The British journal of surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
The bacteriology of primary wound sepsis in potentially contaminated abdominal operations: the effect of irrigation, povidone-iodine and cephaloridine on the sepsis rate assessed in a clinical trial.
Two hundred and nine potentially contaminated abdominal operations were randomly allocated to prophylaxis with a single dose of 1 g cephaloridine intraincisionally, irrigation of the wound at the end of the operation with saline or spraying of the wound with povidone-iodine. In high risk operations (ileocolorectal or those in obese patients) the rate of major wound sepsis in those protected by cephaloridine was 3.8% compared with 13.2% in the irrigation and 16.7% in the povidone-iodine groups. ⋯ Bacteriological studies of incised organs, subcutaneous fat and pus showed that the majority of wound infections arose from endogenous sources. The outstanding problem remains that of prevention of contamination of the abdominal wall during surgery.
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The results of 134 Gritti-Stokes amputations for ischaemia are presented. The mortality rate was 11% and healing occurred in 88%, reaffirming the good results already reported for this operation. ⋯ Stump pain and mobility of the patella were not major problems. The difficulties in fitting a suitable prosthesis are discussed and attention is drawn to the advantages of a new prosthesis that has been developed for this amputation.
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Penetrating gunshot wounds of the chest in civilian practice: experience with 250 consecutive cases.
Our experience indicates a continued rising incidence of gunshot wounds of the chest in the United States. During the past 4 1/2 years, 250 consecutive cases were treated at the King-Drew Medical Center in Los Angeles. Ninety per cent presented with a haemothorax or haemopneumothorax. ⋯ The complication rate was 5.3 per cent, most complications occurring in patients with associated intra-abdominal and spinal cord injuries. The average period of hospitalization was 6.5 days. The management plan and the indications for the two courses of therapy are discussed.
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The increasing incidence of perforated duodenal ulcer among Black patients admitted to the Johannesburg General Hospital between 1966 and 1976 is described against a background of the different forms of peptic ulcer disease seen in this hospital population. Admission for perforation during the years 1973-6 was as common among Black as among White patients. ⋯ In the White group the age range was broader (20-70 years) and the male : female ratio only 2.7 : 1. Duodenal ulcer occurred predominantly in males (ratio 6 : 1), and the spectrum of the disease among the Black population in this urban environment resembled that among the White population in Johannesburg and in Western countries in the relative frequency of perforation and haemorrhage, rarity of stenosis and ratio of duodenal to gastric ulceration.