The influence of Mechanical bowel preparation in elective colorectal surgery for diverticulitis

Background: Mechanical bowel preparation (MBP) has been shown to have no influence on the incidenc

Results, Retrospectively Analysed, of the Current Trauma Database in Curacao, Dutch Caribbean

Background: A trauma registry plays an important role in the process of health-service improvement. The organization of trauma care in the Caribbean is limited; there is a lack of registry and distribution of patients. Objective: The purpose was to compare incidence-trends of patients with trauma-related injuries in the Curacao trauma registry over 14 years, since Curacao is part of the Dutch Caribbean. Methods: The data of all injured patients admitted to the Emergency Department (ED) from January 1, 2000 to December 31, 2013, were retrospectively analysed using a prospective trauma registry. Subsequently, they were crosschecked with the registry of Central Bureau of Statistics, Curacao (CBSC). Results: In the ED, 14 886 patients with trauma-related injuries were selected: 9390 M and 5496 F. The incidence per 100 000 inhabitants per year of traffic-related trauma was 529.7 (95% confidence interval [CI]: 430.9, 628.5); firearm-related 29.2 (95% CI: 18.3, 40.2); stab wound-related 26.4 (95% CI: 18.4, 34.4) and molestation-related 173 (95% CI: 127.5, 218.5). There is an overall decline in the incidence through the years. In all the trauma-related groups, there were significantly more men and people aged between 15 and 34 years. The hospitalization of traffic-related injured patients was 22.7%, firearm-related 48.3%, stab wound-related 30.5% and molestation-related 18.9%. Conclusion: The hospitalizations percentages differ. The incidence and trauma mechanism seem to be age-and gender-related. There is a higher incidence of trauma-related injuries, in Curacao compared with the incidence in the other countries in the region. This study is a start to the set-up of a new trauma registry

Commonly used bowel preparations have significant and different effects upon cell proliferation in the colon: a pilot study

BACKGROUND: Markers of crypt cell proliferation are frequently employed in studies of the impact of genetic and exogenous factors on human colonic physiology. Human studies often rely on the assessment of tissue acquired at endoscopy. Modulation of cell proliferation by bowel preparation with oral laxatives may confound the findings of such studies, but there is little data on the impact of commonly used bowel preparations on markers of cell proliferation. METHODS: Crypt length, crypt cellularity and crypt cell proliferation were assessed in biopsies acquired after preparation with either Klean-Prep or Picolax. Crypt cell proliferation was assessed by whole-mount mitotic figure count, and by two different immunohistochemical (IHC) labelling methods (Ki-67 and pHH3). Subsequent biopsies were obtained from the same patients without bowel preparation and similarly assessed. Parameters were compared between groups using analysis of variance and paired t-tests. RESULTS: There were significant differences in labelling indices (LI) between biopsies taken after Klean-prep and those taken after Picolax preparation, for both Ki67 (p = 0.019) and pHH3 (p = 0.017). A similar trend was seen for whole-mount mitotic figure counts. Suppression or elevation of proliferation parameters by bowel preparation may mask any effect due to an intervention or disease. CONCLUSION: Commonly used bowel preparations may have significant and different effects on crypt cell proliferation. This should be taken into account when designing studies and when considering the findings of existing studies

Preoperative mechanical preparation of the colon : the patient's experience

Background Preoperative mechanical bowel preparation can be questioned as standard procedure in colon surgery, based on the result from several randomised trials. Methods As part of a large multicenter trial, 105 patients planned for elective colon surgery for cancer, adenoma, or diverticulitis in three hospitals were asked to complete a questionnaire regarding perceived health including experience with bowel preparation. There were 39 questions, each having 3 – 10 answer alternatives, dealing with food intake, pain, discomfort, nausea/vomiting, gas distension, anxiety, tiredness, need of assistance with bowel preparation, and willingness to undergo the procedure again if necessary. Results 60 patients received mechanical bowel preparation (MBP) and 45 patients did not (No-MBP). In the MBP group 52% needed assistance with bowel preparation and 30% would consider undergoing the same preoperative procedure again. In the No-MBP group 65 % of the patients were positive to no bowel preparation. There was no significant difference between the two groups with respect to postoperative pain and nausea. On Day 4 (but not on Days 1 and 7 postoperatively) patients in the No-MBP group perceived more discomfort than patients in the MBP group, p = 0.02. Time to intake of fluid and solid food did not differ between the two groups. Bowel emptying occurred significantly earlier in the No-MBP group than in the MBP group, p = 0.03. Conclusion Mechanical bowel preparation is distressing for the patient and associated with a prolonged time to first bowel emptying