Time to symptom onset and manual reduction outcomes as predictors of bowel viability in incarcerated obturator hernias.

The current study aimed to identify the indications for manual reduction in incarcerated obturator hernias (OH). Further, whether time to symptom onset and manual reduction outcomes can be predictors of bowel viability and the need for bowel resection in incarcerated OH were examined. This retrospective study included 26 patients with incarcerated OH who underwent surgery. All patients underwent manual reduction, and computed tomography scan after manual reduction confirmed hernia release. Multivariate analyses were performed to determine the predictors of bowel resection. The bowel resection group had a significantly longer average time to symptom onset than the nonbowel resection group (88 vs 36 h). Further, the bowel resection group was more likely to have failed manual reduction than the nonbowel resection group. A time to symptom onset of ≥ 72 h and failed manual reduction were significant predictors of bowel viability. Age, sex, hernia localization, American Society of Anesthesiologists physical status score, and laboratory findings did not differ significantly between the bowel resection and nonbowel resection groups. Time to symptom onset and manual reduction outcomes are significant predictors of bowel viability in incarcerated OH. Patients with a time to symptom onset of ≥ 72 h and failed manual reduction require surgical evaluation due to a high risk of bowel nonviability. Therefore, a cautious approach is required in the management of OH, and further research on optimized treatment protocols should be conducted.

Manual reduction for incarcerated obturator hernia.

Emergent surgery is a common approach for incarcerated obturator hernias, with high morbidity and mortality rates. Moreover, there have been reports of elective surgery cases after noninvasive manual reduction. For a decade, the initial approach in our institution is also manual reduction unless bowel viability is poor. This study aimed to clarify the efficacy and safety of manual reduction followed by elective surgery. We retrospectively reviewed 50 cases of incarcerated obturator hernia from 2010 to 2022 at Iwate Prefectural Iwai Hospital. Manual reduction was attempted in 31 (62%) patients. The reduction was successful in 21 (42%) patients, and most of them received mesh repair using the extraperitoneal approach as elective surgery. However, two patients underwent emergent surgery in the waiting period because of late-onset constriction and a small bowel perforation. Patients with irreducible hernia underwent emergent surgery, except for two patients who received the best supportive care. Postoperative complications were observed in 5% and 22% of reducible and irreducible cases, respectively. Postoperative mortality was zero in both groups. Manual reduction is useful in some cases, but careful observation is needed because late-onset constriction and perforation could occur.

Reconstructed gastric conduit obstruction caused by a bezoar after esophagectomy: a case report.

BACKGROUND: Bezoars are rare but may cause gastrointestinal obstruction and ulcers. To the best of our knowledge, only two cases of bezoars in the reconstructed gastric conduit have been reported, but there has been no report on reconstructed gastric conduit obstruction due to bezoars. CASE PRESENTATION: A 60-year-old man presented to our clinic with abdominal pain and vomiting that occurred suddenly after dinner. Three years before presentation, he had undergone radical thoracoscopic esophagectomy followed by reconstruction of the gastric conduit through the posterior sternum, for esophageal cancer. Enhanced computed tomography scans showed distension of only the gastric conduit without ischemia and distension of the small intestine. According to our findings, we initially diagnosed the patient with postoperative intestinal obstruction caused by adhesions. After conservative treatment failed, the patient underwent an endoscopic study that showed a bezoar at the pylorus ring. We initially failed to remove the bezoar endoscopically because of its large size; hence, we attempted enzymatic dissolution. Three days after the first endoscopic study, the bezoar was disintegrated using a snare and extracted during a second endoscopy. The patient recovered uneventfully and presented with no complications during the 1-year follow-up interval. CONCLUSION: In cases wherein the discharge of materials in the reconstructed gastric conduit is delayed, bezoars should be considered in the differential diagnosis, and an endoscopic study should be performed to verify the cause of obstruction.

Quantitative analyses of amount and localization of radiosensitizer gold nanoparticles interacting with cancer cells to optimize radiation therapy.

Previous studies showed that gold nanoparticles (AuNPs) are useful radiosensitizers which optimize radiation therapy under low-dose radiation. However, the mechanisms of AuNP radiosensitization, including the amount and localization of the AuNPs interacting with cancer cells, has not yet been quantified. To answer these questions, we prepared AuNPs conjugated with anti-human epidermal growth factor receptor type 2 (HER2) antibody via polyethylene glycol (PEG) chains (AuNP-PEG-HER2ab). AuNP-PEG-HER2ab specifically bound to the HER2-expressing cancer cells and entered the cells via endocytosis. Whether endocytosis of AuNP-PEG-HER2ab occurred had no effect on radiosensitization efficacy by AuNP-PEG-HER2ab in vitro. The radiosensitization efficacy in vitro depended on dose of AuNP-PEG-HER2ab or dose of X-ray. Moreover, AuNP-PEG-HER2ab administrated into tumor-bearing mice was localized to both the periphery of the tumor tissue and near the nuclei in cancer cells in tumor deep tissue. The localization of AuNP-PEG-HER2ab in tumor tissues was important factors for in vivo powerful radiosensitization efficacy.

Esophageal cancer with severe funnel chest treated by simultaneous funnel chest surgery and thoracoscopic esophagectomy: a case report.

BACKGROUND: Funnel chest is the most common chest deformity, occurring in 0.06-0.3% of the general population. When it occurs concomitantly with esophageal cancer, it hinders intrathoracic surgery that is necessary for treatment. Although there are a few reports of esophagectomy performed in patients with funnel chest, simultaneous treatment of esophageal cancer and funnel chest with funnel chest surgery (Nuss method) and esophagectomy has not been reported. We report the first case of advanced esophageal cancer complicated by severe funnel chest that was treated using the Nuss method and radical thoracoscopic esophagectomy. CASE PRESENTATION: A 59-year-old man was diagnosed with advanced thoracic esophageal cancer and severe funnel chest. Because his sternum was almost attached to the vertebral bone, thereby creating a narrow space in the mediastinum, esophageal surgery was expected to be complicated. After the patient underwent neoadjuvant chemotherapy, we used the Nuss method to reconstruct the chest and widen the mediastinum. Subsequently, radical thoracoscopic esophagectomy was performed with the patient in the left decubitus position without any difficulty, and the postoperative course was uneventful. CONCLUSION: Simultaneous funnel chest surgery (Nuss method) and thoracoscopic esophagectomy with the patient in the left decubitus position are recommended for esophageal cancer patients with severe funnel chest.

Fabrication of silica-coated gold nanorods and investigation of their property of photothermal conversion.

This study described the preparation of silica-coated Au nanorods (AuNR/SiO2) in a colloidal solution, assessed their property of photothermal conversion, and investigated their ability to kill cancer cells using photothermal conversion. Au-seed nanoparticles were produced by reducing hydrogen tetrachloroaurate (HAuCl4) with sodium borohydride (NaBH4) in aqueous n-hexadecyltrimethylammonium bromide (CTAB) solution. AuNRs were then fabricated by reducing HAuCl4 and silver nitrate (AgNO3) with l-ascorbic acid in the aqueous CTAB solution in the presence of Au-seed nanoparticles. The as-prepared AuNRs were washed by a process composed mainly of centrifugation to remove the CTAB. The washed AuNRs were coated with silica by mixing the AuNR colloidal solution, an aqueous solution of (3-aminopropyl)trimethoxysilane, and tetraethylorthosilicate/ethanol solution with a water/ethanol solution. We found that the addition of AuNR/SiO2 in water, in mice, and in a culture medium with cancer cells, followed by irradiation with a laser, cause an increase in temperature, demonstrating that AuNR/SiO2 have the ability of photothermal conversion. In addition, the cancer cells in the culture medium were found to be killed due to the increase in temperature caused by the photothermal conversion.

[A Case of Recurrent Spontaneous Pneumomediastinum with Anorexia Nervosa].

In the present case, the subject was a 31-year-old woman with obesophobia who restricted her energy intake and repeatedly induced vomiting and misused laxatives after binge eating, which caused a sudden weight loss of 29 kg in approximately 5 months. In January 20XX, the subject was first examined as an outpatient at our psychiatric department at the recommendation of her eldest son. Upon diagnosis of anorexia nervosa, the subject underwent outpatient treatment ; however, there was no improvement in the disturbance in self-per- ceived weight or shape, and the subject voiced her desire to lose weight. In May 20XX, the subject complained of chest pain, pharyngeal pain, and respiratory distress after self-induced vomiting and was, thus, examined at the psychiatric outpatient services. Chest X-ray and chest CT revealed pneumomediastinum and subcutaneous emphysema. Spontaneous oesophageal rupture, a fatal condition, was suspected and, therefore, the subject was transferred to a more advanced medical institution capable of esophageal surgery. After admission, spontane- ous oesophageal rupture was ruled out based on the results of upper gastrointestinal endos- copy with esophagography, and spontaneous pneumomediastinum was diagnosed. The pneu- momediastinum disappeared with conservative treatment ; however, after approximately 8 months, spontaneous pneumomediastinum recurred, following self-induced vomiting. For patients with eating disorders and who are involved in self-induce vomiting, we believe that the vomiting can cause pneumomediastinum, and it is assumed that continuation or recommencement of vomiting can potentially increase the risk that pneumomediastinum will recur. We, therefore, report recurring pneumoediastinum as a physical complication caused by self- induced vomiting that should be noted in clinical practice of the psychiatric department.