We retrospectively reviewed and discussed hematostatic managements for tooth extraction in patients maintained on oral anticoagulant. From 2001 to 2007, 109 patients maintained with oral anticoagulant treatment underwent a total of 143 occasions of tooth extraction in our department. At the time of tooth extraction, oral anticoaglant medication was maintained on 76 occasions (53%), and had been discontinued on 55 occasions (38%). Postoperative bleeding happened in 5 cases (9.1%) in patients without interruption of oral anticoagulant, and in 3 cases (3.9%) in patients with interruption. There was no significant difference in the Prothrombin Time International Normalized Ratio (PT-INR) and in postoperative hemostatic procedures between them. The results of this study suggest that dental extraction can be performed without modification of oral anticoagulant treatment in cases where the PT-INR is less than 3.0. Strict local hemostatic procedures are necessary to prevent postoperative bleeding.
Percutaneous endoscopic gastrostomy (PEG) has been used generally as a safe method of enteral nutrition for patients who are unable to take oral alimentation. However, there are some patients who can not be receive PEG because of technical problems. For example, prior gastrectomy and the presence of other organs between the stomach and abdominal wall are recognized as relative contraindications for PEG. We performed percutaneous transesophageal gastro-tubing (PTEG) in seven patients in whom we had been unable to place a standard PEG tube. Based on our experience, we recommend PTEG as a safe and effective alternative to open surgical gastrostomy when PEG is not possible.
We report a case of liver hemangioma with extrahepatic growth in a 53-year-old man, who was admitted to our hospital after he was suspected to have a liver tumor during a routine medical check-up. An abdominal computed tomography (CT) scan revealed a partially enhanced mass, 11 cm in diameter. Abdominal angiography revealed a tumor that had a cotton wool-like stain, which was fed by the left lateral hepatic artery (A2). After the patient was diagnosed with liver hemangioma showing extrahepatic growth, we performed a handassisted laparoscopic partial hepatectomy. The resected specimen was 11×10×8 cm in diameter and 424 g in weight. A histopathological analysis revealed that the tumor was a cavernous hemangioma. Hand-assisted laparoscopic surgery permits an adequate surgical field, and other essential management procedures during surgery. Laparoscopic hepatectomy using hand-assisted laparoscopic surgery is thus one of several effective procedures that provide a superior level of operability and safety.