Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the sequential organ failure assessment score in nonocclusive mesenteric ischemia: a multicenter retrospective cohort study.

BACKGROUND: Several large-scale studies have assessed endovascular and surgical treatment methods for nonocclusive mesenteric ischemia (NOMI); however, the prognostic factors for NOMI remain unclear. Therefore, this study aimed to evaluate risk factors for in-hospital mortality among patients with NOMI who underwent laparotomy and to examine therapeutic strategies that may improve the prognosis. MATERIALS AND METHODS: In this multicenter retrospective study, the authors reviewed the electronic medical records retrieved from the inpatient database of patients with NOMI at eight district general hospitals between January 2011 and January 2021. A total of 88 patients who underwent laparotomies were divided into survivor and nonsurvivor groups, and statistical analysis was performed to determine clinical and physiological factors. RESULTS: Exploratory laparotomy based on second-look surgery was the first treatment choice. The overall mortality rate was 48.8%, with a male-to-female ratio of 1.1:1. The median Sequential Organ Failure Assessment (SOFA) score was 8 [interquartile range: 3.75-14.2], and the median SOFA scores were 5 [3-7] in the survivor group and 13 [9-17.5] in the nonsurvivor group. Univariate analysis revealed a significant difference in BMI ( P <0.001), hypoglycemia ( P =0.0012), previous cardiovascular surgery ( P =0.0019), catecholamine use ( P <0.001), SOFA score ( P <0.001), platelet count ( P =0.0023), and lactate level ( P <0.001). Logistic regression analysis using the factors with significant differences revealed that SOFA score ≥10 (odds ratio 23.3; 95% CI: 1.94-280.00; P =0.013) was an independent prognostic factor. In addition, catecholamine use was suggested as a factor with a SOFA score greater than or equal to 10. CONCLUSION: This study confirmed that a SOFA score of greater than or equal to 10 may be associated with increased mortality. While closely monitoring low blood pressure and renal dysfunction, survival rates may be improved if surgical intervention is performed before the SOFA score reaches greater than or equal to 10.

A Rare Case of Pancreatic Endometrial Cyst and Review of the Literature.

Pancreatic cysts include a variety of benign, premalignant, and malignant lesions. Endometrial cysts in the pancreas are extremely rare lesions that are difficult to diagnose before surgery. We report the case of a 26-year-old patient with a recent episode of left abdominal pain who presented with a large cyst in the pancreatic body. Laboratory results showed white blood cell and C-reactive protein elevation, whereas the patient's tumor marker levels were within the normal range. Distal pancreatectomy with splenectomy was performed. The final histopathological examination confirmed the presence of endometriotic cysts within the pancreas. Only 13 cases of endometriotic cysts of the pancreas have been previously reported. The preoperative diagnosis is challenging, and most patients undergo pancreatic resection because of suspected neoplasms. This case report reviews previous studies and discusses the clinicopathological features, pathogenesis, and appropriate treatment for pancreatic endometrial cysts.

[The current status and problems associated with outpatient chemotherapy at our hospital].

Administration of outpatient chemotherapy cases at a community-based General Private Hospital such as ours has been increasing year after year. Therefore, we present a current status of cancer chemotherapy at the outpatient department of General Surgery in our hospital and to review the problems and solutions. There were 30 cases where our surgical department administered outpatient chemotherapy in March 2006. The required hospitalization during the chemotherapy enforcement was 2 cases where both of them were due to a progress of primary disease, but not from chemotherapeutic adverse drug reactions. Each department copes and handles outpatient chemotherapy because we do not carry an exclusive department dedicated to treat patients at our hospital. Therefore, various problems will arise along with the therapy. As a community-based General Hospital, we coordinated with relevant public sectors in order to fulfill a lack of human resources, and we found out that it was necessary to build a system that operates smoothly and administers safe outpatient chemotherapy.

[A case report of 3 patients treated at home with ulcers in the lower extremities, illustrating the difficulty in differential diagnosis between ASO and pressure sores].

It is difficult to diagnostically differentiate pressure sores and cutaneous ulcers that occur at the tip of an appendicular. There are many ways to treat them based on the cause of the problems. However, an inadequate treatment had resulted in limb amputation cases. We report 3 cases performed by a lap treatment for lower extremities ulcers of which occurred at their homes, and that resulted in abscission because their cutaneous ulcers have not improved. The lap therapy was performed due to the fact that these cases involved elderly patients who are inactive and have complications with diabetes mellitus causing comparatively easy pressure sores. However, all three cases were complications seen in arterial sclerosis obliterans of both lower extremities caused by a blood flow disorder of an inferior limb resulting in a pathologic body. Therefore, it was thought that the efficacy of lap therapy could not be indicated. As a result, abscission of the lesion was accomplished. In conclusion, a lap treatment requires careful observation at the beginning and during the treatment of cutaneous ulcers.