Fatal reaction to transfusion of red-cell concentrate contaminated with Serratia liquefaciens.

A 60-year-old woman undergoing surgery died from endotoxic shock and DIC after receiving a 19-day-old unit of optimal additive red-cell concentrate found contaminated with Serratia liquefaciens. No source of contamination could be found. This normally free-living organism is usually of low pathogenicity. It is a very unusual contaminant of stored donated blood, although it appears to be on the increase. When transfused, blood contaminated with S. liquefaciens always causes severe morbidity and is associated with a high death rate. This is the fifth report in the English literature.

Audit of outcome of major surgery in the elderly.

The clinical outcome of 152 patients aged 65 years or over who were referred to the author's institute between August 1990 and August 1991 with certain specified gastrointestinal malignancies and acute, life-threatening abdominal conditions, were audited concurrently. Two groups were considered: patients aged 65-79 years and those over 80 years. The mortality rate within 30 days of surgery was 14 per cent in both age groups, although significantly fewer patients aged over 80 years (35 of 54) were considered suitable for surgery than in the 65-79 years age group (84 of 98) (0.01 > P > 0.001). Morbidity after operation and cost of treatment were not significantly different between the two groups. Two years after surgery 40 per cent of the patients aged over 80 years and 58 per cent of those aged 65-79 years were alive. Quality of life in these survivors was good with 85 per cent of those aged over 80 years living at home and 72 per cent fit enough to undertake light work.

Which antibiotic for surgical nosocomial infection?

Nosocomial infection means hospital-acquired infection. In this article we discuss treatment of nosocomial infections which relate to, or arise as a consequence of, general surgical procedures. Most such infections become apparent during the patient's stay in hospital, but some patients with nosocomial infection first present to their general practitioners after discharge and this group should not be overlooked.

Endometriosis of the sigmoid colon: a diagnostic problem.

Colonic endometriosis is often difficult to diagnose pre-operatively and most cases are diagnosed postoperatively from histology. The main problems with pre-operative diagnosis are due to the radiographic similarities between endometriosis and malignant lesions and the difficulties in obtaining satisfactory biopsy material.

Splenic repair for trauma.

The risks of overwhelming post-splenectomy infection (OPSI) are now well documented both in children and adults. Although the incidence of OPSI is comparatively low following splenectomy for trauma, it has a high mortality. Splenectomy is no longer the treatment of choice for splenic injury and splenic salvage is recommended whenever feasible. Since 1982, in the Isle of Wight hospitals, 13 cases of splenic injury following trauma have been treated applying various salvage procedures and are reported here.

Smooth muscle neoplasms of the rectum and anal canal.

Forty-eight patients who presented to St. Mark's Hospital, London between 1948 and 1979 with smooth muscle neoplasms of the rectum or anal canal have been reviewed. Twenty-six tumours arose from the muscularis mucosae of the rectum. These lesions were small, asymptomatic and did not recur after local removal. Eighteen tumours arose from the muscularis externa of the rectum. Local excision of these resulted in a high local recurrence rate regardless of the degree of differentiation of the tumour but long-term survival figures were similar whether the tumours were treated by local or radical techniques. However, the prognosis did relate to the degree of tumour differentiation, being worst in the poorly differentiated group. In four cases the smooth muscle tumour arose from the internal sphincter of the anal canal.

The muscle content and contractile capability of the common bile duct.

The supraduodenal portion of the human and canine common bile duct has been shown by indirect immunofluorescent staining with anti-actin sera to contain scattered bundles of smooth muscle arranged predominantly in a longitudinal direction with respect to the axis of the bile duct. Isolated strips of canine common bile duct in vitro can contact in response to stimulation with cholecystokinin. The force of contraction in a longitudinal direction is about three times that in a transverse direction but only 3% of that produced by isolated gallbladder strips. There appears to be a roughly proportional relationship between the amount of muscle demonstrated and the force of contraction in response to cholecystokinin.

Heat production and chemical change in tortoise muscle.

1. Measurements have been made of heat production and changes in levels of phosphorylcreatine (PC), ATP and lactic acid resulting from contraction of tortoise muscle under anaerobic conditions.2. The only significant chemical change found was a break-down of PC.3. The amount of heat produced per mole of PC split (-DeltaH) was 13.18 +/- 1.04 kcal/mole (mean and S.E. from thirty-five observations).4. (-DeltaH) is probably rather greater in tortoise than in frog muscle. The value of (-DeltaH) cannot easily be accounted for by the known processes accompanying PC splitting in either type of muscle.