Risk Factors for Surgical Site Infection after Gastrointestinal Surgery (original) (raw)
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Postoperative nausea and vomiting (PONV) , the most frequent complication after surgery, may evoke severe morbidities such as postoperative bleeding, aspiration and others. This complication, possibly caused by patient-related, surgical and anesthesia-related aspects, occurs through at least over 5 different neural pathways. Unlike other countries, the indication of effective anti-emetics to prevent or to treat PONV is quite limited in Japan due to little regard to the risk of this significant complication and its high cost. In this article, we reviewed the cause of PONV, known predictors, and promising new predictors. In our country, a more accurate scoring system or high-sensitive and specific biomarkers would be very helpful in preventing PONV by allowing the effective use of prophylactic antiemetic drugs.
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We examined the relationships between physical activity performed during the perioperative period by patients undergoing gastrectomy for gastric cancer and such factors as life condition, psychological condition, and health-related quality of life (QOL). Patients undergoing gastrectomy for gastric cancer were assessed, and data on such factors as physical activity (exercise intensity (METs)× duration (h) =Ex), gastrointestinal symptoms, and dietary intake were collected continuously from before hospital admission until 2 months after surgery. Results of the Hospital Anxiety and Depression Scale (HADS) and the SF-8 Health Survey (a QOL scale), body weight, and hematological data were collected at the time of admission and discharge, 1 month after surgery, and 2 months after surgery. The subjects were 14 patients (9 men and 5 women) with a median age of 65.5 years. The median physical activity performed was 2.95 Ex/day preoperatively, 0.43 Ex/day at discharge, 2.18 Ex/day 1 month afte...
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Extensive liver resection for hilar bile duct carcinoma with jaundice has high morbidity and mortality rates because of postoperative liver failure. To minimize postoperative liver dysfunction, a portal venous branch was embolized before surgery to induce atrophy of the lobe to be resected and hypertrophy of the contralateral lobe in 14 patients with hilar bile duct carcinoma. Bile was drained before surgery in 11 patients with jaundice. Portal embolization did not produce major side effects, and moderate increases of serum transaminase activity or bilirubin returned to baseline values within 1 week. Hepatectomy with bile duct resection and lymphadenectomy was performed 6 to 41 days after embolization, at which time the embolized lobe was atrophied in 12 of the patients. Extended right or left lobectomy or left trisegmentectomy (10, 3, and 1 cases, respectively) with biliointestinal reconstruction was performed. One patient with jaundice and suppurative cholangitis died 30 days afte...
Pyoderma gangrenosum arising after the surgery for lower gingival cancer
Journal of Japanese Society of Oral Oncology, 2018
Pyoderma gangrenosum (PG) is an uncommon rapid progressive and ulcerating skin disease of unknown etiology. The early lesion shows a clinical feature similar to postoperative infection, so the diagnosis of PG is difficult. In this report, we present a rare case of PG arising after surgery for oral cancer. A 72-year-old woman received radical resection for lower gingival cancer with reconstruction using delto-pectoral flap (D-P flap). Six days after the surgery, she had pyrexia and water diarrhea. The submandibular skin around the insertion site of the D-P flap became reddish with diffuse swelling, pus discharge and severe tenderness. A provisional diagnosis was postoperative infection of the wound. Although the patient was given repeated courses of antibiotics, debridement and drainage, the lesion extended to the whole neck of the affected side and a necrotic ulcer with bluishpurple undermined borders surrounded by erythema was observed 13 days after the surgery. The patient was referred to a dermatologist and PG was strongly suspected. From the postoperative 15 th day, treatment with prednisolone and minocycline over the next several days improved her symptoms dramatically. Histopathological examination revealed that severe inflammatory cells, predominantly of neutrophils, had infiltrated into the dermis without bacterial components. These clinical and histopathological findings fulfilled the diagnostic criteria of PG. PG should be taken into consideration as a potential complication in oral and maxillofacial surgery too.
Usefulness of a Pouch for Management of Postoperative Pharyngocutaneous Fistula
Nippon Jibiinkoka Tokeibugeka Gakkai Kaiho(Tokyo)
Postoperative saliva leakage associated with wound dehiscence is one of the serious postoperative complications of major head and neck oncological surgery. Usually, a pharyngocutaneous fistula has to be formed for appropriate drainage of the infectious saliva to protect cervical vital structures, including the carotid artery. After the microvascular circulation around the fistula becomes stable, the fistula can be closed safely using a hinge flap and local rotation or a free island flap. Conventionally, the pharyngocutaneous fistula is maintained by plugging it with ointment gauze and covering it tightly with dry gauze and adhesive tapes ; the tracheal stoma has to be managed with a cuffed cannula to prevent aspiration of saliva. However, this conventional method is associated with heavy distress to the patient, such as skin damage and pain due to frequent replacement of gauze and tapes, and increased cough and sputum induced by the