The Influence of Nutritional Assessment on the Outcome of Ostomy Takedown

PURPOSE: Ostomy takedown is often considered a simple procedure without intention; however, it is associated with significant morbidity. This study is designed to evaluate factors predicting postoperative complications in the ostomy takedown in view of metabolism and nutrition. METHODS: A retrospective, institutional review-board-approved study was performed to identify all patients undergoing takedown of an ostomy from 2004 to 2010. RESULTS: Of all patients (150), 48 patients (32%; male, 31; female, 17) had complications. Takedown of an end-type ostomy showed a high complication rate; complications occurred in 55.9% of end-type ostomies and 15.7% of loop ostomies (P 1.3 mg/dL) was associated with postoperative complications, particularly surgical site infection (SSI). Marked weight loss such as body mass index downgrading may be associated with the development of complications. CONCLUSION: A temporary ostomy may not essentially result in severe malnutrition. However, a postoperative significant decrease in the albumin concentration is an independent risk factor for the development of SSI and complications.

Usefulness of Self-expandable Metallic Stents for Malignant Colon Obstruction

PURPOSE: Treatment for malignant colonic obstruction consists of a multiple-staged emergency operation. In recent years, some authors have reported low morbidity and mortality rates using self-expandable metallic stents. This study is designed to evaluate the usefulness of self-expandable metallic stents in patients with malignant colonic obstruction. METHODS: The records of 38 patients who had undergone surgery for malignant colonic obstruction at our institution between January 2004 and August 2006 were reviewed retrospectively. Seventeen patients were treated with elective surgery after stent insertion, bowel decompression, and bowel preparation (stent group), and 21 patients were treated with emergency surgery without stent insertion (control group). RESULTS: There were no significant differences in age, sex, tumor node metastasis (TNM) stage, or cancer position between the two groups (elective operation after stent insertion vs. emergency operation). Of the 17 patients who underwent elective operation after stent insertion, primary anastomosis was possible in 15 (88.2 vs. 57.1% in the control group), with a lower need for a colostomy (11.8 vs. 42.9% in the control group, P=0.036). Also, the number of patients with severe complications (17.6 vs. 47.6% in the control group, P=0.048) and the hospital stay (10.82 vs. 13.43 days in the control group, P=0.032) were significantly lower in the study group. CONCLUSION: Placement of a self-expandable metallic stent for malignant colonic obstruction is a safe and effective procedure. It can reduce the colostomy, mortality, and morbidity rates and the hospital fee for treatment.

Management of Traumatic Injury to the Lower Rectum and Anal Sphincter Muscle Combined with Deep Perineal Laceration

Although rare, traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration present substantial diagnostic and management challenges for surgeons. Between February 2004 and February 2006, six patients were treated for traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration at the Department of Surgery, Chonnam National University Hospital. All six patients underwent a diverting colostomy, primary repair, and presacral a drainage, but only three cases underwentva a sphincteroplasty. Three patients who underwent a sphincteroplasty had normal findings on anorectal manometry. Traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration have a high morbidity rate and a great influence on the quality of life. Thus, such injuries require aggressive management, and treatment modalities should be tailored to the individual case.

A Case of Segmental Nectotizing Jejunitis / 대한소아소화기영양학회지

Segmental necrotizing jejunitis is characterized by severe abdominal pain of acute onset, bilious vomitings and foul smelling loose stools containing blood. Pathologic features include circumferential intestinal wall inflammation ranging from edema with minimal congestion to severe congestion, hemorrhage with necrosis, ulceration, and gangrene with perforation. Early diagnosis and suitable supportive measures prevent unnecessary laparatomy and complications. There was no report of this disease entity in children in Korea. We experienced a case of segmental necrotizing jejunitis with fever, abdominal pain and bloody stools, which was diagnosed by exploration and was treated successfully by antibiotics and supportive measures.

Radiological , Biomechanical and Histological Analysis on the Surgical Treatment of Bone Defect in Rabbit Tibia using Glass Ceramics / 대한정형외과학회잡지

To investigate in vivo reaction of newly developed glass ceramics, five milimeters of one proximal tibia of the rabbits were resected and the defect was replaced by ready-made glass ceramics cylinder of 5mm height. As a control, the other intact tibia was used in biomechanical study. Radiological examination was performed every 2 weeks postoperatively. Histological and electromicroscopic examinations were performed postoperatively at 2nd, 4th, 8th and 16th weeks. And fourpoint bending study was performed postoperatively at 8th and 16th week. Following findings were observed : On radiological examination, radiolucent line was seen around glass ceramic at 2-week X-ray. This line was obliterated gradually until 6-week X-ray. Remodelling of medullary cavity was noted from 6-week or 8-week X-ray, and was almost completed at 12-week X-ray. The glass ceramic was innocently incorporated into the host bone. On biomechanical examination, 8-week specimen was broken at 33% of break strength of control group and 16-week specimen was broken at 62%. On histological examination, in 2-weeks specimen, part of implanted glass ceramics was covered with new bone; in 4 weeks, implanted glass ceramics was surrounded by new bone and the surface was tightly bound to the new bone; in 8-week specimen, mature lamellated bone was showed and amount-of bone was increased. Based upon above findings, it was suggested that the glass ceramics was innocently incorporated into the host bone and revealed good biomechanical strength.