Background and Objective: Rectal washout with saline solution may theoretically prevent anastomotic recurrence in patients with resectable rectal cancer, although exact clinical effects have not yet been determined. In order to derive a more precise estimation of the relationship, the present meta-analysis was performed. Method: Relevant studies were identified by a search of Medline, Embase and Google Website with no restrictions to September 1, 2013, and included in the systematic review and meta-analysis. Results: 5 trials (642 participants) were included to assess the association between rectal washout with saline solution and anastomotic recurrence. The rate of anastomotic recurrence (AR) was 6.23% (40/642), with the pooled OR derived from the five studies being 0.32 (95 % CI=0.15-0.70, P=0.004). The pooled OR derived from the TME and radical resection subgroups were 0.72 (95%CI=0.16-3.12, P=0.66) and 0.51 (95%CI=0.13-1.96, P=0.32), respectively. Conclusion: Results from this analysis show that intra-operative rectal washout with mere saline solution largely reduces the risk of anastomotic recurrences in patients with resectable rectal cancer.
Purpose: Previous studies have addressed the role of the hypercoagulable state in the pathogenesis of cancer progression and metastasis. In this study, we investigated the association between coagulation factors, including tissue factor (TF) expression, platelet count, and fibrinogen level, and disease recurrence in patients with non-metastatic colorectal cancer. Methods: Patients who underwent curative resection for stage II or III colorectal cancer between 2000 and 2007 were included in this study. Data from a prospectively maintained database were retrospectively reviewed. TF expression was determined by immunohistochemistry using an anti-TF monoclonal antibody. The Kaplan-Meier method was used to estimate 5-year disease-free survival. Results: TF was highly expressed in 257 of 297 patients (86.5%). TF expression was not significantly associated with the platelet counts (P=0.180) or fibrinogen level (P=0.281). The 5-year disease-free survival rate was lower in patients with high TF expression than in patients with low TF expression (72.3% vs. 83.9%, P=0.074). In Cox hazard analysis, high TF expression was an independent risk factor for tumor recurrence (hazard ratio [HR] 2.446; 95% confidence interval [CI], 1.054-5.674; P=0.037). Undifferentiated histologic type (HR, 2.911; 95% CI, 1.308-6.481; P=0.009), venous invasion (HR, 2.784; 95% CI, 1.431-5.417; P=0.003), and lymph node metastasis (HR, 2.497; 95% CI, 1.499-4.158; P<0.001), were also significantly associated with disease recurrence. Conclusion: TF expression is associated with a recurrence in patients with non-metastatic colorectal cancer. However, further studies are required to clarify the underlying mechanisms relating TF expression with oncologic outcomes and its potential role as a therapeutic target.
The milk fever and mastitis that occur during the colostrum period in dairy cattle cause great damage in the dairy industry by causing a rapid decline in the cattle's health and decreasing milk production. In order to prevent this, gradual milking (GM), calcium injection with gradual milking (CG), and calcium injection with complete milking (CC) methods are used. However, differences in effectiveness between these methods have not been established. Therefore, this study was conducted to determine the effects of each preventive method on milk fever and mastitis. The results of this study showed that while there was a significant negative correlation of GM with milk fever and mastitis (r = -0.657, p < 0.05), there was no correlation of CG and CC with milk fever and mastitis. The incidence of milk fever was significantly lower in CG and CC than in GM (p < 0.05) but no differences in the incidence of mastitis were observed between the three groups. No significant differences in the rate of recovery from milk fever and mastitis were observed between the three groups. The recurrence rate of milk fever was significantly higher in CG and CC than in GM (p < 0.05), though no differences in the recurrence rate of mastitis were observed. This study showed an inverse relationship between the incidence rates of milk fever and mastitis when calcium injection was not used during the colostrum period. When calcium injections were used, the incidence of milk fever was reduced without affecting the incidence of mastitis regardless of the milking method, but the recurrence rate of milk fever was increased. The results of this study would be useful for controlling blood calcium concentrations and establishing efficient milking strategy in order to effectively prevent milk fever and mastitis in dairy cattle during the colostrum period.
Background: Secondary spontaneous pneumothorax is caused by various underlying lung diseases, and this is despite that primary spontaneous pneumotherax is caused by rupture of subpleural blebs. The treatment algorithm for secondary pneumothorax is different from that for primary pneumothorax. We studied the recurrence rate, the characteristics of recurrence and the treatment outcomes of the patients with secondary spontaneous pneumothorax. Material and Method: Between March 2005 to March 2007, 85 patients were treated for their first episodes of secondary spontaneous pneumothorax. We analyzed the characteristics and factors for recurrence of secondary spontaneous pneumothorax by conducting a retrospective review of the medical records. Result: The most common underlying lung disease was pulmonary tuberculosis (49.4%), and the second was chronic obstructive lung disease (27.6%), The recurrence rate was 47.1% (40/85). The second and third recurrence rates were 10.9% and 3.5%, respectively. The mean follow up period was $21.1{\pm}6.7$ months (range: $0{\sim}36$ month). For the recurrence cases, 70.5% of them occurred within a year after the first episode. The success rates according to the treatment modalities were thoracostomy 47.6%, chemical pleurodesis 74.4%, blob resection 71% and Heimlich valve application 50%. Chemical pleurodesis through the chest tube was the most effective method of treatment. The factor that was most predictive of recurrence was 'an air-leak of 7 days or more' at the first episode. (p=0.002) Conclusion: The patients who have a prolonged air-leak at the first episode of pneumothorax tend to have a higher incidence of recurrence. Further studies with more patients are necessary to determine the standard treatment protocol for secondary spontaneous pneumothorax.
Purpose: Submandibular gland tumor is rare, less than 6% of head and neck tumor. The purpose of this article is to analysis the clinical experience and treatment outcomes of malignant submandibular gland tumor, suggesting a guideline of management. Methods: We retrospectively evaluated 26 patients who underwent operation for malignant submandibular gland tumor at Severence hospital between 1986 and 2004. Statistical analysis was performed by Kaplan-Meier method, log rank test, Chi-square test, Fisher's exact test using SPSS v12.0 for Windows. Results: They consisted of 18 males and 8 females whose median age was 47 years(range: 20-71). 10 cases of adenocystic carcinoma, 8 cases of carcinoma ex pleomorphic adenoma, 4 cases of mucoepidermoid carcinoma, 1 case each for acinic cell carcinoma, undifferentiated carcinoma, adeno carcinoma, epithelioid hemangioendothelioma. Sialoadenectomy only was performed in 10 cases(36.5%) and sialoadenectomy with neck node dissection was performed in 16 cases(63.5%). Adjuvant radiotherapy was done in 22 cases(84.6%). 10 year disease free survival rate for malignant submandibular gland tumor was 63.1 % and 10 year overall survival rate for malignant submandibular gland tumor was 70.1%. In univariate analysis, prognostic factors affecting recurrence of malignant submandibular gland tumor was initially papable lateral neck node in physical examination and metastasis of lateral neck node in pathologic confirmation. The prognostic factors affecting survival of malignant submandibular gland tumor was tumor size, TNM stage, recurrence and type of recurrence. Conclusion: In this study, prognostic factors affecting recurrence of malignant submandibular gland tumor was initially papable lateral neck node in physical examination and metastasis of lateral neck node in pathologic confirmation. The prognostic factors affecting survival of malignant submandibular gland tumor was tumor size, TNM stage, recurrence and type of recurrence. To prevent recurrence and to improve survival, early diagnosis and aggressive surgery must be considered.
Yoon, Hee Soo;Park, Sang Gyu;Park, Hae Jin;Song, Chang Myeon;Ji, Yong Bae;Tae, Kyung
Korean Journal of Head & Neck Oncology
/
v.34
no.2
/
pp.23-28
/
2018
Background/Objectives: Adenoid cystic carcinoma is the second most common salivary carcinoma. It occurs commonly in the submandibular gland, sublingual gland and minor salivary gland. Local recurrence and distant metastasis are the leading cause of death. The aim of this study was to evaluate long-term oncologic outcomes of patients with head and neck adenoid cystic carcinoma focusing on distant metastasis. Materials & Methods: We retrospectively studied 39 patients who were diagnosed with and treated for adenoid cystic carcinoma of the head and neck from December 1996 to May 2018. The clinicopathologic characteristics of patients such as age, sex, primary site and TNM stage, and treatment methods, recurrence and distant metastasis after treatment, survival rate, and treatment method for recurrence were analyzed. Results: Of 39 patients, 18 were males and 21 were females, and the mean age was $5.9{\pm}14.4$ (28-89) years. The most common primary site was oral cavity (12 cases), and followed by sino-nasal cavity (11 cases), parotid gland (5 cases), and etc. For treatment, 17 patients underwent surgery alone, 16 received surgery with postoperative radiation therapy, and 3 patients received radiation therapy only. Three patients refused any further treatments. Recurrence occurred in 15 patients. The most common site of recurrence was the lung. The mean time to recurrence was 31.7 months. The 5 and 10 years' overall survival rate was 79.3% and 74%, respectively. The 2 and 5 years' overall survival rate was 69.6% and 62.6% in patients with distant metastasis. Conclusion: Distant metastasis is an important prognostic factor in adenoid cystic carcinoma, and eventually one third of patients have distant metastasis, especially in the lung. An appropriate treatment for lung metastasis is necessary because some patients with pulmonary metastasis survive for a quite long time.
Purpose: Sacrococcygeal pilonidal sinus is a chronic inflammatory disease that mostly affects young people, which warrants surgical intervention. Although many surgical methods have been suggested, an optimal surgical method remains controversial because of high recurrence rates and postoperative complications. The objective of this study is to evaluate the results of wide excision and coverage with fasciocutaneous advancement flap for the treatment of sacrococcygeal pilonidal sinus, and to assess the usefulness of this method Methods: From May 1995 to October 2006, the authors treated 19 patients with the use of coverage with fasciocutaneous flap after wide excision. The results were evaluated regarding recurrence rates, complications, and the change in sensitivity of the gluteal region after surgery. The follow-up period was 7 to 142 months (mean, 76 months). All patients were male. Results: Postoperative complications were wound infection at the suction drain insertion site and skin necrosis around the suture margin in one case, respectively. During the follow up period, only one recurrence (5.3%) was seen in fifth postoperative month, which was successfully treated by the same operative procedure. There was no other complications such as seroma, hematoma, wound dehiscence and flap loss. Extensive scarring and anatomic distortion did not occur in the reconstructed area. In addition, sensitivity of the gluteal region did not diminish. The aesthetic results were satisfactory for all patients as well. Conclusion: The authors advocate that fasciocutaneous flap closure be a good alternative method to cover defects after the excision of sacrococcygeal pilonidal sinus.
Purpose: Peritoneal recurrence has been reported to be the most common form of recurrence of gastric cancer. Peritoneal recurrence can generally be suggested by several types of image studies and also if there is evidence of ascites or Bloomer's rectal shelf. It can be confirmed by explorative laparotomy, but diagnostic laparoscopy is a good alternative method and laparoscopic surgery has also been widely used. We reviewed and analyzed the ability of diagnostic laparoscopy to detect peritoneal recurrence or carcinomatosis, and especially for gastric cancer. Materials and Methods: We performed a retrospective review the 45 gastric cancer patients who were operated via diagnostic laparoscopy between 2004. 2. and 2009. 3. We analyzed the perioperative clinical characteristics and the accuracy of the diagnostic methods. Results: The study groups included 14 patients who had confirmed gastric cancer, but they suspected to have carcinomatosis, and 31 patients who had previously underwent gastric resection, but they suspected to have recurrence. The mean operation time was $44.1\pm26.9$ minutes and the mean postoperative hospital stay was $2.7\pm2.8$ days. There was one case of operation-related complication and no postoperative mortality occurred. The sensitivities for detecting peritoneal recurrence or carcinomatosis were 92.1% for diagnostic laparoscopy, 29.7% for detecting ascites and rectal shelf on the physical examination, 86.5% for abdominal computed tomography, 69.2% for PET CT and 18.8% for CEA. Conclusion: Diagnostic laparoscopy does not require a long operation time or a long hospital stay, and it showed a low complication rate in our study. It has high sensitivity for detecting peritoneal recurrence of gastric cancer. It can be an alternative diagnostic confirmative method and it is useful for deciding on further treatment.
Han, Jun;Hong, Yong Taek;Lim, Young kook;Kim, Hoon Nam
Archives of Plastic Surgery
/
v.36
no.1
/
pp.51-55
/
2009
Purpose: Excessive apocrine gland secretion and bacterial decomposition cause axillary osmidrosis, which results in physical discomforts and social problems of patients. Many surgical procedures have been introduced such as skin excision and simple closure, local flap, skin graft, subcutaneous shaving and liposuction method, but the result was not satisfactory to patients and several complications, such as symptom recurrence, hematoma, seroma, delayed wound healing, skin flap necrosis and scarring remain as problems. Methods: For the purpose of reducing these problems, we employed combination treatment of liposuction and rasping method. From January 2006 to February 2008, Total 54 patients were treated with this procedure for bilateral axillary osmidrosis. Results: Follow - up evaluation period was from 2 months to 12 months, and the results were satisfactory. In our method, the length of skin incision is less than 1 cm, so the resultant scar is negligible. Apocrine glands in subcutaneous tissue were mostly removed by liposuction apparatus and remained other glands in subdermal area were mostly removed by rasping. The recurrence rate and postoperative complication were minimal. Conclusion: Our method is very simple, short operation time and excellent results without specific complication.
Improvements to the Gumbel method of extreme value analysis of wind data made over the last two decades are reviewed and illustrated using sample data for Jersey. A new procedure for extending the Gumbel method to include M-th highest annual extremes is shown to be less effective than the standard method, but leads to a method for calibrating peak-over-threshold methods against the standard Gumbel approach. Peak-over-threshold methods that include at least the 3rd highest annual extremes, specifically the modified Jensen and Franck method and the "Method of independent storms" are shown to give the best estimates of extremes from observations.
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