Association of pre-hospital tracheal intubation with outcomes after out-of-hospital cardiac arrest by drowning comparing to supraglottic airway device: A nationwide propensity score-matched cohort study.

AIM OF THE STUDY: This study aimed to compare the survival outcomes of adult patients with out-of-hospital cardiac arrest (OHCA) by drowning who were treated with either endotracheal intubation (ETI) or a supraglottic airway (SGA) device. METHODS: We compared the outcomes of patients with OHCA by drowning according to airway management using a Japanese nationwide population-based registry (All-Japan Utstein Registry). Adult patients with OHCA treated in 2014-2020 with advanced airway management (ETI or SGA) were included. Patients who received ETI during cardiopulmonary resuscitation were matched with those treated with SGA based on propensity scores in a 1:1 ratio with a 0.2 calliper width. The outcome measures were the return of spontaneous circulation (ROSC), survival at one month, and favourable neurological outcomes defined as a Cerebral Performance Category Scale score of 1 or 2. RESULTS: Of the 11,703 eligible patients, 4,467 (38.2%) and 7,236 (61.8%) underwent ETI and SGA, respectively. A total of 3,566 patients in each cohort were matched. The ROSC rate was higher in those treated with ETI versus SGA (207/3,566 [5.8%] versus 167/3,566 [4.7%], respectively; adjusted odds ratio, 1.25; 95% confidence interval [CI], 1.02-1.55). There was no intergroup difference in one-month survival or favourable neurological outcome (32/3566 [0.90%] versus 34/3566 [0.95%]; odds ratio, 0.94; 95% CI, 0.58-1.53; and 9/3566 [0.25%] versus 8/3566 [0.22%]; odds ratio, 1.13; 95% CI, 0.43-2.92), respectively. CONCLUSIONS: In this propensity score-matched study of adult OHCA by drowning, ETI compared to SGA was associated with ROSC but not associated with survival and favourable neurological outcomes at one month.

Morel-Lavallée Lesion in a Female Breast: A Case Report.

Morel-Lavalée lesions (MLLs) are caused by closed degloving injuries that mostly occur in the thigh, flank, and buttocks. We report a rare case of an MLL in the breast that was successfully treated with surgical removal in the acute phase. A 57-year-old woman sustained a breast injury from a seatbelt in a motor vehicle accident. Contrast-enhanced CT was performed, and the patient was diagnosed with an MLL in her breast. Surgical removal was performed after five days, and the patient was discharged six days postoperatively. No recurrence was observed, and the cosmetic results were good at six months postoperatively. Early detection and treatment of MLL in the female breast are critical to avoid recurrence and ensure good cosmetic outcomes.

A stylized two-stage debridement strategy using an electric dermatome and a Versajet™ hydrosurgery system for deep axillary burns.

Treatment of axillary contracture after extensive deep burns is a serious clinical challenge. Various surgical intervention for releasing contracture using skin grafts, flaps and artificial skin have been used, but no consensus on the optimal treatment has been obtained. A standardized two-stage debridement strategy using an electric dermatome (for eschar) and the Versajet™ hydrosurgery system (for slough) can be an appropriate debridement strategy that provides reliable wound bed preparation in cases of for axillary deep burns. Using this approach focus on management of acute axillary burns, it is possible to avoid engraftment failure and prevent contracture caused by prolonged infection. This treatment strategy can be standardized and can be performed easily, even by non-experts.

Iatrogenic abdominal hematoma and severe anemia due to cosmetic liposuction.

A 40-year-old woman presented with a 3-days history of lightheadedness after tumescent liposuction. Computed tomography revealed a hematoma in the subcutaneous fat of the abdomen. She was diagnosed with iatrogenic abdominal hematoma after cosmetic liposuction.

A novel fixation method for panfacial fracture using an Ilizarov-type external fixator.

In general, internal plate fixation is mainly performed in order to reduce multiple facial bone fractures and rarely uses an external fixator. Although it would be ideal to successfully achieve or preserve the occlusal relationship of the upper and lower jaws, it is difficult to successfully manage multiple bone fragments in order to use them to achieve internal fixation, especially when treating a severely comminuted facial fracture. In addition, it is also important to prevent the onset of severe infection after sub-periosteal dissection, due to the presence of avascular bony fragments and an internal fixation implant which thus represents a foreign body. In order to treat extensive comminuted fracture without internal plate fixation, we performed external fixation using an Ilizarov-type external fixator. The Ilizarov-type external fixator is characterized by a few circular external structures and threaded rods. This device can be modified for use in the field of orthopedic surgery to correct three-dimensional deformities caused by fragile complicated fractures and bone defects. The advantages of the Ilizarov-type external fixator for treating panfacial fractures include a low invasiveness, utility in various fracture situations, easy adjustment of threaded rods, and a low potential cost. We herein report the first case of a severe panfacial fracture that was successfully treated using an Ilizarov-type external fixator.

Primary cutaneous adenoid cystic carcinoma on the lower leg.

Primary cutaneous adenoid cystic carcinoma (PCACC) is a very rare malignant tumor. Here a case of PCACC on the left lower leg with metastasis to the inguinal lymph node. The tumor resection and the inguinal lymph node dissection were performed under general anesthesia, and the defect was covered with free meshed skin graft. No complication or recurrence has occurred after the surgery.

Reconstruction of Medial Canthal Tendon Using Novel Suture Anchoring System: A Case Report.

For medial canthal tendon reattachment, many kinds of surgical technique have previously been reported. They are complicated and generally require technical skill and prolonged operating times. We, for the first time, describe a novel device, the Caraji Anchor Suture System, used for reattaching the medial canthal tendon to the medial orbital wall after removal of squamous cell carcinoma. The medial canthal tendon was excellently fixed with this rapid and simple method. No complications, such as local infection or exposure, have occurred up to the present. This technique appears to be safe, fast, and effective for reconstruction of the medial canthus after tendon avulsion or loss from excision of cutaneous carcinoma in plastic and reconstructive surgery.

Giant Nevus Lipomatosus Cutaneous Superficialis on the Buttock.

Nevus lipomatosus cutaneous superficialis is a benign hamartoma characterized by the presence of mature ectopic adipocytes in the dermis. Here, we report a case of giant nevus lipomatosus cutaneous superficialis, measuring 24 × 14 cm in diameter, on the buttock. The tumor was resected, and the cutaneous defect was closed with a rotation flap under general anesthesia. No complication or recurrence occurred after surgery. Giant nevus lipomatosus cutaneous superficialis is very rare, and repair of the skin defect required plastic and reconstructive surgery.