Validation of a Brief Internet-Based Self-Report Measure of Maladaptive Personality and Interpersonal Schema: Confirmatory Factor Analysis.

BACKGROUND: Existing digital mental health interventions mainly focus on the symptoms of specific mental disorders, but do not focus on Maladaptive Personalities and Interpersonal Schemas (MPISs). As an initial step toward considering personalities and schemas in intervention programs, there is a need for the development of tools for measuring core personality traits and interpersonal schemas known to cause psychological discomfort among potential users of digital mental health interventions. Thus, the MPIS was developed. OBJECTIVE: The objectives of this study are to validate the MPIS by comparing 2 models of the MPIS factor structure and to understand the characteristics of the MPIS by assessing its correlations with other measures. METHODS: Data were collected from 234 participants who were using web-based community sites in South Korea, including university students, graduate students, working professionals, and homemakers. All the data were gathered through web-based surveys. Confirmatory factor analysis was used to compare a single-factor model with a 5-factor model. Reliability and correlation analyses with other scales were performed. RESULTS: The results of confirmatory factor analysis indicated that the 5-factor model (χ2550=1278.1; Tucker-Lewis index=0.80; comparative fit index=0.81; and Root Mean Square Error of Approximation=0.07) was more suitable than the single-factor model (χ2560=2341.5; Tucker-Lewis index=0.52; comparative fit index=0.54; and Root Mean Square Error of Approximation=0.11) for measuring maladaptive personality traits and interpersonal relationship patterns. The internal consistency of each factor of the MPIS was good (Cronbach α=.71-.88), and the correlations with existing measures were statistically significant. The MPIS is a validated 35-item tool for measuring 5 essential personality traits and interpersonal schemas in adults aged 18-39 years. CONCLUSIONS: This study introduced the MPIS, a concise and effective questionnaire capable of measuring maladaptive personality traits and interpersonal relationship schemas. Through analysis, the MPIS was shown to reliably assess these psychological constructs and validate them. Its web-based accessibility and reduced item count make it a valuable tool for mental health assessment. Future applications include its integration into digital mental health care services, allowing easy web-based administration and aiding in the classification of psychological therapy programs based on the obtained results. TRIAL REGISTRATION: ClinicalTrials.gov NCT05952063; https://www.clinicaltrials.gov/study/NCT05952063.

Association of low meal frequency with decreased in vivo Alzheimer's pathology.

Little is known about the association between meal frequency and Alzheimer's disease (AD) in humans. We tested the hypothesis that low meal frequency (LMF) is associated with reduced in vivo AD pathology in human brain, and additionally investigated the mediation of serum ghrelin, a hunger-related hormone, for the association. A total of 411 non-demented older adults were systematically interviewed to identify their dietary patterns including meal frequency and underwent multi-modal neuroimaging for cerebral beta-amyloid (Aß) and tau deposition, glucose metabolism, and cerebrovascular injury. LMF (less than three meals a day) was significantly associated with lower Aß deposition compared to high meal frequency (HMF). In addition, both LMF and reduced Aß deposition were significantly related to elevated serum ghrelin. Our findings suggest that LMF may be related to the lower risk of AD through reduced brain amyloid deposition. Additionally, ghrelin appears mediate the association between LMF and lower amyloid deposition.

Management of the enteroatmospheric fistula: A case report.

BACKGROUND: Enteroatmospheric fistula (EAF) is a catastrophic complication that can occur after open abdomen. EAFs cause severe body fluid loss, hypercatabolism, and wound complications, leading to adverse clinical outcomes. CASE SUMMARY: A 72-year-old female patient underwent ventral hernia repair. Five days after the surgery, she exhibited severe abdominal pain with septic shock. Exploratory laparotomy revealed extensive intestinal adhesions and severe intraperitoneal contamination. Since the patient was hemodynamically unstable, a salvage operation rather than definite surgery was needed, and three surgical open drains were inserted into the peritoneal cavity. Postoperative EAFs developed, and it was almost impossible to isolate and reduce the fistula output despite the use of vacuum-assisted closure dressings and endoscopic stent insertion. Finally, we anastomosed two vascular grafts to the openings of each EAF to restore enteric continuity. The inserted vascular grafts showed acceptable patency, and the patient could receive optimal nutritional support with elemental enteral feeding. She underwent EAF resection 76 d after graft implantation. CONCLUSION: Control of the enteric effluent are key elements in achieving favorable clinical conditions which should precede definite surgery for EAFs.

Learning curve analysis using the cumulative summation method for totally extraperitoneal repair of the inguinal hernia.

PURPOSE: The totally extraperitoneal repair (TEP) technique has been widely performed, and compared with open surgery, TEP results in less postoperative pain and similar surgical outcomes in the treatment of inguinal hernias. However, TEP has a longer learning curve than does conventional surgery. METHODS: The data for patients who underwent TEP for inguinal hernias by a single surgeon between April 2017 and July 2019 were analyzed retrospectively. The cumulative summation (CUSUM) method and the following two variables were used to analyze the learning curve: (1) the operation event (OE), including intraoperative complications and conversion to open surgery; and (2) the operation score (OS), as calculated by the operation time, patient body mass index, and disease characteristics. RESULTS: The CUSUM chart showed three phases for both the OE and OS. The former reached a first inflection point after the 85th case and decreased after the 200th case, and the latter reached a plateau after the 101st case and decreased after the 203rd case. The operation time was longer in phases 1 and 2 than in phase 3 (64.2 min versus 47.9 min versus 31.1 min; p < 0.001), and the OS was lower in phase 3 than in the other phases (71.9 points versus 106.4 points versus 142.7 points; p < 0.001). Ten cases of intraoperative complications were observed, all in the first and second phases (p = 0.011). CONCLUSION: At least approximately 100 cases are required for the initial learning period, and an additional 103 cases are required for the accumulation of additional experience. Surgical competency can be gained after 203 TEPs are performed.

Cognitive reserve proxies, Alzheimer pathologies, and cognition.

This study aimed to explore the moderating effects of the frequently used cognitive reserve (CR) proxies [i.e., education, premorbid intelligence quotient (pIQ), occupational complexity (OC), and lifetime cognitive activity (LCA)] on the relationships between various in vivo Alzheimer's disease (AD) pathologies and cognition. In total, 351 [268 cognitively unimpaired (CU), 83 cognitive impaired (CI)] older adults underwent multi-modal brain imaging to measure AD pathologies and cognitive assessments, and information on CR proxies was obtained. For overall participants, only education moderated the relationship between Aß deposition and cognition. Education, pIQ, and LCA, but not OC, showed moderating effect on the relationship between AD-signature cerebral hypometabolism and cognition. In contrast, only OC had a moderating effect on the relationship between cortical atrophy of the AD-signature regions and cognition. Such moderation effects of the CR proxies were similarly observed in CI individuals, but most of them were not in CU individuals. The findings suggest that the proposed CR proxies have different moderating effects on the relationships between specific AD pathologies and cognition.

Functional Neural Correlates of Semantic Fluency Task Performance in Mild Cognitive Impairment and Alzheimer's Disease: An FDG-PET Study.

BACKGROUND: Total score (TS) of semantic verbal fluency test (SVFT) is generally used to interpret results, but it is ambiguous as to specific neural functions it reflects. Different SVFT strategy scores reflecting qualitative aspects are proposed to identify specific cognitive functions to overcome limitations of using the TS. OBJECTIVE: Functional neural correlates of the TS as well as the other strategy scores in subjects with mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia using Fluorine-18-Fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS: Correlations between various SVFT scores (i.e., TS, mean cluster size, switching (SW), hard switching, cluster switching (CSW)) and cerebral glucose metabolism were explored using voxelwise whole-brain approach. Subgroup analyses were also performed based on the diagnosis and investigated the effects of disease severity on the associations. RESULTS: Significant positive correlation between TS and cerebral glucose metabolism was found in prefrontal, parietal, cingulate, temporal cortex, and subcortical regions. Significantly increased glucose metabolism associated with the SW were found in similar but smaller regions, mainly in the fronto-parieto-temporal regions. CSW was only correlated with the caudate. In the subgroup analysis conducted to assess different contribution of clinical severity, differential associations between the strategy scores and regional glucose metabolism were found. CONCLUSION: SW and CSW may reflect specific language and executive functions better than the TS. The SVFT is influenced by brain dysfunction due to the progression of AD, as demonstrated by the SW with larger involvement of temporal lobe for the AD, and CSW with significant association only for the MCI.

Normative Study of the Block Design Test for Adults Aged 55 Years and Older in Korean Aging Population.

OBJECTIVE: The Block Design Test (BDT) is known to be an effective measure in diagnosing age-related cognitive decline of visuospatial function. The goal of this study is to investigate the effects of age, education years, and gender on the performance of the BDT and to provide normative data in Korean community-dwelling participants who are 55 to 90 years old. METHODS: The participants were 432 non-demented adults aging from 55 to 90 years old. The BDT was administered to participants according to its manual. Multiple linear regressions and analyses of variance were conducted, including age, gender, and educations were used as covariates. RESULTS: Age, educational years, and gender were found to be significantly associated with performance on the BDT. As age increased, BDT performance decreased. Educational years were associated with BDT performance. Men showed higher performance (29.9±10.3) compare to women (26.1±8.7). The BDT is influenced by age, educational years, and gender. CONCLUSION: Unlike the previous study, the current study shows that gender has a significant influence in visuospatial ability in the old population. Present normative data will be useful for clinicians in evaluating aging participants with cognitive impairment.

Validation of the Korean Version of the Anosognosia Questionnaire for Dementia.

OBJECTIVE: Anosognosia is a common phenomenon in individuals with dementia. Anosognosia Questionnaire for dementia (AQ-D) is a well-known scale for evaluating anosognosia. This study aimed to establish a Korean version of the AQ-D (AQ-D-K) and to evaluate the reliability and validity of the AQ-D-K in patients with Alzheimer's disease (AD) dementia. METHODS: We translated the original English version of AQ-D into Korean (AQ-D-K). Eighty-four subjects with very mild or mild AD dementia and their caregivers participated. Reliability of AQ-D-K was assessed by internal consistency and one-month test-retest reliability. Construct validity and concurrent validity were also evaluated. RESULTS: Internal consistencies of the AQ-D-K patient form and caregiver form were high (Cronbach alpha 0.95 and 0.93, respectively). The test-retest reliability of AQ-D-K measured by intra-class correlation coefficient was 0.84. Three factors were identified: 1) anosognosia of instrumental activity of daily living; 2) anosognosia basic activity of daily living; and 3) anosognosia of depression and disinhibition. AQ-D-K score was significantly correlated with the clinician-rated anosognosia rating scale (ARS), center for epidemiological studies-depression scale (CES-D) and state-trait anxiety inventory (STAI). CONCLUSION: The findings suggest that the AQ-D-K is a reliable and valid scale for evaluating anosognosia for AD dementia patients using Korean language.

Visual interpretation of [18F]Florbetaben PET supported by deep learning-based estimation of amyloid burden.

PURPOSE: Amyloid PET which has been widely used for noninvasive assessment of cortical amyloid burden is visually interpreted in the clinical setting. As a fast and easy-to-use visual interpretation support system, we analyze whether the deep learning-based end-to-end estimation of amyloid burden improves inter-reader agreement as well as the confidence of the visual reading. METHODS: A total of 121 clinical routines [18F]Florbetaben PET images were collected for the randomized blind-reader study. The amyloid PET images were visually interpreted by three experts independently blind to other information. The readers qualitatively interpreted images without quantification at the first reading session. After more than 2-week interval, the readers additionally interpreted images with the quantification results provided by the deep learning system. The qualitative assessment was based on a 3-point BAPL score (1: no amyloid load, 2: minor amyloid load, and 3: significant amyloid load). The confidence score for each session was evaluated by a 3-point score (0: ambiguous, 1: probably, and 2: definite to decide). RESULTS: Inter-reader agreements for the visual reading based on a 3-point scale (BAPL score) calculated by Fleiss kappa coefficients were 0.46 and 0.76 for the visual reading without and with the deep learning system, respectively. For the two reading sessions, the confidence score of visual reading was improved at the visual reading session with the output (1.27 ± 0.078 for visual reading-only session vs. 1.66 ± 0.63 for a visual reading session with the deep learning system). CONCLUSION: Our results highlight the impact of deep learning-based one-step amyloid burden estimation system on inter-reader agreement and confidence of reading when applied to clinical routine amyloid PET reading.

Regional Quantitative Magnetic Resonance Imaging Data Improve Screening Accuracy of Subjective Memory Complaints and Informant Reports of Cognitive Decline.

OBJECTIVE: We investigated whether the addition of Alzheimer's disease-signature region cortical thickness (AD-Ct) and hippocampal volume (Hv) obtained from brain MRI to subjective memory complaints and informant-reports of cognitive decline enhances the screening accuracy for cognitive disorders in a memory clinic setting. METHODS: 120 participants (40 cognitively normal, 40 MCI, 40 dementia) underwent clinical evaluation, neuropsychological assessment, and brain MRI. The Subjective Memory Complaints Questionnaire (SMCQ) and Seoul Informant-Report Questionnaire for Dementia (SIRQD) were applied to assess subjective memory complaints and informant-reports of cognitive decline respectively. Logistic regression and ROC curve analyses were conducted to compare the screening abilities of SMCQ+SIRQD, SMCQ+SIRQD+Hv, and SMCQ+SIRQD+AD-Ct models for cognitive disorders. RESULTS: SMCQ+SIRQD+Hv model indicated better screening accuracy for MCI and overall cognitive disorder (CDall) than SMCQ+ SIRQD model. SMCQ+SIRQD+AD-Ct model had superior screening accuracy for dementia in comparison to SMCQ+SIRQD model. ROC curve analyses revealed that SMCQ+SIRQD+Hv model had the greatest area under the curve (AUC) for screening MCI and CDall (AUC: 0.941 and 0.957), while SMCQ+SIRQD+AD-Ct model had the greatest AUC for screening dementia (AUC: 0.966). CONCLUSION: Our results suggest that the addition of regional quantitative MRI data enhances the screening ability of subjective memory complaints and informant-reports of cognitive decline for MCI and dementia.

Cephalic vein approach for the implantable central venous access: A retrospective review of the single institution's experiences; Cohort Study.

Long-term venous access is usually required in patients receiving chemotherapy. We hypothesized that, out of the various central line approach techniques, the cephalic vein cut-down technique can be a safe and simple alternative in terms of surgical safety, feasibility, cost-effectiveness, and functional outcomes.We retrospectively reviewed the medical records of 569 patients who underwent implantable central venous access between January 2012 and December 2014 at our hospital.We classified our cohort according to access routes, as follows: 230 patients underwent subclavian vein access, 134 patients underwent internal jugular vein access, 25 patients underwent external jugular vein access, and 119 patients underwent cephalic vein access. The cephalic vein group had a significantly longer operation time than the subclavian group (P < .01); however, there was no difference in operation time between the internal jugular vein and cephalic vein groups (P = .59). The procedure-related complications and functional outcomes of the implanted venous port during chemotherapy were comparable between the cephalic group and other groups. Additionally, body mass index, operation time, and age did not correlate with catheter dysfunction in the multivariate logistic regression analysis (P = .53; P = .66; P = .19, respectively).We suggest that a cut-down central venous catheter insertion through the cephalic vein can be performed easily and safely with no differences in surgical and clinical outcomes compared to those of conventional percutaneous approaches. Moreover, the cephalic vein approach requires no specialized equipment, including percutaneous vascular kits, tunneling instruments, and intraoperative ultrasonography. Therefore, this technique might incur less medical expenses than conventional approaches and would be helpful for both patients and surgeons.

Retroperitoneal abscess with pylephlebitis caused by lumbar acupuncture: a case report.

BACKGROUND: Retroperitoneal abscess (RA) is an unusual life-threatening disease that has insidious and occult presentations. Although the incidence of this disease is low, diagnosis and treatment are challenging due to its nonspecific presentation and the complex anatomy of the retroperitoneal space. Recently, we experienced one case of a RA with extensive thrombophlebitis of the portal venous system. CASE PRESENTATION: An 80-year-old male presented to the emergency room with symptoms and signs of septic shock; however, the decision making for diagnosis and treatment was difficult, as no clinical and radiological evidence supported key findings regarding the origin of sepsis. Although this patient eventually recovered after surgical drainage, we suggested that more straightforward diagnostic and treatment procedures were required in this patient to avoid possible critical complications. Through a retrospective review of operative findings, patient history, and microbiology, we found that the RA in this patient was caused by lumbar acupuncture, which is usually performed for the management of chronic back pain with long needles. CONCLUSION: Early surgical intervention should be considered for RA whenever the patient does not respond to broad-spectrum antibiotic treatment. Acupuncture is a possible cause of otherwise unexplained soft tissue infections, such as RA, especially in Asian countries.

Clinical implication of discrepancies between surgical and pathologic diagnoses of acute appendicitis.

PURPOSE: The postoperative treatment after appendectomy is usually decided on the basis of the surgeons' intraoperative findings. Comparatively, the pathologic diagnosis of appendicitis is confirmed several days after the surgery; therefore, it usually does not affect the postoperative treatment strategy. The aim of this study was to investigate the discrepancies between the surgical and pathologic diagnoses of appendicitis and to identify their clinical implication. METHODS: A retrospective observational study was performed in 1,817 patients who underwent 3-port laparoscopic appendectomy for the final diagnosis of appendicitis. The clinical variables that could estimate the severity of appendicitis and the intensity of postoperative treatment were analyzed and compared according to the surgical and pathologic diagnoses. RESULTS: Of 1,321 cases of surgically simple appendicitis, 254 (29.3%) were pathologically complicated appendicitis. On the other hand, 221 of 496 cases (44.5%) of surgically complicated appendicitis were pathologically simple. Neither the surgical nor the pathologic diagnosis of appendicitis affected the development of postoperative intra-abdominal abscess (P = 0.079 for surgical diagnosis; P = 0.288 for pathologic diagnosis); however, the surgical diagnosis showed more correlation with the severity of disease and the intensity of the treatment pathway than did the pathologic diagnosis. CONCLUSION: There were discrepancies between the surgeons' intraoperative assessment and the pathologists' final histologic diagnosis of appendicitis. The surgeon's classification might be more predictive of the outcome than the pathologist's because only the surgeon's findings are available immediately after surgery.

Magnetic foreign body ingestion in pediatric patients: report of three cases.

BACKGROUND: Although foreign bodies (FBs) typically pass spontaneously and uneventfully through the digestive tract, a subset of such bodies may become trapped, eventually leading to significant injury. In particular, the ingestion of magnetic materials can cause serious morbidity due to proximate attraction through the intestinal wall. CASE PRESENTATION: We recently treated three pediatric patients who had ingested several magnetic foreign materials. None of these patients exhibited any clinical symptoms or signs suggestive of surgical abdomen. Moreover, it was difficult to determine a definite diagnosis and a treatment plan due to limitations in history taking and radiologic examination. After admission to the hospital, these patients underwent surgery for the following reasons: (1) failure to spontaneously pass ingested foreign materials; (2) sudden-onset abdominal pain and vomiting during hospitalization; and (3) gastric perforation incidentally discovered during gastroduodenoscopy. Subsequently, all patients were discharged without complications; however, their conditions might have been fatal without surgery at an appropriate time. CONCLUSIONS: As the clear identification about the number and characteristics of ingested magnets via radiographic examination or patient history appears to be difficult in pediatric patients, close inpatient observation would be required in any case of undetermined metallic FB ingestion. Patients who are confirmed to have ingested multiple magnets should be regarded as conditional surgical patients, although their clinical conditions are stable.

Single-incision endoscopic thyroidectomy for papillary thyroid cancer: A pilot study.

BACKGROUND: Recently, we have reported single incision endoscopic thyroidectomy using an axillary approach with gas inflation (SIET) in cases with benign thyroid tumors to reduce post-operative pain and invasiveness of the conventional endoscopic thyroidectomy. The aim of this study was to present our experiences with SIET for papillary thyroid cancer (PTC). METHODS: Patients who were diagnosed with histologically papillary thyroid carcinoma (≤1 cm) with single, unilateral, and intra-thyroidal lesion and without clinical lymph node metastasis were included. We analyzed clinico-pathological characteristics, surgical outcomes, and oncologic adequacy of the SIET procedure. RESULTS: Between January 2011 and July 2012, a total of 75 patients underwent hemi-thyroidectomy with ipsilateral central lymph node dissection via SIET. The mean tumor size was 0.5 cm and 4.1 ± 2.43 central lymph nodes were removed. Of the patients, 98.3% were satisfied with their surgical wound post-operatively and no critical post-operative complications occurred during the study, except for one case of post-operative bleeding. There was one case of disease recurrence, which occurred in the contra-lateral cervical lymph node region 6 months after SIET. This patient underwent completion thyroidectomy with selective neck dissection. CONCLUSION: The SIET is a safe and acceptable procedure for PTC with a reduced dissection field, less post-operative pain, and more cosmetic satisfaction than conventional endoscopic thyroid surgery.

Single-incision endoscopic thyroidectomy by the axillary approach with gas inflation for the benign thyroid tumor: retrospective analysis for a single surgeon's experience.

BACKGROUND: Trans-axillary endoscopic thyroid surgery offers the advantage of a good cosmetic outcome; however, it requires a wider dissection field compared to the other endoscopic approaches or open surgery. Therefore, it might cause severe postoperative pain occasionally. To reduce the dissection field required, we perform trans-axillary single-incision endoscopic thyroidectomy (SIET) with gas inflation. The aim of this study was to present a single surgeon's experience with SIET and to investigate the learning curve of SIET. METHODS: Between June 2009 and September 2014, a total of 105 patients who underwent hemithyroidectomy for benign thyroid tumor via an SIET procedure were included in the present study. All of the procedures were performed by the same surgeon. Each patient's operative outcomes were collected and retrospectively analyzed. The cumulative summation (CUSUM) analysis was used to assess the learning curve of SIET. RESULTS: No mortality or serious morbidity was observed during the study period. The adverse postoperative outcomes included wound hematoma (2 cases; 1.9 %), transient skin paresthesia (5 cases; 4.76 %), transient voice change (5 cases; 4.76 %), skin pigmentation (1 case; 0.9 %), and fibrous band of wound (1 case; 0.9 %). The overall mean operative time was 105 min, and the mean operative time in the experienced phase was 95 min. CUSUM analysis showed a decreasing trend at the 35th patient, suggesting that more than 35 cases were needed for the surgeon to gain proficiency. In 76.19 % of the cases, patients showed extreme satisfaction with the cosmetic results. CONCLUSION: Our results showed reasonable surgical outcomes compared to previous studies on endoscopic thyroidectomy. The SIET procedure is safe and feasible for benign thyroid tumors and has an acceptable learning curve for surgeons who are proficient in conventional endoscopic thyroidectomy.

Ischemic necrosis of the tongue in surgical patients with septic shock: a case report.

BACKGROUND: As the tongue is a well-vascularized organ, ischemic necrosis of the tongue is a rare disease entity. Critically ill patients with profound shock may experience end-organ hypoperfusion, which might result in tongue necrosis. However, to our best knowledge, there are no reports regarding ischemic necrosis of the tongue in surgical patients with septic shock. CASE PRESENTATION: Two patients recently developed ischemic necrosis of the tongue in our surgical intensive care unit. Both patients had undergone emergent surgery for ischemic enteritis and developed postoperative septic shock. The first patient responded to critical treatment with a short period of circulatory shock, and the delivered dose of the vasopressor seemed to be acceptable. In contrast, the second patient developed postoperative refractory shock, and high-dose vasopressor treatment was required to maintain adequate tissue perfusion. Both patients developed ischemic necrosis of the tongue and died shortly after its emergence, despite vigorous resuscitation. CONCLUSIONS: We suggest that ischemic necrosis of the tongue is an under-reported manifestation of any type of circulatory shock, which may have a complex pathogenic mechanism. Clinicians should be aware of the possibility of ischemic necrosis of the tongue in patients with circulatory shock, even if the patient exhibits clinical improvement, as this awareness may facilitate estimation of their prognosis and preparation for clinical deterioration.

Antimicrobial treatment after laparoscopic appendectomy for preventing a post-operative intraabdominal abscess: A Prospective Cohort Study of 1817 patients.

INTRODUCTION: Post-operative antimicrobial treatment is usually administered to prevent a post-operative intraabdominal abscess (IAA) after laparoscopic appendectomy (LA). The aim of this study was to identify the role of post-operative antibiotic treatment and the optimal length for the antibiotic course to prevent post-operative IAA after LA. METHODS: Between January 2010 and December 2013, 1817 patients who underwent three-port LA were enrolled in this study. Patients were classified into four groups according to the type of appendicitis and infectious source control. The characteristics of antimicrobial treatment and the incidence of IAA were analyzed and compared among the four groups. RESULTS: The incidence of IAA after three-port LA was 1.5% (27/1817). The mean durations of post-operative antibiotic use were 3.1 days for the non-IAA group and 3.3 days for the IAA group, with no significant difference between the groups (p = 0.510). DISCUSSION: The length of post-operative antibiotic treatment and antimicrobial combination therapy did not affect the development of IAA, and prolonged antibiotic treatment did not prevent IAA. However, when source control was not completely achieved, an IAA was frequently observed in the patient group that received a short course of antibiotic treatment. CONCLUSION: The role of antibiotic treatment for preventing post-appendectomy IAA seems to be related with achieving intraperitoneal infectious source control. In the setting of incomplete source control, we recommend a 5-day course of antimicrobial combination therapy and consecutive source control such as peritoneal drainage.

Advanced Gastric Cancer Perforation Mimicking Abdominal Wall Abscess.

Surgeons occasionally encounter a patient with a gastric cancer invading an adjacent organ, such as the pancreas, liver, or transverse colon. Although there is no established guideline for treatment of invasive gastric cancer, combined resection with radical gastrectomy is conventionally performed for curative purposes. We recently treated a patient with a large gastric cancer invading the abdominal wall, which was initially diagnosed as a simple abdominal wall abscess. Computed tomography showed that an abscess had formed adjacent to the greater curvature of the stomach. During surgery, we made an incision on the abdominal wall to drain the abscess, and performed curative total gastrectomy with partial excision of the involved abdominal wall. The patient received intensive treatment and wound management postoperatively with no surgery-related adverse events. However, the patient could not receive adjuvant chemotherapy and expired on the 82nd postoperative day.

Risk Factors for Postoperative Intra-Abdominal Abscess after Laparoscopic Appendectomy: Analysis for Consecutive 1,817 Experiences.

BACKGROUND: Possible risk factors for postoperative intra-abdominal abscess (IAA) formation after laparoscopic appendectomy (LA) remain controversial. A perforated appendicitis, diabetes mellitus, peritoneal irrigation, obesity and age are considered to be possible risk factors for postoperative IAA, but the existing evidence is insufficient. This study aimed to identify the risk factors for IAA formation in patients receiving LA. METHODS: Between January 2010 and December 2013, 1,817 patients who underwent 3-port LA were enrolled in this study. Patients were classified into 2 groups according to the development of postoperative IAA, and the differences between the groups were analyzed. RESULTS: The incidence of IAA after LA was 1.5%, and the only identified risk factor for IAA was peritoneal irrigation. On logistic regression analysis of those patients who received peritoneal irrigation, suppurative appendicitis and non-placement of the peritoneal drain were found to be significant risk factors for the development of IAA. CONCLUSIONS: Peritoneal irrigation in a case of abdomen contamination was shown to be a risk factor for the development of postoperative IAA after LA. When peritoneal irrigation is performed, surgeons should consider using peritoneal drainage and postoperative antibiotics (including anti-anaerobic antibiotics) to prevent postoperative IAA formation.