Successful resection of pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy.

We present a rare case in which a pancreatectomy was performed for a recurrent tumor in the remnant pancreas after a pancreaticoduodenectomy, and we review the associated literature. A 67-year old man underwent pancreaticoduodenectomy for pancreatic cancer on April 9, 2003. The tumor was composed of well differentiated adenocarcinoma and diagnosed as R0, pT2, pN1, pM0, pStage III according to UICC TNM classification. Five years and eight months later, his serum level of carcinoembryonic antigen was found to be elevated, and a computed tomography showed a low-density mass near the site of the pancreaticojejunostomy and dilatation of the jejunal stump. We conducted a total resection of the remnant pancreas including pancreaticojejunostomy, splenectomy and peripancreatic lymph node dissection without any residual macroscopic tumor. Histologically, it was diagnosed as a well differentiated adenocarcinoma, similar to the initial tumor. It is difficult to assess whether this tumor developing in the remnant pancreas was a local recurrence or a second primary cancer. However, we believe this tumor was a second primary tumor because of the long interval period and the absence of a neoplastic invasion in the resection margins of the initial specimens.

Left main coronary malperfusion from acute non-communicating aortic dissection.

A 64-year-old man was admitted with sudden back and chest pain. He had undergone aortic valve replacement 5 years earlier. Enhanced computed tomography showed acute type A non-communicating aortic dissection. He was initially treated with supportive medical therapy. Since he was restless, he was placed on a respirator. He went into sudden shock 6 h after onset. Percutaneous cardiopulmonary support was administered, and coronary arteriography showed progression of the dissection to the left main trunk. Percutaneous coronary intervention was performed. He recovered from shock and then underwent ascending aorta replacement. He was discharged from hospital without any major complications.

Impact of glucose control on early vein graft failure after coronary artery bypass grafting: one-month angiographic results.

Objectives: To identify factors that determine early saphenous vein graft failure (VGF) within 1 month after coronary artery bypass grafting (CABG). Methods: Seven hundred forty-nine consecutive patients underwent primary isolated CABG with saphenous vein grafts at three Japanese centres from 1 January 2005 to 31 December 2014. According to angiographic findings within 1 month of CABG surgery, 63 patients (8.4%) developed early VGF. We examined the relationships between variables and early VGF by using multivariable logistic regression analysis. Results: The preoperative clinical characteristics were similar between patients with and without early VGF, except for median preoperative haemoglobin A1c levels, which were significantly higher among patients with early VGF (6.7 vs 6.4%, P = 0.046). Additionally, anastomosis to the vessel with chronic total obstruction was performed more frequently among patients with early VGF (22/63 [34.9%] vs 140/686 [20.4%], P = 0.007), and myocardial infarction during the hospital admission occurred more frequently among patients with early VGF (4/63 [6.3%] vs 2/686 [0.3%], P < 0.0001). Results of multivariable analysis showed that the preoperative haemoglobin A1c level was associated with early VGF (odds ratio per unit increase, 1.30; 95% confidence interval, 1.06-1.60; P = 0.013). Conclusions: An increased preoperative haemoglobin A1c level was strongly associated with early VGF after CABG. Thus, VGF happened more frequently in patients with poorly controlled diabetes mellitus.

Fate of Hancock valve in tricuspid position 36 years after implantation.

Mid- to long-term durability of bioprosthesis in tricuspid position is acceptable. However, little is known about more extended long-term structural valve changes of Hancock valve. In present report, we describe Hancock valve images 36 years after implantation.

Importance of early detection of oesophageal complications after aortic stent graft repair.

Oesophageal complications after endovascular aortic stent repair are rare, but may lead to catastrophic consequences. Early detection is mandatory, but is sometimes difficult because of a lack of specific signs in the early stages. We report 2 cases with opposing results of oesophageal complications after aortic stent graft repair, and discuss the early signs of this disastrous complication and potential methods for early detection.

Emergent total arch replacement for acute type A aortic dissection with aberrant right subclavian artery in a systemic lupus erythematosus patient.

A 50-year-old man with a history of systemic lupus erythematosus and hemodialysis developed acute type A aortic dissection. Computed tomography demonstrated acute type A aortic dissection with chronic distal arch aneurysm and aberrant right subclavian artery that arose from the proximal descending aorta and ran in a retro-esophageal track. Emergent total arch replacement was performed using antegrade cerebral perfusion with circulatory arrest. Both common carotid arteries and the left subclavian artery were chosen as selective cerebral perfusion sites. The right subclavian artery was snared during cerebral perfusion. The right subclavian artery was reconstructed with the right common carotid artery in an end-to-side fashion in the anterior mediastinum. The patient's postoperative course was uneventful, and computed tomography showed excellent blood flow to all four branches. The case description is followed by a discussion of cerebral protection, reconstruction route of the right aberrant subclavian artery and steroids for systemic lupus erythematosus.