Systemic versus Oral and Systemic Antibiotic Prophylaxis (SOAP) study in colorectal surgery: prospective randomized multicentre trial.

BACKGROUND: There is no consensus regarding the role of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OABP) in reducing postoperative complications in colorectal surgery. The aim of this study was to examine the effect of OABP given in addition to MBP in the setting of a prospective randomized trial. METHODS: Patients awaiting elective colorectal surgery in four Hungarian colorectal centres were included in this multicentre, prospective, randomized, assessor-blinded study. Patients were randomized to receive MBP with or without OABP (OABP+ and OABP- groups respectively). The primary endpoints were surgical-site infection (SSI) and postoperative ileus. Secondary endpoints were anastomotic leak, mortality, and hospital readmission within 30 days. RESULTS: Of 839 patients assessed for eligibility between November 2016 and June 2018, 600 were randomized and 529 were analysed. Trial participation was discontinued owing to adverse events in seven patients in the OABP+ group (2.3 per cent). SSI occurred in eight patients (3.2 per cent) in the OABP+ and 27 (9.8 per cent) in the OABP- group (P = 0.001). The incidence of postoperative ileus did not differ between groups. Anastomotic leakage occurred in four patients (1.6 per cent) in the OABP+ and 13 (4.7 per cent) in the OABP- (P = 0.02) group. There were no differences in hospital readmission (12 (4.7 per cent) versus 10 (3.6 per cent); P = 0.25) or mortality (3 (1.2 per cent) versus 4 (1.4 per cent); P = 0.39). CONCLUSION: OABP given with MBP reduced the rate of SSI and AL after colorectal surgery with anastomosis, therefore routine use of OABP is recommended.

Surgical Aspects of Intraductal Papillary Mucinous Neoplasms of the Pancreas.

Intraductal papillary mucinous neoplasms (IPMN) play an important role mongst exocrine tumours of the pancreas due to several causes. Although they count for only 1% of all the tumours, they represent some 20-30% of all cystic neoplasms, a histologically defined group that has gained a lot of attention lately. IPMNs of the main or the secondary (branch) pancreatic ducts have remarkably different rates of malignant transformation, prognosis and thus indication for surgery. Prognosis of a ductal carcinoma developing from IPMN does not differ from classic ductal adenocarcinoma, with a very poor (10%) 5-year survival rate. However, prognosis of IPMN can still be regarded favourable, because the above rate can be as high as 70% if the tumour is non-invasive. This fact leads to the importance of diagnosing and resecting IPMN before its malignant transformation into an invasive carcinoma.

Predicting acute appendicitis? A comparison of the Alvarado score, the Appendicitis Inflammatory Response Score and clinical assessment.

BACKGROUND: Patients presenting with suspected appendicitis pose a diagnostic challenge. The appendicitis inflammatory response (AIR) score has outperformed the Alvarado score in two retrospective studies. The aim of this study was to evaluate the AIR Score and compare its performance in predicting risk of appendicitis to both the Alvarado score and the clinical impression of a senior surgeon. METHODS: All parameters included in the AIR and Alvarado scores as well as the initial clinical impression of a senior surgeon were prospectively recorded on patients referred to the surgical on call team with acute right iliac fossa pain over a 6-month period. Predictions were correlated with the final diagnosis of appendicitis. RESULTS: Appendicitis was the final diagnosis in 67 of 182 patients (37 %). The three methods of assessment stratified similar proportions (~40 %) of patients to a low probability of appendicitis (p = 0.233) with a false negative rate of <8 % that did not differ between the AIR score, Alvarado score or clinical assessment. The AIR score assigned a smaller proportion of patients to the high probability zone than the Alvarado score (14 vs. 45 %) but it did so with a substantially higher specificity (97 %) and positive predictive value (88 %) than the Alvarado score (76 and 65 %, respectively). CONCLUSIONS: The AIR score is accurate at excluding appendicitis in those deemed low risk and more accurate at predicting appendicitis than the Alvarado score in those deemed high risk. Its use as the basis for selective CT imaging in those deemed medium risk should be considered.

[The therapeutic significance of bronchial suction-drainage in infants]. / Die therapeutische Bedeutung der Bronchus-Saugdrainage im Säuglingsalter

Bronchial suction-drainage in infants--according to our observations--is a life-saving procedure in cases of aspiration, severe bronchitis and retention of bronchial secretion. It can also be very effective in atelectasis, bronchopneumonia and pulmonary abscess. The earlier the drainage the quicker the clearing up of the atelectasis. An additional indication for performing bronchial suction in severe lower respiratory tract infections is to gagain secretion for bacterial culture. This is especially important in the Gram negative and Staphylococcus infections of young infants. The right upper pulmonary lobe is the most common localisation for atelectasis and pneumonia in this age group. One possible explanation for this could be that malformed bronchi are more frequently found in the right than in the left upper lobe. It is such a characteristical phenomenon in infancy that we called it "the right upper lobe syndrome".

[Otitis media in premature infants]. / Mittelohrentzündung bei frühgeborenen Säuglingen

From the 253 infants admitted to the praemature unit of the Department of Pediatrics, University of Pécs in 1971 87 showed signs of respiratory tract infection. 44 of these babies suffered from otitis media diagnosed by means of tympanal suction-drainage. This reliable diagnostic method is completely harmless and less traumatic than paracentesis. We have isolated Gram negative bacteria from the tympanal secretion in three quarters of the cases Bacterial culture proved to be negative in only two infants. We should like to stress that tympanal suction drainage--apart from its good therapeutic effect--is also beneficial to the anatomical development of the ear: the early embryonal tissues sucked out in this way could disturb the transformation of embryonal tissue to normal mucoperiosteum. The persistent embryonal tissue thickens the tympanal mucosa. This is a factor promoting inflammation.