. The incidence and severity of PONV, pain score and the amount of rescue antiemetics were assessed for 48 hours after surgery. RESULTS: The number of patients with moderate to severe nausea (20 vs. 10, P = 0.029), and overall incidence of vomiting (13 vs. 5, P = 0.037) were significantly lower in the group RD than in the group R, respectively. Rescue antiemetic was used less in the RD group without significance. CONCLUSIONS: Combination of ramosetron and dexamethasone significantly reduced the incidence of moderate to severe nausea and vomiting compared to ramosetron alone in highly susceptible patients receiving opioid-based IV PCA after surgery.