METHODS: A cross-sectional study using retrospective data from January 2000 to May 2002 was performed pertaining to elective colorectal surgery, cholecystectomy and inguinal hernia repairs. Appropriateness of antibiotic administration was determined based on compliance with national and internationally accepted guidelines on prophylactic antibiotic prescribing policy. A single dose or omission of antibiotic administration was judged appropriate for cholecystectomy and inguinal hernia repair, while up to 24 hours' dosing was considered appropriate practice for colorectal surgery.
RESULTS: Of 419 cases, there were 55 (13.1%) colorectal procedures, 97 (23.2%) cholecystectomies and 267 (63.7%) inguinal hernia repairs. Antibiotics were administered in a total of 306 (73%) cases, with single-dose prophylaxis in only 125 (41%) of these. Prophylaxis was inappropriately prolonged in 80%, 52% and 31% of colorectal, cholecystectomy and inguinal hernia cases, respectively. The corresponding mean duration of anti-biotic administration was 2.4+/-2.2, 1.6+/-1.8 and 1.1+/-1.3 days, respectively.
CONCLUSION: Antibiotic prophylaxis in elective surgery continues to be administered haphazardly. This study supports close surveillance of antibiotic utilization by a dedicated team, perhaps consisting of microbiologists or pharmacists, to minimize inappropriate administration.
METHODS: A questionnaire survey was conducted among general surgeons attending the annual Malaysian College of Surgeons meeting in 2002. A total of 110 questionnaires were distributed to specialist-grade general surgeons with varying subspecialty interests.
RESULTS: Seventy-seven (70%) surgeons returned the questionnaire. Of these, 43% were of the opinion that VTE was as common in Asian patients as in the West. Selective VTE prophylaxis was used by 99% in their practice. The indications for use, in order of frequency, were: previous VTE disease, risk grading, prolonged surgery, obesity, malignancy and age. Low molecular weight heparin was the most common type of prophylaxis used. VTE-related morbidity was reported by 44 surgeons (57%) over the past year, and 39% of these cases were fatal.
CONCLUSION: The high incidence of VTE-related complications indicates that the use of thromboprophylaxis is either insufficient or not matched to the level of risk. Updated guidelines on VTE prophylaxis should be used so that a standardized approach can ensure that patients receive adequate prophylaxis where indicated.
PATIENTS AND METHODS: Formalin-fixed, paraffin-embedded tissue samples of 47 CRCs surgically resected at the Kuala Lumpur Hospital (KLH) between 1999 and 2000 were used. Immunohistochemical staining with monoclonal antibodies against cyclin-D1 and survivin and polyclonal antibodies against Wnt-1 and WISP-1 was performed. Results of immunohistochemistry were analysed for correlation between biomolecules and histopathological data of the patients.
RESULTS: Of the 47 CRCs, 26 (55.3%), 15 (31.9%), 5 (10.6%) and 28 (59.6%) of the tumours exhibited positivity for Wnt-1, WISP-1, cyclin D1 and survivin, respectively. A lower percentage of the 40 apparently normal adjacent tissues were found to be positive for Wnt-1 (7, 17.5%), WISP-1 (+/-5, 12.5%) and survivin (13, 32.5%), but cyclin D1 was not detected in any of them. Interestingly, the total scores of Wnt-1, WISP-1 and survivin were significantly higher in CRC tissues (p=0.001, 0.034 and 0.044, respectively). Using the Spearman rank correlation test, a positive linear relationship was found between total Wnt-1 score with total WISP-1 score (rho=0.319, p=0.003) and total survivin score (rho=0.609, p=or<0.001). The expression of WISP-1 in the CRC tissues was found to be positively correlated with patients older than 60 years old (p=0.011). In addition, nuclear cyclin-D1 expression was found to be associated with poorly differentiated CRC tissues (p<0.001, Table 5) and right-sided CRC tumour (p=0.019, Table 6). Total WISP-1 score was associated with well-differentiated CRC tissues (p=0.029).
CONCLUSIONS: Overexpression and interplay between Wnt-1, WISP-1, survivin and cyclin-D1 may play a role in tumorigenesis, possibly by promoting cell cycle checkpoint progression, accelerating cell growth and inhibiting apoptosis. Our data may provide useful information towards the search for potent therapeutic targets towards the development of novel treatment strategies for CRC.
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