Wound infection following biliary surgery. A prospective surgery

Biliary surgery in general, with cholecystectomy in particular, is probably the commonest major elective abdominal operation worldwide. A prospective study has been completed on 141 biliary operations in which intra-operative bile swabs were taken, and other risk factors for wound infection sought. Patients' characteristics were: males 51, females 90 (1:1.8); mean age 42.4 +/- 16 years; mean Quetelet index for adults was 32 +/- 5. The operations were: emergencies 10, simple-cholecystectomies 112, and choledochotomies (including other concomitant procedures) 29. The observed wound infection rates were: overall 7.8%, simple cholecystectomy 3.6% and choledochotomies 24.1%, figures which agree closely with the national and international literature. The infected patients consumed, on average, 7 days more in hospital than the uninfected ones. We found three major risk factors for wound infection: patients aged 40 years or older (over 4-fold), choledochotomy (over 6-fold), and microbiologically proven wound co-ntamination (9-fold). We conclude that, given the consistently low (less than 4%), incidence of wound infection following simple cholecystectomy, routine antibiotic prophylaxis in this subset is probably unjustified.     

A comparison of the effects of strength and aerobic exercise training on exercise capacity and lipids after coronary artery bypass surgery

BACKGROUND: Coronary artery surgery improves symptoms and prognosis in patientswith angina. Aerobic exercise rehabilitation improves exercisecapacity and prognosis in cardiac patients. Strength exercisetraining has not been extensively studied. DESIGN: We studied the effects of 6 months aerobic and strength exercisetraining after coronary artery surgery in 81 men, mean age 57years. RESULT: Treadmill time(s) increased by l30·3 (95% confidenceinterval 467·4 to 214·2) in the aerobic group;by 83·1 (0·9 to l65·3) in the strengthgroup, and by 34·3 (–1 to 69·6 in the controlgroup (P=0·04 control versus aerobic) after 3 months;and by l96·4 (112·2 to 280·7) in the aerobicgroup, by 122·7 (37·7 to 207·6) in thestrength group and by 27 (– 40·4 to 94·4)in the control group (P=0·002, control versus aerobic,and P=0·03 control versus strength) after 6 months. Thelevel of fitness improved more in the strengthtrained group,and there was a minor reduction in body weight and degree offatness. There were no changes in lipoprotein levels. Aerobicexercise training causes early and sustained benefit in treadmillexercise capacity, while the effects of strength exercise trainingare later in onset. Exercise training alone did not influencelipid levels. CONCLUSION: Cardiac rehabilitation programmes should be comprehensive, includingadvice on diet and other risk factor modifications in additionto exercise sessions involving aerobic and strength trainingelements.     

Increased Rate of Cholecystectomy after Introduction of Laparoscopic Cholecystectomy in Saudi Arabia

A rapid increase in the rate of cholecystectomy was reported in eastern Saudi Arabia between 1977 and 1986. The aim of this study was to determine whether the rate of cholecystectomy in the same region was still rising after the introduction of laparoscopic cholecystectomy. From 1987 to 1995 a total of 24 hospitals in eastern Saudi Arabia were surveyed using a questionnaire. During the 9-year study period, the rate of total cholecystectomy (open and laparoscopic) increased by 91%. Whereas the cholecystectomy rate decreased by 4% per annum from 1987 to 1990, it increased by 63.7% from 1991 to 1995 after the introduction of laparoscopic cholecystectomy. The increase in the rates of cholecystectomy was observed in all age groups and both sexes. Cholecystectomy was, however, most frequent among the age group 45–64 years followed by the age group 25–44 years. Young and female patients were more likely to undergo laparoscopic cholecystectomy than the open procedure. The rise in cholecystectomy rate deserves further evaluation with regard to the following: reasons for the increased rate of cholecystectomy, cholecystectomy-related morbidity and mortality, and the total costs of cholecystectomy.     

Survival of Burkitt's lymphoma patients in Ghana

Of 141 suspected cases of Burkitt''s lymphoma referred from all over Ghana between November 1965 and June 30, 1969, the diagnosis of Burkitt''s lymphoma was confirmed histologically in 60. This report deals with survival of all 50 treated and evaluable cases. The overall estimated long term survival rate was 38·5% calculated actuarially. It was 63·2% for Stage I (10 of 18); 20·0% for Stage II (2 of 10); and 25·4% for Stages III and IV combined (3 of 22), thus confirming the value of staging as a rough guide to prognosis. Six Stage I patients who died all had large tumors. These results have been compared with a similar study by Morrow et al. (1967) from Uganda.     

The current status of peritoneal drainage

It is hard to get physicians to give up their professional beliefs and alter their clinical practice. With simple cholecystectomy, the message must be a compromise: drainage is not necessary in most cases; but if one must use a drain, it must be the suction type, and removed within 48 hours. Peritoneal drainage may be used selectively after laparotomy for generalised peritonitis, but can be safely omitted after appendicectomy, colonic anastomosis, and splenectomy.