Surgery today
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Clinically significant and palpable enlargement of the gastrocnemio-semimembranosus bursa is known as a Baker's cyst. Baker's cysts may rupture, resulting in a swollen, painful leg that is clinically indistinguishable from acute deep vein thrombosis. For this reason, ruptured Baker's cysts are sometimes called pseudothrombophlebitis. ⋯ Lymphedema was also common, being diagnosed in 16 limbs. Ruptured Baker's cysts were observed in three limbs, with an incidence of 2.4%. In all of these patients, a large hypoechoic space was seen behind the calf muscles and this sonolucent area was easily detected by a conventional scanner, being pathognomonic of a ruptured Baker's cyst.
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We developed a new technique of aortic root repair which may be able to eliminate the potential problem of leaflet damage, resulting from the direct contact of the aortic leaflets with synthetic vascular grafts during systole. This report describes our technique of annuloaortic repair and the operative results. Between February 1995 and October 1998, 13 patients underwent annuloaortic repair. ⋯ Ten patients were class I and 2 were class II. This technique of annuloaortic repair with or without aortic valvuloplasty is applicable to a certain subset of patients with aortic root disease and AR. Both the indications for this procedure and the long-term results should be confirmed.
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Case Reports
Successful surgical removal of an intrapulmonary aberrant needle under fluoroscopic guidance: report of a case.
We describe herein the successful surgical removal of an intrapulmonary aberrant needle. An asymptomatic 47-year-old woman underwent a routine chest X-ray which revealed a needle located in the right S8 area. ⋯ To avoid rethoracotomy, the operation was done under fluoroscopic guidance. An intrathoracic aberrant needle should always be removed surgically as soon as possible, even if the patient is asymptomatic, due to the possibility of its migration into the vessels and the development of lung abscess or pyothorax.
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To demonstrate the prognostic value of measuring blood lactate concentrations and to investigate the mechanisms of lactate production in patients with systemic inflammatory response syndrome (SIRS), we conducted a prospective cohort study. Among 22 patients with SIRS, there were 9 survivors and 13 nonsurvivors. Serial arterial lactate concentrations were measured on the day of admission to the intensive care unit (day 0). then on days 1-4. ⋯ The changes in lactate concentration over time were statistically different between the patients with DIC and those without DIC. The findings of this study clearly demonstrated that serial arterial lactate measurements can predict a poor outcome in patients with SIRS, severe sepsis, or septic shock. DIC might play an important role in the pathogenesis of lactate production in these newly defined critically ill patients.
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Case Reports
Pneumoperitoneum following the spontaneous rupture of a gas-containing pyogenic liver abscess: report of a case.
We report herein the case of a ruptured liver abscess that resulted in pneumoperitoneum. A patient with diabetes mellitus presented with symptoms of acute abdomen. ⋯ An emergency operation was performed, and the abscess was drained followed by peritoneal lavage and the administration of appropriate antibiotics. To the best of our knowledge, very few cases of spontaneous pneumoperitoneum occurring secondary to the rupture of a gas-containing liver abscess have been encountered in Japan.