Negative pressure wound therapy for prolonged surgical wound healing after brachiobasilic arteriovenous fistula creation in a patient with end-stage liver failure.

A 54-year-old male patient diagnosed with hepatorenal syndrome caused by decompensated alcoholic cirrhosis was referred for arteriovenous fistula (AVF) creation after initiation of hemodialysis. A brachiobasilic arteriovenous fistula (BBAVF) was created because neither forearm had suitable vasculature. Large-volume serous effusion from the incision persisted postoperatively, and we started negative pressure wound therapy (NPWT) for wound protection. The effusion volume decreased gradually; however, up to 80 ml of discharge continued daily. Re-operation was performed 35 days after the initial operation, followed by continued NPWT. The wound was almost healed 85 days after the primary surgery. We present a case of severe surgical wound complication after AVF creation in a patient with hemostatic and coagulation disorders and malnutrition caused by end-stage hepatic failure. We confirmed the usefulness of NPWT for excessive surgical wound effusion and the adequacy of BBAVF for vascular access.

Prognostic significance of propofol-based intravenous anesthesia in early-stage lung cancer surgery.

PURPOSE: The purpose of this study was to assess whether the anesthetic type is associated with the prognosis of pathological stage I non-small cell lung cancer (NSCLC). METHODS: Clinicopathological data from 431 consecutive patients who underwent lobectomy for NSCLC between 2010 and 2016 were collected. Patients were classified into groups according to the type of anesthesia: propofol-based total intravenous anesthesia (TIVA) or inhalation anesthesia (INHA). We investigated the prognostic differences between these two groups. RESULTS: A total of 72 patients in the TIVA group and 158 patients in the INHA group were eligible for the analysis. Recurrence was observed in 4 (5.6%) patients in the TIVA group and 19 (12.0%) patients in the INHA group (P = 0.159), and all-cause death occurred in 4 (5.6%) patients in the TIVA group and 24 (15.2%) patients in the INHA group (P = 0.049). The 5-year recurrence-free survival (RFS) and overall survival rates of the TIVA/INHA groups were 91.7%/77.4% and 94.4%/83.5%, respectively. TIVA was associated with a significantly better prognosis. A multivariable analysis of factors associated with RFS revealed that the type of anesthesia as a significant prognostic factor (P = 0.047). CONCLUSION: Propofol-based TIVA was associated with a better prognosis in comparison to INHA in patients with surgically resected pathological stage I NSCLC.

The dose-dependent effects of isoflurane on outcome from severe forebrain ischemia in the rat.

Isoflurane improves outcome against cerebral ischemia in the rat. However, the optimal neuroprotective concentration has not been defined. We examined the effects of different isoflurane concentrations on outcome from severe forebrain ischemia in the rat. Fasted rats were subjected to 0.5, 1.0, 1.5, 2.0, or 2.5 minimum alveolar concentration (MAC) isoflurane during 10 min bilateral carotid occlusion plus systemic hypotension. Each isoflurane concentration was administered only before ischemia. Arterial blood pressure was not pharmacologically manipulated. After ischemia, the anesthetic regimen was changed to fentanyl/nitrous oxide and maintained for 2 h. Pericranial temperature was maintained normothermic during the experiment. Neuromotor score, % dead hippocampal CA1 neurons, and cortical injury were measured 5 days postischemia. Preischemic arterial blood pressure decreased as MAC was increased. Animals administered >1.0 MAC frequently exhibited postischemic seizures resulting in increased mortality. There was no difference among MAC conditions for % dead CA1 neurons (93 approximately 95%). In the cortex, neuronal necrosis was less severe with 0.5 MAC and 1.0 MAC isoflurane relative to >1.0 MAC values. The neuromotor score in the 1.0 MAC isoflurane group was superior to the 2.5 MAC group. Dose-dependent effects of preischemic administration of isoflurane on histologic and behavioral outcome after severe forebrain ischemia were observed. Isoflurane MAC values <1.5 provided superior overall outcome relative to larger isoflurane concentrations.

Factors affecting denture use in some institutionalized elderly people.

This study was conducted to assess which factors were related to the ability of elderly residents of nursing homes to use dentures. For 205 patients in two nursing homes in Chuou-ku, Tokyo, dentists and caregivers examined oral status (caries, status of restoration, missing teeth and occlusal support) as well as denture use, Activities of Daily Living (ADL), ability to rinse the mouth, and degree of dementia. Fifty percent of subjects lacked dentures. Seven items were selected for variance in factor analysis. There was a significant relationship between denture use and all analyzed items except age. The items which proved to be significant, included the number of remaining teeth, the ability to rinse, communication, ability to dress/undress, ability to transfer, and eating (Fisher's exact test). A multiple stepwise logistic regression analysis showed that the nonuse of dentures was significantly related to dressing (p<0.01), the number of remaining crowns (p<0.01) and the ability to rinse the mouth (p<0.0001). The nonuse of dentures was also related to the number of remaining teeth and to the disability of hand and oral functions.

[Effect of extended paraaortic lymph node dissection on postoperative pancreatic function in gynecologic procedures].

BACKGROUND: We tested a hypothesis that extended gynecological paraaortic lymph node dissection seriously impairs postoperative pancreatic function. METHODS: We studied 82 patients who underwent gynecologic surgery for malignancy from January, 2002 to October, 2003. After scheduled operation, we assigned them to one of two groups; patients who underwent extended gynecological paraaortic lymph node dissection (n=34) or those who did not (n=48). We measured plasma amylase levels in all patients before operation and 1, 3, 7 days after operation. RESULTS: Preoperative amylase levels were the same in the two groups. Time-dependent increases in plasma amylase level were noted in both groups. From 1 to 3 days after operation, however, plasma amylase levels were significantly higher in patients who had undergone paraaortic lymph node dissection than in those who had not. Furthermore, lethal postoperative pancreatitis developed in one patient who showed marked high levels in plasma amylase level after paraaortic lymph node dissection. CONCLUSIONS: Our results suggest that paraaortic lymph node dissection in gynecologic operations seriously impairs pancreatic function and that one should maintain a high suspicion of postoperative pancreatitis.