Protocols and complications in the reconstruction of major scalp defects

Introduction: This study aimed to analyze the protocols and complications in four unusual cases of large and complex scalp defects, in which conventional, non-microsurgical flaps were used. Methods: This was a critical and retrospective analysis of four cases. Three immunosuppressed patients had squamous cell carcinomas (SCC) (one underwent liver transplant, one underwent renal transplant, and one had rheumatoid arthritis). The other patient had sequelae of head trauma and multiple neurosurgeries using self-polymerizing acrylic, followed by osteomyelitis and fistula. Results: The cases of large carcinoma were reconstructed with rotation large scalp flaps. Two of them had epidermolysis/necrosis in a small distal portion of the flaps, which were treated, with excellent aesthetic results. The case of sequelae of trauma was reconstructed with expanded advancement scalp flap over cranioplasty using ribs. Despite the extrusion of one osteosynthesis, the patient healed without recurrence of the fistula, with na excellent aesthetic result. Conclusion: The analysis of these complex and unusual cases indicates that temporal pedicles are preferred in the planning of flaps for the conventional reconstruction of large scalp defects. The treatment employed for the possible epidermolyses and distal necroses in these flaps led to satisfying aesthetic and functional results

Compartment Syndrome after Prostatectomy

Robot-assisted laparoscopic prostatectomy (RALP) for prostate cancer was introduced in 2000 and rapidly gained popularity. The Da Vinci Surgical System® can ensure improved local control of cancer and fewer perioperative complications. However, RALP is performed in the steep-Trendelenburg position (a combination of lithotomy and head-down tilt position / Lloyd-Davies position) to obtain a good surgical view, and as a result, well leg compartment syndrome (WLCS) can become a serious complication of RALP. Here, we report a case of WLCS after RALP. A 75-year-old man underwent surgery for prostate cancer and immediately complained of pain and numbness after surgery. The pressure of the four leg compartments increased. Ultimately, we diagnosed the patient with WLCS in his right leg, and an emergency fasciotomy was performed. He completely recovered with no permanent disability and was discharged one month after rehabilitation. Although WLCS after RALP is a rare and severe complication, the patient recovered completely with early diagnosis and intervention. Measuring the compartment pressure is useful when the patient is drowsy immediately after recovery from anesthesia. Preventing WLCS requires identifying this condition as a potential complication of RALP and all urologic surgeries performed in the lithotomy position

Primary leiomyoma of the bladder

The case presented is of a 47-year-old patient with an extravesical pedunculated bladder leiomyoma, which was difficult to distinguish from a retroperitoneal tumor. Preoperatively, it was suspected to be a retroperitoneal tumor and a laparotomy with tumor resection was performed. lntraoperatively, the bladder and tumor were connected by a cord-like tissue. A retrospective review of preoperative images revealed that cord-like tissue, identified intraoperatively, was also present. Bladder leiomyomas can grow as extravesical pedunculated tumors. Therefore, when the continuity between the bladder and tumor is only a cord-like object, the finding of continuity is useful to diagnose with bladder leiomyoma

MICROCOMPUTER BASED CONTROL SYSTEM FOR LEFT VENTRICULAR ASSIST PUMP

During the left ventricular bypass, it is important to keep the arterial and atrial pressures at a physiological level to maintain the circulation and at the same time to rest the failing heart (recovery of the failing heart). We have developed a microcomputer based control system for the left ventricular assist pump (LVAP). The control system regulates the arterial and atrial pressures at a physiological level by adjusting the cardiac output of the LVAP. The superior feature of the control system is that it has an indirect measuring system. The arterial and atrial pressures are observed from the careful analysis of pressure in the LVAP air chamber. The assist air pressure shows that the air pressure at the specific momentary points when a diaphragm begins to move reflects the pressure in proportion to the arterial or atrial pressure. The specific momentary points are monitored by an optical diaphragm position sensor when a diaphragm begins to move at a systolic or diastolic period of LVAP, and the pressures at those points are measured by means of a drive air pressure transducer. A microcomputer obtains the indirectly measured arterial and atrial pressures through the A/D converters. The control system regulates the cardiac output of LVAP by adjusting the driving conditions (driving pressure, vacuum pressure, ejection duration, and driving rate) according to the indirectly monitored parameters. The control system consists of an optical diaphragm position sensor, pulse motor driven pressure regulators, a drive air pressure transducer, and a microcomputer. As a result of in vitro experiments, the control system regulated the arterial and atrial pressures smoothly at a desired level

Design evaluation of microwave transmission properties of YBa2Cu3O7-based kinetic inductance detectors

We designed, fabricated, and characterized microwave transmission properties with rewound strip structures for YBa _2 Cu _3 O _7 (YBCO)-based kinetic inductance detectors (KIDs). The superconducting rewound strip serves as a microwave resonator and as a broadband terahertz-wave antenna. To predict the microwave resonance characteristics before fabrication, the line-width ( w ) and space ( s ) dependence of the spiral resonators were analyzed using an electromagnetic simulator; the resonance frequency increased, and the quality factor decreased with increasing w and s from 10 to 40 μ m. YBCO-based KID arrays with different w (10 and 40 μ m) were fabricated on 10 mm-square MgO substrates, cooled to 3 K using a ^4 He refrigerator, and evaluated using a vector network analyzer to verify the result of the simulation experimentally. The measured resonance frequency ratio of 1.11 times (5.04 → 5.59 GHz) agreed with the simulated ones of 1.10 times (4.84 → 5.33 GHz) between w  = 10 and 40 μ m. The other resonance characteristics, such as transmission coefficient and quality factor, have a similar w dependence with the simulation

A case of marked rectal stenosis due to Douglas’ pouch metastasis of renal pelvic carcinoma successfully treated with salvage enfortumab vedotin: correlation between serum KL‐6 levels and tumor response

Introduction We report a rare case of marked rectal stenosis due to Douglas' pouch metastasis of renal pelvic urothelial carcinoma successfully treated with enfortumab vedotin. Case presentation A 77‐year‐old female presented with difficulty in defecation and abdominal distension. She had received two courses of cisplatin plus gemcitabine followed by four courses of maintenance avelumab for postoperative lymph node metastasis of renal pelvic urothelial carcinoma. KL‐6 levels were elevated, and a computed tomography scan revealed an irregularly shaped large mass occupying Douglas' pouch, with marked rectal stenosis. Metastatic urothelial carcinoma was pathologically diagnosed, and enfortumab vedotin was initiated after colostomy. After 12 courses of enfortumab vedotin, metastatic lesions showed marked shrinkage and KL‐6 levels decreased. Conclusion Enfortumab vedotin elicited a remarkable response in treating rectal stenosis due to metastasis of renal pelvic urothelial carcinoma in Douglas' pouch. Furthermore, serum KL‐6 levels were correlated with the severity of metastatic urothelial carcinoma

Real-World Insights into Efficacy and Safety of Enfortumab Vedotin in Japanese Patients with Metastatic Urothelial Carcinoma: Findings, Considerations, and Future Directions

This study presents the enfortumab vedotin (EV) treatment analysis at our institution. We retrospectively analyzed patients with metastatic urothelial cancer (mUC) treated with EV between January 2021 and October 2023. EV was administered at 1.25 mg/kg on days 1, 8, and 15 in a 28-day cycle. Whole-body computed tomography scans were performed to assess the treatment response. Patient characteristics, treatment histories, response rates, progression-free survival, and adverse events were evaluated. Response rates were determined, and adverse events were recorded. Among the 20 patients, 70% were male and 65% had bladder tumors. Most patients had lung (65%) or lymph node (65%) metastases. The median follow-up was 11.2 months, with 45% of the patients succumbing to the disease. The overall response rate was 55%. The median progression-free and median overall survivals were 10.5 and 12.9 months, respectively. Severe adverse events occurred in 35% of patients. In this real-world study, EV demonstrated promising efficacy and manageable safety profiles in Japanese patients with mUC. The study’s results were consistent with previous clinical trials, although a longer follow-up was required. Our findings support EV use as a treatment option for patients with mUC who exhibit disease progression after platinum-based chemotherapy and immune-checkpoint inhibitor therapy