The impact of multiple operations on the importance of arterial wall cultures

The present study reviewed arterial culture data from 172 patients undergoing major vascular reconstructions between July 1, 1977, and Dec. 31, 1984. Prosthetic graft infection was documented in 0 of 97 cases (0%) with negative arterial cultures but in six of 75 cases (8%) with positive arterial cultures (chi 2 = 5.84; 0.01 less than p less than 0.025). The data were reanalyzed after the patients were subdivided into two groups on the basis of the numbers of operations: group I (132 patients)--a culture obtained at initial vascular reconstruction--and group II (40 patients)--a culture obtained at a subsequent vascular reconstruction. Positive arterial cultures had no predictive value for graft infection among patients in group I (1 of 57 cases vs. 0 of 75 cases; chi 2 = 0.019), whereas the presence of positive arterial cultures was associated with a significant increase in the incidence of graft infection in group II patients (5 of 18 cases vs. 0 of 22 cases; chi 2 = 4.68; 0.025 less than p less than 0.05). For group I patients, we believe that neither routine arterial culture nor long-term antibiotic therapy for patients with positive arterial cultures is indicated. For group II patients we recommend that routine arterial cultures should be obtained; perioperative antibiotics should be continued until definitive arterial culture information is available; and positive arterial cultures should be treated with a short course of high-dose intravenous antibiotics. Thereafter, long-term treatment of positive arterial cultures with oral antibiotics, although not statistically validated, is probably appropriate.     

Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations

We conducted a prospective cohort study in order to determine whether suction drain specimen cultures from orthopaedic surgery predicted an early wound infection. We included 218 consecutive clean orthopaedic operations requiring drains in one unit over a period of 1 year. The suction drain tip, drain fluid and wound discharge specimens were cultured, and the surgical wound was followed up for 3 months. There were six deep and two superficial wound infections. Wound infection was significantly related to positive suction tip culture but not to positive drain fluid culture. Following our methodology for culture, a positive drain tip culture predicts wound infection in 50% and a negative culture virtually excludes the possibility of a deep infection.

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Résumé Nous avons conduit prospectivement une étude de cohorte pour déterminer si les cultures dun échantillon du produit de drainage aspiratif peuvent être prédictives précocément dune infection. Nous avons inclus 218 opérations orthopédiques propres consécutives, exigeant un drainage, sur une période dune année. Lextrémité du drain, le liquide de drainage, et des prélévements opératoires étaient mis en culture et la cicatrice chirurgicale surveillée pendant 3 mois. Il y avaient 2 infections superficielles et 6 pronfondes. Linfection était en rapport significatif avec la culture du drain mais sans rapport avec celle du liquide de drainage. En suivant notre méthodologie, une culture positive de lextrémité du drain prédit linfection de la blessure dans 50% et une culture négative exclut la possibilité dune infection profonde.

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First presented at the Tenth International Scientific Meeting of the European Society of Chemotherapy, Vienna, 30 June 2003.     

Significant of positive bacterial cultures from aortic aneurysms

Samples for bacteriological examination were obtained from the aneurysm wall of 85 patients subjected to abdominal aortic aneurysmectomy. Twelve patients (14%) had positive cultures. A total of 13 bacterial strains were isolated, the majority of which were present in only small numbers and were regarded as contaminants. One patient developed a graft infection due to ischemic necrosis of the sigmoid colon. During the follow-up period no further graft infection was noted in patients with positive or negative aortic cultures. It is concluded that the aneurysm wall itself does not represent an important source of early or late graft infection.     

Physical work performed by surgeons during orthopaedic operations.

Four surgeons participated in a study which aimed to demonstrate the physical work load during operations. Maximal oxygen uptake and maximum heart rate were determined by using the Douglas bag technique and recording the heart rate during the tests. By working at two submaximal work loads, heart rate was recorded and miximal oxygen uptake was determined indirectly. Using telemetry, heart rate was recorded during operation, and the mean oxygen uptake was determined. In 90 per cent of all operations the surgeons were working at a level of 20 to 30 per cent of their maximal aerobic capacity. There was an increase in body temperature and a decrease of body weight after all operations. In long lasting operations a decrease of grip force was noted.     

Significance of positive bacterial cultures from aortic aneurysm contents

Aneurysm contents were cultured in 275 patients out of a series of 546 cases undergoing infrarenal aortic aneurysm repair between 1961 and 1981. The incidence of positive cultures was 8 per cent. Cultures were more likely to be positive if taken from ruptured (16.7 per cent) and acute (9.1 per cent) aneurysms than from elective (4.2 per cent) cases (X2 = 6.69, P less than 0.01). Gram-positive organisms predominated with Micrococcus being the commonest isolate. Positive cultures were seen at an annual rate of 1-3 cases up to 1976 since which time all have been negative and we believe this may be due to prophylactic antibiotics being given preoperatively rather than postoperatively. The incidence of subsequent graft sepsis was greater in patients with positive aneurysm contents cultures (7 out of 22) than in those with negative cultures (6 out of 253) (X2 = 32.7, P less than 0.001). We recommend the routine culture of aneurysm contents to identify patients who are at high risk of developing graft sepsis and suggest that those cases with positive cultures receive prolonged organism-specific antibiotic therapy. In addition, there is evidence that pre-operative antibiotics may eliminate organisms from aneurysms, thus reducing the subsequent risk of graft sepsis.     

全身麻醉期间呼气末正压通气对骨肿瘤手术患者血流动力学的影响

目的观察全身麻醉期间使用呼气末正压(PEEP)通气对骨肿瘤手术患者血流动力学的影响。方法选取2009年10月至2010年3月ASAⅠ或Ⅱ级择期全麻下行骨肿瘤科大型手术患者10例。常规麻醉诱导后行机械通气,于患者循环和容量状态相对稳定的条件下,逐渐增加PEEP水平,观察并记录PEEP为0、5、8cmH2O时的血流动力学指标、呼吸功能参数和脉搏指数剂连续心排血量监测(PiCCO)指标。结果随PEEP的增加,气道峰压(Ppeak)及气道平台压(Ppla)显著增加(P<0.01)。HR、MAP及CVP及胸腔内血容量指数(ITBI)、全心舒张末期容积指数(GEDI)、血管外肺水指数(ELWI)及每搏量变异(SVV)等在不同PEEP水平下差异无统计学意义。结论对机械通气患者加用不同PEEP,Ppeak、Ppla相应增加,但对PiCCO各项指标的测定无明显影响。     

Quantitative bacterial tissue cultures from 209 prostatectomy specimens: findings and implications

To define the prevalence of prostatic bacterial infection or colonization, tissue from 209 patients undergoing prostatectomy (204 transurethral and 5 suprapubic) was submitted for quantitative bacterial tissue cultures. Tissue from 44 patients (21 per cent) yielded positive, single organism bacterial growth. In an attempt to identify preoperatively this patient subgroup, multiple preoperative and intraoperative variables were examined. Although the presence of a preoperative indwelling catheter was associated with positive prostate cultures, only 34 per cent (24 of 70) of the patients with preoperative catheters had positive prostate cultures. Of the 44 patients with positive prostate cultures 36 (82 per cent) had sterile urine cultures documented preoperatively, all urine specimens having been obtained in the absence of antibiotics. The data support a significant prevalence (21 per cent or more) of prostatic infection in patients undergoing prostatic surgery for obstructive symptoms and an apparent paucity of reliable indicators by which to identify preoperatively this patient population.     

Freezing of orthopaedic specimens before mechanical testing

The effect of storage at sub-zero temperatures and subsequent thawing was investigated in dissected muscles, tendons, limbs and spines. Freezing caused a noticeable shortening of muscles which when thawed could easily be elongated; the same effects, though less pronounced, were observed with tendons. During freezing, myotomy or tenotomy led to the development of a striking deformity owing to unopposed shortening of the opposing muscles. After thawing, all frozen specimens containing muscles and joints showed an increased range of passive movements, easily demonstrable by mild tensile forces.     

Antibiotic treatment for traumatic brain injury patients without positive bacterial cultures

Prophylactic administration of antibiotics is prevalent for traumatic patients including head injury, when the patients have contaminated wounds, CSF leakage, and multiple injuries. In cases with prolonged fever and inflammatory signs, other antibiotics must be selected without confirming the infections by cultures. Usually, 1st or 2nd generation cefalosporins are selected as empiric therapy for traumatic patients, but, successive antibiotics are usually selected according to the situation. In this study, we analyzed 60 cases of head injured patients with Glasgow Coma Scale under 12, in terms of the selection of antibiotics and the reasons for the antibiotic selections. CEZ > PIPC > FMOX were used for initial treatment without any culture results. The second selection was made without any positive culture results in 85.7%, and tertiary selection without culture results in 50% of the patients. CPR > CFSL > FMOX > PAPM/BP were mainly used as second selection, and IPM/CS > CPR = PIPC were mainly used as tertiary selection. In cases with traumatic brain injuries, it is important to prevent antibiotic resistances. 1) by selecting appropriate antibiotics, 2) by using antibiotics after excluding catheter related infections, 3) by not using antibiotics and performing frequent cultures when no apparent infection focuses are detected.     

自体输血在骨科手术中的应用

我院自1999年3月开展自体血回输技术,明显减少了异体输血用量,未出现明显不良反应,现报告如下. 1 临床资料 本组275例,男176例,女99例;年龄17～82岁,平均68岁.     

Efficacy of intraoperative cultures obtained during revision total hip arthroplasty

The purpose of this study was to determine the incidence of positive intraoperative cultures, correlate the findings of the permanent histopathology with the results of culture, and determine the natural history and predictive value of the positive intraoperative culture in a consecutive series of 138 revision total hip arthroplasties. The incidence of positive cultures was 30% (42 hips). Of these 42 hips, only 1 ultimately developed sepsis, requiring a second surgical procedure. After a mean follow-up period of 48 months, the remaining 41 culture-positive hips show no evidence of sepsis and are considered clinical successes. The histologic appearance of the infected case was characterized by polymorphonuclear leukocyte infiltration suggestive of acute inflammation. The remaining hips demonstrated findings of chronic inflammation consistent with a diagnosis of aseptic loosening. With the development of sepsis as an endpoint, the positive predictive value of a positive intraoperative culture is 2.4%. The results demonstrate that intraoperative cultures are an unreliable predictor of sepsis and that permanent histologic sectioning is a more useful tool in determining sepsis at the time of revision surgery.     

Incidence of positive inguinal lymph node cultures during peripheral revascularization

Synthetic vascular graft infections occur more commonly at the inguinal incision, and there is contamination of the graft by transection of bacteria-laden lymphatics proximal to a distal extremity infection. In 45 consecutive peripheral revascularizations, significant positive inguinal lymph node cultures were not obtained in 30 normal extremities; two of 15 distally infected extremities demonstrated the same bacteria in the distal infection and the inguinal lymph node. Both patients subsequently developed graft infections. Inguinal lymph nodes proximal to a distal infection may harbor bacteria capable of causing a synthetic vascular graft infection. Consideration should be given to culture-directed rather than routine antibiotic prophylaxis under this circumstance.     

The clinical importance of bacterial urinary tract infections during pregnancy. II. Events during delivery

Inertia in labour could be more often observed and the number of intra-uterine foetal distress signs increased in case of bacterial infection of the maternal uropoietic and urinary system. Consequently, stimulation of labour pains and surgical termination of the delivery were required several times. The data in concert with those mentioned in the first part of the study indicate that the clinical pictures associated with the bacterial infections of the urine constitute a significant part of the pathological aspects of pregnancy.     

Efficacy of antibiotic prophylaxis in clean neurosurgical operations

Four controlled trials and one case control study have presented data supporting the efficacy of perioperative administration of antibiotics in reducing the rate of infection following clean neurosurgical procedures. Their results are, for the most part, consistent with uncontrolled studies reported since 1980. Taken together, these studies clearly and consistently demonstrate the value of perioperative antibiotic prophylaxis in clean neurosurgical operations.     

The importance of computer-based procedures for planning and documentation of orthopaedic surgery

The demand for efficiency in OR management and increase in the necessity of surgical documentation require the use of software applications in hospitals. A client-server based OP-planning and documentation system has been in use in the department of orthopedic surgery in Giessen University since 1992 and is being continuously further developed. Aside from the lawful requirements, the demands of clinical doctors have been especially considered. The main functions are management of non medical patient data, scheduling and documentation of operations with coding of diagnoses and therapy, tissue banking, implant inventory, on call scheduling, storage of medical video images, clinical word processing and e-mail. With an integrated web-server, MedXS has the capabilities to offer functions accessible over any webbrowser (Netscape, Internet-Explorer) in the internet or intranet. Through the usage of this application clinical procedures could be more efficiently realized and better agreeing positions with the insurance companies could be reached.     

Depression of myocardial ATPase activity by plasma obtained during positive end-expiratory pressure

Dogs treated with 15 cm H2O positive end-expiratory pressure (PEEP) invariably show a decrease in cardiac output (CO). Plasma that is obtained from PEEP-treated dogs and applied to an isometrically contracting rat papillary muscle results in a significant depression of the peak developed tension. The present study evaluates the nature of the circulating negative inotropic agent with respect to its action on the coupling of myocardial energy production and contraction. PEEP plasma was found to depress Ca++-ATPase activity (P less than 0.025) when incubated with cardiac subfractions obtained from dog and rat myofibrils, sarcolemma, and sarcoplasmic reticulum. No change in Mg++-ATPase activity was observed. The declines in Ca++-ATPase activity correlate significantly with decreases in left ventricular stroke work, stroke volume, and CO during PEEP treatment. The decrease in Ca++-ATPase with PEEP plasma also correlates with a decrease in developed tension of a rat papillary muscle bathed with PEEP plasma. There were no changes in CO in animals who were simply anesthetized; plasma from these animals did not alter developed tension or ATPase. These observations suggest that PEEP plasma and serum contain a negative inotropic agent(s) that may reduce contractility by Ca++-ATPase inhibition.     

The rate of instrument breakage during orthopaedic procedures

The current study investigates instrument breakages during both emergency and elective orthopaedic surgery. Over a 2 year period a total of 7,775 procedures were performed. We found that 14 instruments were broken during 12 operative cases. Drill bits accounted for the largest proportion of breakages (11/14), and a specialist registrar was the lead surgeon in the majority (8/12) of cases. Only one case had a consultant as the lead surgeon. In seven cases the broken bit of the surgical instrument was left in the patient. Documentation of this peri-operative complication was deficient, and the patient was often not informed.