Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Even within a hospital, the prognosis after a cardiac arrest is extremely poor if intervention starts only after the event; thus, early recognition and intervention is crucial to reduce inhospital cardiac arrests. This paper aims to assess the results of in-clinic surveys conducted for the implementation of the Rapid Response System (RRS) at our hospital and changes in awareness after awareness initiatives. Excluding the neonatal intensive care unit, all wards were targeted for implementation, with the creation of criteria for requesting the RRS and hospital-wide awareness initiatives. Four items were defined for the request criteria—namely, (1) respiration, (2) circulation, (3) state of consciousness, and (4) others (any concerns)—with a request being warranted if any one of these criteria was met. A pre-awareness survey revealed that respiratory rates were recorded only 6.9% of the time on average, indicating inadequate observation of respiratory rates across all wards. In response to this issue, we announced that respiratory status should be observed at least once a day, which resulted in the recording rate improving to 68.2% after 2 months. Survey results before and after the awareness initiatives among doctors and nurses showed a significant increase in RRS awareness. The percentage of nurses who answered “well aware” or “somewhat aware” increased from 34.8% to 77.6%, and from 63.4% to 88.0% among doctors. However, while the introduction of the RRS was relatively well-received by nurses struggling with on-site responses, some doctors questioned the necessity of the RRS. Upon implementation, it is important to make it known that it is a hospital-wide effort. Simplifying and thoroughly utilizing the request criteria can lead to early recognition of abnormalities. Since it is not easy to gain doctors’ understanding, it is necessary to listen to the needs and requests of each department and patiently continue awareness activities before implementation

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

A 32-year-old woman was diagnosed with Takayasu's arteritis 5 years ago and underwent aortic valve replacement for aortic regurgitation 1 year ago. She had been taking Prednisolone and Azathioprine for Takayasu's arteritis, but these drugs were switched to subcutaneous Tocilizumab 4 months ago. One month ago, she had dyspnea on exertion, and 2 days ago, chest discomfort appeared, and she came to our hospital. Blood tests showed CRP 0.02 mg/dl, and echocardiography and CT showed perivalvular leakage and aortic root pseudoaneurysm, which led us to suspect aortic root pseudoaneurysm due to Takayasu's arteritis and to perform emergency surgery. Although a circumferential pseudoaneurysm was observed at the aortic root, no destruction of the prosthetic valve was observed. The suture from the previous surgery was attached to the sawing cuff of the prosthetic valve, and the prosthetic valve was not fixed to the aortic annulus and could be easily removed. The Bentall operation was performed using a bioprosthetic valve. The histopathological diagnosis was subacute infective endocarditis, and the patient was diagnosed with a pseudoaneurysm of the aortic root due to infection. The patient had a good postoperative course and was discharged home on the 19th day. We report a case of Takayasu's arteritis with valve annular abscess after AVR, which was treated surgically during biologic drug administration.

We report a case of a 56-year-old woman. She had a history of emergent ascending aorta replacement due to type A dissection. Seven years later, aortic arch enlargement (55 mm) was detected on CT scan, and indicated secondary repair. Because of the existence of the aberrant right subclavian artery (ARSA), the safer surgical management needed to be discussed. Total arch replacement with the use of open stent-grafting technique and extra-anatomical reconstruction of ARSA was chosen for the treatment. In the operation, straight woven grafts (7 mm in diameter) were firstly anastomosed to the bilateral axillary arteries. Deep hypothermic circulatory arrest with antegrade cerebral perfusion through median sternotomy was established. The aortic arch was transected between the right and left subclavian arteries. The left subclavian artery was ligated at its origin, and an aortic open stent graft was inserted distally. An aortic reconstruction was performed between the left common carotid artery and the left subclavian artery with a 4 branched J-graft. The left carotid artery was reconstructed anatomically, and the tube grafts anastomosed to the bilateral axillary arteries were reconstructed in an extra-anatomical fashion. On the 11th postoperative days, coil-embolization of the ARSA was performed to complete the treatment. The patient had an uneventful post-operative recovery. Total arch replacement using an open stent-grafting technique was a feasible treatment option for the aortic arch aneurysm with ARSA.

Methods: We investigated 154 foramina at L5–S1 in 77 patients. All the patients had degenerative lumbar disorders and had undergone both conventional MRI and 3D-MRI during the same visit. Differences between the FSRs calculated from conventional and 3D-MRI reconstructions and any correlations with the plain radiography findings were assessed. Results: In foramina that had a FSR of <50% on conventional MRI, the difference between the FSR obtained using conventional MRI and 3D-MRI was 5.1%, with a correlation coefficient of 0.777. For foramina with a FSR ≥50% on conventional MRI, the difference was 20.2%, with a correlation coefficient of 0.54. FSR obtained using 3D-MRI was significantly greater in patients who required surgery than in those who were successfully treated with conservative methods (88% and 42%, respectively). Segments with spondylolisthesis or lateral wedging showed higher FSRs than those without these conditions on both types of MRI. Conclusions FSRs <50% obtained using conventional MRI were sufficiently reliable; however, the results were inaccurate for FSRs ≥50%. Patients with high FSRs on 3D-MRI were more likely to require surgical treatment. Therefore, 3D-MRI is recommended in patients with suspected stenosis detected using conventional MRI or plain radiographs.

A 79-year-old woman presented to our hospital with high energy trauma. Enhanced CT revealed injury to the aortic arch. The left carotid artery was pulled out due to extension force and a drawing out lesion formed. Cardiopulmonary bypass was established with cannulation of the right femoral artery and the right atrium, and systemic cooling was started. We opened the aortic arch with deep hypothermic circulatory arrest, and detected a 10 mm drawing out lesion at the bottom of the left carotid artery. Aortic arch was transected at the distal of the left carotid artery to exclude the drawing out lesion, and partial arch replacement was performed. The patient's postoperative course was uneventful, and she was discharged from our hospital without any complication.

Blunt traumatic rupture of the heart carries a high mortality rate. Anatomical injuries have included the atrium, appendage and ventricle but injury to the left appendage has been reported very rarely. We present the case of a 71-year-old female who was a driver in a motor collision with major front-end damage where air bags were deployed. After being intubated and receiving pericardiocentesis for cardiac tamponade at an advanced critical care and emergency medical center, the patient was taken to our hospital and emergently to the operating room for exploration. There was brisk bleeding coming from a 2 cm laceration on the left atrial appendage. The injury was repaired using 4-0 polypropylene felt pledget-supported horizontal mattress sutures on the beating heart with the assistance of cardiopulmonary bypass. The present report describes this patient and our findings from a literature review.

Methods: We investigated 154 foramina at L5–S1 in 77 patients. All the patients had degenerative lumbar disorders and had undergone both conventional MRI and 3D-MRI during the same visit. Differences between the FSRs calculated from conventional and 3D-MRI reconstructions and any correlations with the plain radiography findings were assessed. Results: In foramina that had a FSR of <50% on conventional MRI, the difference between the FSR obtained using conventional MRI and 3D-MRI was 5.1%, with a correlation coefficient of 0.777. For foramina with a FSR ≥50% on conventional MRI, the difference was 20.2%, with a correlation coefficient of 0.54. FSR obtained using 3D-MRI was significantly greater in patients who required surgery than in those who were successfully treated with conservative methods (88% and 42%, respectively). Segments with spondylolisthesis or lateral wedging showed higher FSRs than those without these conditions on both types of MRI. Conclusions FSRs <50% obtained using conventional MRI were sufficiently reliable; however, the results were inaccurate for FSRs ≥50%. Patients with high FSRs on 3D-MRI were more likely to require surgical treatment. Therefore, 3D-MRI is recommended in patients with suspected stenosis detected using conventional MRI or plain radiographs.