Ampicillin-Sulbactam versus Cefoxitin for Prophylaxis in High-Risk Patients Undergoing Abdominal Surgery

This double-blind study compared ampicillin-sulbactam 3 g versus cefoxitin 2 g in 136 adult patients at risk for developing an infection after abdominal surgery. Separate randomization schedules were used for colorectal, upper gastrointestinal/biliary, and other abdominal procedures. Study antibiotics were administered within 30 minutes before incision and repeated 6 hours later. Patients having colorectal surgery received a third dose of antibiotic 6 hours after the second. Efficacy evaluations were made on 123 patients, 62 in the ampicillin-sulbactam group and 61 in the cefoxitin group. The overall postoperative infection rates were 12.9% for ampicillin-sulbactam and 9.8% for cefoxitin (p>0.05); one wound infection occurred in each group. Adverse events were experienced by 13.2% of the ampicillin-sulbactam and 19.1% of the cefoxitin recipients (p>0.05). Cost-minimization analysis revealed that ampicillin-sulbactam was a cost-effective alternative to cefoxitin for the prevention of infection after abdominal surgery.     

Round table conference on clinical trials for the treatment of sepsis Brussels,March 12–14, 1994

The Proceedings of the Round Table Conference will be published as volume 19, in the series Update in Intensive Care and Emergency Medicine (Springer Verlag) in January, 1995.     

Social support,onset of depression and personality

Summary The effects of personality characteristics on social support and hence risk of depression are explored in a group of 150 largely working-class mothers, a subsample of 400 women who took part in a prospective study. This established that once those with depression at first interview were excluded, practically all of the onsets of depression in the follow-up year occurred among 150 women with a severe event or major difficulty — that is a provoking agent. It was also found that low self-esteem and lack of support from a core tie at the time of the crisis was associated with a considerably increased risk. In the subsample as a whole, measures of dependency and attitudinal constraints to support taken at first interview were not associated with risk of depression. But, it is argued, any enduring personality traits that play a role in the link between lack of support and depression would most likely be seen in a smaller group, namely those who had had early inadequate parenting. And the most promising lead concerning the role of personality characteristics did in fact emerge in relation to a small high risk group with such parenting. Most of them had low self-esteem, and they appeared to confide in inappropriate and unreliable sources of support at time of crisis.     

Decentralization of forensic services

Decentralization of mental health services to persons in contact with the criminal justice system is essential in the application of community mental health concepts. This is feasible considering the levels of "dangerousness" of such persons, costs of the typical isolated central facility, and implications of the Supreme Court decision Jackson v. Indiana (406 U.S. 715, 1972). In Tennessee, reform began with legal review of unit records, pretrial screening in mental health centers, revision of state law, liaison with the Tennessee Board of Pardons and Paroles, and use of consultant staff. The results are positive wherever decentralization of services has been maintained.     

Gonorrhoea in the asymptomatic patient: Presentation and the role of contact tracing for heterosexual men and women and for homosexual men

Summary Clinically silent gonorrhoea is the major problem in the control of the disease. Only 12 per cent of infected women reported in 1974 because of symptoms, compared with 97 per cent of infected heterosexual men and only 35 per cent of homosexual men with gonococcal proctitis alone. Homosexual men, compared with heterosexual men, had twice as many subsequent sexual contacts after infection and had a higher incidence of early syphilis. Eighty-four per cent had experienced passive anorectal intercourse. Ninety-seven per cent of men with gonococcal urethritis reported because of symptoms, but occasionally (particularly after unsuccessful treatment) urethral gonorrhoea in men may be clinically silent and even require tests of the overnight urethral secretion for diagnosis. For women, and for homosexual men who have had passive anorectal (or oral) intercourse, the indication for attendance for tests for gonorrhoea should be having run the risk, and not the presence of symptoms. Routine tests of the anorectum for gonorrhoea are essential in cases of women at risk, and for most homosexual men since over 80 per cent of these men will have had passive anorectal intercourse. Because gonococcal infections following treatment-failure are often clinically silent in both women and men, symptoms cannot be relied upon to indicate such failure. Follow-up smears and cultures are always essential.

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Kasuistik von Patienten mit asymptomatischer Gonorrhöe und die Bedeutung der durch Personen durchgeführten Kontaktermittlung bei heterosexuellen Männern und Frauen sowie bei homosexuellen Männern

Zusammenfassung Die asymptomatische Gonorrhöe ist das Hauptproblem bei der Kontrolle dieser Krankheit. Nur 12 Prozent der erfaßten infizierten Frauen im Jahre 1974 kamen wegen Beschwerden zur Untersuchung im Gegensatz zu 97 Prozent der infizierten heterosexuellen Männer und nur 35 Prozent der homosexuellen Männer mit isolierter gonorrhoischer Proktitis. Im Vergleich mit heterosexuellen Männern hatten homosexuelle Männer zweimal so viel sexuelle Kontakte nach der Infektion und eine höhere Inzidenz einer Syphilis im Frühstadium. 84 Prozent hatten passiven anorektalen Verkehr gehabt. 97 Prozent der Männer mit gonorrhoischer Urethritis meldeten sich wegen Beschwerden, aber gelegentlich (insbesondere nach unzureichender Behandlung) kann die gonorrhoische Urethritis bei Männern klinisch stumm sein und sie kann sogar Untersuchungen der nächtlichen urethralen Sekretion zur Diagnose erfordern. Für Frauen und für homosexuelle Männer, die passiven anorektalen (oder oralen) Verkehr gehabt haben, sollte der Grund ihres Kommens nicht das Vorhandensein von Symptomen sein, sondern ein mögliches eingegangenes Infektionsrisiko. Routine-Untersuchungen der Analgegend auf Gonorrhöe sind bei Frauen nach entsprechendem Geschlechtsverkehr unbedingt erforderlich, gleichfalls bei den meisten homosexuellen Männern, weil über 80 Prozent dieser Männer wohl einen passiven anorektalen Verkehr gehabt haben werden. Da Gonokokken-Infektionen nach Behandlungsversagen bei Männern und Frauen oft asymptomatisch sind, ist das Verschwinden der Symptome keine verläßliche Indikation für eine erfolgreiche Behandlung. Ständige Überwachung in Form von Abstrichen und kulturellen Untersuchungen ist auf alle Fälle erforderlich.

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This paper was presented in part on 27 September 1974 at a meeting of the British Society for Antimicrobial Chemotherapy.