Background & Aims: The purpose of this study is to identify the clinical and immunohistological factors that inhibit bone healing after extirpation of extensive radicular cysts and endodontic microsurgery-microscopic apicoectomy, and utilize these factors as predictors of treatment outcome. Methods: Endodontic microsurgery-microscopic apicoectomy was performed in 26 patients. Outcomes were evaluated based on clinical signs and radiographs. Expression levels of cytokines (IL-1β, TNF-α, RANKL) in the cyst epithelium and subepithelial connective tissue were also investigated. Results: The success rate was 88.5%. The radiological reduction rate was ≥75% in 16 patients (good bone healing) and <75% in 10 (poor bone healing). In clinical analysis, penetrating bone defects and the site (maxilla) showed significant differences between the two groups (P<0.05). In immunohistochemical analysis, expression of IL-1β and TNF-α showed significant differences between the two groups (P<0.05). Conclusions: Penetrating bone defects, inflammation, and a maxillary site are prognostic factors for a poor outcome after treatment of extensive radicular cysts. Endodontic microsurgery-microscopic apicoectomy is a new technique for treatment of an extensive radicular cyst, and this study is the first to identify factors that influence the outcome after extirpation of the cyst.

A male patient in his 60s was admitted to our hospital with abdominal pain. He was diagnosed with acute appendicitis and localized peritonitis, and we performed appendectomy with a prophylactic drain. His postoperative course was uneventful, but he later developed a surgical site infection (SSI) at the site of the drain after its removal. He underwent debridement several times, but the procedures were not curative. We finally performed complete surgical resection of the fistula. This report describes a rare case of intractable SSI at the site of the drain after appendectomy.

Gastric duplication cyst is a rare congenital malformation. We report a case of gastric duplication cyst resected under laparoscopy. A 41 year-old man was found to have an asymptomatic gastric tumor on computed tomography (CT) and presented to our department for further evaluation and treatment. CT showed a cystic mass 40mm in diameter in the lesser curvature of the proximal stomach. Endoscopic ultrasonography showed a cystic lesion continuous with the proper muscle layer of the gastric wall. Under the working diagnosis of a gastric duplication cyst, we performed laparoscopic enucleation of the tumor. Histopathological findings were consistent with gastric duplication cyst.

Presurgical diagnosis of gastric duplication cyst is difficult. Surgical resection and histopathological evaluation are necessary for definitive diagnosis. Malignancy in these lesions is rare but reported. Laparoscopic resection may be useful in diagnosis and treatment of gastric duplication cysts.

Robot-assisted radical cystectomy was performed in three patients with bladder cancer. Urinary diversion was extracorporeal with ileal conduit. All three patients were men; two were in their 60s and one was in his 70s. Two patients underwent urethrectomy. The patients were perioperatively managed according to a clinical pathway. We investigated the validity of the clinical pathway for patients undergoing robot-assisted radical cystectomy. Perioperative data (surgical time, amount of bleeding, transfusion requirement, and complications) were investigated, and critical indicators (drinking and eating before surgery; drinking, eating, sitting, walking, completion of drip infusion, and discharge after surgery) were evaluated. Urinary tract infection was observed in one patient. All three patients achieved the target levels of all critical indicators, demonstrating the validity of the clinical pathway for perioperative management of patients undergoing robot-assisted radical cystectomy. Use of a postoperative recovery enhancement program in the perioperative management of patients undergoing radical cystectomy has attracted attention in recent years,. The clinical pathway for patients undergoing radical cystectomy should be revised taking promises of ERAS into consideration.

A male patient in his sixties visited our hospital with right shoulder pain secondary to a fall from a height of two meters. Following clinical examination, he was diagnosed with traumatic isolated fracture of the first rib. There were no other rib, neurovascular, or brachial plexus injuries. He was managed successfully with conservative therapy. First rib fractures are associated with injuries to the subclavian vessels and brachial plexus. Hence, when a patient has a first rib fracture, careful evaluation of those injuries is necessary. This case report describes the very rare traumatic isolated fracture of the first rib in details.