[A case of complete disappearance of paraneoplestic syndrome after curative resection of bone metastasis in renal cell carcinoma].

A case of renal cell carcinoma presenting with paraneoplastic syndrome is reported. A 69-year-old man with uncontrolled diabetes was incidentally found to have a left thoracic tumor and a right renal tumor. He had intermittent fever of 39℃ or more and laboratory data showed diabetes and high C-reactive protein level. A radical nephrectomy was performed, but the neoplastic syndrome did not improve. After a second surgery consisting of complete resection of solitary bone metastasis the symptoms resolved immediately. At 6 months postoperatively, he had no reoccurence. Generally prognosis of patients with bone metastasis from renal cell carcinoma has been said to be poor, but surgical control of bone metastasis may be a key factor for the prognosis of patient with metastatic RCC in the era of targeted therapy.

Transzygomatic Kirschner wire fixation for the treatment of blowout fracture.

BACKGROUND: Total orbital floor reconstruction with sheet-shape materials is available for the treatment of extensive and crushed-type blowout fractures. Simple blowout fractures, on the other hand, require only manual reduction without fixation. Although several types of blowout fractures do not require total reconstruction, some fixation is usually necessary. METHODS: Eighteen cases of blowout fracture were treated with transzygomatic Kirschner wire fixation between 2002 and 2009. This technique was applied to simple fracture cases in which periorbital soft tissue re-herniated through the floor defect into the maxillary sinus after manual reduction, despite improvement of the extra-ocular muscle entrapment. The wire was used to directly support the fracture segment in five cases and used together with a maxillary sinus anterior wall bone graft in 13 cases. RESULTS: Mean follow-up was 12.5 months. Mild diplopia remained as a subjective symptom in one case. None of the cases developed major complications or conspicuous scars on the cheek. CONCLUSIONS: Transzygomatic Kirschner wire fixation for blowout fracture has the advantages of precise and rigid fixation of all parts of the inferior floor, minimal morbidity without requiring an orbital approach and long-term safety without artificial remnants. This technique can be applied for the treatment of simple blowout fractures.

Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema.

OBJECTIVE: Lymphaticovenous anastomosis has been used for patients with peripheral lymphedema. However, the efficacy of this procedure is controversial due to a lack of evidence regarding postoperative patency. We sought to determine midterm postoperative patency of lymphaticovenous side-to-end anastomoses (LVSEAs) using indocyanine green fluorescence lymphography. METHODS: This was a retrospective observational study set in a teaching hospital. Of 107 patients with chronic lymphedema who underwent 472 LVSEAs, 57 (223 anastomoses) consented to fluorescence lymphography and comprised the study cohort. The intervention consisted of a microsurgical LVSEA performed with a suture-stent method. Patients also had preoperative and postoperative complex decongestive physiotherapy. Anastomosis patency was assessed using indocyanine green fluorescence lymphography ≥6 months after surgery. Patency rates were calculated using Kaplan-Meier analysis. We assessed volume reduction on the operated-on limb and compared this between patients in whom anastomoses were patent and those in whom anastomoses were not obviously patent. RESULTS: Patency could be evaluated only at the dorsum of the foot, ankle, and lower leg because the near-infrared rays emitted by the special camera used could not penetrate the deep subcutaneous layer containing collective lymphatics in areas such as the thigh. Several patterns were observed on fluorescence lymphography: straight, radial, and L-shaped. Cumulative patency rates of LVSEAs were 75% at 12 months and 36% at 24 months after surgery. No significant difference in volume change of the affected limb was seen between the 34 patients with patent anastomosis (600 ± 969 mL) and the 24 patients without obvious evidence of patency (420 ± 874 mL). CONCLUSIONS: Although further study is required to determine factors leading to anastomotic obstruction and to optimize the results of microlymphatic surgery, the present LVSEA technique appears promising.