[Report concerning a new anesthetic agent to replace sulfuric ether in surgery and obstetrics. Presented at the Medico-surgical Society of Edinburgh, November 10, 1847].
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Interceed(TC7) is a fabric composed of oxidized, regenerated cellulose that was designed to reduce the formation of postsurgical adhesions. We evaluated Interceed(TC7) in a randomized, multicenter clinical study. Sixty-three infertility patients had bilateral pelvic sidewall adhesions removed at laparotomy. One pelvic sidewall was covered by Interceed(TC7) and the other was left uncovered. The deperitonealized areas (N = 205) of all sidewalls were divided into three groups: less than 100 mm2, N = 72; 100-1000 mm2, N = 95; and more than 1000 mm2, N = 38. The effectiveness of Interceed(TC7) was evaluated at laparoscopy 10-98 days after laparotomy. Significantly more adhesions were observed at laparoscopy on the control pelvic sidewalls (48 of 63, 76%) than on the treated sides (26 of 63, 41%) (P less than .0001). The Interceed(TC7)-treated sidewalls also had significantly less area involved with adhesions at laparoscopy (P less than .05, P less than .001, and P less than .001 in the three groups, respectively). Twenty-eight women with severe endometriosis also had significantly more adhesions on the control side (23 of 28, 82%) than on the treated side (14 of 28, 50%) (P less than .05). We conclude that Interceed(TC7) effectively reduced the incidence and extent of postoperative adhesions, even in patients with severe endometriosis.
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The Authors review, on the basis of their experience, the literature data concerning chemo-antibiotic prophylaxis in gynaecological surgery. Prophylaxis is widely employed although some important aspects are still under evaluation: bacterial selection and resistance, benefit in case of abdominal hysterectomy or elective Cesarean section, risk of pseudomembranous colitis. The most effective drugs are Piperacillin/Mezlocillin given in a single dose preoperatively. The same drugs are useful in the treatment of postsurgical infections.
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This article presents the first series with long-term results of a large number of patients. As a result, it is difficult to compare these results with anything but spontaneous recovery. In most cases, the end result after surgical treatment will be better than spontaneous recovery.
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