Search

Aim Clostridium difficile infection (CDI) is a cause of morbidity and mortality in hospitals. Various independent risk factors have been identified, including age and antibiotic exposure. This study attempted to determine whether surgery and associated antibiotic use influence the development of CDI. Method A retrospective review of all patients with a diagnosis of CDI diagnosed during admission to a colorectal unit was conducted over a 20-month period. Patient records were cross-referenced with a microbiology database to identify previous episodes of infection and cases of recurrence. Results There were 38 CDI episodes in 29 patients, including nine with recurrence. In 33, the use of antibiotics prior to the onset of CDI was documented, but in 14 (37%) patients this was limited to perioperative prophylaxis. The incidence of CDI after various procedures was as follows: ileostomy closure (4.2%), right hemicolectomy (2.1%) and anterior resection (1%). Conclusion Ileostomy closure may carry a higher risk of CDI.

The study by Falvey and colleagues[1][1] is a useful one which adds to our understanding of the natural history of patients requiring admission to hospital for treatment of ulcerative colitis (UC) (see page 35). The major findings of the study are: 1. Three year mortality after admission for

Records of domestic animals brought to the Veterinary Entomology Laboratory for diagnosis of suspected lice and mite infestation over a 10 year period were analysed. From a total of 794 suspected cases, 137 (17.3%) and 247 (31.1%) were positive for lice and mange mites respectively. The most common lice species recorded were Linognathus vituli (66.7%) on cattle, L. ovillus (83.3%) on sheep, Haematopinus suis (100%) on pigs and Menacanthus stramineus (54.5%) on poultry. Other lice species recorded included Haematopinus bovis and Solenopotes capillatus on cattle, Damalinia ovis on sheep, Linognathus stenopsis and Menacanthus stramineus on goats, Goniocotes sp. on a horse, Linognathus setosus and Menacanthus stramineus on dogs, Goniodes gigas, Lipeurus caponis, Menopon gallinae and Chelopistes meleagrides on poultry. The most common mite species were Demodex folliculorum on cattle (96.9%) and on dogs (80.8%), Sarcoptes scabiei on pigs (100%) and Notoedres cati (80.3%) on rabbits. Other mite species included Psoroptes communis, Cheyletiella parasitivorax, Ornithonyssus gallinae and Dermanyssus gallinae.

The in vitro toxicity of neem seed oil (Azadiracta indica, family: Meliaceae, 'Dogon yaro' in Hausa -language) was tested against the larvae of a three-host tick, Amblyomma variegatum (family: Ixodidae or hard tick) parasitic to cattle commonly found in Nigeria. Undiluted neem oil (100% concentration) was found to kill all (100% mortality) the larvae after 48 h. The toxicity was concentration and time dependent.

No Abstract. Animal Production Research Avancees Vol. 3 (2) 2007: pp. 104-107

Patients with metastatic rectal cancer precluding curative low anterior resection (LAR) or abdominoperineal resection (APR) can require palliation for impending obstruction. LAR or APR is frequently not optimal because of the associated operative morbidity. Lesser procedures such as diverting colostomy require patients to live with a permanent stoma. Endoscopic transanal resection (ETAR) has been used for excision of rectal lesions. To determine whether ETAR provides palliation equivalent to LAR or APR, we reviewed the outcomes of 49 patients with rectal adenocarcinoma and unresectable liver metastases who required palliative intervention between January 1989 and July 1996. Of these 49 patients, 24 underwent ETAR; the intraluminal tumor was resected using the urologic resectoscope to achieve a hemostatic, patent lumen. The outcomes of these patients were compared to those of the other 25 patients who had palliative LAR, APR, or a Hartmann procedure during the same period. The median distance of the tumors from the anal verge was similar (5 cm; range 1 to 15 cm). ETAR patients had a higher percentage of poorly differentiated tumors (35% vs. 6%, P = 0.034) and higher preoperative alkaline phosphatase values (478 +/- 75 mg/dl vs. 231 +/- 24 mg/dl; P0.015), suggesting more aggressive disease and greater hepatic tumor burden, respectively. Despite these differences, overall survival and time spent outside the hospital were similar in the two groups. The median number of debulking procedures required in the 24 ETAR patients was two (range 1 to 17). Resections in the 25 LAR/APR patients included LAR in 20, APR in two, and Hartmann procedures in three. There was a trend toward more stomas in the LAR/APR group (28% vs. 17%). More important, morbidity was significantly higher in the LAR/APR patients (24% vs. 4%; P = 0.049). In conclusion, ETAR is a safe alternative for the palliation of incurable rectal tumors. Compared to transabdominal resection, ETAR provides equivalent palliation as measured by survival and proportion of the patient's life spent outside the hospital, with a lower stoma rate and significantly less morbidity. Therefore, in select patients with metastatic rectal cancer, ETAR is an important palliative option.

The quality of a patient's consent form signature was assessed in 42 adult patients undergoing emergency major abdominal surgery. Patients with a poor quality or absent consent form signature had a significantly higher mortality and higher APACHE II scores than those with a satisfactory consent form signature.

Over four years the histological features of benign breast diseases, diagnosed after biopsy of non-palpable mammographic abnormalities, were reviewed and correlated with the mammographic appearances. The histological features were compared with those from all other benign biopsy specimens taken during the same period. The incidence of sclerosing adenosis and microcalcifications was considerably higher in the group of non-palpable mammographic lesions; fibrous disease of the breast and radial scar (infiltrating epitheliosis) were also more common. There was no difference in the incidence of epithelial hyperplasia between the two groups. Correlation with the mammographic appearances showed that microcalcification was most often associated with blunt duct adenosis and that stromal distortion or masses were most often caused by fibrous disease.

It is natural that present attitudes towards safety at sea and collision avoidance should reflect a justifiable preoccupation with electronics in meeting the exigencies of marine traffic congestion and collision hazards. Despite the frequency with which marine casualties occur during darkness and in conditions of poor visibility there is a tendency to minimize the positive, if modest, contribution of efficient and distinctive ships' navigation lights towards safety at sea in these circumstances.

An article entitled ‘Defining the Close-Quarters Situation at Sea’ in this Journal (36, 454, September 1983), described how certain manoeuvres made by ships could safeguard against close-quarters situations developing at sea and, when circumstances demanded, these manoeuvres could ensure compliance with Rule 19(e) of the Collision Regulations.Basically it was suggested that engines should be stopped when the distance between two such approaching vessels was N nautical miles, which was pre-calculated. If that action appeared insufficient, full astern power should be applied after an interval of Δt minutes had elapsed or, at the latest, when the separation distance between the two vessels was not less than Ab(SP) nautical miles.

Summary Two cases of male breast carcinoma presenting as cystic swellings are reported. Cysts of the male breast are rare, but unlike cysts in female breasts are more likely to represent significant pathology. We recommend consideration of excision biopsy of isolated cysts in male breasts.