Role of postoperative antibiotics after appendectomy in non-perforated appendicitis

To determine the role of postoperative antibiotics in reducing the surgical site infections [SSIs] after open appendectomy in patients with non-perforated appendicitis [NPA]. Randomized controlled trial. The Department of Surgery, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, from January 2010 to July 2011. Three hundred and seventy seven patients, who underwent appendectomy for NPA and fulfilled the selection criteria, were randomized into two groups. The patients in group A received a single dose of pre-operative antibiotics [cefuroxime sodium and metronidazole], while the group B patients received one more dose of the same antibiotics postoperatively. Patients of both the groups were followed-up for 30 days to assess the postoperative infective complications. Group A had 195, while group B comprised of 182 patients. The groups were comparable in the baseline characteristics. Statistically there was no significant difference in rates of SSIs between both the groups [p = 0.9182]. Mean hospital stay was 2.29 +/- 0.81 and 2.35 +/- 0.48 days for group A and B respectively [p = 0.4403]. None of the patients developed intraabdominal collection. Single dose of pre-operative antibiotics [cefuroxime and metronidazole] was sufficient in reducing the SSIs after appendectomy for NPA. Postoperative antibiotics did not add an appreciable clinical benefit in these patients

Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost Gallstones

Laparoscopic Cholecystectomy [LC] is associated with a significant risk of gallbladder perforation with spillage of bile and stones into the peritoneal cavity. The retrieval of the spilled stones is not always possible by laparoscopic technique. Majority of these cases do not have any problem in future but sometimes the lost stones lead to serious complications. The authors present a case of lost gallstones, which resulted into an abdominal wall abscess and discharging sinus 9 years after LC. This late presentation is among the very few reports after LC. Risk factors for gallbladder perforation, various techniques to avoid spillage of stones, possible complications and their management is discussed

Trend of Low Serum Vitamin B[12] in Jordanian Adults from Two Ethnic Groups in Amman

To investigate the prevalence of vitamin B[12] deficiency in Jordanian adults from two ethnic groups in Amman. The plasma B[12] level was measured in 290 subjects [124 men, 166 women, aged 16-72] from two ethnic groups; Circassians and Arabs. These participants were recruited by simple random sampling from both communities from June 2004 to March 2005. The prevalence of vitamin B[12] deficiency [B[12] level lower than 200 pg/ ml] was 50.8 and 46.9% in Arab and Circassians, respectively. No significant differences in the plasma B[12] level were found between the different age groups in Arabs and Circassians and between the same age groups of the two populations. One notable exception was the subjects who are older than 60 years in Circassians. Their plasma B[12] levels were significantly lower than those in the other age groups in Circassians and the same age group in Arab [P<0.05]. There were differences in the plasma B[12] level according to gender; the plasma B[12] levels for men were lower than those obtained for women in both groups. This difference was significant [P<0.001] for Arab population. Compared to Circassian men, the plasma B[12] levels of Arab men were also significantly lower [P< 0.001]. The plasma B[12] level was significantly lower in smokers compared to non-smokers in both groups [P<0.005]. The current study demonstrates the high prevalence of suboptimal cobalamin levels in Jordanian subjects living in Amman, and it shows that there are no differences in the prevalence as related to the two ethnic groups studied

Management of complicated gallstone disease during pregnancy

Controversy still exists regarding the optimal management of complicated gallstrones during pregnancy owin to the possible risks for the fetus. Generally the management of such problems during pregnancy is conservative, however, endoscopic retrograde cholangiopancreatography [ERCP] and/ or operative intervention may be required in some patients. Aim of Study: The aim is to evaluate the management of complicated gallstone disease with particular reference to the indications, timing and risks of ERCP and operative intervention during pregnancy and its effect on fetus outcome. Patients and methods: This retrospective study was conducted on 32 pregnant women, who were admitted with complication of cholelithiasis at Riyadh Medical complex [RMC] through the emergency during the period of March 1998-October 2002. Their files were evaluated for age, hematological, radiological, fetus assessment, management, fetus outcome and how ERCP and surgery were performed. Among the 32 pregnant women studies, 22 responded satisfactorily to conservative treatment. They had laparoscopic cholecystectomy [LC] after delivery. Ten patients needed further treatment, two were operated for acute cholecystitic [AC] and recurrent biliary colic [BC]. Eight patients had ERCP for obstructive jaundice and recurrent pancreatitis following which two had LC cholecystectomy. All patients remained well until delivery. Majority of gallstone complications during pregnancy can be managed conservatively. Surgery can be deferred until delivery. few patients who needed ERCP and/ or surgery can be managed safely during second and third trimester

Haemodialysis - associated septecaemia: Incidence, causes and outcome

The aims of this study were to investigate the incidence, causes, associated conditions, outcome and therapy of hemodialysis-associated septicaemia. The files of all 61 haemodialysis patients who developed septicaemia from 01.01.2000 to 31.12.2001 were studied. The following parameters were analyzed - age, gender, vascular access lifespan, type of access, causative organism, therapy, salvage or loss of vascular access, mortality, Kt/V, haemoglobin, albumin, underlying cause of renal failure, need for hospitalisation and duration on dialysis. Patients who did not develop septicaemia over the same period acted as controls. There were 78 episodes of septicaemia in 61 patients. The overall annual incidence of septicaemia was 14%. The annual incidence differs accordingly to type of vascular access, being 2.8% for arteriovenous fistula [AVF], 35% for permanent catheter [PC], 42.5% for jugular catheter [JC] and 100% for femoral catheter [FC]. The commonest causative organism was staphylococcus species [52.6%] followed by pseudomonas [10%] and acinobacter [4%]. Haemoglobin and albumin levels were lower in the septicaemic group but this did not reach statistical significance. However, there were statistically significant differences in Kt/V [P>. 0003], presence of diabetic nephropathy [P>. 050], catheter vs. AVF [P>. 0001]. No difference could be noted in relation to age or sex. The duration on dialysis was significantly greater in the control group [47.7 months vs. 17.8 months>.005]. The mortality rate was 6.5%, the hospitalisation rate was 48.7% and 56.4% of the access catheter were preserved. Seventy-five percent of the patients who died were diabetic [compared to 38% in those who survived]; their mean age was 57.7 years compared to the mean age of the whole group of 52.5 years. The mean duration on dialysis was 3.1 months compared to 17.8 months in the surviving patients. The therapy consisted of vancomycin alone in 45 episodes, vancomycin based in 14 episodes, gentamycin alone in 6 episodes and others in 11 episodes. Septicaemia is common in haemodialysis patients. It is particularly common when catheter accesses are used. Staphylococcus species is the commonest causative organism. Early aggressive therapy with vancomycin with or without gentamycin reduces the mortality, morbidity and access loss