ABSTRACT
Purpose@#Laparoscopic surgery is a choice in several emergency settings. However, there has been no nationwide study or survey that has compared the clinical use of laparoscopic emergency surgery (LES) versus open abdominal emergency surgery (OES) in Korea.Therefore, we examined the state of LES across multiple centers in Korea and further compared this data with the global state based on published reports. @*Methods@#Data of 2,122 patients who received abdominal emergency surgery between 2014 and 2019 in three hospitals in Korea were collected and retrospectively analyzed. Several clinical factors were investigated and analyzed. @*Results@#Of the patients, 1,280 (60.3%) were in the OES group and 842 (39.7%) were in the LES group. The most commonly operated organ in OES was the small bowel (25.8%), whereas that for LES was the appendix. In appendectomy and cholecystectomy, 93.7% and 88.0% were in the LES group. In small bowel surgery, gastric surgery, and large bowel surgery, 89.4%, 92.0%, and 79.1% were in the OES group. The severity-related factors of patient status demonstrated statistically significant limiting factors of selection between LES and OES. @*Conclusion@#Although our study has several limitations, compared to the LES data from other countries, the general LES state was similar in appendectomies, cholecystectomies, and small bowel surgeries. However, in gastric and colorectal surgeries, the LES state was different from those of other countries. This study demonstrated the LES state and limiting factors of selection between LES and OES in various operated organs. Further studies are required to analyze these differences and the various limiting factors.
ABSTRACT
The gut is a complex organ that has played an important role in digestion, absorption, endocrine functions, and immunity. The gut mucosal barriers consist of the immunologic barrier and nonimmunologic barrier. During critical illnesses, the gut is susceptible to injury due to the induction of intestinal hyperpermeability. Gut hyperpermeability and barrier dysfunction may lead to systemic inflammatory response syndrome. Additionally, gut microbiota are altered during critical illnesses. The etiology of such microbiome alterations in critical illnesses is multifactorial. The interaction or systemic host defense modulation between distant organs and the gut microbiome is increasingly studied in disease research. No treatment modality exists to significantly enhance the gut epithelial integrity, permeability, or mucus layer in critically ill patients. However, multiple helpful approaches including clinical and preclinical strategies exist. Enteral nutrition is associated with an increased mucosal barrier in animal and human studies. The trophic effects of enteral nutrition might help to maintain the intestinal physiology, prevent atrophy of gut villi, reduce intestinal permeability, and protect against ischemia-reperfusion injury. The microbiome approach such as the use of probiotics, fecal microbial transplantation, and selective decontamination of the digestive tract has been suggested. However, its evidence does not have a high quality. To promote rapid hypertrophy of the small bowel, various factors have been reported, including the epidermal growth factor, membrane permeant inhibitor of myosin light chain kinase, mucus surrogate, pharmacologic vagus nerve agonist, immune-enhancing diet, and glucagon-like peptide-2 as preclinical strategies. However, the evidence remains unclear.
ABSTRACT
The retroperitoneum is a posterior space of the peritoneum, which has many visceral and vascular structures. Spontaneous retroperitoneal hemorrhages have variable causes, the most common of which are diseases of retroperitoneal organs. However, retroperitoneal hemorrhages may be caused by bare area injury. In this case study, a bare area was observed in the right upper quadrant (RUQ) of the retroperitoneum, the posterosuperior region of Couinaud liver segment 7 (bare area) is directly connected to the anterior pararenal space. The rupture or exophyte of the hepatocellular carcinoma on the bare area could invade the retroperitoneum, which may lead to inaccurate diagnosis of the condition. When the mass or the hemorrhage in the RUQ of the retroperitoneum is observed in computed tomography images, it is possible that ruptured hepatocellular carcinoma or a mass on the bare area of the liver, looks like a spontaneous retroperitoneal hemorrhage in the RUQ area for example a right adrenal hemorrhage.
ABSTRACT
The retroperitoneum is a posterior space of the peritoneum, which has many visceral and vascular structures. Spontaneous retroperitoneal hemorrhages have variable causes, the most common of which are diseases of retroperitoneal organs. However, retroperitoneal hemorrhages may be caused by bare area injury. In this case study, a bare area was observed in the right upper quadrant (RUQ) of the retroperitoneum, the posterosuperior region of Couinaud liver segment 7 (bare area) is directly connected to the anterior pararenal space. The rupture or exophyte of the hepatocellular carcinoma on the bare area could invade the retroperitoneum, which may lead to inaccurate diagnosis of the condition. When the mass or the hemorrhage in the RUQ of the retroperitoneum is observed in computed tomography images, it is possible that ruptured hepatocellular carcinoma or a mass on the bare area of the liver, looks like a spontaneous retroperitoneal hemorrhage in the RUQ area for example a right adrenal hemorrhage.
ABSTRACT
Malignant peripheral nerve sheath tumor (MPNST) is rare, accounting for 5-10% of all soft tissue sarcomas. MPNST is characteristically aggressive and has a poor prognosis. Fifty percent of patients with MPNST have neurofibromatosis type 1 (NF1). NF-associated MPNST occurs more often at younger ages than sporadic MPNST, but the survival difference is controversial. Superficial MPNST from a recurrent neurofibroma is extremely rare and only a limited number of cases have been reported in the literature. Herein, we report an unusual case of superficial MPNST from a recurrent neurofibroma in a patient without NF1.
ABSTRACT
Malignant peripheral nerve sheath tumor (MPNST) is rare, accounting for 5-10% of all soft tissue sarcomas. MPNST is characteristically aggressive and has a poor prognosis. Fifty percent of patients with MPNST have neurofibromatosis type 1 (NF1). NF-associated MPNST occurs more often at younger ages than sporadic MPNST, but the survival difference is controversial. Superficial MPNST from a recurrent neurofibroma is extremely rare and only a limited number of cases have been reported in the literature. Herein, we report an unusual case of superficial MPNST from a recurrent neurofibroma in a patient without NF1.
Subject(s)
Humans , Abdominal Wall , Nerve Sheath Neoplasms , Neurilemmoma , Neurofibroma , Neurofibromatoses , Neurofibromatosis 1 , Neurofibrosarcoma , Peripheral Nerves , Prognosis , SarcomaABSTRACT
PURPOSE: Ensuring the stability of central venous catheter placement for treating patients hospitalized in an intensive care unit is very important. Although PICC requires an ultrasound and fluoroscopy machine, it is difficult to use a fluoroscopy machine for PICC insertion in the intensive care unit. This study analyzed the cases of the insertion of a PICC under ultrasonic guidance at the bedsides in the intensive care unit to determine the usefulness of PICC in the intensive care unit. METHODS: A retrospective study was conducted on patients hospitalized in the surgical intensive care unit and received PICC using ultrasonography at their bedsides from October 2015 to January 2018. RESULTS: One hundred and twenty patients were collected. The number of successful PICCs stood at 105 patients, which was equal to 87.5%. Among them, 65 and 55 cases had left and right insertion, respectively; the corresponding success rate was 81.8%, and 92.3%. No statistically significant difference in success rates was observed between the left and right, as well as in the success rates depending on the presence of shock, sepsis, acute kidney injury, and mechanical ventilation. In the failed 15 cases, seven cases were due to the course of the procedure and eight cases were confirmed have been malpositioned after insertion. CONCLUSION: PICC at the bedside in an intensive care unit is a safe method for central venous catheterization without severe complications and death. The insertion sites, left or right, are equally acceptable. Further study of the cases of malposition will be necessary.
Subject(s)
Humans , Acute Kidney Injury , Catheterization , Catheterization, Central Venous , Catheters , Central Venous Catheters , Critical Care , Critical Illness , Fluoroscopy , Intensive Care Units , Methods , Respiration, Artificial , Retrospective Studies , Sepsis , Shock , Ultrasonics , UltrasonographyABSTRACT
PURPOSE: Many disposable laparoscopic instruments are used in laparoscopic surgery. There are several disadvantages in use of disposable laparoscopic instruments, including cost ineffectiveness, environmental contamination, and resource recycling. In addition, a disposable specimen bag has been used in laparoscopic appendectomy. Use of the trans-trocar appendix removal technique provides several advantages compared to use of a specimen bag. Therefore, the aim of this study is to analyze the adequate trocar size for trans-trocar appendix removal. METHODS: A total of 62 patients undergoing appendectomy between June 2012 and September 2012 were identified. After appendectomy, we performed a trans-trocar test using removed appendix specimen and trocars. Three different types of trocars were used for the trans-trocar test, 5 mm, 12 mm, and 11 mm Xcel(R) (Ethicon). We analyzed the success rate. RESULTS: Significant relationships were observed between maximal specimen diameter and body mass index. When BMI was below 20, the success rate of the 11 mm trocar was 86% in the trans-trocar appendix removal test. When BMI was between 20 and 25, the success rate of the 12 mm trocar was 71%, but that of 11 mm was 57%. When BMI was above 25, the success rate of the 15 mm trocar was 62%. CONCLUSION: Although this study had many limitations, a large-sized trocar was needed for trans-trocar appendix removal in more body mass index. When BMI is below 20, an 11 mm trocar is recommended in trans-trocar appendix removal. When BMI is between 20 and 25, a 12 mm trocar is. When BMI is above 25, a 15 mm trocar and a disposable specimen bag are recommended. Further continuous study will be needed for analysis of clinical outcome.