Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer.

BACKGROUND/AIMS: To assess preliminary results of preoperative embolization of the common hepatic artery in preparation for distal pancreatectomy with en bloc resection of the celiac and common hepatic arteries for carcinoma of the body of the pancreas involving these arteries. METHODOLOGY: Four patients underwent the embolization with coils 1-7 (median: 5) days before surgery. A detachable coil was used to obtain the best position of the first coil as an anchor in 3 patients. RESULTS: Immediately after embolization, collateral pathways developed from the superior mesenteric artery via the pancreatoduodenal arcades to the proper hepatic and gastroduodenal arteries in all 4 patients; however, they were relatively poor in one patient. There were no complications after embolization. The pulsation of the proper hepatic and gastroduodenal arteries was well palpable during surgery, although it had been compromised sometimes in previous cases without embolization. There were no ischemia-related complications in the 2 patients who underwent radical surgery. CONCLUSIONS: Preoperative embolization of the common hepatic artery is a safe technique and has the potential to enlarge the collateral pathways by the time of distal pancreatectomy with en bloc resection of the celiac artery and prevent postoperative fatal ischemia-related complications.

Importance of pre-operative recognition of the nonrecurrent laryngeal nerve.

The nonrecurrent laryngeal nerve is vulnerable during thyroid surgery. Pre-operative recognition of this nerve allows surgeons to avoid injuring the nerve. This anomaly depends upon the aortic arch anomaly and, therefore, in some cases, surgeons are able to predict the presence of this nerve pre-operatively by chest X-ray or barium swallow. Two patients with nonrecurrent laryngeal nerve are reported, one of whom, a 48-year-old man, had an abnormal shadow of the aortic arch, which led to confirmation of a right aberrant subclavian artery. Barium swallow plays a decisive role in the diagnosis of nonrecurrent laryngeal nerve, and this test is mandatory in patients who complain of difficulty in swallowing.

Incidence of transient bacteremia following dental surgery--prophylactic use of cefuroxime, ceftriaxone or clindamycin.

The incidence of transient bacteremia after dental surgery as examined in 15 ml of venous blood has been previously found to amount to 69%. In this study, cefuroxime (1.5g), ceftriaxone (1.0g) or clindamycin (0.6g) was used for chemoprophylaxis to investigate the rate of transient bacteremia after dental surgery. The concentrations of these antimicrobial agents in peripheral blood and an effusion from the tooth extraction wound were measured. The incidence of transient bacteremia was limited to 4.2% by cefuroxime, 0% by ceftriaxone and 5.9% by clindamycin.

Mediastinal bronchial artery aneurysm with hematemesis.

Mediastinal bronchial artery aneurysm is a rare condition which can lead to potentially fatal hemorrhage. In most cases it presents respiratory symptoms due to rupture into pleural parenchyma. But when it develops mediodorsally and compresses the esophagus, it may cause dysphagia or hematemesis. Here we report a case of mediastinal bronchial artery aneurysm which presented with hematemesis. Computed tomography and endoscopic ultrasound showed what seemed to be a submucosal tumor on the esophagus. We were able to correctly diagnose the aneurysm using magnetic resonance imaging and probe thoracoscopy, and were able to successfully treat with transluminal artery embolization.

Seven-day triple therapy with omeprazole, amoxycillin and clarithromycin for Helicobacter pylori infection in haemodialysis patients.

BACKGROUND: Triple therapy is accepted as the treatment of choice for Helicobacter pylori eradication, but there is no consensus on how long the therapy should be maintained in haemodialysis (HD(+)) patients. Our aims in this study were to evaluate the safety and efficacy of the 7-day triple therapy in HD(+) patients. METHOD: Forty-seven HD(+) and 55 HD(-) patients with dyspepsia underwent endoscopy. The prevalence of H. pylori was detected by Giemsa stain, followed by the urea breath test (UBT). H. pylori(+) patients were scheduled to undergo 7-day triple therapy and the success of eradication was investigated by UBT. RESULTS: Forty-five (44%) patients were positive for H. pylori. Forty of them underwent triple therapy and 39 (98%) patients completed the treatment. Eradication was successful in 32 (82%) and unsuccessful in 7 (18%) patients. There was no significant difference between these groups in age, gender, endoscopic findings or HD, and only previous treatment was significant for eradication failure by univariate and multivariate logistic regression analysis. Side effects were observed in 2 (15%) of 13 HD(+) and 3 (11%) of 27 HD(-) patients, and one HD(-) patient had to stop medication because of severe nausea and vomiting. The eradication rate was 93% (28/30) in patients without previous treatment. The triple therapy was unsuccessful in 7 patients, and 4 of them again underwent 7-day triple therapy, but all resulted in failure. CONCLUSIONS: Seven-day triple therapy is safe and effective for primary treatment of H. pylori infection in both HD(+) and HD(-) patients, but a new treatment is necessary for patients with previous treatment.

Atrial fibrillation impairs endothelial function of forearm vessels in humans.

BACKGROUND: Although there have been many studies on the effects of atrial fibrillation (AF) on cardiac function, few studies have been done on its effects on endothelial function. The present study was designed to examine the effects of AF on endothelial function in human subjects. METHODS AND RESULTS: Changes in forearm blood flow (FBF) induced by acetylcholine and nitroglycerin were measured by using plethysmography in 14 patients with lone AF, 13 patients with AF and underlying heart disease, and 12 normal control subjects. In the patients, these measurements were repeated after cardioversion. Although baseline FBF was the same in the 3 groups, acetylcholine-induced increases in FBF were significantly smaller in both patient groups than in the control group, and FBF increases were particularly depressed in AF patients with underlying heart disease. After restoration of sinus rhythm by cardioversion, FBF response to the highest dose of acetylcholine increased by 46% in patients with lone AF (n = 10) and by 90% in AF patients with underlying heart disease (n = 11). Nitroglycerin-induced vasodilatation was the same in all 3 groups and was not affected by cardioversion. CONCLUSIONS: These findings suggest that endothelium-dependent vasodilatation is impaired by AF and improves after sinus rhythm is restored.