Predictors of surgical wound infection in Australia: a national study

In July 1984, the first national Australian Nosocomial Prevalence Survey collected data on 12,742 surgical patients from 265 hospitals. This sample represented 59% of public and private hospitals with 50 or more acute-care beds in Australia. The infection control officers at each hospital provided data on patients in a random sample of beds. The over-all surgical wound infection rate was 4.6%. The surgical wound infection rate was twice (5.4%) as high in public than in private (2.8%) hospitals. The infection rates were greater in larger hospitals in both the public and private sector. However, after adjusting for the other predictor factors that are noted below the infection rate did not show any particular pattern for the size of hospital. Clean surgery had a higher (4.8%) infection rate than did clean-contaminated surgery (2.9%). The infection rate for contaminated surgery was 15.0%. Men were found to have nearly twice (6.5%) the infection rate of women (3.4%). Infection rates were lowest in the 15-to-34 years' age-group and highest in those of over 55 years of age. These trends remained even after adjusting for the other risk factors for infection. The cost of surgical wound infections for all hospitals during the year of 1984 was estimated at approximately $60 million. We suggest that a concerted effort should be made to attempt to reduce the infection rate for clean surgery to 1% or less.     

Meningioma of the floor of the anterior cranial fossa with bilateral intraorbital extension

We report meningioma of the floor of the anterior cranial fossa with bilateral, symmetrical intraorbital extension, describing the findings on plain films and CT.     

Subclavian vein thrombosis: a continuing challenge

Subclavian vein thrombosis is a relatively uncommon but potentially morbid disease entity. To determine the frequency, cause, and best mode of treatment of this problem, we performed a chart review of all patients with a diagnosis of subclavian vein thrombosis at two major metropolitan hospitals during a 6-year period. A total of 40 patients were identified with subclavian vein thrombosis, which represented 3.5% of all venous thromboses detected during the 6-year period. No side or sex predilection was noted and the majority of patients were outpatients. The cause was fairly evenly divided among intravenous catheters (32%), anatomic abnormalities (45%), and carcinoma with postoperative radiation (22.5%). Despite the increasing use of the subclavian veins for pacemaker leads, hyperalimentation, and permanent intravenous access for chemotherapy, there has not been an increase in diagnosed subclavian vein thrombosis. Anatomic abnormalities with compression of the vein respond well to either heparinization or lytic therapy but require surgery if the venous abnormality persists. Treatment consisted of lytic therapy in 20%, heparinization in 55%, and elevation with removal of the central line in 25% of patients. All patients responded well to treatment, with a decrease in swelling and symptoms; no patient progressed to venous gangrene and only one (2.5%) had a documented pulmonary embolus. Medical treatment provides excellent long-term benefit in most cases unless complicated by an anatomic abnormality.     

An intervention for multiethnic obese parents and overweight children.

The purpose of this pilot study was to determine the effects of the addition of coping skills training for obese multiethnic parents whose overweight children were attending a weight management program. At 6 months, parents in the experimental group had significantly lower body mass index (BMI) and body fat percentage (BFP) and higher numbers of pedometer steps compared with those in the control group. Parents in the experimental group also demonstrated significant improvement in interpersonal relationships, behavior control, and stress management compared with those in the control group. Children in the experimental group demonstrated trends toward decreased BMI and BFP and increased pedometer steps.     

The micro gas-liquid chromatographic analysis of 4-(3',3'-dimethylallyl)-1,2-diphenylpyrazolidine-3,5-dione (feprazone) in human biosamples

A gas-liquid chromatographic method for the determination of feprazone in various biological matrixes, employing a choice of detector options, is described. After rapid, micro-scale extraction of the sample with n-butyl acetate at physiological pH, the solution was injected directly onto the chromatograph. Separation was with either an OV7 column and flame ionisation or electron capture detection, or with a carbowax high polymer column and nitrogen specific detection. When 100 mul of plasma was extracted the limit of accurate measurement was 2 mg 1(-1) for F.I.D. and N.P.D. and 0.5 mg 1(-1) with E.C. detection. Quantification was by comparison with a range of plasma calibrators carried throughout the procedure, and determination of peak height ratios against an internal standard incorporated into the extracting solvent. The CV of the assay throughout the concentration range normally encountered in patients undergoing feprazone treatment, ranged between 2.4 and 7.8% for the various detector options. The analytical method has been applied to samples collected both from patients and normal volunteers undergoing treatment with a range of feprazone maintenance doses.     

Enzymatic determination of potassium in serum

This is a kinetic assay for measuring K+ in serum, based on the activation of pyruvate kinase (EC 2.7.1.40) by K+. We eliminated interference from Na+ and NH4+ ions, which also activate this enzyme, by including Na+-binding and NH4+-consuming reagents in the reaction mixture. The assay was developed with and evaluated in the Cobas Fara centrifugal analyzer (and has been used in other kinetic analyzers). Within-run and between-run CVs were less than 1.4% and less than 1.6%, respectively. The reaction rate per millimole of K+ per liter (0.05 delta A/min) was more than double that of the reagent blank (0.02 delta A/min). Results correlated well with those by flame photometry, and interference from bilirubin, hemoglobin, lipids, heparin, and other cations was negligible. This method, in conjunction with a previous method we have reported in which beta-galactosidase is used for measuring Na+ in serum, offers a practical alternative to the use of ion-selective electrodes and flame photometry for measuring these clinically important monovalent cations in high-throughput or "stat" biochemical analyzers.