Living domino liver transplantation in an adult with congenital absence of portal vein.

Congenital absence of the portal vein (CAPV) is a rare malformation of the splanchnic venous system. Although CAPV is usually detected in the pediatric age group, our patient was a 35-year-old woman. She had been diagnosed with CAPV in 1996 when she was 27 years old. In 1998, she was placed on hemodialysis due to chronic renal failure. After several episodes of encephalopathy in 2002, liver transplantation (LT) was recommended to her and her family. Since there was no suitable living donor candidate, she was put on the waiting list for a deceased donor liver transplant in Japan. In 2004, her ammonia level increased to around 300 microg/dl, and she went into a coma lasting for three days. After recovering from this event, she underwent a living domino transplantation using a whole liver donated by a familial amyloid polyneuropathy (FAP) patient. Her portal vein, which had drained directly into the inferior vena cava (IVC), was transected together with a cuff of the IVC wall and anastomosed to the graft liver portal vein in an end-to-end fashion. In conclusion, liver transplantation proved to be a safe and effective way to save this patient and improve her quality of life.     

Leg Anterior Compartment Syndrome Following Ankle Arthroscopy After Maisonneuve Fracture

We report a case of leg anterior compartment syndrome following ankle arthroscopy after Maisonneuve fracture. A 21-year-old football player sprained his left ankle. Plain radiography of his left ankle showed a lateral dislocation of the talus without obvious fractures. Plain radiography of his left lower extremity showed a spiral fracture of the proximal fibula approximately one third distal to the fibular head. According to these findings, we diagnosed this fracture as a Maisonneuve fracture and treated it by ankle arthroscopy and drilling of the talar osteochondral injury followed by arthroscopic ankle visualization during syndesmosis screw fixation. Six hours after surgery, the patient complained of pain in the lower extremity. We diagnosed acute compartment syndrome and performed emergent fasciotomy. One year after surgery, he was able to fully participate in athletic activities. We consider ankle arthroscopy to be available for the treatment of ankle fracture with the suspected complication of an intra-articular disorder such as a Maisonneuve fracture. However, with this type of ankle fracture, there is a higher potential risk of acute compartment syndrome developing than with other types of ankle fractures. Therefore we suggest that surgeons guard against this complication.     

Reconstructive surgery for a fusiform common celiomesenteric trunk aneurysm and coexistent abdominal aortic aneurysm: Report of a case

A celiomesenteric trunk (CMT) accounts for fewer than 1% of all visceral artery anomalies. Aneurysms involving a CMT are exceptionally rare: our search of the literature found only eight cases reported. We treated a 73-year-old man with both a fusiform CMT aneurysm and an abdominal aortic aneurysm (AAA). The celiac artery and superior mesenteric artery were reconstructed by performing a retrograde prosthetic-graft bypass originating from the right limb of the bifurcated aortic graft used to repair the AAA. To our knowledge, this is the first report of successful surgical treatment of a CMT aneurysm and coexistent AAA.     

Retrospective investigation of pulmonary resection in patients with high total pulmonary vascular resistance during preoperative unilateral pulmonary artery occlusion

Purpose  The aim of this study was to evaluate the indications for pulmonary resection (lobectomy) in patients with increased total pulmonary vascular resistance (TPVR) during a preoperative unilateral pulmonary artery occlusion (UPAO) test. According to our previous report, the feasibility of performing lobectomy in patients with a high risk of cardiopulmonary complications is determined on the basis of the increase in TPVR after 15 min of obstruction during the UPAO test (occluded TPVR). Methods  A total of 19 high-risk [occluded TPVR ≥700 dynes/s/cm⁻⁵/m² (dynes)] patients who underwent lobectomy or pneumonectomy were studied and a detailed analysis of postoperative cardiopulmonary complications was performed. The subjects were divided into four groups based on the occluded TPVR (700–799 dynes, 800–899 dynes, 900–999 dynes, or ≥1000 dynes) to compare the incidence of postoperative complications. Results  Two patients died after surgery. One of them had an occluded TPVR >1000 dynes and died 313 days after right upper lobectomy; the other had an occluded TPVR of 783 dynes and died 20 days after right pneumonectomy. Postoperative cardiopulmonary complications occurred in 6 of 19 patients (31.6%), and all three patients with an occluded TPVR ≥900 dynes developed cardiopulmonary complications. Conclusion  Limited surgery should be performed in patients with an occluded TPVR ≥900 dynes.     

Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease

Background

Although many reports have described laparoscopic pancreatic surgery, pancreaticoduodenectomy (PD) has not been widely accepted. The present study aimed to compare laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy (PPPD) to investigate the feasibility, safety, and tumor clearance.

Methods

Fifteen patients with periampullary disease underwent laparoscopy-assisted PPPD, in which resection was performed laparoscopically and the reconstruction was performed through a small midline incision. These patients were compared with 15 patients who, during the same period, underwent conventional open PPPD.

Results

Mean operative time and mean blood loss were similar between groups. No significant differences in the incidence of complications or hospital stay were noted between groups. Surgical margin and number of lymph nodes found in the resected specimen did not differ between groups.

Conclusions

Laparoscopy-assisted PPPD is on the same level with conventional open surgery in terms of perioperative outcomes or treatment efficacy.     

Long-term clinical outcome of acetabular cup revision surgery: comparison of cemented cups,cementless cups,and cemented cups with reinforcement devices

The aim of the present study was to analyze the clinical and radiographic outcomes and Kaplan–Meier survivorship of patients who underwent revision surgeries of the acetabular cup that had sustained aseptic loosening. We reviewed 101 consecutive patients (120 hips; 10 men 11 hips; 91 women 109 hips; age at surgery 66 years; range 45–85) who underwent acetabular component revision surgery, at a follow-up period of 15.6 years (range 10–32). To evaluate the state of the acetabulum, acetabular bony defects were classified according to the AAOS classification based on intraoperative findings: type I (segmental deficiencies n = 24 hips), type II (cavity deficiency n = 48), type III (combined deficiency n = 46), and type IV (pelvic discontinuity n = 2). The Harris hip score improved from 42.5 ± 10.8 (mean ± SD) before surgery to 74.9 ± 14.6 points at follow-up. The survival rates of the acetabular revision surgery with cemented, cementless, and cemented cups plus reinforcement devices were 74, 66, and 82 %, respectively. The difference in the survival rate between the cemented and cementless group was marginal (p = 0.048 Gehan–Breslow–Wilcoxon, p = 0.061 log-rank), probably due to the early-stage failure cases in the cementless group. The cementless and reinforcement groups included nine early-stage failure cases. To prevent early-stage failure, we recommend the cementless cups for types I and II acetabular bone defects with adequate contact between host bone and acetabular component, and the cemented cup with or without reinforcement devices, together with restoration of bone stock by impaction or structured bone grafting, for cases lacking such contact.     

Living donor liver transplantation with hyperreduced left lateral segments

Liver transplantation is now an established technique to treat children with end-stage liver disease. Implantation of left lateral segment grafts (Couidaud's segments II and III) can be a problem in small infants because of a large-for-size graft. Reduced left lateral segmental liver transplantation has been recently introduced for small infants to mitigate the problem of large-for-size graft. Further reduction of the left lateral segment graft increases the possibility of supplying an adequate hyperreduced left lateral segment graft as an alternative surgical technique. We report 3 cases of our experience of transplantation using hyperreduced left lateral segment grafts from living donors.     

Minimally invasive hemiarthroplasty in femoral neck fractures. Randomized comparison between a mini-incision and an ordinary incision: preliminary results

Minimally invasive osteosynthesis is a well-recognized treatment; however, those of arthroplasty or hemiarthroplasty may rarely be performed. We reviewed the comparison of a mini-incision approach in hemiarthroplasty versus that of an ordinary approach in patients with femoral neck fractures. Two different operative procedures were compared. Thirty-two patients (group 1) had a mini-incision in hemiarthroplasty. Thirty-two patients (group 2) were treated with the conventional approach. The postoperative treatment course was the same for both groups. The mean length of follow-up was 25 months. The results were excellent or good in 86% of the patients (50 of 64) and were equally good for both procedures. However, the full weight bearing term was significantly shortened for patients treated by the mini-incision procedure. Good and excellent results can be expected from either the mini-incision or the ordinary approach in hemiarthroplasty. Only full weight bearing term was significantly short following the mini-incision. This approach results in less dissection and facilitates rapid patient recovery and possibility earlier discharge from the hospital.     

alpha2-Adrenoceptor activation by clonidine enhances stimulation-evoked acetylcholine release from spinal cord tissue after nerve ligation in rats

BACKGROUND: Spinally administered clonidine produces analgesia via alpha2-adrenergic receptors. The analgesic potency of clonidine and its dependency on muscarinic acetylcholine receptors increase in rats after nerve injury. The authors hypothesized that these changes reflect greater acetylcholine release from the spinal cord by clonidine, either through direct or indirect effects. METHODS: Male Sprague-Dawley rats were divided into two groups: no surgery or left L5 and L6 spinal nerve ligation (SNL). All experiments were performed 3 weeks after SNL. Crude synaptosomes were prepared from the spinal enlargement and loaded with [H]choline. Samples were incubated with clonidine in the absence or presence of KCl depolarization. The authors also examined the effect of clonidine on KCl evoked acetylcholine release using perfusion of spinal cord slices, in which some spinal circuitry is maintained. RESULTS: In synaptosomes, clonidine alone induced minimal acetylcholine release, which was actually greater in tissue from normal rats than in tissue from SNL rats. In the presence of KCl depolarization, however, clonidine enhanced acetylcholine release in tissue from SNL rats but inhibited release in tissue from normal rats. Similarly, in spinal cord slices, clonidine enhanced KCl evoked acetylcholine release in tissue from SNL animals but inhibited such release in tissue from normal animals. The alpha2-adrenoceptor antagonist idazoxan inhibited the effects of clonidine in slices from SNL rats. CONCLUSION: These results suggest that clonidine enhances depolarization-induced acetylcholine release in neuropathic but not in normal spinal cord tissue. Interestingly, this enhanced acetylcholine release by clonidine occurs in a synaptosomal preparation, consistent with a direct effect on alpha2 adrenoceptors on cholinergic terminals. Enhanced release of acetylcholine by clonidine could contribute to increased analgesia of clonidine in neuropathic pain.     

Primary neurogenous sarcoma of the lung; report of a case

We report a case of a 27-year-old woman with primary neurogenous sarcoma of the lung. She had no symptoms but an abnormal shadow of the right lower lung field on the chest X-ray. Chest computed tomography (CT) revealed a well defined round mass, 20 mm in maximum diameter, at the right S9. Pathological study of the specimen obtained by CT-guided percutaneous needle biopsy showed undefferentiated carcinoma. Positron emission tomography (PET) disclosed intensely increased uptake of fluoro-2-deoxy-D-glucose (FDG) at the lung lesion without other abnormal uptakes. The patient underwent right lower lobectomy of the lung and mediastinal lymph nodes dissection. Results from immunohistological study yielded a definitive diagnosis of neurogenous sarcoma. Postoperative course was uneventful, and there has been no evidence of recurrence and metastasis for more than a year after the surgery. Reported cases of primary neurogenous sarcoma of the lung are reviewed.