Current status of initial antibiotic therapy and analysis of infections in patients with solitary abdominal trauma:a multicenter trial in Korea

Purpose@#Proper use of antibiotics during emergency abdominal surgery is essential in reducing the incidence of surgical site infection. However, no studies have investigated the type of antibiotics and duration of therapy in individuals with abdominal trauma in Korea. We aimed to investigate the status of initial antibiotic therapy in patients with solitary abdominal trauma. @*Methods@#From January 2015 to December 2015, we retrospectively analyzed the medical records of patients with solitary abdominal trauma from 17 institutions including regional trauma centers in South Korea. Both blunt and penetrating abdominal injuries were included. Time from arrival to initial antibiotic therapy, rate of antibiotic use upon injury mechanism, injured organ, type, and duration of antibiotic use, and postoperative infection were investigated. @*Results@#Data of the 311 patients were collected. The use of antibiotic was initiated in 96.4% of patients with penetrating injury and 79.7% with blunt injury. Initial antibiotics therapy was provided to 78.2% of patients with solid organ injury and 97.5% with hollow viscus injury. The mean day of using antibiotics was 6 days in solid organ injuries, 6.2 days in hollow viscus. Infection within 2 weeks of admission occurred in 36 cases. Infection was related to injury severity (Abbreviated Injury Scale of >3), hollow viscus injury, operation, open abdomen, colon perforation, and RBC transfusion. There was no infection in cases with laparoscopic operation. Duration of antibiotics did not affect the infection rate. @*Conclusion@#Antibiotics are used extensively (84.2%) and for long duration (6.2 days) in patients with abdominal injury in Korea.

Endovascular Salvage for Traumatic Midthoracic Aortic Rupture with Left Diaphragmatic Injury

Patients with traumatic aortic rupture rarely reach the hospital alive. Even among those who arrive at the hospital alive, traumatic aortic rupture after high-speed motor vehicle accidents leads to a high in-hospital mortality rate and is associated with other major injuries. Here, we report a rare case of descending midthoracic aortic rupture with blunt diaphragmatic rupture. Successful management with emergency laparotomy after an immediate endovascular procedure resulted in a favorable prognosis in this case.

Hybrid Approach of Ruptured Type B Aortic Dissection with an Aberrant Subclavian Artery in a Single Patient with Turner Syndrome: A Case Report

Turner syndrome, also described as 45, X, may present with most serious cardiovascular anomalies including risk of aortic dissection and rupture. In emergency situation, management for aortic dissection with complicated anatomy accompanying vascular anomaly is challenging. Here, we report a rare case of ruptured type B aortic dissection with aberrant subclavian artery and partial anomalous pulmonary venous connection in a Turner syndrome. Through right carotid-subclavian artery bypass and thoracic endovascular aortic repair, successful hybrid endovascular management correlated with a favorable result in this emergency situation.

A Case of Perimembranous Ventricular Septal Defect Associated with Sinus of Valsalva Aneurysm Mimicking Membranous Septal Aneurysm

Sinus of Valsalva aneurysms are rare. Sinus of Valsalva aneurysms are frequently associated with ventricular septal defect (VSD) and aortic regurgitation. They often remain asymptomatic until abruptly presenting with acute chest pain and heart failure secondary to rupture. Here, we describe a case of 20-year-old man who presented with chest pain with a history of VSD. Initial work-up concluded that the patient had VSD associated membranous septal aneurysm. Four years later, the patient presented with symptoms of heart failure. Work-up showed that the ruptured sinus of Valsalva aneurysm was the cause of symptoms. Due to its close proximity to the aortic annulus, sinus of Valsalva aneurysm should be differentiated from membranous septal aneurysm.

Correlation of blood pressure and the ratio of S1 to S2 as measured by esophageal stethoscope and wireless bluetooth transmission

Esophageal stethoscope has the advantage of being non-invasive, easily placed and capability to monitor the heart sound. This study was designed to determine whether the ratio of S1 to S2 analyzed by esophageal stethoscope and wireless bluetooth transmission can be accurate indicator that express the correlation with blood pressure. Total 33 adult male and female without cardiac disorder and with normal heart rhythm were selected randomly as the subjects of this Study. Two microphones were used with one for acquisition of heart sound by connecting it to the esophageal stethoscope while the other was used to measure the background noise in the operating room. After having transmitted the heart sound measured with the esophageal stethoscope to the receiver by using bluetooth module, it was saved in PC and outputted, following removal of noise in the operating room and the respiratory sound. S1 and S2 were measured with computation of the ratio of S1 to S2. Correlations between the systolic blood pressure with each of the S1, S2 and ratio of S1 to S2 were examined by using correlation analysis. The ratio of S1 to S2 displayed the highest correlation with the systolic blood pressure, with S1 and S2 also displaying positive correlation with the systolic blood pressure. As the result of analysis of the heart sound and the systolic blood pressure measured by using the esophageal stethoscope, the radio of S1 to S2 displayed greater correlation with the systolic blood pressure in comparison to the S1

Risk Factors of Peritoneal Recurrence after Curative Resection of Colorectal Cancer

PURPOSE: Peritoneal recurrence after curative resection of colorectal cancer has been considered to be a lethal condition and to be suitable for palliative chemotherapy. Recently, aggressive approaches such as cytoreductive surgery and perioperative intraperitoneal chemotherapy were introduced for peritoneal malignancies to improve survival. The aim of this study is to identify the risk factors of peritoneal recurrence after curative resection of colorectal cancer and to determine the indication of early postoperative intraperitoneal chemotherapy (EPIC). METHODS: From January 1997 to December 2007, a total of 2,320 patients' records with curative resection for colorectal cancer were collected through the prospective colorectal cancer registry protocol in Kyungpook National University Hospital, Korea. Of those, a total of 1,929 patients were included for analysis of the relationship between perioperative clinicopathologic variables and peritoneal recurrence. RESULTS: The study group was composed of 1,086 men and 843 women with a mean age of 61.1. In multivariate analysis, preoperative level of serum CA19-9>37 U/ml (odd ratio [OR] 3.217; 95% confidence interval [95% CI] 1.525~6.788), right colon cancer (OR 2.524; 95% CI 1.158~5.502), pT4 tumor (OR 2.131; 95% CI 1.009~4.502) and positive apical lymph node (OR 3.045; 95% CI 1.023~9.066) were independent risk factors of peritoneal recurrence after curative resection of colorectal cancer. CONCLUSION: In colorectal cancer patients with increased preoperative serum levels of CA19-9, right-sided location, serosal exposure or invasion of adjacent organ, and positive apical lymph node, more scrupulous surveillance for peritoneal recurrence was necessary during the postoperative follow-up period. In selective patients with risk factors of peritoneal recurrence, more aggressive strategies for management, such as EPIC, were able to be considered under the acceptable general condition and life-expectancy.

A Comparison of the Oncologic Results after Laparoscopic Abdominoperineal Resection and Ultra-low Anterior Resection with Hand-sewn Coloanal Anastomosis for Treating Distal Rectal Cancer / 대한내시경복강경외과학회지

PURPOSE: Abdominoperineal resection (APR) has been regarded as the standard procedure for the treatment of distal rectal cancer since Miles first described it in 1908. But because of the better understanding of the patterns of spreading tumor, the pelvic physiology, the development of stapling devices and introduction of total mesorectal excision (TME), the rate of sphincter preserving surgery has been increasing. The aim of this study is to compare the oncologic outcomes after laparoscopic APR and ultra-low anterior resection with handsewn coloanal anastomosis (CAA) for treating distal rectal cancer. METHODS: Between January 2003 and October 2007, 95 patients who were followed up for more than 2 years after curative laparoscopic APR or CAA for distal rectal cancer were included in this study. The clinical characteristics, pathologic findings, postoperative complications and oncologic results were retrospectively analyzed. RESULTS: There were 31 APRs and 64 CAAs. The median follow-up period was 43 (5~79) months. The mean distance between the lower margin of the tumor and the anal verge was 2.1+/-1.2 cm in APR and 3.7+/-1.4 cm in CAA (p<0.001). There were 2 (6.5%) local recurrences and 8 (25.8%) systemic recurrences after APR and 3 (4.7%) local recurrences and 10 (15.6%) systemic recurrences after CAA, respectively (p=0.641, p=0.161). The 3-year disease-specific survival rate was 86.7% in APR and 93.5% in CAA (p=0.407). The 3-year disease free survival rate was 73.7% in APR and 80.1% in CAA (p=0.161) but there were no significant differences in the oncologic results according to the stages between the two groups. CONCLUSION: The operative procedures are changing toward sphincter preservation. Laparoscopic ultra-low anterior resection and hand-sewn coloanal anastomosis is oncologically as safe as laparoscopic APR for treating lower rectal cancer. However, APR should be considered the standard treatment for distal rectal cancer when it invades the anal sphincter or the levator ani.

Acute Pseudoseptic Inflammatory Local Reactions after Intra-articular Hyaluronic Acid Injections in Patients with Knee Osteoarthritis

Knee osteoarthritis is a common, but difficult problem to manage in primary care. Intra-articular hyaluronic acid injection has recently been frequently used for treating knee osteoarthritis. The adverse local reactions, except septic arthritis, following intra-articular hyaluronic acid injections are generally transient and not severe. Pseudoseptic arthritis is an extreme form of inflammatory arthritis that is not due to bacterial infection and it is important to distinguish this from true septic arthritis. In this article, we report 2 cases of acute pseudoseptic local reactions after intra-articular hyaluronic acid injections in patients with knee osteoarthritis.

Anastomosis Protection with Mallecot in Low Rectal Anastomosis

PURPOSE: Anastomotic leakage following surgery is one of the most significant causes of morbidity and mortality. Therefore, prevention of anastomotic leakage is crucial for safe rectal surgery. The aim of this study is to determine the effect of Mallecot(R) insertion on the prevention of anastomotic leakage after low rectal anastomosis. METHODS: From January 2002 to December 2006, 264 rectal cancer surgeries were performed in one center and by one surgeon. Among them, 110 cases whose anastomosis was located below 6 cm from the anal verge were collected and reviewed retrospectively. We made a diverting stoma on 6 out of 20 patients with high risk of anastomotic leakage, and inserted Mallecot(R) on the remaining 14 patients transanally. Removal of Mallecot(R) was done at the 7th postoperative day after a digital rectal examination to identify the completeness of anastomosis had been performed. RESULTS: Totally, anastomotic leakage occurred in 8 of 110 patients (73%). Among the 90 patients without any preventive measures, 7 incidents of anastomotic leakage were observed; on the other hand, 1 of 14 patients with Mallecot(R) insertion suffered anastomotic leakage. In two of the patients with leakage, including 1 in the Mallecot(R) group, the leakage was resolved via percutaneous drainage; in the other 6 patients were reoperated. CONCLUSIONS: The importance of preventing an anastomotic leakage after low rectal surgery cannot be overemphasized to reduce morbidity and to improve the prognosis. In addition, Mallecot(R) insertion may be an alternative method for diverting stoma formation.

Prognosis of Early Gastric Cancer: Impact of Lymph Node Metastasis

PURPOSE: Early gastric cancer (EGC) is defined as gastric cancer confined to the mucosa or submucosa, regardless of lymph node (LN) metastasis. The prognosis of EGC is more favorable than that of advanced gastric cancer. Due to the variety of prognosis of EGC, in relation to LN metastasis, this study was undertaken to determine the impact of LN metastasis on the survival of patients with EGC, and to aid in planning therapeutic approaches for such patients. METHODS: A retrospective study of 517 patients with EGC, who had undergoing a gastrectomy with lymphadenectomy, between 1990 and 1999 was performed. Stages were classified using the UICC TNM classification (1997). RESULTS: LN metastasis was observed in 67 cases (13.0%). 6.7% (17/288) of the EGC within the mucosa, and 19.0% (50/281) within the submucosa, had LN metastasis. The overall Five-year survival rates (5YSR) of 517 EGC patients was 95.5%, and for the EGC patients in N0, N1, N2 and N3 groups were 98.3, 82.2, 27.8 and 0%, respectively (P<0.001). The 5YSRs for patients with mucosal and submucosal cancers were 98.9 and 92.4%, respectively (P= 0.023), and was poorer in those EGC patients with tumor sizes above 5 cm than in those below 5 cm (5YSR 96.3 and 86.7%, respectively. P=0.020). However, the survival rates for EGC patients did not differ significantly based on the gross and histological types. The 5YSR for EGC patients with stage IA, IB, II and IV were 98.3, 82.1, 40.0 and 33.3%, respectively (P<0.001). LN metastasis and depth of invasion were found to be significant risk factor from the multivariate analysis. CONCLUSION: Based on the results of this study, the significant prognostic factors of EGC were LN metastasis and depth of invasion. Although the prognosis of EGC is favorable, it depends upon the prognostic factors.