Background: Clostridium difficile colitis is associated with increased age, antibiotic usage, and hospitalization. Severe C. difficile colitis refractory to medical therapy may require surgical intervention including subtotal colectomy. We initiated an adjuvant intracolonic vancomycin (ICV) enema protocol for inpatients with severe C. difficile colitis and compared the response to this therapy in patients from the community and nursing homes. Methods: A single-hospital, retrospective chart review was done on 47 consecutive patients with C. difficile colitis treated with ICV (1 g/500 mL normal saline q6h) from January 2007 through October 2009. The proportions of patients with the outcomes of response to the ICV protocol, need for subtotal colectomy, and death were described. Associations of patient characteristics with these outcomes were examined with bivariate tests and multivariable logistic models with adjustment for age, hypoalbuminemia, acidosis, and nursing-home status. Results: Thirty-three of 47 patients (70%) with severe C. difficile colitis responded to adjunct ICV with complete resolution without surgery. Incomplete responders who had surgery were more likely to survive than those patients who did not undergo subtotal colectomy (p < 0.01). Seven of nine patients who underwent surgery survived > 90 d, and overall, 37 of 47 patients (79%) survived after ICV therapy. Nursing-home residence, acidosis, and hypoalbuminemia were significantly associated with the non-resolution of colitis in bivariate analyses (all p < 0.01), whereas nursing-home residence and hypoalbuminemia showed non-significant trends toward association with death (p = 0.07 and p = 0.06, respectively). Multivariate logistic-regression models showed significant associations of acidosis with an incomplete response to ICV (p = 0.02), of older age with death (p = 0.04), and of hypoalbuminemia with both an incomplete response to ICV and death (both p = 0.04). No complications were attributable to ICV. Conclusion: Complete resolution without surgery was achieved in 70% in this series of patients with severe C. difficile colitis who received adjunct ICV therapy. A clinical trial will be needed to determine whether ICV as compared with standard therapy alone can reduce the need for surgery with non-inferior or superior outcomes.

Numerous reports document elevated cancer rates among children living near nuclear facilities in various nations. Little research has examined U.S. rates near the nation's 103 operating reactors. This study determined that cancer incidence for children < 10 yr of age who live within 30 mi (48 km) of each of 14 nuclear plants in the eastern United States (49 counties with a population > 16.8 million) exceeds the national average. The excess 12.4% risk suggests that 1 in 9 cancers among children who reside near nuclear reactors is linked to radioactive emissions. If cancer incidence in 5 western states is used as a baseline, the ratio is closer to 1 in 5. Incidence is particularly elevated for leukemia. Childhood cancer mortality exceeds the national average in 7 of the 14 study areas.

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The learning curve for successful consistent completion of SILS cholecystectomy cases appears to be after 25 cases. In addition, conversion rates drop dramatically after the first ten cases.

The authors suggest that laparoscopic right colectomy utilizing a single port may be performed with excellent cosmetic results.

Acute appendicitis is one of the most common causes of abdominal pain that a general surgeon will encounter. We describe our modification to the laparoscopic appendectomy: a single-incision laparoscopic (SILS) appendectomy completed entirely intracorporeally. From September 2008 to September 2009, a retrospective review of the electronic medical record was performed in all patients who underwent a SILS appendectomy to specifically analyze the demographic characteristics, time in the operating room to perform SILS appendectomy, length of postoperative hospital stay, and postoperative complications. Twenty-five patients underwent SILS appendectomy in the study period. There were 18 males and seven females with a mean age of 41 ± 15 years and mean body mass index of 26.5 ± 5 kg/m2. Single-incision laparoscopic appendectomy was performed successfully in all of our cases (100%). Mean operative time was 56 ± 16 minutes. Blood loss in all cases was minimal and there were no intraoperative complications. We successfully completed 25 appendectomies using the SILS method. Operative times were similar compared with the traditional laparoscopic technique. We believe that the SILS appendectomy is a safe and effective method that leaves a virtually invisible scar.

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