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Early ambulation and related procedures in surgical management
“Early
Leithauser, 232 Pages.
Ambulation
and
Related
Procedures
St M.D., F.A.C.S., Chief of Sur!jc~$~~n~.~~ Charles C Thomas, SpringAel .
in
Surgioal
.Jos$~ . Mercy
Msnagement.
Hospital.
By Detroit,
Daniel .I. X-lwhigan.
BOOK
REVIEWS
postoperatively, 4 liters of water is given with 9 Gm. of sodium chloride, partly by subcutaneous route. No enema or cathartics are given on the day of operation. As contraindication to early rising, only profound shock, hopeless conditions as carcinoma, midline rectus incision, or an insecure suture technique would be considered. No morphine is given after the first twenty-four hours. The first bowel evacuation can wait for several days or up to a week after operation. Catheterization is rarely necessary in patients who get up early. In cystocele operation, a retention catheter is kept in situ for twenty-four hours, and yet these patients are treated as early ambulants. Several interesting chapters deal with the operative techniques of the author, particuTransverse or gridiron incisions are advocated. The larly the placing of his incisions. peritoneum and transversalis is sutured with 000 chromic catgut and for fascia, 32 alloy steel A subcuticular metal suture is used for the skin. is used. Drainage of either appendix, gall bladder, or any other intra-abdominal incision, if indicated, does not prevent early rising. An analysis of the operations performed and a detailed analysis of all of the fatal eases are given. Thorough study of this ambulation is suggested.
monograph
by
all
surgeons
who
are
not
yet
converted
to early
R. T. FRANK.
Penicillin, Its Practical Application,10 which appeared under the general editorship of l’rofessor Alexander Fleming, is really a mustfor anyone who intends to produce, market, or use penicillin widely. It is an all-British product, having twenty-eight contributors whose independent views do not show too much conflict. The book is intended for the practitioner, and shows him how to use penicillin to the best advantage. It likewise includes two chapters on dental and veterinary practice. The senior author, Fleming, writes an introduction and a chapter on “Bacteriological Control of Penicillin Therapy. ” Few will agree with his remark, “ Mv own contribution to this He recommends that it, is “ bet.ter to give m&e than enough than too book is small. . . .” little” because to all intents and purposes penicillin is a nontoxic substance. He describes how he discovered it in 1928 as a contaminant in a csulture plate of staphylococci; how the flora grows in chains; how penicillin was concentrated 1,000 times in 1940; how the International XJnit which equals 0.0006 mg. of pure crystalline sodium salt of penicillin II (United States, penicillin G) was evolved. This corresponds to 5,000 units, equalling 3 milligrams in weight. It is quite impossible to discuss the really enormous amount of facts contained in lhis test and source book in the form of a review. A few chapters will be mentioned. Chemistry (Bacharaeh and Hems) shows that the substance, if the P-lactam formula is accepted, is a monocarboxylic acid, to be used as a sodium or calcium salt. The production and manufacture Surface growth has been abandoned in favor of deep hare nuw become a huge industry. growth in 2,000 to 10,000 gallon tanks. The main steps are aeration, agitations, and asepsis. The production has been greatly accelerated by the use of “corn steep liquor.” Pnder phnrmary (Berry), the lack of toxicity, the sterility, the use of either calcium or sodium salt, the storing at less than 50 degrees Centigrade, the drying and freezing at pH 6.5, the incompatabilities (mainly aqueous sulfonamide solutions strong alcohols), and the various preparations such as aqueous, oily, cream, unguents, and troches are described. The pharmacology by (+arrntl is important. Among other things, il shows that 60 per cent of penicillin is excreted in the urine; that unless the blood level is raised and unduly high, no cnt,ranec into the cerebrospinal fluid is observed, and that oral dosages must be about five times that of parenteral. The chapter on bacteriological control of penicillin therapy by Fleming shows the rapid method of assay which is now essential during the course of mass production; also the estimation in body fluids, urine, etc. Its Practical Application. Under the General Editorship of Professor Sir Professor of Bacteriology in the Fle&g. M.B., B.S.. F.R.C.P., F.R.C.S., F.R.S.. London. 380 pages. The Blakiston Company, of London, St. Mary’s Hospital. 1946.
~oPenicillin
Alexander Cniversity Philadelphia.
Leithauser, 232 Pages.
Ambulation
and
Related
Procedures
St M.D., F.A.C.S., Chief of Sur!jc~$~~n~.~~ Charles C Thomas, SpringAel .
in
Surgioal
.Jos$~ . Mercy
Msnagement.
Hospital.
By Detroit,
Daniel .I. X-lwhigan.
BOOK
REVIEWS
postoperatively, 4 liters of water is given with 9 Gm. of sodium chloride, partly by subcutaneous route. No enema or cathartics are given on the day of operation. As contraindication to early rising, only profound shock, hopeless conditions as carcinoma, midline rectus incision, or an insecure suture technique would be considered. No morphine is given after the first twenty-four hours. The first bowel evacuation can wait for several days or up to a week after operation. Catheterization is rarely necessary in patients who get up early. In cystocele operation, a retention catheter is kept in situ for twenty-four hours, and yet these patients are treated as early ambulants. Several interesting chapters deal with the operative techniques of the author, particuTransverse or gridiron incisions are advocated. The larly the placing of his incisions. peritoneum and transversalis is sutured with 000 chromic catgut and for fascia, 32 alloy steel A subcuticular metal suture is used for the skin. is used. Drainage of either appendix, gall bladder, or any other intra-abdominal incision, if indicated, does not prevent early rising. An analysis of the operations performed and a detailed analysis of all of the fatal eases are given. Thorough study of this ambulation is suggested.
monograph
by
all
surgeons
who
are
not
yet
converted
to early
R. T. FRANK.
Penicillin, Its Practical Application,10 which appeared under the general editorship of l’rofessor Alexander Fleming, is really a mustfor anyone who intends to produce, market, or use penicillin widely. It is an all-British product, having twenty-eight contributors whose independent views do not show too much conflict. The book is intended for the practitioner, and shows him how to use penicillin to the best advantage. It likewise includes two chapters on dental and veterinary practice. The senior author, Fleming, writes an introduction and a chapter on “Bacteriological Control of Penicillin Therapy. ” Few will agree with his remark, “ Mv own contribution to this He recommends that it, is “ bet.ter to give m&e than enough than too book is small. . . .” little” because to all intents and purposes penicillin is a nontoxic substance. He describes how he discovered it in 1928 as a contaminant in a csulture plate of staphylococci; how the flora grows in chains; how penicillin was concentrated 1,000 times in 1940; how the International XJnit which equals 0.0006 mg. of pure crystalline sodium salt of penicillin II (United States, penicillin G) was evolved. This corresponds to 5,000 units, equalling 3 milligrams in weight. It is quite impossible to discuss the really enormous amount of facts contained in lhis test and source book in the form of a review. A few chapters will be mentioned. Chemistry (Bacharaeh and Hems) shows that the substance, if the P-lactam formula is accepted, is a monocarboxylic acid, to be used as a sodium or calcium salt. The production and manufacture Surface growth has been abandoned in favor of deep hare nuw become a huge industry. growth in 2,000 to 10,000 gallon tanks. The main steps are aeration, agitations, and asepsis. The production has been greatly accelerated by the use of “corn steep liquor.” Pnder phnrmary (Berry), the lack of toxicity, the sterility, the use of either calcium or sodium salt, the storing at less than 50 degrees Centigrade, the drying and freezing at pH 6.5, the incompatabilities (mainly aqueous sulfonamide solutions strong alcohols), and the various preparations such as aqueous, oily, cream, unguents, and troches are described. The pharmacology by (+arrntl is important. Among other things, il shows that 60 per cent of penicillin is excreted in the urine; that unless the blood level is raised and unduly high, no cnt,ranec into the cerebrospinal fluid is observed, and that oral dosages must be about five times that of parenteral. The chapter on bacteriological control of penicillin therapy by Fleming shows the rapid method of assay which is now essential during the course of mass production; also the estimation in body fluids, urine, etc. Its Practical Application. Under the General Editorship of Professor Sir Professor of Bacteriology in the Fle&g. M.B., B.S.. F.R.C.P., F.R.C.S., F.R.S.. London. 380 pages. The Blakiston Company, of London, St. Mary’s Hospital. 1946.
~oPenicillin
Alexander Cniversity Philadelphia.