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Results for “Prophylactic Surgical Procedures”

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At least 19 recordsLinked to original sources
PubMed1988

Prophylactic antibiotics for cesarean section and surgical procedures.

Although prophylactic antibiotics are used frequently on women undergoing pelvic surgery, including cesarean section, they should be reserved for patients who have a significant risk of infection. Among such patients are those who have undergone vaginal hysterectomy or cesarean section after having been in labor with ruptured membranes. Prophylaxis should be limited to one to three doses of antibiotic, with the newer broad-spectrum antibiotics and combination antimicrobial agents reserved for more serious, established infections.

Anti-Bacterial Agents↗
PubMed1995

Arguments against routine contralateral mastectomy or undirected biopsy for invasive lobular breast cancer.

BACKGROUND: Management of the contralateral normal-appearing breast in a patient with ipsilateral invasive lobular carcinoma (ILC) is controversial. METHODS: The case histories of patients with histologically proven ILC who underwent definitive surgery at our institution from 1978 to 1991 were retrospectively reviewed. RESULTS: Of the 419 women with ILC, 36 (8.6%) had bilateral cancer, with a cumulative risk of 10% at 10 years. Twenty-five (69%) of these cancers were suspected before operation. From 105 contralateral prophylactic surgical procedures, seven (64%) in-situ and four (36%) invasive cancers were detected. The age at presentation and multifocality of the index cancer were significantly different between patients with unilateral and those with bilateral cancers. No survival difference was noted between patients whose contralateral cancers were suspected clinically and those whose cancers were detected prophylactically. Survival rates between patients with unilateral versus bilateral cancers were also not different. However, patients with contralateral prophylactic surgery had a better prognosis than those with unilateral tumors and no prophylaxis. CONCLUSIONS: Ten percent of patients with ILC experienced bilateral cancers during a period of 10 years. Survival was not influenced by the development of a second cancer, but it improved with surgical prophylaxis.

Adult↗
PubMed1977

The thoracic outlet syndrome as a cause of aneurysm formation, thrombosis, and embolization.

The thoracic outlet syndrome may have a serious vascular component consisting of subclavian artery aneurysm with possible thrombosis and embolization which can result in severe ischemic symptoms in the upper extremity, gangrene, amputation, and even hemiplegia. Four cases of subclavian artery aneurysm in association with thoracic outlet syndrome are presented. Two of the patients required surgical intervention because of thrombosis and embolization, while the other two had prophylactic surgical procedure to prevent those complications.

Adolescent↗
PubMed1989

[Lymph node failure in epithelioma of the glottic floor treated by partial laryngeal surgery. Apropos of 432 patients].

The authors assessed ganglionic failure in a series of 432 cases of N0 M0 epidermoid carcinomas of the glottic floor following partial laryngeal surgery. The overall of ganglionic failure was 7.8%. This rate of failure is related to 64.7% death rate, i.e. 5.1% of the 432 patients under study. This retrospective study differentiates between primary ganglionic failure and secondary ganglionic failure. Primary ganglionic failure is the first local/regional carcinologic event to develop after treatment of any glottic lesion. Secondary ganglionic failure is related to isolated local failures. The percentage of primary ganglionic failure was 5.1%. It was responsible for deaths occurring in 54.5% of cases. The percentage of secondary ganglionic failure was 2.7% and it was responsible for deaths occurring in 83.3% of cases. Factors promoting ganglionic failure (real tumor extension, tumor infiltration, altered laryngeal mobility, local control and efficacy of retakes of local failures) are discussed. The importance of prophylactic surgical procedures guarding from ganglionic failure, such as the ipsilateral jugular-carotid and recurrent nerve approaches is emphasized. Although such procedures can be of aid in cases of T2 or T3 N0 M0 epitheliomas of the glottic floor, they present no alternative in the course of retake operations of local failures.

Adult↗
PubMed1980

Use of prophylactic antibiotics in surgical procedures: peer review guidelines as a method for quality assurance.

Concomitant with the development of guidelines for the use of prophylactic antibiotics in surgery, the Veterans Administration undertook a survey of its surgical chiefs in which the likelihood of peer review guidelines being an effective method of quality assurance was assessed. The scope of the present problem was also assessed in terms of the misuse of antimicrobial agents in surgical units. The implications of this study for quality assurance are:(1) Chiefs of surgery can be influenced by peer review guidelines, but other sources can also have impact. (2) The control practices used by chiefs to influence their staffs are limited. (3) The mechanisms used by chiefs to monitor adherence to their policies are mostly informal. The implications of this study in relation to surgical antibiotic prophylaxis are: (1) The practices of surgical chiefs differ significantly from peer review guidelines. (2) The problem is far more serious for certain surgical procedures than for others. (3) Most misuse errors are errors of commission rather than omission.

Anti-Bacterial Agents↗
PubMed1990

[The Arabin cerclage pessary--an alternative to surgical cerclage].

During 1986-1988, the Arabin-cerclage pessary was used alternatively to surgical cerclage in 58 patients for prophylactic and in 44 cases of therapeutic indications. In 5 additional patients, the pessary was applied instead of emergency cerclage. The advantages of the cerclage pessary compared to other rigid pessary types, are based on its flexibility and adjustment to the anatomic conditions of vagina and cervix. The bowl-shaped pessary is inserted with the curvature upwards and the cervix is fixed in the central opening of the cerclage pessary. Thus a constriction, reconfiguration, and elongation of the incompetent cervix is obtained as evidenced by ultrasonography. The only side effect of the pessary treatment is an increase in cervical secretion and subsequent vaginal discharge. No infectious complications occurred. In 92% of the treated gravidae the cerclage pessary could be removed after the 36th week of gestation. Cerclage pessary can be recommended as a favourable alternative to surgical procedures as prophylactic or therapeutic approach, reducing surgical treatment significantly to less than 0.5%.

Cervix Uteri↗
PubMed1992

Which prophylactic regimen for which surgical procedure?

For optimal prevention of infection subsequent to a surgical intervention, it is necessary to follow a series of general principles, including the classification of the type of surgical intervention, the characteristics of the antibiotic used, and the route and the time of its administration. Moreover, with reference to the different types of surgery, other factors assume importance: the etiology of the infection and the ability of the antibiotic to achieve adequate levels in the tissues at the beginning of the infective process. In general abdominal, biliary, and obstetric-gynecologic surgery, which covers many clean-contaminated and contaminated interventions for which antibiotic prophylaxis has been shown to be the most effective, the etiology is often mixed (aerobic and anaerobic flora) with a predominance of gram-negative microorganisms. Thus, an appropriate prophylactic regimen must consider a third-generation cephalosporin, such as cefotaxime, that is effective against most gram-negative bacteria, in particular against Klebsiella pneumoniae. Acylureido penicillins can also be used because of their activity against enterococci, gram-positive microorganisms that are also causes of infection in this area of surgical intervention. Combining an antimicrobial such as clindamycin or metronidazole, which are particularly active against anaerobes, may be recommended as well. In urologic surgery, most infections are caused by Enterobacteriaceae; in addition to the antimicrobial spectrum, the ability of the antibiotic to concentrate adequately in the urine and renal tissue must also be considered. Beta-lactam antibiotics are the agents of choice, in particular, third-generation cephalosporins, aztreonam, and acylureido penicillins. In cardiac, orthopedic, and partially in neurologic surgery, where most infections are due to gram-positive bacteria (primarily methicillin-resistant staphylococci), antibiotic prophylaxis should include a glycopeptide agent (teicoplanin, vancomycin). In the field of surgical prophylaxis, more experience has been accumulated with cefotaxime, used as a short-course regimen or as a convenient single dose, than with any other newer cephalosporin. Cefotaxime's broad spectrum of action provides coverage against most potential pathogens and, when used as a single dose, is both convenient and cost-effective.

Anti-Bacterial Agents↗
PubMed1988

Infection rates in clean surgical procedures with and without prophylactic antibiotics.

One hundred calves with an uncomplicated umbilical hernia were included in a prospective study. The frequency of wound infection and recurrence of herniation were compared in animals operated on either with or without prophylactic antibiotics. In 90 calves operated on for the first time (60 without antibiotics and 30 with antibiotics) there were no infections and only one hernia recurred. In 10 calves operated on for the second time (seven without antibiotics and three with antibiotics) there were two infections and one hernia recurred in the group not receiving antibiotics.

Animals↗
PubMed1988

Infection rates in contaminated surgical procedures: a comparison of prophylactic treatment for one day or four days.

Eighty-three calves with a complicated umbilical hernia were included in a randomised prospective study. The frequency of wound infection was compared in two groups. The first group received antibiotics for one day, the second group for four days. The infection rate in calves receiving antibiotics for one day was 25 per cent compared with 8 per cent in calves treated for four days (P less than 0.05). Male calves were more susceptible to infection than female calves.

Ampicillin↗
PubMed1990

Predicting failure of low-dose prophylactic heparin in general surgical procedures.

Despite prophylaxis with low-dose heparin (LDH), postoperative thromboembolism (TE) still occurs in 10 per cent of patients undergoing abdominal operations. To identify predictors of TE in spite of LDH, 171 patients undergoing abdominal operations and receiving LDH were screened with the fibrinogen uptake test. Diagnosis of TE was confirmed in 24 (14 per cent; 95 per cent confidence limits of 9 to 20 per cent) by either venography or pulmonary scintigraphy, or both, or autopsy. As analyzed by multiple logistic regression, only age, body mass index, preoperative hemoglobin concentration and colorectal operations (yes or no) contributed to the prediction of failure of LDH, whereas sex, malignant lesion, previous TE, hypertension, diabetes mellitus and varicose veins did not. Based on the first 81 patients, an index was constructed that was able to identify 11 of 13 patients with TE and exclude 34 of 68 without TE. This index was then applied on a second series of 90 patients in whom it correctly identified ten of 11 patients with TE and excluded 40 of 79 patients without TE. It is concluded that, with the use of the index, it is possible to identify a group of patients undergoing elective abdominal operations in whom LDH is not sufficient prophylaxis. A practical approach to bedside prediction of failure of LDH prophylaxis by use of a simple score table is suggested.

Abdomen↗
PubMed1984

Prophylactic antibiotic usage in clean surgical procedures.

The article is a review of the results of a method of use of prophylactic antibiotic therapy in 2278 clean procedures performed by the author from 1959 to 1981. The procedures analyzed are mastectomy, cholecystectomy, inguinal hernia repair, incisional hernia repair, laparotomy, and thyroidectomy. These cases are considered separately and compared with other detailed series in the literature. The author feels that the infection rate of 0% in this series when compared to rates of 1.7 per cent to 5 per cent in the literature for the same type of cases warrants use of this method. The major points in the method are 1) use of topical irrigating solution of 0.5 per cent neomycin sulfate; 2) beginning proper intravenous antibiotic administration when the patient reaches the recovery room; 3) limit the use of antibiotic to 3 days past the day of surgery unless drains or hemovacs are still in place, in which case the antibiotic is continued for 24 hours after their removal; 4) careful and strict daily examination and evaluation of the patient in order to discontinue the antibiotic at the outset of any problems; 5) continued strict adherence to basic surgical principles throughout the entire surgical experience of the patient.

Anti-Bacterial Agents↗
PubMed1984

Basic principles in the use of prophylactic antibiotics.

The prophylactic administration of antibiotic to the surgical patient is generally indicated whenever complicating infection of the incision or coelom to be violated is associated with a significant morbidity and/or mortality rate. For maximal benefit, antibiotic must be in the tissues at risk just prior to and throughout the entire period of bacterial contamination. When a parenteral route for delivery is uncertain, as in the case of shock or a burn wound, then topical application becomes a practical alternative. Only hospital surveillance, however, can dictate which patients and which surgical procedures warrant prophylactic antibiotic. Intelligently implemented, such a preventive programme can reduce significantly total expenditure for surgical health care.

Administration, Topical↗
PubMedDate not supplied

Postoperative wound infections in a children's hospital.

A prospective study was made of postoperative wound infections at Milwaukee Children's Hospital for 1 year. Essentially all procedures requiring a skin incision were included. The clean surgical wound infection rate was 3.1% (26 infections in 849 cases). There were no significant differences in clean wound infection rates among the individual surgeons or among the four busiest surgical services. The occurrence of postoperative wound infections was associated with administration of prophylactic antibiotics, longer duration of surgical procedures and longer hospital stay before and after surgery. About 50% of patients having a clean surgical procedure were given prophylactic antibiotics. Prophylactic antibiotic were given for 4 days or more in about half the cases.

Anti-Bacterial Agents↗