Survival benefits of interventional radiology and surgical teams collaboration during primary trauma surveys: a single-centre retrospective cohort study.

BACKGROUND: A team approach is essential for effective trauma management. Close collaboration between interventional radiologists and surgeons during the initial management of trauma patients is important for prompt and accurate trauma care. This study aimed to determine whether trauma patients benefit from close collaboration between interventional radiology (IR) and surgical teams during the primary trauma survey. METHODS: A retrospective observational study was conducted between 2014 and 2021 at a single institution. Patients were assigned to an embolization group (EG), a surgery group (SG), or a combination group (CG) according to their treatment. The primary and secondary outcomes were survival at hospital discharge compared with the probability of survival (Ps) and the time course of treatment. RESULTS: The analysis included 197 patients, consisting of 135 men and 62 women, with a median age of 56 [IQR, 38-72] years and an injury severity score of 20 [10-29]. The EG, SG, and CG included 114, 48, and 35 patients, respectively. Differences in organ injury patterns were observed between the three groups. In-hospital survival rates in all three groups were higher than the Ps. In particular, the survival rate in the CG was 15.5% higher than the Ps (95% CI: 7.5-23.6%; p < 0.001). In the CG, the median time for starting the initial procedure was 53 [37-79] min and the procedure times for IR and surgery were 48 [29-72] min and 63 [35-94] min, respectively. Those times were significantly shorter among three groups. CONCLUSION: Close collaboration between IR and surgical teams, including the primary survey, improves the survival of severe trauma patients who require both IR procedures and surgeries by improving appropriate treatment selection and reducing the time process.

Transcatheter arterial embolization for acute lower gastrointestinal bleeding using imipenem/cilastatin: a single-center retrospective study.

BACKGROUND: Transcatheter arterial embolization (TAE) is a standard treatment for acute lower gastrointestinal bleeding (LGIB) in situations where endoscopic approaches are impossible or ineffective. Various embolic materials, such as metallic coils and N-butyl cyanoacrylate, are used. This study aimed to evaluate the clinical outcomes of an imipenem/cilastatin (IPM/CS) mixture as an embolic agent in TAE for acute LGIB. RESULTS: Twelve patients (mean age, 67 years) with LGIB treated with TAE using IPM/CS were retrospectively evaluated between February 2014 and September 2022. All patients showed evidence of extravasation on computed tomography and 50% (6/12) also showed evidence on angiography. The technical success rate for TAE in this study was 100%, including in patients who showed active extravasation on angiography. The clinical success rate was 83.3% (10/12), with two patients experiencing rebleeding within 24 h after the procedure. No ischemic complications were observed, and no bleeding episodes or other complications were reported during the follow-up period. CONCLUSIONS: This study revealed that using IPM/CS as an embolic agent in TAE for acute LGIB may be safe and effective, even in cases of active bleeding.

Successful treatment of multiple microbleeds in a large area of the small bowel by transcatheter arterial embolization using imipenem/cilastatin as embolization material.

A 44-year-old man with chronic idiopathic pseudo-intestinal obstruction and lumbar disc herniation presented with orthostatic dizziness, black vomiting, and stools. He was suspected to have an ulcer caused by nonsteroidal anti-inflammatory drugs and treated conservatively but continued to have transfusion-dependent anemia. Trans-arterial contrast-enhanced computed tomography showed multiple microbleeds in the small intestine. We diffusely embolized 7 small intestine branches of the superior mesenteric artery using imipenem/cilastatin on 2 separate occasions. This stopped the bleeding, and the patient progressed well without ischemic complications and was discharged on the 25th postoperative day. Transcatheter arterial embolization with imipenem/cilastatin may be a viable treatment option for patients with multiple small bowel bleeds in a large area of the small intestine that are unresponsive to conservative treatment or endoscopic methods.

The effect of participation of interventional radiology team in a primary trauma survey on patient outcome.

PURPOSE: The purpose of this study was to examine the survival benefits of a workflow in which an interventional radiology (IR) team participates in a primary trauma survey on patients with hemodynamically unstable trauma. MATERIALS AND METHODS: A retrospective observational study was conducted between 2012 and 2019 at a single institution. Patients who underwent an IR procedure as the initial hemostasis were assigned to the hemodynamically stable group (HSG) or hemodynamically unstable group (HUG). The primary and secondary outcomes were survival at hospital discharge compared with the probability of survival (Ps) and the time course. RESULTS: A total of 160 patients (100 men, 60 women; median age, 57.5 years [interquartile range (IQR): 31.5-72 years]) with an injury severity score of 24 (IQR: 13.75-34) were included. A total of 125 patients were included in the HSG group and 35 patients in the HUG group. The observational survival rate was significantly greater than the Ps rate by 4.9% (95% confidence interval [CI]: 1.6-8.4%; P = 0.005) in HSG and by 24.6% in HUG (95% CI: 16.9-32.3%; P < 0.001). The observational survival rate was significantly greater than Ps in HUG than in HSG (P < 0.001). The median time to initiate IR procedures and the median procedure time in HUG were 54 min [IQR: 45-66 min] and 48 min [IQR: 30-85 min], respectively; both were significantly shorter than those in the HSG. CONCLUSION: A trauma workflow utilizing an IR team in a primary survey is associated with improved survival of patients with hemodynamically unstable trauma when compared with Ps with a shorter time course.

Left superior pulmonary vein stump thrombosis and right renal infarction after left upper lobectomy: case report and literature review.

Left upper lobectomy (LUL) has been considered to have a higher risk of thrombus formation in the pulmonary vein stump (PVS) than other lobectomies. A case of thrombus formation in the PVS and right renal infarction detected by contrast-enhanced computed tomography (CECT) 12 days after LUL is presented. The thrombus in the PVS was considered to be related to the renal infarction because of the lack of other potential explanations. After intravenous heparin treatment for 1 week and continuous oral anticoagulation, the thrombus in the PVS became smaller 3 months after the operation, and it basically disappeared after 1 year. Scar formation was detected in the area of renal infarction 3 months after the operation, and no specific change was detected from then on. One should consider performing postoperative chest and abdominal CECT routinely within 1 week after LUL, and, if thrombosis is found, antithrombotic therapy might then be given.

Fatal Fulminant Legionnaires' Disease in a Patient on Maintenance Hemodialysis.

We herein report a case of fulminant Legionnaires' disease with autopsy findings in a patient on maintenance hemodialysis (HD). Chronic kidney disease is a strong risk factor for Legionnaires' disease, although there have been only a few reports in HD patients. Because most patients on HD are anuric, the use of rapid assay kits to detect antigens in urine samples for the diagnosis of Legionnaires' disease is not always feasible. We suggest the use of clinical predictive tools or the loop-mediated isothermal amplification (LAMP) method, which can be applied for anuric patients, such as those on HD, with pneumonia.

Two Surgical Patients with Paget-Schroetter Syndrome Presenting with Atypical Pathophysiology: Non-Effort Thrombosis.

Paget-Schroetter syndrome (PSS) is an upper extremity thrombosis occurring in the axillary and subclavian veins. PSS is also known as "effort thrombosis," because it is usually associated with repetitive and strenuous activities of the upper limbs. We present 2 patients with atypical PSS, so-called "non-effort thrombosis," who were not involved in vigorous activities. They underwent thoracic outlet decompression through the infraclavicular approach without concomitant venoplasty. They were discharged without postoperative anticoagulant therapy. Venography and computed tomography after surgery revealed successful recanalization of the subclavian vein in each case. We highlight the characteristic pathophysiology of "non-effort thrombosis," an atypical PSS entity.

Successful Treatment of Streptococcal Toxic Shock Syndrome with Both Diffuse Peritonitis and Necrotizing Fasciitis.

Streptococcal toxic shock syndrome (STSS) is a life-threatening disease caused by infection of beta-hemolytic streptococci. Here, we report an uncommon case of STSS with both diffuse peritonitis and necrotizing fasciitis and summarize previous cases. The patient was diagnosed with STSS due to an infection of the soft tissue of the lower extremity after surgery for diffuse peritonitis. The general condition had rapidly deteriorated with multiple organ dysfunction. Immediate intensive care, including mechanical ventilation, hemodiafiltration, and repeated debridement, is indispensable for a favorable outcome.

Asymmetric synthesis of allyl- and alpha-allenylamines from chiral imines and alkynes via (eta(2)-imine)Ti(O-i-Pr)2 complexes.

[reaction: see text] The reaction of a divalent titanium reagent Ti(O-i-Pr)(4)/2i-PrMgX with optically active arylaldimines derived from arylaldehydes and O-methylphenylglycinol provided, in a highly diastereoselective manner, chiral (eta(2)-imine)Ti(O-i-Pr)(2) complexes, which in turn reacted with 1-alkynes or propargyl compounds to give optically active allyl- and alpha-allenylamines, respectively.

Site-selective Pd-catalyzed coupling of 1,4-diiodo-1,3-alkadienes with Grignard reagents and its application to the synthesis of fulvenes.

[reaction: see text] The coupling reaction of 1,4-diiodo-1,3-alkadienes with a Grignard reagent in the presence of a catalytic amount of Pd(PPh3)4 proceeded with excellent site-selectivity. Synthetic application of the reaction was demonstrated by a regio- and stereoselective synthesis of 1,3,6-trisubstituted fulvenes.

Concise and stereoselective synthesis of enamides and dienamides by a titanium-mediated coupling method.

Ynamide-titanium alkoxide complexes underwent hydrolysis or addition to aldehydes and ketones to give single, stereodefined di- or trisubstituted enamides in good yields. Alternatively, coupling of a variety of alkyne-titanium alkoxide complexes with terminal ynamides generated amino-substituted titanacyclopentadienes, hydrolysis or aldehyde addition of which afforded stereodefined dienamides. [reaction--see text]

Efficient and general synthetic method for preparing oligoenynes with either trans- or cis-olefinic configuration.

[reaction: see text] Efficient and practical synthesis of a variety of 1-iodo-4-trimethylsilylbut-1-en-3-yne derivatives with trans- and cis-olefinic configuration, and their repeated use as building blocks for the synthesis of trans- and cis-oligoenynes, respectively, are described.

Practical preparation of N-(1-Alkynyl)sulfonamides and their remote diastereoselective addition to aldehydes via titanation.

Aliphatic and aromatic sulfonamides were alkynylated with 1-bromo-1-alkynes in the catalytic presence of CuI to give N-(1-alkynyl)sulfonamides in good to excellent yields. The acetylene-titanium complexes generated from N-(1-alkynyl)benzosultams underwent diastereoselective addition to aldehydes. [reaction: see text]

Efficient convergent synthesis of 1alpha,25-dihydroxyvitamin D3 and its analogues by Suzuki-Miyaura coupling.

[reaction: see text] 1alpha,25-Dihydroxyvitamin D(3) was synthesized by the Suzuki-Miyaura coupling of the A-ring intermediate 1, which was efficiently prepared from readily available 1,7-enyne 2, with the corresponding boronate compound of the C,D-ring portion. The method was applied to prepare des-C,D analogues of 1alpha,25-dihydroxyvitamin D(3).

Site-selective monotitanation of dialkynylpyridines and its application for preparation of highly fluorescent pi-conjugated oligomers.

Reaction of Ti(O-i-Pr)(4)/2i-PrMgCl reagent with 2,n-bis[(trimethylsilyl)ethynyl]pyridines, where n is 3, 4, 5, and 6, or with 3,4-bis[(trimethylsilyl)ethynyl]pyridines, proceeded with excellent site-selectivity to afford the corresponding monotitanated complex. Synthetic application of the reaction was demonstrated by an efficient preparation of pi-conjugated oligomers having pyridine and enyne units alternately, which possess intense blue fluorescence emission.

Synthesis of conjugated oligomers having aromatic and enediyne units alternately in the backbone that show intense fluorescence emission.

[structure: see text] Synthesis and fluorescence properties of pi-conjugated compounds having alternately an aromatic ring such as benzene, pyridine, and thiophene and an enediyne unit in the backbone are described.

Neurons in the caudal frontal eye fields of monkeys signal three-dimensional tracking.

To maintain optimal clarity of objects moving in three dimensions, precise coordination of binocular eye movements is required in frontal-eyed primates. Caudal parts of the frontal eye fields (FEFs) contain smooth pursuit neurons and the discharge of the majority of them is related to vergence eye movements as well. However, whether or not those pursuit neurons carry true binocular signals has not been tested critically. Using dichoptic stimuli that dissociate horizontal movements of the left and right eyes, we found that all pursuit-related, FEF neurons tested carried binocular signals.

Stereoselective one-pot preparation of 1,2,4,5-tetraalkylidene- and 1,4-dialkylidenecyclohexanes.

1,2,4,5-Tetraalkylidene- and 1,4-dialkylidenecyclohexanes were prepared by the regio- and stereoselective homocoupling of skip-type diynes and enynes, and their Diels-Alder reaction to form a polycyclic compound was demonstrated.

Site-selective mono-titanation of conjugated diynes with a Ti(II) alkoxide reagent. Concise preparation of stereo-defined enynes and dienynes.

Conjugated diynes underwent selective mono-titanation with a Ti(II) reagent to give 1:1 diyne-titanium alkoxide complexes, which reacted with proton, aldehyde, and another acetylene to give stereo-defined enynes, enynols, and dienynes.

Intramolecular Nucleophilic Acyl Substitution Reaction of 3,4-Alkadienyl Carbonates Mediated by Ti(O-i-Pr)(4)/2 i-PrMgCl Reagent. Efficient Synthesis of Optically Active beta,gamma-Unsaturated Esters with an alpha-Substituent.

Treatment of 3,4-alkadienyl carbonates 2a-i with a low-valent titanium reagent diisopropoxy(eta(2)-propene)titanium (1), readily generated by the reaction of Ti(O-i-Pr)(4) with 2 i-PrMgCl, resulted in an intramolecular nucleophilic acyl substitution (INAS) reaction to afford vinyltitanium compounds 3 which, in turn, reacted with H(3)O(+), D(2)O, or iodine to give alpha-substituted beta,gamma-unsaturated esters 4 in good to excellent yields. The olefin moiety of the hydrolysis product 4 has (Z)-geometry mainly except for 4h. Starting from chiral 2f or 2g, the reaction proceeded stereospecifically to give optically active alpha-substituted beta,gamma-unsaturated ester 4f or 4g having (Z)-olefin geometry exclusively.