RESUMEN
BACKGROUND: Surgical site infections (SSIs) are common complications after abdominal surgery. AIM: To compare which suture devices could reduce the incidence of incisional surgical site infections (SSIs) after gastrointestinal surgery using a systematic review and network meta-analysis. METHODS: The CENTRAL, PubMed, and ICHUSHI-Web databases were searched from January 1st, 2000, to December 31st, 2022, for randomized clinical trials (RCTs) comparing the incidence of incisional SSI after gastrointestinal surgery among patients treated with different surgical suture devices, including non-absorbable sutures, absorbable sutures, skin staplers, and tissue adhesives (last searched in August 23th, 2023). The risk of bias was assessed using the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. To estimate the pooled odds ratios (ORs) for each comparison, a fixed-effect inverse-variance model based on the Mantel-Haenszel approach was employed. FINDINGS: A total of 18 RCTs with 5496 patients were included in this study. The overall SSIs in absorbable sutures were significantly lower than those in skin staplers (OR: 0.77; 95% confidence intervals (CI): 0.63-0.95) and non-absorbable sutures (OR: 0.62; 95% CI: 0.39-0.99), whereas SSIs in absorbable sutures were not significantly different from the SSIs in tissue adhesive. The highest P-score was 0.91 for absorbable sutures. A funnel plot for estimating the heterogeneity of the studies revealed that a publication bias would be minimal (Egger test, P = 0.271). CONCLUSION: This study showed that absorbable sutures reduced incisional SSIs in gastrointestinal surgical operations compared to any other suture devices.
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Procedimientos Quirúrgicos del Sistema Digestivo , Infección de la Herida Quirúrgica , Suturas , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/etiología , Humanos , Incidencia , Suturas/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Metaanálisis en RedRESUMEN
BACKGROUNDS: Anastomotic leakage (AL) represents a major complication after rectal low anterior resection (LAR). Transanal drainage tube (TDT) placement offers a potential strategy for AL prevention; however, its efficacy and safety remain contentious. METHODS: A systematic review and meta-analysis were used to evaluate the influence of TDT subsequent to LAR as part of the revision of the surgical site infection prevention guidelines of the Japanese Society of Surgical Infectious Diseases (PROSPERO registration; CRD42023476655). We searched each database, and included randomized controlled trials (RCTs) and observational studies (OBSs) comparing TDT and non-TDT outcomes. The main outcome was AL. Data were independently extracted by three authors and random-effects models were implemented. RESULTS: A total of three RCTs and 18 OBSs were included. RCTs reported no significant difference in AL rate between the TDT and non-TDT groups [relative risk (RR): 0.69, 95% confidence interval (CI) 0.42-1.15]. OBSs reported that TDT reduced AL risk [odds ratio (OR): 0.45, 95% CI 0.31-0.64]. In the subgroup excluding diverting stoma (DS), TDT significantly lowered the AL rate in RCTs (RR: 0.57, 95% CI 0.33-0.99) and OBSs (OR: 0.41, 95% CI 0.27-0.62). Reoperation rates were significantly lower in the TDT without DS groups in both RCTs (RR: 0.26, 95% CI 0.07-0.94) and OBSs (OR: 0.40, 95% CI 0.24-0.66). TDT groups exhibited a higher anastomotic bleeding rate only in RCTs (RR: 4.28, 95% CI 2.14-8.54), while shorter hospital stays were observed in RCTs [standard mean difference (SMD): -0.44, 95% CI -0.65 to -0.23] and OBSs (SMD: -0.54, 95% CI -0.97 to -0.11) compared with the non-TDT group. CONCLUSIONS: A universal TDT placement cannot be recommended for all rectal LAR patients. Some patients may benefit from TDT, such as patients without DS creation. Further investigation is necessary to identify the specific beneficiaries.
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Canal Anal , Fuga Anastomótica , Drenaje , Proctectomía , Ensayos Clínicos Controlados Aleatorios como Asunto , Recto , Humanos , Fuga Anastomótica/prevención & control , Fuga Anastomótica/etiología , Drenaje/instrumentación , Drenaje/métodos , Proctectomía/efectos adversos , Proctectomía/métodos , Recto/cirugía , Canal Anal/cirugía , Neoplasias del Recto/cirugía , Resultado del Tratamiento , Femenino , Masculino , Estudios Observacionales como Asunto , Persona de Mediana EdadRESUMEN
The aim of this study was to conduct a systematic review and meta-analysis of the efficacy of fascial closure using antimicrobial-sutures specifically for the prevention of surgical site infections (SSIs) in gastrointestinal surgery, as part of the revision of the SSI prevention guidelines of the Japanese Society of Surgical Infectious Diseases (JSSI). We searched CENTRAL, PubMed and ICHUSHI-Web in May 2023, and included randomized controlled trials (RCTs) comparing antimicrobial-coated and non-coated sutures for fascial closure in gastrointestinal surgery (PROSPERO No. CRD42023430377). Three authors independently screened the RCTs. We assessed the risk of bias and the GRADE criteria for the extracted data. The primary outcome was incisional SSI and the secondary outcomes were abdominal wall dehiscence and the length of postoperative hospital stay. This study was supported partially by the JSSI. A total of 10 RCTs and 5396 patients were included. The use of antimicrobial-coated sutures significantly lowered the risk of incisional SSIs compared with non-coated suture (risk ratio: 0.79, 95% confidence intervals: 0.64-0.98). In subgroup analyses, antimicrobial-coated sutures reduced the risk of SSIs for open surgeries, and when monofilament sutures were used. Antimicrobial-coated sutures did not reduce the incidence of abdominal wall dehiscence and the length of hospital stay compared with non-coated sutures. The certainty of the evidence was rated as moderate according to the GRADE criteria, because of risk of bias. In conclusion, the use of antimicrobial-coated sutures for fascial closure in gastrointestinal surgery is associated with a significantly lower risk of SSI than non-coated sutures.
RESUMEN
BACKGROUND: Surgical antimicrobial prophylaxis (SAP) is one of the major purposes of antimicrobial use. AIM: To determine the adherence to the Japanese SAP guidelines in Japanese university hospitals. METHODS: This was a retrospective cohort study including 15 general hospitals and one dental university hospital. Up to three cases of 18 designated surgeries were evaluated regarding adherence to Japanese SAP guidelines: selection of antibiotics, timing of administration, re-dosing intervals, and duration of SAP. When all items were appropriate, surgery was defined as 'appropriate'. FINDINGS: In total, 688 cases (22-45 cases per surgery) were included. The overall appropriateness was 46.8% (322/688), and the appropriateness of each surgery ranged from 8.0% (2/25, cardiac implantable electronic device implantation) to 92.1% (35/38, distal gastrectomy). The appropriateness of each item was as follows: pre/intraoperative selections, 78.5% (540/688); timing of administrations, 96.0% (630/656); re-dosing intervals, 91.6% (601/656); postoperative selection, 78.9% (543/688); and duration of SAP, 61.4% (423/688). The overall appropriateness of hospitals ranged from 17.6% (9/51) to 73.3% (33/45). The common reasons for inappropriateness were the longer duration (38.5%, 265/688) and choice of antibiotics with a non-optimal antimicrobial spectrum before/during, and after surgery (19.0%, 131/688 and 16.9%, 116/688, respectively), compared to the guideline. CONCLUSIONS: Adherence to the guidelines differed greatly between the surgeries and hospitals. Large-scale multi-centre surveillance of SAP in Japanese hospitals is necessary to identify inappropriate surgeries, factors related to the appropriateness, and incidences of surgical site infections.
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Antiinfecciosos , Profilaxis Antibiótica , Humanos , Estudios Retrospectivos , Hospitales Universitarios , Japón , Adhesión a Directriz , Antibacterianos/uso terapéutico , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/tratamiento farmacológico , Antiinfecciosos/uso terapéuticoRESUMEN
Stroke can be a cause of death, while in non-fatal cases it is a common cause of various disabilities resulting from associated brain damage. However, whether a specific periodontal pathogen is associated with increased risk of unfavorable outcome after stroke remains unknown. We examined risk factors for unfavorable outcome following stroke occurrence, including serum antibody titers to periodontal pathogens. The enrolled cohort included 534 patients who had experienced an acute stroke, who were divided into favorable (n = 337) and unfavorable (n = 197) outcome groups according to modified ranking scale (mRS) score determined at 3 months after onset (favorable = score 0 or 1; unfavorable = score 2-6). The associations of risk factors with unfavorable outcome, including serum titers of IgG antibodies to 16 periodontal pathogens, were examined. Logistic regression analysis showed that the initial National Institutes of Health stroke scale score [odds ratio (OR) = 1·24, 95% confidence interval (CI) = 1·18-1·31, P < 0·001] and C-reactive protein (OR = 1·29, 95% CI = 1·10-1·51, P = 0·002) were independently associated with unfavorable outcome after stroke. Following adjustment with those, detection of the antibody for Fusobacterium nucleatum ATCC 10953 in serum remained an independent predictor of unfavorable outcome (OR = 3·12, 95% CI = 1·55-6·29, P = 0·002). Determination of the antibody titer to F. nucleatum ATCC 10953 in serum may be useful as a predictor of unfavorable outcome after stroke.
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Anticuerpos Antibacterianos/sangre , Fusobacterium nucleatum/metabolismo , Inmunoglobulina G/sangre , Accidente Cerebrovascular/sangre , Anciano , Anciano de 80 o más Años , Anticuerpos Antibacterianos/inmunología , Femenino , Fusobacterium nucleatum/inmunología , Humanos , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de Riesgo , Accidente Cerebrovascular/inmunologíaRESUMEN
BACKGROUND: The Japanese government adopted a national action plan on antimicrobial resistance, which aims to reduce drug-resistant pathogens and antimicrobial use. A point-prevalence survey (PPS) is a useful surveillance method to gain information about hospital epidemiology; however, no multi-centre PPS has previously been performed in Japan. AIM: To investigate general information about hospital epidemiology, healthcare-associated infections (HCAIs), and antimicrobial use in multiple Japanese university hospitals. METHODS: In July 2016, a multi-centre PPS was conducted using a standardized protocol at four university hospitals in Japan. FINDINGS: A total of 3199 patients were included. Median age and duration of hospital stay were 64 years and 10 days, respectively. A total of 246 (7.7%; 95% confidence interval (CI): 6.8-8.7) patients had 256 active HCAIs, and 933 (29.2%; 95% CI: 27.6-30.8) patients received 1318 antimicrobials. Pneumonia and gastrointestinal system infection were the most common HCAIs (N = 42, 16.4%), and Enterobacteriaceae (N = 49, 30.8%) were the predominant causative organisms. Carbapenems (N = 52, 17.8%), anti-MRSA medications, and cephems with antipseudomonal activity were the most frequently prescribed antimicrobials for HCAIs. As surgical prophylaxis, 46 of 278 antimicrobials (16.5%) were administered orally. Proportions of HCAI and antimicrobial use in each hospital ranged from 4.8% to 9.5% and 19.3%-35.0%, respectively. CONCLUSION: This multi-centre PPS recorded detailed HCAI data and distinct antimicrobial use in Japanese university hospitals. Further surveillance is necessary to reduce HCAIs and formulate feasible plans to achieve the national action plan on antimicrobial resistance.
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Antibacterianos/uso terapéutico , Infección Hospitalaria/epidemiología , Utilización de Medicamentos , Infecciones por Enterobacteriaceae/epidemiología , Enterobacteriaceae/aislamiento & purificación , Hospitales Universitarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Japón , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Although meropenem is commonly used for intra-abdominal infections, its penetration into the abdominal cavity is not well understood. Meropenem (500 mg) was administered intravenously to 8 patients with inflammatory bowel diseases undergoing laparotomy. The drug concentrations were analyzed and used for a Monte Carlo simulation with minimum inhibitory concentration (MIC) data. Meropenem concentrations in peritoneal fluid (PF) and plasma were similar at 1 h after the end of a 0.5-h infusion. The probabilities of target achievement of drug concentrations over the MIC in PF for 40% of the dosing interval with 500 mg every 8 h and 1000 mg every 8 h, were 84% and 90% against Bacteroides spp., 98% and 99% against Escherichia coli , and 76% and 83% against Pseudomonas aeruginosa, respectively. In conclusion, meropenem penetrated PF well, and 500 mg every 8 h or 1000 mg every 8 h would be suitable for the therapy for intraabdominal infections.
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Antibacterianos/farmacología , Líquido Ascítico/microbiología , Bacterias Gramnegativas/efectos de los fármacos , Enfermedades Inflamatorias del Intestino/cirugía , Tienamicinas/farmacología , Adulto , Antibacterianos/farmacocinética , Área Bajo la Curva , Femenino , Humanos , Enfermedades Inflamatorias del Intestino/microbiología , Masculino , Meropenem , Tasa de Depuración Metabólica , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Método de Montecarlo , Tienamicinas/farmacocinéticaRESUMEN
The present study aimed to examine the peritoneal pharmacokinetics and pharmacodynamic exposure of intravenous cefotiam. One gram of cefotiam was administered to eight patients before abdominal surgery. Venous blood and peritoneal fluid (PF) samples were obtained at the end of infusion (0.5 h) and 1, 2, 3, 4, 5, and 6 h afterwards. The drug concentrations in the plasma and PF were determined, analyzed pharmacokinetically, and used for a stochastic simulation with minimum inhibitory concentration (MIC) data. Cefotiam penetrated well into the PF with the area under the drug concentration-time curve ratio of 0.88 +/- 0.18 (mean +/- SD, n = 8). Regarding the pharmacodynamic exposures against Escherichia coli and Klebsiella species, the probabilities of attaining the bacteriostatic target (40% of the time above MIC) in the PF using 0.5 g every 12 h, 1 g every 12 h, and 2 g every 12 h were 88.3-93.6%. However, 1 g every 8 h was needed for 89.7 and 91.6% probabilities of attaining the bactericidal target (70% of the time above MIC). These results should help us to understand better the peritoneal pharmacokinetics of cefotiam while also helping us to choose the appropriate dosage for intra-abdominal infections.
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Antibacterianos/farmacocinética , Líquido Ascítico/metabolismo , Infecciones Bacterianas/tratamiento farmacológico , Cefotiam/farmacocinética , Infección de la Herida Quirúrgica/tratamiento farmacológico , Cavidad Abdominal/microbiología , Cavidad Abdominal/cirugía , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Cefotiam/administración & dosificación , Cefotiam/farmacología , Escherichia coli/efectos de los fármacos , Femenino , Humanos , Inyecciones Intravenosas , Klebsiella/efectos de los fármacos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Método de Montecarlo , Estudios ProspectivosRESUMEN
PURPOSE: The aim of this study was to determine the contribution of gastrointestinal motility to bowel function and the pathogenesis of pouchitis after ileal pouch-anal anastomosis. METHODS: Gastrointestinal transit time was assessed by a radiopaque marker technique in 32 patients with ulcerative colitis. RESULTS: Small intestinal transit time and pouch emptying time were 4.1 +/- 2 hours and 4.1 +/- 2.5 hours, respectively. There was no significant difference in pouch emptying time between patients with and without pouchitis. When only patients with acute pouchitis that responded to metronidazole were analyzed, there was a trend toward a prolonged pouch emptying time compared with those without pouchitis (P = 0.095). Whole gut transit time was inversely correlated with 24-hour stool frequency in patients without pouchitis (r = -0.63, P < 0.005). In the analysis of regional transit time, only small intestinal transit time was inversely correlated with 24-hour stool frequency (r = -0.472, P < 0.05). Significant prolongation of small intestinal transit time was demonstrated in patients over a period of 41 months (the median time) after ileostomy closure compared with those whose pouches had been functioning for 6 to 41 months (5.4 +/- 1.7 hours vs. 3.1 +/- 1.3 hours, P < 0.005). CONCLUSIONS: There was an association between small intestinal motility and bowel frequency. Further investigation is necessary in the pathogenesis of acute pouchitis regarding the relationship between delayed pouch emptying and subsequent development of mucosal inflammation.
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Canal Anal/cirugía , Anastomosis Quirúrgica/métodos , Colitis Ulcerosa/cirugía , Tránsito Gastrointestinal , Íleon/cirugía , Adolescente , Adulto , Sulfato de Bario , Colitis Ulcerosa/fisiopatología , Femenino , Humanos , Ileostomía , Masculino , Persona de Mediana Edad , Cloruro de Polivinilo , Análisis de Regresión , Estadísticas no Paramétricas , Resultado del TratamientoRESUMEN
We report a case of progression of primary biliary cirrhosis (PBC) after proctocolectomy for ulcerative colitis. A 43-year-old woman underwent a total proctocolectomy after being diagnosed with ulcerative colitis. In the course of the preoperative investigation, liver function test results were within the normal range. Four months after the proctocolectomy, the patient showed a high level of alkaline phosphatase (2398 IU/l) and a positive anti-mitochondrial antibody titer (>1:160). There were no associated symptoms. A liver biopsy demonstrated expansion of all portal areas by infiltrates of lymphocytes and histiocytes. These appearances indicated chronic biliary disease and were compatible with PBC. The association of PBC and ulcerative colitis is rare. However, a review of the recent literature suggests that PBC and ulcerative colitis may be associated; this combination should be kept in mind.
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Colitis Ulcerosa/cirugía , Cirrosis Hepática Biliar/patología , Proctocolectomía Restauradora , Adulto , Colitis Ulcerosa/complicaciones , Progresión de la Enfermedad , Femenino , Humanos , Hígado/patología , Cirrosis Hepática Biliar/complicacionesRESUMEN
We carried out a prospective clinical trial of colon preparation with a regimen of oral antibiotics starting on the day before surgery. The patients were assigned to one of two groups consisting of either a mechanical preparation alone group (group 1, 45 cases) or a mechanical bowel preparation with oral antibiotics group (group 2, 38 cases). Group 2 received kanamycin and metronidazole three times on the day before surgery. Cefmetazole was administered for 3 consecutive days as prophylaxis in both groups. In a study using intraoperative mucosal swabs, the rates of group 2 patients with cultures yielding anaerobes or Gram-negative bacteria were significantly lower than those of group 1. There were no significant differences in the rates of patients with cultures yielding fungi or Gram-positive organisms. The positive culture rate in the peritoneal fluid of group 1 was also higher than that of group 2 (40%, 16%, P < 0.05). The surgical site infection rate was 18% in group 1 and 13% in group 2. Organisms isolated from the sites of postoperative infections were not identical with those from the peritoneal fluid. This relatively brief course preparation minimized the emergence of resistant strains. However, in spite of the colonic bacterial burden and the intraoperative inoculation in the patients with mechanical cleansing alone, their incidence of subsequent infections was comparable to that of patients who were administered oral antibiotics provided that the prophylactic antibiotic was administered for 3 days after surgery.
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Infecciones Bacterianas/prevención & control , Colectomía , Colon/efectos de los fármacos , Quimioterapia Combinada/administración & dosificación , Kanamicina/administración & dosificación , Metronidazol/administración & dosificación , Complicaciones Posoperatorias/prevención & control , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/aislamiento & purificación , Infecciones Bacterianas/microbiología , Colon/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/microbiología , Estudios Prospectivos , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
Involvement of the gastroduodenum is extremely rare in Crohn's disease. For obstructing duodenal Crohn's disease, bypass procedures have traditionally been selected. However, more recently, strictureplasty has become an acceptable surgical option. We treated two Crohn's disease patients with short proximal duodenal stenosis, using Finney-type strictureplasty. Their postoperative courses were uneventful and they have remained asymptomatic during follow-up periods of more than 5 years, and 4 months, respectively. Owing to the good clinical results of our two patients, we consider strictureplasty to be indicated for short proximal duodenal stenosis in Crohn's disease.
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Enfermedad de Crohn/cirugía , Obstrucción Duodenal/cirugía , Adulto , Enfermedad de Crohn/complicaciones , Obstrucción Duodenal/diagnóstico por imagen , Femenino , Humanos , Japón , Masculino , RadiografíaRESUMEN
Pancreatic ascites can occur in association with the rupture of a pseudocyst or the disruption of a pancreatic duct during the natural course of chronic pancreatitis. We report herein the successful treatment of three patients with pancreatic ascites by performing a surgical procedure after 4-6 weeks of total parenteral nutrition (TPN) proved ineffective. The principles of our surgical procedure for pancreatic ascites are as follows: (1) minimum pancreatic tissue is resected; (2) surgical intervention to repair leaking sites is not necessary; (3) pancreatic duct drainage is facilitated by an intestinal Roux-en-Y loop; (4) An external drainage tube is inserted through the Roux-en-Y loop into the main pancreatic duct. All three patients who underwent our surgical procedure had a good outcome. Although the mean follow-up time is still only 18.3 months, their condition has improved, with no evidence of recurrent ascites. Thus, our surgical procedure should be considered as an appropriate treatment for pancreatic ascites because it can be applied for all types of leakage, including leakage from the posterior wall of pancreas; it preserves pancreatic function, especially endocrine function; and it enables preservation of the spleen.
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Anastomosis en-Y de Roux/métodos , Ascitis/cirugía , Enfermedades Pancreáticas/cirugía , Pancreatitis/complicaciones , Anciano , Ascitis/etiología , Enfermedad Crónica , Drenaje/métodos , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/etiologíaRESUMEN
We report herein on the follow-up of ten consecutive patients who underwent perineal rectosigmoidectomy, and discuss the indications, surgical technique, and outcomes of this procedure. The median age of the patients was 79 years, with a range of 26 to 85 years, and eight patients had complicating medical conditions. Of five patients who underwent this procedure for a recurrent prolapse after another type of perineal procedure, four had previously undergone the Thiersch operation combined with the Gant-Miwa technique. The mean length of the excised rectum and sigmoid colon was 22.1 cm. Pain was minimal or absent in all patients and oral intake was commenced after 2 days. There were no mortalities, but anastomotic leakage occurred in one patient. The mean follow-up period was 3.5 years. Only one patient developed recurrent rectal prolapse 24 months after the operation. Of seven patients who underwent concomitant levatoroplasty for incontinence, five became fully continent within 3 weeks after the operation, while the remaining two improved after 2 months. We propose that perineal rectosigmoidectomy is indicated for patients who have suffered an early recurrence of prolapse after another transperineal repair; elderly or high-risk patients with incontinence; male patients; and patients with an incarcerated or gangrenous prolapsed rectal segment.
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Colon Sigmoide/cirugía , Prolapso Rectal/cirugía , Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Complicaciones Posoperatorias , Factores de Riesgo , Resultado del TratamientoRESUMEN
We examined the pancreatic tissue concentrations of cefazolin in ten patients undergoing pancreatectomy, and determined the optimal intraoperative time to deliver a repeat dose of cefazolin. An intravenous bolus dose of 1 g cefazolin was administered at the time of skin incision. Peripheral blood, subcutaneous adipose tissue, and peritoneal samples were obtained intraoperatively every hour for 4 h after the antibiotic was first administered, and pancreatic tissue samples were obtained at the time of pancreatectomy. To determine adequate tissue levels of cefazolin, minimum inhibitory concentrations (MIC) were measured for four bacterial species, namely 360 isolates of methicillin-sensitive Staphylococcus aureus (MSSA), 204 isolates of Klebsiella pneumoniae, 314 isolates of Escherichia coli, and 30 isolates of Streptococcus spp. The antibiotic concentrations in adipose tissue and peritoneum 3 h after the administration of cefazolin were lower than the MIC80 for K. pneumoniae, E. coli, and Streptococcus spp. Most pancreatic tissue samples showed antibiotic concentrations greater than the MIC80 for these bacterial species; however, those from four patients complicated by severe chronic pancreatitis, massive intraoperative bleeding, or obesity showed concentrations lower than the MIC80. Thus, we recommend that a second dose of cefazolin be given 3 h after the first administration to maintain adequate levels of antibiotic activity.
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Profilaxis Antibiótica/métodos , Cefazolina/administración & dosificación , Cefalosporinas/administración & dosificación , Complicaciones Intraoperatorias/prevención & control , Neoplasias Pancreáticas/cirugía , Anciano , Cefazolina/farmacocinética , Cefalosporinas/farmacocinética , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico , Pronóstico , Factores de Tiempo , Resultado del TratamientoRESUMEN
The purpose of this study was to assess the point at which the postoperative infection has occurred in order to decide upon the proper duration of prophylactic antibiotic use. Another goal of this study was to determine whether prediction for the development of postoperative infections in major surgery such as esophagectomy should be the same as that in routine gastroenterological surgery. Twenty-five patients who underwent transthoracic esophagectomy and 127 patients who underwent gastrectomy were studied. On the third day after gastric surgery, the body temperature of patients who developed an infection was higher than that of the patients who did not develop an infection. The relative changes in peripheral white blood count (WBC), and C-reactive protein (CRP) concentration on the third and fourth days were more predictive of the development of infection than the absolute values. Almost all patients with systemic inflammatory response syndrome (SIRS) on the third day after gastric surgery developed an infection. On the other hand, the incidence of SIRS in patients who did not develop an infection was high on both the third and fourth days after esophageal surgery. It was nearly impossible to predict who would develop an infection in esophageal surgery. The high incidence of postoperative infections, and their significant consequences justify planned successive postoperative antibiotic use in esophageal surgery.
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Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Gastrectomía/efectos adversos , Infecciones/etiología , Complicaciones Posoperatorias/etiología , Profilaxis Antibiótica , Humanos , Neoplasias Gástricas/cirugía , Síndrome de Respuesta Inflamatoria Sistémica/etiologíaRESUMEN
We experienced a case of acute aortic dissection without an intimal tear. A 55-year-old woman with SLE presented with acute chest pain. TEE study showed dissection of the ascending aorta, and accompanied by pericardial effusion. An emergency operation was performed four hours after onset. Intraoperatively, thrombus was encountered in the false lumen of the ascending aorta and the proximal arch. However, intimal tear was not found. She underwent graft replacement of the ascending aorta and the total aortic arch, and had an uneventful postoperative course. Histological examination of a segment of ascending aorta showed no evidence of mucinous degeneration and pathological rupture of the elastic fiber.
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Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Enfermedad Aguda , Aorta/cirugía , Aorta Torácica/cirugía , Prótesis Vascular , Urgencias Médicas , Femenino , Humanos , Persona de Mediana Edad , Derrame Pericárdico/complicacionesRESUMEN
A 20-year-old man of Marfan's syndrome who had mitral valve regurgitation, annuloaortic ectasia with aortic valve regurgitation and aortic arch aneurysm was successfully treated with radical operation. Mitral valve replacement was performed with superior wall incision of the left atrium directly. Complete transection of the aortic root made it easy to reach the mitral valve. The diameter of his ascending aorta was 70 mm, and modified Bentall' procedure, Carrel patch method, was performed. Aortic arch was 40 mm in diameter, and total aortic arch replacement was performed under hypothermic circulatory arrest. After the combined operation, patient was recovered uneventfully.
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Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Prótesis Vascular , Prótesis Valvulares Cardíacas , Síndrome de Marfan/complicaciones , Insuficiencia de la Válvula Mitral/cirugía , Adulto , Aneurisma de la Aorta Torácica/complicaciones , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/cirugía , Humanos , Masculino , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/complicacionesRESUMEN
Modified Fontan procedure was successfully performed in two patients with complex cardiac anomaly and nonconfluent pulmonary artery. A nonconfluent portion of the pulmonary artery was interposed with a xenopericardial roll. In one patient, the central pulmonary artery was completely absent. Two-staged reconstruction of the central pulmonary artery was carried out through a left thoracotomy and a median sternotomy before the Fontan procedure. In the other patient, a juxtaductal segment of the pulmonary artery was nonconfluent. Correction of the nonconfluent pulmonary artery was performed concomitantly with the Fontan procedure. Fenestrated Fontan procedure seemed to be the beneficial modification for survival. Both patients have been day well during the midterm follow-up period.