Consideration of the nutritional status of patients with acute respiratory failure and mechanical ventilation is important for effective patient assessment and management. Patients with acute respiratory failure are at a high risk for developing malnutrition. High glucose intakes given during the administration of total parenteral nutrition (TPN) have been demonstrated to increase CO2 production. The workload imposed by the high CO2 production may precipitate respiratory distress in patients experiencing compromised pulmonary function. The authors report a case of successful weaning from mechanical ventilation in patient with post-operative ARDS by proper nutritional support and by changing the proportion of calories derived from carbohydrates and fats. Substitution of fat calories for carbohydrate in TNA solutions can reduce CO2 production and help wean patients from mechanical ventilation. Conclusively, the TNA (total nutrients admixture) system is more beneficial to patients with acute respiratory failure due to less CO2 production and surfactant production than TPN. For patients with hypercapnia, providing 25% to 30% of calories as carbohydrate and 50% to 55% of calories from fat may be beneficial.
Carbohydrates ; Fats ; Glucose ; Humans ; Hypercapnia ; Malnutrition ; Nutritional Status ; Nutritional Support* ; Parenteral Nutrition, Total ; Respiration, Artificial ; Respiratory Insufficiency* ; Ventilator Weaning* ; Ventilators, Mechanical* ; Weaning

BACKGROUND AND OBJECTIVES: The incidence of retropharyngeal abscess has been decreased with use of antibiotics, but it still causes critical complications such as airway obstruction, aspiration pneumonia, mediastinitis, or sepsis. For this reason, early diagnosis and proper management of retropharyngeal abscess should be undertaken as soon as possibile. The treatment includes maintaining airway, performing surgical drainage, and administering antibiotics; but there are no definite guidelines for treating patients with retropharyngeal abscess, nor a golden rule for the correct surgical approach. SUBJECTS AND METHOD: A retrospective analysis of patients with retropharyngeal abscess who were treated at the Chungbuk University Hospital from 1993 to 2003 was performed. We analized general symptoms, signs, causing factors, and causing bacteria. We also analized the treatment outcome and selected approaches from the surgically treated patients. RESULTS: The general symptoms of retropharyngeal abscess were sore throat, fever, dyspnea, with the most common cause being the upper airway infection. Bacteriologically, hemolytic streptococcus was the most common bacteria among aerobes and bacteroides was the most common bacteria among anaerobes. However, in most cases, both aerobe and anaerobes were cultured at the same time. Among 18 cases, 6 cases were treated conservatively with antibiotics and surgical interventions were performed in 12 cases, which included 11 cases of transoral and 1 case of transcervical approach. CONCLUSION: Retropharyngeal abscess can be treated with either conservative or surgical treatment according to initial abscess size. The abscess size which is greater than 3 cm is prefered to be treated surgically, and transoral approach is a useful way of dealing with less invasive procedure.
Abscess ; Airway Obstruction ; Anti-Bacterial Agents ; Bacteria ; Bacteroides ; Chungcheongbuk-do ; Drainage ; Dyspnea ; Early Diagnosis ; Fever ; Humans ; Incidence ; Mediastinitis ; Pharyngitis ; Pneumonia, Aspiration ; Retropharyngeal Abscess* ; Retrospective Studies ; Sepsis ; Streptococcus ; Treatment Outcome

PURPOSE: To compare the surgical outcomes of laparoscopic total gastrectomy between elderly and non-elderly patients. MATERIALS AND METHODS: Between 2008 and 2015, a total of 273 patients undergoing laparoscopic total gastrectomy for gastric carcinoma were divided into two age groups: elderly (> or =70 years, n=71) vs. non-elderly (<70 years, n=172). Postoperative outcomes, including length of hospital stay, morbidity, and mortality were compared between the groups. RESULTS: The elderly group showed a significantly higher rate of comorbidities and American Society of Anesthesiologists scores than those in the non-elderly group. No significant differences were found with respect to lymphadenectomy or combined organ resection between the groups. After surgery, the elderly group showed a significantly higher incidence of grade III and above complications than the non-elderly group (15.5% vs. 4.1%, P=0.003). Among the complications, anastomosis leakage was significantly more common in the elderly group (9.9% vs. 2.9%, P=0.044). Univariate and multivariate analyses showed that old age (> or =70 years) was an independent risk factor (odds ratio=4.42, 95% confidence interval=1.50~13.01) for postoperative complications of grade III and above. CONCLUSIONS: Elderly patients are more vulnerable to grade III and above complications after laparoscopic total gastrectomy than non-elderly patients. Great care should be taken to prevent and monitor the development of anastomosis leakage in elderly patients after laparoscopic total gastrectomy.
Aged* ; Comorbidity ; Gastrectomy* ; Humans ; Incidence ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Mortality ; Multivariate Analysis ; Postoperative Complications ; Retrospective Studies* ; Risk Factors ; Stomach Neoplasms

PURPOSE: Previous studies indicated conflicting results regarding the prognosis of gastric cancer with a family history (FHX). This study aimed to determine the clinicopathological features and survival of patients with gastric cancer with a FHX. MATERIALS AND METHODS: We reviewed 2,736 patients with gastric cancer who underwent surgery between 2003 and 2009. The prognostic value of a FHX was determined in the multivariate model after adjusting for variables in the Asian and internationally validated prognostic models. RESULTS: Of the patients, 413 (15.1%) had a FHX of gastric cancer. The patients with a FHX were younger (58.1 vs. 60.4 years; P<0.001) than the patients without a FHX. There were no significant differences in the histopathological characteristics between the 2 groups. A FHX was associated with a better overall survival (OS) rate only in the stage I group (5-year survival rate, 95% vs. 92%; P=0.006). However, the disease-specific survival (DSS) rate was not significantly different between the 2 groups in all stages. The multivariate model adjusted for the variables in the Asian and internationally validated prognostic models revealed that FHX has no significant prognostic value for OS and DSS. CONCLUSIONS: The clinicopathological features and survival of the patients with gastric cancer with a FHX did not significantly differ from those of the patients without a FHX.
Asian Continental Ancestry Group ; Humans ; Prognosis ; Stomach Neoplasms* ; Survival Rate

PURPOSE: Colorectal cancer is one of the most common gastrointestinal malignancies in Korea. However, there have been few studies concerning the prognosis of colorectal cancer in Korea. The purpose of this study is to elucidate the prognostic factors of colorectal cancer and identify those independent prognostic factors. METHODS: A total of 960 cases with colorectal cancer who received surgery at Chonnam University Hospital of Korea between Jan 1, 1980 and Dec 31, 2000 were analyzed retrospectively with respect to several prognostic factors including age, sex, location of tumor, histologic grade, stage, Borrmann type, depth of invasion, invasion of lymph node, tumor size, liver metastasis, peritoneal seeding, preoperative serum CEA level and DNA ploidy. Survival curves were estimated by the Kaplan-Meier method, and differences were analyzed by the Log-rank test. The Cox proportional hazard model was used for multivariate analysis. The data was considered to be significant when the p value was less than 0.05. RESULTS: The mean age was 57 years and median follow-up was 26.7 months. By univariate analysis, significant prognostic factors were stage by TNM, histologic grade, invasion of lymph node, liver metastasis, peritoneal seeding, depth of invasion, Borrmann type and preoperative serum CEA level. By multivariate analysis, TNM stage was the most obvious independent prognostic factor. Histologic grade and depth of invasion were also significant independent prognostic factors. CONCLUSION: In this study, TNM stage, histologic grade and depth of invasion were revealed independent prognostic factors.
Colorectal Neoplasms* ; DNA ; Follow-Up Studies ; Jeollanam-do ; Korea ; Liver ; Lymph Nodes ; Multivariate Analysis* ; Neoplasm Metastasis ; Ploidies ; Prognosis ; Proportional Hazards Models ; Retrospective Studies

PURPOSE: With increasing life expectancy, the presence of comorbidities has become a major concern in elderly patients who require surgery. However, little is known about the impact of different comorbidities on the outcomes of laparoscopic total gastrectomy (LTG). In this study, we investigated the impact of comorbidities on postoperative complications in patients undergoing LTG for gastric carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the cases of 303 consecutive patients who underwent LTG for gastric carcinoma between 2005 and 2016. The associations between each comorbidity and postoperative complications were assessed using univariate and multivariate analyses. RESULTS: A total of 189 patients (62.4%) had one or more comorbidities. Hypertension was the most common comorbidity (37.0%), followed by diabetes mellitus (17.8%), chronic viral hepatitis (2.6%), liver cirrhosis (2.6%), and pulmonary (27.1%), ischemic heart (3.3%), and cerebrovascular diseases (2.3%). The overall postoperative morbidity and mortality rates were 20.1% and 1.0%, respectively. Patients with pulmonary disease significantly showed higher complication rates than those without comorbidities (32.9% vs. 14.9%, respectively, P=0.003); patient with other comorbidities showed no significant difference in the incidence of LTG-related complications. During univariate and multivariate analyses, pulmonary disease was found to be an independent predictive factor for postoperative complications (odds ratio, 2.14; 95% confidence interval, 1.03–4.64), along with old age and intraoperative bleeding. CONCLUSIONS: Among the various comorbidities investigated, patients with pulmonary disease had a significantly higher risk of postoperative complications after LTG. Proper perioperative care for optimizing pulmonary function may be required for patients with pulmonary disease.
Aged ; Cerebrovascular Disorders ; Comorbidity* ; Diabetes Mellitus ; Gastrectomy* ; Heart ; Hemorrhage ; Hepatitis ; Humans ; Hypertension ; Incidence ; Laparoscopy ; Life Expectancy ; Liver Cirrhosis ; Lung Diseases ; Mortality ; Multivariate Analysis ; Perioperative Care ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: Laparoscopic surgery is associated with lower surgical site infection (SSI) rates due to minimal skin incision and non-exposure of visceral organs. Most previous studies have analyzed the efficacy of prophylactic antibiotic use in open surgery. Here, we investigated the feasibility of total laparoscopic distal gastrectomy (TLDG) for gastric carcinoma without prophylactic antibiotic use.MATERIALS AND METHODS: Seventy-one patients who underwent TLDG without prophylactic antibiotic use were 1:1 propensity score matched with 393 patients who underwent TLDG with antibiotic prophylaxis. The short-term surgical outcomes, including SSI rates, were compared between the groups.RESULTS: After matching, 65 patients were selected in each group. The baseline clinicopathological characteristics were well balanced in the matched sample. In the matched group, there was no significant increase in postoperative morbidity in the non-prophylactic group compared with the prophylactic group (18.5% vs. 15.4%, P=0.640), and there were no grade 3≤ complications (1.4% vs. 0%, respectively; P=1.000). The SSI rates in the non-prophylactic and prophylactic groups were 3.1% and 1.5%, respectively (P=0.559). The time to gas passage, diet initiation, and mean hospital stay were not significantly different between the 2 groups. The SSI rate did not increase in the non-prophylactic group in the different subgroups based on different clinicopathological characteristics.CONCLUSIONS: Postoperative morbidity, including SSI rates, did not significantly increase in patients undergoing TLDG without prophylactic antibiotic use. A large prospective randomized trial is warranted to reappraise the efficacy of prophylactic antibiotic use in patients undergoing TLDG.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Case-Control Studies ; Diet ; Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Propensity Score ; Prospective Studies ; Research Design ; Skin ; Stomach Neoplasms ; Surgical Wound Infection

Purpose: The role of prophylactic abdominal drainage in total gastrectomy is not wellestablished. This study aimed to evaluate the efficacy of abdominal drainage in the prevention and management of major intra-abdominal complications after total gastrectomy for gastric carcinoma. Materials and Methods: We retrospectively reviewed the data of 499 patients who underwent total gastrectomy for gastric carcinoma in a high-volume institution. The patients were divided into drainage and non-drainage groups and compared for the development and management of major intra-abdominal complications, including anastomotic leak, abdominal bleeding, abdominal infection, and pancreatic fistulas. Results: The drainage group included 388 patients and the non-drainage group included 111 patients. The 2 groups showed no significant differences in clinicopathological characteristics or operative procedures, except for more frequent D2 lymphadenectomies in the drainage group. After surgery, the overall morbidity (drainage group vs. non-drainage group: 24.7% vs. 28.8%, P=0.385) and incidence of major intra-abdominal complications (6.4% vs. 6.3%, P=0.959) did not significantly differ between the two groups. The nondrainage group showed no significant increase in the incidence rate of major intra-abdominal complications in the subgroups divided by age, sex, comorbidity, operative approach, body mass index, extent of lymphadenectomy, and pathological stage. Abdominal drainage had no significant impact on early diagnosis, secondary intervention or reoperation, or recovery from major intra-abdominal complications. Conclusions Prophylactic abdominal drainage showed little demonstrable benefit in the prevention and management of major intra-abdominal complications of total gastrectomy for gastric carcinoma.

PURPOSE: It is well known that the clinicopathologic stages of colorectal cancer are correlated to the prognosis of patients and are used to select the method of adjuvant treatment. Many studies suggest that the DNA ploidy pattern is a supplementary prognostic marker. For that reason, we studied the relationships between the DNA ploidy pattern and the incidence, sex, age, tumor location, tumor size, histopathological classification, stage, lymph node, liver, pertioneal metastases and prognosis in patients with colorectal cancer. METHODS: 373 patients with colorectal cancer who had undergone surgical resection at the Hospital between January 1980 and January 2000 were studied. The DNA ploidy pattern was analyzed by FACScan flow cytometry (Becton- Dickinson Immunocytometrical Systems, Mountain View, CA). The relationships between DNA ploidy pattern and various clinicopathologic characteristics were compared retrospectively. RESULTS: Cases of diploidy numbered 167 (44.8%) and aneuploidy 206 (55.2%). The mean size of the tumor mass was larger in the diploidy group. DNA diplody was more frequent in ascending, transverse and descending colon cancers. Aneuploidy was more frequent in sigmoid colon and rectal cancers. In regards to histopathologic classification, mucinous & poorly differentiated adenocarcinomas were inclined to diploidy and well differentiated and moderately differentiated adenocarcinomas were inclined to aneuploidy. Lymph node and liver metastases were more statistically significant in the aneuploidy cases. The DNA ploidy pattern had no significant correlation to age, sex, stage, peritoneal metastasis, or prognosis. CONCLUSION: The DNA ploidy pattern is useful for evaluating the biological behavior of tumors such as tumor growth, tumor location, histopathological differentiation and lymph node metastasis, although it is not useful for determining survival or prognosis.
Adenocarcinoma ; Aneuploidy ; Classification ; Colon, Descending ; Colon, Sigmoid ; Colorectal Neoplasms* ; Diploidy ; DNA* ; Flow Cytometry ; Humans ; Incidence ; Liver ; Lymph Nodes ; Mucins ; Neoplasm Metastasis ; Ploidies* ; Prognosis ; Rectal Neoplasms ; Retrospective Studies

PURPOSE: To compare the differential findings of tuberculous otitis media(TOM) with those of chronic suppurative otitis media with or without cholesteatoma, as seen on high resolution temporal bone CT. MATERIALS AND METHODS: We retrospectively reviewed 14 cases of TOM, 30 cases of chronic suppurative otitis media(CSOM), and 30cases of chronic otitis media with cholesteatoma(Chole). All had been pathologically confirmed. We evaluated thepreservation of mastoid cells without sclerotic change, the location and extension of soft tissue to the externalauditary canal, the erosion of ossicles, the tegmen tympani, scutum, bony labyr inth, facial nerve canal andsigmoid sinus, and the presence of intracranial co mplications. RESULTS: Soft tissue in the mastoid antrum wasseen in all cases of TOM(100%), 29 cases of CSOM(96.7%), and 26 cases of Chole(86.7%). In contrast, the softtissue in the entire middle ear cavity was noted in 13 cases of TOM(92.8%), 7 cases of CSOM(23.3%), and 12 casesof Chole(40%). Soft tissue extended to the superior aspect of the external auditory canal in 4 cases of TOM(28.6%) and 5 cases of Chole (16.7%). Mastoid air cells were seen in 9 cases of TOM (64.3%), 4 cases of CSOM(13.3%), and 3 cases of Chole(10%). Ossicular erosion was noted in 6 cases of TOM (42.9%), 12 cases of CSOM (40%),and 26 cases of Chole(86.7%), while in one case of TOM (7.1%), 5 cases of CSOM (16.7%), and 15 cases of Chole(50%)there was erosion of the scutum. In one case of TOM, follow-up CT study after 9 months of antituberculousmedication without surgery revealed complete clearing of previously noted soft tissue in the middle ear cavity. CONCLUSION: Specific CT findings of TOM were not seen, but if there were findings of soft tissue in the entiremiddle ear cavity, soft tissue extension to the external auditory canal, preservation of mastoid air cells withoutsclerotic change, and intact scutum, TOM may be differentiated from other chronic otitis media.
Cholesteatoma ; Ear ; Ear Canal ; Ear, Middle ; Facial Nerve ; Follow-Up Studies ; Mastoid ; Otitis Media* ; Otitis Media, Suppurative ; Otitis* ; Retrospective Studies ; Temporal Bone* ; Tuberculosis