[Discovery of sinus diseases. Historical research].
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Biomedical subjects
Publications and source records attributed to J Michel.
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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.
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Sixty-one amniotic fluid samples from women in their second and third trimesters of pregnancy were examined for antimicrobial activity. Seventy per cent of the fluids were found to be active. The factor or factors responsible for this activity were present in low concentrations. The presence of spermine in the fluids accounted for some of the antimicrobial activity.
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The combination of clindamycin and gentamicin was used to treat 25 pediatric surgical patients. In 9 of the 11 patients with perforated appendicitis, B. fragilis was isolated from the peritoneal cavity. There was a rapid clinical response to treatment in all cases. No side effects were observed. Clindamycin and gentamicin seem to be the antibiotics of choice for such infections.
Forty-two patients with stage III melanoma were treated with a combination of CCNU, bleomycin, and vincristine. Seventeen of 35 evaluable patients achieved an objective response (48.5%) including five patients with CRs. The median duration of response was 4 months (range, 1-18 months). The responders had a median survival of 278 days (range, 78-1100 days) and the nonresponders had a median survival of 168 days (range 34-619 days). The toxicity off the combination was within an acceptable range with no toxic deaths.
Surveillance of hospital-associated infections at the Hadassah University Hospital has been carried out since 1970. Criteria for infection were defined and were monitored by trained nurse-epidemiologists, with the cooperation of the surgical staff. This report deals with the results of a prospective study of infections present on admission, and those acquired during hospitalization, in six surgical departments between January 1972 and June 1973. Of the 7,339 patients discharged, 7.5% acquired an infection in hospital, while 10.6% were admitted with an infection. Several important factors appeared to increase the risk of acquiring an infection in hospital. These include advanced age, certain surgical procedures, such as gallbladder and small and large bowel operations, and the presence of infection on admission. Most of the latter occurred at the site of the proposed operation, and thus increased the risk of development of postoperative wound infection.
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A randomized clinical trial of nafoxidine, a non-steroidal oestrogen antagonist, and ethinyloestradiol in postmenopausal patients with advanced breast cancer produced objective remissions in 31% of 49 women receiving nafoxidine and in 14% of 49 receiving ethinyloestradiol. The differences in remission rates was almost significant (0.05 less than P less than 0.10). Life-threatening complications were more frequent with ethinyloestradiol than with nafoxidine but the latter produced specific toxic reactions on skin and hair that may limit its practical usefulness. Synthetic oestrogen antagonists may occupy a privileged place in the treatment of breast cancer, and other representatives of this new class of compounds should be accurately assessed in randomized clinical trials.
Eight consecutive cases of ventriculitis detected and treated during a four year period are reviewed. This complication represented 7.9% of all cases of spina bifida treated surgically, and 5.4% of all shunt precedures performed during the study period. Prophylactic antibiotic treatment did not reduce the incidence of ventriculitis, and in fact seemed to produce resistant strains, which led to difficulties in treatment and a worse prognosis. The presence of an intraventricular foreign body precludes permanent sterilization of the ventricular fluid. Finally, in those cases in which the antibiotic of choice penetrates poorly into the cerebrospinal fluid; intraventricular as well as systemic administration of the drug is indicated. With Gram negative organisms, Gentamicin is currently the drug of choice.
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A synergistic in vitro bactericidal effect of combinations of chloramphenicol and beta-lactams on strains of Enterobacteriaceae is described. The synergism is seen with strains which are resistant to the beta-lactam and is due to chloramphenicol-induced inhibition of beta-lactamase production.
The penetration of parenterally administered gentamicin into the CSF was examined in dogs. The experiments were carried out in three stages: (1) in healthy dogs, (2) in dogs with meningitis, and (3) during recovery from the acute inflammation. Gentamicin was found to penetrate poorly into the CSF, reaching mean peak levels of 0.7 mug/ml in healthy dogs. During the height of the meningeal inflammation the mean peak gentamicin level in the CSF was 0.9 mug/ml. The ratio of mean maximum CSF to mean maximum serum levels of gentamicin was 5.8% in healthy dogs, and 11.3% in dogs with meningitis. Thus, inflammation increases the penetration of parenterally administered gentamicin into the CSF, but therapeutically adequate levels for gram-negative bacillary meningitis are not achieved.
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