Cecal Diverticulitis(CD) is a rare condition with a higher incidence in Oriental populations, which symptoms and signs are closely simulate acute appendicitis. The present study was designed to resume the optimal therapeutic modalities. A retrospective review was conducted between 1991 and 1996 on 28 surgically treated patients(18 men, 10 women ; mean age 45 years) with documented CD in Kon-Kuk University Hospital. Most patients presented with right lower quadrant pain and tenderness. Acute appendicitis was the preoperative diagnosis in 89.2%(25/28) of the patients. The CD patients were divided into three groups : CD-RC(right hemicolectomy group; n=4), CD-DV(diverticulectomy group; n=5), and CD-AP(appendectomy only group; n=19) by operative options. Information on patient demographics, duration of symptom, white blood cell count, radiologic studies, operative procedure, operation time, hospital days, duration of intravenous antibiotics administration, complications and recurrent symptoms were reviewed and analyzed. CD-RC and CD-DV patients required more hospital days than CD-AP(mean 20.6 days, 9.6 days versus 8.4 days, respectively) and more complications(50%, 60% versus 26%). There was no recurrent patient in this series and also there were no reoperated cases. But there was one death in CD-RC group. Of the 4 patients who had right hemicolectomy, one was expired by sepsis and one had minor wound infection. Minor wound infections are the most common complications : 5 in CD-AP, 3 in CD-DV group. Conclusively, if CD could be diagnosed preoperatively, surgical management should be reserved and initial medical treatment with intravenous antibiotics should be considered, and in those patient who underwent emergency operation presumed acute appendicitis, right hemicolectomy with primary ileocolic anastomosis is recommended with acceptable low morbidity. But alternatively appendectomy only is a safe and effective procedure for the treatment of CD if there is no evidence of free perforation, abscess formation or strongly suggested cecal carcinoma.
Abscess ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Demography ; Diagnosis ; Diverticulitis* ; Emergencies ; Female ; Humans ; Incidence ; Leukocyte Count ; Male ; Retrospective Studies ; Sepsis ; Surgical Procedures, Operative ; Wound Infection

We are reporting a case of fatality due to the acute hemolytic reaction during the whole blood transfusion. The minor reactions of the blood transfusion are relatively transfusion. But one of the most serious and difficult reaction is the acute hemolytic reaction, and it is not rare. The symptoms and treatment for the acute hemolytic reaction are described.
Blood Transfusion*

With the remarkable progress of modern medicine, many monitoring systems and technics have been designed and applied clinically, but the monitoring of the central venous pressure is the most simple, convenient and dependable method to, monitor for a cert patients diagnosis and treatment among the varieties of the monitoring systems. There is need for a convenient and dependable method for estimating fluid volume requirement under diverse circumstances. An adequate circulation depends upon three factors: a. the pumping action of the heart b. the volume of blood being pumped c. the capacity of the vascular system and its resistance. Therefore central venous pressure (C.V.P.) is one of the guides for the adequate circulation. C.V.P. monitoring is indicated in: a. Suspected blood volume deficit: major trauma, severe burns, or penetrating wounds of major body cavity. b. Hypotensive patient c. During and after the open heart surgery or major neurosurgery d. When shock origin is obscure, for diagnostic and therapeutic reasons e. Pulmonary edema and acute heart failure f. Instruction of young physicians in the physiology of the shock. The technic of internal jugular vein cannulation using one of the needle catbeters and its complications are described.
Blood Volume ; Burns ; Catheterization* ; Catheters* ; Central Venous Pressure* ; Diagnosis ; Heart ; Heart Failure ; History, Modern 1601- ; Humans ; Jugular Veins* ; Methods ; Needles ; Neurosurgery ; Physiology ; Pulmonary Edema ; Shock ; Thoracic Surgery ; Wounds, Penetrating

We experienced a case where extracorporeal membrane oxygenation ECMO was used for a cardiac arrest that occurred during spinal anesthesia. An 84-year-old man underwent total hip replacement surgery. The patient developed sudden cardiac arrest at around 40 minutes after the administration of spinal anesthesia. The cardiac arrest was difficult to manage with ordinary CPR (cardiopulmonary resuscitation) and went on to complete cardiac arrest. ECMO (venoarterial ECMO from the right femoral artery to the right femoral vein) was immediately applied while performing cardiac massage. Heparin was infused with ACT (activated coagulation time) monitoring during ECMO. We also found multiple rib fractures and hemothorax resulting from the chest massage as seen on a chest X-ray. On the third day after resuscitation, communication with the patient was possible. Hemodialysis was performed due to acute renal failure on the same day. On the seventh day, the vital signs became stable. The flow of the pump was lowered and the patient was weaned from ECMO. However, the patient could not be weaned from ventilatory support due to the hemothorax caused by the CPR. Thereafter, weaning from ventilatory support was delayed due to a decline of pulmonary function. The patient organ functions (kidney, lung, liver, heart) were gradually getting worse. The patient expired due to multiple organ failure on day 92. ECMO can be considered in case of cardiac arrest due to reversible causes.
Acute Kidney Injury ; Aged, 80 and over ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Cardiopulmonary Resuscitation ; Death, Sudden, Cardiac ; Extracorporeal Membrane Oxygenation* ; Femoral Artery ; Heart Arrest* ; Heart Massage ; Hemothorax ; Heparin ; Humans ; Liver ; Lung ; Massage ; Membranes* ; Multiple Organ Failure ; Renal Dialysis ; Resuscitation ; Rib Fractures ; Thorax ; Vital Signs ; Weaning

We report our initial experience with laparoscopic radical cystectomy of an orthotopic neobladder. A 68 years old male patient with muscle invasive, organ confined, and transitional cell carcinoma of the bladder underwent operation. The operation specimen was extracted through the 5 cm sized, muscle splitting incision in the umbilical trocar site. The urinary diversion was achieved by ileal W-neobladder through a removal site of a specimen. The orthotopic neobladder was sutured to the urethra intracorporeally. Operation time and blood loss were 11 hours and 450 ml, respectively. The patient was discharged on the 14th postoperative day. Laparoscopic radical cystectomy, which involves the orthotopic neobladder creation, is feasible, although difficult and technically demanding. With growing experience, laparoscopic radical cystectomy can be an alternative to open technique.
Aged ; Carcinoma, Transitional Cell ; Cystectomy* ; Humans ; Laparoscopy ; Male ; Surgical Instruments ; Urethra ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion

BACKGROUND: Descending necrotizing mediastinitis (DNM) is a serious disease originating in odontogenic or oropharyngeal infection with high mortality despite adequate antibiotics and aggressive surgery. We analyzed results of treatment for DNM. MATERIAL AND METHOD: We studied 8 cases diagnosed as DNM from 1998 to 2007. All patients received emergent surgical drainage and debridement with broad spectrum antibiotics just after diagnosis. Antibiotics were changed after bacterial susceptibility testing. The surgical approach included 2 cases of cervicotomy, 6 cases of cervicotomy, and a thoracotomy. RESULT: The interval between symptom onset and hospitalization was 4.6+/-1.8 days (1~9 day). DNM originated in 4 cases of odontogenic infection (50%), 2 cases of oropharyngeal infection (25%), and 2 cases of unknown origin (25%). Causative organisms were found in 6 cases; Streptococcus in 4 cases, Staphylococcus in 1 case, and Klebsiella in 1 case. The Endo DNM classification was type I (2 cases), IIA (3 cases), and IIB (3 cases). The incidence of thoracotomy was 75%. The surgical mortality rate was 25% (2/8). The cause of death was multiple organ failure caused by septic shock. All mortality cases received only cervicotomy and aggravated infections after initial drainage. CONCLUSION: Early diagnosis, immediate surgical drainage, and adequate antibiotics, including covered anaerobes, are required. Thoracotomy should be performed with cervicotomy even for localized DNM.
Anti-Bacterial Agents ; Cause of Death ; Debridement ; Drainage ; Early Diagnosis ; Hospitalization ; Humans ; Incidence ; Klebsiella ; Mediastinitis ; Multiple Organ Failure ; Necrosis ; Shock, Septic ; Staphylococcus ; Streptococcus ; Thoracotomy

BACKGROUND: Recently, percutaneous cardiopulmonary support (PCPS) has been widely used to rescue patients in cardiogenic shock or cardiac arrest. However, patients with cardiopulmonary bypass (CPB) weaning failure during open heart surgery still have very poor outcomes after PCPS. We investigated clinical results and prognostic factors for patients who underwent PCPS during open heart surgery. MATERIAL AND METHOD: From January 2005 to December 2008, 10 patients with CPB weaning failure during open heart surgery underwent PCPS using the CAPIOX emergency bypass system (EBS(R), Terumo Inc, Tokyo, Japan). We retrospectively reviewed the medical records of those 10 patients. RESULT: The average age of the patients was 60.2+/-16.5 years (range, 19~77 years). The mean supporting time was 48.7+/-64.7 hours (range, 4~210 hours). Of the 10 patients, 6 (60%) were successfully weaned from the PCPS While 5 (50%) were able to be discharged from the hospital. Complications were noted in 5 patients (50%). In univariate analysis, long aortic cross clamp time during surgery, mediastinal bleeding during PCPS and high level of Troponin-I before PCPS were significant risk factors. All of the discharged patients are still surviving 34+/-8.6 months (range, 23~48 months) post-operatively. CONCLUSION: The use of PCPS for CPB weaning failure during open heart surgery can improve the prognosis. More experience and additional clinical studies are necessary to improve survival and decrease complications.
Cardiopulmonary Bypass ; Emergencies ; Extracorporeal Circulation ; Heart ; Heart Arrest ; Hemorrhage ; Humans ; Medical Records ; Prognosis ; Retrospective Studies ; Risk Factors ; Shock, Cardiogenic ; Thoracic Surgery ; Tokyo ; Troponin I ; Weaning

We examined the hypothesis that mild hypothermia (rectal temperature 34 degrees C) results in the same survival time, whether induced spontaneously or intentionally, during untreated, lethal, uncontrolled hemorrhagic shock in rats. Sixty-four Sprague-Dawley male rats were randomly assigned to normothermia (Nth) (n=19), spontaneous mild hypothermia (Sp.Hth) (n=25) or controlled mild hypothermia (Con.Hth) (n=20) groups. After blood withdrawal of 3 mL/100 g over 15 minutes, followed by 75% tail amputation under spontaneous breathing and light anesthesia by i.p. injection of pentobarbital sodium, rats were observed without fluid resuscitation or hemostasis for 180 minutes or until death. The initial temperature of the Nth group was artificially maintained throughout the experiment. For the mild hypothermia groups, the Sp.Hth group was exposed to ambient temperature while the Con. Hth group was actively cooled to a target rectal temperature of 34 degrees C. In the Con.Hth group, all rats except one died before 180 minutes. All rats in the Nth group died within 38 minutes, and within 67 minutes in the Sp.Hth group. The average survival time was shortest in the Nth group at 20.3 +/- 5.3 minutes, followed by the Sp.Hth group at 30.1 +/- 13.5 minutes, and the Con.Hth group at 81.9 +/- 39.8 minutes (p 0.01). Tail bleed out volume was 0.51 +/- 0.19, 0.26 +/- 0.15 and 0.19 +/- 0.12 mL/100 g in the Nth, Sp.Hth and Con.Hth groups, respectively (p 0.05). In conclusion, spontaneous mild hypothermia did not prolong the survival time as much as controlled mild hypothermia in the rat model for untreated, lethal, uncontrolled hemorrhagic shock.
Animal ; Blood Pressure ; Body Temperature ; Hypothermia/*physiopathology ; *Hypothermia, Induced ; Male ; Rats ; Rats, Sprague-Dawley ; Shock, Hemorrhagic/*mortality/physiopathology/therapy

A 59-year old female patient was admitted due to massive hemoptysis. 6-months previously, we performed ascending aorta graft interposition for terating Debakey type 1 acute aortic dissection. Chest CT scan showed the fistula between the descending thoracic aorta and the left lower lobe. We performed descending thoracic aorta graft interposition under cardiopulmonary bypass. She recovered well without any postoperative problems. Distal aorto-bronchial fistula after a previous aortic operation is very rare. We report here the good results of treating aorto-bronchial fistula because we recognized this lesion early and performed an early operation.
Aorta* ; Aorta, Thoracic ; Bronchi ; Cardiopulmonary Bypass ; Female ; Fistula* ; Hemoptysis ; Humans ; Middle Aged ; Postoperative Complications ; Tomography, X-Ray Computed ; Transplants*

A 40 year-old male patient admitted for dyspnea and edema of the lower extremities. A pulsatile abdominal mass with a bruit was palpable in the right lower quadrant. Four months previously, he had underwent left partial laminectomy (L4~5) and discectomy at the L4 level due to disc protrusion. Computed tomography showed an ilio-iliac AV fistula with pseudoaneurysm at the L5 level. Because massive bleeding occurred when the aneurysm was entered, we closed the aneurysm and performed resection and suture of the aorta and both iliac arteries very near the aneurysm. After exclusion of the arterial side, we performed reduction angioplasty at the aneurysm and aorto-biiliac reconstruction with an artificial graft. Twenty-four months after operation, he is doing well and hasn't had any complications on the follow-up.
Adult ; Aneurysm ; Aneurysm, False ; Angioplasty ; Aorta ; Arteriovenous Fistula* ; Diskectomy ; Dyspnea ; Edema ; Fistula ; Follow-Up Studies ; Hemorrhage ; Humans ; Iliac Artery ; Laminectomy* ; Lower Extremity ; Male ; Sutures ; Transplants