Right lumbar lymph trunk injury after right laparoscopic donor nephrectomy: a case report.

Laparoscopic donor nephrectomy (LDN) is increasingly popular because of its advantages over open surgery. Chyle leak after donor nephrectomy is a rare but potentially lethal complication if not treated appropriately. We describe a case of a 43-year-old female patient with no remarkable history who presented a chyle leak on day 2 after right transperitoneal LDN. Since conservative treatment failed, the patient underwent magnetic resonance imaging (MRI) and intranodal lipiodol lymphangiography, which confirmed the chyle leak from the right lumbar lymph trunk into the right renal fossa. The chyle leak was percutaneously embolized twice, on postoperative day (POD) 5 and POD 10, by a mixture of N-butyl-2-cyanoacrylate and lipiodol. The drainage fluid decreased significantly after the second embolization. The subhepatic drainage tube was withdrawn on POD 14, and the patient was discharged on POD 17. MRI lymphangiography and intranodal lipiodol lymphangiography effectively identified the chyle leak point. Percutaneous embolization seems to be a safe, effective method for treating high-output chyle leaks.

Safety and Efficacy of Liver Venous Deprivation Following Transarterial Chemoembolization Before Major Hepatectomy for Hepatocellular Carcinoma.

Objective: This study aimed to evaluate the safety and efficacy of liver venous deprivation (LVD) following transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods: Between January 2021 and December 2022, HCC patients indicated for hepatectomy with initial insufficient future liver remnant (FLR) underwent LVD after TACE to induce preoperative liver hypertrophy. Results: Twenty-seven HCC patients with a median age of 55 years underwent LVD. No TACE or LVD procedure-associated complications occurred, except for 1 case presenting with grade A liver failure after LVD (then recovered after 7 days). The FLR volume was 29.3% (interquartile range [IQR] = 7.5) and 48.9% (IQR = 8.6) of the total liver volume before and after LVD, respectively (p < 0.001). The degree of hypertrophy and FLR hypertrophy rate were 14.8% (IQR = 8.4) and 55.2% (IQR = 36.7), respectively. All 27 patients demonstrated sufficient FLR after LVD (24 patients at three weeks post-LVD, one at six weeks, and two at ten weeks), but only 21 patients accepted surgery. Postoperative histopathology showed 16 patients with cirrhosis and five with mild fibrosis (F1, F2). One patient presented with severe intraoperative bleeding due to damage of left hepatic vein and developed grade C liver failure, then died on day 32 postoperation. Conclusion: LVD following TACE seems to be a safe, effective, and feasible method of inducing significant FLR regeneration in HCC, even in well-selected cirrhotic livers. Comparative studies with a large patient population and multicenter data are needed for further evaluation.

A survival after cardiac arrest during CT scan: The critical imaging findings.

It obtains infrequently hemodynamic images of patients undergoing impending cardiac arrest. Heart pump failure causes blood stasis in the venous system and organs, which is demonstrated on imaging by the deposition and layering of contrast in the veins. We present a case of a multi-trauma patient undergoing imminent cardiac arrest during computed tomography scan under sedation. Signs of early cardiac arrest were immediately found during the examination, including contrast pooling in the inferior vena cava and hepatic veins, poor opacification of the left heart chambers and the aorta. Fortunately, the patient was quickly resuscitated, and his heart pump returned to normal. Although cardiac arrest on computed tomography scan is extremely rare, detecting imaging signs of this situation helps patients receive timely resuscitation and better survival.

A Computed Tomographic Study of Vietnamese C1-C2 Morphology for Atlantoaxial Crew Fixation Techniques.

OBJECTIVES: This study aimed to define variations in radiological C1 and C2 measurements among Vietnamese subjects and to determine the feasibility of implementing C1-2 fixation techniques. MATERIAL AND METHODS: From October 2017 to April 2018, 120 patients underwent thin slide computed tomography (CT) scans of the cervical spine, in our hospital. Various dimensions of the C1 and C2 were analyzed, using axial and sagittal reconstructions of CT images. Differences in characteristics between the two sides and between sexes were investigated, using Student's t-test, with significance at P < 0.05. RESULTS: The mean anteroposterior dimension and the transverse width of the C1 lateral mass were 19.7 ± 2.1 mm and 12.2 ± 1.7 mm, respectively. The mean angles of the screw, directed to the maximal medial, lateral, cranial, and caudal directions, were 36.6 ± 2.8°, 28.2 ± 3.0°, 49.6 ± 4.1°, and 26.4 ± 5.5°, respectively. The average isthmus height, internal height, and pedicle width of the C2 were 5.8 ± 1.0 mm, 4.8 ± 1.3 mm, and 5.0 ± 1.3 mm, respectively. No significant differences were observed for any parameters, between the left and right side of the C1 or C2 or between the two sexes. CONCLUSION: This study revealed that the morphology of the C1 and C2 did not differ between genders in the studied subjects, but morphologic variations exist between Vietnamese subjects and other populations. Pre-operative anatomy evaluations based on CT data are essential be performed for screw placement and trajectory planning to avoid neurovascular complications and to enhance the treatment outcome.

The clinical and subclinical features of spinal cord injury on magnetic resonance imaging of patients with N2O intoxication.

Nitrous oxide (N2O) is a weak anesthetic gas that was first used in 1844 in the field of dental anesthesia. However, currently, N2O is being abused for entertainment purposes in the form of N2O-filled balloons, called funky balls, which can cause many adverse effects, especially nervous system injury. This study aimed to investigate the detailed clinical and subclinical features associated with N2O intoxication. We retrospectively reviewed 47 patients diagnosed with N2O intoxication, from May 2018 to July 2019, and collected demographic data, clinical and laboratory tests, and spinal cord magnetic resonance imaging (MRI) findings. The mean time of funky ball use was 8.8 months, with a mean use of 36.3 balls per day. All patients presented with superficial sensory disorders. Reductions in muscle strength, decreased vibration sensation, and decreased or lost tendon reflexes were the most common clinical signs of N2O intoxication. Romberg sign and Lhermitte sign were observed in 39 patients (83%) and 21 patients (44.7%), respectively. Spinal cord lesions on MRI were observed in 32 patients (68.1%), which mostly presented with an inverted V sign. The total duration of N2O use, the number of days of using N2O per week, and the presence of Lhermitte sign (P<0.05) were significantly different between patients with and without spinal cord lesions on MRI. Serum levels of homocysteine and vitamin B12 were significantly different between the time of admission and discharge (P<0.05). Our study indicated that the days of using N2O per week was significantly associated with Spinal Cord Injuries (SCI) on MRI. According to the Receiver Operating Characteristic (ROC) curve analysis, a cutoff days of using per week value of 2.5 days could predict SCI with a sensitivity of 81.3%, a specificity of 73.3%, and an area under the ROC curve (AUC) of 0.813. Changes in the serum levels of homocysteine and vitamin B12 were effective markers for the evaluation of treatment response.

Torsion of Ileum Due To Giant Meckel's Diverticulum - A Case Report.

BACKGROUND: Meckel's diverticulum (MD) is detected in approximately 2% of all individuals and only 2-4% MD patients may develop symptoms. Small intestinal obstruction is a frequent complication in adults. CASE REPORT: A 48-year-old male was admitted to emergency department for high intestinal obstruction symptoms. The imaging examinations were failed to detect the underlying causes. A median laparotomy revealed small bowel obstruction (SBO) due to a segment of ileum twisted around a giant MD axis. CONCLUSION: Thus, a giant MD generating torsion of ileum is an unusual complication. Preoperative diagnosis is challenging. Emergency surgery is preferred to make an accurate diagnosis and for treatment.