Usefulness of Intraoperative Cone Beam CT Images on Video-assisted Thoracic Surgery.

For the resection of pulmonary ground glass opacity (GGO) or non-palpable nodule on video-assisted thoracic surgery (VATS), preoperative computed tomography (CT)-guided VATS marker pricking is usually performed. Recently, air embolisms after VATS marker pricking have been reported to be serious problems. The purpose of this study was to evaluate the usefulness of intraoperative cone beam CT images on VATS to avoid preoperative VATS marker pricking. The CT number of the both GGO and nodule indicate the range from -200 to -800 HU in general. We evaluated the detection ability of the lesion in seven elements and the simulated lungs. The result indicated that there was a linear equation of "y=1.0599×-2.1492" and the degree of correlation was "R2=0.9826" for the relationship between CT number and W number [voxel number in cone beam computed tomography (CBCT)]. Evaluation of low contrast resolution has been performed. The contrast noise ratios were 2.86 on CBCT and 1.50 on multi detector-row computed tomography (MDCT), while the relative contrast ratios were same both on CBCT and MDCT (0.19) as the lowest CT number (-700 HU). In clinical situation, four types of pulmonary lesions (pure GGO, mixed GGO, solid nodule, and cyst) were detected on MDCT, and intraoperative CBCT could identify all lesions as same configuration as on MDCT. The contrast noise ratio (CNR) and relative contrast ratio (RCR) could not admit the significant difference. In conclusion, the intraoperative CBCT can be used as a non-invasive image navigator for VATS, and the preoperative CT-guided VATS marker pricking can be avoided.

Accurate diagnosis and treatment of Vibrio vulnificus infection: a retrospective study of 12 cases

BACKGROUND AND AIMS: Vibrio vulnificus causes an infectious disease that has extremely poor convalescence and leads to necrotic fasciitis. In this study, we sought to define the characteristic epidemiology of V. vulnificus infection and clarify its diagnosis at the global level. METHODS: Over a period of 10 years, we investigated the appearance of symptoms, underlying conditions, treatment, and mortality in 12 patients (eight men, four women; >50 years old; average age, 66 years,) infected with V. vulnificus. RESULTS: The development of symptoms occurred primarily between June and September, a period during which seawater temperature rises and the prevalence of V. vulnificus increases. All patients had underlying diseases, and seven patients reported a history of consuming fresh fish and uncooked shellfish. The patients developed sepsis and fever with sharp pain in the limbs. Limb abnormalities were observed on visual examination. All patients underwent debridement; however, in the survival group, the involved limb was amputated early in 80% patients. The mortality rate was 58.3%. CONCLUSION: Recognition of the characteristic epidemiology and clinical features of this disease is important, and positive debridement should be performed on suspicion. When the illness reaches an advanced stage, however, amputation should be the immediate treatment of choice.

Accurate diagnosis and treatment of Vibrio vulnificus infection: a retrospective study of 12 cases.

BACKGROUND AND AIMS: Vibrio vulnificus causes an infectious disease that has extremely poor convalescence and leads to necrotic fasciitis. In this study, we sought to define the characteristic epidemiology of V. vulnificus infection and clarify its diagnosis at the global level. METHODS: Over a period of 10 years, we investigated the appearance of symptoms, underlying conditions, treatment, and mortality in 12 patients (eight men, four women; >50 years old; average age, 66 years,) infected with V. vulnificus. RESULTS: The development of symptoms occurred primarily between June and September, a period during which seawater temperature rises and the prevalence of V. vulnificus increases. All patients had underlying diseases, and seven patients reported a history of consuming fresh fish and uncooked shellfish. The patients developed sepsis and fever with sharp pain in the limbs. Limb abnormalities were observed on visual examination. All patients underwent debridement; however, in the survival group, the involved limb was amputated early in 80% patients. The mortality rate was 58.3%. CONCLUSION: Recognition of the characteristic epidemiology and clinical features of this disease is important, and positive debridement should be performed on suspicion. When the illness reaches an advanced stage, however, amputation should be the immediate treatment of choice.

Iodoform intoxication; a case report of prolonged consciousness disturbance in a patient with a high plasma iodine level.

This report describes a case in which a consciousness disturbance was associated with a high plasma iodine level and which improved after the removal of iodoform gauze that had been applied to infected wounds. A 71-year-old male with poorly controlled diabetes underwent a laminectomy for an epidural abscess. On the 6th and 8th postoperative days, he underwent debridement for fasciitis in the both arms and iodoform gauze was applied to the wounds (both arms and lumbar region) at the end of the first debridement and then changed every day. His consciousness then gradually deteriorated after the debridement. His plasma iodine level was measured and was shown to be remarkably high (6,280 microg/dl) 19 days after the laminectomy (13 days after the beginning of iodoform application). His consciousness recovered gradually with a concomitant decrease in the plasma iodine level. Three months after the removal of the iodoform he became almost alert. Caution should be exercised in using iodoform gauze because of the possibility that it could affect consciousness.