Local measures in the prevention of wound infections: trials with cephaloridine and two methods of haemostasis.
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Biomedical subjects
Publications and source records attributed to A V Pollock.
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Antibiotic sensitivities of 15302 organisms of common pathogenic species isolated in one hospital pathology department in 1971 and 1974 have been studied. Resistance to cephaloridine did not change materially. The proportion of strains resistant to ampicillin did, however, increase, and this is attributed to the widespread therapeutic use of the antibiotic. Cephaloridine, on the other hand, was largely used in the hospital as a single-dose, intra-incisional prophylactic against surgical wound sepsis.
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In a randomized, controlled clinical trial of two methods of preventing postoperative leg vein thrombosis patients undergoing major surgery were divided into three groups. One received intermittent electrical calf muscle stimulation during surgery, the second subcutaneous heparin calcium 5000 IU every eight hours for six days, and the third no specific prophylaxis. Leg vein thrombosis was detected by the 125-I-fibrinogen uptake test. Neither method was effective in patients undergoing open bladder or prostatic surgery. Stimulation did not reduce the incidence of leg vein thrombosis in patients with malignant disease undergoing laparotomy, but heparin calcium was highly successful in this group (P smaller than 0-001). When the laparotomy was for a benign condition, however, both heparin calcium (P smaller than 0-001) and stimulation (P smaller than 0-01) were effective.
Holter valves have been used in 9 cases to drain ascites, and in 1 case of pleural effusion, into the superior vena cava. All these effusions were due to malignant disease. Three patients died before the results of the operation could be assessed and in 1 case ascites rapidly recurred. Five patients were relieved until death from their primary disease. One patient died 3 1/4 years after insertion of the valve, but ascites had returned--probably as a result of recurrent blockage of the valve by particulate matter.
Forty-seven selected patients presenting with acute abdominal symptoms were investigated by examination of the fluid obtained by peritoneal lavage. In 34 patients this confirmed the clinical diagnosis, in 11 it was a more positive help in that it corrected an erroneous clinical diagnosis and in 2 the results of the investigation were misleading.
One hundred and ninety-two operation wounds ina general surgical practice were randomly allocated to receive either topical cephaloridine or a providone-iodine spray, and the rate of wound sepsis was studied. In all types of operation cephaloridine proved superior to providone-iodine as a prophylactic, the difference reaching a significant level in potentially contaminated wounds.
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Jaundice often complicates recovery after surgery. We have studied 180 patients undergoing 218 major operations and found an incidence of 3.7% severe jaundice and 16.5% mild jaundice. The causes of the jaundice were diverse, but the most important was a bilirubin overload (primarily from blood transfusion) which could not be excreted effectively by a liver whose cellular metabolism was disturbed. We found no evidence of a relationship between halothane and liver damage.
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