Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study.

BACKGROUND: Deep venous thrombosis (DVT) and pulmonary embolism are serious potential complications after anterior cruciate ligament reconstruction (ACLR). Little is known about the influence of tourniquet use on the incidence of DVT after ACLR. PURPOSE: To compare the incidence of DVT after ACLR with and without the use of a tourniquet. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between November 2018 and May 2020, a total of 60 consecutive ACLRs in 60 patients, including 7 revision surgeries, were performed without tourniquet use at our hospital and were enrolled in this study (T- group). In addition, 55 consecutive ACLRs in 55 patients, including 10 revision surgeries, were performed with tourniquet use between April 2017 and September 2018 and were enrolled as the control group (T+ group). DVT was diagnosed using ultrasonography of both legs performed preoperatively and at postoperative week 1. The incidence of postoperative DVT was compared between the T- and T+ groups. Logistic regression analysis was performed to evaluate the effect of older age (≥40 vs <40 years) and tourniquet use on the occurrence of DVT. RESULTS: No DVTs were detected preoperatively. The incidence of postoperative DVT was significantly lower in the T- group compared with the T+ group (1 patient [1.7%] vs 9 patients [16.4%]; P = .005). All patients with DVT were asymptomatic. Although the mean operative time was not significantly different (80.8 minutes in the T+ group vs 78.5 minutes in the T- group; P = .461), the mean blood loss from the drain was significantly lower in the T- group than in the T+ group (149.9 vs 201.9 mL; P < .001). Age ≥40 years and tourniquet use were significantly related to the occurrence of DVT (odds ratio, 8.3 [95% CI, 1.9-36.8]; P = .005; and odds ratio, 8.8 [95% CI, 1.0-75.3]; P = .047, respectively). CONCLUSION: ACLRs performed without tourniquet resulted in a significantly lower incidence of DVT after ACLR and significantly less bleeding from drains. If adequate visibility of the surgical field is obtained, ACLR without tourniquet use may reduce the incidence of DVT.

Concomitant carotid endarterectomy and aortic valve replacement in a patient with high risk of perioperative stroke.

Surgical strategy for significant carotid artery stenosis complicated with severe aortic valve stenosis is still controversial. Herein, we report a case of 80-year-old female in whom 78% stenosis by the NASCET criteria in left internal carotid artery was pointed out during preoperative checkup for symptomatic severe aortic stenosis. Carotid endarterectomy was done concomitantly with aortic valve replacement. No neurological complication occurred perioperatively.

Clinical experience with chemoradiotherapy comprising S-1 plus low-dose cisplatin in a patient with stage IV anal cancer.

We report a case of anal cancer in a 58-year-old woman who complained of narrow, bloody stools and anal pain. Physical examination revealed anal stenosis associated with a circular mass arising in the anal canal. Histological examination of biopsy specimens confirmed a diagnosis of moderately differentiated squamous cell carcinoma. Enhanced computed tomography revealed anal cancer invading the levator ani and the vagina, with lymph-node, multiple hepatic, and pulmonary metastases. The patient received two cycle of chemoradiotherapy with S-1 plus low-dose cisplatin with rest for 4 weeks, leading to complete response of the primary lesion and a partial response of the metastatic lesions. Each cycle included oral S-1 (120 mg/body; day 1-21), cisplatin (10 mg/body; day 1-5, 8-12) and radiotherapy (2 Gy/day; day 1-5, 8-12, 15-19). Adverse effects of treatment were mild perineal skin erosion and mild appetite loss, but no hematologic toxicity. Although the patient died 16 months after first admission, chemoradiotherapy with S-1 plus cisplatin is potentially effective for the management of advanced anal cancer.

Stomach-partitioning gastrojejunostomy for gastroduodenal outlet obstruction.

HYPOTHESIS: The outcome of the stomach-partitioning gastrojejunostomy (SPGJ) procedure is superior to that of stenting procedures. DESIGN: Data from patients who underwent an SPGJ were collected retrospectively from hospital medical records (body weight, hemoglobin and albumin levels, assessment of food intake, duration of hospitalization, complications, and survival rates), and we compared the results with those obtained from patients treated with stenting. SETTING: Departments of Gastrointestinal Surgery and Gastroenterology, Tokyo University Hospital, Tokyo, Japan. PATIENTS: A series of 16 consecutive patients with gastroduodenal outlet obstruction who underwent an SPGJ and 9 patients who were treated with stenting between January 5, 1998, and August 18, 2004. MAIN OUTCOME MEASURES: Mann-Whitney, Fisher exact, and generalized Wilcoxon tests were used for statistical analyses. RESULTS: There were no differences between the 2 groups concerning background data, physiological status, or laboratory data. The starting point of food intake by patients treated with stenting was significantly earlier (at 4.2 days in the stent group vs at 6.0 days in the SPGJ group, P < .004). The numbers of patients taking a regular meal at 2 weeks after treatment were 12 of 16 patients in the SPGJ group and 1 of 9 patients in the stent group (P < .001). There was no significant difference between the 2 groups regarding the duration of hospitalization. The complication rates were significantly different between the 2 groups (P = .48). The median survival was 7.3 months in the SPGJ group and 2.8 months in the stent group (P = .008), and the mean 6-month survival rates were 81% (13 of 16) and 33% (3 of 9), respectively (P < .04). CONCLUSION: Stomach-partitioning gastrojejunostomy achieved improved quality of life and a better prognosis compared with stenting procedures, and it is the treatment of choice for gastroduodenal outlet obstruction.