Salvage restoration after conduit necrosis

In patients with esophageal cancer, esophageal conduit necrosis is a catastrophic complication of esophagectomy that requires surgical restoration. Because such patients are generally fatigued, less-invasive surgery is encouraged whenever possible. Therefore, we trim the sternum minimally above the healthy part of the gastric conduit, expose its surface, and then make anastomoses between the remnant esophagus and the exposed gastric conduit using a free jejunal graft through a retrosternal-subcutaneous route. The risk involved with this procedure is low, because we avoid manipulation of the heavily inflamed lesion due to mediastinitis

Gradually shrinking intra-abdominal desmoid tumor derived from the stomach in a young boy: a case report

Abstract Background Intra-abdominal desmoid tumors, particularly those derived from the stomach, are rare. Such tumors are associated with a history of familial adenomatous polyposis (FAP), trauma, or surgical procedures in general. In addition, spontaneous shrinking of an intra-abdominal desmoid tumor is rarer. And desmoid tumors most commonly arise during the fourth decade of life. Case presentation A 17-year-old boy with lower abdominal pain was diagnosed with a gastrointestinal stromal tumor (GIST) or a hematoma at a local hospital. He had no history of FAP, trauma, or previous surgery. Abdominal computed tomography (CT) was performed for observational purposes three times over a 9-month period. The tumor gradually decreased in size over time; however, the tumor did not shrink sufficiently to be diagnosed as a hematoma. Because there was a high possibility of a GIST from the stomach, he underwent laparotomy. Operative findings revealed that the tumor was a hard mass firmly attached to both the greater curvature of the stomach and the inferior pole of the spleen. Pathologically, the tumor was diagnosed as a desmoid tumor derived from the stomach. Conclusion For a young boy without a history of FAP, trauma, or surgical procedures, it is difficult to define an intra-abdominal tumor near the stomach as a desmoid tumor. In such cases, surgical resection is recommended for a definitive diagnosis

Clinical value of a prophylactic minitracheostomy after esophagectomy: analysis in patients at high risk for postoperative pulmonary complications

Abstract Background The aim of this study is to evaluate the clinical value of a prophylactic minitracheostomy (PMT) in patients undergoing an esophagectomy for esophageal cancer and to clarify the indications for a PMT. Methods Ninety-four patients who underwent right transthoracic esophagectomy for esophageal cancer between January 2009 and December 2013 were studied. Short surgical outcomes were retrospectively compared between 30 patients at high risk for postoperative pulmonary complications who underwent a PMT (PMT group) and 64 patients at standard risk without a PMT (non-PMT group). Furthermore, 12 patients who required a delayed minitracheostomy (DMT) due to postoperative sputum retention were reviewed in detail, and risk factors related to a DMT were also analyzed to assess the indications for a PMT. Results Preoperative pulmonary function was lower in the PMT group than in the non-PMT group: FEV1.0 (2.41 vs. 2.68 L, p = 0.035), and the proportion of patients with FEV1.0% <60 (13.3% vs. 0%, p = 0.009). No between-group differences were observed in the proportion of patients who suffered from postoperative pneumonia, atelectasis, or re-intubation due to respiratory failure. Of the 12 patients with a DMT, 11 developed postoperative pneumonia, and three required re-intubation due to severe pneumonia. Multivariate analysis revealed FEV1.0% <70% and vocal cord palsy were independent risk factors related to a DMT. Conclusion A PMT for high-risk patients may prevent an increase in the incidence of postoperative pneumonia and re-intubation. The PMT indications should be expanded for patients with vocal cord palsy or mild obstructive respiratory disturbances

Sexual Differences in Homing Profiles and Shortening of Homing Duration by Gonadotropin-Releasing Hormone Analog Implantation in Lacustrine Sockeye Salmon (Oncorhynchus nerka) in Lake Shikotsu

Adult sockeye salmon (Oncorhynchus nerka) in Lake Shikotsu were captured in September, October and November adjacent to their natal hatchery prior to spawning. They were sampled for hormones, tagged and released in the center of lake. Fish were again sampled at recapture to characterize changes in steroid hormone levels in individual migrants as well as homing percentage and duration in each month. All males returned faster than females early in the breeding season, although a half of the tagged males did not return to the natal site late in the season (November). A high percentage of females always returned, and homing duration shortened late in the season. In males, the shortening of homing duration coincided with an increase in serum testosterone (T) and 11-ketotestosterone levels. In females, the shortening of homing duration corresponded to an elevation of serum T and 17α,20β-dihydroxy-4-pregnen-3-one (DHP) levels, and a drop in serum estradiol-17β levels. Sustained administration of gonadotropin-releasing hormone analog (GnRHa, via implants) in September greatly shortened homing duration, especially in females. GnRHa treatment caused a dramatic increase in serum DHP levels in both sexes on average. Individual GnRHa-treated males which rapidly returned, however, showed higher serum T levels and lower serum DHP levels than slower returning males. The present study indicates sexual differences in homing profiles as well as shortening of homing duration following GnRHa implantation in lacustrine sockeye salmon in Lake Shikotsu which may be reflective of changes in serum steroid hormone levels

Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p &lt; 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p &lt; 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p &lt; 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC