A Case of Traumatic Cervical Braun–Sequard Syndrome

A traumatic Braun-Sequard syndrome of the cervical spine is reported in a 53-year-old male. The patient recovered spontaneously over several days with surgical intervention. The diagnosis was made on magnetic resonance imaging with physical examination, which also demonstrated subsequent resolution of bone marrow intensity. The etiological factors of spinal Braun-Sequard syndrome are reviewed.ope

Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery

Few studies have evaluated the risk factors for in-hospital mortality in critically ill surgical patients who have undergone emergency gastrointestinal (GI) surgery. The aim of this study was to identify the risk factors associated with in-hospital mortality in critically ill surgical patients after emergency GI surgery.The medical records of 362 critically ill surgical patients who underwent emergency GI surgery, admitted to intensive care unit between January 2007 and December 2011, were reviewed retrospectively. Perioperative biochemical and clinical parameters of survivors and nonsurvivors were compared. Logistic regression multivariate analysis was performed to identify the independent risk factors of mortality.The in-hospital mortality rate was 15.2% (55 patients). Multivariate analyses revealed cancer-related perforation (odds ratio [OR] 16.671, 95% confidence interval [CI] 2.629-105.721, P?=?0.003), preoperative anemia (hemoglobin <10?g/dL; OR 6.976, 95% CI 1.376-35.360, P?=?0.019), and preoperative hypoalbuminemia (albumin <2.7?g/dL; OR 9.954, 95% CI 1.603-61.811, P?=?0.014) were independent risk factors of in-hospital mortality after emergency GI surgery.The findings of this study suggest that in critically ill patients undergoing emergency GI surgery, cancer-related peritonitis, preoperative anemia, and preoperative hypoalbuminemia are associated with in-hospital mortality. Recognizing risk factors at an early stage could aid risk stratification and the provision of optimal perioperative care.ope

Patterns of In-hospital Mortality and Causes of Death in Blunt Poly-trauma Patients

Purpose: This study evaluates patterns of in-hospital mortality and causes of death in blunt poly-trauma patients.Methods: Data of blunt poly-trauma patients admitted between 2011 and 2013 were retrospectively collected and analyzed. Poly-trauma was defined as an Injury Severity Score (ISS) was greater than 15. The following variables were extracted and analyzed: age, sex, ISS, Revised Trauma Score (RTS), injury mechanism, cause of death, and patterns in-hospital mortality rate. Results: Two hundred and ten patients with blunt poly-trauma were admitted. Injuries occurred predominately in the age group of 45∼64 years. Injuries occurred predominantly in males (70%). Traffic accidents (67.6%) and falls (30.5%) were the main causes of trauma. Forty-six patients (21.9%) died in the study sample. Six patients (13%) died within one hour, 23 (23.9%) between one and four hours after arrival to emergency room, six (6.5%) died during the first two weeks of hospitalization, and six (6.5%) died in the fourth week of hospitalization. The median ISS of those who died was 39.5 (20.5∼70.5) and median RTS was 4.01 (1.85∼6.15). The major cause of early death was exsanguination (39.1%), followed by central nervous system injury (34.8%). Sepsis or multi-organ failure (26.1%) were the predominant causes of late death. Conclusion: The in-hospital mortality rate is similar to other studies. However, cause of death and injury mechanisms of blunt poly-trauma death are somewhat different from other countries. Recognition of these injury and mortality patterns will help improve the trauma system.ope

Management of Perirectal Laceration without Fecal Diversion: A Case Report

Clinical research on multiple lacerations of perineum or buttock is sparse and rare so limited to case reports. But a missed rectal injury combined bladder or vessel can have devastating consequence. Although it is generally known that it should be treated accompanying with diverting ileostomy or colostomy, the aim of this case is announce the possibility of management of perectal injury without diversion.ope

Technical Compensation for Hepatic Vein Injury during Robotic Single Site Cholecystectomy

This video describes an event that could occur during any cholecystectomy. To the best of our knowledge, this video is the first description of the technical compensation for hepatic vein injury during robotic single-site cholecystectomy (RSSC). A 61-year-old male with a 1.6 cm gallbladder stone sought to go through with RSSC. During dissection of gallbladder from the liver bed, the hepatic vein was unexpectedly exposed and injured. Using the angulated robotic needle holder, the injured hepatic vein was repaired with 5-0 prolene monofilament suture. Although there is a lack of EndoWrist movement in RSSC, suturing was feasible. The patient was discharged on the second postoperative day without complications. Incidental hepatic vein injury could be safely managed using RSSC and prevent the need for conversion to a conventional laparoscopic or open approach.ope

Prevalences of Incidental Findings in Trauma Patients by Abdominal and Pelvic Computed Tomography

Purpose: Abdominal and pelvic computed tomography (APCT) is frequently used as a diagnostic tool in trauma patients. However, trauma unrelated, incidental findings are frequently encountered. The aim of this study was to determine the prevalences of incidental findings on APCT scans in trauma patients. Methods: The archived records of 801 trauma patients treated from January 2013 to December 2015 were reviewed retrospectively. Six hundred and forty of these patients underwent contrast enhanced APCT in an emergency department and were included in this study, and 205 (32.1%) of these patients had incidental findings. These findings were divided into two categories: category I, meaning a radiological benign finding not requiring further evaluation or follow-up, and category II, requiring further evaluation and follow-up. Results: One hundred and sixty (24.8%) patients were allocated to category I and 45 (7.2%) to category II. The most frequent incidental findings were discovered in kidneys (34.6%), followed by liver (28.8%), and gallbladder (15.6%). The most frequent finding in category I was a benign cyst (60.1%), followed by a simple stone (15.6%), and hemangioma (11.9%). Adenomyomatosis of the gallbladder (17.8%) was the most common lesion in category II, followed by atypical mass (15.6%), complicated stone (15.6%) and cystic neoplasm (15.6%). Conclusion: The prevalence of an incidental finding on APCT scans was 32.1%. Although category II lesions were not common in trauma patients, these findings should be communicated to patients, and when necessary referred to a primary care physician. Systems are required for producing appropriate discharge summaries and informing patients about the implications of incidental findings.ope

Effects of early enteral nutrition on patients after emergency gastrointestinal surgery: a propensity score matching analysis

Early postoperative enteral feeding has been demonstrated to improve the outcome of patients who underwent surgery for gastrointestinal (GI) malignancies, trauma, perforation, and/or obstruction. Thus, this study was conducted to assess the efficacy of early postoperative enteral nutrition (EN) after emergency surgery in patients with GI perforation or strangulation. The medical records of 484 patients, admitted between January 2007 and December 2012, were reviewed retrospectively. Patients were divided into 2 groups: the early EN (EEN, N=77) group and the late EN (LEN, N=407) group. The morbidity, mortality, length of hospital, and intensive care unit (ICU) stays were compared between the 2 groups. Propensity score matching was performed in order to adjust for any baseline differences. Patients receiving EEN had reduced in-hospital mortality rates (EEN 4.5% vs LEN 19.4%; P=0.008), pulmonary complications (EEN 4.5% vs LEN 19.4%; P=0.008), lengths of hospital stay (median: 14.0, interquartile range: 8.0-24.0 vs median: 17.0, interquartile range: 11.0-26.0, P=0.048), and more 28-day ICU-free days (median: 27.0, interquartile range: 25.0-27.0 vs median: 25.0, interquartile range: 22.0-27.0, P=0.042) than those receiving LEN in an analysis using propensity score matching. The significant difference in survival between the 2 groups was also shown in the Kaplan-Meier survival curve (P=0.042). In a further analysis using the Cox proportional hazard ratio after matching on the propensity score, EEN was associated with reduced in-hospital mortality (hazard ratio, 0.03; 95% confidence interval, 0.01-0.49; P=0.015). EEN is associated with beneficial effects, such as reduced in-hospital mortality rates, pulmonary complications, lengths of hospital stay, and more 28-day ICU-free days, after emergency GI surgery.ope

The Influence of How the Trauma Care System Is Applied at the Trauma Center: The Initial Experience at Single Trauma Center

Purpose: To evaluate the influence of how the trauma care system is applied on the management of trauma patients. Methods: We divided the patients into a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in our institution. We compared the general characteristics, injury severity score, initial response time to the trauma patients, number of preventable deaths, and clinical outcomes between the two groups. Results: The numbers of patients in the pre-trauma system group and the post-trauma system group were 188 and 257, respectively. No differences in the patient’s median ages, trauma scores (ISS, RTS, TRISS) and proportions of severe trauma patients (ISS>15) were observed between the two groups. The number and the proportion of patients who were admitted to our hospital were increased in the post-trauma system group. The time interval from trauma CP activation to emergency surgery or angio-embolization, and the patient’s time spent in emergency room were shortened in the posttrauma system group. However, the lengths of the ICU stay and the hospital stay, and the number of in-hospital mortalities were not improved in the post-trauma system group. In severe trauma patients (ISS>15), there were no differences between the two groups in the number and the proportion of admitted patients, and the time interval from trauma CP activation to performing a diagnostic and therapeutic procedure was not shortened in the post-trauma system group. Conclusion: Application of the trauma care system has shortened the time between the initial response and patient management. However, this improvement was not enough to result in better clinical outcomes. More trauma physicians, multidisciplinary cooperation, and a well-organized trauma management process will be needed if the maximum efficacy of the trauma system is to be achieved.ope

The first experiences of robotic single-site cholecystectomy in Asia: a potential way to expand minimally-invasive single-site surgery?

PURPOSE: Herein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventional laparoscopic single-site cholecystectomy. MATERIALS AND METHODS: From October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomes with our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC). RESULTS: Four female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisons with SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis, and American Society of Anesthesiologist score showed no significant differences between two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperative pain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertion or open conversion cases in either group. CONCLUSION: RSSC provides a comfortable environment and improved ergonomics to laparoscopic single-site cholecystectomy; however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease.ope

Is Single Administration of Prophylactic Antibiotics Enough after Laparoscopic Appendectomy for Uncomplicated Appendicitis?

Purpose: Research comparing the effectiveness of different doses of antibiotics prior to surgery for preventing infection is sparse. This study examines whether a single dose of preoperative antibiotics suffices to treat uncomplicated appendicitis via laparoscopic appendectomy. Methods: This study retrospectively reviewed the medical records of 149 patients who underwent laparoscopic appendectomy from July 2013 to December 2014 in a single institution. The participants were divided into two groups; group A (n=99) was given a single dose of prophylactic antibiotics before surgery, and group B (n=50) was given both preoperative and postoperative antibiotics. Clinical factors and surgical outcomes were compared between two groups. Results: The mean length of hospital stay for group A (2.5 days) was shorter than for group B (3.2 days) (p<0.001). Average operation time was 58.7 minutes for group A, longer than for group B (52.2 minutes, p=0.027). There was no difference in pathologic results and postoperative complications, such as surgical site infection (SSI) between the two groups. In groups A and B, 4.0% of patients had superficial SSIs. One patient (2.0%) in group B had deep/organ SSI. Conclusion: A single dose of prophylactic antibiotics administration to patients undergoing laparoscopic appendectomy is acceptable as a treatment in uncomplicated appendicitis.ope