Antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: an updated systematic review and meta-analysis.

BACKGROUND: The efficacy and necessity of prophylactic antibiotics in clean and clean-contaminated surgery remains controversial. METHODS: The studies were screened and extracted using databases including PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials.gov according to predefined eligibility criteria. Randomized controlled trials (RCTs) comparing the effect of preoperative and postoperative prophylactic antibiotic use on the incidence of surgical site infections (SSIs) in patients undergoing any clean or clean-contaminated surgery. RESULTS: A total of 16 189 participants in 48 RCTs were included in the primary meta-analysis following the eligibility criteria. The pooled odds ratio (OR) for SSI with antibiotic prophylaxis versus placebo was 0.60 (95% CI: 0.53-0.68). The pooled OR among gastrointestinal, oncology, orthopedics, neurosurgery, oral, and urology surgery was 3.06 (95% CI: 1.05-8.91), 1.16 (95% CI: 0.89-1.50), 2.04 (95% CI: 1.09-3.81), 3.05 (95% CI: 1.25-7.47), 3.55 (95% CI: 1.78-7.06), and 2.26 (95% CI: 1.12-4.55), respectively. Furthermore, the summary mean difference (MD) for patients' length of hospitalization was -0.91 (95% CI: -1.61, -0.16). The results of sensitivity analyses for all combined effect sizes showed good stability. CONCLUSION: Antibiotics are both effective, safe, and necessary in preventing surgical wound infections in clean and clean-contaminated procedures, attributed to their reduction in the incidence of surgical site infections as well as the length of patient hospitalization.

[Clinical analysis of 47 patients with psoriasis arthropathy treated by traditional Chinese medicine syndrome differentiation and integrative medicine].

OBJECTIVE: To analyze the clinical characteristics of psoriasis arthropathy (PA) and to explore the effect of treatment by traditional Chinese medicine (TCM) syndrome differentiation and integrative medicine. METHODS: The initiating characteristics, clinical manifestations, related laboratory and X-ray data as well as the therapeutic efficacy of syndrome dependent TCM and integrative medicine on 47 PA patients were analyzed. RESULTS: Among all the 47 patients, 38 (80.6%) had the skin lesion revealed earlier to joint symptoms, the average time between the appearance of skin lesion and joint symptoms was 9.2 years; joint X-ray abnormality was found in 32 cases (68.1%); and psoriasis nail involvement was found in 33 cases (70.2%). Seventeen patients were treated with TCM alone and obtained satisfactory results, while the other 30 patients, were treated by integrative medicine with the dosage of medicine reduced immediately after symptoms were relieved, and finally cured or improved. CONCLUSION: TCM and integrative medicine are effective in treating PA, with lesser side effects.

[Comparison of primary extraovarian peritoneal serous papillary carcinoma with stage III-IV ovarian papillary serous carcinoma].

OBJECTIVE: Extraovarian peritoneal serous papillary carcinoma (EPSPC) is both histologically and clinically similar to stage III-IV ovarian papillary serous carcinoma (OPSC). The purpose of this study is to investigate the clinical findings, treatment, and outcome of EPSPC patients compared with stage III-IV OPSC patients. METHODS: The data of 12 EPSPC patients and 45 stage III-IV OPSC patients were retrospectively reviewed, comparing the characteristics on clinical presentation and treatment, sensitivity to first-line chemotherapy agents and survival. RESULTS: By analysis of patients' characteristics, presenting signs and symptoms, type and extent of surgery, tumor response to first-line chemotherapy, recurrence-free interval, recurrence site and serum CA-125 levels, no significant difference was observed between the EPSPC patients and stage III-IV OPSC controls. The prevailing presenting symptoms were abdominal mass and ascites. The mainstay of treatment was debulking surgery followed by adjuvant platinum-based chemotherapy. The complete clinical response of stage III-IV OPSC was 91.8% compared with 25.0% for women with EPSPC (P < 0.01). CONCLUSION: The clinical and surgical characteristics of EPSPC are similar to those of stage III-IV OPSC. When the same treatment strategy is applied, similar response and survival are expected in either condition.

General anesthesia versus local anesthesia for penetrating keratoplasty: a prospective study.

AIM: To examine which anesthesia general or local is more effective for penetrating keratoplasty (PKP). METHODS: Patients with indications for PKP (n=141) were enrolled in a prospective study and randomly divided into general anesthesia group (group A, 70 eyes) and local anesthesia group (group B, 71 eyes). Patients received optical PKP (group A1, 30 eyes; group B1, 30 eyes) or therapeutic PKP (group A2, 40 eyes; group B2, 41 eyes). Measurement of anterior chamber treatment time (T) for PKP patients and the ratio (R) of the area of the pupils to that of recipient graft region. T and R values, as well as perioperative and postoperative complications, were compared between groups A and B using t-test or χ (2) test. RESULTS: Patients were followed for 2wk after PKP. T was (13.45±8.64)min for group A and (7.36±5.24)min for group B, a statistically significant difference (P<0.001). The R value for group A was stable during the operation, while for PKP patients in group B the value initially increased then gradually decreased to normal after suturing. In group B, extrusion of intraocular contents occurred in 5 eyes, and iridal prolapse occured in 11 cases; no perioperative complications occurred in group A. Relapse rate for fungal keratitis was 13.04% in group B and 0% in group A. CONCLUSION: Under general anesthesia, pupils remaine stable during PKP and perioperative complications are averted. General anesthesia gives more time to treat pathological changes in the anterior chamber and treatment success rate is higher.

[Primary peritoneal malignant tumor: clinical analysis of 28 cases].

BACKGROUND & OBJECTIVE: Primary malignant peritoneal tumor is a kind of rare malignancy. Its morphology and clinical manifestations are very similar to the advanced ovarian cancer, therefore, they are usually misdiagnosed and the proper treatment were delayed. This paper analyzed the clinical characteristics, diagnosis, treatment, and prognosis of primary malignant peritoneal tumor. METHODS: The clinical data of 28 cases of primary peritoneal malignant tumor patients admitted between January 1996 to February 2002 in People's Hospital, Peking University, was analyzed retrospectively. There are 20 cases of primary peritoneal seropapillary adenocarcinoma, 8 cases of primary peritoneal malignant Muellerian tube tumor. Their age ranged from 33 to 74, with median age of 54. RESULTS: Among 28 patients, 22 were misdiagnosed preoperatively, the misdiagnose rate were 79%. In all cases, cytoreductive surgery were performed. Postoperative chemotherapy were given either with CAP regimen or TP regimen. Postoperative survival time was 1-83 months, the median survival time was 30 months. CONCLUSION: The recognition of this special tumor should be stressed, to improve early diagnosis and treatment. The authors suggest that cytoreductive surgery on time and postoperative adjuvant chemotherapy should be implemented to improve survival rate.