Surgery today
-
Intraoperative indocyanine green (ICG) lymphography was performed on a 62-year-old man, who was diagnosed to have chylothorax after an esophagectomy for esophageal cancer. After exploration of the thorax, a slowly increasing effusion was identified in the mediastinal space above the diaphragm, but the exact site of the lymph fistula could not be identified. By injecting 1.5 ml of ICG subcutaneously at the bilateral inguinal region, fluorescence images of the lymph flow in the thoracic cavity were obtained using a near-infrared camera system. ⋯ The postoperative course was uneventful. The patient was discharged on the 16th postoperative day. This is the first report using ICG fluorescence lymphography for the successful intraoperative detection of the exact site of a fistula causing chylothorax.
-
To evaluate childhood bicycle handlebar injuries. ⋯ Although bicycle handlebar injuries occur at relatively low speeds, the transfer of energy from the end of the handlebar, with a small cross-sectional area, to a small field leads to intra-abdominal injuries that are more severe than predicted. Thus, bicycle handlebar injuries should be considered as a serious intraabdominal injury until proven otherwise.
-
The exact relationship between larger caseload volume and lower morbidity following esophagectomy has not been established. This study investigates the effect of surgical volumes on reducing postoperative complications and length of stay after esophagectomy. ⋯ These findings indicate that morbidity after esophagectomy is more dependent on individual surgeon-specific skill than on hospital-based factors.
-
Preoperative autologous blood donation (PAD) is important for reducing exposure to allogenic blood in cardiac surgery. Unfortunately, even after PAD, allogenic blood transfusion is not always avoided. We investigated the predictors of blood component usage during elective cardiac surgery in patients prepared with PAD. ⋯ Even with PAD for elective cardiac surgery, patients whose pre-donation hemoglobin value and preoperative platelet count are low may require allogenic blood transfusion.
-
We investigated whether Tempol, a water-soluble antioxidant, prevents the harmful effects of superior mesenteric ischemia/reperfusion on intestinal tissues in rats. ⋯ Tempol prevents bacterial translocation while precluding the harmful effects of ischemia/reperfusion injury on intestinal tissues in a rat model of superior mesenteric artery occlusion.