Monitoring of antimicrobial prophylaxis in general surgery.

The incidence of infections in general surgery is related to different factors. Cost-benefit analysis of antimicrobic prophylaxis is positive, even though incorrect use may be even dangerous (development of resistance and/or superinfections, for instance). The authors report data on a study concerning a total of 316 patients divided into two series, who had antimicrobic prophylaxis before a surgical operation. 274 patients out of 316 (or 86.7%) had an ultra-short (one-shot-only) or short (<24 hours) prophylaxis, 42 (13.3%) standard (>24 hours). The operations performed were classified following class of contamination, i.e. I (clean), II (potentially contaminated), III (contaminated). Antibiotics used were ceftizoxime, cefepime, ceftriaxone, piperacillin and gentamicin in combination. A total of 16 postoperative infections was observed (5%); 11 of these 16 belonged to class III operations. Escherichia coli and Staphylococcus aureus were isolated in most of the infected wounds. The data confirm what is reported in the literature. The authors conclude that a preoperative single-shot 3rd or 4th generation cephalosporin reduces the incidence of wound infections in clean and clean-contaminated surgery.

[Hepatic and renal trauma: importance of arteriography in diagnosis and treatment]. / I traumi del fegato e del rene: importanza dell'arteriografia in diagnosi e terapia.

OBJECTIVES: The aim of this study was to show the importance of non-invasive approach in diagnosis and treatment of renal and hepatic trauma, using arteriography as primary treatment in moderate-severe grade injury. MATERIALS AND METHODS: We observed 24 cases of hepatic and renal trauma in four hospitals in Rome in the 1996. Trauma were classified about their type and gravity (11-19) and ATLS classification for emodinamical conditions (1) were used to classify patients (Tab. I). RESULTS: 12 patients were treated with surgery because of their unstable haemodinamical conditions (III IV classes of ATLS classification) (1). Four patients were treated by arteriographical embolization (in two cases arteriography was primary used) with complete solution of sintomatology. DISCUSSION AND CONCLUSION: Arteriography was an importance procedure in non surgical treatment of hepatic and renal trauma in haemodinamically stable patients. In our study patients treated with arteriographic embolization were definitively restored from hemorrhage. In diagnosis and treatment of these injuries was essential the team collaboration between radiologists and surgeons.