Comparison of a Hemorrhoidectomy With Ultrasonic Scalpel Versus a Conventional Hemorrhoidectomy

PURPOSE: A variety of instruments, including circular staplers, ultrasonic scalpels, lasers, and bipolar electrothermal devices, are currently used when performing a hemorrhoidectomy. This study compared outcomes between hemorrhoidectomies performed with an ultrasonic scalpel and conventional methods. METHODS: The study was a randomized prospective review of data available between May 2013 and December 2013, involving 50 patients who had undergone a hemorrhoidectomy for grade III or IV internal hemorrhoids. The hemorrhoidal pedicle was coagulated with an ultrasonic device in the ultrasonic scalpel group (n = 25) and sutured with 3-0 vicryl material after excision in the conventional method group (n = 25). RESULTS: The patients' demographics, clinical characteristics, and lengths of hospital stay were similar in both groups. The mean ages of the conventional and the ultrasonic scalpel groups were, respectively, 20.8 ± 1.6 and 22.4 ± 5.0 years (P = 0.240). In comparison with the conventional method group, the ultrasonic scalpel group had a shorter operation time (P < 0.005), less postoperative pain on the visual analogue scale score (for example, P = 0.211 on postoperative day 1), and less postoperative bleeding (P = 0.034). No significant differences in postoperative complications were observed between the 2 groups. CONCLUSION: A hemorrhoidectomy using an ultrasonic scalpel is an effective and safe procedure. The ultrasonic scalpel reduces the operation time, the postoperative blood loss, and the postoperative pain. Long-term follow-up with larger-scale studies is required to evaluate normal activity after a hemorrhoidectomy performed with an ultrasonic scalpel.

Status and prospect of workforce requirement for surgery in republic of Korea / 대한외과학회지

PURPOSE: In order to prepare long-term alternatives to surgical residency training and workforce policies in Korea, objective data are needed; in addition, determination of the status of surgical procedures being performed is also needed. METHODS: Cases of surgeries performed by board-certified Korean surgeons for 1 year, from July 2009 to June 2010 were reviewed and analyzed. Variation of the last five years was also investigated against the number of surgery cases of the same item and for data on status of population, medical institutions, and surgeons. RESULTS: Difficulty in distribution of a given surgery varied according to the classification of medical institution types, and performance of highly difficult surgeries occurred more in tertiary hospitals. The number of surgeries has increased over the last 5 years (28.1%). The number of surgeries among elderly patients (41.5%), high difficulty (41.8%), and tertiary hospitals (34.9%) has especially increased. There has been no increase in the number of diagnosis related group claim cases for the last 5 years (-0.8%). 43.3% of surgeons working at private clinics in Korea did not present surgery as an indicating item of their clinics. CONCLUSION: While the demand for surgeons in high risk and highly difficult surgeries is continuously increasing, stagnation is expected in the traditional area. Considering the proportion and current status of surgeons working at private clinics, the need for a realistic reduction in the quota of surgical residents and reconsideration of personnel policies is raised.

Difference in Bacteriology and Antibiotics Resistance with the Change of Burn Wound Dressing

PURPOSE: This study aims to analyse the difference in bacteriology and antibiotics resistance on colonization of burn wound by the change of burn wound dressing. METHODS: A retrospective review of all medical records of patients admitted with burns to the burn center of the Hanil General Hospital in 2002 when the conservative wound dressing was managed and in 2009 when the advanced wound dressing was carried out. Patient demographics, extent and type of burn, mortality rates were reviewed. Isolation and identification of microorganisms was done using the standard procedure. Disc diffusion tests were performed for all the isolates for antimicrobial susceptibility. RESULTS: A total of 456 patients in 2002 and a total of 208 patients in 2009 were admitted. Of them, 27 patients in 2002 (Group A) and 35 patients in 2009 (Group B) have the result of colonization on burn wound by surface swab culture after post admission day 7. Mean age was 43.59+/-3.64 (Group A), 49.46+/-2.79 (Group B). The sex ratio of the patients was 1:0.4 with 20 men and 7 women (Group A), 1:0.5 with 24 men and 11 women (Group B). The mean admission day was 61.46+/-12.02 (Group A), 61.62+/-7.55 (Group B). The average value of total body area burned was 32.30+/-4.43 (Group A), 10.40+/-1.73 (Group B). A total of 3 patients (Group A) has inhalation burn. Three patients (Group A) and one patient (Group B) died. The most common cause of burn was flame burn (59.3%) (Group A), scald burn (48.6%) (Group B). The frequency of resistant microorganisms causing colonization on burn wound was 44.44% (Group A), 22.86% (Group B). CONCLUSION: In group managed with the conservative burn dressing, the resistant microorganisms and pathogens are more frequent than in the advanced burn dressing group. However there was no statistically significant. Ongoing data collection and reanalysis is required.

The Case Report of Burn Wound Healing in the Patient with Arteriovenous Fistula

PURPOSE: Arteriovenous fistula (AV fistula) and immune suppressive drug have a different effect on wound healing. AV fistula supposed to have a positive role of wound healing by the increased blood flow around the wound. But immunosuppressive drug has a well known effect of delayed wound healing. METHODS: We experienced 55 years old female patient who suffered from 9% burn of TBSA, 2nd to 3rd degree burn of arm and chest wall with arteriovenous fistula in the burned arm. She also take immunosuppressive drugs for 13 years due to kidney transplantation. RESULTS: She takes two consecutive skin graft operations on post admission day 14 and 42. Bleeding from the surface of eschar excised arm was profuse so it makes us unable to finish in the first operation. But graft skins were well taken except partial take-off in chest wall area. Episode of shock make 2nd skin graft postponed for a month but the skin uptake of arm was very successful. CONCLUSION: The arteriovenous fistula has the positive effect in the case of burn wound healing including the skin graft, exceed the negative role of immunosuppressive drugs in the wound healing.

A Retrospective Epidemiologic Analysis of Elderly Burn Patients at Hanil General Hospital

PURPOSE: This study aims to analyse the epidemiologic characteristics of burn in the elderly and to discusses a possible prevention program for this population. METHODS: A retrospective review of all medical records of elderly patients (above 60 years old) admitted with burns to the burn center of the Hanil General Hospital from January 1996 to December 2007 was carried out. Patient demographics, etiology, extent, and type of burn, seasonal variation, and mortality rates were reviewed. RESULTS: A total of 537 elderly patients (mean age of 69.8 years, median age of 68 years, range 60~97 years) was admitted. The gender ratio of the patients was 1:.5 with 217 men and 320 women. The most common causes were scald burn (44.9%) and flame burn (35.4%). The average total body area burned was 13.5% (range 0~95%). Twenty six patients (4.8%) died. CONCLUSION: In elderly patients, scald burns are more common in women but flame burns are more common in men. The mortality rate is higher in flame burns and men

Clinical Analysis of Cholecystitis: Acalculous Cholecystitis Compared to Calculous Cholecystitis

PURPOSE: The purpose of this study was to analyse the characteristics of acalculous cholecystitis (AC) compared with those of calculous cholecystitis (CC), and also to find the relationship of preoperative radiologic findings to the classification of pathological degree of inflammation of the gallbladder in AC. METHODS: Between March 1996 and June 2000 a total of 163 patients undergoing cholecystectomy for cholecystitis were divided into group AC (21 patients) and group CC (142 patients) and retrospectively studied by analyzing clinical data. RESULTS: The incidence of AC among cholecystitis cases was 12.9%. there was male preponderance in group AC whereas female preponderance in group CC (P<0.036). The pulse rate (P<0.02) and white blood cell count (P<0.003) were significantly elevated in group AC. Possible etiological factors were found in 6 cases (28%) in group AC. The rates of preoperatively observed pericholecystic fluid collection in US (P<0.033) and dilatation of the gallbladder in CT (0.012) were significantly higher in group AC than in group CC. Additionally, the rate of tube drainage during surgery was significantly higher in group AC than group CC (P<0.02). Finally, wall thickness (P<0.05), dilatation (P<0.05) of the gallbladder in CT and the total sum of findings in CT (P<0.01) and US (P<0.05) were strongly related to the degree of inflammation of the gallbladder. CONCLUSION: The majority of AC patients exhibit nonspecific clinical findings, often delaying diagnosis; however, if it develops, AC tends to display more acute and inflammatory characteristics than calculous cholecystitis. laparoscopic surgery cannot be sucessful in cases of delayed diagnosis. US, CT and scintigram are useful diagnostic tools if we interpretate each finding in relation to the severity of inflammation.

Clinical Analysis of Patients with Acute Appendicitis Operated on during

PURPOSE: During the night time decision making on patients suspicious of appendicitis is often difficult because diagnosis and timing for operation are frequently delayed. Therefore, we analyzed above cases and solution is suggested. METHODS: This retrospective study included 360 patients who underwent laparotomies for suspected appendicitis at Hanil Hospital during one year, from March 1998 to Feb. 1999. They were divided into two groups according to presenting time to physician (Day time: 6 a.m. to 6 p.m., Night time: 6 p.m. to 6 a.m.). Sex & age distribution, time of presentation to physician, duration of symptoms, symptoms & physical findings, white blood cell counts, interval from presentation to operation, hospital stay, and pathologic diagnosis were compared. RESULTS: There were no significant differences in sex & age distribution, duration of symptoms, symptoms & physical findings, white blood cell counts, pathologic diagnosis between the two groups. However, during the night time, the interval from presentation to operation was longer than that of the day time (9.15 hours versus 4.83 hours, p<0.001), the rate of delayed appendectomy during the night was 58.0%, the rate of negative laparotomy increased when appendectomy was delayed for more than 12 hours compared with less than 12 hours (28.1% vs 11.7%, p<0.01), and in the cases with perforated appendicitis, delayed appendectomy for more than 12 hours had longer hospital stay compared with less than 12 hours (12 days vs 9.44 days, p<0.01). Factors causing delayed appendectomy were related to the physician (42.5%), lack of anesthetic & nursing supports (19.5%), failure to structure the operation team (20.7%), and patient itself (17.3%). When white blood cell counts were rechecked in the next morning, levels above 10,000 cells/mm3 were highly associated with appendicitis in contrast to that below 10,000 cells/mm3 (91.7% vs 43.5%, p<0.002).

The Effect of Glutamine and Cabbage-Supplemented Oral Total Parenteral Nutritional Feeding on Gut Immunity in Rat Including Bacterial Translocation to Mesenteric Lymph Nodes

BACKGROUND : Treatment of a severe burn injury with total parenteral nutrition can produce bacterial translocation to mesenteric lymph nodes through the intestinal mucosa due to permeability changes. Early enteral feeding will help to restore the mucosal barrier function. Certain nutrients may have a beneficial effect on bacterial translocation and gut immunity. METHODS : We choose the glutamine and korean cabbage as dietary factors to study the beneficial effect on gut immunity of feeding different dietary formulations of low amino acid concentrated total parenteral nutritional fluids in burned rats. Forty-eight (48) male pathogen-free Sprague-Dowley rats were allocated in 4 groups(group A, control chow diet and water ad libitum; group B, oral TPN diet; group C, oral TPN diet supplemented with 2% glutamine; and group D, oral TPN diet supplemented with korean cabbage). All groups, except control group A, recieved 40% total body surface area, full-thickness burn injury. Group A received sham burn injury. Bacterial translocation to mesenteric lymph nodes, the cecal bacterial population level, the intestinal mucosal protein content, and the total IgA of the intestinal luminal washing fluid were measured and light-microscope changes of the small intestine were observed in the rats on the 4th and the 7th days after corresponding diet intake. RESULTS : The incidence of bacterial translocation in the oral TPN diet group B was reduced signifi cantly compared with control group A and glutamine supplemented group C on 4th day postburn (p< 0.05) The cecal bacterial population level of control group A showed significant lower values, compared with the other groups, in total aerobic (on 4th day p<0.01, on 7th day p<0.01) and gram-negative enterics species (on 4th day p<0.01, on 7th day p<0.05). The mucosal protein amount per cm of length of intestine was decreased slightly in groups B, C, and D, compared with the control group A, but without statistical significance, on the 7th day postburn. The total (serum and secretary) IgA per cm of length of intestine was increased significantly in the glutamine-supplemented group C and the cabbage- sup plemented group D on the 7th day postburn, compared with the oral TPN group B (p<0.05). However,there was no corresponding decrease in the bacterial translocation ratio or the cecal bacterial population level. Histologic observations on the 4th and the 7th days of glutamine-supplemented group C & cabbage- supplemented group D revealed increases in the villous height, and the numbers of villous cells and goblet cells, compared with the oral TPN group B. A slight desquamation of the villous cells was observed in the cabbage-supplemented group on the 7th day. CONCLUSION : In summary, early enteral feeding is not sufficient to avoid bacterial translocation. Certain nutritional factors such as glutamine are helpful in overcoming the bacterial translocation in burned rats. Korean cabbage was beneficial became promoted an IgA increase in the intestine without a direct effect on the bacterial translocation.