[A patient with sepsis and a gas-forming liver abscess caused by Clostridium perfringens treated with continuous perfusion drainage].

A 64-year-old man presented with diarrhea, fever, and disturbance of consciousness; he was subsequently diagnosed with acute renal and hepatic disorder. Abdominal computed tomography identified a gas-forming liver abscess, and the patient underwent emergency drainage. However, his condition did not improve, and Clostridium perfringens was observed in his blood culture. Continuous perfusion drainage was performed by placing an additional drainage tube, which resulted in abscess shrinkage and improved the patient's general condition. Despite the low survival rate in patients with gas-forming liver abscesses caused by C. perfringens, therapy was successful in this patient.

The Effectiveness of Endovenous Thermal Ablation for the Knee Symptoms of the Osteoarthritis with Varicose Veins.

Patients with varicose veins of the lower extremities with osteoarthritis of the knee often experience improvement in knee joint symptoms after endovascular treatment. We considered that it was important to decide the operation indication of lower extremity varices, to know the correlation between the two diseases in the treatment of varicose veins. To investigate the postoperative improvement of knee symptoms related to varicose veins with knee osteoarthritis, we conducted a questionnaire survey for a total of 12 months, from December 2014 to May 2015 and from October 2018 to March 2019. The participants were 35 patients (7 men and 28 women) with varicose veins complicated with knee osteoarthritis. We classified knee osteoarthritis according to a grading scale and compared the improvement of knee symptoms after endovenous thermal ablation. The higher the knee grade, the lower the degree of improvement. However, the improvement was observed in all knee osteoarthritis grades, and as a whole, 25 patients (71.4%) have experienced improvement of subjective symptoms. For patients with knee osteoarthritis, we strongly recommend surgical treatment of the varicose veins regardless of the progression of knee grade. (This is a translation of Jpn J Phlebol 2019; 30(3): 279-283.).

[A case report: an ileus caused by cecal volvulus and intersigmoidal hernia due to mesenterium commune].

A 33-year old woman was referred to our hospital because of gradually progressing abdominal pain and abdominal distension. A computed tomography demonstrated that distended cecum was located in the left retroperitoneal space. Barium enema revealed that the descending colon was positioned at the right side of the abdomen and transverse colon became severely tapered. Ceacal volvulus in addition to the internal herniation into the left retroperitoneal space was clinically diagnosed. The patient received an emergent operation. Operative findings showed that mesenterium commune, no fixation of the colon to the retroperitonium, and the internal herniation of terminal ileum to transverse colon into the sigmoid mesentery. Moreover, the cecal volvulus was diagnosed at the left retroperitoneal space. The mesenterium commune with internal herniation and cecal volvulus is extremely rare but one of important causes of acute abdomen.

[Consideration of positioning in radiography for the waist of the scaphoid bone fractures].

PURPOSE: The most common type of scaphoid bone fracture is the transverse fracture of the waist (central 1/3). However, traditional Positioning frequently fail to visualize fracture line. This may be caused by the fact that X-rays cannot be irradiated perpendicularly onto the scaphoid long axis. In this study we searched with the optimal limb position for visualizing the waist of the scaphoid bone. METHOD: In 30 volunteers, the scaphoid bone was taken in the ulnoradial direction at 40 degrees ulnar deviation (group A) and 40 degrees ulnar deviation with the fist clenched (group B) , and measured the angle between the cassette plane and the long axis of the scaphoid (C-S) and also the angle between the cassette plane and the volar tilt (C-V) . RESULT: The C-S angle at group A was 32.5+/-9.9 degrees and at group B was 15.8+/-7.5 degrees . The C-V angle was 12.1+/-3.2 degrees . It was suggested to should be lifting upward the distal suprapalmar side at about 30 degrees in group A, at about 15 degrees in group B. These positioning make the long axis parallel to the cassette. Especially, the later view was able to visualize the ulna-scaphoid joint more clearly without overlap of radius and scaphoid bones as compared to with traditional methods. CONCLUSION: In fractures of the scaphoid bone, in which early diagnosis is critical, optimization of first-choice X-ray imaging is a key factor, and an additional image involving a 15 degrees scaphoid waist view will be useful.

The influence of residual below-knee reflux and incompetent perforating veins on venous function after stripping surgery.

Persisting incompetent great saphenous vein (GSV) below the knee and residual incompetent perforating veins (IPV) are often found after selective stripping of GSV from the groin to upper calf. The aim of this study is to evaluate the venous function when the calf GSVs or calf perforating veins are incompetent after stripping surgery. One hundred-thirty-one limbs were treated by stripping from the groin to upper calf with stab avulsion or sclerotherapy of varices. One month and twelve months after surgery, the patients were examined clinically to establish the extent of persisting varices by duplex ultrasonography and air-plethysmography. Venous filling index (VFI) was a little higher in those who had residual calf GSV reflux 12 months later; it was also higher in the group with incompetent perforating veins than the group without. The chief complaints were found to have improved in all groups. The findings suggest that removal of the saphenous vein below the knee is not necessary, but it is important to take care of the incompetent perforating veins. (English Translation of Jpn J Phlebol 2011; 22: 239-244.).