Bacteriological study of bile in patients with cholelithiasis

Objective: To determine the aerobic microbial flora in bile of patients having cholelithiasis

Methods: Study included seventy patients of cholelithiasis, out of which 56 [80%] underwent open cholecystectomy, while 14 [20%] were operated by laparoscopic cholecystectomy. Bile for culture was taken per operatively in all patients

Results: Mean age of patients was 44.17 +/- 13.20 and majority of patients were in age group 35- 72. Female to male ratio was 3.4: 1. Pain in right hypochondrium was major presenting feature in 65 patients [93%]. Mean pain duration was 26.21 +/- 23.44 months. Bile culture was positive in 25 [36%] patients.13 [62%] culture positive patients were diabetics. Postoperatively 7 patients [10%] developed fever while 4 patients [5.7%] developed wound infection

Conclusion: SThe frequency of positive bile culture in patients of cholelithiasis was 36%, in this series, commnest organisms being E. coli and Klebsiella. Wound infection 5.7% could have been due to endogenous or exogenous contamination. As all patients who developed wound infection were culture positive in this series, peri-operative antibiotic prophylaxis is recommended in patients undergoing biliary surgery

Role of C-reactive protein in diagnosis of acute appendants

Objective: the objective of this study is to determine the role of C-reactive protein in the diagnosis of acute appendicitis

Material and Methods: seventy patients with suspicion of acute appendicitis were collected for this study. The patients were collected on the basis of history, clinical examination and laboratory investigations. Operation was done in all patients and appendix was sent for histopathology. Histopathology was considered as gold standard

Results: the mean age of patients was 22.40+/-7.95 years. The mean C-reactive protein of the patients was 21.64+/-19.63?g/ml. There were 14.3% patients of C-reactive protein range of less than 6?g/ml and 85.7% patients of C-reactive protein range of more than 6?g/ml. In the histopathology findings, there were 94.3% patients of acutely inflamed appendix and 5.7% patients of normal appendix. The sensitivity was found to be 86%, specificity 91 %, and positive predictive value 86%, negative predictive value 87% and accuracy 89%

Conclusion: a normal pre-operative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal appendix. Deferring surgery in the patients would probably reduce the rate of unnecessary appendectomies