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The usefulness of preoperative laboratory screening
CURRENT LITERATURE
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progressive bradycardia be automatically responded to by giving 100%’oxygen and directing all attention to providing adequate ventilation.-JAMES R. HUPP Reprint requests to Dr. Keenan: Dept. of Anesthesiology. Medical College of Virginia. Box 695, MCV Station. Richmond. VA 23298.
Cellular and Bacterial Toxicities of Topical Antimicrobials. Lineaweaver W, McMorris S. Saucy D. Howard R. Plast Reconstr Surg 75:394-396, 1985 Tissue toxicity to various topical antimicrobial agents and the effects of these agents on wound healing is a controversial area. This study quantitatively assessed the in-vitro effects of various topical antimicrobial agents on human fibroblast cultures and on cultures of Str~phylo~OCCIISadders. Various dilutions of 1% povidone-iodine, 0.5% sodium hypochlorite, 0.25% acetic acid, and ?‘% hydrogen peroxide were used as a suspension for l5minute exposures of both fibroblasts and S. NIII’~US.After this exposure, the cells and bacteria were washed. placed in nutrient solutions for 24 hours. and examined to determine a percentage survival. At full strength, the 0.75% acetic acid reduced bacterial survival by only 2O’Z, while the other agents were equally toxic to bacteria and fibroblasts. In further dilutions, there were no strengths found of the hydrogen peroxide or the acetic acid that were not more damaging to the fibroblasts than bacteria. The povidone-iodine and sodium hypochlorite did have dilutions that were still bactericidal while not being cytotoxic. This study provides quantitative data that would seem to indicate the need for further wound healing studies at these new dilutions and the avoidance of acetic acid and hydrogen peroxide in wound management.-DAKYL BEE Reprints to Dr. Lineaweaver: Department of Surgery. University of Florida. College of Medicine. Gainesville. Florida 32610. The Influence of the Surgical Scrub on Hand Bacterial Flora. Coelho JCU. Lerner H. Murad 1. Int Surg 69:305-307, 1984 To evaluate the effect of the routine use of the IOminute surgical scrub on the skin bacterial population. cultures were made from the hands of I5 surgical residents and compared with those obtained from I5 residents in internal medicine. The surgical residents had usually employed the IO-minute surgical scrub several times a week for months, whereas the internal medicine residents had not. Results showed more hand bacteria were obtained from surgical residents than from internal medicine residents. Predominant organisms included Staphylococcus epidermidis. Corynebacterium sp.. and Micrococcus sp. The authors suggest that the surgical scrub of the hands several times a week for months may remove the outer layers of the epidermis, cause minor abrasions of the skin, and modify the bacterial flora of the hand.-GREGoRu K. INGALLS Reprint requests to Coelho: University of Texas Medical School. Department of Surgery. Room 4162. 6431 Fannin, Houston, Texas 77030.
The Usefulness of Preoperative Laboratory Screening. Kaplan EB, Sheiner LB. Boeckmann AJ, et al. JAMA 253:3576-3581, 1985
The usefulness of routine laboratory screening of preoperative patients was assessed. Computer-readable laboratory, demographic. and discharge diagnostic data were assembled for 2,000 patients undergoing elective surgery over a four-month period, and randomly selected sample5 of patients were studied. Several tests ordered by protocol and performed by the laboratory at the time of admission were examined in these samples. including complete blood cell count. differential cell count. prothrombin time. partial thromboplastin time. platelet count, six-factor automated multiple analysis. and glucose level. Sixty per cent of these routinely ordered tests would not have been performed if testing had only been done for recognizable indications. and only 0.2% of these revealed abnormalities that might influence perioperative management. Chart review indicated that these few abnormalities were not acted on nor did they have adverse surgical or anesthetic consequences. In the absence of specific indications, routine preoperative laboratory tests contribute little to patient care and could reasonably be eliminated. Calcifying Epithelial Odontogenic Tumor: A Case Showing Features of Malignancy. Basu MK. J Oral Pathol 13:3. 1984 The calcifying epithelial odontogenic tumor is known as a benign neoplasm: its recurrence rate of 14% is attributed to inadequate resection. However. one other unsubstantiated case of a malignant calcifying epithelial odontogenic tumor in a 92-year-old man has previously been reported in literature. A 75-year-old white man presented with a right mandibular swelling associated with an impacted molar. After initially refusing treatment. the patient agreed to block resection of this multilocular lesion after a pathologic fracture. An enlarged submandibular lymph node was also removed at the time of surgery. Histologic examination of the lesion revealed polyhedral epithelial cells with marked nuclear and cellular pleomorphism, giant cells. and concentrically laminated amyloid in a fibrous tissue stroma. There were numerous mitotic figures. The lymph node was similar histologically and had a fibrous capsule with no evidence of invasion. A diagnosis of calcifying epithelial odontogenic tumor with regional node metastasis was made. This tumor exhibited many features of malignancy. such as extensive bone destruction with pathologic fracture. abnormal mitotic figures, and regional node metastasis.-BRIAN c. HARSHA
Request reprints to Dr. Basv: Dept. of Oral Pathology. The Dental School, St. Chad’s Queensway. England.
Birmingham 64 6NN.
Prostaglandin Synthesis in Dental Cysts. Matejka M, Porteder H, Ulrich W, Watzek G. Sinzinger H. Br J Oral Surg 23:190-194. 1985 The synthesis of prostaglandins by dental squamous cell cysts was studied. Radio-thin-layer-chromatography (RTLC) showed Cl”-labelled arachidonic acid to be converted into the prostaglandins PGE,. h-0x0-PGF,,, PGF:,, and PDG,. In addition, hydroxyfatty acid synthesis in excess of total prostaglandin production was observed. The substances mentioned are thought to be causally involved in the osteolytic activity of dental cysts.
918
progressive bradycardia be automatically responded to by giving 100%’oxygen and directing all attention to providing adequate ventilation.-JAMES R. HUPP Reprint requests to Dr. Keenan: Dept. of Anesthesiology. Medical College of Virginia. Box 695, MCV Station. Richmond. VA 23298.
Cellular and Bacterial Toxicities of Topical Antimicrobials. Lineaweaver W, McMorris S. Saucy D. Howard R. Plast Reconstr Surg 75:394-396, 1985 Tissue toxicity to various topical antimicrobial agents and the effects of these agents on wound healing is a controversial area. This study quantitatively assessed the in-vitro effects of various topical antimicrobial agents on human fibroblast cultures and on cultures of Str~phylo~OCCIISadders. Various dilutions of 1% povidone-iodine, 0.5% sodium hypochlorite, 0.25% acetic acid, and ?‘% hydrogen peroxide were used as a suspension for l5minute exposures of both fibroblasts and S. NIII’~US.After this exposure, the cells and bacteria were washed. placed in nutrient solutions for 24 hours. and examined to determine a percentage survival. At full strength, the 0.75% acetic acid reduced bacterial survival by only 2O’Z, while the other agents were equally toxic to bacteria and fibroblasts. In further dilutions, there were no strengths found of the hydrogen peroxide or the acetic acid that were not more damaging to the fibroblasts than bacteria. The povidone-iodine and sodium hypochlorite did have dilutions that were still bactericidal while not being cytotoxic. This study provides quantitative data that would seem to indicate the need for further wound healing studies at these new dilutions and the avoidance of acetic acid and hydrogen peroxide in wound management.-DAKYL BEE Reprints to Dr. Lineaweaver: Department of Surgery. University of Florida. College of Medicine. Gainesville. Florida 32610. The Influence of the Surgical Scrub on Hand Bacterial Flora. Coelho JCU. Lerner H. Murad 1. Int Surg 69:305-307, 1984 To evaluate the effect of the routine use of the IOminute surgical scrub on the skin bacterial population. cultures were made from the hands of I5 surgical residents and compared with those obtained from I5 residents in internal medicine. The surgical residents had usually employed the IO-minute surgical scrub several times a week for months, whereas the internal medicine residents had not. Results showed more hand bacteria were obtained from surgical residents than from internal medicine residents. Predominant organisms included Staphylococcus epidermidis. Corynebacterium sp.. and Micrococcus sp. The authors suggest that the surgical scrub of the hands several times a week for months may remove the outer layers of the epidermis, cause minor abrasions of the skin, and modify the bacterial flora of the hand.-GREGoRu K. INGALLS Reprint requests to Coelho: University of Texas Medical School. Department of Surgery. Room 4162. 6431 Fannin, Houston, Texas 77030.
The Usefulness of Preoperative Laboratory Screening. Kaplan EB, Sheiner LB. Boeckmann AJ, et al. JAMA 253:3576-3581, 1985
The usefulness of routine laboratory screening of preoperative patients was assessed. Computer-readable laboratory, demographic. and discharge diagnostic data were assembled for 2,000 patients undergoing elective surgery over a four-month period, and randomly selected sample5 of patients were studied. Several tests ordered by protocol and performed by the laboratory at the time of admission were examined in these samples. including complete blood cell count. differential cell count. prothrombin time. partial thromboplastin time. platelet count, six-factor automated multiple analysis. and glucose level. Sixty per cent of these routinely ordered tests would not have been performed if testing had only been done for recognizable indications. and only 0.2% of these revealed abnormalities that might influence perioperative management. Chart review indicated that these few abnormalities were not acted on nor did they have adverse surgical or anesthetic consequences. In the absence of specific indications, routine preoperative laboratory tests contribute little to patient care and could reasonably be eliminated. Calcifying Epithelial Odontogenic Tumor: A Case Showing Features of Malignancy. Basu MK. J Oral Pathol 13:3. 1984 The calcifying epithelial odontogenic tumor is known as a benign neoplasm: its recurrence rate of 14% is attributed to inadequate resection. However. one other unsubstantiated case of a malignant calcifying epithelial odontogenic tumor in a 92-year-old man has previously been reported in literature. A 75-year-old white man presented with a right mandibular swelling associated with an impacted molar. After initially refusing treatment. the patient agreed to block resection of this multilocular lesion after a pathologic fracture. An enlarged submandibular lymph node was also removed at the time of surgery. Histologic examination of the lesion revealed polyhedral epithelial cells with marked nuclear and cellular pleomorphism, giant cells. and concentrically laminated amyloid in a fibrous tissue stroma. There were numerous mitotic figures. The lymph node was similar histologically and had a fibrous capsule with no evidence of invasion. A diagnosis of calcifying epithelial odontogenic tumor with regional node metastasis was made. This tumor exhibited many features of malignancy. such as extensive bone destruction with pathologic fracture. abnormal mitotic figures, and regional node metastasis.-BRIAN c. HARSHA
Request reprints to Dr. Basv: Dept. of Oral Pathology. The Dental School, St. Chad’s Queensway. England.
Birmingham 64 6NN.
Prostaglandin Synthesis in Dental Cysts. Matejka M, Porteder H, Ulrich W, Watzek G. Sinzinger H. Br J Oral Surg 23:190-194. 1985 The synthesis of prostaglandins by dental squamous cell cysts was studied. Radio-thin-layer-chromatography (RTLC) showed Cl”-labelled arachidonic acid to be converted into the prostaglandins PGE,. h-0x0-PGF,,, PGF:,, and PDG,. In addition, hydroxyfatty acid synthesis in excess of total prostaglandin production was observed. The substances mentioned are thought to be causally involved in the osteolytic activity of dental cysts.