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PURPOSE: To compare the 3-year clinical outcomes of endoluminal bypass with those of surgical bypass for complex femoropopliteal (FP) arterial lesions. MATERIALS AND METHODS: In this retrospective multicenter study, 530 patients with symptomatic peripheral artery disease (Rutherford classification 1-3, 66.0%; 4-6, 34.0%) who underwent either endoluminal bypass with Viabahn stent grafts (n = 276) or surgical bypass (n = 254) (with saphenous vein grafts, 74.4%; prosthetic grafts, 25.6%) for FP arterial lesions between 2010 and 2018 were analyzed. The propensity score-matched analysis was performed to compare the 3-year clinical outcomes of endoluminal bypass with those of surgical bypass. The primary end point was primary patency (freedom from restenosis). The secondary end points were secondary patency, freedom from target lesion revascularization (TLR), limb salvage, and overall survival. The interaction effect of baseline characteristics on the association of the revascularization strategy with the risk of restenosis was analyzed using the Poisson mixed-effect model. RESULTS: The propensity score-matched analysis extracted 107 pairs. After propensity score matching, the primary patency rate at 1, 2, and 3 years was 84.5%, 75.1%, and 70.9%, respectively, for the endoluminal bypass group versus 78.6%, 73.3%, and 72.0%, respectively, for the surgical bypass group (P = .65). There was no significant difference in secondary patency, freedom from TLR, limb salvage, and overall survival (all P > .05). The subsequent interaction analysis revealed that the involvement of popliteal lesions, small distal reference vessel diameters, and long lesions favored surgical bypass over endoluminal bypass because of improved primary patency (all P for interaction < .05). CONCLUSIONS: The 3-year clinical outcomes after endoluminal bypass or surgical bypass for FP arterial lesions were similar.
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Implante de Prótese Vascular , Doença Arterial Periférica , Humanos , Prótese Vascular , Grau de Desobstrução Vascular , Resultado do Tratamento , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/cirurgia , Estudos Retrospectivos , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Salvamento de MembroRESUMO
Patients with organ malperfusion from acute aortic dissection (AAD) have poor outcomes, and the surgical indications for patients with AAD complicated by extensive cerebral infarction have not been established. Here, we report a successfully treated surgical case of a patient with cerebral infarction and Stanford type A, AAD. A 77-year-old man was admitted to the hospital with a chief complaint of left paresis. After confirming that there was no cerebral hemorrhage with a head computed tomography and an incision in the right neck, and the right internal carotid artery was ligated and closed, emergency surgery was performed with a 24 mm Triplex® raft. The ascending aorta was replaced, and a bypass was performed with a prosthetic graft from the right axillary artery. No cerebral hemorrhage or neurological issues were observed postoperatively, which indicates the possibility of surgical intervention as a treatment strategy for this disease.
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Dissecção Aórtica , Implante de Prótese Vascular , Masculino , Humanos , Idoso , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Infarto Cerebral , Aorta/cirurgia , HemorragiaRESUMO
BACKGROUND: Pulmonary arterial capacitance (PAC) is a determinant of right ventricular afterload and a strong independent predictor of unfavorable outcomes in advanced heart failure (HF) with pulmonary hypertension (PH). We aimed to test the hypothesis that preoperative PAC may affect postoperative clinical outcomes in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS), even in the absence of PH.MethodsâandâResults:We studied 116 patients who underwent AVR for severe AS between January 2005 and December 2017. Right heart catheterization was performed for all patients prior to surgery. PAC and pulmonary vascular resistance (PVR) fit well to a hyperbolic relationship (PAC=0.23/PVR, R2=0.73). PAC also showed an inverse relationship with pulmonary capillary wedge pressure (PCWP) (r=-0.15) and mean pulmonary arterial pressure (r=-0.29) and provided a stronger prediction of death or HF admission than PCWP or PVR (area under the ROC curve of 0.74 vs. 0.40 and 0.41, respectively, P=0.002). During a median follow-up of 36 months, PAC (hazard ratio, 0.48; 95% confidence interval, 0.30-0.78; P=0.003) was an independent predictor of death or hospitalization for HF. CONCLUSIONS: In these patients undergoing AVR for severe AS, even in the absence of PH, preoperative reduced PAC was independently associated with adverse surgical outcomes. It seems that preoperative PAC has potential as an independent predictor of long-term prognosis after AVR for severe AS.
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Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Artéria Pulmonar/fisiopatologia , Capacitância Vascular , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/fisiopatologia , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Masculino , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular DireitaRESUMO
BACKGROUND: The aim of this study is to compare the outcome of endovascular abdominal aortic aneurysm repair (EVAR) using the Zenith® Spiral Z abdominal aortic aneurysm iliac leg (ZSLE) versus the Zenith® Flex abdominal aortic aneurysm iliac leg (TFLE). METHODS: Patients undergoing EVAR using TFLE or ZSLE between October 2009 and December 2017 were retrospectively reviewed. Clinical end points were freedom from limb-related complications and change in arterial tortuosity indexes. Limb-related complication was defined as limb stenosis or occlusion, stent kink, stent disconnection, and type 1b endoleak. Tortuosity indexes were measured on the preoperative and postoperative computed tomography and compared. RESULTS: A total of 56 patients (11 female, average age 78.5 ± 5.5 years), 111 limbs, were enrolled. One patient was treated using aortouni-iliac device. TFLE was deployed in 43 limbs (22 patients) and ZSLE in 68 limbs (34 patients). Average follow-up was 43.6 ± 27.6 months. During follow-up, 8 limb-related complications occurred in the TFLE group and 2 in the ZSLE group. Freedom from limb-related complications at 3 years was 84.4% in the TFLE group and 96.1% in the ZSLE group (P = 0.039). There was no statistically significant difference between the TFLE and the ZSLE group in the aortoiliac tortuosity change (TFLE versus ZSLE -6.1 ± 5.8 vs. -4.9 ± 6.4, P = 0.324). However, there was significance in the iliac tortuosity change (-7.4 ± 11.7 vs. -3.0 ± 7.9, P = 0.022). CONCLUSIONS: Spiral Z leg showed less occurrence of limb-related complications and less iliac artery tortuosity index change compared to Zenith Flex leg. The spiral Z leg provided better conformability as a stent-graft limb.
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Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Stents , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Feminino , Hemodinâmica , Humanos , Masculino , Maleabilidade , Complicações Pós-Operatórias/etiologia , Intervalo Livre de Progressão , Desenho de Prótese , Estudos Retrospectivos , Fatores de TempoRESUMO
PURPOSE: Fusion angiography using reconstructed multidetector-row computed tomography (MDCT) images, and cholangiography using reconstructed images from MDCT with a cholangiographic agent include an anatomical gap due to the different periods of MDCT scanning. To conquer such gaps, we attempted to develop a cholangiography procedure that automatically reconstructs a cholangiogram from portal-phase MDCT images. METHODS: The automatically produced cholangiography procedure utilized an original software program that was developed by the Graduate School of Information Science, Nagoya University. This program structured 5 candidate biliary tracts, and automatically selected one as the candidate for cholangiography. The clinical value of the automatically produced cholangiography procedure was estimated based on a comparison with manually produced cholangiography. RESULTS: Automatically produced cholangiograms were reconstructed for 20 patients who underwent MDCT scanning before biliary drainage for distal biliary obstruction. The procedure showed the ability to extract the 5 main biliary branches and the 21 subsegmental biliary branches in 55 and 25 % of the cases, respectively. The extent of aberrant connections and aberrant extractions outside the biliary tract was acceptable. Among all of the cholangiograms, 5 were clinically applied with no correction, 8 were applied with modest improvements, and 3 produced a correct cholangiography before automatic selection. CONCLUSIONS: Although our procedure requires further improvement based on the analysis of additional patient data, it may represent an alternative to direct cholangiography in the future.
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Sistema Biliar/diagnóstico por imagem , Colangiografia/métodos , Colestase/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Icterícia Obstrutiva/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Colestase/complicações , Feminino , Humanos , Icterícia Obstrutiva/etiologia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Right-sided hepatectomy is often selected for perihilar cholangiocarcinoma, due to the anatomic consideration that "the left hepatic duct is longer than that of the right hepatic duct". However, only one study briefly mentioned the length of the hepatic ducts. Our aim is to investigate whether the consideration is correct. METHODS: In surgical study, the lengths of the resected bile duct were measured using pictures of the resected specimens in 475 hepatectomized patients with perihilar cholangiocarcinoma. In radiological study, the estimated lengths of the bile duct to be resected were measured using cholangiograms reconstructed from computed tomography images in 61 patients with distal bile duct obstruction. RESULTS: In surgical study, the length of the resected left hepatic duct was 25.1 ± 6.4 mm in right trisectionectomy (n = 37) and 14.9 ± 5.7 mm in right hepatectomy (n = 167). The length of the right hepatic duct was 14.1 ± 5.7 mm in left hepatectomy (n = 149) and 21.3 ± 6.4 mm in left trisectionectomy (n = 122). In radiological study, the lengths of the bile duct corresponding to the surgical study were 34.1 ± 7.8, 22.4 ± 7.1, 20.8 ± 4.8, and 31.6 ± 5.3 mm, respectively. Both studies determined that the lengths of the resected bile ducts were (1) similar between right and left hepatectomies, (2) significantly shorter in right hepatectomy than in left trisectionectomy, and (3) the longest in right trisectionectomy. CONCLUSIONS: The aforementioned anatomical assumption is a surgeon's biased view. Based on our observations, a flexible procedure selection is recommended.
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Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/anatomia & histologia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Hepatectomia/métodos , Tumor de Klatskin/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiografia , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada MultidetectoresRESUMO
BACKGROUND: Hepatectomy for an invisible small tumor using intraoperative ultrasonography requires technical ingenuity. We used a 3D print of a liver to perform a hepatectomy on two patients with synchronous multiple liver metastases from colorectal cancer. Because of preoperative chemotherapy, one of the tumors became smaller and invisible to ultrasonography in each case. We present our procedure here. METHODS: Multidetector-row computed tomography images of anatomical structures were digitally segmented using the original software "PLUTO," which was developed at the Graduate School of Information Science, Nagoya University. After converting the final segmentation data to stereolithography files, a 3D printed liver at a 70 % scale was produced. The support material was washed and the mold charge was removed from the 3D-printed hepatic veins. The surface of the 3D-printed model was abraded and coated with urethane resin paint. After air-drying, the 3D-printed hepatic veins were colored by injecting a dye. The 3D printed portal veins were whitish because mold charge remained. All procedures after 3D printing were performed by hand. RESULTS: Hepatectomy for the small tumor that is invisible to intraoperative ultrasonography was performed by referring to a 3D-printed model. The planned resections were successful with histologically negative surgical margins. CONCLUSIONS: The application of a 3D-printed liver to perform a hepatectomy for a small tumor that is invisible to intraoperative ultrasonography is an easy and feasible procedure. Use of 3D-printing technology in hepatectomy requires further improvement and automation of hand work after the 3D print has been made.
Assuntos
Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Impressão Tridimensional , Idoso , Quimioterapia Adjuvante , Hepatectomia/métodos , Veias Hepáticas/diagnóstico por imagem , Humanos , Cuidados Intraoperatórios , Neoplasias Hepáticas/secundário , Masculino , Tomografia Computadorizada Multidetectores , Terapia Neoadjuvante , Veia Porta/diagnóstico por imagemRESUMO
Injury of the thoracic aorta following a major blunt trauma to the chest occurs most frequently at the aortic isthmus and more than 80% of such patients die within 1st 30 minutes. However, less than 5% of patients survive and later develop chronic thoracic aortic aneurysm (TAA). Usually, most cases of chronic traumatic TAA have no symptoms for a long time after an accident. We report a case of successful repair for a chronic traumatic TAA 16 years after a jet skiing crash. A 37-year-old woman complained of left chest pain, back pain, and cough. A computed tomography showed a descending TAA, which was 5 cm in a maximum diameter. The final diagnosis was chronic traumatic TAA. Thoracic endovascular aortic repair (TEVAR) or graft replacement was considered as an operative procedure. We performed graft replacement to avoid complications of TEVAR, considering her small external iliac arteries.
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Aorta Torácica/lesões , Aneurisma da Aorta Torácica/cirurgia , Traumatismos em Atletas , Adulto , Aneurisma da Aorta Torácica/etiologia , Prótese Vascular , Doença Crônica , Feminino , Humanos , Fatores de TempoRESUMO
Efficacy of percutaneous deep venous arterialization (pDVA) has been reported for patients with no-option chronic limb-threatening ischemia (CLTI). In the countries where a manufactured device dedicated for pDVA has not been reimbursed, pDVA using the off-the-shelf technique has alternatively spread. The off-the-shelf techniques for arteriovenous fistula (AVF) creation reported are as follows: AV spear technique, venous arterialization simplified technique (VAST), and a use of penetration guidewire or a reentry device. Technical success rates of the procedures are similar to those using the dedicated device. pDVA could be a last resort for the patients with no-option CLTI, including those suffering from stump ulcer after major limb amputation or those with occluded surgical bypass.
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OBJECTIVES: Although reoperation has been increasingly performed in cardiovascular surgery in recent years, preventing surgical adhesions remains an unsolved complication. Therefore, this study aimed to investigate whether gelatine sealing sheets are more effective than fibrin sealing sheets in preventing surgical adhesions. METHODS: Bilateral femoral arteries of 20 beagle dogs under general anaesthesia were pricked with syringe needles, and gelatine and fibrin sealing sheets were applied on the bleeding points to make canine adhesion models. The femoral artery was harvested after 4 and 12 weeks to evaluate adhesion formations. The adhesive grade was quantified by scoring the area and strength of adhesion tissues. Histological staining was performed to examine the structural features of surgical adhesions. RESULTS: Significantly fewer macroscopic adhesions were observed with gelatine sealing sheets than those with fibrin sealing sheets at 4 and 12 weeks postoperatively. Microscopically, CD3+ T lymphocytes at 4 and 12 weeks postoperatively in gelatine sealing sheets were significantly lower than those in fibrin sealing sheets. Microvessel density determined by CD34 at 4 and 12 weeks postoperatively in gelatine sealing sheets was also significantly lower than those in fibrin sealing sheets. CONCLUSIONS: The gelatine sealing sheets are more effective than the fibrin sealing sheets in preventing surgical adhesions. These findings suggest that the gelatine sealing sheet may help prevent adhesions and thus be a therapeutically effective biomaterial in vascular surgery.
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Gelatina , Adesivos Teciduais , Animais , Materiais Biocompatíveis , Cães , Adesivo Tecidual de Fibrina , Humanos , Aderências Teciduais/prevenção & controleRESUMO
Background: Patent false lumens carry a high risk of aortic events including rupture. False lumen embolization is a useful method to promote thrombosis of false lumen. In the case presented here, direct penetration of the dissected membrane was employed to obtain access to the false lumen, enabling embolization. Case report: The case was a 64-year-old female who developed a Stanford type A acute aortic dissection. Replacement of ascending aorta and aortic arch with frozen elephant trunk technique was performed. After the operation, there was a residual flow through the false lumen in the descending thoracic and abdominal aorta. Twenty months later, the patient complained of sudden back pain, and a CT scan demonstrated another new dissection at the distal edge of the open stent. Additionally, the false lumen that had remained since the onset of the type A aortic dissection enlarged during the observation period. An endovascular procedure was planned to exclude the false lumen. Despite closing all communicating channels between true and false lumen using a vascular plug, coils, and stent grafts, the false lumen continued to expand due to the residual flow at the visceral segment. The origin responsible for the flow was not identified. To perform an embolization of the false lumen, access into the false lumen was obtained by penetration of the dissected flap using a trans-septal needle. Following the successful penetration of the flap, embolization of the false lumen was performed using coils and glue. After the embolization, an angiogram of the false lumen confirmed the significant reduction of leakage into the true lumen. The size of the aorta and false lumen decreased after the embolization. Conclusion: Direct penetration of the dissected membrane of the aorta was a safe and useful measure for regaining access to the false lumen and for the following endovascular intervention.
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Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aorta Abdominal , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Stents , Resultado do TratamentoRESUMO
BACKGROUND: Optimal dose of local anesthetics for supraclavicular brachial plexus block (BPB) is still unknown. We prospectively investigated the analgesic effect of ultrasound-guided continuous supraclavicular BPB with ropivacaine at different infusion rates. METHODS: Thirty-nine patients scheduled to undergo shoulder surgery were randomly assigned to four groups; receiving no continuous BPB (control group, n = 10), BPB with 0.2% of ropivacaine at an infusion rate of 4 ml x hr(-1) (n = 12), BPB with 6 ml x hr(-1) (n = 12) or BPB with 8 ml x hr(-1) (n = 5). All patients were permitted to receive nonsteroidal anti-inflammatory drugs (NSAIDs) after surgery. Visual analogue scale (VAS) for postoperative pain was assessed and frequencies of the requirement of NSAIDs were recorded in each group. RESULTS: The pain scores during 24 hours after surgery in the 6 ml x hr(-1) group (3-24 mm) were significantly lower than those in the 4 ml x hr(-1) group (4-42 mm) and control group (6-56 mm). Mean frequency of administrations of NSAIDs for 24 hours after surgery in the 6 ml x hr(-1) (0.8 +/- 0.8) group was significantly lower than that in the control group (1.7 +/- 1.0). Continuous administration in two cases in the 8 ml x hr(-1) group was discontinued due to leakage of local anesthetics and headache. CONCLUSIONS: Continuous supraclavicular BPB with 0.2% ropivacaine at 6 ml x hr(-1) is effective for the pain management after shoulder surgery and is not an excess dose.
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Amidas/farmacologia , Anestésicos Locais/farmacologia , Plexo Braquial , Bloqueio Nervoso/métodos , Articulação do Ombro/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RopivacainaRESUMO
BACKGROUND/AIM: Treating abdominal aortic aneurysms (AAA) of the juxtarenal artery with renal artery clamps burdens the kidneys. We investigated the outcomes of intra-operative renal artery perfusion using the cold Ringer's solution method for renal protection. PATIENTS AND METHODS: We enrolled 290 AAA patients who underwent open aortic repair. Surgical outcomes were investigated based on renal protection. RESULTS: We evaluated 231 patients requiring infrarenal artery clamp (Group I), and 59 patients requiring perfusion in addition to the clamp (Group J). Patient demographics, acute kidney injury (AKI) incidence (Group I: 11.7% and Group J: 20.3%), hospital mortality (Group I: 1.3% and Group J: 1.7%), and 30-day mortality (Group I: 0.4% and Group J: 0%) were not different between the groups. The AKI incidence was low (13%) in cases requiring a renal artery clamp for ≥45 min (n=40). CONCLUSION: Perfusion with cold Ringer's solution offers renal protection and may improve surgical outcomes.
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Injúria Renal Aguda/complicações , Aneurisma da Aorta Abdominal/cirurgia , Artéria Renal/cirurgia , Solução de Ringer/administração & dosagem , Injúria Renal Aguda/diagnóstico , Idoso , Aneurisma da Aorta Abdominal/complicações , Temperatura Baixa , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Perfusão , Substâncias Protetoras/administração & dosagem , Fatores de RiscoRESUMO
BACKGROUND: Copeptin, the C-terminal portion of the arginine vasopressin precursor, is a novel candidate biomarker. This study investigated the prognostic value of copeptin levels following cardiac surgery for the occurrence of postoperative acute kidney injury. METHODS: We studied 23 patients who underwent cardiac surgery between January 2018 and December 2019. The primary endpoint was postoperative acute kidney injury onset. Copeptin levels were measured before, right after, and daily for 7 days. The patients were divided into two groups according to the copeptin levels: low (values <43.7 pmol/L) and high (values ≥43.7 pmol/L). Correlations between copeptin levels and variables, such as central venous pressure, were assessed by bivariate analysis. RESULTS: The high copeptin group exhibited significantly higher levels of arginine vasopressin and cortisol following surgery, compared to those of the low copeptin group. The copeptin concentration following surgery was correlated to central venous pressure (P=0.03) and norepinephrine administered dose (P=0.008). Also, the copeptin levels right after surgery robustly predicted the onset of postoperative acute kidney injury (area under the receiver operating characteristic curve of 0.83, P=0.004). CONCLUSIONS: Elevated copeptin levels in patients following cardiac surgery predicted postoperative acute kidney injury development. Therefore, the copeptin concentration after surgery could represent a promising clinical biomarker of the postoperative cardiac outcome.
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AIM: This study aimed to evaluate the structural and functional changes of left-sided cardiac chambers by cardiac magnetic resonance imaging (CMRI) in patients with chronic mitral regurgitation after mitral valve repair (MVR). PATIENTS AND METHODS: Among 103 patients who underwent MVR, 21 showed normal left ventricular (LV) function; their pre- and postoperative left atrial (LA) and LV functions were examined by CMRI. RESULTS: LV end-diastolic volume, LV end-systolic volume, and LV mass significantly were reduced postoperatively (p<0.01) and postoperative LV ejection fraction tended to decrease. LA volume parameters also significantly decreased postoperatively (p<0.01). The conduit function positively affected the LV filling volume postoperatively (p<0.01); however, no effect on the booster pump function was noted (p=0.01). CONCLUSION: Restoration of LA and LV functions after a successful MVR was not associated with structural improvement in LA and LV.
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Insuficiência da Valva Mitral , Valva Mitral , Humanos , Imageamento por Ressonância Magnética , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Volume Sistólico , Função Ventricular EsquerdaRESUMO
Although laparoscopic hepatectomy is widely accepted for primary hepatectomy, the clinical value of laparoscopic hepatectomy for repeat hepatectomy is still challenging. We herein describe our experience with laparoscopic repeat hepatectomy after right hepatopancreaticoduodenectomy. A 72-year-old woman who had undergone right hepatopancreaticoduodenectomy for perihilar cholangiocarcinoma 31 months prior was diagnosed with liver metastasis in segment 3. We performed laparoscopic repeat hepatectomy. Because mild adhesions in the left side of the abdominal cavity were detected by laparoscopy, the planned procedure was accomplished. The operative time and intraoperative blood loss were 139 min and less than 1 mL, respectively. The patient was discharged at 6 days after surgery and was healthy with no evidence of recurrence at 21 months after laparoscopic repeat hepatectomy. Laparoscopic repeat hepatectomy is a suitable and safe procedure for minor hepatectomy, provided that careful technique is used after the working space is secured under pneumoperitoneum.
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Neoplasias dos Ductos Biliares/patologia , Ducto Colédoco , Hepatectomia/métodos , Tumor de Klatskin/secundário , Laparoscopia , Neoplasias Hepáticas/secundário , Pancreaticoduodenectomia , Idoso , Neoplasias dos Ductos Biliares/cirurgia , Feminino , Humanos , Tumor de Klatskin/cirurgia , Neoplasias Hepáticas/cirurgia , ReoperaçãoRESUMO
Left ventricular noncompaction is a rare cardiac pathology that results from an arrest in endomyocardial development in early embryogenesis. With great advances in imaging modalities, this pathological entity has been noted not only in the pediatric population but also in adults. Herein we report the case of a 62-year-old woman who successfully underwent aortic valve replacement for aortic regurgitation complicated by left ventricular noncompaction.
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Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Miocárdio Ventricular não Compactado Isolado/complicações , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/fisiopatologia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Miocárdio Ventricular não Compactado Isolado/diagnóstico , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: The bilayer gelatin sealing sheet was developed as a safe, effective, easy-to-handle and low-cost hemostatic agent. OBJECTIVE: To examine the feasibility of gelatin sealing sheets using a canine arterial hemorrhage model. METHODS: In vivo degradation of gelatin sealing sheets was examined by implanting subcutaneously in rats. For the hemostatic and anti-adhesion efficacy investigations, femoral arteries of dogs were pricked with syringe needle to make a small hole and a gelatin (i.e. experimental group) or fibrin glue sealing sheet (i.e. control group) was applied on the hole to stop bleeding (n=8). After discontinuation of the bleeding, the skin incisions were closed and re-examined 4 weeks postoperatively. RESULTS: From the degradation study, 4 h thermally treated gelatin sheet which degraded within 3 weeks in vivo was chosen for the further hemostatic study. In all cases of gelatin and fibrin glue sealing sheets, bleeding from the needle hole on canine femoral arteries was effectively stopped. Postoperative adhesions and inflammation at the site in the experimental group were significantly less than those in the control group (P<0.01 for adhesion scores). CONCLUSIONS: The gelatin sealing sheet was found to be as effective as the fibrin glue sealing sheet as a surgical hemostatic agent, and more effective in preventing postoperative adhesions.
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Artérias/efeitos dos fármacos , Gelatina/farmacologia , Hemostasia , Procedimentos Cirúrgicos Vasculares , Animais , Artérias/metabolismo , Materiais Biocompatíveis/química , Modelos Animais de Doenças , Cães , Avaliação Pré-Clínica de Medicamentos , Feminino , Adesivo Tecidual de Fibrina/farmacologia , Hemorragia/tratamento farmacológico , Microscopia Eletrônica de Varredura , Cuidados Pós-Operatórios , Ratos , Ratos Wistar , Aderências Teciduais/tratamento farmacológicoRESUMO
BACKGROUND: Anastomotic needle hole bleeding is a frequently encountered problem in cardiovascular surgeries. OBJECTIVE: To examine the feasibility of crosslinked gelatin glue as an anastomotic needle hole sealant in comparison with fibrin glue. METHODS: The in vitro burst water pressures were measured for gelatin and fibrin glue sealed needle holes of expanded polytetrafluoroethylene (ePTFE) or collagen coated woven polyester grafts. For in vivo investigations, abdominal aorta-ePTFE graft anastomoses of heparinized beagle dogs were sealed by gelatin or fibrin glue and hemostatic efficacy was judged. The implanted sites were re-examined 4 weeks postoperatively. RESULTS: The in vitro burst water pressures of gelatin glue sealed needle holes of both grafts were higher than those sealed by fibrin glue. For in vivo canine studies, hemostasis was successful for all gelatin glue applied suture lines, but not two out of three fibrin glue treated sites when 3-0 polypropylene suture was employed. Although adhesions of surrounding tissues were intense for all sites 4 weeks postoperatively, inflammation was more severe for the fibrin glue group compared to those of gelatin glue. CONCLUSIONS: Gelatin glue was found to be an effective and safe sealant for accomplishing hemostasis of anastomotic needle holes of vascular grafts.