RESUMO
Patients developing severe incisional abscesses following laparotomy were treated with incision and drainage followed by early reclosure under antibiotic cover with metronidazole and ampicillin anhydricum. Patients with subcutaneous abscesses were randomized into two groups that were treated with antibiotics for one day (n = 23) or four days (n = 27). These patients all underwent reclosure four days later. In a third group of patients (n = 14) abscesses had developed down to, but not through, the peritoneum. These patients received antibiotic treatment for four days and underwent reclosure a mean of 5 1/2 days later (range, four to eight days). No abscesses reappeared in any group and all wounds healed by first intention. Five patients healed totally, with minor defects, but there was no need for surgical intervention. We conclude that the early reclosure technique is a safe procedure under antibiotic cover with metronidazole and ampicillin. One day and four days of antibiotic treatment are equally safe in patients with subcutaneous abscesses.
Assuntos
Abscesso/tratamento farmacológico , Metronidazol/uso terapêutico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Cicatrização , Abscesso/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ampicilina/uso terapêutico , Método Duplo-Cego , Drenagem , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Distribuição Aleatória , Infecção da Ferida Cirúrgica/fisiopatologia , Suturas , Fatores de TempoRESUMO
A randomized double-blind investigation was undertaken to assess the effect of treatment with metronidazole and ampicillin in patients with subcutaneous wound infection after laparotomy and early resuture. The wounds were closed in the fourth day and the antibiotic cover lasted from one to four days. None of the patients developed signs of sepsis or new abscesses. All of the wounds healed primarily but there were slight defects in two patients. These did not require surgical treatment. It is concluded that early closure of infected wounds after laparotomy may be undertaken under metronidazole and ampicillin cover and that treatment for one day is sufficient.
Assuntos
Ampicilina/administração & dosagem , Metronidazol/administração & dosagem , Reoperação , Procedimentos Cirúrgicos Operatórios , Infecção da Ferida Cirúrgica/cirurgia , Método Duplo-Cego , Humanos , Laparotomia , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecção da Ferida Cirúrgica/tratamento farmacológico , SuturasAssuntos
Celulose , Motilidade Gastrointestinal , Verduras , Adulto , Dieta , Dieta Vegetariana , Fezes , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
The urinary excretion of oxalate, calcium, magnesium and creatinine was investigated in 21 outpatients who underwent jejunoileal bypass operation 6-9 years previously. Furthermore, a urinary stone index expressed as the quotient (calcium X oxalate)/(magnesium X creatinine) (mmol/mol) was calculated. The oxalate excretion exceeded normal ranges in 20 patients (1.20 +/- 0.55 mmol/24 h), and the stone index was found critically high in all. Daily administration of 1,100 mg ionized calcium in 17 of these patients die not change the urinary excretion of oxalate, calcium and magnesium separately, but the stone index was reduced significantly suggesting some preventive effect of calcium on the tendency of stone formation after jejunoileal bypass.
Assuntos
Cálcio/uso terapêutico , Íleo/cirurgia , Jejuno/cirurgia , Obesidade/terapia , Cálculos Urinários/tratamento farmacológico , Adulto , Cálcio/urina , Creatinina/urina , Feminino , Humanos , Magnésio/urina , Masculino , Oxalatos/urina , Ácido OxálicoRESUMO
The effect of 1-day treatment vs. 4-day treatment with metronidazole and ampicillin in association with primary closure of perianal and pilonidal abscesses was evaluated in a double-blind clinical trial. The patients were randomly allocated to 1-day (group I) or 4-day (group II) antibiotic regimen. No clinical signs of sepsis appeared in any patient. Primary healing, without fistula formation was achieved in all 17 perianal abscesses in the 1-day therapy group and in 14 of 15 in the 4-day group (non-significant difference). Excision with primary suture of pilonidal abscess resulted in primary healing in 20 of 26 cases in group I and 20 of 30 in group II (non-significant difference). Healing with formation of a new sinus or secondary healing occurred in four and two cases, respectively, in the 1-day therapy group, and in two and nine of the 4-day group. One-day administration of metronidazole/ampicillin is as effective as 4-day treatment in primary closure of perianal and pilonidal abscess. The procedure appears to be safe in both groups, but more efficacious in perianal abscess.
Assuntos
Abscesso/cirurgia , Ampicilina/administração & dosagem , Canal Anal/cirurgia , Metronidazol/administração & dosagem , Seio Pilonidal/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Canal Anal/patologia , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seio Pilonidal/patologia , Estudos Prospectivos , SuturasRESUMO
The concentration of magnesium in muscle was determined and a standardized magnesium load test was performed in 21 patients, who 4 to 10 years previously had undergone intestinal bypass operations for severe obesity. The plasma concentration and 24-h urinary excretion of magnesium were also studied. Basic urinary excretion of magnesium and muscle magnesium were significantly lower in patients compared to healthy controls, while no differences were found in plasma magnesium. A slight negative correlation between muscle magnesium and retained magnesium was demonstrated (r = -0.51, P less than 0.05). Patients with magnesium retention greater than 20 per cent showed a significant decrease of magnesium retention after treatment with magnesium chloride mixture. Four patients with primarily low muscle magnesium all demonstrated an increment in the amount of magnesium in muscle after treatment. The load test described can be applied as a screening test in diagnosing magnesium deficiency.