Humans ; Leukocytosis ; complications ; Lymphatic Diseases ; complications ; Male ; Middle Aged

Acupuncture Therapy ; Female ; Humans ; Leukocytosis ; complications ; therapy ; Middle Aged ; Thrombocytosis ; complications ; therapy

Pseudomembranous colitis (PMC) is highly prevalent in patients with broad spectrum antibiotic therapy. It can result in significant morbidity and mortality, especially if it is not diagnosed early. The clinical manifestation of PMC is diverse and symptoms usually are increased order of severity. Although leukocytosis is common, leukemoid reaction is very rare in PMC. We report a case of PMC associated with a leukemoid reaction without typical symptoms in a type 2 diabetic patient who have the multiple diabetic complications.
Clostridium difficile ; Diabetes Complications ; Diabetes Mellitus ; Enterocolitis, Pseudomembranous* ; Humans ; Leukemoid Reaction* ; Leukocytosis ; Mortality

We report a case of the intestinal lesion in Henoch-Schonlein purpura, presented with an acute abdomen in a 4 year old boy. Five days after sudden colicky abdominal pain, skin purpura and painful joint swelling developed. These manifestations were associated with abdominal distension, hematemesis, hematochezia and hematuria. Exploratory laparotomy revealed a marked bowel distension with edema and patchy dark reddish discoloration of the jejunum and ileum. These patchy areas showed transmural hemorrhage and necrosis associated with characteristic leukocytoclastic vasculitis in and around the hemorrhagic lesions. These vasculitis was thought to be related to Henoch-Schonlein purpura.
Child, Preschool ; Edema/complications/pathology/surgery ; Gastrointestinal Diseases/*etiology/pathology/surgery ; Humans ; Leukocytosis/complications/pathology/surgery ; Male ; Pain/complications ; Purpura, Schoenlein-Henoch/*complications/pathology/surgery

Leukemoid reaction is defined as leukocytosis exceeding 50,000 cells/mm3. When it occurs in a patient with a malignancy, secondary causes such as infections, drugs, hematologic diseases and hemorrhage need to be ruled out. After excluding such causes, paraneoplastic leukemoid reaction can be considered as a diagnosis of exclusion. Paraneoplastic leukemoid reactions have been described in association with lung, gastrointestinal, genitourinary and head and neck cancers. However, pancreatic cancer with leukemoid reaction has been rarely reported. We diagnosed a case of a 55-year-old Korean woman with extreme leukocytosis associated with advanced pancreatic cancer.
Carcinoma, Pancreatic Ductal/complications/*diagnosis ; Female ; Humans ; Leukocytes/cytology ; Leukocytosis/*complications ; Magnetic Resonance Imaging ; Middle Aged ; Pancreatic Neoplasms/complications/*diagnosis ; Positron-Emission Tomography ; Tomography, X-Ray Computed

There is a continuing debate among surgeons about whether postoperative adhesive small bowel obstruction is best managed operatively or nonoperatively. This retrospective study was designed to determine the factors influencing the treatment modality of postoperative small bowel obstruction. A clinical analysis was conducted on 112 cases of small bowel obstruction after previous abdominal operation, who were admitted to the department of general surgery of Korea Veterans Hospital from January, 1984 to December, 1994. The patients were divided into two groups according to the modality of treatment: operatively(N=35) and nonoperatively(N=77) treated groups. Clinical parameters such as age, sex, symptoms and signs, type of previous operation, interval between previous operation and admission due to obstructive symptoms, time period from onset of symptoms to admission, and interval from admission to operation, were compared between two groups. Among 112 cases, the conservative treatment was performed in 77 cases and operative management was performed in 35 cases. There was no significant difference in the distribution of age and sex between two groups. The previous operations leading to adhesive intestinal obstruction were appendectomy(18.8%), gastroduodenal operation(17.0%), operation for multiple organ injury(16.1%), and Obsetric & Gynecologic surgery(9.8%) in that orders. The interval between previous abdominal operation and admission was under 1 month in 20 cases, 1 to 6 months in 10 cases, 7 to 12 months in 16 cases, and 1 to 2 years in 16 cases. The major symptoms and signs were abdominal pain, abdominal tenderness, vomiting, abdominal distension, hyperperistalsis, and leukocytosis. Among the above signs and symptoms, continuous abdominal pain, leukocytosis, and tachycardia were significantly higher in the operative group compared to those of the nonoperative group. The most common procedures of operative management were adhesiolysis, small bowel resection, bypass surgery, and colon resection in that orders. The incidence of postoperative complications was 31.4% and the most common complication was wound infection. In conclusion, at admission, the presence of strangulating signs such as continuous abdominal pain, leukocytosis, and tachycardia in patients with small bowel obstruction after previous abdominal operation mandates early operative intervention rather than conservative treatment.
Abdominal Pain ; Adhesives ; Colon ; Hospitals, Veterans ; Humans ; Incidence ; Intestinal Obstruction ; Korea ; Leukocytosis ; Postoperative Complications ; Retrospective Studies ; Tachycardia ; Vomiting ; Wound Infection

This clinical report is a review of the medical records of the 161 cases of postoperative adhesive intestinal obstruction treated at the Department of Surgery, Chung-Goo Sungsim General Hospital during 5 years from January 1991 to December 1995. The results of the study are as follows; 1) The most frequent age group was the 4th decade and the most prevalent age groups in the strangulated intestinal obstruction were below 10 years and above 60 years. 2) There was no difference among the types of previous abdominal operations in terms of the possibility of the strangulation. 3) The incidence of postoperative complication in the strangulated intestinal obstruction(58.3%) was higher than that in the non-strangulated intestinal obstruction(7.7%). 4) The overall mortality rate was 2.5%. The mortality rate in the strangulated intestinal obstruction was 8.3%, and was higher than that in the non-strangulated intestinal obstruction. 5) It is ideal to operate just before progression to strangulation, but it is not easy to decide when it happens. An operation should be considered in the following cases. (1) The presence of two or more symptoms; abdominal pain, obstipation, vomiting and abdominal distension. (2) The presence of two or more signs; leukocytosis, fever, tachycardia, localized abdominal tenderness, rebound tenderness and continuous abdominal pain. (3) Clinical signs of deterioration after 72 hours of conservative treatment.
Abdominal Pain ; Adhesives* ; Fever ; Hospitals, General ; Humans ; Incidence ; Intestinal Obstruction ; Leukocytosis ; Medical Records ; Mortality ; Postoperative Complications ; Tachycardia ; Vomiting

BACKGROUND: Almost all cholecystectomies these days are performed using laparoscopic equipment. Recently, this has been applied in all possible pathologies of the gallbladder by many surgeons. However, we occasionally have had bitter experiences, difficult operations and long operative times, when doing laparoscopic cholecystectomies. The aim of this study was to detect the factors causing long operative times, conversions to open surgery, and higher postoperative complication rates, when difficult laparoscopic cholecystectomies are encountered. METHODS: From among the 250 patients who had undergone laparoscopic cholecystectomies during the recent 5 years (from November 1992 to January 1998), the clinical data of the 58 patients who had undergone laparoscopic cholecystectomies with operative times over 120 minutes (a long operative time) were compared with those of 45 patients with operative times of 60 minutes or less (short operative time). RESULTS: Clinical data for the patients with long operative times showed a higher incidence of steady pain (29.3 versus 0%), fever (36.2 versus 4.4%), previous history of upper abdominal surgery (6.9 versus 4.4%), tenderness (48.3 versus 4.4%), rebound tenderness (20.0 versus 0%), palpable tender mass (12.1 versus 0%), thick abdominal wall (13.8 versus 4.4%), leukocytosis (36.2 versus 8.9%), elevated bilirubin level (10.3 versus 0%), wall thickening of the gallbladder (34.5 versus 6.7%), fibrous adhesion after gastric surgery (5.1 versus 0%), inflammatory adhesion (39.7 versus 2.2%), and contracted gallbladder (1.2 versus 0%), as well as a higher required level of surgical experience (5.2 versus 2.2%). The surgical complication rate was 13.8% in the long-operation group and 0% in the short-operation group. Laparoscopic cholecystectomy was completed successfully in 250 of the 258 patients and the overall conversion rate to open surgery was 3.1%; that of the long-operation group was 7.9%. CONCLUSIONS: A laparoscopic cholecystectomy with a long operative time is inevitable in patients with acute severe inflammation of the gallbladder, previous history of gastric surgery, and a contracted gall-bladder. Also, the surgeon needs a learning period to be able to overcome the long operation. In spite of the higher rates complications and conversions to open surgery in the long-operation group, a difficult laparoscopic cholecystectomy with a long operative time is a clinically acceptable procedure in patients who need a cholecystectomy.
Abdominal Wall ; Bilirubin ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Fever ; Gallbladder ; Humans ; Incidence ; Inflammation ; Learning ; Leukocytosis ; Operative Time* ; Pathology ; Postoperative Complications

PURPOSE: A spontaneous rupture is a rare but life-threatening complication in patients with a hepatocellular carcinoma (HCC). Whether this condition has any influence on the subsequent outcome following a resection is unclear. Therefore, the long-term results of liver resection were compared in patients with and without a tumor rupture. METHOD: This retrospective study was conducted on 17 patients with a spontaneous rupture of an HCC out of 256 with an HCC who underwent hepatic resection. RESULTS: Reduced hemoglobin and albumin, as well as increased leukocytosis, a poor Child Class, large tumor and portal vein tumor thrombosis were more frequent clinical findings in patients with a ruptured HCC. The postoperative complication and extrahepatic recurrence rates were similar between the two groups. The 1- and 3- year survival rates in the 17 patients with a ruptured HCC were 41.2 and 17.7%, respectively, while these were 80.3 and 48.3%, respectively, in the 239 patients without a rupture. However, when these patients were compared exclusively with the 8 patients with a corresponding AJCC/UICC 6th ed. TNM stage IIIB disease without a rupture (50 and 0%, respectively), no significant difference was found in the overall survival rates between the groups. CONCLUSION: The surgical outcomes of stage matched patients with and without a ruptured HCC were similar.
Carcinoma, Hepatocellular* ; Child ; Humans ; Leukocytosis ; Liver ; Portal Vein ; Postoperative Complications ; Prognosis* ; Recurrence ; Retrospective Studies ; Rupture ; Rupture, Spontaneous ; Survival Rate ; Thrombosis

Granulocytosis occurs in 40% of patients with lung and gastrointestinal cancers, 20% of patients with breast cancer, 30% of patients with brain tumor and ovarian cancer and 10% of patients with renal cell carcinoma. Granulocytosis occurs because of production of G-CSF, GM-CSF and IL-6. Uterine cervical carcinoma with granulocytosis as a paraneoplastic syndrome, however, has been rarely reported. We recently witnessed a case of invasive squamous cell carcinoma of the uterine cervix with granulocytosis. Leukocytosis developed up to 69, 000/micro L, and then normalized after chemo-radiotherapy. There was no evidence of infection, tumor necrosis, glucocorticoid administration, or myeloproliferative disease by examination of a bone marrow aspirate when granulocytosis appeared. This phenomenon was probably associated with the secretion of hematopoietic growth factors such as G-CSF, GM-CSF and IL-6 by the tumor. We suggest that, like some other solid tumors, cervical cancer can present with granulocytosis as a paraneoplastic syndrome.
Uterine Neoplasms/complications/*diagnosis ; Uterine Cervical Neoplasms/complications/*diagnosis/physiopathology ; Paraneoplastic Syndromes/*etiology ; Middle Aged ; Leukocytosis/*etiology ; Humans ; Granulocytes/*pathology ; Female