A prospective random study of a single agent versus combination antibiotics as therapy in penetrating injuries of the abdomen.

One hundred patients undergoing operation for penetrating and potentially contaminated wounds of the abdomen were given cefamandole or a combination of cephalothin-tobramycin by a random, single blind method as preventive therapy. Results were evaluable for 49 patients receiving cefamandole for a success rate of 93.9 per cent. The 45 evaluable results in the second group had a success rate of 88.9 per cent. Those in the single therapy group also required fewer days of treatment and of hospital confinement, resulting in lower per patient cost. Results of this study show cefamandole to be an efficacious alternative for surgeons seeking a single agent therapy.

Cholecystitis and delayed emptying of the gallbladder.

A number of patients with symptoms of biliary colic have biliary tract disorders despite repeatedly normal oral cholecystograms. These patients will benefit from cholecystectomy. To better define such disorders, a test is needed that is noninvasive, relatively inexpensive and highly accurate. Delayed emptying of the gallbladder after a standard dosage oral cholecystogram using Telepaque is such a test. Twenty-eight patients with this finding underwent cholecystectomy. All gallbladder specimens exhibited both gross and pathologic changes. Twenty-six of the patients had relief of symptoms.

A clinical and bacteriologic evaluation of cefamandole therapy in serious skin and skin structure infections.

The results of this study suggest that the enhanced in vitro spectrum of cefamandole may be clinically advantageous, particularly when complex mixtures of aerobic and aerobic-anaerobic bacteria are present in the lesions of serious skin and skin structure infections. The reported incidence of satisfactory clinical and bacteriologic responses appears to justify the use of cefamandole as a single agent for the treatment of these infections.

Cephalothin-tobramycin as a preventive antibiotic combination.

Antimicrobial therapy should never be used indiscriminately, nor can it take the place of meticulous surgical technique. Appropriate antimicrobial agents administered within the critical time period and in the recommended dosage to achieve adequate serum concentrations effectively reduce the incidence of postoperative wound and other systemic infections. The low incidence of infection and virtual absence of adverse effects strongly suggest that cephalothin-tobramycine combination therapy is a valuable adjunct in emergency surgical procedures.

Treatment of second degree burns: nitrofurazone, povidone-iodine, and silver sulfadiazine.

Nitrofurazone (N), povidone-iodine (P), and silver sulfadiazine (S) were compared in the emergency department outpatient treatment of 84 patients suffering second degree burns over less than 15% (adults) or 5% (children) of their total body surface area. Indices of healing were percent of healing, degree of dryness, crust separation, eschar separation, tissue granulation, and wound pain. Statistical analysis indicates that healing in N-treated patients was superior to that in S-treated patients: tissue granulation began sooner, crusts separated more rapidly, wounds were dryer, and the amount of healing at two weeks was greater. Results in P-treated patients were equivalent to those in N-treated when cases with complications were excluded from analysis. Among patients with less serious burns, N-treated patients suffered less pain than S-treated, but there was no significant difference in pain between N and P or between P and S. In patients with more serious second-degree burns there was more pain with P than with N, but neither P nor N differed significantly from S in this regard.

Falciform ligament. A possible twist?

Abdominal pain radiating to the right upper quadrant, producing peritoneal signs, developed in a 30-year-old pregnant woman. At surgery, she was found to have an infarction of the falciform ligament that was excised.

Gastric fistula following splenectomy: its cause and prevention.

Gastro-cutaneous fistula following splenectomy, a rare but serious occurrence, may result in death or prolonged disability. Six previous cases have been reported in detail, while 8 others have been mentioned briefly. The current report reviews the literature and describes 4 additional instances of this complication. Two of the 4 patients died. Sever factors, acting singly or incombination, may predispose to the development of post-splenectomy gastrocutaneous fistulas. These include direct surgical trauma to the gastric wall, generalized arteriosclerotic disease, hematoma in the gastrosplenic omentum, and reflection of gastric muscle fibers into the gastrosplenic ligament. The usual site of rupture of stomach is along the greater curvature in the fundic portion. In circumstances in which splenectomy is associated with known or suspected compromise of the blood supply to this portion of the stomach, a method of enfolding the greater curvature is proposed to prevent the development of a gastro-cutaneous fistula. Awareness of the possibility of this uncommon but serious complication will aid in its early recognition and treatment.