The effect of surgical wound infection on postoperative hospital stay.

OBJECTIVE: To determine the effect of surgical wound infection on postoperative duration of hospital stay. DESIGN: A case-control study nested within a cohort. SETTING: A tertiary-care hospital. PATIENTS: Selected from a cohort of 4702 inpatients who underwent surgical procedures over a 12-month period. There were 3602 patients, 1100 having been excluded because of lack of infection associated with a particular surgical procedure, because of "lumping" of procedures under a nonhomogeneous heading or because a procedure was unlikely to be the reason for the patient's hospitalization. MAIN OUTCOME MEASURE: Postoperative duration of hospital stay. RESULTS: In the cohort 89 wound infections were identified, 73 of these occurring with procedures selected for study. Five patients were excluded from the study because of data deficiencies, leaving 68 patients who underwent 15 different procedures. These were compared with 136 control patients selected by stratified random sample from a list of patients who underwent the same risk-indexed procedure in the same surgical division. Wound infection patients and controls did not differ in anesthetic risk score or procedure duration. Patients with infection remained in hospital 19.5 days longer than controls (95% confidence interval, range from 11.0 to 27.9 days). Deep-seated infections prolonged the hospital stay more than superficial incisional infections (24.3 versus 13.2 days). CONCLUSIONS: Surgical wound infection markedly prolonged the duration of hospitalization in the University of Alberta Hospitals, longer than that documented in previous studies in other countries. Maximizing opportunities to prevent wound infection would be beneficial to both patients and hospitals.

The role of transrectal ultrasound (TRUS) in the evaluation of cancer of the prostate.

While TRUS is not of value as a screening tool, it is of considerable value in the early detection of cancer of the prostate in men with abnormal DRE and/or PSA. TRUS enables calculation of PSA density to identify men at low risk, thus eliminating many unnecessary biopsies. This results in favorable impact on both cost and morbidity. When biopsy is necessary, TRUS greatly enhances accuracy. Its role in staging is of less importance but can be useful when positive, and it adds little to the cost or complexity of the examination.

Aggressive bladder carcinoma in an adolescent. Report of a case with immunohistochemical, cytogenetic, and flow cytometric characterization.

Malignant bladder neoplasms of urothelial origin are rare among children; fewer than 125 cases have been reported. Typically, these tumors are single papillary lesions of low grade and stage that have an excellent prognosis following surgical excision. A grade III transitional cell carcinoma of the bladder occurred in a 14-year-old boy who had no urinary tract malformation, carcinogenic exposure, or family history of cancer. Immunohistochemical stains of the tumor were positive for cytokeratin and high-molecular-weight keratin. The tumor tissue failed to stain with an antibody to the patient's blood group [anti-ABO(H)] but was positive for the Thomsen-Frieden-reich antigen. Flow cytometry of the tumor cells demonstrated a diploid or near-diploid DNA content. A karyo-type of the tumor showed a modal chromosome number of 46 with one reciprocal translocation between chromosomes 17 and 22 and a nonreciprocal translocation between chromosomes 18 and 22. The tumor was unique because of its highly aggressive nature and its diploid chromosome number. This case represents the first indepth characterization of a transitional cell carcinoma in a pediatric patient by flow cytometry and cytogenetics, as well as a variety of immunohistochemical studies including ABO(H) blood group and Thomsen-Freidenreich antigens.