BACKGROUNDAcute hypoxemic respiratory failure (AHRF) often develops acute respiratory distress syndrome (ARDS), and its incidence and mortalities in critically ill pediatric patients in China were 2% and 40% respectively. This study aimed at prospectively investigating incidence, causes, mortality and its risk factors, and any relationship to initial tidal volume (V(T)) levels of mechanical ventilation, in children £5 years of age with AHRF and ARDS.

METHODSIn 12 consecutive months in 23 pediatric intensive care units (PICU), AHRF and ARDS were identified in those requiring > 12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge. ARDS was diagnosed according to the American-European Consensus definitions. The mortality and ventilation free days (VFD) were measured as the primary outcome, and major complications, initial disease severity, and burden were measured as the secondary outcome.

RESULTSIn 13 491 PICU admissions, there were 439 AHRF, of which 345 (78.6%) developed ARDS, resulting in incidences of 3.3% and 2.6%, and corresponding mortalities of 30.3% and 32.8% respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia (62.9%) and sepsis (33.7%) as major underlying diseases respectively. No association was found in V(T) levels during the first 7 days with mortality, nor for V(T) at levels < 6, 6 - 8, 8 - 10, and > 10 ml/kg in the first 3 days with mortality or length of VFD. By binary Logistic regression analyses, higher pediatric risk of mortality score III, higher initial oxygenation index, and age < 1 year were associated with higher mortality or shorter VFD in AHRF.

CONCLUSIONSThe incidence and mortalities of AHRF and ARDS in children £5 years were similar to or lower than the previously reported rates (in age up to 15 years), associated with initial disease severity and other confounders, but causal relationship for the initial V(T) levels as the independent factor to the major outcome was not found.

Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Pneumonia ; complications ; epidemiology ; mortality ; Respiratory Distress Syndrome, Adult ; epidemiology ; mortality ; Respiratory Insufficiency ; epidemiology ; mortality ; Sepsis ; complications ; epidemiology ; mortality

In order to identify the relationship between the patient's age and the presence of another disease, and the postoperative complications and mortality, we reviewed the medical records of 6156 patients admitted to the Department of Surgery, Dae Jeon Eul Ji General Hospital, during the period from January 1991 through December 1995. There were 1546 geriatric patients(>65 years of age) and 4610 adult patients (age between 16 and 64). Six hundred sixty-five patients (43%) in the geriatric group had one or more concurrent diseases preoperatively, whereas 1127 patients (24.4%) in adult group did. Postoperative complications were more frequent in the geriatric group: 21.6% (310 patients) in the geriatric group vs 15.2%(217 patients) in the adult group. Geriatric patients who had more than one concurrent disease and who underwent an emergency operation showed a higher postoperative complication rate than those who had only one concurrent disease and who underwent elective surgery. The postoperative mortality was also higher in the geriatric group: 3.8%(48 patients) in the geriatric group vs 0.7% (32 patients) in the adult group. The most frequent cause of postoperative death in the geriatric group was sepsis. The geriatric patients who had a concurrent disease account for 16.4% of postoperative complications and 1.5% of the mortalities, whereas those who did not have any concurrent disease account for 2.67% and 0.2%, respectively. Among 1127 adult patients who had a concurrent disease, 124 (11.0%) had postoperative complications and 24 (2.2%) died postoperatively. In conclusion, the elderly patients more frequently had one or more concurrent diseases, and these patients had higher postoperative complication and mortality rates, especially after emergency operations. Accordingly, it is crucial for the surgeon to completely evaluate and manage any concurrent diseases in elderly patients preoperatively.
Adult ; Aged ; Daejeon ; Emergencies ; Hospitals, General ; Humans ; Medical Records ; Mortality ; Postoperative Complications ; Sepsis

Although the obstruction of the right colon is usually handled by primary anastomosis following resection, fear of the increased incidence of septic complication, especially anastomotic leakage with sepsis has turned surgeons away from doing anastomosis in the face of acute obstruction of the left colon. However, from recent reports, enough experiences have been accumulated to show that primary anastomosis is associated with minimum morbidity and mortality in the acute obstruction of the left colon. We experienced 54 cases of colon cancer obstruction at Holy Family Hospital from January 1988 to December 1997. Twenty six cases of them were right colon cancers, 24 cases were left colon cancers and 4 cases were rectal cancers. We reviewed these three groups for evaluation of the safety of one-stage resection and anastomosis of left colon cancer obstruction. The postoperative complication rate was 18% in right colon obstruction versus 38% in left colon obstruction. The most common complication was wound infection(43%). In using of primary resection and anastomosis, complication of right colon revealed 15% and left colon was 29%. But in a method of primary resection and anastomosis with decompression, complication of right colon was 17% and left colon was 13%. Especially on the left colon, primary resection and anastomosis with decompression revealed lower complication(13%) than that without decompression(67%). The mortality of colon cancer obstruction was 2% but this was a patient who had a poor general condition and took a primary resection and anastomosis without decompression. In cases of left colon cancer obstruction primary resection and anastomosis with decompression of left colon cancer obstruction can be a safe operation method with low morbidity and mortality.
Anastomotic Leak ; Colon* ; Colonic Neoplasms* ; Decompression ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Rectal Neoplasms ; Sepsis ; Wounds and Injuries

OBJECT: It is well known that infratentorial surgery is more difficult to approach to the lesion and may result in poorer outcome than supratentorial surgery. The prognostic factors and outcome were analyzed for one hundred forty-five consecutive patients who underwent surgical treatment for infratentorial tumor between 1989 and 1997. METHODS: Neurilemmoma was the most common tumor(41 cases), followed by astrocytoma(19 cases), hemangioblastoma(19 cases), medulloblastoma(18 cases), meningioma(17 cases) respectively. We studied the relationship between postoperative outcome known various factors retrospectively: age at surgery, pathology, duration of symptoms, tumor size, location of tumor, presence of hydrocephalus, and extent of resection. A statistical analysis of clinical characteristics was conducted to evaluate the significance of associations by student t-test. Surgical results were evaluated by Ojemann's method. RESULTS: Of 145 cases, excellent were in 25 patients, good in 60 patients, fair in 41 patients, poor in 9 patients, and dead in 10 patients. Large size of tumor(p<0.01) and presence of hydrocephalus(p<0.05) were factors that indicate poor outcome. Surgical results of tumors in the cerebellopontine angle(CPA) or clival area were poorer than those in cerebellum(p<0.05). Age, duration of symptom, pathology, and extent of resection did not influence postoperative outcome significantly. The most common postoperative complication was facial palsy(21 cases). The operative mortality was 6.9% and sepsis was the leading cause of death. CONCLUSION:Large size(p<0.01), presence of hydrocephalus(p<0.05), and location in CPA and clival region(p<0.05) were factors that indicate poor outcome after infratentorial tumor surgery.
Cause of Death ; Humans ; Hydrocephalus ; Infratentorial Neoplasms* ; Mortality ; Neurilemmoma ; Pathology ; Postoperative Complications ; Retrospective Studies ; Sepsis

Blood Coagulation Disorders ; therapy ; Fever ; complications ; therapy ; Humans ; Lung Injury ; therapy ; Multiple Organ Failure ; therapy ; Sepsis ; complications ; mortality ; therapy ; Syndrome

Patients with cirrhosis who are hospitalized for an acute decompensation (AD) and also have organ failure(s) are at high risk of short-term death. These patients have a syndrome called Acute-on-Chronic Liver Failure (ACLF). ACLF is now considered as a new syndrome that it is distinct from "mere" AD not only because of the presence of organ failure(s) and high short-term mortality but also because of younger age, higher prevalence of alcoholic etiology of cirrhosis, higher prevalence of some precipitants (such as bacterial infections, active alcoholism), and more intense systemic inflammatory response. ACLF is a new syndrome also because severe sepsis or severe alcoholic hepatitis do not account for 100% of the observed cases; in fact, almost 50% of the cases are of "unknown" origin. In other words, severe sepsis, severe alcoholic hepatitis and ACLF of "unknown origin" are subcategories of the syndrome.
Acute-On-Chronic Liver Failure/complications/mortality/*pathology ; Age Factors ; Cytokines/metabolism ; Hepatitis, Alcoholic/complications ; Humans ; Liver Cirrhosis/*complications/diagnosis ; Sepsis/complications ; Severity of Illness Index ; Survival Rate

We retrospectively reviewed the medical records of 284 patients with neutropenic fever following chemotherapy for acute leukemia at the Catholic Hematopoietic Stem Cell Transplantation Center from January 1998 to December 1999, to identify prognostic factors for infection related mortality. Twenty-eight patients died of infections. There was no difference in median age, gender ratio, or underlying disease between the dying and surviving groups. Bacteria were the main pathogens following chemotherapy, and Gram positive organisms predominated in the dying group. Pneumonia and sepsis were the main causes of death. There were 72 cases of invasive fungal infection and their mortality was 27.8%. Invasive fungal infection and previous history of fungal infection were independent prognostic factors for outcome. Recovery from neutropenia was the significant protective factor for mortality. In conclusion, the prognostic factors identified in this study could be useful for deciding on more intensive treatment for those patients at greater risk of death. To our knowledge, this is the first Korean study delineating prognostic factors in acute leukemic patients with infectious complications.
Adolescent ; Adult ; Aged ; Bacterial Infections/complications/*mortality ; Cause of Death ; Female ; Humans ; Korea ; Leukemia ; Leukemia, Lymphocytic, Acute/complications/*microbiology/*mortality ; Leukemia, Myelocytic, Acute/complications/*microbiology/*mortality ; Male ; Middle Aged ; Morbidity ; Multivariate Analysis ; Mycoses/complications/mortality ; Neutropenia ; Pneumonia/complications/mortality ; Prognosis ; Retrospective Studies ; Sepsis/complications/mortality ; Survival Rate

Differential surgical procedures have been described on the treatment of patients with obstructing carcinoma of the left colon and rectum, and these vary from classical three stage approach to primary resection and anastomosis using intraoperative colonic irrigation or subtotal colectomy. Staged colonic prcedures are associated with significant morbidity and mortality eventhough its initial easy performance, and many patients, unfit for further surgery, are left with a permanent colostomy. We have already reported the initial results of intraoperative antegrade colonic irrigation for one-stage operation in obstructing left colorectal cancers. In this investigation, we evaluated the results of prospective trials of primary resection and anastomosis using intraoperative colon irrigation and subtotal colectomy in obstructing left colon and rectal carcinomas. During recent five years, 19 cases of obstructing left colon and rectal carcinomas which could not received regular colon preparation due to marked abdominal distension were enrolled to this study. There were 12 men and 7 women, and mean age was 61. 14 of the 19 patients which tumors located below mid-descending colon were subjected to primary resection and anastomosis using intraoperative antegrade colonic irrigation, 4 patients which tumors located above the mid-descending colon were treated with subtotal colectomy, and remaining one patient which tumor located upper rectum was performed subtotal coloectomy because of underlying colonic ischemia. There was no mortality and significant postoperative complications such as anastomotic lealrage, pelvic abscess or intraabdominal sepsis which seemed to be related with anastomotic dehiscence. Therefore, primary resection and anastomosis using intraoperative colonic irrigation or subtotal colectomy depending on tumor locations in cases of obstructing left colon and rectal carcinomas might be useful methods to obtain safe one-stage restorative colorectal resections.
Abscess ; Colectomy ; Colon* ; Colorectal Neoplasms ; Colostomy ; Female ; Humans ; Intestinal Obstruction ; Ischemia ; Male ; Mortality ; Postoperative Complications ; Prospective Studies ; Rectum ; Sepsis

BACKGROUND: The results of recent reports suggest that mechanical bowel preparation before colonic resection and primary anastomosis may be unnecessary. To determine whether mechanical bowel preparation influences the incidence of postoperative complications following colorectal surgery, the records of patients who had undergone colonic or rectal resection were retrospectively reviewed. METHODS: Between March 1992 and October 1997, colonic resection and primary anastomosis without colostomy was performed on 56 patients. Among these, 27 patients had undergone mechanical bowel preparation (MBP) before surgery, and 29 patients had not. We compared the data from both groups with respect to wound infection, anastomotic leak, intra-abdominal sepsis and death. RESULTS: The postoperative complication and mortality rates were similar in the two groups. Wound infection occurred in seven patients (four with MBP, three without), and the incidence of wound infection was similar in the two groups (14.8% versus 10.3%, P=0.700). Wound disruption occurred in two patients (one with MBP, one without). Anastomotic leaks occurred in two patients who had undergone bowel preparation. The overall anastomotic leak rate was 3.6% (7.4% versus 0%), but the incidence of anastomotic leaks was not significantly different between the two groups (P=0.228). No intra-abdominal sepsis was clinically apparent in either group. There was one death, a patient who had undergone bowel preparation. The mortality rate was not significantly different between the two groups (P=0.482). CONCLUSIONS: We believe that mechanical bowel preparation before colonic resection and primary anastomosis may be unnecessary, so routine MBP should be further scrutinized.
Anastomotic Leak ; Colon* ; Colorectal Surgery ; Colostomy ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Retrospective Studies ; Sepsis ; Wound Infection ; Wounds and Injuries

PURPOSE: Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. METHODS: Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. RESULTS: Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. CONCLUSION: Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.
Classification ; Colon* ; Comorbidity ; Humans ; Inflammation ; Intestinal Perforation ; Ischemia ; Mortality* ; Postoperative Complications ; Retroperitoneal Space ; Retrospective Studies ; Risk Factors* ; Sepsis