A newborn baby presented with a lump in the right hypochondrium. She had a bout of upper gastrointestinal bleeding. At operation, a pyloroduedenal duplication cyst was successfully removed. The relevant literature is reviewed.
A prospective study was carried out in 200 consecutive patients undergoing biliary surgery to compare the prophylactic effectiveness of ceftriaxone and clavulanate-potentiated (CP-) amoxycillin. Patients were assigned in a randomized fashion to two groups and received ceftriaxone (2 g intravenously pre-operatively), or CP-amoxycillin (1200 mg, to be repeated for 2 more doses in the case of patients undergoing procedures other than elective cholecystectomy). Post-operative wound infection occurred in 4% of patients in each group. Administration of ceftriaxone was associated with a lower incidence of post-operative pyrexia and chest infection as well as with a shorter hospital stay.
The object of this study is to focus attention on the causes of intestinal obstruction in Libya. In this study, spread over 30 months and involving 114 patients, the most common cause was the entrapment of bowel in an external hernia. Postoperative adhesions accounted for obstruction in a third of our patients, and 59 per cent of them followed appendicectomy. Biliary lithiasis is the most common surgical disease in Libya, yet there was only one instance of gallstone ileus in this series. Sigmoid volvulus and intestinal lymphoma were also rare, and tubercular stricture and Crohn's disease were remarkable by their absence. There were no cases of idiopathic intussusception during or immediately following Ramadan.
This paper reports the results of a prospective randomized study of antibiotic prophylaxis in 200 patients over the age of 12 years undergoing emergency appendicectomy at Al-Jala Hospital for Trauma and Emergency Surgery, Benghazi. We have compared the efficacy of ceftriaxone, a long-acting broad-spectrum cephalosporin with that of our routine regimen consisting of metronidazole, gentamicin and ampicillin, given together. Ceftriaxone was administered as a single pre-operative dose of 2 g (to be continued as a daily injection for 5 days in patients with perforated appendicitis). The triple combination was given on an 8-hourly basis for 3 days, extended to 5–7 days in cases of perforation. Patients receiving ceftriaxone did as well as or slightly better than those on the triple-antimicrobial regimen, in terms of wound infection rate (3 vs. 5%), incidence of transient post-operative pyrexia and duration of hospital stay (on average 4.5 vs. 5.9 days). More importantly, administering ceftriaxone as 1 injection per day led to a dramatic saving in terms of nursing effort and time (1 injection instead of 9 per 24 h) and of the daily financial cost of therapy per patient. It is concluded that the clinical results and economic implications seem to justify the use of ceftriaxone as a routine prophylactic antibiotic for patients undergoing emergency appendicectomy.
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