The impact of different methods of wound closure and dressing on the rate of wound infection in patients with fracture of the neck of femur

A prospective, pilot study was conducted to compare infection rates in four groups with different methods of wound closure and dressing among a convenience sample (n = 65) of patients with a fracture of the neck of femur. The four groups were:

Clips with Mepore dressing (n = 25)

Subcuticular suture with Mepore (n = 11)

Clips with Opsite dressing (n = 16)

Subcuticular suture with Opsite (n = 13)

There were a total of 65 participants (5 males and 60 females) with ages ranging from 70 to 103 years (mean = 86, sd = 5.7). Patients were followed during their stay on the ward. The four groups were evaluated with respect to infection rates. Gross purulent discharge, dehiscence, or purulent discharge from a single suture was considered a wound infection and this was confirmed microbiologically. Infection was noted in 6/25 (24%) of cases in which clips were used with Mepore dressing as compared to 1/11 (9%) when subcuticular sutures and Mepore were used. Infection rates for clips and Opsite, and subcuticular and Opsite were 2/16 (12.5%) and zero, respectively. Statistically there was no difference in infection rates between Mepore dressing and either type of skin closure (p = 0.4) and similarly for Opsite and either skin closure type (p = 0.48). The authors feel that the methods of wound closure and type of dressing probably have no additional benefit for the prevention of wound infection rate among elderly patients with fractures of the neck of femur, and that a larger randomized controlled study would be useful.

溃疡性结肠炎的外科治疗指南

0引言此治疗指南是在Medline,PudMed以及循证医学Cochrane中心数据库中进行的一次回顾性资料的有组织查询分析．其中关键词包括溃疡性结肠炎、回肠肛管储袋式吻合、回肠造瘘术、结直肠肿物、外科手术、回肠直肠吻合术和一些相关的主题．循证医学水平和推荐等级见表1．     

Current recommendations in prevention of thrombosis in surgery

Fatal pulmonary embolism is a major cause of postoperative death. When no prophylaxis is given in general surgery, it has a frequency of about 1%. Apart from the immediate risk to life, one must also consider the late sequelae of extensive deep vein thrombosis--swelling of the legs, varicose veins, ulceration and other trophic changes which represent an equally distressing situation. Recently, three large-scale surveys have been published, where the data of over 100 randomized controlled clinical trials of prophylaxis against venous thromboembolism has been analysed. The purpose of this talk is to provide an overview of the currently available prophylactic methods analysed in these surveys, with an aim to define a policy for preventing venous thromboembolism, with particular emphasis on the surgical patients. There is evidence suggesting that the frequency of fatal pulmonary embolism can be reduced by such prophylactic remedies as low-dose heparin, dextran, the combination of dihydroergotamine plus heparin, and low molecular weight heparin.     

Formula for converting mmHg to kPa as the unit for measurement of pressure when using newer tourniquet machines that measure pressure using the SI (Systeme International)

Tourniquets use is common in hand surgery. The correct tourniquet pressure is important to achieve a bloodless operating field and to prevent tourniquet syndrome and tourniquet paralysis syndrome. Newer tourniquet devices use kPa as the unit to measure pressure. This article highlights the existence of such machines and also describes the formula to convert mmHg to kPa which can be done quite easily to ensure that the correct pressure (in kPa) is used.     

用一种新型加压螺钉治疗踝关节骨折

作者用一种自行设制的新型加压螺钉治疗各种类型的踝关节骨折,采用改良式的 ccdell方法,从主观、客观及放射学三方面加以综合评价,结果显示:该加压螺钉具有固定牢靠,加压等优点,不仅可促进骨折愈合,而且能有效地纠正腓骨短缩移位,允许早期关节功能锻练,促进关节功能恢复。