SUMMARY -Th e aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. Th is prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. Th e secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization. Intermediate outcomes included patient satisfaction, time out of bed, rate of side eff ects and postoperative complications, and time of discharge. Recovery of postoperative ileus occurred sooner (p<0.001) and resumption of dietary intake was achieved earlier (p<0.001) in TEA group. Intensity of pain during the first 3 postoperative days was significantly lower at rest, on coughing and during mobilization (p<0.001), and mobilization was much more effi cient (p<0.005) in TEA than in IV-PCA group. Satisfaction scores were better in TEA group (p<0.001). Nausea, sedation and postoperative delirium occurred less frequently in TEA group (p<0.05, p<0.001 and p<0.05, respectively). TEA demonstrated significantly better eff ectiveness than IV-PCA after open colorectal cancer surgery and had a positive impact on bowel function, dietary intake, patient satisfaction and early mobilization. Th e results of this study demonstrated the importance of implementation of TEA as a preferred method for postoperative pain control after major open colorectal surgery.

Based on skeleton examination, cave-paintings and mummies the study of prehistoric medicine tells that the surgical experience dated with skull trepanning, male circumcision and warfare wound healing. In prehistoric tribes, medicine was a mixture of magic, herbal remedy, and superstitious beliefs practiced by witch doctors. The practice of surgery was first recorded in clay tablets discovered in ancient rests of Mesopotamia, translation of which has nowadays been published in Diagnoses in Assyrian and Babylonian Medicine. Some simple surgical procedures were performed like puncture and drainage, scraping and wound treatment. The liability of physicians who performed surgery was noted in a collection of legal decisions made by Hammurabi about the principles of relationship between doctors and patients. Other ancient cultures had also had surgical knowledge including India, China and countries in the Middle East. The part of ancient Indian ayurvedic system of medicine devoted to surgery Sushruta Samhita is a systematized experience of ancient surgical practice, recorded by Sushruta in 500 B.C.E. Ancient Indian surgeons were highly skilled and familiar with a lot of surgical procedures and had pioneered plastic surgery. In the ancient Egyptian Empire medicine and surgery developed mostly in temples: priests were also doctors or surgeons, well specialized and educated. The Edwin Smith Papyrus, the world’s oldest surviving surgical text, was written in the 17th century B.C.E., probably based on material from a thousand years earlier. This papyrus is actually a textbook on trauma surgery, and describes anatomical observation and examination, diagnosis, treatment, and prognosis of numerous injuries in detail. Excavated mummies reveal some of the surgical procedures performed in the ancient Egypt: excision of the tumors, puncture and drainage pus abscesses, dentistry, amputation and even skull trepanation, always followed by magic and spiritual procedures. Various types of instruments were innovated, in the beginning made of stone and bronze, later of iron. Under the Egyptian influence, surgery was developed in ancient Greece and in Roman Empire. Prosperity of surgery was mostly due to practice in treating numerous battlefield injuries. Records from the pre-Hippocrates period are poor, but after him, according to many writings, medicine and surgery became a science, medical schools were formed all over the Mediterranean, and surgeons were well-trained professionals. Ancient surgery closed a chapter when Roman Empire declined, standing-by up to the 18th century when restoration of the whole medicine began

PurposeTo describe data on epidemiology, microbiology, clinical characteristics and outcome of adult ICU patients with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS ) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (<2 hours), 'urgent' (2-6 hours), and 'delayed' (>6 hours). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and [95% confidence interval]. ResultsThe cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs . 61.3%, p=0.102). A stepwise increase in mortality was observed with increasing SOFA scores (19.6% for a value £4 to 55.4% for a value >12, p<0.001). The highest odds of death were associated with septic shock .00]), late-onset hospital-acquired peritonitis ) and failed source control evidenced by persistent inflammation at Day 7 ). Compared with 'emergency' source control intervention (<2 hours of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality ). Conclusions 'Urgent' and successful source control were associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome.

Background: Rectal cancer treatment has been dramatically improved during the last two decades in terms of a lower local recurrence rate and prolonged survival. This improvement was achieved mainly due to a better surgical technique (implementation of a total mesorectal excision-TME) and neoadjuvant chemo and radio therapy. A more radical approach to abdominoperineal excision, extralevator abdominoperineal excision technique in the prone Jackknife position, may improve the oncological outcome. The aim of this study is to show our early experience by using extralevator abdominoperineal excision. Methods: Extralevator abdominoperineal excision has been used routinely at Oncology Institute of Vojvodina since 2011. In the last 23 months, we had 11 operations. Clinical and pathological data were obtained from operative protocols, histopathological data and patients’ medical history. Results: An audit of results showed reduced rate of intra-operative perforations and circumferential resection margin involvement. Late postoperative complications have occurred in two patients, sexual dysfunction in one and pelvic pain in the other. The follow up period is too short (min 2 months, max 23 months, median 8 months) for analysis of local recurrence. Conclusion: Extralevator abdominoperineal excision, with the emphasis on the perienal dissection and prone Jackknife position, may help achieve the goals of radical resections for low rectal cancer. This technique could be associated with less intra-operative perforations and circumferential resection margin involvement

Retroperitoneal liposarcoma is a rare type of tumor characterized by slow growth and nonspecific symptoms, and is usually diagnosed at an advanced stage. Patients with huge retroperitoneal liposarcoma have a high risk of developing perioperative complications, and require special preoperative preparation and a carefully planned anesthetic approach. We present the case of a 57-year-old man, who was diagnosed with a huge retroperitoneal liposarcoma, 70 cm in diameter, weighing 30.4 kg and planned for surgical resection of the tumor under general anesthesia. Perioperative treatment and anesthesia for this patient were a great challenge for the anesthesiologist. However, due to preoperative preparation, monitoring and fluid replacement, hemodynamic and respiratory stability of the patient was maintained perioperatively.