150 years after. A tribute to Joseph Lister.
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Biomedical subjects
Publications and source records attributed to O J Gilmore.
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Clinical and experimental studies have suggested that intraperitoneal noxytiolin prevents adhesion formation. A reliable experimental animal model was therefore established and the effect of noxytiolin on adhesion formation was evaluated in a controlled trial using 80 rats. All 40 rats given Ringer solution developed adhesions, whereas in 7 out of 40 given noxytiolin no adhesions were found (P less than 0-02). Noxytiolin reduced both the total and the mean number of adhesions formed (P less than 0-2) and their mean length of attachment (P less than 0-05). The anti-adhesive effect of noxytiolin may be due to its anticoagulant, cytotoxic or antibacterial properties.
Povidone iodine is now being increasingly used in hospitals as an antiseptic. The possible habituation of bacteria to iodine was studied by serial passage of two strains of Pseudomonas aeruginosa, two strains of Escherichia coli, two strains of Klebsiella aerogenes, and one strain of Serratia marcescens in subinhibitory concentrations. After 20 passages, no significant change was observed in the minimal inhibitory concentration, minimal bactericidal concentration, and killing times between parent strains and 20th subcultures under standardized conditions.
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A prospective study of 444 consecutive patients diagnosed as having acute appendicitis was carried out in a district general hospital. The appendix was acutely inflamed, gangrenous, or perforated in 346 patients. Diagnostic error, 22% overall, was twice as common in females as in males. Organisms were isolated from the outer appendix wall in 117 patients, isolation increasing with the severity of inflammation. 12% of children under 11 had mesentric adenitis, 10% of all females had gynaecological lesions, and 14% of patients over 50 had acute diverticulitis. In only 6% of patients was no abnormality found at operation, and in every case the disorder was dealt with through the gridiron incision.
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This study sought to determine in a district general hospital (a) the frequency and nature of bacterial contamination at operation, (b) the incidence of consequent infection and (c) the prophylactic effect, if any, of interparietal povidone-iodine against postoperative wound infection. Bacterial contamination was shown in 49 per cent of all the abdominal surgical wounds at the end of operation. From 61 per cent of the subsequently infected wounds, organisms identified as contaminants at operation were again found. Interparietal instillation of povidone-iodine resulted in a statistically significant reduction in wound infection (P less than 0.01) in treated patients compared with untreated, randomized, matched controls. It was of significant value in cases of intestinal resection and peritonitis, in obese patients and in those with paramedian incisions. Laboratory studies indicate that povidone-iodine does not induce bacterial resistance. This chemical antibacterial agent may thus provide a preferable alternative to antibiotics in preventing such infections.
This paper offers guidance on antibiotic usage in surgical patients. A policy is outlined rather than the comprehensive coverage of every surgical situation. The principles of antibiotic prescribing are given. The antibiotics available and their routes of administration are reviewed. Indications for the prophylactic and therapeutic use of antibiotics are discussed. Factors causing the failure of antibiotic therapy are considered in brief.
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