ナイ ジカク ニ タイ スル リュウサン アルミニウム ・ タンニン サン チュウシャ エキ ( ALTA ) リョウホウ シコウ 5 カゲツゴ ニ ショウジ タ コウモン カン ・ チョクチョウ ネンマク ヘンセイ ノ 1 レイ : ALTA シコウ ゴ ノ ネンマク ヘンセイ

症例60歳女性,10年来の脱出性内痔核の治療として2014.2.12硫酸アルミニウムカリウム・タンニン酸注射液(Aluminium Potassium Sulfate Tannic Acid:以下ALTA)を使用した四段階注射痔核硬化療法を受けた.経過良好であったが,7月中旬よりの肛門痛・発熱にて入院,触診のみでボロボロ崩れ落ちてゆく5時方向を中心とした約1/4周を占める広範な肛門管・直腸粘膜変性壊死を認めデブリードマン施行.疼痛・発熱は持続したが,禁食,抗生物質・解熱剤の投与,2回の追加デブリードマンにて,変性壊死部位は脱落し潰瘍と変化し,一か月後軽快退院した.非常に稀な経過と考えられたため報告した.Recently, the number of the Aluminum Potassium Sulfate and Tannic Acid(ALTA)injections therapy for internal hemorrhoids have been increasing markedly in Japan because of its minimal invasive therapy, quick response and acceptable recurrence rate. However, there are some reports of adverse reactions and side effects after ALTA such as Fournier\u27s Gangrene, rectovaginal fistula and rectal ulcer. We experienced a case of anorectal mucosal degeneration and necrosis after five months ALTA injection for internal hemorrhoids. A 60 year-old female was treated with sclerosing therapy with ALTA injection for grade II～III internal hemorrhoids according to the Gligher classification. Although the patient was in good course in 5 months after therapy, she developed a high fever and anal pain. Antibiotics were administrated, but remission was not achieved. Three times debridements were performed under local and intravenous anesthesia with a diagnosis of anorectal mucosal degeneration and necrosis. After approximately a month admission in the hospital was necessary for the treatment of the anorectal ulcer after debridements, she has been free from fever, pain and hemorrhoids

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

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