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Background and Aims: Critically ill patients with liver failure have high mortality. Besides the management of organ‐specific complications, liver transplantation constitutes a definitive treatment. However, clinicians may hesitate to introduce mechanical ventilation for patients on liver transplantation waitlists because of poor prognosis. This study investigated the outcomes of intensive care and ventilation support therapy effects in patients with liver failure. Methods: This single‐center study retrospectively enrolled 32 consecutive patients with liver failure who were admitted to the intensive care unit from January 2014 to December 2020. The medical records were reviewed and analyzed retrospectively for Acute Physiologic and Chronic Health Evaluation (APACHE)‐II. The model for end‐stage liver disease scores, 90‐day mortality, and survival was assessed using the Kaplan–Meier method. Results: The average patient age was 45.5 ± 20.1 years, and 53% of patients were women. On intensive care unit admission, APACHE‐II and model for end‐stage liver disease scores were 20 and 28, respectively. Among 13 patients considered for liver transplantation, 4 received transplants. Thirteen patients (40.6%) were intubated and mechanically ventilated in the intensive care unit. The 90‐day mortality rate of patients with and without mechanical ventilation in the intensive care unit (13, 61.5% vs. 19, 47.4%, p = 0.4905) was similar. APACHE‐II score >21 was an independent predictor of mechanical ventilation requirement in patients with liver failure during intensive care unit stay. Conclusion: Although critically ill patients with liver failure are at risk of multiorgan failure with poor outcomes, mechanical ventilation did not negatively affect the 90‐day mortality or performance rates of liver transplantation. Clinicians should consider mechanical ventilation‐based life support in critically ill patients with liver failure who are awaiting liver transplantation. Key points: What's known As critically ill patients with liver failure have high mortality, clinicians hesitate to introduce mechanical ventilation for patients on liver‐transplantation waitlists because of the poor prognosis. What's new We aimed to clarify the management and treatment outcomes of patients with liver failure, especially those who needed mechanical ventilation. What the clinical implications of this study are Mechanical ventilation‐based life support is not an adverse prognostic factor for critically ill patients with liver failure who are on a waitlist for liver transplantation. Therefore, clinicians should unhesitatingly provide mechanical ventilation‐based life support in this patient group. [ABSTRACT FROM AUTHOR]

OBJECTIVES We aimed to identify predictors of postoperative permanent neurological deficits (PNDs) and evaluate the early management of cerebral perfusion in patients undergoing surgical repair of acute type A aortic dissection with cerebral malperfusion. METHODS Between October 2009 and September 2018, a total of 197 patients with acute type A aortic dissection underwent aortic replacement. Of these, 42 (21.3%) patients had an imaging cerebral malperfusion (ICM). ICM was assessed preoperatively, which also revealed whether dissected supra-aortic branch vessels were occluded or narrowed by a thrombosed false lumen. After September 2017, early reperfusion and extra-anatomic revascularization were performed in cases with ICM. RESULTS Hospital mortality rates for cases with ICM were 4.8% (2/42). Before September 2017, PND were observed in 6 patients (54.5%) with preoperative neurological symptoms (n  = 11), and 7 patients (33.3%) without neurological symptoms (n  = 21) in patients with ICM. Occlusion or severe stenosis of supra-aortic branch vessels (odds ratio, 7.66; P  <   0.001), regardless of preoperative clinical neurological symptoms, was a risk factor for PND. After September 2017, 7 of 10 patients with ICM underwent early reperfusion and extra-anatomic revascularization. PND did not occur in any of these 7 patients. CONCLUSIONS Occlusion or severe stenosis of supra-aortic branch vessels is a predictor of PND risk in patients undergoing surgery for acute type A aortic dissection. Early reperfusion and extra-anatomic revascularization may reduce the risk of neurological complications in patients with ICM, with or without neurological symptoms. [ABSTRACT FROM AUTHOR]

Objectives: Synchrotron radiation-based X-ray phase-contrast tomography (XPCT) has proven innovative modality for analyzing 3D morphology and is useful for understanding the pathophysiology of various cardiovascular disease. To elucidate mechanisms of aneurysmal wall enlargement after endovascular aortic repair (TEVAR or EVAR), we evaluated aortic wall samples after TEVAR and EVAR with XPCT. Methods: Human aortic samples of the descending aorta or abdominal aorta were obtained during open aortic repair for aortic aneurysm (Group-A; n=5),and for aneurysm expansion after endovascular repairs (Group-E: n=7). Normal aorta (Group-N: n=10), obtained from autopsy, were also investigated. Effective resolution of XPCT in Japan Synchrotron Radiation Research Institute / SPring-8 is 11.7 μm. Pathological analysis was performed, subsequently. Results: Age of patients was 76.8 ± 5.4 years old in Group-A, 83.4 ± 5.2 in Group-E, and 57.5 ± 9.5 in Group-N. In Group-E, time from endovascular repair to open aortic repair was 64.2 ± 7.2 months, and initial endovascular repair included TEVAR (n=2) and EVAR (n=5). Representative findings of three groups were demonstrated in figures, including XPCT findings (Fig.A), changes of wall density (B), and pathological findings (C). In Group-N, density of the tunica media was not different within tunica media and average of medial density was 1.085 ± 0.003g/cm3. In Group-A, thickness of aortic wall was lower than Group-N, but density of the tunica media was unchanged (1.079 ± 0.022g/cm3). On contrast, in Group-E, density of the tunica media was significantly lower than Group-N (1.063 ± 0.008; p < 0.005), and differences in density within tunica media were well correlated with distribution of elastic fibers and existence of medial necrosis in pathological analysis. Conclusions: X-ray phase-contrast tomography was a cutting-edge modality to understand aortic structures and degeneration of tunica media in aneurysm expansion after endovascular repair was clearly demonstrated. [ABSTRACT FROM AUTHOR]

A 41-year-old man stuck himself with needle through his pericardium during suicide attempt. Chest radiography revealed several needles in the bilateral lung fields as well. Computed tomography (CT) and echocardiography showed massive pericardial effusion and a needle penetrating the pericardium. The patient was initially treated conservatively, including pericardial drainage, and, seven days later, we removed the needle using syngo Needle Guidance in hybrid operating room. The length of skin incision was only 2 cm, and the postoperative course was uneventful. No previous studies, to the best of our knowledge, have shown the use of syngo Needle Guidance to remove a needle in the pericardial cavity. This surgical procedure is minimally invasive for the patient.

Chronic expanding hematoma (CEH) after coronary artery bypass grafting (CABG) is extremely rare. We reported a case of successful surgical repair of CEH through lower partial sternotomy approach. The patient was a 73-year-old man who underwent CABG. Fifteen years after the operation, he was admitted to referral hospital because of dyspnea on exertion. Echocardiography and computed tomography revealed a giant intrapericardial mass, which was pressing on the inferior wall of the ventricle. To avoid injury of the aorta and the patent bypass graft in the reentry of the chest, we selected lower partial sternotomy approach. The mass was encapsulated with thick fibrous membrane containing old degenerated coagula and was histopathologically diagnosed as CEH. Postoperative course was uneventful and diastolic heart failure was relieved.

Left atrial free ball thrombus (LABT) after mitral valve replacement (MVR) is very rare, and sudden death may occur by thrombus impaction to the mitral valve orifice. A 81-year-old woman who underwent MVR and tricuspid annuloplasty ten years ago presented with syncope. She was admitted to a hospital, and echocardiography revealed a LABT. When she took sitting position, she fainted. The free ball thrombus possibly impacted mitral valve orifice. She was transferred to our hospital and an emergent operation was performed. There was a LABT of 4 cm in diameter, which was removed. Postoperative course was uneventful. There are 12case reports which described LABT after MVR, and anticoagulant therapy was insufficient in most of those cases. Strict anticoagulant therapy is important to prevent left atrial thrombus after MVR.

A 33-year-old woman had hematochezia for 5 months. A total colonoscopy showed an easily-bleeding elevated lesion with a nodular lesion in the lower rectum. Histological findings of a conventional biopsy from the lesion showed MALT (mucosa-associated lymphoid tissue) lymphoma and she was diagnosed as stage I. The monoclonality of B-cells was not detected by polymerase chain reaction products for immunoglobulin heavy chain. We selected antibiotic therapy because Helicobacter pylori was detected in culture of the patient's gastric biopsy specimens. The antibiotic therapy was successful, but her symptoms worsened. We therefore gave her with 30 Gy radiation therapy. She recovered a month after the radiation. Histological complete remission was confirmed 4 months after the radiation. Adverse events of the radiation therapy included anal pain for 1 month and premature ovarian failure. Radiation therapy may be useful for localized rectal MALT lymphoma.