John C. Woodfield

Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review.

The increased reporting of tuberculosis of the pancreas is related to a worldwide increase in tuberculosis and an increase in emigration from countries where tuberculosis is endemic into countries where more sophisticated healthcare and radiological imaging are available. Three recent cases of pancreatic tuberculosis in Auckland, New Zealand, emphasize that tuberculosis should now be included in the differential diagnosis of a pancreatic mass. Diagnostic indicators include emigration from, or recent travel to, a country where tuberculosis is endemic, the association of a pancreatic mass with fever, the presence of abdominal pain and a cystic pancreatic mass in a younger male. Radiological appearances might be similar to a mucinous cystic neoplasm or could show a pancreatic mass with involvement of peripancreatic lymph nodes or a mass centred in a peripancreatic lymph node. When the diagnosis is suspected an human immunodeficiency virus test and a comprehensive screening for tuberculosis at other sites should be performed. If tuberculosis is unable to be diagnosed then pancreatic biopsy and culture is indicated. Endoscopic ultrasound with fine needle aspiration for cytology is likely to become the preferred technique. Most patients have an excellent clinical response to standard antituberculosis regimens.

American Society of Anesthesiologists classification of physical status as a predictor of wound infection.

Background:  Wound infection occurs when bacterial contamination overcomes the hosts’ defences against bacterial growth. Wound categories are a measurement of wound contamination. The American Society of Anesthesiologists (ASA) classification of physical status may be an effective indirect measurement of the hosts’ defence against infection. This study examines the association between the ASA score of physical status and wound infection.

Clinical variables associated with positive angiographic localization of lower gastrointestinal bleeding.

Background:  Localizing the source of severe lower gastrointestinal (GI) bleeding is often difficult but is important to plan the extent of colonic resection. The purpose of the present paper was to audit the Auckland Hospital experience of selective angiography, in localizing lower GI bleeding.

Accuracy of the Surgeons’ Clinical Prediction of Perioperative Complications Using a Visual Analog Scale

BackgroundThe ability to predict who will develop perioperative complications remains difficult because the etiology of adverse events is multifactorial. This study examines the preoperative and postoperative ability of the surgeon to predict complications and assesses the significance of a change in prediction.MethodsThis was a prospective study of 1013 patients. The surgeon assessed the risk of a major complication on a 100-mm visual analog scale (VAS) immediately before and after surgery. When the VAS score was changed, the surgeon was asked to document why. Patients were assessed up to 30 days postoperatively.ResultsSurgeons made a meaningful preoperative prediction of major complications (median score = 27mm vs. 19mm, p < 0.01), with an area under the receiver operating characteristic curve of 0.74 for mortality, 0.67 for major complications, and 0.63 for all complications. A change in the VAS score postoperatively was due to technical reasons in 74% of stated cases. An increased VAS score identified significantly more complications, but the improvement in the discrimination was small. When included in a multivariate model for predicting postoperative complications, the surgeon’s VAS score functioned as an independent predictive variable and improved the predictive ability, goodness of fit, and discrimination of the model.ConclusionsClinical assessment of risk by the surgeon using a VAS score independently improves the prediction of perioperative complications. Including the unique contribution of the surgeon’s clinical assessment should be considered in models designed to predict the risk of surgery.

Laparoscopy in the management of colorectal cancer metastatic to the liver

Background:  This investigation was undertaken to define the value of laparoscopy in the staging of patients with colorectal carcinoma metastatic to the liver.

Using Cost of Infection as a Tool to Demonstrate a Difference in Prophylactic Antibiotic Efficacy: A Prospective Randomized Comparison of the Pharmacoecomonic Effectiveness of Ceftriaxone and Cefotaxime Prophylaxis in Abdominal Surgery

The purpose of this study was to test the hypothesis that cost, as well as frequency of infection, could be used to demonstrate a difference in the performance of prophylactic antibiotics. In a prospective, randomized, double-blind study, 1013 patients undergoing abdominal surgery were given 1 g of intravenous ceftriaxone (R) or cefotaxime (C) at induction of anesthesia, and an additional 500 mg of metronidazole for colorectal surgery. Infection was checked for during the hospital stay and at 30 days postoperatively. The inpatient, outpatient, and community costs of infection were prospectively collected. The frequency of wound infection for appendectomies when additional metronidazole was not administered was greater with cefotaxime (R 6%, C 18%, p < 0.05), but the cost of infection was the same (average cost R

EXPERIENCE WITH THE USE OF VACUUM DRESSINGS IN THE MANAGEMENT OF ACUTE ENTEROCUTANEOUS FISTULAS

994 ± SD

Accuracy of the Surgeons’ Clinical Prediction of Postoperative Major Complications Using a Visual Analog Scale

1101, C

Stercoral perforation of the blind end of a side-to-end colorectal anastomosis: Letter to the Editor

878 ±

A comparison of the cost of primary closure or rectus abdominis myocutaneous flap closure of the perineum after abdominoperineal excision

1318). For all other procedures, the frequency of wound infection was similar (R 8%, C 10%), but the cost was less with ceftriaxone (R