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Antibiotic activity in surgical incisions
ABSTRACTS weight, mortality, or incidence of respiratory distress syndrome. Pancuronium prevents swallowing of air but it does not inhibit gut peristalsis, this accounting for the evacuation of the abdomen 3 hr or more after administration of the drug. Clinicians who treat infants with pancuronium should be aware of the phenomenon to avoid needless roentgenographic studies.--J. J. Tepas 111 I N T E G U M E N T A N D CONNECTIVE TISSUE Successful Treatment Protocol for Canine Fang Injuries.
E. G. Zook, M. Miller, A. L. Van Beck, and P. Wavak. J Trauma 20:243-247, (March), 1980. The authors state that an estimated two million dog bites occur in the United States each year and with the increasing number of dogs, out of proportion with the increase in population, the number of dog bites can be expected to increase. Thirty percent of dog bites in adults are in the face and scalp area, whereas in children 80% are face and scalp, the smaller the child the more likely the occurrence of face or scalp injury. Two hundred and fifteen lacerations and perforations in 61 patients were treated according to the following protocol: pressure irrigation with a forceful stream of normal saline, excision of wound edges, exploration of the wound with removal of loose fatty tissue, followed again by saline irrigation under pressure. Ampicillin or cephalosporin was given at the beginning of the surgical procedure, followed by intravenous antibiotics for 48 hr and oral antibiotics for 5 days for patients who were treated in the operating room. Those treated in the emergency room received one intramuscular injection followed by oral antibiotics for 5 days. Hemostasis was achieved by coagulation, fine absorbable s u t u r e s in minimal numbers were used in an attempt to obliterate deadspace with pressure dressings for 24 hr. All patients received tetanus and rabies prophylaxis. Out of 215 skin perforations from dog bites, infection occurred in only a single wound, or 1 infection in 61 patients (1.6%). No infections occurred in 135 wounds treated in the operating room (92% of the 61 patients were children under 21 yr of age, 26% were 2 yr or younger.) Two editorial comments regret that it is not clear which factor played a significant role in the successful treatment reported. One of the editorial comments, relating to the antibiotic treatment, finds the use of antibiotics in all patients to be superfluous, since "a dog's mouth is indeed as clean as a hound's tooth."--J. Chang Antibiotic Activity in Surgical Incisions. H. C. Polk, Jr.,
L. Trachtenberg, and M. P. Finn. J A M A 244:1353-1354, (September), 1980. The authors measured antibiotic concentration in surgical wounds at the conclusion of operations by absorbing fluid from the subcutaneous tissues with a 6-ram filter paper disk. They compared the duration of activity of cefazolin, cephaloridine, and cephalothin. The first two had reasonable concentrations for 4 hr in the case of cefazolin and 5 hr or more in the case of cephaloridine. However, cephalothin showed a fairly precipitous drop in concentration to the point of insufficient activity at approximately 3 hr after the operation was commenced. In all cases the drugs were given parenterally in adequate doses 45 min before incision.--David L. Collins
411 Malignant Melanoma in Children and Adolescents. I. Peled
andE. Kessler. Harefuah 97:1-4, (July), 1979. Twelve cases of invasive malignant melanoma in childhood and adolescence, with and without metastases, were found among 304 cases of malignant melanoma treated in a 22-yr period. There were only two deaths. In more than 80% there was long-term survival of 5-21 yr after initial treatment. This figure is much higher than those reported in the literature. Thus, contrary to general opinion, even in the presence of metastases, the prognosis is much better in children and adolescents than in adults.--Shemuel Nissan HEAD A N D NECK Osteomyelitis and Bacteremia Caused by Bacteroides fragilis: A Complication of Fetal Monitoring. /. Brook. Clin
Pediatr 19:639-640, (September), 1980. A term male infant monitored with a scalp electrode for 5 hr with 36 hr elapsing between membrane rupture and delivery, developed an occipital abscess with underlying osteomyelitis. Blood cultures grew out Bacteroides fragilis while the abscess fluid grew 6 organisms including 4 Bacteroides species. Incision and drainage, periodic debridement and long-term antibiotics cleared the infection. The authors quote a recent study involving 42 infants who developed scalp abscess following scalp monitoring. Fifty-eight percent grew a mixture of aerobic and anaerobic organisms, aerobes only in 9% and anaerobes only in 11%. Serious complications such as these with anaerobic organisms can be expected with increased use of scalp monitors.--Randall W. Powell Facial Plastic Surgery in Children With Down's Syndrome.
G. Lemperle and D. Radu. Plas Reconstr Surg 66:337-342. The clinical entity of Down's syndrome, or trisomy 21, seems to occur in 1 out of 1600 births and rises to 1 out of 100 births in parents over 40. The cause of the disease appears to be due to a disorder in the cell division either within the ova or theoretically in the spermatozoa. The plastic surgical correction of the six facial characteristics are simple and straightforward plastic surgical procedures. The results of these procedures have enhanced the social acceptability of these children and in some situations, have led to enhanced development and personal respect. The operations are generally performed between the ages of 4 to 6 and currently the report is based on experience with 67 children. The operations are for the correction of: Mongoloid fold (epicanthus), oblique lid axis, saddle nose, conspicuous macroglossia, hypotonia of the lower lip (chei|osis), and receding chin (microgenia). The operations are all performed in one sitting under general anesthesia. The article details pictorial results that are certainly convincing of this surgical assistance to the child so afflicted. It is obvious that the parental acceptance of the child thus operated would certainly be enhanced.-A. B. Sokol Acute Mastoiditis in Infants and Children. C. M. Ginsburg,
R. Rudoy, and J. D. Nelson. Clin Pediatr 19:549-553, (August), 1980. Fifty-seven patients ranging in age from 2 mo to 12 yr presented with acute mastoiditis over a 25-yr period. All
E. G. Zook, M. Miller, A. L. Van Beck, and P. Wavak. J Trauma 20:243-247, (March), 1980. The authors state that an estimated two million dog bites occur in the United States each year and with the increasing number of dogs, out of proportion with the increase in population, the number of dog bites can be expected to increase. Thirty percent of dog bites in adults are in the face and scalp area, whereas in children 80% are face and scalp, the smaller the child the more likely the occurrence of face or scalp injury. Two hundred and fifteen lacerations and perforations in 61 patients were treated according to the following protocol: pressure irrigation with a forceful stream of normal saline, excision of wound edges, exploration of the wound with removal of loose fatty tissue, followed again by saline irrigation under pressure. Ampicillin or cephalosporin was given at the beginning of the surgical procedure, followed by intravenous antibiotics for 48 hr and oral antibiotics for 5 days for patients who were treated in the operating room. Those treated in the emergency room received one intramuscular injection followed by oral antibiotics for 5 days. Hemostasis was achieved by coagulation, fine absorbable s u t u r e s in minimal numbers were used in an attempt to obliterate deadspace with pressure dressings for 24 hr. All patients received tetanus and rabies prophylaxis. Out of 215 skin perforations from dog bites, infection occurred in only a single wound, or 1 infection in 61 patients (1.6%). No infections occurred in 135 wounds treated in the operating room (92% of the 61 patients were children under 21 yr of age, 26% were 2 yr or younger.) Two editorial comments regret that it is not clear which factor played a significant role in the successful treatment reported. One of the editorial comments, relating to the antibiotic treatment, finds the use of antibiotics in all patients to be superfluous, since "a dog's mouth is indeed as clean as a hound's tooth."--J. Chang Antibiotic Activity in Surgical Incisions. H. C. Polk, Jr.,
L. Trachtenberg, and M. P. Finn. J A M A 244:1353-1354, (September), 1980. The authors measured antibiotic concentration in surgical wounds at the conclusion of operations by absorbing fluid from the subcutaneous tissues with a 6-ram filter paper disk. They compared the duration of activity of cefazolin, cephaloridine, and cephalothin. The first two had reasonable concentrations for 4 hr in the case of cefazolin and 5 hr or more in the case of cephaloridine. However, cephalothin showed a fairly precipitous drop in concentration to the point of insufficient activity at approximately 3 hr after the operation was commenced. In all cases the drugs were given parenterally in adequate doses 45 min before incision.--David L. Collins
411 Malignant Melanoma in Children and Adolescents. I. Peled
andE. Kessler. Harefuah 97:1-4, (July), 1979. Twelve cases of invasive malignant melanoma in childhood and adolescence, with and without metastases, were found among 304 cases of malignant melanoma treated in a 22-yr period. There were only two deaths. In more than 80% there was long-term survival of 5-21 yr after initial treatment. This figure is much higher than those reported in the literature. Thus, contrary to general opinion, even in the presence of metastases, the prognosis is much better in children and adolescents than in adults.--Shemuel Nissan HEAD A N D NECK Osteomyelitis and Bacteremia Caused by Bacteroides fragilis: A Complication of Fetal Monitoring. /. Brook. Clin
Pediatr 19:639-640, (September), 1980. A term male infant monitored with a scalp electrode for 5 hr with 36 hr elapsing between membrane rupture and delivery, developed an occipital abscess with underlying osteomyelitis. Blood cultures grew out Bacteroides fragilis while the abscess fluid grew 6 organisms including 4 Bacteroides species. Incision and drainage, periodic debridement and long-term antibiotics cleared the infection. The authors quote a recent study involving 42 infants who developed scalp abscess following scalp monitoring. Fifty-eight percent grew a mixture of aerobic and anaerobic organisms, aerobes only in 9% and anaerobes only in 11%. Serious complications such as these with anaerobic organisms can be expected with increased use of scalp monitors.--Randall W. Powell Facial Plastic Surgery in Children With Down's Syndrome.
G. Lemperle and D. Radu. Plas Reconstr Surg 66:337-342. The clinical entity of Down's syndrome, or trisomy 21, seems to occur in 1 out of 1600 births and rises to 1 out of 100 births in parents over 40. The cause of the disease appears to be due to a disorder in the cell division either within the ova or theoretically in the spermatozoa. The plastic surgical correction of the six facial characteristics are simple and straightforward plastic surgical procedures. The results of these procedures have enhanced the social acceptability of these children and in some situations, have led to enhanced development and personal respect. The operations are generally performed between the ages of 4 to 6 and currently the report is based on experience with 67 children. The operations are for the correction of: Mongoloid fold (epicanthus), oblique lid axis, saddle nose, conspicuous macroglossia, hypotonia of the lower lip (chei|osis), and receding chin (microgenia). The operations are all performed in one sitting under general anesthesia. The article details pictorial results that are certainly convincing of this surgical assistance to the child so afflicted. It is obvious that the parental acceptance of the child thus operated would certainly be enhanced.-A. B. Sokol Acute Mastoiditis in Infants and Children. C. M. Ginsburg,
R. Rudoy, and J. D. Nelson. Clin Pediatr 19:549-553, (August), 1980. Fifty-seven patients ranging in age from 2 mo to 12 yr presented with acute mastoiditis over a 25-yr period. All