Antimicrobial prophylaxis in laparoscopic gynecologic surgery: a prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin.

Numerous studies have been published in recent years about antimicrobial prophylaxis in gynecologic surgery, but the optimal drug and schedule for the different surgical procedures is still a matter of debate. The aim of the present study was to compare two ultra-short term antimicrobial prophylaxis regimens (amoxicillin-clavulanic acid and cefazolin) in preventing infections following laparoscopic gynecologic operations. Three hundred sixty women hospitalized for a laparoscopic gynecologic surgery procedure were included in the study between January 1999, and December 2001. Patients were randomly allocated to receive amoxicillin-clavulanic acid (2.2 g) [Group A] or cefazolin (2 g) [Group B] as a single dose 30 minutes before surgery. Each patient was assessed daily until discharge to evidence febrile status and the presence of infections at the operative site, urinary tract and respiratory tract. In the amoxicillin-clavulanic acid (Group A) and cefazolin (Group B) groups, overall 164 and 172 patients, respectively, were evaluable for prophylactic efficacy at hospital discharge. Infectious complications were infrequent in both groups with febrile morbidity occurring in only one patient (0.6%) in the amoxicillin-clavulanic group. No sign of infections at the surgical site, urinary tract and respiratory tract was observed in either group. No death due to sepsis was recorded. It is concluded that ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe and effective in elective laparoscopic gynecologic surgery.

Antimicrobial prophylaxis in laparotomic gynecologic surgery: a prospective randomized study comparing amoxicillin-clavulanic acid with cefazolin.

A prospective randomized study was conducted at the Department of Obstetrics and Gynecology, University of Bari to compare two antimicrobial regimens, amoxicillin-clavulanic acid with cefazolin as ultra-short term prophylaxis in laparotomic gynecologic surgery. Patients were randomly allocated to receive a single dose of amoxicillin-clavulanic acid (2.2 g) [Group A] or cefazolin (2 g) [Group B] 30 minutes before surgery. Each patient was assessed daily until discharge for fever and the presence of infection of the surgical wound, urinary tract and respiratory tract. In the amoxicillin-clavulanic acid (Group A) and cefazolin (Group B) groups, overall 258 and 253 patients, respectively were evaluable for prophylactic efficacy at hospital discharge. Infectious complications were infrequent in both arms. Febrile morbidity occurred in 16 (6.3%) and 21 (8.1%) patients respectively in the amoxicillin-clavulanic acid and cefazolin groups. Wound infection and urinary tract infection were also higher but not significantly in the cefazolin group (0.8% versus 0% and 2.7% versus 2.0% respectively). There was no respiratory tract infection or septic death in either group. It is concluded that ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe and effective in elective laparotomic gynecologic surgery.

Ultra short-term antimicrobial prophylaxis in patients undergoing surgery for gynecologic cancer.

OBJECTIVE: To evaluate the efficacy of ultra short-term antimicrobial prophylaxis with ceftazidime in patients undergoing radical gynecologic surgery. PATIENTS AND METHODS: Two hundred patients undergoing surgery for a malignant disease of the female genital tract were enrolled in a prospective trial to receive 2.0 g ceftazidime as a single dose, 30 minutes before induction of anaesthesia. After surgery, each patient was assessed to confirm febrile status and the presence of infections at the surgical site, urinary tract and respiratory tract. RESULTS: Postoperative morbidity occurred in 23 patients (11, 5%). Ten patients (5%) developed febrile morbidity, five (2, 5%) vaginal cuff infections, four asymptomatic bacteriuria and two each wound infiltration and urinary tract infection. Twelve patients had microbiological evidence of infection and Staphylococccus aureus was the most common pathogen isolated. Univariate analysis demonstrated that pre-existing systemic disease, extensive blood loss (more than 500 ml) and long duration of surgery (more than 150 minutes) were the only factors associated with a significant increase in postoperative febrile morbidity. CONCLUSIONS: Ultra short-term antimicrobial prophylaxis with ceftazidime is safe and effective in patients undergoing surgery for gynecologic cancer.

Intramedullary spinal cord metastasis from ovarian carcinoma.

BACKGROUND: Intramedullary spinal cord involvement by ovarian carcinoma is extremely rare. CASE: A patient with stage IV serous cystadenocarcinoma of the ovary presented with neurologic complaints 16 months after primary treatment. Magnetic resonance imaging demonstrated a metastatic lesion in the intramedullary area of the spinal cord. No other site of metastatic disease was observed. The patient received three cycles of carboplatin with complete resolution of the neurologic symptoms and a remarkable reduction of the lesion. Following chemotherapy she was given radiotherapy on the spinal cord, but died 10 months later for disseminated abdominal disease, without neurologic symptoms. CONCLUSION: Spinal cord involvement is unusual in ovarian carcinoma; multidisciplinary treatment, including chemotherapy and radiotherapy, may offer good palliation of the symptomatology.

[Prevalence and distribution of congenital cardiopathy at birth and in pregnancy termination: impact of prenatal diagnosis in 4 years of experience]. / Prevalenza e distribuzione delle cardiopatie congenite alla nascita e nelle interruzioni di gravidanza: impatto della diagnosi prenatale in quattro anni di esperienza.

OBJECTIVE: To evaluate in two time intervals the potential impact of prenatal diagnosis on prevalence and spectrum of CHD at birth and in aborted fetuses. PATIENTS AND METHODS: At the University Hospital of Bari, south-east Italy, in the period between January 1st 1996 and December 31st 1999 a retrospective study was performed of all newborns and termination of pregnancy (TOP) beyond 18 weeks' gestation with postnatally diagnosed CHD. An antenatal fetal ultrasonic evaluation had been always performed between 18-22 weeks' gestation. The prevalence, distribution and detection rate of CHD at birth and in TOP were assessed and compared between two different periods of time (96-97 vs 98-99) to verify an eventual improvement in the prenatal diagnosis due to the learning curve and to new technologies. RESULTS: Prevalence of severe CHD in livebirths and aborted fetuses showed no significant changes between the two study periods (respectively 4.6@1000 vs 5.4@1000, at birth; 10% vs 11%, in TOP) and the same was observed as for as distribution of CHD. Maternal or fetal risk factors were found in 23% of cases of CHD at birth and in 74% of cases of CHD in aborted fetuses. The antenatal detection rate of CHD did not change between the two study periods in newborns (25% vs 27%, NS) while in aborted fetuses it was higher and showed a significant longitudinal improvement (53% vs 85%, p < 0.05), which was more evident if only selected cases were considered (56% vs 93%, p < 0.03). DISCUSSION: Our data show that gain in experience in fetal echocardiography has increased the prenatal diagnostic accuracy for congenital cardiac malformations only in selected cases, evaluated by more expert operators. In conclusion the impact of antenatal routine screening for congenital heart disease appears still relatively small.