History Of Intra-abdominal Surgery Research Articles

Clinical Outcomes of Patients With Gastric Phytobezoars: Implication of Drinking Carbonated Beverages as a Treatment

Objectives: Although phytobezoars are the most common type of gastric bezoar, a standardized treatment method has not been adopted.Methods: In this study, we evaluated patient clinical features and treatment outcomes following the use of different treatment methods, with a focus on the efficacy of carbonated beverage consumption. A review of medical charts and endoscopic reports revealed 15 cases of gastric phytobezoars from September 2008 to May 2016. Patient medical records were retrospectively reviewed to assess patient clinical characteristics and treatment results.Results: The mean patient age was 71.3±11.1 years. The most common symptoms were epigastric pain (46.7%) and bloating (40.0%). A history of intra-abdominal surgery was found in 26.7% of the patients. The mean bezoar size was 47.3±14.5 mm. The final successful treatment methods were consumption of a carbonated beverage alone (n=7, 46.7%), endoscopic removal (n=5, 33.3%), and surgery (n=3, 20.0%). During the treatment course, few patients (3/15, 20.0%) experienced small bowel obstructions after the consumption of the carbonated beverage and endoscopic fragmentation; these obstructions required surgical interventions. There was no significant difference in the baseline characteristics between patients successfully or unsuccessfully treated with the carbonated beverage.Conclusions: Most patients presenting with gastric phytobezoars can be successfully treated by consuming carbonated beverages in conjunction with endoscopic therapy. However, small bowel obstructions may occur due to the migration of a fragmented bezoar, necessitating surgical intervention.

Assessing risk of recurrent small bowel obstruction after non-operative management in patients with history of intra-abdominal surgery: a population-based comprehensive analysis in Taiwan.

Despite a significant 30% ten-year readmission rate for SBO patients, investigations into recurrent risk factors after non-operative management are scarce. The study aims to generate a risk factor scoring system, the 'Small Bowel Obstruction Recurrence Score' (SBORS), predicting 6-month recurrence of small bowel obstruction (SBO) after successful non-surgical management in patients who have history of intra-abdominal surgery. We analyzed data from patients aged ≥ 18 with a history of intra-abdominal surgery and diagnosed with SBO (ICD-9 code: 560, 568) and were successful treated non-surgically between 2004 and 2008. Participants were divided into model-derivation (80%) and validation (20%) group. We analyzed 23,901 patients and developed the SBORS based on factors including the length of hospital stay > 4 days, previous operations > once, hemiplegia, extra-abdominal and intra-abdominal malignancy, esophagogastric surgery and intestino-colonic surgery. Scores > 2 indicated higher rates and risks of recurrence within 6 months (12.96% vs. 7.27%, OR 1.898, p < 0.001 in model-derivation group, 12.60% vs. 7.05%, OR 1.901, p < 0.001 in validation group) with a significantly increased risk of mortality and operative events for recurrent episodes. The SBORS model demonstrated good calibration and acceptable discrimination, with an area under curve values of 0.607 and 0.599 for the score generation and validation group, respectively. We established the effective 'SBORS' to predict 6-month SBO recurrence risk in patients who have history of intra-abdominal surgery and have been successfully managed non-surgically for the initial obstruction event. Those with scores > 2 face higher recurrence rates and operative risks after successful non-surgical management.

Risk factors associated with fluconazole resistance in Candida parapsilosis candidemia: A case-case study.

Candida species are among the most important invasive pathogens in intensive care units (ICUs). Non-albicans species including Candida parapsilosis (C. parapsilosis) has increased in recent years. Fluconazole is the leading antifungal agent but resistance is a concern among C. parapsilosis species. The aim of this study was to determine the factors associated with fluconazole resistance in patients with candidemia due to C. parapsilosis in ICUs. This case-case study was conducted in a 750-bed, tertiary hospital between 2015 and 2021. Patients with fluconazole-resistant C. parapsilosis candidemia constituted the 'cases of interest' group and patients with fluconazole-susceptible C. parapsilosis candidemia constituted the 'comparison cases' group. Demographic and clinical data of the patients were recorded. Logistic regression analysis was performed using the backward elimination method to determine the independent predictors of fluconazole-resistant C. parapsilosis bloodstream infections. The study included 177 patients. In the cultures of these patients, 76 (43%) fluconazole-resistant, 13 (7.3%) fluconazole-reduced susceptible, and 88 (49.7%) fluconazole-susceptible isolates were found. In the regression analysis the risk factors for fluconazole-resistant C. parapsilosis bloodstream infection, malignancy, immunosuppressive treatment, history of intra-abdominal surgery, hypoalbunemia, previous fluconazole use, and SOFA score were found to be associated in univariate analysis. In multivariate regression analysis, history of intra-abdominal surgery (OR: 2.16; 95% CI: 1.05-4.44), hypoalbuminemia (OR: 2.56; 95% CI: 1.06-6.17) and previous fluconazole use (OR: 3.35; 95% CI: 1.02-11) were found to be independent predictors. In this study, a significant correlation was found between candidemia due to fluconazole-resistant C. parapsilosis in ICUs and intra-abdominal surgery, hypoalbuminemia, and previous fluconazole use. C. parapsilosis isolates and fluconazole resistance should be continuously monitored, strict infection control measures should be taken and antifungal stewardship programs should be implemented.

A Single-center 12-year Experience of Patients with Gastrointestinal Bezoars.

Gastrointestinal (GI) bezoars are relatively rare diseases with clinical characteristics and treatment modalities that depend on the location of the bezoars. This study evaluated the clinical characteristics and treatment outcomes in patients with GI bezoars. Seventy-five patients diagnosed with GI bezoars were enrolled in this study. Data were collected on the demographic and clinical characteristics and the characteristics of the bezoars, such as type, size, location, treatment modality, and clinical outcomes. Among the 75 patients (mean age 71.2 years, 38 males), 32 (42.6%) had a history of intra-abdominal surgery. Hypertension (43%) and diabetes (30%) were common morbidities. The common location of the bezoars was the stomach in 33 (44%) and the small intestine in 33 (44%). Non-surgical management, including adequate hydration, chemical dissolution, and endoscopic removal, was successful in 2/2 patients with esophageal bezoars, 26/33 patients with gastric bezoars, 7/9 patients with duodenal bezoars, and 20/33 patients with small intestinal bezoars. The remaining patients had undergone surgical management. The management of GI bezoars requires multidisciplinary approaches, including the appropriate correction of fluid and electrolyte imbalances, chemical dissolution, and endoscopic and surgical treatments.

Robotic assited perineal prostatectomy (RAPP) as a new era for anesthesiology: It's effects on hemodynamic parameters and respiratory mechanics.

Robotic-assisted perineal prostatactomy(RAPP) is a new alternative surgical technique, in prostate cancer patients especially with a history of intra-abdominal surgery. The aim of this study is to examine the effects of the challenging patient position and CO2 insufflation in perineal space during RAPP on both hemodynamic parameters and respiratory mechanics. Hemodynamic and respiratory parameters of 30 patients who underwent RAPP and 31 patients who underwent Robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer between 2017 and 2019 were retrospectively evaluated. Comparison between RAPP and RALP patients showed that anesthesia, surgery and insufflation times were shorter in RAPP patients (p < 0.05). Blood pCO2 level was higher, and the pH decrease was more prominent in the RAPP patients 30 and 60min after perineal CO2 insufflation (p < 0.05). The mean arterial pressures, driving pressure, Ppeak and Pplato values were statistically higher in the RALP patients and 60min after insufflation while static and dynamic lung compliance values were found to be lower. Our results showed that blood pCO2 level may severely increaseafter perineal CO2 insufflation. The fact that respiratory mechanics are less affected despite the difficult patient position for lungs in RAPP patients, the presence of higher CO2 level supports that the perineal CO2 insufflation plays a more important role in increased CO2 level. Considering these changes, especially the sudden increase in the risk of CO2 level, close follow-up and timely intervention by anesthesiology can ensure all changes remain in a clinically safe range.

Discordant intestinal malrotation in adult monozygotic twins discovered incidentally during laparoscopic gastric bypass: A case report and review of the literature

Introduction and importanceIntestinal Malrotation is an uncommon entity in the adult population; more so in monozygotic twins, where concordance is expected. In literature, discordant intestinal Malrotation has only been discovered when one twin became symptomatic, and the other was screened. To the best of our knowledge, this is the first documented case of discordant adult type intestinal Malrotation in otherwise asymptomatic monozygotic twins discovered incidentally during Laparoscopic Roux-en-Y Gastric bypass (LRYGB).Case presentationTwins A and B met the NIH criteria for bariatric surgery, neither having symptoms of acute or chronic volvulus or history of intraabdominal surgery. Twin A had a LRYGB performed by a trained bariatric surgeon, noting no anatomic anomalies. 5 months later, Twin B had LRYGB and intestinal Malrotation was diagnosed incidentally.Clinical discussionDiagnosis of Intestinal Malrotation is rare in adults, usually discovered after becoming symptomatic or during abdominal imaging for another indication. Two cases of discordant intestinal Malrotation in monozygotic twins have been documented, both discovered when one twin became symptomatic due to acute volvulus, suggesting epigenetic phenomena. When discovered incidentally during surgery, patients can safely undergo their intended procedure, but literature suggests prophylactic division of Ladd's bands, while appendectomy is left to the discretion of the surgeon.ConclusionsIntestinal Malrotation appears to be associated with epigenetic phenomena and if discovered incidentally during surgery, the proposed procedure can be carried out by an experienced surgeon, in addition to division of Ladd's bands and appendectomy.

S3689 Small Bowel Obstruction in COVID-19 Patient Without Risk Factors

Introduction: The documented gastrointestinal associations of COVID-19 infection include enteritis, colitis, ileus, and mesenteric thrombosis from associated coagulopathy. A direct link to small bowel obstruction (SBO) has yet to be proposed. Aside from isolated cases of bacterial enteritis, infection is not a widely accepted cause of SBO. SBO is mostly caused by adhesions formed after intra-abdominal surgery. Other causes include congenital adhesions, neoplasms, hernias, and stenosis from inflammatory bowel disease (IBD) or bowel ischemia. We report a unique case of acute SBO in a patient with COVID-19 symptoms but no known risk factors of SBO. Case Description/Methods: A 67-year-old man with history of HTN and TURP for BPH presented with intermittent fever and dry cough for 1 week. He had no history of abdominal surgery, hernia, malignancy, IBD, or bowel ischemia. He was febrile to 102.6F and O2 saturation was 100% on room air without respiratory distress. SARS-CoV-2 PCR assay was positive. After two days of remdesivir, he was hypoxic requiring nasal cannula and had abdominal pain with loose stool. On exam, abdomen was distended with guarding. CT abdomen showed 2 transition points, multiple dilated bowel loops, and fluid and stool in distal bowel consistent with partial SBO. Nasogastric tube drained gastric contents with bile. He was intubated for ex-lap which showed no transition points or congenital adhesions. Proximal two-thirds of bowel were dilated, thickened, and hyperemic but the distal third was normal caliber. Creeping fat and friable mesentery with ecchymosis were noted throughout. Abdomen was left open with plan for closure the following day. Closure was delayed by 4 days due to worsening hypoxia and new pressor requirements. Oxygen and pressor requirements improved after starting steroid and antibiotic treatment. Abdomen was then closed as bowel remained viable. He was extubated, weaned to room air, and able to tolerate food within 1 week followed by discharge to rehab. Discussion: In our patient who developed partial SBO in the setting of worsening COVID-19 respiratory symptoms with no history of intra-abdominal surgery or other risk factors of SBO, COVID-19 should be considered as a possible etiology. Ex-lap findings were non-specific and could indicate inflammatory or ischemic evidence of COVID-19 gut involvement. Further research is required to better understand this patient’s diagnosis and a possible relationship between COVID-19 enteritis and acute development of SBO.Figure 1:: CT Abdomen Showing Two Transition Points Image A: Transition point in left mid abdomen. Image B: Transition point in right mid abdomen.

It is feasible to perform laparoscopic pancreaticoduodenectomy for patients with prior abdominal operation

Background: A history of intra-abdominal surgery is a relative contraindication for laparoscopic surgery. The safety and feasibility of laparoscopic pancreaticoduodenectomy (LPD) in patients with previous upper abdominal operation (PUAO) are uncertain. Methods: We performed 282 LPD cases from November 2010 to May 2017. A cohort of 84 patients was matched in terms of age, gender, body mass index, American Society of Anesthesiology, tumor size, tumor location, and histopathologic diagnosis (group 1 consisting of 42 cases with PUAO and group 2 comprising 42 cases without PUAO). Data were collected and analyzed retrospectively in terms of demographic characteristics, intraoperative variables, and postoperative variables. Results: Only one patient in group 1 required to convert to hand-assisted surgery due to massive adhesion. No 30-day mortality was reported in both groups. The mean time for adhesiolysis in group 1 was 16 min, but the total operative time (392±41 vs . 385±33 min, P=0.217) and the estimated blood loss (147±32 vs . 162±43 mL, P=0.142) was comparable between the two groups. No statistical difference was observed between the groups in terms of complications and postoperative hospital stay. Conclusions: LPD can be safely performed in patients with PUAO. PUAO should not be regarded as a contraindication for LPD.

Obesity as a Risk Factor for Clostridium difficile Infection

Obesity and Clostridium difficile infection (CDI) are both related to an increased Firmicutes/Bacteroidetes ratio in the intestinal microbiota. However, an association between obesity and CDI is unknown. We aimed to assess the association between obesity and CDI in hospitalized patients. We conducted a retrospective case-control study. From January to December 2011, all consecutive patients hospitalized with CDI, in 2 internal medical departments in 2 hospitals, were included. Patients with CDI were compared to hospitalized patients without diarrhea, during the same period and in the same departments, and matched by age, sex, Charlson score, length of hospitalization, and antibiotic use during the last 3 months. Of the 6300 patients hospitalized, 178 were diagnosed with CDI. CDI prevalence was 2.8% (178/6300). Thirty patients were excluded from the study. The 148 cases with CDI were compared to 148 hospitalized controls. Mean body mass index (BMI) in the CDI group was 33.6 (SD, 4.3) versus 28.9 (SD, 5.4) in the control group (P = .001). The multivariable model of conditional logistic regression for matched pairs showed that a history of intra-abdominal surgery (odds ratio [OR] = 2.865; 95% confidence interval [CI], 1.26-6.52) and a high BMI value (OR = 1.196 per 1-unit increase in the BMI scale; 95% CI, 1.12-1.27) were the only variables found to be significantly associated with CDI. Our findings suggest that obesity is associated with the risk of CDI. Further studies are needed to reveal the exact mechanisms underlying this association.

Do statins protect against the development of Clostridium difficile-associated diarrhoea?

To assess whether prior statin use protects against the development of Clostridium difficile-associated diarrhoea (CDAD) in hospitalized patients. A retrospective case-control study conducted in three hospitals included all hospitalized patients diagnosed with CDAD in the Internal Medicine Departments (IMDs) during a 1 year period. Subjects were determined to have CDAD if their stool sample was positive for C. difficile toxin in the context of diarrhoea at the time of diagnosis. Patients with CDAD were compared with patients without CDAD, hospitalized during the same period and in the same departments, matched for age, gender, comorbidities (Charlson score), length of hospitalization and antibiotic use during the last 3 months. Prevalence of CDAD was 2.87% (197/6850 patients hospitalized in the IMDs). The 197 cases with CDAD were compared with 169 hospitalized patient controls. Sixty-four out of 197 (32.5%) patients in the CDAD group were statin users versus 87/169 (51.5%) of the controls (P = 0.02). Multivariate analysis showed that a Charlson score >3 [OR = 2.2 (95% CI 1.8-2.8), P = 0.024], chemotherapy during the last 6 months [OR = 3.09 (95% CI 1.95-3.91), P = 0.002], a history of intra-abdominal surgery [OR = 2.99 (95% CI 2.58-3.24), P = 0.003] and no statin use [OR = 2.2 (95% CI 1.82-2.73), P = 0.034] were associated with CDAD. Prior statin use may provide protection against CDAD. Further studies are warranted to evaluate this association.

Tube Found in Anus during Defecation: Sigmoid Colon Perforation after Ventriculoperitoneal Shunt Surgery in an Elderly Patient

Bowel perforation with anal protrusion of the ventriculoperitoneal (VP) shunt catheter is a rare complication of VP shunt surgery. Most of the complications reported to date have occurred in children, and there are very few reports of complications in elderly patients. An 80-year-old man with normal pressure hydrocephalus (NPH) was treated by VP shunting by mini-laparotomy; a subsequent abdominal wall infection necessitated additional VP shunting, which was performed using the blind puncture technique. Three months after the second VP shunting, the patient presented with anal protrusion of the shunt catheter. Exploratory laparotomy revealed that the shunt catheter had penetrated the subcutaneous tissue through the mesocolon into the redundant sigmoid colon and formed a colocutaneous fistula. Subsequently, exploratory laparotomy with closure of the colocutaneous fistula, loop colostomy of sigmoid colon, and extrusion of the catheter was performed. Fever or signs of meningeal irritation, and increased intracranial pressure were not noted at the follow-up examination performed 1 month after the procedure. In conclusion, this case suggests that if the patient has a history of intra-abdominal surgery, the surgeon should exercise caution while performing the blind puncture technique for VP shunt surgery since this surgery may result in direct injury to the adhesive bowel.

1185 “CLOSED” ACCESS IN PEDIATRIC UROLOGIC LAPAROSCOPY—A VIABLE ALTERNATIVE TO “OPEN” ACCESS IN A LARGE, CONTEMPORARY SERIES

You have accessJournal of UrologyPediatrics: Reconstructive Surgery1 Apr 20111185 “CLOSED” ACCESS IN PEDIATRIC UROLOGIC LAPAROSCOPY—A VIABLE ALTERNATIVE TO “OPEN” ACCESS IN A LARGE, CONTEMPORARY SERIES Eric Nelson, Harsha Mittakanti, Shelly Bian, Kirk Jackson, David Roth, and Lars Cisek Eric NelsonEric Nelson Houston, TX More articles by this author , Harsha MittakantiHarsha Mittakanti Houston, TX More articles by this author , Shelly BianShelly Bian Houston, TX More articles by this author , Kirk JacksonKirk Jackson Houston, TX More articles by this author , David RothDavid Roth Houston, TX More articles by this author , and Lars CisekLars Cisek Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.818AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of laparoscopy in pediatric urologic surgery is now routine. Placement of the initial trocar is a critical step and avoidance of bowel and major vessel injury is paramount. The ideal technique for placement has not been explored in the pediatric urologic literature. We hypothesize that a “closed” access method is technically straight-forward, safe, and can be applied to routine pediatric urologic operations. METHODS An Institutional Review Board-approved retrospective chart review was performed of all patients undergoing laparoscopic surgery between 2003 and 2010. Data extracted included: age, procedure, previous surgical history, method and location of access, presence or absence of intra-abdominal adhesions, and intra-operative complications. Method of access was classified as either “open” (Hassan) or “closed” which included: the direct technique, optical access with a Visiport, or use of a Veress needle/Step Trocar system. For the direct access technique, an umbilical incision is made and the skin on either side is elevated in a “lifted table” technique. A bladeless trocar is then pushed and twisted with gentle, firm pressure through the rectus fascia. Intra-abdominal position is confirmed visually and the abdomen is then insufflated. In the Veress/Step Trocar group, a Veress needle confirmed intra-abdominal position and the timing of insufflation varied. RESULTS 668 encounters (631 patients) were identified and average age was 7.53 years (0.13–19.68). The procedures were performed by five surgeons and encompassed a variety of procedures (orchiopexy- related—179, inguinal hernia repair—180, varicocelectomy—160, ureteral reimplant—31, pyeloplasty—102). A “closed” access technique was utilized in 661/668 encounters (direct—475; Veress/Step—164; Visiport—20). 12.3% of the patients had a history of intra-abdominal surgery and significant adhesions were seen in 14 (2.1%). There was one complication during access—a small liver laceration during initial port placement for a pyeloplasty. The bleeding was minimal and required no intervention. An open technique was chosen in seven patients—five of these had concomitant umbilical hernia repair. CONCLUSIONS The “closed” technique for laparoscopic access in the pediatric population is safe and feasible even in patients with previous intra-abdominal surgery. We believe the technique is technically straight-forward and efficient. These data support “closed” access techniques as viable alternatives to the Hassan method for routine use in pediatric laparoscopy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e476 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Nelson Houston, TX More articles by this author Harsha Mittakanti Houston, TX More articles by this author Shelly Bian Houston, TX More articles by this author Kirk Jackson Houston, TX More articles by this author David Roth Houston, TX More articles by this author Lars Cisek Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Safe alternative transgastric peritoneal access in humans: NOTES

Diagnostic transgastric endoscopic peritoneoscopy has been used to evaluate the abdomen. We present our experience with transgastric endoscopic peritoneoscopy (TEP) to access the peritoneum, direct trocar placement, and perform adhesiolysis without laparoscopic visualization in patients undergoing laparoscopic Roux-en-Y gastric bypass. Forty patients participated. There are 2 arms to the study. The initial 20 patients underwent pre-insufflation of the abdomen prior to TEP. The second 20 had no pre-insufflation. Ten patients in each arm had no surgical history. The other 10 had previous intra-abdominal procedures. TEP was performed through a gastrotomy created without laparoscopic visualization. Adhesions were visualized and taken down endoscopically prior to trocar placement. Diagnostic findings, operative times, and clinical course were recorded. Average TEP time was 19 min. Three patients had limited visualization due to intra-abdominal adhesions (2) and omental fat (1). Three of the 20 without and 17 of 20 with a history of intra-abdominal surgery had adhesions visualized endoscopically. Endoscopic adhesiolysis was performed in 1 and 4 patients in these groups respectively. Six occult umbilical hernias, 1 inguinal hernia, and 1 hiatal hernia were noted on endoscopic exploration. There were no complications related to intubation of the stomach, accessing the peritoneum, or endoscopic exploration. TEP is a safe and accurate means to access the peritoneum, visualize the abdominal wall, perform adhesiolysis, and direct trocar placement without laparoscopic guidance. Safe and reliable gastric closure remains the sole limitation to its clinical use outside of a protocol necessitating a gastrotomy.

The Characteristics of Acute Pyelonephritis in Geriatric Patients: Experiences in Rural Northeastern Taiwan

Acute pyelonephritis causes hospitalization and is a commonly-ignored cause of death in geriatric patients. It has been well studied in young-adult populations but rarely in geriatric populations. The aim of our study was to analyze the characteristics of acute pyelonephritis in geriatric patients. The electronic admission records of a community hospital in northeastern Taiwan were retrospectively screened from July 1, 2003 to June 30, 2006. The basic characteristics, laboratory findings and infectious microorganisms of all subjects were evaluated. Sixty-five subjects (mean age 71.6 +/- 4.9 years; range 65-84 years) and 73 admission records contributed by them were enrolled. These 65 subjects, including one who died in hospital, were predominantly female (52 subjects; 80%). Twenty-two subjects (33.8%) had co-existing diabetes mellitus, 9 subjects (13.8%) had co-existing tumors, and 19 subjects (29.2%) had a history of intra-abdominal surgery. The admission records revealed right kidney involvement (52.1%), co-existing urolithiasis (50.7%) and admission to wards of internal medicine (57.5%). Urological procedures were performed on 20 (27.4%) of all 73 admission records. Escherichia coli was the most common infecting microorganism (19.2% of all records; 42.4% of records with positive microorganism culture). Hemoglobin < 10 g/dl was a significant predictive factor for both hospital stay > 7 days and serum creatinine > 2.0 mg/dl (p = 0.003 and 0.002, respectively). Positive microorganism culture was also a significant predictive factor for hospital stays > 7 days (p < 0.001). In our geriatric patients with acute pyelonephritis, low hemoglobin levels implied co-existing renal insufficiency and prolonged hospitalization. Positive microorganism culture also implied prolonged hospitalization.

Solitary actinomycotic abscesses of liver: report of two cases

Hepatic actinomycotic abscesses are rare and secondary to other intra-abdominal infections. History of intra-abdominal surgery is a principal contributing factor for the abscess formation. Patients with hepatic actinomycotic abscess may suffer from fever, malaise, abdominal pain and bodyweight loss. The clinical progress of actinomycotic abscess is more indolent than the usual course of other pyogenic abscess. It is sometimes diagnosed as malignancy. This report consists of two cases of hepatic actinomycotic abscess mimicking tumours. Laboratory data revealed elevated alkaline phosphatase and leucocytosis. The abdominal computed tomography scan showed multiloculated lesions with peripheral contrast enhancement appearance. Diagnosis confirmation was based on the typical histologic feature of sulfur granules with inflammatory process by echo-guided fine needle biopsy or surgical specimen. These two cases were resolved with extended courses of intravenous and oral penicillin treatment.

Relationship Between Obesity and the Risk of Gynecologic Laparoscopy in Korean Women

Study Objective To determine whether obesity increases risk of performing laparoscopic gynecologic surgery in Korean women. Design Retrospective analysis over 35 consecutive months (Canadian Task Force classification II-2). Setting University-affiliated hospital. Patients Two hundred seventy-seven women who underwent gynecologic laparoscopic surgery. Intervention Patients were analyzed by chart review. Measurements and Main Results Obesity was defined as body mass index (BMI) 25 kg/m 2 or greater. Patients were categorized on the basis of BMI [weight (kg)/height 2 (m 2)] as obese (BMI ≥ 25, 74 women) or nonobese (BMI <25, 203). Each group was further divided into three subgroups according to operation difficulty. No significant differences in patient age, parity, menopausal status, medicosurgical illness, or history of intraabdominal surgery were apparent between groups, except for distribution of operation difficulty and adhesion grade; however, the adhesion grade was evenly distributed in each operation grade subgroup. In the two BMI groups, no significant differences were seen in surgical values (estimated blood loss, operating time, operative complications, postoperative complications, hospital stay, rate of conversion to laparotomy). Conclusion Obesity had generally been thought to increase the risk of laparoscopic surgery. In our study in obese Korean women, however, it did not seem to increase the risk, and gynecologic laparoscopic surgery was performed safely.