Association between transfusion of stored blood and bacterial infective complications after biliary operations.

OBJECTIVE: To examine the association between blood transfusion and infective complications after biliary operations. DESIGN: Retrospective cohort study. SETTING: District hospital. SUBJECTS: 875 consecutive patients who required biliary operations. MAIN OUTCOME MEASURES: Postoperative infective morbidity in hospital. RESULTS: 73 patients (8%) developed postoperative infections in hospital. Univariate analysis showed that the development of infections was significantly associated with blood transfusion (p < 0.001), stones in the common bile duct (p < 0.001), operations on the common bile duct (p < 0.001), T-tube drainage (p < 0.001), duration of operation (p = 0.008), and age (p = 0.03). Multivariate logistic regression analysis showed that only blood transfusion and stones in the common bile duct were independent predictors of infection. The corrected odds ratios for infection were 4.7 (95% confidence interval (CI) 2.4 to 9.3) when 1-3 units of blood were given and 5.6 (95% CI 2.3 to 13.6) when more than three units were given. CONCLUSION: Transfusion is an independent risk factor in the development of postoperative infection in hospital in patients who have had biliary operations.

[Diagnosis-related groups and injuries. Is multiple trauma underrated?]. / Diagnoserelaterte grupper ved skader. Blir multitraume undervurdert?

A consecutive registration of all trauma patients admitted to the Department of Surgery, total 868, was made in 1989. Such patients constituted 20% of all surgical patients. The aim was to study the relation between the Norwegian Diagnosis-related group (DRG) cost weights and severity of injury and use of resources. The DRG system correlated reasonably well with the Injury Severity Score and use of resources, except in the case of serious multi-trauma, which seemed to be under-rated.

The benefit of colonoscopy.

In a prospective study involving 833 consecutive outpatient and open-access colonoscopies, attempts were made to characterize the benefit of colonoscopy in terms of both predicted and unpredicted findings and therapeutic procedures. The endoscopist therefore predicted the endoscopic findings before the endoscopy. The results were compared for the different indications for colonoscopy. The overall agreement between the predictions and the colonoscopic findings was 61%. Clinically significant abnormalities were found in about half the examinations. The most frequent abnormal findings were benign polyps (24%), inflammatory bowel disease (17%), and malignancy (5%). In about half the patients with a malignancy the indication for colonoscopy was rectal bleeding, and half of the malignancies were not predicted. The greatest benefit of colonoscopy was found in patients referred because of overt rectal bleeding or occult faecal blood, and abnormal barium enema or endoscopy findings. The importance of complete colonoscopy in connection with operation for colorectal carcinoma is emphasized.

Balloon dilation of rectal strictures.

Twelve strictures subsequent to colorectal (11) or ileorectal (1) anastomosis were treated with balloon dilation. Six of the anastomoses were located within 10 cm from the anal verge. The stricture diameter was 3-12 mm. The time from operation to finding of stricture was 6 +/- 4 (range 2-17) months and the post-dilation observation time was 9 +/- 7 (1-24) months. Relief of symptoms was obtained in ten patients, in six of them after only one dilation. Treatment is being continued in one of the other two cases, and one was classified as failure after five dilation attempts. Most dilations were performed in the out-patient department under light sedation. There were no complications. Balloon dilation of rectal stricture is well tolerated as an out-patient procedure. It is safe and can give a satisfactory result in most cases of benign stricture.