Tonsilloadenoidectomy is performed over 340,000 times per year in the United States, usually as a same day admission procedure with a postoperative overnight stay. Because of the current emphasis on reducing health care costs, many insurers are requiring the procedure of tonsilloadenoidectomy be performed on an outpatient basis, even though there is a lack of data supporting the safety of such a requirement. The charts of 2,944 pediatric patients who underwent tonsillectomy and/or adenoidectomy from January 1, 1983 to December 31, 1984 were reviewed. Analyses revealed predictive variables that could be used to identify patients with a low risk of complications. Nineteen percent of the patients could be released 4 hours postoperatively with an 8.1% chance of subsequent complications. No patients who underwent the combined procedure of tonsillectomy and adenoidectomy were in this group. Of the remaining patients, 0.4% could be released 6 hours after surgery, or 85.9% could be released 8 hours after surgery, or 98.2% could be released 10 hours after surgery, all with a less than 10% chance of subsequent complications. This study supports keeping tonsilloadenoidectomy patients at least 8 hours and possible 10 hours after surgery to minimize the risk of complications after discharge.

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Epidemiological evidence suggests a link between meat consumption and prostate cancer. In this study, benign prostatic hyperplasia tissues, obtained by transurethral resection or radical retropubic prostatectomy from UK-resident individuals (n = 18), were examined for CYP1 expression and for their ability, in short-term organ culture, to metabolically activate carcinogens found in cooked meat. Semi-quantitative RT-PCR analysis of CYP1 expression detected CYP1A2 mRNA transcripts in the prostates of four individuals, as well as mRNA transcripts from CYP1A1 and CYP1B1. The compounds tested for metabolic activation were 2-amino-1-methyl-6-phenylimidazo[4, 5-b]pyridine (PhIP; 500 microM, n = 9) and its metabolite N:-hydroxy PhIP (20 microM, n = 8), 2-amino-3-methylimidazo[4,5-f]quinoline (IQ; 500 microM, n = 6) and benzo[a]pyrene (B[a]P; 50 microM, n = 5). After incubation (PFMR medium, 22 h, 37 degrees C), DNA was isolated from tissue fragments and DNA adducts were detected and quantified by (32)P-postlabelling analysis. DNA adduct formation was detected in all samples incubated with PhIP (mean, adducts per 10(8) nucleotides), N:-hydroxy-PhIP (2736/10(8)) or B[a]P (1/10(8)). IQ-DNA adducts were detected in 5/6 tissues (mean, 1/10(8)). The CYP1 inhibitor alpha-naphthoflavone (10 microM) reduced B[a]P-DNA adduct formation in tissues from two individuals by 96 and 64%, respectively. This pilot study shows that human prostate tissue can metabolically activate 'cooked meat' carcinogens, a process that could contribute to prostate cancer development.

The main aim of this study was to determine the susceptibility to photo-activated disinfection (PAD) of Streptococcus mutans when the organism was present in a collagen matrix – an environment similar to that which would exist within a carious tooth. In addition, the susceptibility to PAD of bacteria present in carious human teeth was also determined. Light was delivered to the collagen and teeth using a system comprising a 0.8-mm diameter isotropic tip emitting light at 633 ± 2 nm. A single concentration of TBO (10 µg/ml) was used with both collagen and dentine. Two contact times, 30 and 180 s, were evaluated in intact collagen and additionally, for 180 s only, in collagen partially disrupted by shredding. The effect of energy doses from 1.8 to 14.4 J on the kills attained was assessed by determining the number of surviving viable bacteria. In carious dentine, two contact times, 30 and 60 s and one energy dose, 4.8 J, were used. Antibacterial effects were less than those obtained using planktonic suspensions with a maximum mean log reduction of 1.4 in shredded collagen and dentine. Increasing contact time increased the antibacterial effectiveness in both substrates although this was not always of statistical significance. Shredding the collagen resulted in significantly increased bacterial kills compared to those obtained in intact collagen for the 30-second contact time. The collagen matrix appeared to be a suitable model for carious dentine with advantages of availability and reproducibility. The results of this study have shown that PAD can achieve appreciable kills of oral bacteria, including S. mutans, when the organisms are embedded in a collagen gel or are present in carious teeth.

T‐tube drainage of the common bile duct (CBD) following duct exploration has become standard surgical practice. This randomized prospective study has compared primary closure versus T‐tube drainage of the CBD following exploration for calculous disease. Thirty‐seven patients underwent primary closure and 26 underwent closure over T‐tube. Both groups were comparable in terms of age, indications for surgery, associated illnesses, pre‐operative bilirubin, amylase and white cell count. Forty‐three per cent of operations were performed by a consultant in the primary closure group and 65% in the T‐tube group. There was no significant difference in the duration of operation, incidence of wound infection, surgical or other complications following operation between the two groups. However, the postoperative stay was significantly prolonged in the T‐tube group, to a median of 11 days, compared to 8 days in the primary closure group (P= 0.0001). This prolongation in stay was unrelated to whether admission was as an emergency or elective. T‐tube drainage of the bile continued for a median of 7 days postoperative, whereas the bile drained via a wound drain in only 13 (35%) of the primary closure group, for a median of 5 days in these 13 patients. Long‐term follow up was achieved in 48 patients, by a questionnaire sent at a median of 2.8 years following operation. Abdominal pains following recovery from the operation were experienced by 18% of the primary closure group and 20% of the T‐tube group. No patient developed jaundice or pancreatitis, nor needed further biliary surgery following operation. Primary closure of the CBD following exploration for calculous disease significantly reduces hospital stay, and is as safe as closure with T‐tube, in both the short and long‐term.