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1.
Langenbecks Arch Surg ; 408(1): 229, 2023 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-37291445

RESUMO

BACKGROUND/OBJECTIVES: Bismuth type IV perihilar cholangiocarcinoma has been considered an unresectable disease. The aim of the study was to assess whether the surgical resection of type IV perihilar cholangiocarcinoma was associated with better survival rates. METHODS: The data of 117 patients diagnosed with type IV perihilar cholangiocarcinoma at Keimyung University Dongsan Hospital from 2005 to 2020 were retrospectively reviewed. The Bismuth type was assigned based on the patient's radiological imaging findings. The primary outcomes were the surgical results and median overall survival. RESULTS: The demographic characteristics of the 117 patients with type IV perihilar cholangiocarcinoma were comparable between the surgical resection and non-resection groups. Thirty-two (27.4%) patients underwent surgical resections. A left hepatectomy was performed in 16 patients, right hepatectomy in 13 patients, and a central bi-sectionectomy in three patients. The remaining 85 patients received non-surgical treatments. Thirteen (10.9%) received palliative chemotherapy, and 72 (60.5%) patients received conservative treatment including biliary drainage. The patients in the resection group showed significantly longer median overall survival than the patients in the non-resection group (32.4 vs 16.0 months; P = 0.002), even though the positive resection margin rate was high (62.5%). Surgical complications occurred in 15 (46.9%) patients. Complications of Clavien-Dindo classification grade III or higher occurred in 13 (40.6%) patients and grade V in two patients (6.3%). CONCLUSION: Surgical resection for Bismuth type IV perihilar cholangiocarcinoma is technically demanding. The survival of the resection group was significantly better than that of the non-resection group. The resection of selected patients achieved a curative goal with acceptable postoperative morbidity, although the microscopically positive resection margin rate was high.


Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Tumor de Klatskin , Humanos , Tumor de Klatskin/cirurgia , Colangiocarcinoma/cirurgia , Bismuto , Ductos Biliares Intra-Hepáticos/cirurgia , Estudos Retrospectivos , Margens de Excisão , Resultado do Tratamento , Neoplasias dos Ductos Biliares/patologia , Hepatectomia/métodos
2.
Sci Rep ; 14(1): 14352, 2024 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-38906968

RESUMO

Ischemic colitis (IC) and sarcopenia are associated with aging and multiple comorbidities. We aimed to investigate the prevalence and predictive role of sarcopenia in patients with IC. We retrospectively analyzed 225 hospitalized patients (median age, 72 years; women, 67.1%; severe IC, 34.2%) who were diagnosed with IC between January 2007 and February 2022. Sarcopenia was defined as the skeletal muscle index at the third lumbar vertebra determined by computed tomography. It was present in 49.3% (n = 111) of the patients and was significantly associated with severe IC compared to those without sarcopenia (48.6% vs. 20.2%, P < 0.001). Sarcopenia was associated with extended hospitalization (median: 8 vs. 6 days, P < 0.001) and fasting periods (4 vs. 3 days, P = 0.004), as well as prolonged antibiotic use (9 vs. 7 days, P = 0.039). Sarcopenia was linked to a higher risk of surgery or mortality (9.0% vs. 0%, P = 0.001) and independently predicted this outcome (odds ratio [OR], 11.17; 95% confidence interval [CI], 1.24‒1467.65, P = 0.027). It was prevalent among hospitalized patients with IC, potentially indicating severe IC and a worse prognosis. This underscores the importance of meticulous monitoring, immediate medical intervention, and timely surgical consideration.


Assuntos
Colite Isquêmica , Hospitalização , Sarcopenia , Humanos , Sarcopenia/epidemiologia , Sarcopenia/complicações , Sarcopenia/diagnóstico , Feminino , Masculino , Idoso , Prevalência , Colite Isquêmica/epidemiologia , Colite Isquêmica/complicações , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Tomografia Computadorizada por Raios X , Prognóstico , Fatores de Risco
3.
BMJ Open ; 10(11): e041989, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33184086

RESUMO

OBJECTIVE: The reliable risk factors for mortality of COVID-19 has not evaluated in well-characterised cohort. This study aimed to identify risk factors for in-hospital mortality within 56 days in patients with severe infection of COVID-19. DESIGN: Retrospective multicentre cohort study. SETTING: Five tertiary hospitals of Daegu, South Korea. PARTICIPANTS: 1005 participants over 19 years old confirmed COVID-19 using real-time PCR from nasopharyngeal and oropharyngeal swabs. METHODS: The clinical and laboratory features of patients with COVID-19 receiving respiratory support were analysed to ascertain the risk factors for mortality using the Cox proportional hazards regression model. The relationship between overall survival and risk factors was analysed using the Kaplan-Meier method. OUTCOME: In-hospital mortality for any reason within 56 days. RESULTS: Of the 1005 patients, 289 (28.8%) received respiratory support, and of these, 70 patients (24.2%) died. In multivariate analysis, high fibrosis-4 index (FIB-4; HR 2.784), low lymphocyte count (HR 0.480), diabetes (HR 1.917) and systemic inflammatory response syndrome (HR 1.714) were found to be independent risk factors for mortality in patients with COVID-19 receiving respiratory support (all p<0.05). Regardless of respiratory support, survival in the high FIB-4 group was significantly lower than in the low FIB-4 group (28.8 days vs 44.0 days, respectively, p<0.001). A number of risk factors were also significantly related to survival in patients with COVID-19 regardless of respiratory support (0-4 risk factors, 50.2 days; 49.7 days; 44.4 days; 32.0 days; 25.0 days, respectively, p<0.001). CONCLUSION: FIB-4 index is a useful predictive marker for mortality in patients with COVID-19 regardless of its severity.


Assuntos
Fatores Etários , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Infecções por Coronavirus/sangue , Mortalidade Hospitalar , Linfopenia/sangue , Contagem de Plaquetas , Pneumonia Viral/sangue , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Betacoronavirus , COVID-19 , Estudos de Coortes , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Modelos de Riscos Proporcionais , República da Coreia , Respiração Artificial , Estudos Retrospectivos , Medição de Risco , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica/imunologia
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