Changing patterns in the morbidity and mortality of colorectal surgery

Article Abstract:

Prior to the use of antibiotics, colon and rectal surgery was associated with a high rate of complications and death (13 to 28 percent for elective procedures). Although mortality has decreased (ranging from 1.7 to 6 percent), colorectal surgery is still risky for elderly patients, particularly those with heart or lung problems. A study was undertaken to evaluate the patterns of complications from colorectal surgery performed in two separate time periods and to determine the impact of improvements in surgical care and technique. Researchers also hoped to be able to identify risk factors for a poor outcome. The records of 362 patients who had colorectal surgery were reviewed; 136 were treated between 1970 and 1975 (group 1), and 226 were treated between 1984 and 1987 (group 2). There was a higher number of elderly patients in the second patient group. The rate of death was comparable in both groups, as was the rate of complications following elective procedures. Emergency surgery resulted in a higher rate of complications in group 2 patients, 66 percent versus 54 percent for group 1 patients. The types of complications shifted between the two time periods. In group 1, surgical complications occurred in 33 percent of patients, and medical complications affected 26 percent of patients; whereas in group 2, the rates of surgical and medical complications were 15 percent and 47 percent, respectively. It is noted that as infectious complications have been brought under control, abnormalities of other systems and organs have become increasingly important determinants of survival. It is recommended that the underlying medical conditions of elderly patients be brought under control as much as possible prior to colorectal surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Colon (Anatomy), Rectum, Colon surgery

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A comparison of monobactam antibiotics in surgical infections

Article Abstract:

The antibiotic gentamicin, an aminoglycoside introduced 20 years ago, is effective for fighting infections caused by gram-negative bacteria. During the last few years, the appearance of antibiotics such as cephalosporins, aztreonam and imipenem, which are just as effective against gram-negative bacteria as aminoglycosides, has led to a reassessment of the use of aminoglycosides in treating infection. Relative effectiveness, safety, and cost should be considered in comparing these different antibiotics. Considerations of cost are only relevant when the effectiveness and safety of the drugs are equivalent. Other factors can influence the selection of an antibiotic treatment regimen, including how the drug moves through the body, its effects on the normal bacteria present in the body, and how effectively it kills microorganisms under laboratory conditions. A new class of antibiotics, the monobactams, is reviewed. Aztreonam is the only member of the class currently being used. Comparisons of these antibiotics with aminoglycosides are particularly meaningful because aztreonam can fight gram-negative bacteria which require oxygen. Acknowledged concerns over the use of aminoglycosides are discussed, as are the comparative characteristics of aztreonam and aminoglycosides currently on the market.

Health aspects, Evaluation, Antibiotics, Aminoglycosides, Gentamicin, Gentamicins, Aztreonam

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Surgical morbidity in patients with systemic lupus erythematosus

Article Abstract:

This paper examined the result and course of 36 different surgical procedures on 29 patients with systemic lupus erythematosus (SLE). (SLE is a multiorgan system disease believed to be caused by the body being allergic to itself an autoimmune disease.) In persons with the disease, individual organs are inflamed, and a frequent method of treatment is steroids. In 19 cases surgery was performed on an emergency basis. Most patients had more than one organ affected by the disease and many were being treated by some form of medication. Twenty patients representing 37 complications were further examined and compared to the other patients who did not have complications of surgery. More of the patients in the former group had been treated with steroids before surgery, more of their organs were diseased, and more had been treated surgically on an emergency basis. The authors conclude that these factors failed to predict the outcome of patients with SLE. The authors also note that surgical complications are frequent in patients with lupus erythematosus.

Inflammation, Systemic lupus erythematosus

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