Antibiotics versus no antibiotics in the treatment of acute uncomplicated diverticulitis - a systematic review and meta-analysis.

BACKGROUND: Acute uncomplicated diverticulitis (AUD) is common and antibiotics are the cornerstone of traditional conservative management. This approach lacks clear evidence base and studies have recently suggested that avoidance of antibiotics is a safe and efficacious way to manage AUD. The aim of this systematic review is to determine the safety and efficacy of treating AUD without antibiotics. METHODS: A systematic search of Embase, Cochrane library, MEDLINE, Science Citation Index Expanded, and ClinicalTrials. gov was performed. Studies comparing antibiotics versus no antibiotics in the treatment of AUD were included. Meta-analysis was performed using the random effects model with the primary outcome measure being diverticulitis-associated complications. Secondary outcomes were readmission rate, diverticulitis recurrence, mean hospital stay, requirement for surgery and requirement for percutaneous drainage. RESULTS: Eight studies were included involving 2469 patients; 1626 in the non-antibiotic group (NAb) and 843 in the antibiotic group (Ab). There was a higher complication rate in the Ab group however this was not significant (1.9% versus 2.6%) with a combined risk ratio (RR) of 0.63 (95% CI, 0.25 to 1.57, p=0.32). There was a shorter mean length of hospital stay in the Nab group (standard mean difference of -1.18 (95% CI, -2.34 to -0.03 p= 0.04). There was no significant difference in readmission, recurrence and surgical intervention rate or requirement for percutaneous drainage. CONCLUSION: Treatment of AUD without antibiotics may be feasible with outcomes that are comparable to antibiotic treatment and with potential benefits for patients and the NHS. Large scale randomised multicentre studies are needed. This article is protected by copyright. All rights reserved.

Routine preoperative blood group and save testing is Unnecessary for elective laparoscopic Cholecystectomy.

BACKGROUND: Although the practice of preoperative testing of ABO group and Rh (D) type for elective cholecystectomy has deep historical roots, it is not evidence-based. We aimed to assess the preoperative blood group and save testing practice for a cohort of patients subjected to elective laparoscopic cholecystectomy for symptomatic cholecystolithiasis between January 2010 and October 2014. METHODS: National Health Service (NHS) hospital based, surgical procedure-specific, retrospective study was conducted. A final group consisted of 2,079 adult patients. We estimated the incidence of perioperative blood transfusion attributable to laparoscopic cholecystectomy. The results of eight other studies are presented. RESULTS: A preoperative blood group and save test was performed in 907 patients (43.6%), whereas cross-matching was documented in 28 patients (3.1%). None required an intraoperative blood transfusion. Twelve patients (0.58%) underwent blood transfusion postoperatively following laparoscopic cholecystectomy, of which ten were transfused due to severe intra-abdominal bleeding (0.48%). There were no deaths. CONCLUSIONS: The likelihood of blood transfusion attributable to elective laparoscopic cholecystectomy is 1:200. A routine preoperative blood group and save testing is unnecessary. It neither alters the management of severe hypovolemia, secondary to perioperative bleeding, nor does it lead to better outcomes.

Comparison of Umbilical Cord Milking and Delayed Cord Clamping on Cerebral Blood Flow in Term Neonates.

OBJECTIVE: To compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on cerebral blood flow in term neonates. METHODS: This randomized controlled trial was conducted at a teaching hospital in India during 2012 to 2013. Two hundred newborns (>36wk) were randomized to UCM and DCC groups. UCM was done on 25cm of cord length. In DCC group, clamping was delayed by 60 to 90s. Resistive Index (RI), Pulsatility Index (PI) and cerebral blood flow velocities of middle cerebral artery (MCA) were measured at 24 to 48h of life. RESULTS: Baseline characteristics and hemodynamic parameters were comparable. Mean PI [1.18 (0.26)] and RI [0.65 (0.08)] in UCM group was comparable to mean PI [1.18 (0.25)] and RI [0.65 (0.08)] in DCC group. The peak systolic velocity and end diastolic velocity (cm/s) of blood flow in MCA for UCM group were 34.94 (11.82) and 11.71 (4.75) respectively, while in DCC group they were 37.24 (12.63) and 13.07 (4.78) (p 0.23 and 0.07) respectively. Indices among growth retarded babies were not different. CONCLUSIONS: DCC and UCM had similar effect on cerebral blood flow velocities and Doppler indices in MCA, in term neonates.

Gastrointestinal stromal tumor causing ileo-ileal intussusception in an adult patient a rare presentation with review of literature.

Gastrointestinal stromal tumors (GIST) are mesenchymal tumors occurring anywhere along the gastrointestinal tract and are believed to originate from the interstitial cells of Cajal. They commonly arise in the stomach or small intestine. The usual growth pattern is exophytic invading adjacent organs or perforation into the peritoneal cavity which may result in bleeding or obstructive symptoms. Intussusception and obstruction is a very uncommon presentation of these lesions because of their tendency to grow in an extraluminal fashion. We report an unusual case of 59 yrs old man presenting with acute small bowel obstruction, which on exploration was found to be due to ileo-ileal intussusception and the lead point of intussusception was a tumor, which was histologically diagnosed as GIST.

Rupture of Pseudo aneurysm of Popliteal vessels due to pin migration of External Fixator- A Rare Case Report.

External fixators for fracture stabilization or limb lengthening cause complications such as pseudoaneurysm, acute ischemia, bleeding, compartment syndrome, and arterio venous fistula. This is a report of a patient who sustained open fracture of both bones of the right leg and the recovery period was complicated by a rare complication where migration of the proximal pin of external fixator into the popliteal vessels and caused rupture of pseudoaneurysm with popliteal vessels injury after a trivial trauma.

Arginase activity in carcinoma of the gallbladder: a pilot study.

Carcinoma of the gallbladder is the third most common cancer of the gastrointestinal tract. Recent studies have shown increased arginase activity in various malignancies. The main aim of this study was to evaluate whether arginase activity increases in carcinoma of the gallbladder. The arginase activity was evaluated in serum and gallbladder tissue in 22 patients with histologically proven carcinoma of the gallbladder and 20 patients with cholecystitis using spectrophotometry and western blot assay. The Student's t-test, analysis of variance, and Student-Newman-Keuls test were used for comparison of data and for statistical significance. The mean tissue arginase and serum arginase activity (118.64+/-17.45 and 15.91+/-1.91, respectively) in cases of carcinoma of the gallbladder were significantly higher in comparison with cholecystitis (86.37+/-4.45 and 12.73+/-0.72, respectively). Subgroup analysis showed stage III gallbladder carcinoma had the maximum tissue arginase activity (142.00+/-21.68 U/g of tissue) followed by stage II (124.15+/-19.88) and stage I (108.46+/-6.73). This significant rise in mean tissue arginase and serum arginase activity in patients with gallbladder cancer probably supports an association between arginase activity and the malignancy.