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We evaluated the clinical efficacy and safety of teicoplanin according to the pharmacokinetics (PK) therapeutic level achieved in patients with renal dysfunction. Target trough concentration (C min ) was ≥15–30 μg/ml which has been recommended in patients with normal renal function. Adult patients (estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m 2 ) who were treated by teicoplanin were included in the study. We adopted two types of regimen for the initial 3 days: the conventional regimen, and the enhanced loading regimen (10 mg/kg twice daily on the 1st day, followed by 6.7–10 mg/kg once daily for the 2nd and 3rd days]. Two hundred and eighty-eight patients were evaluated for safety, and 106 patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were evaluated for clinical efficacy. A significantly higher success rate was obtained in patients who achieved the target initial C min compared with those that did not (75.0 % vs 50.0 %, p  = 0.008). In a multivariate analysis, initial C min ≥15 μg/ml was an independent factor for clinical success (adjusted odds ratio: 4.20, 95 % confidence interval: 1.34–13.15). In patients with 15–30 μg/ml of maximal C min during therapy, nephrotoxicity occurred in 13.1 %, and hepatotoxicity in 2.6 %, and these incidences were not significantly higher compared with those patients with <15 μg/ml. In conclusion, achievement of C min of 15–30 μg/ml without delay was necessary to improve clinical outcomes for the treatment by teicoplanin in patients with renal dysfunction. Further investigation is required regarding the optimal loading regimen to achieve the therapeutic levels in those patients.

INTRODUCTION: Abdominal compartment syndrome (ACS) is a serious complication that can occur after endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA). Prompt recognition and appropriate management are crucial to improve patient outcomes.CASE PRESENTATION: An octogenarian with an 11-cm rAAA underwent emergent EVAR due to cardiovascular instability. Postoperatively, the patient developed ACS, necessitating open abdominal management (OAM) due to intestinal edema and retroperitoneal hematoma. Despite multiple surgical interventions, including aneurysmorrhaphy and removal of retroperitoneal hematoma, the patient experienced prolonged difficulty in abdominal closure. The following procedures were attempted for abdominal closure: 1) Dissection of skin and subcutaneous tissues from the rectus sheath on both sides. 2) Release of the external oblique muscle from the anterior layer of the rectus by longitudinally cutting the superficial fascia. 3) Closure of both rectus sheaths with horizontal mattress sutures and negative pressure wound therapy (NPWT). On POD 20, fluid accumulation from bleeding complicated abdominal closure. However, the abdominal wall was successfully closed by achieving hemostasis and using NPWT. Despite these efforts, the patient developed multiple organ failure, including respiratory and renal failure. Sepsis ultimately led to the patient's death on the 80th POD.CONCLUSIONS: ACS following EVAR for rAAA significantly impacts patient prognosis. Specific techniques for abdominal closure, as described in this case, may help minimize the duration of OAM in challenging cases.

INTRODUCTION: Thromboangiitis obliterans (TAO) has become increasingly uncommon in Japan due to declining smoking prevalence. However, in advanced cases with severely compromised distal vasculature, achieving durable limb salvage remains a formidable surgical challenge.CASE PRESENTATION: A 51-year-old man with a 12-year history of TAO presented with rest pain and a necrotic ulcer on the 2nd toe. He had recently ceased smoking after a 31-year history. Imaging demonstrated complete occlusion of the popliteal and tibial arteries, with foot perfusion reliant on corkscrew collaterals. The ankle-brachial index was 0.43, and skin perfusion pressure (SPP) was critically low. A severely diseased plantar artery was identified as a potential distal target. Given the high risk of graft failure, a hybrid strategy combining in situ bypass and surgical distal venous arterialization (DVA) was preoperatively planned. To mitigate perioperative vasospasm, a lumbar sympathetic block was administered 1 week prior to surgery. An in situ bypass using the ipsilateral great saphenous vein was constructed from the superficial femoral artery to the plantar artery. DVA was established via retrograde puncture of the plantar vein, balloon angioplasty for valve sites, and end-to-side anastomosis to the bypass graft. Early duplex ultrasonography revealed anastomotic stenosis at the DVA site as well as stenosis at valve sites, both of which were successfully managed with a single endovascular procedure. The toe stump healed completely within 3 months. The graft remained patent for 2 years, and SPP was preserved even after graft occlusion. Notably, graft failure coincided with DVA occlusion, suggesting its critical role in maintaining flow. At 42 months postoperatively, the patient remained ulcer-free with favorable perfusion, pain-free ambulation, and full return to work.CONCLUSIONS: Preoperatively planned surgical DVA, in conjunction with sympathetic modulation and timely postoperative intervention, may offer a durable limb salvage strategy in advanced TAO with limited distal targets.

Thrombus formation is a troublesome and sometimes lethal complication occurring in patients with severe heart failure and supported by a left ventricular assist device (LVAD). Appropriate treatment for pump thrombosis especially in emergency cases with severe pump failure is difficult to choose. Herein, we present important findings of a case of unexpected LVAD pump thrombosis that rapidly developed into serious pump failure and circulatory arrest due to total obstruction of the LVAD inflow tract by a huge thrombus.

Cephalic arch stenosis (CAS) is a common cause of vascular access dysfunction in patients undergoing hemodialysis. This report describes a case of recurrent stent fractures and restenosis following endovascular treatment for CAS. A 34-year-old man with diabetic nephropathy and chronic hemodialysis underwent multiple stent placements for CAS. Complications, including stent entanglement during balloon angioplasty and stent fracture due to the cephalic arch's anatomical characteristics, necessitated surgical intervention. This case highlights two critical considerations: the unsuitability of balloon-expandable stents for CAS, as they lack resilience to deformation caused by shoulder movements, and the importance of selecting appropriate balloons to minimize stent damage. The unique anatomical characteristics of the cephalic arch increase the risk of stent bending and fracture, emphasizing the need for careful device selection. This case increases the awareness of stent placement for CAS.

Purpose A retro-odontoid pseudotumor is usually a reactive fibrocartilaginous mass associated with atlantoaxial subluxation (AAS). However, a retro-odontoid pseudotumor not associated with AAS, which undergoes spontaneous regression following C1 laminoplasty, has been reported. The purpose of this study was to report surgical outcomes of C1 laminectomy for retro-odontoid pseudotumor without AAS. Materials and methods The cases of seven patients (mean age 75.6 ± 7.6 years-old) with retro-odontoid pseudotumor without AAS were reviewed. The mean follow up time was 52.3 ± 25.5 months. Each patient underwent a C1 laminectomy with an additional C3–6 expansion laminoplasty in three patients. The Japanese Orthopaedic Association score (JOA score) was used for neurological assessment. Pseudotumor size and additional AAS were analyzed using MRI and radiography. Results All patients exhibited neurological improvement following surgery, the JOA score improved from 7.2 ± 3.2 to 14.1 ± 2.6. The mean O-C2 and C2–7 angle decreased from −3.2 ± 2.1° to −3.9 ± 1.7°, showing a slight kyphotic change. Postoperative AAS was not observed. All pseudotumors spontaneously resolved, and recurrence and regrowth were not observed. Five patients had MRIs after gadolinium administration; four patients who showed enhancement of the pseudotumor had almost complete reduction within 1 year following surgery. Discussion Our study, assessing the outcome of C1 laminectomy for retro-odontoid pseudotumor, found neurological improvement in all cases. Since all pseudotumors were reduced and additional AAS was not observed, C1 laminectomy for retro-odontoid pseudotumor, in the absence of AAS, is recommended as a therapeutic strategy.

Background Celiac axis stenosis (CAS) is frequently observed in patients undergoing pancreaticoduodenectomy (PD). This poses challenges because of the potential disruption of the hepatic arterial blood flow. Case presentation We present the case of an 81-year-old woman diagnosed with pancreatic head cancer and severe CAS caused by calcification. The patient received neoadjuvant chemotherapy (NAC) and underwent preoperative endovascular stenting of the celiac axis to restore blood flow. After two cycles of NAC, subtotal stomach-preserving PD was performed. An intraoperative assessment of the hepatic arterial blood flow determined that it was well maintained. PD was performed using the standard technique; specialized techniques were not necessary. Importantly, no ischemic complications were encountered. Conclusion This case report describes the successful combination of preoperative celiac axis stenting, NAC, and surgical intervention for the management of CAS in an elderly patient with pancreatic cancer. This approach offers a potential solution for maintaining the hepatic arterial blood flow in the presence of CAS without vascular reconstruction, particularly in elderly individuals.

Purpose To clarify the femoral insertion of the lateral collateral ligament (LCL) and popliteus tendon (PT) and related osseous landmarks on three-dimensional images. Methods Twenty-six non-paired, formalin-fixed human cadaveric knees were evaluated in this study. Femoral insertion of the LCL and PT was identified and marked. Three-dimensional images were created, and the surface area, location, positional relationships, and morphology of the femoral insertion of the LCL, PT, and related osseous structures were analysed. Results The mean surface areas of the LCL and PT femoral insertions were 55.8 ± 25.0 and 52.5 ± 24.2 mm 2 , respectively. Variations in the positional relationships between the LCL and PT insertions (PT inserted parallel and posterior to the LCL insertion to the long axis of the femur) were observed. The lateral epicondyle and popliteal sulcus could be clearly identified as osseous landmarks on three-dimensional images in all knees. Most of the LCL was inserted postero-distal to the apex of the lateral epicondyle, and the PT was inserted at the anterior end of the popliteal sulcus in all knees. Conclusion We observed variation in the positional relationship between the femoral insertion of the LCL and PT. However, the relationships between their insertions and osseous landmarks were consistent. The findings of this study contribute to the understanding of the PLC osseous anatomy and should assist surgeons in performing PLC surgery with a more anatomic perspective.

Cultured cells easily develop resistance to kinesin-5 inhibitors (K5Is) often by overexpressing a related motor protein, kinesin-12/KIF15, or by acquiring mutations in the N-terminal motor domain of kinesin-5/KIF11 itself. We aimed to identify novel mechanisms responsible for resistance to S-trityl L-cysteine (STLC), one of the K5Is, using human osteosarcoma cell lines. Among six lines examined, U-2OS and HOS survived chronic STLC treatment and gave rise to resistant cells with IC50s at least 10-fold higher than those of the respective parental lines. Depletion of KIF15 largely eliminated the acquired K5I resistance in both cases, consistent with the proposed notion that KIF15 is indispensable for it. In contrast to the KIF11-independent property of the cells derived from HOS, those derived from U-2OS still required KIF11 for their growth and, intriguingly, expressed a C-terminal truncated variant of KIF11 resulting from a frame shift mutation (S1017fs). All of the isolated clones harbored the same mutation, suggesting its clonal expansion in the cell population due to the growth advantage during chronic STLC treatment. Transgenic expression of KIF11S1017fs in the parental U-2OS cells, as well as in HeLa cells, conferred a moderate but reproducible STLC resistance, probably owing to STLC-resistant localization of the mutant KIF11 on mitotic spindle. Our observations indicate that both KIF15 and the C-terminal-truncated KIF11 contributes to the STLC resistance of the U-2OS derived cells.

INTRODUCTION: In chronic limb-threatening ischemia (CLTI), especially with diabetes and dialysis dependence, below-the-ankle arterial lesions and severe calcification often limit distal bypass options. While surgical distal venous arterialization (sDVA) can restore perfusion, achieving wound healing requires additional surgical strategies such as free flap transfer to provide adequate soft tissue coverage.CASE PRESENTATION: A male patient in his 70s with diabetes and end-stage renal disease on hemodialysis presented with a right toe ulcer and rest pain. He had severe intradialytic hypotension and reduced cardiac function (ejection fraction: 22%) with multivessel coronary artery disease. Coronary artery bypass grafting (CABG) with 5 grafts was performed, and balloon angioplasty of the peroneal artery was added 53 days later to improve infrapopliteal perfusion. Cardiac function improved to an ejection fraction of 55% within 1 month, but the toe ulcer progressed to total toe gangrene. Six months later, the patient was readmitted with a deep foot infection. Despite the infection, lower limb muscle strength was preserved. sDVA was performed using a popliteal artery–posterior tibial vein bypass with the ipsilateral great saphenous vein, combined with sequential anastomosis to the diseased tarsal artery and Lisfranc-level amputation. Following sDVA, extensive debridement of infected tissue resulted in a large soft tissue defect. During the waiting period for definitive wound coverage, rheopheresis therapy using Rheocarna was administered to promote wound bed preparation. A free latissimus dorsi musculocutaneous flap was subsequently transferred to achieve wound closure. Four years after the initial intervention, the patient maintains favorable cardiac and limb function without ulcer recurrence.CONCLUSIONS: We report a case of CLTI with below-the-ankle disease in a dialysis-dependent patient, successfully treated with CABG, endovascular therapy, rheopheresis therapy, sDVA, and free flap transfer. This case underscores the importance of combining revascularization and soft tissue reconstruction to achieve wound healing and preserve ambulatory function as key goals in managing complex below-the-ankle arterial lesions.