Annals of surgery
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The association of Streptococcus bovis endocarditis and colon carcinoma has been reported previously in small series in the medical, but not surgical, literature. Although the fecal carriage rate of S. bovis increases with colonic pathology, no explanation exists for the development of bacteremia in these cases. To explore the possible contribution of hepatic dysfunction to the development of portal and systemic bacteremia, the incidence of both colonic pathology and liver disease or dysfunction was determined in 92 patients with S. bovis endocarditis and/or bacteremia. ⋯ Either the underlying colonic disease or alterations in hepatic secretion of bile salts or immunoglobulins may promote the overgrowth of S. bovis and its translocation from the intestinal lumen into the portal venous system. A compromised hepatic reticuloendothelial system may then contribute to the development of S. bovis septicemia and subsequent endocarditis. We conclude that S. bovis bacteremia is an indication to the clinician of the possibility of underlying liver disease as well as colon pathology.
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Comparative Study
Early burn wound excision significantly reduces blood loss.
The hypothesis that near-total early excision of large burns in children can be performed safely with a reduction in blood loss was tested. Of 1662 acutely burned patients admitted to this institution between 1982 and 1989, 594 underwent near-total excision of cutaneous flame or scald burn injuries in a single procedure. Operations took less than 3 hours and there were no operative deaths. ⋯ Blood loss for burns of less than 30% TBSA was of 1.19 +/- 0.13 mL/cm2. Early excision did not increase mortality rate when compared to later excision times. We suggest that near-total excision of large burns within the first 24 hours reduces blood requirements and morbidity without adversely altering hemodynamic stability or increasing mortality risks.