Skin closure after infrainguinal bypass surgery: a prospective randomised study.

BACKGROUND AND PURPOSE: wound complications after infrainguinal bypass surgery occur frequently and may jeopardise an underlying graft. The purpose of this study was to investigate the role of suture material in the occurrence of wound complications. METHODS: prospective randomised trial. 170 consecutive patients underwent femoro-popliteal or femoro-tibial bypass surgery and were randomised between wound closure with continuous polyamide sutures (Ethilon) or with skin staples. RESULTS: ten patients were excluded because of re-intervention or death within 2 weeks after operation. The wound was closed with a continuous polyamide suture (Ethilon) in 77 patients and with metallic skin staples in 83 patients. The groups were comparable in age, use of corticosteroids, occurrence of diabetes mellitus and operation time. Skin closing time was significantly shorter in the staples group (6.4 min versus 2.7 min, p<0.001). Overall, there were no significant differences between continuous polyamide sutures and metallic skin staples in superficial infections (8% versus 2%), deep infections (1% versus 1%), serous leakage or haematoma. CONCLUSION: we found no significant differences in the incidence of wound complications in infrainguinal bypass surgery comparing continuous polyamide (Ethilon) and skin staples. The time needed for wound closure was significantly reduced using metallic staples, but this had no effect on the total operation time. Choices of closing materials should be guided by surgeon's preference.

Is there an effect of perioperative blood transfusion on the outcome of radical hysterectomy with lymphadenectomy for cervical cancer in South Africa?

The aim of this study was to investigate whether there is an effect of perioperative blood transfusion on the outcome of radical hysterectomy with lymphadenectomy for cervical cancer. One hundred and thirty-one patients with cervical cancer were treated by Wertheim radical hysterectomy in the period from 1984-1991. Eighty-six patients received blood transfusions during surgery or within two weeks, whereas 45 patients did not receive any blood transfusion. Transfused and non-transfused patients did not differ with respect to mean age, race, weight, FIGO-stage, cell-type, grade, size, depth of invasion and nodal involvement. Transfused patients had more blood loss, longer surgical time and lower haemoglobin levels. Using log rank analysis, the calculated five-year survival was 81% for the transfused group and 84% for the non-transfused group, a non-significant difference. The five-year disease-free survival rate was 87% for the transfused group and 88% for the non-transfused group. This study suggests that perioperative blood transfusion does not adversely influence survival after the Wertheim operation for cervical cancer.

[Inventory and follow-up of patients with surgery for (uterine) vaginal prolapse, combined with or without, (masked) stress incontinence]. / Inventarisatie en follow-up van patiënten, geopereerd vanwege (utero) vaginale prolaps, al dan niet gecombineerd met (gemaskeerde) stressincontinentie.

OBJECTIVE: Evaluation of the development or persistence of urinary stress incontinence in patients operated on because of prolapsed uterus, with cooperation between gynaecologists and urologists. DESIGN: Retrospective. SETTING: Department of Gynaecology and Obstetrics, Leyenburg Hospital, The Hague, the Netherlands. METHODS: In 178 patients subjected to prolapse correction in the period 1992-1996, presence of urinary incontinence was analysed by means of a written enquiry after an average of 22 months. The 91 patients who had visited the gynaecological outpatient clinic and were seen together with a urologist, were subjected to urodynamic examination in the absence of symptoms of stress incontinence and were operated in cooperation with the urologist. Four groups were distinguished on the basis of preoperative features: group I (n = 37) with manifest stress incontinence, group II (n = 22) with masked stress incontinence, group III (n = 32) in whom no (masked) stress incontinence could be demonstrated and group IV (n = 87) not subjected to urodynamic examination. The patients of groups I and II, in addition to prolapse correction, were also subjected to urethral suspension. RESULTS: Twenty-five (68%) of the group with manifest stress incontinence were free of stress incontinence after the operation, while eight patients (22%) reported improvement (a total of 89%). In 22 of the 54 patients (41%) who preoperatively had no incontinence symptoms, urodynamic examination revealed a masked stress incontinence. Sixteen of them (73%) did not develop symptoms of stress incontinence after the operation, while eight (15%) did develop such symptoms. Thirty of the 32 patients (94%) who preoperatively had no (masked) stress incontinence remained symptom-free. Out of 64 patients without preoperative incontinence, who were operated without urological cooperation, 12 (19%) developed stress incontinence.

[Acute perceptive hearing loss and metabolic acidosis as complications of the topical treatment of psoriasis with salicylic acid-containing ointment]. / Acute perceptieve slechthorendheid en metabole acidose als complicaties van externe behandeling van psoriasis met salicylzuurbevattende zalf.

A 36-year-old woman, hospitalized because of an exacerbation of psoriasis, developed fever, sudden deafness and severe metabolic acidosis after treatment with a 10% salicylic acid containing ointment for four days. The use of salicylic acid on large areas of inflamed skin enhances the risk of transcutaneous resorption and intoxication. High serum concentrations (> 300 mg/l) of salicylic acid deregulate the blood glucose metabolism and cause damage to the inner ear. After timely intervention such symptoms are largely reversible.