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Background@#Coronavirus disease 2019 (COVID-19) was first reported in December 2019 in China, and then it has disseminated worldwide. In Korea, a religious group-related super-spreading event triggered a sudden outbreak in Daegu city and Gyeongsangbuk-do in southeast Korea. This study was undertaken to document the clinical characteristics of patients hospitalized in Gyeongsangbuk-do. @*Methods@#Three hundred and fifty-two patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection hospitalized at Dongguk University Gyeongju Hospital or at the Andong Medical Center between February 18th and June 30th were enrolled in this study. Medical records were reviewed and demographic and clinical features, including comorbidities, symptoms, radiological and laboratory findings on admission were analyzed. In addition, we sought to identify risk factors of mortality. @*Results@#Mean age of the 352 study subjects was 56 years (range, 14–95). The mortality rate was 6.8% and mean age at death was 81 years (range, 57–91). The most common symptom was cough (31.8%) followed by a febrile sensation (28.4%), sputum (17.0%), sore throat (15.6%), and myalgia (13.1%). Eighty-one (23.0%) patients were asymptomatic, but a half of these patients exhibited pneumonic infiltration at presentation. Chest radiology showed no active lesion in 41.8% of the study subjects, bilateral pneumonia in 46.9%, and unilateral pneumonic infiltration in 11.4%. Among 24 patients that died, 18 subjects were transferred from a care facility. An age of ≥ 70 years, previous history of malignancy or diabetes, and fever (≥ 37.5°C) on admission were found to be significant risk factors of mortality. @*Conclusion@#Patients aged ≥ 70 years, those with fever on admission, and patients with an underlying malignancy or diabetes were found to be more likely to succumb to COVID-19.Elderly in care facilities or hospitalized patients with an underlying disease should receive more attention and be considered for preventive quarantine.
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The long QT syndrome (LQTS) is a rare hereditary disorder in which affected individuals have a possibility of ventricular tachyarrhythmia and sudden cardiac death. We investigated 62 LQTS (QTc > or = 0.47 sec) and 19 family members whose genetic study revealed mutation of LQT gene. In the proband group, the modes of presentation were ECG abnormality (38.7%), aborted cardiac arrest (24.2%), and syncope or seizure (19.4%). Median age of initial symptom development was 10.5 yr. Genetic studies were performed in 61; and mutations were found in 40 cases (KCNQ1 in 19, KCNH2 in 10, SCN5A in 7, KCNJ2 in 3, and CACNA1C in 1). In the family group, the penetrance of LQT gene mutation was 57.9%. QTc was longer as patients had the history of syncope (P = 0.001), ventricular tachycardia (P = 0.017) and aborted arrest (P = 0.010). QTc longer than 0.508 sec could be a cut-off value for major cardiac events (sensitivity 0.806, specificity 0.600). Beta-blocker was frequently applied for treatment and had significant effects on reducing QTc (P = 0.007). Implantable cardioverter defibrillators were applied in 6 patients. Congenital LQTS is a potentially lethal disease. It shows various genetic mutations with low penetrance in Korean patients.
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Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Humanos , Lactente , Pessoa de Meia-Idade , Adulto Jovem , Povo Asiático/genética , Canais de Cálcio/genética , Eletrocardiografia , Parada Cardíaca/genética , Canal de Potássio KCNQ1/genética , Canal de Potássio KCNQ2/genética , Síndrome do QT Longo/diagnóstico , Mutação/genética , /genética , Penetrância , Canais de Potássio Corretores do Fluxo de Internalização/genética , República da Coreia , Fatores de Risco , Convulsões/genéticaRESUMO
PURPOSE: We aimed to verify whether the formal clinical index derived from infants and toddlers have a good association with the disease severity when we confine subjects to only infants, who undergo profound changes physically and immunologically. METHODS: We retrospectively reviewed the medical records of hospitalized infants with acute bronchiolitis caused by respiratory syncytial virus between January 1, 2010 and December 31, 2011 in three hospitals. The age, respiratory rate, presentation of chest retraction, and percutaneous oxygen saturation upon admission; presentation of fever, use of oxygen therapy and inhaled corticosteroid within 24 hours after admission were investigated. We then examined the effect of clinical index on severity of acute bronchiolitis; the mean length of stay, mean duration of fever and oxygen therapy. RESULTS: A total of 172 infants were studied. The mean length of stay was longer in patients younger than 3 months (P=0.015), in those with fever (P=0.028) and chest retraction (P=0.014), and in those who needed oxygen supplement (P=0.000). In the patients with fever, the mean duration of fever was longer in those who needed the oxygen supplement than those who did not (P=0.046). CONCLUSION: Younger than 3 months of age, chest retraction upon admission; fever, need of oxygen supplement within 24 hours after admission may predict the severe course of infants with acute bronchiolitis.
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Humanos , Lactente , Bronquiolite , Febre , Tempo de Internação , Prontuários Médicos , Oxigênio , Taxa Respiratória , Vírus Sinciciais Respiratórios , Estudos Retrospectivos , TóraxRESUMO
PURPOSE: The aim of this study was to evaluate the prognostic effectiveness of multivisceral resections of organs involved by locally advanced colorectal cancer. METHODS: A retrospective study was performed to analyze the data collected for 266 patients who underwent a curative resection for pT3-pT4 colorectal cancer without distant metastasis from January 2000 to December 2007. Of these 266 patients, 54 patients had macroscopically direct invasion of adjacent organs and underwent a multivisceral resection. We evaluated the short-term and the long-term outcomes of a multiviceral resection relative to that of standard surgery. RESULTS: The most common location for the primary lesion was the rectum, followed by the right colon and the sigmoid colon. Among the combined resected organs, common organs were the small bowel, ovary, and bladder. In the multivisceral resection group, tumor infiltration was confirmed histologically in 44.4% of the cases while in the remaining patients, a peritumorous adhesion had mimicked tumor invasion. Postoperative complications occurred in 17.5% of the patients who underwent standard surgery vs. 35.2% of those who underwent a multivisceral resection (P < 0.0001). But the survival rate of patients after a multivisceral resection was similar to that of patients after standard surgery (5-year survival rates: 61% vs. 58%; P = 0.36). CONCLUSION: For locally advanced colorectal cancer, multivisceral resection was associated with higher postoperative morbidity, but the long-term survival after a curative resection is similar to that after a standard resection. Thus, a multivisceral resection can be recommended for most patients of locally advanced colorectal cancer.
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Feminino , Humanos , Colo , Colo Sigmoide , Neoplasias Colorretais , Metástase Neoplásica , Ovário , Complicações Pós-Operatórias , Reto , Estudos Retrospectivos , Taxa de Sobrevida , Bexiga UrináriaRESUMO
PURPOSE: The aim of this study was to develop a baptist electronic Nutritional Screening Program (B-eNSP) that could be easily used to identify patients with nutrition at risk or malnutrition on their admission to hospital using an integrated medical information system and to evaluate validity, reliability and efficiency of B-eNSP. METHODS: From June 1 2009 to June 21 2009, we enrolled 496 patients for prospective research. We analyzed age, sex, weight, height, weight loss in the last 3 months, serum albumin, alteration of dietary intake, gastrointestinal symptom, functional capacity, diagnosis and its relationship to nutritional requirements, physical examination and Subjective Global Assessment (SGA). B-eNSP included body mass index (BMI), weight loss in the last 3 months, serum albumin. Each component was scored. Sensitivity and specificity were calculated to evaluate the validity of the B-eNSP. The receiver operating characteristic (ROC) curve was drawn by using B-eNSP to choose a cut-off value that maximizes sensitivity and specificity and Yoden Index. Comparison with SGA and the reliability of the B-eNSP was done using kappa statistics. RESULTS: The maximum Yoden Index was 0.866 and the cut-off value of the ROC curve was 2. A B-eNSP score higher than 2 was defined as nutrition at risk or malnutrition. Reliability of the B-eNSP was in accordance with SGA by kappa 0.845. CONCLUSION: The B-eNSP can be used efficiently to identify patients with nutrition at risk or malnutrition by simply using an integrated medical information system.
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Humanos , Índice de Massa Corporal , Eletrônica , Elétrons , Sistemas de Informação , Desnutrição , Programas de Rastreamento , Necessidades Nutricionais , Exame Físico , Estudos Prospectivos , Protestantismo , Curva ROC , Sensibilidade e Especificidade , Albumina Sérica , Redução de PesoRESUMO
BACKGROUND AND OBJECTIVES: Only a few studies have specifically investigated the reasons for emergency room (ER) visits in patients with congenital heart disease (CHD). The aim of this study was to identify the major reasons for ER presentation among patients with CHD that were acutely and seriously ill at a tertiary medical center in Korea. SUBJECTS AND METHODS: All 368 admissions of patients with CHD via the ER from 2003 to 2008 were enrolled. We conducted a retrospective study with review of the medical records. RESULTS: Eighty two patients were newly diagnosed as having CHD. Their major presentations were: symptoms of heart failure (41.5%), murmur (31.7%), and cyanosis (18.3%). There were 286 visits that were cases with known CHD. Their major presentations were respiratory tract infection (24.1%, 2.7+/-4.1 years of age), dysrhythmia (16.4%, 16.7+/-9.5 years), symptoms of heart failure (14.3%, 7.6+/-9.4 years), aggravated cyanosis (5.6%, 0.8+/-1.4 years), protein-losing enteropathy (4.9%), hemoptysis (4.5%), drug side effects (4.1%), and infective endocarditis (3.0%). There were significant correlations between the age distributions and major modes of presentation. Surgical treatments were required within 1 month in 38%, and 2.7% of all patients died during hospitalization. The patient group with respiratory infections and CHD showed the highest mortality (5.8%). Atrial flutter was the most frequent arrhythmia (70.2%) and 70% of these patients were post-Fontan surgery condition. The causes of heart failure in the patients with previous surgical repair were: pulmonary hypertension, myocardial dysfunction, valve regurgitation, and uncorrected lesions. CONCLUSION: Improved understanding of the common problems in the ER can help prepare clinicians to manage patients that present with CHD.
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Humanos , Distribuição por Idade , Arritmias Cardíacas , Flutter Atrial , Cianose , Emergências , Endocardite , Coração , Cardiopatias , Insuficiência Cardíaca , Hemoptise , Hospitalização , Hipertensão Pulmonar , Coreia (Geográfico) , Prontuários Médicos , Enteropatias Perdedoras de Proteínas , Infecções Respiratórias , Estudos RetrospectivosRESUMO
We analyzed parasitic diseases diagnosed by tissue biopsy specimens at KyungHee Medical Center (KMC) from 1984 to 2005. The total number of parasite infection cases was 150 (0.07%) out of the total 211,859 biopsy specimens submitted for histopathological examinations. They consisted of 62 cysticercosis, 23 sparganosis, 16 paragonimiasis, 15 amebiasis, 11 anisakiasis, 11 clonorchiasis, 3 ascariasis, 2 scabies, 2 enterobiasis, 2 trichuriasis, 1 leishmaniasis, 1 taeniasis, and 1 thelaziasis. Out of 62 cysticercosis cases, 55 were detected in subcutaneous tissues or the central nerve system. Eighteen out of 23 sparganosis cases were involved in muscular and subcutaneous tissues. In most anisakiasis cases, the involved organ was the stomach. The lung and the pleura were the most common site of paragonimiasis. The incidence of parasitic diseases during the first 5 years (1984-1988) was the highest of all observed periods. After 1989, similar incidences were shown throughout the period. Whereas cysticercosis was diagnosed in 34 cases during 1984-1988, no case has been diagnosed since 2000. In the case of sparganosis, the chronological incidence was almost uniform throughout the period 1984-2005. Paragonimiasis showed a similar tendency to cysticercosis. In gender and age distribution of parasitic diseases, men showed higher incidence rates than females, and the age groups of the 40s or older indicated higher infection frequencies than other age groups. Therefore, these results are a significant report to appear the tendency of human parasitic disease diagnosed by tissue biopsy in association with parasitosis at KMC in Seoul.
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Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Fatores Etários , Biópsia , Incidência , Doenças Parasitárias/diagnóstico , República da Coreia/epidemiologia , Fatores SexuaisRESUMO
We report here a human case probably mixed-infected with Clonorchis sinensis and Fasciola sp. who was diagnosed by computed tomography (CT) scan, serological findings, and/or fecal examination. The patient was a 43-year-old Korean female and was admitted to Kyung Hee University Hospital with the complaints of fever and abdominal pain. On admission, marked eosinophilia was noted in her peripheral blood. CT scan showed specific lesions for clonorchiasis and fascioliasis in the liver, along with lesions suggestive of amebic abscess. Micro-ELISA revealed positive results for the 2 helminthic infections. Eggs of C. sinensis and trophozoites of Entamoeba histolytica were observed in the stool. Treatment with praziquantel followed by metronidazole and tinidazole reduced abnormalities in the liver and eosinophilia. This is the first case report of a possible co-infection with 2 kinds of liver flukes in the Republic of Korea.
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Since the first descriptions of Brugada as a new clinical entity defined by sudden cardiac death in patients with typical electrocardiogram (ECG) patterns, Brugada syndrome (BS) has been increasingly diagnosed. This syndrome is known as a disease that is inherited via an autosomal dominant trait, and the SCN5A mutation has been found in 20-25% of BS patients. Because BS primarily manifests in adulthood, little information is available on BS during childhood. Although there have been several reports on adult BS in Korea, pediatric BS has not been reported. Herein, we report on childhood BS in two families. One infantile BS patient and his family had a novel SCN5A mutation (c.4035G>T, p.W1345C, heterozygote) in domain III of the sodium channel.
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Adulto , Humanos , Síndrome de Brugada , Morte Súbita Cardíaca , Eletrocardiografia , Coreia (Geográfico) , Canais de Sódio , Taquicardia VentricularRESUMO
PURPOSE: Laparoscopic cholecystectomy (LC) has been the treatment of choice for acute and chronic disease of the gallbladder. We have performed 621 cases of LC from January 02 2001 to April 30 2008. This study aims to clinically analyze 621 cases of LC that were performed by a single surgeon over a 7 year period and to evaluate the effectiveness and safety of laparoscopic treatment for gallbladder disease. METHODS: From January 02 2001 to April 30 2008, 621 patients underwent LC at the Department of Surgery by a single surgeon. We retrospectively analyzed the patients' ages, gender distribution and chief complaints, the operation times, the duration of hospitalization, the conversion rate to open cholecystectomy and the causes, the diagnostic methods and the postoperative complications through a review of the patients' charts. RESULTS: The mean age was 46 years and the ratio of males to females was 1:1.4. The most common chief complaint was right upper quadrant pain (52.97%). The mean operative time was 67.37 minutes and the duration of hospitalization was 5.12 days and the duration of postoperative hospitalization was 3.86 days. The conversion rate was 3.29% and the most common cause of conversion was anatomic uncertainty due to inflammatory adhesion. Abdominal sonography was the most common diagnostic method and this was performed in 73.27% of the patients. The postoperative complication rate was 1.93%. CONCLUSION: LC has become the gold standard for the treatment of benign gallbladder diseases. We think that LC is effective and safe, and even at a secondary care hospital, if the surgeon has accumulated operative experience and improved operative skill.
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Feminino , Humanos , Masculino , Colecistectomia , Colecistectomia Laparoscópica , Colecistite , Doença Crônica , Vesícula Biliar , Doenças da Vesícula Biliar , Hospitalização , Duração da Cirurgia , Polienos , Complicações Pós-Operatórias , Estudos Retrospectivos , Atenção Secundária à Saúde , IncertezaRESUMO
We established an in vitro experimental system using the following procedure. We first introduced tritium-labeled norepinephrine ([3H]-NE) into PC12 cells. The [3H]-NE incorporated-PC12 cells were stimulated by a high concentration (60 mM) of K+ buffer during 12 minutes. Then, we collected 100 microliter supernatant and counted the amount of [3H]-NE release from PC12 cells with a scintillation counter. After screening fungal, Streptomyces spp. or bacterial product using this experimental sytem, we obtained FS390 from Streptomyces spp. which inhibited [3H]-NE release from PC12 cells. FS390 also inhibits the release of ATP as a neurotransmitter of PC12 cells and rat cortical neurons. The inhibitory effect was seen even when the PC12 cells were treated with low K+ buffer containing ionomycin (1 micrometer) as an ionopore. This result suggests that the inhibitory action of FS390 on neurotransmitter release appeared after the influx of Ca2+.
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Animais , Ratos , Trifosfato de Adenosina , Exocitose , Ionomicina , Programas de Rastreamento , Neurônios , Neurotransmissores , Norepinefrina , Células PC12 , Contagem de Cintilação , StreptomycesRESUMO
FS390, a novel microbial metabolite from Streptomyces spp. was identified as a small molecular substance and shown a inhibition activities for the release of neurotransmitter from rat hippocampal neuron and PC12 cells. FS390 is an inhibitor of trifiated norepinephrine ([3H]-NE) release in high K+ buffer solution containing ionomycin, indicating that FS390 inhibits neurotransmitter release after the influx of Ca2+ ions. When examined the effect of FS390 on beta-glucuronidase release from guinea pig neurophils, FS390 inhibited beta-glucuronidas release: when treated with 5 microgram/mL of FS390, which was not induced cellular cytotoxicity. The fact that the beta-glucuronidase release in neutrophil and norepinephrine release in neuron was inhibited suggests the similarity in the locations and the mechanisms of FS390 action targets. When treated with 5 microgram/mL of FS390, [3H]-NE release and neurite extension for both rat hippocampal neurons and PC12 cells were prevented. These observations of FS390 functioning as an inhibitor of neurotransmitter release suggest that FS390 has an important role in synaptic transmission in neuron.
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Animais , Ratos , Exocitose , Glucuronidase , Cobaias , Ionomicina , Íons , Neuritos , Neurônios , Neurotransmissores , Neutrófilos , Norepinefrina , Células PC12 , Streptomyces , Transmissão SinápticaRESUMO
Peritoneal desmoplastic small round cell tumor is a very rare malignant neoplasm and has specific clinical features; It is predominant in children and young males and has a well-demarcated large intra-abdominal tumor, which has not been associated with a primary visceral organ, with diffusely scattered multiple small tumors and rarely involves ovaries. It is a very aggressive and fast growing tumor along the peritoneal surfaces of the abdomen and pelvis. It has a typical histologic features and a specific immunohistochemical staining pattern. There is no definite treatment. It responses to surgery and chemotherapy at early period of therapy but relapses soon and rapidly progresses and then causes the death. We have experienced a peritoneal desmoplastic small round cell tumor which involved both ovaries, so we report this case with a brief review of literature.
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Criança , Feminino , Humanos , Masculino , Abdome , Tumor Desmoplásico de Pequenas Células Redondas , Tratamento Farmacológico , Ovário , Pelve , RecidivaRESUMO
PURPOSE: High resolution ultrasonography has made it possible to detect many non-palpable small nodules in thyroid gland. We investigated the prevalence and clinical features of non-palpable thyroid nodule and carcinoma discovered incidentally at screening ultrasonography in healthy women. METHODS: A retrospective review was undertaken on the previous healthy asymptomatic 1, 714 women where selected to undergo screening ultrasonography for the detection of the presence of non-palpable thyroid nodules from January 2004 to December 2004. The aims of study were to define the prevalence of thyroid nodule and carcinoma in healthy asymptomatic women and to access the extent of disease in patients with malignant nodule by surgery. RESULTS: Of the 1, 714 subject, thyroid nodule were detected in 822 (48.0%) women with their prevalence increasing with the increasing age of patients. The malignant detection rate based on the USG-guided fine-needle aspiration (USGFNA) results, including both suspicious and malignant groups, was 2.8% (48/1, 714) of all subjects. 38 of 50 patients with malignant, suspicious or indeterminate cytology underwent surgery and all of them were confirmed to have papillary carcinoma on histological results. In 38 patients with papillary thyroid carcinoma, the average size of tumors was 0.87+/-0.33 cm, a range of 0.3 to 1.5 cm, multifocal tumors were found in 50% (19/38), bilaterality was found in 44.7% (17/38), extrathyroidal extension was observed in 50.0% (19/38), and regional lymph node metastasis was found in 29.4% (5/17). CONCLUSION: High resolution ultrasonography detected a high percentage (48%) of nonpalpable thyroid nodules. Characteristics of thyroid nodules on ultrasonography can be used to decision of optimal management strategies. Total thyroidectomy with lymph node dissection may be suitable in patients with non-palpable papillary thyroid carcinoma due to its high incidence of extrathyroidal extension, bilaterality and regional lymph node metastasis.
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Feminino , Humanos , Biópsia por Agulha Fina , Carcinoma Papilar , Incidência , Excisão de Linfonodo , Linfonodos , Programas de Rastreamento , Metástase Neoplásica , Prevalência , Estudos Retrospectivos , Glândula Tireoide , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Tireoidectomia , UltrassonografiaRESUMO
PURPOSE: This prospective study was done to assess the effectiveness of a preoperative intercostal nerve block (ICNB) for postoperative pain relief in patients undergoing an appendectomy. METHODS: In this study, thirty patients were divided into two groups, an ICNB group (n=15) and a control group (n=15), by non-randomized selection. The ICNB group patients had a preoperative ICNB on the right 10th, 11th, and 12th intercostal nerve, each with a mixture of 5 ml 0.25% bupivacaine and 1:200,000 epinephrine. The technical failure rate, the onset time, and side reactions were recorded in ICNB group, and the pain score on the visual analogue scale (VAS), the first injection time of analgesics, and the frequency of analgesics injection within postoperative 24 hours were compared in both groups. RESULTS: In the ICNB patients, the technical failure rate was 28.6%, the mean onset time was 6.7 min, and no serious side reactions were seen in any of the cases. There was also a statistically significant decrease in the pain score on the VAS at the 2nd, 4th, and 8th hours after the appendectomy in the ICNB group compared to control group (P<0.05). In the control group, the pain scores on the VAS were 5.06 at the 2nd hour, 5.03 at the 4th hour, and 4.51 at the 8th hour. In the ICNB group, they were 3.62 at the 2nd hour, 3.32 at the 4th hour, and 3.29 at the 8th hour. CONCLUSION: A preoperative ICNB is not a satisfactory method for postoperative pain relief in patients undergoing an appendectomy due to its short acting time. Hence it is necessary to develop a new long-acting drug with low toxicity for pain relief in patients after receiving an appendectomy.
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Humanos , Analgésicos , Apendicectomia , Bupivacaína , Epinefrina , Nervos Intercostais , Dor Pós-Operatória , Estudos ProspectivosRESUMO
BACKGROUND: We understand that central parenteral nutrition has a wide range of technical, metabolic, and septic complications and that lipid-based parenteral nutrition, like Total Nutrients Admixture (TNA), is more physiologic than glucose-based parenteral nutrition. Peripheral parenteral nutrition has become more convenient sinse the introduction of the TNA system and the development of large-bored silicon venous catheters. We have administered peripheral TNA (p-TNA) selectively to patients in whom central vein access is difficult or in whom central vein access is not required in case of surgical observation with conservative therapy for a certain period. We investigated the convenience and effectiveness of p-TNA in this study. METHOD:We evaluated retrospectively 50 patients to whom p-TNA had been administered at the Department of Surgery, Wallace Memorial Baptist Hospital, sometime during the year from Dec. 1996 to Nov. 1997. RESULT:In the Subjective Global Assessment (SGA) designed by Detskey et al. as a method of nutritional status assessment before administration of p-TNA, Class A was 24%, Class B was 64%, and Class C was 12%. Common indications for p-TNA were recent GI anastomosis in 19 cases (38%), acute pancreatitis in 8 cases (16%), and prolonged ileus or delayed gastric emptying in 6 cases (12%). Most patients were administered 1.5~2 L daily, and the maximal daily administered volume was 2.5 L. The mean duration of administration was 9.5 day, and no patients was administered p-TNA for longer than 2 weeks. Nutritional status indices, like body weight, transferrin, 24h-UUN, and lymphocyte count, were checked serially after administration of p-TNA. Nutritional status indices improved in above 80% of the cases. Clinical progress was improved in 86% of patients. CONCLUSION:We believe p-TNA used under the proper indications to be efficacious and safe and to have fewer complications. The lipid, as the major calorie source is more physiologic, so p-TNA can supply patients with improved nutritional status easily.
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Humanos , Peso Corporal , Catéteres , Esvaziamento Gástrico , Íleus , Contagem de Linfócitos , Estado Nutricional , Pancreatite , Nutrição Parenteral , Protestantismo , Estudos Retrospectivos , Silicones , Transferrina , VeiasRESUMO
PURPOSE: Although the cancer of the right side colon is usually managed by primary anastomosis following resection, but the optimal management of obstructing left side colon cancer is controversial. So, we performed this study to evaluate the feasibility and safety of subtotal or total colectomy as a method of one-stage operation in malignant obstruction of left side colon. METHODS: We analyzed retrospectively 35 patients with obstructing left side colon cancer among 74 cases of obstructing colorectal carcinoma who were treated surgically at the Wallace Memorial Baptist Hospital from January 1989 to December 1998. RESULTS: One-stage operation was performed in 16 patients (subtotal colectomy in 13, total colectomy in 3). Staged operation was performed in 15 patients (two-stage operation in 10, three-stage operation in 5). Palliative colostomy was performed in 4 patients. Postoperative complications had been developed in 6 patients (37.5%) with subtotal or total colectomy group and in 7 patients (46.7%) with staged operation group. The postoperative frequent bowel movement was shown in 13 patients (81.2%) with subtotal or total colectomy group and in 7 patients (70.0%) with staged operation group. Frequent bowel movement was improved with antidiarrheal medications within 3 months. Operative mortality was 6.3% (1 patient) in subtotal or total colectomy group and 13.3% (2 patients) in staged operation group. There was no significant difference in morbidity and mortality statistically between two groups. CONCLUSIONS: We believe that subtotal or total colectomy as a method of one-stage operation can be performed with acceptable morbidity and mortality in selected patients with obstructing left side colon cancer.
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Humanos , Colectomia , Colo , Neoplasias do Colo , Neoplasias Colorretais , Colostomia , Mortalidade , Complicações Pós-Operatórias , Protestantismo , Estudos RetrospectivosRESUMO
Acute necrotizing pancreatitis (ANP) is a disease with high morbidity and mortality despite the progress made in intensive medical care. This study was conducted to clarify the strategy and the prognostic factors in its surgical management.We reviewed retrospectively 26 patients who had operative treatment for ANP from March 1990 to February 1995 at Wallace Memorial Baptist Hospital. The results were as follows:1) The most common cause of the ANP was alcohol (38.5%) and the next most common cause was gallstone (23.1%). 2) The operative indications were an acute surgical abdomen (15 cases), sepsis (6 cases), organ failure (3 cases), and shock (2 cases). 3) The culture results for the specimens which were obtained from the necrotic lesions or from fluid collections showed bacterially positive patients in 78.9% of the cases and polymicrobial infection in 31.6% of the cases. 4) Of the operative methods, a necrosectomy with open drainage and delayed lavage was applied to 17 cases (65.4%), and the mortality of this procedure was 23.5%. 5) During the postoperative course, reoperation was required in 3 cases (11.5%) and diabetes was seen in 6 cases of 22 cases (27.3%). 6) We analyzed prognostic factors like the Ranson score, infection, inadequate necrosectomy with drainage, and preoperative organ failure with statistical methods (Student's t-test and Chi-square test). The Ranson score and infection showed little correlation with the postoperative mortality, but an inadequate necrosectomy with drainage and preoperative organ failure showed a statistically significant correlation (p=0.006, p=0.009, respectively). In conclusion, we applied a necrosectomy with open drainage and delayed lavage to most of the ANP patients. An inadequate necrosectomy with drainage and preoperative organ failure had important meanings as prognostic factors and affected the postoperative mortality. Hence we think that necrotic lesions and fluid collections require early radical debridement and wide drainage, especially in infected necrotizing pancrectitis, and that multiple, well-positioned drains are important for decreased morbidity and mortality.