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Background: This study aimed to investigate the diagnostic performance of combined computed tomography (CT) and fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for predicting histologic invasiveness of pure ground-glass nodules (pGGNs). Methods: The study analyzed 91 patients who underwent resection of pGGNs and examined the correlation of pathologic invasiveness with preoperative CT and FDG PET findings. Results: Overall, 24, 36, and 31 patients had adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAD), respectively. Compared with AIS and MIA, IAD was significantly correlated with larger CT size (P = .001), maximum CT value (P = .026), and high maximum standardized uptake value (SUVmax; P < .001). Multivariable logistic analyses revealed that CT size (odds ratio [OR], 3.848; P = .019) and SUVmax (OR, 4.968; P = .009) were independent predictors of histologic invasiveness. Receiver operating characteristic curve analysis revealed that a cutoff CT size value of 18 mm predicted histologic invasiveness with a sensitivity and specificity of 65% and 80%, respectively; similarly, a cutoff SUVmax value of 1.5 predicted histologic invasiveness with a sensitivity and specificity of 61% and 90%, respectively. Of 20 lesions with CT size ≥18 mm and SUVmax ≥1.5, 16 (80%) were IAD. Of 54 lesions with CT size

Abstract Background In Japan, dilatation & curettage (D&C) has been performed under general anesthesia as a surgery for an early pregnancy miscarriage for a long time. In 2016, manual vacuum aspiration (MVA) under general anesthesia was introduced at our hospital and has been used as a surgical treatment for first-trimester pregnancy miscarriage, with its utility to date being reported here. In July 2018, our hospital introduced the MVA procedure under local anesthesia. In this study, we evaluated the efficacy and safety of MVA under general and local anesthesia in first-trimester pregnancy miscarriage surgery in Japanese women. Methods In this retrospective observational cohort study, we enrolled 322 pregnant women at less than 12 weeks of gestation, who underwent MVA surgery under local anesthesia (n = 166) or conventional general anesthesia (n = 156). The duration of surgery, blood loss volume, quantity of anesthesia, presence or absence of retained products of conception, and clinical complications were evaluated. In addition, the intraoperative pain and treatment satisfaction were assessed using the visual analog scale (VAS). Results The duration of surgery was significantly shorter in the local anesthesia group. No significant differences were observed between both groups in terms of the blood loss volume and incidence of retained products of conception. In addition, no serious complications were observed in either group. No significant differences were noted between the two groups in the VAS scores for pain and treatment satisfaction. Conclusions In this retrospective study, the use of MVA under local anesthesia for early pregnancy miscarriage surgery was found to be equally safe and effective when performed under conventional general anesthesia. This technique allowed the achievement of appropriate pain control with excellent patient satisfaction.

Objectives: Postoperative atrial fibrillation (POAF) is a common problem of cardiac surgery. Beta-blockers are recognized as effective prophylactic agents available for POAF management. To better understand its effect on isolated atrial fibrillation after cardiac surgery, a meta-analysis was conducted. Methods: Randomized controlled trials (RCTs) were searched and filtered by comparing the efficacy of beta-blockers and control users in isolated POAF for cardiac surgery. Seventeen RCTs were identified and analyzed by typical meta-analysis methods. The search was performed from inception to May 31, 2020. Subgroup analyses were conducted for type of surgery and beta-blocker, starting time and route of administration of beta-blocker, and dosage of intravenous landiolol hydrochloride. Results: Beta-blockers were effective in reducing isolated POAF risk (risk ratio [RR], 0.52 [0.41, 0.66], P = .31, I2 = 12%). In subgroup analyses, beta-blocker administration during postoperative period (RR, 0.43 [0.29, 0.62], P = .84, I2 = 0%) and on-pump coronary artery bypass graft (RR, 0.34 [0.04, 3.15], P = .56, I2 = 0%) had lowest risk of isolated POAF incidence. Intravenous landiolol hydrochloride at 2 μg/kg/min also had low risk of isolated POAF occurrence. Conclusions: Beta-blocker treatment helps to reduce isolated atrial fibrillation incidence after cardiac surgery. Our subgroup analyses also reveal postoperative beta-blocker administration after on-pump coronary artery bypass graft surgery is most effective in reducing isolated POAF risk. Intravenous landiolol hydrochloride at a dosage of 2 μg/kg/min has also displayed favorable results. Further trials may be required to explore these factors.

Background:. A transverse paddle latissimus dorsi (LD) flap has the advantage that if the skin paddle is placed in the transverse bra line, the donor site scar is well hidden by underwear. With this transfer, medial back tissues are usually moved to the medial area of the reconstructed breast following 180 degree rotation. Because these tissues are thinner than the lateral thoracic area, the medial part of the reconstructed breast sometimes becomes flatter than expected. Methods:. To add bulk in the medial lower quadrant for giving an impression of an outward-expanding breast, we modified the LD flap by adding a part of the trapezius muscle. Seven patients underwent mastectomy and simultaneously received a modified LD flap. To hide the donor site scar beneath underwear, the skin paddle needed to be oriented transversely. The additional harvested tissues were tested for vascularity by fluorescence following intravascular injections of indocyanine green. If this was negative, the tissue was not used for breast reconstruction. Postoperatively, another surgeon judged whether this modification had contributed favorably to the reconstructed medial lower quadrant. Results:. Indocyanine green testing was positive in six cases. The shape of the lower medial quadrant was judged as good in five of the seven cases. Complications included an animation deformity of the LD muscle, donor site seroma, and donor site wound dehiscence. Conclusion:. This transversely oriented LD flap with extension to the trapezius muscle placed at the bra-line is one option to add bulk to the medial lower quadrant of the reconstructed breast when an additional scar is not desired for cosmetic reasons.

Abstract Background Carney complex (CNC) is a very rare disease. Although thyroid lesions are included in the diagnostic criteria for CNC, they are an infrequent occurrence. Case presentation The patient was a 69-year-old woman who had undergone the removal of a left atrial myxoma 10 years earlier, at the age of 59. At the time of the operation, thyroid ultrasonography (US) revealed multiple hypoechoic nodules. Thyroid scintigraphy revealed an increased uptake of 99mTc in these lesions, which was consistent with toxic multinodular goiter, and she was diagnosed with CNC. Genetic studies showed no mutation in the PRKAR1A (protein kinase A regulatory subunit 1-α) gene. From then on, she received annual brain magnetic resonance imaging (MRI), abdominal computed tomography (CT), and thyroid US examinations. Her follicular thyroid nodules gradually increased in number and size. Although aspiration cytology samples from the thyroid nodules diagnosed them as class III, thyroid cancer could not be ruled out. The patient underwent a partial thyroidectomy, and the pathological diagnosis was multiple follicular adenomas. Conclusion Careful and frequent evaluation of the thyroid gland should be required for CNC patients due to the potential for carcinoma to develop in the context of a variety of follicular thyroid lesions.

Abstract Background Clinical results of ischemic left ventricular free-wall rupture show high mortality rates. Methods We reviewed studies published after 1993 on PubMed. Results A sutureless technique using fibrin glue sheets or patches with/without fibrin glue might contribute to improved clinical results. However, some technique limitations remain for blowout-type ruptures, and the possibility of a pseudoaneurysm formation at the repair site after surgery should be considered. Conclusions The sutureless technique can be a promising strategy for the treatment of ischemic rupture, but serial echocardiographic studies should be mandatory for diagnosing a left ventricular pseudoaneurysm formation thereafter.

Objectives: Surgical procedures for various aortic arch pathologies still result in high mortality and morbidity. Success in these aortic procedures is directly related to cerebral protection techniques during circulatory arrest. Herein, we analyzed risk factors for postoperative neurological dysfunction. Methods: Between June 2008 and April 2010, 104 patients underwent surgery for aneurysms or dissections using hypothermic circulatory arrest, with or without retrograde cerebral perfusion or antegrade cerebral perfusion. The mean age of patients was 68.5 +/- 12 years, and 63.5% were male. Sixty patients were treated for acute aortic dissection, eight patients for chronic dissection, and 36 patients for a degenerative and atherosclerotic aneurysm. Results: Hospital mortality was 2.9%, and the overall post-operative neurological dysfunction rate was 16.3%. In addition, the incidence of permanent and temporary neurological dysfunction was 12.5% and 3.8%, respectively. Univariate analysis of risk factors for permanent neurological dysfunction revealed that acute aortic dissection, emergency case pre-operative neurological dysfunction, partial arch replacement, cannulation from cardiac apex, and deep hypothermic circulatory arrest plus retrograde cerebral perfusion duration were associated with post-operative permanent neurological dysfunction. Multivariate analysis revealed that pre-neurological dysfunction and deep hypothermic circulatory arrest plus retrograde cerebral perfusion duration were significant independent risk factors for permanent neurological dysfunction. Conclusions: Prolonged duration of deep hypothermic circulatory arrest plus retrograde cerebral perfusion and pre-operative neurological dysfunctions were risk factors for permanent neurological dysfunction. The moderate hypothermic circulatory arrest plus an antegrade cerebral perfusion method used at our institution can reduce the incidence of postoperative neurological dysfunction. [Arch Clin Exp Surg 2013; 2(3.000): 141-148]

Purpose: This study aimed to determine the procedure-related major morbidity of infrarenal abdominal aortic aneurysm (AAA) repair, to investigate the changes in perioperative laboratory values, and to clarify the degree of physical strain of surgery and specific independent predictive factors for major morbidity. In addition, in the case of endovascular aneurysm repair (EVAR), we weighed how occlusion of the internal iliac artery related to physical strain of surgery in terms of laboratory values. We retrospectively evaluated patients who were treated at Jichi Medical University Hospital. Methods: Consecutive patients with an AAA (excluding ruptured AAA) between April 2007 and August 2010 were studied. The effects of various patient- and operation-related variables on outcomes (major morbidity, duration of stay in hospital, renal insufficiency, and endoleakage) were assessed by univariate and multivariate analyses. Results: Overall in-hospital mortality was 0.4%. Statistically significant differences, mostly in favor of EVAR, were observed in the intraoperative and postoperative data. The presence of an internal iliac artery occlusion did not affect the perioperative laboratory data. Of various patient- and operation-related variables for each outcome, the relative factors were duration of operation, blood loss, white blood cells, C-reactive protein, lactate dehydrogenase, creatine phosphokinase, and potassium. In multivariate logistic analysis, blood loss, C-reactive protein, creatine phosphokinase, and potassium were significantly related to each outcome. Conclusions: Both elective open repair and EVAR can be safely performed in patients with an infrarenal AAA. EVAR has perioperative advantages of reduced blood loss and blood transfusions as well as a decreased duration of stay in hospital. In particular, we identified specific independent relative factors of laboratory values for major morbidity, duration of stay in hospital, renal insufficiency, and endoleakage. and #8195; [Arch Clin Exp Surg 2013; 2(2.000): 71-79]

Purpose: This study aimed to determine the procedure-related morbidity and mortality of infrarenal abdominal aortic aneurysm (AAA) repair, to investigate the changes in perioperative laboratory values, and to clarify the specific independent predictive factors for mortality and morbidity. We retrospectively evaluated patients who were treated in Jichi Medical University Hospital. Methods: Consecutive patients with AAA between April 2007 and August 2010 were studied. The possible predictive values of various patient- and operation-related variables on outcomes (mortality, duration of stay in hospital (>7 days), and major morbidity) were assessed by multivariate analysis. Results: Overall in-hospital mortality was 3.3%. Statistically significant differences, all in favor of endovascular aneurysm repair (EVAR), were observed in the intraoperative and post-operative data. In multivariate logistic analysis, potassium, serum creatinine and C-reactive protein levels were significantly related to outcomes. Conclusions: Open repair and EVAR can both be safely performed in patients treated for elective and emergency infrarenal AAA. EVAR has perioperative advantages of reduced blood loss and blood transfusion, as well as decreased mortality and duration of post-operative hospital stay. In particular, we identified specific independent predictive factors of serum chemistry values for mortality and renal insufficiency. [Arch Clin Exp Surg 2013; 2(1.000): 8-15]

Purpose: This study aimed to determine the morbidity and mortality of infrarenal ruptured abdominal aortic aneurysm (rAAA) repair, and to investigate the changes in perioperative laboratory values, as well as clarify the specific independent predictive factors for mortality and morbidity. We retrospectively evaluated patients who were treated in Jichi Medical University Hospital. Methods: A consecutive fifty-six patients with rAAA between April 2007 and August 2010 were studied. The possible predictive values of various patient-related variables on outcomes (mortality, major morbidity and renal insufficiency) were assessed by univariate and multivariate analysis. Results: The overall in-hospital mortality was 16.1%. In univariate logistic analyses, lactate dehydrogenase, alanine aminotransferase, as well as pre-operative and post-operative serum creatinine levels were significantly related to mortality. Blood transfusion volume, white blood cells and C-reactive protein levels were significantly related to major morbidity. Intraoperative blood loss, white blood cells, C-reactive protein levels, lactate dehydrogenase and pre-operative serum creatinine levels were significantly related to renal insufficiency. Conclusions: Emergency open repair can be safely performed in patients for infrarenal rAAA. In particular, we identified specific independent predictive factors of clinical examination and laboratory studies for mortality, major morbidity and renal insufficiency. [Arch Clin Exp Surg 2012; 1(2.000): 94-101]