[Does a correlation exist between positive wound cultures at the end of an operation and later wound and prosthetic sepsis?]. / Bestaan daar 'n verband tussen positiewe wondkwekings by operasie en latere wonden prostesesepsis?

A prospective study was carried out on 51 patients in whom a reconstructive vascular procedure was performed in order to determine whether any correlation between positive wound cultures at the end of the operation and later wound and/or prosthetic sepsis exists. Swabs were taken from all surgical wounds and cultured for aerobic and anaerobic organisms. The patients were monitored for 72-89 months and all instances of wound or prosthetic sepsis thoroughly investigated. The incidence of positive wound cultures was 13%, with a variety of organisms present. No increased incidence of wound or prosthetic sepsis was observed in patients with positive wound cultures. The incidence of wound sepsis was 3.7% and of prosthetic sepsis 2%. No correlation was found between organisms cultured during operation and organisms isolated from septic wounds. The 1 case of prosthetic sepsis (at 19 months postoperatively) was probably due to secondary haematogenous infection.

[Gallstone disease in the elderly]. / Galsteensiekte in bejaardes.

The clinical manifestations, management and outcome of gallstone disease in 100 elderly patients are described. A total of 65 patients presented with a complication, acute cholecystitis (43), gallstone pancreatitis (8) and obstructive jaundice (6) being the commonest manifestations. The clinical picture was often misleadingly mild. Associated disease occurred in 70 patients but precluded surgery in only 3. Emergency surgery was indicated in 18 patients. Surgery was performed on 96 patients (cholecystostomy 2, cholecystectomy 94); 35 explorations of the common bile duct were done, with stones present in 33. Four patients died, 1 following an endoscopic retrograde cholangiopancreatography (ERCP) and 3 postoperatively (2 patients with gallstone pancreatitis); no death occurred following an elective operation. Alternative modalities of treatment of gallstone are expected to play a minor role in the management of gallstone disease in the elderly.

[Abdominal aorta aneurysm in aged patients. Is an operation worthwhile?]. / Abdominale aorta-aneurisme in bejaarde pasiënte. Is die operasie die moeite werd?

Although abdominal aortic aneurysm (AAA) is an unpredictable and sometimes fatal condition, it can be cured, and studies have indicated that improved peri-operative care has led to a lowering of the operative risk in the elderly. In this study mortality after AAA repair was 3,8% in patients over 60 years compared with 3,2% in those under 60 years. Eighty-seven per cent of the over-60s regained their physical capacities after the operation, and 92% considered the operation to have been worth while. A plea is made that all patients with AAA be referred to a hospital for objective evaluation of the operative risks with a view to elective surgery, since the mortality from ruptured aneurysms is still in the region of 50%.