PURPOSE: Intra-abdominal fluid collection is one of the risk factors associated with postoperative morbidity or mortality for patients who undergo gastric cancer surgery. The aim of this study was to analyze the clinicopathological characteristics of the patients with postoperative intra-abdominal fluid collection and to identify the indications for inserting a percutaneous drain (PCD) in patients with intra-abdominal fluid collection. MATERIALS AND METHODS: Among the 1,277 patients who underwent operations for gastric cancer at Seoul National University Hospital between April 2005 and July 2006, the data of 117 patients with an intra-abdominal fluid collection were reviewed. RESULTS: The number of patients' with pathologic stage I, II, III and IV disease was 42 (36.8%), 23 (20.2%), 16 (14%) and 33 (28.9%), respectively. Forty-three patients (36.3%) underwent PCD insertion and the other 43 patients received conservative management. A univariate analysis of multiple clinical variables revealed that age, gender, diabetes, liver disease, lymph node dissection, the pathologic stage and the body mass index (BMI, kg/m2) were not significantly associated with PCD insertion (P>0.05). However, the univariate analysis showed that two characteristics were associated with a significantly high incidence of PCD insertion: a diameter of an intra-abdominal fluid collection greater than 4 cm and infectious signs such as leukocytosis, fever and bacteremia. CONCLUSION: About two thirds of the intra-abdominal fluid collections after surgery for gastric cancer were managed with only conservative method without other morbidities of mortality. Surgeons should consider performing PCD insertion if the largest diameter of an intra-abdominal fluid collection is over 4 cm or if infectious signs are seen.
Bacteremia ; Body Mass Index ; Fever ; Humans ; Incidence ; Leukocytosis ; Liver Diseases ; Lymph Node Excision ; Risk Factors ; Stomach Neoplasms

Distal renal tubular acidosis is a condition characterized by an inability of the distal nephron to acidify urine, causing hyperchloremic metabolic acidosis. Distal renal tubular acidosis is classified as proton secretory defect, permeability defect and voltage defect based on its pathophysiology. In the former two, serum level of potassium decreases due to increased excretion of potassium. But in the latter (voltage defect), hyperkalemia is characteristic by impaired the generation of an optimal electrical gradient for hydrogen ion and potassium secretion. We experienced a case of Sj gren's syndrome associated with both voltage defect distal renal tubular acidosis and nephrogenic diabetes insipidus. The patient was a 58- year-old woman who complained of general weakness, nausea and xerostomia. Laboratory analysis showed metabolic acidosis with alkaline urine and hyperkalemia. Anti-nuclear antibody and anti-ds DNA antibody were positive. She presented with polyuria, low urine osmolarity and inadequate response to DDAVP. The response to Shirmer test was decreased. Salivary scintigraphy showed decrease of uptake in the parotid and submandibular salivary glands. We believe this is the first case report in which Sj gren's syndrome is associated with both voltage defect distal renal tubular acidosis and nephrogenic diabetes insipidus.
Acidosis ; Acidosis, Renal Tubular* ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Nephrogenic* ; DNA ; Female ; Humans ; Hyperkalemia ; Nausea ; Nephrons ; Osmolar Concentration ; Permeability ; Polyuria ; Potassium ; Protons ; Radionuclide Imaging ; Salivary Glands ; Xerostomia

Distal renal tubular acidosis is a condition characterized by an inability of the distal nephron to acidify urine, causing hyperchloremic metabolic acidosis. Distal renal tubular acidosis is classified as proton secretory defect, permeability defect and voltage defect based on its pathophysiology. In the former two, serum level of potassium decreases due to increased excretion of potassium. But in the latter (voltage defect), hyperkalemia is characteristic by impaired the generation of an optimal electrical gradient for hydrogen ion and potassium secretion. We experienced a case of Sj gren's syndrome associated with both voltage defect distal renal tubular acidosis and nephrogenic diabetes insipidus. The patient was a 58- year-old woman who complained of general weakness, nausea and xerostomia. Laboratory analysis showed metabolic acidosis with alkaline urine and hyperkalemia. Anti-nuclear antibody and anti-ds DNA antibody were positive. She presented with polyuria, low urine osmolarity and inadequate response to DDAVP. The response to Shirmer test was decreased. Salivary scintigraphy showed decrease of uptake in the parotid and submandibular salivary glands. We believe this is the first case report in which Sj gren's syndrome is associated with both voltage defect distal renal tubular acidosis and nephrogenic diabetes insipidus.
Acidosis ; Acidosis, Renal Tubular* ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Nephrogenic* ; DNA ; Female ; Humans ; Hyperkalemia ; Nausea ; Nephrons ; Osmolar Concentration ; Permeability ; Polyuria ; Potassium ; Protons ; Radionuclide Imaging ; Salivary Glands ; Xerostomia