Autonomic neuropathy in type 1 juvenile-onset diabetes mellitus

Thirty five juvenile-onset type1 diabetic children and fifteen control matching subjects had their autonomic nervous system assessed using four autonornic function tests. The diabetics had an average age of 12.8 years and their mean duration of diabetes mellitus since diagnosis was 33 months. They showed a significantly higher resting heart rate and a significant drop in systolic and diastolic blood pressures upon standing compared to the control. Patients who featured autonomic and peripheral nerve dysfunction showed higher significant changes in the blood pressure and heart rate response to standing tests. The duration of diabetes mellitus showed linear correlation to the presence of autonomic symptoms. The tests may help in the assessment of diabetic patients and their management

Conservative one-stage surgery for spontaneous biliaryenteric fistula

A one-stage conservative surgical procedure for 27 patients with spontaneous biliary-enteric fistula is presented. Seventeen cases were secondary to cholelithiasis and 10 due to chronic duodenal ulcer. There were 13 males and 14 females. Their ages ranged between 45 and 75 years for the biliary group with an average of 57 years, while for the peptic ulcer group the ages ranged between 27 and 65 years with an average of 49 years. The type of the fistula was cholecysto-duodenal in 19 cases, choledocho-duodenal in six cases, one cholecysto-colic, and one cholecysto-duodeno-colic. The surgical management consisted of closure of the enteric end of the fistula together with definitive treatment of the underlying pathology in a one-stage surgical procedure. The surgery included cholecystectomy and dealing with the pathological common bile duct, for the biliary cases, together with vagotomy and pyloroplasty for the peptic ulcer group. There was no mortality and the operative morbidity was low so that we may conclude that the procedures were safe and effective for spontaneous biliary-enteric fistulae

Post-operative antibiotic coverage in gastro-intestinal and biliary surgery

The effect of post-operative antibiotics on wound infection is studied in a prospective clinical trial. Four commonly used antibiotic regimens were used on patients undergoing surgical operations on the G.I.T. and biliary system. 230 patients were included and the results compared with a control group. The regimens used were Cephalothin, Ampicillin with Cloxacillin, Gentamycin, and Gentamycin with Metronidazole. There were 122 males and 108 females. Age ranged between 4 and 80 years with an average of 45 years. The total wound infection rate of antibiotic group was 7.7% compared to 8.1% of the control, which was not statistically significant [P>0.05]. Biliary operations were associated with more wound infections than G.I.T. operations. In all 72% of wound infections were minor in degree, and 50% were delayed in onset. In conclusion antibiotics given post-operatively have no true benefit in reducing the incidence of wound infection