Visible negative pressure wound therapy for open abdominal management: A single-center retrospective study.

Aim: This study aimed to compare open abdominal management (OAM) between visible negative pressure wound therapy (NPWT) and commercial NPWT to determine whether NPWT can detect intestinal ischemia in its early stages without causing complications or worsening prognosis, and to determine whether the actual visualization results in early detection. Methods: Patients were divided into two groups: those who underwent OAM with visible NPWT (A: 32 patients) and those who underwent OAM with commercial NPWT (B: 12 patients). We compared background factors, disease severity, vital signs, blood test values, and 28-day outcomes between the two groups. We also checked the records to determine how many visualized cases were detected early and operated on. We then examined the weaknesses of this method. Results: No differences were observed in the background factors or disease severity between the two groups. The duration of the open abdomen and intensive care unit stay were significantly shorter for group A than for group B. The groups showed no significant differences in lactate levels, 28-day outcomes, complications during OAM, or other factors. After a review of the medical records, ischemic progression was detected early, and surgery could be performed in seven cases in the visible NPWT group. The progression of ischemia was confirmed at the time of the second-look operation in two cases in the ascending colon. Conclusion: The visualization device allowed us to gain insights into the intra-abdominal cavity and determine the appropriate time for closing the abdomen without worsening the prognosis.

Near-fatal bleeding due to ruptured peripheral varicose vein that developed after previous orthopedic surgery: A case report.

This case highlights the necessity to inform patients with vein ligation about the possibility of varicose vein formation in the periphery and brings awareness to emergency staff that bleeding could be caused by a ruptured peripheral varicose vein.

Cytomegalovirus enteritis resistant to antiviral drugs improved following total colectomy.

BACKGROUND: Cytomegalovirus (CMV) infection, often subclinical in childhood, is reactivated during a state of cell-mediated immunodeficiency. In cases of organ damage, patients can require medical treatment for an infectious disease, generally through the use of antiviral drugs. There are no reports of surgical treatment in cases, where infection was found, and medical treatment was difficult. We encountered a case of CMV enteritis that was difficult to treat because of resistance to antivirals but improved after total colectomy. CASE PRESENTATION: A previously healthy, 74-year-old woman visited a doctor with a chief complaint of watery diarrhea persisting for 2 weeks; she was transferred to our hospital because of hypoxemia and hypovolemic shock. Computed tomography scan indicated wall thickening over the entire colon and the patient was diagnosed with infectious colitis. Conservative and antibacterial therapies were started with fasting fluid replacement. Subsequently, bloody stools were observed 11 days after admission. Colonoscopy was then performed, which showed mucosal edema and longitudinal ulcer, while a histopathological examination of the colon mucosa revealed C7HRP positive on 22 days after admission. CMV enteritis was diagnosed, and the antiviral medication, ganciclovir, was started. Diseases causing immunosuppression and other possible causes of enteritis were also closely examined; however, all were negative. Furthermore, the patient's symptoms and her endoscopic findings did not improve with ganciclovir administration; therefore, the antiviral drug was changed to foscarnet. Unfortunately, the patient did not improve despite the additional administration of gamma globulin and methylprednisolone, and she was determined to have enteritis resistant to medical therapy. A total colon resection was performed 88 days after the admission. Her condition gradually stabilized postoperatively, and oral intake was initiated and tolerated. The patient was transferred to another hospital for rehabilitation for home discharge. She is now at home and has had no recurrences. CONCLUSIONS: In previous reports of surgical treatment for CMV enteritis, many cases were initially undiagnosed, emergency surgery was performed after perforation or stenosis was recognized, and then CMV was diagnosed and treated. In CMV enteritis without immunodeficiency, surgical treatment may be an option if medical treatment is ineffective.

Lung Abscess with a Refractory Bronchopleural Fistula Saved from Potentially Fatal Sepsis by Omentoplasty and Extracorporeal Membrane Oxygenation.

Controlling air leaks during thoracic drainage in patients with lung abscesses caused by bronchopleural fistulas is challenging. To reduce the occurrence of air leaks, positive pressure ventilation should be avoided whenever possible. A 69-year-old man presented with a 10-day history of gradually worsening chest pain. He had lost consciousness and was brought to the emergency room. His SpO2 was approximately 70%, and his systolic blood pressure was approximately 60 mmHg. Chest radiography and computed tomography revealed findings suggestive of a right pyothorax. Therefore, thoracic drainage was performed. However, the patient's respiratory status did not improve, and his circulatory status could not be maintained. Therefore, extracorporeal membrane oxygenation was introduced after the improvement in circulation by noradrenaline and fluid resuscitation, resulting in adequate oxygenation and ventilation without the use of high-pressure ventilator settings. Subsequently, omentoplasty for a refractory bronchopleural fistula was successfully performed, and the air leak was cured without recurrence of the lung abscess.

Damage Control Management of Perforating Pyometra Presenting with Septic Shock after the Return of Spontaneous Circulation.

INTRODUCTION: Perforation of pyometra is often severe but rare. We report a case of pyometra detected on second-look surgery in an elderly patient with life-threatening septic shock and cardiopulmonary arrest before hospital arrival. Case Presentation. A 70-year-old woman with cardiopulmonary arrest received adrenaline. Computed tomography revealed ascites, and abdominal paracentesis was performed to identify the cause of cardiopulmonary arrest. The ascitic fluid was purulent, and intraperitoneal infection was identified. Emergency exploratory laparotomy revealed pyometra. CONCLUSION: If perforated, pyometra may cause peritonitis and lethal septic shock. Not only gynecologists but also emergency physicians should be aware of this possibility. Moreover, patient education is necessary. In patients with cardiopulmonary arrest, diagnostic abdominal paracentesis should be performed when the sole imaging finding is ascites. Improving outcomes in patients with difficult-to-diagnose pyometra with cardiopulmonary arrest by implementing damage control strategies before hysterectomy is possible.

A case of necrotizing fasciitis following Edwardsiella tarda septicemia with gastroenteritis.

Edwardsiella tarda is an uncommon pathogen that causes gastroenteritis in humans and is found in the aquatic environment. In rare cases, it also causes fatal infections, including sepsis and necrotizing fasciitis. However, it remains unknown whether E. tarda gastroenteritis could lead to these lethal diseases via hematogenous spread. Here we have reported a previously healthy 64-year-old woman with necrotizing fasciitis consecutively caused by E. tarda septicemia with gastroenteritis. The patient was transferred to the emergency department due to disturbance of consciousness and hypotension after suffering from diarrhea for a month. As whole-body computed tomography (CT) revealed an edematous change in the small intestine, septic shock following gastroenteritis was suspected, and the patient was immediately started on empiric antibiotic therapy and provided critical care. Her general physical conditions gradually began improving, but, on day 7, rapidly appearing blisters on both the lower limbs were noted, and she was accordingly examined again by conducting a CT scan. Based on the results, she was diagnosed with necrotizing fasciitis in both lower extremities, and surgical debridement was rapidly performed. Microbiological analysis of the specimens revealed E. tarda bacteremia, which suggested that E. tarda caused a series of infections in this patient. Finally, she fully recovered and was discharged within 3 months. Cumulatively, we proposed that gastroenteritis by E. tarda could directly result in fatal infections through the blood stream.

Serial change of C1 inhibitor in patients with sepsis--a preliminary report.

OBJECTIVE: C1 inhibitor (C1INH) regulates not only the complement system but also the plasma kallikrein-kinin, fibrinolytic, and coagulation systems. The biologic activities of C1INH can be divided into the regulation of vascular permeability and anti-inflammatory functions. The objective was to clarify the serial change of C1INH in patients with sepsis. METHODS: We serially examined C1INH activity values (reference range, 70%-130%) and quantitative values (reference range, 160-330 µg/mL) in patients with sepsis admitted into the intensive care unit of the Trauma and Acute Critical Care Center at Osaka University Hospital (Osaka, Japan) during the period between December 2012 and February 2013. We also analyzed their clinical course. We defined "refractory shock" as septic shock requiring steroid administration to maintain hemodynamics. RESULTS: The serial change of C1INH was evaluated in 5 patients (4 survivors and 1 nonsurvivor). Two patients were diagnosed as having refractory shock. In the nonsurvivor after refractory shock, C1INH activity on admission was 97.2%, and the quantitative value was 133.1 µg/mL. In the other patient with refractory shock, C1INH activity on admission was 94.4%, and the quantitative value was 126.7 µg/mL. This patient's general condition had improved by day 6, with increases in C1INH activity (139.9%) and quantitative value (250.1 µg/mL). In the 3 nonrefractory shock patients, C1INH activity on admission was 130.6%±8.7%, and the quantitative value was 215±26.5 µg/mL. CONCLUSIONS: Enhancement of C1INH activity was not observed in the refractory shock patients, and the C1INH quantitative values were low. Further evaluation of the serial change of C1INH and the validity of C1INH replacement therapy in patients with septic shock may lead to a new strategy for sepsis management.

Designed self-assembly of molecular necklaces using host-stabilized charge-transfer interactions.

A novel approach to the noncovalent synthesis of molecular necklaces successfully led to the first quantitative self-assembly of a molecular necklace [6]MN, in which five small rings are threaded on a large ring, from 10 components. Our strategy involves the host-guest complex formation between the molecular host cucurbit[8]uril (CB[8]) and a guest molecule in which an electron donor and an electron acceptor unit are connected by a rigid linker with a proper angle, to form a cyclic oligomer through the host-stabilized intermolecular charge-transfer (CT) complex formation. In the structure of the molecular necklace [6]MN, five molecules of the guest form a cyclic framework by the intermolecular CT interactions, on which five CB[8] molecules are threaded with an arrangement reminiscent of a five-fold propeller. The molecular necklace measures approximately 3.7 nm in diameter and approximately 1.8 nm in thickness.

Facile synthesis of cucurbit[n]uril derivatives via direct functionalization: expanding utilization of cucurbit[n]uril.

A long-standing problem in cucurbituril chemistry is answered through the first direct functionalization of cucurbit[n]uril (CB[n]; n = 5-8)) leading to perhydroxyCB[n] which can be further modified to provide tailored CB[n] derivatives with desired functional groups and good solubility. Anchoring a CB[6] derivative on the surface and its potential application as a sensor are demonstrated. A CB[6] derivative forms nanospheres with possible use in protein and peptide drug delivery.