ABSTRACT
BACKGROUND: Since the patient's skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine-alcohol is more protective against infection than is povidone-iodine. METHODS: We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections. RESULTS: A total of 849 subjects (409 in the chlorhexidine-alcohol group and 440 in the povidone-iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5% vs. 16.1%; P=0.004; relative risk, 0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine-alcohol was significantly more protective than povidone-iodine against both superficial incisional infections (4.2% vs. 8.6%, P=0.008) and deep incisional infections (1% vs. 3%, P=0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups. CONCLUSIONS: Preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine for preventing surgical-site infection after clean-contaminated surgery. (ClinicalTrials.gov number, NCT00290290.)
Subject(s)
2-Propanol/therapeutic use , Anti-Infective Agents, Local/therapeutic use , Chlorhexidine/analogs & derivatives , Povidone-Iodine/therapeutic use , Surgical Wound Infection/prevention & control , 2-Propanol/adverse effects , Adult , Analysis of Variance , Anti-Infective Agents, Local/adverse effects , Antisepsis/methods , Chlorhexidine/adverse effects , Chlorhexidine/therapeutic use , Cross Infection/prevention & control , Drug Combinations , Female , Humans , Kaplan-Meier Estimate , Logistic Models , Male , Middle Aged , Polymerase Chain Reaction , Povidone-Iodine/adverse effects , Risk Factors , Skin/microbiology , Surgical Wound Infection/epidemiology , Surgical Wound Infection/microbiologyABSTRACT
BACKGROUND: Uterine bleeding frequently complicates gestational trophoblastic disease, particularly after uterine evacuation. Hysterectomy and other procedures used to control this bleeding incur significant risk and can limit fertility. CASE: We present a case of massive hemorrhage complicating uterine curettage performed for metastatic gestational trophoblastic disease. The patient's bleeding was controlled successfully by intrauterine tamponade performed using a balloon catheter. After catheter removal, she achieved complete disease remission. CONCLUSION: Intrauterine balloon catheterization appears to be a promising alternative to control uterine hemorrhage and preserve fertility for young women undergoing treatment for gestational trophoblastic disease. Its use may help avoid invasive interventions, such as hysterectomy and embolization, currently used to control hemorrhage after uterine evacuation.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Balloon Occlusion , Catheterization , Dilatation and Curettage/adverse effects , Gestational Trophoblastic Disease/surgery , Lung Neoplasms/secondary , Uterine Hemorrhage/therapy , Adult , Dactinomycin/administration & dosage , Etoposide/administration & dosage , Female , Gestational Trophoblastic Disease/drug therapy , Humans , Leucovorin/administration & dosage , Lung Neoplasms/drug therapy , Methotrexate/administration & dosage , PregnancyABSTRACT
A 62-year-old homemaker underwent an uneventful TVT (tension-free vaginal tape) procedure. Eleven days postoperatively she presented to the Emergency Department with agonizing low abdominal pain, elbow pain, fever, and drainage from her suprapubic puncture sites. Her evaluation was consistent with a diagnosis of necrotizing fasciitis and she was started on antibiotics and taken to surgery for exploration and debridement, where the diagnosis was confirmed. This is the first report of necrotizing fasciitis following TVT placement.