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Background/Aims@#The incidence of stercoral perforation of the colon (SPC) is expected to rise, given the increased life expectancy and the aging population. On the other hand, the prognostic factors of mortality after surgery for SPC remain unclear. This study examined the prognostic factors of patients with SPC after surgery. @*Methods@#The medical records of 145 patients who underwent surgery for colonic perforation between April 2010 and May 2019 were reviewed retrospectively. In 145 patients, 22 patients who underwent SPC surgery were categorized into the following two groups according to in-hospital survival after surgery: alive (group A, n=15) and dead (group B, n=7). @*Results@#In all enrolled patients, the mean age was 75.7±9.0 years, with a female predominance (female patients, n=19, 86.4%). Sixteen patients (72.7%) had chronic constipation with medications, and five patients (22.7%) were bedridden. The rate of preoperative bedridden status was significantly higher in group B than group A (6.7% vs. 57.1%; p=0.021). Univariate analysis revealed immobility, a sequential organ failure assessment (SOFA) score, and lactate levels of more than 2.0 mmol/L to be factors associated with increased mortality rates in the postoperative period. Multivariate analysis revealed abnormal lactate levels to be the only factor related to mortality (hazard ratio 16.50, 95% CI 1.48-183.07, p=0.022). @*Conclusions@#Preoperative abnormal serum lactate levels may be a risk factor for mortality after surgery in patients with stercoral perforation. Further research will be needed to identify the postoperative prognostic SPC factors.
ABSTRACT
Acupuncture is a well-known traditional medical procedure in Korea and is being increasingly used to treat various conditions including pain control, especially among the older generation. However, several problems related to acupuncture have been reported. A 27-year-old woman expressed that she had back pain occurring despite her posture. She received acupuncture therapy 2 months prior. We discovered a needle-shaped foreign material near the T12 vertebra body in the retroperitoneum. We extracted 2 pieces of deteriorated broken needles by laparoscopy. Postoperatively, the woman was discharged within 5 days with no complications.We report a patient that received laparoscopy with a full recovery after having severe back pain caused by a broken needle which was stuck in the retroperitoneum.
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PURPOSE: This study aimed to examine the outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastasis (PM) of advanced gastric cancer (AGC). MATERIALS AND METHODS: Between May 2015 and June 2017, 38 CRS and HIPEC procedures were performed in patients with PM of AGC at the Dankook University Hospital. We prospectively collected and analyzed data regarding PM grade, morbidity and mortality rates, and short-term follow-up results (median, 13.5 months). RESULTS: The mean peritoneal cancer index was 15 (range, 0–39). Complete cytoreduction was achieved in 21 patients (55.2%), whereas complications occurred in 16 (42.1%) and 2 (5.7%) patients died. The overall median patient survival time was 19 months. The patients who underwent complete cytoreduction had a median survival time of 26 months, which was significantly longer than the median survival time of 16 months in the patients who did not undergo complete cytoreduction (P=0.006). CONCLUSIONS: CRS with HIPEC may have a beneficial effect in patients with PM of AGC. However, the rates of complications and mortality associated with this combined therapeutic approach are high. Therefore, this treatment should be performed only in selected patients by surgeons experienced in the field of gastric cancer with PM.
Subject(s)
Humans , Drug Therapy , Follow-Up Studies , Mortality , Neoplasm Metastasis , Prospective Studies , Stomach Neoplasms , SurgeonsABSTRACT
Duodenal diverticula are common, but perforated duodenal diverticulum is rare. Because of the disease rarity, there is no standard management protocol for perforated duodenal diverticulum. To properly manage this rare complication, a clear preoperative diagnosis and clinical disease severity assessment are important. An abdomino-pelvic CT is an unquestionably crucial diagnostic tool. Perforation is considered a surgical emergency, although conservative treatment based on fasting and broad-spectrum antibiotics may be offered in some selected cases. Herein, we report two cases of perforated duodenal diverticulum, one case managed with surgical treatment and one with conservative treatment.
Subject(s)
Aged , Humans , Male , Middle Aged , Diverticulum/complications , Duodenal Diseases/complications , Endoscopy, Digestive System , Intestinal Perforation/diagnosis , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Aspergillosis infection is associated with high morbidity and mortality in liver transplant recipients. This study investigated the prognosis of liver transplant recipients with a pre-operative treatment for paranasal aspergillosis. METHODS: We collected data from 979 cases of patients who underwent liver transplants at the Samsung Medical Center from May 1996 to Feburary 2010. RESULTS: Eight patients were diagnosed with paranasal aspergillosis after functional endoscopic sinus surgery (FESS), before liver transplantation. In these 8 patients, 7 (87.5%) were male, with a mean age of 55 years. All patients had a hepatitis B virus infection, and 6 patients had hepatocellular carcinoma. The mean days from FESS to liver transplantation was 31 (range, 12~47 days) and anti-fungal agents were not used during these periods. All 8 patients were free from a recurrence of aspergillosis after liver transplantation. CONCLUSIONS: Surgical treatment for paranasal aspergillosis in patients prior to liver transplantation does not induce aspergillosis infection after transplantation.
Subject(s)
Humans , Male , Aspergillosis , Carcinoma, Hepatocellular , Hepatitis B virus , Liver , Liver Transplantation , Prognosis , Recurrence , TransplantsABSTRACT
BACKGROUND: Aspergillosis infection is associated with high morbidity and mortality in liver transplant recipients. This study investigated the prognosis of liver transplant recipients with a pre-operative treatment for paranasal aspergillosis. METHODS: We collected data from 979 cases of patients who underwent liver transplants at the Samsung Medical Center from May 1996 to Feburary 2010. RESULTS: Eight patients were diagnosed with paranasal aspergillosis after functional endoscopic sinus surgery (FESS), before liver transplantation. In these 8 patients, 7 (87.5%) were male, with a mean age of 55 years. All patients had a hepatitis B virus infection, and 6 patients had hepatocellular carcinoma. The mean days from FESS to liver transplantation was 31 (range, 12~47 days) and anti-fungal agents were not used during these periods. All 8 patients were free from a recurrence of aspergillosis after liver transplantation. CONCLUSIONS: Surgical treatment for paranasal aspergillosis in patients prior to liver transplantation does not induce aspergillosis infection after transplantation.
Subject(s)
Humans , Male , Aspergillosis , Carcinoma, Hepatocellular , Hepatitis B virus , Liver , Liver Transplantation , Prognosis , Recurrence , TransplantsABSTRACT
PURPOSE: The aim of this study was to review the epidemiology, clinical features, diagnosis, and effect of treatments of aspergillosis infections in adult liver transplantation patients. METHODS: We retrospectively studied the cases of aspergillosis among 625 (164 deceased donor liver transplantation (DDLT), 461 living donor liver transplantation (LDLT)) adult liver transplantation recipients (> or =18 yrs old) operated between May 1996 to May 2008. RESULTS: Fourteen cases of aspergillosis infection were detected, which consisted of 9 cases of invasive aspergillosis, 5 cases of aspergilloma in maxillary sinuses which occurred before the transplantation. One patient with invasive aspergillosis, who had received liver transplantation overseas and had post-operation care in our center, was also included. Among the 8 cases (1.28%) of invasive aspergillosis (excluding one case operated overseas), 6 cases (3.7%) were DDLT and 2 cases (0.4%) LDLT (P-value<0.05). Among the 6 patients with early onset of invasive aspergillosis, 5 patients (1.8%) had fluconazole and only 1 patient (0.3%) had itraconazole as prophylactic antifungal agent (P-value<0.05). The three cases with localized lesions in the lung survived after lobectomy, but the disseminated and inoperable cases died. CONCLUSION: The incidence of invasive aspergillosis was lower in LDLT cases and prophylactic itraconazole might be more effective than fluconazole. Paranasal aspergilloma, detected before transplantation had no relation with posttransplant invasive aspergillosis infection. Patients who had localized lesion in the lung, and underwent surgery had better survival than who could not.