R. C. N. Williamson

Decline in admission rates for acute appendicitis in England.

The incidence of acute appendicitis declined in western countries between the 1930s and the early 1990s. The aim of this study was to determine time trends in hospital admissions for acute appendicitis in England between 1989–1990 and 1999–2000, and in population mortality rates for appendicitis from 1979 to 1999.

Single-loop biliary and gastric bypass for irresectable pancreatic carcinoma.

Twenty-five patients with irresectable carcinoma of the pancreatic head received a modified type of palliative bypass in which the transected bile duct and the gastric antrum were anastomosed to the same Roux loop of jejunum. There were 13 women and 12 men with a median age of 54 (range 35-74) years. All but three patients were jaundiced and 11 underwent preoperative biliary decompression. In 18 patients jaundiced at the time of operation, the median preoperative serum bilirubin level was 287 (range 57-804) mumol/l. The median operative time was 4.0 (range 2.5-6.0) h. There were no hospital deaths. Minor postoperative complications occurred in nine patients and the median hospital stay after operation was 13 (range 7-49) days. The median postoperative survival was 4.8 (range 1.5-11.5) months. This operation provides good palliation safely in selected patients with irresectable pancreatic carcinoma.

Antibióticos e infección biliar

Resumen La principal caracteristica de la infeccion quirurgica es que se puede eliminar mediante una operacion. La infeccion biliar no es una excepcion, ya que la extirpacion de la vesicula biliar infectada y el completo drenaje de la via biliar o el absceso hepatico son las principales armas del cirujano para combatirla. Los antibioticos tienen un papel importante, aunque secundario, en el tratamiento de esta infeccion. Las infecciones de origen biliar son frecuentes y potencialmente graves, suelen ser polimicrobianas, se asocian a un alto porcentaje de bacteriemias y requieren un abordaje multidisciplinar. El uso juicioso de la endoscopia, la radiologia intervencionista y la cirugia para conseguir el control del foco infeccioso o el drenaje de la via biliar es el primer paso del tratamiento. Este debe completarse con la administracion empirica de antibioticos con el espectro antibacteriano adecuado. El uso mas racional de los antibioticos en la infeccion biliar, especialmente en lo que respecta a la duracion optima del tratamiento, la posibilidad de desescalada terapeutica o el tratamiento secuencial con antibioticos orales aun esta sujeto a un amplio debate y debera ser objeto de futuros ensayos clinicos.

Biliary Tract Infections

Biliary tract infections are a group of severe diseases that threaten thousands of people each year. The world-wide prevalence of gallstones and the increasing number of biliary operations and diagnostic interventions explain the high incidence of sepsis originating from the biliary tract. Gallstones affect about 10% of the population of the United States [1] and 17% of the population of Asian countries [2].

Cytokine Response to Elective Surgery: A Possible Mechanism for Intraperitoneal Adhesion Pathogenesis

Cytokines are biologically active mediators of the immune and acute phase responses to inflammation [1]. The main actions of cytokines occur locally and influence a number of processes, including wound healing, debridement of dead tissues and control of infection, all of which may lead to subsequent scarring and adhesion formation. In addition, the local production of cytokines probably contributes to the systemic disturbance observed following surgery [2]. Within the peritoneal cavity, they are produced by mononuclear phagocytes [3] and mesothelial cells [4]. Previous studies have measured cytokines in peritoneal fluid and plasma following surgery [5–8], but the correlation of systemic with intraperitoneal cytokine concentrations has been poorly documented. The aim of this study was to investigate the intraperitoneal and systemic cytokine responses in patients undergoing elective laparotomy. The results of this study have been reported in brief elsewhere [7].