Peritonitis in patients over the age of 50 years: 98 cases managed surgically.

Generalized peritonitis in patients over the age of 50 years is a common surgical emergency. This is a retrospective analysis of 98 cases managed surgically. Duodenal ulcer perforations, necrotizing enteritis, acute cholecystitis with perforation and small bowel perforations were the common causes. Most of them presented late, and many had associated conditions. Re-look laparotomies had a definite role to play. While there is significant decrease in the number of typhoid and tubercular peritonitis, there appears to be an increase in the incidence of necrotizing enteritis and acute cholecystitis.

Respiratory complications in postoperative patients.

OBJECTIVES: This study was conducted to see the extent of respiratory morbidity in the general surgical unit of a teritiary care teaching hospital and to look for probable factors that were responsible for them. METHODS: A prospective study was conducted over a six month period, of patients who underwent both elective and emergency surgeries. Patients were assessed pre-operatively, on the fifth post operative day and at the time of discharge for respiratory complications. RESULTS: Five hundred eighty four consecutive patients who underwent surgeries were studied. Eighty one of them (13.9%) had respiratory complications. Pneumonia was the most common complication (68%). The others included pleural effusion, empyema, pneumothorax and exacerbations of asthma and chronic obstructive pulmonary disease (COPD). One patient developed ARDS (Adult respiratory distress syndrome) and died. Patients who underwent upper abdominal surgery (both elective and emergency), those who had a stay in the surgical ICU for more than 24 hours and those who were on the ventilator for more than 24 hours had a higher incidence of respiratory complications (p < 0.001). CONCLUSION: Respiratory complications increase the morbidity in post operative patients. Pre-operative respiratory illnesses, upper abdominal surgery, ICU stay and mechanical ventilation in the post-operative period predispose patients to respiratory complications. Pre-operative respiratory assessment and treatment of any underlying respiratory disorder is necessary and may decrease the morbidity in surgical patients.

Prevalence of nosocomial infection in critically ill patients with abdominal pathology.

Bacterial infection is a problem in the intensive care unit (ICU). We conducted the present study in the surgical ICU over a period of 5 months to determine the prevalence of nosocomial infection. Our ICU has a bed strength of 7 with an average occupancy rate of 5.46 patients. Mechanical ventilation associated pneumonitis was the commonest nosocomial infection. Older patients, patients with organ system failure and patients with co-morbid conditions were at high risk of developing nosocomial infections. E. coli was the commonest and most resistant organism grown in our study.

Nutritional assessment of marginally nourished surgical patients.

BACKGROUND: Anthropometric indices are known to be good indicators of nutritional status in the long term. However, there are conflicting reports about their effectiveness in short term assessments. METHODS: In 45 patients undergoing elective operations, the mid-arm circumference, biceps and triceps skin fold thickness and arm muscle area were measured. These were compared with haematological indices of nutritional status such as serum albumin, total protein and haemoglobin. The patients were divided into two groups based on their body mass index (< or > 18.5) or weight (< or > 52 kg). In another 10 patients, anthropometric and blood indices were studied pre- and postoperatively along with changes in body composition. RESULTS: When patients were grouped according to weight or body mass index, the anthropometric indices studied showed significant differences between the two groups, i.e. weight < 52 kg v. > 52 kg (mid-arm circumference: 22 +/- 3.3 cm v. 10 +/- 1.8 cm, p < 0.01; triceps skin fold thickness: 5.6 +/- 1.4 mm v. 10 +/- 4.9 mm, p < 0.01) although there were no differences in the blood indices. The 10 patients studied longitudinally were on energy-deficient intakes in the first postoperative week and lost lean tissue and body fat (-43 g, -33 g and -19 g protein and -78 g, -88 g and -97 g fat on postoperative days 1, 4 and 8 respectively). There was a variable response in terms of weight and body water. The measured anthropometric indices, however, showed no significant differences. CONCLUSIONS: Our results suggest that anthropometric indices are useful measures of nutritional status on a cross-sectional basis, whereas blood indices are not. Weight changes and anthropometric indices are not reliable guides to the short term nutritional course after an operation.

Resting energy expenditure and nitrogen loss after surgery in chronically undernourished patients.

Chronically undernourished patients (n = 10) undergoing elective abdominal surgery were assessed with regard to their energy expenditure and urinary nitrogen loss. These measurements were made for 1 week after the surgery, and stress factors for each parameter were computed. The responses of the chronically undernourished patients were compared to those of relatively well nourished patients (n = 10) undergoing comparable surgeries. It was found that the postoperative resting energy expenditure (REE) of the chronically undernourished patients was not significantly elevated when compared to their preoperative values (mean +/- SEM): 1210.66 +/- 88.13, 1354.91 +/- 86.61, 1215.09 +/- 89.68, and 1188.23 +/- 86.61 kcal/day preoperatively and on postoperative days 1, 4, and 8, respectively. On the other hand, the postoperative REE of the controls was significantly elevated (p < 0.05) over their baseline values: 1357.18 +/- 70.81, 1574.66 +/- 100.35, 1502.89 +/- 109.44, and 1477.23 +/- 83.52; kcal/day, respectively, for the same days. The stress factors for the controls were higher than those for the undernourished (1.16 versus 1.12, 1.11 versus 1.00, and 1.09 versus 0.98 on postoperative days 1, 4, and 8, respectively). The urinary nitrogen excretion in both groups (for the 4 days) was not significantly elevated over baseline (6.23 +/- 0.87, 7.72 +/- 0.71, 8.36 +/- 0.87, and 8.04 +/- 1.56 grams/day in the undernourished; and 7.59 +/- 1.03, 9.57 +/- 1.33, 9.49 +/- 1.03, and 8.67 +/- 0.76 grams/day in the controls. The stress factors for nitrogen excretion were slightly higher in the undernourished group.(ABSTRACT TRUNCATED AT 250 WORDS)

Liver atrophy associated with monolobar Caroli's disease.

The association of the atrophy-hypertrophy complex in monolobar Caroli's disease (Type I) is reported in a 30 year old male who presented with recurrent cholangitis. Ultrasound and CT scan showed localised, right sided, saccular biliary dilatation in a normal sized liver. Severe right lobar atrophy was detected at operation and the resected right lobe weighed only 140 gms. Distortion of the hilar vascular anatomy and posterior displacement of the right hepatic duct orifice were problems encountered at surgery.