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Hyperpigmentation*

A ruptured aneurysm of the pancreaticoduodenal arteries is an emergency condition, with a high mortality rate. Therefore, early diagnosis and adequate management are needed. Recently, treatment with a transcatheter arterial embolization has decreased the mortality rate. A 68-year-old man presented with persistent abdominal pain and dyspnea. Contrast abdominal computed tomography revealed a large retroperitoneal hematoma, with an actively bleeding focus. An urgent celiac and superior pancreaticoduodenal arteriogram showed a contrast extravasation, about 15 X 8 mm in size, with a saccular aneurysm of the distal anterior superior pancreaticoduodenal artery; therefore transcatheter arterial embolization was performed. The patient's condition improved without complication after the embolization.
Abdominal Pain ; Aged ; Aneurysm* ; Aneurysm, Ruptured ; Arteries* ; Dyspnea ; Early Diagnosis ; Emergencies ; Hematoma* ; Hemorrhage ; Humans ; Mortality

PURPOSE: The optimal antibiotic regimen for appendicitis still remains poorly defined. The aim of this study was to define the optimal duration and route of antibiotics after an appendectomy, with regard to the clinicopathololgical aspects. METHODS: This study was performed on 73 consecutive patients who underwent an appendectomy. Groups A and B, which were composed of cases of simple appendicitis (phlegmonous and suppurative type) and complicated appendicitis (gangrenous and perforated type), respectively. Group A was randomized after the appendectomy into either A1 (n=17), a 1-day course of a combination of IV first generation cephalosporin and tobramycin; or to A2 (n=26), a 3-day course of the same regimen. Group B was randomized into either B1 (n=16), a 3-day course of a combination of IV cephalosporin, tobramycin, and metronidazole, followed by conversion to a 4-day course of a combination of PO third generation cephalosporin and metronidazole; or B2 (n=7), a 7-day course of a combination of IV cephalosporin and metronidazole, along with a 5-day course of tobramycin. The total leukocyte count (WBC), neutrophil count, and C-reactive protein (CRP) were analyzed preoperatively and on POD #3 and #7. An intraoperative culture of the surface of the appendix was also performed. RESULTS: The most common cultured organism was Escherichia coli (n=30). Ampicillin and first generation cephalosporin were 73% and 49% resistant to Gram-negative organisms, respectively. Third generation cephalosporin and imipenem were 100% sensitive. The subjects in group A were all under normal limits in the postoperative laboratory analyses, and had no complication. Groups B1 and B2 showed no significant differences in their WBC (P=0.301), neutrophil count (P=0.730), and complications (P=0.907), with the exception of CRP (P=0.040). CONCLUSION: After the appendectomy, simple appendicitis was treated with antibiotics for 24 hrs, with no complications. For complicated appendicitis, a 3-day IV course, followed by a conversion to 4-day PO antibiotics, was found to be safe. Surveillance of the WBC and neutrophil counts, CRP values, and body temperature permitted safe utilization of this regimen.
Ampicillin ; Anti-Bacterial Agents ; Appendectomy* ; Appendicitis ; Appendix ; Body Temperature ; C-Reactive Protein ; Escherichia coli ; Humans ; Imipenem ; Leukocyte Count ; Metronidazole ; Neutrophils ; Prospective Studies* ; Tobramycin

BACKGROUND: This nationwide survey was undertaken to characterize the general pathological features of colorectal cancer in Korea, and especially to elucidate the geographical characteristics by means of their anatomical distribution. METHODS: We analysed 1,676 colorectal cancers (from 1,602 patients) surgically resected in 1998 at 15 institutions from nine geographical sites in Korea. RESULTS: The topographic incidence of colorectal cancer in seven out of the total nine geographical sites, was the highest in the rectum (32-54%); and those from Wonju and Cheongju were in the sigmoid colon (28% for both). The right colon cancer incidence was 42% in Wonju and 36% in Cheongju, while it was 17-22% in the other areas. The cecal cancer incidences in Wonju and in Taegu were 7% and 8%, respectively, but 0-4% in the other areas. As for histology, moderately differentiated adenocarcinoma was the most frequent (46-84%), except for in Wonju and Chonju, where the most predominant type was well differentiated (63% and 52%, respectively). CONCLUSION: The incidence of right colon cancer was higher in Wonju and Cheongju, than in the other geographical sites. The cecal predilection was prominent in Taegu and Wonju. The Elucidation of geographical differences in degree of differentiation for tubular adenocarcinoma seems to require further cumulative study with strict guidelines.
Adenocarcinoma ; Cecal Neoplasms ; Chungcheongbuk-do ; Colon, Sigmoid ; Colonic Neoplasms ; Colorectal Neoplasms* ; Daegu ; Gangwon-do ; Humans ; Incidence ; Jeollabuk-do ; Korea ; Pathology ; Rectum