ABSTRACT
AIM: The purpose of this study was to determine if bowel preparation influences outcomes in patients with inflammatory bowel disease undergoing surgery. METHODS: The database of the American College of Surgeons National Surgical Quality Improvement Program, Procedure Targeted Colectomy, from 2012 to 2014 was analyzed. Inflammatory bowel disease patients undergoing colorectal resection with or without bowel preparation were included in the study. RESULTS: In all, 3679 patients with inflammatory bowel disease were identified. 42.5% had no bowel preparation, 21.5% had mechanical bowel preparation only, 8.8% had oral antibiotic bowel preparation only and 27.2% had combined mechanical and oral antibiotic preparation. Combined mechanical and oral antibiotic preparation is associated with lower rates of anastomotic leak, ileus, surgical site infection, organ space infection, wound dehiscence and sepsis/septic shock. CONCLUSION: Combined mechanical and oral antibiotic preparation for inflammatory bowel disease patients undergoing colectomy is associated with decreased rates of surgical site infection, anastomotic leak, ileus. Combined bowel preparation should be the standard of care for inflammatory bowel disease patients undergoing colorectal resection.
Subject(s)
Antibiotic Prophylaxis/methods , Cathartics/therapeutic use , Colectomy/methods , Inflammatory Bowel Diseases/surgery , Preoperative Care/methods , Adult , Anti-Bacterial Agents/therapeutic use , Colectomy/adverse effects , Databases, Factual , Female , Humans , Male , Middle Aged , Postoperative Complications/etiology , Retrospective Studies , Treatment OutcomeABSTRACT
C5 nerve root palsy is a rare and potentially debilitating complication of cervical spine surgery. Currently, however, there are no guidelines to help surgeons to prevent or treat this complication. We carried out a systematic review of the literature to identify the causes of this complication and options for its prevention and treatment. Searches of PubMed, Embase and Medline yielded 60 articles for inclusion, most of which addressed C5 palsy as a complication of surgery. Although many possible causes were given, most authors supported posterior migration of the spinal cord with tethering of the nerve root as being the most likely. Early detection and prevention of a C5 nerve root palsy using neurophysiological monitoring and variations in surgical technique show promise by allowing surgeons to minimise or prevent the incidence of C5 palsy. Conservative treatment is the current treatment of choice; most patients make a full recovery within two years.
Subject(s)
Brachial Plexus Neuropathies/epidemiology , Cervical Vertebrae/injuries , Decompression, Surgical/adverse effects , Spinal Nerve Roots/injuries , Brachial Plexus Neuropathies/prevention & control , Decompression, Surgical/methods , Female , Humans , Intraoperative Complications/epidemiology , Intraoperative Complications/prevention & control , Intraoperative Neurophysiological Monitoring , Laminectomy/adverse effects , Male , Ossification of Posterior Longitudinal Ligament/epidemiology , Postoperative Complications/epidemiologyABSTRACT
Hereditary hemochromatosis (HH), an autosomal recessive disease of iron overload, is one of the most common inherited diseases. The candidate gene (HFE) for HH has been identified recently and a DNA-based test for the mutation is available. Treatment for HH patients with elevated iron stores include repeated phlebotomy. Left untreated, iron overload can lead to cirrhosis, organ failure, and a shortened life expectancy. In the past and present, blood collected for therapeutic purposes from patients with HH has been discarded. The aim of this article is to address whether blood collected from HH patients should be used for allogeneic transfusion in the future.
