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PubMed1975

Refinement in application of total artificial heart, with improvement in survival and histopathological findings.

Recent improvements in total artificial heart (TAH) experiments have changed the pathological findings as well as the concept of the TAH. In the past 3 years, 67 experiments were performed in our laboratory. This study concerns the 11 calves operated upon most recently. Histopathological findings in the lungs, kidneys, livers and spleens of these animals were greatly improved over findings from previously studied animals. Disseminated intravascular coagulation (DIC) syndrome has been seen in only 1 calf. These improvements can be attributed to the following factors: (1) Improved management of the lumg during surgery has essentially eliminated pulmonary insufficiency;(2) liver damage has been successfully prevented by the discovery of the relationship between high right atrial pressure and anemia; (3) careful aseptic surgical procedures and optimal prophylactic use of antibiotics and anticoagulants have minimized the incidence of infection and clot formation.

Animals↗

PubMed1988

Use of cephalosporins with enhanced anti-anaerobic activity for treatment and prevention of anaerobic and mixed infections.

The microbiology, adverse-effect profiles, pharmacokinetics, published results of comparative clinical trials, and costs of cephalosporins with enhanced antianaerobic activity are reviewed. Cefoxitin, ceftizoxime, cefotetan, and moxalactam have been used as single agents in the treatment or prophylaxis of anaerobic or mixed aerobic and anaerobic infections, including intra-abdominal, female genital tract, and soft-tissue infections. None of these agents is as active against Bacteroides species as is clindamycin or metronidazole, but differences among the four cephalosporins do not appear to be clinically important. These agents differ somewhat in their activity against gram-positive and gram-negative bacteria. The majority of adverse reactions to these agents are immunological; disulfiram-like reactions and alterations in normal hemostasis have also been observed with cefotetan and moxalactam. All of these agents are well absorbed after intramuscular injection and produce serum concentrations adequate to treat most infections. Only ceftizoxime and moxalactam produce cerebrospinal fluid concentrations adequate for treatment of gram-negative meningitis. The primary route of elimination is renal, and each agent requires dosage adjustments in patients with renal impairment. Major differences exist among the elimination half-lives of the agents in patients with normal renal function. The decision to use a cephalosporin for treatment of anaerobic infections should be based on the results of clinical trials that have demonstrated the efficacy of the agent. Data are available to support the use of cefoxitin, ceftizoxime, and moxalactam in the treatment of intra-abdominal infections; cefoxitin and moxalactam to prevent infection of traumatic injury to the abdomen; all four agents in the treatment of female genital tract infections; and all four agents for prophylactic use in surgical procedures that may involve enteric anaerobes, especially B. fragilis. Cephalosporins with enhanced antianaerobic activity appear to have similar in vitro microbiological activity and have efficacy similar to that of combination regimens for the treatment and prophylaxis of intra-abdominal infections, abdominal contamination, obstetric and gynecological infections, and soft-tissue infections.

Bacteria, Anaerobic↗

PubMed1983

Recent developments in antimicrobial therapy with beta-lactam antibiotics.

There are three new penicillin and three new cephalosporin compounds available in the United States. All have been developed via biochemical manipulation of the beta-lactam ring and its adjacent chemical groups. The antibacterial spectrum of activity has been greatly expanded. Each of the six new agents has a unique antimicrobial profile which mandates independent evaluation. Therapeutic use of these drugs, particularly in treatment of gram-negative meningitis, has yielded success rates not previously witnessed. Application of these antibiotics as prophylactic agents for surgical procedures remains controversial. Guidelines are offered to distinguish one agent from another based on antimicrobial, pharmacokinetic and toxicologic properties.

Anti-Bacterial Agents↗

PubMed1977

Transient bacteremia and endocarditis prophylaxis. A review.

Transient, usually asymptomatic bacteremia occurs in a wide variety of procedures and manipulations, particularly those associated with mucous membrane trauma. It may also occur with such daily functions as tooth brushing and bowel movements. These brief bacteremias are especially common in tooth extraction and other dental procedures. Although numerical risk is uncertain, these bacteremias can occasionally give rise to infective endocarditis in the susceptible patient. While no proof exists that antibiotics given prior to procedures causing bacteremia prevent endocarditis in humans, experimental evidence in rabbits supports their use. Therefore, in situations where bacteremia is highly predictable, it would seem wise to administer prophylactic antimicrobials. Procedures in the susceptible host where prophylactic antibiotics seem prudent include dental manipulations and urinary tract instrumentation. Whether patients with acquired valvular or congenital heart disease who are to undergo abdominal surgical procedures should routinely receive prophylactic antibiotics is unclear. However, until the incidence of transient bacteremia associated with various abdominal procedures is further defined, endocarditis-prone patients should probably receive prophylaxis. Furthermore, patients with prosthetic valves who are subjected to upper gastrointestinal endoscopy, sigmoidoscopy, liver biopsy, or barium enema should also probably have antibiotic pretreatment. For dental procedures and for upper gastrointestinal endoscopy in patients with prosthetic valves, a combination of penicillin and streptomycin or vancomycin alone is recommended. For urinary tract instrumentation in all patients and for sigmoidoscopy, liver biopsy, or barium enema in patients with prosthetic valves, prophylaxis should be with ampicillin and gentamicin or vancomycin and gentamicin.

Anti-Bacterial Agents↗

PubMed1980

Clinical experiences with left gastric vena caval shunt in patients with esophageal varices.

Left gastric vena caval shunt (Inokuchi) was performed in four patients with liver cirrhosis; electively in two and prophylactically in two cases. The overall results have been satisfactory in terms of the effect on esophageal varices and postoperative complications. This procedure appeared to be superior to distal splenorenal shunt or other direct surgical procedures in several aspects. Since left gastric vena caval shunt does not require particularly elaborate surgical techniques and can be performed safely even in patients with considerably impaired hepatic function, it can be recommended as an ideal surgical procedure to be performed in elective and prophylactic surgical candidates.

Adult↗

PubMedDate not supplied

Acute bilateral postoperative endophthalmitis in a HLA-DQ5-positive patient: possible susceptibility to infections.

An unusual case of bilateral acute endophthalmitis in association with the HLA-DQ5 histocompatibility antigen is reported. A 35-year-old woman with high myopia and cataracts in both eyes underwent phacoemulsification procedures performed in separate sessions using different viscoelastic substances and following the same strict prophylactic measures. After each surgical procedure, she developed S. epidermidis acute endophthalmitis in the right eye and Propionibacterium acnes acute endophthalmitis in the left eye; both were successfully treated with capsular bag irrigation and intracameral vancomycin (1 mg/0.1 mL). She tested positive for the HLA-DQ5 (DQ1), DQ2 antigen. The question is raised as to whether the HLA-DQ5 histocompatibility antigen may be a predisposing factor for both staphylococcal and P. Acnes acute endophthalmitis. A multicenter prospective study is proposed to identify this HLA antigen in all patients scheduled for cataract surgery who have a history of postoperative endophthalmitis in the fellow eye.

Acute Disease↗

PubMed2003

A national survey of surgical antibiotic prophylaxis in Turkey.

OBJECTIVE: To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures. DESIGN: A cross-sectional, country-wide survey. SETTING: Thirty-six hospitals in 12 cities in Turkey. PARTICIPANTS: Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest. METHODS: A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures. RESULTS: Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426-3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890-8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95 0.225-0.772; P < .001) were associated with inappropriate prophylaxis. CONCLUSION: Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.

Antibiotic Prophylaxis↗

PubMed1977

Pattern of prophylactic use of antibiotics in six surgical departments of a teaching hospital in Jerusalem.

The prophylactic use of antibiotics for various surgical procedures was studied in six surgical departments of the Hadassah University Hospital over an 18-month period between January 1972 and June 1973. A total of 7,339 patients was discharged from the six departments during this period. Antibiotics had been used prophylactically in 17.7% of these patients and in 20.4% of the 6,313 patients in whom there was no evidence of infection on admission. The rate of prophylactic use varied from 12.8 to 47.8% in different departments. Different prophylactic regimes were used in the various departments, but there was a tendency for the same regime to be used within one department, irrespective of the nature of the surgical procedure. The antibiotics were usually started postoperatively. The duration of the prophylactic courses varied but there was a general tendency to continue for more than five days, often up to 10 or more days. The frequency of use seemed to be related to the presence of factors regarded as carrying a high risk of infection, such as advanced age, operation through a contaminated field and the presence of malignancy. The association between prophylactic use and subsequent wound infection was examined. The importance of continuous surveillance of the prophylactic use of antibiotics and the role of the infection-control unit in this surveillance is stressed.

Adult↗

PubMedDate not supplied

[Authors' experience with the role of preoperative ultrasonography in the study of benign lesions of the gallbladder].

The benign parietal lesions of the gallbladder are diseases that, as known, found their pathogenetic moment on hyperplasia of constituent tissues of the gallbladder wall and comprises the controversial chapter of "cholecystosis". The Authors, to contribute to their better clinical and pathogenetic staging, report their experience on 25 cases. They debate on the usefulness of ultrasonography, surely a diagnostic progress for these formations, which are small structures more or less echogenic and that they develop in the gallbladder; the echographic imaging, for its sharpening, has substituted the cholecystographic procedure. The aim of present study is to analyse the results obtained by using echography as diagnostic preoperative procedure of "cholecystosis". The ultrasonography supplies the surgeon an indication to prophylactic surgical treatment as single, effective procedure in preventing the gallbladder carcinoma.

Adenoma↗

PubMed1994

Prophylactic and therapeutic role of antibiotics in wound care.

Even though surgical infection rates have decreased dramatically during the past 25 years, questions and clinical problems with respect to prophylaxis, diagnosis, and treatment remain. After it was realized that widespread use of antibiotics resulted in a rise of resistant organisms, indiscriminate use of these drugs was curtailed. Studies soon showed that antibiotic prophylaxis for a limited period of time was not only effective, but also reduced the incidence of side effects. Today, clean surgical procedures that involve no implantation of a prosthesis do not warrant routine antibiotic use. Prophylactic antibiotic coverage is indicated for clean contaminated or contaminated surgical procedures, and dirty wounds need both prophylactic and therapeutic antibiotic use. The most effective administration route of prophylactic antibiotics remains a matter of discussion. With respect to open wounds, antibiotic-containing topical wound treatments are widely used, even though their efficacy has not been established. Open wounds do not have to be sterile to heal, and the emergence of allergy, sensitivity, and resistant organisms following the use of these topical treatments is of concern. Controlled clinical studies are needed to provide us with more definitive guidelines on these issues. In the meanwhile, we do know that meticulous surgical and nursing techniques, as well as surveillance of infection rates, are important in achieving and maintaining a low infection rate.

Anti-Bacterial Agents↗

PubMed2001

Prevention of hypertrophic scars and keloids by the prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting.

BACKGROUND: Topical silicone gel sheeting has been used for more than 20 years to help reduce the size of hypertrophic scars and keloids. Its clinical efficacy and safety is well established. OBJECTIVE: To determine whether topical silicone gel sheeting can be used to prevent hypertrophic scars and keloids from forming following dermatologic skin surgery. METHODS: Patients undergoing skin surgery were stratified into two groups: those with no history of abnormal scarring (low-risk group) and those with a history of abnormal scarring (high-risk group). Following the procedure, patients within each group were randomized to receive either routine postoperative care or topical silicone gel sheeting (48 hours after surgery). Patients were followed for 6 months. RESULTS: In the low-risk group, there were no statistical differences between individuals using routine postoperative care or using topical silicone gel sheets. In the high-risk group, there was a statistical difference (39% versus 71%) between patients who did not develop abnormal scars and used topical silicone gel sheeting and patients who developed abnormal scars after routine postoperative treatment. Those individuals having a scar revision procedure also showed a statistical difference if topical silicone gel sheeting was used following surgery. CONCLUSION: Topical silicone gel sheeting, with a 20-year history of satisfaction in dermatology, now appears to be useful in the prevention of hypertrophic scars and keloids in patients undergoing scar revision.

Adult↗

PubMedDate not supplied

The value of fibrin sealant in thyroid surgery without drainage.

Fibrin sealant is widely used to achieve complete hemostasis in many fields of surgery. A retrospective review of the surgical management of 81 patients with thyroid diseases between 1992 and 1998 was undertaken to determine if drainage after thyroid surgery could be safely avoided and substituted by fibrin sealing before closure of the wound. Complications were few and resulted in one patient with hoarseness, four minor oedemas and one case of unexplained fever during 48 h. The subjective discomfort from the collar incision was unusual and aesthetic healing was obtained in most of the cases (93.8%). These results suggest that the application of fibrin sealant can be advocated in thyroid surgery as an adjunct to a good surgical procedure and perhaps that prophylactic drainage is unnecessary.

Adolescent↗

PubMed1981

Prophylactic digitalization preoperatively of patients with arteriosclerotic heart disease.

This study was undertaken to investigate the hemodynamic effect of prophylactic digitalization before major surgical procedures. Sixteen patients, all admitted for an elective vascular operation for arteriosclerotic disease and all with impaired left ventricular function, were investigated. In half of the patients, digitalis was given before the operation, the other half of the patients served as the control study. The measured parameters were pulmonary artery mean pressure, pulmonary capillary wedge pressure, central venous pressure, mean arterial blood pressure, heart rate, cardiac output, blood volume and arterial, as well as venous, oxygen content. Preoperatively, before digitalization, no significant differences were noted between the two groups at rest and during exercise. Before anesthesia and postoperatively, those given digitalis had improved cardiac function. Those in both groups, however, had a normal hemodynamic response to the surgical trauma. In this study, a definite answer is not provided concerning the usefulness of prophylactic digitalization but an increase in the ability of the digitalized heart to withstand the imposition of a pressure load postoperatively is suggested.

Aged↗

PubMedDate not supplied

Integrated approach to construction and maintenance of prosthetic arteriovenous access for hemodialysis.

Autogenous arteriovenous access is the preferred access for hemodialysis patients with end-stage renal disease but is not feasible in a significant number of patients. The creation of a prosthetic arteriovenous access (PAVA) for hemodialysis using expanded polytetrafluoroethylene is technically simple and the short-term results are usually good, but the PAVA's 1-year patency rate is low (less than 60% in many centers). We have developed an integrated approach for the creation and maintenance of PAVAs, under the direction of a dedicated vascular access surgeon, involving preoperative imaging, anesthetic and surgical techniques, and a postoperative graft surveillance program, to improve patency rates. The design used was a prospective nonrandomized study. Between January 1, 1999 and December 31, 2001, 158 PAVAs were created (37.7% of the 419 fistulae created during this period). High-resolution duplex ultrasonography was added to careful clinical assessment in planning and follow-up of the dialysis access. The preferred method of PAVA creation was the forearm loop using tapered 4 to 7 mm stretch expanded polytetrafluoroethylene. After surgery, patients entered a program of close follow-up and regular graft surveillance and maintenance. Prophylactic surgical revisions and endovascular interventions were performed routinely according to ultrasonography findings to prevent thrombosis. Thrombolysis and thrombectomy were performed without delay when the PAVA thrombosed, minimizing the use of central venous access and salvaging the central veins. No patients were excluded from the study. One-, 2-, and 3-year assisted primary patency rates (including patients without occlusion but who were judged to require prophylactic revision) were 65%, 54.1%, and 48.8%, respectively. With surveillance-directed surgical revisions and endovascular treatment before or after occlusion, the 1-, 2-, and 3-year secondary patency rates (functional patency) were 91.4%, 84.3%, and 78.5%. Of the 158 grafts, 110 never occluded during the study period. There were 155 interventions in 74 PAVAs: 30 surgical revisions, 63 prophylactic endovascular procedures, and 52 instances of thrombolytic therapy combined with percutaneous transluminal angioplasty. The use of prosthetic arteriovenous access for hemodialysis, when autogenous arteriovenous access is not feasible, can still be associated with excellent long-term patency, in spite of previously published poor results, as long as good planning, close follow-up, and aggressive intervention (when indicated) are carried out.

Angioplasty, Balloon↗

PubMedDate not supplied

[Surgery of malformations of extrahepatic bile ducts in childhood].

The actual hypothesis on the etiology and pathogenesis of neonatal hepatitis, intrahepatic and extrahepatic biliary atresia and choledocal cyst is that these disorders can be different results or permissible outcomes of a single basic process: infantile obstructive cholangiopathy. This hypothesis can explain the failure of many infants with operable extrahepatic biliary atresia to do well following surgically successful anastomosis. Very possibly no surgical mode of therapy will cure a significant fraction of infants with biliary atresia (correctable and non-correctable types) because the basic disease process actually produces portal fibrosis and destroys intrahepatic bile ducts as well. However, since the obliterative process can resolve, even if not usually completely, surgical procedures of conventional or of hepatic-portoenterostomy type should be considered for all infants who are found to have biliary atresia. Probably biliary atresia is more in need of preventive or prophylactic measures than of new surgical procedures.

Adolescent↗

PubMed1999

Lack of morbidity from urodynamic studies in children with asymptomatic bacteriuria.

OBJECTIVES: Patients on clean intermittent catheterization (CIC) have a high rate of asymptomatic bacteriuria. Although prophylactic antibiotics for routine surgical procedures in patients with bacteriuria is common practice, the role of prophylaxis for invasive diagnostic procedures remains unclear. The aim of this study was to investigate the morbidity associated with urodynamic evaluation in patients with asymptomatic bacteriuria. METHODS: Routine urodynamic evaluation was performed in 69 pediatric patients (mean age 10 years). Ninety-six percent had a neurogenic bladder, and most were on CIC. Routine urine cultures were obtained at the time of the cystometrogram. Forty-six patients had positive urine cultures, and 23 patients with sterile urine served as a comparison. Patients were evaluated subjectively for symptoms of a urinary tract infection (UTI) within 1 week of the procedure. The results of the cystometrograms were compared between the patients with and without bacteriuria. RESULTS: No patient developed symptomatic UTI after the urodynamic studies. Overall, 65% of the patients with and 52% of the patients without bacteriuria had adequate capacity and compliance, and there was no difference in the urodynamic findings between the patients with and without bacteriuria (P = 0.4). CONCLUSIONS: Urodynamic studies were performed safely in the presence of asymptomatic bacteriuria in the present study. Therefore, routine use of urine cultures or prophylactic antibiotics before urodynamic studies in pediatric patients with a neurogenic bladder does not appear to be indicated.

Bacteriuria↗

PubMed2005

Paint-only is equivalent to scrub-and-paint in preoperative preparation of abdominal surgery sites.

BACKGROUND: Antiseptic preoperative skin site preparation is used to prepare the operative site before making a surgical incision. The goal of this preparation is a reduction in postoperative wound infection. The most straightforward technique necessary to achieve this goal remains controversial. STUDY DESIGN: A prospective randomized trial was designed to prove equivalency for two commonly used techniques of surgical skin site preparation. Two hundred thirty-four patients undergoing nonlaparoscopic abdominal operations were consented for the trial. Exclusion criteria included presence of active infection at the time of operation, neutropenia, history of skin reaction to iodine, or anticipated insertion of prosthetic material at the time of operation. Patients were randomized to receive either a vigorous 5-minute scrub with povidone-iodine soap, followed by absorption with a sterile towel, and a paint with aqueous povidone-iodine or surgical site preparation with a povidone-iodine paint only. The primary end point of the study was wound infection rate at 30 days, defined as presence of clinical signs of infection requiring therapeutic intervention. RESULTS: Patients randomized to the scrub-and-paint arm (n = 115) and the paint-only arm (n = 119) matched at baseline with respect to age, comorbidity, wound classification, mean operative time, placement of drains, prophylactic antibiotic use, and surgical procedure (all p > 0.09). Wound infection occurred in 12 (10%) scrub-and-paint patients, and 12 (10%) paint-only patients. Based on our predefined equivalency parameters, we conclude equivalence of infection rates between the two preparations. CONCLUSIONS: Preoperative preparation of the abdomen with a scrub with povidone-iodine soap followed by a paint with aqueous povidone-iodine can be abandoned in favor of a paint with aqueous povidone-iodine alone. This change will result in reductions in operative times and costs.

Abdominal Wall↗

PubMed1999

Antibiotic prophylaxis in orthognathic surgery: a 1-day versus 5-day regimen.

PURPOSE: The effect on infection rates of 1-day and 5-day administration of prophylactic antibiotics in orthognathic surgical procedures was compared. PATIENTS AND METHODS: A prospective, randomized, double-blind clinical trial using placebo was conducted. Thirty patients were distributed equally between two groups. Each group received penicillin G, two million units intravenously, immediately preoperatively, and one million units intravenously every 3 hours intraoperatively and once postoperatively 3 hours after the last intraoperative dose. Group 1 then received penicillin G, one million units intravenously, every 6 hours for eight doses, followed by penicillin V suspension 300 mg orally every 6 hours for eight doses. Group 2 received placebo in a similar dosing schedule. The wounds were inspected on a regular schedule and evaluated for infection according to criteria established by the Centers for Disease Control. RESULTS: One of 15 patients in group 1 (6.7%) and 9 of 15 patients (60%) in group 2 became infected. The overall infection rate was 33.3%. There was a statistically significant difference in rates of infection between the two groups (P < .01). CONCLUSION: Antibiotic prophylaxis for orthognathic surgical procedures should continue beyond the immediate postoperative period. Five days of antibiotic administration appears to provide adequate coverage.

Antibiotic Prophylaxis↗