Spontaneous pneumothorax. When and how to treat.

INTRODUCTION: Spontaneous pneumothorax, whether primary or secondary, may occur in patients with or without a history of pneumonic disease. AIM OF THE STUDY: From 1992 to 2002, we treated 275 patients, 230 male and 45 female, in the department of Thoracic Surgery of the General Hospital of Nikaia-Piraeus. In this study the Authors report the data concerning the frequency correlated with age, sex, causes, symptoms, as well as the ways of treatment, in order to compare them and their results with those recorded in Greek and international literature. CONCLUSIONS: It is made obvious by our material that only approximately 10% of patients suffering from spontaneous pneumothorax need surgery (thoracotomy), while the remaining patients can be managed with closed thoracic drainage or conservative treatment and monitoring.

The value of chemoprophylaxis against Enterococcus species in elective cholecystectomy: a randomized study of cefuroxime vs ampicillin-sulbactam.

HYPOTHESIS: Cephalosporins are widely used and considered to be effective as prophylaxis in biliary surgery. Nevertheless, they lack activity against enterococci. We conducted a study to compare the efficacy of ampicillin-sulbactam vs cefuroxime in preventing surgical site infections following elective cholecystectomy. DESIGN: A prospective randomized controlled trial. SETTING: A major tertiary care hospital. PATIENTS: Four hundred eighteen randomized patients (of 549 total), who from July 2002 to August 2004 underwent elective open or laparoscopic cholecystectomy with prospective assessment for development of surgical site infections for 1 month postoperatively. INTERVENTION: A single intravenous dose of 1.5 g of cefuroxime (group A, n = 207) or 3 g of ampicillin-sulbactam (group B, n = 211) was administered during induction of anesthesia. Bile and gallbladder mucosal cultures were taken intraoperatively from all patients. MAIN OUTCOME MEASURE: Number of postoperative surgical site infections. RESULTS: A postoperative surgical site infection was noted in 19 (4.5%) of 418 patients, 18 from group A and 1 from group B (P<.001). In the group that received cefuroxime, 15 (83.3%) of 18 surgical site infections were due to Enterococcus species. Intraoperative bactibilia as well as intraoperative gallbladder rupture were associated with surgical site infections (P<.001). CONCLUSIONS: A single dose of ampicillin-sulbactam favored better compared with cefuroxime for prevention of postoperative surgical site infections due to Enterococcus species after elective cholecystectomy. Ampicillin-sulbactam may be a better agent for antimicrobial prophylaxis in high-risk patients undergoing elective cholecystectomy, especially in a setting where the incidence of enterococcal infections is higher.

Sternal fracture with or without associated injuries. Assessment of the difference in the diagnosis, management and complications. Eighteen years of experience.

AIM OF THE STUDY: To determine the incidence of sternal fracture as an isolated injury as well as those which presented with concomitant injuries, and compare them in order to manage them more effectively. The Greek and International Literature related to the subject was also reviewed. MATERIAL AND METHODS: From 1984 to 2002 the Authors treated 134 patients with sternal fracture in the Department of Thoracic Surgery of their hospital, 59 males and 45 females, age from 17 to 84 years. Ninety patients had isolated sternal fracture and 44 sustained in addition fractured ribs, flail chest, pneumo-haemothorax, pneumo-haemomediastinum, some of them experienced respiratory failure, vertebral fractures, myocardial infarction, heart contusion, pericarditis, head injuries, fractures of upper lower limbs and intraperitoneal bleeding. Twelve patients were admitted in ITU and 4 with multiple trauma were fatally injured. Aortic tears or ruptures didn't occur in any of our patients. Sternal fracture as an isolated injury has a better prognosis compared to those with associated injuries. CONCLUSIONS: The management of sternal fracture is usually conservative with a good outcome, provided early diagnosis and treatment of concomitant injuries is offered from a well-trained and experienced medical team.

A causal factors and treatment of obstructive ileus in 369 patients.

From 1998 to 2002, 369 patients (47.39% M, 52.61% F; mean age 67.9 yrs) were faced in the Authors' Department due to acute intestinal obstruction. The main reasons of obstruction were adhesions in 281 patients (76.15%), followed by malignant neoplasms of large intestine in 41 patients (11.11%) hernias in 9 patients (2.44%), Ischemic colitis (4.1%), bezoars (2.39%), bile stone (2.71%) and volvulus (1.1%). In this study the clinical and laboratorial investigation, the preoperative preparation and the applied surgical treatment of patients with obstructive ileus are discussed. Also it is stressed the importance of the proper preoperative support, as well as the convenient surgical confrontation of patients.