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At least 253 records · Page 14Linked to original sources
PubMed1983

Total body bathing with 'Hibiscrub' (chlorhexidine) in surgical patients: a controlled trial.

Total body bathing with 'Hibiscrub' (chlorhexidine-detergent) solution was compared with non-medicated soap in 224 patients admitted for surgery. Some 9.6 per cent of patients were found to be nasal carriers of Staphylococcus aureus on admission but 17.3 per cent were colonized at some time during their inpatient stay. Skin colonization by Staph, aureus was only seen in four patients (2 per cent), three were cleared by 'Hibiscrub' bathing but carriage persisted in the other patient who used non-medicated soap. A greater reduction in the total bacterial count on the skin and in the perianal region was seen in patients using 'Hibiscrub'. An increase in the bacterial count was frequently seen in patients using non-medicated soap. Postoperative staphylococcal wound infection occurred in nine patients (4-0 per cent) but nasal or skin carriage was only present in two patients. Although there was no difference in the rates of infection using 'Hibiscrub' or ordinary soap, pre-operative bathing with 'Hibiscrub' may be beneficial as there is a greater reduction in the total bacterial count. The use of non-medicated soap is of dubious value and may even increase the numbers of bacteria on the skin.

Anal Canal↗
PubMed1996

[Personal experience with Garamycin Schwamm in routine surgical practice].

The author demonstrates the use of Garamycin Schwamm of Schering-Plought Co. in common surgical practice. He draws attention to its advantages in septic surgery and operations where an infectious agent was not detected on cultivation but where there is a high risk of infection (open fractures). Garamycin Schwamm has a very wide spectrum of action and therefore its use in emergency surgery where there is no time for cultivation examinations, is very useful.

Adolescent↗
PubMed1997

[Treatment results for inguinal hernia repair with the mesh-plug method].

In the years 1992-1996 367 operations were performed in 350 patients aged 15-88. The type of the hernia was classified according to Gilbert's classification in Rutkow's modification. Type 2 and 3 was the most often (136 and 102 patients respectively). Recurrent hernia after classical operations were treated in 33 patients. Local, epidural or subarachnoid anesthesia was applied in 93% of patients In 75% of patients no analgetics were administered within first 24 hours after operation. In the remaining only traditional analgetics were given. Early complications were noted in 6 patients: wound infections, scrotal oedema, hydrocele. The time of operation was 35 minutes and the time of hospitalization was 2-5 days. Patients returned to their normal activity within 2 weeks. In the follow up period 1-5 years only 2 recurrences of hernia were noted (0.5%).

Adolescent↗
PubMed1998

Pancreatic surgery: cutting-edge developments and technology.

In the 1980s, Japanese pancreatic surgeons used aggressive strategies to treat pancreatic cancer under the influence of Fortner's regional pancreatectomy and developed several surgical approaches including extended lymph node and connective tissue clearance with autonomic nerve dissection around the celiac and superior mesenteric arteries. Nagakawa's "translateral retroperitoneal approach" in extended radical pancreatectomy was accepted and used by many Japanese surgeons; however, whereas this operation prolonged postoperative survival, it also induced high rates of postoperative complications and ultimately failed to improve the quality of the patient's life. A pylorus-preserving pancreatoduodenectomy with modified extended dissection of the lymph node and connective tissues did not decrease the survival rate for resected patients but improved their quality of life. In the next decade, Takada developed duodenum-preserving total pancreatic head resection, which preserves the integrity of the digestive and biliary tracts. This operation, to anastomose the main pancreatic duct with the duodenum, is unique and is applicable to benign or low-grade malignant lesions of the pancreas. Adjuvant treatments have not offered satisfactory results as expected. Finally, it is recommended that the aggressive Japanese surgical strategies be reevaluated in a formal trial with a prospective randomized study to improve the quality and longevity of the patients' lives.

Humans↗
PubMed1998

Burn wound excision and massive blood transfusion did not affect perioperative vancomycin levels.

INTRODUCTION: The effect of burns surgery that requires intraoperative transfusion of five or more units of blood on serum vancomycin levels was assessed. METHODS: Serum vancomycin levels were measured 10 min and 6 h after vancomycin administration with surgery being performed in the interval. The following day the same dose of vancomycin was given and serum vancomycin levels measured at the same times without intervening surgery. RESULTS: Thirteen operations involving nine patients who required a mean blood transfusion of 9.2 units were studied. There was very little difference between 10-min levels, 6-h levels and the change over interval (absolute and percentage) on the day of surgery and the following day. The recorded serum levels were often at the lower end of the desired range, especially in patients who underwent the larger operations. This was the case on both day of surgery and the control day. CONCLUSIONS: Large volume blood loss and replacement during burns surgery did not significantly affect perioperative vancomycin levels. 1998 Elsevier Science Ltd for ISBI.

Adolescent↗
PubMed1979

[Complications following aorto-iliac surgery (author's transl)].

We report on complications following vascular surgery of the aorto-iliac segment. Recurrent occlusions were observed in 15.3% of our cases. The operative mortality was 1.8%. The etiology of anastomotic false aneurysms is discussed. One deep graft infection was successfully managed. Ureteric lesions following aortic surgery are exceptional. No ischemic colitis occurred among our patients. Two cases of aorto-intestinal fistulae are described.

Aged↗
PubMed1980

[Fatty masses in the mediastinum. A report on 21 cases including 16 after computer tomography investigations (author's transl)].

The authors use this term to describe collections of fatty material in the tissues, circumscribed or not, which may cause permanent deformity of the mediastinum. This definition may not be based upon histological examinations but it is perfectly appropriate following the recent use of computer tomography (CAT) investigations. The authors base their comments on the study of 21 cases divisible into two groups of unequal size: in 5 cases, studied without using CAT, diagnosis was made during operation; in the 16 other cases it was made by CAT. The masses may be circumscribed or not, but mixed forms have been observed. Among the circumscribed masses. Those in the right cardiophrenic region appear to be the frequent and are observed mainly in women: a retrocardiac location implies than an associated hiatus hernia must be searched for; the mediastinoparietal reduplicated form being rarely seen. The spreading types are noted mainly in men and occur usually in the superior or median part of the mediastinum. These masses can be demonstrated and diagnosis simplified by the use of CAT, as it is a truly specific radiological examination which eliminates the use of tomography, pneumomediastinum, and angiography as diagnostic procedures. Surgical operation is no longer practiced for diagnostic purposes and can be avoided in very many cases.

Adult↗
PubMed2001

[Problems with infections during the perioperative period].

The paper addresses issues related to the prophylactic and empirical use of antibiotics in surgery. Apart from the factors related to post-operation infections, it presents recommendations and proposals for the prophylactic use of antibiotics in particular types of operations. The recommendations are based on the American and European specialist literature, with the differences between these two approaches clearly outlined. Additional comments are provided for the important elements of prophylactics in particular types of operations. In the part concerning the use of antibiotics in treatment of intra-abdominal infections, the focus is on the general rules for antibiotherapy in pancreatitis. There is also a discussion of mycotic complications accompanying intra-abdominal infections. The paper ends with specific indications for the empirical use of antibiotics in intra-abdominal infections.

Anti-Bacterial Agents↗
PubMed1982

Abdominal surgery in patients undergoing long-term peritoneal dialysis.

Nineteen patients undergoing long-term peritoneal dialysis (LTPD) required abdominal operations--11 elective and 8 emergency. The preoperative hemoglobin level was 9.0 +/- 2.6 gm/dl, and the serum albumin was 28.8 +/- 4.9 gm/L. There was one death in the elective group (an inguinal herniorrhaphy) and four deaths in the emergency group (three spontaneous colonic perforations and one strangulated ventral hernia). Wound complications occurred in five patients. To obtain an indication of nutritional status of patients on intermittent LTPD and high-protein diets, 17 in-center patients underwent nutritional assessment, and deficiencies in delayed hypersensitivity skin testing and total lymphocyte counts were prevalent. Wounds require secure, watertight closure to prevent dialysis leakage. In elective abdominal surgery, LTPD should be carried out shortly preoperatively to delay dialysis for a few days after operation and to decrease defective platelet function. Preoperative transfusion for anemia is generally unnecessary. Drains should be avoided or removed before resumption of LTPD. Abdominal wall hernias should be repaired electively. Constipation should be avoided. Marked protein loss accompanies peritonitis. In certain instances, transfer to hemodialysis is indicated.

Abdomen↗
PubMed1999

Monitoring of antimicrobial prophylaxis in general surgery.

The incidence of infections in general surgery is related to different factors. Cost-benefit analysis of antimicrobic prophylaxis is positive, even though incorrect use may be even dangerous (development of resistance and/or superinfections, for instance). The authors report data on a study concerning a total of 316 patients divided into two series, who had antimicrobic prophylaxis before a surgical operation. 274 patients out of 316 (or 86.7%) had an ultra-short (one-shot-only) or short (<24 hours) prophylaxis, 42 (13.3%) standard (>24 hours). The operations performed were classified following class of contamination, i.e. I (clean), II (potentially contaminated), III (contaminated). Antibiotics used were ceftizoxime, cefepime, ceftriaxone, piperacillin and gentamicin in combination. A total of 16 postoperative infections was observed (5%); 11 of these 16 belonged to class III operations. Escherichia coli and Staphylococcus aureus were isolated in most of the infected wounds. The data confirm what is reported in the literature. The authors conclude that a preoperative single-shot 3rd or 4th generation cephalosporin reduces the incidence of wound infections in clean and clean-contaminated surgery.

Antibiotic Prophylaxis↗
PubMed1995

A new operation for chronic lateral ankle instability.

We have treated 45 patients (47 ankles) for chronic lateral instability by a new reconstructive procedure. The operation includes lateral shift of the entire lateral capsule-ligament complex and proximal advancement of the talocalcaneal ligament and the inferior extensor retinaculum. We reviewed 39 patients (39 ankles) at a mean of 4.6 years (2 to 7) after operation. There were 29 men and 10 women with an average age of 27 years (19 to 43); 11 of them were competitive college-level athletes and 28 were recreational athletes. The functional rating was excellent in 26 patients, good in 8, fair in 3 and poor in 2. Thirty-six patients (92%) were satisfied with the result and 34 (9 of 11 college-level athletes and 25 of 28 recreational athletes) have been able to return to their preinjury level of sport. At the last review, there had been only three episodes of recurrent ankle instability, all in recreational athletes; none had required further surgery. The unsatisfactory results were associated with pre-existing degenerative changes in the ankle.

Adult↗
PubMed1999

[Surveillance of surgical-site infections: results of the INCISO 1998 Network].

OBJECTIVE: Surveillance of Surgical-Site Infection (SSI) in general and visceral surgical departments. DESIGN: Prospective cohort study. SETTING: Inter-regional Co-ordinating Center for Nosocomial Infection Control (C.CLIN Paris-Nord). Regions of Ile de France, Haute Normandie, Nord-Pas de Calais and Picardie. PATIENTS AND METHODS: From January 1 to April 1, 1998, each surgical department had included 200 consecutive operations. To diagnose SSI occurring after discharge, patients were followed during one month after surgery. SSI were defined according to standardized criteria. RESULTS: Overall, 16.506 surgeries were followed in 120 surgical units. The rate of postoperative SSI was 3.9% (95CI = [3.6%-4.2%]). The rate of SSI varied from 5.2% for digestive surgery to 0.9% for endocrine system, and 2.3% for cholecystectomy to 16.6% for peritonitis. According to the NNIS index, SSI rates increased from 2.2% for patients with a risk index of 0 to 26.7% for patients with a risk index of 3. The case fatality rate directly or indirectly attributable to SSI was 2.0% (95CI = [1.1%-3.5%]). CONCLUSION: The high incidence of SSI render crucial the implementation of SSI surveillance in surgery. Risk factors and type of surgical procedures are required to obtain standardized rates for comparisons between services.

Adult↗