The patient is a 66-year-old woman. She had been taking steroids for some years for rheumatoid arthritis and had been using crutches for some years because of multiple joint deformities. She presented herself to an orthopedic clinic for right upper extremity numbness and was diagnosed with cervical spondylosis and was kept under observation. However, 7 days later, a pulsatile mass on her right upper arm was found and she was referred to our hospital. Contrast-enhanced CT revealed a right brachial artery aneurysm (19×17×16 mm）, and the numbness was considered to be a symptom of nerve compression caused by the aneurysm. Since the cause of the brachial artery aneurysm was long-term inappropriate use of crutches, we confirmed that the patient would not use crutches and would use other assistive devices after the surgery, and then performed aneurysm resection and direct anastomosis under general anesthesia. Aneurysms of the upper extremities are rare and are often traumatic or iatrogenic pseudoaneurysms, and surgery is recommended because they can cause complications such as embolism, nerve compression, and rupture. In revascularization in cases where the aneurysm is caused by crutches, it is necessary to consider the risk of recurrence. In our case, we were able to perform direct anastomosis by switching the walking aid from crutches to Lofstrand clutches.

A 58-year-old male patient presented with acute alcohol-induced severe necrotizing pancreatitis. He reported a symptomatic acute necrotic collection in the pancreatic head. No improvements were observed despite one week of antimicrobial therapy. Endoscopic ultrasound-guided drainage via the superior duodenal angle was conducted and a lumen-apposing metal stent (LAMS) was placed. He had an obstructive jaundice progression 3 days postintervention. Endoscopic retrograde cholangiography showed that the cystic side flange of the LAMS caused the distal bile duct smooth stricture. The jaundice improved immediately after the placement of plastic stent in the bile duct, and the LAMS could be removed on the 15th day after placement. The plastic stent was removed after 4 months, and the biliary stricture improved, with no recurrence of jaundice. Here, we report a case of successful conservative treatment of a benign biliary stricture caused by the distal flange of the LAMS.

A 58-year-old male patient presented with acute alcohol-induced severe necrotizing pancreatitis. He reported a symptomatic acute necrotic collection in the pancreatic head. No improvements were observed despite one week of antimicrobial therapy. Endoscopic ultrasound-guided drainage via the superior duodenal angle was conducted and a lumen-apposing metal stent (LAMS) was placed. He had an obstructive jaundice progression 3 days postintervention. Endoscopic retrograde cholangiography showed that the cystic side flange of the LAMS caused the distal bile duct smooth stricture. The jaundice improved immediately after the placement of plastic stent in the bile duct, and the LAMS could be removed on the 15th day after placement. The plastic stent was removed after 4 months, and the biliary stricture improved, with no recurrence of jaundice. Here, we report a case of successful conservative treatment of a benign biliary stricture caused by the distal flange of the LAMS.

A 58-year-old male patient presented with acute alcohol-induced severe necrotizing pancreatitis. He reported a symptomatic acute necrotic collection in the pancreatic head. No improvements were observed despite one week of antimicrobial therapy. Endoscopic ultrasound-guided drainage via the superior duodenal angle was conducted and a lumen-apposing metal stent (LAMS) was placed. He had an obstructive jaundice progression 3 days postintervention. Endoscopic retrograde cholangiography showed that the cystic side flange of the LAMS caused the distal bile duct smooth stricture. The jaundice improved immediately after the placement of plastic stent in the bile duct, and the LAMS could be removed on the 15th day after placement. The plastic stent was removed after 4 months, and the biliary stricture improved, with no recurrence of jaundice. Here, we report a case of successful conservative treatment of a benign biliary stricture caused by the distal flange of the LAMS.

We use transumbilical laparoscopic-assisted appendectomy (TULAA) with a lifting retractor as the surgical technique of first choice for acute appendicitis. Although this technique provides excellent cosmetic results and contributes to reducing medical costs, it is less advantageous in difficult-to-complete cases that require conversion to pneumoperitoneum or additional ports. We retrospectively reviewed the records of 76 patients who underwent laparoscopic appendectomy between June 2020 and March 2023 (43 in a TULAA group and 33 in a pneumoperitoneal conversion group) to identify preoperative factors associated with pneumoperitoneal conversion. Univariate analysis showed significant differences for preoperative C-reactive protein (CRP) level, age, and body mass index. Logistic regression analysis identified preoperative CRP level and age as significant risk factors for pneumoperitoneal conversion. The pneumoperitoneal conversion rate was 12.5%, 48.2%, and 68% for patients with 0, 1, and 2 preoperative risk factors, respectively, indicating patients with 2 risk factors were more likely to undergo pneumoperitoneal conversion. These data may inform the selection of the surgical technique and the decision to convert to pneumoperitoneum.

A 60-year-old man underwent open surgery for chronic dissecting abdominal aorta accompanied with a horseshoe kidney. Through open laparotomy, the abdominal aortic aneurysm was exposed without revision of the horseshoe kidney. Cold ringer solution was infused to accessory renal arteries for renal protection. After supra-renal clamping, proximal anastomosis was then performed at the level just below the renal arteries. Abdominal cross clamp time at the level of the supra-renal arteries was 23 min. Median and right accessory arteries were reattached with an ischemic time of 73 and 103 min, respectively. Although serum creatine was elevated a preoperative level of 1.17 mg/dl to 3.63 mg/dl at postoperative day 2, that was gradually decreased to nearly preoperative level of 1.25 mg/dl at discharge. Postoperative enhanced CT demonstrated patency of the reattached accessory arteries. The patient was discharged without major complication on postoperative day 21. One year postoperatively, his follow-up course was uneventful without deterioration of renal function.

Background: and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. Methods: The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. Results: Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). Conclusion Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.

Methods: This study included 50 patients with CSM and 39 with C-OPLL who underwent multi-segment laminoplasty. Decreased CL was defined as the difference between preoperative and 2-year postoperative neutral C2–7 Cobb angles. Radiographic parameters included preoperative neutral C2–7 Cobb angles, C2–7 sagittal vertical axis (SVA), T1 slope (T1S), dynamic extension reserve (DER), and range of motion. The radiographic risk factors were investigated for decreased CL in CSM and C-OPLL. Additionally, the Japanese Orthopedic Association (JOA) score was assessed preoperatively and 2 years postoperatively. Results: C2–7 SVA (p =0.018) and DER (p =0.002) were significantly correlated with decreased CL in CSM, while C2–7 Cobb angle (p =0.012) and C2–7 SVA (p =0.028) were correlated with decreased CL in C-OPLL. Multiple linear regression analysis revealed that greater C2–7 SVA (B =0.22, p =0.026) and small DER (B =−0.53, p =0.002) were significantly associated with decreased CL in CSM. By contrast, greater C2–7 SVA (B =0.36, p =0.031) was significantly associated with decreased CL in C-OPLL. The JOA score significantly improved in both CSM and C-OPLL (p <0.001). Conclusions C2–7 SVA was associated with a postoperative decreased CL in both CSM and C-OPLL, but DER was only associated with decreased CL in CSM. Risk factors for decreased CL slightly differed depending on the etiology of the condition.

Laparoscopy is useful for minimally invasive detailed examination of patients with suspected gastrointestinal perforation. Here we report a case of gastrointestinal perforation of unknown cause that was diagnosed laparoscopically as perforation of the sigmoid colon by a toothpick. The patient was a 41-year-old woman. She presented with a chief complaint of left lower abdominal pain and CT showed a small amount of free air in the peritoneal cavity, so emergency surgery was performed. Laparoscopy revealed a foreign body penetrating the sigmoid colon. After mobilization of the sigmoid colon, the surgical technique was switched to minilaparotomy and partial sigmoid colectomy was performed. The foreign body that had penetrated the intestine was identified as a toothpick. We later learned that the patient had become intoxicated while eating at a yakiniku barbecue restaurant 7 days prior to the operation, and she guessed that she had accidentally consumed a toothpick stuck in an onion. Gastrointestinal perforation by a toothpick is rare and is difficult to diagnose preoperatively because toothpicks appear transparent on X-ray imaging. In this case, laparoscopy was useful for identifying the site and cause of perforation as well as the extent of leakage into the peritoneal cavity.