Application of the left side hepatic parenchymal transection-first approach in laparoscopic central tumor anatomical hepatectomy / 中华消化外科杂志

Acting as a difficult and high risk procedure in the operation, laparoscopic central tumor anatomical hepatectomy possesses various technical points that shall be noted in the process of application. The choice of laparoscopic approach has been recognized to be one of the key technical links for this technique. According to the anatomical characteristics of the middle lobe of liver and "Easy first" strategy, the authors summarize the laparoscopic central tumor anatomical hepatectomy technology with left side hepatic parenchymal transection-first approach. The left side hepatic parenchymal transection-first approach is found to be simple, fast, safe and effective in operation, which overcomes the challenges of complicated target Glisson pedicle operation and high technical risk of laparoscopic anatomical hepatectomy. The approach also better complies with the "no-touch" principle for malignant tumors. Significantly, it exhibits clinical application value in laparoscopic central tumor anatomical hepatectomy.

Early and long-term outcomes after left-side heart valve replacement and tricuspid valve replacement in rheumatic patients / 中华胸心血管外科杂志

Objective:To evaluate and compare the early and long-term outcomes of rheumatic patients who underwent left-side heart valve replacement with concomitant tricuspid valve replacement, and analyze the difference of early mortality and long-term survival rate between mild pulmonary artery systolic pressure (PASP) and moderate to severe PASP patients.Methods:From January 2009 to December 2018, 79 cases of patients were reviewed and summarized. The mean age before operation was (45.7±7.8) years old. These patients were divided into mild PASP group(<50 mmHg, 38 cases) (1 mmHg=0.133 kPa) and moderate-severe PASP group (>50 mmHg, 41 cases) . Kaplan- Meier method was used to estimate the overall long-term survival rate and the incidence of complications, and to compare the long-term survival rate of patients with mild and moderate -severe PASP elevation. Results:The mortality rate of early postoperative patients was 8.9% (7/79). The causes of death included: low cardiac output syndrome in 3 cases, multiple organ failure caused by pulmonary infection in 2 cases, acute renal insufficiency in 1 case, sudden cardiac arrest in 1 case. Although the mortality rate of early moderate-severe PASP group (12.2% vs. 5.3%) was higher than that of mild PASP group, there was no significant difference ( P>0.05). The mean follow-up time was (51.8±31.7) months (3-115 months). Kaplan- Meier method was used to estimate the 10-year survival rate, the rate of avoiding thrombosis, the rate of avoiding serious bleeding event and the rate of avoiding reoperation, which were (67.2±10.6)%, (85.7±6.2)%, (83.4± 6.9)% and (93.7 ± 3.7)%, respectively. Although the long-term survival rate of mild PASP (78.0±10.6) % was higher than that of moderate-severe PASP (62.8 ± 13.4) %, there was no significant difference ( P>0.05). Conclusion:The early mortality rate of rheumatic patients who underwent left-side heart valve replacement with concomitant tricuspid valve replacement is still relatively high. The recurrent heart failure is the major causes of long-term death.

Endovascular Treatment in the Subclavian Steal Syndrome: Series of 29 Patients

Subclavian steal syndrome is a group of symptoms resulting fromretrograde flow in the vertebral artery, "stealing" blood from the posterior intracranial circulation and other territories, caused by stenosis or occlusion of the subclavian artery proximal to the origin of the same vertebral artery, or even of the brachiocephalic trunk. Most of the time, it is an incidental finding in patients with other conditions or cerebrovascular risk factors. We report a series of 29 patients with an angiographic diagnosis, in which 7 received treatment (all endovascular), all with symptoms directly related to this condition. Advanced age, systemic arterial hypertension, diabetes mellitus, smoking and stroke were comorbidities frequently related. Six patients improved completely after the procedure and one remained with vertigo.

Supervivencia a los cinco años en pacientes con valvulopatías izquierdas operados de cirugía cardíaca valvular / Five-year survival of patients with left-side heart valve disease who underwent heart valve surgery

RESUMEN Introducción: La supervivencia a mediano y largo plazo es un parámetro necesario para evaluar los resultados de la cirugía valvular cardíaca. Objetivos: Determinar la supervivencia a los cinco años de los pacientes operados de cirugía cardíaca valvular aórtica, mitral o ambas, y las variables que pueden pronosticar de manera independiente una peor sobrevida en el seguimiento. Método: Se realizó un estudio de cohorte que evaluó a los 139 pacientes operados de cirugía cardíaca valvular en el trienio 2010-2012, en el Instituto de Cardiología y Cirugía Cardiovascular de La Habana, Cuba, y que fueron egresados vivos del postoperatorio, hasta un período de cinco años posteriores a la intervención. Se realizó una curva de Kaplan Meier para determinar la supervivencia al final del seguimiento, así como un análisis multivariable de Cox para determinar las variables que se asociaron a una menor supervivencia. El nivel de significación estadística empleado fue p<0,05. Resultados: La muestra resultó homogénea según las variables clínicas y demográficas. La supervivencia al término del seguimiento, que tuvo una media de 5,8 años, fue de un 93%. El incremento de la edad (HR=1,15; p=0,001) y el haber sufrido bajo gasto cardíaco durante el perioperatorio (HR=3,54; p=0,037) se asociaron de manera independiente a una peor sobrevida en el seguimiento. Conclusiones: La supervivencia de los pacientes al concluir el seguimiento fue elevada. El incremento de la edad y el bajo gasto cardíaco perioperatorio fueron las variables asociadas de manera independiente a una menor sobrevida.

ABSTRACT Introduction: The mid and long term survival rate is a necessary parameter to evaluate the outcomes of heart valve surgery. Objectives: To determine the five-year survival of patients who underwent aortic and/or mitral valve surgery, and the variables that could independently predict a lower survival in the follow-up. Method: A cohort study was conducted for evaluating 139 patients who underwent a heart valve surgery, in the period 2010-2012, at the Instituto de Cardiología y Cirugía Cardiovascular of Havana, Cuba, all of which survived the postoperative period, and were followed up to five years after the surgery. A Kaplan-Meier curve was performed to determine the survival after surgery. Also, a multivariate Cox regression was carried out to determine the variables that were independently associated with a lower survival rate. The statistical significance level used was p<0.05. Results: The sample was homogeneous according to clinical and demographic variables. The overall survival rate was 93% at the end of the study, with a mean follow up of 5.8 years. The older age (HR=1.15; p=0.001) and the history of perioperative low cardiac output syndrome (HR= 3.54; p=0.037) were the variables independently associated to lower survival in the follow-up. Conclusions: The patients' survival when concluded the follow-up was high. The older age and the perioperative low cardiac output syndrome were the variables independently associated to lower survival.

Pseudocyst of pinna: a clinical experience

Background: Pseudocyst of pinna is an intracartilagenous accumulation of fluid in pinna and is hardly encountered in routine ENT practice. The etiology is unclear. It is seen to affect most commonly middle-aged males. Medical treatment is ineffective. Various treatments are suggested in the literature. The aims of the paper were to study the clinical and demographic characteristic of patients with pseudocysts.Methods: Forty patients were diagnosed with pseudocyst of the auricle between July 2016 and July 2019 on the basis of clinical characteristics, colour of aspirated fluid and absence of infection. Clinical and demographic characteristics were noted.Results: Out of 40 patients only five were females. Involvement of left side was seen more than right one. None had bilateral involvement. Adults in the age group of 31-45 were commonly affected. Most common site of involvement was triangular fossa.Conclusions: Pseudocyst of the pinna is a benign condition characterized by intracartilagenous accumulation of fluid. The disease is seen commonly unilaterally in middle aged males. Many modalities of treatment have been recommended in the literature with varied recurrence and failure rates.

Increased Prevalence of Left-sided Skin Cancer: A Systematic Review and Meta-analysis / 대한피부과학회지

BACKGROUND: Based on trends demonstrated in the United States, a very insignificant number of people have shown a predisposition to left-sided skin cancer. However, to date, no systematic review or meta-analysis has demonstrated the predominance of left-sided skin cancers over right-sided skin malignancies. OBJECTIVE: We systematically reviewed and meta-analyzed all data pertaining to locations of skin cancers. METHODS: All data were pooled using the Mantel-Haenszel method (random-effects weighting); an inverse variance model featuring fixed-effects weighting was applied to explore the robustness of modeling. Heterogeneity was evaluated using the I2 test. Dichotomous outcomes with respect to the prevalence of left- and right-sided skin cancers are presented as relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Nine studies were included in our evaluation. Our study sample included: 182,840 patients with malignant melanoma (MM), 1,419 patients with basal cell carcinoma (BCC), and 331 patients with squamous cell carcinoma (SCC). Meta-analyses of pooled observational data revealed greater prevalence of left-sided MM compared to right-sided MM (RR 0.91, 95% CI 0.89~0.92, p<0.01), while left-sided SCC was more prevalent than right-sided SCC (RR 0.83, 95% CI 0.71~0.97, p=0.02). However, right-sided BCC was more prevalent than left-sided BCC (RR 1.07, 95% CI 0.95~1.19, p=0.26). CONCLUSION: Observational studies vary greatly in terms of design, methodological quality, and types of patients studied. Of note, only a few studies analyzing BCC and SCC were included in our present meta-analysis. Additionally, a selection and reporting bias could have affected our results. Our meta-analysis suggests that both MM and SCC demonstrate a left-side bias, but BCC does not.

Increased Prevalence of Left-sided Skin Cancer: A Systematic Review and Meta-analysis / 대한피부과학회지

BACKGROUND: Based on trends demonstrated in the United States, a very insignificant number of people have shown a predisposition to left-sided skin cancer. However, to date, no systematic review or meta-analysis has demonstrated the predominance of left-sided skin cancers over right-sided skin malignancies. OBJECTIVE: We systematically reviewed and meta-analyzed all data pertaining to locations of skin cancers. METHODS: All data were pooled using the Mantel-Haenszel method (random-effects weighting); an inverse variance model featuring fixed-effects weighting was applied to explore the robustness of modeling. Heterogeneity was evaluated using the I2 test. Dichotomous outcomes with respect to the prevalence of left- and right-sided skin cancers are presented as relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: Nine studies were included in our evaluation. Our study sample included: 182,840 patients with malignant melanoma (MM), 1,419 patients with basal cell carcinoma (BCC), and 331 patients with squamous cell carcinoma (SCC). Meta-analyses of pooled observational data revealed greater prevalence of left-sided MM compared to right-sided MM (RR 0.91, 95% CI 0.89~0.92, p<0.01), while left-sided SCC was more prevalent than right-sided SCC (RR 0.83, 95% CI 0.71~0.97, p=0.02). However, right-sided BCC was more prevalent than left-sided BCC (RR 1.07, 95% CI 0.95~1.19, p=0.26). CONCLUSION: Observational studies vary greatly in terms of design, methodological quality, and types of patients studied. Of note, only a few studies analyzing BCC and SCC were included in our present meta-analysis. Additionally, a selection and reporting bias could have affected our results. Our meta-analysis suggests that both MM and SCC demonstrate a left-side bias, but BCC does not.

Continuous and long term measurement of reticuloruminal pH in crossbreed dairy cows in Brazil by an indwelling and wireless data transmitting unit / Medidas contínuas e de longo prazo do pH retículo-ruminal em vacas leiteiras brasileiras por meio de uma unidade interna de transmissão de dados sem fio

O objetivo do presente experimento foi medir continuamente valores de pH e temperatura em vacas leiteiras usando uma unidade interna de transmissão de dados sem fio. Valores de pH retículo-ruminais foram medidos automaticamente a cada 600 segundos por um período de 50 dias em três vacas leiteiras Holandesas, no pós-parto recente. Valores de pH retículo-ruminais médios diferiram (P<0,05) entre as três vacas (5,69±0,20; 6,10±0,18; 5,99±0,15), assim como o tempo em minutos por dia (332; 23; 18) mantido abaixo de pH 5,5. A variação diurna de pH nas vacas 2 e 3 demonstrou um padrão circadiano e frequente, como consequência dos momentos de fornecimento da alimentação e da ingestão alimentar, respectivamente. Esse padrão diário não pode ser observado no padrão de pH da vaca 1. Os picos e os valores baixos de pH na vaca 1 eram aleatórios, sem relação evidente com os momentos de alimentação, e as amplitudes de pH eram igualmente desordenadas. O valor de pH retículo-ruminal permaneceu anormalmente baixo nesta vaca durante todo o período de observação, caracterizando uma acidose ruminal subaguda. A temperatura retículo-ruminal da vaca 1 foi mais baixa (38.8°C; 39.1°C; 39.0°C) e ela bebeu mais frequentemente por dia (9,5; 6,4; 7,0) quando comparada com as vacas 2 e 3 (P<0,05). O exame clínico revelou um deslocamento de abomaso à esquerda (DAE). Pela literatura consultada, este é o primeiro relato indicando um padrão de pH e temperatura em uma vaca com DAE.(AU)

pidemiologic study of 80 patients with ulcerative colitis referred to Imam Hospital in Ardabil city during 2004-2011.

Background: Ulcerative colitis is one of the inflammatory bowel diseases with unknown etiology. Genetic and environmental factors are thought to be effective in this disease. The aim of this study is to assessment of demographic features and clinical symptoms of ulcerative colitis patients refereed to Emam hospital in Ardabil city. Methods: In this retrospective cross-sectional study, 80 cases of ulcerative colitis referred to Emam hospital in Ardabil city were evaluated during 2004-2011. The diagnosis was confirmed based on clinical features, colonoscopy, and pathology and resulting of other causes. Data were collected through direct interview and analyzed by statistical method in SPSS software. Results: Mean age of patients was 36.4 (SD=18.4). Duration of symptoms onset until diagnosis was 8 months. Male to female ratio was 0.8/1. 38(47.5%) of patients were male and 42 (52.5%) were female. 3 (3.75%) of patients have history of positive UC and 4 (5%) history of appendectomy. According to colonoscopy finding, 1 (1.25%) have rectum involvement, 27 (33.75%) recto sigmoid, 23 (28.75%) left side colon and 4 (5%) have pan colitis. Conclusion: Results showed that in compare with other places, clinical signs of ulcerative colitis in Ardabil province are different and so doing other d epidemiologic studies based on population to determine incidence and prevalence ulcerative colitis in Ardabil province is necessary.

The Effectiveness of Left Side Pericardiotomy in Off-Pump Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

In off-pump coronary artery bypass grafting (OPCAB), adequate exposure under stable hemodynamic condition is mandatory. We introduced left side pericardiotomy to expose the left anterior descending artery without lifting up the ventricle in 2008. With this pericardiotomy approach, the exposure of the circumflex and right coronary artery territory became easier and OPCAB with left side pericardiotomy was compared with OPCAB with midline pericardiotomy. From 2004 to 2011, 194 elective first time coronary artery bypass grafting (CABG) were performed in our hospital. Before 2008, 62 patients underwent OPCAB with midline pericardiotomy which constituted 61% of the CABG in that period. After 2008, the pericardium was dissected on the left side and a small pericadiotomy was made on the left side of the main pulmonary artery. This incision was then extended to the apex. With this pericardiotomy, only two patients underwent CABG with cardiopulmonary bypass (one patient with 15% left ventricle ejection fraction and one more patient who developed acute coronary syndrome during anesthesia induction). Thus 91 out of 93 patients underwent OPCAB (98%) (Group L). In Group L, old myocardial infarction and unstable angina patients were frequent. The frequency of the patients with left ventricular ejection fraction less than 40% tended to be more in Group L. The operation time was significantly shorter in Group L (Group M 305±71 min, Group L 223±54, <i>p</i><0.0001) and the number of distal anastomoses number was significantly more in Group L (Group M 2.3±0.7, Group L 2.8±1.0, <i>p</i><0.0001). Blood pressure during left circumflex coronary artery and right coronary artery anastomosis was significantly higher in Group L, and even continuous dopamine infusion requirement was significantly less in Group L (92% in Group M, 13% in Group L, <i>p</i><0.001) among the patients with left ventricle ejection fraction less than 60%. There was only 1 hospital death in Group M. Postoperative maximum CK-MB was significantly lower in Group L (Group M 48±107 IU/<i>l</i>, Group L 13±16 IU/<i>l</i>, <i>p</i>=0.005) and the patients with CK-MB more than 12 IU/<i>l </i>was significantly frequent in Group M (Group M 73%, Group L 33%, <i>p</i><0.0001). Postoperative ICU and hospital stay period was significantly shorter in Group L (ICU stay : Group M 3.4±2.3 days, Group L 2.0±1.4 days, <i>p</i><0.0001, hospital stay : Group M 27±21 days, Group L 16±7 days, <i>p</i><0.0001). The patency of the graft to the left anterior descending artery did not differ significantly (Group M 94%, Group L 99%), however the patencies of the grafts to left circumflex artery and right coronary artery were significantly better in Group L (left circumflex artery : Group M 75%, Group L 98%, <i>p</i>=0.001, right coronary artery : Group M 81%, Group L 98%, <i>p</i>=0.014). Left side pericardiotomy seemed to be useful because OPCAB with left side pericardiotomy yielded shorter operation time, less myocardial enzyme release, improved postoperative recovery and better patency of graft to the left circumflex and right coronary artery.

Increased Left Side Prevalence of Head and Neck Skin Cancers / 대한피부과학회지

BACKGROUND: Several studies have shown an increase in skin cancers on the left side of the face. But such studies have not been conducted in Korean patients. OBJECTIVE: In this study, we analyzed the prevalence of left or right sided skin cancers in head and neck areas. METHODS: We retrospectively included 384 head and neck skin cancers (Basal cell carcinoma, Squamous cell carcinoma, Bowen disease, Malignant melanoma) diagnosed at our center from January 1995 to February 2011. Location, age, and sex were recorded and analyzed. RESULTS: All types of skin cancers occurred more on the left (54.17%) than on the right (45.83%) (p=0.051), with no stronger trend in men. CONCLUSION: There are more skin cancers on the left than the right side in Korean patients. But further study is needed because of the small patient population studied.

Clinical Significance of Subtotal or Total Colectomy in Obstructing Left Side Colon Cancer

PURPOSE: Although the cancer of the right side colon is usually managed by primary anastomosis following resection, but the optimal management of obstructing left side colon cancer is controversial. So, we performed this study to evaluate the feasibility and safety of subtotal or total colectomy as a method of one-stage operation in malignant obstruction of left side colon. METHODS: We analyzed retrospectively 35 patients with obstructing left side colon cancer among 74 cases of obstructing colorectal carcinoma who were treated surgically at the Wallace Memorial Baptist Hospital from January 1989 to December 1998. RESULTS: One-stage operation was performed in 16 patients (subtotal colectomy in 13, total colectomy in 3). Staged operation was performed in 15 patients (two-stage operation in 10, three-stage operation in 5). Palliative colostomy was performed in 4 patients. Postoperative complications had been developed in 6 patients (37.5%) with subtotal or total colectomy group and in 7 patients (46.7%) with staged operation group. The postoperative frequent bowel movement was shown in 13 patients (81.2%) with subtotal or total colectomy group and in 7 patients (70.0%) with staged operation group. Frequent bowel movement was improved with antidiarrheal medications within 3 months. Operative mortality was 6.3% (1 patient) in subtotal or total colectomy group and 13.3% (2 patients) in staged operation group. There was no significant difference in morbidity and mortality statistically between two groups. CONCLUSIONS: We believe that subtotal or total colectomy as a method of one-stage operation can be performed with acceptable morbidity and mortality in selected patients with obstructing left side colon cancer.

Role of Coronary Sinus Electrode Catheter in Catheter Ablation of the Left-side Atrioventricular Accessory Pathways

BACKGROUND: Coronary sinus(CS) electrode catheter has been used ad a very useful mapping and guiding tool in catheter ablation of the left-side atrioventricular pathway(AP). Recently, it was reporter that single catheter approach of catheter ablation of the manifest left-side AP was feaside with a comparable success rate but shorter fluoroscopy time, compared with the standard approach. This study was performed to evaluate the role of CS electrode catheter in catheter avlation of the lefr-side AP. SUBJECTS AND METHODS: Sixty-five consecutive patients(43 men, 22 women) with a single left-side AP were included in this study. The first 32 patients underwent catheter ablation with an eletrode catheter in CS(CS+ group: 19 men, 13 women: 42.3+/- 14.6 years) and the later 33 patients with no electrode catheter in CS(CS- group: 24 men, 9 women: 38.8+/- 14.1 years). APs were localized by mapping the CS in CS+ group or by mapping the mitral valve annulus in CS- group with a 4mm-tipped deflectable catheter(7F, Webster or EPT). Radiofrequency energy(RF) was delivered unipolarly at a fixed power of 30-50 volts or 30-60 seconds. AP location, succes rate, number of RF applications, fluoroscopy time, and complications were compared between 2 group. RESULTS: APs were located at the left posteroseptal wall in 2(6.2%), left posterior wall in 5(15.5%), left posterolateral wall in 3(9.3%), left lateral wall in 18(56.3%), left anterolateral wall in 4(12.5%) in CS+ group. In CS- group, there were 6(18.2%) left posteroseptal, 2(6.1%) left posterior, 5(15.2%) left posterolateral, 12(36.4%) left lateral, 8(24.2%) left anterolateral AP with no significant difference in the distribution of the APs between 2 groups. The proportions of concealed and manifest APs wrer similar in 2 groups(17/15 vs. 19/14). Twenty-eight(87.5%) of 32 APs in CS+ group and 30(90.9%) of 33 APs in CS- group were successfully ablated showing no signigicant difference in the succes rates between 2 groups. The numbers of RF applications to ablate the APs were similar between 2 groups(3.9+/-3.4 vs. 3.5+/-2.9). Total fluoroscopy times wrer also similar between 2 groups(54.3+/-33.5 minutes vs. 47.2+/-21.4 minutes). There were no major conplications in both groups. CONCLUSIONS: Radiofrequency catheter ablation of the left-side APs may be successfully performed without using a CS electrode catheter as a guide in diagmosing and localizing left-side APs.

A Case of Horseshoe Kidney Associated with Left Side Ureteral Stone / 대한비뇨기과학회지

A 24-year-old Korean soldier was found to have horseshoe kidney with left ureter stone. The diagnosis was made radiographically. Considering the rarity of this disorder, we decided to report this case. According to the literature. horseshoe kidney was described by Berengeri da Carpi for the first time in 1552. After Allen, the ratio of incidence of the horseshoe kidney is approximately 0.25% of the general population. Its etiology, incidence, complication, diagnosis and treatment was discussed. Recent related literatures were reviewed.