Uterus-Preserving Treatment for Placenta Percreta by Reconstruction of the Lower Uterine Segment Using Wave Compression Suture: A Retrospective Cohort Study

Purpose To observe the hemostatic efficacy of reconstructing the lower uterine segment by wave compression sutures (WCSs) in patients with placenta previa who underwent cesarean section (CS). Methods Retrospective analysis the medical records with placenta previa underwent WCS at the West China Second University Hospital of Sichuan University.One-hundred-and-twenty-three women who received WCSs as the first uterine suture technique from January 1, 2016, to December 31, 2020, were included in this study. The hemostatic effect of WCS was compared according to the type of placenta previa and the intraoperative situation. All patients were followed up after CS. Results The hemostatic effect during CS and postpartum hemorrhage were observed. Seventy-two (58.5%) patients successfully achieved hemostasis without further intervention. Fifty-one (41.5%) cases required additional uterine artery ligation (UAL), cervical hanging maneuver (CHM), and Bakri tamponade. Seventy-nine cases exhibited thin anterior walls and lower uterine atony after placental dissection; of these, 72 (91.1%) obtained hemostasis by WCS. No patient required repeat laparotomy or hysterectomy. There were no complications attributable to the WCS following surgery. Among the five patients who had a second pregnancy, no intrauterine adhesions or abnormal uterine morphologies were caused by WCS. No ectopic or incision pregnancies occurred. Conclusions Reconstruction of the lower uterine segment by WCS is a suitable technique for patients with thin anterior walls and uterine atony of the lower uterine segment along with placenta previa. WCS is easy to perform, effective, and safe.

Clinical and VNG Features in Anterior Canal BPPV—An Analysis of 13 Cases

Objective: To define diagnostic VNG features in anterior canal BPPV during positional testing (Dix-Hallpike, supine head hanging, and McClure Pagnini tests).Study Design: A retrospective study of patients diagnosed with anterior canal BPPV across four referral centers in New Delhi, Kochi, Bangalore, and Dubai.Subjects and Methods: Clinical records of 13 patients with AC BPPV out of 1,350 cases, during a 3-years period, were reviewed and analyzed by four specialists.Results: Four patients had positional down beating nystagmus with symptoms of vertigo during the bilateral DHP maneuver. Seven cases had positional down beating nystagmus only on one side of DHP. Typical down beating nystagmus was seen in 10 out of 13 cases during the straight head hanging maneuver. Down beating torsional nystagmus was seen in 6 out of 13 cases. Down beating with horizontal nystagmus was seen in three cases (in DHP and MCP mainly) while pure down beating nystagmus during SHH was only seen in four cases.Conclusion: We conclude that anterior canal BPPV is a rare but definite entity. It may not be apparent on positional testing the first time, so repeated testing may be needed. The most consistent diagnostic maneuver is SHH though there were patients in which findings could only be elicited using DHP testing. We recommend a testing protocol that includes DHP testing on both sides and SHH. MCP testing may also evoke DBN with or without the torsional component. Reversal of nystagmus on reversal of testing position is unusual but can occur. The Yacovino maneuver is effective in resolving AC BPPV. We also propose a hypothesis that explains why DHP testing is sensitive to AC BPPV on either side, whereas MCP lateral position on one side is only sensitive to AC BPPV on one side. We have explained a possible role for the McClure Pagnini test in side determination and therapeutic implications.

Fifteen-Year Survival Of Hepatocellular Carcinoma Extending Into The Right Atrium Treated By Multidisciplinary Therapies Including Surgical Resection Under Cardiopulmonary Bypass: A Case Report And Literature Review

Background: Hepatocellular carcinoma (HCC) with tumor thrombus (TT) extending into the right atrium (RA) is rare, and most cases are at an advanced stage with a poor prognosis. We report a case of HCC with TT in the RA (RATT) with 15-year survival.Case presentation: The patient was a 67-year-old man with a huge HCC with RATT. He developed edema of the lower extremities in November 2002. Then, a liver tumor 6.5 cm in diameter in hepatic segments 7 and 8 was identified by ultrasonography and computed tomography. Cavo-atrial thrombectomy was performed successfully using cardiopulmonary bypass (CPB) with heparinization and cardiac arrest. After the thrombectomy, right hepatectomy was performed using the hanging maneuver. The right hepatic vein was transected, and the stump was closed with a running suture. The total operation time was 10 h 48 min, and the total blood loss was 7267 mL. The patient recovered uneventfully except for right pleural effusion, and he experienced no side effects related to CPB, such as immunosuppression or cerebral infarction. He was cancer-free for approximately 9 years after the surgery. A new lesion in the remnant liver was detected by magnetic resonance imaging in March 2012. He underwent six rounds of transcatheter arterial chemoembolization, followed by sequential administration of sorafenib and sunitinib. Radiation therapy was administered to the remnant liver twice and to the spine after he was diagnosed with bone metastasis. Finally, the patient died 6 years after the recurrence. Conclusions: Cavo-atrial thrombectomy under CPB prior to hepatectomy for HCC with RATT can be performed safely to prevent major complications related to CPB. Our patient’s postoperative clinical course followed by multidisciplinary therapies led to an approximately 15-year survival.

The Knack and Pitfall of the Retropancreatic Nerve Plexus Hanging Maneuver for Pancreatoduodenectomy for Pancreatic Head Carcinoma.

Background The efficacy of the hanging maneuver for the retropancreatic nerve plexus (RNP) to enhance the confirmation of the margin status and to facilitate en-bloc resection for pancreatoduodenectomy (PD). In this report, we present the knack and pitfall of the hanging maneuver of the RNP. MethodsThe exit of the hanging maneuver of the RNP is the left part of the superior mesenteric artery (SMA), and the entry is the cranial part of the celiac axis. The entry of the hanging maneuver was connected to the dissection line on the right side of the celiac axis. Thereafter, the tape of the hanging maneuver was pulled to the right side, and the RNP was deployed widely. Finally, the RNP was easily dissected using a sealing device other than IPDA ResultsIt is important to clarify the entrance and exit of the hanging taping in this procedure. This permitted the wide spaces between the SMA, SMV, and the resected side, and it was easier to identify the IPDA. By traction of the hanging maneuver tape, a clear line may be drawn between the resection side and the remaining side. ConclusionsWith the correct implementation of the hanging maneuver, we believe that it would be possible to obtain reliable R0 resection as well as a reduction in blood loss and operation time.