Few studies have reported injuries caused by a blank cartridge shot (BCS) into the head and neck. We experienced a case of minor injury resulting from BCS (despite the close proximity). The patient was a 20-year-old male soldier who attempted suicide by firing a BCS from a K2 rifle into his mouth. He suffered from skin and soft tissue defect in the submandibular area with burns and minimal bleeding. A computed tomography scan showed subcutaneous emphysema which was suspected to be related to the projectile gas released during the firing of the BCS, and a tiny fragment without hematoma or structure injuries. We closely observed the clinical features including the occurrence of infection and functional abnormalities. The subcutaneous emphysema faded away along with the soft tissue defect. After wound management was completed on the 13th hospital day, the patient was transferred to the Department of Psychiatry without any problems.

PURPOSE: To determine whether early visual acuity response to intravitreal bevacizumab in macular edema (ME) secondary to branch retinal vein occlusion (BRVO) is associated with 12-month follow-up outcome. METHODS: Sixty treatment-naïve patients (60 eyes) with ME secondary to BRVO treated with intravitreal bevacizumab (1.25 mg) were retrospectively included. Initially, all patients were injected monthly to achieve fluid resolution and followed up with a pro re nata regimen for at least 12 months. The relationship between early (month 1) and late (month 12) visual acuity response (mean change from baseline in best-corrected visual acuity [BCVA]; categorized improvement [<1, 1–3, or ≥3 logMAR lines in BCVA]) was explored. RESULTS: The proportions of eyes with <1, 1-<3, and ≥3-line improvements at 1 month were 19 eyes (31.7%), 17 eyes (28.3%), and 24 eyes (40%), respectively. Within each of the three response categories, the mean BCVA change from baseline at 12 months and onward did not vary by more than 1 line from the observed mean BCVA improvement at 1 month. Inter-cohort differences across the three response categories in mean BCVA change from baseline were statistically significant at each time point. Early BCVA response at 1 month showed significant associations with ≥3 line improvement and BCVA response at 12 months in multiple logistic and linear regression analyses. CONCLUSIONS: Early BCVA responses to bevacizumab are associated with subsequent responses over the entire 12-month duration of treatment.
Bevacizumab* ; Follow-Up Studies ; Humans ; Linear Models ; Macular Edema* ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Visual Acuity

PURPOSE: To compare the short-term efficacy of intravitreal aflibercept and ranibizumab treatment according to the subtypes of polypoidal choroidal vasculopathy (PCV) based on indocyanine green angiography (ICGA). METHODS: Fifty-five treatment naïve patients with PCV who underwent intravitreal anti-vascular endothelial growth factor (VEGF) (ranibizumab, 26 eyes; aflibercept, 29 eyes) injection were retrospectively analyzed. Based on ICGA, subjects with feeder and draining vessels were defined as type 1 PCV (33 eyes), and subjects who did not have either feeder or draining vessels, but had branch vascular networks were defined as type 2 PCV (22 eyes). The complete polyp regression was assessed at 3 months after the initial treatment using ICGA. Changes in best-corrected visual acuity (BCVA) and optical coherence tomographic parameters were evaluated at 3 and 6 months. RESULTS: Patients with type 1 PCV showed a higher complete polyp regression percentage (p = 0.034) and better visual improvement (p = 0.017) after three monthly injections compared to patients with Type 2 PCV. At 3 and 6 months, the BCVA was significantly improved in type 1 PCV patients, but not in type 2 PCV patients. In patients with type 1 PCV, the aflibercept-treated group showed a better response in anatomical outcomes (p = 0.020), and complete polyp regression percentage (p = 0.027; dry macula) than the ranibizumab-treated group, and only the aflibercept-treated group showed a significant improvement of BCVA at 3 and 6 months. In patients with type 2 PCV, there were no significant differences in visual and anatomical outcome between the anti-VEGF agents. CONCLUSIONS: Type 1 PCV showed better visual improvement with a higher percentage of polyp regression than type 2 PCV. Anatomical changes were greater in patients treated with aflibercept than with ranibizumab, particularly in patients with type 1 PCV. These results suggest that a consideration of angiographic features is important in establishing a treatment strategy for patients with PCV.
Angiography ; Choroid* ; Classification* ; Endothelial Growth Factors ; Humans ; Indocyanine Green ; Polyps ; Ranibizumab* ; Retrospective Studies ; Visual Acuity

PURPOSE: Inadequate bowel preparation (IBP) is commonly observed during surveillance colonoscopy after colorectal resection. We investigated potential risk factors affecting bowel preparation. METHODS: We studied potential factors affecting bowel preparation quality. The Boston bowel preparation score was used to measure bowel preparation quality. Factors affecting IBP were analyzed, including age, body mass index, time elapsed between surgery and colonoscopy, and amount of bowel preparation drug consumed (conventional-volume vs. low-volume). Odds ratios were calculated for IBP. RESULTS: This retrospective cohort study included 1,317 patients who underwent colorectal resection due to malignancy. Of these patients, 79% had adequate bowel preparation and 21% had IBP. In multivariate regression analysis, a surveillance colonoscopy within 1 year after surgery and age >80 were used as independent predictors of IBP. IBP rate of the low-volume group was significantly higher than that of the conventional-volume group among patients who underwent a surveillance colonoscopy within 1 year after surgery. CONCLUSION: For surveillance colonoscopy after colorectal resection, bowel preparation is affected by factors including colonoscopy timing after surgery and age. We recommend the use of conventional-volume 4-L polyethylene glycol solution when performing a surveillance colonoscopy, especially up to 1 year after surgery.
Body Mass Index ; Cohort Studies ; Colonic Neoplasms ; Colonoscopy ; Humans ; Odds Ratio ; Polyethylene Glycols ; Rectal Neoplasms ; Retrospective Studies ; Risk Factors

The standard treatments for locally advanced rectal cancer typically involved neoadjuvant therapy with either short-course radiation or long-course chemoradiation, followed by radical surgery and adjuvant chemotherapy. While the advancement of surgical techniques and the adoption of multimodal therapy have greatly contributed to reducing local failure, there has been limited improvement in overall survival, primarily due to the stagnation in systemic failure. In response to this challenge, a new strategy known as total neoadjuvant therapy (TNT) has emerged, involving the administration of both fulldose chemotherapy and radiation before surgery. It has shown promise in reducing systemic failure, enhancing tumor regression, and improving treatment adherence, ushering in a new era in the standard treatment of locally advanced rectal cancer. This review aims to summarize the evolution of multimodal treatments for locally advanced rectal cancer, ultimately converging into the current TNT strategy, and provides an assessment of the benefits and limitations of TNT based on available evidence, serving as a foundation for selecting the best treatment option.

Purpose: Choosing the appropriate antibiotic is important for treatment of complicated appendicitis. However, increasing multidrug resistant bacteria have been a serious problem for successful treatment. This study was designed to identify bacteria isolated from patients with complicated appendicitis and reveal their susceptibilities for antibiotics and their relationship with patient clinical course. Methods: This study included patients diagnosed with complicated appendicitis and examined the bacterial cultures and antimicrobial susceptibilities of the isolates. Data were retrospectively collected from medical records of Kangbuk Samsung Hospital from January 2008 to February 2018. Results: The common bacterial species cultured in complicated appendicitis were as follows: Escherichia coli (n=113, 48.9%), Streptococcus spp. (n=29, 12.6%), Pseudomonas spp. (n=23, 10.0%), Bacteriodes spp. (n=22, 9.5%), Klebsiella (n=11, 4.8%), and Enterococcus spp. (n=8, 3.5%). In antibiotics susceptibility testing, the positive rate of extended-spectrum beta lactamase (ESBL) was 9.1% (21 of 231). The resistance rate to carbapenem was 1.7% (4 of 231), while that to vancomycin was 0.4% (1 of 231). E. coli was 16.8% ESBL positive (19 of 113) and had 22.1% and 19.5% resistance rates to cefotaxime and ceftazidime, respectively. Inappropriate empirical antibiotic treatment (IEAT) occurred in 55 cases (31.8%) and was significantly related with organ/space surgical site infection (SSI) (7 of 55, P=0.005). Conclusion The rate of antibiotic resistance organisms was high in community-acquired complicated appendicitis in Koreans. Additionally, IEAT in complicated appendicitis may lead to increased rates of SSI. Routine intraoperative culture in patients with complicated appendicitis may be an effective strategy for appropriate antibiotic regimen.

PURPOSE: This study compared a subtotal colectomy to self-expandable metallic stent (SEMS) insertion as a bridge to surgery for patients with left colon-cancer obstruction. METHODS: Ninety-four consecutive patients with left colon-cancer obstruction underwent an emergency subtotal colectomy or elective SEMS insertion between January 2007 and August 2014. Using prospectively collected data, we performed a retrospective comparative analysis on an intention-to-treat basis. RESULTS: A subtotal colectomy and SEMS insertion were attempted in 24 and 70 patients, respectively. SEMS insertion technically failed in 5 patients (7.1%). The mean age and rate of obstruction in the descending colon were higher in the subtotal colectomy group than the SEMS group. Sex, underlying disease, American Society of Anesthesiologists physical status, and pathological stage showed no statistical difference. Laparoscopic surgery was performed more frequently in patients in the SEMS group (62 of 70, 88.6%) than in patients in the subtotal colectomy group (4 of 24, 16.7%). The overall rate of postoperative morbidity was higher in the SEMS group. No Clavien-Dindo grade III or IV complications occurred in the subtotal colectomy group, but 2 patients (2.9%) died from septic complications in the SEMS group. One patient (4.2%) in the subtotal colectomy group had synchronous cancer. The total hospital stay was shorter in the subtotal colectomy group. The median number of bowel movements in the subtotal colectomy group was twice per day at postoperative 3–6 months. CONCLUSION: A subtotal colectomy for patients with obstructive left-colon cancer is a clinically and oncologically safer, 1-stage, surgical strategy compared to SEMS insertion as a bridge to surgery.
Colectomy* ; Colon* ; Colon, Descending ; Colonic Neoplasms* ; Emergencies ; Humans ; Intestinal Obstruction ; Laparoscopy ; Length of Stay ; Prospective Studies ; Retrospective Studies ; Stents*

PURPOSE: Laparoscopic surgery is accepted as a standard alternative to open procedures in the management of both benign and malignant colorectal disease. However, the safety and efficacy of the laparoscopic approach for emergency colorectal surgery has not been established. Hand-assisted laparoscopic (HAL) surgery might be a suitable option for colectomy in an emergency setting. The aim of this study was to report our experience of emergency HAL colectomy. METHODS: This was a retrospective review of consecutive colorectal emergency cases that were treated using HAL colectomy. Patient demographics, indications for surgery, operative details, and postoperative complications were examined. RESULTS: From March 2015 to April 2016, 18 patients underwent emergency HAL colectomy for complicated colorectal disease. Eight patients (44%) had an obstruction that required intraoperative decompression procedure. Sixteen patients (89%) had a perforation (five of which were sealed perforations involving large abscesses and inflammatory changes). Eight patients underwent sigmoidectomy, four underwent anterior resection, one underwent low anterior resection, two underwent left hemicolectomy, and three underwent Hartmann's procedure. There were two instances of open conversion (11%). The median duration of surgery was 178 minutes. The median time to bowel function recovery and median postoperative stay were 3 days and 10 days, respectively. The postoperative complication rate associated with the operation was 33% (6/18). There was one postoperative mortality. CONCLUSION: For the experienced surgeon, HAL can be a reasonable option for emergency colorectal surgery.
Abscess ; Colectomy ; Colorectal Surgery ; Decompression ; Demography ; Emergencies* ; Hand-Assisted Laparoscopy* ; Humans ; Laparoscopy ; Mortality ; Postoperative Complications ; Recovery of Function ; Retrospective Studies

The abscess is a common complication of Crohn’s disease (CD), with the perianal form more frequent than gluteal or presacral which is relatively rare. There are few case reports of gluteal abscess combined with presacral abscess caused by CD and the treatment has not been established. A 21-year-old male was admitted with right buttock and lower back pain with a duration of 3 months. He had a history of CD in the small intestine diagnosed 10 months previously. He had poor compliance and had not returned for follow-up care during the previous 6 months. Abdominopelvic CT indicated newly developed multiple abscess pockets in right gluteal region, including piriformis muscle and presacral space. Additionally, fistula tracts between small bowel loops and presacral space were observed. Patient’s CD was moderate activity (273.12 on the Crohn’s Disease Activity Index [CDAI]). Treatment was started with piperacillin/tazobactam antibiotic but patient developed a fever and abscess extent was aggravated. Therefore, surgical incision and drainage was performed and 4 Penrose drains were inserted. Patient’s pain and fever were resolved following surgery. Infliximab was then administered for the remaining fistulas. After the induction regimen, multiple fistula tracts improved and patient went into remission (CDAI was -0.12).