Endoscopic hematoma evacuation following emergent burr hole surgery for acute subdural hematoma in critical conditions: Technical note

Background: Acute subdural hematoma (ASDH) is generally managed by large craniotomy with extended operating time and high relative blood loss. Recently, minimally invasive endoscopic hematoma evacuation of ASDH has been successfully demonstrated; however, non-elderly patients, moderate or massive cerebral contusion, and enlarging hematoma are generally not accepted as indications for endoscopic surgery. Clinical presentation: We report our experience with two ASDH patients with impending herniation successfully evacuated via an endoscopic surgery following emergent burr hole craniostomy. Case 1: A 70-year-old man was admitted to our hospital because of severe head trauma. Neurological examination demonstrated a fixed, dilated right pupil and a CT scan showed ASDH. The entire procedure was completed in approximately 2.5 h. He was transferred to a rehabilitation hospital. Case 2: A 51-year-old comatose woman was transferred to our hospital after a motor vehicle accident. Radiological examination revealed ASDH and severe multiple trauma. Acute traumatic coagulopathy was confirmed by laboratory tests. The entire procedure was completed in approximately 1.5 h. Almost complete evacuation of the hematoma was achieved. Conclusion: If intracranial pressure becomes sufficiently low after emergent burr hole craniostomy, endoscopic hematoma evacuation of ASDH may be a safe and effective method even in critically injured patients. Keywords: Acute subdural hematoma, Burr hole surgery, Endoscopic evacuation, Minimally invasive surgery, Intracranial pressure, Acute traumatic coagulopath

Unilateral Chronic Lung Allograft Dysfunction Assessed by Biphasic Computed Tomographic Volumetry in Bilateral Living-donor Lobar Lung Transplantation

Background. Early diagnosis of unilateral chronic lung allograft dysfunction (CLAD) is difficult because the unaffected contralateral lung functions as a reservoir in bilateral living-donor lobar lung transplantation (LDLLT). We previously reported the usefulness of 133Xe ventilation scintigraphy for detection of unilateral change, but the supply of 133Xe has been stopped globally. The present study aimed to examine the usefulness of inspiratory and expiratory computed tomography (I/E CT) volumetry for detection of unilateral change in CLAD patients. Methods. This was a retrospective single-center, observational study using prospectively collected data. A total of 58 patients who underwent bilateral LDLLT from August 2008 to February 2017 were analyzed. Respiratory function tests, I/E CT were prospectively conducted. ΔLung volume was defined as the value obtained by subtracting expiratory lung volume from inspiratory lung volume. Results. Fourteen (24%) cases were clinically diagnosed with CLAD, of which 10 (71%) were diagnosed as unilateral CLAD. ΔLung volume of bilateral lungs strongly correlated with forced vital capacity (r = 0.92, P < 0.01) and forced expiratory volume in 1 second (r = 0.80, P < 0.01). Regardless the phenotypes (bronchiolitis obliterans syndrome or restrictive allograft syndrome) of CLAD, Δlung volume onset/baseline significantly decreased compared with that in the non-CLAD group. Among the 10 unilateral CLAD patients, 3 with clinically suspected unilateral rejection yet did not show a 20% decline in forced expiratory volume in 1 second. In 2 of these, Δlung volume of unilateral lungs on the rejection side decreased by 20% or more. Conclusions. Our findings suggest that I/E CT volumetry may be useful for assessment and early diagnosis of unilateral CLAD after bilateral LDLLT

The ability of biomarkers to assess the severity of atopic dermatitis

Background: To develop precision medicine for atopic dermatitis (AD), it is critical to establish relevant biomarkers. However, the characteristics of various biomarkers have not been fully understood. We previously carried out the Biomarkers to Predict Clinical Improvement of AD in Patients Treated with Dupilumab (B-PAD) study, a comprehensive nationwide study in Japan, to explore biomarkers for AD. Objective: The aim of this study is to find biomarkers associated with objective and subjective clinical findings in patients with moderate-to-severe AD based on the B-PAD study and to identify biomarkers sensitive enough to assess the severity of AD. Methods: We performed the B-PAD study as a consortium composed of 19 medical facilities in Japan, enrolling 110 patients with moderate-to-severe AD. We evaluated the Eczema Area and Severity Index (EASI) for objective assessment as well as the Patient-Oriented Eczema Measure (POEM) and a numeric rating scale for pruritus (pruritis-NRS) for subjective assessment, measuring 19 biomarkers at baseline. Results: We found that 12, 6, and 7 biomarkers showed significant and positive associations with the EASI, POEM, and pruritis-NRS, respectively. Most of the biomarkers associated with either the POEM or the pruritis-NRS were included among the biomarkers associated with EASI. Of the biomarkers examined, CCL26/eotaxin-3 and SCCA2 were the most capable of assessing severity for EASI, as shown by the 2 kinds of receiver operating characteristic analyses, respectively, whereas lactate dehydrogenase was the best for both the POEM and pruritis-NRS, again using the 2 analyses. Conclusion: We found biomarkers associated with the EASI, POEM, and pruritis-NRS, respectively, based on the B-PAD study. Moreover, we identified CCL26/eotaxin-3 and/or SCCA2 as the biomarkers having the greatest ability to assess severity in the EASI; lactate dehydrogenase did the same for the POEM and pruritis-NRS. These findings will be useful in treating patients with moderate-to-severe AD