Profile and predictors of bile infection in patients undergoing laparoscopic cholecystectomy

To study the bacteriological profile, and to determine predictors of bile infection and septic complications following laparoscopic cholecystectomy. This cross-sectional study reviewed 1248 laparoscopic cholecystectomy cases performed between January 1994 and December 2007 by one surgical team at the Jordan University Hospital, Amman, Jordan. Bile cultures were performed for all patients and statistical analysis was performed on culture results and postoperative complications as well as, on the possible predictors of bile infection including age, gender, associated diseases, preoperative retrograde cholangiopancreatography [ERCP], and indications for surgery. Uncomplicated gallstone disease was diagnosed in 993 patients [79.6%], 221 patients [17.7%] had acute cholecystitis, and 34 patients [2.7%] had jaundice. Associated morbidities were present in 513 patients [41.1%], preoperative ERCP was performed for 132 patients [10.6%], and postoperative septic complications developed in 25 patients [2%]. Bile culture was positive in 250 patients [20%], 134 [53.6%] of whom had Gram negative bacteria, 73 [29.2%] had Gram positive bacteria, and 43 [17.2%] had mixed cultures. The chi-square test has shown that positive bile culture is significantly associated with age, gender, preoperative ERCP, associated morbidities, and complicated gallbladder disease, whereas multinomial regression analysis has shown that age and preoperative ERCP were the only significant predictors of bile infection. Bile infection commonly complicates gallstone disease, and it can be influenced by age and preoperative endoscopic interventions, but it does not influence the occurrence of postoperative septic complications

Rupture of spleen post colonoscopy

We review an interesting case of elective colonoscopy for rectal bleeding in a 68-year-old woman complicated by splenic rupture. She was managed by aggressive fluid and blood resuscitation followed by splenectomy. She had a smooth recovery and was discharged home 4 days after admission. The extreme rarity and interesting clinical course of the patient are discussed

Duration of venous occlusion with lidocaine for preventing propofol induced pain

To study the effect of the venous occlusion duration using lidocaine on the incidence and severity of propofol induced pain. A prospective double-blind randomized study was designed at Jordan University Hospital, Amman, Jordan between October 2007 and November 2007. One hundred and fifty patients aged 14-70 years, American Society of Anesthesiologists [ASA] clinical status I and II who underwent elective surgeries under general anesthesia, were divided into 3 groups. All 3 groups had propofol 1% infusion at a constant rate after applying venous occlusion with lidocaine. The occlusion was applied for 15 seconds [group I, n=50], 30 seconds [group II, n=50] and 60 seconds [group III, n=50]. Pain was assessed during injection according to a verbal pain score. Fourteen patients 28% had pain in group I, compared to 16 patients 32% in group II, and 9 patients 18% in group III. This difference did not reach statistical significance p>0.05 for the incidence and severity of pain. While venous occlusion with lidocaine is an effective method in relieving propofol induced pain, we found no difference when the duration of venous occlusion was 15, 30, or 60 seconds

Assessing predictors of outcome in necrotizing fasciitis at Jordan University Hospital

Necrotizing fasciitis is a life threatening infection characterized by rapidly developing necrosis of the subcutaneous tissue and fascia with subsequent gangrene of the overlying skin. Necrotizing fasciitis [NF] is increasingly being diagnosed at Jordan University Hospital [JUH] with an apparent difference in the bacteriology of this disease. The aim of this study was to examine the presentation, etiology, course of the disease, treatment, and to identify the variables that are associated with high mortality. Information on the presentation, etiology, treatment, pathology and complications in all cases diagnosed with necrotizing fasciitis from January 1987 to January 1998 A total of 23 patients underwent surgical exploration for necrotizing fasciitis during the study period. Six variables identified that significantly increased the risk of death from necrotizing fasciitis: Age above 60 years, female sex, perineal location, delayed operative management, white blood cell count more than 30,000 cell per mm[3] and infection mainly with Gram negative [G-ve] bacteria species. This study suggests that necrotizing% fasciitis is a serious and potentially fatal infection particularly in old, female patients presenting with perineal infection, high WBC count, and Gram negative [G-ve] bacterial isolates. Early diagnosis, aggressive initial debridement and redebridement in addition to adequate nutritional support and antibiotics are the mainstay of treatment