Comparative study of cefamandole versus cephalothin as antibiotic prophylaxis for open heart surgery

Cefamandole nafate and cephalothin sodium were administered as prophylaxis in a randomized, prospective study to 80 consecutive patients undergoing open heart surgery. The two groups matched well in age, sex, and type of operation. Postoperative infection developed in 2 of 40 patients (5%) in the cefamandole-treated group and in 11 of 40 patients (27.5%) in the cephalothin-treated group (p less than 0.01). The two patients in the former group had respiratory tract infections. There were no instance of endocarditis, mediastinitis or bacteraemia in any of the two groups. Both antibiotics were well tolerated with no adverse reactions. Cefamandole appears to be an effective and preferable prophylactic antibiotic for use during cardiac surgery.     

Patient Obesity Influences Pelvic Lift During Cup Insertion in Total Hip Arthroplasty Through a Lateral Transgluteal Approach in Supine Position

Background

Movement of the pelvis during implantation of total hip arthroplasty (THA) has a major influence on the positioning of the acetabular cup. Strong traction caused by retractors leads to iatrogenic pelvic lift and can thus be partly responsible for cup malpositioning. The objective of this study was to investigate such factors that influence pelvic lift.

Unusual vascularization and nerve supply of the fifth finger.

During a dissection course, an unusual variation in vascularization and nerve supply of the fifth finger of the right hand was found in a 73-year-old human male cadaver. The proper digital palmar artery arose from the superficial branch of the ulnar artery distel to the Guyon's canal. The proper digital palmar artery coursed first palmar to the ulnar nerve then between the abductor minimi and flexor digiti minimi muscles to reach the ulnar side of the fifth finger. Besides this, the ulnar border of the fifth finger was supplied on its palmar side by the dorsal branch of the ulnar nerve, which gave off two tiny twigs for the sensory innervation on the dorsal side of the same finger.     

A simple surgical method for removing a large floating thrombus from the ascending aorta

We report the successful surgical removal of a large floating thrombus from the ascending aorta causing systemic embolization. It was diagnosed by transesophageal echocardiography (TEE), CT scan, aortography and Cardiovascular Magnetic Resonance Imaging (CMR). The free-floating, highly embolic source 2 cm distal to the left coronary sinus was removed from the ascending aorta using a simple surgical technique. Isolated cerebral perfusion with circulatory arrest on normothermia provided a simple and safe access to the thrombus attached to a ruptured atherosclerotic plaque. The patient was discharged on the 7 th postoperative day after an uneventful recovery.     

Beneficial effect of iloprost on early pulmonary function after lung preservation with modified eurocollins solution

Prostacyclin (PGI2) has proven beneficial effects on organ preservation. Iloprost (ZK 36 374), a stable synthetic analogue with a longer half-life of 14 minutes is reported to have less hypotensive effects than PGI2 while offering increased cytoprotective and antiaggregation action. In this study its effects on lung-preservation were investigated. The heart lung block of 12 Beagle dogs was harvested after flushing of the pulmonary artery with 60 ml/kg modified Eurocollins (MEC) solution, the left lung was stored for 4 hours and then transplanted into 12 weight-matched dogs. Prior to operation the animals were randomized into two groups with MEC solution as the only preservative in group A and an additional i.v. infusion of 1 microgram/kg/min Iloprost during 15 minutes prior to flushing and 15 micrograms/kg Iloprost administered to the perfusate in group B. Arterial pO2, alveolo-arterial oxygen difference (AaDO2) and pulmonary artery pressure (PAP) of the transplanted lungs were measured 1, 4, 12, and 24 hours after transplantation during occlusion of the contralateral pulmonal artery. The application of Iloprost resulted in a significant improvement of pO2 (p = 0.047), AaDO2 (p = 0.002) and PAP (p = 0.018) after 1 hour. Results in group B at later time points were improved without reaching statistical significance. Iloprost therefore showed beneficial effects on pulmonary function early after lung preservation with MEC.     

Die offene Arthrolyse der posttraumatischen Ellenbogensteife

BACKGROUND: The incidence of relevant posttraumatic functional deficits in the sense of elbow stiffness with less than 30 degrees in extension or flexion less than 120 degrees , is unknown. A differentiation can be made between intraarticular, extraarticular and combined causes. An open procedure is indicated in elbow stiffness after correct analysis of the situation and failure of conservative treatment. MATERIALS AND METHODS: An open procedure was carried out on 35 patients between March 1995 and November 2001, 10 (3-24) months after the trauma. The mean age of the 24 men and 11 women was 45 (range 17-75) years. Of the patients 15 had distal humerus fractures, 10 radius head or neck fractures and 12 proximal ulnar fractures. RESULTS: Of the patients 11 (31%) had an excellent result in the Cauchoix and Deburge score, 15 (42%) a good, 4 (11%) a fair, 4 (11%) a bad and 1 (3%) a very bad result after a mean follow-up of 21.5 (range 9-60) months. Of the patients 11 (31%) had an excellent result in the Mayo elbow performance score, 14 (40%) a good, 5 (14%) a fair and 5 (14%) a poor result. CONCLUSION: Open arthrolysis for severe posttraumatic elbow stiffness carried out 10 months (range 3-24 months) after the accident led to good results in most cases with a clear improvement in functional mobility.     

A cross-country review of strategies of the German development cooperation to strengthen human resources

Background  

Recent years have seen growing awareness of the importance of human resources for health in health systems and with it an intensifying of the international and national policies in place to steer a response. This paper looks at how governments and donors in five countries – Cameroon, Indonesia, Malawi, Rwanda and Tanzania – have translated such policies into action. More detailed information with regard to initiatives of German development cooperation brings additional depth to the range and entry doors of human resources for health initiatives from the perspective of donor cooperation.