Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery.

BACKGROUND: Mechanical bowel preparation (MBP) is performed routinely before colorectal surgery to reduce the risk of postoperative infectious complications. The aim of this randomized clinical trial was to compare the outcome of patients who underwent elective left-sided colorectal surgery with or without MBP. METHODS: Patients scheduled for elective left-sided colorectal resection with primary anastomosis were randomized to preoperative MBP (3 litres of polyethylene glycol) (group 1) or surgery without MBP (group 2). Postoperative abdominal infectious complications and extra-abdominal morbidity were recorded prospectively. RESULTS: One hundred and fifty-three patients were included in the study, 78 in group 1 and 75 in group 2. Demographic, clinical and treatment characteristics did not differ significantly between the two groups. The overall rate of abdominal infectious complications (anastomotic leak, intra-abdominal abscess, peritonitis and wound infection) was 22 per cent in group 1 and 8 per cent in group 2 (P = 0.028). Anastomotic leak occurred in five patients (6 per cent) in group 1 and one (1 per cent) in group 2 (P = 0.210) [corrected] Extra-abdominal morbidity rates were 24 and 11 per cent respectively (P = 0.034). Hospital stay was longer for patients who had MBP (mean(s.d.) 14.9(13.1) versus 9.9(3.8) days; P = 0.024). CONCLUSION: Elective left-sided colorectal surgery without MBP is safe and is associated with reduced postoperative morbidity.

Are airbags dangerous?

Several articles have shown that airbags are not without danger. A brief overview of the literature shows their impact on motor vehicle collisions. Several criteria of severity are listed to avoid underestimating airbag-crash patients with a "no crash" look.

Ruptured aneurysm of the omentum. Case report.

A 61-year-old man was operated on for a ruptured aneurysm located on the free margin of the omentum. Such patients should have preoperative arteriography as the source of the haemorrhage can be difficult to find at operation.

[Surgery of digestive system cancers in patients over 80 years of age]. / Chirurgie des cancers digestifs chez les patients de plus de 80 ans.

231 patients over 80 years old were operated at the Clinique de chirurgie digestive of Geneva University Hospital between 1981 and 1990 for a malignant tumor of the gastrointestinal tract. The following parameters were studied: intra- and postoperative morbidity and mortality, duration and quality of survival. Surgery proved valid in this age group given its low mortality (15%). Postoperative morbidity (44%) did not prolong hospital stay, since 90% of all patients were discharged within one month of surgery. Following surgery, quality of life was excellent: 75% of patients returned home, and 80% were better off than pre-operatively. Such operations provide better results in term of mortality and survival when performed on an elective basis and curatively.

Quantitation of the third component of human complement attached to the surface of opsonized bacteria: opsonin-deficient sera and phagocytosis-resistant strains.

The role of the third component of human complement (C3) in the opsonization of bacteria in nonimmune human sera was evaluated. The amount of C3 that becomes attached to the surface of bacteria upon incubation in serum was measured in a quantitative fluorescent immunoassay using fluorescein-conjugated monospecific antiserum to human C3. The intensity of the fluorescence from opsonized bacteria was found to be directly proportional to the absolute amount of C3 fixed, and this enabled the detection of as few as 300 molecules of bound C3 per bacterium. In normal serum the rate of C3 fixation was closely correlated with an increase in opsonization of the bacteria for human PMNs. Both C3 fixation and opsonization were maximal after 15 min of incubation. C3 fixation was also observed, albeit at a significantly slower rate, in human serum with a nonfunctional classical pathway but an intact alternative complement pathway and in serum deficient in immunoglobulins. Again, the kinetics of C3 fixation correlated with bacterial opsonization. Using a total of 21 strains of several bacterial species, including Staphylococcus aureus and Escherichia coli, encapsulation of bacteria was found to interfere with the process of C3 fixation in normal human serum, rendering these organisms resistant to subsequent phagocytosis by human polymorphonuclear leukocytes.