Surgical findings and technical knacks to performing living donor liver transplantation for hepatocellular carcinoma recurrence after carbon ion radiotherapy

Abstract

Although carbon-ion radiotherapy (CIRT) has been reported to achieve good local control of hepatocellular carcinoma (HCC), liver transplantation is still required in patients with tumor recurrence. However, few cases of living donor liver transplantation (LDLT) after curative CIRT for HCC has been reported. It would be of great interest to ascertain the true situation of the irradiated region as well as to clarify the surgical points. We herein report the surgical findings and our experience along with technical difficulties and knacks concerning two cases of LDLT for HCC after CIRT. Both patients suffered tumor recurrence after curative CIRT for HCC. Severe adhesions were found between the irradiated region and the surrounding tissues, which resulted in surgical difficulties. Histological findings showed severe tissue fibrosis in the CIRT area. We should pay attention to adhesions in the irradiated area caused by CIRT including the vascular reconstruction during surgery.

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Primary gastric volvulus: a report of two cases

Abstract

Gastric volvulus is an uncommon cause of gastric obstruction. It can be classified as primary when no underlying condition is identified as the cause for the rotation. An acute presentation includes typical symptoms and is frequently detected by imaging studies. Chronic cases present with intermittent vague symptoms and imaging studies may be normal during the symptomatic interval. The lack of specific symptoms and signs delays the diagnosis of chronic volvulus. However, appropriate treatment demands prompt diagnosis. We report two cases of primary gastric volvulus, with chronic or subacute symptoms and normal imaging studies during the asymptomatic periods. Both were treated surgically and had an uneventful follow-up.

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Traumatic cerebrospinal fluid oculorrhea managed with an external ventricular drain

Abstract

Cerebrospinal fluid (CSF) leaks following head injuries are rare complications with significant morbidity and mortality if left untreated. CSF oculorrhea secondary to a cranio-orbital fistula is a rare presentation of this complication. Standard treatment for a CSF leak involves management of intracranial pressure, CSF diversion and surgical repair of any dural defect. Lumbar drains have commonly been inserted to aid in diverting CSF. We describe a case of a 16-year-old male who presented with an open comminuted depressed skull fracture and CSF oculorrhea. Following a bifrontal decompressive craniectomy, he was successfully treated with CSF diversion following a conservative trial using an external ventricular drain. The use of an external ventricular drain for this purpose has not been described in the literature to date. We report this case as a method of demonstrating the use of an external ventricular drain to adequately divert CSF.

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Lateral intermuscular septum as cause of radial nerve compression: case report and review of the literature

Abstract

Multiple sites of compression of the radial nerve have been described, some more commonly than others. In this case report we describe a case of radial nerve compression at the lateral intermuscular septum in a patient with a history of open reduction and internal fixation of a mid-shaft humerus fracture 10 years prior. To our knowledge, only one previous case of chronic radial nerve compression by the lateral intermuscular septum associated with a humeral shaft fracture has been described. Our patient's clinical presentation with specific electrodiagnostic abnormalities, operative findings and post-operative symptom relief point towards the rare diagnosis of compression of the radial nerve at the level of the lateral intermuscular septum as the cause of his symptoms.

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An Unusual Case of DMEK Graft Loss into the Vitreous and Its Successful Retrieval and Survival

Purpose: The aim of this article is to report an unusual case of postoperative graft loss into the vitreous cavity after Descemet membrane endothelial keratoplasty (DMEK) in a patient with an unstable iris-lens diaphragm (scleral-fixated intraocular lens [sf-IOL]) and its successful retrieval with a favourable outcome. Methods: This is a retrospective case report. Results: DMEK procedure was performed in a vitrectomized eye of an 80-year-old woman with pre-existing sf-IOL due to pseudophakic bullous keratopathy. In the setting of an inadvertently created oversized Ando iridectomy and unstable iris-lens diaphragm due to sf-IOL, repeated loss of an anterior chamber gas tamponade occurred. At the 3rd postoperative day, the patient noticed a change in visual perception, and we could detect a loss of the graft into the vitreous via B-scan ultrasound. A 23-G vitrectomy was performed promptly to recover the graft using a bimanual hand-over-hand technique. Six months after DMEK, the patient had a clear cornea without dehiscences with a central corneal thickness of 533 µm and endothelial cell count of 1,219 cells/mm². Conclusions: This case demonstrates the possibility of graft recovery from the vitreous after DMEK and subsequent corneal clearing despite unstable iris-lens diaphragm and vitrectomized eye.
Case Rep Ophthalmol 2018;9:381–387

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Diagnostic difficulties of primary angiosarcoma of the breast: a case report

Angiosarcoma of the breast is a rare tumor, which may be primary or secondary to breast surgery or irradiation. It is characterized by polymorphic and nonspecific clinical and radiological features. A patholog...

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Age is a predictive factor in the femoral nerve positioning: an anatomical ultrasound study

Abstract

Precise identification of the femoral nerve (FN) is essential for an ultrasound-guided femoral nerve block. We hypothesized that the distance between the FN and the femoral artery (FA) is correlated with patient age. In this prospective observational study, we evaluated the FN–FA (from the lateral edge of the FA to the medial edge of the FN) distance [0.42 ± 0.42 (mean ± standard deviation) cm] in 102 patients using ultrasound. In addition, we calculated the cross-sectional area of the iliopsoas muscle using computed tomography or magnetic resonance imaging. Multiple regression analyses revealed that age was significantly and positively correlated with the FN–FA distance (R² = 0.72, p < 0.001) and that this correlation was greater than that between height, weight, or gender and the FN–FA distance. Further, the cross-sectional area of the iliopsoas muscle per weight was significantly correlated with age (R² = 0.54, p < 0.001) and the FN–FA distance (R² = 0.50, p < 0.001). These findings may help refine the ultrasound techniques used for the femoral nerve block.

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