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 The new evidence will be noted in fluid therapy among 2012 SSC Severe Sepsis and Septic Shock Guideline update (unpublished).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

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

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

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

BACKGROUND : There is so different between Doctors at managing the patient with intestinal obstruction. Some prefer conservative management and prefer to delay the operation. But others prefer the early operation. So, we have studied in order to compare the clinical difference between early operation and delayed operation for intestinal obstruction. METHODS : This clinical report is based on a review of the records of 226 patients with intestinal obstruction that have been managed at the Department of General Surgery, Seventh Adventist Hospital in Seoul, during about 4 years from January, 1994 to October, 1997. RESULTS : 1) Male to female ratio was 2.32 : 1. The most frequent age group was within 1 year. 2) The common causes of intestinal obstruction were postoperative adhesion (35.8%), intussusception (19.1%), hernia (16.6%) and neoplasm (8.6%). 3) The chief complaints on admission were abdominal pain in 142 cases (62.8%), nausea and vomiting in 110 cases (48.7%), bloody stool in 43 cases (19.0%) and fever in 27 cases (11.9%). The physical findings were abdominal tenderness in 117 cases (51.8%), increased peristalsis in 98 cases (43.4%) and abdominal distension in 64 cases (28.3%). 4) The previous abdominal operation leading to intestinal obstruction were appendectomy in 16 cases (27.6%), small bowel operation in 13 cases (23.4%), gastro-duodenal operation in 9 cases (15.5%) and gynecologic operation in 7 cases (12.1%). 5) In patients who admit because of intestinal obstruction due to previous operation, most of them entered in hospital within 6months after previous operation. 6) Among 226 cases, 46 cases (20.4%) had emergency operation, 64 cases (28.3%) had only conservative treatment and 116 cases (51.3%) had elective delayed operation 7) In patients who was cured with only conservative management, 12 cases (18.8%) of them stayed for 1day on hospital and 32 cases (50%) of them stayed for 1 or 2 days. 8) Exploratory laparotomy was performed in 162 cases. The types of obstruction were composed of 36 cases (22.2%) of strangulated obstruction and 126 cases (77.8%) of simple obstruction. The frequency of strangulated obstruction was 14 cases (38.9%) when the early operation were done, and that ofstrangulated obstruction was 22 cases (61.1%) when the delayed operation were done. There was significant difference between early operation group and delayed operation. 9) As for operative procedure, adhesiolysis was done in 38 cases (23.5%), bandlysis was done in 30 cases (26.1%), manual reduction and incidental appendectomy was done in 28 cases (17.3%). 10) The incidence of postoperative complication was 46 cases (28.4%) and the most cause of death was septic shock. CONCLUSIONS : The early operation for the patient who suffered from intestinal obstruction due to previous operation is better than delayed operation.
Abdominal Pain ; Appendectomy ; Cause of Death ; Emergencies ; Female ; Fever ; Hernia ; Humans ; Incidence ; Intestinal Obstruction* ; Intussusception ; Laparotomy ; Male ; Nausea ; Peristalsis ; Postoperative Complications ; Seoul ; Shock, Septic ; Surgical Procedures, Operative ; Vomiting

PURPOSE: To assess the current status of endourology and laparoscopy in Korea. MATERIALS AND METHODS: Using the database directory of the Korean Urological Association, 83 urology training hospitals were identified. A detailed questionnaire was designed and sent by post and e-mail. The questionnaire included questions regarding the number of various endourological and laparoscopic procedures between 1998 and 2002. The questionnaires of those responding were analyzed. RESULTS: Responses were received from 45 hospitals (response rate 54.2%). 133 antegrade and 626 retrograde endourological procedures for urinary strictures were performed during the period of the study in 12 and 35 hospitals, respectively. 42 hospitals (93.3%) were performing shock wave lithotripsy for urinary stone disease. 29 hospitals (64.4%) reported having performed more than one laparoscopic procedure during the five years. The annual total numbers of laparoscopic procedures increased from 217 in 1998 to 725 in 2002. Simple laparoscopic nephrectomy was the most widely accepted procedure, and was being performed in 18 hospitals. Laparoscopic adrenalectomy, radical nephrectomy, diagnostic laparoscopy, laparoscopic renal cyst marsupialization, nephroureterectomy and donor nephrectomy were performed in more than 10 hospitals. However, the actual number of laparoscopic procedures was limited in most hospitals. More than 40 laparoscopic procedures per year were performed by only four hospitals. CONCLUSIONS: This survey revealed an increasing number of endourological and laparoscopic procedures. However, laparoscopy seems to be mainly a larger hospital-based technology in Korea. These results can be utilized as fundamental data for establishing future developmental requirements of endourology and laparoscopy in Korea.
Adrenalectomy ; Constriction, Pathologic ; Electronic Mail ; Endoscopy ; Humans ; Korea ; Laparoscopy* ; Lithotripsy ; Nephrectomy ; Surveys and Questionnaires ; Shock ; Surgical Procedures, Minimally Invasive ; Tissue Donors ; Urinary Calculi ; Urology*