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[Endosseous integrated implantation: multiple post-extraction implantationing threaded cyclindric titanium. Use of a semipermeable reabsorbable membrane].

On the basis of their experience of postextractive oral grafts, the authors examine all the surgical possibilities of this technique, at times using osteoinducing materials or at others semipermeable reabsorbable membrane; on other occasions an ostroinducing material associated with reabsorbable membrane is used to stimulate piloted regeneration of underlying bone tissue. Although not widely used, the post-extractive technique is presented as a fascinating reality that certainly, if used with due care, produces satisfactory and gratifying results. The authors are convinced that the contribution to simplifying surgical procedures and the reduced number of sessions that a patient has to undergo is without doubt a considerable advantage. In fact, using the postextractive technique with reabsorbable membrane the patient only undergoes a single operation. The authors have experience of three hundred post-extractive grafts with a very low failure rate (loss of seven grafts). These results can be attributed to clear rules: respect for antisepsis precautions, minimum surgery involving bone tissue, design of access flap to bone arch, positioning of fixture in correct spatial and occlusal direction, instant graft stability and perioplantar bone neoformation free of interference. The use of grafts has become a routine technique and is a valid alternative to prosthetic rehabilitation stages. It has become a true field with precise characteristics in the context of modern dentistry.

Adult↗

Abdominal aortic aneurysm combined with a second intraabdominal non vascular disease--a clinical study and surgical treatment.

The surgical tactics in cases of aneurysm of the infrarenal abdominal aorta and a second intraperitoneal operative procedure are not uniform in the literature and still remain a matter of debate. In 170 aneurysms of the abdominal aorta there were 18/170 (10.5%) other co-existent surgical non-vascular diseases as follows: Thirteen cases with symptomatic or asymptomatic cholecystopathy, one case with abdominal hernia, three cases with Ca of the colon and one case with Ca of the liver. In 9 cases, the aneurysm and the gallbladder were removed concomitantly, in 3 cases only aneurysmectomy was carried out due to cardiopulmonary problems, of which in two cholecystectomy was carried out in a second stage. In one case with cholecystitis, the gallbladder was removed and aneurysmectomy followed one month after. Aneurysmectomy and sigmoidectomy were carried out in one case and in a second similar case sigmoidectomy preceded followed by aneurysmectomy 6 months later. In one case aneurysmectomy and restoration of the abdominal hernia was performed concomitantly, while two more cases, one with liver lobectomy and another with orthosigmoidectomy due to Ca. No one of the above patients presented with any infection of the graft or other postoperative complication. No other complications were noted during a follow-up period of 19 months. The one stage operation management of infrarenal abdominal aortic aneurysm and a second (intra-abdominal) surgical procedure is feasible if appropriate care is given to the technical details and due consideration to the rules of antisepsis, without affecting surgical morbidity and mortality of the patient.

Aged↗

[Kinetics of in vitro bactericidal activity of the antiseptic biseptine combining 3 active principles].

Biseptine, is an association of chlorhexidine digluconate, benzalkonium chloride and benzylic alcohol. Little is known, in literature, on this antiseptic, used for cutaneous antisepsis. We studied killing kinetic of Biseptine, at different concentrations, on 4 AFNOR bacterial strains. Killing curves were studied at antiseptic concentration of 90 to 0.1% in 10 ml of distilled water. Bacterial counts were determined after neutralization in liquid medium. Synergy of chlorhexidine and benzalkonium chloride in Biseptine, allowed to obtain similar bactericidal activity than Hibitane champ with chlorhexidine concentrations 2 fold less. At 90, 50, 25, 10 and 5% concentrations, bactericidal activity (5 log10 reduction of the initial bacterial count) was effective in one minute. After 5 to 15 minutes, activity persisted at 1 and 0.5% concentrations. The 0.1% solution was inefficacious. This report disclosed an important security margin in antiseptic activity.

Anti-Infective Agents, Local↗

Monocyte activation after open and laparoscopic surgery.

BACKGROUND: The level of expression of major histocompatibility complex class II antigens, human leucocyte antigen (HLA)-DR, on monocytes correlates with the development of sepsis after surgery or trauma. Normally interferon (IFN) gamma can increase monocyte HLA-DR expression and thus may be a potential biological prophylactic antisepsis agent in patients suffering from accidental or surgical trauma. The purpose of this study was to determine the capacity of monocytes to respond to IFN-gamma after conventional open surgery and laparoscopic surgery of similar magnitude. METHODS: A whole blood flow cytometric assay was used to measure monocyte HLA-DR antigen expression before and after monocyte activation with either IFN-gamma or bacterial lipopolysaccharide (LPS). Blood was obtained before operation and on postoperative day 1 from 43 patients undergoing conventional open surgery and from 15 undergoing laparoscopic surgery of similar magnitude. RESULTS: Whole blood monocyte HLA-DR expression fell significantly after both conventional open and laparoscopic surgery. IFN-gamma caused monocyte HLA-DR expression to rise by a median (interquartile range) of 43 (26-60) per cent and 63 (10-124) per cent before operation in the open and laparoscopic groups respectively. However, after operation the corresponding values were 20 (6-41) per cent and 26 (9-74) per cent (P < 0.003 in all cases). Identical findings but of greater magnitude were observed with LPS stimulation before and after operation in the two surgical groups. CONCLUSION: Monocyte HLA-DR expression is diminished by surgical operations and is relatively refractory to further stimulation by IFN-gamma or LPS after surgery. Laparoscopic surgery is as suppressive as conventional surgery in this regard. The resistance of postoperative monocytes to further activation by IFN-gamma suggests that this agent may be ineffective as a biological response modifier after major surgery or trauma.

Adult↗

[Stability and antimicrobial effectiveness of Javel water in a tropical hospital environment].

A sodium hypochlorite solution (NaClO) containing 0.5% w/v of available chlorine (0.5% Cl2 or 5000 ppm) is a good and cheap solution for disinfecting material used to medical care. It is effective against bacteria, fungi and viruses. It is easy to prepare. It can be a good solution for antisepsis and disinfection in dispensaries in developing countries. However, it is not always easy to keep it in adequate conditions. That's the reason why we have evaluated the durability of such a solution of NaClO exposed to disadvantageous factors, specially daylight and air, and its antibacterial effectiveness. In this study, after exposure of NaClO containing 4350 ppm of available chlorine to these adverse conditions, the final concentration of NaClO was 2300 ppm of available chlorine and was found effective for decontamination of medical material. A protocol for conservation and use of a sodium hypochlorite solution (0.5% Cl2) in dispensaries of developing countries is proposed.

Bacteria↗

[Perioperative antibiotic prophylaxis from the microbiological viewpoint].

The practice of using antibiotic prophylaxis before surgery has evolved greatly in the past 20 years and is regarded as the third cornerstone in the prevention of postoperative wound infections. In contrast to asepsis and antisepsis, which have been standard techniques for almost a century, perioperative antibiotic prophylaxis is all too frequently administered in a suboptimal fashion. During the last few years, improvements in the timing of initial administration, the appropriate choice of antibiotic agents in each clinical setting, and the limitation of the duration of administration have defined more clearly the value of this technique in reducing postoperative wound infections. Implementation of these guidelines must be regarded as major issues in improving the quality of care in surgery.

Antibiotic Prophylaxis↗

[Our experience in introducing current antibiotic prophylaxis into abdominal surgery--the initial results].

Over a one-year period (Nov. 1996-Nov. 1997), a total of 154 patients are admitted on an emergency basis, with deferred emergency and for routine treatment in the Clinic of Emergency Surgery. They are distributed in three groups, as follows: patients not requiring perioperative antibiotic prophylaxis and postoperative antibiotic therapy--27, patients subjected to perioperative parenteral antibiotic prophylaxis under adequate hospital conditions--121, and patients undergoing antibiotic prophylaxis in conditions inappropriate for its application--six. The drug schemes elaborated are in conformity with worldwide and Bulgarian experience along this line, and with the concrete hospital and economical conditions in this country. In all patient indicated for antibiotic prophylaxis the listed below antibacterial agents (presented as drug schemes) are administered i.v. a single time prior to anesthesia induction: in operations on the gastrointestinal tract except for interventions in acute appendicitis: cephalotin/cefazolin 2.0 g and metronidazole 0.5 g i.v.; in operations for acute appendicitis: amoxicillin/clavulanate 1.2 g and petronidazole 0.5 f i.v.; biliary surgery free of extrahepatic cholestasis: cephalotin/cefazolin 2.0 g i.v.; biliary surgery with present or preceding extrahepatic cholestasis: cefotetan 2 g i.v.; contaminated liver cysts (parasitic and nonparasitic): cefotetan 2 g i.v.; abdominal trauma without perforation of a hollow organ: cefotetan 2 g i.v.; in plastic repair of the anterior abdominal wall (congenital defects, postoperative eventration) and in poor risk patients (local and general status: cephalotin/cefazolin 2.0 g i.v. In 135 patients the postoperative period runs a course free of complications worthy of notice. Complications directly linked to introduction of the method proposed are recorded in ten cases: operative wound suppuration (4) and hospital infection (6). Complications not related directly to the procedure are observed in nine cases: urinary tract infection (4), bronchopneumonia (2), fever with unknown source of infection (including negative hemoculture) necessitating additional antibiotic therapy (2) and secondary infection (within a week of intervention) necessitating further therapy with antibiotics. The specific features of antibiotic prophylaxis used in the various types of operative interventions are discussed from microbiological, clinical and pharmacotherapeutic viewpoints. The obtained results are compared with pertinent literature data on the issue with a special reference to the clinical efficacy attained. They mirror the approach against the background of the concrete hospital conditions in this country. The method developed is fully consistent with the level of surgical expertise in Bulgaria. All efforts should be aimed at intrahospital environment improvement by means of meticulous asepsis and antisepsis.

Abdomen↗

Proto-surgery in ancient Egypt.

This article investigates the evidence we have for the existence of proto-surgery in ancient Egypt during the Dynastic Period (c.3200-323 BC). Climate and chance have preserved medical literature as well as paleoarcheological specimens and these artefacts, along with extant Greek and Roman treatises appear to support the conclusion that proto-surgery was practised in ancient Egypt (the prefix proto-designates an original or early form). Elements of proto-surgical development including analgesia and sedation, the incision, trephination, proto-surgery of trauma, mythical proto-surgery and antisepsis, drawing on primary sources, surviving artefacts and modern commentary are discussed. Where appropriate comparisons are made with proto-surgery in ancient Mesopotamia and the Bronze Age Aegean.

Egypt, Ancient↗