Purpose: Surgical management of obstructive left colon cancer (OLCC) is still a matter of debate. The classic Hartmann procedure (HP) has a disadvantage that requires a second major operation. Subtotal colectomy/total abdominal colectomy (STC/TC) with ileosigmoid or ileorectal anastomosis is proposed as an alternative procedure to avoid stoma and anastomotic leakage. However, doubts about morbidity and functional outcome and lack of long-term outcomes have made surgeons hesitate to perform this procedure. Therefore, this trial was designed to provide data for morbidity, functional outcomes, and long-term outcomes of STC/TC. Methods: This study retrospectively analyzed consecutive cases of OLCC that were treated by STC/TC between January 2000 and November 2020 at a single tertiary referral center. Perioperative outcomes and long-term outcomes of STC/TC were analyzed. Results: Twenty-five descending colon cancer (45.5%) and 30 sigmoid colon cancer cases (54.5%) were enrolled in this study. Postoperative complications occurred in 12 patients. The majority complication was postoperative ileus (10 of 12). Anastomotic leakage and perioperative mortality were not observed. At 6 to 12 weeks after the surgery, the median frequency of defecation was twice per day (interquartile range, 1–3 times per day). Eight patients (14.5%) required medication during this period, but only 3 of 8 patients required medication after 1 year. The 3-year disease-free survival was 72.7% and 3-year overall survival was 86.7%. Conclusion The risk of anastomotic leakage is low after STC/TC. Functional and long-term outcomes are also acceptable. Therefore, STC/TC for OLCC is a safe, 1-stage procedure that does not require diverting stoma.

Purpose: Surgery to create a stoma for decompression might be required for unresectable stage IV cancer patients with complete colonic obstruction. The aim of this study was to compare the results of blowhole colostomy with those of loop ostomy. Methods: Palliative ileostomy or colostomy procedures performed at a single center between January 2011 and October 2020, were analyzed retrospectively. Fifty-nine patients were identified during this period. The demographic characteristics and outcomes between the blowhole colostomy group (n=24) and the loop ostomy group (n=35) were compared. Results: The median operative time tended to be shorter in the blowhole colostomy group (52.5 minutes; interquartile range [IQR], 43–65) than in the loop ostomy group (60 minutes; IQR, 40–107), but the difference did not reach statistical significance (P=0.162). The median length of hospital stay was significantly shorter with blowhole colostomy (blowhole, 13 days [IQR, 9–23]; loop, 21 days [IQR, 14–37]; P=0.013). Mean cecum diameter was significantly larger in the blowhole group than in the loop group (8.83±1.91 cm vs. 6.78±2.36 cm, P=0.001), and the emergency operation rate was higher in the blowhole group than in the loop group (22 of 24 [91.7%] vs. 23 of 35 [65.7%], P=0.021). Conclusion In surgical emergencies, diverting a blowhole colostomy can be safe and effective for palliative management of colonic obstruction in patients with end-stage cancer and might reduce the operative time in emergent situations.

Background: Data illustrating the impact of atopic dermatitis (AD) on lives of adults with AD in South Korea are limited. Objective: To assess the AD disease severity and its impact on quality of life (QoL) in patients with AD from South Korea. Methods: Patients with AD utilizing the specialist dermatology services of major hospitals in South Korea were assessed for disease severity using Eczema Area and Severity Index (EASI) score, for QoL using Dermatology Life Quality Index (DLQI) (for QoL), and for comorbidities and treatment experience via retrospective review of 12-month medical records. Clinical and sociodemographic characteristics were also measured. Results: Of the 1,163 patients, 695 (59.8%) were men (mean age [years]±standard deviation: 31.6±12.1). Overall, 52.9% (n=615) patients had moderate-to-severe disease (EASI>7).The QoL of 72.3% (n=840) patients was affected moderately-to-severely (DLQI score: 6~30).Systemic immunosuppressants were used ≥1 over past 12 months in 51.9% (n=603) patients, and the most commonly used were cyclosporines (45.7%, n=531) and systemic corticosteroids (40.5%, n=471). Approximately, 10.8% (n=126) patients consulted or received treatment for AD-related eye problem. Of these, 40% (n=50) patients reported poor, very poor, or completely blind status; approximately, 16.7% patients (n=192) reported having depression or anxiety; and 35.5% (n=410) reported suicidal ideation or suicidal attempt. Conclusion A large proportion of patients had moderate-to-severe AD, a compromised QoL, and ocular or mental health comorbidities, indicating a high disease burden despite systemic treatment. These findings highlight the importance of a holistic approach for the evaluation and treatment of patients with AD.

Background: In 2015, the Korean Atopic Dermatitis Association (KADA) working group published consensus guidelines for treating atopic dermatitis (AD). Objective: We aimed to provide updated consensus recommendations for systemic treatment of AD in South Korea based on recent evidence and experience. Methods: We compiled a database of references from relevant systematic reviews and guidelines on the systemic management of AD. Evidence for each statement was graded and classified based on thestrength of the recommendation. Forty-two council members from the KADA participated in three rounds of voting to establish a consensus on expert recommendations. Results: We do not recommend long-term treatment with systemic steroids forpatients with moderate-to-severe AD due to the risk of adverse effects. We recommend treatment with cyclosporine or dupilumab and selective treatment with methotrexate or azathioprine for patients with moderate-to-severe AD. We suggest treatment with antihistamines as an option for alleviating clinical symptoms of AD. We recommend selective treatment with narrowband ultraviolet B for patients with chronic moderate-to-severe AD. We do not recommend treatment with oral antibiotics for patients with moderate-to-severe AD but who have no signs of infection. We did not reach a consensus on recommendations for treatment with allergen-specific immunotherapy, probiotics, evening primrose oil, orvitamin D for patients with moderate-to-severe AD. We also recommend educational interventions and counselling for patients with AD and caregivers to improve the treatment success rate. Conclusion We look forward to implementing a new and updated consensus of systemic therapy in controlling patients with moderate-to-severe AD.

Atopic dermatitis (AD) is a common, chronic, relapsing, inflammatory skin disease that affects both children and adults. AD is the cause of considerable morbidity including severe pruritus and impaired quality of life. Treatments for active disease include avoidance of triggering factors, barrier repair, topical medications including topical corticosteroids (TCs) and topical calcineurin inhibitors (TCIs), phototherapy, antibacterial agents, and systemic immunosuppressants including cyclosporine. Until recently, the only Food and Drug Administration (FDA)-approved systemic treatment options for patients with moderate-to-severe AD were steroids and cyclosporine. Systemic steroids are not recommended by current guidelines and are commonly associated with disease rebound. Instead, clinicians choose from several off-label immunosuppressants. In 2018, the Korean FDA approved dupilumab for adults with moderate-to-severe AD whose disease is not adequately controlled with topical therapies. The implementation of treatment guidelines for AD is challenging. Herein, we review the several treatment modalities for AD and recommend a treatment algorithm.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Calcineurin Inhibitors ; Child ; Cyclosporine ; Dermatitis, Atopic* ; Humans ; Immunosuppressive Agents ; Phototherapy ; Pruritus ; Quality of Life ; Skin Diseases ; Steroids ; United States Food and Drug Administration

PURPOSE: Acute appendicitis is one of the most common surgical emergencies worldwide. Laparoscopic appendectomy (LA) is being accepted as the 'gold standard' surgery for simple acute appendicitis over open appendectomy (OA); however, for complicated appendicitis, no consensus has been reached with regard to which produces better outcomes. METHODS: We analyzed the data of patients who were diagnosed as complicated appendicitis, older than 18 years old, and underwent LA or OA from January 2008 to December 2012. A total of 2,173 patients had acute appendicitis during this period and 461 (21.2%) of them had complicated appendicitis; 335 patients were finally enrolled and divided into LA (280), OA (49), and Converted to open Appendectomy (CA) groups (6), respectively. Age, sex, preoperative WBC, operating time, stapler usage, time to diet and discharge, total cost and complication among the three groups were analyzed. RESULTS: No significant differences were observed in sex, age, history of abdominal surgery, preoperative WBC, and total cost. Shorter operating time (62.3+/-30.0 vs 87.3+/-40.2, p=0.000), shorter time to diet (2.7+/-2.2 vs 3.7+/-1.6, p=0.001), shorter postoperative stay (4.8+/-2.6 vs 7.1+/-2.5, p=0.000), shorter duration of pain (3.4+/-1.7 vs 5.6+/-2.8, p=0.000), and less frequent usage of pain killer (68.2% vs 89.1%, p<.001) were observed in the laparoscopic group. Complication rate was significantly lower in the LA group (4.6% vs 18.4%, p=0.002). CONCLUSION: Results of this study provide clinical evidence that laparoscopic surgery is a feasible and safe surgical modality for complicated appendicitis. Conduct of more reliable, large scaled, randomized prospective study will be necessary in order to prove the superiority of laparoscopic surgery for complicated appendicitis.
Appendectomy* ; Appendicitis* ; Consensus ; Diet ; Emergencies ; Humans ; Laparoscopy

Intussusception in adult is a rare disease and laparotomy is usually considered because of the probability of malignancy. Especially with obstruction symptom or sign, it might be needed emergency operation. This case was a simultaneous development of small bowel intussusception and acute hepatitis A. The patient had abdominal pain and vomiting. Intitial laboratory examination with elevated aminotransferase revealed that the diagnosis was acute hepatitis. As managing acute hepatitis, the abdominal pain was not improved and the patient had tenderness on periumbilical area on physical examination. A jejunal intussusception with a lead point was proved on the abdominal computed tomography scan. Fortunately, symptom of intussusception was relieved while nulli per os (NPO) and intravenous hydration. After recovery of acute hepatitis, laparotomy was done. The lead point was 2.5x3.0 cm sized hamartoma. This was the case that the symptom of intussusception was confused with that of acute hepatitis.
Abdominal Pain ; Adult ; Emergencies ; Hamartoma ; Hepatitis ; Hepatitis A ; Humans ; Intussusception ; Laparotomy ; Physical Examination ; Rare Diseases ; Vomiting

Small bowel lesions located in long and multiple complex loop configurations were difficult to diagnose early because of vague clinical manifestations and because of the poor diagnostic yield of conventional examination methods. In this setting, double-balloon enteroscopy (DBE) was an epoch-making diagnostic and therapeutic tool for the management of patients with small bowel disease. Single-balloon enteroscopy (SBE), lacking a balloon at the endoscopic tip, is also a useful method for investigating and managing suspected small bowel lesions. Mucosa associated lymphoid tissue (MALT) lymphoma of the small bowel is relatively uncommon and remains a localized disease for long periods in most patients. Recently, we experienced a case of advanced-stage MALT lymphoma in the jejunum. A 60-year old female, with a history of anemia of unknown etiology and who was suspected of having a small bowel lesion, presented with complaints of vague abdominal pain and dizziness. She had undergone SBE via the oral route. She was diagnosed with MALT lymphoma of the jejunum and treated with medical management.
Abdominal Pain ; Anemia ; Dizziness ; Double-Balloon Enteroscopy ; Female ; Humans ; Jejunum ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone ; Mucous Membrane