BACKGROUND: The major causes of small bowel obstruction (SBO) are postoperative adhesion, hernia, intussusception and malignancies. However, in cases of uncommon causes of SBO, surgeons are be in a dilemma because the preoperative diagnosis and the decision to operate are frequently difficult and delayed. METHODS: We reviewed retrospectively the cases of 29 patients with SBO who were operated on for unknown etiology at Daedong Hospital between Jan. 1, 1991, and Dec. 31, 1997. The common causes of SBO, such as postoperative adhesion, external hernia, congenital anomaly of the gastrointestinal tract in neonate, intussusception in children, and known intraabdominal malignancy, were all excluded. RESULTS: 1) The incidence of uncommon causes of SBO included in this study was 8.7% of all cases of SBO operated on during the same period. 2) Among the 29 cases, 12 cases were caused by tumors (41.4%), of which the number of malignant tumors was double that of benign ones. 3) Besides tumors, there were 3 cases of bezoar, two cases of congenital bands, mesenteric cysts, internal hernias, Meckel's diverticula, and intussusception, one case each of mesenteric panniculitis and Crohn's disease, and two cases with an unknown etiology of inflammation. 4) Five cases were due to adult intussusception, 3 cases of which were due to benign tumors of the small bowel. All of the SBOs by intussusception were located at the terminal ileum. 5) The most common site of obstruction was the ileum (20 cases), followed by the jejunum (7 cases), and the duodenum (2 cases). 6) Males were dominant (1.6:1) especially in cases of tumor-origin SBOs (2:1). 7) In viewing the age distribution, the incidence was relatively high in the 5th and the 8th decades. Especially, tumor-origin SBOs had their peak in the 5th decade, and all cases of bezoar were found in 8th decade. 8) Operations were performed within 72 hours in 19 cases (65.5%) after first inspection of the patients, and intussusception, congenital band, and bezoar were the common causes of the cases involved in early surgical intervention. 9) Segmental resection of the small bowel was the most common surgical procedure (19 cases, 65.5%), followed by bypass surgery (6 cases), removal of the bezoar (2 cases), and excision of the mesenteric cyst or band (1 case, respectively). Coclusions: We think it reasonable to perform an exploratory laparotomy in cases of unknown causes of SBO as early as possible because almost all the cases require surgical intervention eventually, and studies searching for the causes of obstruction will only be time-consuming. While surgeons should keep in mind that tumors are major causes of uncommon SBOs.
Adult ; Age Distribution ; Bezoars ; Child ; Crohn Disease ; Diagnosis ; Diverticulum ; Duodenum ; Gastrointestinal Tract ; Hernia ; Humans ; Ileum ; Incidence ; Infant, Newborn ; Inflammation ; Intussusception ; Jejunum ; Laparotomy ; Male ; Mesenteric Cyst ; Panniculitis, Peritoneal ; Retrospective Studies

An incisional hernia is still one of the common complications of abdominal surgical procedures and is a significant source of morbidity. The exact incidence of incisional hernias has not been well defined, although a number of reports in the literature suggest that it is between 2% and 11%. Repair of incisional hernias is a common procedure from the surgeon's viewpoint. The authors evaluated the clinical data of 34 patients with incisional hernias at the Department of Surgery, Daedong Hospital, Busan, between January 1990 and December 1996. Incisional hernias were more common in females(9 men and 25 women), and the range of ages was 29 to 79. The incidence was highest in lower midline incisions. Some factors supposed to be associated with the development of incisional hernias were a lower midline incision, increased abdominal pressure, wound infection, reincision, and previous incisional hernia. Severe vomiting, abdominal distension, severe coughing, obesity, and pregnancy contributed to the increased abdominal pressure. An appendectomy was the most common preceding operation for the occurrence of an incisional hernia, although the incidence of appendectomies at the author's hospital was the highest of all other operations. The most frequent symptom or sign of the patients was mass or bulging at the previous operation site. Herniation occurred in 18 patients (52.9%) within 1 year after the preceding operation and herniorrhaphies were performed in 14 cases (41.2%) within 1 year after herniation. The size of hernia in 32 patients (94.1%) was less than 10 cm in diameter, and mesh was used in four patients (11.8%). The method of repair was determined by the size of the defect and by the tension around the defect. Postoperative follow up was made by telephone in 20 of the 34 patients. Among them, the authors were notified of two recurrent incisional hernias: One developed after an operation for mechanical obstruction due to an appendectomy. The other recurred at the lower midline incision for an operation due to rupture of the small bowel and was accompanied by wound infection.
Appendectomy ; Busan ; Cough ; Follow-Up Studies ; Hernia* ; Herniorrhaphy ; Humans ; Incidence ; Male ; Obesity ; Pregnancy ; Rupture ; Telephone ; Vomiting ; Wound Infection

We investigate the potentials and limitations of computational fluid dynamics (CFD) analysis of patient specific models from 3D angiographies. There are many technical problems in acquisition of proper vascular models, in pre-processing for making 2D surface and 3D volume meshes and also in post-processing steps for display the CFD analysis. We hope that our study could serves as a technical reference to validating other tools and CFD results.
Angiography ; Arteries ; Carotid Arteries ; Hemodynamics ; Humans ; Hydrodynamics

PURPOSE: This study was conducted to describe the characteristics of patients with carbon monoxide (CO) poisoning. METHODS: We retrospectively surveyed data from the Emergency Department based Injury In-depth Surveillance of 20 hospitals (2011-2014). We included patients whose mechanism of injury was acute CO poisoning caused by inhalation of gases from charcoal or briquettes. We surveyed the annual frequency, gender, age, result of emergency treatment, rate of intensive care unit (ICU) admission, result of admission, association with alcohol, and place of accident. We also surveyed the cause and experience of past suicide attempts by intentional poisoning. RESULTS: A total of 3,405 patients were included (2,015 (59.2%) and 1,390 (40.8%) males and females, respectively) with a mean age of 39.83±18.51 year old. The results revealed that the annual frequency of CO poisoning had increased and the frequency of unintentional CO poisoning was higher than that of intentional CO poisoning in January, February and December. The mean age of intentional CO poisoning was younger than that of unintentional CO poisoning (38.41±13.03 vs 40.95±21.83) (p<0.001). The rates of discharge against medical advice (DAMA), ICU care and alcohol association for intentional CO poisoning were higher than for unintentional CO poisoning (36.4% vs 14.0%, 17.8% vs 4.7%, 45.2% vs 5.6%) (p<0.001). The most common place of CO poisoning was in one's residence. CONCLUSION: The annual frequency of total CO poisoning has increased, and unintentional CO poisoning showed seasonal variation. DAMA, ICU care, and alcohol association of intentional CO poisoning were higher than those of unintentional CO poisoning.
Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Charcoal ; Emergency Service, Hospital ; Emergency Treatment ; Female ; Gases ; Humans ; Inhalation ; Intensive Care Units ; Intention ; Male ; Poisoning ; Retrospective Studies ; Seasons ; Suicide

Pleural effusion is a common pulmonary manifestation of systemic lupus erythematosus (SLE) and often occurs as bilateral exudative pleural effusion. The condition usually responds quickly to corticosteroid therapy. However, massive pleural effusion refractory to immunosuppressive drugs has rarely been reported; thus, the proper therapeutic modality is largely decided on a case-by-case basis. In this case, we describe successful treatment with surgical pleurectomy for massive refractory pleural effusion in a patient with SLE.
Humans ; Lupus Erythematosus, Systemic* ; Pleural Effusion*

Mucormycosis is a rare but fatal disease and usually affects the rhinocerebrum, lungs, traumatic wounds or surgical sites. Vertebral osteomyelitis due to mucormycosis is very rare, with only three cases caused by mucormycosis since 1970 being reported, and none in Korea. Here, we present a case of vertebral osteomyelitis caused by mucormycosis in a 67-year-old woman, having type 2 diabetes mellitus for 10 years, who was in complete remission from acute leukemia after chemotherapy 3 years previously.
Aged ; Amphotericin B ; Diabetes Mellitus, Type 2 ; Drug Therapy ; Female ; Humans ; Korea ; Leukemia ; Lung ; Mucormycosis* ; Osteomyelitis* ; Spine ; Wounds and Injuries

Background/Aims: We investigated the real-world effectiveness and safety of ustekinumab (UST) as induction treatment for Koreans with Crohn’s disease (CD). Methods: CD patients who started UST were prospectively enrolled from 4 hospitals in Korea. All enrolled patients received intravenous UST infusion at week 0 and subcutaneous UST injection at week 8. Clinical outcomes were assessed using Crohn’s Disease Activity Index (CDAI) scores at weeks 8 and 20 among patients with active disease (CDAI ≥150) at baseline. Clinical remission was defined as a CDAI <150, and clinical response was defined as a reduction in CDAI ≥70 points from baseline. Safety and factors associated with clinical remission at week 20 were also analyzed. Results: Sixty-five patients were enrolled between January 2019 and December 2020. Among 49 patients with active disease at baseline (CDAI ≥150), clinical remission and clinical response at week 8 were achieved in 26 (53.1%) and 30 (61.2%) patients, respectively. At week 20, 27 (55.1%) and 35 (71.4%) patients achieved clinical remission and clinical response, respectively. Twenty-seven patients (41.5%) experienced adverse events, with serious adverse events in 3 patients (4.6%). One patient (1.5%) stopped UST therapy due to poor response. Underweight (body mass index <18.5 kg/m2) (odds ratio [OR], 0.085; 95% confidence interval [CI], 0.014–0.498; P=0.006) and elevated C-reactive protein at baseline (OR, 0.133; 95% CI, 0.022–0.823; P=0.030) were inversely associated with clinical remission at week 20. Conclusions UST was effective and well-tolerated as induction therapy for Korean patients with CD.

PURPOSE: Computational flow dynamic (CFD) study has not been widely applied in intracranial artery stenosis due to requirement of high resolution in identifying the small intracranial artery. We described a process in CFD study applied to symptomatic severe intracranial (M1) stenosis before and after stenting. MATERIALS AND METHODS: Reconstructed 3D angiography in STL format was transferred to Magics (Materialise NV, Leuven, Belgium) for smoothing of vessel surface and trimming of branch vessels and to HyperMesh (Altair Engineering Inc., Auckland, New Zealand) for generating tetra volume mesh from triangular surface-meshed 3D angiogram. Computational analysis of blood flow in the blood vessels was performed using the commercial finite element software ADINA Ver 8.5 (ADINA R & D, Inc., Lebanon, MA). The distribution of wall shear stress (WSS), peak velocity and pressure in a patient was analyzed before and after intracranial stenting. RESULTS: Computer simulation of wall shear stress, flow velocity and wall pressure before and after stenting could be demonstrated three dimensionally by video mode according to flow vs. time dimension. Such flow model was well correlated with angiographic finding related to maximum degree of stenosis. Change of WSS, peak velocity and pressure at the severe stenosis was demonstrated before and after stenting. There was no WSS after stenting in case without residual stenosis. CONCLUSION: Our study revealed that CFD analysis before and after intracranial stenting was feasible despite of limited vessel wall dimension and could reveal change of WSS as well as flow velocity and wall pressure.
Angiography ; Arteries ; Atherosclerosis ; Blood Vessels ; Cerebral Arteries ; Characidae ; Computer Simulation ; Constriction, Pathologic ; Glycosaminoglycans ; Humans ; Lebanon ; Magic ; Stents

PURPOSE: Image-based computational models with fluid-structure interaction (FSI) can be used to perform plaque mechanical analysis in intracranial artery stenosis. We described a process in FSI study applied to symptomatic severe intracranial (M1) stenosis before and after stenting. MATERIALS AND METHODS: Reconstructed 3D angiography in STL format was transferred to Magics for smoothing of vessel surface and trimming of branch vessels and to HyperMesh for generating tetra volume mesh from triangular surface-meshed 3D angiogram. Computational analysis of blood flow in the blood vessels was performed using the commercial finite element software ADINA Ver 8.5. The distribution of wall shear stress (WSS), peak velocity and pressure was analyzed before and after intracranial stenting. RESULTS: The wall shear stress distributions from Computational fluid dynamics (CFD) simulation with rigid wall assumption as well as FSI simulation before and after stenting could be compared. The difference of WSS between rigid wall and compliant wall model both in pre- and post-stent case is only minor except at the stenosis region. These WSS values were greatly reduced after stenting to 15~20 Pa at systole and 3~5 Pa at end-diastole in CFD simulation, which are similar in FSI simulations. CONCLUSION: Our study revealed that FSI simulation before and after intracranial stenting was feasible despite of limited vessel wall dimension and could reveal change of WSS as well as flow velocity and wall pressure.
Angiography ; Arteries ; Atherosclerosis ; Blood Vessels ; Cerebral Arteries ; Characidae ; Constriction, Pathologic ; Glycosaminoglycans ; Hydrodynamics ; Magic ; Stents ; Systole