Antibiotic prophylaxis and open groin hernia repair.

Antibiotic prophylaxis is not routinely given for nonimplant, clean operations, although this view has recently been challenged. We have conducted a randomized multicenter, double-blind prospective trial to compare co-amoxiclav with placebo in 619 patients undergoing open groin hernia repair. Altogether 563 (91%) patients fulfilled the protocol; 283 received co-amoxiclav and 280 placebo. There was no difference between the groups in the number of patients receiving local or general anesthetic, the type of repair performed, the use of a subcutaneous fat suture, the type of skin closure used, the use of wound analgesia, or the use of a wound drain. Patients were given a card to return to the hospital in the event of their wound discharging or their needing to see their general practitioner. All patients were reviewed at approximately 6 weeks after operation. Fifty (8.9%) patients sustained a wound infection, 25 in the co-amoxiclav group and 25 in the placebo group. We conclude that antibiotic prophylaxis is of no benefit to patients undergoing open groin hernia repair.

Studies of the thiadiazine, taurolidine-I. Identification of the molecular species present in aqueous solutions by (1)H- and (13)C-NMR spectroscopy.

The equilibria in deuterium oxide solutions of the diamine, 4,4'-methylenebis(tetrahydro-1,2,4-thiadiazine-1,1-dioxide), were studied using highfield (1)H- and (13)C-NMR with the aid of solutions of tetrahydro-2H-1,2,4-thiadiazine-1,1-dioxide (taurultam), its two N-methyl detivatives and methylene glycol. Comparison of the (1)H-NMR spectrum of taurolidine with the one obtained from a mixture of taurultam and methylene glycol indicated that the same equilibria exists in both these solutions. It was concluded that taurolidine, taurultam and its 4-hydroxymethyl adduct and methylene glycol are the major components present. To facilitate the interpretation of the (13)C-spectra, (13)C-enriched methylene glycol was added to solutions of taurultam. The (13)C-studies confirmed the (1)H-NMR study.

Mixed follicular-parafollicular carcinoma of the thyroid.

We present a case of mixed follicular-parafollicular carcinoma of the thyroid. Immunohistochemical studies demonstrated the presence of both thyroglobulin and calcitonin within tumour cells. The recognition of thyroid tumours showing this mixed differentiation may have implications for existing concepts of C-cell and follicular cell development in the human thyroid.

Hepaticocholecystojejunostomy as a simple technique for decompression of the biliary tract.

A technique for decompressing the biliary tree obstructed by tumors in the upper part of the bile duct is described. It involves draining intrahepatic bile ducts through the gallbladder to a loop of the jejunum. The problem of bleeding is obviated by compression of the crushed liver by the balloon of a Foley catheter which also forms a temporary drain. Only two simple anastomoses are involved and complications are avoided if due attention is paid to the anatomy of the bed of the gallbladder.

NMR studies and GC analysis of the antibacterial agent taurolidine.

The NMR spectrum of taurolidine in deuterium oxide was compared with spectra obtained from model experiments with amines and formaldehyde. Head-space analysis combined with capillary GC showed that there was less than 0.004% free formaldehyde present in 2% solutions of taurolidine. This value is comparable to the concentration of formaldehyde found when the taurolidine solutions were injected directly onto GC columns.

Peritoneal absorption of the antibacterial and antiendotoxin taurolin in peritonitis.

1 Taurolin metabolite plasma concentrations were measured in two groups of patient undergoing abdominal surgery, one group with peritonitis and the other without peritonitis, each group receiving taurolin by intraperitoneal instillation. 2 There was no significant difference in the area under the curves, for the two groups, for one of the metabolites. This would suggest that the absorption of taurolin was not modified in inflammatory conditions such as bacterial peritonitis.

Gas gangrene in intestinal angina.

A patient with Clostridium welchii infection complicating intestinal angina is reported. Surgical resection of bowel of dubious viability is important to avoid this unusual complication.

The treatment of peritonitis by an antiseptic - taurolin.

An open study was carried out on patients with acute appendicitis to assess the effectiveness of taurolin, a new antiseptic which destroys both bacteria and endotoxin, when used intraperitoneally in cases of purulent peritonitis associated with perforated or gangrenous appendicitis. Seventy-four out of 319 patients received taurolin; the others were treated by operation only or by operation and antibiotics as required. The results suggest that taurolin was effective as monotherapy in peritonitis and endotoxic shock and its use avoids the problems associated with antibiotics.

Carcinoid tumour of the oesophagus: report of a case.

A case of carcinoid tumour of the oesophagus in a 54-year-old man is described and the literature is briefly reviewed. This is the third reported case in the world literature and the rarity of the disease is emphasised.