Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-16-00263.1
S. Pouwels, H. Smelt, J. Smulders
Several studies indicate that there is a relationship between vitamin B12 levels and inflammatory status. Some studies showed a significantly correlation between vitamin B12 status and inflammation. The aim of this study is to investigate the influence of inflammatory status on the effect of different vitamin B12 supplementation regimes. We selected patients with a vitamin B12 deficiency based on methylmalonic acid (MMA) levels. A moderate vitamin B12 deficiency was defined as an MMA blood level between ≥300 and 430 nmol/L. In included patients, C-reactive protein (CRP), leukocytes, serum vitamin B12, and MMA levels were measured at baseline and after 6 months of follow-up. A total of 63 patients were included, treated with 3, 6, or no intramuscular vitamin B12 injections. In the 6 intramuscular injections group, the presupplementation CRP levels significantly predicted the response in terms of vitamin B12 increase (P = 0.015). Also, there was a significant reduction in CRP levels (P = 0.03) after 6 injections. There was a significant correlation between presupplementation MMA and presupplementation CRP (r = 0.127, P = 0.049). This study showed that presupplementation CRP levels significantly predicted the response on 6 intramuscular vitamin B12 injections in patients after bariatric surgery. Second, the 6 intramuscular injection regimen showed a significant reduction in CRP levels. Third, there was a significant correlation between MMA and presupplementation CRP. This might indicate that there is interplay between the vitamin B12 supplementation and inflammatory levels in patients after bariatric surgery.
{"title":"Is Inflammation Status in Postbariatric Patients Predictive for Their Response to Vitamin B12 Supplementation Therapy?","authors":"S. Pouwels, H. Smelt, J. Smulders","doi":"10.9738/intsurg-d-16-00263.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-16-00263.1","url":null,"abstract":"\u0000 \u0000 Several studies indicate that there is a relationship between vitamin B12 levels and inflammatory status. Some studies showed a significantly correlation between vitamin B12 status and inflammation. The aim of this study is to investigate the influence of inflammatory status on the effect of different vitamin B12 supplementation regimes.\u0000 \u0000 \u0000 \u0000 We selected patients with a vitamin B12 deficiency based on methylmalonic acid (MMA) levels. A moderate vitamin B12 deficiency was defined as an MMA blood level between ≥300 and 430 nmol/L. In included patients, C-reactive protein (CRP), leukocytes, serum vitamin B12, and MMA levels were measured at baseline and after 6 months of follow-up.\u0000 \u0000 \u0000 \u0000 A total of 63 patients were included, treated with 3, 6, or no intramuscular vitamin B12 injections. In the 6 intramuscular injections group, the presupplementation CRP levels significantly predicted the response in terms of vitamin B12 increase (P = 0.015). Also, there was a significant reduction in CRP levels (P = 0.03) after 6 injections. There was a significant correlation between presupplementation MMA and presupplementation CRP (r = 0.127, P = 0.049).\u0000 \u0000 \u0000 \u0000 This study showed that presupplementation CRP levels significantly predicted the response on 6 intramuscular vitamin B12 injections in patients after bariatric surgery. Second, the 6 intramuscular injection regimen showed a significant reduction in CRP levels. Third, there was a significant correlation between MMA and presupplementation CRP. This might indicate that there is interplay between the vitamin B12 supplementation and inflammatory levels in patients after bariatric surgery.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43273259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-20-00029.1
J. Bong, Younuk Joo, J. Seo, Sanghee Kang, S. Lee, P. Park, Sae-Byeol Choi, B. Min
We aimed to evaluate the changes in liver function after repeat hepatectomy and their relationship with survival of patient with colorectal cancer. Repeat hepatectomy has been accepted as an effective treatment for recurrent liver metastases; however, how repeat hepatectomy changes the liver function during the follow-up period is not well understood. Data regarding patients underwent R0 resections at initial hepatectomy for colorectal cancer with liver metastasis from 2012 to 2017 were retrospectively reviewed. Patients were divided into groups according to the total number of hepatectomies. Overall survival and Child-Turcotte-Pugh score after hepatectomy were analyzed. Fifty-three patients underwent single hepatectomy and 37 patients underwent repeat hepatectomy. There was no significant difference in the overall survival rates between the 2 groups. At 27 months after the initial hepatectomy, mean Child-Turcotte-Pugh scores of patients with repeat hepatectomy started to become statistically higher than those of patients with single hepatectomy. Overall survival of patients who survived after 27 months from the initial hepatectomy showed a statistical difference between the 2 groups. The total number of liver metastases ≥ 4 and Child-Turcotte-Pugh score ≥ 6 at 27 months after the initial hepatectomy were significant risk factors for overall survival of patient who survived after 27 months from the initial hepatectomy. Liver function after repeat hepatectomy can be deteriorated after a long-term period. Careful approach and continuous assessment of the liver function after hepatectomy are necessary to maintain long-term survival after repeat hepatectomy.
{"title":"Child-Turcotte-Pugh Score as a Predictive Factor for Long-Term Survival After Repeat Hepatectomy for Recurrent Liver Metastases of Colorectal Cancer","authors":"J. Bong, Younuk Joo, J. Seo, Sanghee Kang, S. Lee, P. Park, Sae-Byeol Choi, B. Min","doi":"10.9738/intsurg-d-20-00029.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00029.1","url":null,"abstract":"\u0000 \u0000 We aimed to evaluate the changes in liver function after repeat hepatectomy and their relationship with survival of patient with colorectal cancer.\u0000 \u0000 \u0000 \u0000 Repeat hepatectomy has been accepted as an effective treatment for recurrent liver metastases; however, how repeat hepatectomy changes the liver function during the follow-up period is not well understood.\u0000 \u0000 \u0000 \u0000 Data regarding patients underwent R0 resections at initial hepatectomy for colorectal cancer with liver metastasis from 2012 to 2017 were retrospectively reviewed. Patients were divided into groups according to the total number of hepatectomies. Overall survival and Child-Turcotte-Pugh score after hepatectomy were analyzed.\u0000 \u0000 \u0000 \u0000 Fifty-three patients underwent single hepatectomy and 37 patients underwent repeat hepatectomy. There was no significant difference in the overall survival rates between the 2 groups. At 27 months after the initial hepatectomy, mean Child-Turcotte-Pugh scores of patients with repeat hepatectomy started to become statistically higher than those of patients with single hepatectomy. Overall survival of patients who survived after 27 months from the initial hepatectomy showed a statistical difference between the 2 groups. The total number of liver metastases ≥ 4 and Child-Turcotte-Pugh score ≥ 6 at 27 months after the initial hepatectomy were significant risk factors for overall survival of patient who survived after 27 months from the initial hepatectomy.\u0000 \u0000 \u0000 \u0000 Liver function after repeat hepatectomy can be deteriorated after a long-term period. Careful approach and continuous assessment of the liver function after hepatectomy are necessary to maintain long-term survival after repeat hepatectomy.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42648350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-17-00117.1
T. Onuma, K. Tajima, Kumiko Sato, Katsushige Hattori, Shin Fukuda, Takahiro Tsuji, Y. Yoshida
To assess the utility of preoperative magnetic resonance imaging (MRI) in the diagnosis of tubal pregnancy. Most cases of ectopic pregnancy are tubal pregnancies. Preoperative accurate diagnosis including the location of the tubal pregnancy is important. We performed a retrospective single-center cohort study evaluating patients who underwent surgery for ectopic pregnancy from April 2004 to March 2016 and who underwent preoperative MRI. Sixty patients were enrolled in the study. Chorion confirmed at the tubal pregnancy site detected by MRI was defined as a correct diagnosis. Mean estimated gestational age at the time of MRI according to the last menstrual period was 7 weeks (median: 5 weeks; range: 3–10 weeks). Ectopic pregnancy was diagnosed by MRI in 57 cases, and all cases were either left or right tubal pregnancy. In 52 cases, the actual position matched the MRI findings. In 5 cases, the location of tubal ectopic pregnancy was different from that diagnosed by MRI, or no tubal pregnancy was observed intraoperatively. In 2 cases, no ectopic pregnancy site was observed on MRI, but tubal pregnancy was confirmed by surgery. In one case, an ectopic pregnancy site was not found, and the tube showed normal findings on MRI. The sensitivity of MRI diagnosis was 96.2%, specificity was 16.7%, positive predictive value was 91.1%, and negative predictive value was 33.3%. In cases of ectopic pregnancy treated surgically, the sensitivity of MRI diagnosis, including identification of the location of ectopic pregnancy, is high.
{"title":"Diagnostic Accuracy of Preoperative Conventional MRI for Patients With Ectopic Pregnancy","authors":"T. Onuma, K. Tajima, Kumiko Sato, Katsushige Hattori, Shin Fukuda, Takahiro Tsuji, Y. Yoshida","doi":"10.9738/intsurg-d-17-00117.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-17-00117.1","url":null,"abstract":"\u0000 \u0000 To assess the utility of preoperative magnetic resonance imaging (MRI) in the diagnosis of tubal pregnancy.\u0000 \u0000 \u0000 \u0000 Most cases of ectopic pregnancy are tubal pregnancies. Preoperative accurate diagnosis including the location of the tubal pregnancy is important.\u0000 \u0000 \u0000 \u0000 We performed a retrospective single-center cohort study evaluating patients who underwent surgery for ectopic pregnancy from April 2004 to March 2016 and who underwent preoperative MRI. Sixty patients were enrolled in the study. Chorion confirmed at the tubal pregnancy site detected by MRI was defined as a correct diagnosis.\u0000 \u0000 \u0000 \u0000 Mean estimated gestational age at the time of MRI according to the last menstrual period was 7 weeks (median: 5 weeks; range: 3–10 weeks). Ectopic pregnancy was diagnosed by MRI in 57 cases, and all cases were either left or right tubal pregnancy. In 52 cases, the actual position matched the MRI findings. In 5 cases, the location of tubal ectopic pregnancy was different from that diagnosed by MRI, or no tubal pregnancy was observed intraoperatively. In 2 cases, no ectopic pregnancy site was observed on MRI, but tubal pregnancy was confirmed by surgery. In one case, an ectopic pregnancy site was not found, and the tube showed normal findings on MRI. The sensitivity of MRI diagnosis was 96.2%, specificity was 16.7%, positive predictive value was 91.1%, and negative predictive value was 33.3%.\u0000 \u0000 \u0000 \u0000 In cases of ectopic pregnancy treated surgically, the sensitivity of MRI diagnosis, including identification of the location of ectopic pregnancy, is high.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46292994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-21-00009.1
I. Ozgur, B. Karip, C. Kulle, B. Çavuş, Recep Ercin Sonmez, F. Akyuz, A. Poyanli, E. Balik, T. Bulut, M. Keskin
Crohn's disease needs a multidisciplinary approach, and surgery will ultimately be necessary for most patients. Complications usually occur after surgery. This study aims to present complication rates in surgically treated Crohn's disease patients at a single institution and to determine possible risk factors. A retrospective analysis of 112 consecutive surgery performed on Crohn's disease patients between 2003 and 2015. The demographic data, patient and disease characteristics, surgery type, and complications were analyzed. Of 112 patients, 64 (57.1%) were male and 48 (42.9%) were female. The mean age was 34 (range, 18–78) years. The mean follow-up was 114 ± 32.4 (range, 61–197) months. The most common early complications were intra-abdominal abscess formation (n = 10, 8.9%) and wound infection (n = 7, 6.26%). The incisional hernia was the most common late complication (n = 4, 3.6%). Nonmodifiable disease features associated with complications were colonic involvement of the disease (P = 0.001), penetrating disease character (P = 0.037), stoma formation (P = 0.000), fistula (P = 0.008), and concomitant fistula and intra-abdominal abscess existence (P = 0.043). Stoma formation was found to be an independent risk factor for complications (P = 0.001). Colonic involvement, penetrating disease, fistula, concomitant abscess and fistula, and stoma formation were identified as nonmodifiable risk factors for complications after surgery for Crohn's disease.
{"title":"The Risk Factors for Complications After Crohn's Disease Surgery","authors":"I. Ozgur, B. Karip, C. Kulle, B. Çavuş, Recep Ercin Sonmez, F. Akyuz, A. Poyanli, E. Balik, T. Bulut, M. Keskin","doi":"10.9738/intsurg-d-21-00009.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-21-00009.1","url":null,"abstract":"Crohn's disease needs a multidisciplinary approach, and surgery will ultimately be necessary for most patients. Complications usually occur after surgery.\u0000 \u0000 \u0000 \u0000 This study aims to present complication rates in surgically treated Crohn's disease patients at a single institution and to determine possible risk factors.\u0000 \u0000 \u0000 \u0000 A retrospective analysis of 112 consecutive surgery performed on Crohn's disease patients between 2003 and 2015. The demographic data, patient and disease characteristics, surgery type, and complications were analyzed.\u0000 \u0000 \u0000 \u0000 Of 112 patients, 64 (57.1%) were male and 48 (42.9%) were female. The mean age was 34 (range, 18–78) years. The mean follow-up was 114 ± 32.4 (range, 61–197) months. The most common early complications were intra-abdominal abscess formation (n = 10, 8.9%) and wound infection (n = 7, 6.26%). The incisional hernia was the most common late complication (n = 4, 3.6%). Nonmodifiable disease features associated with complications were colonic involvement of the disease (P = 0.001), penetrating disease character (P = 0.037), stoma formation (P = 0.000), fistula (P = 0.008), and concomitant fistula and intra-abdominal abscess existence (P = 0.043). Stoma formation was found to be an independent risk factor for complications (P = 0.001).\u0000 \u0000 \u0000 \u0000 Colonic involvement, penetrating disease, fistula, concomitant abscess and fistula, and stoma formation were identified as nonmodifiable risk factors for complications after surgery for Crohn's disease.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41621464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-20-00023.1
T. Ishida, Y. Kagawa, A. Naito, K. Kawai, T. Hata, A. Takeno, Takayoshi Goto, M. Yoshimura, S. Nakatsuka, Y. Takeda, Takeshi Kato, K. Murata
Sarcomatoid carcinoma (SC) is a rare subtype of malignant neoplasm with a poor prognosis that involves both carcinomatous and sarcomatous components. Although it may develop in various organs, SC in the large intestine has rarely been reported. It is not rare for patients with SC to have distant metastasis, reflecting its highly aggressive oncologic features, but cases with brain metastasis on initial visit are rare. In this report, we described a case of SC in the transverse colon with brain metastases whose initial symptom was neurological disorder, and reviewed 31 reported cases of SC. A 70-year-old man was admitted to our hospital with the chief complaints of gait disorder and severe dizziness. Head magnetic resonance imaging revealed tumor masses in the anterior lobe and cerebellum. A large tumor in the transverse colon was detected by colonoscopy and abdominal enhanced computed tomography (CT), and was diagnosed as undifferentiated adenocarcinoma by histology. Laparoscopic extended right hemicolectomy was performed to remove the obstruction, and the resected specimens revealed an invasive tumor consisting of a mixture of carcinomatous and sarcomatous components. According to the immunopathological study, the patient was diagnosed with SC. The clinical course was extremely aggressive, and the patient died on the 28th postoperative day because of disease progression. To the best of our knowledge, this is the first case of SC in the transverse colon with a neurological disorder derived from brain metastases. This experience may contribute to the guidance regarding proper therapeutic options for SC.
{"title":"Sarcomatoid Carcinoma of the Transverse Colon With Extremely Aggressive Brain Metastases","authors":"T. Ishida, Y. Kagawa, A. Naito, K. Kawai, T. Hata, A. Takeno, Takayoshi Goto, M. Yoshimura, S. Nakatsuka, Y. Takeda, Takeshi Kato, K. Murata","doi":"10.9738/intsurg-d-20-00023.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00023.1","url":null,"abstract":"\u0000 \u0000 Sarcomatoid carcinoma (SC) is a rare subtype of malignant neoplasm with a poor prognosis that involves both carcinomatous and sarcomatous components. Although it may develop in various organs, SC in the large intestine has rarely been reported. It is not rare for patients with SC to have distant metastasis, reflecting its highly aggressive oncologic features, but cases with brain metastasis on initial visit are rare. In this report, we described a case of SC in the transverse colon with brain metastases whose initial symptom was neurological disorder, and reviewed 31 reported cases of SC.\u0000 \u0000 \u0000 \u0000 A 70-year-old man was admitted to our hospital with the chief complaints of gait disorder and severe dizziness. Head magnetic resonance imaging revealed tumor masses in the anterior lobe and cerebellum. A large tumor in the transverse colon was detected by colonoscopy and abdominal enhanced computed tomography (CT), and was diagnosed as undifferentiated adenocarcinoma by histology. Laparoscopic extended right hemicolectomy was performed to remove the obstruction, and the resected specimens revealed an invasive tumor consisting of a mixture of carcinomatous and sarcomatous components. According to the immunopathological study, the patient was diagnosed with SC. The clinical course was extremely aggressive, and the patient died on the 28th postoperative day because of disease progression.\u0000 \u0000 \u0000 \u0000 To the best of our knowledge, this is the first case of SC in the transverse colon with a neurological disorder derived from brain metastases. This experience may contribute to the guidance regarding proper therapeutic options for SC.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47862045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-15-00219.1
Y. Ekici, G. Moray
The aim of this study is to analyze both previously proposed and new risk factors for the development of pilonidal sinus. This is a prospective case-control study consisting of 145 patients with pilonidal sinus disease (n = 45) and a control group (n = 100). All patients were admitted to the department of general surgery between January 2013 and May 2015. The patients' age, family history, medical history, sitting time in a day, sitting posture, body mass index (BMI), Garn hairiness score, and hair type were evaluated. There were significant differences between the groups in the following characteristics: age (P = 0.01); positive family history (P = 0.01); medical history (P = 0.01); sitting time in a day (P = 0.01); sitting posture (P = 0.01); BMI (P = 0.01); Garn score (P = 0.01); and hair type. Multivariate logistic regression analysis indicated that positive family history (P = 0.03); Garn score (P = 0.05); medical history (P = 0.01); and sitting posture (P = 0.02) were independent risk factors for the development of pilonidal sinus disease.
{"title":"Pili Multigemini Is a Possible Risk Factor for Pilonidal Sinus Disease","authors":"Y. Ekici, G. Moray","doi":"10.9738/intsurg-d-15-00219.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-15-00219.1","url":null,"abstract":"The aim of this study is to analyze both previously proposed and new risk factors for the development of pilonidal sinus. This is a prospective case-control study consisting of 145 patients with pilonidal sinus disease (n = 45) and a control group (n = 100). All patients were admitted to the department of general surgery between January 2013 and May 2015. The patients' age, family history, medical history, sitting time in a day, sitting posture, body mass index (BMI), Garn hairiness score, and hair type were evaluated. There were significant differences between the groups in the following characteristics: age (P = 0.01); positive family history (P = 0.01); medical history (P = 0.01); sitting time in a day (P = 0.01); sitting posture (P = 0.01); BMI (P = 0.01); Garn score (P = 0.01); and hair type. Multivariate logistic regression analysis indicated that positive family history (P = 0.03); Garn score (P = 0.05); medical history (P = 0.01); and sitting posture (P = 0.02) were independent risk factors for the development of pilonidal sinus disease.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47879836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-15-00268.1
T. Shiraishi, N. Tomizawa, Tatsumasa Andoh, Hiroaki Sato, I. Ninomiya
A 63-year-old man was evaluated for a 20-year history of dysphagia and vomiting. Barium-swallow esophagography showed a Zenker's diverticulum at the upper end of the esophagus. Esophagogastroduodenoscopy revealed the diverticulum about 20 cm from the incisors. There was no mucosal inflammation or irregularity in the diverticulum. Computed tomography showed that the diverticulum was about 8 cm in size. There was no lymphadenopathy around the esophagus. Because the patient's symptoms were worsening, we performed diverticulectomy using a linear stapling device and cricopharyngeal myotomy. The mucosa of the resected specimen had no macroscopically abnormal lesions. However, an area unstained by iodine that widely involved the surgical margin was recognized at pathologic examination. Pathologic findings revealed squamous cell carcinoma invading the lamina propria mucosa with inflammatory cell infiltration. In addition, the pathologic surgical margin was widely positive. However, a remnant tumor lesion was not detected by postoperative esophagogastroduodenoscopy. Biopsies near the staple line were negative. After obtaining informed consent, we performed resection of the cervical esophagus including the proximal stump of the diverticulum and cervical lymphadenectomy approximately 4 months after the primary operation as an additional surgery. Reconstruction was performed by free jejunal transplantation with microvascular anastomosis. The patient was discharged on postoperative day 45. Pathologic examination revealed no malignant lesion in the resected specimen, and radical cure was confirmed.
{"title":"Occult Early Squamous Cell Carcinoma in Zenker's Diverticulum Treated With Diverticulectomy Followed by Additional Esophagectomy With Free Jejunal Reconstruction: A Case Report","authors":"T. Shiraishi, N. Tomizawa, Tatsumasa Andoh, Hiroaki Sato, I. Ninomiya","doi":"10.9738/intsurg-d-15-00268.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-15-00268.1","url":null,"abstract":"A 63-year-old man was evaluated for a 20-year history of dysphagia and vomiting. Barium-swallow esophagography showed a Zenker's diverticulum at the upper end of the esophagus. Esophagogastroduodenoscopy revealed the diverticulum about 20 cm from the incisors. There was no mucosal inflammation or irregularity in the diverticulum. Computed tomography showed that the diverticulum was about 8 cm in size. There was no lymphadenopathy around the esophagus. Because the patient's symptoms were worsening, we performed diverticulectomy using a linear stapling device and cricopharyngeal myotomy. The mucosa of the resected specimen had no macroscopically abnormal lesions. However, an area unstained by iodine that widely involved the surgical margin was recognized at pathologic examination. Pathologic findings revealed squamous cell carcinoma invading the lamina propria mucosa with inflammatory cell infiltration. In addition, the pathologic surgical margin was widely positive. However, a remnant tumor lesion was not detected by postoperative esophagogastroduodenoscopy. Biopsies near the staple line were negative. After obtaining informed consent, we performed resection of the cervical esophagus including the proximal stump of the diverticulum and cervical lymphadenectomy approximately 4 months after the primary operation as an additional surgery. Reconstruction was performed by free jejunal transplantation with microvascular anastomosis. The patient was discharged on postoperative day 45. Pathologic examination revealed no malignant lesion in the resected specimen, and radical cure was confirmed.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45952142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-16-00215.1
Fengfei Lin, Bin Chen, Chaohui Lin, Ke Zheng
To evaluate the comparative efficacy and safety of the use of foot pump versus low-molecular-weight heparin (LMWH) for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in total knee replacement (TKR) and total hip replacement (THR). The use of chemoprophylactic agents in TKR and THR has been shown to result in increased complications like bleeding and wound drainage. Relevant publications indexed in PubMed, Cochrane Library, Embas, Web of Science, Wanfang Data, CNKI, and VIPI were identified. Appropriate articles identified from the reference lists of the above searches were also reviewed. No significant difference in the rate of distal in the lower extremity was observed between the 2 groups (OR: 0.99; CI: 0.61–1.61; Z = 0.03; P = 0.97). No significant difference in the rate of proximal DVT in the lower extremity was observed between 2 groups (OR: 1.60, CI: 0.85–3.03, Z = 1.44, P = 0.15). No significant difference in the rate of PE was observed between 2 groups (OR 3.84, CI: 0.42 to 34.80, Z = 1.20, P = 0.23). But we found that postoperative drainage in foot pump group was less than that in LMWH group (OR -68.93, CI: −73.81 to −64.05, Z = 27.68, P < 0.00001), and oozing in foot pump group was less than that in LMWH group (OR: 0.21; CI: 0.10–0.47; Z = 3.86, P = 0.0001). The foot pump is a suitable alternative for TKR and THR patients in preventing DVT and PE, and can get less postoperative drainage and oozing side effects that are associated with LWMH.
评价足泵与低分子肝素(LMWH)在全膝关节置换术(TKR)和全髋关节置换术(THR)中预防深静脉血栓形成(DVT)和肺栓塞(PE)的比较疗效和安全性。在TKR和THR中使用化学预防药物已被证明会导致出血和伤口引流等并发症的增加。检索PubMed、Cochrane Library、Embas、Web of Science、万方数据、中国知网和VIPI的相关文献。还审查了从上述检索的参考文献清单中确定的适当文章。两组患者下肢远端复位率差异无统计学意义(OR: 0.99;置信区间:0.61—-1.61;Z = 0.03;P = 0.97)。两组患者下肢近端DVT发生率比较差异无统计学意义(OR: 1.60, CI: 0.85 ~ 3.03, Z = 1.44, P = 0.15)。两组PE发生率比较差异无统计学意义(OR 3.84, CI: 0.42 ~ 34.80, Z = 1.20, P = 0.23)。但我们发现足泵组术后引流量少于低分子肝素组(OR: -68.93, CI: - 73.81 ~ - 64.05, Z = 27.68, P < 0.00001)，足泵组术后渗液少于低分子肝素组(OR: 0.21;置信区间:0.10—-0.47;Z = 3.86, p = 0.0001)。足泵是TKR和THR患者预防DVT和PE的合适选择，并且可以减少与LWMH相关的术后引流和渗出副作用。
{"title":"Foot Pump Versus Low-Molecular-Weight Heparin for Preventing Deep Vein Thrombosis Following Surgery for Hip and Knee Replacement","authors":"Fengfei Lin, Bin Chen, Chaohui Lin, Ke Zheng","doi":"10.9738/intsurg-d-16-00215.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-16-00215.1","url":null,"abstract":"\u0000 \u0000 To evaluate the comparative efficacy and safety of the use of foot pump versus low-molecular-weight heparin (LMWH) for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in total knee replacement (TKR) and total hip replacement (THR).\u0000 \u0000 \u0000 \u0000 The use of chemoprophylactic agents in TKR and THR has been shown to result in increased complications like bleeding and wound drainage.\u0000 \u0000 \u0000 \u0000 Relevant publications indexed in PubMed, Cochrane Library, Embas, Web of Science, Wanfang Data, CNKI, and VIPI were identified. Appropriate articles identified from the reference lists of the above searches were also reviewed.\u0000 \u0000 \u0000 \u0000 No significant difference in the rate of distal in the lower extremity was observed between the 2 groups (OR: 0.99; CI: 0.61–1.61; Z = 0.03; P = 0.97). No significant difference in the rate of proximal DVT in the lower extremity was observed between 2 groups (OR: 1.60, CI: 0.85–3.03, Z = 1.44, P = 0.15). No significant difference in the rate of PE was observed between 2 groups (OR 3.84, CI: 0.42 to 34.80, Z = 1.20, P = 0.23). But we found that postoperative drainage in foot pump group was less than that in LMWH group (OR -68.93, CI: −73.81 to −64.05, Z = 27.68, P < 0.00001), and oozing in foot pump group was less than that in LMWH group (OR: 0.21; CI: 0.10–0.47; Z = 3.86, P = 0.0001).\u0000 \u0000 \u0000 \u0000 The foot pump is a suitable alternative for TKR and THR patients in preventing DVT and PE, and can get less postoperative drainage and oozing side effects that are associated with LWMH.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71208190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-20-00031.1
Hideyuki Yokokawa, R. Imaizumi, Yoshitomo Ito, T. Kono, T. Koike, Yuta Miyano, K. Oyama, S. Shiozawa, K. Yoshimatsu
Because splenic metastasis from colorectal cancer is usually a result of metastasis from widely disseminated disease, cases with resectable isolated splenic metastasis are uncommon. We report here a case of synchronous isolated splenic metastasis from cecal cancer that was treated with sequential laparoscopic splenectomy after short-term observation following laparoscopic ileocecal resection. Both postoperative courses were uneventful, allowing the patient to be discharged early. Two years have passed, without recurrence, since the second operation. There are very few case reports on synchronous isolated splenic metastasis from colorectal cancer. Sequential laparoscopic resection might contribute to obtaining an uneventful postoperative course, especially in elderly patients such as ours.
{"title":"An Octogenarian Case of Sequential Laparoscopic Surgery for Synchronous Isolated Splenic Metastasis From Cancer of the Cecum","authors":"Hideyuki Yokokawa, R. Imaizumi, Yoshitomo Ito, T. Kono, T. Koike, Yuta Miyano, K. Oyama, S. Shiozawa, K. Yoshimatsu","doi":"10.9738/intsurg-d-20-00031.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00031.1","url":null,"abstract":"\u0000 \u0000 Because splenic metastasis from colorectal cancer is usually a result of metastasis from widely disseminated disease, cases with resectable isolated splenic metastasis are uncommon.\u0000 \u0000 \u0000 \u0000 We report here a case of synchronous isolated splenic metastasis from cecal cancer that was treated with sequential laparoscopic splenectomy after short-term observation following laparoscopic ileocecal resection. Both postoperative courses were uneventful, allowing the patient to be discharged early. Two years have passed, without recurrence, since the second operation.\u0000 \u0000 \u0000 \u0000 There are very few case reports on synchronous isolated splenic metastasis from colorectal cancer. Sequential laparoscopic resection might contribute to obtaining an uneventful postoperative course, especially in elderly patients such as ours.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44866850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-16-00250.1
M. Ikeguchi, T. Hanaki, Kyoichi Kihara, K. Endo, Kazunori Suzuki, Seiichi Nakamura, T. Sawada, Tetsu Shimizu
Emergent surgery is necessary in patients with strangulation ileus. However, such procedures are associated with high morbidity and mortality. A retrospective analysis was performed to determine whether the preoperative C-reactive protein/albumin ratio (CAR); neutrophil/lymphocyte ratio (NLR); and prognostic nutritional index (PNI) are good indicators of mortality or morbidity in patients undergoing emergent operations for treatment of strangulation ileus. Emergent surgery was performed for 1698 patients at Tottori Prefectural Central Hospital from 2012 and 2015. Among them, 45 patients (2.7%) were preoperatively diagnosed with strangulation ileus. We evaluated the clinical importance of the preoperative CAR, NLR, and PNI in these patients. We excluded pediatric patients from this study. Postoperative complications developed in 14 of 45 (31.1%) patients. The mean postoperative hospital stay among the 14 patients with postoperative complications was significantly longer than that of the 31 patients without postoperative complications (44.0 versus 11.3 days, respectively; P = 0.006). Three patients died of postoperative complications. The overall operative mortality and morbidity rates were 6.7% and 31.1%, respectively. We found strong correlations of postoperative complications with older age, a longer operation time, and an abnormal preoperative CAR, NLR, and PNI. Not only inflammation, but also a patients' nutritional and immune status appear to be strongly correlated with mortality or morbidity after emergent operations for strangulation ileus. Patients with a high CAR and NLR and low PNI preoperatively must be closely monitored for the occurrence of postoperative complications such as surgical site infections or pulmonary complications.
{"title":"Correlation of Operative Mortality and Morbidity With Preoperative C-Reactive Protein/Albumin Ratio, Neutrophil/Lymphocyte Ratio, and Prognostic Nutritional Index in Patients Undergoing Emergent Operations Due to Strangulation Ileus","authors":"M. Ikeguchi, T. Hanaki, Kyoichi Kihara, K. Endo, Kazunori Suzuki, Seiichi Nakamura, T. Sawada, Tetsu Shimizu","doi":"10.9738/intsurg-d-16-00250.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-16-00250.1","url":null,"abstract":"Emergent surgery is necessary in patients with strangulation ileus. However, such procedures are associated with high morbidity and mortality. A retrospective analysis was performed to determine whether the preoperative C-reactive protein/albumin ratio (CAR); neutrophil/lymphocyte ratio (NLR); and prognostic nutritional index (PNI) are good indicators of mortality or morbidity in patients undergoing emergent operations for treatment of strangulation ileus. Emergent surgery was performed for 1698 patients at Tottori Prefectural Central Hospital from 2012 and 2015. Among them, 45 patients (2.7%) were preoperatively diagnosed with strangulation ileus. We evaluated the clinical importance of the preoperative CAR, NLR, and PNI in these patients. We excluded pediatric patients from this study. Postoperative complications developed in 14 of 45 (31.1%) patients. The mean postoperative hospital stay among the 14 patients with postoperative complications was significantly longer than that of the 31 patients without postoperative complications (44.0 versus 11.3 days, respectively; P = 0.006). Three patients died of postoperative complications. The overall operative mortality and morbidity rates were 6.7% and 31.1%, respectively. We found strong correlations of postoperative complications with older age, a longer operation time, and an abnormal preoperative CAR, NLR, and PNI. Not only inflammation, but also a patients' nutritional and immune status appear to be strongly correlated with mortality or morbidity after emergent operations for strangulation ileus. Patients with a high CAR and NLR and low PNI preoperatively must be closely monitored for the occurrence of postoperative complications such as surgical site infections or pulmonary complications.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48504191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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