Case of anal fistula with Fournier's gangrene in an obese type 2 diabetes mellitus patient.

A 64-year-old man was admitted to Shin-suma General Hospital, Kobe, Japan, complaining of a 3-day history of scrotal swelling and high fever. He had type 2 diabetes mellitus. On examination, his body temperature had risen to 38.5 °C. Examination of the scrotum showed abnormal enlargement. Laboratory data were as follows: white cell count 35,400/µL and glycated hemoglobin 9.6%. Anal fistula was found in an endorectal ultrasound. Computed tomography scan showed a relatively high density of subcutaneous tissue and elevated air density. Thus, he was diagnosed with Fournier's gangrene. On the fourth hospital day, the patient underwent debridement of gangrenous tissue. Seton surgery was carried out for anal fistula on the 34th hospital day. He responded to the treatment very well. He was discharged on the 33rd postoperative day. Once Fournier's gangrene has been diagnosed, considering the association of anal fistula and perianal abscess is important.

Traumatic disruption of saphenous vein graft bypassed to the dorsalis pedis artery.

We describe a rare case of traumatic disruption of saphenous vein graft bypassed to the dorsalis pedis artery. The vein graft was disrupted at the level of ankle joint by blunt trauma and symptoms of acute foot ischemia were recognized. The injured vein graft was reconstructed with cephalic vein graft interposition. He has been free from any events of foot ischemia at 10 months follow-up with patent vein graft to the dorsalis pedis artery.

A one-stage operation for abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas: report of a case.

Pancreatic surgery concomitant with abdominal aortic repair is rarely chosen due to concerns about prosthetic infection following pancreatic leakage and the poor prognosis of pancreatic neoplasms. We herein report a successfully treated case of infrarenal abdominal aortic aneurysm and intraductal papillary mucinous neoplasms of the pancreas treated by a one-stage operation. A 75-year-old male with a history of cerebral infarction and chronic subdural hematoma was referred to our department with a pulsatile abdominal mass. A 70-mm infrarenal abdominal aortic aneurysm with severe proximal neck angulation and a 28-mm multilocular cystic tumor with mural nodules in the pancreas body were detected. Abdominal aortic repair with a prosthetic graft and distal pancreatectomy were performed simultaneously. The postoperative course was mostly uneventful, and he was discharged to a rehabilitation facility.

Popliteal pseudoaneurysm caused by stent fracture.

Stent fracture with pseudoaneurysm formation in the femoropopliteal artery has uncommonly been reported. We present the case of a 72-year-old man with a fracture of self-expanding nitinol stent and a pseudoaneurysm formation in the suprageniculate popliteal artery. The popliteal artery was successfully reconstructed with a small saphenous vein graft interposition.

Early results of magnetic resonance-guided focused ultrasound surgery of adenomyosis: analysis of 20 cases.

STUDY OBJECTIVE: To evaluate the thermal ablative effects of magnetic resonance-(MR) guided focused ultrasound surgery (MRgFUS) on adenomyosis and to assess improvement in clinical parameters. DESIGN: Twenty patients with adenomyosis were treated with MRgFUS. Extensive adenomyosis (6 cases) was treated with 2 applications. Uterine volume was evaluated by MR imaging before and immediately after MRgFUS. Ablation of adenomyosis and the architecture of nonperfused areas were evaluated immediately after MRgFUS. Improvement in patient symptoms was assessed through the symptom severity score questionnaire (Canadian Task Force classification II-3). SETTING: Department of gynecology at a Japanese general hospital. PATIENTS: Premenopausal women at least 18 years of age with symptomatic adenomyosis. INTERVENTIONS: Thermal ablation by MRgFUS. MEASUREMENTS AND MAIN RESULTS: We classified the nonperfused lesions on contrast-enhanced MR images immediately after MRgFUS into 3 types: lesions with round margins (type R), serrated margins (type S), and honeycomb architecture (type H). Type R was the most common (16/20 patients). Most adenomyosis lesions could be sufficiently ablated close to the serosal surface or to the endometrium by MRgFUS. The mean uterine volume 6 months after therapy was decreased by 12.7%. Symptom severity score improved significantly during 6 months of follow-up. No serious complications were observed. CONCLUSION: These early results indicate the safe and effective ablation of adenomyosis tissue by MRgFUS. The procedure also resulted in the improvement in clinical symptoms during the 6 months of follow-up.

Subjective effect of magnetic resonance-guided focused ultrasound surgery for uterine fibroids.

AIM: We treated 69 patients with symptomatic uterine fibroids using a magnetic resonance-guided focused ultrasound surgery (MRgFUS) system. Our objective was to determine the clinical outcome of MRgFUS, focusing on symptom improvement, with emphasis on the time and extent of improvement. METHODS: Patients who would have been otherwise offered conventional surgery were considered for eligibility. They were asked to report their symptom severities before and after treatment on the same query form. The questionnaire, given 6 months after treatment, included a question asking when the patients' symptoms started to improve. Their fibroids were classified into three types according to the signal intensity on T2-weighted magnetic resonance images: type 1, low intensity as skeletal muscle, type 2, intermediate intensity, lower than myometrium but higher than skeletal muscle; and type 3, high intensity, the same as or higher than myometrium. RESULTS: No severe adverse events occurred in any of the patients. Seven patients required alternative treatment after MRgFUS, with five of them having type 3 fibroids. Mean symptom scores were all reduced after MRgFUS, regardless of the symptom types. Frequent urination improved first, while heavy bleeding took longer to resolve than the other symptoms. CONCLUSION: MRgFUS is an effective and safe method for treating symptomatic uterine fibroids, especially for type 1 and type 2 fibroids. Type 3 fibroids, however, are difficult to treat using the current MRgFUS system.

Magnetic resonance-guided focused ultrasound surgery for uterine fibroids: relationship between the therapeutic effects and signal intensity of preexisting T2-weighted magnetic resonance images.

OBJECTIVE: This study was undertaken to clarify the relationship between the signal intensity of T2-weighted magnetic resonance images and the therapeutic effect of magnetic resonance-guided focused ultrasound surgery (MRgFUS) on uterine fibroids. STUDY DESIGN: Ninety-five fibroids in 63 patients were classified into 3 types based on the signal intensity of T2-weighted magnetic resonance images as follows: type 1, low intensity; type 2, intermediate intensity; type 3, high intensity. The treated area ratio of MRgFUS and the volume reduction ratio 6 months after treatment were used as the indices of therapeutic effect. RESULTS: The treated area ratio of type 3 fibroids was the lowest among the 3 types (P < .01). The volume reduction ratio correlated with the treated area ratio (r = 0.64; P < .01). CONCLUSION: The efficacy of MRgFUS correlates with the signal intensity of T2-weighted magnetic resonance images. Type 1 and type 2 fibroids are suitable candidates for MRgFUS, whereas type 3 fibroids are not.