"Diagnostic value of MRCP in biliary pancreatitis: result of long-term follow-up".

AIM: Magnetic resonance cholangiopancreatography (MRCP) has increasingly been used to evaluate the common bile duct. This study was to determine the role of MRCP instead of endoscopic retrograde cholangiopancreatography (ERCP) in the management of patients with acute biliary pancreatitis. METHODS: A total of 81 patients with mild or moderate biliary pancreatitis who underwent MRCP and were treated in our department with selective ERCP between May 2001 and July 2007 were entered into a prospective database. RESULTS: MRCP was considered abnormal in 13 patients. Ten patients underwent ERCP. Three patients did not undergo ERCP due to protocol violations. In nine patients, stone extraction was performed. The remaining patient who had dilatation of the CBD underwent ES. The false positive rate of MRCP was 10%. The median follow-up of overall patients was 36 months (range 23-99 months). The patients with normal MRCP had a median follow-up of 39.5 months (range 23-99 months). During the follow-up period in the normal MRCP group, five patients were diagnosed with recurrent biliary pancreatitis, of which three underwent ERCP (7.4%). There was no disease-related mortality during this period. CONCLUSION: In conclusion, the use of MRCP in acute biliary pancreatitis is safe and may be recommended as a tool to aid in the selective use of ERCP.

Effect of local gentamicin application on healing and wound infection in patients with modified radical mastectomy: a prospective randomized study.

This study investigated the effects of Gentacoll implants on healing in patients (n = 44) undergoing modified radical mastectomy and axillary dissection. Group I, the Gentacoll group (n = 22), underwent surgery followed by insertion of 10 × 10 × 0.5 cm Gentacoll implants (280 mg collagen sponge plus 200 mg gentamicin sulphate) into the axillary area and under the flap area of the breast before wound closure. Group II, the control group (n = 22), underwent surgery without the application of Gentacoll. Neither group received oral or parenteral post-operative antibiotic therapy. Outcome measures included wound infection, seroma formation, total drainage volumes, drain removal time and duration of hospital stay. Post-operative infection rate, seroma formation, drainage volumes and duration of hospital stay were significantly reduced in the Gentacoll group compared with the control group. In conclusion, the application of Gentacoll significantly improved post-operative outcomes in patients undergoing modified radical mastectomy.

Effect of gentamicin-absorbed collagen in wound healing in pilonidal sinus surgery: a prospective randomized study.

Pilonidal sinus is a common disease that causes the loss of many working hours, but treatment is variable and problematic. The effect of gentamicin-absorbed collagen on healing, infection and recurrence, and length of hospital stay were examined after pilonidal sinus surgery. Patients undergoing surgical treatment for pilonidal sinus were randomly assigned into two groups each of 40 patients. Both groups were treated with excision and primary closure under local anaesthesia. Group 1 (control) received oral antibiotics for 7 days post-operatively. In group 2, prior to wound closure, gentamicin-absorbed collagen sponges were placed on the sacral fascia and these patients did not receive oral post-operative antibiotic therapy. Patients in group 2 had a significantly shorter mean wound healing time, significantly lower infection and recurrence rates, and a significantly shorter hospital stay than those in group 1. It is concluded that implantation of a gentamicin-containing collagen sponge on the wound area in pilonidal sinus decreased the rates of infection and recurrence, and shortened the hospital stay.

The relationship between mortality and inflammation in patients with gastrointestinal bleeding.

The objective of this study was to investigate the association between mortality and inflammation in patients who were admitted to the emergency room with gastrointestinal bleeding. Patients (n = 96) managed at two medical centres were included in the study. Initial levels of serum C-reactive protein (CRP), haemoglobin and albumin, and leucocyte and thrombocyte counts for 28 patients who died were compared with those for the 68 patients who survived and were successfully discharged. The data were analysed using the chi(2)-test. Serum levels of CRP and leucocyte counts were significantly higher, and albumin and haemoglobin were significantly lower in patients who died compared with patients who survived. The increased levels of serum CRP and leucocyte counts, and decreased levels of albumin and haemoglobin were found to be independent risk factors for mortality. It is concluded that increased serum CRP levels and leucocyte counts combined with decreased albumin and haemoglobin levels on admission to the emergency room may be used as predictive factors of mortality in patients with gastrointestinal bleeding.

[The value of C-reactive protein and leucocyte count in preventing negative appendectomies]. / Negatif apendektomileri önlemede C--reaktif protein ve lökosit sayiminin degeri.

This study was designed to determine the values of C-Reactive Protein measurements (an acute phase reactant, CRP) and leucocyte counts in prevention of negative appendectomies. Despite improvements in diagnostic methods, negative appendectomy rates still remain between 10-30% in acute appendicitis. Cost-effective and easily applicable diagnostic methods with prompt results are required to reduce negative appendectomy rates. In this prospective study, one hundred twenty-six patients were operated on for initial diagnosis of acute appendicitis between July 1999 and July 2000. CRP and leucocyte count were measured in all cases. The data of the outcomes of clinic and pathological findings were analyzed statistically. Among the 126 study patients, 71 (56.3%) were male and 55 (43.7%) were female. 79 (62.6%) cases had noncomplicated appendicitis, 27 (21.4%) cases had complicated appendicitis and 20 (15.8%) cases had negative appendectomy. The mean CRP level was significantly higher (p < 0.001) in patients with complicated acute appendicitis than in those with noncomplicated acute appendicitis and in those with negative appendectomy. The mean leucocyte count was significantly lower (p < 0.001) in patient with negative appendectomy than in those with noncomplicated appendicitis and in those with complicated appendicitis. Although CRP increases with inflammation, it increases markedly after the occurrence of complication. The increase in leucocyte count is early sign of appendix inflammation. CRP measurements or leucocyte counts are not effective alone to prevent negative appendectomies.