Successful Surgical Strategy for Graft-esophageal Fistula After Total Arch Replacement : A Case Report.

BackgroundGraft infection is one of the catastrophic complications in the aortic surgical area. Case presentationA 62-year-old man was diagnosed graft-esophageal fistula after total arch replacement. We have experienced aggressive debridement, that includes the infected previous graft and unhealthy esophagus under the same operative field, and staged esophageal reconstruction was performed 4 months later. ConclusionsWe believe that this successful surgical strategy, which involves aggressive debridement using re-median incision plus a left posterolateral thoracotomy under the same operative field, is useful and safe and achieved a favorable result.

Effective Treatment for Incarcerated Obturator Hernia With Bowel Dilatation by Combined Laparoscopy and Preperitoneal Approach: A Case Report

Background: We report a case of a 90-year-old woman with intestinal obstruction due to left-sided incarcerated obturator hernia, which was revealed using computed tomography. Methods: Emergency surgerywas performed using laparoscopy, which showed a dilated small intestine and bilateral obturator hernia in the intraperitoneal space. After reducing incarceration of the small intestine using laparoscopy, we approached the bilateral preperitoneal space and inserted a Kugel patch via a small lower abdominal median incision (approximately 4 cm). Results: The patient was discharged on postoperative day 10 and showed no recurrence at the 18-month follow-up. Although relatively rare, obturator hernia can significantly cause intestinal obstruction. It has no specific clinical symptoms and is thus often difficult to diagnose. Treating obturator hernia is essential; however, mesh infection, recurrence, and opposite side of the obturator hernia should be carefully monitored. Conclusions: Although laparoscopy is used for treating obturator hernia, it may be difficult in patients with intestinal obstruction. In this case, a surgical technique combining laparoscopy and preperitoneal space approach via a small lower abdominal median incision was used to effectively treat an incarcerated occult bilateral obturator hernia.

Primary Urachal Hydatid Cyst in a Child: A Case Report

The hydatid cyst (HC) is an endemic parasitic disease worldwide. Although the HC can locate in every part of a body, it rarely occurs over the abdominal wall. A 12-year-old female patient was brought to Department of Pediatric Surgery, Firat University School of Medicine, Elazig, Turkey in 2017. She had been suffering from abdominal pain for one week. A lump was determined underneath her skin in the suprapubic region. It was swollen, tense and movable. A cystic mass filling the midline was found in the radiological bladder superior. It was an anechoic cyst causing ondulation on the muscles of the anterior abdominal wall. The sizes of the mass were measured approximately as 9x7 cm (mesentery cyst?). The cystic mass was occurred in the urachal area of the anterior abdominal wall, not in the abdomen. After the cyst was emptied with applying mini median incision below the umbilicus, we saw the germinative membrane inside the cyst. Diagnosis of the HC was confirmed with the pathologic evaluation. For the differential diagnosis of a pure cystic mass, which can locate in every part of a body, diagnosis of the HC should be considered.

A review of the Barbatula loaches (Teleostei: Nemacheilidae) from north-eastern China, with the description of four new species

The species of the genus Barbatula from north-eastern China are reviewed, based on morphological and molecular characters. A total of ten species are recognized. Barbatula nuda, B. toni, B. gibba, B. potaninorum, B. kirinensis and B. pechiliensis are treated as valid and four new species are described herein. Barbatula zhangwuensis, new species, from northern China, is distinguished by having widely spaced nostrils, a pointed snout, a shallow median incision in the upper lip, a short lateral expansion of the lower lip, the pelvic-fin origin situated behind the vertical through the dorsal-fin origin, and no scales on the back and the flank anterior to the vertical through the dorsal-fin origin and irregularly set scales on the post-dorsal back and flank. Barbatula liaoyangensis, new species, from the Taizi River (a tributary of the Liao River), is distinguished by having widely spaced nostrils, a blade-shaped lateral expansion of the mental lobe, a shallow median incision in the upper lip, a short lateral expansion of the lower lip and sparsely set scales on the back and the flank anterior to the vertical through the dorsal-fin origin, but densely set behind. Barbatula emuensis, new species, from the Heilongjiang and Yalu River drainages, is distinguished by having closely set nostrils, a deep median incision in the upper lip, no lateral expansion of the lower lip, and sparsely set scales on the back and the flank anterior to the vertical through the dorsal-fin origin, but densely set behind. Barbatula linjiangensis, new species, from the Yalu River, is distinguished by having closely set nostrils, a shallow median incision in the upper lip, no lateral expansion of the lower lip, and sparsely set scales on the back and the flank anterior to the vertical through the dorsal-fin origin, but densely set behind.

Evaluation of the New Classification and Surgical Strategy for Myasthenia Gravis

The aim of this study was to discuss the new methods of clinical classification and staging of patients with myasthenia gravis (MG) proposed by our group and to summarize the experiences of surgical treatment of MG with a novel incision by cutting the sternum cross-sectionally at the second intercostal level. A retrospective analysis was made for the clinical data from the patients with MG who underwent thymectomy from July 1988 to May 2009. The surgical procedures were designed into three groups, a group with Osserman classification and median incision of the sternum (Group 1), a group with MGFA typing (Myasthenia Gravis Foundation of America) and a small transverse sternal incision at the second intercostal level (Group 2), and a group with new typing and a smaller transverse sternal incision at the second intercostal level (Group 3). Observation of the clinical typing and staging was made in the patients with myasthenia crisis. The parameters such as procedure duration in Group 2 and 3 was significantly lower than those in Group 1 ( P < 0.05). The incidence of myasthenia crisis in Group 3 was significantly lower than that in Groups 2 and 3 ( P < 0.05). The procedure with a smaller transverse sternal incision at the second intercostal level (Group 3) is a safer method for patients with MG. The combination of this procedure with the new typing and staging methods proposed by our group could facilitate the selection of operation indications and opportunity, resulting in the lower incidence of myasthenia crisis and mortality. Our new procedure is well deserved to be a preferential selection by other hospitals.

Hand-assisted bilateral nephrectomy in a patient with adult polycystic kidney disease

CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days.