Fluid therapy has been the focus of attention and dispute. In this paper, there are three aspects including postoperative bowel function, surgical prognosis, and acute diffuse peritonitis. Colloidal supplement and appropriate crystal/colloid ratio should be noted in low perfusion conditions. The different types of fluid in recent studies did not show a significant difference in the long term. The new evidence will be noted in fluid therapy among 2012 SSC Severe Sepsis and Septic Shock Guideline update (unpublished).
Digestive System Surgical Procedures ; Fluid Therapy ; Humans ; Perioperative Care ; Peritonitis ; therapy ; Prognosis ; Shock, Septic ; therapy

OBJECTIVEThis study was to develop a new method that can improve flap survival.

METHODSA long skin flap spanning the full length of the rat dorsum was used to make a bilateral skin tube, which was based on the lateral thoracic artery proximally, and the deep circumflex iliac artery distally. The animals were randomly divided into 3 groups of 8 rats in each group: the control and two experimental groups with elevation of the tube (the proximal pedicle divided) immediately or 24 hours following ischemic preconditioning. All tube flaps were observed for 3 days postoperatively and the surviving flap area was measured as a percentage of the whole flap using the paper template technique. Heat shock protein 70 in the three groups was examined by means of immunohistochemistry.

RESULTSThere was an overall statistical significance in comparison of flap survival of the preconditioned flaps with that of the controls. There was no statistical significance between the two preconditioned groups. Heat shock protein 70 (HSP70) was demonstrated immunohistochemically in the preconditioned skin flap but not in the control skin flap.

CONCLUSIONIschemic preconditioning can improve skin flap survival and the contents of HSP70. It is suggest that the mechanism be related to the function of HSP70.

Animals ; HSP70 Heat-Shock Proteins ; analysis ; physiology ; Immunohistochemistry ; Ischemic Preconditioning ; Male ; Rats ; Rats, Wistar ; Surgical Flaps

OBJECTIVETo evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock.

METHODSTwo hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perioperative periods in two groups were retrospectively analyzed.

RESULTSAll patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications.

CONCLUSIONOperative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experienced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.

Adult ; Blood Loss, Surgical ; Blood Transfusion ; Fallopian Tubes ; surgery ; Female ; Gynecologic Surgical Procedures ; methods ; Humans ; Laparoscopy ; Pregnancy ; Pregnancy, Ectopic ; surgery ; Pregnancy, Tubal ; surgery ; Shock ; etiology ; surgery

There are many cause of cholinesterase deficiency, including drugs, liver disease, chronic anemia, malignant states, cardiac failure, severe acute infection, surgical shock, severe burn, collagen disease and vasculitis syndromes. Vasculitis syndromes are relatively rare, and among them, Churg-Strauss syndrome (CSS) is even rarer. We report here on a case of a patient with CSS who underwent endoscopic sinus surgery under general anesthesia.
Anemia ; Anesthesia, General ; Burns ; Cholinesterases ; Churg-Strauss Syndrome ; Collagen Diseases ; Heart Failure ; Humans ; Liver Diseases ; Shock, Surgical ; Vasculitis

The author have experienced two cases of cardiac arrest during general anesthesia foroperation of total hysterectomy and cholecystectomy in the reserpinized patient. There are many influecning factors for cardiac depression during anesthesia, namely, excessive premedication, influence of potent therapeutic drugs used prior to anesthesia, overdose of general anesthetics, raised airway pressure, hemorrhage, surgical maneuvers, change in position or moving the patient, abnormalities of the circulatory system, septic shock, incompatible transfusion, and anaphylactic reaction. For the cases presented, I believe that prior antihypertensive agent was the causative factor. There are many preventive measures and treatment for cardiac depression in antihypertensive cured patient. However in such cases, I conclude that careful history taking and prompt recognition and attention are the most important precaution.
Anaphylaxis ; Anesthesia ; Anesthesia, General* ; Anesthetics, General ; Blood Loss, Surgical ; Cholecystectomy ; Depression ; Heart Arrest* ; Humans ; Hysterectomy ; Premedication ; Shock, Septic

A 4 years old Korean male child was presented with delay of regaining consciousness after general anesthesia for the correction of the right hand deformity and limitation of motion. In 1961 Frederich described the failure to regain consciousness after general anesthesia. 1.Hypoxia. 2. Excess of CO2.3. Anesthetic overdose, surgical shock, hypotension. 4. Miscellaneous factors: cerebro-vascular accidents, metabolic acidosis, hypoglycemia, uremia, hemorrhage, cerebral thrombosis, electrolyte imbalance. In this case, we believed that hypoxia was responsible for this complication.
Acidosis ; Anesthesia, General* ; Anoxia ; Cerebral Hemorrhage ; Child ; Child, Preschool ; Consciousness ; Hand Deformities ; Humans ; Hypoglycemia ; Hypotension ; Male ; Shock, Surgical ; Thrombosis ; Uremia

OBJECTIVETo explore the temperature change at the testis surface, apoptosis of spermatogenous cells and the expression of the heat shock protein 70 (HSP70) after scrotal reconstruction with the skin flap.

METHODSWe included 36 healthy New Zealand white rabbits, 24 males and 12 females, in this study, and equally randomized the males into an experimental and a control group. The scrotal of the experimental rabbits were excised and reconstructed with the hypogastric flap, while the controls were left untreated. At the end of the 8th week after surgery, 6 animals were randomly taken from each of the two groups for measurement of the testis surface temperature and testicular biopsy. The apoptosis of spermatogenous cells in the testis tissues was detected by HE staining, and the expression of HSP70 determined by immunohistochemistry and imaging analysis. The other 6 animals exempt from testicular biopsy in each of the experimental and control groups were mated with the female rabbits, and observed for fertility.

RESULTSAt the end of the 8th week after scrotal reconstruction, the testicular surface temperature was (38.1 +/- 0.6) degrees C in the experimental group, significantly higher than (36.0 +/- 0.30) degrees C before surgery (P < 0.05), and the apoptosis index (AI) of the spermatogenous cells was (71.85 +/- 2.7) %, as compared with (7.73 +/- 4.95) % in the control group (P < 0.05). The expression of HSP70 was found mainly in the spermatogenous cells of the experimental group and in the spermatoblasts of the control. A total of 6.0 +/- 1.3 baby rabbits were born in the control group, but none in the experimental group (P < 0.05).

CONCLUSIONThe testicular surface temperature rises after scrotal reconstruction with the hypogastric flap, which increases the apoptosis of spermatogenic cells and causes infertility. HSP70 is involved in protecting spermatogenic cells from apoptosis after scrotal reconstruction.

Animals ; Apoptosis ; Female ; HSP70 Heat-Shock Proteins ; metabolism ; Male ; Rabbits ; Scrotum ; surgery ; Spermatids ; cytology ; metabolism ; Surgical Flaps

BACKGROUND: Despite major advance in surgical techniques from open surgery to robot-assisted surgery, acute kidney injury (AKI) is still major postoperative complication in rectal surgery. The purpose of this study is to compare the incidence of postoperative AKI according to different surgical techniques and also the risk factors, outcomes of AKI in patients undergoing rectal cancer surgery. METHODS: A retrospective medical chart review was done in a total of 288 patients who received proctectomy because of rectal cancer from 2011 to 2013. RESULTS: The mean patient age was 62 ± 12 years, and male was 64.2%. Preoperative creatinine was 0.91 ± 0.18 mg/dL. Open surgery was performed in 9%, and laparoscopy assisted surgery or robot assisted surgery were performed in 54.8% or 36.1% of patients, respectively. AKI developed in 11 patients (3.82%), 2 (18%) of them received acute hemodialysis. Incidence of AKI was not different according to the surgical technique, however, the presence of diabetes, intraoperative shock, and postoperative ileus was associated with the development of AKI. In addition, AKI patients showed significantly longer hospital stay and higher mortality than non-AKI patients. CONCLUSION: Our study demonstrated that despite advances in surgical techniques, incidence of postoperative AKI remains unchanged and also that postoperative AKI is associated with poor outcome. We also found that presence of diabetes, intraoperative shock and postoperative ileus are strongly associated with the development of AKI. More careful attention should be paid on high risk patients for the development of postoperative AKI regardless of surgical techniques.
Acute Kidney Injury* ; Creatinine ; Humans ; Ileus ; Incidence ; Laparoscopy ; Length of Stay ; Male ; Mortality ; Postoperative Complications ; Rectal Neoplasms ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures ; Shock

A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte* ; Pneumonia ; Pneumonia, Aspiration* ; Shock, Septic ; Spine ; Vomiting

The current case describes a case of uterine rupture from placenta percreta in a woman who had only a single gynecologic surgery. We met the case of intrauterine fetal death (IUFD) with hemoperitoneum and found uterine rupture from placenta percreta by CT imaging. A 25-year-old woman was admitted to the emergency service for acute upper abdominal pain and severe hypotension at 33 weeks' gestation. She had undergone a single pelviscopic surgery due to cornual pregnancy 11 months previously. Ultrasonogram detected IUFD and hemoperitoneum. CT showed uterine rupture from placenta percreta. An emergency laparotomy was performed to correct the defect. The current case presents that placenta percreta can occur in a woman who had a single gynecologic surgery and clinicians should consider possible placenta percreta in diagnosing pregnant patients who present with acute abdominal pain and shock.
Abdominal Pain ; Adult ; Emergencies ; Female ; Fetal Death ; Gynecologic Surgical Procedures* ; Hemoperitoneum ; Humans ; Hypotension ; Laparotomy ; Placenta Accreta* ; Placenta* ; Pregnancy* ; Shock ; Ultrasonography ; Uterine Rupture*