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Purpose@#This study aimed to investigate the impact of different types of complications on long-term survival following total gastrectomy for gastric cancer. @*Materials and Methods@#A total of 926 patients who underwent total gastrectomy between 2008 and 2016 were included. Patients were divided into the morbidity and no-morbidity groups, and long-term survival was compared between the 2 groups. The prognostic impact of postoperative morbidity was assessed using a multivariate Cox proportional hazard model, which accounted for other prognostic factors. In the multivariate model, the effects of each complication on survival were analyzed. @*Results@#A total of 229 patients (24.7%) developed postoperative complications. Patients with postoperative morbidity showed significantly worse overall survival (OS) (5-year, 65.0% vs. 76.7%, P<0.001) and cancer-specific survival (CSS) (5-year, 74.2% vs. 83.1%, P=0.002) compared to those without morbidity. Multivariate analysis adjusting for other prognostic factors showed that postoperative morbidity remained an independent prognostic factor for OS (hazard ratio [HR], 1.442; 95% confidence interval [CI], 1.136–1.831) and CSS (HR, 1.463; 95% CI, 1.063–2.013). There was no significant difference in survival according to the severity of complications. The following complications showed a significant association with unfavorable long-term survival: ascites (HR, 1.868 for OS, HR, 2.052 for CSS), wound complications (HR, 2.653 for OS, HR, 2.847 for CSS), and pulmonary complications (HR, 2.031 for OS, HR, 1.915 for CSS). @*Conclusions@#Postoperative morbidity adversely impacted survival following total gastrectomy for gastric cancer. Among the different types of complications, ascites, wound complications, and pulmonary complications exhibited significant associations with longterm survival.
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Aortic dissection is one of the causes of acute ischemic stroke. Endovascular recanalization therapy (EVT) has emerged as an essential treatment for acute ischemic stroke due to large artery occlusion. However, it is rarely performed in the situation of hidden aortic dissection (AD). Two patients presented to the emergency room with focal neurologic deficits. The first patient was diagnosed with right internal carotid artery (ICA) occlusion. Angiography revealed that the ICA was occluded by the dissection flap. After a stent deployment in the proximal ICA, the antegrade flow was restored. The patient was diagnosed with AD on chest computed tomography (CT) after EVT. For the second patient, intraarterial thrombectomy was performed to treat left middle cerebral artery occlusion. AD was first detected on echocardiography, which was performed after EVT. Herein, we report successful endovascular recanalization therapy performed in two patients with acute ischemic stroke in the situation of undiagnosed aortic dissection. We also reviewed previous case reports and relevant literature.
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Objective@#: Chronic subdural hematoma (CSDH) is a common neurosurgical disease and generally treated with burr-hole surgery alone. Tranexamic acid (TXA) is an antifibrinolytic agent that potentially reduces recurrence rates and the residual hematoma volume. However, the role of postoperative TXA medication remains unclear to date. This study aimed to verify the effectiveness of adjunctive TXA in the view of early hematoma resolution. @*Methods@#: Between January 2018 and September 2021, patients with CSDH who underwent burr-hole trephination in a single tertiary institute were reviewed. The study population was divided into three groups, TXA, non-TXA, and antithrombotics (AT) groups, according to the medical history of cardio-cerebrovascular disease and TXA administration. The primary endpoint was CSDH recurrence, defined as re-appearance or re-accumulation of CSDH requiring neurosurgical interventions. The secondary outcome was CSDH resolution, defined as complete or near-complete resorption of the CSDH. The CSDH resolution time and serial changes of hematoma thickness were also investigated. @*Results@#: A total of 240 patients was included in the analysis consisting of 185 male and 55 female, with a median age of 74 years. During the median imaging follow-up period of 75 days, 222 patients were reached to the primary or secondary endpoint. TXA was administered as an adjunctive therapy in 41 patients (TXA group, 16.9%) while 114 patients were included in the non-TXA group (47.9%) and 85 were in the AT group. The recurrence rate was the lowest in the TXA group (2.4%), followed by non-TXA (7.0%) and AT (8.2%) groups. However, there was no statistical significance due to the small number of patients with recurrence. CSDH resolution was achieved in 206 patients, and the median estimated time to resolution was significantly faster in the TXA group (p<0.001). Adjunctive TXA administration was a significant positive factor for achieving CSDH resolution (p<0.001). The hematoma thickness was comparable among the three groups at the initial time and after surgery. However, CSDH thickness in the TXA group decreased abruptly in a month and showed a significant difference from that in the other groups (p<0.001). There was no TXA-related adverse event. @*Conclusion@#: The adjunctive use of TXA after CSDH surgery significantly facilitated the resorption of residual CSDH and resulted in the early CSDH resolution. Adjunctive TXA may be an effective treatment option to reduce recurrence by enhancing CSDH resolution in the selective patients.
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Objective@#This study investigates the triggers and clinical features of anaphylaxis, and determines the risk factors associated with severe anaphylaxis. @*Methods@#This is a retrospective observational study spanning a duration of 2 years (2020-2021) using the electronic data of patients diagnosed with anaphylaxis in the university-affiliated emergency center. Severe anaphylaxis was defined as refractory anaphylaxis requiring ≥3 times epinephrine administration and/or continuous epinephrine infusion. Baseline and clinical characteristics were compared between the severe and the non-severe anaphylaxis groups. Binary logistic regression analysis was performed to reveal independent risk factors associated with severe anaphylaxis. @*Results@#The median age of study patients was determined to be 53.0 years (range, 37.5-65.0 years). Fifty-eight patients (58.0%) were male. Drugs were found to be the most common trigger. In clinical manifestations, cutaneous manifestation was the most common. Severe anaphylaxis occurred in 19 patients (19.0%). Latent time was shorter in the severe anaphylaxis group-10.0 minutes (5.0-20.0) vs. 30.0 minutes (10.0-60.0), P<0.001. Drug as a trigger (68.4% vs. 39.5%, P=0.023), hypotension (57.9% vs. 9.9%, P<0.001), cardiovascular manifestation (84.2% vs. 40.7%, P=0.001), and hyperlactatemia (73.7% vs. 46.9%, P=0.036) were more frequently observed in the severe anaphylaxis group. Shorter latent time, drug as a trigger, and presence of hypotension were independent risk factors for severe anaphylaxis. @*Conclusion@#Anaphylaxis patients with shorter latent time, diagnosed with drugs as a trigger, and presenting with hypotension, must be subjected to careful monitoring and early active treatment.
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Objective@#Hip fractures in elderly populations are a major public concern worldwide. This study aims to demonstrate the emergency department (ED)-related factors associated with medical complications in older patients with hip fractures who underwent surgery. @*Methods@#This was a retrospective observational study of 150 elderly patients (≥65 years) presenting with hip fractures in 2020. The data collected were analyzed to investigate medical complications and determine the predictors of complications after a hip fracture surgery by comparing the complication and non-complication group patients. Logistic regression analysis was applied to determine the independent predictors of postoperative medical complications. @*Results@#The overall complication rate was determined to be 39.3%, and delirium (40.7%) was observed to be the most common affliction. Independent walking (adjusted odds ratio [AOR], 0.459; 95% confidence interval [CI], 0.214-0.985), pre-operative medical conditions (AOR, 4.823; 95% CI, 1.735-13.408), and estimated glomerular filtration rate (eGFR; 3rd quartile [AOR, 3.224; 95% CI, 1.086-9.576], 4th quartile [AOR, 5.584; 95% CI, 1.861-16.756]) were independently associated with the development of medical complications post-surgery. @*Conclusion@#The overall incidence of complications following hip fracture surgery is relatively high. Independent walking, preoperative medical condition, and decreased eGFR are independent predictors of postoperative complications that can be screened in the ED in elderly hip fracture patients.
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Background@#Anterior choroidal artery (AchA) aneurysms are usually small in diameter because of the size of the involved artery and are often wide-necked. Coil embolization of AchA aneurysm is thus challenging because of serious risks, such as thromboembolic occlusion of artery and perforation of aneurysm dome. Therefore, aneurysmal neck clipping remains widely performed despite a recent increase in the use of coil embolization for aneurysm treatment. We report the treatment results of AchA aneurysms mostly (92.3%) treated with coil embolization at our institute. @*Methods@#The database and medical records of patients who underwent coil embolization for AchA aneurysms were retrospectively analyzed. The clinical and imaging results and procedure-related complications were investigated after coil embolization performed between January 2006 and March 2022 at our institute. @*Results@#In total, 96 AchA aneurysms comprising 65 unruptured and 31 ruptured aneurysms, including only 1 ruptured aneurysm (1.0%) re-embolized at postoperative day 192 because of coil compaction, were evaluated. After the initial coil embolization, complete occlusion was attained in 41, residual neck in 45, and residual aneurysm in 10 patients. Follow-up radiological studies after 6–174 months were performed for 80 aneurysms. Complete occlusion was noted in 57 patients, residual neck in 22, and residual aneurysm in 1. The dysarthria experienced by one (1.0%) patient was the only symptomatic procedure-related complication. After coil embolization, neither delayed new rupture nor re-rupture was observed. @*Conclusions@#The results of this study demonstrate that coil embolization is a safe and effective treatment option for patients with AchA aneurysms.
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Objective@#This study evaluates the general clinico-toxicological characteristics, and determines whether they are varied with toxin source, in patients admitted to the hospital and diagnosed with grayanotoxin (GTX)/mad honey poisoning. @*Methods@#Patients diagnosed with GTX/mad honey poisoning at the University Teaching Hospital emergency department between January 2001 and December 2015 were included in this retrospective study. The clinico-toxicological characteristics were compared by classifying patients into two groups, according to the toxin source: group A, poisoned by the Himalayan mad honey, and group B, poisoned by biologic materials containing GTX other than Himalayan mad honey. @*Results@#Totally, 26 patients were identified with symptomatic grayanotoxin/mad honey poisoning. There were no statistical differences in the clinico-toxicological characteristics, except systolic blood pressure (SBP). At presentation, the SBP was significantly decreased in group B (P=0.013). Although dizziness and blurred vision were statistically not significant symptoms, there was a trend of significance (P<0.1) in group B. Notably, 5 of the 8 patients who consumed Rhododendron brachycarpum complained of blurred vision, and had a relatively low mean SBP (68.6±15.6 mmHg). @*Conclusion@#The general clinico-toxicological characteristics were similar, subsequent to ingestion of Himalayan mad honey and Rhododendron species. However, since blurred vision and hemodynamic instability were relatively more common in poisoning by R. brachycarpum than other Rhododendron species, emergency physicians need to be aware that the symptoms or severity of poisoning may vary according to the Rhododendron species ingested.
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Objective@#This study evaluated the clinical features of acute Phytolacca poisoning and investigated the prognostic factors associated with severe poisoning. @*Methods@#This is a retrospective observational study using the data of patients presenting with acute Phytolacca poisoning. Demographic data, toxicological data, vital signs, laboratory data, and electrocardiographic data were collected. Study patients were divided into mild and severe poisoning patients. After a univariate analysis, binary logistic regression analysis, which used ‘severe poisoning’ as a dependent variable, was performed to figure out the independent variables. In addition, the area under the curve and the cut-off value of independent variables were suggested by using receiver operating characteristics analysis. @*Results@#Most poisonings (80.5%) occurred in winter and spring. Most patients (98.4%) ingested the root of Phytolacca. It took 2 hours from ingestion to the beginning of the symptoms (interquartile range, 1.0-3.0) which included nausea/vomiting (98.4%), abdominal pain (58.6%), or diarrhea (53.1%). Severe poisoning developed in 21 patients (16.4%). For prediction of severe poisoning, the adjusted odds ratio of time from ingestion to the onset of symptoms was 0.18 (95% confidence interval [CI], 0.05-0.61) and that of the amount of ingestion was 1.42 (95% CI, 0.99-2.03). The area under the curve of time from ingestion to the onset of symptoms (≤1 hour) was 0.81 (95% CI, 0.73-0.88) and that of the amount of ingestion (>1.5 knuckles) was 0.75 (95% CI, 0.65-0.83). @*Conclusion@#Acute Phytolacca poisoning has clinical features of acute enterocolitis. Severe poisoning could develop especially in patients with a rapid onset of symptoms (≤1 hour) and ingesting over 1.5 knuckles.
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Objective@#This study evaluates the general clinico-toxicological characteristics, and determines whether they are varied with toxin source, in patients admitted to the hospital and diagnosed with grayanotoxin (GTX)/mad honey poisoning. @*Methods@#Patients diagnosed with GTX/mad honey poisoning at the University Teaching Hospital emergency department between January 2001 and December 2015 were included in this retrospective study. The clinico-toxicological characteristics were compared by classifying patients into two groups, according to the toxin source: group A, poisoned by the Himalayan mad honey, and group B, poisoned by biologic materials containing GTX other than Himalayan mad honey. @*Results@#Totally, 26 patients were identified with symptomatic grayanotoxin/mad honey poisoning. There were no statistical differences in the clinico-toxicological characteristics, except systolic blood pressure (SBP). At presentation, the SBP was significantly decreased in group B (P=0.013). Although dizziness and blurred vision were statistically not significant symptoms, there was a trend of significance (P<0.1) in group B. Notably, 5 of the 8 patients who consumed Rhododendron brachycarpum complained of blurred vision, and had a relatively low mean SBP (68.6±15.6 mmHg). @*Conclusion@#The general clinico-toxicological characteristics were similar, subsequent to ingestion of Himalayan mad honey and Rhododendron species. However, since blurred vision and hemodynamic instability were relatively more common in poisoning by R. brachycarpum than other Rhododendron species, emergency physicians need to be aware that the symptoms or severity of poisoning may vary according to the Rhododendron species ingested.
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Objective@#This study evaluated the clinical features of acute Phytolacca poisoning and investigated the prognostic factors associated with severe poisoning. @*Methods@#This is a retrospective observational study using the data of patients presenting with acute Phytolacca poisoning. Demographic data, toxicological data, vital signs, laboratory data, and electrocardiographic data were collected. Study patients were divided into mild and severe poisoning patients. After a univariate analysis, binary logistic regression analysis, which used ‘severe poisoning’ as a dependent variable, was performed to figure out the independent variables. In addition, the area under the curve and the cut-off value of independent variables were suggested by using receiver operating characteristics analysis. @*Results@#Most poisonings (80.5%) occurred in winter and spring. Most patients (98.4%) ingested the root of Phytolacca. It took 2 hours from ingestion to the beginning of the symptoms (interquartile range, 1.0-3.0) which included nausea/vomiting (98.4%), abdominal pain (58.6%), or diarrhea (53.1%). Severe poisoning developed in 21 patients (16.4%). For prediction of severe poisoning, the adjusted odds ratio of time from ingestion to the onset of symptoms was 0.18 (95% confidence interval [CI], 0.05-0.61) and that of the amount of ingestion was 1.42 (95% CI, 0.99-2.03). The area under the curve of time from ingestion to the onset of symptoms (≤1 hour) was 0.81 (95% CI, 0.73-0.88) and that of the amount of ingestion (>1.5 knuckles) was 0.75 (95% CI, 0.65-0.83). @*Conclusion@#Acute Phytolacca poisoning has clinical features of acute enterocolitis. Severe poisoning could develop especially in patients with a rapid onset of symptoms (≤1 hour) and ingesting over 1.5 knuckles.
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Objective@#The aims of this study were to determine the prevalence of deep vein thrombosis (DVT) and assess the association of concomitant DVT and unfavorable outcomes in patients with acute symptomatic pulmonary embolism (PE). @*Methods@#We conducted a retrospective analysis of patients with acute symptomatic PE by a computed tomography angiography. Study patients were divided into two groups, including unfavorable and favorable outcome groups. Baseline characteristics and radiologic findings were compared between the two groups. Then, binary logistic regression analysis using the unfavorable outcome as a dependent variable was performed to assess whether concomitant DVT was associated with unfavorable outcomes. @*Results@#Of the 128 patients, 67.2% (86 of 128) had concomitant DVT, and 20.3% (26 of 128) had an unfavorable outcome. The median age was 75.0 years (interquartile range, 63.0-82.0 years), and 76 (59.4%) patients were female. Concomitant DVT and proximal DVT were associated with unfavorable outcomes (P<0.05). In multivariate analysis, proximal DVT (adjusted odds ratio, 7.03; 95% confidence interval, 1.01-49.12) was an independent risk factor of unfavorable outcome. @*Conclusion@#In patients with acute symptomatic PE, about two-thirds of patients had DVT. This study suggests that proximal DVT is significantly associated with unfavorable outcomes.
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Pyometra is a rare clinical entity, leading to life-threatening complications, such as perforation of the uterus and peritonitis, when the diagnosis is delayed. Emergency department physicians should take into consideration whether older women have a fever and abdominal pain. Early surgical drainage and the diagnosis of pyometra should be confirmed. An 89-year-old woman was admitted to the emergency department because of fever and general fatigue. We reported a clinical case of a postmenopausal woman with a large pyometra, which was misdiagnosed as a distended bladder filled with urine.
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Purpose@#The numeric N stage has replaced the topographic N stage in the current tumor node metastasis (TNM) staging in gastric carcinoma. However, the usefulness of the topographic N stage in the current TNM staging system is uncertain. We aimed to investigate the prognostic value of the topographic N stage in the current TNM staging system. @*Materials and Methods@#We reviewed the data of 3350 patients with gastric cancer who underwent curative gastrectomy. The anatomic regions of the metastatic lymph nodes (MLNs) were classified into 2 groups: perigastric and extra-perigastric. The prognostic value of the anatomic region was analyzed using a multivariate prognostic model with adjustments for the TNM stage. @*Results@#In patients with lymph node metastasis, extra-perigastric metastasis demonstrated significantly worse survival than perigastric metastasis alone (5-year survival rate, 39.6% vs. 73.1%, respectively, P<0.001). Extra-perigastric metastasis demonstrated significantly worse survival within the same pN stage; the multivariate analysis indicated that extra-perigastric metastasis was an independent poor prognostic factor (hazard ratio=1.33; 95% confidence interval=1.01–1.75). The anatomic region of the MLNs improved the goodness-of-fit (likelihood ratio statistics, 4.57; P=0.033) of the prognostic model using the TNM stage. @*Conclusions@#The anatomic region of MLNs has an independent prognostic value in the numeric N stage in the current TNM staging of gastric carcinoma.
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Purpose@#With advances in surgical techniques, reduced-port laparoscopic surgery is increasingly being performed for the treatment of gastric carcinoma. Many studies have reported satisfactory short-term outcomes after reduced 3-port laparoscopic gastrectomy (LG). The aim of this study was to investigate the long-term oncological outcomes of 3-port LG in patients with gastric carcinoma. @*Materials and Methods@#We reviewed the medical records of 1,117 patients who underwent LG for gastric carcinoma in three major institutions between 2012 and 2015. The data showed that 460 patients underwent 3-port LG without assistance, and 657 underwent conventional 5-port LG. We compared the overall and disease-free survival rates between the 2 groups. @*Results@#There were 642 male and 475 female patients with a mean age of 56.1 years.Among them, 1,028 (92.0%) underwent distal gastrectomy and 89 (8.0%) underwent total gastrectomy. In the final pathologic examination, 1,027 patients (91.9%) were stage I, 73 (6.5%) were stage II, and 17 (1.5%) were stage III, and there were no significant difference in the pathologic stage between groups. The 3- and 5-port LG groups showed no significant differences in the 5-year overall survival (94.3% vs. 96.7%, P=0.138) or disease-free survival (94.3% vs. 95.9%, P=0.231). Stratified analyses according to pT and pN stages also showed no significant differences in overall or disease-free survival between the two groups. @*Conclusions@#Long-term survival after 3- and 5-port LG was comparable in patients with early-stage gastric carcinoma. The 3-port technique requiring limited surgical assistance may be an appropriate surgical option for this patient population.
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Purpose@#To date, there are no promising treatments for gastric carcinoma with peritoneal metastasis. Some researchers have suggested a survival benefit of gastrectomy in select patients. This study investigated the survival of gastric carcinoma patients with stand-alone peritoneal metastasis according to the type of treatment modality. @*Materials and Methods@#We reviewed the data of 132 patients with gastric carcinoma and stand-alone peritoneal metastasis. We performed gastrectomy when the primary tumor was deemed resectable and systemic chemotherapy was administered. We analyzed patient survival according to the type of treatment, and the prognostic value of gastrectomy was evaluated in univariate and multivariate models. @*Results@#Among all patients, 70 underwent gastrectomy plus chemotherapy, 20 underwent gastrectomy alone, 36 underwent chemotherapy alone, and 6 received supportive care.The median patient survival was 13 months. Patients who underwent gastrectomy had significantly longer survival than those who did not undergo gastrectomy (14 vs. 8 months, P<0.001). Patients who received chemotherapy showed significantly longer survival than those who did not (13 vs. 7 months, P=0.032). Patients who underwent gastrectomy plus chemotherapy showed better survival than those who underwent other treatments. In multivariate analysis, gastrectomy was found to be an independent prognostic factor (hazard ratio, 0.52; 95% confidence interval, 0.33–0.82) in addition to chemotherapy. @*Conclusions@#Our study showed that patients who underwent gastrectomy plus chemotherapy had the best survival. Although the survival benefit of gastrectomy remains uncertain, it is a favorable prognostic indicator in patients with stand-alone peritoneal metastasis.
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Purpose@#The post-operative quality of life (QoL) is a significant concern for patients undergoing gastrectomy. Unlike subtotal gastrectomy, the detailed aspects of QoL involving the ability to perform everyday activities that reflect physical, psychological, and social well-being; and satisfaction with levels of functioning and control of the disease after total gastrectomy remain poorly investigated. @*Materials and Methods@#We enrolled 170 patients who underwent total gastrectomy for gastric carcinoma and completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life questionnaires (QLQ) C30 and STO22 preoperatively and post-operatively at 1, 6, and 12 months. We investigated the QoL change in terms of the minimally important difference (MID), which refers to a score change patients would perceive as clinically important (effect size >0.5). @*Results@#At 1-month post-surgery, MID in global health, physical, social, role, emotional, and cognitive functions was observed at 44.0%, 68.0%, 42.7%, 38.7%, 32.0%, and 16.0% respectively. Of QLQ-C30 symptoms, MID was frequently observed in appetite (52.9%). Of the QLQ-STO22 symptoms, MID was frequently observed in eating restrictions (74.1%), dysphagia (63.5%), pain (51.8%), and anxiety (50.6%). At 12 months post-surgery, MID in global health, physical, role, cognitive, social, and emotional functions was 32.9%, 58.8%, 42.4%, 40.0%, 36.5%, and 17.6%, respectively. Of QLQ-C30 symptoms, MID was frequently observed in diarrhea (52.9%). Of the QLQ-STO22 symptoms, MID was frequently observed in eating restrictions (63.5%), dysphagia (52.9%), body image (55.3%), pain (55.3%), and anxiety (51.8%). Male sex, comorbidity, D2 lymphadenectomy, and post-operative morbidity were associated with MID in global health at 12 months post-surgery. @*Conclusion@#This study provides information about the detailed aspects of impairment in various functions and symptoms of QoL after total gastrectomy. This information can be used to develop a tailor-made management plan for QoL.
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Objective@#May-Thurner syndrome (MTS) is a condition, in which the left common iliac vein is compressed by the right common iliac artery and spine, resulting in an increased risk of deep vein thrombosis (DVT). This study examined the clinical features of MTS and relationship of MTS with a pulmonary embolism (PE) in acute DVT patients. @*Methods@#This study was a retrospective observational study using the electronic medical records of patients with acute DVT in 2018. Acute DVT patients were divided into the MTS group (n=18, 23.1%) and non-MTS group (n=60, 76.9%) according to the presence of MTS. The following items were compared: demographic data, risk factors of DVT, vital signs, laboratory results, involvement site of vein, incidence of PE, and severity of PE. @*Results@#The presence of risk factors was similar in the two groups. All MTS patients had DVT in the left lower extremity. The ilio-femoral DVT (21.7% vs. 77.8%, P<0.001) and mixed DVT (both ilio-femoral and femoro-popliteal, 10.0% vs. 44.4%; P=0.002) were observed more frequently in the MTS group. The incidence of PE was higher in the non-MTS group (65.0%) than in the MTS group (33.3%) (P=0.017). On the other hand, the severity of PE assessed with main pulmonary artery involvement or hemodynamic instability, and right ventricular dysfunction did not show a significant difference between the two groups. @*Conclusion@#DVT could develop with the presence of risk factors in MTS patients. DVT patients with MTS might reduce the risk of developing PE compared to those without MTS, but the severity of PE was similar in the two groups.
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Purpose@#The role of prophylactic abdominal drainage in total gastrectomy is not wellestablished. This study aimed to evaluate the efficacy of abdominal drainage in the prevention and management of major intra-abdominal complications after total gastrectomy for gastric carcinoma. @*Materials and Methods@#We retrospectively reviewed the data of 499 patients who underwent total gastrectomy for gastric carcinoma in a high-volume institution. The patients were divided into drainage and non-drainage groups and compared for the development and management of major intra-abdominal complications, including anastomotic leak, abdominal bleeding, abdominal infection, and pancreatic fistulas. @*Results@#The drainage group included 388 patients and the non-drainage group included 111 patients. The 2 groups showed no significant differences in clinicopathological characteristics or operative procedures, except for more frequent D2 lymphadenectomies in the drainage group. After surgery, the overall morbidity (drainage group vs. non-drainage group: 24.7% vs. 28.8%, P=0.385) and incidence of major intra-abdominal complications (6.4% vs. 6.3%, P=0.959) did not significantly differ between the two groups. The nondrainage group showed no significant increase in the incidence rate of major intra-abdominal complications in the subgroups divided by age, sex, comorbidity, operative approach, body mass index, extent of lymphadenectomy, and pathological stage. Abdominal drainage had no significant impact on early diagnosis, secondary intervention or reoperation, or recovery from major intra-abdominal complications. @*Conclusions@#Prophylactic abdominal drainage showed little demonstrable benefit in the prevention and management of major intra-abdominal complications of total gastrectomy for gastric carcinoma.
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Objective@#As the average life span in modern society continues to increase, much interest is focused on high-risk procedures in elderly patients, including major surgical operations. We investigated the results of endovascular coiling of unruptured intracranial aneurysms (UIA) in patients over 80 years of age. @*Methods@#We retrospectively analyzed 39 patients aged over 80 years who underwent coil embolization for UIA between April 2007 and April 2019 at our hospital. @*Results@#Complete occlusion on digital subtraction angiography (DSA) immediately after surgery was performed in 44 (84.6%) of 52 cases of cerebral aneurysms. Four patients (7.7%) had residual aneurysmal necks, and four (7.7%) had contrast flow in the aneurysmal sac. Follow-up magnetic resonance angiography (mean: 8.2 months) was performed in 37 aneurysms in 24 patients. There was evidence of blood flow in the neck in seven cases (18.9%) and aneurysm in two cases (5.4%). Follow-up DSA (mean: 20.5 months) was performed in 14 aneurysms in 11 patients, and 11 aneurysms (78.6%) had complete occlusion, 1 aneurysm (7.1%) had an aneurysmal neck, and 2 aneurysms (14.3%) had contrast filling into the aneurysmal sac. Coil embolization procedure-related complications occurred in 3 patients (7.7%). Cerebral infarction occurred in 1 (2.6%), arterial dissection in 1 (2.6%), and hypoesthesia in 1 (2.6%). @*Conclusions@#Active treatment of UIA in elderly patients over 80 years of age through endovascular coil embolization can be considered.
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Purpose@#The role of prophylactic abdominal drainage in total gastrectomy is not wellestablished. This study aimed to evaluate the efficacy of abdominal drainage in the prevention and management of major intra-abdominal complications after total gastrectomy for gastric carcinoma. @*Materials and Methods@#We retrospectively reviewed the data of 499 patients who underwent total gastrectomy for gastric carcinoma in a high-volume institution. The patients were divided into drainage and non-drainage groups and compared for the development and management of major intra-abdominal complications, including anastomotic leak, abdominal bleeding, abdominal infection, and pancreatic fistulas. @*Results@#The drainage group included 388 patients and the non-drainage group included 111 patients. The 2 groups showed no significant differences in clinicopathological characteristics or operative procedures, except for more frequent D2 lymphadenectomies in the drainage group. After surgery, the overall morbidity (drainage group vs. non-drainage group: 24.7% vs. 28.8%, P=0.385) and incidence of major intra-abdominal complications (6.4% vs. 6.3%, P=0.959) did not significantly differ between the two groups. The nondrainage group showed no significant increase in the incidence rate of major intra-abdominal complications in the subgroups divided by age, sex, comorbidity, operative approach, body mass index, extent of lymphadenectomy, and pathological stage. Abdominal drainage had no significant impact on early diagnosis, secondary intervention or reoperation, or recovery from major intra-abdominal complications. @*Conclusions@#Prophylactic abdominal drainage showed little demonstrable benefit in the prevention and management of major intra-abdominal complications of total gastrectomy for gastric carcinoma.