Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Mar 1979
Randomized Controlled Trial Clinical TrialIntraperitoneal irrigation with povidone-iodine solution for the prevention of intra-abdominal abscesses in the bacterially contaminated abdomen.
A prospective randomized investigation was undertaken, involving 168 consecutive patients undergoing laparotomy for conditions accompanying bacterially contaminated peritoneal cavities, to evaluate the effectiveness of povidone-iodine irrigation of the peritoneum in preventing the development of intra-abdominal abscesses. In the treatment group irrigated with povidone-iodine solution, 0.1 per cent available iodine, one of 80 patients had an abscess, 1.3 per cent, while, in the saline solution irrigated control group, nine of 88 patients had abscesses, 10.2 per cent, p less than 0.05. ⋯ Thyroxine levels showed no major changes. No complications resulting from the use of povidone-iodine were recognized.
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Surg Gynecol Obstet · Mar 1979
Management of severe ischemia of the foot secondary to occlusive vascular disease.
One hundred patients, 111 limbs, with gangrene of the lower extremity were initially treated with lumbar sympathectomy. Lumbar sympathectomy appears to be most beneficial in the management of gangrene of the toe with a limb salvage rate of 75 per cent. The best results were seen when only one toe, not the big toe, was involved. ⋯ The presence of diabetes had no affect on limb salvage for gangrene of the toe but did have an apparent affect on limb salvage for gangrene of the foot. Sympathectomy appeared to aid in stump healing, with 77 per cent of the amputations done not requiring revision to a higher level. Results of our experience appear to indicate that, for patients presenting with gangrene of the toes or forefoot who are not candidates for reconstructive arterial procedures, lumbar sympathectomy as an initial operative procedure should be given serious consideration.
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Patients in a state of shock require careful monitoring to carry out intelligently appropriate treatment. Many methods of monitoring are available. Some are required for all patients in a state of shock, some are only required in severe or refractory shock, some are of little value, some are valuable but difficult or expensive and some are confusing and may mean the opposite of what they seem to indicate.
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Surg Gynecol Obstet · Feb 1979
Randomized Controlled Trial Clinical TrialIrrigation of subcutaneous tissue with povidone-iodine solution for prevention of surgical wound infections.
Five hundred patients undergoing a variety of general surgical operative procedures were prospectively randomly allocated into a treatment group, in which the incisions were irrigated with povidone-iodine solution prior to skin closure or into a control group in which wounds were irrigated with saline solution. Wounds were classified according to the degree of bacterial contamination as clean, potentially contaminated, contaminated or dirty. For all categories of surgical incisions, povidone-iodine irrigation resulted in a significant decrease in wound infections over that for saline solution irrigation. Over-all incidence of wound sepsis in the treatment group was seven of 242 patients, 2.9 per cent, compared with the control rate of 39 wound infections of 258 patients, 15.1 per cent--p less than 0.001.
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Although it is undesirable to perform an unneeded laparotomy in patients with abdominal trauma, it is more serious to delay exploration and incur morbidity or mortality. Because a negative finding at laparotomy has a low incidence of complications, early exploration is justified in instances in which intra-abdominal injury is suspected. Although peritoneal lavage for blunt trauma and selective exploration for some stab wounds may reduce the incidence of unnecessary laparotomies, the high incidence of major injury associated with gunshot wounds precludes use of selective exploration as a reasonable policy.