Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest* ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced* ; Hysterectomy* ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage* ; Postpartum Period* ; Pregnancy ; Pregnant Women ; Resuscitation

Purpose: Cone beam computed tomography (CBCT) is widely used to evaluate the temporomandibular joint (TMJ). For the three-dimensional (3D) assessment of the TMJ, segmentation of the mandibular condyle and articular fossa is essential. This study aimed to perform deep learning-based 3D segmentation of the mandibular condyle on CBCT images and evaluate the performance of the segmentation. Methods: CBCT scan data from 99 patients (mean age: 53.3±19.2 years) diagnosed with TMJ disorders were analyzed. From the CBCT images, sagittal, coronal, and axial planes showing the mandibular condyle were selected and combined to form two-dimensional (2D) images. The U-Net deep learning model was used to exclusively segment the mandibular condyle area from the 2D images. From these results, 3D images of the mandibular condyle were reconstructed. Accuracy, precision, recall, and the Dice coefficient were calculated to appraise segmentation performance in each plane. Results: The average Dice coefficient was 0.92 for the coronal and axial planes and 0.82 for the sagittal plane. The CBCT image-based segmentation performance of the mandibular condyle in the coronal and axial planes exceeded that in the sagittal plane. The sharpness and uniformity of the 2D images affected segmentation performance, with segmentation errors more likely occurring in non-uniform images. Certain segmentation errors were corrected through software processing. Finally, the segmented mandibular condyle images were applied to the CBCT data to reconstruct a 3D TMJ model. Conclusions Mandibular condyle 3D segmentation on CBCT images using U-Net may help evaluate and diagnose TMJ disorders. The proposed segmentation method may assist clinicians in efficiently analyzing CBCT images, particularly in cases involving anatomical abnormalities.

Perioperative stroke can lead to mortality or serious disability and usually occurs in patients undergoing cardiac, vascular, or neurologic surgery; it is rare in gynecological surgery. We report the case of a patient who suffered life-threatening cerebral infarction after elective laparoscopic hysterectomy. During the surgery, the patient was placed in the Trendelenburg position. On postoperative day one, the patient was diagnosed with right hemisphere cerebral infarction; brain computed tomographic angiography showed proximal right internal carotid artery occlusion. Decompressive craniectomy was performed to resolve brain swelling, but the patient died 10 days later.
Angiography ; Brain ; Brain Edema ; Carotid Artery, Internal ; Cerebral Infarction* ; Decompressive Craniectomy ; Female ; Gynecologic Surgical Procedures ; Head-Down Tilt* ; Humans ; Hysterectomy* ; Mortality ; Stroke

Postpartum hemorrhage is a common cause of maternal mortality; its main cause is placenta accreta. Therapeutic hypothermia is a generally accepted means of improving clinical signs in postcardiopulmonary resuscitation patients. A 41-year-old pregnant woman underwent a cesarean section under general anesthesia at 37 weeks of gestation. After the cesarean section, the patient experienced massive postpartum bleeding, which led to cardiac arrest. Once spontaneous circulation returned, the patient underwent an emergency hysterectomy and was placed under therapeutic hypothermia management. The patient recovered without neurological complications.
Adult ; Anesthesia, General ; Cesarean Section ; Emergencies ; Female ; Heart Arrest ; Hemorrhage ; Humans ; Hypothermia ; Hypothermia, Induced ; Hysterectomy ; Maternal Mortality ; Placenta Accreta ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Pregnant Women ; Resuscitation

Submental intubation has been the recommended airway management procedure for maxillofacial surgery since proposed by Altemir in 1986. We adopted various submental intubation modifications based on modified intubation protocols and report on the effectiveness and problems of each modified method. Case: Among a total of 13 submental intubation cases during the last five years, five representative methods are described. The proximal end of the endotracheal tube was protected by a nelaton catheter in case 1, by a suction connector in case 2, and by a dental needle cap in case 3. In case 4, a nasal speculum was used to expand a single route, and in case 5, a laparoscopic trocar was used to secure a single route. Conclusions: Use of a laparoscopic trocar might be the most effective way to obtain a single submental route. However, considering cost, use of a nasal speculum is also an effective suboptimal solution.

We describe the occurrence of acute type A aortic dissection in a patient with situs inversus totalis. A 37-year-old man presented to the emergency department with acute chest pain. Initial chest X-ray findings showed a right-sided heart and a left-sided liver. Contrast-enhanced computed tomography revealed a Stanford type A acute aortic dissection, aortic root dilatation, and situs inversus totalis. All of the thoracic structures were mirror-image reversed and an abnormal coronary artery was observed. The Bentall operation was performed. This report demonstrates that computed tomography and echocardiography were useful for understanding the anatomy and the presence or absence of concurrent anomalies in a patient with situs inversus totalis. The patient’s postoperative course was uneventful.

Objectives: Given that cardiopulmonary resuscitation (CPR) is an aerosol-generating procedure, it is necessary to use a mechanical ventilator and reduce the number of providers involved in resuscitation for in-hospital cardiac arrest in coronavirus disease (COVID-19) patients or suspected COVID-19 patients. However, no study assessed the effect of changes in inspiratory time on flowrate and airway pressure during CPR. We herein aimed to determine changes in these parameters during CPR and identify appropriate ventilator management for adults during CPR. Methods: We measured changes in tidal volume (Vt), peak inspiratory flow rate (PIFR), peak airway pressure (Ppeak), mean airway pressure (Pmean) according to changes in inspiratory time (0.75 s, 1.0 s and 1.5 s) with or without CPR. Vt of 500 mL was supplied (flowrate: 10 times/min) using a mechanical ventilator. Chest compressions were maintained at constant compression depth (53 ± 2 mm) and speed (102 ± 2/min) using a mechanical chest compression device. Results: Median levels of respiratory physiological parameters during CPR were significantly different according to the inspiratory time (0.75 s vs. 1.5 s): PIFR (80.8 [73.3 – 87.325] vs. 70.5 [67 – 72.4] L/min, P < 0.001), Ppeak (54 [48 – 59] vs. 47 [45 – 49] cmH2O, P < 0.001), and Pmean (3.9 [3.6 – 4.1] vs. 5.7 [5.6 – 5.8] cmH2O, P < 0.001). Conclusions Changes in PIFR, Ppeak, and Pmean were associated with inspiratory time. PIFR and Ppeak values tended to decrease with increase in inspiratory time, while Pmean showed a contrasting trend. Increased inspiratory time in low-compliance cardiac arrest patients will help in reducing lung injury during adult CPR.

and Relevance: This case is the first instance of using tracheal stenting to effectively manage tracheal stenosis in a cat, successfully resolving a respiratory emergency, and ensuring long-term care.

and Relevance: This case is the first instance of using tracheal stenting to effectively manage tracheal stenosis in a cat, successfully resolving a respiratory emergency, and ensuring long-term care.

and Relevance: This case is the first instance of using tracheal stenting to effectively manage tracheal stenosis in a cat, successfully resolving a respiratory emergency, and ensuring long-term care.