Successful one-stage operation for type B acute intramural hematoma with descending aortic rupture.

A 76-year-old man who complained of back pain was referred to our hospital. Computed tomography revealed an intramural hematoma with a descending aortic rupture. Total arch replacement with the frozen elephant trunk technique and thoracic endovascular aortic repair was performed emergently in one stage. The patient was discharged without symptoms.

Single-stage clipping with bifrontal and bilateral frontotemporal craniotomies for subarachnoid hemorrhage with multiple cerebral aneurysms using Sugita head holding system: A case report.

BACKGROUND: Subarachnoid hemorrhage with multiple aneurysms is very challenging because it is difficult to identify the ruptured aneurysm. We could not identify the ruptured aneurysm preoperatively, so we decided to treat all of the aneurysms as a single-stage surgery. CASE DESCRIPTION: A 79-year-old woman was diagnosed with subarachnoid hemorrhage with multiple cerebral aneurysms at the right distal anterior cerebral artery, left middle cerebral artery, and right internal carotid artery- posterior communicating artery bifurcation. We could not identify the ruptured aneurysm preoperatively. We fixed her head using the Sugita head holding system (Mizuho Co., Ltd., Tokyo) and performed clipping for each aneurysm with bifrontal craniotomy and bilateral frontotemporal craniotomy as a single-stage operation. The last aneurysm seemed ruptured, and clipping for all the aneurysms was successful. She was discharged with a good postoperative course. The Sugita head holding system allowed turning the head of the patient toward the right and left with single fixation, leading to this single-stage operation. CONCLUSION: Several methods for identifying a ruptured aneurysm from multiple aneurysms have been reported, but under limited medical resources, this procedure would be one of the treatment strategies.

Reach out and grasp the opportunity: reconstructive hand surgery in tetraplegia.

Reconstructive upper extremity surgeries in tetraplegia are technically challenging because of the many complicated real-time decisions that need to be made, e.g. extent of release of donor muscle-tendon complex, routing of donor muscles, tissue preparation and optimization, tensioning of muscle-tendon units, balancing joints and suturing tendon-to-tendon attachments. Nerve transfer surgeries can add functionality but also make the reconstruction planning more complex. In this overview, we present some of the fundamental muscle-tendon-joint mechanics studies that allow for single-stage surgical reconstruction of hand function as well as early postoperative activity-based training in patients with cervical spinal cord injuries. We foresee an increased need for studies addressing combined nerve and tendon transfer reconstructions in parallel with patient-perceived outcome investigations. These should be combined with implementation of assistive technology such as functional electrical stimulation for diagnostic, prognostic and training purposes.

Comparative study of postoperative complications in patients with and without an obstruction who had left-sided colorectal cancer and underwent a single-stage operation after mechanical bowel preparation.

PURPOSE: The purpose of this study is to compare postoperative complications for single-stage surgery after mechanical bowel preparation in patients who experienced obstruction and those who did not. METHODS: From 2000 to 2011, 1,224 patients underwent a single-stage operation for left colorectal cancer after bowel preparation. Nonobstruction (NOB) and obstruction (OB) colorectal cancer patients were 1,053 (86.0%) and 171 (14.0%), respectively. Postoperative morbidity and mortality were compared between groups. RESULTS: The OB group had poor preoperative conditions (age, white blood cell, hemoglobin, albumin level, and advanced tumor stage) compared with the NOB group (P < 0.05). Mean on-table lavage time for the OB group was 17.5 minutes (range, 14-60 minutes). Mean operation time for the OB group was statistically longer than that of the NOB group (OB: 210 minutes; range, 120-480 minutes vs. NOB: 180 minutes; range, 60-420 minutes; P < 0.001). Overall morbidity was similar between groups (NOB: 19.7% vs. OB: 23.4%, P = 0.259). Major morbidity was more common in the OB group than in the NOB group, but the difference was without significance (OB: 11.7% vs. NOB: 7.6%, P = 0.070). Postoperative death occurred in 16 patients (1.3%), and death in the OB group (n = 7) was significantly higher than it was in the NOB group (n = 9) (4.1% vs. 0.9%, P = 0.001). Twelve patients had surgical complications, which were the leading cause of postoperative death: postoperative bleeding in five patients and leakage in seven patients. CONCLUSION: Postoperative morbidity for a single-stage operation for obstructive left colorectal cancer is comparable to that for NOB, regardless of poor conditions of the patient.

Comparative Study of Postoperative Complications in Patients With and Without an Obstruction Who Had Left-Sided Colorectal Cancer and Underwent a Single-Stage Operation After Mechanical Bowel Preparation

PURPOSE: The purpose of this study is to compare postoperative complications for single-stage surgery after mechanical bowel preparation in patients who experienced obstruction and those who did not. METHODS: From 2000 to 2011, 1,224 patients underwent a single-stage operation for left colorectal cancer after bowel preparation. Nonobstruction (NOB) and obstruction (OB) colorectal cancer patients were 1,053 (86.0%) and 171 (14.0%), respectively. Postoperative morbidity and mortality were compared between groups. RESULTS: The OB group had poor preoperative conditions (age, white blood cell, hemoglobin, albumin level, and advanced tumor stage) compared with the NOB group (P < 0.05). Mean on-table lavage time for the OB group was 17.5 minutes (range, 14-60 minutes). Mean operation time for the OB group was statistically longer than that of the NOB group (OB: 210 minutes; range, 120-480 minutes vs. NOB: 180 minutes; range, 60-420 minutes; P < 0.001). Overall morbidity was similar between groups (NOB: 19.7% vs. OB: 23.4%, P = 0.259). Major morbidity was more common in the OB group than in the NOB group, but the difference was without significance (OB: 11.7% vs. NOB: 7.6%, P = 0.070). Postoperative death occurred in 16 patients (1.3%), and death in the OB group (n = 7) was significantly higher than it was in the NOB group (n = 9) (4.1% vs. 0.9%, P = 0.001). Twelve patients had surgical complications, which were the leading cause of postoperative death: postoperative bleeding in five patients and leakage in seven patients. CONCLUSION: Postoperative morbidity for a single-stage operation for obstructive left colorectal cancer is comparable to that for NOB, regardless of poor conditions of the patient.

The Role of Intraoperative Colonoscopy in Patients with Left Side Colon Cancer Obstruction / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to evaluate the role of an intraoperative colonoscopy for a single stage operation in patients with a left-side colon cancer obstruction. METHODS: From September 1999 to August 2002, 62 patients (mean age=61+/-14 year old, M:F=30:32) underwent an intraoperative colonoscopy during a single stage operation for a left side colon cancer. Intraoperative colonic irrigation method and colonoscopy with NICI (new intraoperative colonic irrigator, MITech Co., Ltd, Seoul, Korea) were used. RESULTS: The locations of the left-side colon cancers were the rectum in 33 (53.2%), sigmoid colon in 20 (32.3%), and descending colon in 9 (14.5%). Synchronous polyps were found in 31 patients (50%). Six patients (9.7%) had a synchronous colon cancer and 2 (3.2%) had a high grade dysplasia. Of these 62 patients, 11 (17.7%) required more extensive surgery than dictated by the primary tumor. Altered operative methods were a total colectomy in 2 patients, an extended resection in 8 patients, and a wedge resection in 1 patient. CONCULSIONS: An intraoperative colonoscopy in patients with a left-side colon cancer is a useful adjunct in diagnosing a synchronous lesions, which should allow a more appropriate surgical procedure.

Interim Results of Single Stage Operation for Coarctation of Aorta with Large Ventricular Septal Defect in Infancy

PURPOSE: There are controversies in the operative methods of aorta with ventricular septal defect in infancy. Recent results of single stage operation for coarctation of aorta with intracardiac defects were regarded as comparable to staged operation. We evaluated our interim results after single stage operation for coarctation of aorta with large ventricular septal defect in infancy. METHODS: Twenty six infants who had received single stage operation for coarctation of aorta with large ventricular septal defect between January 1989 and December 1994 were analyzed retrospectively. Evaluated variables were : age and weight at operation, type of ventricular septal defect, absence or presence of left ventricular outflow tract obstruction, aortic cross clamping time, total circulatory arrest time, methods of coarctoplasty, operative mortality rate, complications and cardiovascular abnormalities on follow up. RESULTS: Age and weight at operation were 2.8+/-2.6 months and 4.0+/-1.2kg respectively. Perimembranous ventricular spetal defect was most common (15 cases; 57.7%). Twelve cases (46.2%) had left ventricular outflow tract obstruction. Aortic cross clamping time was 65.6+/-12.1 minutes and total circulatory arrest time was 51.7+/-14.6 minutes. Coarctation of aorta was corrected with extended resection and end-to-end anastomosis in 23 cases and patch aortoplasty in 3 cases. Among 12 cases of left ventricular outflow tract obstruction, 8 cases received correction and only 1 case of other 4 cases showed significant obstruction on follow up. Early mortality rate was 19.2% (5 cases) and all others survived for the follow up period of 33.5+/-16.6 months. Early complication rate was as high as 71.4% (15 cases), even though all except 3 cases of hypoxic encephalopathy resolved. Statistically significant operative risks were age and weight at operation, especially in cases under 2 month of age and 4.0kg. Aortic cross clamping time and total circulatory arrest time was somewhat longer in expired group, although it was statistically not significant. CONCLUSIONS: Operative mortality rate of single stage operation for coarctation of aorta with large ventricular septal defect in infancy during the study period was not low. In this study, the age and weight at operation was significant factors associated with mortality. However, the results of single stage operation could be improved in case of proper selection of candidates and after some learing period.