Formosan Journal of Surgery

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Background: Tracheoplasty is a challenging surgical procedure for treating tracheal diseases. Preserving the voice and achieving normal breaths are considered favorable results. This article reports the mid-term results of tracheoplasty. Materials and Methods: From July 1988 to June 2018, a total of 91 adults with various tracheal diseases who underwent tracheoplasty were enrolled in this study. Tracheal diseases were divided into two categories. Category 1 was not related to neoplasm and included posttracheostomy or postintubation tracheal stenosis, caustic tracheal stricture, tuberculous tracheal stenosis, and congenital tracheal stenosis. Category 2 was related to neoplasm and included tracheal neoplasm and tracheal invasion by thyroid cancer or esophageal cancer. The surgical procedures mainly involved segmental resection of the trachea, telescopic anastomosis following a middle split of thyroid-cricoid cartilage, spiral tracheoplasty, and slide tracheoplasty. Results: One hospital death (1.1%) occurred. Favorable results of tracheoplasty were 81.3% (74/91). The failure rate of tracheoplasty was higher in Category 1 (24.2%, 15/62) than Category 2 (3.6%, 1/28). The subglottic involvement also induced a higher failure rate of tracheoplasty (35.3%, 6/17 vs. 13.7%, 10/73). However, the multivariate logistic regression model demonstrated that the category of tracheal disease and subglottis involvement did not statistically significant induce surgical failure of tracheoplasty. Sixteen (17.6%) patients had surgical failure resulted from anastomotic leaks, regrowth of granulation, or subglottic involvement. Conclusions: Carefully evaluating the tracheal lesions and selecting the appropriate surgical procedure can yield favorable results of tracheoplasty.

Background: This study was designed to investigate the impact of alcohol intoxication on injury severity and outcomes of adult patients who experienced different modes of trauma. Materials and Methods: This retrospective study collected data of hospitalized patients who experienced trauma at age ≥20 years between January 1, 2009 and December 21, 2015, from the Trauma Registry System of a Level I trauma center. Patients were categorized into two groups according to their blood alcohol concentrations (BACs): alcohol intoxication (BAC of ≥50 mg/dL at the time of arrival to the emergency room) and nonalcohol intoxication (BAC of <50 mg/dL). The Abbreviated Injury Scale (AIS) score of each injured body region, Injury Severity Score, length of stay (LOS) in the hospital, and in-hospital mortality of these trauma patients according to different modes of trauma were compared between patients with or without alcohol intoxication. Results: Among 20,513 patients included in this study, 1206 had alcohol intoxication and 19,307 did not. Patients with alcohol intoxication were predominantly males and younger than those without alcohol intoxication. Among patients who had a motorcycle accident, bicycle accident, fall accident, and hit by/against an object, AIS of ≥3 head/neck injuries more commonly occurred in patients with alcohol intoxication than in those without. In addition, compared to those without alcohol intoxication, patients with alcohol intoxication who experienced motorcycle accidents and hit by/against an object had longer hospital LOS, whereas those who experienced motor vehicle and motorcycle accidents had significantly higher mortality rates. Conclusions: This study revealed that alcohol intoxication had impacted the injury severity and outcomes in adult patients who experienced different modes of trauma.

Background: Erectile dysfunction (ED) is regarded as a warning of systemic disease. Controversy still exists in the relationship between ED and subsequent cardiovascular disease (CVD). This study aims to investigate the incidence and the interval of subsequent CVD in Taiwanese men who initially presented with the complaint of ED. Materials and Methods: Consecutive ED patients without a history of obvious CVD at outpatient clinics from 1999 to 2013 were enrolled in the study. Data were collected by chart review and a structured interview through telephone calling. The main outcome measures were incidence and interval of subsequent CVD after the initial presentation of ED. Results: During the study period, a total of 4713 patients presented at our clinics with the complaint of ED. After excluding patients who reported a history of major CVD (n = 347), younger than 40 years old (n = 484), and who did not have follow-up visit and could not be contacted (n = 409), 3473 patients' data (73.7%) were found eligible for analysis. Their mean age was 62.2 ± 11.2 years (range: 40–91 years), and the mean follow-up period was 82.5 ± 51.8 months (range: 1–173 months). Of them, 9.1% (n = 316) had subsequent CVD with an ED–coronary artery disease temporal relationship of 58.7 ± 36.4 months (range: 1–170 months). Patients with subsequent CVD had a higher proportion of diabetes, hypertension (HT), and dyslipidemia compared with those who were free of subsequent CVD (P < 0.05). Age and comorbidities are independent risk factors for subsequent CVD in men with ED (P < 0.001). Of them, 7.4% (n = 258) expired, with malignancy (38.0%), infection (20.0%), and CVD (15.5%) being the three leading causes of death. Conclusions: Among patients with ED, old age and having diabetes, HT, and dyslipidemia are associated with subsequent CVD. CVD risk reduction to halt the progress by lifestyle modification and well control of comorbidities should be advised to ED patients.

Background: To compare the radiological and clinical outcomes of kyphoplasty (KP) with intravertebral reduction device (IRD) and vertebroplasty (VP) for treating osteoporotic vertebral compression fracture (OVCF)-associated spinal canal encroachment (SCE). Materials and Methods: From January 2013 to December 2016, 57 patients with OVCF-associated SCE treated through VP or KP with an IRD were enrolled. Kyphotic angle (KA) anterior, middle, and posterior body heights (ABH, MBH, and PBH, respectively) at postoperative week 1 3, 6, and 12 months of the cemented vertebrae were evaluated. Visual analog scale (VAS), Oswestry Disability Index (ODI), and EuroQol-5D-5 L (EQ-5D-5 L) were followed, and the complications were recorded. Results: Sixteen and 41 patients were treated through KP with IRD and VP (IRD and VP groups, respectively), and their characteristics were comparable. Compared with the VP group, KA, ABH, MBH, and PBH in the IRD group were significantly greater after the operation at postoperative 12 months (IRD vs. VP: KA −1.68° ± 6.02° vs. −10.34° ± 4.99°; ABH 2.06 ± 0.29 vs. 1.35 ± 0.26; MBH 2.21 ± 0.51 vs. 1.21 ± 0.31; PBH 2.91 ± 0.62 vs. 2.11 ± 0.33 cm, P< 0.05). Significant postoperative improvements were observed in the VAS, ODI, and EQ-5D-5 L in both groups; these improvements were similar between the two groups. No new neurological deficits occurred, and the incidence rates of cement leakage into the SC were similar. Conclusions: KP with IRD was associated with better body heights and KA at least for 1 year for OVCF-associated SCE with noninferior clinical outcomes to VP.

World over, Spigelian hernia (SH) is a puzzling entity and is a diagnosis of exclusion. It has a low incidence rate and a relatively high rate of omission. We present a 57-year-old female patient who came to our clinic 2 years ago with an incisional hernia. During dissection, she was found to have a bulge in the right Spigelian belt adjacent to the incisional hernia. Both the herniae were repaired. She again presented to us with a large bulge over the left iliac fossa. On evaluation, she was diagnosed with a left SH which was then repaired. We present this case to highlight the possibility of bilateralism of SH in patients.

Association of duodenal atresia (DA) with gastric duplication cyst is an extremely rare entity. Furthermore, DA type III with the presence of distal bowel gas is very rare. We report the case of a 13-day-old preterm male with neonatal intestinal obstruction. Radiological evaluation revealed duodenal obstruction at the second part with the presence of few distal bowel gas shadows. Laparotomy revealed dilated gastroduodenum, atypical malrotation, and a cystic structure (duplication cyst) identical to the stomach attached to its greater curvature along with type III atresia of the second part of the duodenum. Duodenotomies revealed the presence of bile along with air at either blind ends of the duodenum which could be explained by the presence of bile duct duplication at the distal end. We propose that this association is due to “defective mesenchyme formation during organogenesis,” which may explain multiple duplication abnormalities and DA.

Primary hyperparathyroidism (PHPT) is a disease characterized by excessive secretion of parathormone. During the disease, bone loss occurs, particularly depending on the resorption of the skeletal system. One of the complications of PHPT is fibrotic, cystic bony changes which are called a brown tumor (BT). Skeletal manifestations in the form of BTs are rare, and according to literature studies, it occurs in <2% of patients suffering from any form of HPT. As it is a rare disease and multiple benign lesions may simulate a malignant neoplasm and pose a real challenge for the clinician in its differential diagnosis. We present the case of a 35-year-old man who was evaluated for multiple lytic expansile lesions with a strong suspicion of malignancy and fibrous dysplasia but turned out to be a case of PHPT.

Online since 27^th Feb, 2017