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PubMedDate not supplied

Safe handling of cytotoxic drugs in the physician's office: a procedure manual model.

PURPOSE/OBJECTIVE: To present a model of an adapted manual of safety procedures designed for education and implementation of standardized cytotoxic drug handling in the private oncology office setting. DATA SOURCES: Published articles, textbook chapters, published technical bulletins and guidelines, research studies identifying risks of occupational exposure and procedural guideline sources for reducing these risks. DATA SYNTHESIS: Most published guidelines on safe handling of cytotoxic drugs address the hospital setting but lack practical guidelines for use within an oncology office. The procedures presented in this model are a composite of several current guidelines offering recommendations for minimizing chronic low-level exposure to cytotoxic drugs. The recommendations are compiled into a procedure manual for office settings. CONCLUSIONS: The mere provision of laminar flow hood equipment in a physician's office is insufficient without a consistent policy for nursing personnel to follow. Such a policy should be established through the development of a standardized manual appropriate for the office that includes procedures required for the equipment. Adapting safety guidelines into an office procedural manual provides a practical and consistent approach to enhancing personal safety for oncology nurses within community office settings. IMPLICATIONS FOR NURSING PRACTICE: With today's rapid expansion of ambulatory chemotherapy services, the need for specialized instruction in the safe handling of cytotoxic drugs has become increasingly apparent. In the course of their duties, private office oncology nurses endure daily exposure to toxic agents, which poses a concern for occupational safety. An established procedure manual standardizes safe work practices for use in training new personnel and evaluating staff exposure to cytotoxic drugs.

Antineoplastic Agents↗

PubMed1996

[Cardiosurgical stand-by and acute interventions after interventional cardiologic procedures].

Interventional cardiologists and cardiac surgeons agree in the treatment of symptomatic coronary artery stenosis: high risk patients with severe coronary disease (such as left main stem stenosis, triple vessel disease and double vessel disease with involvement of the proximal LAD in particular with severely impaired ventricular function) are treated preferentially with coronary artery bypass grafting (CABG); less severe cases allow alternatively PTCA treatment. However, even in controlled and randomised studies (RITA, GABI, ERACI, CABRI, and BARI-studies) looking into these alternatives (PTCA versus CABG) it was found that 1.1% to 10.1% of all PTCA incidents required a surgical emergency procedure. Although, in favourable conditions the risk is considerably lower than the above value and despite of improvement of catheter techniques (stent implantation, perfusion catheters) in less favourable conditions which reduced the risk to a similar value, the results of surgical emergency procedures are still significantly impaired compared with elective procedures. Moreover it has been shown that there is a relation between the outcome of the surgical procedure and the time elapsed between PTCA-incident and surgical intervention. Perioperative myocardial infarction and mortality are much lower if there is no delay caused by occupied theaters, unsolved transportation problems and/or time intensive attempts of recanalisation by catheter. Considering the high numbers of PTCA procedures, in some centers even performed simultaneously, it seems acceptable to perform a dilatation in the low risk group without surgical standby. If strict observance of the indication criteria is provided early complication rate and mortality of PTCA is even less than in CABG-procedures. On the other hand (from a cardiosurgical point of view), it has to be emphasized that PTCA procedures in the high risk group potentially endangering large myocardial areas, a cardiosurgical standby has to be available and emergency surgery should be performed ultimately within 60 minutes (after myocardial infarction).

Angioplasty, Balloon, Coronary↗

PubMed1994

Single Puncture Laparoscopic Sling Procedure

The sling procedure has become the procedure of choice for women with recurrent stress incontinence with a poorly mobile, fibrotic urethra and for women with primary incontinence and very low urethral closure pressures consistent with inadequate intrinsic urethral tone. In addition to the increased risk of graft infection or postoperative rejection associated with the use of synthetic materials, the technical drawback of traditional sling procedures is that the placement of the graft through the space of Retzius is carried out blindly, increasing the risk of bladder and urethral injury, hemorrhage, infection and nerve trauma. We had the opportunity to perform the first successful laparoscopic sling procedure using a single puncture technique in a 43 year-old woman at the time of laparoscopic hysterectomy for large symptomatic leiomyomata. In addition to her gynecologic problem, the patient had very low proximal urethral pressure. The procedure was performed under direct laparoscopic view, avoiding the blind placement of the sling under the proximal urethra and bladder neck and avoiding injury to the bladder and urethra. The procedure was almost bloodless. The patient was discharged 24 hours postoperatively. The Foley catheter was removed on the third postoperative day. No voiding difficulties occurred. Her postoperative course was uneventful. Postoperative evaluation 6 months after surgery demonstrated normal urethral closure pressure, urinary continence, and absence of reaction to the sling graft material. This singular experience appears to demonstrate that laparoscopy may play an important role in improving the surgical performance and outcome of the sling procedure.

Journal Article↗

PubMed1996

[External canthopexy using the Edgerton-Montandon procedure in lagophthalmos of leprosy patients. Technique and indications. Apropos of 30 cases].

This paper deals with the results observed in 21 ancient leprosy patients suffering from lagophthalmos (13 of whom suffered from bilateral lagophthalmos) and treated by the Edgerton-Montandon surgical procedure which associates lateral canthopexy and tarsorraphy. Eighteen of the 21 treated patients were reviewed at one month after the procedure and, overall, results could be evaluated for 30 eyes. Improvement was noted in all of the 30 eyes and, globally, the residual palpebral fissure (during voluntary closing of the eyes by the patient) decreased from 6.7 mm before the procedure to 1.8 after the procedure. The following recommendations may be proposed. For young patients with intact corneal sensation, the Gillies procedure remains the procedure of choice to correct lagophthalmos. For older patients with corneal anesthesia, at high risk of blindness, the Edgerton-Montandon procedure should be recommended.

Aged↗

PubMed1997

Learning relevant procedural skills. Are supervisors providing opportunities?

OBJECTIVE: The aim of this study is to assess general practice registrars' (GPRs) learning needs in relation to their procedural skills development and compare these with the learning opportunities offered by their general practice supervisors (GPSs). METHOD: A 43 item questionnaire was designed to assess the procedural skills development needs of GPRs. The questionnaire was administered to GPSs and GPRs. RESULTS: GPRs can expect to consolidate their skills in the areas of joint injections. ENT procedures and some small surgical procedures. They are unlikely to gain experience in the areas of proctology, the use of the microscope as a diagnostic tool, cardiac stress testing, hearing assessment and some less frequently needed procedures. Respondents identified spinal mobilisation manipulation, flexible sigmoidoscopy, colposcopy and fine needle aspiration biopsy as procedures they would like to see performed in general practice. CONCLUSION: GPRs are keen to enhance their procedural skills in a wide range of areas. They cannot necessarily expect that their general practice attachment will provide the opportunities to develop all skills desired. The Royal Australian College of General Practitioners (RACGP) Training Program needs to provide registrars with a list of core skills that are expected of every general practitioner (GP). To ensure this objective is achieved, innovative learning opportunities for GPSs and GPRs in the domain of psychomotor competencies need to be developed.

Adult↗

PubMedDate not supplied

[Vascular intracranial procedures in Jehovah's Witnesses. Erythropoietin in the preparation for the surgery].

Intraoperative haemorrhage or major bleeding may still cause serious problem in present-day neurosurgery, especially with reference to major vascular procedures despite the improving surgical techniques and methods of performing bloodless procedures. This is why certain neurosurgical procedures are not attempted without prior preparation of a major amount of blood. Jehovah's Witnesses refuse their consent to be subjected to blood transfusion of their own or foreign blood despite their full awareness of a potential danger to their lives. This paper describes three patients subjected to the major vascular intracranial procedures (two cases of clipping intracranial aneurysms, and one case of removal of arteriovenous intracranial angioma in anaemic patient), and one case of endovascular neuroradiosurgical procedure in intracranial aneurysm. This last method is presented as alternative procedure to decrease complications that are related to bloodless interventions suggest certain management methods which may decrease the surgical risk. One of those methods erythropoietin in treatment of postoperative anaemia and in preparing anaemic patients to vascular intracranial procedures.

Anemia↗

PubMed1998

[Surgical repair of male epispadias by the Cantwell-Ransley procedure: technical aspects and functional results in a series of 40 patients].

From 1989 to 1997, 40 patients underwent primary (n = 29) or a secondary (n = 11) epispadias repair according to the Cantwell Ransley Procedure. 23 patients had bladder exstrophy, 6 had penopubic epispadias, and 11 had penile epispadias. The mean age at surgery was 5 years (1-28 years); 23 patients were prepubertal and 17 were postpubertal. The procedure associated an IPGAM meatoplasty, ventral transposition of the urethra, and dorsal rotation and approximation of the corpora with (16) or without (24) caverno-cavernostomy. With a mean follow-up of 4 years, 19 patients (47.5%) achieved a good cosmetic and functional result after a single procedure. 18 patients (45%) developed complications that required minor revision (8 patients) or a more major procedure (10 patients). Finally 3 patients (7.5%) had a complete failure. 3 patients also had a loss of continence (complete in one case) after the procedure. The complication rate was slightly higher in the postpubertal group (58%) than in the prepubertal group (47%). A prior urinary diversion did not increase the complication rate. All 17 patients in the postpubertal group reported satisfactory erections. All 16 patients who had minor to major urethral complications had previously undergone transection of the urethral plate. Overall 35 patients (87.5%) achieved a satisfactory cosmetic and functional result. The Cantwell Ransley procedure is an excellent procedure for the repair of male epispadias. However the complication rate is significant, mainly related to previous operations compromising the blood supply to the posterior penile urethra.

Adolescent↗

PubMed2006

A modified procedure for velopharyngeal sphincteroplasty in primary cleft palate repair and secondary velopharyngeal incompetence treatment and its preliminary results.

During cleft repair, velopharyngeal sphincter reconstruction is still a challenge to plastic surgeons. To improve the surgical treatment for cleft palate and secondary velopharyngeal incompetence (VPI), a carefully designed modified procedure for primary palatoplasty and secondary VPI was presented. Fifty-six patients (48 for primary cleft palate repair and eight for secondary VPI of previously repaired clefts) underwent this procedure from 1988 to 2001. The modified procedure is a combination of the tunnelled palatopharyngeus myomucosal flap for dynamic circular reconstruction of the pharyngeal element of the velopharyngeal sphincter and the double-reversing Z-plasty with levator velo palatini muscles reposition in the velar element of the sphincter. The satisfactory velopharyngeal competence (complete velopharyngeal closure and marginal velopharyngeal closure) was achieved in 23 of 25 patients with primary cleft palate repair examined by nasendoscopy and the nasality, speech articulation and intelligibility are also assessed in 25 primary cleft palate repaired patients with 92% satisfactory result (normal speech and speech with mild VPI) in single word test and 88% in continuous speech evaluation. Based on our experience, we believe that this modified procedure is a reasonable choice for primary cleft repair and secondary VPI treatment because it is in accord with normal physiology and anatomy of the velopharyngeal sphincter, can lengthen the soft palate, decrease the enlarged velopharynx, augment the posterior pharyngeal wall, and enhance the relationship between the muscles of velopharyngeal sphincter which results in a dynamic neo-sphincter in palatopharyngoplasty. Further study of the procedure is needed. The theoretical basis, operative highlights, velopharyngeal function, advantages and disadvantages of the modified procedure were discussed.

Adolescent↗

PubMed2003

Computational fluid dynamics in the evaluation of hemodynamic performance of cavopulmonary connections after the Norwood procedure for hypoplastic left heart syndrome.

OBJECTIVE: Computational fluid dynamics have been used to study the hemodynamic performance of surgical operations, resulting in improved design. Efficient designs with minimal energy losses are especially important for cavopulmonary connections. The purpose of this study was to compare hydraulic performance between the hemi-Fontan and bidirectional Glenn procedures, as well as the various types of completion Fontan operations. METHODS: Three-dimensional models were constructed of typical hemi-Fontan and bidirectional Glenn operations according to anatomic data derived from magnetic resonance scans, angiocardiograms, and echocardiograms. Boundary conditions were imposed, and fluid dynamics were calculated from a mathematic code. Power losses, flow distribution to each lung, and pressures were measured at three predetermined levels of pulmonary arteriolar resistance. Models of the lateral tunnel, total cavopulmonary connection, and extracardiac conduit completion Fontan operations were constructed, and power losses, total flow distribution, vena caval and pulmonary arterial pressures, and flow distribution of inferior vena caval return were calculated. RESULTS: The hemi-Fontan and bidirectional Glenn procedures performed nearly identically, with similar power losses and nearly equal flow distributions to each lung at all levels of pulmonary arteriolar resistance. However, the lateral tunnel Fontan procedure as performed after the hemi-Fontan operation had lower power losses (6.9 mW, pulmonary arteriolar resistance 3 units) than the total cavopulmonary connection (40.5 mW) or the extracardiac conduit (42.9 mW), although the inclusion of an enlargement patch toward the right in the total cavopulmonary connection was effective in reducing the difference (10.0 mW). Inferior vena caval flow to the right lung was 52% for the lateral tunnel, compared with 19%, 30%, 19%, and 15% for the total cavopulmonary connection, total cavopulmonary connection with right-sided enlargement patch, extracardiac conduit, and extracardiac conduit with a bevel to the left lung, respectively. CONCLUSIONS: According to these methods, the hemi-Fontan and bidirectional Glenn procedures performed equally well, but important differences in energy losses and flow distribution were found after the completion Fontan procedures. The superior hydraulic performance of the lateral tunnel Fontan operation after the hemi-Fontan procedure relative to any other method may be due to closer to optimal caval offset achieved in the surgical reconstruction.

Cardiac Surgical Procedures↗

PubMed2000

New surgical and catheter-based modifications of the Maze procedure.

There is currently an intense interest in applying the principles of the Maze procedure in a less invasive manner so that a wider group of patients with atrial fibrillation can be treated safely and effectively. These efforts have centered around surgical attempts to curtail the number of lesions placed in the atria at the time of valve surgery and catheter-based attempts to re-create a part or all of the Maze procedure with radiofrequency ablation. Thus far, these techniques remain highly experimental and largely without merit. Many of the problems that we encountered several years ago in developing the surgical Maze procedure are now being repeated in patients undergoing these highly experimental and inadequately evaluated procedures. Nevertheless, there are occasional flashes of promise with some of these approaches. Moreover, it is clear that only a miniscule percentage of the patients with atrial fibrillation will ever become candidates for the open-heart Maze procedure as it is now performed. Therefore, the continuing struggle to relieve the invasive downside of the Maze procedure is warranted but with the caveat, especially to our cardiologist colleagues, to proceed with caution.

Animals↗

PubMed2002

Secondary shunt procedure for alaryngeal patients in an outpatient clinic.

The shunt procedure used for laryngectomized patients undergoing secondary tracheo-esophageal (T-E) puncture is inconvenient and causes stress to the patient. In order to overcome these problems we developed a novel surgical T-E shunt technique using the Groningen voice prosthesis that does not require esophagoscopy or general anesthesia and can be performed in an outpatient clinic. In this procedure, a shunt is created using a pair of nasal forceps with the patient seated. An endoscope with biopsy forceps is used to insert the Groningen voice prosthesis. The procedure is usually completed within 20 min after inducing local anesthesia. Neither the technique itself nor the time taken to complete the procedure differed for T-E and tracheo-neoesophageal (reconstructed with flap) shunting. We believe that this procedure is suitable for patients who are afraid of esophagoscopy and/or are not considered suitable candidates for esophagoscopy and repeated general anesthesia. The procedure is also beneficial for both patients and surgeons with regard to its duration and the cost-effectiveness of treatment.

Ambulatory Surgical Procedures↗

PubMed2005

[TVT associated with other gynecological operations in the same procedure: results and complications].

OBJECTIVES: We report our experienced with TVT combined with other gynecological procedures, and the complications appeared intraoperative and during the immediate postoperative period. METHODS: Between October 2001 and March 2004 76 patients underwent TVT procedures following the classic technique in the Urogynecology and Vaginal Surgery Unit of Las Condes Clinic. Median age was 53 years old. Urodynamic tests had demonstrated genuine stress urinary incontinence (SUI) (49 cases), intrinsic sphincter deficiency (ISD) (5 cases), and mixed urinary incontinence (MUI) (22 cases). In 61 cases (80.3%) TVT was associated with another gynecological surgery. RESULTS: 82 gynecological operations were associated to TVT Twenty one patients underwent 2 procedures (34%) and 40 patients one (66%). Laparoscopic surgery 25 cases (41%). Vaginoplasty was the most frequent procedure in 49 cases (80%), laparoscopic hysterectomy 17 (28%), vaginal hysterectomy 5 (8%), laparoscopically assisted vaginal hysterectomy 5 (8%), laparoscopic tubal ligation 3 (5%), Gargiulo operation 1 (2%), annexectomy 1 (2%), and trachelectomy 1 (2%). Introoperative complications appeared in 4 patients (6.6%). 3 cases of bladder perforation (5%), and 1 case of parietal peritoneum perforation (1.6%). No surgical intervention was necessary to solve complications. Two cases of transitory acute urinary retention appeared in the immediate postoperative period. CONCLUSIONS: Our clinical experience demonstrates that the combination of TVT with other gynecological operations in the same procedure is effective and safe. It enables a more comprehensive solution of patient's problems in the same procedure without increasing morbidity.

Adult↗

PubMed2005

Relationship between tunnel widening and different rehabilitation procedures after anterior cruciate ligament reconstruction with quadrupled hamstring tendons.

BACKGROUND: It has been demonstrated that bone tunnel widening could appear after knee anterior cruciate ligament (ACL) reconstruction, especially for those patients whose ruptured ACL were reconstructed with semitendinosus and gracilis tendons. Many factors can influence the extent of tunnel widening. Few studies have investigated the relationship between bone tunnel widening and rehabilitation procedures. This research was carried out to find the rehabilitation procedures' influence on the tibial bone tunnel widening after ACL reconstruction. METHODS: Sixty-five cases, whose ACL reconstructions were done using quadrupled semitendinosus and gracilis tendons, were divided into two groups. Group A had 33 cases, 19 men, 14 women, averaged (31.2 +/- 12.4) years old, only ACL reconstruction was done using Paessler's technique, and aggressive rehabilitation procedure was used for function recovery post operation. Group B had 32 cases, 20 men, 12 women, averaged (30.3 +/- 10.3) years old. Except for ACL reconstruction, every patient in group B accepted meniscus repair using re-fixation methods or cartilage repair using microfracture technique, conservative rehabilitation procedure was used post operation. Six months post operation, standard posterior-anterior radiographic plates were taken for each case, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification effect of X-ray plates was taken out after measurement. RESULTS: Six months after ACL reconstruction the tibial tunnel widening of the upper, middle and lower parts on both the posterior-anterior and lateral X-ray plates in Group A with aggressive rehabilitation procedure was much more serious than in Group B with conservative rehabilitation. KT-1000 knee stability measurement and clinical manifestation showed no difference between the two groups. CONCLUSIONS: Rehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It not only can directly influence the function recovery of ACL reconstructed knee, but also perhaps indirectly influence the function recovery and long-term clinical result of the operated knee by influencing the tunnel widening.

Adult↗

PubMed2005

Tension-free vaginal tape (TVT) procedure.

OBJECTIVE: To provide an introduction to the tension-free vaginal tape(TVT) procedure, placing it in the context of minimally invasive surgeries for the treatment of urinary stress incontinence in women, and to provide guidance to surgeons counseling women on the merits of this surgical choice. OPTIONS: This discussion is limited to surgical treatment of urinary stress incontinence in women. EVIDENCE: A search of both MEDLINE and the Cochrane Library identified the most relevant medical evidence. This document represents an abstraction of the evidence rather than a methodological review. VALUES: This update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada (SOGC). BENEFITS, HARMS, AND COSTS: Counseling for the surgical treatment of urinary incontinence should consider the harms-benefits ratios of various options and include a measure of the"weight" of the evidence. RECOMMENDATIONS: 1. The Burch procedure should be offered as the gold standard. The TVT procedure is promising but currently under evaluation in trials that will establish its efficacy and safety (II-3A). 2. Proper training is recommended prior to performing TVT procedures. 3. Long-term trial results are needed before the TVT procedure can be offered to patients as an equal alternative to the Burch procedure. VALIDATION: This technical update has been approved by the Sub-Committee on Urogynaecology and Executive and Council of the SOGC.

Female↗

PubMed2007

Iatrogenic bladder injuries during obstetric and gynecological procedures.

OBJECTIVE: To review the frequency of iatrogenic bladder injuries (IBI) occurring during obstetric and gynecological (OBG) procedures and we report a single center experience with these emergency urological consultations and interventions and analyze their outcomes and correlate them with the present day trends. METHODS: We reviewed retrospectively the relevant data of all IBI during various OBG procedures from the Medical Records of Abha Maternity Hospital, the OBG wing of Assir Central Hospital, Abha, Saudi Arabia over a period of 4.5 years (September 2000 to February 2005). Various relevant factors of the injuries were studied with their final outcome. RESULTS: Out of the 8,684 OBG procedures carried out during this period there were 20 occasions of IBI directly related, with an overall incidence of 0.23%. The majority of injuries were seen during obstetric procedures (85%) and 15% during gynecological procedures. Notably 90% of them were recognized intraoperatively and managed. Concomitant ureteric injury was noticed in 20% of the cases. Endourological and surgical options were both used in the management. Overall outcomes were very satisfactory, unrelated to the site, type or other associated injuries. CONCLUSION: The bladder is the most commonly injured organ during OBG interventions. Prompt recognition and repair of injuries should be the main goal. Gynecologists should be able to do at least a minimum diagnostic cystoscopy in emergency situations. It is well established that this can lessen, missing iatrogenic urinary tract injuries in this era of increasing gamut of gynecologic surgical and laparoscopic procedures.

Adult↗

PubMed2003

Evaluation of low ligation and high ligation procedures of varicocele.

OBJECTIVE: To describe the mode of presentation of varicocele and to compare the low ligation (Inguinal approach/Ivanissevich's procedure) and high ligation (Retroperitoneal approach/modified Palomo's procedure) of varicocele repair regarding efficacy and postoperative complications. DESIGN: Institutional-based randomized comparative clinical trial. PLACE AND DURATION OF STUDY: This study was conducted at the Urology Department, Bolan Medical College and Sandeman Provincial Teaching Hospital, Quetta from December 1996 to November 2001 (5 years). SUBJECTS AND METHODS: A total of 213 patients of varicocele who underwent treatment in the department and completed 6 months follow-up were included in the study. The mode of presentation of varicocele was recorded for all patients. For treatment purpose patients were randomly divided into two groups: in group I (n: 115) varicocele was ligated by inguinal approach (Ivanissevich's procedure) while in group II (n: 98) by retroperitoneal approach (modified Palomo's procedure). The efficacy and postoperative complications of the two procedures were carefully recorded and compared between the two groups. RESULTS: The mean age of the patients of group-I and group-II was 27.2 and 27.5 years respectively. More than 50% patients of both groups presented with feeling of heaviness/dragging sensation on ipsilateral side. Presentation with infertility/sub fertility in group-I and group-II was 16.5% and 15.3% respectively. Majority of patients of both groups had grade III varicocele with visible deformity. The rate of postoperative complications was very low in both groups of patients. Recurrence of varicocele and postoperative hydrocele formation were slightly more common in group-II as compared to group-I but the difference was statistically not significant (p>0.05). An extremely significant improvement occurred postoperatively in both sperms density and motility in infertile/sub fertile patients of both groups. CONCLUSION: Both procedures of varicocele repair are equally effective and have a low rate of complications. There is no significant difference in postoperative complications. An extremely significant improvement occurs in semen parameters of infertile/sub fertile patients postoperatively, irrespective of method/technique of varicocelectomy

Adolescent↗

PubMed1992

Epidemiology of bacterial endocarditis in The Netherlands. II. Antecedent procedures and use of prophylaxis.

BACKGROUND: The reported frequency with which endocarditis is ascribed to an antecedent dental or medical procedure varies from 3% to 62%. METHODS: We performed a nationwide prospective study of the epidemiology of bacterial endocarditis in the Netherlands. During a 2-year period, all consecutively hospitalized patients suspected of having endocarditis were visited while still hospitalized for a review of the medical record and an in-person interview that focused on antecedent procedures and administered prophylaxis. All information was checked with pharmacists and dental and medical practitioners. RESULTS: Of 427 patients with late prosthetic or native valve endocarditis, 275 were eligible for antibiotic prophylaxis because of a previously known cardiac lesion (n = 197) or a prosthetic valve (n = 78). Of these 275 patients, 64 (23.3%) had undergone a procedure with an indication for prophylaxis within 180 days of onset; in 31 (11.3%) the procedures had been within 30 days of onset. Antibiotic prophylaxis had been administered to 17 (26.6%) of the 64 patients and to eight (25.8%) of the 31 patients. CONCLUSION: The results indicate that medical and dental procedures cause only a small fraction of endocarditis. The majority of patients develop the disease along other routes. For an incubation period of 180 days, full compliance with prophylaxis might have prevented endocarditis in 47 (17.1%) of 275 patients with late prosthetic or native valve endocarditis involving a previously known cardiac lesion who underwent a procedure with an indication for prophylaxis. For an incubation period of 30 days, prophylaxis might have prevented endocarditis in 23 (8.4%) of these 275 patients, or 5.3% of all patients with endocarditis (n = 427).

Anti-Bacterial Agents↗

PubMed1997

Ganciclovir implant exchange. Timing, surgical procedure, and complications.

BACKGROUND: The ganciclovir implant is effective for the treatment of cytomegalovirus (CMV) retinitis. The device eventually runs out of drug, however, and must be replaced. We report our experience with exchanging ganciclovir implants during the course of a randomized clinical trial. METHODS: During our study, patients with newly diagnosed peripheral CMV retinitis were treated with a ganciclovir implant. The implant was scheduled for exchange at 32 weeks. It was exchanged earlier if progression of CMV retinitis occurred. Patient examinations and standard fundus photography were performed at 2-week intervals after the exchange procedure. RESULTS: Twenty-six exchange procedures were performed. Twenty-two eyes in 15 patients received a second implant and 4 eyes in 4 patients later received a third implant. Cytomegalovirus retinitis was rendered or maintained inactive in 22 of 23 cases with more than 1 month of follow-up after the second or third implants. Complications after the second implant procedure included transient vitreous hemorrhage in 5 eyes, postoperative inflammation in 1 eye, and retinal detachment in 1 eye. Median visual acuity returned to 20/25 by 28 days and to 20/20 by 42 days. Complications after the third implant procedure included dense vitreous hemorrhage in 3 of 4 eyes. Median survival time after a second implant procedure was 89 days. CONCLUSIONS: The initial ganciclovir implant exchange procedure is well tolerated with continued long-term control of CMV retinitis. Multiple reentries through the same wound may be associated with an increased risk for vitreous hemorrhage.

Antiviral Agents↗