BACKGROUND: There is a continuing increase in geriatric population. Many workers have reported an increased mortality rate after operation on patients over 65 years of age. The aim of this study is to analyze and to measure the risk factors associated with geriatric surgery. METHODS: We reviewed the medical records of 467 patients over 65 years of age who had been admitted and operated on in the department of General Surgery, Konkuk University Hospital, between January, 1993 and December, 1999. An analysis was done on age and sex distribution, duration of admission, type of anesthesia, duration of general anesthesia, number of benign and malignant disease, number of coexistent disease, number of emergency and elective operation, and then, we analyzed the above factors to know whether they influence mortality rate or not. RESULTS: 1) Overall operative mortality rate was 4.3%, and the factors influencing mortality rate were, malignant disease, coexisting disease, emergency operation and long duration of general anesthesia. 2) Old age in itself did not affect the mortality. CONCLUSION: In order to reduce the operative mortality in geriatric surgery, careful preoperative evaluation and elective surgery rather than emergency operation must be done, and the operation chosen should be the one of less magnitude, not very radical operations to achieve permanent cures.
Anesthesia ; Anesthesia, General ; Emergencies ; Humans ; Medical Records ; Mortality* ; Risk Factors ; Sex Distribution

BACKGROUND: Recently the number of elderly gallstone patients has increased, in Korea. The aim of this study is to analyze and to measure the risk factors associated with operation on elderly gallstone patients. METHODS: We reviewed the medical records of 206 gallstone patients who had been admitted and operated on in the department of general surgery. Konkuk University Hospital, between January, 1993 and December, 1999. The patients were divided into 2 groups, over and under age 65. In each group, analysis was done on sex distribution, the ratio according to location of gallstone, duration of hospital stay, duration of general anesthesia and operative mortality, and then the above factors of each group were compared. RESULTS: 1) The ratio of common bile duct stones in patients over age 65 was two times of that in patients under age 65(48%,24%) 2) The overall operative mortality was 1.9% and has no correlation with old age. 3) Severe coexisting disease may seem the risk factor for operative mortality. CONCLUSION: In the diagnosis and management of gallstones in the elderly, the possibility of common bile duct stone should be suspected. And in order to reduce the operative mortality, careful preoperative evaluation and treatment of coexisting disease should be done.
Aged ; Anesthesia, General ; Common Bile Duct ; Diagnosis ; Gallstones* ; Humans ; Korea ; Length of Stay ; Medical Records ; Mortality ; Risk Factors ; Sex Distribution

Purpose: We investigated the effect of severe calcification of the femoropopliteal artery on intervention outcomes in patients with ischemic tissue loss. Materials and Methods: A retrospective review of the first endovascular treatment of the femoropopliteal artery for ischemic tissue loss between May 2010 and February 2018 was performed. The calcification of femoropopliteal lesions was estimated by the Compliance 360° score, and lesions with a score of 4 were defined as severe calcification lesions. Results: Overall, 135 first femoropopliteal endovascular procedures on 135 limbs from 112 patients were included in this study. Among the 135 limbs that received treatement of the femoropopliteal arteries, 74 limbs had Trans-Atlantic Inter Society Consensus (TASC) A or B lesions and 61 limbs had TASC C or D lesions. Among 61 cases of TASC C or D lesions, 21 limbs (34.4%) had severe calcification; there was no statistically significant difference in limb salvage (P=0.75), and amputationfree survival (P=0.11) based on the degree of calcification. However, the survival rate in TASC C or D lesions was significantly different between the two groups (non-severe calcification group vs severe calcification group at 1-year, 2-years, and 3-years: 88.6%, 79.7%, and 61.0% vs 70.0%, 56.0%, and 28.0%, respectively, P=0.01). In multivariate analysis of influencing factors for poor survival in TASC C or D using the Cox proportional hazards model, severe calcification (hazard ratio, 2.362; 95% confidence interval, 1.035-5.391; P=0.041) was a statistically significant risk factor. Conclusion Severe femoropopliteal artery calcification was associated with poor survival, especially in TASC C or D lesions.

We report a 13-year-old girl with multiple angiokeratomas on lower extremity. Her skin lesions were asymptomatic but became larger and darker and bled intermittently with subtle trauma. Skin biopsy confirmed the diagnosis of angiokeratoma. We emphasize the importance of this lesion in the differential diagnosis of pigmented nevus or malignant melanoma.
Adolescent ; Angiokeratoma* ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Lower Extremity ; Melanoma ; Nevus, Pigmented ; Skin

We report a 37-year-old man who had a cutaneous marker of tuberous sclerosis with angiofibromas, periungal fibromas and who also showed bilateral verrucous hemangiomas on buttock. It is not known whether there is association between verrucous hemangioma and tuberous sclerosis, but there are some evidence suggest a more than chance association. We describe a case of bilateral verrucous hemangiomas combined with tuberous sclerosis.
Adult ; Angiofibroma ; Buttocks ; Fibroma ; Hemangioma* ; Humans ; Tuberous Sclerosis*

Intraperitoneal foreign body is a rare but extremely troublesome condition. Such as forceps, rubber tubes, pieces of broken instruments can retained during surgery but most commonly foreign body is the surgical sponge. The retained foreign body produce intra-abdominal abscess, peritonitis, intestinal obstruction in the postoperative period or even after weeks, months or years and very uncommonly migrate into the bowel. We report a case of intracolonic surgical sponge misdiagnosed as retained intraperitoneal foreign body with brief review of literatures.
Abdominal Abscess ; Foreign Bodies* ; Intestinal Obstruction ; Peritonitis ; Postoperative Period ; Rubber ; Surgical Instruments ; Surgical Sponges*

Rhabdomyolysis is a common clinical and laboratory syndrome resulting from reversible skeletal muscle injury, with release of muscle cell contents into the plasma. Cardioversion, and cardiopulmonary resuscitation may produce rhabdomyolysis and myoglobinuria. We report a 5-year-old boy surviving after cardiopulmonary resuscitation and repeated 5 times of cardioversion. He showed elevated serum BUN and creatinine levels, requiring hemodialysis treatment. We had tried 5 times of intermittent hemodialysis, but oliguria was continued and there was no change of serum BUN and creatinine. His urine output was less than 100 cc per day and he showed severe edema and weight gain of 7 kg, and so we started the continuous renal replacement therapy (Prismaflex(R), gambro). After 12 days of continuous venovenous hemodiafiltration (CVVHDF), his urine output recovered and his BUN, creatinine, liver enzyme, creatine kinase, and lactate dehydrogenase levels returned to normal. During the treatment of CVVHDF, he had shown persistent hypercalcemia, and so we changed dialysate and replacement solution from hemosol B0 to calcium free solution. The hypercalcemia was controlled successfully using this calcium free pharmacy-made bicarbonate solution.
Calcium ; Cardiopulmonary Resuscitation ; Creatine Kinase ; Creatinine ; Edema ; Electric Countershock ; Hemodiafiltration ; Humans ; Hypercalcemia ; L-Lactate Dehydrogenase ; Liver ; Muscle Cells ; Muscle, Skeletal ; Myoglobinuria ; Oliguria ; Plasma ; Preschool Child ; Renal Dialysis ; Renal Replacement Therapy ; Rhabdomyolysis ; Weight Gain

PURPOSE: In order to establish therapeutic guidelines for TASC C & D iliac lesions, we compared outcomes of surgical and endovascular treatment. METHODS: From May 2002 to April 2007, 27 limbs of 18 patients underwent bypass operation and 23 limbs of 21 patients underwent stent placement for TASC C & D iliac lesions at Dongsan Medical Center. Age, sex, risk factor, combined diseases, clinical symptoms, treatment method, and patency rate were reviewed retrospectively. RESULTS: Technical and clinical success was achieved in all patients of the bypass group and in 95.8% of patients in the stent group. There were no complications in the surgical group, but 4 major complications in the stent group: 3 distal embolizations, and 1 arterial rupture. The primary patency rates at 6 months, 1, 2, and 3 years were all 90% in the bypass group and 95%, 89%, 89%, and 89%, respectively, in the stent group (P=0.99). The respective secondary patency rates were all 90% in the bypass group and 100%, 94%, 94%, and 94% in the stent group (P=0.56). CONCLUSION: Arterial bypass and stent placement are technically safe and effective treatment modalities in TASC C & D lesions of the iliac artery. A liberal posture to open arterial reconstruction extends the ability to treat diffuse TASC C & D lesions via endovascular means.
Extremities ; Humans ; Iliac Artery ; Posture ; Retrospective Studies ; Risk Factors ; Rupture ; Stents

Intestinal obstruction occurs rarely as a cause of acute abdominal pain during pregnancy. It is very difficult to make diagnosis, as nausea, vomiting and abdominal pain are commonly associated with pregnancy, and X-rays are avoided if possible. However, delayed diagnosis can cause intestinal strangulation, which results in a high incidence of maternal morbidity, mortality, premature labor, and fetal loss. The incidence of intestinal obstruction seems to increase at the time of rapid uterine size changes such as between 16~20 weeks, 32~36 weeks or even in the puerperium. The possibility of intestinal obstruction must always be kept in mind when a pregnant woman with an operation scar on her abdomen develops abdominal pain. We present a case of small bowel obstruction during early pregnancy with a brief review of the literature who had the history of right salpingo-oophorectomy and appendectomy operation
Abdomen ; Abdomen, Acute ; Abdominal Pain ; Appendectomy ; Cicatrix ; Delayed Diagnosis ; Female ; Humans ; Incidence ; Intestinal Obstruction ; Mortality, Premature ; Nausea ; Postpartum Period ; Pregnancy ; Pregnant Women ; Vomiting

No abstract available.
Aged, 80 and over ; Cholecystitis/*complications/diagnosis ; Hemobilia/diagnosis/*etiology ; Humans ; Jaundice, Obstructive/etiology ; Male