ABSTRACT
The objective was to determine the efficacy and safety of same-session endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy. Twenty-two patients who had ERCP and cholecystectomy performed in the same session under one general anesthetic were compared with 77 patients who had ERCP followed by surgery in the ensuing days. In the 93 patients who underwent attempted laparoscopic cholecystectomy, there was no difference in conversion to open rates between the same-session group and the delayed group. The length of stay after ERCP was longer in the delayed group. Same-session ERCP and cholecystectomy is safe and efficacious, and its routine use should be considered.
Subject(s)
Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/surgery , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Anesthesia, General , Cholelithiasis/diagnosis , Cholelithiasis/surgery , Gallstones/diagnosis , Gallstones/surgery , Humans , Length of Stay , Middle Aged , Retrospective StudiesABSTRACT
Group B streptococci (GBS) have been infrequently recognized as a cause of pharyngitis. We report three cases of GBS pharyngitis in patients with underlying diseases, two of whom were treated with and responded incompletely to oral beta-lactam antibiotics. The susceptibility of 20 clinical isolates of GBS was tested by a broth dilution method to six antibiotics which could conceivably be used in the therapy of GBS pharyngitis. Penicillin G, clindamycin, and erythromycin were most active with mean minimal inhibitory concentrations (MIC) of 0.06 µg/ml or less. Rifampin and cefaclor were least active with mean MICs of 0.71 ug/ml or more. Ampicillin was intermediate in its activity. Therapy traditionally used for Group A streptococcal (GAS) pharyngitis may, at times, be suboptimal for GBS pharyngitis in compromised patients. This may be due to higher minimal bactericidal concentrations (MBC) of GBS than GAS, to inadequate penetration of penicillins into pharyngeal tissues or to host factors. It is suggested that GBS can cause pharyngitis in adults, particularly the compromised patient, and that in cases where there is a poor response to penicillin or ampicillin therapy, alternative drugs (erythromycin or clindamycin) may be used.
