Does the type of resuscitative fluid affect healing of colonic anastomosis in experimentally induced hemorrhagic shock in rats?

The aim of the study was to investigate the effects of different resuscitative fluids on the healing of intestinal anastomosis in a hemorrhagic-shock rat model. Closed-colony Wistar male rats [n = 40; 8 rats per group] were subjected to volume-controlled hemorrhagic shock, followed by a 30-min shock phase. The animals were then resuscitated with one of the following fluids [which also corresponds to their respective groups]: lactated Ringer's solution [LR], hydroxyethyl starch [HES], 7.5% hypertonic saline [HS] and autologous blood [AB]. There was also a control group [CL], which did not experience hemorrhagic shock or receive any resuscitative fluids. All rats underwent laparotomy, segmental resection and anastomosis of the left colon. Five days later, a 2nd laparotomy was performed and the anastomotic bursting pressure was measured in vivo. Thereafter, the anastomosed segment was resected to measure the tissue hydroxyproline level and the grade of anastomotic fibrosis. All experimental groups [LR, HES, HS and AB] exhibited lower anastomotic bursting pressures than the CL group; however, nointergroup differences achieved statistical significance. The mean tissue hydroxyproline level and fibrosis grade also were similar across all 5 groups. In traumatic hemorrhagic shock, anastomosis safety does not appear to be affected by the type of fluid used for resuscitation. Moreover, LR, HES and HS all seemed to reinforce healing as effectively as transfused blood

comparison of different hemorrhoidectomy procedures

To evaluate the pain level, analgesic consumption, operation time, bleeding and early complications after open and closed hemorrhoidectomy using a harmonic scalpel [HS] and classical methods. Between January 2005 and January 2006, 87 patients with grade III-IV hemorrhoids, admitted in General Surgery Clinic, Gulhane Military Medical Academy, Ankara, Turkey were enrolled in the study. They were randomized into open HS [n=22], closed HS [n=22], Miligan Morgan [n = 22], and Ferguson [n = 21] hemorrhoidectomy. Patients were evaluated for postoperative pain, painkiller consumption, bleeding and operation time. Bleeding volume was significantly lower in Groups I-II [p < 0.001]. Operation time was significantly shorter in Group I [p < 0.001]. Postoperative pain and pain at the time of first defecation, was significantly lower in Groups I-III [p < 0.001] compared with the other 2 groups and lower during days 2-6 in Group I compared to the Group III [p < 0.004]. Visual Analogue Scale results were similar in Groups II and IV. Analgesic consumption in Groups I-III was significantly lower than Groups II-IV [p < 0.001]. Oral analgesic consumption during 2-5 postoperative days was lower in Group I than in Group III [p < 0.007] and similar in closed hemorrhoidectomy group. The use of HS in hemorrhoidectomy reduces postoperative pain, analgesic consumption, operation time, and bleeding. Harmonic scalpel hemorrhoidectomy is an effective, comfortable, and safe procedure. Use of suture in hemorrhoidectomy is a major cause of postoperative pain