Endoscopic retrograde cholangiopancreatography in pancreatic trauma

The sensitivity and specificity of ERCP for the diagnosis of suspected pancreatic ductal rupture was prospectively studied. Fourteen consecutive patients who were referred for abdominal pain and hyperamylasemia subsequent to abdominal trauma underwent ERCP, the majority within 24 hours of admission. Twelve of these also underwent abdominal CT, and 7 had peritoneal lavage. Four patients were found to have ductal rupture at ERCP. This was confirmed at laparotomy. Three additional patients who underwent laparotomy were found not to have a ductal rupture, although one had a pancreatic capsular laceration. The remaining 7 had clinical resolution. ERCP was 100% sensitive and specific in the diagnosis of pancreatic ductal rupture, whereas no combination of serum amylase, CT scan, and peritoneal lavage was equally effective

Pharming animals: a global history of antibiotics in food production (1935–2017)

Since their advent during the 1930s, antibiotics have not only had a dramatic impact on human medicine, but also on food production. On farms, whaling and fishing fleets as well as in processing plants and aquaculture operations, antibiotics were used to treat and prevent disease, increase feed conversion, and preserve food. Their rapid diffusion into nearly all areas of food production and processing was initially viewed as a story of progress on both sides of the Iron Curtain. However, from the mid-1950s onwards, agricultural antibiotic use also triggered increasing conflicts about drug residues and antimicrobial resistance (AMR). Significantly, antibiotic concerns did not develop evenly but instead gave rise to an international patchwork of different regulatory approaches. During a time of growing concerns about AMR and a post-antibiotic age, this article reconstructs the origins, global proliferation, and international regulation of agricultural antibiotics. It argues that policymakers need to remember the long history of regulatory failures that has resulted in current antibiotic infrastructures. For effective international stewardship to develop, it is necessary to address the economic dependencies, deep-rooted notions of development, and fragmented cultural understandings of risk, which all contribute to drive global antibiotic consumption and AMR