C Jaeschke | PubMed Health

PubMed1994

[Splenectomy--a strictly aseptic intervention?].

To determine the factors causing wound infections after splenectomy, 211 patients undergoing surgery during 1982-1991 were studied in two groups:--Patients with clean-contaminated or contaminated operations with additional splenectomy in the same session;--Patients with elective splenectomy only. While in the first group the rate of disorders of wound healing (DWH) was 31.6%, the second group had a rate of 8.15%. This rate was higher than for other clean operations in our hospital and was as high as for clean-contaminated operations such as cholecystectomy. Among the patients older than 60 years, 38.2% had DWH, as against 8.9% of the patients younger than 60 years. The mean operating time in patients with wound infections was 223 min, while the mean operating time in patients without infections was 125 min. In patients with wound infections the gamma-GT was higher than in patients who had no infection. After these results we have given 2 g ceftriaxon as single-shot prophylaxis before every splenectomy. Since starting this, we have performed 28 splenectomies, and DWH has been observed in only 1 (3.57%). We therefore recommend antibiotic prophylaxis.

Adolescent↗

PubMedDate not supplied

[Growth disorders of the acetabular roof after acetabuloplasty in congenital hip dysplasia].

PURPOSE: The aim of this long-term study was to evaluate whether the Lance acetabuloplasty for congenital dysplasia of the hip causes a growth disturbance of the acetabular roof during or after puberty. METHOD: 71 hips of 58 patients were followed clinically and radiologically over a maximum time of 16 years after the operative procedure of a Lance acetabuloplasty. The average age of the patients at the time of operation was 2.8 years (1-6 years). In order to assess the growth of the acetabulum in the early and long-term postoperative phase quantitative parameters (acetabular index of Hilgenreiner, CE angle of Wiberg, ACM angle of Idelberger) as well as qualitative parameters (disturbance of the ossification of the acetabulum and the femoral head) were determined in standardized X-rays of the pelvis, done routinely 6 months, 3 years, 5 years, 8 years and at an average of 11 years as the last follow-up examination after the operation. The assessment of these metrical parameters were carried out in accordance to the classification of the study-group "hip dysplasia" of the DGOT (normal--slight pathological--serious pathological) respecting the different age-groups and degrees of dysplasia. RESULTS: Although in the early postoperative phase the acetabular roof showed a positive development (65% of the CE angles could be considered normal 3 years after operation), the further growth of the acetabulum was disturbed in the period of puberty (8 years after operation only 33% of the CE angles could be considered normal, 51% were extremely pathological). And also in the last X-ray control after an average follow-up time of 11 years a significant retardation of the acetabular roof was seen in 51% of all cases. CONCLUSION: The Lance acetabuloplasty seems to damage the Ossa acetabuli, which are as centers of ossification the essential anatomic structures for the growth of the acetabular rim in adolescence. CLINICAL RELEVANCE: Other procedures such as the Salter osteotomy are to be preferred for the therapy of hip dysplasia.

Acetabulum↗