Analysis of the Risk Factors in Colorectal Injuries

PURPOSE: To evaluate factors that influence morbidity and mortality in colorectal injuries. METHODS: We reviewed the medical records of 59 patients who underwent emergency operation in JNUH from Jan. 1988 through Dec. 1997. Univariate and multivariate analyses were used to calculate the prognostic significance of the following variables: sex, age, time to operation, preoperative shock, penetrating abdominal trauma index (PATI), APACHE II score, site of injury, organ injury scale (OIS), Flint grade, associated intraabdominal injuries, the sum of transfusion during 48hours of preoperative and postoperative period and operative method. RESULTS: Univariate analysis showed that colorectal organ iujury scale, and operative method were related to the complication, and preoperative shock, APACHE II score, PATI, and transfusion in 48hrs of injury were related to the mortality of colorectal injury. Multivariate logistic regression analysis showed that colorectal organ injury scale (2 vs 1) was significant risk factor in the development of complication, and the odds ratios were 5.0 and 1.69 respectively. The sum of transfusion in 48hours of injury was a only significant risk factor in the mortality and the odds ratio was 1.5. CONCLUSIONS: We concluded that preoperative condition was very important and preservation of hemodynamic stability was critical in improvement of prognosis. We also concluded that the shortening of operative time and proper management of associated injury may reduce the development of complication and even death.

A Case of Extraskeletal Osteosarcoma in the Abdominal Wall after Low Anterior Resection Due to Rectal Cancer

The case of a 44-year-old female with extraskeletal osteosarcoma is reported. She had been treated by low anterior resection and radiation therapy due to rectal cancer (Modified Duke's classification B2) about 35 months ago. Also, she had a history of hematoma formation in a previous incision scar of the low mid-abdomen due to a fall. The patient developed a hard, nontender, fixed mass in the low abdominal wall after the hematoma. Treatment consisted of a wide surgical excision and local advanced flap. To our knowledge, an osteosarcoma of the abdominal wall is very rare, but the outlook for recovery is grave.

A Case of Extraskeletal Osteosarcoma in the Abdominal Wall after Low Anterior Resection Due to Rectal Cancer

The case of a 44-year-old female with extraskeletal osteosarcoma is reported. She had been treated by low anterior resection and radiation therapy due to rectal cancer (Modified Duke's classification B2) about 35 months ago. Also, she had a history of hematoma formation in a previous incision scar of the low mid-abdomen due to a fall. The patient developed a hard, nontender, fixed mass in the low abdominal wall after the hematoma. Treatment consisted of a wide surgical excision and local advanced flap. To our knowledge, an osteosarcoma of the abdominal wall is very rare, but the outlook for recovery is grave.

Clinical Review of Crohn's Disease

PURPOSE: Crohn's disease is chronic, nonspecific inflammatory process and the incidence is becoming larger recently. The authors studied the clinical course of the Crohn's disease by reviewing the clinical characteristics, anatomical distribution, operative indications, operative procedures and postoperative results. METHODS: We reviewed medical records of 30 patients who had treatment at the Chonbuk national university hospital from June 1988 to December 1997. We analyzed their age, sex distribution, clinical symptoms, anatomical distribution, operative indication, operative procedure, postoperative recurrence rate and postoperative results. RESULTS: Sex ratio was 1.5:1 (male:female) and average age of onset was 33 year. Thirteen patients (43%) underwent operation but there was no remarkable difference between the groups that received operation and that had medical treatment. Abdominal pain and diarrhea were common but there were no extraintestinal symptoms. The most common site of involvement was ileocecum and the next was small intestine, followed by large intestine. Intestinal obstruction was the most common indication for surgery and fistula, abscess formation and palpable abdominal mass in order. Three cases out of 13 patients who had undergone primary resection needed second operation, and 2 cases of the 3 recurrent cases underwent the third operation. During the follow up period, there were two cases of re-operation due to anastomotic leak or ileus. The patient who received the third operation (right hemicolectomy, retroperitoneal abscess drainage and jejunal resection) died of anastomotic leak, enterocutaneus fistula, sepsis and respiratory failure. CONCLUSIONS: The incidence of Crohn's disease in Korea is gradually increasing and the disease has been challenging problems to most surgeonsfor its frequent surgical indication, high recurrence rate, complication and poor surgical results. The above results suggest that Crohn's disease needs follow-up even after the operation.

Effect of Enalapril Treatment on Erythrocytosis after Renal Transplantation

Posttransplant erythrocytosis (PTE) is a common complication of renal transplantation. It afflicts 5-15 % of renal transplant recipients with good renal function and is associated with an increased incidence of thromboembolic events. Traditional therapies for PTE include serial phlebotomy and native nephrectomy, neither of which has proved optimal. Recently, angiotensin converting enzyme (ACE) inhibitors have been developed as an alternative for PTE treatment. The aim of the study was to evaluate the therapeutic effect of an ACE inhibitor, enalapril, on PTE by the measurement of serum erythropoietin (EPO) level. Ninety consecutive cyclosporine (CsA)-treated recipients who have received living donor kidneys were investigated during the first two years. Eleven recipients (12.2%) had developed PTE, and ten of them were prospectively treated with enalapril (5-10 mg/day) for 1 year for PTE. The average age for the nine men and one woman was 32+/-7.8 years . All retained their native kidneys. Seven recipents were hypertensive, 5 on diuretics, and 2 were smokers. Serum creatinine was 1.4+/-0.3 mg/dl. Onset of PTE occured 9.8+/-5.5 months posttransplant. Duration of PTE was 7.7+/-6.8 mos (range 1-24 mos). Three had undergone 1-2 phlebotomies during the previous year. None had experienced thromboembolic event. In 10 recipients, hematocrit (HCT) during 3 clinic visits before treatment was 55.8+/-3.4 %. After the application of enalapril, HCT in all recipients decreased. Mean HCT at 3 months was decresed to 44.1+/-3.3 % (p<0.001 vs. pre-enalapril values). One patient became anemic (HCT<40 %). One patient who had initially responsed to enalapril stopped using the drug due to dry cough and suffered a recurrence of PTE. Serum EPO levels (RIA) decresed significantly, from a mean of 15.6+/-6.7 to 8.7+/-3.8 mU/ml at 2 month (p<0.05), although the values were within the normal range for our laboratory. Regardless of pre-enalapril EPO level, the HCT normalized in all patients. Mean arterial pressure decreased (105.2+/-14 vs. 97.2+/-12 mmHg, p<0.05) at 12th month. Serum creatinine did not change (1.4+/-0.3 vs. 1.5+/-0.4 mg/dl) during the study period. No patient required phlebotomy after starting enalapril. We conclude that enalapril administration resulted in a reversible decline of HCT to normal levels in renal transplant recipients with PTE. Clinically, enalapril is a safe and effective alternative to traditional treatment of PTE.