Antibiotic prophylaxis for hernia repair.

BACKGROUND: The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES: The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair. SEARCH STRATEGY: In the present review, we searched for eligible trials in august 2006, using the search terms below. This revealed four new included trials (total of twelve). We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline and Embase was conducted using the following terms: #1 antibiotic* or antimicrob* or anti infecti* or antiinfecti*; #2 prophyla* or prevent*; #3 #1 and #2; #4 clean and (surgery or tech* or proced*); #5 herni*; #6 (wound infection) and #4; #7 #3 and (#4 or #5 or #6). Reference lists of the included studies were checked to identify additional studies. SELECTION CRITERIA: Only randomized clinical trials were included. DATA COLLECTION AND ANALYSIS: Twelve randomized clinical trials were identified. Six of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorraphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A random effects model was used in the analysis. MAIN RESULTS: The total number of patients included was 6705 (treatment group: 4128, control group: 2577). Overall infection rates were 2.9% and 3.9% in the prophylaxis and control groups, respectively (OR 0.64, 95%CI 0.48 - 0.85). The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 - 1.00). The subgroup of patients with hernioplasty had infection rates of 1.4% and 2.9% in the prophylaxis and control groups, respectively (OR 0.48, 95% CI 0.27 - 0.85). AUTHORS' CONCLUSIONS: Based on the results of this meta-analysis the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Nevertheless, its administration cannot either be recommended against when high rates of wound infection are observed.

[Effect of preconceptional metabolic control in the course of pregnancy in diabetic patients]. / Influencia del control metabólico preconcepcional en la evolución de la gestación de la paciente diabética.

BACKGROUND: We analysed the relationship between metabolic control parameters during the preconception stage and pregnancy outcome in diabetic patients. PATIENTS AND METHOD: We examined 69 diabetic patients who underwent a preconception control at the Diabetes and Pregnancy Unit between 1992-1998. At the end of the preconception care period, 50 women (72.6%) became pregnant. Eight out of them (16%) had an abortion. RESULTS: Women who had an abortion did not differ from those who had not an abortion with regard to HbA1c levels at the end of the preconception period, age, duration of diabetes, age at diagnosis,anti-thyroid antibodies or microvascular disease. Among 41 single age stations, fetal macrosomia was observed in 36.6% cases, neonatal hypoglycemia in 19.5% and major congenital malformations in one case. Average level of HbA1c was 7.6 +/- 1.3%and 6.5 +/- 0.7 at the beginning and at the end of the preconception period, respectively (p < 0.001). In the group with macrosomia,average HbA1c at the end of the preconception period was 6.8 +/- 0.66% as opposed to 6.3 +/- 0.7% for the non-macrosomic group (p < 0.05). A linear correlation was seen between HbA1c levels at the end of the preconception period and infant weight (r = 0,432; p = 0,014), birth weight ratio (r = 0,450; p = 0,009), and a morbidity score (r = 0,458;p = 0,007). CONCLUSIONS: A better metabolic control during the preconception period may contribute to lessen the risk of fetal macrosomia and neonatal morbidity.

[Antibiotic prophylaxis and hernia repair. Systematic quantitative review results]. / Profilaxis antibiótica y reparación herniaria. Resultado de una revisión sistemática cuantitativa.

BACKGROUND: The usefulness of the antibiotic prophylaxis in hernia repair is currently a controversial subject. Comparative studies have shown disparate results, and that is why it is difficult to have a clear idea of its utility. The purpose of the present study is to make a systematic quantitative review or meta-analysis of the published controlled studies on antibiotic prophylaxis in hernia repair, to give the best possible evidence as to the effectiveness of this prophylaxis. METHODS: The described steps for the realization of a systematic quantitative review, based on the practice of evidence based medicine, have been followed. The steps are these: formulation of a relevant question (is antibiotic prophylaxis useful in open inguinal hernia repair in the prevention of post-operative infection of surgical wound?), search of the best available evidence, selection criteria of those trials found, analysis of each one of them, combination of the results (Yusuf and Peto method) and conclusions.Results. Twelve studies were found, of which eight fulfilled the inclusion criteria for the meta-analysis. Our results show that antibiotic prophylaxis in hernia repair, whether prosthetic material is used or not, diminishes the rate of infection by 42%, 61% and 48% in herniorraphies, hernioplasties and the two combined, respectively. The number of patients to whom prophylaxis was administered in order to avoid a post-operative infection was 42 for herniorraphies, 37 for hernioplasties and 40 for general hernia repair.Conclusions. Antibiotic prophylaxis in hernia repair is useful in preventing wound infection. Nevertheless, this does not imply its indiscriminate administration, rather it is necessary to base it on the local rate of wound infection and on the analysis of the patients' risk factors in order to avoid its administration when the possible benefit is considered to be limited.

[Extramedullary plasmacytoma and hypercalcemia]. / Plasmocitoma extramedular e hipercalcemia.

Extramedullary plasmocytoma (EMP) is an infrequent entity characterized by the proliferation of malignant plasma cells which are generally found on the mucosa of the upper respiratory tract. A case of EMP located in the right maxillary sinus is referred. Peculiarities of the same were resistance to radiotherapy with local relapse and severe hyperkalemia. Despite deliberate searching, disease dissemination could not be demonstrated.

[An unusual case of systemic toxocariasis]. / Una presentación poco usual de toxocariasis sistémica.

Systemic toxocariasis generally causes fever, liver enlargement and lymph node swelling. This is an unusual case report which was initially confused with juvenile rheumatoid arthritis due to the presence of fever, arthralgias, arthritis of the smaller joints, important leukocytosis and hypergammaglobulinemia, besides testing positive for rheumatoid factor type IgM. After finding severe eosinophilia in both the patient's blood as well as in the bone marrow, systemic toxocariasis was diagnosed also finding very high levels of antibodies against Toxocara canis using the ELISA technique. Briefly discussed are the clinical and laboratory data, and the management of systemic toxocariasis and the possible origin of the rheumatoid factor in this disease.