Fluid Dynamics of Single-needle Dialysis in an Experimental Model

Background:Acceptance has grown for single-needle dialysis when a vascular access is not suited for the insertion of two needles. Its impact on flow patterns was unknown. Methods:We produced transparent life-size models of arteriovenous(AV)fistulas and AV grafts that we placed into a pulsatile flow system to examine flow characteristics during simulated dialysis cycles. For this purpose we injected dye, and recorded and analyzed the resulting flow patterns using suitable software tools. Results:There is a definite flow reversal during the arterial phases in both AV fistulas and -less pronounced-in AV grafts leading to flow oscillations. Conclusion:Flow oscillations initiate subintimal hyperplasia possibly leading to stenoses in vivo. Reversal of the flow direction may also cause steal phenomena in the poorly perfused distal extremity. Single-needle dialysis should therefore be avoided if possible

Wernicke\u27s Encephalopathy after Gastrectomy and Adjuvant Chemotherapy Using S-1 for Gastric cancer :Report of a Case

Wernicke\u27s encephalopathy is a disease usually related to chronic alcoholism. We reported a case of Wernicke\u27sencephalopathy after distal gastrectomy and chemotherapy using S-1 despite of no history of alcoholism.A 58-year-old woman underwent distal gastrectomy for gastric carcinoma in February, 2005. Shereceived adjuvant chemotherapy using S-1, since histological examination of the removal specimens showedregional lymph nodes metastasis. After this therapy, she rapidly developed diplopia, ataxia and disturbanceof consciousness. Although brain CT and the routine laboratory data showed no abnormal changes, brainMRI showed a symmetrical high-intensity area in the third ventricle and periaqueductal regions;this wascharacteristic of Wernicke\u27s encephalopathy. She was immediately treated with thiamine, and recoveredconsciousness within a few hours. S-1 based on 5-fluorouracil( 5-FU) which reduced the thiamine levels inthe patient, may have worsened the thiamine deficiency caused by distal gastorectomy. Therefore, cliniciansshould pay attention to suspicious symptoms of thiamine deficiency in patients who have undergone gastrectomy,particularly those who receive adjuvant chemotherapy with S-1 or 5-FU

Massive Desmoid with Keloid of the Anterior Neck

It is a case report of a massive recurrent desmoid and overlying keloid that simultaneously occurred inthe anterior neck. A 21-year woman presented with a 4-year history of a recurrent desmoid with a keloidof the skin in the anterior neck. The desmoid and overlying keloid were excised en-bloc with episternotomy.The defect was covered with the rotated pectoralis major muscle flap, and then resected episternum wasreturned after inactivation by liquid nitrogen. Skin defect of the anterior neck was covered with the free radialforearm flap. Although there is no evidence of recurrence of the desmoid a year later, recurrence of thekeloids is remarkable. As to our knowledge, it is rare that desmoids and keloids occur simultaneously. Itmight be an opportunity to explain a strange character of desmoids based on clinical nature of keloids

Splenomegaly and Tumor Marker Response Following Selective Internal Radiation Therapy for Non-Resectable Liver Metastases from Neuroendocrine Tumor

PURPOSE:The aim of this study was to investigate changes in spleen size, the level of chromogranin Aas a tumor marker, and the relationship between these two parameters before and 3 months after selectiveinternal radiation therapy (SIRT) for non-resectable liver metastases from neuroendocrine tumor (NET).Our first serious adverse event with this relatively new treatment is also discussed.METHODS:A retrospective review of a prospective database identified patients with non-resectable livermetastases from NET who underwent SIRT between 2003 and 2007. Patients who underwent CT scansbefore and 3 months after treatment were included. The patients were divided into two groups:those withand without a 20 % or more increase in splenic volume on the CT scans. The percentages of patients showinga tumor marker response in the two groups were then comparedRESULTS:Fourteen patients were included in the present analysis. A tumor marker response was seenin 6 of 7 patients( 85.7%) who showed an increase in splenic volume of>20%, and in 3 of 7 patients( 42.9%) without an increase in splenic volume (p=0.266). There was one death as a result of oesophageal varicealbleeding due to portal hypertension at 9 months after treatment.CONCLUSION:Splenic enlargement after SIRT may be associated with tumor marker response, althoughthis could not be confirmed statistically in this study due to the small number of patients. Long-termsplenomegaly and portal hypertension may be important complications of SIRT. This issue needs to be investigatedfurther using a larger number of patients and longer follow-up

Evaluation of Gastroesophageal Reflux and Gastroesophageal Reflux Disease with Esophageal Endoscopy and Histology in Children

Objectives:The roles of esophageal endoscopy and mucosal biopsy in making diagnoses of gastroesophageal reflux( GER) and gastroesophageal reflux disease( GERD) were retrospectively examined in children.Methods:Thirty-four patients, whose ages ranged from 1 month to 18 years (median, 4 years), underwent diagnostic evaluation of GER/GERD. Group I patients( n=5) had symptoms suggesting GER, but had no underlying abnormalities. Group II patients( n=23) had chronic symptoms suggesting GERD and underlying abnormalities, neurologic impairment( n=22) and post-repair of esophageal atresia( n=1). Group III patients( n=6) were neurologically impaired but had no symptoms and underwent evaluation as a preoperative examination of gastrostomy placement. Reflux esophagitis was endoscopically graded according to the modified Los Angeles classification and grouped into grades?M, A, and?B. The results of GER studies and the histologic findings of reflux esophagitis were compared between these groups.Results:The parameters of 24-h pH monitoring were significantly higher in patients with grade?B than grade?M, and endoscopic grades improved after antireflux surgery along with the improvements in reflux index. There were no significant correlations between the endoscopic grade and the percentages of patients in whom histologic findings of reflux esophagitis were present.Conclusion:Esophageal endoscopy is useful for examining the severity of reflux esophagitis and monitoring the effect of treatment in children with GER/GERD. The modified Los Angeles classification can also be used for that purpose. Although treatment is seldom influenced by the results, histologic evaluation of the esophageal mucosa should be performed to exclude other disorders

A Case of Retroperitoneal Schwannoma Difficult to Diagnose Preoperatively

We report a case of retroperitoneal schwannoma misdiagnosed as a liver tumor in the caudate lobe. Preoperative diagnoses should be made with great care in cases of retroperitoneal tumors contacted to the liver since it is difficult to differentiate from intrahepatic tumors

Gallbladder schistosomiasis: rare but possible, a case report and review of the literature

After Malaria, schistosomiasis remains the most important tropical disease in large parts of the world. It affects mainly the colon and the urinary tract. The hepatic involvement is significantly frequent, particularly by the mansoni species. Still one of the extremely rare locations is the gallbladder. Our case is about a 51 year old woman from Tunisia, which is no longer considered an endemic country, with no particular medical history, underwent surgery for symptomatic cholelithiasis. She had a laparoscopic cholecystectomy. Post operative period was uneventful. Histology of the gallbladder showed fibrosis in the mucosa and schistosomal ova in the wall. As a conclusion we can see that due to the lack of specific clinical and radiological signs, the diagnosis of gallbladder schistosomiasis is established only after the histological examination

Reinforcement of Coracoacromial Ligament Transfer for Severe Acromioclavicular Dislocation using the Suture Anchor and the Hook Plate : Results of the cases

Introduction : Three cases of successfully treated Rockwood type V acute acromioclavicular joint dislocation in high activity patients with modified (reinforced) coracoacromial ligament transfer were reported. Materials and methods : All patients were operated on within 3 weeks after injury. The operation is constructed with three parts, namely the coracoclavicular ligament repair with 2 suture anchors, the coracoacromial ligament transfer, and internal fixation of the acromioclavicular joint with short-hook-3-hole plate as a temporary support until ligaments heal. Postoperatively, the patient\u27s shoulder is lightly immobilized with a sling. The sling is removed at the first postoperative day and the patient is allowed to begin circumduction exercises with a gradual increase. No overhead activities or full abduction was allowed until the hook plate removal at three months. Results : The mean follow-up duration was one year. Mean Constant score at a year was 95 out of a maximum of 100. Mean ASES score at a year was 29 out of a maximum of 30. Although follow-up was a short period, both subjective and objective assessments including X-ray evaluation were excellent. Conclusion : Combination of the repaired coracoclavicular ligament with the suture anchors and the transferred coracoacromial ligament must keep more rigid strength against redisplacement, and the temporary hook plate strongly prevents the ligaments from any stress during their healing period. Since reliable stability from the initial postoperative stage can ease mandatory limitation in daily activities earlier, this reinforced procedure may consequently help early reinstatements of the patients

A Comparison of Partial and Full Median Sternotomy for Re-do Cardiac Valve Surgery

Background. Minimally invasive cardiac surgery (MICS) has been reported to reduce surgical trauma, postoperative pain, blood loss, and length of stay. This study compares MICS using partial sternomy with full sternotomy in re- do cardiac valve surgery. Methods. The records of 20 patients who underwent full median sternotomy (group F) and 17 patients who underwent MICS (group M) for re- do cardiac valve surgery from April 1990 to April 2001 were compared retrospectively. Results. Time of operation (skin-to-skin), perfusion time, time of extubation, and length of Intensive Care Unit stay were shorter in group M than group F (352.19 ± 76.05 min vs. 510.70 ± 256.26 min, 143.65 ± 29.41 min vs. 254.60 ± 192.72 min, 16.31 ± 7.56 h vs. 48.47 ± 40.14 h, 2.13 ± 0.81 days vs. 4.53 ± 2.20 days). Intra operative blood loss and chest drainage also were less in group M than group F (774.53 ± 415.48 mL vs. 3781.30 ± 5207.07 mL, 779.70 ± 666.48 mL vs. 1687.56 ± 984.23 mL). Conclusions. This study demonstrates the advantages of MICS for re-do cardiac valve surgery

Thrombophlebitis in Central Vein Caused by Indwelling Catheter for Total Parenteral Nutrition : A Case Report and Venous Angiographic Study of 27 Cases with Central Vein Catheterization

A fifty-three-year-old man developed thrombophlebitis in the left subclavian and jugular vein after 16-days total parenteral nutrition (TPN) with a catheter indwelling in the central vein via the left subclavian vein for nutritional management during perioperative period of distal gastrectomy. We herein report the case with a venous angiographic study of 27 cases that underwent central vein catheterization for TP