ABSTRACT
Pancreatic tuberculosis is unusual occurring in only 2.7% of autopsy studies of persons with miliary disease. Reports of focal pancreatic tuberculosis are rare, even in patients with the acquired immunodeficiency syndrome (AIDS) in whom abdominal tuberculosis is a frequent feature. We describe two patients infected with the human immunodeficiency virus (HIV) who developed tuberculous pancreatic abscesses. In both this was their AIDS-defining illness.
Subject(s)
AIDS-Related Opportunistic Infections/complications , Abscess/complications , Pancreatic Diseases/complications , Tuberculosis, Endocrine/complications , Abscess/microbiology , Adult , Humans , Male , Middle Aged , Pancreatic Diseases/microbiologyABSTRACT
Fifteen patients with acquired immune deficiency syndrome (AIDS), and one who tested positive for human immunodeficiency virus but had no AIDS-defining diagnosis, underwent a range of laparoscopic procedures between March 1991 and March 1993. Seven cholecystectomies and one cholecystojejunostomy were performed. Three patients underwent diagnostic laparoscopy after presenting with abdominal emergencies. Two further patients had laparoscopic adhesiolysis and one appendicectomy. A further patient underwent laparoscopically assisted end colostomy and another an inguinal hernia repair, both performed electively. Two patients died in the postoperative period. There was little postoperative morbidity. Six patients died 3-18 months after surgery from progressive AIDS. This early experience suggests that laparoscopic surgery is well tolerated in these patients.
Subject(s)
Acquired Immunodeficiency Syndrome/surgery , Laparoscopy , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/mortality , Adult , Cholecystectomy, Laparoscopic/mortality , Choledochostomy/mortality , Female , Humans , Infectious Disease Transmission, Patient-to-Professional , Laparoscopy/mortality , Length of Stay , Male , Middle AgedABSTRACT
In a comparative study, we examined the use of a peripherally implantable venous access system which does not require either central venous cannulation or radiological screening. We compared the complication rate in 85 patients receiving this system with that in 112 similar patients receiving Hickman lines. In addition, we examined the safety and cost implications of using a ward setting instead of full operating facilities for port insertion. There was a 10.7% incidence of early and 37.6% incidence of late complications in the group receiving Hickman lines compared with only 2.4% early complications and 10.6% late complications in those receiving peripherally implantable ports. There was no difference in complication rates between those patients who had the ports inserted in a ward side room compared with those who had their procedure performed in the operating theatre. We have demonstrated the ease and reliability of port insertion in the absence of screening radiology and we therefore suggest the peripheral port as a safe, cost-effective alternative to existing venous access systems.
Subject(s)
Catheters, Indwelling , Infusion Pumps, Implantable , Adolescent , Adult , Aged , Aged, 80 and over , Algorithms , Anesthesia, General , Anesthesia, Local , Antineoplastic Agents/administration & dosage , Antiviral Agents/administration & dosage , Catheters, Indwelling/adverse effects , Child , Child, Preschool , Female , Humans , Infant , Infusion Pumps, Implantable/adverse effects , Male , Middle Aged , Parenteral Nutrition/methodsSubject(s)
Cysts/etiology , HIV Infections/complications , Parotid Diseases/etiology , Adult , Female , Humans , Male , Middle AgedSubject(s)
Aneurysm/diagnosis , Duodenum/blood supply , Pancreas/blood supply , Aged , Aneurysm/therapy , Embolization, Therapeutic , Humans , Ischemia/etiology , MaleSubject(s)
Anti-Bacterial Agents/therapeutic use , Digestive System Surgical Procedures , Surgical Wound Infection/prevention & control , Abdomen , Administration, Topical , Anti-Bacterial Agents/administration & dosage , Antibiotic Prophylaxis , Clavulanic Acids/administration & dosage , Clavulanic Acids/therapeutic use , Humans , Injections, Intravenous , Sepsis/prevention & control , Ticarcillin/administration & dosage , Ticarcillin/therapeutic useABSTRACT
A sugar and polyethylene glycol paste is introduced which has marked antimicrobial activity and is available in thick and thin forms. The paste was used to treat 20 patients with chronically infected abdominal and perineal wounds that had failed to respond to conventional forms of treatment. Complete healing was achieved in 19 patients. The paste was especially effective in the treatment of large abscess cavities with small external openings. It was inexpensive, and easy and painless to apply.
Subject(s)
Abscess/therapy , Bacterial Infections/therapy , Carbohydrates/therapeutic use , Polyethylene Glycols/therapeutic use , Wound Infection/therapy , Adolescent , Adult , Aged , Female , Humans , Male , OintmentsABSTRACT
A seriously ill patient was found to have megaloblastic changes in his bone marrow after a nitrous oxide anaesthesia which lasted for 105 min. After an interval of 7 h a second nitrous oxide anaesthetic was administered, during which the patient received 30 mg of folinic acid. His marrow was normal when assessed 4 h later.
Subject(s)
Anesthesia, Inhalation/adverse effects , Bone Marrow/drug effects , Erythrocytes, Abnormal/drug effects , Leucovorin/therapeutic use , Megaloblasts/drug effects , Nitrous Oxide/adverse effects , Adolescent , Humans , MaleABSTRACT
In a prospective randomised trial 190 consecutive admissions undergoing emergency abdominal surgery were allocated to receive a 24-h peri-operative prophylactic regime of either cefotetan or gentamicin and tinidazole. Wound sepsis developed in 14 patients in each group and one patient in each group developed intra-abdominal abscess. Nine patients in the cefotetan group and 10 patients in the gentamicin and tinidazole group died within 1 month of surgery. The death of one patient in each group was directly related to sepsis. Sixty-five per cent of aerobes isolated at operation were sensitive to cefotetan and 62% sensitive to gentamicin. The in vitro anaerobic cover of tinidazole was complete, whereas 13% of anaerobes isolated at operation were resistant to cefotetan. Anaerobes, predominantly Bacteroides fragilis, were isolated from six of the 14 infected wounds following cefotetan prophylaxis and two of the 14 infected wounds in the gentamicin and tinidazole group. It is therefore recommended that cefotetan should be combined with a nitroimidazole in patients undergoing emergency colo-rectal procedures.
