Characteristics of the pneumonia patients transferred from long-term care hospitals:retrospective study of one regional emergency medical center

Objective@#This study investigated the characteristics of elderly pneumonia patients transferred from long-term care hospitals(LTCH). @*Methods@#The initial emergency department (ED) data of patients, who were transferred from other hospitals and over 65years old and hospitalized from 2014 to 2018 for pneumonia management through the ED, were extracted from the electronicmedical records. The differences in the initial status and prognosis between the LTCH group and non-LTCH groupwere compared, and the initial ED variables that affect the in-hospital mortality of the LTCH group were investigated. @*Results@#The total number of patients was 1,032; 423 (41.0 %) were included in the LTCH group. Compared to the non-LTCH group, the following severity indices, some laboratory data, and mortality were worse in the LTCH group: systemicinflammatory reaction syndrome (SIRS) criteria ≥2 (65.0% vs. 56.7%, P=0.008), quick Sequential Organ FailureAssessment score ≥2 (48.2% vs. 20.4%, P<0.001), CURB-65 (Confusion, Urea nitrogen, Respiration rate, Blood pressure,Age≥65 years) criteria ≥3 (51.8% vs. 29.2%, P<0.001), pneumonia severity index (PSI) class ≥4 (86.5% vs.61.2%, P<0.001), modified early warning score ≥5 (38.8% vs. 18.4%, P<0.001), serum albumin (median [IQR], 2.6 [2.2-2.9] g/dL vs. 2.8 [2.4-3.2] g/dL; P<0.001), blood urea nitrogen/albumin (B/A) ratio (median [IQR], 8.0 [5.0-12.8] vs. 6.6[4.4-10.4]; P<0.001), and in-hospital mortality (26.0% vs. 15.9%, P<0.001). Multivariate regression analysis revealed thealbumin grade, B/A ratio grade, PSI class, and SIRS criteria to independently affect the in-hospital mortality of the LTCHgroup. @*Conclusion@#The LTCH group had poorer initial severity indices and higher in-hospital mortality than the non-LTCHgroup. In addition, the albumin grade, B/A ratio grade, could be used for the severity index of pneumonia patients transferredfrom the LTCH.

Clinicopathological Features and Prognostic Factors for Patients with Clinical T4 Gastric Cancer that Underwent Combined Resection of Invaded Organs

PURPOSE: The surgical treatment of gastric cancer that invades adjacent organs is a radical gastrectomy with combined resection including the adjacent organs or a palliative operation by performing either a gastrojejunostomy or gastrectomy. However, since it is impossible to determine the exact stage of the cancer, either T or N, in the case of palliative surgery, it is inappropriate to predict patient prognosis. This study analyzes the prognoses for patients whose final TNM stages are determined by a combined resection performed due to macroscopical infiltration into the adjacent organs. MATERIALS AND METHODS: Of 2,452 patients that underwent surgery for gastric cancer at our hospital from 1983 to 2002, we evaluated 102 patients where a combined resection was performed because direct infiltration into the adjacent organs was discovered. RESULTS: Univariate analysis showed that the survival rate differed by the depth of invasion into the gastric walls, the degree of lymph node metastasis, distant metastasis, pathological TNM stage, surgical curability, the location of tumor, and histological differentiation. By multivariate analysis, it was found that the surgical curability, the location of the tumor and the degree of lymph node metastasis were independent prognostic factors. CONCLUSION: It is suggested that even when infiltration into adjacent organs is suspected, radical surgery should be performed as to allow a prediction of prognosis through an exact determination of disease stage, and to improve the survival rate.

Risk Factors of the Recurrence after a Curative Resection of Gastric Carcinoma Invading the Muscularis Propria

PURPOSE: Advanced gastric cancer confined to the muscularis propria is considered to be an intermediate-stage carcinoma, between early and more advanced cancer from both the pathological and clinical viewpoints of the primary tumor stage. Although many prognostic factors for early gastric cancer and advanced gastric cancer have been identified, there are few reports concerning prognostic factors for gastric cancer invading the muscularis propria, and the characteristics of recurrence are not completley understood. METHODS: One hundred and fifty-six patients who had undergone curative resection for gastric cancer invading the muscularis propria from 1992 to 2000 were retrospectively reviewed. The risk factors that determined the recurrence were investigated by univariate and multivariate analysis. RESULTS: Disease recurred in 31 patient (19.9%) after a median interval of 17.2 months. Based on our univariate analysis, the recurrence was associated with lymph node metastasis, tumor size and histologic type. Multivariate analysis showed that independent risk factor for the recurrence was only lymph node metastasis. Recurrent disease patterns included hematogenous (38.7%), peritoneal (16.1%) and locoregional (25.8%). CONCLUSION: Lymph node metastasis is an important risk factor of the recurrence after curative resection for gastric cancer invading the muscularis propria. Patients with lymphatic metastasis, particularly with 4 or more nodal imvolvements, should undergo postoperative adjuvant therapy.

Clinicopathological Analysis of Superficial Spreading and Small-sized Types of Early Gastric Cancer

PURPOSE: The superficial spreading type of early gastric cancer has different clinicopathologic features from other types of early gastric cancers in terms of its invasiveness and lymph node metastases. Therefore, the clinicopathological features of the superficial spreading type and the small-sized early gastric cancers, were analyzed, and the influence of those features on the surgical procedures and prognosis was investigated. METHODS: During an 8-year period (1992~1999), 22 superficial spreading early gastric cancers were analyzed with respect to the macroscopic type, lymph node metas tasis, and the surgical procedure, and compared with those of 219 small-sized early gastric cancers. The superficial spreading type was defined as a lesion more than 5 5 cm and small-sized type, as a lesion less than 2 2 cm. The survival rate was analyzed using the Kaplan-Meier method and those patients who died of diseases unrelated to gastric cancer were excluded. Other statistical analyses were performed using the chi-square test. RESULTS: Twenty two out of 369 (6%) early gastric cancers were the superficial spreading type. The incidence of a LN metastasis was 12.3% in early gastric cancer, 8.7% in the small-sized type, and 27.3% in the superficial spreading type. The incidence of a LN metastasis was greater in the superficial spreading type than in the small-sized type (P=0.006). The location of the lesions, the histological type, and the depth of the invasion in the superficial spreading and small-sized early gastric cancers were similar There was difference in the method of surgery and the extent of the lymph node dissection between two groups. CONCLUSION: Because the incidence of a lymph node meta stasis is higher in the superficial spreading type than in the small-sized early gastric cancer, a wide resection with an extensive lymph node dissection appears to be appropriate treatment for the superficial spreading type of early gastric cancer.

An Analysis of Complications according to Cartridge Size Following Total Gastrectomy with Roux-en-Y Esophagojejunostomy Using the EEA Stapler

PURPOSE: Anastomotic stricture is one of the most common problems in esophagojejunostomy using an end-to-end anastomosing (EEA) instrument following total gastrectomy. Because anastomotic stricture often develops with small- cartridge EEA, a larger EEA may be used to avoid stricture. The purpose of this retrospective study is to evaluate the difference of complications between patients treated using the EEA25 and ones using EEA28. METHODS: A total of 283 patients underwent curative total gastrectomy and esophagojejunostomy with Roux-en-Y anastomosis, using EEA25 or EEA28, between January 1992 and December 1999. The differences between the EEA25 and EEA28 groups were investigated by comparing them in terms of reflux esophagitis, dysphagia, and stricture. RESULTS: Stricture developed in five patients (13.8%) in the EEA28 group and in 11 patients (4.45%) in the EEA25 group (P<0.05), dysphagia was experienced less frequently in the EEA25 than in the EEA28 group (P<0.05), and no significant differences were evident with regards to reflux esophagitis. CONCLUSION: The choice of a large EEA to avoid anastomotic stricture did not affect the development of dysphagia or stricture. However, a randomized, prospective study should be done to better define the relationship between the size of EEA and the complications of total gastrectomy.