ABSTRACT
BACKGROUND: Mediastinoscopic surgery for esophageal cancer facilitates early postoperative recovery. However, it can occasionally cause serious complications. Here, we present the case of a patient with a tracheal injury diagnosed by a sudden increase in end-tidal carbon dioxide (EtCO2) during mediastinoscopic subtotal esophagectomy. CASE PRESENTATION: A 52-year-old man diagnosed with esophageal cancer was scheduled to undergo mediastinoscopic subtotal esophagectomy. During the mediastinoscopic procedure, the EtCO2 level suddenly increased above 200 mmHg, and the blood pressure dropped below 80 mmHg. We immediately asked the operator to stop insufflation and found a tracheal injury on the right side of the trachea near the carina by bronchoscopy. The endotracheal tube was replaced with a double-lumen tube, and the trachea was repaired via right thoracotomy. There were no further intraoperative complications. After surgery, the patient was extubated and admitted to the intensive care unit. CONCLUSIONS: Monitoring EtCO2 levels and close communication with the operator is important for safely managing sudden tracheal injury during mediastinoscopic esophagectomy.
ABSTRACT
Based on the obesity paradox, people with a normal body mass index (BMI) may have a higher risk of mortality than those with a BMI that falls within the obese range. Despite the availability of other anthropometric measures, obesity is commonly evaluated based on BMI. A body shape index (ABSI) and body roundness index (BRI) have recently been proposed as new anthropometric measures that are calculated with height, weight, and waist circumference. This study investigated the associations between the traditional and new body composition indices and arterial stiffness using the brachial-ankle pulse wave velocity (baPWV). Overall, 3512 individuals (1228 men and 2284 women) were enrolled and were divided into two groups according to BMI. Multiple regression analysis was performed to assess the relationship between baPWV and body composition. baPWV was significantly associated with ABSI (ß = 0.087, p = 0.002), visceral adipose tissue (VAT; ß = 0.081, p = 0.002), and the visceral/subcutaneous adipose tissue (VAT/SAT) ratio (ß = 0.108, p < 0.001) in non-obese men. In non-obese women, baPWV was significantly associated with several variables but not the VAT/SAT ratio. Similarly, baPWV was significantly associated with BMI (ß = 0.103, p = 0.038), BRI (ß = 0.104, p = 0.036), VAT (ß = 0.167, p = 0.001), and the VAT/SAT ratio (ß = 0.106, p = 0.028) in obese women. ABSI can be used with high accuracy to evaluate fat distribution in non-obese men to predict arterial stiffness. However, the BRI should be used in addition to BMI to assess the body composition of women more accurately. ABSI and the BRI can be used to identify predictors of vascular remodeling or organic vascular dysfunction.
