C-reactive protein(CRP), a normal constituent of the serum in healthy individuals, increases in response to various bacterial infections and cellular necrosis. To find out if the C-reactive protein concentration is of any value in the diagnosis of acute appendicitis, ninety consecutive patients suspected to have acute appendicitis were studied prospectively. Of these, 54 patients(group A) had acute appendicitis and 6 patients(group B) underwent surgery with a diagnosis of acute appendicitis; however, histopathology disclosed a normal appendix. Seventeen patients(group C) had no identifiable cause for their illness and 13 patients(group D) had an identifiable cause for their illness, though not appendicitis. The mean serum CRP value was 49.00mg/L in group A, 18.92mg/L in group B, 20.31mg/L in group C, and 63.22mg/L in group D. Within group A, the mean CRP value in the 36 patients with the inflammed appendix was 33.56mg/L. The mean value in the 7 patients with the gangrenous appendix was 73.16mg/L, and 97.61mg/L in 11 patients with the perforative appendix. Serum CRP levels were normal in two patients with acute appendicitis. Besides these 2 patients, all patients with normal CRP had a normal appendix found at the time of operation or their symptoms resolved spontaneously. It is concluded that an increase in CRP levels to more than 5 mg/L is not a definitive indicator of acute appendicitis. However, when there is doubt about the diagnosis of acute appendicitis, a normal serum CRP level should be used as a basis for the decision to defer surgery.
Appendicitis* ; Appendix ; Bacterial Infections ; C-Reactive Protein* ; Diagnosis ; Humans ; Necrosis ; Prospective Studies

PURPOSE: The routine use of postoperative nasogastric decompression after abdominal surgery has been challenged. Furthermore, investigators have recently shown that early postoperative oral feeding is safe and generally well tolerated. This study was aimed to determine whether or not early postoperative feeding is safe after elective colorectal surgery. METHODS: All patients who underwent elective colorectal surgeries between June 1998 and March 1999 were permitted to take oral intake one day after the operations. The patients were compared with other patients, who had underwent elective colorectal surgeries between September 1997 and June 1998 and permitted to have a meal after resolving postoperative ileus. The nasogastric tube was removed from all patients immediately after surgery. The patients were monitored for the time of ileus resolution, nausea/vomiting, abdominal distension, nasogastric tube reinsertion and complications. RESULTS: Fifty-one patients were studied, 24 patients in early feeding group and 27 patients in traditional feeding group. Eighteen patients (75.0%) in the early feeding group tolerated the early oral intake. There were no significant differences between two groups in the time for resolution of ileus (3.46 1.38 days vs 3.56 1.80 days), nausea/vomiting (33.3% vs 29.6%), abdominal distension (16.6% vs 14.8%) and nasogastric tube reinsertion (12.5% vs 7.4%). No significant difference was noted in complications such as wound infection, pulmonary problems, intestinal obstruction and anastomotic leak. CONCLUSIONS: Early oral intake after elective colorectal surgery was safe and most of the patients tolerated it. And it may become a kind of managements after elective colorectal surgery.
Anastomotic Leak ; Colorectal Surgery* ; Decompression ; Humans ; Ileus ; Intestinal Obstruction ; Meals ; Research Personnel ; Wound Infection

We performed this study to analyse the morbidity and mortality of stoma formation in infants and children over a 17-year period. Thirty-seven stoma formations were performed in 37 patients: 21 for anorectal malformation, 9 for Hirschsprung's disease, 3 for necrotizing enterocolitis, 2 for multiple ileal atresia, 1 for volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation. There were 26 boys and 11 girls with a mean age of 0.4 years. Complications after stoma formation were encountered in 12 patients(32.4%) and included stomal prolapse, stenosis, retraction, dysfunction, skin excoriation and parastomal hernia. Four patients(10.8%) required stomal revision. The incidence of complications was neither related to the age nor to the primary indication for the stoma formation, but sigmoid colostomy was associated with a lower complication rate compared to transverse colostomy(22.1% versus 42.1%, P<0.05). Five patients died, but only one(2.7%) was dead, which was directly related to stoma formation. Eighteen of these children subsequently underwent stoma closure which was associated with complications in six patients(33.3%). The most common complication after stoma closure was wound sepsis in 4 children. In conclusion, because the significant morbidity of stoma formation still exists the refinements in surgical technique may help in reducing the incidence of complications and a sigmoid loop colostomy should be used whenever possible.
Child* ; Colon ; Colon, Sigmoid ; Colostomy ; Constriction, Pathologic ; Enterocolitis, Necrotizing ; Female ; Hernia ; Hernia, Diaphragmatic ; Hirschsprung Disease ; Humans ; Incidence ; Infant* ; Intestinal Volvulus ; Mortality ; Prolapse ; Sepsis ; Skin ; Wounds and Injuries

A through knowledge of the anatomy of colonic mesenteric arteries is necessary to accomplish successful, uncomplicated abdominal operations, especially laparoscopic colonic resections in which the mesenteric vessels can't be palpated. Such knowledge is also important when performing a colonic resection for cancer using proximal vascular ligation and wide en bloc resection. Most surgical textbooks depict a "normal pattern" of arterial supply to the right colon as consisting of three arterial branches (the ileocolic, the right colic, and the middle colic arteries) arising independently from the superior mesenteric artery (SMA). Based on the literature, there are only two colonic arteries arising independently from the SMA in many cases. We examined the anatomy of these arteries in 50 patients who had had SMA angiographies for various diseases from January 1995 to May 1997. In all of our cases, the ileocolic artery and the middle colicartery emanated directly from the SMA, but the right colic artery originated directly from the SMA in only 54% of the cases. The right colic artery was absent in 8% of the cases. It also arose as a single trunk with the middle colic artery (22% of the cases) and from the ileocolic artery (16% of the cases). Our data, together with published anatomic studies, lead us to conclude that in many cases there are only two independent branches arising from the SMA that supply the large intestine, the ileocolic artery and the middle colic artery. This knowledge may be helpful in laparoscopic colon surgery, radical colon resections for cancer, and colon replacements after operations on the esophagus or the urinary bladder.
Angiography ; Arteries* ; Colic* ; Colon ; Esophagus ; Humans ; Intestine, Large ; Ligation ; Mesenteric Arteries ; Mesenteric Artery, Superior ; Urinary Bladder

BACKGROUND AND OBJECTIVES: The Oriental herbal materials known as aconitine have long been used in oriental traditional medicine for their analgesic and antiinflammatory effects. Aconitine and its related alkaloids are known cardiotoxins with no therapeutic role in modern western medicine. We have studied the cardiovascular side effects of intoxication that took place in otherwise healthy individuals after ingestion of herbal decoctions containing aconite alkaloids. MATERIALS AND METHOD: During a six-year interval from 1990 to 1996, 9 cases of accidental herb-induced aconitine intoxication were managed in Kyung Hee university medical center. Hospital records were reviewed in detail. RESULTS: All patients developed symptoms of aconitine toxicity within 4 hours of herb ingestion. The frequency of the order in cardinal symptoms of acute aconitine poisoning was nausea or vomiting, irritability, chest discomfort, dizziness, etc. Nine patients developed arrhythmias, including multifocal APC with aberrancy, multifocal VPC, ventricular tachycardia, etc. Administration of isotonic saline, dopamine, atropine and lidocaine with supportive cares brought clinical recovery and disappearance of arrhythmias in most cases within several hours. However, one case of acute aconitine poisoning had been dead of cardiac arrest due to ventricular fibrillation. CONCLUSION: Aconitine and its related alkaloids can cause toxic effects and even fatal poisoning. These cases point to the need for strict surveillance of herbal substances with low safety margins.
Academic Medical Centers ; Aconitine* ; Aconitum ; Alkaloids ; Arrhythmias, Cardiac ; Atropine ; Cardiotoxins ; Dizziness ; Dopamine ; Eating ; Heart Arrest ; Hospital Records ; Humans ; Lidocaine ; Medicine, East Asian Traditional ; Nausea ; Poisoning* ; Tachycardia, Ventricular ; Thorax ; Ventricular Fibrillation ; Vomiting

This is a clinical analysis and review of one-hundred ninety-four patients with periappendiceal abscesses who were treated at the Departmeat of Surgery, Masan Samsung Hospital over a ten year period from January 1985 to December 1994. The following results were obtained. The incidence of periappendiceal abscesses was 7.24% of the total cases of appendicitis operated on during the same period, and most of the patients(43.8%) were over fifty years old. The male to female ratio was 1:1.02. 41.2% of the patients had operations within four days after their symptoms occurred. On admission, the most common physical finding was tenderness on the right lower quadrant of the abdomen (92.9%) and leukocytosis(> OR = 10,000/mm3) was noted on CBC in 82% of the patients. Abdominal sonograms revealed periappendiceal abscesses in 88% of the patients, 83% were revealed with barium enema and 88% with abdominal CT scan. Many patients(75.5%) visited the local clinic and were treated under the diagnosis of gastritis or enteritis instead of appendicitis. One-hundred eighty-three patients(94.3%) had appendectomies with drainages(94.3%), two patients had drainages of abscesses without appendectomy, six patients had ileocecal resections and three patients had right hemicolectomies. Microbiologically, E. coli was the most frequently cultured species(63%) from abscess, and Klebsiella, Enterococcus and Proteus were isolated in some cases. Postoperative complication occurred in seventy-five patients(38.6%) and the most frequent complication was wound infection(28.8%). There was no mortality and the mean hospital stay was fifteen days.
Abdomen ; Abscess* ; Appendectomy ; Appendicitis ; Barium ; Diagnosis ; Enema ; Enteritis ; Enterococcus ; Female ; Gastritis ; Humans ; Incidence ; Klebsiella ; Length of Stay ; Male ; Mortality ; Postoperative Complications ; Proteus ; Tomography, X-Ray Computed ; Wounds and Injuries

While colon perforation as a complication of diseases such as carcinoma, colitis, diverticular disease, or abdominal trauma is not uncommon, spontaneous perforation of the colon is rare. Although spontaneous perforation is classified as either stercoral or idiopathic on the basis of its etiological background, the pathological mechanisms of the lesions have yet to be determined in detail. Stercoral perforation is a very rare cause of acute abdomen, with fewer than 70 cases documented in the literature; and idiopathic perforation is also infrequently reported. Both disease entities have often been grouped together as idiopathic or spontaneous perforation, resulting in confusion. We report herein two cases of stercoral perforation of the sigmoid colon. The clinical features, diagnosis, and treatment of the disease are reviewed. Surgeons should be aware of the possibility of this fatal disease, despite its rare incidence. Furthermore, it is important to recognize the condition at an early stage of the disease because it has significantly high mortality if surgery is delayed.
Abdomen, Acute ; Colitis ; Colon* ; Colon, Sigmoid ; Diagnosis ; Incidence ; Mortality

No abstract available.
Baculoviridae* ; Bombyx* ; Coinfection*

Peutz-Jeghers syndrome is an autosomal dominant disease characterized by hamartomatous polyps in the gastrointestinal tract and by mucocutaneous melanin pigmentations. The relationship between gastrointestinal polyps and the syndrome has been discussed for many years, and many reports have recently suggested an association between the development of gastrointestinal carcinomas and the presence of the syndrome. The reasons for such an association are unknown; some possible reasons are 1) the transformations of some hamartomas into adenomatous polyps and cancer, 2) malignant transformation of adenomatous polyps, or 3) de novo occurrence of malignant tumors. We here present our clinical experience with a 53-year-old male patient who had Peutz-Jeghers syndrome and an adenocarcinoma at the hepatic flexure of the colon.
Adenocarcinoma ; Adenomatous Polyps ; Colon* ; Colonic Neoplasms* ; Gastrointestinal Tract ; Hamartoma ; Humans ; Male ; Melanins ; Middle Aged ; Peutz-Jeghers Syndrome* ; Pigmentation ; Polyps

An apomorphine-induced rotational test has been used in the evaluation of rat parkinsonian models lesioned with neurotoxin 6-hydroxydopamine (6-OHDA). Previous parkinsonian rat models have generally been characterized by unilateral destruction of both nigrosriatal pathway and mesolimbic pathway using 6-OHDA. The authors created partial lesioned rat parkinsonian models using 6-OHDA in which there is destruction of the dopaminergic nigrostriatal pathway and sparing of the mesolimbic pathway. Rats with unilateral lesions of the substantia nigra pars compacta(SNpc) were tested for rotational asymmetry using a cylindrical rotometer device with flat bottom(diameter, 30.5cm) after administration of apomorphine. After completion of the rotation test, the animals were sacrificed and their brains were immunolabeled for tyrosine hydroxylase(TH). Analysis of anatomical and behavioral data suggests that the pattern of rotation(pivotal rotation) is more reliable index for loss of TH-immunoreactive neurons in lesioned SNpc than the total number of rotational responses to apomorphine. The exact cause of the abnormal ipsiversive rotation which some rats showed is unclear. Further research should be pursued to explain this finding.
Animals ; Apomorphine ; Brain ; Models, Animal ; Neurons ; Oxidopamine* ; Parkinson Disease ; Rats* ; Substantia Nigra ; Tyrosine