[Effective preoperative studies in outpatient anesthesiology]. / Doelmatig preoperatief onderzoek in de polikliniek Anesthesiologie.

OBJECTIVE: To determine the effect of preoperative patient evaluation by the anaesthesist instead of the surgeon on the requests for additional specialist consultation and investigation and on the costs involved. SETTING: St. Antonius Hospital, Nieuwegein, the Netherlands. DESIGN: Descriptive. METHODS: From June 1993 to June 1995 (2 years), 20,000 patients were evaluated preoperatively by an anaesthesiologist in the outpatient clinic, additional investigations and consultations were requested only when indicated. The data were compared with the routine minimum package of additional requests advised by the Health Council of the Netherlands. The costs were calculated. RESULTS: During the 2-year period there were 19 requests for additional laboratory investigations, ECG or chest X-ray. Consultations of a cardiologist, pulmonologist or internist were required in 137 patients (< 1.4%). Of these patients 67% required further treatment. Elimination of routine consultations and investigations led to a decrease in preoperative hospital admissions. This resulted in savings of approximately 1,300,000 Dutch guilders. CONCLUSIONS: Preoperative outpatient anaesthetic evaluation reduces the number of investigations and consultations and can result in a significant decrease in costs.

Clinical relevance of lysozyme in the faeces.

To elucidate the value of faecal lysozyme determination in the differential diagnosis of patients with atypical abdominal complaints, stool samples of healthy controls, patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) were analysed. Faecal lysozyme concentration in healthy controls ranged from 0 to 6 mg/l with a mean of 3 mg/l. Patients with IBS had similar faecal lysozyme levels. In contrast, faecal lysozyme concentrations in patients with IBD were increased (range 6 to 104 mg/l). The difference between patients with IBS and IBD was highly significant (P less than 0.001). The determination of faecal lysozyme concentration may provide a useful test in the work-up of patients with abdominal complaints. In addition, the faeces lysozyme concentration appeared to be an objective parameter of the inflammatory activity of IBD in 11 patients investigated.

Faecal lysozyme: determination, reference intervals and some data in gastro-intestinal disease.

After diluting faecal samples with a solution of Brij and saline and subsequently ultrafiltrating the faecal mixtures, lysozyme concentration can be reproducibly measured in the obtained faecal fluids, using a turbidimetric method. Measuring faecal lysozyme concentration enables discrimination normal individuals and patients with irritable bowel syndrome between patients with inflammatory bowel disease and colonic cancer. Lysozyme distribution in stools appears to be homogeneous. Faecal lysozyme concentration is stable when samples are stored during at least 1 wk at 6 degrees C. It appears that the lysozyme activity is directly correlated with the clinical status and severity of the disease. Faecal lysozyme may thus serve as an important tool both in diagnosis and in follow-up in the out-patients clinic for gastroenterology.