BACKGROUND: Although pneumonia is the third most common type of nosocomial infection following urinary tract infection and surgical wound infection, it is associated with the highest mortality rate (28-37%), and 16% of deaths in hospitals are caused by it. The purpose of this study was to analyze our cases of postoperative pneumonia and to establish the principles of prevention and treatment for postoperative pneumonia. METHODS: Thirteen cases diagnosed as postoperative pneumonia out of 11,227 patients who were operated on from Jan. 1994 to June 1997 at the Department of Surgery, Seoul National University Hospital, were analyzed by a retrospective review of their medical records. The diagnosis of postoperative pneumonia was based on the `Center for Disease Control' criteria. RESULTS: The incidence of postoperative pneumonia was 0.12%. The median patient age was 58 years (ranging from 31 to 70 years). There were 7 males and 6 females. The causal diseases for the operations were 7 gastric cancers, 2 ileus, and 4 others. Five subtotal gastrectomies, 3 total gastrectomies, and 5 other operations were performed, and there were 10 elective and 3 emergent operations. The preoperative status was investigated. Two cases were preoperatively diagnosed as bronchiectasis. Other associated medical illnesses were 2 coronary arterial diseases, 2 hypertensions, and 2 others. Six patients had a history of smoking. The `American Society of Anesthesiologist' physical status score was checked in 11 cases. There were 2 cases with one points, six cases with two points, and 3 cases with a higher number of points. The average time until diagnosis after operation was 4.0 +/- 3.85 days. All had purulent sputum and high fever, and showed pneumonic infiltration on Chest PA. Four Gram positive and 7 Gram negative bacteria were isolated from the sputum of 12 patient, including three cases with Pseudomonas aeruginosa and two cases with MRSA. All patients were treated with antibiotics. Five patients were admitted to the ICU, and 3 patients maintained intubation after anesthesia. Twelve patients had a nasogastric tube, for which the average period of intubation was 14.1 +/- 14.61 days. One patient expired, and 12 improved. CONCLUSIONS: There was a very low incidence of postoperative pneumonia, and most patients were old. Upper abdominal surgery proved to be an important risk factor, and prolonged maintenance of the nasogastric tube may predispose postoperative patients to pneumonia. The appearance of many antibiotics- resistant bacteria demanded the judicious use of antibiotics.
Anesthesia ; Anti-Bacterial Agents ; Bacteria ; Bronchiectasis ; Cross Infection ; Diagnosis ; Female ; Fever ; Gastrectomy ; Gram-Negative Bacteria ; Humans ; Ileus ; Incidence ; Intubation ; Male ; Medical Records ; Methicillin-Resistant Staphylococcus aureus ; Mortality ; Pneumonia* ; Pseudomonas aeruginosa ; Retrospective Studies ; Risk Factors* ; Seoul ; Smoke ; Smoking ; Sputum ; Stomach Neoplasms ; Surgical Wound Infection ; Thorax ; Urinary Tract Infections

PURPOSE: The purpose of this study was aimed to disclose main affected organisms in patients with perforated appendicitis and to analyze correlations between culture-sensitivity test and infectious complication. METHODS: In 26 of 421 patients who had undergone appendectomy due to acute appendicitis from April 1996 to March 1999, we performed culture-sensitivity test. The clinical records of these patients were collected and reviewed about clinicopathological features and results of culture-sensitivity test, retrospectively. Culture material was collected in BBL transport media with cotton swab and cultured by MacConkey agar plate. The method of MIC by VITEK was used for sensitivity test. RESULTS: Cultured organisms were E. coli (18 cases), Pseudomonas (4), Enterobacter (2), Enterococcus (1), and Proteus (1). In sensitivity test, sensitive antibiotics against all cultured organism were amikacin, ceftriaxone, imipenem and cefotetan. But ampicillin, sulfametoxazole/trimethoprim and piperacillin were mostly resistant. Infectious complications occurred in 11 of 26 patients (42.3%) and consisted of 9 wound infection and 2 intraabdominal abscess. Especially, 13 of 18 cases in which E. coli were isolated, were resistant to ampicillin. And they had infectious complications statistically more than those who were not resistant to ampicillin (p=0.036). CONCLUSIONS: E. coli was a main organism in perforated appendicitis. In case of ampicillin-resistant E. coli, the patients were susceptible to infectious complication such as wound infection and intraabdominal abscess.
Abscess ; Agar ; Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis* ; Cefotetan ; Ceftriaxone ; Enterobacter ; Enterococcus ; Humans ; Imipenem ; Piperacillin ; Proteus ; Pseudomonas ; Retrospective Studies ; Wound Infection

PURPOSE: The purpose of this study was to clarify the risk factors of early recurrence within 1 year by comparing them with patients without recurrence within 3 years after curative liver resection in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Three hundred and twenty six patients with HCC who underwent curative liver resection between 1991 Jan, to 1995 June were observed for possible recurrence for least 3 years. These patients were divided into two groups: 79 patients who had recurrence within 1 years (early recurred group) and 132 patients who had no recurrence within 3 years (no recurred group). RESULTS: Overall survival rates in 5 years after 1iver resection were 17.5% in early recurred group and 94.9% in no recuned group. Risk factors of early recurrence in multivariate analysis were the presence of liver cirrhosis in nontumorous parenchyme (p=0.011, relative risk (RR)=2.5), tumor size (p=0.004, RR 2.9), multiple mass (p 0.015, RR=3.4), the presence of angioinvasion (p=0.043, RR=3.7), serum alpha-fetoprotein more than 20 ng/dl (p=0.007, RR=2.7), major liver resection more than lobectomy (p=0.039, RR=3.2). However, other factors such as age, sex, preoperative transcatheter arterial embolization (TAE), several liver function tests, Child classification, reseetion margin, total necrosis of tumor after preoperative TAE, tumor encapsulation, histologic type, Edmondsons grade, were not significant in our study. CONCLUSION: The risk factors of early recurrence were liver cirrhosis, tumor size, number of tumor, angioinvasion, serum alpha-fetoprotein, and major liver resection. Biologic characteristics of tumor were the most important risk factors of early recurrence. Because the extent of liver resection is the only risk factor that depends on surgeons decision, we must consider this factor in liver resection for HCC.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Child ; Classification ; Humans ; Liver ; Liver Cirrhosis ; Liver Function Tests ; Multivariate Analysis ; Necrosis ; Population Characteristics ; Recurrence ; Risk Factors* ; Survival Rate

To further define the prognostic factors associated with long term survival of hepatocellular carcinoma, we retrospectively studied 371 patients with pathologically diagnosed hepatocellular carcinoma who underwent curative hepatic resection between 1991 and 1995. We included the 16 patients who underwent noncurative hepatic resection in calculating overall survival. The male to female ratio was 5.1 to 1 and their average age was 52.5 years. About 20 variables were subject to univariate and multivariate analysis and their survivals were calculated using the Kaplan-Meier method. 55.6% of (220 of 396) patients had liver cirrhosis and 73.2% of (290 of 396) patients were positive in HBsAg. Operative mortality and inhospital death rate were 1.5% and 0.8%, each and postoperative morbidity rate was 22.5%. The cumulative 1, 3 and 5 year survival rates including noncurative resected cases were 85.9%, 67.2% and 54.8%, respectively. The cumulative 1, 3 and 5 year survival rates of 371 curative resected cases were 87.3%, 68.7% and 56.4%, respectively. Disease free 1, 3, 5 year survival rates of 371 curative resected cases were 74.8%, 48.2% and 40.8%, respectively. The factors such as alpha- fetoprotein, Child's classification, prothrombin time, extent of liver resection, and number of tumor were statistically significant factors associated with cumulative survival.(p<0.05) And alpha-fetoprotein, total necrosis after TACE, viral hepatitis, and invasion of portal vein were significant factors associated with cumulative disease free survival. Only alpha-fetoprotein was associated significantly with cumulative survival and cumulative disease free survival. Length to the resection margin was not significantly associated with survival.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Classification ; Disease-Free Survival ; Female ; Fetal Proteins ; Hepatectomy ; Hepatitis ; Hepatitis B Surface Antigens ; Humans ; Liver ; Liver Cirrhosis ; Male ; Mortality ; Multivariate Analysis ; Necrosis ; Portal Vein ; Prothrombin Time ; Retrospective Studies ; Survival Rate

BACKGROUND/AIMS: In the immunological and functional aspects, freshly isolated human hepatocytes are better than animal hepatocytes from other species such as the pig and hepatocytes from human tumor cell lines. Human liver tissue for hepatocyte isolation can be obtained either from surgical specimens of patients with liver disease, such as hepatocellular carcinoma or from donor livers that are not suitable for transplantation. In the latter case, the liver may be preserved in 4 degrees C UW solution. Therefore, studies of the limit on the preservation time to get clinically applicable hepatocytes, and proper isolation techniques improving cell viability are needed. In this study, the authors isolated hepatocytes from a few kinds of the liver with different UW preservation times and different isolation techniques. METHODS: Male Sprague-Dawley rats weighing 200g-250g were used. The hepatocytes were isolated from unpreserved livers(control), livers preserved for 24 hours in UW solution, and livers preserved for 48 hour in UW solution, with a modified Seglen's two step method. To improve cell viability, 5mM glycin was added to the EDTA solution in one group and in another, the pH of the EDTA solution was slowly changed from 6.5 to 7.25. RESULTS: The control group showed 80.0% of cell viability. 53.8% of isolated hepatocytes were viable even after 24 hours of preservation. The cell viability decreased to 36.1% and severe cellular damage was observed after 48 hours preservation. The glycin and pH change showed no protective effect on the isolation of hepatocytes from UW preserved livers. CONCLUSION: After 24 hours preservation in UW solution, many clinically useful hepatocytes were isolated with a modified Seglen's two step method. Further studies concerning the preservation of functions of hepatocytes isolated from UW preserved livers and on the technique of cell culture and cryopreservation are needed.
Animals ; Carcinoma, Hepatocellular ; Cell Culture Techniques ; Cell Line, Tumor ; Cell Survival ; Cryopreservation ; Edetic Acid ; Hepatocytes* ; Humans ; Hydrogen-Ion Concentration ; Liver Diseases ; Liver* ; Male ; Rats* ; Rats, Sprague-Dawley ; Tissue Donors

BACKGROUND/AIMS: There are many reports in which perioperative transfusion was closely related to the survival of cancer. The long-term survival rate of patients with hepatocellular carcinoma undergoing hepatectomy has improved, and it may be related to the reduction of intraoperative transfusion. The aim of this study is to evaluate the effect of intraoperative transfusion on the prognosis in the hepatectomized hepatocellular carcinoma patients and the relationship between the survival improvement and reduction of intraoperative transfusion. METHODS: From 1988 Jan. to 1995 Dec., 507 cases in which the amount of intraoperative transfusion was known were reviewed. Operative transfusion of whole blood or packed red cells was included in this study. The clinical, operative, and pathological factors were analyzed to identify factors that affected long-term survival and disease free survival. RESULTS: By multivariate analysis, Child classification, the extent of resection, portal vein invasion, and blood transfusion(more than 7 units) were shown to be independent factors in overall survival. Child classification, the number of tumors, portal vein invasion, and blood transfusion(more than 7 units) were shown to be independent factors in disease free survival. CONCLUSION: Operative blood transfusion affects the long-term survival and the disease free survival. Therefore, the intraoperative transfusion should be reduced if possible. Through the improvement of surgical technique and instrument, surgeon can reduce the intraoperative bleeding, and this reduction of intraoperative bleeding may contribute the improvement of survival through the reduction of intraoperative transfusion.
Blood Transfusion ; Carcinoma, Hepatocellular* ; Child ; Classification ; Disease-Free Survival ; Hemorrhage ; Hepatectomy ; Humans ; Multivariate Analysis ; Portal Vein ; Prognosis* ; Survival Rate

PURPOSE: Whole body Positron Emission Tomography (PET) was used to evaluate the existence of cancer cells. However, PET had limitations in identifying thyroid cancer cells because of their slow progression, and evidence regarding its accuracy in finding thyroid cancer cells is insufficient. Therefore, we investigated the usefulness of PET for evaluation of patients with thyroid nodules by studying the relationships between PET and thyroid ultrasonography. METHODS: We evaluated 4,627 patients who had undergone PET from January 2007 to October 2011 and selected 370 patients who had undergone thyroid ultrasonography. We compared and analyzed the amount of thyroid SUVmax of PET, the pattern of glucose uptake, and findings of thyroid ultrasonography based on their size, shape, location, and FNAC. RESULTS: Of 370 patients, 197 (53.2%) subjects were found to have thyroid nodules, and 211 (57.0%) subjects had higher sugar metabolism, regardless of having thyroid nodules. No statistical correlations were observed among nodule size, nodule location,and higher sugar metabolism, however, noticeable relationships were observed between the shape of the cells on thyroid ultrasonography and FDG uptake of PET. In cases of papillary thyroid cancer, there was higher FDG uptake, compared to benign lesions in particular, SUVmax of the papillary thyroid cancer showed a significantly elevated level of FDG uptake. CONCLUSION: Despite its limited usefulness in identifying the characteristics of thyroid nodules being benign or malignant, PET is appropriate for evaluation of the malignancy of thyroid cells
Diagnosis* ; Electrons* ; Glucose ; Humans ; Metabolism ; Positron-Emission Tomography* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Ultrasonography

Eosinophilic gastrointestinal disorder is uncommon and it has rarely been reported. The presence of increased numbers of eosinophils in the biopsy specimens of the gastrointestinal tract, the infiltration of eosionophils in intestinal crypts and gastric glands, the absence of involvement of other organs and the exclusion of other causes of eosinophilia support the diagnosis of eosinophilic gastroenteritis. This is characterized by infiltration of eosinophils in the gastrointestinal wall, and it's associated with protein-losing enteropathy, hypoalbuminemia, motility abnormalities and ascites. Although it is an idiopathic disorder, allergic and immunologic etiologies have been suggested. Steroid is the treatment of choice, but an operation is necessary in case of a surgical abdomen or if the patient is refractory to steroid therapy. Recently, authors experience 2 cases of eosinophilic gastroenteritis causing gastro-intestinal obstruction, and report here with clinical evaluation and literature review.
Abdomen ; Ascites ; Biopsy ; Diagnosis ; Eosinophilia ; Eosinophils* ; Gastric Mucosa ; Gastroenteritis* ; Gastrointestinal Tract ; Humans ; Hypersensitivity ; Hypoalbuminemia ; Intestinal Obstruction* ; Protein-Losing Enteropathies

Mesenteric venous thrombosis (MVT) is uncommon, but it is often aggravated to a lethal form of intestinal ischemia. Multiple risk factors are associated with mesenteric venous thrombosis, including hypercoagulable or inflammatory states, previous abdominal surgery, abdominal trauma, portal hypertension and oral contraceptives. The use of estrogen-containing oral contraceptives accounts for 4% to 5% of all the cases of MVT. Oral contraceptives have been reported to decrease antithrombin III, increase the levels of prothrombin complex factor and factor VIII, and to inhibit the fibrinolytic system. We describe here a case of 42-year-old woman who had taken oral contraceptives for 7 years and she was diagnosed to have Protein C and Protein S deficiency, and superior mesenteric venous (SMV) and portal vein thrombosis. She underwent segmental resection of the small bowel. She was later discharged without suffering with short bowel syndrome or any other complications.
Adult ; Antithrombin III ; Contraceptives, Oral ; Factor VIII ; Female ; Humans ; Hypertension, Portal ; Ischemia ; Protein C* ; Protein S Deficiency* ; Protein S* ; Prothrombin ; Risk Factors ; Short Bowel Syndrome ; Thrombosis* ; Venous Thrombosis

PURPOSE: Transcatheter arterial embolization (TAE) is widely used as a diagnostic and therapeutic tool for hepatocellular carcinomas (HCC). Although there are many controversies about the effect of preoperative TAE, in some centers, it has been done in most patients with HCC. We investigated the effect of preoperative TAE on the prognosis for the patients who had undergone curative hepatic resection for HCC. METHODS: We retrospectively studied 541 patients who had undergone curative hepatic resection for HCC at the Department of Surgery in Seoul National University Hospital between 1988 and 1995. Among those, preoperative TAE was done in 489 patients (TAE (+) group) and was not done in 52 patients (TAE (-) group). We examined demographics, tumor-free survival rate, overall survival rate, and complications. RESULTS: There were no statistical differences of demographic data between TAE (+) and TAE (-) groups. The 1-year, 3-year and 5-year tumor-free survival rates for TAE (+)/TAE (-) groups were 72.9%/70.6%, 43.8%/36.7% and 35.7%/30.5%, respectively. There was no statistical difference. The 1-year, 3-year and 5-year overall survival rates for TAE (+)/TAE (-) group were 85.5%/86.0%, 69.1%/63.3% and 56.6%/51.7%, respectively. These differences were not statistically significant (p>0.05). The postoperative complication rates were 26.6% for patients undergoing pre operative TAE and 26.9% for patients not undergoing it; these differences were not statistically significant (p>0.05). In the patients who had preoperative TAE, the hospital stay was prolonged (24.4+/-11.4 days vs. 17.8+/-8.8 days) and cost increased significantly (about 1,300,000 won). CONCLUSION: Preoperative TAE shows no advantages in the treatment of resectable HCC. Rather, it prolongs hospital stay and increases cost. Therefore, preoperative TAE should be done only in selected patients.
Carcinoma, Hepatocellular* ; Demography ; Humans ; Length of Stay ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Seoul ; Survival Rate