Actual compliance rate of Enhanced Recovery After Surgery protocol in laparoscopic distal gastrectomy

Purpose@#The Enhanced Recovery After Surgery (ERAS) protocol enhances recovery rate after laparoscopic distal gastrectomy (LDG). An ERAS protocol has been applied to most patients who underwent LDG at our center. In this study, we determined the actual compliance rate of the ERAS protocol and analyzed the risk factors for noncompliance. @*Methods@#Medical records of 1,013 patients who underwent LDG from March 2016 to December 2017 were reviewed retrospectively. The compliance group (A) included 327 patients who were discharged within four days postoperatively. The noncompliance group (B) comprised 686 patients who were not discharged within four days postoperatively. @*Results@#The compliance rate of the ERAS protocol was 32.3%. Potential compliance rate was 53.2%. Most common reasons for noncompliance were fever (n = 115) and ileus (n = 111). The 30-day emergency room visit rate was significantly lower in group A than that in group B (p = 0.006). Median age, American Society of Anesthesiologists (ASA) physical status classification, operation time, and pathologic stage were significantly higher in group B than those in group A (p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively). Risk factors for noncompliance were ASA classification of ≥III (odds ratio [OR], 2.251; p = 0.007), age of ≥70 years (OR, 1.572; p = 0.004), operation time of ≥180 minutes (OR, 1.475; p = 0.003), and pathologic stage of ≥III (OR, 2.224; p < 0.001). @*Conclusion@#The current ERAS protocols should be applied to patients without risk factors.

The Relation between Rhabdomyolysis and Microscopic Hematuria in Doxylamine Ingested Patients / 대한신장학회잡지

BACKGROUND: Doxylamine is the most commonly intoxicated drug in the emergency room. This drug is relatively safe but is known to induce rhabdomyolysis and acute renal failure in rare occasions. We found the presence of microscopic hematuria in doxylamine intoxicated patients. But no previous studies have documented this hematuria. Our objectives of this study were to determine the incidence of microscopic hematuria after doxylamine overdose and to find the prognostic factors that contribute to this complication. METHODS: This study was conducted from 22 patients admitted to Kyung Hee Medical Center after doxylamine intoxication during the period from January 2001 to December 2003. Using the protocol made beforehand, the amount ingested, past history and laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase (CK) over 1, 000 IU/L. Data were analyzed using SPSS program with t- test, Fisher's exact test and discriminant analysis. RESULTS: The microscopic hematuria was detected in 63.6% of patients. The amount ingested per body weight, presence of rhabdomyolysis and the time when the muscle enzymes reach highest level were related to the hematuria. CONCLUSION: The incidence of microscopic hematuria was higher when more than 30 mg per body weight of doxylamine was ingested than less this amount. Microscopic hematuria suggests the presence of kidney and urinary tract injury. Urine pH of hematuria is over 7.5. Our findings provide no support for the belief that the ferrihemate injures the kidney of doxylamine ingested patients.

Emphysematous Pyelonephritis Associated with Pneumoperitoneum and Pneumomediastinum: A Case Report

Emphysematous pyelonephritis (EPN) is a life-threatening suppurative infection of the renal parenchyma, with formation of gas within the collecting system, renal parenchyma, or perirenal tissues. Since Kelly and MacCullum reported the first case of pneumaturia from a gas-forming renal infection, several terms have been used to describe the condition, such as renal emphysema, pneumonephritis, and emphysematous pyelonephritis. We describe a case of emphysematous pyelonephritis, which presented as an acute abdomen with pneumoperitoneum and pneumomediastinum in a diabetic patient. A subsequent exploratory laparotomy did not identify the site of visceral perforation or the source of infection, and an ensuing nephrectomy with intensive antibiotic therapy was lifesaving. Occasionally, retroperitoneal infection can contaminate the peritoneal cavity and produce gas to create pneumoperitoneum, and retroperitoneal air can migrate to the mediastinum to create a pneumomediastinum. Therefore, we recommend that a differential diagnosis of a pneumoperitoneum or a pneumomediastinum should also include retroperitoneal infection, such as emphysematous pyelonephritis.