A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II (P<0.05). The reduction in infection rate was significant (P<0.05) in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis. Ann Saudi Med 1994;14(3):233-236. A considerable morbidity following appendectomy is caused by wound infection, 1-5 the rate of which ranges from 9% to 30% in early appendicitis and may reach up to 70% in advanced appendicitis.3-6 Systemic antibiotics were shown to reduce the wound infection rate significantly. 3,4,7 In vitro studies demonstrated 100% kill rates with clinically usable concentrations of antimicrobials in irrigating solutions after only 60-second exposure of the organisms. 8,9 Unlike parenterally administered antimicrobials, topical usage was found to attain prolonged effective local concentrations when used in the powder form. 10Experimental studies have shown that the combined use of systemic and topical antibiotics is better in advanced appendicitis than systemic antibiotics alone.11 Similarly, Seco et al. 12 have concluded in a clinical study that prophylaxis with a combination of systemic clindamycin and topical ampicillin solution, when compared with systemic clindamycin alone, was more effective in preventing wound infection after appendectomy, especially in patients with high wound contamination. However, the study of Seco et al. was criticized because the control group wounds were not irrigated with normal saline and clindamycin may not be the systemic antibiotic of choice for many surgeons. This communication aims at investigating the efficacy of the addition of topical ampicillin to systemic antimicrobials in reducing post appendectomy wound infection rate in a properly controlled randomized prospective study. Material and MethodsAll patients who underwent appendectomy through gridiron incision for clinically suspected acute appendicitis were considered for the study. Exclusion criteria were allergy to ampicillin and other systemic diseases requiring systemic antibiotic administration and therefore three patients who were allergic to ampicillin were excluded from the study, as well as another two patients who had valvular heart disease warranting preoperative prophylactic systemic ampicillin in addition to the systemic gentamicin and Flagyl. A total of 254 patients fulfilled the criteria of the study and were random...
AA Batouk, AM Albdah, HA Agina, AR Khan, Primary Pleural Liposarcoma. 1995; 15(2): 159-161 Liposarcomas are among the most common mesenchymal tumors occurring in adults.1 They occur mostly in the soft tissues of the lower extremities, retroperitoneum, peritoneum and shoulder region. Primary intrathoracic liposarcomas are, however, very uncommon; Razzak et al.2 in 1971 published 44 such cases, of which 43 originated in the mediastinum and one in the pulmonary hilum. These authors, however, did not list any liposarcoma which arose from the pleural surfaces. Later in 1982, Sawamura et al.3 reported seven cases of primary pulmonary liposarcoma. Most of them present within the lung parenchyma. Our review of literature revealed eight cases of pleural liposarcoma.1,4-7 We like to add here another indubitable case of well-differentiated pleural liposarcoma. Case ReportA 55-year-old female presented in the Outpatient Department of King Saud Hospital in Unaiza, Al-Qassim with a history of mild dull aching pain in the right upper chest for the last seven months. She also had mild difficulty in breathing for one month prior to this admission. She was a known case of hypertension and diabetes and had received atenolol (Tenormin) 50 mg once daily and glucophage 500 mg twice daily for the last five years. There was no history of smoking. On physical examination, the blood pressure was 140/70 mm/Hg and the heart rate was 74/min. She was slightly obese with mild shortness of breath. On auscultation, decreased air entry in the right upper lung was noted. The examination of blood revealed hemoglobin concentration to be 11.2 g/dL, white cell count 10.4x10, random blood sugar 7.27 mmol/L. Plasma electrolytes, liver function tests, and blood chemistry were normal. Arterial blood gas analysis was pH 7.345, PCO 2 40.6 mm/Hg, HCO 3 21.7 mm/L, PO 2 69.2 mm/Hg, oxygen saturation 92.3%. Examination of the sputum for acid fast bacilli, neoplastic cells and asbestos bodies was negative. The patient was unable to perform pulmonary function tests. Chest radiograph showed a large well-defined oval opacity in the right upper zone and normal heart size (Figures la and b). A thoracic axial computed tomographic scan showed a well-defined soft tissue mass occupying the apical region of the right hemithorax measuring 5.2x4.5 cm (Figure 2). Bronchoscopy was not considered as the mass was seen on the CT scan outside the lung parenchyma.
A retrospective analysis of 27 sternal fracture patients out of 267 patients with chest trauma was done in the period between March 1990March (9-1410 and April 1994April (11-1414 at Asir Central Hospital, giving an incidence of 10% in all chest trauma. There were 25 males and two females, giving a ratio of 12.5:1. The age range was 18-70, with a mean age of 37.5 years and a median age of 35 years. The mean hospital stay was 12.2 days, with a range of 3 to 53 days and a median of seven days. The mechanism of injury and the types of associated injuries are presented. Twentyeight percent of the sternal fracture patients had abnormal electrocardiogram. Echocardiogram was done on only eight patients (32%); two were abnormal. Ann Saudi Med 1996;16(3):285-290. A Batouk, Sternal Fracture -Regional Experience. 1996; 16(3): 285-290 In 1751, Du Verney reported an exceptional case of compound fracture of the sternum in a quarry man.1 In 1864, Gurlt cited a series of 22,616 fractures of all types; among them were only 22 cases of uncomplicated fracture of the sternum caused by indirect violence.2 Different mechanisms have been reported, among which are muscle contraction 3 and labor, 4 but the most frequent cause of sternal fracture is the forceful impact of the sternum against the steering column of an automobile after a rapid deceleration. 5,6 Seat belts have been blamed in many studies. 7-9The bone injury itself has generally been reported as being inconsequential. The degree of association of sternal fracture with other types of injury, such as myocardial, major thoracic, vascular and spinal, is, however, significant. 10-18Our objectives are to determine the incidence, morbidity and mortality of patients with fractures of the sternum, to identify specific features of the sternal fracture which may predict the outcome, and to identify the factors that affect the duration of hospital stay in patients with sternal fracture. MethodsAsir Central Hospital is a 450-bed hospital in Abha City, located in the southwestern region of Saudi Arabia. It is a tertiary hospital, Level II Trauma Center, with a catchment population of one million.Data were collected from the medical records of 267 patients with chest trauma between March 1990 (9-1410) and April 1994April (11-1414, of whom 27 patients had sternal fracture. These were analyzed with regard to demographics, area of sternal fracture, admission electrocardiographic (ECG) and echocardiographic changes, treatment modalities and outcome of treatment.ECG was classified as abnormal when there were arrhythmias, conduction defects, nonspecific ST segment or T-wave changes, evidence of anatomical specific ischemia, sinus tachycardia or any other abnormality interpreted by a cardiologist. Chi-squared, two-tailed, Fisher's exact and Mann-Whitney-Wilcoxon tests were used as tests of significance at a 5% level of significance. ResultsDuring the four-year study period, there were 267 patients who sustained chest trauma, among whom 27 were found to have sternal fracture, giving an ...
Signet ring cells consider one of the rare diagnosis that can be managed among the oncological diseases.Confined on poor prognosis and advancement of their stage.Not seems to be affected properly with the chemotherapy. And still the surgical option is the best in operable case to decrease the burden
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.