Isolation of Mycobacterium thermoresistible from a mesh used in an incisional hernia repair.

We present a case of Mycobacterium thermoresistible infection from a hernia repair mesh, the first reported case of this infection in New Zealand. Mycobacterium thermoresistible infection is rare, with only seven recorded cases in the literature. The presence of this isolate has implications for antibiotic regime and treatment duration. In this report we detail the case particulars and a brief summary of the previously documented cases.

CT colonography in a rural New Zealand hospital.

AIM: Computed tomographic colonography (CTC) has been advocated for use after incomplete colonoscopy. Most of the literature is based on data from urban centres. The purpose of this study is to evaluate the use of CTC in a rural New Zealand hospital. METHODS: Patient files, electronic endoscopy and radiology records of patients from Timaru Hospital between who had a CTC between 1 April 2004 and 1 December 2006 were retrospectively reviewed. RESULTS: 196 CTCs were performed after incomplete colonoscopy. The diagnostic yield of CTC for lesions > or = 10 mm was 8.7%; and for lesions less < 10 mm was 5.6%. CTC was performed as the primary investigative modality in 568 patients. The sensitivity and specificity of CTC for detecting colonic lesions were 90.7% and 50.4% respectively. The positive and negative predictive values of CTC were 71.9% and 79.5%. The sensitivity and specificity for lesions that were 10 mm or more were 100% and 92.1%. CONCLUSION: CTC may be an effective tool for the detection of clinically important colorectal lesions, particularly after incomplete colonoscopy. The advent of remote viewing of radiology images has made it possible to utilise CTC in the rural setting.

Randomized controlled trial of Gastrografin in adhesive small bowel obstruction.

BACKGROUND: Several previous studies have shown that Gastrografin can be utilized to triage patients with adhesive small bowel obstruction (ASBO) to an operative or a non-operative course. Previous studies assessing the therapeutic effect of Gastrografin have been confounded by post-administration radiology alerting the physician to the treatment group of the patient. Therefore the aim of the present paper was to test the hypothesis that Gastrografin hastens the non-operative resolution of (ASBO). METHODS: Patients, diagnosed with ASBO on clinical and radiological grounds, were randomized to receive Gastrografin or placebo in a double-blinded fashion. Patients did not undergo further radiological investigation. If the patient required subsequent radiological intervention or surgical intervention they were excluded from the study. End-points were passage of time to resolution of ASBO (flatus and bowel motion), length of hospital stay and complications. RESULTS: Forty-five patients with ASBO were randomized to receive either Gastrografin or placebo. Two patients were excluded due to protocol violations. Four patients in each group required surgery. Eighteen of the remaining patients received Gastrografin and 17 received placebo. Patients who received Gastrografin had complete resolution of their ASBO significantly earlier than placebo patients (12 vs 21 h, P = 0.009) and this translated into a median of a 1-day saving in time in hospital (3 vs 4 days, P = 0.03). CONCLUSIONS: Gastrografin accelerates resolution of ASBO by a specific therapeutic effect.

Role of Gastrografin in assigning patients to a non-operative course in adhesive small bowel obstruction.

BACKGROUND: Adhesive small bowel obstruction (SBO) is a common surgical emergency. Water soluble contrast agents have been used to identify patients who might be treated non-operatively rather than operatively. The present study was designed to audit the introduction of such use of Gastrografin contrast into clinical practice. METHOD: Patients presenting acutely to hospital with clinically suspected and radiologically proven SBO were entered in the study. As soon as practicable, 100 mL of undiluted Gastrografin was given either orally or by the nasogastric tube (which was then spigotted). After 4 h, a plain supine abdominal X-ray (AXR) was taken. If the contrast was seen in the large bowel, and there had been no deterioration in the patient's condition, then non-operative treatment was continued. If the contrast remained in the small bowel, a clinical judgement was made as to whether to proceed with operative intervention. A group of historical controls were obtained by a retrospective review of the hospital medical records through data obtained from the Department of General Surgery Audit System. RESULTS: Twenty-five patients were entered into the study. In 20 of these patients the contrast was seen to arrive in the large bowel at 4 h. All of these patients completed a non-operative course to full recovery. In another two patients a successful decision was made to pursue a non-operative management strategy. These 22 patients had a mean hospital stay of 3.9 days. Eighty historical controls had successfully completed a non-operative course for SBO. They had a mean hospital stay of 5.6 days. This was significantly longer than that of the Gastrografin group (P < 0.016, t-test). CONCLUSION: This paper has demonstrated that undiluted Gastrografin may be safely used to assign patients to a non-operative management plan and this results in a decreased hospital stay.