Scand J Infect Dis, 1988, 20(6), 633 - 9 Antibiotic prophylaxis in craniotomy: a prospective double-blind placebo-controlled study; van Ek B et al.; A prospective double-blind placebo-controlled study was performed to evaluate the efficacy of cloxacillin for the prevention of infections after craniotomy . 310 patients were admitted to the study . 39 died within 90 days after craniotomy without an infection, 20 and 19 of them belonging to the cloxacillin and placebo groups, respectively . In the cloxacillin group 6 neurosurgical infections occurred after 183 operations (3.3%) in 156 patients (3.9%), and in the placebo group 20 after 195 operations (10.3%) in 154 patients (13%) . These differences between the 2 groups are statistically significant (p less than 0.01 and p less than 0.05 for patients and operations, respectively) . For a craniotomy subgroup, there was no significant difference in infection rate between the cloxacillin and placebo groups . We conclude that cloxacillin significantly reduces the rate of infection after craniotomy, and recommend administration of this antibiotic for prophylaxis in patients undergoing this operation. Zentralbl Gynakol, 1988, 110(9), 575 - 7 {Once again: the perioperative antibiotic prophylaxis in cesarean section}; Fiedler FB et al.; In continuation of our clinical observations on perioperative prophylaxis by application of Halospor and Gentamicin the dosage of Halospor has been reduced to 2 grams once only . According to our experiences in 98 cases of cesarean section we can recommend these advance: fever in 12.2% (21.2% without prophylaxis), secondary wound-healing in 2% (6.7%) and therapeutical antibiotics in 13.3%, Metronidazol as often as not (36.6%). Arthroscopy, 1988, 4(1), 10 - 4 Septic arthritis following arthroscopy, with cost/benefit analysis of antibiotic prophylaxis; D'Angelo GL et al.; Nine cases of septic arthritis following arthroscopy are reviewed retrospectively . All cases of septic arthritis followed arthroscopic surgery . The average age of the patients was 49 years . The diagnosis was confirmed by bacterial cultures of the joint aspirates . All cases were treated by appropriate antibiotics supplemented by repeat arthroscopy and placement of a suction irrigation system . The average stay in hospital was 21 days . The authors suggest that it is not possible to predict such a major complication based on risk factors and therefore present a cost/benefit analysis of antibiotic prophylaxis using first-generation cephalosporins as a possible means of reducing hospital costs and patient morbidity. Zentralbl Gynakol, 1988, 110(19), 1218 - 23 {Preventive use of antibiotics in obstetric-gynecologic operations}; Gerstner GJ; In the past decade modern, perioperative short-term antibiotic-prophylaxis has been widely accepted in certain gynecological operations and in caesarean section . Many studies demonstrate the clinical effectiveness . Well established indications are vaginal hysterectomy and high risk caesarean section with a high rate of infections . The infectious morbidity should be carefully evaluated at every department . The older Cephalosporins (first and second generation) should be used for prophylaxis. Ital J Surg Sci, 1988, 18(3), 259 - 65 Ventral incisional hernias: incidence, date of recurrence, localization and risk factors; Regnard JF et al.; Over an 8-year period, 1246 consecutive patients undergoing abdominal surgery were followed up postoperatively for a maximum of 5 years to study retrospectively the incidence, date of occurrence location and risk factors of incisional hernia . Only 1081 cases were assessable . Overall 94 incisional hernias (9%) were evidenced . The actuarial rate of incisional hernia was shown to be 13% at 5 years, occurring during the first 24 months in 80% of cases . Risk factors were analyzed according to four parameters: patient's status, underlying disease, surgical technique, postoperative complications . Morbid obesity, underlying disease, emergency surgery, wound or deep abscesses or early reoperation were all statistically significant factors . From the overall analysis of results it is shown that at 5 years 13% of patients at risk present postoperative incisional hernia . The two main factors on which surgeons are able to act preventively are the choice of incision site and the onset of wound abscesses . Subcostal incision is the most suitable and prevention of abscesses can be obtained essentially by antibiotic prophylaxis. Chir Pediatr, 1988, 29(6), 336 - 41 {Early excision and grafting in the burned child . Apropos of 49 cases studied retrospectively 1986-1987}; Boussard N et al.; Early excision and grafting (EEG) is a commonly-used surgical technique which limits the risk of infection and improves healing . However, when used on children, their particular anatomic and physiological specificities must be taken into account . The authors present a retrospective investigation concerning 49 EEG performed on 45 patients from five months to nineteen years old, presenting a burnt skin surface of between 1% and 70% . This short operation (1 h 30) gives rise to an important and early haemorrhage induced by blood losses which are impossible both to stop and to evaluate . This explains the frequency and the severity of the peroperative complications (one cardiocirculatory deficiency, eleven low blood pressure/tachycardias) related to an underestimated blood loss . The post-operative period is characterized by hemodynamic, infectious and hypothermic complications . As regards operative results, they can be considered to be good or excellent in 80% of the cases both from a functional and an anaesthetic point of view . In order to decrease the important operative morbidity related to EEG in the case of children, the authors stress the necessity or taking certain precautions: During the operative period --Antibiotic prophylaxis against cutaneous bacteria when the excision is important and BSS greater than 20%; --ordering sufficient quantities of blood and plasma taking into account the estimated amount of blood losses during the per and post-operative period, and also with regard to the patient's weight and the excised (AE): During the operation --prevention of hypothermia by the permanent use of an infrared radiator, warming up the solutions before perfusion, using of a heating mattress...); --provision of two large diameter venous passages; --initiation of the transfusion before the first incision.(ABSTRACT TRUNCATED AT 250 WORDS) Curr Med Res Opin, 1988, 11(3), 159 - 70 Infectious problems in elective non-colorectal abdominal surgery . The Norwegian Gastro-Intestinal Group (NORGAS); The use of vascular clips to minimize blood loss in colpourethropexy; Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los AngelesA serious intraoperative and postoperative complication associated with colpourethropexy as described by Burch and Tanagho and others is hemorrhage . We performed the Tanagho modification of the Burch procedure in 13 patients, as the sole procedure in the treatment of genuine stress incontinence . Vascular clips were used to circumscribe the fat overlying the anterior part of the vaginal wall, thereby allowing en bloc resection of the vascular fat pad . Suspensory sutures of 1-0 Vicryl (polyglactin 910) were placed; no retroperitoneal drains were used . The blood loss was estimated to be less than 50 milliliters in ten instances and less than 75 milliliters in three . The average hospital stay was 4.2 days . All of the patients were given antibiotic prophylaxis and were discharged home with suprapubic drainage of the bladder . There were no intraoperative or postoperative complications . Thus, one of the serious complications of colpourethropexy can be avoided by using vascular clips to facilitate the removal of the periurethral and paravesical fat from the anterior part of the vaginal wall. Z Geburtshilfe Perinatol, 1987 Nov-Dec, 191(6), 238 - 42 {Puerperal uterine inversion}; Gauwerky JF et al.; Inversion of the uterus is a rare but dangerous postpartal complication . Morbidity and Mortality depend to a significant degree on early diagnosis and treatment . When the condition is detected early manual reposition and simultaneous shock therapy, which are usually possible, are of prime importance . Antibiotic prophylaxis should always be instituted in order to prevent any upward spread of infection . With appropriate obstetric management subsequent births can be uncomplicated, as in the case described by the authors. J Bone Joint Surg Br, 1987 Nov, 69(5), 787 - 9 Antibiotic prophylaxis with cefuroxime in arthroplasty of the knee; Johnson DP; A randomised prospective trial was undertaken of antibiotic prophylaxis given at various intervals before inflation of the tourniquet for arthroplasty of the knee . Cefuroxime assays of bone and subcutaneous fat from samples collected throughout the operation demonstrated that an interval of 10 minutes was necessary to obtain adequate prophylaxis . Improvement in the timing of antibiotic prophylaxis may result in a reduction in the incidence of infection. Presse Med, 1987 Oct 10, 16(33), 1633 - 5 {Antibioprevention in reconstructive arterial surgery . A double-blind study}; Branchereau A et al.; Routine antibiotic prophylaxis in reconstructive vascular surgery was established on a small number of controlled trials . A comparative double-blind study of cefazolin versus placebo was conducted in 179 patients who underwent reconstructive vascular surgery over a 23 month period . The surgical procedures were divided in three groups: aorto-iliac reconstructions (112 cases) infra-inguinal reconstructions (50 cases), extra anatomic by-passes (17 cases) . The arterial diseases encountered and the systemic and local conditions in favour of infection were equal in the 2 randomized groups . Among the 93 patients who received cephazolin, 13 (13.97%) developed an infection which was systemic in 1 case and local in 12 cases; 1 amputation and 1 death were observed in this group . In the placebo group 26 patients among 86 (30.23%) developed an infection, systemic in 4 cases and local in 22 cases with 1 death and 1 amputation . Statistical analysis (chi-square test) showed a significant difference in favour of the active substance . A short time massive dose of antibiotic administered in the perioperative period is the best method to reduce the incidence of infection in this type of surgery. Am Surg, 1987 Oct, 53(10), 584 - 6 Role of antibiotic prophylaxis in surgery for nonperforated appendicitis; Coleman RJ et al.; This report examines the efficacy of preoperative antibiotics in cases of nonperforated appendicitis . The charts of 61 patients who had an operative and pathologic diagnosis of acute nonperforated appendicitis were reviewed . Thirty-one patients received preoperative cephalosporins, and in one patient (3.2%) a subsequent wound infection developed . Of 30 patients who did not receive preoperative antibiotics, four (13.2%) patients developed septic complications . The difference in postoperative septic complications between these groups is not statistically significant (P = .3310) . Preoperative prophylaxis with cephalosporins in cases of nonperforated appendicitis is not indicated. Gynecol Oncol, 1987 Oct, 28(2), 201 - 4 Antibiotic prophylaxis for radical abdominal hysterectomy; Bendvold E et al.; Records of 35 patients with cervical cancer Stage IB operated with radical abdominal hysterectomy and pelvic lymphadenectomy were surveyed retrospectively for incidence of febrile morbidity and site-related infections . Febrile morbidity was observed in 6 patients (17%) . No surgical site-related infections were observed . It is concluded that radical abdominal hysterectomy in our hospital does not carry any significant risk of postoperative site-related infections and that prophylactic antibiotics cannot be recommended. Acta Chir Scand, 1987 Oct, 153(10), 571 - 5 Single-dose v . short-term antibiotic therapy for prevention of wound infection in general surgery . A prospective, randomized double-blind trial; Oostvogel HJ et al.; To investigate the effectiveness of a single-dose antibiotic regimen for preventing postoperative wound infection, a prospective, randomized double-blind trial was carried out in patients undergoing "clean-contaminated", "contaminated" or "clean" (vascular) surgery . Both elective and emergency operations were included . Single-dose (preoperative) prophylaxis was compared with short-term prophylaxis (1 dose preoperatively and 2 doses postoperatively) . The antibiotics were penicillin, tobramycin and metronidazole in various combinations, and comparisons between single-dose and short-term prophylaxis were made with all the regimens . The incidence of wound infection was 5/277 (1.8%) in the short-term group and 9/287 (3.1%) in the single-dose group . The difference was not statistically significant . Nor was statistically significant difference found when the type of operation and the degree of contamination were considered . Single-dose antibiotic prophylaxis thus gave a low incidence of postoperative wound infection, even in "clean-contaminated" or "contaminated" cases. Int J Clin Pharmacol Ther Toxicol, 1987 Oct, 25(10), 582 - 8 Ceftazidime in antibiotic prophylaxis for emergency cesarean section: a randomized prospective study; Tassi PG et al.; The efficacy of two randomized antibiotic prophylactic schedules with ceftazidime (group A: single preoperative 2 g intramuscular dose; group B: 3 perioperative 1 g intramuscular doses every 6 h) was evaluated in 200 pregnant women undergoing cesarean section . Postoperative complications were observed in 9 cases (4 in group A and 5 in group B; p = NS) . Analysis of possible risk factors revealed 1) a relationship between postoperative morbidity and overweight (body mass index above 30) in group A only; 2) a possible contributory effect of duration of labor (more than 6 h) in group A; and 3) a possible effect of duration of rupture of the membranes (more than 6 h) in group B only . The results obtained lead to the conclusion that single-dose prophylaxis with ceftazidime is as effective as short-term 3-dose ceftazidime prophylaxis in preventing post-cesarean complications. Arch Otolaryngol Head Neck Surg, 1987 Oct, 113(10), 1055 - 7 Antibiotic prophylaxis for facial fractures . A prospective, randomized clinical trial; Chole RA et al.; Although antibiotics are widely used in an attempt to decrease the incidence of infections after facial fractures, no systematic prospective study of their efficacy has been performed . In this study, all adult patients with facial fractures who had not received antibiotics were asked to participate in a clinical trial . There were 101 patients with facial fractures enrolled into the study and randomized prospectively into two groups . One group received no antibiotics . The other group received cefazolin sodium, 1 g intravenously, one hour prior to the surgical procedure, and a similar dose eight hours later . Of the 101 patients enrolled in the study, 79 had mandibular fractures, 18 had zygoma fractures, and four had Le Fort fractures . When all facial fractures were considered, perioperative intravenous cefazolin reduced the incidence of postoperative infections; 42.2% in the no-antibiotic group became infected, and 8.9% in the antibiotic group became infected . On the basis of this study, we conclude that cefazolin, used perioperatively, diminished the incidence of postoperative infections in facial fractures. Acta Chir Scand, 1987 Oct, 153(10), 577 - 80 Antibiotic prophylaxis in high-risk gastric surgery . A prospective, randomized clinical comparison of cefuroxime and doxycycline; Svaninger G et al.; The efficacy of two antibiotics as prophylaxis in high-risk gastric surgery was evaluated in a prospective, randomized trial: 400 mg doxycycline in a single dose (98 patients) was compared with 1.5 g cefuroxime given twice with an 8-hour interval (101 patients) . The two groups were comparable in regard to all relevant factors of importance for susceptibility to infection . The incidence of postoperative abdominal infection was 8.2% in the doxycycline group and 7.9% in the cefuroxime group . The most common extraabdominal infectious complications were in the lungs (20% of the patients in both groups) . No subgroup of patients was identifiable in which one antibiotic was superior to the other . The efficacy of the two investigated prophylaxis regimens was apparently identical. Int J Oral Maxillofac Surg, 1987 Oct, 16(5), 554 - 8 Postoperative contamination of mandibular osteotomy sites with saliva; Koole R et al.; Postoperative salivary contamination of surgical wounds around the mandible was found in several types of osteotomy and bone grafting procedure . This problem was investigated by determining the amylase content of wound secretions in redon bottles every 24 h . The implications for antibiotic prophylaxis are discussed. J Antimicrob Chemother, 1987 Sep, 20 Suppl A, 99 - 104 Controversies in the prophylaxis of infective endocarditis: a cardiological view; Oakley CM; Antibiotic prophylaxis is logical but it is impossible to prove its efficacy . Most cases of infective endocarditis follow seemingly 'spontaneous' bacteraemias and cases of seemingly 'failed' prophylaxis may have done the same, the prophylaxis having been 'successful' for the occasion for which it was given . We cannot find out how many cases of infective endocarditis would have occurred but for successful prophylaxis. J Antimicrob Chemother, 1987 Sep, 20 Suppl A, 87 - 98 Relevance of animal models to the prophylaxis of infective endocarditis; Glauser MP et al.; Intravascular or cardiac endothelial lesions may become colonized during bacteraemic episodes and lead to the development of bacterial endocarditis (BE) . It has therefore long been recommended that patients with known cardiac lesions receive prophylactic antibiotics before undergoing procedures that might release bacteria into the blood stream . Because clinical trials of antibiotic prophylaxis of endocarditis cannot be conducted in humans for ethical as well as for statistical reasons (Durack, 1985), the questions of which antibiotic, what dosage, and for how long are a matter of controversy . Unfortunately, these questions can only be studied in animals, with all the limitations that this type of approach brings with it . However, animal experimental studies have helped in understanding the conditions and, to some extent, the mode of action of antibiotics in preventing the development of endocardial infection, thus allowing some rationale for devising prophylactic recommendations for the various patients at risk of developing BE. J Antimicrob Chemother, 1987 Sep, 20 Suppl A, 105 - 9 A dental view of controversies in the prophylaxis of infective endocarditis; McGowan DA; Dental care of patients at risk of endocarditis must reflect changes in dental disease prevalence and in patients' expectations . Simplified recommendations on antibiotic prophylaxis are being widely applied. Ann Thorac Surg, 1987 Aug, 44(2), 173 - 9 Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures; Ottino G et al.; From January, 1979, to December, 1984, at the Cardiac Surgery Department of the University of Torino Medical School, major sternal wound infections developed in 48 (1.86%) of 2,579 consecutive patients . These patients underwent open-heart procedures through a midline sternotomy and survived long enough for infection to appear . Possible risk factors were evaluated by means of a multivariate analysis . For the group of patients, we considered age, sex, hospital environment (different locations of our surgical facilities over the years), interval between hospital admission and operation, antibiotic prophylaxis, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, postoperative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of treatment in the intensive care unit . Univariate analysis indicated that age, sex, type and mode of surgical procedure, antibiotic prophylaxis, and duration of mechanical ventilation were not significantly associated with wound infection . For all other predisposing factors, a p value of less than .05 was demonstrated . These variables were entered in a multiple stepwise logistic regression . Six emerged as significant: hospital environment (p = .0001), interval between admission and surgery (p = .041), reoperation (p less than .0001), blood transfusions (p = .031), early chest reexploration (p less than .0001), and sternal rewiring (p less than .0001) . Contamination of patients may occur before, during, and after operation, and any kind of reintervention may predispose to wound infection. HNO, 1987 Aug, 35(8), 355 - 9 {Perioperative prophylaxis with cefmenoxime and metronidazole in patients with head and neck tumors}; Geyer G et al.; Twenty-one patients with carcinoma of the larynx, hypopharynx and the tongue underwent surgery under perioperative prophylaxis with cefmenoxime and metronidazole . Healing was uneventful and the clinical and the chemical parameters remained normally . The level of the antibiotics was effective against most of the bacteria cultured from tracheal aspirate and the posterior wall of the oral cavity . Effective perioperative antibiotic prophylaxis is necessary in head and neck surgery: the use of simple antibiotics in short courses should be assessed. Am J Obstet Gynecol, 1987 Aug, 157(2), 491 - 7 Changing concepts in obstetric antibiotic prophylaxis; Galask RP; The evolution of antibiotic prophylaxis in cesarean section is traced from the discovery of sulfa compounds in the 1940s to the present . Prolonged courses of antibiotics, initiated before the surgical incision, have given way to shorter, three-dose and even single-dose regimens administered after clamping of the umbilical cord . Several factors have been proposed to help identify patients at greatest risk of infection . Guidelines for antibiotic prophylaxis are reviewed . The effects of antibiotics on host flora are described, and the implications of bacterial resistance for selection of a prophylactic agent, particularly with respect to induction of the Richmond-Sykes type I beta-lactamase enzyme, are discussed. Life Support Syst, 1987 Jul-Sep, 5(3), 223 - 31 Surgical aspects of permanent cardiac pacemakers; Kirk AJ et al.; This study discusses the surgical aspects of permanent cardiac pacemakers with reference to a ten-year review involving 628 procedures . The most suitable route for electrode placement was found to be subclavian vein puncture, access being achieved in 97% of cases . This method was however, associated with a small incidence of pneumothorax (1.4%) and haemothorax (0.9%) . The commonest late complication is infection in spite of sterile technique and antibiotic prophylaxis . Experience with infected pacemakers suggest that the best line of management is complete removal of the system followed by delayed replacement once the infection has been eradicated . Pacemaker technology is constantly improving, providing both patient and physician with increasingly elaborate tools . In order to reap the benefit of these pacemakers, the data from this review demonstrates the need for meticulous technique in their insertion and an ability to deal with any complication promptly and adequately. Drug Intell Clin Pharm, 1987 Jul-Aug, 21(7-8), 648 - 52 Surgical antibiotic prophylaxis, patient morbidity, and cost reduction: a three-year study; Scalley RD et al.; Twenty-five to 50 percent of all antibiotics prescribed for hospitalized patients are for prevention, not treatment, of infection . Procedures to institute rational, cost-effective utilization of these agents should have a significant impact on drug cost and pharmacy inventory . Several authors have described antibiotic cost reduction programs using pharmacy intervention . Unfortunately, measures that are successful in one institution may not be effective or appropriate in another . A three-year study was undertaken to examine the impact on physician prescribing of an infection control bulletin and formalized recommendation for antibiotic utilization . Patient records also were examined to determine if any change in antibiotic utilization would influence patient morbidity . Over the three examination periods there was a significant reduction in cost of prophylaxis in 7 surgical groups, and a trend toward cost reduction in 21 additional groups . Cost of prophylaxis also increased in other surgical groups . Cost reduction was associated with limited duration of prophylaxis and a shift toward use of first generation cephalosporin products . Patient morbidity did not differ significantly. Med Care, 1987 Jul, 25(7), 652 - 7 The impact of echocardiographic results on treatment decisions for patients suspected of mitral valve prolapse; Retchin SM et al.; Although echocardiography is frequently ordered in ambulatory settings for patients suspected of mitral valve prolapse (MVP), its impact on their subsequent management is unknown . We studied the relationship between the results of echocardiography for outpatients suspected of MVP, and two frequent medical decisions: treatment with beta blockers and the recommendation of antibiotic prophylaxis to prevent bacterial endocarditis . A medical record audit was performed on 274 outpatients referred to a university medical center echocardiography laboratory to rule out MVP . Although echocardiographic evidence for MVP significantly influenced the decision to recommend antibiotic prophylaxis (P less than 0.001), symptoms were more likely to be used as indications for beta-blocker therapy in patients suspected of the condition . We conclude that echocardiographic results are used for recommending antibiotic prophylaxis to outpatients suspected of MVP, but not for beta-blocker therapy. Chemioterapia, 1987 Jun, 6(3), 221 - 4 Antibiotic genitourinary surgical prophylaxis; Childs SJ; Urologists continue to use antibiotics inappropriately . We should rethink the reasons why certain attitudes exist about powerful drugs for prophylaxis and adjust our prescribing habits for therapy as well . Using catheters and urethral instrumentation sparingly and only when necessary, while employing proper infection control techniques and judicious antibiotic prophylaxis can control the nosocomial infections resulting from genitourinary surgery. Obstet Gynecol, 1987 Jun, 69(6), 879 - 82 Single-dose antibiotic prophylaxis in women undergoing vaginal hysterectomy; Soper DE et al.; One hundred thirty-five patients undergoing vaginal hysterectomy were randomly assigned to one of three regimens of prophylactic antibiotics . There was no statistically significant difference among the three groups in the incidence of postoperative pelvic cellulitis, fever index, or duration of hospitalization . A single preoperative dose of cefazolin was as effective as three perioperative doses of cefazolin or a single dose of cefonicid in preventing postoperative infectious morbidity. Quad Sclavo Diagn, 1987 Jun, 23(2), 176 - 83 {Control study of bacterial infections in patients with carcinoma of the breast subjected to radical mastectomy}; Quaranta M et al.; Surgical patients have a high risk of infections . In the breast surgery, a "clean" surgery, the infection rate should not be more than 2% . In this work, we have studied 174 women with breast cancer, which did not receive the antibiotic prophylaxis . After surgery the patients were monitored for infective complications . The total incidence of infections was 5.1%: 3.4% of surgical wound infections and 1.7% of nosocomial infections . The preoperative antibiotic therapy should not be used in the "clean" surgery, as the mastectomy, except in the patients with high infective risk . In fact we can prevent the wound infections of breast surgery with adequate control measures about the aseptic procedures of operating suite, the members of the surgical team and the preparation of the patient. Surg Gynecol Obstet, 1987 Jun, 164(6), 525 - 9 The hematologic effects of latamoxef sodium when used as a prophylaxis during surgical treatment; Salem RR et al.; Latamoxef sodium, a third generation cephalosporin antibiotic, has been shown to provide good prophylaxis against postoperative infection . It has, however, been implicated as causing disturbances of hemostasis particularly when used in treatment . We have studied 40 patients who required antibiotic prophylaxis prior to surgical treatment randomizing and stratifying them according to age and type of operation, to receive either latamoxef or piperacillin . Five hematologic parameters were studied, prothrombin time, activated partial thromboplastin time, plasma factor II concentration, plasma factor VII concentration and platelet count . Minor differences were noted with latamoxef producing mild persistant elevation of prothrombin time (0.7 second) associated with depression of factor II and factor VII . In our study, we found that, when used as three dose, single agent prophylaxis, there was no difference between latamoxef and piperacillin in producing clinical disturbances of hemostasis . However, attention is drawn to the importance of recognizing that hemostatic disturbances can occur after the use of broad spectrum antibiotics as prophylaxis for surgical treatment Mechanisms of hemostatic disorders are reviewed and alternative hypotheses are suggested. Urol Clin North Am, 1987 May, 14(2), 265 - 71 Prophylactic antibiotics in urology; Scherz HC et al.; The emergence of prosthetic surgery and nonoperative surgical treatment of urolithiasis has seen with it an expanded application of prophylactic antibiotics . The very nature of these procedures with the often increased risk of infectious complications lends itself perfectly to wider but more judicious use of prophylactic antibiotics . Controlled clinical trials that address issues such as dosing, selection, and indications for antibiotic prophylaxis are lacking . Until that information is forthcoming, only recommendations can be made as we have tried to provide in this article. Laryngoscope, 1987 May, 97(5), 587 - 90 Etiologic factors in head and neck wound infections; Brown BM et al.; The use of antibiotic prophylaxis does not prevent all postoperative wound infections . The records of 245 patients undergoing major head and neck surgery were reviewed to determine the cause of wound infection which developed in 17 patients . Patients with Stage IV tumors had an increased infection rate as compared to lesser stages (p less than .01) . Reconstruction with a myocutaneous flap was associated with an increased infection rate when compared to primary closure or split-thickness skin graft reconstruction (p less than .001) . Probable errors in surgical technique were identified in 10 of 17 infected patients . Neither weight loss, diabetes mellitus, prior radiation therapy, nor prior tracheotomy were found to increase the risk of wound infection (p greater than .05) . This study lends insight into factors that may potentiate the development of wound infection despite antibiotic prophylaxis . A strategy to minimize postoperative infection is offered. Med Clin North Am, 1987 May, 71(3), 357 - 68 Prophylactic antibiotics for surgery; Bergquist EJ et al.; This article discusses the determination of surgical patients to be given antibiotic prophylaxis . In addition, current concepts regarding selection of antibiotic prophylaxis necessary for a variety of surgical procedures are reviewed. CMAJ, 1987 May 1, 136(9), 935 - 8 The effect of cephalothin prophylaxis on postoperative ventriculoperitoneal shunt infections; Rieder MJ et al.; Postoperative infection is an important complication after insertion of a ventriculoperitoneal (VP) shunt in children with hydrocephalus . A randomized double-blind placebo-controlled study was performed to determine the efficacy of cephalothin in preventing postoperative shunt infection . Sixty-three children who presented for elective VP shunt insertion between January 1982 and December 1985 and who did not have a history of shunt infections were randomly assigned to receive four doses of prophylactic cephalothin, 25 mg/kg (32 patients), or of a multivitamin placebo (31 patients) . Postoperative infection developed in 6% of the treatment group, compared with 10% of the placebo group, a difference that was not statistically significant, although a clinical significance may have been masked by the small sample size . A large multicentre trial is needed to determine the efficacy of antibiotic prophylaxis in reducing the incidence of postoperative VP shunt infections. Arch Otolaryngol Head Neck Surg, 1987 Apr, 113(4), 368 - 9 Infection following uncontaminated head and neck surgery; Johnson JT et al.; The efficacy of perioperative antibiotic administration during major head and neck surgery in which the wound is contaminated by saliva has been clearly established . This study was undertaken to ascertain the incidence of postoperative wound infection encountered in patients undergoing major head and neck surgery in which no contamination occurred . The records of 438 patients who had undergone parotidectomy, thyroidectomy, or submandibular gland excision were reviewed retrospectively . Eighty percent of the patients had received no perioperative antibiotic therapy . Infections developed in three (0.7%) patients during one month following surgery . One of these patients had received perioperative antibiotic prophylaxis . These data clearly demonstrate the non-efficacy of antibiotics administered in patients undergoing parotidectomy, thyroidectomy, or submandibular gland excision when no infection exists prior to surgery. Br J Urol, 1987 Apr, 59(4), 314 - 8 Antibiotic prophylaxis for prostatic surgery . Single-dose cephradine compared with single-dose cefotaxime; Bentsi IK et al.; Several previous studies have attested to the value of antibiotic prophylaxis for prostatic surgery . We report a prospective randomised study which compared a single dose of cefotaxime with a single dose of cephradine given with the induction of anaesthesia . There was little difference between these regimens and it was concluded that either may be used, depending on availability and cost of the antibiotic . We have now completed a 5-year study of antibiotic prophylaxis for prostatic surgery and we also report the results of a long-term survey of the ward flora . There has been no significant change and there is no evidence for the emergence of resistant strains. Acta Chir Scand, 1987 Apr, 153(4), 303 - 6 Stomach cancer: a prospective study of anastomotic failure following total gastrectomy; Viste A et al.; The incidence and cause of esophagojejunal anastomotic leakage were prospectively studied in 350 patients following total gastrectomy for stomach cancer . Anastomotic leak was demonstrated in 30 patients (8.6%), ten of whom underwent reoperation . Nine of the 30 patients died . Statistical analysis revealed that the outcome was better for patients with stapled esophagojejunostomy than when the anastomosis was hand-sutured . The odds for leakage were 2.37 times higher in patients with hand-sutured, than in those with stapled anastomosis . Antibiotic prophylaxis may be significant in preventing leakage . No association was found between anastomotic leakage and type of hospital, patient age or sex, preoperative weight loss, concomitant splenectomy or residual tumor in the resection margin. Br J Surg, 1987 Mar, 74(3), 192 - 4 Single dose antibiotic prophylaxis in high risk patients undergoing transurethral prostatectomy; McEntee GP et al.; In a randomized controlled clinical trial single dose antibiotic prophylaxis (gentamicin 80 mg IV) was evaluated in 36 patients with indwelling urethral catheters undergoing transurethral prostatic resection . Prophylaxis resulted in a significant reduction in postoperative bacteriuria (P less than 0.01), pyrexia (P less than 0.001), bacteraemia (P less than 0.01) and septicaemia (P less than 0.05) . During the same period there was one case of postoperative bacteriuria but no systemic infection in 25 consecutive patients undergoing elective prostatectomy with no local risk factors and in the absence of prophylaxis . A policy of selective antibiotic prophylaxis is justified and in high risk patients with in-dwelling catheters single dose prophylaxis is highly effective. Infection, 1987 Mar-Apr, 15(2), 105 - 6 Recurrent erysipelas: predisposing factors and costs of prophylaxis; Jorup-Ronstrom C et al.; After an average follow-up time of three years, recurrent erysipelas was observed in 29% of 143 patients admitted primarily with erysipelas . Nineteen patients (13%) had two or more recurrences during this period . The predisposing factor with the highest recurrence rate was venous insufficiency . Regular prophylaxis with phenoxymethylpenicillin (or erythromycin in penicillin allergics) after the second recurrence may be cost-effective . This antibiotic prophylaxis is only recommended in patients with predisposing factors who have suffered severe attacks. J Hosp Infect, 1987 Mar, 9(2), 158 - 61 Antibiotic prophylaxis in non-perforated appendicitis of childhood: tetracycline lavage compared with peroperative intravenous cefuroxime and metronidazole; Thomson SR et al.; Eighty-four cases of non-perforated appendicitis in children were randomly allocated to receive either oxytetracycline lavage alone or oxytetracycline lavage plus peroperative intravenous metronidazole and cefuroxime . The wound infection rate with the oxytetracycline lavage alone was 4.4% compared with 7.7% when metronidazole and cefuroxime were added . These rates were not significantly different . This study supports the use of oxytetracycline lavage alone as effective prophylaxis against wound infection in non-perforated appendicitis of childhood. Ann Urol (Paris), 1987, 21(2), 75 - 9 {Prophylactic antibiotic therapy in urology}; Gattegno B; Prophylactic antibiotic therapy is used increasingly frequently in urology to prevent post-operative septic complications . The use of this method is based on experimental and clinical data which define the optimal time of administration of the antibiotic and the criteria for selection of the most effective drug . Transurethral resection of the prostate is the urological operation most frequently associated with antibiotic prophylaxis . It has been the subject of a large number of randomised studies which have confirmed the efficacy and usefulness of antibiotic prophylaxis . The other urological operations are reviewed and a critical study of the basis for antibiotic prophylaxis for each one is presented. Chemotherapy, 1987, 33(4), 297 - 301 Perioperative antibiotic prophylaxis in bile-duct interventions: results of two prospective randomized studies; Harnoss BM et al.; The success of perioperative prophylaxis in gallbladder surgery was examined in two prospective randomized studies with a total of 326 patients . Postoperative wound-healing impairments did not occur in any of the patients receiving a single preoperative application of an antibiotic with a high biliary elimination rate (ceftriaxone or apalcillin) . 11% of a control group without prophylactic antibiotic application evidenced infectious wound-healing disturbances. Ann Fr Anesth Reanim, 1987, 6(2), 83 - 7 {Antibiotic prophylaxis in cardiac surgery: 12-hour cefazolin versus 36-hour cefazolin}; Gerard JL et al.; A prospective randomized study was carried out to assess two protocols of antibiotic prophylaxis in patients undergoing cardiac surgery with cardiopulmonary by-pass . Each patient of the first group received four intravenous injections of 1 g cefazolin over a period of 12 h, whilst in the second group each one received twelve doses over a period of 36 h . Between May 1983 and April 1984, 159 patients scheduled for cardiac surgery entered the study . Those who underwent emergency surgery, or weighed less than 20 kg, or received antibiotics in the week before surgery, or had a previous history of anaphylaxis to cephalosporins were not included in the study . Both groups were similar in their distribution of age, weight, height, sex, past history of infectious disease, surgery and iatrogenic factors . There were no significant differences between the two groups in the number of minor infections and bacterial floral changes . There were no major infections either (septicaemia, mediastinitis, endocarditis) . Temperature charts were the same on the first four days . The length of stay at hospital was the same in both groups . Since the efficacy of the two protocols in preventing major infections was the same, the authors recommend the short prophylaxis with cephazolin for cardiac surgery patients. J Arthroplasty, 1987, 2(1), 77 - 82 Infection rate in total hip arthroplasty as a function of air cleanliness and antibiotic prophylaxis . 10-year experience with 2,384 cementless Lord madreporic prostheses; Marotte JH et al.; To separate the respective effects of sterile air and antibiotic prophylaxis in orthopedic surgery, the authors reviewed 2,384 cementless total hip replacements performed from 1975 to 1984 for incidence of deep sepsis . During this period, a conventionally ventilated room (100 particle-forming units (pfu)/m3) and a laminar vertical flow (1 pfu/m3) were alternately used, without significant difference in the sepsis rate . Beginning in 1979, a prophylactic antibiotic regimen was added, which from 1979 to 1984 reduced the incidence of deep sepsis from 2.78% to 0.52% . There was also a change in common infecting organisms, from sensitive to resistant strains, which is not an insignificant consequence. Clin Exp Obstet Gynecol, 1987, 14(1), 1 - 5 Vaginal preparation with povidone-iodine before abdominal hysterectomy . A comparison with antibiotic prophylaxis; Zakut H et al.; Two groups of women were prepared before total abdominal hysterectomy . The first by povidone-iodine tampons that remained in the vagina until the end of the operation, the second group by administration of a prophylactic antibiotic . We found statistically significant decreases both in infectious morbidity and in the percentage of positive cultures from the cervix and vagina, at the time of the operation in the povidone-iodine group as compared with the antibiotic group . Therefore, it is our impression that prophylactic antibiotic therapy for patients undergoing abdominal hysterectomy should be reserved for the patient with compromised defence mechanisms if it is used at all, and recommend local preparation of the vagina with povidone-iodine as an effective alternative. Acta Neurochir (Wien), 1987, 86(3-4), 75 - 8 Antibiotic prophylaxis in neurosurgery . Study comparing two groups of patients with and without treatment; Reale F et al.; We present the results of a study comparing two groups of patients who underwent neurosurgical operations, one pretreated with Ampicillin (184) and the other not (193), in comparable time-spans . The results of this study argue for a beneficial action of Ampicillin prophylaxis on neurosurgical infections . A brief discussion of the appropriate literature is given. J Hosp Infect, 1987 Jan, 9(1), 81 - 4 Diagnostic amniocentesis and bacteraemia; Klein SA et al.; Thirty antenatal patients with intact membranes were studied to determine the incidence of bacteraemia induced by transabdominal amniocentesis . No bacteraemias were detected following the procedure . Antibiotic prophylaxis is probably not warranted for immunocompetent hospitalized patients undergoing amniocentesis. Acta Chir Scand, 1987, 153(5-6), 369 - 71 Drainage by endoscopic endoprosthesis in biliary obstruction . A report of initial experience; Kullman E et al.; Biliary drainage by endoscopic, transpapillary insertion of endoprosthesis was attempted in 38 patients with obstructive jaundice and was successful in 25 . The procedure was palliative in 17 cases and preoperative in eight . Benefit was obtained by ten of the former and seven of the latter patients, while in eight the serum bilirubin did not fall despite adequate catheterization . In two intubated patients with recurrent nonterminal jaundice, the endoprostheses were repeatedly changed; the median time to clogging was 51 (8-77) days . Cholangitis developed in 15 of the total 38 patients . Antibiotic prophylaxis, though not routinely used, is recommended for all cases with biliary stasis . Unimpeded bile flow was not ensured with 7 F endoprostheses, whose patency time tended to be short . By using sizes 10-12 F the authors hope to improve bile flow, thereby diminishing obstruction, stagnation and infection and prolonging patency . In selected cases the method may offer an alternative to the percutaneous approach, and possibly also to surgical bypass. Presse Med, 1986 Dec 20, 15(46), 2351 - 2 {Short-term antibiotic prophylaxis in colorectal surgery: cefoxitin versus piperacillin . A double-blind randomized study, 60 cases}; Armengaud F et al.; A randomized, double-blind comparative trial of cefoxitine and piperacillin was conducted in two groups of 30 patients with a similar number of the usual risk factors . Doses of cefoxitine 2 g and piperacillin 4 g were administered only once, except in some cases when the operation lasted more than 5 hours . Analysis of the results showed that the two antibiotics had equivalent prophylactic effectiveness (congruent to 6%) in colorectal surgery. Laryngoscope, 1986 Dec, 96(12), 1330 - 4 Prevention of recurrent acute otitis media: chemoprophylaxis versus tympanostomy tubes; Gonzalez C et al.; Otitis media has long been recognized as one of the most common diseases of childhood . Several therapeutic modalities have been advocated for the prevention of recurrent episodes of acute otitis media (AOM) . A blinded, prospective, randomized study was designed to determine the efficacy of tympanostomy tubes, antibiotic prophylaxis, and placebo . Children with recurrent AOM were entered in the study and followed for at least 6 months . A total of 65 children completed the protocol . Sixty-three of those were under the age of 4 years . Treatment failure was defined as two or more episodes of AOM or otorrhea in less than 3 months . Five of 22 children in the tympanostomy tube group failed, compared to 12 of 20 in the placebo group (p = .02) . There were 8 or 21 treatment failures in the sulfisoxazole group . Children with otitis media with effusion (OME) at the time of their initial visit had significantly less middle ear disease when treated with tympanostomy tubes . Tympanostomy tube insertion for prophylaxis of recurrent acute otitis is supported by these findings . Improvement of recurrent AOM was observed in the sulfisoxazole group, but was not statistically significant. J Antimicrob Chemother, 1986 Dec, 18 Suppl E, 109 - 13 Imipenem pharmacokinetics in elective colorectal surgery; Gartell PC et al.; A study of the pharmacokinetics of imipenem in 22 patients undergoing elective colorectal surgery was performed . Samples of plasma, fat, muscle and viscera were assayed at various intervals following intravenous injection of 1 g imipenem and 1 g cilastatin . The concentration of imipenem in plasma was approximately ten times that found in the tissues . The half-life was similar in plasma, muscle and fat (approximately 1 h) . Visceral levels showed a slower fall (T 1/2 83 min) . Plasma and tissue levels exceeded the MIC90 for all common pathogens for at least the first two hours of surgery . We conclude that imipenem is a suitable agent for antibiotic prophylaxis in colorectal surgery. Otolaryngol Head Neck Surg, 1986 Dec, 95(5), 554 - 7 Antibiotic prophylaxis in high-risk head and neck surgery: one-day vs . five-day therapy; Johnson JT et al.; Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis . This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day . A multi-institutional prospective randomized double-blind study was designed . Patients who were identified as requiring pedicled flap reconstruction were potential candidates for the study . Later, patients were randomly assigned to receive cefoperazone sodium for either 24 hours or 120 hours . In each case, the drug was administered intravenously, beginning 1 to 2 hours preoperatively and continued for the prescribed period . One hundred nine patients were evaluable . Fifty-three patients were assigned to 1 day of perioperative prophylaxis . Wound infection developed in ten patients (18.9%) . Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis . Wound infection developed in 14 (25%) of these patients (P greater than .05) . These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction. Eur J Obstet Gynecol Reprod Biol, 1986 Nov, 23(3-4), 187 - 94 Effect of a strict preoperative hygienic routine on the rate of infections following cesarean section; Hagglund L et al.; The frequency of postoperative infections after cesarean section was studied during two periods . In the first period no strict preoperative hygienic routines were applied; 321 patients were delivered by cesarean section during this period . In the next period strict hygienic routines were introduced; this period included 337 patients . The infection rate was significantly reduced during the second period from 20% to 16% . This reduction was found among the elective operations, and among parturients who had been treated in the hospital for more than 24 h prior to delivery . The frequency of endometritis decreased significantly from the first to the second period, whereas no difference was found concerning wound infections . Significantly fewer patients contracted septicemia during the second period . Since all septicemia cases occurred in endometritis patients the results might indicate that not only the number of patients contracting infection but also the severity of the infections was reduced . No reduction of infections was found after emergency operations . Antibiotic prophylaxis might therefore be of value in this group of patients. Am J Med, 1986 Nov, 81(5), 751 - 8 Complications of mitral valve prolapse . Disproportionate occurrence in men and older patients; Devereux RB et al.; To determine factors influencing the strength of association between mitral valve prolapse and mitral regurgitation, ruptured chordae tendineae, and infective endocarditis, the prevalence of mitral prolapse in patients with disease was compared with both clinical and population control groups . The prevalence of mitral valve prolapse was 4 percent among population and clinical control groups (eight of 196 and 84 of 2,146, respectively) and was significantly higher (p less than 0.001) in patients with endocarditis (11 of 67, 16 percent), mitral regurgitation (17 of 31, 55 percent, and ruptured chordae (27 of 43, 63 percent) . Odds ratios for complications in persons with mitral valve prolapse ranged from 4.6 for endocarditis to 41.4 for ruptured chordae in overall analyses, and from 6.8 for endocarditis to 53.0 for ruptured chordae based on age- and sex-matched case-control triplets (p less than 0.001 for each) . All complications occurred disproportionately in men with mitral valve prolapse, in whom odds ratios ranged from 2.5 to 7.4 compared with an additional control group of unselected subjects with mitral valve prolapse . Compared with this control group, patients with mitral valve prolapse and endocarditis were slightly more likely to have a previously known heart murmur (odds ratio 3.2, difference not significant) but significantly more likely to have murmurs at the time of evaluation (odds ratio 8.5, p less than 0.01) . Patients with mitral valve prolapse and mitral regurgitation and ruptured chordae tendineae were also significantly older than the unselected subjects with mitral valve prolapse (48 +/- 14 and 55 +/- 16 versus 38 +/- 14 years, p less than 0.005 for both) . The concentration of risk of endocarditis in men with mitral valve prolapse and patients with antecedent murmur suggests that antibiotic prophylaxis is warranted in these groups but not in women without a murmur of mitral regurgitation. Am J Emerg Med, 1986 Nov, 4(6), 507 - 10 Antibiotic prophylaxis in intraoral wounds; Altieri M et al.; This study of 100 patients was undertaken to determine the efficacy of penicillin/erythromycin prophylaxis in the management of intraoral lacerations in the pediatric population . Only six patients of the evaluable population developed infections (6.4%) . Two of these patients received antibiotic prophylaxis (4%), and the other four were control patients (8%) who developed wound infections (P = 0.41) . Although most injuries were minor, if the injury was large enough to require suturing, the infection rate was slightly greater in the control group . Cross-product ratios for these small sample subgroups indicated that the likelihood of infection for non-prophylactically treated patient wounds of greater than 1 cm length and/or those requiring suturing was two to three times higher than that of patients treated prophylactically . Although no statistical significance could be ascribed to the observed differences of these post hoc categories, benefit from antibiotic prophylaxis may have been quantifiable in a study designed to assess only these major wounds utilizing a large sample size . In general, routine antibiotic prophylaxis appears unwarranted for simple intraoral lacerations in children, although it may be useful when the wounds are large enough to be sutured. Geburtshilfe Frauenheilkd, 1986 Oct, 46(10), 706 - 9 {Perioperative antibiotic prevention with cefoxitin in cesarean section . Management and uses}; Fischbach F et al.; Antibiotic prophylaxis and febrile morbidity following non-elective Caesarean section were studied retrospectively . Febrile morbidity was found to be 5.4% in the treated group as compared to 20% in the untreated group . Percentage of endomyometritis was 2.2% in the treated group and 16% in the untreated group . Our results prove the efficacy of antibiotic prophylaxis in patients undergoing Caesarean section . Antibiotic application in 79% of all these patients led to a significant reduction in puerperal febrile morbidity and endomyometritis . Experience shows that positive results gained by the study do not have a positive feedback on the ward if there is lack of communication or reconfirmation. South Med J, 1986 Oct, 79(10), 1248 - 51 Mezlocillin prophylaxis against infection after cesarean section: a comparison of techniques; Lavery JP et al.; We studied 212 patients undergoing emergency cesarean section at an urban hospital . Four techniques of antibiotic prophylaxis were used, including single-dose and triple-dose parenteral therapy, parenteral and lavage therapy, and lavage therapy alone . One agent, mezlocillin, was used for all patients . There was no significant difference in surgically related infectious morbidity among the groups . This antibiotic proved efficacious when related to historical controls, and was the most economical of the modalities of administration studied. Z Urol Nephrol, 1986 Oct, 79(10), 545 - 8 {Preventive use of antibiotics in kidney transplantation}; Wilms H et al.; Antibiotic prophylaxis in kidney transplantation is controversial . In a prospective controlled study, 34 cadaveric kidney transplant recipients were investigated . Antibiotic prophylaxis was given in a random order to 16 patients whereas 18 without prophylaxis served as controlls . In 4 of 20 investigated clinical parameters statistically significant differences were found between both groups: the controlls happened to have better initial conditions; perioperative and postoperative better initial conditions; perioperative and postoperative infections were less frequent in the prophylaxis group and more antibiotics postoperatively were needed in the controlls . These findings indicate that antibiotic prophylaxis has a beneficial effect in kidney transplantation. J Am Dent Assoc, 1986 Oct, 113(4), 612 - 6 Achieving oral health in patients with renal failure and renal transplants; Eigner TL et al.; The protocols for oral evaluation and treatment of patients with renal failure and renal transplants are presented . Guidelines for dental treatment planning are outlined, and extraction versus conservation of teeth is discussed . Information on special considerations involving dialysis, antibiotic prophylaxis, drug therapy, and immunosuppression is provided . The goal of treatment is to restore maximum function while minimizing the risk of oral infection after transplantation. Invest Radiol, 1986 Sep, 21(9), 705 - 9 Infectious complications of percutaneous biliary drainage; Cohan RH et al.; The infectious complications of percutaneous biliary drainage were reviewed in 132 patients with obstructive jaundice . Cholangitic or septic episodes occurred more frequently in patients with malignant (54%) than in those with benign (22%) disease, and frequently were not related to catheter insertions or manipulations . The frequency and mechanisms of bacterial colonization of bile and blood in patients with obstructive jaundice before and after biliary drainage are reviewed . The significant morbidity and mortality related to postdrainage infectious episodes is stressed, and the efficacy of antibiotic prophylaxis is discussed . The significant risks and complications of percutaneous biliary drainage must be considered prior to catheter placement, particularly in the most debilitated patients. Clin Orthop, 1986 Sep, (210), 128 - 31 Infected total hip arthroplasty due to Actinomyces israelii after dental extraction . A case report; Strazzeri JC et al.; Late infection of a total hip arthroplasty after dental extraction has been reported, but never with an organism that is found exclusively in mouth flora . Actinomyces israelii is an organism responsible for dental caries . A 61-year-old woman developed an infected total hip arthroplasty after dental work . She denies ever being instructed to take prophylactic antibiotics by her orthopedic surgeon, by her internist, or by her dentist . Considering the extensive morbidity and potential mortality of an infected hip prosthesis, it is essential that all physicians are aware of the indications for antibiotic prophylaxis following joint arthroplasty . Recommendations for antibiotic prophylaxis for dental manipulation are a loading dose of 2.0 g of penicillin V orally or 1.2 million U of aqueous procaine penicillin G with 1.0 gram of streptomycin given intramuscularly 30 minutes before dental work, followed by four doses of 0.5 g of penicillin V orally every six hours. Drug Intell Clin Pharm, 1986 Jul-Aug, 20(7-8), 592 - 3 Cost of antibiotic prophylaxis in cesarean section; Ford LC; Two hundred sixty-three patients were randomly assigned to receive either piperacillin or cefoxitin for prophylaxis in cesarean section . Although both drugs were considered effective, piperacillin achieved a level of 98 percent satisfactory prophylaxis compared with only 91 percent for cefoxitin . Costs of prophylactic failure in cesarean section were calculated and then assessed for four different antibiotic regimens (based on 100 patients) . Because of its high failure rate, ampicillin was the most expensive antibiotic; piperacillin was the least expensive . It was suggested that highly effective prophylaxis with an antibiotic agent such as piperacillin can result in significant cost savings when used for high-risk patients undergoing cesarean section. Am J Med Genet, 1986 Jul, 24(3), 387 - 92 Prevalence of mitral-valve prolapse in the Stickler syndrome; Liberfarb RM et al.; An increased prevalence of mitral-valve prolapse occurs in several connective tissue dysplasias, including Marfan syndrome, Ehlers-Danlos syndrome, and pseudoxanthoma elasticum . We evaluated 57 patients diagnosed as having the Stickler syndrome for mitral-valve prolapse by auscultation and two-dimensional echocardiography . The diagnosis was made on the basis of craniofacial and musculoskeletal abnormalities, sensorineural hearing loss, eye defects, and a family history of Stickler syndrome . Twenty-six patients (45.6%) had mitral-valve prolapse, including 11 of 22 females (50.0%) and 15 of 35 males (42.9%) . The age range of our study population was 4 to 60 years . Prevalence of mitral-valve prolapse did not increase with age . Nine patients (34.6% of those with mitral-valve prolapse) had the click-murmur syndrome; only one of them was symptomatic . Because of the growing list of complications associated with mitral-valve prolapse, all patients with Stickler syndrome should be evaluated by auscultation, electrocardiogram, and echocardiography . Those with mitral-valve prolapse should be advised to have periodic follow-up and to instruct physicians caring for them of their need for antibiotic prophylaxis with certain surgical procedures. Vestn Khir Im I I Grek, 1986 Jul, 137(7), 11 - 5 {Antibiotic prophylaxis in emergency abdominal surgery}; Guseinov AKh et al.; The effectiveness of antibiotic prophylaxis was analysed in 1054 emergency operations (337 patients were included in the experimental group and 717 patients in the control group) . The amount of suppurations was reduced from 11.5% to 5.04%; the period of staying at the hospital was shortened from 17.3 to 14.1 days. Chir Ital, 1986 Jun, 38(3), 305 - 9 {Short-term antibiotic prophylaxis in elective abdominal surgery}; Dell'Orto V; The frequency of the infections in the surgical pounds is still high, and remarkably affects the cost of surgical patient: this is prevailingly due to the extension of hospitalization because of the infective complication . The Authors recognized the S.T.P . as a technique significantly reducing the risks of infection, without remarkably affecting the costs, and exempt from the secondary effects consequent to the extended antibiotic prophylaxis. Arzneimittelforschung, 1986 Jun, 36(6), 976 - 80 {Systemic antibiotic prophylaxis with metronidazole in elective colonic and rectal surgery . Results of a clinical controlled study and a critical literature review}; Raetzel G et al.; The pathogen spectrum of wound infections in colon surgery is composed almost exclusively of facultatively aerobic and obligatorily anaerobic intestinal flora . A study was performed in which a one-shot prophylaxis was carried out by applying metronidazole, 500 mg i.v., or latamoxef (lamoxactam) 2 g i.v., on induction of anesthesia . The metronidazole group evidenced a 26.3% incidence of infections due exclusively to aerobic pathogens . In the latamoxef (lamoxactam) group, it was possible to achieve a reduction of the postoperative rate of wound infections to 11.1% . The study was prematurely terminated because of the high rate of wound infections in the metronidazole group and the exclusive selecting of aerobic pathogens. Compr Ther, 1986 Jun, 12(6), 21 - 32 Mitral valve prolapse: recent advances in diagnosis and therapy; Liebson PR et al.; MVP is a common condition with rare life-threatening implications . Recent follow-up studies over several years in children, and young and middle-aged adults failed to suggest increase in prolapse in most of the subjects . Older individuals with MVP appear to have increased complications, primarily due to mitral regurgitation . Echocardiography supports the diagnosis of MVP made by auscultation in over 90% of individuals, with excellent reproducibility . MVP is more common in young women than young men . The prevalence of prolapse decreases with age in women; it is relatively constant in men . Although complications are rare, MVP is the most common underlying disorder in rupture of the chordae tendineae . These spontaneous ruptures are usually unassociated with infective endocarditis . Familial studies indicate that isolated MVP is an autosomal dominant condition with variable expression . It is recommended that first-degree relatives of patients with isolated prolapse be examined . Infective endocarditis is uncommon, but it is recommended that antibiotic prophylaxis be implemented in patients with prolapse and evidence for mitral regurgitation . Prolapse is frequently associated with autonomic imbalance, primarily an increased catecholamine sensitivity . The use of beta blockers may reverse symptoms secondary to this abnormality . Sudden death is exceedingly rare despite marked arrhythmias in many patients . On the basis of retrospective studies, sudden death is associated with floppy valves, marked mitral regurgitation, and arrhythmias . There is no evidence that any class of antiarrhythmic agents can prevent the rare sudden deaths in these patients. Arch Intern Med, 1986 Jun, 146(6), 1207 - 8 Rarity of failure of penicillin prophylaxis to prevent postsplenectomy sepsis; Zarrabi MH et al.; All splenectomized individuals are at risk of developing pneumococcal sepsis, but most reports fail to mention how many patients are given prophylactic penicillin therapy . Fourteen reported cases of postsplenectomy bacterial sepsis in patients receiving prophylactic penicillin therapy are reviewed . In only five cases, the patients had penicillin-sensitive pneumococcal infection . Hence, the exact frequency of the failure of penicillin prophylaxis cannot be calculated, but it appears to be very rare . Continuous antibiotic prophylaxis used indefinitely and pneumococcal vaccine are both strongly recommended for all children and adults undergoing splenectomy. Int J Gynaecol Obstet, 1986 Jun, 24(3), 165 - 8 Prevention of postoperative infection in cesarean section after rupture of the membranes; Schedvins K et al.; Patients having a cesarean section more than 6 h after rupture of the membranes constitute a high risk group for postoperative infections . Two such groups were studied . Patients were given either cefuroxime 1.5 g every 8th hour for 24 h followed by cefadroxil 0.5 g twice daily for 6 days or received no medication . The infection rate was significantly reduced in the treatment group as compared to the control group (15% vs . 48%) . Non-infected patients had a significantly shorter stay in hospital (8 days vs . 12 days) . Combined use of these drugs for prevention of post-cesarean infection has not previously been reported . No side effects of the antibiotic prophylaxis were reported. Antimicrob Agents Chemother, 1986 May, 29(5), 744 - 7 Randomized comparison of cefamandole, cefazolin, and cefuroxime prophylaxis in open-heart surgery; Slama TG et al.; A total of 337 patients undergoing coronary artery bypass grafting or cardiac valve replacement were randomly assigned to receive cefazolin (1 g every 8 h {q8h}), cefamandole (2 g q6h), or cefuroxime (1.5 g q12h) as an intravenous antibiotic prophylaxis . All drugs were administered within 60 min before the initial incision and were continued for 48 h postoperatively . No adverse effects related to the study drugs were observed . The percentage of patients with postoperative infection was 9% for the cefazolin group, 6% for the cefamandole group, and 5% for the cefuroxime group or 6.5% overall . There were more infection sites in patients treated with cefazolin than in those treated with cefuroxime (P = 0.05) or cefamandole (P = 0.06) . Fewer wound infections occurred with cefuroxime (P less than 0.01) and cefamandole (P = 0.06) than with cefazolin . Analyses of the prophylactic regimens used in this study showed cefazolin and cefuroxime to be less costly than cefamandole. Rev Infect Dis, 1986 May-Jun, 8 Suppl 2, S111 - 6 Travelers' diarrhea: an overview; Kean BH; The diarrhea of travelers is a syndrome and not a disease; its history is reviewed here . Dysentery is caused by agents that damage the epithelium of the intestinal tract; diarrhea results from the response of intact intestinal cells to toxins that stimulate enzymatic processes to release liquid and ions . Toxigenic Escherichia coli, the most frequent pathogen in diarrhea, produces a recognizable, benign syndrome; however, other agents of disease, including viruses, bacteria, and protozoa, are responsible for a significant proportion of cases of diarrhea . Hygienic precautions are generally advised, despite the lack of evidence supporting their efficacy . Antibiotic prophylaxis is effective in reducing the incidence of diarrhea caused by E . coli but may not be desirable because of toxicity and the possibility of complicating the diagnostic process . Diagnosis requires better laboratory methods than are usually available but can be made with limited accuracy by a clinician acquainted with the various manifestations of potential causes . Treatment after diarrhea has started should be limited to fluid and ion replacement, with the possible addition of drugs that reduce intestinal motility, although some advocate the use of antibiotics at this time . The number of people traveling, especially to developing countries, continues to increase . This trend would expand enormously if the fear of diarrhea were removed. J Antimicrob Chemother, 1986 May, 17 Suppl C, 183 - 7 Prophylactic Timentin in patients undergoing thoracic or vascular surgery; Kitzis M et al.; Timentin (ticarcillin + clavulanic acid) and cefamandole were compared in 484 patients undergoing elective thoracic or vascular surgery . Two hundred and forty eight patients received three 3 g/200 mg injections of Timentin and 236 patients received three 0.75 g injections of cefamandole . The patients were evaluated at discharge . Among the 248 patients given Timentin, only six (2.4%) had a post-operative infection, while nine (3.8%) of the 236 patients given cefamandole had a post-operative infection . There was no statistically significant difference between the two treatment regimes . This comparative study shows that Timentin may be used for antibiotic prophylaxis of clean vascular or thoracic surgery. N Z Med J, 1986 Apr 23, 99(800), 269 - 71 Colonoscopy and bacteraemia: an experience in 50 patients; London MT et al.; There is little consensus concerning the incidence of bacteraemia during colonoscopy and the need for antibiotic prophylaxis in susceptible patients . Hepatic abscesses in one patient which may have been related to prior colonoscopic examinations led the authors to carry out a prospective study of 50 patients undergoing colonoscopy . Multiple blood cultures were carried out to maximise the positive yield of transient bacteraemia and to attempt to determine the time when bacteraemia is most likely to occur . Five patients had positive blood cultures . In two patients S epidermidis was isolated, but only from the precolonoscopic blood sample . In three subjects enteric organisms were cultured from blood samples obtained during the procedure . In one of these three the same organism was cultured from the preendoscopic blood sample so that in only two patients (4%) could the bacteraemia be attributed to the colonoscopy . These results would suggest that the risk of bacteraemia during colonoscopy is low. Obstet Gynecol, 1986 Apr, 67(4), 545 - 8 Effect of irrigation or intravenous antibiotic prophylaxis on infectious morbidity at cesarean section; Gonen R et al.; The efficacy of intraoperative irrigation with cefamandole nafate at cesarean section was evaluated in a prospective, randomized double-blind study . Two hundred and eight patients were treated with antibiotic irrigation and intravenous placebo or with perioperative intravenous cefamandole and irrigated with normal saline . The rate of endometritis was 10.9% in the irrigation group and 14% in the intravenous group, but the difference was not statistically significant . The rate of any infection, the number of days with fever, additional hospitalization days, and number of antibiotics used for treatment were similar in the two groups . It thus was concluded that irrigation with antibiotic is equal but not superior to perioperative intravenous antibiotics. Chir Ital, 1986 Apr, 38(2), 253 - 7 {Clinical value of ceftriaxone in the preoperative prevention of sepsis in orthopedic and traumatologic surgery}; Gaetani G et al.; Authors reported the results of clinical experiments on the use of Ceftriaxone in the prophylaxis of post operative orthopaedic and traumatological complications in 30 patient . The absence of post operative infection and the good tolerance confirm its usefulness for antibiotic prophylaxis in orthopaedic surgery. Clin Orthop, 1986 Apr, (205), 184 - 7 Short-term preventive antibiotics; Heydemann JS et al.; In a study of the duration of antibiotic prophylaxis in elective surgery, 466 procedures were surveyed over a four-year period . It is difficult to prove the efficacy of antibiotic prophylaxis when the rate of infection is so low, and, although not statistically significant, there is no difference in the infection rate whether the antibiotics are given intraoperatively only or for 48 hours, three days, or seven days . Per 100,000 patients, the cost savings of giving antibiotics intraoperatively rather than for 48 hours would have been $7,700,000; with the reduction from seven days to one-dose antibiotics, the savings would have been $29,700,000. Int J Gynaecol Obstet, 1986 Apr, 24(2), 157 - 60 Broad spectrum antibiotics as short term prophylaxis for elective abdominal hysterectomy: comparison of mezlocillin, cefazolin and placebo; Hakim M et al.; A prospective randomized placebo controlled double-blind study was conducted in order to evaluate the effect of short term perioperative antibiotic prophylaxis on patients undergoing elective abdominal hysterectomy . Fifty-two patients received 3 doses of 0.5 g cefazolin, 54 patients received 3 doses of 1 g mezlocillin and 53 patients received placebo . Postoperative infectious morbidity and the rate of pelvic cellulitis were significantly lower in either antibiotic group in comparison to the placebo group, but neither drug proved to be superior in this respect . The fever index was significantly lower in the mezlocillin group in comparison to both cefazolin and placebo groups . It was thus concluded that antibiotic prophylaxis has a beneficial effect on patients undergoing abdominal hysterectomy and both drugs--cefazolin and mezlocillin--seem to be equally effective. J R Soc Med, 1986 Mar, 79(3), 137 - 41 Single-dose antibiotic prophylaxis of abdominal surgical wound infection: a trial of preoperative latamoxef against peroperative tetracycline lavage; Sauven P et al.; A randomized controlled clinical trial was undertaken in 542 consecutive emergency and elective abdominal operations, with one group of patients receiving tetracycline peritoneal and wound lavage and the other a single intravenous injection of 1 g latamoxef at induction of anaesthesia . Seventy-five patients were withdrawn because no potentially contaminated hollow viscus was opened, and a further 36 because they could not be assessed for wound infection . Of the remaining 431 patients, 212 received latamoxef resulting in 5 major and 8 minor wound infections in hospital; another 4 minor infections occurred at home (total incidence 8.0%) . In the tetracycline group (n = 219) there were 7 major and 19 minor wound infections in hospital and 10 minor infections later (total incidence 16.4%) . This is significantly higher than the rate with latamoxef (P = 0.012) . Monitoring of operative and postoperative bleeding revealed no evidence (except in one doubtful case) of excessive bleeding associated with the use of a single dose of latamoxef . It is concluded that single-dose preoperative latamoxef is more effective than peroperative tetracycline lavage for the prevention of wound infections after potentially contaminated abdominal operations. Lancet, 1986 Feb 8, 1(8476), 311 - 3 A scoring method (ASEPSIS) for postoperative wound infections for use in clinical trials of antibiotic prophylaxis; Wilson AP et al.; To compare antibiotic regimens for their effectiveness in preventing or treating wound sepsis, well-defined criteria for outcome are needed . A method of assessing wound healing has been devised that defines carefully the characteristics to be considered and how they are to be awarded points . Objective criteria are also included in the assessment . Points are given for the need for Additional treatment, the presence of Serous discharge, Erythema, Purulent exudate, and Separation of the deep tissues, the Isolation of bacteria, and the duration of inpatient Stay (ASEPSIS). Chir Ital, 1986 Feb, 38(1), 113 - 8 {Short-term prophylaxis in orthopedic and traumatologic surgery}; Gaetani G et al.; The rational and selective use of the perioperative antibiotic prophylaxis plays a decisive role in prevention of post-operative infections in orthopedic surgery and traumatology . The conceptual bases for the application of the Short-Term chemioprophylaxis are presented in accord to the most recent data reported in the literature. Am J Surg, 1986 Feb, 151(2), 209 - 12 Duration of antibiotic prophylaxis . An experimental study; Scher KS et al.; An animal wound model was used to evaluate single dose cefazolin, multiple dose cefazolin, and single dose cefonicid in the prevention of wound infection . Incisions made in Swiss-Webster mice were contaminated with either Staph . aureus (1.94 X 10(8) colony forming units) or E . coli (4.39 X 10(8) colony forming units) . Five experimental groups were studied . Group I encompassed control animals given saline solution, Group II animals given 10 mg cefazolin preoperatively, Group III animals given 10 mg of cefazolin preoperatively and postoperatively, Group IV animals given 10 mg of cefonicid preoperatively, and Group V animals given 20 mg of cefonicid preoperatively . All medications were given by intraperitoneal injection . Antibiotics were given 1 hour before operation . Postoperative doses were given 4 hours after operation . Incisions were opened 48 hours after surgery and wound bacterial concentrations were determined . After both Staph . aureus and E . coli contamination, each of the four cephalosporin regimens significantly reduced the mean wound bacterial concentrations compared with that of the control animals (p less than 0.001) . Each of the four cephalosporin regimens also significantly reduced the number of infected wounds compared with that of the control subjects (p less than 0.001) . No significant differences were noted among the four antibiotic regimens with respect to mean wound bacterial concentration or infection rate . In the context of this model, a single dose of cefazolin seems to be equally effective as multiple doses of the drug for surgical prophylaxis . Extended half-life cephalosporins, like cefonicid, do not appear to be more effective than a single dose of cefazolin, which is a much less expensive antibiotic. J Am Dent Assoc, 1986 Feb, 112(2), 198 - 203 Dental care for patients receiving chemotherapy; DePaola LG et al.; Common oral complications of chemotherapy include mucositis, infections secondary to profound bone marrow aplasia, and gingival bleeding . Mucositis and infections were treated with appropriate antibiotic therapy; a symptomatic tooth was extracted before chemotherapy was begun . Transfusions were performed to obtain adequate platelet levels . A regimen of ticarcillin disodium and gentamicin sulfate is recommended for antibiotic prophylaxis for selected dental procedures. Acta Chir Belg, 1986 Jan-Feb, 86(1), 52 - 6 Fasciitis necroticans; Rosseel B et al.; Fasciitis necroticans (F.N.) is a rapidly progressing necrotizing process of subcutaneous tissue and fascia which results in large soft tissue defects and severe systemic toxicity . During the last five years nine patients with F.N . were admitted at our department of surgery . Antibiotic prophylaxis immediately after the eliciting trauma was associated with a significant delay in treatment . Early recognition and surgical treatment are the most important factors influencing survival. Arch Surg, 1986 Jan, 121(1), 23 - 30 Efficacy of short-course antibiotic prophylaxis after penetrating intestinal injury . A prospective randomized trial; Dellinger EP et al.; Infection is the leading cause of morbidity and mortality occurring more than 48 hours after penetrating abdominal injury . Antibiotics are routinely administered to patients with penetrating intestinal injuries and are usually given for five days or more . We randomized 116 patients with confirmed penetrating injuries of the colon and/or small bowel to receive either 12 hours or five days of antibiotics . Age, sex, weapon, severity of injury, and other risk factors were evenly distributed between groups . Twenty-one patients (18%) developed trauma-related infections, 28 (24%) any infection, and three (2.6%) died . There were no significant differences between groups in any category of outcome . For patients with penetrating intestinal or colonic injury, a 12-hour course of antibiotics is as effective as a five-day course and has the advantage of lower cost and, theoretically, fewer side effects. Langenbecks Arch Chir, 1986, 369, 263 - 7 {Risk of infection and surgical consequences of splenic loss in childhood}; Roth HG; Among 1882 splenectomized children with a mean follow-up period of more than 5 years the incidence of sepsis was 3.2% with a mortality of 1.4% . As expected the lowest risk (1.6%) was found in case of trauma . Susceptibility to sepsis increases after splenectomy caused by severe disease . It was highest (9.8%) in case of M . Hodgkin, portal hypertension and thalassemia . The younger the patient the higher the risk of PSI . 55% of the affected patients suffered from sepsis within the first two years, 35% after three up to six years . Vaccination and antibiotic prophylaxis are recommended including information about the risk of sepsis . Preservation of orthotopic splenic tissue, if indicated, should be the surgical consequence in childhood. Cor Vasa, 1986, 28(1), 61 - 6 Comparative study of cefamandole versus cephalothin as antibiotic prophylaxis for open heart surgery; Meszaros R et al.; Cefamandole nafate and cephalothin sodium were administered as prophylaxis in a randomized, prospective study to 80 consecutive patients undergoing open heart surgery . The two groups matched well in age, sex, and type of operation . Postoperative infection developed in 2 of 40 patients (5%) in the cefamandole-treated group and in 11 of 40 patients (27.5%) in the cephalothin-treated group (p less than 0.01) . The two patients in the former group had respiratory tract infections . There were no instance of endocarditis, mediastinitis or bacteraemia in any of the two groups . Both antibiotics were well tolerated with no adverse reactions . Cefamandole appears to be an effective and preferable prophylactic antibiotic for use during cardiac surgery. Eur Urol, 1986, 12(5), 289 - 93 Preoperative preparation of the bowel for urological surgery: a review; Ackermann D et al.; The risk of postoperative complications following opening of the intestine can be reduced by lowering the intraluminal bacterial count . The latter is achieved principally by decreasing the mass of the gut content and by antibiotic prophylaxis . Macroscopically satisfactory decontamination of the gut can be attained with laxatives, enemas, elementary diet or orthograde lavage . We prefer oral lavage with Golytely solution since it allows rapid preparation of the gut and is well tolerated . The value of antibiotic prophylaxis in association with operations on the colon or rectum is undisputed and a number of regimes have been shown to be effective . In view of its effectiveness and lack of side effects . 24-hour perioperative parenteral prophylaxis with metronidazole can be recommended. Zentralbl Chir, 1986, 111(5), 252 - 60 {Quality assurance in general surgery by prospective patient documentation . A comparison over 5 years}; Grundmann R et al.; All patients who had undergone general surgery in three different periods of time were prospectively recorded . Results were found to have been improving with significance owing to peri-operative antibiotic prophylaxis, mechanical suturing (for gastro-intestinal anastomoses), and introduction of a system of regular documentation . Rates of postoperative complications were also affected by the individual surgeon's efficiency and techniques. J Reprod Med, 1986 Jan, 31(1), 15 - 8 Antibiotic prophylaxis in cesarean section . Comparison of intrauterine lavage and intravenous administration; Donnenfeld AE et al.; Intrauterine irrigation with a cefazolin solution at cesarean section was compared with intravenous cefazolin administration for prophylaxis against post-cesarean-section endomyometritis in a randomized, controlled, prospective fashion . There were no statistically significant differences in the incidence of infection between the lavage and intravenous groups . The incidence of endomyometritis was 37% in the lavage group and 29% in the intravenous (P = NS) . Intrauterine cefazolin lavage is safe, effective, time saving and more cost effective than intravenous cefazolin in preventing post-cesarean-section endomyometritis. J Antimicrob Chemother, 1986 Jan, 17(1), 105 - 13 Antibiotic prophylaxis in vascular reconstructive surgery: a double-blind placebo-controlled study; Worning AM et al.; In a prospective randomized double-blind study of 141 patients referred for reconstructive vascular surgery on the abdominal aorta and the lower extremities, placebo was compared to antibiotic prophylaxis . The prophylaxis group received three doses of a combination of methicillin, 2 g and netilmicin, 200 mg . Antibiotic prophylaxis reduced postoperative wound infections as compared to placebo, i.e . 4/69 (5.8%) vs . 12/72, (16.7%) respectively (P = 0.04) . No graft infections occurred . Two cases of postoperative septicaemia were seen in the placebo group, none in the antibiotic group . Among different procedures aortic-femoral bypass operations showed the highest wound infection rates . The two treatment groups were comparable with regard to all other postoperative complications registered, including nephro- and ototoxicity . The antibiotic regimen was considered safe, but had only marginal value as prophylaxis in vascular reconstructive surgery on the abdominal aorta and the lower extremities. Obstet Gynecol, 1986 Jan, 67(1), 29 - 32 Comparison of lavage or intravenous antibiotics at cesarean section; Elliott JP et al.; The route of administration of prophylactic antibiotics was studied in a randomized prospective trial . Cefoxitin was administered to high-risk patients at cesarean section by three treatment regimens: intravenous antibiotic (2 g) for eight doses, irrigation of uterus and peritoneum with 2 g of antibiotic, and a combination of intravenous and irrigation as described . A control group received no antibiotic prophylaxis . The incidence of febrile morbidity was similar in each treatment group: intravenous, two of 39 (5%); irrigation, three of 42 (7%); intravenous and irrigation, two of 38 (5%), and were all significantly lower than the control group 14 of 39 (36%) (P less than .05) . Similar results were found when prevention of endometritis was the end point: intravenous, two of 39 (5%); irrigation, two of 42 (5%); intravenous and irrigation, two of 38 (5%) compared with 13 of 39 (33%) in the control group (P less than .05) . Administration of antibiotics by irrigation is equally effective in preventing postoperative febrile morbidity and endomyometritis as intravenous dosing and a combination of intravenous and irrigation . This affords a potential cost savings. Acta Med Scand Suppl, 1986, 708, 1 - 39 Long term results after operative treatment of isolated ventricular septal defect in adolescents and adults; Otterstad JE et al.; A series of 125 consecutive patients with isolated ventricular septal defect (VSD) aged 10 or over, were followed until death or beyond the age of 30 (31-73) years . A prospective restudy was performed after a mean follow-up of 15 (3-21) years . Forty-one patients (group 1) were treated with surgical repair of VSD at a mean age of 23 (10-51) years, and early mortality was 10%, i.e . 3 with severe aortic insufficiency and one with systemic pulmonary artery pressure . Surgery was initially not regarded indicated in 70 patients with small defects (group 2) . A further 14 patients were judged inoperable (group 3) . Long-term mortality was 5% in group 1, 9% in group 2 and 71% in group 3 . When restudied, group 2 patients had significantly higher (p less than 0.01) and group 1, lower (p less than 0.01) pulmonary artery pressures than initially . A moderate deterioration in NYHA-rating was noted in group 2 (p less than 0.05) vs . a slight improvement in group 1 (p less than 0.05) . The non-operated patients had a higher incidence of valvular lesions (19% vs . 13%) and bacterial endocarditis (4.3% vs . 2.7%) than the operated but not to a statistically significant level . Spontaneous closure was 6% in group 2 whereas mostly small residual defects were found in 34% of the operated . Patients with uncomplicated VSDs (absence of valvular lesions or coronary heart disease) had subnormal exercise tolerance as judged from a standardized ergometer bicycle test . These patients also had impaired left ventricular function based upon haemodynamic studies during moderate supine exercise . No major differences were noted between groups 1 and 2, but operated patients with residual VSDs tended to have the poorest cardiac performance . Non-cardiac disease represented only a minor problem and no significant differences in psychosocial function were observed between groups 1 and 2 . Only 50% in group 1 and 60% in group 2 attended a regular medical clinic . Antibiotic prophylaxis had only been practiced by 50% in both groups . Although small, but differences between groups 1 and 2 favour surgery . This must be regarded as a positive result of surgical treatment since those operated on had basically larger and thus more severe defects than the others . In view of the very low operative risk associated with modern surgical technique one should direct patients with significant shunts to operative treatment. Zentralbl Gynakol, 1986, 108(7), 435 - 9 {Initial results of perioperative antibiotic premedication with halospor and gentamycin in cesarean section}; Loser B et al.; The perioperative application of antibiotics in prophylaxis of infections is disputed . In a preliminary prospective study the infections morbidity of 44 patients after caesarean section was determined to investigate the effect of short term prophylaxis with halospor and gentamycine . A control group of 104 patients remained without any antibiotic prophylaxis . The patients of the prophylaxis group showed a statistically significant reduction of postoperative infectious morbidity . The costs are equalized by reduction in therapeutic applications of antibiotics. Fetal Ther, 1986, 1(2-3), 116 - 8 Genitourinary tract anomalies: neonatal surgical problems; Domini R et al.; This paper is based on our experience in managing 79 cases of genitourinary tract anomalies diagnosed in utero and treated after birth . These babies seldom present as emergencies, and the antenatal diagnosis can usually be confirmed in the first few days of life . The surgical correction of these babies requires the services of a surgeon skilled and experienced in neonatal surgery . Surgeons experienced only in adult surgery may find these procedures technically difficult . Magnification is recommended . Postoperatively careful attention to fluid and electrolyte balance and correct functioning of drainage tubes is stressed . Antibiotic prophylaxis is vital, as is long-term follow-up. Int Arch Allergy Appl Immunol, 1986, 79(1), 45 - 8 Synergism between gammaglobulin prophylaxis and penicillin treatment in experimental post-splenectomy sepsis in the rat; Offenbartl KS et al.; In spite of long-term antibiotic prophylaxis and pneumococcal vaccination, there still exists a proportion of highly susceptible splenectomized or functionally hyposplenic patients at risk of contracting fatal overwhelming infections . We have studied the effect of gammaglobulin prophylaxis in experimental sepsis among splenectomized rats . Administration of 37.5 mg human gammaglobulin/kg body weight 24 h before challenge with 10(3) pneumococci resulted in the survival of 19 of 24 rats, in contrast to 1 of 24 controls . A dose of 19 mg/kg body weight was not protective (7 of 23 survived) . However, treatment with penicillin 18 h after challenge in the gammaglobulin-pretreated group of animals saved 21 of 24 animals, although penicillin without gammaglobulin prophylaxis showed no effect . These data indicate that even relatively low circulating concentrations of specific antibody after gammaglobulin prophylaxis might nonetheless be adequate to render septic disease easier to treat. J Oral Maxillofac Surg, 1985 Dec, 43(12), 981 - 6 Salvage of the mandibular staple bone plate following bone infection; Davenport WL et al.; Two cases of previously unreported complications associated with implantation of a mandibular staple bone plate are presented . One was a proven case of chronic osteomyelitis, and the other had a close clinical and radiographic resemblance to osteomyelitis . It is suspected in both cases that complications were due to the use of a dull twist drill that caused local tissue injury . Differences in the clinical courses are believed to be related to the degree of oral hygiene after surgery, with a more severe infection occurring in the patient who maintained extremely poor home care . There is the possibility that some degree of osteoporosis was present in the same patient that may also have influenced the clinical course . While the salvage of implants in areas of osteomyelitis is controversial, it was shown to be justifiable in these cases . Crucial to such salvage is the selection of an antibiotic that is effective against the organisms involved and safe for prolonged use . Cefotaxime and clindamycin were used in the cases reported and proved to be effective and without adverse effect . Although it will take time to see to what degree bone refills the affected areas, it appears at present that the resorptive process has ceased and that bone regeneration is in progress . Prevention of the complications reported here is believed to be possible with the use of sharp drills, slow drilling speed, copious cool irrigation, appropriate antibiotic prophylaxis, and meticulous oral hygiene. Am Fam Physician, 1985 Nov, 32(5), 137 - 41 Nondomestic mammalian bites; Klein M; Life-threatening injuries resulting from wild animal bites are always treated first . Local wound management varies, depending on the type of wound and its location, but scrupulous cleansing and copious irrigation are mandatory . Tetanus prophylaxis and rabies prophylaxis are provided according to accepted guidelines . Antibiotic prophylaxis is not routinely necessary but is advisable for wounds of the hands or joints and for wounds in immunocompromised individuals. J Oral Maxillofac Surg, 1985 Nov, 43(11), 865 - 9 Antibiotic prophylaxis for major maxillocraniofacial surgery; Conover MA et al.; A shortened prophylactic regimen of antibiotics for maxillofacial and craniofacial surgery is evaluated . Eighty-five patients were divided into two groups on the basis of the type of incision used . Forty-nine patients undergoing intraoral procedures received penicillin perioperatively and were given one postoperative dose (regimen A) . Thirty-six patients undergoing extraoral or combined intraoral and extraoral procedures received penicillin and oxacillin perioperatively, with nine receiving one postoperative dose and 27 receiving an average of seven postoperative doses (regimen B) . One infection was observed in the regimen A group, and three were observed in the regimen B group . This infection rate compares favorably to that encountered in the authors' previously reported study on longer prophylactic courses of antibiotics. Dis Colon Rectum, 1985 Nov, 28(11), 804 - 6 Topical ampicillin in addition to a systemic antibiotic prophylaxis in elective colorectal surgery . A prospective randomized study; Juul P et al.; Prophylactic use of topical ampicillin in addition to intravenous ampicillin and metronidazole was studied in a randomized trial including 203 consecutive patients undergoing elective colorectal surgery . All received ampicillin, 1 g X 3, and metronidazole, 0.5 g X 3, intravenously for at least three days from induction of anesthesia, and 105 also received topical ampicillin, 1 g, in each of the surgical wounds . Deep wound infection or dehiscence was seen in 12 of 105 having both administrations of antibiotics, and in nine of 98 having only intravenous antibiotics . The two groups were similar according to distribution of sex, age, type of surgery, and efficiency of bowel preparation . Topical ampicillin should be omitted in elective colorectal surgery when systemic prophylaxis with ampicillin and metronidazole is used. Med Care, 1985 Oct, 23(10), 1156 - 62 The application of official policy . Prophylaxis recommendations for patients with mitral valve prolapse; Retchin SM et al.; In 1977, the American Heart Association recommended that patients with mitral valve prolapse (MVP) and mitral insufficiency receive antibiotic prophylaxis prior to procedures that place them at risk for bacterial endocarditis . To study how clinicians conformed to this recommendation, the authors selected 126 patients with MVP admitted to a University Medical Center in 1978, the year following the official policy . Overall, only 47 patients (37%) had the antibiotic prophylaxis recommended . Furthermore, information that might have increased the certainty of diagnosis of MVP or the likelihood of mitral insufficiency did not influence the physician's decision: symptoms, previous history, procedures, sex, evidence for mitral insufficiency, other serious illnesses, or the use of cardiac medications . However, patients seen in consultation by a cardiologist were much more likely to have prophylaxis recommended (P less than 0.05) . It was concluded that the application of an official policy about prophylaxis for a condition such as MVP, where the risks are uncertain, is likely to be guided by other factors, such as the opinions of local experts. Am J Surg, 1985 Oct, 150(4), 406 - 13 Tumors of the paranasal sinuses: a therapeutic challenge; Ketcham AS et al.; Cancer involving the ethmoid and sphenoid frontal sinus complex can be successfully eradicated by a combined transcranial and transfacial surgical dissection . Survival rates of 44 to 58 percent with a 3 percent hospital mortality rate in patients whose previous surgery or radiotherapy was largely unsuccessful suggest that this cosmetically acceptable surgical endeavor should be used more often by the head and neck surgeon in treating paranasal sinus cancer . Utilizing the principles of antibiotic prophylaxis, strict attention to principles of tumor removal and surgical technique, and the talents of the combined surgical and neurosurgical team, this aggressive surgical approach to the paranasal sinuses can be safely and successfully carried out . The approach described herein has the following advantages: it allows accurate evaluation of intracranial tumor extension while protecting the intracranial contents, it essentially avoids cerebrospinal fistulization, it provides adequate exposure for hemostasis, facilitates en bloc tumor resection, selectively conserves the orbital contents, and provides patient survival rates up to 58 percent for paranasal cancer that involves the ethmoid and sphenoid frontal sinus complex. Int Surg, 1985 Oct-Dec, 70(4), 349 - 52 Prophylactic antibiotics in patients undergoing total vaginal or abdominal hysterectomy; Tchabo JG et al.; A prospective study to evaluate the effect of antibiotic prophylaxis in 57 patients undergoing total abdominal or vaginal hysterectomy was conducted at Arlington Hospital . Patients were assigned randomly to one of two regimens . Group I received a single 1 gram preoperative dose of Cefotaxime (Claforan) . Group II received a 2 gram dose of Cefoxitin (Mefoxin) preoperatively and also four 2 gram doses postoperatively . There was no significant group difference in the incidence of postoperative infection or in the mean duration in hospital stay . One dose of Cefotaxime was as effective as five doses of Cefoxitin in preventing infection. Eur J Obstet Gynecol Reprod Biol, 1985 Oct, 20(4), 229 - 34 Short-term prophylactic antibiotic for elective abdominal hysterectomy: how short? Gonen R, Hakim M, Samberg I, Levitan Z, Sharf M. A prospective double-blind study was conducted in order to evaluate the effect of antibiotic prophylaxis on patients undergoing elective abdominal hysterectomy . In the first stage of the study, 116 patients received, on call to the operating room and subsequently 8 and 16 h post-operatively, cefazolin sodium or placebo . In the second stage of the study, 90 patients received the same antibiotics, but treatment was extended to 6 doses, 8 h apart . Of the 53 women who received placebo, 27 (50.9%) became morbid, while only 15 of the 63 (23.8%) who received 24 h prophylaxis were classified as morbid (p less than 0.005) . By extending the prophylactic treatment to 48 h further reduction of the morbidity was achieved . Of the 90 patients only 11 (12.2%) became morbid (P less than 0.005) . When morbidity rates were compared between different ethnic groups, over-weight and normal weight patients, pre- and post-menopausal women, it was not possible to define a group which is at a higher risk for post-operative morbidity . It was thus concluded that prophylactic antibiotics should be administered routinely to all patients undergoing abdominal hysterectomy, preferably for 48 h. J Periodontol, 1985 Oct, 56(10), 611 - 7 Phagocytic cells in periodontal defense . Periodontal status of patients with chronic granulomatous disease of childhood; Cohen MS et al.; Both qualitative and quantitative neutrophil abnormalities have been associated with severe forms of periodontitis . Defects in chemotaxis, phagocytosis and bacterial killing have been reported among both peripheral blood and gingival neutrophils harvested from patients with juvenile and rapidly progressive periodontitis . Chronic granulomatous disease of childhood (CGD) is a rare, inherited disorder associated with the occurrence of severe, life-threatening, suppurative infections of skin, liver, lymph nodes and other organs . Neutrophils and monocytes from individuals with CGD lack enzymes necessary for the production of oxygen reduction/products such as H2O2 and superoxide anion, and therefore are unable to kill many species of bacteria and fungi . However, no detailed study of the periodontium of these patients has been undertaken . Accordingly, five patients whose ages ranged from 17 to 32 years were included in this study . An additional (sixth) patient was included based on complete dental records . Neutrophils from all patients demonstrated defective O2 metabolism, and all patients had histories of chronic recurrent abscesses consistent with CGD . All patients were receiving antibiotic prophylaxis . Several patients had ulcerative lesions of the oral cavity of unknown etiology . Examination of the periodontium revealed that three patients had gingivitis, one had localized early periodontitis, and one had generalized early-to-moderate periodontitis . The severity of periodontal disease was consistent with patient age and local etiologic factors . No patients had evidence of juvenile, severe or rapidly-progressing disease in spite of their leukocyte defects . These findings suggest the following possibilities.(ABSTRACT TRUNCATED AT 250 WORDS) Acta Anaesthesiol Belg, 1985 Sep, 36(3), 168 - 75 Craniostenosis: the importance of the anesthesiologist; Vercauteren M et al.; Based on the experience with 15 patients operated for craniostenosis in our hospital, guidelines were determined for the anesthetic and postoperative management with optimal maintenance of vital parameters . Subgaleal accumulation of blood may cause a spectacular drop of hemoglobin level during the first postoperative days . Since it is better to prevent than to cure, systematic anti-convulsive and antibiotic prophylaxis must be considered. Neurochirurgia (Stuttg), 1985 Sep, 28(5), 188 - 9 Pharmacokinetics and CSF penetration of moxalactam in antibiotic prophylaxis in neurosurgery; Sachsenheimer W et al.; Moxalactam, a new oxa-beta-lactam antibiotic, suggests a possible role in prophylaxis in neurosurgery . Therefore, CSF penetration of Moxalactam was determined in 12 patients with absence of clinical or laboratory evidence of meningitis . In the dose employed (25 mg/kg 3 times/day) CSF samples showed a penetration of Moxalactam through the blood-cerebrospinal barrier with concentrations higher than 0.1 microgram/ml which persisted for more than seven hours . The drug was well tolerated and adverse effects were not observed. Chirurg, 1985 Sep, 56(9), 573 - 8 {Experiences with 2 years of quality control following general and vascular surgery in 3193 patients}; Grundmann R et al.; 3193 general and vascular surgical interventions were prospectively controlled regarding the postoperative complication rates . The examination of all complication data was necessary to define the risk of the various operations . By a regular follow-up system the risk of wound infections and other complications decreased . Although perioperative antibiotic prophylaxis and stapling devices for gastrointestinal end-to-end anastomoses were routinely used, the surgeon still influenced the complication rates. Surg Gynecol Obstet, 1985 Sep, 161(3), 197 - 203 Ceftriaxone and cefazolin prophylaxis for hysterectomy; Hemsell DL et al.; Two hundred and twenty-five women scheduled for elective hysterectomy were entered into a prospective, comparative, randomized, double-blind clinical trial of antibiotic prophylaxis; 117 had vaginal hysterectomy and 108 had abdominal hysterectomy . They were given a 1 gram preoperative dose of ceftriaxone, an investigational cephalosporin or three 1 gram parenteral doses of cefazolin over a 16 hour period . Antibiotic concentrations were measured in serum and vagina, myometrium, fallopian tube or ovary and mean ceftriaxone concentrations were consistently higher than those of cefazolin . Both regimens were safe, well tolerated and equally effective at preventing major postoperative infection . Diabetes increased the risk for infection regardless of regimen and surgical approach (p = 0.009) and specific risk factors were identified for women undergoing vaginal hysterectomy . The incidence of infection was 1.7 per cent after vaginal hysterectomy, significantly lower than the 7.4 per cent observed after abdominal hysterectomy (p = 0.039) . Several of the clinical and surgical variables were identified that could explain this difference. Br J Surg, 1985 Sep, 72(9), 759 - 62 Study of cardiothoracic wound infection at St . Thomas' Hospital; Farrington M et al.; Wound infection occurred after 14.3 per cent of 433 open heart operations . In 309, saphenous veins were harvested for coronary artery bypass grafting (CABG) and 8.7 per cent of sternal wounds and 12.9 per cent of leg wounds were infected . Only 1.6 per cent of the remaining 124 patients who had open heart operations without leg surgery suffered sternal wound infections . In the CABG group sternal infection was theatre-related and significantly associated with length of pre-operative stay, diabetes and re-operation . Similar organisms were isolated from both leg and sternal wounds which suggest that organisms were transferred from legs to sternum with the veins . No clinically relevant cross infection was demonstrated . Skin disinfection and surgical technique seem more important than antibiotic prophylaxis in the control of these infections. Geburtshilfe Frauenheilkd, 1985 Aug, 45(8), 546 - 51 {Pattern changes in the framework of cesarean sections in 1980/83 as compared to 1974/76 in the University Women's Clinic in Jena}; Krause W et al.; In a comparative study on Caesarean section problems-based on investigations from 1974/76 and 1980/83-conducted at the Gynaecological and Obstetrical Hospital of Jena University, changes are apparent in the indication for Caesarean section and in maternal morbidity . The evident decrease in statistically uncorrected perinatal mortality as well as in uncorrected intra-and postnatal mortality during this period (difference statistically significant at p less than 0.05) was not due to a further increase in Caesarean sections from 8.23% (period 1974/76) to 9.27% (period 1980/83), but to other factors (improved medical care for pregnant women and improved neonatal check-up) . In comparison with uncorrected intra-and postnatal mortality, perinatal Caesarean section lethality even showed a 2,46-fold relative increase . As late morbidity among high-risk children related to the immediate stage of labour is still poorly understood, "extended" indication for Caesarean section is maintained-in spite of high infection morbidity among mothers . General perioperative antibiotic prophylaxis for these women is recommended because of the statistically significant poor situation of secondary Caesarean sections as far as maternal morbidity is concerned. Surg Gynecol Obstet, 1985 Aug, 161(2), 136 - 8 One row anastomosis in colonic operations with antibiotic prophylaxis; Entner M et al.; Eighty-nine patients who underwent elective operations and 26 patients who underwent nonelective operations for diseases of the large intestine were studied for mortality and morbidity . In the patients who underwent elective operations, there was no anastomotic leakage or wound infection and only 1 per cent mortality . Additionally, 2 per cent nonfatal surgical complications were observed . In patients who underwent nonelective operation, a morbidity of 46.2 per cent and a mortality of 15.0 per cent were observed . Fourteen patients with acute illness were without serious complications postoperatively . All anastomoses except two were one row in elective operations without protective colostomy . All patients who underwent elective operation received antibiotic prophylaxis-a combination of cefotaxime and metronidazole. Pediatr Inf