Reliability of Preoperative Inguinal Sonography for Evaluating Patency of Processus Vaginalis in Pediatric Inguinal Hernia Patients.

Background: Among childhood illnesses requiring surgery, inguinal hernia is the most common entity. Pediatric inguinal hernia has been traditionally operated through a small incision in the inguinal region. Contralateral metachronous inguinal hernia has been the topic of discussion in pediatric surgeon's domain for a long time. Many studies have been conducted to prevent it from occurring. Although patency of processus vaginalis is known to be the cause of metachronous inguinal hernia, it is difficult to know the status of contralateral processus vaginalis preoperatively when the patient is non-symptomatic. Recently, the introduction of laparoscopic surgery has facilitated the observation and surgery of contralateral inguinal hernia during scheduled surgery of unilateral hernia repair while the processus vaginalis is intact. The standard treatment for inguinal hernia is herniotomy. Laparoscopic inguinal hernia repair has not been widely applied in Korea. The objective of this study was to analyze the accuracy of preoperative sonography results of inguinal lesion on the contralateral side in patients that needed laparoscopic operation of inguinal hernia. Methods: Data of 107 patients who received laparoscopic inguinal hernia repair and evaluation by preoperative ultrasonography at Dongguk University Ilsan Hospital from 2011 to 2015 were analyzed. Results: Preoperative sonography for inguinal lesion had a sensitivity of 20.5%, a specificity of 95.2%, a positive predictive value of 75%, and a negative predictive value of 63.2%. Its accuracy was 64.5%. A total of 107 patients had no inguinal hernia recurrence or metachronous contralateral inguinal hernia. Conclusion: Ultrasonography performed prior to traditional pediatric herniotomy is not enough for accurate diagnosis of patency of processus vaginalis in our retrospective study. Multicenter prospective study is needed to estimate accuracy of sonographic diagnosis for patency of processus vaginalis.

Prognostic significance of non-curative gastrectomy for incurable gastric carcinoma.

BACKGROUND: To date, there is no convincing evidence regarding the benefits of non-curative gastrectomy for gastric carcinoma. In the present study, we reviewed the outcomes of patients who underwent surgery for incurable gastric carcinoma and evaluated the prognostic significance of non-curative gastrectomy. METHODS: Between 2004 and 2011, a total of 197 patients undergoing elective surgery for incurable gastric carcinoma were divided into the gastric resection and non-resection groups. Patient survival was compared between the two groups, and the prognostic significance of non-curative gastrectomy was investigated using multivariate analysis. RESULTS: Overall, 162 (82.2 %) patients underwent non-curative gastrectomy with morbidity and mortality of 21.0 and 1.2 %, respectively. The median survival of patients undergoing non-curative gastrectomy was significantly longer than that of patients without gastrectomy (12.4 vs. 7.1 months, p = 0.003). Patients who received postoperative chemotherapy also showed significantly better survival than those without chemotherapy (13.2 vs. 4.3 months, p < 0.001). Multivariate analysis revealed that non-curative gastrectomy was an independent prognostic factor (hazard ratio 0.61, 95 % CI 0.40-0.93, p = 0.023) after adjusting for postoperative chemotherapy and other clinical factors. Median survival in patients receiving non-curative gastrectomy combined with postoperative chemotherapy was 13.9 months, which was significantly longer than gastrectomy alone (5.4 months), chemotherapy alone (9.6 months), and no treatment (3.2 months) (p < 0.001). CONCLUSION: Primary tumor resection and postoperative chemotherapy are the most important prognostic factors for incurable gastric carcinoma. The survival benefits of non-curative gastrectomy need to be confirmed in a large-scale, randomized trial.

Risk factors and learning curve associated with postoperative morbidity of laparoscopic total gastrectomy for gastric carcinoma.

BACKGROUND: Laparoscopic total gastrectomy (LTG) is a challenging surgical procedure that has substantial technical difficulties and complications. In this study, we investigated risk factors for morbidity and mortality after LTG, and the learning curve associated with postoperative morbidity. METHODS: Prospectively constructed data of 203 patients undergoing LTG between 2004 and 2013 were retrospectively reviewed. The multivariate logistic regression model was used to analyze risk factors for postoperative morbidity. The Cumulative Sum (CUSUM) technique was used to assess the learning curve. RESULTS: Postoperative morbidity and mortality after LTG was 18.7 and 1.5 %, respectively. Of 38 patients with postoperative morbidity, 7 (3.4 %) were managed with reoperation, 8 (4.0 %) with radiologic or endoscopic intervention, and 23 (11.3 %) with a conservative treatment. Of local complications, gastrointestinal bleeding was the most common (12 patients), followed by anastomosis leakage (9 patients) and intra-abdominal abscess (9 patients). Respiratory complication was the most common of the systemic complications. There were 17 cases (8.4 %) of complications exceeding grade III severity, of which anastomosis leakage was the most common. CUSUM analysis showed that postoperative morbidity reached a plateau after around 45 cases. Univariate and multivariate analyses revealed that old age (over 65 years of age) and surgical experience (<45 cases) were independent factors for postoperative morbidity after LTG. CONCLUSION: LTG is a feasible technique with acceptable morbidity and mortality. However, substantial surgical experience is of most importance to reduce postoperative morbidity and mortality.

Purification of landfill gas by extracted calcium ions from municipal solid waste incineration fly ash.

This study proposes the utilization of CO2 based on the purification of landfill gas (LFG). The process included absorption of CO2 from LFG using monoethanolamine (MEA) absorbent, extraction of calcium ions from municipal solid waste incineration (MSWI) fly ash using various acids, and formation of calcium carbonate using the extracted calcium ions. During LFG purification, the concentration of CH4 in the gas after absorption was time dependent. The pH swing method was used for the extraction of calcium ions and comprised three phases: calcium ion leaching from MSWI fly ash phase, removal of cations from the supernatant, and calcium ion recovery. Hydrochloric and nitric acids, known as strong acids, and citric, acetic, and formic acids, which are weak acids, were used as extraction agents. Hydrochloric acid, nitric acid, acetic acid, and formic acid showed significant calcium ion recovery rates of 99.32%, 99.18%, 98.35%, and 97.99%, respectively, whereas citric acid showed a relatively low recovery rate of 82.82%. The extracted calcium ions were converted into calcium carbonate by reacting with ionic CO2 in the saturated MEA. The calcium carbonate formed showed different crystal structures based on the extraction agent used: aragonite for hydrochloric acid and nitric acid, amorphous CaCO3 for citric acid, vaterite for acetic acid, and calcite for formic acid. The results of this study can be applied to various CO2 utilization processes based on LFG and MSWI fly ash.

Burden on Caregivers of Adults with Multiple Chronic Conditions: Intersectionality of Age, Gender, Education level, Employment Status, and Impact on Social Life.

Intersectionality analysis is the study of overlapping or intersecting social identities. Intersecting social identities may have an impact on the perception of burden by family caregivers of older persons with multiple chronic conditions (MCC). The purpose of this study was to explore the interaction of social factors on the burden of caring for older adults with MCC. A total of 194 caregivers of older adults with MCC were recruited from Alberta and Ontario. Survey data were collected at two time points, six months apart. Additive and multiplicative models were analysed using a generalised linear model to determine the level of caregiver burden. Medium-high social interference (impact on social life) was associated with higher burden when adjusted for age, gender, education, and employment status. The overall results of the five-way interaction suggest that males in general had lower burden scores than females. Irrespective of their education and employment status, females had generally higher burden scores. These results add to the current body of literature, suggesting areas for further research to fill knowledge gaps, and promoting ideas for evidence-guided public health interventions that focus on caregivers.

Surgical Outcomes and Survival Prognostic Factors for Palliative Gastrectomies in Stage IV Resectable Gastric Cancer Outlet Obstruction Patients.

PURPOSE: Currently, there is no clear evidence to support any specific treatment as a principal therapy for stage IV gastric cancer outlet obstruction (GCOO) patients. This study evaluated the outcomes of palliative gastrectomies and survival prognostic factors in patients with stage IV resectable GCOO. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 48 stage IV GCOO patients who underwent palliative gastrectomies between June 2010 and December 2019. Palliative gastrectomies were performed only in patients with resectable disease. Early surgical outcomes and prognostic factors were analyzed using univariate and multivariate analyses. RESULTS: There were no specific risk factors for postoperative complications, except for being underweight. Severe postoperative complications developed in five patients, and most of the patients underwent interventional procedures and received broad-spectrum antibiotics for intra-abdominal abscesses. The multivariate survival analysis showed that palliative chemotherapy is a positive prognostic factor, while the specific type of hematogenous and lymphatic metastasis is a negative prognostic factor. CONCLUSIONS: We recommend that the treatment method for stage IV GCOO should be selected according to each patient's physical condition and tumor characteristics. In addition, we suggest that palliative gastrectomies can be performed in stage IV resectable GCOO patients without unfavorable prognostic factors (types of hematogenous and lymphatic metastases).

Appropriate selection of patients for combined organ resection in cases of gastric carcinoma invading adjacent organs.

BACKGROUND AND OBJECTIVES: Proper patient selection for multi-organ resection in T4 gastric carcinoma remains controversial. Our aim was to investigate which patients might benefit from multi-organ resection. METHODS: Among 1,775 consecutive patients receiving gastric cancer surgery, 71 had adjacent organ invasion. Short- and long-term surgical outcomes and associations between clinicopathological factors and overall survival were investigated. RESULTS: Forty-seven patients underwent curative surgery with multi-organ resection, and 24 underwent non-curative surgery, with or without multi-organ resection. Postoperative morbidity and mortality rates were 31.7% and 3.3%, respectively. Patients receiving curative surgery via multi-organ resection survived longer than those without (MST, 31.5 months vs. 19.1 months, P = 0.046). Multi-organ resection did not affect survival when performed in non-curative surgery. N3 lymph node metastasis was an independent prognostic factor for poor outcome (HR = 3.89, 95% CI = 1.40-10.83) in curatively resected patients; patients with N3 lymph node metastasis showed similar survival to patients receiving non-curative surgery. CONCLUSION: Multi-organ resection should be performed only when no incurable factors are present, and R0 resection is most likely. Multi-organ organ resection does not, however, seem to be effective in patients with N3 lymph node metastasis, even when curative resection is performed.

PCB levels and congener patterns from Korean municipal waste incinerator stack emissions.

Congener specific polychlorinated biphenyl (PCB) data from the stack gas of nine Korean municipal waste incinerators was used to determine characteristic congener patterns of emitted PCBs. Principal component analysis revealed three classes of incinerators according to their pattern of PCB congener emissions: those resembling the background sampling material; those producing large quantities of a few tetra-chlorinated congeners; those producing large proportions of mono (MO-) and non-ortho (NO-) congeners relative to di-ortho (DO-) levels. Also, correlations between individual PCB congeners and polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) were discovered for several NO-PCBs and tetra and penta chlorinated PCDFs. Full PCB congener data is presented along with operating conditions for each incinerator.

[Rhabditis Elongata Schneider, 1866 From Students In Korea]

As the result of a fecal examination performed in October 1978 on 320 middle and high school students of Hapcheon, Korea, we found 2 cases of Rhabditis nematodes in 16-year old high school girls. Rhabditis nematodes isolated from their feces were cultured at 30 degrees C by a filter paper culture method. After careful observation of male and female adults, we confirmed them as Rhabditis elongata Schneider, 1866 on the morphological basis of the male genitalia, and the papillae and measurements of various parts of the worm bodies.