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Risk Factors for Complications after Reconstructive Surgery for Sternal Wound Infection
Hashimoto, Ichiro,Takaku, Mitsuru,Matsuo, Shinji,Abe, Yoshiro,Harada, Hiroshi,Nagae, Hiroaki,Fujioka, Yusuke,Anraku, Kuniaki,Inagawa, Kiichi,Nakanishi, Hideki Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.3
Background Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results The patients' BMI ranged from 15.2 to $33.6kg/m^2$ (mean, $23.1{\pm}3.74kg/m^2$). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study.
Risk Factors for Complications after Reconstructive Surgery for Sternal Wound Infection
Ichiro Hashimoto,Mitsuru Takaku,Shinji Matsuo,Yoshiro Abe,Hiroshi Harada,Hiroaki Nagae,Yusuke Fujioka,Kuniaki Anraku,Kiichi Inagawa,Hideki Nakanishi 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.3
Background: Although the utility of flaps for the treatment of sternal wound infections following median sternotomy has been reported for 30 years, there have been few reports on the risk factors for complications after reconstruction. The objective of this investigation was to identify factors related to complications after the reconstruction of sternal wound infections. Methods: A retrospective analysis of 74 patients with reconstructive surgery after sternal wound infection over a 5-year period was performed. Clinical data including age, sex, body mass index (BMI), comorbidities, bacterial culture, previous cardiac surgery, wound depth, mortality rate, type of reconstructive procedure, and complication rate were collected. Results: The patients’ BMI ranged from 15.2 to 33.6 kg/m2 (mean, 23.1±3.74 kg/m2). Wound closure complications after reconstructive surgery were observed in 36.5% of the cases. The mortality rate was 2.7%. Diabetes mellitus significantly affected the rate of wound closure complications (P=0.041). A significant difference in the number of complications was seen between Staphylococcus aureus (S. aureus) and coagulase-negative Staphylococci (P=0.011). There was a correlation between harvesting of the internal thoracic artery and postoperative complications (P=0.048). The complication rates of the pectoralis major flap, rectus abdominis flap, omentum flap, a combination of pectoralis major flap and rectus abdominis flap, and direct closure were 23.3%, 33.3%, 100%, 37.5%, and 35.7%, respectively. Conclusions: Diabetes mellitus, S. aureus, harvesting of the internal thoracic artery, and omentum flap were significant factors for complications after reconstruction. The omentum flap volume may be related to the complications associated with the omentum flap transfer in the present study.
Motoyasu Kan,Yusuke Hashimoto,Taro Shibuki,Gen Kimura,Kumiko Umemoto,Kazuo Watanabe,Mitsuhito Sasaki,Hideaki Takahashi,Hiroshi Imaoka,Izumi Ohno,Shuichi Mitsunaga,Masafumi Ikeda 소화기인터벤션의학회 2019 International journal of gastrointestinal interven Vol.8 No.2
Background: In patients with distal malignant biliary obstruction, it is a challenge to manage acute cholecystitis secondary to cystic duct obstruc-tion associated with tumor progression or stent compression. Percutaneous transhepatic gallbladder drainage (PTGBD) has been used as the treatment option of choice, because of its ease of performance and safety, but because of the use of an external drainage tube, some patients experience a de-creased quality of life. We report the technical success and clinical success of conversion from PTGBD to endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for the treatment of acute cholecystitis in patients with unresectable malignant biliary obstruction.Methods: We included the patients with cholecystitis secondary to unresectable malignant biliary obstruction who underwent conversion from PT-GBD to EUS-GBD in the study. After PTGBD for the treatment of acute cholecystitis, we performed EUS-GBD and a plastic stent or a self-expandable metal stent (SEMS) was placed for fistulostomy.Results: Fourteen patients (median age, 69 years; 9 males and 5 females) underwent conversion to EUS-GBD after clinical improvement of cholecys-titis by PTGBD. The technical success rate of the conversion from PTGBD to EUS-GBD was 100% (14/14). EUS-GBD was performed in a median of 9.5 days (range, 3–51 days) after PTGBD procedure, using mainly a plastic stent (13 patients) and a covered SEMS in one patient. The early (within 24 hours) adverse events rate was 14.3% (2/14), and the late (after 24 hours) adverse events rate was 7.1% (1/14). The rate of recurrence of cholecystitis was 28.6% (4/14). These patients underwent endoscopic re-intervention and there were no cases of further recurrence of cholecystitis. Conclusion: Conversion of PTGBD to EUS-GBD demonstrated a feasible and safe technique for acute cholecystitis in non-surgical candidates with malignant biliary obstruction.
Renma Ito,Yusuke Hashimoto,Masafumi Ikeda 소화기인터벤션의학회 2019 Gastrointestinal Intervention Vol.8 No.3
Endoscopic ultrasound-guided hepaticoesophagostomy (EUS-HES) refers to EUS-guided biliary access from the abdominal part of the esophagus, an uncommon choice of route for biliary drainage. In the patient reported herein, an esophageal laceration and leakage at the site of placement of a metal stent occurred a few days after EUS-HES. To plug the laceration, 0.5 mL of n-butyl-2 cyanoacrylate mixed with 1 mL of lipiodol was injected through an endoscopic retrograde cholangiopancreatography catheter. We performed EUS-guided transgastric drainage for drainage of the peritoneal fluid collection. The procedures were successful and the laceration eventually healed, with no further leakage.
Renma Ito,Yusuke Hashimoto,Masafumi Ikeda 소화기인터벤션의학회 2019 International journal of gastrointestinal interven Vol.8 No.3
Endoscopic ultrasound-guided hepaticoesophagostomy (EUS-HES) refers to EUS-guided biliary access from the abdominal part of the esophagus, an uncommon choice of route for biliary drainage. In the patient reported herein, an esophageal laceration and leakage at the site of placement of a metal stent occurred a few days after EUS-HES. To plug the laceration, 0.5 mL of n-butyl-2 cyanoacrylate mixed with 1 mL of lipiodol was injected through an endoscopic retrograde cholangiopancreatography catheter. We performed EUS-guided transgastric drainage for drainage of the peritoneal fluid collection. The procedures were successful and the laceration eventually healed, with no further leakage.
Motoyasu Kan,Yusuke Hashimoto,Taro Shibuki,Gen Kimura,Kumiko Umemoto,Kazuo Watanabe,Mitsuhito Sasaki,Hideaki Takahashi,Hiroshi Imaoka,Izumi Ohno,Shuichi Mitsunaga,Masafumi Ikeda 소화기인터벤션의학회 2019 Gastrointestinal Intervention Vol.8 No.2
Background: In patients with distal malignant biliary obstruction, it is a challenge to manage acute cholecystitis secondary to cystic duct obstruc-tion associated with tumor progression or stent compression. Percutaneous transhepatic gallbladder drainage (PTGBD) has been used as the treatment option of choice, because of its ease of performance and safety, but because of the use of an external drainage tube, some patients experience a de-creased quality of life. We report the technical success and clinical success of conversion from PTGBD to endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for the treatment of acute cholecystitis in patients with unresectable malignant biliary obstruction.Methods: We included the patients with cholecystitis secondary to unresectable malignant biliary obstruction who underwent conversion from PT-GBD to EUS-GBD in the study. After PTGBD for the treatment of acute cholecystitis, we performed EUS-GBD and a plastic stent or a self-expandable metal stent (SEMS) was placed for fistulostomy.Results: Fourteen patients (median age, 69 years; 9 males and 5 females) underwent conversion to EUS-GBD after clinical improvement of cholecys-titis by PTGBD. The technical success rate of the conversion from PTGBD to EUS-GBD was 100% (14/14). EUS-GBD was performed in a median of 9.5 days (range, 3–51 days) after PTGBD procedure, using mainly a plastic stent (13 patients) and a covered SEMS in one patient. The early (within 24 hours) adverse events rate was 14.3% (2/14), and the late (after 24 hours) adverse events rate was 7.1% (1/14). The rate of recurrence of cholecystitis was 28.6% (4/14). These patients underwent endoscopic re-intervention and there were no cases of further recurrence of cholecystitis. Conclusion: Conversion of PTGBD to EUS-GBD demonstrated a feasible and safe technique for acute cholecystitis in non-surgical candidates with malignant biliary obstruction.
Maeda, Yutaka,Higo, Junki,Amagai, Yuri,Matsui, Jun,Ohkubo, Kei,Yoshigoe, Yusuke,Hashimoto, Masahiro,Eguchi, Kazuhiro,Yamada, Michio,Hasegawa, Tadashi,Sato, Yoshinori,Zhou, Jing,Lu, Jing,Miyashita, Tok American Chemical Society 2013 JOURNAL OF THE AMERICAN CHEMICAL SOCIETY - Vol.135 No.16
<P>This report describes a helicity-selective photoreaction of single-walled carbon nanotubes (SWNTs) with disulfide in the presence of oxygen. The SWNTs were characterized using absorption, photoluminescence (PL), Raman, and X-ray photoelectron spectroscopy, scanning electron microscopy, and current–voltage (<I>I</I>–<I>V</I>) measurements. Results showed remarkable helicity-selective (metallic SWNTs/semiconducting SWNTs and diameter) functionalization of SWNTs. The reaction rate decreases in the order of metallic SWNTs > semiconducting SWNTs and small-diameter SWNTs > large-diameter SWNTs. Control experiments conducted under various experimental conditions and ESR and femtosecond laser flash photolysis measurements revealed that the helicity-selective reaction proceeds via a photoinduced electron transfer reaction. The PL and <I>I</I>–<I>V</I> measurements showed that the photoreaction is effective not only to control SWNT conductivity but also for the band gap modulation of semiconducting SWNTs.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/jacsat/2013/jacsat.2013.135.issue-16/ja402199n/production/images/medium/ja-2013-02199n_0012.gif'></P><P><A href='http://pubs.acs.org/doi/suppl/10.1021/ja402199n'>ACS Electronic Supporting Info</A></P>