Background: Transconjunctival fat removal (TFR) is a widely practiced aesthetic procedure for lower eyelid bulging, with the traction method commonly used to secure the surgical field. However, this approach carries risks such as lower eyelid skin penetration and extraocular muscle injury. To address these concerns, a compression method that avoids energy devices and enables blunt dissection through orbital compression was evaluated. Methods: A retrospective study was conducted of 60 TFR cases performed by a single surgeon between March 2024 and February 2025. Patients were categorized into compression (n=30) and traction (n=30) method groups based on the technique used for surgical field exposure. Postoperative complications were assessed over a 1-month period. Results: No significant differences were found in baseline demographics. Postoperative complications occurred in three cases (10.0%) in the compression group and two cases (6.7%) in the traction group (P=0.640). All complications were mild and resolved without reoperation. No severe adverse events, including orbital hemorrhage, infection, or visual impairment, were observed. One case of residual orbital fat in the compression group was attributed to limited visualization due to orbital pressure. Conclusions The compression method demonstrated a safety profile comparable to that of the traction method and may serve as a viable alternative, particularly for less experienced surgeons. It offers a simplified and potentially safer approach for performing TFR, supporting its utility in clinical practice and surgical training.

An 84-year-old woman with severe aortic stenosis (AS) and coronary artery disease (CAD) was admitted repeatedly with syncope and heart failure. Due to her comorbidities, concomitant transapical transcatheter aortic valve replacement (TAVR) and off-pump coronary artery bypass grafting (OPCAB) were performed. She did well postoperatively. CAD is often found concurrently in patients presenting with severe symptomatic AS. Concomitant TAVR and OPCAB is considered as a less invasive and more feasible treatment option in high-risk patients.

The splenic artery is a common site of intraabdominal aneurysms. Very few patients present with symptoms before a splenic artery aneurysm ruptures. However, the symptoms vary depending on the type of aneurysm. Some patients present with hemodynamic shock, while others develop mild lumbago, anemia, or syncope. Thus, it is sometimes difficult to diagnose and treat ruptured splenic aneurysms. We report a rare case of rupture of a small splenic artery aneurysm, which remained undetected for 3 months after the appearance of the first symptoms, i.e., anemia and melena, despite conducting different examinations at our hospital. A 74-year-old man who underwent a graft replacement of an abdominal aortic aneurysm in 2006 complained of melena in May 2011. He was severely anemic, but presented with no other symptoms. A 16-mm-diameter splenic aneurysm was detected during a previous operation. The splenic artery aneurysm, as seen on computer tomography (CT) scans, showed no significant change in diameter for 5 years. The patient underwent upper and lower gastrointestinal endoscopy, capsule endoscopy, and enhanced CT at the Department of Gastroenterology to determine the site of the bleeding. However, the source of the bleeding was unclear. Finally, a diagnosis by elimination was made and the cause of the melena was identified as a ruptured splenic aneurysm. The splenic artery aneurysm was treated with coil embolization, and the patient's anemia was cured. The splenic artery aneurysm ruptured and bled into the pancreatic duct. The findings of this case suggest that a small splenic artery aneurysm rupture might not cause major symptoms like hemodynamic shock or large hematomas that can be identified on CT scans, but they may bleed into visceral organs. Therefore, interventions for the treatment of a non-symptomatic abdominal visceral artery aneurysm should be carried out promptly.

A 58-year-old man who complained of dyspnea on effort was given a diagnosis of decompensated congestive heart failure. Echocardiography revealed severe aortic regurgitation and cardiomegaly. We decided to perform aortic valve replacement with a mechanical valve, however his past history made us suspicious of allergy to metal. From his previous patient records, we determined he was allergic to many metals : gold, iron, platinum, cobalt, chrome, bronze, and zinc. Newly performed skin patch tests showed positive reactions to aluminum, tin, palladium, indium, iridium and stainless steel. We selected a CarboMedics mechanical valve made of nickel-titanium alloy. Aortic valve replacement with a 27-mm CarboMedics mechanical valve was performed by median sternotomy. At sternum closure, we used polyester non-absorbable suture thread, instead of surgical steel wire, because it contains stainless steel. His postoperative progress was good and he was discharged on the 10th postoperative day. One year after surgery he is doing well without any allergic symptoms.