Effect of stent graft fixation types on pararenal aortic diameter and renal function after endovascular aortic repair.

BACKGROUND: This study aims to identify pararenal aortic diameter changes following endovascular aortic repair and to investigate the effects of suprarenal fixation on renal function. METHODS: Between May 2006 and January 2019, a total of 168 patients (135 males, 33 females; mean age: 75.2±8.4 years; range, 48 to 93 years) who underwent endovascular aortic repair were retrospectively analyzed. To compare the effects of graft types, we measured the change in pararenal aortic diameter at four levels: below the celiac artery, below the superior mesenteric artery, at the lowest renal artery, and 1 cm below the lowest renal artery. To evaluate the effect of suprarenal fixation on renal function, serial measurements of serum creatinine, glomerular filtration rate, creatinine clearance rate, and estimated glomerular filtration rate were made. We examined the factors related to post-procedural aortic diameter. RESULTS: The mean change in the aortic diameter was statistically significant, being 12.9±10% in the suprarenal fixation group and 6.19±6.9% in the infrarenal fixation group only at the lowest renal artery level (p=0.001). There was no significant difference in the rate of type I endoleak (p=0.330) or renal function and adverse events (p>0.107) between the groups. The formula for calculating post-procedural aortic diameter was as follows: post-procedural aortic diameter (renal artery level, mm) =1.845 (in case of suprarenal fixation) + 1.012 × pre-procedural aortic diameter (renal artery level, mm) + 0.029 × follow-up time (months) + 0.039 × oversizing (%) (R2=0.773, p<0.001). CONCLUSION: Suprarenal fixation affects the infrarenal aortic diameter at the lowest renal artery level without significant type I endoleak. However, it does not result in significant renal dysfunction. Pre-procedural aortic diameter, computed tomography follow-up time, suprarenal fixation type, and stent oversizing are the only definite independent correlation factors for postprocedural aortic diameter. This formula can predict the change of aortic diameter after endovascular aortic repair.

Utility of the DECAF Score in Patients Admitted to Emergency Department with Acute Exacerbation of Chronic Obstructive Pulmonary Disease / 대한구급학회지

BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are common and can be fatal. However, it is difficult to predict the in-hospital mortality, severity and prognosis of patients. Prognostic tools are needed to assess exacerbations of COPD in the emergency department. Towards this end, we compared DECAF (dyspnea, eosinopenia, consolidation, acidemia, atrial fibrillation) score with other prognostic tools available in the emergency department. METHODS: Consecutive patients admitted to the emergency department with exacerbations of COPD were recruited. We compared the DECAF score to CAPS (chronic obstructive pulmonary disease and asthma physiology score), BAP (blood urea nitrogen, altered mental status, pulse)-65 class and CURB (confusion, urea, respiratory rate, blood pressure)-65 score and assessed in-hospital mortality, endotracheal intubation, admission to the intensive care unit and admission to the hospital. RESULTS: The in-hospital mortality rate was 4.9%. The DECAF score showed excellent discrimination for in-hospital mortality (AUROC = 0.72, p = 0.002), endotracheal intubation (AUROC = 0.92, p < 0.001), admission to the intensive care unit (AUROC = 0.90, p < 0.001) and admission to the hospital (AUROC = 0.83, p < 0.001). CONCLUSIONS: The DECAF score is a simple and effective prognostic tool for assessing cases involving exacerbation of COPD in the emergency department. Emergency physicians should consider hospital admission if the DECAF score is more than 1 and consider admission to the intensive care unit and endotracheal intubation if the DECAF score is more than 3.

A Clinical Analysis of Abdominal Stab Wounds

PURPOSE: A classic approach to abdominal stab wounds has been a routine laparotomy for the purpose of diagnosis or treatment. However, management protocols for abdominal stab wounds are still contentious in most trauma centers. We examined the relationship between the character of the stab wound and the injured intraabdominal organs by retrospectively analyzing the medical records of patients with abdominal stab wounds admitted to Gil hospital, and the findings for our patients are then confronted with a review of the literature. We aimed to propose proper management protocols to approach abdominal stab wounds. METHODS: The medical records of all 80 patients sustaining abdominal stab wounds, admitted at the Department of Surgery, Gil Hospital, Gachon Medical School, from January 2004 to December 2008 were retrospectively reviewed. All the abdominal stab wounds were collated based on the site and the character of the injury, investigations performed on admission, results of investigations, operations performed and findings at the time of the operation. RESULTS: The most prevalent age group was patients in their forties and the average age of the patients was 41 years for both genders. The stab wounds were most commonly located at the periumbilical area (16.9%), followed by the epigastric area (15.6%), and 18.2% of the patients had multiple wounds. The most commonly eviscerated organ was the omentum (9 out of 16 cases); 61.7% of non-eviscerated patients underwent a therapeutic laparotomy while 81.3% of eviscerated patients underwent a therapeutic laparotomy. The small bowel was the most commonly injured organ (22.7%, 17 out of 75 injuries). The review revealed a relatively common diaphragmatic injury in abdominal stab wound patients (8 cases, 10.5%). The average hospital stay was 11 days. CONCLUSION: This review revealed commonly eviscerated and injured intraabdominal organs in abdominal stab wound patients and their relationship with a therapeutic laparotomy. Although the management is still controversial, the authors suggest indications for an immediate laparotomy and a protocol for managing abdominal stab wounds. Hemodynamic instability and peritoneal irritation signs are definite indicators for an immediate laparotomy, but the review revealed intraabdominal organ evisceration alone not to be a statistically significant factor. In addition, the authors suggest that abnormal CT findings can be valuable for making a decision on management of hemodynamically stable stab wound patients. Further study may clarify a role for a more selective approach to operative intervention and for a more extensive use of selective observation.