A giant abdominal aortic aneurysm (AAA) renders surgical treatment much more difficult by deforming the proximal infrarenal aortic neck (shortened length and disturbed angulation), by altering the iliac arteries (marked tortuosity and aneurysmal dilatation), and by displacing abdominal organs. Because the retroperitoneal rupture of giant AAA makes the mesentery more elongated and deformed, compromising its blood flow and thus increasing the risk of mesenteric ischemia such as colon ischemia. We describe here the surgical repair of a large infrarenal AAA with a ruptured huge left common iliac artery aneurysm of 13.5 cm in diameter, accompanied by colostomy due to colon ischemia which occurred during the operation. We discuss the pathophysiology and preventive strategy of colon ischemia during ruptured giant AAA repair.
Aneurysm* ; Aneurysm, Ruptured ; Aortic Aneurysm, Abdominal ; Colitis, Ischemic ; Colon* ; Colostomy ; Iliac Artery ; Ischemia* ; Mesentery ; Neck ; Rupture

PURPOSE: Our study aims to evaluate to evaluate clinical outcomes after cephalic vein transposition (CVT) to the axilla in patients with brachiocephalic arteriovenous fistula (BC-AVF) and cephalic arch stenosis (CAS). MATERIALS AND METHODS: Hospital records of 13 patients (median age, 61 years; males, 54%) who received CVT to the proximal basilic/axillary vein due to either dysfunction (n=2) or thrombosis (n=11) between January 2010 and February 2014 were retrospectively reviewed. RESULTS: Operation was performed under local anesthesia in all cases. There was no technical failure. Concomitant inflow procedure (banding or aneurysmorrhaphy) was performed in 5 patients (38%). During follow-up (1 to 50 months, median 17 months), 3 patients died with functioning AVF and one was successfully transplanted. Two patients suffered from recurrent symptomatic stenosis of AVF and received percutaneous balloon angioplasty. Another 2 patients experienced AVF occlusion treated with interposition graft and manual fragmentation. Overall primary, assisted primary, and secondary patency rates were 77.5%, 92.3%, and 100% at 6 months and 66.1%, 92.3%, and 100% at 1 year, respectively. CONCLUSION: Although most patients presented with BC-AVF occlusion, technical success and access patency rates after CVT were favorable compared with historical data for interventional treatment. CVT should be considered as an appropriate option in selected patients with CAS.
Anesthesia, Local ; Angioplasty, Balloon ; Arteriovenous Fistula* ; Axilla ; Constriction, Pathologic* ; Follow-Up Studies ; Hospital Records ; Humans ; Male ; Renal Dialysis ; Retrospective Studies ; Thrombosis ; Transplants ; Veins*

PURPOSE: To determine the long-term outcomes of patients with diabetes mellitus (DM) and tissue loss who have undergone infrainguinal bypass surgery (IBS). METHODS: We retrospectively reviewed the medical records of 91 patients with DM and tissue loss who underwent IBS between July 2003 and December 2013. We determined the rates of overall survival (OS), amputation-free survival (AFS), limb salvage (LS), and graft patency (GP). In addition, we evaluated data to identify risk factors that affected long-term outcomes. RESULTS: The mean age of patients was 66 +/- 8 years, and 78 patients (85.7%) were men. The locations of tissue loss were toe on 76 limbs (71.6%), heel on 6 limbs (5.7%) and others on 24 limbs (22.6%). Single lesions were found in 81 limbs (76.4%). According to categorization by distal anastomosis artery, there were 57 popliteal (53.8%) and 49 infrapopliteal bypasses (46.2%). Among infrapopliteal bypasses, 5 cases (10.2%) were sequential bypasses. The OS at 1, 3, and 5 years was 90.5%, 70.9%, and 44.2%, respectively. At 1, 3, and 5 years, the LS was 92.1%, 88.9%, 88.9%, respectively; and AFS was 84.4%, 67.6%, 45.7%, respectively. At 1, 3, and 5 years, the GP was 84.8%, 74.5%, and 69.8%, respectively. Renal failure was a negative predictor for OS, and female gender was a negative predictor for GP. CONCLUSION: IBS for patients with DM and tissue loss led to acceptable OS, AFS, LS, and GP. Active revascularization for patients with DM and tissue loss can reduce the risk of major amputation.
Amputation ; Arteries ; Diabetes Mellitus* ; Extremities ; Female ; Heel ; Humans ; Limb Salvage ; Male ; Medical Records ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Toes ; Transplants

BACKGROUND/OBJECTIVES: Diet planning in childcare centers is difficult because of the required knowledge of nutrition and development as well as the high design complexity associated with large numbers of food items. Artificial intelligence (AI) is expected to provide diet-planning solutions via automatic and effective application of professional knowledge, addressing the complexity of optimal diet design. This study presents the results of the evaluation of the utility of AI-generated diets for children and provides related implications.MATERIALS/METHODS: We developed 2 AI solutions for children aged 3–5 yrs using a generative adversarial network (GAN) model and a reinforcement learning (RL) framework.After training these solutions to produce daily diet plans, experts evaluated the human- and AI-generated diets in 2 steps. RESULTS: In the evaluation of adequacy of nutrition, where experts were provided only with nutrient information and no food names, the proportion of strong positive responses to RLgenerated diets was higher than that of the human- and GAN-generated diets (P < 0.001). In contrast, in terms of diet composition, the experts’ responses to human-designed diets were more positive when experts were provided with food name information (i.e., composition information). CONCLUSIONS To the best of our knowledge, this is the first study to demonstrate the development and evaluation of AI to support dietary planning for children. This study demonstrates the possibility of developing AI-assisted diet planning methods for children and highlights the importance of composition compliance in diet planning. Further integrative cooperation in the fields of nutrition, engineering, and medicine is needed to improve the suitability of our proposed AI solutions and benefit children’s well-being by providing high-quality diet planning in terms of both compositional and nutritional criteria.

PURPOSE: It remains controversial whether to use a tube graft or a bifurcated graft during open abdominal aortic aneurysm (AAA) repair, due to the potential for progression or development of a common iliac artery (CIA) aneurysm. This study evaluated the fate of CIA after tubular AAA repair. METHODS: On a retrospective basis, we reviewed 61 patients who underwent open AAA repair with a tube graft, between March 2000 and December 2009. Fifty-seven patients were included in this study; we excluded 4 cases in which the patients died in-hospital. Of those enrolled, 24 patients underwent follow-up computed tomography at least 1-year after surgery. CIAs were categorized into 3 groups: normal (< or =12 mm), ectasia (range, 13 to 18 mm), and aneurysm (range, 19 to 25 mm). The incidence of CIA aneurysm rupture was investigated, and the expansion rate of CIA was calculated. RESULTS: Mean patient age was 64 years and 73% of patients were male. Preoperatively, 8 patients had 2 normal CIAs, 14 patients had one CIA aneurysm at least, 27 patients had one CIA ectasia, and 8 patients were unknown. There was a mean follow-up of 51 months; no deaths were caused by rupture of CIA aneurysm, and no patient underwent invasive treatment for a CIA aneurysm. The mean follow-up for 24 patients with 48 CIAs was 45 months. The mean expansion rate of CIA was 0.5 mm/y. CONCLUSION: AAA repair using a tube graft was a safe and durable procedure. However, a bifurcated graft should be considered when patients are young and there is the expectation of a long life expectancy is anticipated allowing for a CIA expansion rate of 0.5 mm/y.
Aneurysm ; Aortic Aneurysm, Abdominal ; Dilatation, Pathologic ; Follow-Up Studies ; Humans ; Iliac Artery ; Incidence ; Life Expectancy ; Male ; Retrospective Studies ; Rupture ; Transplants

PURPOSE: To report follow-up data on upper extremity (UE) macroreplantation in patients with traumatic amputation injuries. METHODS: Between 1996 and 2003, 11 patients underwent UE macroreplantation at a single institution. All patients had an open fracture (n=9; upper arm, 5; forearm, 4) or an open dislocation of the elbow (n=2), combined with neurovascular and soft tissue transection injuries. The replantation procedures were performed on an emergency basis by a multi-departmental team. The mean warm ischemic time was 328 minutes (range, 165 to 480 minutes). Functional recovery of the replanted UE was evaluated with Chen's classification system, and patient satisfaction was determined using Russell's questionnaire; periodic examinations were conducted over a minimum follow-up period of 2 years. RESULTS: Early complications consisted of 2 arterial thromboses, 1 soft tissue infection resulting in sepsis, and 1 episode of acute renal failure; UE reamputation was required in 2 patients. As a result, limb salvage was achieved in 82% of patients (9/11). A functional extremity, defined as grades I and II using Chen's criteria, was preserved in 33.3% of patients with successfully replanted limbs. Despite the objectively poor rate of function preservation, 89% of patients who had successful replantation procedures were satisfied with the results. CONCLUSION: Even though the functional recovery rate was low, UE macroreplantation resulted in acceptable limb salvage rates and good patient satisfaction.
Amputation ; Amputation, Traumatic ; Arm ; Dislocations ; Elbow ; Emergencies ; Extremities ; Follow-Up Studies ; Forearm ; Fractures, Open ; Humans ; Limb Salvage ; Patient Satisfaction ; Replantation ; Sepsis ; Soft Tissue Infections ; Thrombosis ; Upper Extremity ; Warm Ischemia

PURPOSE: We analyze the outcomes of open repair (OR) in patients with ruptured abdominal aortic aneurysm (RAAA) according to the anatomic suitability for endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: We reviewed retrospectively all consecutive RAAA patients who underwent OR from January 2005 to March 2014. All suspected patients underwent preoperative computed tomography (CT). Outcomes were major morbidities and mortality. Multivariate analysis was performed by using logistic regression adjusted by controlled variables; gender, Hardman index, maximal aneurysmal diameter, rupture type, perioperative transfusion requirement, and perioperative urinary output. RESULTS: Among 54 consecutive patients with RAAA who underwent OR, 45 patients were included after exclusion of 9 patients (7, suprarenal; 1, infected; 1, inflammatory). Preoperative CT showed 27% (12/45) EVAR-suitable patients. Hostile neck anatomy was found in 88% (29/33) among unsuitable anatomy (UA) (n=33). The maximal aneurysmal diameter was statistically larger (83.1+/-21.0 mm vs. 68.8+/-12.3 mm, P=0.032) in the UA group. The 30-day mortality was 28.9% (13/45; 33% vs. 17% in UA group vs. suitable anatomy [SA] group, P=0.460; adjusted P=0.445). UA group had more patients with cardiac morbidity (55% vs. 25%, P=0.079; adjusted P=0.032; odds ratio, 12.914; 95% confidence interval, 1.238-134.675). There was no statistical difference in survival rate between SA and UA groups (74.1%, 74.1%, and 74.1% vs. 60.6%, 55.6%, and 32.4% at 1-, 3- and 5-year, respectively; P=0.145). CONCLUSION: In this study, relatively unfavorable outcomes were found in the EVAR-unsuitable group after OR in RAAA patients. However, unsuitable anatomy did not influence patient survival after OR by multivariate analysis.
Aneurysm* ; Aneurysm, Ruptured ; Aortic Aneurysm, Abdominal* ; Endovascular Procedures ; Humans ; Logistic Models ; Mortality* ; Multivariate Analysis ; Neck ; Odds Ratio ; Retrospective Studies ; Rupture ; Survival Rate

Celiac artery aneurysms are extremely rare vascular lesions usually diagnosed by chance. A 62-year-old male was being referred to Kyungpook National University Hospital with a seven day history of upper right quadrant abdominal pain. A computed tomography scan revealed an acute cholecystitis and a 7-cm sized huge aneurysm located from the origin of celiac artery to the bifurcation of celiac artery. After an initial cholecystectomy, the aneurysm was opened and the origin of celiac artery was oversewn with aorta followed by transposing and implanting the conjoined splenic-hepatic trunk to supraceliac aorta. The patient was discharged without complications on the tenth postoperative day. Conjoined splenic-hepatic trunk transposition for the repair of a celiac artery aneurysm may be an appropriate alternative option especially in cases complicated with other infectious conditions.
Abdominal Pain ; Aneurysm ; Aorta ; Celiac Artery ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Humans ; Male ; Splenic Artery

PURPOSE: To evaluate shunt rate and discuss the resultsrelated to selective shunt placement during carotid endarterectomy (CEA) using routine awake test. METHODS: Patients with CEA from 2007 to 2011 were retrospectively reviewed from prospectively collected data. The need for shunt placement was determined by the awake test, based on the alteration in the neurologic examination. We collected data by using the clinical records and imaging studies, and investigated factors related to selective shunt such as collateral circulation and contralateral internal carotid artery (ICA) stenosis. RESULTS: There were 45 CEAs under regional anesthesia with the awake test in 44 patients. The mean age was 61.8 +/- 7.1 years old. There were 82.2% (37/45) of males, and 68.9% (31/45) of symptomatic patients. Selective shunt placement had been performed in only two (4.4%) patients. Among them fewer cases (4%) had severe (stenosis >70%) contralateral ICA lesions, and more cases (91%) of complete morphology of the anterior or posterior circulation in the circle of Willis. There was no perioperative stroke, myocardial infarctionor death, and asymptomatic new brain lesions were detected in 4 patients (9%), including 2 cases of selective shunt placement. CONCLUSION: CEA under routine awake test could besafe and feasible method with low shunt placement rate in selected patients.
Anesthesia, Conduction ; Brain ; Brain Ischemia ; Carotid Artery, Internal ; Circle of Willis ; Collateral Circulation ; Endarterectomy, Carotid ; Humans ; Male ; Monitoring, Intraoperative ; Neurologic Examination ; Prospective Studies ; Retrospective Studies ; Stroke

A new blood bank system was established in our trauma bay, which allowed immediate utilization of uncross-matched type O packed red blood cells (UORBCs). We investigated the efficacy of UORBC compared to that of the ABO type-specific packed red blood cells (ABO RBCs) from before the bank was installed. From March 2016 to February 2017, data from trauma patients who received UORBCs in the trauma bay were compared with those of trauma patients who received ABO RBCs from January 2013 to December 2015. Propensity matching was used to overcome retrospective bias. The primary outcome was 24-hour mortality, while the secondary outcomes were in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Data from 252 patients were reviewed and UORBCs were administered to 64 patients. The time to transfusion from emergency room admission was shorter in the UORBC group (11 [7–16] minutes vs. 44 [29–72] minutes, P < 0.001). After propensity matching, 47 patients were included in each group. The 24-hour mortality (4 [8.5%] vs. 9 [13.8%], P = 0.135), in-hospital mortality (14 [29.8%] vs. 18 [38.3%], P = 0.384), and ICU LOS (9 [4–19] days vs. 5 [0–19] days, P = 0.155) did not differ significantly between groups. The utilization of UORBCs resulted in a faster transfusion but did not significantly improve the clinical outcomes in traumatic shock patients in this study. However, the tendency for lower mortality in the UORBC group suggested the need for a large study.
Bays ; Bias (Epidemiology) ; Blood Banks ; Emergency Service, Hospital ; Erythrocyte Transfusion* ; Erythrocytes* ; Hospital Mortality ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; Propensity Score* ; Retrospective Studies ; Shock* ; Shock, Traumatic ; Trauma Centers ; Wounds and Injuries