Purpose: Treatment options for distal radius malunion with dorsal angulation include open-wedge osteotomy using a volar approach or closed-wedge osteotomy. An advantage of open-wedge osteotomy is that it preserves the length of the radius; however, it often requires bone grafting and presents difficulties in achieving reduction. In contrast, closed-wedge osteotomy makes correction easier, but it requires ulnar shortening osteotomy. Therefore, in this study, we propose an effective surgical method that compensates for the disadvantages of both techniques by using half-wedge osteotomy and rotational placement. Methods: This study presents five cases of distal radius corrective osteotomy and ulnar shortening osteotomy performed at our institution using half-wedge osteotomy and rotational placement for distal radius malunion between 2017 and 2021. Surgical efficacy was evaluated by assessing radiographic changes, visual analog scale scores, and the quick Disability of the Arm, Shoulder, and Hand score postoperatively. Results: The bone union was achieved in all cases, and computed tomography scans performed 6 months postoperatively showed ongoing bone healing. Postoperative dorsal tilt was restored to the normal range, and the clinical scores improved. Conclusion Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius are effective treatments, as they facilitate the correction of malunion, reduce the need for ulnar shortening length, and eliminate the need for bone grafting from the iliac crest.

Purpose: Treatment options for distal radius malunion with dorsal angulation include open-wedge osteotomy using a volar approach or closed-wedge osteotomy. An advantage of open-wedge osteotomy is that it preserves the length of the radius; however, it often requires bone grafting and presents difficulties in achieving reduction. In contrast, closed-wedge osteotomy makes correction easier, but it requires ulnar shortening osteotomy. Therefore, in this study, we propose an effective surgical method that compensates for the disadvantages of both techniques by using half-wedge osteotomy and rotational placement. Methods: This study presents five cases of distal radius corrective osteotomy and ulnar shortening osteotomy performed at our institution using half-wedge osteotomy and rotational placement for distal radius malunion between 2017 and 2021. Surgical efficacy was evaluated by assessing radiographic changes, visual analog scale scores, and the quick Disability of the Arm, Shoulder, and Hand score postoperatively. Results: The bone union was achieved in all cases, and computed tomography scans performed 6 months postoperatively showed ongoing bone healing. Postoperative dorsal tilt was restored to the normal range, and the clinical scores improved. Conclusion Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius are effective treatments, as they facilitate the correction of malunion, reduce the need for ulnar shortening length, and eliminate the need for bone grafting from the iliac crest.

Purpose: Treatment options for distal radius malunion with dorsal angulation include open-wedge osteotomy using a volar approach or closed-wedge osteotomy. An advantage of open-wedge osteotomy is that it preserves the length of the radius; however, it often requires bone grafting and presents difficulties in achieving reduction. In contrast, closed-wedge osteotomy makes correction easier, but it requires ulnar shortening osteotomy. Therefore, in this study, we propose an effective surgical method that compensates for the disadvantages of both techniques by using half-wedge osteotomy and rotational placement. Methods: This study presents five cases of distal radius corrective osteotomy and ulnar shortening osteotomy performed at our institution using half-wedge osteotomy and rotational placement for distal radius malunion between 2017 and 2021. Surgical efficacy was evaluated by assessing radiographic changes, visual analog scale scores, and the quick Disability of the Arm, Shoulder, and Hand score postoperatively. Results: The bone union was achieved in all cases, and computed tomography scans performed 6 months postoperatively showed ongoing bone healing. Postoperative dorsal tilt was restored to the normal range, and the clinical scores improved. Conclusion Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius are effective treatments, as they facilitate the correction of malunion, reduce the need for ulnar shortening length, and eliminate the need for bone grafting from the iliac crest.

Owing to a large-jeopardized myocardium, left main coronary artery disease (LMCAD) represents the substantial high-risk anatomical subset of obstructive coronary artery disease.For several decades, coronary artery bypass grafting (CABG) has been the “gold standard” treatment for LMCAD. Along with advances in CABG, percutaneous coronary intervention (PCI) has also dramatically evolved over time in conjunction with advances in the stent or device technology, adjunct pharmacotherapy, accumulated experiences, and practice changes, establishing its position as a safe, reasonable treatment option for such a complex disease. Until recently, several randomized clinical trials, meta-analyses, and observational registries comparing PCI and CABG for LMCAD have shown comparable long-term survival with tradeoffs between early and late risk-benefit of each treatment. Despite this, there are still several unmet issues for revascularization strategy and management for LMCAD. This review article summarized updated knowledge on evolution and clinical evidence on the treatment of LMCAD, with a focus on the comparison of state-of-the-art PCI with CABG.

Reconstructive options for multidigit or soft tissue defects of the hand are varied, yet complex hand defects remain particularly challenging. These cases often necessitate microvascular reconstruction using osteocutaneous free flaps to achieve functional limb salvage. This paper presents two cases of osteocutaneous lateral arm free flap surgery performed at our institution, demonstrating the efficacy of this technique in managing complex hand defects. One case involved a severe crushing injury on an index finger with only the ulnar neurovascular bundle remaining, and the other involved a crushing injury on the first web space with severe comminution of the first metacarpal bone. After an emergency simple debridement, reconstructive surgery using the osteocutaneous lateral arm free flap was performed a few days later. Both cases healed without necrosis. Although both patients lost interphalangeal joint function, they were able to maintain grasping function and finger length without amputation. The osteocutaneous lateral arm free flap is an effective reconstruction method for addressing small to moderate-sized segmental bone and soft tissue defects of the hand caused by trauma. This procedure can be conveniently performed in a single session under regional anesthesia.

Reconstructive options for multidigit or soft tissue defects of the hand are varied, yet complex hand defects remain particularly challenging. These cases often necessitate microvascular reconstruction using osteocutaneous free flaps to achieve functional limb salvage. This paper presents two cases of osteocutaneous lateral arm free flap surgery performed at our institution, demonstrating the efficacy of this technique in managing complex hand defects. One case involved a severe crushing injury on an index finger with only the ulnar neurovascular bundle remaining, and the other involved a crushing injury on the first web space with severe comminution of the first metacarpal bone. After an emergency simple debridement, reconstructive surgery using the osteocutaneous lateral arm free flap was performed a few days later. Both cases healed without necrosis. Although both patients lost interphalangeal joint function, they were able to maintain grasping function and finger length without amputation. The osteocutaneous lateral arm free flap is an effective reconstruction method for addressing small to moderate-sized segmental bone and soft tissue defects of the hand caused by trauma. This procedure can be conveniently performed in a single session under regional anesthesia.

Reconstructive options for multidigit or soft tissue defects of the hand are varied, yet complex hand defects remain particularly challenging. These cases often necessitate microvascular reconstruction using osteocutaneous free flaps to achieve functional limb salvage. This paper presents two cases of osteocutaneous lateral arm free flap surgery performed at our institution, demonstrating the efficacy of this technique in managing complex hand defects. One case involved a severe crushing injury on an index finger with only the ulnar neurovascular bundle remaining, and the other involved a crushing injury on the first web space with severe comminution of the first metacarpal bone. After an emergency simple debridement, reconstructive surgery using the osteocutaneous lateral arm free flap was performed a few days later. Both cases healed without necrosis. Although both patients lost interphalangeal joint function, they were able to maintain grasping function and finger length without amputation. The osteocutaneous lateral arm free flap is an effective reconstruction method for addressing small to moderate-sized segmental bone and soft tissue defects of the hand caused by trauma. This procedure can be conveniently performed in a single session under regional anesthesia.

Objective: Early prediction of the multiple organ dysfunction syndrome (MODS) and providing early innovative treatment may improve outcomes in patients with severe trauma. Lactate and serum albumin levels, which are widely used markers predicting the severity of critically ill patients, tend to diverge during clinical deterioration. This study aimed to evaluate the clinical utility of the lactate/albumin ratio (LAR) as a predictive factor for MODS and 30-day mortality in patients with severe trauma. Methods: This retrospective, observational cohort study was performed with patients prospectively integrated into a critical pathway for trauma. We analyzed severe trauma patients (Injury Severity Score≥16) admitted to the emergency department (ED), between January 1, 2011, and May 31, 2017. The outcomes were the development of MODS and 30-day mortality. Results: In total, 348 patients were enrolled, of which 18 (5.2%) died within 96 hours of ED admission, and the remaining 330 patients (94.8%) were evaluated for the development of MODS. An increase in the LAR at admission (odds ratio, 1.618; P=0.028) was an independent predictor of MODS development. The area under the receiver operating characteristic curve (0.755) and Harrell's C-index (0.783) showed that LAR could predict MODS and 30-day mortality. Conclusion Initial LAR is an independent predictor of MODS development in patients with severe trauma. Our study results suggest that an elevated LAR can be a useful prognostic marker in patients with severe trauma.

BACKGROUND: AVP (arginine vasopressin) shows unique hemodynamic characteristics, as a vasopressor. AVP has been tried in many cathecholamine refractory vasodilatory situations, and sometimes resulted in effective hemodynamic improvement. In this study, we hypothesized that low dose AVP infusion could recover the decreased SVR (systemic vascular resistance) induced by milrinone infusion with minimal effect on PVR (pulmonary vascular resistance). METHODS: Sixteen patients undergoing OPCAB participated in this study. After a loading dose milrinone was infused, low dose vasopressin infusion was started and titrated until the systemic blood pressure increased by 20%. During the study, hemodynamic factors including pulmonary capillary wedge pressure and cardiac output were measured using a continuous thermodilution technique with a Swan-Ganz catheter. RESULTS: Milrinone infusion reduced both SVR and PVR. And vasopression infusion increased SVR, but show relatively less effect on PVR. CONCLUSIONS: Low-dose vasopressin infusion could be used to recover the SVR decrease caused by milirinone infusion with little effect on PVR.
Blood Pressure ; Cardiac Output ; Catheters ; Hemodynamics* ; Humans ; Milrinone* ; Pulmonary Wedge Pressure ; Thermodilution ; Vasopressins*

BACKGROUND: I-gel is a recently developed supraglottic airway device with many advantages. Like laryngeal mask airway (LMA), I-gel is an easier and quicker intubation alternative to endotracheal intubation in certain situations. In this study, we assessed the ease of I-gel insertion and compared the clinical performance of anesthetsiology residents (group R) experienced in endotracheal intubation versus that of interns (group I) with little intubation experience. METHODS: This prospective and randomized study included 60 patients. The ease of insertion, number of I-gel insertion attempts, presence of air leakage, and postoperative complications such as bleeding, dental trauma, hoarseness, and sore throat were evaluated in each group. RESULTS: Insertion was successful on the initial attempt in 29 of 30 cases in group R. In group I, 24 initial insertions were successful. The mean insertion times were 12.5 +/- 4.8 and 27.9 +/- 12.5 seconds for group R and group I, respectively (P < 0.001). No significant differences were observed between the two groups regarding postintubational air leakage. Regarding complications, two cases of bleeding, one case of dental trauma, and two cases of sore throat were recorded. No significant differences were observed between the two groups for any of the complications examined. CONCLUSIONS: I-gel is a suitable alternative insertion device that enables rapid and easy intubation by physicians who are experienced with endotracheal intubation. Moreover, this device also enables efficient and safe insertion during emergent situations for novice clinicians, even those who have little experience in intubation.
Airway Management ; Anesthesiology* ; Hemorrhage ; Hoarseness ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks ; Pharyngitis ; Postoperative Complications ; Prospective Studies