ABSTRACT
OBJECTIVE: To assess the incidence of infected bile and gallbladder wall infection at the time of laparoscopic cholecystectomy, and find out if they influenced the rate of postoperative infective complications. DESIGN: Prospective study. SETTING: District hospital, Kuwait. SUBJECTS: All 279 patients who had their gallbladders removed laparoscopically for gallbladder disease between September 1995 and August 1998. INTERVENTIONS: Samples of bile and gallbladder wall were taken from all patients and cultured separately for aerobic and anaerobic bacteria. Patients with complicated gallbladder disease (n = 80) were given preoperative therapeutic antibiotics for five days (cephalosporin plus metronidazole), and other high-risk patients (n = 138) were given prophylactic ceftriaxone either 1 g x 3 starting at induction of anaesthesia (n = 42), or a single dose at induction (n = 96). MAIN OUTCOME MEASURES: Incidence of infected cultures, and infective morbidity. RESULTS: 26 specimens of bile (9%) and 56 specimens of gallbladder wall (20%) were infected. Two patients in whom neither specimen had shown any growth developed minor infections at the umbilical port. No patient in whom either specimen was infected developed an infective complication. CONCLUSIONS: The overall rate of infective complications was negligible, and did not correlate with the presence of bacteria in the bile or gallbladder wall. This is probably a reflection of our aggressive antibiotic regimen in the management of high-risk patients.
Subject(s)
Bacterial Infections/complications , Bile/microbiology , Gallbladder Diseases , Postoperative Complications/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Antibiotic Prophylaxis , Bacteria/isolation & purification , Cholecystectomy, Laparoscopic , Female , Gallbladder/microbiology , Gallbladder Diseases/complications , Gallbladder Diseases/microbiology , Gallbladder Diseases/surgery , Humans , Male , Middle Aged , Postoperative Complications/prevention & control , Prospective Studies , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & controlABSTRACT
A case of Riedel's thyroiditis in a young euthyroid man is presented. The diffusely enlarged and uniformly hard gland extended laterally beyond the sternomastoid muscles. Aspiration cytology suggested malignancy. Isthmectomy with excision of 50% of the fibrous gland and clearance of two-thirds of the tracheal circumference gave a good result.
Subject(s)
Thyroid Gland/pathology , Thyroidectomy/methods , Thyroiditis/surgery , Adult , Biopsy, Needle , Humans , Male , Sclerosis , Thyroiditis/pathologyABSTRACT
A study of nine cases of Hürthle cell lesions of the thyroid seen in a period of five years at Al-Adan Hospital, Kuwait, is presented. Chart review of physician's contact, patient follow-up and histopathological review showed two cases (22%) were due to Hürthle cell hyperplasia only, and seven (78%) were Hürthle cell tumours, of which Hürthle cell carcinoma was seen in three cases (33%) and Hürthle cell adenoma in four (44%). Of the four cases with adenoma, three (33%) had solitary lesions and one had an associated papillary carcinoma. The extent of primary surgical treatment did not affect the prognosis of adenoma. It is suggested that lobectomy with isthmectomy should be sufficient treatment for Hürthle cell adenoma, while more radical surgery should be reserved for cases with accepted malignant criteria.
Subject(s)
Carcinoma/pathology , Thyroid Neoplasms/pathology , Adenoma/pathology , Adult , Aged , Carcinoma/surgery , Female , Humans , Male , Middle Aged , Pneumonectomy , Retrospective Studies , Thyroid Neoplasms/surgery , ThyroidectomyABSTRACT
Nine cases of solitary caecal diverticulitis treated in Kuwait are presented and the literature is reviewed. The preoperative diagnosis was acute appendicitis in all cases, but diverticulitis was detected during surgical exploration and histologically confirmed. The surgical management in seven cases was simple excision of the diverticulum with closure of resultant defect or invagination of the mucosal bulge with suture of the colonic wall. Right hemicolectomy was performed in two cases because of gangrenous patches in the caecal wall and suspicion of carcinoma. Recognition of solitary caecal diverticulitis requires considerable experience, especially in order to avoid more radical procedures such as right hemicolectomy. Solitary caecal diverticulum does not seem to occur in the indigenous people of Kuwait. All nine patients were of other nationalities, including five from countries of the Far East.
Subject(s)
Cecal Diseases/epidemiology , Diverticulitis/epidemiology , Adult , Cecal Diseases/diagnosis , Cecal Diseases/surgery , Diagnosis, Differential , Diverticulitis/diagnosis , Diverticulitis/surgery , Female , Humans , Intestinal Mucosa/pathology , Kuwait/epidemiology , Male , Middle AgedABSTRACT
A series of 40 patients presented with epididymo-orchitis between January 1983 and August 1985. In 14 brucellosis was diagnosed. In 10 of these (72%) both testis and epididymis were involved and 1 had bilateral disease. All patients with brucella epididymo-orchitis were treated with streptomycin and tetracycline and complete resolution occurred in 8 (57%).
