Anesthesia for free flap reconstruction surgery is challenging due to its length and invasive nature. Although maintaining the blood flow of the skin flap is vital to flap survival, circulatory disturbance of the flap may occur due to postoperative hypotension (PH). We hypothesized that PH can be a risk factor for flap complications. In this report, the predictors of PH and the incidence rate of flap complications are discussed. We retrospectively investigated the causes of PH and the incidence of flap complications. Patients diagnosed with head and neck cancer who underwent cancer resection and immediate free flap reconstruction were enrolled in the study. Subjects were divided in two groups -the PH group (n = 46), and the non-PH group (n = 36) - according to the occurrence of PH after surgery. The PH group included patients who received additional fluid therapy and vasopressor support when systolic arterial pressure was below 90 mmHg. We evaluated the condition of the flaps from medical records. There was no significant difference in the incidence of flap failure between the two groups. However, the incidence of poor flap circulation, total fluid balance during surgery, and systemic inflammatory response syndrome was significantly higher in the PH group. We must be aware of the risk of PH is order to prevent poor flap circulation.

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We aimed to evaluate the efficacy and safety of 12-week treatment with elbasvir (EBR) and grazoprevir (GZR) in patients with hepatitis C virus (HCV) genotype (GT) 1 infection in a real-world setting. A total of 67 patients with chronic hepatitis or compensated hepatic cirrhosis and GT 1 HCV infection were treated with EBR＋GZR for 12 weeks and followed for 12 weeks after the completion of treatment. A sustained virological response (SVR12) was defined as undetectable HCV RNA 12 weeks after completing treatment. The efficacy and safety of this 12-week treatment regimen were analyzed. Among the 67 patients (male, n=39; female, n=28), 23 (34%) had compensated liver cirrhosis, while only 1 (1%) had experienced treatment failure with another DAA treatment regimen. The overall SVR12 rate was 97% (95% confidence interval 0.896 – 0.996), and the rate was not significantly affected by age, sex, liver stiffness, Fib-4 index, or eGFR at baseline. No severe adverse events occurred. The most frequent adverse event was increased alanine aminotransferase concentration in 4 patients (6%). The efficacy and safety of 12 weeks of EBR+GZR for patients with chronic hepatitis or compensated hepatic cirrhosis and HCV GT 1 infection was confirmed in this study.

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Hepcidin is the master regulator of systemic iron bioavailability in humans and plays a key role in preventing iron overload. During pregnancy, iron is transported from the mother to the fetus across the placenta. However, the relationship between hepcidin and iron metabolism in the mother and the fetus remains unknown. To elucidate this relationship, 40 women with singleton pregnanacies and their newborns were enrolled in this study. There were no mothers with active infection during the perinatal period. Hemoglobin, serum iron, ferritin, and hepcidin levels were significantly higher in the fetuses than in the mothers, while transferrin and erythropoietin levels were significantly lower. In the fetus, a significantly positive correlation between ferritin and hepcidin, and a significantly negative correlation between ferritin and transferrin showed sufficient accumulation of iron and prevention of an excessive iron transport. A positive correlation between erythropoietin and reticulocyte count indicates established erythropoiesis in the fetus at birth. Multiple regression analysis showed that fetal hepcidin levels were affected only by maternal serum iron (regression coefficient = -0.605, p=0.0060). Maternal and fetal iron metabolism were independently controlled, except for maternal iron transfer.　

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We describe a case of volvulus of the ascending colon that was diagnosed before surgery. A 69-year-old man visited our hospital due to right lower abdominal pain. Abdominal X-ray showed colonic gas with a specular image, and abdominal computed tomography revealed torsion of the ascending colon. The patient was diagnosed with volvulus of the ascending colon and underwent emergency surgery. During surgery, the ascending colon was found to be twisted on its semimajor axis and was turned cranially; however, no necrosis was observed. The ileum was resected, and the procedure was completed after establishing a functional anastomosis of the resected end. Oral feeding was started 8 days postoperatively, and the patient was discharged 14 days postoperatively following good progress. No recurrence was observed at 2 months postoperatively. As there is a risk of recurrence of an ascending volvulus with noninvasive treatment such as repair or cecal fixation, it is necessary to resect the tortuous bowel, irrespective of the presence of intestinal necrosis. In conclusion, aside from reporting the successful management of a rare case of axial torsion of the ascending colon, we have reviewed the literature relevant to the case.

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