A 63-year-old woman was referred to a breast surgeon with a breast mass discovered incidentally during follow-up study after colon cancer surgery. Invasive adenocarcinoma was revealed on core needle biopsy. Wide excision of the breast including the tumor was performed. On standard histological examination the tumor showed features of moderately differentiated adenocarcinoma. The immunohistochemistry study revealed positive results for cytokeratin (CK)20 and CDX2, but negative for CK7. These are typical characteristics for colon cancer. Considering her history of subtotal colectomy for sigmoid colon cancer, it is presumable that the mass in the breast was of colonic origin, and it was an extremely rare case of metastasis to the breast from primary colorectal neoplasm. Although the instance is rare, clinicians should keep the possibility of breast metastasis from colorectal cancer in mind for early and correct diagnosis.
Adenocarcinoma ; Biopsy, Large-Core Needle ; Breast ; Colectomy ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Middle Aged ; Neoplasm Metastasis ; Sigmoid Neoplasms

No abstract available.
Arrhythmias, Cardiac*

No abstract available.
Chylothorax*

Keratocystic odontogenic tumor (KCOT) is a common benign tumor of osseous lesions in dental and maxillofacial practice. We describe three cases of large KCOT located in the posterior part of the mandible extending to the angle and ramus region, which were enucleated via sagittal split osteotomy (SSO) of the mandible. There are cases in which a conventional enucleation procedure does not ensure complete excision of the entire lesion without damage to vital structures like the inferior alveolar nerve. In such cases, a SSO approach could be a better choice than conventional methods. The purpose of this article is to describe our experience using unilateral mandibular SSO for removal of a KCOT from the mandible.
Mandible* ; Mandibular Nerve ; Odontogenic Cysts* ; Odontogenic Tumors* ; Osteotomy* ; Osteotomy, Sagittal Split Ramus

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to overcome this limitation of single-incision laparoscopic surgery. This new surgical platform has been demonstrated favorable performance in colorectal surgery and its use has been increasing. And, in accordance with the increment of adoption of dVSP, the indication to apply this platform has been expanding. Herein, we report a technique of right hemicolectomy with extended lymphadenectomy beyond conventional lymph node dissection using dVSP.

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to perform pure single-incision surgery in 2018. This new surgical platform demonstrated favorable performance compared with the positive aspect of single-incision laparoscopic surgery and robot surgery. To date, its use has mainly been in urological and gynecological procedures. We report a case of successful robotic single-incision right hemicolectomy for cecal cancer with the dVSP.
Cecal Neoplasms ; Laparoscopy

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to overcome this limitation of single-incision laparoscopic surgery. This new surgical platform has been demonstrated favorable performance in colorectal surgery and its use has been increasing. And, in accordance with the increment of adoption of dVSP, the indication to apply this platform has been expanding. Herein, we report a technique of right hemicolectomy with extended lymphadenectomy beyond conventional lymph node dissection using dVSP.

Purpose: Obesity has been known to contribute to technical difficulties in surgery. Until now, body mass index (BMI) has been used to measure obesity. However, there are reports that BMI does not always correspond to the visceral fat. Recently, bioelectrical impedance analysis (BIA) has been used for body composition analysis. This study aimed to evaluate the usefulness of the body composition index obtained using a BIA device in predicting short-term postoperative outcomes. Methods: Data of patients who underwent elective major colorectal surgery using minimally invasive techniques were reviewed retrospectively. Body composition status was recorded using a commercial BIA device the day before surgery. The relationship between BMI, body composition index, and short-term postoperative outcomes, including operative time, was analyzed. Results: Sixty-six patients were enrolled in this study. In the correlation analysis, positive correlation was observed between BMI and body composition index. BMI and body composition index were not associated with short-term postoperative outcomes. Percent body fat (odds ratio, 4.226; 95% confidence interval [CI], 1.064–16.780; P=0.041) was found to be a statistically significant factor of prolonged operative time in the multivariate analysis. Correlation analysis showed that body fat mass was related to prolonged operative time (correlation coefficients, 0.245; P=0.048). In the area under curve analysis, body fat mass showed a statistically significant predictive probability for prolonged operative time (body fat mass: area, 0.662; 95% CI, 0.531–0.764; P=0.024). Conclusion The body composition index can be used as a predictive marker for prolonged operative time. Further studies are needed to determine its usefulness.

Purpose: Narrow pelvis has been considered an adverse factor for postoperative and oncologic outcomes after rectal cancer surgery. The aim of this study was to investigate the validity of using only axial CT scan images to calculate the pelvic cross-sectional area for the prediction of adverse outcomes after rectal cancer surgery. Methods: The medical records of patients who underwent rectal cancer surgery were reviewed and analyzed retrospectively. Axial images of CT scan were used to measure the pelvic cross-sectional area. Pelvic surgical site infection (SSI), positive resection margin, and early local recurrence were adopted as end-points to analyze the impact of pelvimetry on surgical outcome. Results: The mean pelvic cross-sectional area was 84.3 ± 10.9 cm2. Males had significantly smaller pelvic areas than females (P < 0.001). Comparing pelvic cross-sectional areas according to the surgical outcomes, the results indicated that patients with pelvic SSI and local failure (positive resection margin or local recurrence within 1 year) have significantly smaller cross-sectional-area than SSI and local failure-free patients (P = 0.013 and P = 0.031). A calculated crosssectional area of 88.8 cm2 was determined as the cutoff value for the prediction of pelvic SSI and/or local failure, which was significant in a validating analysis. Conclusion The pelvic cross-sectional area obtained from a routine axial CT scan image was associated with pelvic SSI, positive resection margin, and early local recurrence. It might be an intuitive, feasible, and easily adoptable method for predicting surgical outcomes.

Two cases of acute spontaneous subdural hemorrhage caused by cerebral aneurysmal rupture are presented. The patients’ chief complaints were sudden bursting headache and comatose mentality. There was no history of trauma or proclivity for spontaneous bleeding, and CT scans of the brain indicated subdural hemorrhage without remarkable subarachnoid hemorrhage. In case 1, an aneurysm at the distal segment of the right anterior cerebral artery was identified by CT angiography; the subdural hemorrhage was evacuated and the aneurysm surgically clipped. In case 2, an aneurysm at the junction of the anterior communicating artery and the right anterior cerebral artery was revealed by CT angiography and digital subtraction angiography, and Guglielmi detachable coil embolization of the aneurysm was performed.
Aneurysm ; Angiography ; Angiography, Digital Subtraction ; Anterior Cerebral Artery ; Arteries ; Brain ; Coma ; Embolization, Therapeutic ; Headache ; Hematoma, Subdural* ; Hemorrhage ; Intracranial Aneurysm* ; Rupture* ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed