1.A Case of Sigmoid Colon to Skin Fistula Following Surgery for Abdominal Aortic Aneurysm.
Hideaki Nishimori ; Kunihiko Hirose ; Takashi Fukutomi ; Katsushi Oda ; Toshiyuki Yamashiro
Japanese Journal of Cardiovascular Surgery 1999;28(5):351-354
We present a case of sigmoid colon to skin fistula following surgery for abdominal aortic aneurysm that was believed to have resulted from nonocclusive mesenteric ischemia involved in low cardiac output syndrome. A 65-year-old man underwent surgical treatment for an abdominal aortic aneurysm. Although the patient had operative risks of renal dysfunction and left ventricular dysfunction due to an old myocardial infarction, the abdominal aortic aneurysm was 6cm in diameter and threatened to rupture, thus prompting surgical removal. For the operation, the abdominal aorta was clamped above the renal arteries and the aneurysm was replaced with a Y-shaped prosthetic graft following the aneurysmectomy. Among the vessels supplying the sigmoid colon, both the inferior mesenteric artery and the left internal iliac artery had become obstructed and thus only the right internal iliac artery could be successfully reconstructed. The patient suffered from low cardiac output syndrome after surgery and subsequently experienced renal dysfunction, liver dysfunction and a disturbance of the peripheral circulation. On postoperative day number 7, the patient complained of watery diarrhea occurring several times a day and abdominal distension as a result of the ischemic colitis. On day number 16, the sigmoid colon to skin fistula developed. Oral intake was discontinued and nutritional support thereafter consisted of intravenous hyperalimentation. In addition, enteral nutrition using an elemental diet was begun. The fistula was successfully closed two weeks later and the patient recovered with no further complications.
2.A Case of Post-Transfusion Graft-versus-host Disease.
Hideaki Nishimori ; Kunihiko Hirose ; Takashi Fukutomi ; Katsushi Oda ; Atsushi Hata ; Souichi Asano ; Toshiyuki Yamashiro ; Shouhei Ogoshi
Japanese Journal of Cardiovascular Surgery 1995;24(6):380-383
A 78-year-old man with obstruction of the right common femoral artery due to arteriosclerosis obliterans underwent successful amputation of his leg. On the first postoperative day he received transfusion of three units of preserved blood. He continued to recover until postoperative day 7, when he developed a high fever, erythroderma and diarrhea. His condition gradually deteriorated and on postoperative day 15 he demonstrated severe and progressive leukopenia and thrombocytopenia. Although he underwent intensive treatment he died on postoperative day 20. A skin biopsy specimen revealed evidence of post-transfusion graft-versus-host disease.
3.Staged Arterial Switch Operation without Homologous Blood Transfusion
Takashi Tominaga ; Yukihiro Takahashi ; Nobuyuki Kobayashi ; Dai Nishina ; Toshio Kikuchi ; Ryo Hoshino ; Masahito Yamashiro ; Ikuko Shibasaki ; Kayoko Kobayashi ; Hiroki Kouno
Japanese Journal of Cardiovascular Surgery 2004;33(2):114-117
Staged arterial switch operation without homologous blood transfusion was successfully performed in 5 patients weighing 4.1-11.0kg (double outlet right ventricle: 2 cases, transposition of great arteries: 3 cases). The postoperative hemodynamics and respiratory status were uneventful in all patients (initial central venous pressure after ICU admission: 9.0-14.5cmH2O, mean 12.5cmH2O, duration of intubation: 3.5-18.0h, mean 7.8h). Autologous blood donation immediately after induction of anesthesia and minimization of bypass circuit were effective methods for open heart surgery without homologous blood transfusion, particularly in staged arterial switch operation requiring prolonged cardiopulmonary bypass.
4.A case of severe mandibular retrognathism with bilateral condylar deformities treated with Le Fort I osteotomy and two advancement genioplasty procedures.
Masahiro NAKAMURA ; Takeshi YANAGITA ; Tatsushi MATSUMURA ; Takashi YAMASHIRO ; Seiji IIDA ; Hiroshi KAMIOKA
The Korean Journal of Orthodontics 2016;46(6):395-408
We report a case involving a young female patient with severe mandibular retrognathism accompanied by mandibular condylar deformity that was effectively treated with Le Fort I osteotomy and two genioplasty procedures. At 9 years and 9 months of age, she was diagnosed with Angle Class III malocclusion, a skeletal Class II jaw relationship, an anterior crossbite, congenital absence of some teeth, and a left-sided cleft lip and palate. Although the anterior crossbite and narrow maxillary arch were corrected by interceptive orthodontic treatment, severe mandibular hypogrowth resulted in unexpectedly severe mandibular retrognathism after growth completion. Moreover, bilateral condylar deformities were observed, and we suspected progressive condylar resorption (PCR). There was a high risk of further condylar resorption with mandibular advancement surgery; therefore, Le Fort I osteotomy with two genioplasty procedures was performed to achieve counterclockwise rotation of the mandible and avoid ingravescence of the condylar deformities. The total duration of active treatment was 42 months. The maxilla was impacted by 7.0 mm and 5.0 mm in the incisor and molar regions, respectively, while the pogonion was advanced by 18.0 mm. This significantly resolved both skeletal disharmony and malocclusion. Furthermore, the hyoid bone was advanced, the pharyngeal airway space was increased, and the morphology of the mandibular condyle was maintained. At the 30-month follow-up examination, the patient exhibited a satisfactory facial profile. The findings from our case suggest that severe mandibular retrognathism with condylar deformities can be effectively treated without surgical mandibular advancement, thus decreasing the risk of PCR.
Cleft Lip
;
Congenital Abnormalities*
;
Female
;
Follow-Up Studies
;
Genioplasty*
;
Humans
;
Hyoid Bone
;
Incisor
;
Jaw
;
Malocclusion
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Malocclusion, Angle Class III
;
Mandible
;
Mandibular Advancement
;
Mandibular Condyle
;
Maxilla
;
Molar
;
Orthognathic Surgery
;
Osteotomy*
;
Palate
;
Polymerase Chain Reaction
;
Retrognathia*
;
Tooth