The risk of surgical site infection of oral sulfate tablet versus sodium picosulfate for bowel preparation in colorectal cancer surgery: a randomized clinical trial

Purpose@#Oral sulfate tablets are abundantly used for bowel preparation before colonoscopy. However, their efficiency and safety for bowel preparation before colorectal surgery remain ill-defined. Herein, we aimed to compare the surgical site infection rates and efficiency between oral sulfate tablets and sodium picosulfate. @*Methods@#We designed a prospective, randomized, phase 2 clinical trial. Patients with colorectal cancer aged 19–75 years who underwent elective bowel resection and anastomosis by minimally invasive surgery were administered oral sulfate tablets or sodium picosulfate. Eighty-three cases were analyzed from October 2020 to December 2021. Surgical site infection within 30 days after surgery was considered the primary endpoint. Postoperative morbidities, the degree of bowel cleansing, and tolerability were the secondary endpoints. @*Results@#Surgical site infection was detected in 1 patient (2.5%) in the oral sulfate tablet group and 2 patients (4.7%) in the sodium picosulfate group, indicating no significant difference between the 2 groups. Postoperative morbidity and the degree of bowel cleansing bore no statistically significant differences. Furthermore, none of the investigated tolerability criteria, namely bloating, pain, nausea, vomiting, and discomfort, differed significantly between the 2 groups. The patients’ willingness to reuse the drug was also not significantly different between the 2 groups. @*Conclusion@#Although we could not establish the noninferiority of oral sulfate tablets to sodium picosulfate, we found no evidence suggesting that oral sulfate tablets are less safe or tolerable than sodium picosulfate in preoperative bowel preparation.

Factors Affecting Primary Stability on Sites of Alveolar Ridge Preservation Using Porcine-derived Bone Minerals

Purpose@#The alveolar ridge preservation (ARP) is widely conducted for implant placement. However, experimental results using deproteinized porcine bone mineral (DPBM) have been scarce. This retrospective study evaluated factors affecting the primary stability of implants in an area where ARP was performed using DPBM. @*Materials and Methods@#Thirty-eight patients were divided into two groups based on the primary stability, with torque value of 30 Ncm as borderline. To determine the factors that affect the primary stability of implants, we collected data from patients’ medical records including age, sex, reentry time, socket location, remaining bone wall at the time of extraction, and type of collagen membrane, as well as from radiographs and histomorphometric analysis.Result: The results showed statistically significant difference for the remaining extraction socket wall (P=0.014), residual graft (P=0.029), and fibrovascular tissue (P=0.02) between the two groups. There was an insignificant tendency toward the time of reentry surgery (P=0.052) and location (P=0.077). All implants placed in sites using DPBM functioned well up to 3 years. @*Conclusion@#Within the limitations of the present study, extraction socket wall, residual graft, and fibrovascular tissue can affect the primary stability at the time of implant placement on grafted sites using DPBM and collagen membranes. In addition, reentry time and locations can be considered. In future studies, comparative experiments in quantified models will be required to supporting the findings.

Regenerative procedure using rotary titanium brush for surface decontamination of peri-implantitis: 3 cases with a 2-year follow-up

Peri-implantitis, in which inflammation caused by plaque and biofilm on the implant surface spreads to the hard tissue, can be treated by decontamination of the implant surface and reconstruction of the lost hard tissue through surgical methods. We have described the management of 3 peri-implantitis cases by decontamination of the implant surface using a round titanium brush and regenerative therapy. All cases showed clinical improvements, and no further radiographic bone loss was observed during a 2-year follow-up. This treatment method can be effective for clinical improvement and bone regeneration. However, a longer follow-up period is necessary to support these outcomes.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Mitomycin C Used for Colorectal Peritoneal Carcinomatosis

Purpose@#This study aimed to assess the evaluation of clinical outcomes and consequences of complications after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the peritoneal carcinomatosis (PC) from colorectal cancer. @*Methods@#A total 26 patients underwent CRS and HIPEC for PC from colorectal cancer between March 2009 and April 2018. All the patients underwent CRS with the purpose of complete or near-complete cytoreduction. Intraoperative HIPEC was performed simultaneously after the CRS. Mitomycin C was used as chemotherapeutic agent for HIPEC. @*Results@#Median disease-free survival was 27.8 months (range, 13.4–42.2 months). Median overall survival was 56.0 months (range, 28.6–83.5 months). The mean peritoneal cancer index (PCI) was 8.73 ± 5.54. The distributions thereof were as follows: PCI <10, 69.23%; PCI 10–19, 23.08%; and PCI ≥20, 7.69%. The completeness of cytoreduction was 96.2% of patients showed CC-0, with 3.8% achieved CC-1. The mean operation time was 8.5 hours, and the mean postoperative hospital stay was 21.6 days. The overall rate of early postoperative complications was 88.5%; the rate of late complications was 34.6%. In the early period, most complications were grades I–II complications (65.4%), compared to grades III–V (23.1%). All late complications, occurring in 7.7% of patients, were grades III–V. There was no treatment-related mortality. @*Conclusion@#Although the complication rate was approximately 88%, but the rate of severe complication rate was low. In selective patients with peritoneal recurrence, more aggressive strategies for management, such as CRS with HIPEC, were able to be considered under the acceptable general condition and life-expectancy.

Comparison of post-surgery follow-up methods in patients aged 80 years or older with non-metastatic colorectal cancer

PURPOSE: Studies investigating the appropriate post-surgery follow-up method for elderly patients with colorectal cancer are limited. Thus, the purpose of this study was to compare survival rates between two follow-up methods in patients aged 80 years or older who underwent surgery for colorectal cancer.METHODS: Between January 1, 2002 and December 31, 2010, 165 patients aged 80 years or older underwent curative resection for non-metastatic colorectal cancer at the Department of Surgery, Seoul National University Hospital. Sixty-six of these patients were excluded due to the lack of follow-up, while the remaining 99 were included in our study. These 99 patients were divided into the following two groups depending on their post-surgery follow-up method. Patients who underwent follow-up on a regular basis, which was defined as once every six months to one year, with carcinoembryonic antigen (CEA) and computed tomography (CT) comprised the Regular group, and those who received follow-up with CEA alone or underwent CT procedures once every two years or more comprised the Minimal group. Overall survival was analyzed with the log-rank test and Cox regression analysis.RESULTS: Of the 99 patients, 62 were in Regular group and 37 were in Minimal group. There was no difference in overall survival rate between the two post-surgery follow-up methods (regular group vs. minimal group: 51.6% vs. 50.9% [5-year overall survival rate], P=0.819). Additionally, no significant differences was detected between the groups following multivariate analysis (harzard ratio=0.907; 95% confidence interval=0.460–1.788, P=0.777).CONCLUSION: A significant survival gain was not observed between Regular and Minimal group. To draw a more definite conclusion, a multi-center randomized research study should be conducted.

Impact of body mass index on overall survival after surgery for colorectal cancer

PURPOSE: The studies on the impact of obesity on survival for colorectal cancer (CRC) in Korea are still insufficient. The aim of this study is to evaluate body mass index (BMI) as a prognostic factor of CRC.METHODS: From January 2006 to December 2008, a total of 1873 patients with CRC who underwent surgery at Seoul National University Hospital were included in this study. Study participants were divided into five BMI groups: underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), obese (25–29.9 kg/m2) and morbidly obese (≥30 kg/m2). Clinicopathological variables and survival data were reviewed retrospectively. Overall survival was analyzed using log-rank test and Cox regression analysis.RESULTS: Overall survivals of underweight, normal weight, overweight, obese, and morbidly obese groups were significantly different (5-year overall survivals rates: 54.4%, 73.2%, 78.6%, 77.2%, and 53.8%, respectively; P<0.001). In multivariable analysis for overall survival, BMI was an independently significant risk factor. Normal weight, overweight, and obese groups had lower hazard ratios for overall survival than underweight group (hazard ratio [HR], 0.626; 95% confidence interval [CI], 0.462–0848, P=0.002; HR, 0.530, 95% CI, 0.377–0.744, P<0.001; HR, 0.511, 95% CI, 0.470–1.675, P<0.001, respectively). The hazard ratio of morbid obese group was not significantly different from that of underweight group (HR=0.887, 95% CI=0.470–1.675, P=0.712).CONCLUSION: BMI can be a prognostic factor for CRC in Korea. Underweight and morbidly obese were associated with poor overall survival. Large multicenter studies in the Korean population is needed for a definite conclusion.

Outcomes after local excision for rectal neuroendocrine tumor

PURPOSE: Neuroendocrine tumor is a rare tumor in the rectum, but incidence has been increasing. Local excision is an option for treatment of small tumors, and transanal excision or endoscopic resection can be undergone. But indications for local excision have not been established yet. This study was to compare the long-term oncologic outcomes between transanal excision and endoscopic resection for rectal neuroendocrine tumor.METHODS: Patients diagnosed and treated with rectal neuroendocrine tumor from 2000 to 2015 were collected prospectively, and medical records were analyzed retrospectively.RESULTS: Forty patients were included, mean age was 50.20±13.35 years (male:female=23:17). Transanal excision and endoscopic resection were performed in 28 (70%) and 12 (30%) patients, respectively. Mean tumor size was 0.63±0.37 cm, and tumor location was 5.45±1.89 cm from anal verge. Tumor location was more distal rectum in transanal excision (5.04±1.73 cm vs. 6.42±1.98 cm, P=0.049). Pathologic T stage was T1 in all patients. Most of the patients (90%) showed tumor grade 1. After median 24 months (range, 0–86 months) follow-up, one patient (2.5%) experienced local recurrence. The patient underwent further transanal excision. There was no mortality after local excision.CONCLUSION: Local excision is a safe and effective treatment for small-sized neuroendocrine tumors in rectum.

Surgical treatment for high-grade pseudomyxoma peritonei originated from appendix: Analysis of clinical outcomes of repeated debulking surgery

PURPOSE: To evaluate the effect of repeated debulking surgery for high-grade pseudomyxoma peritonei (PMP) originating from the appendix.METHODS: Between January 1998 and December 2014, fifty patients, who underwent debulking surgery for high-grade PMP originating from the appendix, were obtained from a prospectively collected database and retrospectively analyzed. Two groups according to the number of operations were divided and analyzed.RESULTS: A total of 118 operations were performed. Thirty-one patients received more than two operations. The median interval between operations was 18.2 months (range, 2–170 months). Complications developed after 26 operations (22.0%), including ileus (n=10), intra-abdominal fluid collection (n=7), surgical site infection (n=5), and others. There were two mortalities within 30 days after operation. Between two groups of patients who received one operation only and patients who received more than two operations, transfusion, diversion operation, and postoperative complication rate showed statistically significant differences. Two groups of patients had no differences in overall survival rates.CONCLUSION: Our results indicate that the number of operations does not affect the survival rate of high-grade appendiceal PMP, in which repeated debulking surgery is vital to relieve symptoms of the tumor burden.

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

PURPOSE: An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation. METHODS: We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated. RESULTS: The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels. CONCLUSION: Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

Effect of laser-dimpled titanium surfaces on attachment of epithelial-like cells and fibroblasts

PURPOSE: The objective of this study was to conduct an in vitro comparative evaluation of polished and laserdimpled titanium (Ti) surfaces to determine whether either surface has an advantage in promoting the attachment of epithelial-like cells and fibroblast to Ti. MATERIALS AND METHODS: Forty-eight coin-shaped samples of commercially pure, grade 4 Ti plates were used in this study. These discs were cleaned to a surface roughness (Ra: roughness centerline average) of 180 nm by polishing and were divided into three groups: SM (n=16) had no dimples and served as the control, SM15 (n=16) had 5-microm dimples at 10-microm intervals, and SM30 (n=16) had 5-microm dimples at 25-microm intervals in a 2 x 4 mm2 area at the center of the disc. Human gingival squamous cell carcinoma cells (YD-38) and human lung fibroblasts (MRC-5) were cultured and used in cell proliferation assays, adhesion assays, immunofluorescent staining of adhesion proteins, and morphological analysis by SEM. The data were analyzed statistically to determine the significance of differences. RESULTS: The adhesion strength of epithelial cells was higher on Ti surfaces with 5-microm laser dimples than on polished Ti surfaces, while the adhesion of fibroblasts was not significantly changed by laser treatment of implant surfaces. However, epithelial cells and fibroblasts around the laser dimples appeared larger and showed increased expression of adhesion proteins. CONCLUSION: These findings demonstrate that laser dimpling may contribute to improving the periimplant soft tissue barrier. This study provided helpful information for developing the transmucosal surface of the abutment.

Effect of laser-dimpled titanium surfaces on attachment of epithelial-like cells and fibroblasts

PURPOSE: The objective of this study was to conduct an in vitro comparative evaluation of polished and laserdimpled titanium (Ti) surfaces to determine whether either surface has an advantage in promoting the attachment of epithelial-like cells and fibroblast to Ti. MATERIALS AND METHODS: Forty-eight coin-shaped samples of commercially pure, grade 4 Ti plates were used in this study. These discs were cleaned to a surface roughness (Ra: roughness centerline average) of 180 nm by polishing and were divided into three groups: SM (n=16) had no dimples and served as the control, SM15 (n=16) had 5-microm dimples at 10-microm intervals, and SM30 (n=16) had 5-microm dimples at 25-microm intervals in a 2 x 4 mm2 area at the center of the disc. Human gingival squamous cell carcinoma cells (YD-38) and human lung fibroblasts (MRC-5) were cultured and used in cell proliferation assays, adhesion assays, immunofluorescent staining of adhesion proteins, and morphological analysis by SEM. The data were analyzed statistically to determine the significance of differences. RESULTS: The adhesion strength of epithelial cells was higher on Ti surfaces with 5-microm laser dimples than on polished Ti surfaces, while the adhesion of fibroblasts was not significantly changed by laser treatment of implant surfaces. However, epithelial cells and fibroblasts around the laser dimples appeared larger and showed increased expression of adhesion proteins. CONCLUSION: These findings demonstrate that laser dimpling may contribute to improving the periimplant soft tissue barrier. This study provided helpful information for developing the transmucosal surface of the abutment.

Paracrine effect of the bone morphogeneticprotein-2 at the experimental site on healing of the adjacent control site: a study in the rabbit calvarial defect model

PURPOSE: The aim of this study was to assess the possible paracrine effect of bone morphogeneticprotein-2 (BMP-2) at the experimental site on the adjacent control site for validating a rabbit calvarial defect model as a means of verifying the effect of BMP-2. METHODS: Sixteen rabbits were divided into two groups (n=8 in each) according to whether or not BMP-2 would be used. Two circular defects (8 mm in diameter) were created side by side, 2 mm apart, in the calvarium of all of the rabbits. In each animal, one of the defects was grafted with either BMP-2-loaded carrier or carrier material alone. The control defects adjacent to these grafted defects, designated CB (the nongrafted defect adjacent BMP-2-loaded carrier-grafted defect) and CC (the nongrafted defect adjacent to carrier only-grafted defect), respectively, were the focus of this study, and were filled only with a blood clot in all of the animals. Histologic observation and histomorphometric analysis were performed at 2 and 8 weeks (n=4 animals per point in time) after surgery. RESULTS: There was no noteworthy difference in the healing pattern, and no statistically significant differences in histomorphometric parameters such as the defect closure, new bone area, or total augmented area between the CC and CB groups. CONCLUSIONS: The results of this study suggest that rabbit calvarial defects separated by a distance of 2 mm are suitable for evaluating the effects of BMP-2 and the control defect can be regarded not to be affected by BMP-2 applied defect.

Laparoscopic Versus Open Appendectomy for Simple and Perforated Appendicitis in Children / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic appendectomy is a popular surgical treatment of choice for children with appendicitis. This study compared laparoscopic appendectomy (LA) with an open appendectomy (OA) in children with simple appendicitis (SA) and perforated appendicitis (PA) to confirm the safety and effectiveness of the laparoscopic procedure. METHODS: A retrospective medical record review was performed on 193 patients who underwent an appendectomy at our institution from January, 2008 to August, 2011. The demographic properties and postoperative factors including complications were assessed. RESULTS: Among 140 SA, there were 81 and 59 cases of OA and LA, respectively. In SA, the time to bowel movement in LA was shorter than OA (0.9 vs. 1.2 days, p=0.0005) and the number of times analgesics were used in LA were significantly lower than OA (1.8 vs. 2.5, p=0.027). Of 53 PA, 30 cases received OA whereas 23 cases underwent LA. In patients with PA, the LA group were older (124.0 vs. 98.8 months, p=0.027) with a longer operative time (93.5 vs. 68.2 minutes, p=0.02). On the other hand, the time to diet was faster in LA (1.8 vs. 3.2 days, p=0.02). In both SA and PA, there were no significant differences between OA and LA with respect to gender, hospital stay, drain insertion, duration of antibiotics usage, and complications. In SA, the LA group had fewer complications than the OA group with borderline significance. CONCLUSION: LA is a safe and effective way to treat SA and PA in children.

A Case of Endometrial Ossification Treated by Ultrasound-guided Dilatation and Curettage / 대한산부인과학회잡지

The endometrial osseous metaplasia is one of a rare conditions which gynecologist experience clinically. Clinical presentation may include irregular menstration, abnormal uterine bleeding, discharge, dysmenorrhea, pelvic pain, and secondary infertility. However the etiology and treatment about this disease are unclear. Recently, ultrasound-guided management of ectopic bone in uterus was suggested more potentially safer based on reported multi-patients women, a large majority was successfully treated. We have experienced a case of endometrial osseous metaplasia diagnosed and treated by ultrasound-guided dilatation and curettage. Which is presented with a brief review of literatures.

A case of Hyperstimulated Corpus luteal cyst torsion in Pregnancy after In vitro Fertilization / 대한산부인과학회잡지

Ovarian torsion is the fifth most common condition in gynecologic surgical emergencies, with an incidence of 2.7% occuring mainly in women of reproductive age. It is an uncommon but well recognized complication of ovarian stimulation, especially when ovarian hyperstimulation syndrome occurs. Patients with ovarian torsion normally present with an acute abdomen, necessitating an exploratory laparotomy, with removal of the organ when necrosis is evident. Ultrasound may suggest the diagnosis of adnexal torsion. If the ovarian tumor is a luteal cyst, it is also standard to administer progesterone after surgical treatment, although how efficient this treatment is in preventing miscarriage is questionable. A documented case of adnexal torsion associated with in vitro fertilization is hyperstimulated enlarged corpus luteal cyst. Emergency left salpingo-oophorectomy was done and have concluded a successful pregnancy after exogenous progesterone support. We report a case of enlarged corpus luteal cyst torsion in early pregnancy with a brief review of literatures.

A Study for the Prevalence of High-risk HPV Subtype in Uterine Cervical Neoplasia of Korean Women / 대한산부인과학회잡지

OBJECTIVE: Many studies about Human Papilloma virus (HPV) that is a causative factor uterine cervical cancer have been established and more than 85 HPV types have been identified. The distributions of cancer-associated HPV types are different according to nations and region. To estimate the extent of infection with common HPVs among Korean women, we have examined specimens of various cervical lesion. METHODS: The samples were collected from 135 Korean women visiting the Department of Obstetrics and Gynecology, Chunan Hospital Soonchunhyang University, Chunan, Korea. DNA was extracted from the specimen and 112 samples were available. HPV subtype were identified using HPV DNA Chip and P-E ABI prism 310 DNA Autosequencer. RESULTS: HPV DNA was detected in 98 cervical sample (80.3%) out of 122 cases. HPV typing in the samples revealed the prevalence of HPV 16 in 56 cases (57.1%), followed by HPV 58 in 14 cases (14.3%) and HPV 18 were only 2 cases (2.0%) among 98 HPV (+) cases. HPV-negative case was 34.8% and HPV-positive case was 65.2% in CIN I group. HPV-negative case was significantly high in CIN I group. HPV-positive cases were 83 cases (83.8%) in the cases advanced more than CIN I. There were significant difference comparing CIN I group. The order of cervical neoplasia-associated type were HPV-16, -58, -52 and ect. The pattern is similar to the results reported in China and Japanese. CONCLUSION: The finding indicated that the overall prevalence of HPV among Korean women is similar to that in China and Japanese, the distinct high proportion of HPV 58 infection deserves attention. The prevalence of high-risk HPV in Korean women is different from the one in western women but accumulated data from larger population and different regions in Korea is needed.