Clinical outcome of graft removal versus preservation in abdominal aortic graft infection: a systematic review and meta-analysis

Purpose@#The purpose of this study was to compare the clinical outcomes of abdominal aortic graft infection (AGI) treated with removal of the graft vs. graft preservation. @*Methods@#The electronic databases PubMed, Embase, and Cochrane Library for studies that reported on AGI were searched. Observational studies and case series of at least 10 cases that reporting on the prevalence, microbiology, and outcomes of AGI were included. @*Results@#Our search identified 23 studies that met our inclusion criteria, reporting on a total of 873 patients who underwent open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Of these patients, 833 received graft removal, and 40 received graft preservation. The prevalence of AGI was reported to be 1.0% (95% confidence interval [CI], 0.5%–1.8%) after OSR and 0.4% (95% CI, 0%–1.1%) after EVAR. The pooled estimates of 1-year, 2-year, and 5-year mortality were 28.7% (95% CI, 19.4%–38.8%), 36.6% (95% CI, 24.6%–49.5%), and 51.8% (95% CI, 38.4%–65.1%) in the graft removal group and 16.1% (95% CI, 4.1%–32.2%), 18.5% (95% CI, 5.7%–35.1%), and 50.0% (95% CI, 31.6%–68.4%) in the graft preservation group.The 30-day mortality rate’s risk ratio (RR) for graft removal vs. preservation was 0.98 (95% CI, 0.40–2.38), while the 1-year mortality rate’s RR was 3.44 (95% CI, 1.60–7.42). @*Conclusion@#The 30-day mortality rate of AGI treatment was found to be high, whether using graft removal or preservation.In selected patients, implementing antibiotics with graft preservation as an initial management may be helpful in reducing the mortality rate.

Relationship between Coffee Consumption and Metabolic Syndrome in Korean Adults: Data from the 2013–2014 Korea National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: The gradually increasing demand for coffee worldwide has prompted increased interest in the relationship between coffee and health issues as well as a need for research on metabolic syndrome in adults. METHODS: Data from 3,321 subjects (1,268 men and 2,053 women) enrolled in the 2013–2014 Korean National Health and Nutrition Examination Survey were analyzed. The subjects were divided into three groups according to their daily coffee consumption. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for metabolic syndrome in the coffee-drinking groups were calculated using multiple logistic regression analysis by adjusting for confounding variables. RESULTS: The prevalence of metabolic syndrome was 15.5%, 10.7%, and 9.7% in men and 3.0%, 7.1%, and 6.5% in women according to their coffee consumption (less than one, one or two, or more than three cups of coffee per day), respectively. Compared with the non-coffee consumption group, the ORs (95% CIs) for metabolic syndrome in the group that consumed more than three cups of coffee was 0.638 (0.328–1.244) for men and 1.344 (0.627–2.881) for women after adjusting for age, body mass index, household income, education, smoking, alcohol, regular exercise, and daily caloric intake. CONCLUSION: The OR of metabolic syndrome was not statistically significant in both men and women.

Tumescent local anesthetic technique for inguinal hernia repairs

PURPOSE: We evaluated the adequacy and feasibility of a tumescent solution containing lidocaine and bupivacaine for inguinal hernia repairs. METHODS: The medical records of 146 consecutive inguinal hernia patients with 157 hernia repairs using the tumescent local anesthesia technique performed by a single surgeon between September 2009 and December 2013 were retrospectively reviewed. RESULTS: The mean operation time (+/-standard deviation) and hospital stay were 64.5 +/- 17.6 minutes and 2.7 +/- 1.5 days. The postoperative complication rate was 17.8%. There were four cases of recurrences (2.5%) at a mean follow-up of 24 +/- 14 months. CONCLUSION: Our results suggest that local anesthesia with the tumescent technique is an effective and safe modality for inguinal hernia repairs.

Prospective nonrandomized comparison of quality of life and recurrence between high ligation and stripping and radiofrequency ablation for varicose veins / 대한외과학회지

PURPOSE: Varicose veins are a major problem worldwide and improvement in quality of life (QoL) is the ultimate goal after treatment of this benign disease. However QoL is highly dependent on personal and social factors. This study compares high ligation and stripping (HS) and radiofrequency ablation (RFA) in terms of QoL and recurrence in Korea. METHODS: A retrospective analysis of prospectively collected data between August 2006 and October 2008 was performed for patients undergoing HS and RFA at a single institution. QoL was assessed with a questionnaire preoperatively, at 3 months postoperatively and annually thereafter. Recurrence was assessed by Duplex ultrasound annually after surgery. RESULTS: A total of 272 patients completed the questionnaire at 3 months. Among these patients, 155 patients returned for their annual follow-up. There were no significant differences between HS and RFA in global QoL scores, although RFA showed less pain. However, paresthesia rates were also higher after RFA. Recurrence rates were similar between the two modalities, although technical failures were more common after RFA. CONCLUSION: Overall QoL and recurrence rates were similar between the two modalities. The benefits of RFA do not seem to be enough to overcome the higher costs of HS in Korea.

Differences in the Survival of Gastric Cancer Patients after Gastrectomy according to the Medical Insurance Status

PURPOSE: In Korea, the entire population must enroll in the national health insurance system, and those who are classified as having a lower socioeconomic status are supported by the medical aid system. The aim of this study was to evaluate the association of the medical insurance status of gastric cancer patients with their survival after gastrectomy. MATERIALS AND METHODS: A total of 247 patients who underwent surgical treatment for gastric cancer between January 1999 and December 2010 at the Seoul Medical Center were evaluated. Based on their medical insurance status, the patients were classified into two groups: the national health insurance registered group (n=183), and the medical aid covered group (n=64). The survival rates were calculated using the Kaplan-Meier method. RESULTS: The median postoperative duration of hospitalization was longer in the medical aid covered group and postoperative morbidity and mortality were higher in the medical aid group than in the national health insurance registered group (P<0.05). The overall 5-year survival rate was 43.9% in the medical aid covered group and 64.3% in the national health insurance registered group (P=0.001). CONCLUSIONS: The medical insurance status reflects the socioeconomic status of a patient and can influence the overall survival of gastric cancer patients. A more sophisticated analysis of the difference in the survival time between gastric cancer patients based on their socioeconomic status is necessary.

Clinical Correlation between Gastric Cancer Type and Serum Selenium and Zinc Levels

PURPOSE: We conducted this study to study the clinical correlation between the characteristics of gastric cancer and serum selenium and zinc levels. MATERIALS AND METHODS: The following data were measured in the baseline serum selenium and zinc levels of 74 patients with curative gastrectomy subsequent to confirmed gastric cancer, from March 2005 to August 2012. RESULTS: Among the 74 gastric cancer patients, 53 patients were male. Mean serum selenium and zinc levels were 118.7+/-33.1 ug/L and 72.2+/-24.3 ug/dl, respectively. Seven patients (9.5%) showed lower selenium level, and 33 patients (44.6%) showed lower zinc level. Serum Selenium level was 99.1+/-31.8 ug/L in cardia cancer group (10 cases) and 121.8+/-32.4 ug/L in non-cardia cancer group (64 cases)(P=0.044). According to tumor gross type, zinc level was 78.7+/-29.6 ug/dl in early gastric cancer (33) and 66.9+/-17.8 ug/dl in advanced gastric cancer (41) (P=0.064). CONCLUSIONS: The serum selenium level was highly correlated with the location of gastric cancer. The serum zinc level was lower in advanced gastric cancer.

Clinical Correlation between Gastric Cancer Type and Serum Selenium and Zinc Levels

PURPOSE: We conducted this study to study the clinical correlation between the characteristics of gastric cancer and serum selenium and zinc levels. MATERIALS AND METHODS: The following data were measured in the baseline serum selenium and zinc levels of 74 patients with curative gastrectomy subsequent to confirmed gastric cancer, from March 2005 to August 2012. RESULTS: Among the 74 gastric cancer patients, 53 patients were male. Mean serum selenium and zinc levels were 118.7+/-33.1 ug/L and 72.2+/-24.3 ug/dl, respectively. Seven patients (9.5%) showed lower selenium level, and 33 patients (44.6%) showed lower zinc level. Serum Selenium level was 99.1+/-31.8 ug/L in cardia cancer group (10 cases) and 121.8+/-32.4 ug/L in non-cardia cancer group (64 cases)(P=0.044). According to tumor gross type, zinc level was 78.7+/-29.6 ug/dl in early gastric cancer (33) and 66.9+/-17.8 ug/dl in advanced gastric cancer (41) (P=0.064). CONCLUSIONS: The serum selenium level was highly correlated with the location of gastric cancer. The serum zinc level was lower in advanced gastric cancer.

Safety and efficacy of laparoscopic radiofrequency ablation for hepatic malignancies / 대한외과학회지

PURPOSE: Radiofrequency ablation (RFA) is an accepted treatment option for primary and metastatic liver tumors. As percutaneous RFA has some limitations, laparoscopic RFA (LRFA) has been used as a therapeutic alternative for the treatment of hepatic malignancies. METHODS: Between March 2006 and September 2009, thirty patients with hepatic malignancies that were contraindicated for resection or percutaneous RFA underwent LRFA. Indications for this procedure were hepatocellular carcinoma (HCC, 21 patients), metastatic liver tumor (8 patients) and intrahepatic cholangiocarcinoma (1 patient). RESULTS: Among the 30 patients who underwent LRFA, 5 patients underwent concomitant laparoscopic liver resection. Intraoperative laparoscopic ultrasound detected new malignant lesions in 4 patients (13.3%). A total of 46 lesions were ablated by LRFA. There was no postoperative mortality. The three-year overall survival rate was 83.7% for the HCC group and 64.3% for the metastatic group. CONCLUSION: LRFA for hepatic malignancies proved to be a safe and effective treatment. Also, this procedure is indicated for lesions that are not amenable to percutaneous RFA or liver resection.

Differentiated Muscle-derived Stem Cells Attenuate Intimal Hyperplasia after Carotid Balloon Injury in Rat

PURPOSE: Although progenitor cells may contribute to intimal hyperplasia (IH) after arterial injury, positive contribution of IH is variable with type of injury or cells. This study was designed to examine whether differentiated muscle derived stem cells (MDSC) attenuate IH in rat. METHODS: MDSCs were retrieved using preplate techniques from rat calf muscle and MDSCs (preplate 6th culture fraction, pp6) were exposed to VEGF (50 ng/ml) for endothelial differentiation prior to injection. Male rats were divided into two groups (cell treated vs. control) and underwent carotid balloon injury with 2-Fr catheter. The virus containing Green fluorescent protein (GFP) gene was transfected into cells for monitoring. Cells (5x10(6)) were indwelled into carotid artery for 30 minutes after injury and then blood flow was restored. Arteries were harvested at various intervals (1, 2 and 4 weeks) after injury. The intima to media thickness ratio (IMTR) was calculated with morphometric analysis. RESULTS: Endothelial surface markers such as VE-CADHERIN were strongly expressed on differentiated MDSCs. At 4 weeks after injury, IH was predominantly observed in control group compared to cell treated group. The intensity of GFP was strongly observed at 1 week and declined at 4 weeks in carotid artery wall at MDSC group. CD31(+) endothelial cells were observed at MDSC group compared to control. The mean IMTR in cell treated groups were significantly lower than control at 2 weeks (P=0.005) and 4 weeks (P< or =0.001). CONCLUSION: Our study demonstrates that MDSCs therapy promotes re-endothelialization and leads to attenuation of IH after balloon injury in rat.

EVAR with Hypogastric Artery Bypass in Patient with Abdominal Aorto-Iliac Aneurysm

Endovascular aneurysm repair (EVAR) of combined abdominal and iliac aneurysm requires exclusion of the hypogastric artery for prevention of endoleak. However, exclusion of the hypogastric artery is often associated with significant ischemic complications such as hip or buttock claudication, gluteal necrosis and bowel ischemia. Several techniques have been introduced to preserve the flow of the hypogastric artery. We report a successful case of external iliac artery-to-hypogastric artery bypass with artificial graft combined with EVAR.

Malignant Peripheral Nerve Sheath Tumor of the Pancreas: A Case Report

Malignant peripheral nerve sheath tumor (MPNST) is rare, soft tissue, spindle cell sarcoma of an ectomesenchymal origin. MPNSTs frequently occur in the extremities and trunk, whereas there has been only one previous report of MPNST originated from the pancreas. A 55-yr-old previously healthy man was admitted for a pancreas head mass, which was detected during a routine health inspection. Fine needle aspiration biopsy showed atypical cells that were suspicious for malignancy. On open exploration, a 2.6cm sized hypervascular well capsulated mass was seen between the duodenal first portion and the pancreas head, and so enucleation was performed. The tumor was composed with spindle cells without a typical storiform pattern and the cells were positive for mesenchymal antigen, S-100 and vimentin, whereas they were negative for epithelial membrane antigen and cytokeratin. It was concluded that the tumor was a MPNST with perineural cell differentiation. Primary MPNST of the pancreas is extremely rare and performing immunohistochemical staining is necessary for making its diagnosis.