Ischemic colitis is a serious complication of abdominal aortic surgery. Patients with bilateral internal iliac aneurysm have a high risk of ischemic colitis after operation. A 72-year-old man had infrarenal abdominal aneurysm, bilateral common and internal iliac aneurysm and an occluded right internal iliac artery. We examined the flow of the superior rectal artery during operation by transanal Doppler, and intramucosal pH of the sigmoid colon by a tonometer after operation. The flow of the superior rectal artery did not change after clamping of the left common iliac artery, clamp of the infrarenal aorta. He underwent uneventful abdominal aortic aneurysmectomy, Y-grafting and exclusion of bilateral internal iliac aneurysms. The intramucosal pH of the sigmoid colon returned to the normal range 25h after surgery. He had no complications after surgery. Transanal Doppler examination was essential for the successful prevention of postoperative colonic ischemia, and intestinal intramural pH by tonometry was an early reliable marker of the absence of ischemic colitis.

During a period of 5 years from January 1991 to December 1995, one-stage operation was performed on 10 cases with ischemic heart and occlusive peripheral vascular disease, excluding cases combined with AAA (abdominal aortic aneurysm). They were composed of 7 men and 3 women whose mean age at time of surgery was 65.8 years. The mean number of coronary artery bypass grafts made was 2.2. The procedures employed for occlusive peripheral vascular disease were TEA (thromboendarterectomy) of the internal carotid artery in 2 cases, aorta-subclavian bypass in 2 cases, aorta-bilateral common iliac artery bypass in 1 case, interposition of the common iliac artery in 1 case, aorta-external iliac artery bypass in 1 case, F-P (femolo-popliteal) bypass in 3 cases (4 bypasses), and F-T (femolo-tibial) bypass in 1 case. Mean operation time was 428 minutes, mean extracorporeal circulation time was 121 minutes, and mean aortic cross-clamp time was 61 minutes. Blood transfusion was not made in 4 cases. There was one operative death in a case of MNMS (myonephropatic metabolic syndrome) with emergency IABP (intraaortic balloon pumping) insertion following complication of PMI (perioperative myocardial infarction). A comparative study was made with 183 non-emergency cases of CABG (coronary artery bypass graft) conducted during the same period. Operation time was longer in cases of one-stage operation, but no significant difference was observed in operative mortality rate, rate of cases not requiring blood transfusion, days of intubation, and postoperative hospitalization duration. The surgical procedure was relatively safe.

Objective: Associations between hospital treatment volume and survival outcomes for women with 3 types of gynecologic malignancies, and the trends and contributing factors for high-volume centers were examined. Methods: The Japan Society of Obstetrics and Gynecology tumor registry databased retrospective study examined 206,845 women with 80,741, 73,647, and 52,457 of endometrial, cervical, and ovarian tumor, respectively, who underwent primary treatment in Japan between 2004 and 2015. Associations between the annual treatment volume and overall survival (OS) for each tumor type were examined using a multivariable Cox proportional hazards model with restricted cubic splines. Institutions were categorized into 3 groups (low-, moderate-, and high-volume centers) based on hazard risks. Results: Hazard ratio (HR) for OS each the 3 tumors decreased with hospital treatment volume. The cut-off points of treatment volume were defined for high- (≥50, ≥51, and ≥27), moderate- (20–49, 20–50, and 17–26), and low-volume centers (≤19, ≤19, and ≤16) by cases/year for endometrial, cervical, and ovarian tumors, respectively. Multivariate analysis revealed younger age, rare tumor histology, and initial surgical management as contributing factors for women at high-volume centers (all, p<0.001). The proportion of high-volume center treatments decreased, whereas low-volume center treatments increased (all p<0.001). Treatment at high-volume centers improved OS than that at other centers (adjusted HR [aHR]=0.83, 95% confidence interval [CI]=0.78–0.88; aHR=0.78, 95% CI=0.75–0.83; and aHR=0.90, 95% CI=0.86–0.95 for endometrial, cervical, and ovarian tumors). Conclusion Hospital treatment volume impacted survival outcomes. Treatments at high-volume centers conferred survival benefits for women with gynecologic malignancies. The proportion of treatments at high-volume centers have been decreasing recently.