The Necessity of a Routine Interval Appendectomy Necessary in Adults?: Initial Experience

PURPOSE: The traditional management of a periappendiceal abscess or a perforated appendicitis has been initial conservative treatment, followed by an interval appendectomy (IA). However, the necessity of the interval appendectomy has been questioned by an increasing number of studies recently. The purpose of this study was to clarify the role of conservative treatment, instead of IA, in managing a perforated appendicitis or a periappendiceal abscess after successful initial conservative treatment. METHODS: We prospectively studied 26 out of 80 patients who had been admitted for a perforated appendicitis or a periappendiceal abscess to Chonbuk National University Hospital from March 2005 to December 2007. These 26 patients were initially treated by using conservative treatment instead of surgery. We analyzed these 26 patients' progression and prognosis after treatment. The IAs were conducted at intervals of 6 to 12 wk after colonoscopy when the patient wanted an operation. RESULTS: Twenty-three out of 26 (88.5%, 23/26) patients were improved after initial conservative treatment. Only 3 patients who were not improved were managed surgically. Four out of 23 patients who were relieved by conservative treatment underwent an IA voluntarily at intervals of 6 to 12 wk. Of the remaining 19 patients without IA, 1 patient (5%, 1/19) suffered a recurrence after 6 mo, and an appendectomy was performed. Eighteen (78%, 18/23) patients without an IA have shown no recurrence for 15 mo, and they are still being followed up. CONCLUSION: We conclude that a routine IA after successful initial conservative treatment for a perforated appendicitis or a periappendiceal abscess seems unnecessary. Those patients should undergo colonoscopy to detect any underlying diseases and to rule out coexistent colorectal cancer.

Pulmonary Embolism after Spinal Anesthesia Induction for the Surgical Reduction of a Femur Neck Fracture: A case report / 대한마취과학회지

This case involved a pulmonary thromboembolism, which originated from the lower extremity. A 68-year-old female, with a femur neck fracture, underwent spinal anesthesia with 0.5% heavy bupivacaine 11 mg for total hip arthroplasty. Ten minutes after the induction of spinal anesthesia, dyspnea, tachycardia and hypotension appeared. Under the impression of a pulmonary embolism, intubation was done and dopamine and epinephrine were infused. The operation stopped and she was sent to the intensive care unit. On the spiral CT chest angiogram, a pulmonary embolism was found. Deep venous thrombosis was detected in the left lower extremity on the venogram. Heparin therapy was started at a rate of 800 U/hour with a bolus of 5000 U. A consultative operation for the removal of deep vein thrombosis was performed by a chest surgeon, and total hip arthroplasty was performed successfully under spinal anesthesia.

The Amount of Blood Use and Reorganization of Maximal Surgical Blood Order Schedule (MSBOS) in Elective surgery / 대한수혈학회지

BACKGROUND: Overpreparation of Red Blood Cells for elective surgery causes problems, such as returning of blood, inefficient task of the blood bank and waste of blood resources. At The National Medical Center, Maximal Surgical Blood Order Schedule(MSBOS) was organized for the first time in 1994. Recently, blood use is decreased as various transfusion side effects become known, and operation technique and anesthetic methods develop. As a result, we try to revise MSBOS investigating RBC utilization for elective surgery in 2002. METHODS: We investigated RBC utilization for elective surgery, the number of transfused patient, mean blood amount of all patient having been operated in. It was accomplished by referring to anesthesiologic records and blood delivery sheet at The National Medical Center during the 12 months from January through December in 2002. Average number of transfused units per patient of each operation was selected for MSBOS. RESULTS: For one year, the total number of surgery was 3,204, and transfusion was done in 1095 cases of surgery. Average transfusion rate is 34.4%. In 8 kinds of surgery(275 case, 9.3%), average amount of transfusion was under 0.5 unit and Type and Screen(T&S) is transduced for the elective surgery. Except for Cesarean section(C/S), blood use is decreased significantly, compared with the MSBOS organized at 1994. CONCLUSION: We could revise the guidelines for ordering blood on the basis of above results. And MSBOS should be revised at regular intervals, which can decrease blood disuse and medical cost.