Kyu Rokkaku

Systemic inflammatory response predicts postoperative outcome in patients with liver metastases from colorectal cancer

Few studies have investigated the Glasgow Prognostic Score (GPS) in patients with liver metastases from colorectal cancer (LM‐CRC).

Endovascular Total Arch Repair Using In Situ Fenestration for Arch Aneurysm and Chronic Type A Dissection

BACKGROUNDnTotal arch replacement and ascending aorta and arch replacement are the gold standard treatments for aortic arch aneurysm and are possible treatment strategies for chronic type A dissection, with good reported outcomes. However, because total arch replacement is extremely invasive, it can be difficult to perform in some patients. We designed an endovascular total arch repair procedure with the use of in situ fenestration and commercially available devices, and we present our initial experience.nnnMETHODSnSeven patients (chronic type A aortic dissection, nxa0= 3; thoracic arch aneurysm, nxa0= 4) who underwent endovascular total arch repair with the use of in situ fenestration thoracic endovascular aortic repair from a zone 0 landing were retrospectively analyzed. All the procedures were performed under general anesthesia and cardiopulmonary bypass. The triple branches were manually punctured in a retrograde manner with the use of an 18-gauge/30-cm needle or a 21-gauge aspiration needle, and all the branches were reconstructed with the use of stent grafts; balloon touch-up was performed if appropriate.nnnRESULTSnThe procedure was successful in 6 of the 7 patients; the remaining 1 patient additionally underwent an axillary-axillary artery bypass during the operation because the left subclavian artery was difficult to puncture. All the patients had an acceptable postoperative course, with no 30-day and in-hospital deaths. None of the patients had endoleaks, and all the patients exhibited a reduction in aneurysm diameter or thrombosed false lumen during a mean follow-up period of 17.6 months.nnnCONCLUSIONSnEndovascular total arch repair with the use of in situ fenestration can be performed with commercially available devices with acceptable interim results.

Direct Percutaneous Puncture Embolization of Type II Endoleaks Using a Coaxial Technique

Purpose To demonstrate a coaxial needle technique for direct percutaneous puncture embolization of type II endoleaks. Technique The technique is demonstrated in a 79-year-old woman and an 80-year-old man who developed type II endoleaks after endovascular repair of thoracic and internal iliac artery aneurysms, respectively. Expansion of the aneurysms required additional therapy. Fluoroscopy and cone-beam computed tomography–guided direct percutaneous endoleak sac embolization with n-butyl-2-cyanoacrylate (NBCA)-lipiodol was performed using the coaxial technique, which resulted in complete embolization of the endoleak sac. At 6 and 3 months after embolotherapy, respectively, the NBCA-lipiodol filled the endoleak sacs and the communicating channels up to the respective feeding arteries; no enlargement of the aneurysms was observed. Conclusion Direct percutaneous sac embolization using a coaxial technique for type II endoleaks is a feasible treatment and yields good short-term results. More experience with this technique and longer follow-up of these patients is needed.

Pulmonary artery sarcoma successfully treated by right pneumonectomy after definitive diagnosis

Pulmonary artery sarcoma (PAS) is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy. Early diagnosis and radical surgical resection offer the only chance for survival. However, making a preoperative histopathological diagnosis is quite difficult. We encountered a 57-year-old woman presenting a PAS that mimicked a pulmonary thromboembolism. After confirming a definitive diagnosis using a catheter suction biopsy, we successfully performed a right pneumonectomy via a median sternotomy without cardiopulmonary bypass. Eighteen months after surgery, no recurrence was observed.

Pancreatic Juice Leakage Is a Risk Factor for Deep Mycosis After Pancreatic Surgery

PurposeDeep mycosis (DM) is an opportunistic infection that can be fatal in immunocompromised hosts. Pancreatic surgery is associated with a high degree of stress and patients who undergo pancreatic surgery are considered to be immunocompromised. This study retrospectively evaluated whether DM affects the clinical course after pancreatic surgery.MethodsBetween January 2005 and April 2007, 67 patients underwent pancreatic surgery. There were 42 males (62.7%) and 25 females (37.3%) with a mean age of 66.7 years. Their diagnoses consisted of cancer of the papilla of Vater (n = 9), pancreatic head cancer (n = 20), pancreatic tail cancer (n = 3), bile duct cancer (n = 17), duodenal cancer (n = 3), and others (n = 15). Surgical procedures included pancreatoduodenectomies (PD; n = 52), hepato-pancreatoduodenectomies (HPD; n = 4), distal pancreatectomies (DP; n = 7), total pancreatectomies (TP; n = 2), and the modified Puestow procedure (m-Pp; n = 2). Patients who were positive for any of CAND-TEC (C-T), β-d-glucan (β-d), or culture for mycosis were classified into group 1 (G1; n = 12) and those who were negative for all these examinations were classified into group 2 (G2; n = 55). The preoperative, perioperative, and postoperative data were compared between G1 and G2. An antifungal drug (Micafungin; 75 mg per day) was given to G1 patients.ResultsThe preoperative data included the neutrophil and lymphocyte counts, total protein, blood urea nitrogen, and amylase, and there were no significant differences in these parameters between the two groups. However, the incidences of diabetes mellitus and total bilirubin at maximum in G1 and G2 were 41.7% and 7.3% (P = 0.04), 4.6 ± 1.5 and 1.4 ± 0.9 (P = 0.007), respectively. The mean operation time in G1 and G2 was 548.5 ± 138.1 and 510.0 ± 133.7 min (P = 0.39) and intraoperative blood loss was 762.2 ± 369.5 and 782.5 ± 599.1 ml (P = 0.88), respectively. The postoperative complications included pneumonia (G1: G2 = 7: 20; P = 0.14), pleural effusion (7: 24; P = 0.27) and ascites (10: 33; P = 0.11), with no significant intergroup differences. However, the respective durations of pancreatic juice leakage in G1 and G2 were 12 and 12, respectively, with a statistically significant difference (P < 0.01). All the G1 patients were treated with the antifungal drug for 7.8 days. Postoperative hospital stays in G1 and G2 were 47.3 days and 38.7 days, respectively (P = 0.15) and the survival rates at 19 months after surgery were 46.7% and 79.4%, respectively (P = 0.04).ConclusionsDeep mycosis was observed in patients with pancreatic juice leakage, thus contributing to a poor outcome. Therefore, an early diagnosis of DM and the initiation of antifungal treatment are necessary for the improving prognosis.

Obturator foramen bypass for infective groin caused by closure device.

A 69-year-old man underwent carotid artery stenting through the right femoral artery with a percutaneous vascular closure device for hemostasis. Eleven days later, an infective femoral artery pseudoaneurysm was diagnosed by computed tomography. At surgery, a defect in the femoral artery was observed, corresponding to the remnants of the closure device. Removal of the foreign material, debridement, wound irrigation, and arterial patch plasty were performed, but the infection and leg ischemia did not improve. After several failed attempts to revascularize and control the infection, obturator foramen bypass was performed. The postoperative course was uneventful, indicating the usefulness of this procedure.

Type IA endoleak embolization after TEVAR via direct transthoracic puncture

We report the case of a 74-year-old man who developed type IA endoleak after endovascular thoracic aortic repair. The patient was admitted with expansion of the aneurysm after TEVAR, for additional therapy. Fluoroscopy and cone-beam computed tomography-guided direct transthoracic sac puncture and complete embolization of the endoleak channels with metal coils and glue were performed, and resulted in complete exclusion of the endoleak. Onexa0month after the coil embolization, the type IA endoleak was completely excluded, and the thoracic aneurysm had decreased in size.

Castleman's disease along the left tracheobronchial tree with a difficult preoperative diagnosis.

A 39-year-old man was referred to our hospital because of an asymptomatic middle mediastinal tumor. A preliminary histological diagnosis of the tumor by bronchoscopy was difficult to obtain because the tumor was located along the left tracheobronchial tree, which is difficult to approach. The tumor was resected through a right anteroaxillary thoracotomy without any major complications, and histopathological examination revealed that the lesion was Castleman’s disease, hyaline-vascular type. Radiological findings of the lesion were typical; however, the rarity of the tumor made the imaging diagnosis difficult. If a lesion is located along the tracheobronchial tree, Castleman’s disease should be considered in the differential diagnosis.