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Purpose@#As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy. @*Methods@#Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B). @*Results@#Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate. @*Conclusion@#Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.
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Purpose@#Intrathecal analgesia (ITA) and transverse abdominis plane block (TAPB) are effective pain control methods in abdominal surgery. However, there is still no gold standard for postoperative pain control in minimally invasive colorectal surgery. This study aimed to investigate whether the analgesic effect could be increased when TAPB, which can further reduce wound somatic pain, was administered in low-dose morphine ITA patients. @*Methods@#Patients undergoing elective colorectal surgery were randomized into an ITA with TAPB group or an ITA group. Patients were evaluated for pain 0, 8, 16, 24, and 48 hours after surgery. The primary outcome was the total morphine milligram equivalents administered 24 hours after surgery. The secondary outcomes were pain scores, ambulatory variables, inflammation markers, hospital stay duration, and complications within 48 hours after surgery. @*Results@#A total of 64 patients were recruited, and 55 were compared. There was no significant difference in morphine use over the 24 hours after surgery in the 2 groups (ITA with TAPB, 15.3 mg vs. ITA, 10.2 mg; P = 0.270). Also, there was no significant difference in pain scores. In both groups, the average pain score at 24 and 48 hours was 2 points or less, showing effective pain control. @*Conclusion@#ITA for pain control in patients with colorectal surgery is an effective pain method, and additional TAPB was not effective.
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Purpose@#Minimally invasive colorectal surgery had reduced the rate of surgical site infection. The use of surgical skin adhesive bond (2-octyl cyanoacrylate) for wound closure reduces postoperative pain and provides better cosmetic effect compared to conventional sutures or staples. But role of surgical skin adhesive bond for reducing surgical site infection is unclear. Our objective in this study was to evaluate the role of surgical skin adhesive bond in reducing surgical site infection following minimally invasive colorectal surgery. @*Methods@#We performed a retrospective analysis of 492 patients treated using minimally invasive surgery for colorectal cancer at Seoul St. Mary’s Hospital, the Catholic University of Korea. Of these, surgical skin adhesive bond was used for wound closure in 284 cases and skin stapling in 208. The rate of surgical site infection including deep or organ/space level infections was compared between the 2 groups. @*Results@#The rate of superficial surgical site infection was significantly lower in the group using skin adhesive (p = 0.024), and total costs for wound care were significantly lower in the skin adhesive group (p < 0.001). @*Conclusion@#This study showed that surgical skin adhesive bond reduced surgical site infection and total cost for wound care following minimally invasive colorectal cancer surgery compared to conventional skin stapler technique. Surgical skin adhesive bond is a safe and feasible alternative surgical wound closure technique following minimally invasive colorectal cancer surgery.
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Subclavian venous catheterization was once widely used for volume resuscitation, emergency venous access, chemotherapy, parenteral nutrition, and hemodialysis. However, its use has drastically reduced recently because of life-threatening complications such as hemothorax, pneumothorax. In this case, a patient admitted for a scheduled operation underwent right subclavian venous catheterization for preoperative, intraoperative, and postoperative volume resuscitation and parenteral nutrition. The procedure was performed by an experienced senior resident. Despite detecting slight resistance during the guidewire insertion, the resident continued the procedure to the point of being unable to advance or remove it, then attempted to forcefully remove the guidewire, but it broke and became entrapped within the thorax. We tried to remove the guidewire through infraclavicular skin incision but failed. So video-assisted thoracoscopic surgery was used to remove the broken guidewire. This incident demonstrates the risks of subclavian venous catheterization and the importance of using a proper and gentle technique.
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Humanos , Cateterismo , Cateterismo Venoso Central , Catéteres , Tratamento Farmacológico , Emergências , Hemotórax , Nutrição Parenteral , Pneumotórax , Diálise Renal , Ressuscitação , Pele , Cirurgia Torácica Vídeoassistida , TóraxRESUMO
Subclavian venous catheterization was previously frequently performed, but because of life-threatening complications such as hemothorax, pneumothorax, mediastinal hematoma, and myocardial injury, its use has become less common. However, this practice has some advantages in patient mobility, secured dressing, and rapidity and adequacy of vascular access. In some situations where patient comfort is an especially important consideration, such as with totally implantable venous port insertion for chemotherapy, the subclavian route can be a good choice if an experienced and well-trained faculty is available. The authors have had recent experience with pinch-off syndrome-in other words, spontaneous catheter fracture-in 3 patients who had undergone venous port implantation through the right subclavian route. Through these cases, we intend to review the dangers of subclavian venous catheterization, the causes of pinch-off syndrome, and its clinical presentation, progress, treatments, and prevention.
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Humanos , Bandagens , Cateterismo , Catéteres , Hematoma , Hemotórax , PneumotóraxRESUMO
BACKGROUNDS/AIMS: Simple liver cysts were easily recognizable with the advanced imaging procedures, such as ultrasound and computed tomography scan. A large cyst or significant symptoms were indications for the treatments. Ablation therapy with sclerotic agents was effective, but there were several complications including severe pain. With the surgical cyst unroofing method introduced, we compared the cyst unroofing method and ablation therapy. METHODS: Between March 1997 and May 2011, we performed treatments of simple liver cysts in 27 patients. There were 23 women and 4 men (age range: 42-84 years; mean age: 64 years). The cyst unroofing was undergone with laparoscopic (n=13) and open technique (n=1). The ablation therapy was performed with ethanol (n=13) and acetic acid (n=1). RESULTS: The usual symptoms of the liver cysts were abdominal mass (n=7), indigestion (n=4), abdominal discomfort (n=3), and the increasing size of the cysts (n=4). The mean diameter of the cysts was 10.9 cm. The cyst unroofing method was performed effectively in 14 patients. One patient had bleeding during operation, and was converted to the open technique. One patient had a bile leak from the cyst, but it was successfully closed with the laparoscopic technique. Among the 14 cases with the ablation therapy, there were 4 complications: hematoma (n=1); cyst leaking during aspiration (n=2); acute renal failure (n=1); and death due to acetic acid intoxication (n=1). CONCLUSIONS: Laparoscopic cyst unroofing was more effective and safer in management than the ablation therapy in simple liver cysts.
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Feminino , Humanos , Masculino , Ácido Acético , Injúria Renal Aguda , Bile , Dispepsia , Etanol , Hematoma , Hemorragia , FígadoRESUMO
Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy.
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Autopsia , Endoscopia por Cápsula , Duodeno , Hemorragia Gastrointestinal , Hemorragia , Incidência , Inflamação , Jejuno , Pâncreas , EstômagoRESUMO
Chylous leakage is an extremely rare complication of surgery for breast cancer. We experienced a case of chylous leakage after axillary lymph node dissection. A 38-year-old woman with invasive ductal carcinoma in the left breast underwent a modified radical mastectomy after four cycles of neoadjuvant chemotherapy. The postoperative serosanguinous drainage fluid became "milky" on the fourth postoperative day. After trying conservative management, we re-explored the axilla and ligated the lymphatic trunk. Although the success of many cases supports conservative management, timely surgical intervention represents an alternative in cases where leakage persists or where the output is high.
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Adulto , Feminino , Humanos , Axila , Mama , Neoplasias da Mama , Carcinoma Ductal , Quilo , Drenagem , Excisão de Linfonodo , Linfonodos , Mastectomia Radical ModificadaRESUMO
PURPOSE: The laparoscopic appendectomy has become popular for the treatment of acute appendicitis. A single-incision laparoscopic appendectomy offers better cosmesis. We present the results of single-incision laparoscopic appendectomies in our hospital as initial experience. METHODS: A single-incision laparoscopic appendectomy was performed in 75 patients at The Catholic University of Korea, Bucheon St. Mary's hospital. The operating time, operation type, hospital stay, surgical morbidities, and body mass index were compared. RESULTS: This retrospective study revealed equal operation times in both the suppurative and the perforated appendicitis group. There was an increase in the hospital stay in the perforated appendicitis group. The postoperative complication rate was 4%, and the median operation time was 58.55 +/- 31.79 minutes. CONCLUSION: The single-incision laparoscopic appendectomy was easy and safe procedure for treating acute appendicitis. There were no differences in degree of inflammation and body mass index.
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Humanos , Apendicectomia , Apendicite , Índice de Massa Corporal , Inflamação , Coreia (Geográfico) , Laparoscopia , Tempo de Internação , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Malignant rhabdoid tumors were first described in 1978 by Beckwith and Palmer as a rare variant of Wilms' tumors with a "rhabdomyosarcomatoid" pattern and a particularly poor prognosis. Week reclassified this disease as a distinct disease in 1989 and thereafter, there have been several reports about malignant rhabdoid tumor that occurred in various organs, including the colon. The histologic characteristics of rhabdoid tumor are noncohesive or loosely cohesive cells with high cellularity, an eccentric large nucleus and eosinophilic cytoplasm, and the cytoplasm is usually positive for vimentin and it contain hyaline inclusions. On immunohistochemical staining, the cells are usually positive for vimentin and cytokeratin and they are negative for desmin. This tumor progresses rapidly and it has a very poor prognosis, but survival is better if there is no lymphatic or distant metastasis. We experienced a patient who suffered with undifferentiated adenocarcinoma with rhabdoid features in the ascending colon.
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Humanos , Adenocarcinoma , Colo , Colo Ascendente , Neoplasias do Colo , Citoplasma , Desmina , Eosinófilos , Hialina , Queratinas , Metástase Neoplásica , Prognóstico , Tumor Rabdoide , Vimentina , Tumor de WilmsRESUMO
PURPOSE: The aim of this study is to evaluate the feasibility and surgical outcomes of endoscopic thyroidectomy by the axillary approach for treating papillary thyroid microcarcinoma (PTMC). METHODS: We analyzed 56 patients who underwent endoscopic thyroidectomy by the axillary approach for treating PTMC between May 2002 and October 2008 at Bucheon ST hospital. We evaluated the operation type, the tumor size, the operative time, the hospital days, the number of retrieved lymph nodes and the complications. RESULTS: All the patients except one were women. The mean age was 40.5+/-8.7 years. All the procedure was performed by one surgeon and endoscopic thyroidectomy was done by the axillary approach. There was no conversion to open surgery. The type of operation was classified according to the extent of the surgery. The mean operative time for lobectomy and isthmectomy with CLND (24 cases) and total thyroidectomy with CLND (5 cases) was 142.5+/-40 minutes and 270+/-84.3 minutes, respectively. The mean tumor size was 0.66+/-0.46 cm. The mean number of retrieved lymph nodes was 3.7+/-2.4. The mean number of hospital days was 3.7+/-1.4 days. There were no serious complications. There were no tumor recurrence and the mean follow-up was 50.7 months. All the patients were satisfied with the cosmetic results. CONCLUSION: Endoscopic thyroidectomy by the axillary approach for PTMC is feasible and safe. Although a larger series and longer follow up are necessary, endoscopic thyroidectomy can be a alternative treatment method for selected patients with PTMC.
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Feminino , Humanos , Carcinoma Papilar , Conversão para Cirurgia Aberta , Cosméticos , Seguimentos , Linfonodos , Duração da Cirurgia , Recidiva , Glândula Tireoide , Neoplasias da Glândula Tireoide , TireoidectomiaRESUMO
Carcinoma showing thymus-like elements (CASTLE) is a rare neoplasm arising from the thyroid gland. This tumor is thought to originate from ectopic thymic tissue or remnants related to thymic development in or adjacent to the thyroid gland and usually located in the lower two-thirds of the thyroid gland. The patient was a 66-year-old man admitted to our hospital with rectal carcinoma for surgery. He had undergone a right upper lobectomy of the lung for the pulmonary tuberculosis 35 years previously. He underwent a chest computed tomography (CT) pre-operatively, and an incidental nodule of the thyroid gland was detected. Based on aspiration cytology of the nodule, the lesion was suspected to be an anaplastic carcinoma. He underwent a low anterior resection and thyroid lobectomy for a double primary neoplasm. On the final pathologic examination, the thyroid lesion was shown to be CASTLE. Therefore, completion thyroidectomy with lymph node dissection of the central compartment and radiotherapy were performed, and there was no evidence of recurrence 15 months postoperatively.
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Idoso , Humanos , Carcinoma , Pulmão , Excisão de Linfonodo , Radioterapia , Recidiva , Tórax , Glândula Tireoide , Tireoidectomia , Tuberculose PulmonarRESUMO
Hemangioma is the most common benign tumor of infancy. Greater than 60% of hemangiomas occur on the head and neck, and have an uncomplicated course. In contrast, most complicated hemangiomas develop in the urogenital or anogenital areas. These lesions are frequently associated with pain, bleeding, recurring infections, and ulcerations. Sometimes, perianal ulcerative hemangiomas are difficult to treat with multiple therapies, such as laser and steroid therapy. We managed a case of a severe perianal ulcerative hemangioma in a male newborn who did not respond to conservative management. He was successfully treated after a colostomy.
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Humanos , Recém-Nascido , Masculino , Colostomia , Cabeça , Hemangioma , Hemorragia , Pescoço , Períneo , ÚlceraRESUMO
Purpose: While a carcinoma of the splenic flexure is uncommon, is associated with a high risk of obstruction, and has a dual lymphatic drainage system, A COST study excluded transverse colon cancer, including splenic flexure colon cancer. This study reviews our experience with splenic flexure colon cancer treated laparoscopically and discusses a appropriate, safe laparoscopic surgical procedure. Methods: The authors reviewed the medical records of patients who underwent laparoscopic surgery for splenic flexure colon cancer from January 1995 to June 2006. The splenic flexure colon was defined as 5 cm from the splenic flexure proximally and distally by using radiologic studies. Curative surgery for splenic flexure colon cancer was defined as: primary cancer removal, a safe resected margin, no metastasis, and a complete lymphadenectomy including high ligation of left colic artery and of the left branch of the middle colic artery. Results: A total of 407 patients underwent laparoscopic surgery for colon cancer; among them, 15 patients underwent a laparoscopic left colectomy for splenic flexure colon cancer. The mean age of the patients was 63.8 years, and the male-to-female ratio was 9:6. The mean operation time was 325.3+/-95.1 minutes, and the average hospital stay was 15.8+/-4.9 days. The average number of harvested lymph nodes was 12.3+/-9.7, the average distal resection margin was 15.3+/-7.6 cm, and the average proximal margin was 10.7+/-3.2 cm. One case of chyle discharge and one case of ileus developed, but were treated conservatively. There was no surgical mortality. Conclusions: A laparoscopic left colectomy for splenic flexure colon cancer is a technically feasible and safe procedure with acceptable short-term outcomes in experienced hands.
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Feminino , Masculino , Humanos , MortalidadeRESUMO
Acute necrotizing pancreatitis is a disease with high morbidity and mortality despite the progress made in intensive care. Gas gangrene of the pancreas, usually caused by anaerobe infection, is an extremely rare, but severe form of acute necrotizing pancreatitis. Several severity-of-illness classifications for acute pancreatitis are used to identify patients at risk for complications. Pancreatic necrosis is diagnosed radiographically by dynamic intravenous contrast-enhanced computed tomography (CT) of the abdomen. Early CT in patients with suspected necrotizing pancreatitis contributes to early intervention and many advantageously enhance survival. We report here on two cases of necrotizing pancreatitis with gas gangrene in 49-year-old male patient and 86-year-old female patient.
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Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abdome , Classificação , Cuidados Críticos , Intervenção Educacional Precoce , Gangrena Gasosa , Mortalidade , Necrose , Pâncreas , Pancreatite , Pancreatite Necrosante AgudaRESUMO
An internal hernia is a rare disease that causes bowel obstruction. It is difficult to diagnose because the symptoms and the signs are the same as those for other obstructive diseases of the bowel. Early diagnosis and management are essential, and early surgical management may reduce complications such as ischemia, and strangulation. We experienced two cases of internal hernias. One patient underwent a laparotomy, and had a transmesenteric defect with a herniated and strangulated small bowel segment. The other patient underwent a laparoscopic surgery, and we found that the left broad ligament had a focal defect with a herniated small bowel segment. An internal hernia is an uncommon disease, and its differentiation from other obstructive diseases of the bowel is difficult. However, the clinician should consider that the internal hernia might be the cause of the bowel obstruction, especially in patient with no previous history of intra- abdominal surgery. Early diagnosis can improve the clinical outcome through early surgery.
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Adulto , Feminino , Humanos , Ligamento Largo , Diagnóstico Precoce , Hérnia , Isquemia , Laparoscopia , Laparotomia , Doenças RarasRESUMO
PURPOSE: Endoscopic thyroidectomy has not become a widespread procedure because of limited advantages to its use. We have performed endoscopic thyroidectomies by use of the axillary approach. The purpose of this study was to determine the efficacy of this surgical procedure. METHODS: Between June of 2002 and December of 2002, 17 patients underwent an endoscopic thyroidectomy by use of the axillary approach while 11 patients underwent a conventional thyroidectomy. Each procedure was performed by one surgeon under general anesthesia. Patients with thyroid carcinoma at the preoperative diagnosis or who received a bilateral thyroidectomy were excluded. We compared the age, size of the tumor, postoperative pain (48 hours after surgery), surgical time, cosmetic result, length of hospital stay, and paresthesia. Statistical analysis was determined by use of the Mann-Whitney test and the chi-square test using SPSS software. RESULTS: The mean age of the patients was 46.6 years who received a conventional thyroiodectomy and 32.9 years who underwent the axillary approach. The size of the tumor was 3.1 cm for patients who received conventional thyroiodectomy and 3.3 cm for patients who underwent the axillary approach. The operation time was 80.91±16.1 (65~100) minutes for the conventional thyroiodectomy and 135.3± 34.6 (80~210) minutes for the axillary approach. The difference between the two approaches in regards to parameters such as postoperative pain, parethesia, and total hospital days was negligible. The degree of satisfaction was 2.7±0.8 for the conventional thyroiodectomy and 1.1±0.3 for the axillary approach. CONCLUSION: While conventional thyroidectomy still offers an advantage in terms of surgical time, performance of endoscopic thyroidectomy by the axillary approach has an advantage in producing better cosmetic results. Although a multitude of patients will be necessary to follow in further studies, the use of endoscopic thyroidectomy by the axillary approach could become the procedure of choice by offering better cosmetic results to young patients who present with thyroid nodules.
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Humanos , Anestesia Geral , Diagnóstico , Tempo de Internação , Duração da Cirurgia , Dor Pós-Operatória , Parestesia , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , TireoidectomiaRESUMO
PURPOSE: In humans, nineteen types of WNT genes (WNTs) have been hightlighted up to date. The canonical Wnt cascade has recently emerged as a critical regulator of stem cells. To obtain new insights how nineteen WNTs affect mesenchymal stem cells differentiation, we analyzed the transcriptional activity, osteogenic and adipogenic activity of WNTs in mesenchymal stem cells. MATERIALS AND METHODS: Recombinant adenoviruses expressing nineteen WNTs were constructed to infect pluripotent mesenchymal progenitor C3H10T1/2 cells. Transcriptional activity was determined by using the luciferase reporter assay. Osteogenic activity was determined by measuring the induction of alkaline phosphatase upon Wnt stimulation. Adipogenic activity was measured by histochemical Oil red-O staining. RESULTS: WNT1, 2, 3, 3A and 10B significantly induced transcriptional activity in C3H10T1/2 cells. WNT1, 2, 3, 3A and 10B significantly induced alkaline phosphatase activity, but inhibited adipogenic activity in C3H10T1/2 cells. The results of qualitative and quantitative assay of alkaline phosphatase activity were consistent with those of luciferase assay for transcriptional activity and Oil red-O staining for adipogenic activity. CONCLUSION: We could expect that WNT1, 2, 3, 3A and 10B may play a crucial role in inducing osteoblast differentiation of mesenchymal stem cells.
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Humanos , Adenoviridae , Fosfatase Alcalina , Linhagem Celular , Luciferases , Células-Tronco Mesenquimais , Osteoblastos , Células-TroncoRESUMO
A carcinosarcoma of the esophagus is an uncommon malignancy accounting for approximately 1~2% of all esophageal neoplasms. Histologically, both carcinomatous and sarcomatous components are observed. The terms used to describe this lesion include carcinosarcoma, pseudosarcoma, polypoid carcinoma, pseudosarcomatous carcinoma pseudosarcomatous squamous cell carcinoma and a spindle cell variant of a squamous cell carcinoma. It presents as a bulky intraluminal polypoid lesion mainly in the mid to lower esophagus. It often presents relatively early because of its rapid intraluminal growth. Ultimately, the treatment is similar to that of an esophageal carcinoma requiring an esophagectomy for resectable lesions. We report a case of a 64-year-old man with a carcinosarcoma of the esophagus. Endoscopy revealed a 1.5 cm sized polypoid mass located 25 cm from the incisor with friable nature. Radiological studies revealed a bulky polypoid intraluminal mass with a lobulated border, measuring approximately 7 cm in length, in the mid esophagus that expands the lumen in conjunction with the enlargement of the regional lymph nodes. An esophagectomy was performed.
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Humanos , Pessoa de Meia-Idade , Carcinoma de Células Escamosas , Carcinossarcoma , Endoscopia , Neoplasias Esofágicas , Esofagectomia , Esôfago , Incisivo , LinfonodosRESUMO
Parathyroid cysts are uncommon causes of neck or mediastinal masses. They have been mistaken for cystic thyroid nodules, brachial cleft cysts, or thyroglossal duct cysts. Two types of parathyroid cysts have been recognized; the non- functioning forms, which are more frequent and the functioning paratyroid cysts, which are rarer and cause hyperparathyroidism. Parathyroid cysts are usually located in the inferior parathyroid gland, which are most commonly involved with a left-sides predominance. Although their location in mediastinum has also been described. Parathyroid cysts may present as a diagnostic problem. It is sometimes difficult that parathyroid lesions are distinguished from thyroid ones with current imaging techniques. Diagnosis is based on the histopathological appearance of the cyst and PTH level in the cystic fluid. Percutaneous needle aspiration of parathyroid cysts reveals crystal clear fluid. Elevated PTH levels in the cystic fluid confirms the diagnosis. The presence of parathyroid tissue within the cyst wall is diagnostic. Nonfunctioning cyst may be treated with aspiration alone, surgical excision is indicated for functioning cyst. We present the case of two patients with a parathyroid cyst.