Comparison of ceforanide and cephalothin prophylaxis for vaginal hysterectomies.

We compared the safety and efficacy of a six-dose regimen of cephalothin with a two-dose regimen of ceforanide for the prevention of infection after elective vaginal hysterectomy. A total of 150 patients were randomly assigned to either regimen. The overall incidence of documented pelvic infection was 5.3% and did not differ significantly between the prophylaxis groups when stratified by type of surgery. No serious adverse reactions were encountered in either group, but phlebitis was significantly more common in patients receiving cephalothin. We conclude that a two-dose regimen of ceforanide given intramuscularly is as effective as, and possibly better tolerated than, a six-dose regimen of cephalothin.     

Single-dose piperacillin versus triple-dose cefoxitin prophylaxis at vaginal and abdominal hysterectomy

Two hundred fourteen women having vaginal or abdominal hysterectomy were entered into a prospective, randomized, blind clinical trial comparing a preoperative intravenous dose of piperacillin to three perioperative intravenous doses of cefoxitin given over an eight-hour period. Interregimen clinical, surgical, and outcome variables of the 207 evaluable subjects were statistically similar, but there were significant interprocedure differences in a variety of categories; many benefits exist when vaginal hysterectomy is possible. Efficacy of a single dose of piperacillin was similar to that of three cefoxitin doses. Seven women (3.4%) had major postoperative infection requiring parenteral antimicrobial therapy, two (1.9%) after vaginal hysterectomy and five (4.8%) after abdominal hysterectomy. Three of the latter five infections (60%) occurred after discharge from the hospital. Even with prophylaxis, postoperative anemia was associated with increased frequency of infection at the operative site after both procedures, and diabetes was associated with late infection of the abdominal incision after abdominal hysterectomy.     

Perioperative antibiotics in major elective gynecologic surgery.

The efficacy of a three-dose, perioperative regimen of cefazolin or placebo in reducing postoperative infectious morbidity was evaluated in a double-blind study in 206 patients undergoing elective vaginal or abdominal hysterectomy. Postoperative infectious morbidity was defined as: an oral temperature of 100.4 F (38 C) or greater on any two postoperative days (excluding the first day), positive bacteriologic cultures, or pus from a wound. In premenopausal patients, cefazolin significantly reduced the incidence of postoperative infectious morbidity; 19% of the cefazolin group who had abdominal hysterectomy had evidence of infection compared to 71% of the placebo group, and 10% of the cefazolin group who had vaginal hysterectomies had evidence of infection compared to 37% of the placebo group. In postmenopausal patients undergoing abdominal hysterectomy, cefazolin also reduced the incidence of postoperative infection compared to placebo, but the difference was not significant (20% compared to 37%).     

Prophylactic antibiotics in vaginal and abdominal hysterectomy.

A double-blind, prospective study over a 12-month period evaluated the effectiveness of cefazolin and cephalexin in reducing infection and morbidity in private patients undergoing vaginal and abdominal hysterectomy. Prophylactic antibiotics reduced febrile morbidity from 74.4% to 20.8% in the vaginal group and from 46.2% to 24.0% in the abdominal group. Serious postoperative infections such as pelvic abscess, pelvic cellulitis and abdominal wound infection were reduced from 11.5% to 0% in the abdominal group and from 32.6% to 2.1% in the vaginal group. The use of prophylactic antibiotics was of benefit in the perimenopausal and postmenopausal patient, as well as in the premenopausal patient, although, in some categories, the numbers were too small to be statistically significant.     

Interstitial fluid concentrations of ceftriaxone (1 g.i.v.) in the subperitoneal space after hysterectomy

The ability of an antibiotic to penetrate into the extravascular site of infection is particularly important for a successful perioperative antibiotic prophylaxis and postoperative therapy of bacterial infection. We, therefore, measured interstitial fluid concentrations of ceftriaxone in the subperitoneal space following hysterectomy using Rubinstein's disc method after intravenous administration of 1 g of ceftriaxone preoperatively. After removal of the uterus, two disc units were implanted intraoperatively in the right and left subperitoneal space of 16 patients and were drawn out through the open vaginal cuff after given periods of time. Five disc and blood specimens were obtained after 90 min and 2, 6, 12, 24, and 48 h, respectively. Ceftriaxone concentrations were determined by bioassay. After administration of 1 g of ceftriaxone, interstitial fluid concentrations following hysterectomy were above the MIC90 of most pathogens encountered in gynecologic infections over a period of 24 h.     

经阴道全子宫切除术患者术前焦虑水平的调查

目的 探讨阴式全子宫切除术患者术前的焦虑情绪及年龄、文化程度和婚姻状况对焦虑程度的影响,为实施心理干预提供依据.方法 采用焦虑自评量表(Self-Rating Anxiety Scale,SAS)对109例患者进行术前心理评估,并对不同年龄、文化程度和婚姻状况的焦虑程度进行比较分析.结果 阴式全子宫手术患者SAS得分较国内的常模高,差异有统计学意义(P＜0.05).结论 患者在接受阴式手术前处于较高的焦虑水平,有必要实施系统的、有针对性的护理干预.     

Analgesic Effect of a Single Preoperative Dose of the Antibiotic Ceftriaxone in Humans

Repeated injections of the antibiotic ceftriaxone cause analgesia in rodents by upregulating the glutamate transporter, GLT-1. No evidence is available in humans. We studied the effect of a single intravenous administration of ceftriaxone in patients undergoing decompressive surgery of the median or ulnar nerves. Forty-five patients were randomized to receive saline, ceftriaxone (2 g), or cefazolin (2 g), 1 hour before surgery. Cefazolin, which is structurally related to ceftriaxone, was used as a negative control. Pain thresholds were measured 10 minutes before drug injections and then 4 to 6 hours after surgery. Ceftriaxone caused analgesia in all patients, whereas cefazolin was inactive. We also performed animal studies to examine whether a single dose of ceftriaxone was sufficient to induce analgesia. A single intraperitoneal injection of ceftriaxone (200 mg/kg), but not cefazoline (200 mg/kg), caused analgesia in mouse models of inflammatory or postsurgical pain, and upregulated GLT-1 in the spinal cord. Ceftriaxone-induced analgesia was additive to that produced by blockade of mGlu5 receptors, which are activated by extrasynaptic glutamate. These data indicate that a single dose of ceftriaxone causes analgesia in humans and mice and suggest that ceftriaxone should be used for preoperative antimicrobial prophylaxis when a fast relief of pain is desired.PerspectiveThe study reports for the first time that a single preoperative dose of ceftriaxone causes analgesia in humans. A single dose of ceftriaxone could also relieve inflammatory and postsurgical pain and upregulate GLT-1 expression in mice. Ceftriaxone should be preferred to other antibiotics for antimicrobial prophylaxis to reduce postoperative pain.     

Concentrations of ceftriaxone in serum and gynecological tissues

31 patients received an intravenous 15-min injection of 2 g ceftriaxone at various times before abdominal or vaginal hysterectomy. Ceftriaxone concentrations in salpinges were significantly higher than in myometrium and endometrium. Tissue concentrations of 20 micrograms/g could be maintained for at least 5 h. Due to its high tissue concentrations maintained for the whole operative procedure, ceftriaxone does seem to be one of the antibiotics of choice for single-dose prophylaxis of postoperative infections in gynecology.     

Long-acting versus short-acting cephalosporins for preoperative prophylaxis in breast surgery: A randomized double-blind trial involving 1,766 patients

Postoperative infectious complications after breast surgery may result in significant morbidity, psychological trauma, and additional costs. We assessed the efficacy of preoperative antibiotic prophylaxis for surgery in a randomized, double-blind trial of 1,766 patients undergoing breast surgery. From January 1, 1996 to August 31, 1997, all eligible patients were assigned randomly to receive a single dose of ceftriaxone (2 g) or ceftazidime (2 g) given intravenously at the induction of anesthesia, with no further doses. The groups were similar with respect to age, operative procedure, operative time and time to discharge after operation. The patients who received ceftriaxone prophylaxis had 54. 4% fewer overall infections than those who received ceftazidime prophylaxis. Wound infection occurred in 0.45% of the ceftriaxone recipients (2 of 883) and 0.91% of the ceftazidime recipients (8 of 883). This prospective randomized double-blind study showed that the long-acting regimen containing ceftriaxone is more cost-effective than the short-acting ceftazidime in preventing postoperative infections in patients subjected to breast surgery.     

阴式全子宫切除术后阴道填塞纱布的研究

目的探讨阴式全子宫切除患者术后阴道填塞纱布的作用。方法随机选取我院78例阴式全子宫切除患者,分为观察组（n=39）和对照组（n=39）,对照组术后阴道填塞1块纱布,48h后取出,观察组术后阴道不予填塞纱布。结果观察组与对照组术后阴道渗血量、发热、肛门排气时间、便秘发生率及住院时间比较差异均无统计学意义（P〉0．05）,对照组患者术后舒适状况量表（GCQ）评分低于观察组,差异有统计学意义（P〈0．05）。结论阴式全子宫切除患者术后阴道不填塞纱布更有利于患者恢复。     

三种术前阴道准备方法预防子宫切除术后医院感染的临床效果

目的:探讨三种术前阴道准备方法预防子宫切除术患者术后医院感染的临床效果评价。方法:选取乐山市人民医院2016年4月至2017年6月接受子宫切除术的患者180例,按照随机数字表法分为三组,其中A组58例为碘伏原液组,B组61例为臭氧组,C组61例为甲硝唑片+生理盐水组,均于术前1 d及术前当日擦洗阴道,对比三组患者术后体温(T)、白细胞计数(WBC)、中性粒细胞比例(N)、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)及住院时间。结果:B组住院时间显著短于A组和C组,差异有统计学意义(P<0.01),术后第3天和第6天B组的WBC、N、hs-CRP和PCT低于A组和C组,差异有统计学意义(P<0.05),术后体温比较三组差异无统计学意义(P>0.05)。结论:子宫切除术前用超声波臭氧妇科治疗仪进行阴道准备,可以降低患者术后WBC、N、hs-CRP和PCT指标,预防医院感染的发生,同时缩短住院时间提高床位周转率,具有临床应用价值。     

经脐单孔腹腔镜全子宫切除术不同途径缝合阴道残端的研究

目的比较经脐单孔腹腔镜全子宫切除术采用倒刺线经不同途径缝合阴道残端的效果。方法选取因子宫良性疾病接受经脐单孔腹腔镜全子宫切除术患者56例。56例均采用倒刺线缝合,经腹腔镜缝合阴道残端者被纳入A组(30例),经阴道缝合阴道残端者被纳入B组(26例)。比较2组的术中失血量、手术操作时间、术后住院日数、阴道残端总并发症(术后阴道残端出血、阴道残端感染、阴道残端裂开)、术后阴道残端息肉形成率。结果 2组均能顺利完成单孔腹腔镜全子宫切除术。A组手术操作时间和缝合时间均少于B组(P均<0.05)。术后A组出现1例阴道残端裂开,B组则无(P> 0.05)。A组术后阴道残端息肉形成率高于B组(P <0.05)。A组术后阴道残端总并发症发生率高于B组(P <0.05),但2组术后阴道残端出血、阴道残端感染、阴道残端裂开发生率差异则无统计学意义(P均> 0.05)。结论经脐单孔腹腔镜全子宫切除术采用倒刺线经腹腔镜缝合阴道残端有利于阴道残端的愈合,可降低术后残端并发症发生率。     

Ecological effects of perorally administered pivmecillinam on the normal vaginal microflora

The knowledge of the effects of antimicrobial agents on the normal vaginal microflora is limited. The objective of the present study was to study the ecological impact of pivmecillinam on the normal vaginal microflora. In 20 healthy women, the estimated day of ovulation was determined during three subsequent menstrual cycles. Microbiological and clinical examinations were performed on the estimated day of ovulation and on day 3 in all cycles and also on day 7 after ovulation in cycles 1 and 2. Anaerobic and facultative anaerobic gram-positive rods, mainly species of lactobacilli and actinomycetes, dominated the microflora. One woman was colonized on the third day of administration with a resistant Escherichia coli strain, and Candida albicans was detected in one woman on days 3 and 7 in cycle 2. No other major changes in the normal microflora occurred during the study. Administration of pivmecillinam had a minor ecological impact on the normal vaginal microflora.     

Plasma and tissue concentrations of ceforanide and cefazolin in women undergoing hysterectomy

Thirty-four women who underwent vaginal hysterectomy received either ceforanide or cefazolin as perioperative antimicrobial prophylaxis. Samples of plasma, myometrium, endometrium and fallopian tubes were obtained at various intervals after injection and were assayed for cephalosporin concentration. Following intramuscular injection approximately 1 h prior to surgery, both drugs provided adequate tissue levels at the time of the procedure. Although both antimicrobials achieved similar tissue concentrations, all tissue samples for ceforanide exceeded the MIC90 for Escherichia coli while in the cefazolin group 9/18 myometrial samples and 10/15 endometrial samples fell below the MIC90 for this organism.     

Elective cesarean hysterectomy versus vaginal hysterectomy for the treatment of cervical intraepithelial neoplasia

We retrospectively compared elective cesarean hysterectomy and vaginal hysterectomy for cervical intraepithelial neoplasia. Sixteen patients had cesarean hysterectomy and 53 had vaginal hysterectomy. There were no deaths in either group and no neonatal complications in the cesarean hysterectomy group. Major and minor complications were comparable in the two groups except that urinary tract infection was statistically more common in the cesarean hysterectomy group. The mean hospital stay for the two groups was comparable. The estimated blood loss and transfusion rate were higher in the cesarean hysterectomy group. The transfusion rate was probably artificially increased because of overzealous intraoperative transfusion. Elective cesarean hysterectomy does not cause unacceptably high morbidity, and it is an acceptable alternative to interval vaginal hysterectomy for cervical intraepithelial neoplasia in poorly compliant patients.     

Influence of pregnancy on ceftriaxone, cefazolin and gentamicin pharmacokinetics in caesarean vs. non-pregnant sectioned women

OBJECTIVE: To study the effect of pregnancy on postoperative ceftriaxone, cefazolin and gentamicin elimination rate constant, half-life, volume of distribution and systemic clearance. METHODS: Fifty-four patients undergoing caesarean section and 12 undergoing gynaecological surgery were given intravenous dose of ceftriaxone, cefazolin or gentamicin immediately before the operation, for chemoprophylaxis. The levels of antibiotics were measured in blood plasma, amniotic fluid and umbilical cord blood plasma by HPLC for the cephalosporins and by fluorescence polarization immunoassay for gentamicin. Pharmacokinetic parameters were estimated using a one-compartment model. RESULTS: Pregnancy significantly influenced the pharmacokinetics of ceftriaxone and gentamicin, but not that of cefazolin. Ceftriaxone constant of elimination decreased statistically significantly in caesarean-sectioned women relative to the non-pregnant subjects. Gentamicin constant of elimination increased significantly in caesarean-sectioned women relative to the controls. The concentrations of antibiotics in umbilical cord blood were higher, whereas they were substantially lower in amniotic fluid than in maternal plasma. Six hours after antibiotic administration, only the cefazolin concentrations exceeded the MIC for sensitive bacteria both in pregnant and in non-pregnant patients. CONCLUSION: Analysis of the pharmacokinetic data suggests that a single-dose of cefazolin may well be the optimal preoperative prophylactic treatment for obstetrical and gynaecological surgical procedures.     

Tolerance of vancomycin for surgical prophylaxis in patients undergoing cardiac surgery and incidence of vancomycin-resistant enterococcus colonization

BACKGROUND: In 2001, vancomycin replaced cefuroxime for antibiotic prophylaxis in patients undergoing cardiac surgery at our institution due to high rates of surgical site infections caused by methicillin-resistant Staphylococcus spp. However, few data supported the use of vancomycin for surgical prophylaxis. OBJECTIVE: To determine the tolerance of vancomycin for antibiotic prophylaxis and incidence of vancomycin-resistant Enterococcus (VRE) in cardiac surgery patients. METHODS: In 2 separate studies, we assessed the adverse effects in patients given perioperative vancomycin (study 1) and the incidence of VRE in patients given perioperative vancomycin (study 2). Study 1 was a prospective cohort study of patients undergoing coronary artery bypass graft (CABG) or valve replacement surgery given vancomycin (1 dose preoperatively/2 doses postoperatively) for antibiotic prophylaxis between October 2003 and December 2004. Patients were assessed for tolerance to the antibiotic regimen. In study 2, cardiac surgery patients receiving perioperative vancomycin were screened for VRE before therapy and at day 7 of hospitalization. VRE was detected using standard microbiologic procedures. RESULTS: In study 1, 1161 patients (CABG = 75%; valve = 19%; both = 6%) were evaluated. All patients but one (99.9%) were prescribed preoperative vancomycin. Therapy was changed for 34 (2.9%) patients, of which 20 changes were due to physician preference for another antibiotic. The only toxicity that required a change in the vancomycin regimen was red man's syndrome, which was experienced by 9 (0.8%) patients. Four patients did not receive a second postoperative dose due to prior renal insufficiency. Patients were most commonly switched to cefuroxime (n = 26), linezolid (n = 2), cefepime (n = 2), gatifloxacin, cefazolin, levofloxacin, or ceftriaxone (n = 1, each). In study 2, 100 patients were screened for the emergence of VRE colonization. No patient was VRE positive at baseline and 4 (4%) were positive at day 7. CONCLUSIONS: Surgical antibiotic prophylaxis with vancomycin was reasonably well tolerated in CABG and valve replacement surgery, with a 4% incidence of VRE colonization.     

Management of bacterial endocarditis

Most cases of bacterial endocarditis involve infection with viridans streptococci, enterococci, coagulase-positive staphylococci or coagulase-negative staphylococci. The choice of antibiotic therapy for bacterial endocarditis is determined by the identity and antibiotic susceptibility of the infecting organism, the type of cardiac valve involved (native or prosthetic) and characteristics of the patient, such as drug allergies. Antibiotic therapies discussed in this report are based on recommendations of the American Heart Association. Treatment with aqueous penicillin or ceftriaxone is effective for most infections caused by streptococci. A combination of penicillin or ampicillin with gentamicin is appropriate for endocarditis caused by enterococci that are not highly resistant to penicillin. Vancomycin should be substituted for penicillin when high-level resistance is present. Resistance of enterococci to multiple antibiotics including vancomycin is becoming an increasing problem. Native valve infection by methicillin-susceptible staphylococci is treated with nafcillin, oxacillin or cefazolin. The addition of gentamicin for the first three to five days may accelerate clearing of bacteremia. Infection of a prosthetic valve by a staphylococcal organism should be treated with three antibiotics: oral rifampin and gentamicin and either nafcillin, oxacillin, cefazolin or vancomycin, depending on susceptibility to methicillin. Vancomycin is substituted for penicillin in patients with a history of immediate-type hypersensitivity to penicillin.     

Analysis of factors affecting vaginal hysterectomy

Abstract

The study analyzes factors that affect vaginal hysterectomy to establish the indications of a vaginal approach to benign uterine disease. In a retrospective study, 174 patients underwent vaginal hysterectomy for uterine leiomyomas or adenomyosis by one gynecologist between December 2005 and December 2006. All data were compared and analyzed by X²- test, t-test, and multiple logistic regression. Based on a uterine weight ≥ 500 g, body weight, a history of surgery, concomitant surgery (adenexectomy), penetration of the posterior cul de sac during surgery, uterine descent, and average uterine weight we determined the feasibility of vaginal hysterectomy. Based on an operative time ≥ 33 min, body weight, concomitant surgery (adenexectomy), penetration of the posterior cul de sac, vertical length of the vaginal opening, uterine descent, and the uterine weight had significant effects on the success of vaginal hysterectomy. The range of indications for vaginal hysterectomy may vary greatly depending on the surgeon's experience. If experiences are accumulated gradually, together with the advantages of laparoscopically assisted hysterectomy, most abdominal hysterectomies and laparoscopic hysterectomies can be replaced by vaginal hysterectomy.