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PubMedDate not supplied

Nutritional and immunological evaluations in cancer patients. Relationship to surgical infections.

Several reports provide evidence of the synergism between malnutrition and infection in hospitalized patients. In this study, preoperative complete nutritional assessment (NA) was performed to: 1) evaluate NA modifications in 21 controls with benign minor surgical diseases and in 71 surgical cancer patients; 2) determine the relative value of nutritional and immunological indicators in relation to the postoperative septic complications in cancer patients. The following parameters were used: percent weight loss/month, percent standard arm circumference, percent standard triceps skinfold; hematocrit, hemoglobin, serum proteins, albumin, iron, transferrin, ceruloplasmin, retinol binding protein (RBP); serum creatinine, urine creatinine, creatinine/height index, percent arm muscle circumference; peripheral lymphocytes, white blood cells, complement (C3c), skin tests. In the cancer group percent usual body weight, percent arm muscle circumference, hematocrit, hemoglobin, albumin, iron, ceruloplasmin, retinol binding protein, C3c and delayed hypersensitivity response (DHR) were significantly different from controls. Ceruloplasmin and DHR were the only tests significantly different in the cancer patients who developed postoperative infections. Duration of anesthesia and operative field contamination are other important causative factors which, if associated with malnutrition, may determine a higher susceptibility to infections in surgical cancer patients.

Adolescent↗
PubMed2001

Latex allergy in pediatric surgery is dependent on repeated operations in the first year of life.

BACKGROUND/PURPOSE: Patients with spina bifida represent the highest risk group for hypersensitivity to latex. Recognized risk factors for these patients are repeated surgery and an atopic disposition. Little is known about children operated on in the first year of life for reasons other than spina bifida. METHODS: Eighty-six patients (mean age, 10.2 years) with gastrointestinal or urologic surgery were investigated for the number, type, and date of surgical interventions. Additionally, skin prick tests and provocation tests were performed to classify sensitized and symptomatic latex-allergic individuals. RESULTS: Twenty-seven patients were regarded as sensitized to latex (31.4%). Twenty patients were classified as being atopic (25.6%). Atopic patients were significantly more often sensitized and provocation positive compared with nonsensitized and provocation-negative ones (P <.01). Children already operated on in the first year of life (n = 44) with a positive provocation showed significantly higher latex-specific IgE-values than individuals with a negative outcome (P <.0001). The total number of operations and degree of sensitization showed a significant correlation; more than 8 surgical interventions during the first year of life significantly increased the risk of clinically relevant allergy to latex. CONCLUSION: This study emphasizes that individuals undergoing surgical interventions during infancy should be handled latex free from the very beginning of life.

Adolescent↗
PubMed1991

The effect of moderate operative trauma on the blood lymphocyte reactivity--immunomodulatory effect of interleukin-2.

The influence of moderate operative trauma on lymphocyte responsiveness to phytohemagglutin (PHA) and in autologous mixed lymphocyte response (AMLR) was studied. Furthermore, production of interleukin 2 (IL2) and immunomodulatory effect of exogenous IL2 on lymphocyte reactivity after surgery were examined. The responsiveness to PHA declined on day 1 (p less than 0.05) and the level of AMLR was found decreased on days 1 (p less than 0.05), 3 (p less than 0.02) and 5 (p less than 0.03) after surgery. Production of IL2 significantly decreased on day 1, 3 and 5 (p less than 0.05) after operation. Supplementation of PHA and AMLR cultures with exogenous IL2 restored the attenuated postoperative responsiveness to the levels observed preoperatively. This observation may justify IL2 therapy in surgical patients with high risk of uncontrollable postoperative infections.

Adjuvants, Immunologic↗
PubMed2002

Rate and risk factors of surgical site infections with antibiotic prophylaxis.

OBJECTIVE: This study is aimed at determining the incidence of surgical site infections, with antibiotic use. Furthermore, to correlate infection with type of operations, length of intervention, number of stitches, pre-operative hospitalization, age and sex of the patient. METHODS: All Yemeni patients (N=601) who underwent surgical intervention, with preoperative antibiotic prophylaxis, at Al-Kuwait University Hospital, Sana'a, Republic of Yemen, during 1st August 2000 through to 30th November 2000 were followed up until stitch removal or discharge. Data was registered in a spreadsheet and processed statistically by statistical package for social sciences 10.0. RESULTS: Overall incidence of surgical site infections was 2.2%, 0.5% in clean operation, 2.8% in clean contaminated, 9.1% in contaminated and 2.3% in dirty operations. Surgical site infections were found positively correlated with duration of operation (P=0.015) and number of stitches (P=0.017), but insignificantly associated with sex, age, type of operation and pre-operative hospitalization. CONCLUSION: In conclusion, surgical site infections, with antibiotic use, were found low. Higher number of stitches and longer duration of operation were the risk factors.

Adolescent↗
PubMed2001

Collagen tampons as aminoglycoside carriers to reduce postoperative infection rate in prosthetic repair of groin hernias.

OBJECTIVE: To find out whether collagen tampons treated with gentamicin would prevent postoperative infections in patients operated on for groin hernias by insertion of prostheses. SETTING: University hospital, Italy. DESIGN: Prospective randomised trial. PATIENTS: 595 patients who required prosthetic repair of a groin hernia. INTERVENTIONS: All repairs were by our standard surgical technique including prophylactic ceftriaxone, local anaesthesia, and insertion of a polypropylene mesh. 301 patients also had a gentamicin laced collagen tampon placed in front of the prosthetic mesh before the aponeurosis of external oblique muscle was sutured. RESULTS: 1/301 patients in the gentamicin group (0.3%) developed a postoperative wound infection compared with 6/294 in the control group (2.0%), (p = 0.04 Fisher exact test). CONCLUSIONS: Gentamicin-laced collagen tampons are effective in reducing the postoperative infection rate in patients operated on for groin hernia by insertion of a prosthesis.

Acute Disease↗
PubMed2004

Tissue adhesives for closure of surgical incisions.

BACKGROUND: Sutures, staples and adhesive tapes are the traditional methods of wound closure, whilst tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables meticulous closure, but sutures may induce tissue reactivity and they usually require removal. Tissue adhesives offer the advantages there are no sutures to remove later for the patient and no risk of needlestick injury to the surgeon. Tissue adhesives have been used primarily in emergency rooms but this review looks at the use of tissue adhesives in the operating room where surgeons are increasingly using these for the closure of surgical skin incisions. OBJECTIVES: To determine the relative effects of various tissue adhesives and conventional skin closure techniques on the healing of surgical wounds. SEARCH STRATEGY: The Cochrane Wounds Group Specialised Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Bibliographies of review articles were checked for studies outside the handsearched journals and wound care product manufacturers were contacted. SELECTION CRITERIA: Randomised controlled clinical trials only. DATA COLLECTION AND ANALYSIS: Screening of eligible studies and data extraction was conducted independently and in triplicate whilst assessment of the methodological quality of the trials was conducted independently and in duplicate. Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk with 95% confidence intervals for dichotomous outcomes. Heterogeneity was investigated including both clinical and methodological factors. MAIN RESULTS: Eight RCTs were included (630 patients). No statistically significant differences were found between various tissue adhesives and sutures (8 trials) for dehiscence, infection, satisfaction with cosmetic appearance when assessed by patients' or surgeons' general satisfaction. Nor were differences found between a tissue adhesive and tapes (2 trials) for infection, patients' assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However a statistically significant difference was found for surgeons' assessment of cosmetic appearance with mean difference 13 (95%CI 5 to 21), the higher mean rating for the tissue adhesive group. REVIEWERS' CONCLUSIONS: Surgeons may consider the use of tissue adhesives as an alternative to sutures or adhesive tape for the closure of incisions in the operating room. There is a need for trials in all areas but in particular to include patients that require incision closure in areas of high tension and patients of general health that may impair wound healing.

Bandages↗
PubMed1988

Quantification of risk factors in hospital infection at a surgical service.

In this paper we have analyzed several risk factors for developing nosocomial infections at a Surgical Service of the Hospital Clinico Universitario "San Cecilio", based on a retrospective follow-up program designed specifically for this study. Of all patients admitted to the Service from January 1 to June 17, 1987, we examined the following variables: age, sex, cause of admission, emergency or non-emergency admission, operation and related variables. The overall rate of nosocomial infections was 16.46%. The most significant risk factors we found were "operation", which had a linear correlation coefficient of 0.929 (p less than 0.01) with hospital infection when stratified by its length, "advanced age" (greater than 60 years old), especially in non-operated patients, and chemoprophylaxis. Such risk factors were ascertained taking into account the confounding effect produced by the variables studied in this survey.

Adult↗
PubMed1997

Spinal surgery and alleged medical negligence.

More than 20,000 spinal operations are carried out in the UK each year. The decision when and whether to operate requires mature judgement. Spinal surgery is technically difficult, demanding a high level of surgical skill. It is learnt only by lengthy apprenticeship. The after-care is equally important. The personal supervision of the surgeon who leads a coordinated team of clinicians, nurses and physiotherapists will ensure the best results. It is inevitable and unfortunate that mistakes will occasionally be made and only careful attention to detail in the pre-operative assessment, meticulous surgical care and supervised post-operative management will ensure consistently good results. The spinal surgeon needs to remain up-to-date, be disciplined with a systematic and careful approach and lead a coordinated team to maintain the highest standards.

Blood Vessels↗
PubMed2002

[Surveillance of postoperative wound infections: reference data of the Hospital Infection Surveillance System (KISS)].

BACKGROUND: Surgical site infections (SSI), the third-most-frequent nosocomial infection, are a problem in all fields of surgery. Assessing the level of one's own infection rates is often difficult, since there have been no suitable comparative data available in Germany in the past due to the lack of a uniform method of determining these rates. METHODS: Based on an American model, the Hospital Infection Surveillance System (KISS) has been carrying out a standard recording of SSI since 1997 in meanwhile 132 surgical departments of 89 hospitals. Specially trained hygiene personnel record SSI according to CDC definitions in selected indicator operations. RESULTS: Since January 1997, 1,549 SSI have been recorded in 71,038 operations using 13 different surgical techniques. The risk-ratified SSI rates for each of these surgical techniques are provided and can serve as orientational data for other departments. CONCLUSION: The KISS reference data can help in assessing one's own SSI rates. A prerequisite is surveillance according to the KISS protocol.

Confidence Intervals↗