Acute Cholecystitis in Elderly Patients after Hip Fracture: a Nationwide Cohort Study

BACKGROUND: Because acute cholecystitis in elderly hip fracture is not easily distinguishable from other gastrointestinal symptoms and involves atypical clinical behaviors, it may not be diagnosed in the early stage. However, the exact incidences could not be reported. We utilized data from a nationwide claims database and attempted to assess the incidence of acute cholecystitis in elderly hip fracture patients and how cholecystitis affects mortality rates after hip fracture. METHODS: Study subjects were from the Korean National Health Insurance Service-Senior cohort. From a population of approximately 5.5 million Korean enrollees > 60 years of age in 2002, a total of 588,147 participants were randomly selected using 10% simple random sampling. The subjects included in this study were those who were over 65 years old and underwent surgery for hip fractures. RESULTS: A total of 15,210 patients were enrolled in the cohort as hip fracture patients. There were 7,888 cases (51.9%) of femoral neck fracture and 7,443 (48.9%) cases of hemiarthroplasty. Thirty-six patients developed acute cholecystitis within 30 days after the index date (30-day cumulative incidence, 0.24%). Four of the 36 acute cholecystitis patients (11.1%) died within 30 days versus 2.92% of patients without acute cholecystitis. In the multivariate-adjusted Poisson regression model, hip fracture patients with incident acute cholecystitis were 4.35 (adjusted risk ratio 4.35; 95% confidence interval, 1.66–11.37; P = 0.003) times more likely to die within 30 days than those without acute cholecystitis. CONCLUSION: Incidence of acute cholecystitis in elderly patients after hip fracture within 30 days after the index date was 0.24%. Acute cholecystitis in elderly hip fracture patients dramatically increases the 30-day mortality rate by 4.35-fold. Therefore, early disease detection and management are crucial for patients.

Factors Affecting at 30 Days Mortality after Admission in Severe Trauma patients with Initial Hypotension in the Emergency Department: A Single Center Study

PURPOSE: Early assessment of injury severity is important in management of major trauma patients. In general, hypotensive major trauma patients show more severe outcomes from injuries compared with normotensive major trauma patients. In this study, we analyzed the clinical features of severe trauma patients with initial hypotension and attempted to determine the prognostic factors of mortality in these patients. METHODS: A retrospective study was conducted within our hospital. Review of trauma registry data identified 679 major trauma patients (Injury severity score, ISS>15). From January 2011 to December 2013, all major trauma patients with initial systolic blood pressure lower than 90 mmHg were included (N=77). The patients were divided into two groups - those who survived and those who expired - and the differences in initial and final values were compared between the two groups. RESULTS: Out of a total of 77 patients, 55 patients survived and 22 patients died. The data showed almost no difference in heart rate between the two groups. The expired group showed low Glasgow Coma Scale (GCS) score, systolic blood pressure, revised trauma score, initial pH, and follow-up pH, as well as higher age, ISS, initial lactate, prothrombin time (PT), international normalized ration (INR), and follow-up lactate, compared with the survived group. In multivariate logistic analysis, age (p=0.034, OR 1.071), GCS (p=0.006, OR 0.61), initial base excess (p=0.042, OR 0.57), and follow-up base excess (p=0.041, OR 0.799) were independently associated with mortality. CONCLUSION: The patient's age, initial GCS, initial base excess and follow-up values of base excess were good prognostic factors for mortality in the expired major trauma patients with initial hypotension.

An unusual case of candidemia presenting as acute respiratory distress syndrome after a small bowel bezoar removal operation

We report a rare case of sepsis with acute respiratory distress syndrome (ARDS) caused by Candida parapsilosis and Candida famata after a small bowel bezoar operation. The patient was successfully treated with intensive care including mechanical ventilation and systemic antifungal therapy. A strong association was observed between the intestinal obstruction caused by the bezoar and candidemia presenting as ARDS. This is the first case in which candidemia has led to ARDS after a bezoar removal operation in a patient who was neither immunocompromised nor self-administering an illicit intravenous drug.

Endovascular Aneurysm Repair of the Abdominal Aortic Aneurysm Performed by Vascular Surgeon

PURPOSE: We report our early experience of endovascular abdominal aortic aneurysm repair (EAVR) performed by vascular surgeon. METHODS: A retrospective study was performed based on the medical records of 9 cases operated for EVAR due to abdominal aortic aneurysm at the Eulji University Hospital from Jan. 2007 to Apr. 2008. RESULTS: 9 subjects consisted of 7 males and 2 female and their mean age was 70.0 years. The surgical indications of EVAR were 5 cases of abdominal pain, 3 asymptomatic cases, and 1 of pulsating abdominal mass. The mean diameter of aneurysm, mean diameter of the aortic neck, mean length of the neck and mean aortic neck angle was 56.0 mm, 23.4 mm, 32.0 mm and 46.8o respectively. The mean time for stent-grafting was 241.8 minutes and the mean contrast amount was 301.4 ml. Adjunctive procedures were performed in 3 cases. One case had the type II endoleak from the right internal iliac artery. And all cases showed to be technical and clinical success. Deployment-related complications occurred in 2 cases (access site hematoma and lymphorrhea). Mean length of hospitalization and ICU stay were 10.5, 1.2 days. The mean follow up period was 2.4 months (1~12). There was no newly developed complication such as endoleak and so on. CONCLUSION: In this study, it was shown that vascular surgeon could successfully perform EVAR. In this era of minimal invasive surgery, vascular surgeon should play an important role even in intervention such as EVAR. And it suggests that it requires more effort and the experience of a vascular surgeon.