[Prevention of infections among surgeons]
Schlichting E. Andersen BM.
Gastroenterologisk avdeling, Ulleval sykehus, Oslo.
Accidental exposure to blood may represent a frightening experience for health care workers because of the risk of developing infectious diseases, such as hepatitis B and C virus and HIV infection. Recommendations for follow-up after occupational exposure to HIV- and hepatitis infected blood are presented. Post-exposure chemoprophylaxis decreases the risk of occupational HIV infection after percutaneous exposure and should be administered within two hours. Studies have shown that most accidents could have been avoided with better working routines during operations.
[Clostridium difficile-associated diarrhea treated with homologous feces]
Lund-Tonnesen S. Berstad A. Schreiner A. Midtvedt T.
Medisinsk avdeling Haukeland Sykehus, Bergen.
The incidence of Clostridium difficile-associated diarrhoea has increased during the last few years. Treatment with vankomycin or metronidazol is usually effective, but relapses are not uncommon. Some good results have been reported with faecal enemas, but it is a controversal form of treatment. 18 patients with C. difficile-associated diarrhoea were given homologous faeces from one healthy donor. In 17 patients faeces was instillated via a coloscope and in one patient via a gastrostoma. C. difficile toxin was detected in all patients. Three patients with severe colitis did not respond to the treatment. The remaining patients were clinically cured, and no relapses were observed. Treatment of C. difficile-associated diarrhoea with faeces appears to be an alternative in moderate cases. In our limited number of patients we observed a poor correlation between the clinical picture, the endoscopic findings and the histological findings in colon biopsies. The ethical aspects of treatment with faeces will continue to be subject to discussion.
[Inflammatory bowel disease and pregnancy]
Hovdenak N. Schlichting E.
Medisinsk avdeling, Diakonissehjemmets Sykehus Haraldsplass, Bergen.
Inflammatory bowel disease (ulcerative colitis and Crohn's disease) is a chronic illness, often affecting people of reproductive age. Treatment involves drugs which have potential side effects and because of this pregnancy causes considerable concern. The course of the disease is not much affected by pregnancy. The relapse rate is only slightly increased when the disease is active at the time of conception. Relapses during pregnancy should be treated in the usual manner. Surgical intervention should be carried out on the same indications as in those who are not pregnant. Frequency of complications is not increased during pregnancy, at delivery or post partum. Sectio may be necessary in perianal disease. With few exceptions, drug treatment should be continued throughout pregnancy. No adverse effects are seen with normal doses of sulfasalazine, 5-amino-salicylic acid and steroids. Planned pregnancies should be started in periods of quiescent disease.
[Cecal volvulus as a complication in Cornelia de Lange syndrome. A case report and literature review]
Holthusen J. Rottingen JA.
Kirurgisk avdeling Stokmarknes sykehus.
Colonic volvulus in children is a rare, but serious and important differential diagnosis in acute abdominal illness. Our patient with Cornelia de Lange's syndrome, was admitted with an acute onset of abdominal pain and in a critical condition. Explorative laparotomy revealed a caecal volvulus with necrosis of the distal ileum, caecum and proximal colon. The syndrome is characterized by typical facial expression, both growth and mental retardation, and various gastrointestinal and cardiac anomalies. Predisposing factors contributing to volvulus in this syndrome are mental retardation and a higher incidence of malrotation and nonfixation of the caecum and ascending colon. The parents of children with Cornelia de Lange's syndrome should therefore be counselled so that they are able to provide essential information in the event of their children experiencing acute illness.
Hegstad AC. Rordam S. Bock G. Klafstad PC.
Department of Pathology, McMaster University, Hamilton, Ontario, Canada.
The appropriateness of a laparoscopic approach to cholecystectomy in community hospital settings has been questioned. To address this issue a prospective study of outcomes of laparoscopic cholecystectomies performed during a three year period at Telemark Community Hospital was undertaken. There were 229 procedures performed by five surgeons. 24 (10.5%) of the attempted laparoscopic cholecystectomies were converted to open cholecystectomies. The average hospital stay after laparoscopic cholecystectomy was 3.0 days (SD = 2.6). Minor intraoperative complications (gall bladder perforation, gall bladder bed bleeding) occurred in 43% of the laparoscopic procedures. There were nine cases (4.4%) of major intraoperative complications which included laceration of the common bile duct (n = 4, one discovered during surgery), ileal perforation (n = 1) and laceration of the liver (n = 4). The frequency of postoperative complications after laparoscopic cholecystectomy was 8.8%. Bile peritonitis was observed in three patients, of whom one died. There were no significant differences in intra- and postoperative complications between the surgeons performing the operations. The present results support the argument that laparoscopic cholecystectomies can be performed safely and effectively in community hospitals.