[Comparison of wound infection rates after colon and rectal surgeries using triclosan-coated or bare sutures -- a multi-center, randomized clinical study]. / Sebfertozések gyakoriságának összehasonlítása colon- és rectummutétek után triclosan bevonatú varróanyag (PDS plus®) és azonos alapanyagú nem bevont varróanyag (PDS II®) felhasználása esetén - multicentrikus, randomizált, klinikai tanulmány.

BACKGROUND: Surgical Site Infection (SSI) is the third most frequent nosocomial infection, and accounts for 14-16% of all infections. While the treatment of SSI can be very costly, previous results indicated that triclosan may reduce SSI rate. Therefore, we carried out a prospective randomised trial to further evaluate the effect of triclosan after elective colorectal surgery. METHODS: Seven surgical units in Hungary were involved in a prospective, randomised, multicentric clinical trial to compare triclosan coated (PDS plus®) and uncoated (PDS II®) sutures for abdominal wall closure in elective colorectal surgery. Pre- and perioperative variables were recorded in an online database. The primary aims of the study were to determine the incidence of SSI and the pathogens associated with it, as well as evaluation of additional cost of treatment. RESULTS: 485 patients were randomised. SSI occurred in 47 cases (12.5%), of those 23 (12.23%) from the triclosan group (n = 188) and 24 (12.18%) from the uncoated group (n = 197, p = 0.982). In 13 (27.66%) cases late appearance of SSI was detected, of those 4 patients with triclosan coated suture (8.51%) and 9 patients with uncoated suture (19.15%, p = 0.041). There was no difference between the type of incisions or elective colon and rectal resections in terms of incidence of SSI. CONCLUSION: Beneficial effect of triclosan against Gram positive bacteria could not be confirmed in our study due to the relatively low number of patients with SSI. Furthermore, triclosan did not influence the incidence of SSI due to Gram negative bacteria. SSI rate decreased by 50% compared to our previous study, however, it was regardless of the use of coated or uncoated PDS loop. Finally, operative factors were more important than patient's risk factors in terms of incidence of SSI. In case SSI developed, delayed discharge from hospital as well as special wound care significantly increased overall cost of treatment.

[Metastasis of breast cancer presenting in the appendix]. / Meglepetést okozó appendix avagy primer emlorák metasztázisa okozta appendicitis.

A 45 year-old woman was referred to the Emergency Department of Jósa András County Hospital with typical history and signs of appendicitis. Other than abdominal findings during physical examination we discovered a palpable mass in the right breast. The patient was transferred to the Department of Surgery and she was operated on, appendicectomy was performed. Following the uncomplicated postoperative course investigations were carried out to diagnose the mass in the right breast (mammography, ultrasound, chest X-ray, bone scan). The pathology report of the appendix suggested the possibility of a metastasis of ductal breast carcinoma in the perforated appendix. Probably the inflammation was caused by the infiltration of the appendix wall leading to perforation. Following the investigations a right-sided mastectomy was performed with dissection of axillary lymph nodes. Immunohistochemical examination definitely proved that the metastasis in the appendix originated from the breast tumour.