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Biomedical subjects

J Mignone

Publications and source records attributed to J Mignone.

5 recordsLinked to original sources
PubMed2000

Role of preoperative antibiotic prophylaxis in preventing postoperative peritonitis in newly placed peritoneal dialysis catheters.

The role of vancomycin and other antibiotics in the treatment of acute peritonitis in peritoneal dialysis (PD) patients is well established. However, the role of preoperative vancomycin or cephalosporins in preventing early infection in newly placed PD catheters remains controversial. We performed a prospective randomized study to examine the role of vancomycin or cefazolin prophylaxis in decreasing the incidence of postoperative peritonitis. Over a 6-year period, 221 patients undergoing 254 permanent peritoneal catheter placement procedures were randomized into three groups. Group I patients (86 procedures) were administered a single intravenous (IV) dose of vancomycin, 1,000 mg, 12 hours before peritoneal catheter placement procedures, whereas group II patients (85 procedures) were administered a single IV dose of cefazolin, 1,000 mg, 3 hours before the procedure. Group III patients (83 procedures) were not administered antibiotics preoperatively for at least 1 week before the procedure. Patients were monitored for peritonitis in the following 14 days. Peritonitis developed in 1 patient (1%) in group I (vancomycin group) and 6 patients (7%) in group II (cefazolin group) compared with 10 patients (12%) in group III (control group); P = 0.02. We conclude that the use of preoperative single-dose IV vancomycin prophylaxis for permanent PD catheter placement reduces the risk for postoperative peritonitis. Single-dose vancomycin is superior to single-dose cefazolin in reducing the risk for postoperative peritonitis. Absence of prophylaxis is associated with a high risk for developing postoperative peritonitis.

Adolescent↗
PubMed2000

The role of peritoneal dialysis catheter configuration in preventing catheter tip migration.

Migration of the peritoneal dialysis (PD) catheter from the pelvis to the upper abdomen frequently results in peritoneal dialysis failure and removal of the catheter. Previous studies compared PD catheter survival in various catheter configurations. These studies included single-cuff and double-cuff, straight-end and curled-end catheters, and showed an incidence of catheter migration ranging from 5%-35% depending on the catheter type. Recent studies demonstrated that the double-cuff, Swan-neck, curled-end configuration is associated with a considerably lower incidence of migration. Most of these studies, however, had a small patient sample or no control group, or they compared nonequivalent catheters (for example, Swan-neck, curled-end versus straight, non-curled-end). Over a six-year period, we examined two similar double-cuff, curled-end catheters: Group I catheters had a straight segment between the two cuffs, and Group II catheters had a 60 degrees Swan-neck bend between the two cuffs (Quinton Instrument Co., Bothell, WA, U.S.A.). The two catheters were identical, except for the presence or absence of the Swan-neck bend. All catheters were placed by the closed laparoscopic technique. In the two groups of patients in whom the catheters were implanted, no statistically significant difference was observed in primary disease, age, sex, race, weight, prior abdominal surgery, or duration of dialysis before catheter migration. In group I, 33 of the 219 patients developed catheter migration (15%); in group II, 2 patients of 243 patients developed catheter migration (less than 1%, p = 0.002). In conclusion, the Swan-neck configuration presents an independent factor in preventing PD catheter migration. Review of previous studies and the data from our study, show that double-cuff, curled-end, Swan-neck PD catheters are superior to other catheters in regard to prevention of catheter migration and should be the catheter of choice in PD patients.

Adolescent↗
PubMed2000

Preoperative vancomycin prophylaxis for newly placed peritoneal dialysis catheters prevents postoperative peritonitis.

The role of vancomycin and other antibiotics in treatment of acute peritonitis in peritoneal dialysis patients is well established. However, the role of preoperative vancomycin or cephalosporins in preventing early infection in newly placed peritoneal dialysis catheters remains controversial. We performed a prospective randomized study to examine the role of vancomycin or cefazolin prophylaxis in decreasing the incidence of postoperative peritonitis. Over 8-year period, 265 patients undergoing 305 permanent peritoneal catheter placement procedures were randomized into three groups. Group I (103 procedures) received a single intravenous (i.v.) dose of 1000 mg vancomycin 12 hours before the peritoneal catheter placement procedure. Group II (102 procedures) received a single i.v. dose of 1000 mg of Ancef (cefazolin) 3 hours before the procedure. Group III (100 procedures) received no antibiotics preoperatively for a least one week before the procedure. Patients were monitored for peritonitis during the following 14 days. Peritonitis developed in 1 patient (1%) in Group I (vancomycin group) compared to 12 patients (12%) in Group III (control group), p = 0.002, and in 9 patients (9%) in Group II (cefazolin group) compared to Group III, p = 0.68. We conclude that the use of preoperative single-dose i.v. vancomycin prophylaxis for permanent peritoneal dialysis catheter placement reduces the risk of postoperative peritonitis. Cefazolin did not achieve a statistically significant difference from the control group and may not provide adequate prophylaxis.

Adolescent↗
PubMed1999

Support groups for injured workers: process and outcomes.

We evaluated the efficacy of a support group for injured workers as a low-cost intervention that might modify chronicity and improve outcome among workers' compensation claimants with chronic musculoskeletal disorders. This study examined the impact of support groups on injured workers with musculoskeletal injuries in relation to four health indicators: pain, somatization, depression, and pain-locus-of-control. We held nine support groups between October 1992 and March 1994. A total of 62 subjects completed the groups. The evaluation of the support group program employed a type of quasi-experimental design, a nonequivalent control group design. A comparison group was created for purposes of evaluation from Workers' Compensation Board of Alberta claimants who did not participate in the groups. We found that participation in the support groups did not seem to affect the well-being of injured workers by reducing their levels of pain, somatization, and depression, and/or by altering their pain-locus-of-control. The results do not necessarily rule out any beneficial effects of participating in support groups. However, these methods applied to this type of support group showed no demonstrable effect.

Adult↗