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   Table of Contents - Current issue
January-February 2018
Volume 51 | Issue 1
Page Nos. 1-40

Online since Friday, February 9, 2018

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Treatment strategies for locally advanced rectal cancer with synchronous resectable liver metastasis Highly accessed article p. 1
Youn Young Park, Nam Kyu Kim
Approximately one-third of patients with colorectal cancer are estimated to be diagnosed with synchronous liver metastasis (LM). The only method to get cured is to achieve curative resection for both primary and LM. When it comes to locally advanced rectal cancer with synchronous LM, determination of the treatment strategy for each individual is a quite complex procedure, because it demands sophisticated consideration for both local and systemic control. Timing for the application of systemic chemotherapy (CTx), determination of a chemotherapeutic agent, radiation dose and fractions, and sequencing of preoperative treatment and surgeries are all essential components for establishing optimal treatment strategies for the patients with this disease. In this article, treatment strategies proposed in the literature will be reviewed in the light of oncologic outcomes and treatment toxicity with their possible advantages and disadvantages. Owing to a lack of concrete evidences for the best strategy, this article can guide authors to a better way of determining more tailored treatment for each individual.
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Analysis of electrical injury in a Level I southern Taiwan trauma center p. 9
Rowena Sudario-Lumague, Johnson Chia-Shen Yang, Chih-Che Lin, Shiun-Yuan Hsu, Ching-Hua Hsieh
Background: Electrical injuries are potentially devastating in many ways. This study aimed to profile the epidemiologic characteristics and outcome of these patients in a Level I trauma center in Southern Taiwan. Methods: A retrospective review of 34 (1.9%) patients with electrical injuries and admitted to the Kaohsiung Chang Gung Memorial Hospital Burn Center from 2009 to 2015 from all 23,705 hospitalized patients registered in the trauma registry system. The information such as patient's profile, injury characteristics and severity, description of the burn injury, associated injuries, expenditures, and outcomes were gathered. Results: There were 33 males and one female with an average age of 37.1 ± 10.4 years old. Twenty-eight cases (82.3%) were work related. The average total body surface area burned was 5.26%. The mean injury severity score was 9.8 with the median, and interquartile ranges (Q1–Q3) being 4 and 3.3–9.3. The average hospital length of stay (LOS) was 16.6 ± 14.3 days. Twenty-one patients required Intensive Care Unit (ICU) admission, and the average ICU LOS was 20.1 ± 16.2 days. Fourteen patients underwent operations with each patient averaging 2.5 operations. There were two cases of mortality (5.9%). Although the expenditure seemed to be higher in dealing with the electrical burn patients (n = 34) than the nonelectrical burn patients (n = 1727), there were no significant differences of the average total expenditure as well as the costs of operation, examination, and pharmaceuticals between the electrical burn patients and nonelectrical burn patients. Conclusions: Most of the electrical burn injuries are work related and may associated with injuries to different body regions. With a high incidence of ICU admission and the requirement of frequent operations, the electric burn injuries still carry high morbidities with the risk to mortality.
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Symptomatic hemorrhagic complications associated with dural substitutes p. 15
Po-Yuan Chen, Szu-Ying Chen, Te-Yuan Chen, Han-Jung Chen, Kang Lu, Cheng-Loong Liang, Po-Chou Liliang, Kuo-Wei Wang, San-Nan Yang, Chih-Yuan Huang, Hao-Kuang Wang
Background: Duroplasty has been widely used in cranial surgery when primary closure is not possible. The goal is to protect the cerebrum and thereby ensure that complications were as few as possible. We reviewed a single-institution experience with a variety of dural substitutes in craniotomy and analyzed the risk factors for duroplasty-associated hemorrhagic complications. Patients and Methods: Patients who received dural replacement after craniotomy or craniectomy between July 2004 and June 2009 were enrolled into this study. Medical records were reviewed for diagnosis, procedure, and type of dural replacement. Clinical courses were reviewed for hemorrhagic complications, including subdural hematoma, extradural hematoma, and subarachnoid hemorrhage. Logistic regression models were used to analyzed the risk factors of duroplasty-associated hemorrhagic complications. Results: Two hundred and twelve patients were included in the study. Overall, the hemorrhagic complication rate was 4.7% (10 patients). Complications were seen for microporous polyester urethane, expanded polytetrafluoroethylene monolayer, polyester silicone, and Biomesh in 4.1%, 0%, and 38.5% of patients, respectively. Patients who received duroplasty with Biomesh had a higher hemorrhagic complication rate with the odds ratio of 24.75 (95% confidence interval, 4.33–141.41) in comparison of those with microporous polyester urethane group after adjusting for individual confounders. Conclusion: The increased risk of hemorrhagic complications associated with craniotomy is modified by choice of dural replacement. Our results could assist clinicians in their decision-making with respect to the optimal timing for synthetic dural substitutes in patients with tumor infiltration of the patient's dura, severe brain swelling in traumatic brain injury, or a result of shrinkage from exposure and electrocautery.
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Can mechanical bowel preparation with oral antibiotics reduce surgical site infection and anastomotic leakage rates following elective colorectal resections? p. 21
Wen-Chun Sun, Hsi-Hsien Hsu, Hao-Che Liu, Chien-Kuo Liu
Background: Surgical site infection(SSI) and anastomotic leakage are major causes of morbidity after colorectal resections. Mechanical bowel preparation (MBP) combined with oral antibiotics (OAs) was considered to reduce SSI and anastomotic leakage. Purpose: This study analyzed the influence of oral antibiotic use together with MBP on SSI, anastomotic leakage rate and length of hospital stays in patients with elective colorectal surgery. Materials and Methods: From January 2013 to December 2015, 321 patients who underwent elective colorectal resections with complete bowel preparation were included in the study. All patients received MBP. Patients in group A did not receive OAs, whereas patients in group B received OAs. Exclusion criteria were emergent operation, colonoscopy, colostomy or closure of colostomy and received preoperative chemoradiotherapy. The outcome measured was SSI, anastomotic leakage and prophylactic colostomy. Results: Of 321 patients, group A (n =122) and group B (n =199), both groups had similar age, gender, localization and stage of the disease, underlying disease, prophylactic stomy and operation time. Patients receiving OAs with MBP didn't demonstrated a lower rate of SSI and lower leakage rate after multivariate logistic analysis. Conclusions: OAs with MBP prior to elective colorectal resection was no better than MBP only on reducing SSI and anastomotic leakage rates. And OAs will increase patients uncomfortable and GI function side effect. Therefore, MBP alone might be enough colon prepare and higher compliance for the patients.
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Kimura's disease p. 26
Manish Swarnkar, Anand Agrawal
Kimura's disease (KD) is a benign chronic inflammatory disorder attributed to an immune-mediated hypersensitivity which often presents as a tumor-like swelling in the head and neck region with or without lymphadenopathy, associated with hypereosinophilia and elevated serum immunoglobulin E. Most cases have been described predominantly in Chinese and Japanese people. KD has been confused with angiolymphoid hyperplasia with eosinophilia, from which it probably should be distinguished as a separate entity. The course is usually benign except for the potential cosmetic disfigurement. The diagnosis may be suggested by a fine-needle aspirate but is established by a biopsy. A case of KD in a 42-year-old male with recurrent left submandibular swelling is presented together with a brief review of the literature.
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Sternal metastasis from a rectal cancer p. 29
Arvind Krishnamurthy
Colorectal cancers commonly metastasize to the liver and the lung; it is distinctly unusual for these cancers to metastasize to the skeletal system. The typical locations of skeletal metastases from colorectal cancer are the vertebrae and pelvis. Sternal metastasis from a rectal cancer primary is exceedingly rare, and to the best of our knowledge, there are only two prior case reports in literature. The presence of distant metastases usually portends a poor prognosis, however with continuous improvements in multimodality management, the survival rates of metastatic colorectal cancers has considerably improved. We present an interesting case of a 71-year-old man who underwent a complete metastatectomy for a metachronous sternal metastasis from a locally advanced rectal cancer and discuss its clinical presentation and management implications with a brief review of literature.
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Experience in traumatic small bowel perforation management p. 32
Ping-Tze Chen, Hong-Ming Chao
Small bowel perforations due to blunt abdominal injury are rare. In this study, we compiled five cases of traumatic small bowel perforation and then analyzed a number of the prognostic factors. Elapsed time to surgery was identified as the most important prognostic factor, due to the risk of peritonitis. Laparoscopy surgery appears to be a safe, effective procedure in cases where the diagnosis is uncomplicated by other major problems, such as lacerations to the liver or spleen.
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A noninvasive method for preoperative localization of breast microcalcifications Highly accessed article p. 38
Wei-Hsin Chen, Dah-Cherng Yeh
Wire localization of breast microcalcifications before surgical biopsy has been used for a long time. However, it causes patient's psychical trauma before operation with more cost of money and time as well. We design a noninvasive method using the concept of trigonometric function for preoperative localization. It can yield potential for cost-savings, increased efficacy in operating room and radiology scheduling, and patient comfort and convenience. Our method is simple and its failure rate is low.
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