PURPOSE: The aim of this study is to assess the short-term outcome of intraoperative colonic irrigation and primary anastomosis and to suggest the usefulness of the procedure when a preoperative mechanical bowel preparation is inappropriate. METHODS: This retrospective study included 38 consecutive patients (19 male patients) who underwent intraoperative colonic irrigation and primary anastomosis for left colon disease between January 2010 and December 2016. The medical records of the patients were reviewed to evaluate the patients' characteristics, operative data, and postoperative short-term outcomes. RESULTS: Twenty-nine patients had colorectal cancer, 7 patients had perforated diverticulitis, and the remaining 2 patients included 1 with sigmoid volvulus and 1 with a perforated colon due to focal colonic ischemia. A diverting loop ileostomy was created in 4 patients who underwent a low anterior resection. Complications occurred in 15 patients (39.5%), and the majority was superficial surgical site infections (18.4%). Anastomotic leakage occurred in one patient (2.6%) who underwent an anterior resection due sigmoid colon cancer with obstruction. No significant difference in overall postoperative complications and superficial surgical site infections between patients with obstruction and those with peritonitis were noted. No mortality occurred during the first 30 postoperative days. The median hospital stay after surgery was 15 days (range, 8–39 days). CONCLUSION: Intraoperative colonic irrigation and primary anastomosis seem safe and feasible in selected patients. This procedure may reduce the burden of colostomy in patients requiring a left colon resection with an inappropriate preoperative mechanical bowel preparation.
Anastomotic Leak ; Colon* ; Colon, Sigmoid ; Colorectal Neoplasms ; Colostomy ; Diverticulitis ; Humans ; Ileostomy ; Intestinal Volvulus ; Ischemia ; Length of Stay ; Male ; Medical Records ; Mortality ; Peritonitis ; Postoperative Complications ; Retrospective Studies ; Sigmoid Neoplasms ; Surgical Wound Infection

Acute appendicitis is one of the most common surgical diseases. However, diagnosis is often delayed due to atypical manifestations of appendicitis. Delayed diagnosis causes complications such as perforation, wound infection, abscess, and peritonitis. Necrotizing fasciitis (NF) complicated by perforated appendicitis is extremely rare and can be fatal. Herein, we report the case of an elderly woman presenting with NF of the right leg due to hidden perforated appendicitis. She had multiple medical diseases and initially complained of right leg pain for 3 days without any abdominal symptoms or signs. Her vital signs became unstable on the second day after admission. Computed tomography showed deep NF of the right leg extending from the perforated appendicitis. Emergency surgery was performed after appropriate resuscitation, but she failed to recover from sepsis and died 42 days after surgery.
Abscess ; Aged ; Appendicitis* ; Delayed Diagnosis ; Diagnosis ; Emergencies ; Fasciitis, Necrotizing* ; Female ; Humans ; Leg ; Peritonitis ; Resuscitation ; Sepsis ; Thigh* ; Vital Signs ; Wound Infection

Purpose: Overall 5-year survival rates for colon and rectal cancer reported recently by the American Cancer Society were 89%, 90% for localized disease, 71%, 71% for regional disease, and 14%, 15% for distant disease. But the results of survival rate of colorectal cancer in a single institution were very rare. The aim of this study is to evaluate surgical results and survival rates of colorectal cancer. Methods: We conducted a retrospective study with patients who underwent curative resection for a primary colorectal adenocarcinoma between 2009 and 2018. Results: Five-year overall and disease-free survival were 79.5% and 69.9%, respectively. The overall 5-year survival by stages was 94.7% in stage I, 88.4% in stage II, 74.3% in stage III and 31.5% in stage IV. Five-year disease-free survival was 91% in stage I, 79.8% in stage II, 63.3% in stage III, and 18.9% in stage IV. The overall 5-year survival in rectal cancer was superior to colon cancer (P=0.014) while there was no difference in 5-year disease-free survival (P=0.338). Overall survival in female patients was better than male patient (P=0.029). Overall survival by age was worst in group of less than 40 years old (62.5%), and best in group between 41 and 65 years old (86.5%). Postoperative mortality within 30 days was 0.4%, and the recurrence rate was 19.2%. Conclusion With the development of surgical skills and various treatments, postoperative outcome of colorectal cancer is expected to improve. It may be helpful for surgeons to improve their surgical outcomes when they review their data and conduct active researches.

BACKGROUND: Cabergoline is typically effective for treating prolactinomas; however, some patients display cabergoline resistance, and the early characteristics of these patients remain unclear. We analyzed early indicators predicting long-term response to cabergoline. METHODS: We retrospectively reviewed the cases of 44 patients with macroprolactinomas who received cabergoline as first-line treatment; the patients were followed for a median of 16 months. The influence of various clinical parameters on outcomes was evaluated. RESULTS: Forty patients (90.9%) were treated medically and displayed tumor volume reduction (TVR) of 74.7%, a prolactin normalization (NP) rate of 81.8%, and a complete response (CR; TVR >50% with NP, without surgery) rate of 70.5%. Most patients (93.1%) with TVR > or =25% and NP at 3 months eventually achieved CR, whereas only 50% of patients with TVR > or =25% without NP and no patients with TVR <25% achieved CR. TVR at 3 months was strongly correlated with final TVR (R=0.785). Patients with large macroadenomas exhibited a low NP rate at 3 months, but eventually achieved TVR and NP rates similar to those of patients with smaller tumors. Surgery independently reduced the final dose of cabergoline (beta=-1.181 mg/week), and two of four patients who underwent surgery were able to discontinue cabergoline. CONCLUSION: Determining cabergoline response using TVR and NP 3 months after treatment is useful for predicting later outcomes. However, further cabergoline administration should be considered for patients with TVR >25% at 3 months without NP, particularly those with huge prolactinomas, because a delayed response may be achieved. As surgery can reduce the cabergoline dose necessary for successful disease control, it should be considered for cabergoline-resistant patients.
Dopamine ; Humans ; Hyperprolactinemia ; Prolactin ; Prolactinoma* ; Retrospective Studies ; Tumor Burden

PURPOSE: This study was performed to evaluate the relationship between glomerular basement membrane (GBM) alterations to epithelial cell (EpC) structure and renal function in Alport Syndrome (AS) patients. METHODS: Fifteen patients diagnosed with AS (4-26yrs) were examined. The GBM in AS was categorized as: C1) normal, C2) minor alterations (widening of lamina rara interna or externa without lamina densa change), C3) nonspecific splitting of lamina densa, C4) basket-weaving pattern of lamina densa splitting. The length of each GBM portion along the epithelial side was measured on the systematically obtained electron microscopic photographs. Furthermore to obtain an objective assessment of the degree of glomerular EpC foot process change, the number of slit pores along 10 microm of peripheral GBM in each category was obtained. RESULTS: The percentage of normal GBM portion (C1) correlated inversely with daily protein excretion (g/day/m2, P <0.05) and sum of the percentage of abnormal GBM portion (C2+C3+C4) had direct correlation with daily protein excretion (g/day/m2, P <0.05). There were no significant relationships between the percentages of other categories of GBM alterations and creatinine clearance or protein excretion. There were no significant relationships between of creatinine clearance in relation to normal GBM(C1) portion as well as that in relation to sum of the percentage of abnormal GBM portion (C2+C3+C4). GBM abnormality did not correlate with age at biopsy. CONCLUSION: The extent of GBM structural abnormality is related to proteinuria in AS but the epithelial response is uniform even though the GBM ultrastructural lesions are not.
Creatinine ; Electrons ; Epithelial Cells ; Foot ; Glomerular Basement Membrane ; Humans ; Nephritis, Hereditary ; Phosphorylcholine ; Proteinuria

Lymph node metastasis in early colon cancer is relatively low. Furthermore, skip metastasis beyond principle lymph node is very rare. This is a case of early cecal cancer with skip metastasis to portocaval and retropancreatic space, without regional lymph node metastasis. A 69-year-old female diagnosed as cecal adenocarcinoma. The imaging study revealed as early cecal cancer without enlargement of regional lymph node. However, there is enlargement of portocaval lymph node and high fluorodeoxyglucose (FDG) uptake in positron emission tomography scan image. Right hemicolectomy with extended lymph node dissection was done including retropancreatic, portocaval and hepatoduodenal ligament lymph node. Though whole abdominal cavity exploration was done, there was no evidence of other synchronous cancer. The final pathologic findings revealed the poorly differentiated adenocarcinoma with invasion of submucosal layer and focally superficial layer of muscularis propria. Two of total 27 lymph nodes were involved by metastastatic adenocarcinoma which were from portocaval and retropancreatic space. The detailed preoperative imaging study could find unexpected lymph node metastasis beyond range of routine lymph node dissection. Even though the preoperative clinical stage is relatively early, the detailed and sufficient evaluation for clinical and imaging findings is important not to ignore skip metastasis.
Abdominal Cavity ; Adenocarcinoma ; Aged ; Cecal Neoplasms ; Colonic Neoplasms ; Female ; Humans ; Ligaments ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Metastasis ; Positron-Emission Tomography

PURPOSE: The objective of the current study was to compare surgical outcomes and prognosis based on the longitudinal location of stomach tumors in patients undergoing curative treatment. The specific focus was on the prognosis for adenocarcinomas in the proximal upper-third of the stomach, excluding tumors in the esophagogastric junction (EGJ).METHODS: Data from patients who underwent curative treatment for gastric adenocarcinoma between 2000 and 2010 at a single institution were analyzed retrospectively. Excluding tumors of EGJ origin, data from 797 patients were reviewed—686 with distal gastric cancer and 111 with proximal gastric cancer. Clinicopathology features, tumor stage, surgical outcomes, recurrence, and survival were compared between the groups.RESULTS: Gastric cancer recurred in 136 of the patients (17.1%). Although differences were detected between proximal and distal cancer patients in the prevalence in males versus females (74.8% vs. 63.4%, P=0.020) and in undifferentiated histology (60.4% vs. 47.7%, P=0.013), the prognosis for proximal gastric cancer did not differ from distal gastric cancer. The overall 5-year disease-free survival rate was 84.9% and 81.4% in proximal and distal cancer patients, respectively (P=0.389).CONCLUSION: The prognosis of proximal cancer, excluding tumors of EGJ origin, did not differ from the prognosis of more distal gastric cancer. Clarifying the prognosis of proximal gastric cancer will require the large-scale comparison of an organized, multi-institution database.
Adenocarcinoma ; Disease-Free Survival ; Esophagogastric Junction ; Female ; Humans ; Male ; Prevalence ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach ; Stomach Neoplasms

OBJECTIVES: Effects of aging and leisure time physical activity (LPA) might influence the effect of occupational physical activity (OPA) on risk for cardiovascular disease (CVD). This study was conducted to determine whether OPA affects CVD after controlling the effects of LPA and other risk factors for CVD such as job stress. METHODS: Participants were 131 male Korean manual workers. Tests for heart rate variability (HRV) were conducted for five minutes in the morning at work. We defined OPA as the combined concept of relative heart rate ratio (RHR), evaluated using a heart rate monitor. RESULTS: Whereas high OPA was not related to any HRV items in the younger age group, high OPA was associated with an increased number of low-value cases among all HRV items in older workers. Exercise had beneficial effects only in the younger group. After controlling for exercise and other risk factors, the odds ratios of the root-mean square of the difference of successive normal R-R intervals (rMSSD) and high frequency band power (HF) among the older age and high OPA group compared with the younger age and low OPA group were 64.0 and 18.5, respectively. Social support and shift work were independent risk factors in HRV. CONCLUSIONS: OPA in aging workers increases CVD risks. This study provides support for the need for protection of aging workers from physical work overload, and indicates the need for further study of optimal limits of OPA.
Aging* ; Cardiovascular Diseases ; Heart Rate* ; Heart* ; Humans ; Leisure Activities ; Male* ; Motor Activity* ; Odds Ratio ; Risk Factors