Prospective Clinical Study of Prophylactic Antibiotic Therapy in Nonperforated Appendicitis

PURPOSE: Prophylactic antibiotics have been used in nonperforated appendicitis for preventing infection after an appendectomy. However, the duration of antibiotic administration for surgical prophylaxis in Korea has been noted to be longer than those recommended in other countries. PURPOSE: The objective of this study was to identify the appropriate duration of prophylactic antibiotic therapy in nonperforated appendicitis by comparing the wound infection rates of two different antibiotic regimens, 24 hours of cephalosporin (cefoxitin) alone and 72 hours of cephalosporin (cefoxitin) with aminoglycoside (sissomicin). METHODS: One hundred thirty-four (134) patients of nonperforated appendicitis were enrolled in this prospective, randomized, open trial and were assigned to one of two antibiotic regimens: 1) cefoxitin 1 g every 8 hours given intravenously for 24 hours and 2) cefoxitin 1 g every 8 hours given intravenously plus sissomicin 75 mg every 12 hours given intramuscularly for 72 hours. First doses were given just prior to the induction of anesthesia. RESULTS: Postoperative wound infections were detected in 3 cases (4.5%) of the 72-hour-treated group (n=66) whereas none occurred in the 24-hour-treated group (n=68). However, the difference in the rates of wound infections between the two groups was not statistically significant. Cost analysis identified a saving of 43,470 won per patient in the 24-hour-treated group. CONCLUSION: In nonperforated appendicitis cefoxitin administration alone for 24 hours is sufficient as a surgical prophylaxis.

Comparison of Clinical Outcome in Para-aortic Lymph Node Dissection (PALD) and D2 for Advanced Gastric Cancer / 대한암학회지

PURPOSE: We compared the clinical results of paraaortic lymph node dissection (PALD) with those of D2 to evaluate the survival gain and disadvantage of paraaortic lymph node dissection for advanced gastric cancer. MATERIALS AND METHODS: We analysed the clinical data of 196 patients who underwent curative resection and D2 with or without paraaortic lymph node dissection (PALD or D2) for advanced gastric cancer from May 1990 to June 1999. The operative factors (operative time, the amounts of intraoperative transfusion and hospital stay), operative morbidity and mortality and 5 year survival rates were compared between D2 and PALD groups. RESULTS: The operative time of subtotal gastrectomy was significantly longer in PALD group than D2 group. The operative morbidity rates were 9.2% in D2 group and 10.3% in PALD group. There were 3 operative mortalities in D2 group and none in PALD group. The 5 year survival rates (5YSR's) of stage IB, II, IIIA, IIIB, IV were 88.9%, 92.3%, 30.2%, 24.2%, 28.9% in D2 group and 93.3%, 75.5%, 61.0%, 0%, 0% in PALD group. CONCLUSION: The paraaortic lymph node dissection was a rather safe procedure without significant increase of morbidity and mortality. There was no statistically significant difference in survival in any stage of this retrospective study with limited cases and follow-ups.

Analysis of Surgical Treatments for Hepatolithiasis According to the Site of Biliary stenosis / 한국간담췌외과학회지

BACKGROUND: Hepatolithiasis is found predominantly in Southeast Asia and although it is a pathophysiologically benign disease, it frequently causes serious problems such as recurrent cholangitis, liver abscess, obstructive jaundice and sepsis. As a result it is said to be a clinically malignant disease. In order to select the best surgical treatment according to location of biliary stenosis, we analyzed the clinical manifestation of hepatolithiasis and follow-up results. METHODS: We retrospectively reviewed 42 cases of hepatolithiasis treated by various surgical treatments from Jan. 1987 to Jun. 1998 at the Department of Surgery of Kangnam General Hospital. RESULTS: In cases where the site of biliary stenosis was limited to the left intrahepatic duct, the relative incidence of good results was higher in the hepatectomy group(88.2%) than in the drainage group(0%). And in cases of biliary stenosis in both intrahepatic ducts, the relative incidence of good results was higher in the hepatectomy group(33.3%) than in the drainage group(0%). And in cases of no biliary stenosis, the relative incidence of good results was high(66.7%) even in the drainage group. CONCLUSION: Hepatic resection is a satisfactory treatment option for patients with hepatolithiasis, especially in the cases of biliary stenosis.

Clinical Results of Para-aortic Lymph Node Dissection in Advanced Gastric Cancer / 대한암학회지

PURPOSE: In gastric cancer, metastasis to the paraaortic lymph nodes had been regarded as an incurable factor, but many cases of long term survival have been reported with dissection of metastatic paraaortic nodes. And several reports suggested survival benefit with paraaortic lymph node dissection (D4) in advanced gastric cancer. In patients with advanced gastric cancer who underwent paraaortic lymph node dissection we tried to evaluate the factors predisposing metastasis in these nodes and survival data. MATERIALS AND METHODS: The authors analyzed retrospectively pathological features of 95 patients who underwent paraaortic lymph node dissection for advanced gastric cancer at Kangnam General Hospital Public Corporation from May 1991 to Feb. 1998. And we also analysed survival results of 72 cases among them. We excluded 18 cases of distant metastasis (3 liver metastasis, 15 peritoneal seeding), 2 operative mortalities, 1 other disease mortality, and 2 unknown causes of death in survival analysis. RESULTS: The frequencies of paraaortic lymph node metastasis were 0.0% (0 of 32 cases) in T2, 19.2% (10 of 52 cases) in T3, 18.2% (2 of 11 cases) in T4. And those of paraaortic lymph node metastasis were 5.8% (3 of 52 cases) in antrum, 14.3% (3 fo 21 cases) in body, 20.0% (3 of 15 cases) in cardia, and 42.9% (3 of 7 cases) in whole area. The five-year survival rates (5 YSR's) in relation to the paraaortic lymph node (No16) status was 0.0% in No16 , and 57.8% in No16 with D4 of advanced gastric cancer. The 5 YSR's were 78.1%, 40.8% and 0% in T2, T3 and T4, respectively and 93.8%, 64.2%, 24.2% and 0.0% in n0, n1, n2 and n3, respectively and 88.9%, 80.5%, 57.9% and 0.0% (47.6%) and 0.0% in stage IB, II, IIIA, IIIB and IV, respectively. CONCLUSION: The depth of gastric wall invasion and the location of primary tumor were significant predisposing factors to para-aortic lymph node metastasis in multivariate analysis (p<0.05). Survival of No16 metastasis was very poor. And three factors of T stage, n stage, and Borrmann type were also prognostically significant in terms of five year survival in cases of D4 of advanced gastric cancer in multivariate analysis (p<0.05).