Mycotic abdominal aortic aneurysms (MAAAs) are rare but life-threatening, and no standard therapy has yet been established. Effective surgery with intensive antimicrobial therapy is crucial; however, ...this can be fatal in immunocompromised patients. Only a few reports of MAAA with concomitant autoimmune disease exist; therefore, we were concerned about our lack of experience and knowledge about appropriate treatment. We report a 69-year-old male with an MAAA secondary to septic shock after spinal fusion surgery. He had also been on long-term oral immunosuppressants for systemic lupus erythematosus (SLE). After preoperative cephazolin, we performed debridement of infected tissue, graft replacement with a rifampicin-bonded prosthesis, and omentopexy. On the 52nd post-operative day, he was transferred back to the previous attending hospital under oral antibiotics and prednisolone. MAAA in patients with SLE should be treated with in situ replacement using an antimicrobial prosthetic or biological graft with thorough debridement and omentopexy, followed by antimicrobials and immunosuppressants, as needed.
We describe a rare case of newborn with aortic atresia and transposition of the great arteries who underwent successful surgical repair. To the best of our knowledge, no such case has been previously ...reported. We demonstrated that, even with a complex diagnosis, the patient could survive after rapid two-stage Norwood procedure.
Objective
Currently, several near-infrared spectroscopy oximetry devices are used for detecting cerebral ischemia during cardiopulmonary bypass (CPB) surgery. We investigated whether two different ...models of near-infrared spectroscopy oximetry devices affect the assessment of cerebral ischemia and its management during CPB.
Methods
From January 2017 to August 2017, 70 adult cardiovascular surgery cases were randomly assigned to 1 of 2 different near-infrared spectroscopy oximetry devices. The devices were INVOS 5100C (Medtronic, Minneapolis, MN, USA) (group I;
n
= 35) and FORE-SIGHT ELITE (CAS Medical Systems, Branford, CT, USA) (group F;
n
= 35).
Results
There were no significant differences in patient characteristics. The rSO
2
values were significantly higher for patients in group F than for patients in group I. Scalp–Cortex distance showed negative correlations with the mean rSO
2
values in group I (
P
= 0.01). Interventions for low rSO
2
during CPB for groups I and F were increase perfusion flow (13:5;
P
= 0.03), blood transfusion (7:1;
P
= 0.02), and both (6:1;
P
= 0.04), respectively. The Scalp–Cortex distance in group I was significantly longer in patients who required intervention than in patients who did not (17.1 ± 2.5 vs 15.1 ± 1.6 mm;
P
= 0.007).
Conclusions
It is inappropriate to use the same intervention criteria for different near-infrared spectroscopy oximetry devices. Moreover, brain atrophy influence rSO
2
values depending on device selection. It is important to note that inappropriate device selection may misguide perfusionists into performing unnecessary or excessive intervention during CPB.
Desmoid-type fibromatosis (DF) is a rare, locally infiltrative, and fibroblastic proliferative disease. DF usually arises from abdominal fascial tissue, but in rare cases, it can occur in ...extra-abdominal areas. A 73-year-old Japanese male complained of a painless, left anterior neck mass of 3-month duration. Computed tomography revealed the mass measured 9 × 7 × 6 cm and extended to the anterior mediastinum, with invasion of the left clavicle. En bloc resection of the tumor with the left sternoclavicular joint and the medial portion of the left clavicle was performed by cervico-thoracic approach with L-shaped partial sternotomy. Histopathologic examination showed fascicular growth of spindle-shaped cells separated by abundant collagen. Immunohistologic examination revealed nuclear staining of β-catenin and cytoplasmic staining of vimentin. Genetic analysis of 160 cancer-related genes by next-generation sequencing (NGS) demonstrated only a missense mutation in the CTNNB1 gene (c.133T>C, p.S45P). DF extending from the neck to the anterior mediastinum is rare. We report the complete resection of a large-sized DF with the clavicular invasion. A low-frequency CTNNB1 mutation of DF was identified. Genetic analysis with NGS was beneficial for the diagnosis.
Early extubation in the operating room after congenital open-heart surgery is feasible, but extubation in the intensive care unit after the operation remains common practice at many institutions. The ...purpose of this study was to evaluate retrospectively the adequacy of our early-extubation strategy and exclusion criteria through analysis based on the Risk Adjustment in Congenital Heart Surgery method (RACHS-1).This retrospective analysis included 359 cases requiring cardiopulmonary bypass (male, 195; female, 164; weight > 3.0 kg; aged 1 month to 18 years). Neonates and preoperatively intubated patients were excluded. Other exclusion criteria included severe preoperative pulmonary hypertension, high-dose catecholamine requirement after cardiopulmonary bypass, delayed sternal closure, laryngomalacia, serious bleeding, and delayed awakening. The early-extubation rates were compared between age groups and RACHS-1 classes.Overall, 83% of cases (298/359) were extubated in the operating room, classified by RACHS-1 categories as follows: 1, 59/59 (100%); 2, 164/200 (84%); 3, 61/78 (78%); and 4-6, 10/22 (45%). The early extubation rate in categories 1-3 (86%, 288/337) was significantly higher than for categories 4-6 (45.5%, 10/22) (P < 0.001). Because they met one of the exclusion criteria, 61 patients (17%) were not extubated in the operating room. Eight patients (2.7%) required re-intubation after early extubation in the operating room, and longer operation time was significantly associated with re-intubation (P < 0.001).Extubation in the operating room after congenital open-heart surgery was feasible based on our criteria, especially for patients in the low RACHS-1 categories, and involves a very low rate of re-intubation.
We found a naturalized Rhynchospora recognita (Cyperaceae) in the fallow fields of southeastern parts of Miyazaki Prefecture, Kyushu, Japan. This species is a perennial herb and native to North and ...Central America, and the Caribbean. This is the first report for R. recognita naturalized in Japan.
Background Regional cerebral perfusion provides cerebral circulatory support during aortic arch reconstruction. We report the effectiveness of high-flow regional cerebral perfusion (HFRCP) from the ...right innominate artery to maintain sufficient cerebral and somatic oxygen delivery through collateral vessels. Methods Frontal cerebral and thoracolumbar probes to measure somatic regional oxygen saturation (rS o2 ) were used to continuously measure oxygenation during cardiopulmonary bypass in 18 patients (weight, 2.1 to 4.3 kg) who underwent arch reconstruction using HFRCP (mean flow, 82; range, 43 to 108 ml/kg/min). Procedures included 9 Norwood procedures, 5 coarctation of aorta/interruption of aorta complex repairs, and 4 aortic arch repairs for a single ventricle. Mean HFRCP duration was 51 ± 17 minutes under moderate hypothermia. Mean radial arterial pressure was kept at less than 50 mm Hg during HFRCP, and chlorpromazine (mean dose, 2.8 mg/kg) was given to all patients before and during HFRCP to increase regional cerebral perfusion flow. Plasma lactate concentration was measured before and after HFRCP. Results During HFRCP, mean cerebral rS o2 was 78.8% ± 9.5%, somatic rS o2 was 65.4% ± 12.1%, and lactate concentration increased from 3.8 ± 2.2 to 5.5 ± 2.1 mmol/L. There was significant correlation between regional cerebral perfusion flow and somatic rS o2 . Significant inverse correlations were noted between regional cerebral perfusion flow and the increase of lactate concentration and between somatic rS o2 and the increase of lactate concentration. Conclusions High-flow regional cerebral perfusion preserved sufficient cerebral and somatic tissue oxygenation during aortic arch repair. The reduction of vascular resistance of collateral vessels increased both cerebral and somatic blood flow, resulting in improved tissue oxygen delivery.
Fenestration-related massive aortic regurgitation is rare. The underlying mechanism is reported to be rupture of the fenestrated fibrous strand, and most ruptured cords have been reported in the ...bicuspid valve or in the right coronary cusp of the tricuspid aortic valve. We encountered a rare case of acute aortic regurgitation due to fibrous strand rupture in the fenestrated left coronary cusp. Preoperative echocardiography detected left coronary cusp prolapse, and operative findings revealed rupture of a fibrous strand in the left coronary cusp. For cases such as this, preoperative echocardiography would be useful for appropriate diagnosis.
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