Pus from 84 patients with subcutaneous abscesses was examined for aerobic and anaerobic bacteria: organisms were recovered from 70 (83.3 per cent). In 13 no organisms were seen in the Gram-stained smears and the cultures showed no bacterial growth. Staphylococcus aureus was the most prevalent organism (n = 44), isolated in 43 in pure culture, in marked contrast to the anaerobic organisms which almost invariably were associated with mixed cultures. All patients were treated by the primary suture method. Half of them were not given preoperative antibiotics and 3 developed bacteraemia and 1 septicaemia. Blood isolates were of S. aureus of the same phage type as pus isolates. The other patients received one infection of 300 mg of clindamycin phosphate 30 min to 1 h before surgery. From this group only one patient, with a perianal abscess, developed Escherichia coli bacteraemia. The levels of clindamycin in the abscess aspirate were inhibitory for S. aureus, bacteroides, streptococci and other Gram-positive bacteria but not for E. coli.
We assessed the value of measuring serotonin (5-hydroxytryptamine) in plasma (by HPLC) in the diagnosis of acute appendicitis. Values for patients with subsequently confirmed appendicitis (11-145 nmol/L, median 70 nmol/L) significantly (P congruent to 0.005) exceeded those for patients with abdominal pain in whom appendicitis was only a possible diagnosis (2-45 nmol/L, median 20 nmol/L). The results for appendicitis patients were bimodally distributed, with low results found in patients where surgery revealed gangrenous appendicitis with little viable appendicular tissue. We conclude that measuring serotonin may be of value in confirming or excluding the diagnosis of early acute appendicitis where the physical signs are equivocal, and thus helps reduce unnecessary appendectomies. However, serotonin is of little help in diagnosing gangrenous appendicitis, where physical signs are more likely to be clearcut.
A urinary test strip for amylase (Rapignost-Amylase) was compared with plasma amylase assay in samples of urine and plasma collected on the day of admission to hospital from 23 patients with acute pancreatitis and 38 patients with other causes of acute abdominal pain. Plasma amylase was greater than 1200 IU/l in 24 patients (23 with pancreatitis and 1 with a perforated duodenal ulcer) and all were Rapignost-Amylase positive. Twenty-nine of the remaining patients were Rapignost-Amylase negative, but there were eight "false positives' with plasma amylase levels of 86-474 IU/l. The Rapignost-Amylase test is of potential value to screen for clinically occult acute pancreatitis.
A four-way, double-blind, prospective trial of treatment of abscesses by incision, curettage, and primary closure with and without antibiotic cover (clindamycin injection before operation or capsules after operation, or both) was conducted. There was no appreciable difference in mean healing time between the patients given both the antibiotic injection and the antibiotic capsules and those given the injection and placebo capsules, whereas healing times in those given the placebo injection and antibiotic capsules or placebo only were appreciably longer. Four of the patients who were not given the antibiotic injection developed bacteraemia; one patient who was given the antibiotic injection also developed a bacteraemia, but this was caused by clindamycin-resistant bacteria. These results show that a single injection of an effective antibiotic before operation is sufficient to protect the patient against bacteraemia and permit optimum healing.
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