The British journal of surgery
-
Oral mannitol has been widely accepted as the bowel preparation of choice for colonoscopy and elective colorectal operation because it is well tolerated by patients. Recent concern has been expressed regarding the risk of explosion and sepsis using oral mannitol because it may provide a nutrient for certain gas-producing bacteria in the colon. ⋯ Significantly higher counts of gas-producing Escherichia coli were recovered from patients prepared with mannitol alone compared with whole bowel irrigation or mannitol preceded by oral antimicrobials. These data are consistent with the hypothesis that fermentation of mannitol by Escherichia coli is responsible for the production of potentially explosive gas mixtures after oral mannitol preparation and may also explain the increased incidence of sepsis when oral mannitol is used for bowel preparation.
-
In order to correlate the haematological changes which occur after splenectomy, with the presence or absence of residual splenic tissue, spleen scans using 99Tcm-labelled red blood cells were performed in 36 patients who had had a splenectomy. Positive spleen scans were found in 44 per cent (8 out of 18) of patients who had undergone splenectomy for trauma and in 17 per cent (3 out of 18) of patients who had undergone elective splenectomy. No relationship was found between the presence of Howell-Jolly bodies, platelet counts, the levels of IgG, IgM and IgA and the scan result. It is concluded that these findings are due to the presence of splenunculi, whose incidence is more common than the 12 per cent usually quoted.
-
Randomized Controlled Trial Clinical Trial
The effect of topical povidone iodine on wound infection following abdominal surgery.
The effect of povidone iodine on wound sepsis following gastrointestinal surgery was studied in a trial involving 153 patients of whom 72 had their wounds sprayed with povidone iodine dry powder (Disadine DP) and 81 acted as a control group. The infection rate of 9.9 per cent in the patients treated with povidone iodine was significantly lower than that of 24.4 per cent in the control group (P less than 0.05). ⋯ However, spraying of contaminated wounds with povidone iodine reduced the infection rate to the significantly lower level of 11 per cent (P less than 0.05). We conclude that povidone iodine is a safe and effective means of reducing wound sepsis following gastrointestinal surgery.
-
Comparative Study
A low volume burn resuscitation regimen: assessment of performance by probit analysis.
The findings are presented of a 10-year retrospective review of burn admissions to the Wessex Regional Burn Centre, where a low volume colloid resuscitation regimen is employed. An analysis of mortality probability has been conducted using probit analysis, and the areas of burn injury associated with a 50 per cent mortality probability (LA50) were determined for four different age groups. ⋯ The figures obtained parallel closely those reported from another large burn centre in the United Kingdom where a widely different fluid regimen is used. The results of this analysis suggest that wide variations in fluid resuscitation regimens, particularly with regard to volume, do little to affect the mortality associated with burn injury as assessed by probit analysis.
-
Two cases are reported of gallstone ileus complicating terminal ileal Crohn's disease. Both patients had a prolonged history of Crohn's disease without the need for surgical intervention. They were admitted with small bowel obstruction which failed to resolve on conservative management as is usually the case. The features of these two cases that may lead to the development of this complication and the pointers in diagnosis are discussed.