Surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Parenteral antibiotics in elective colon surgery? A prospective, controlled clinical study.
The addition of perioperative gentamicin and clindamycin to an oral antibiotic bowel preparation was studied in a prospective, randomized, double-blind series of patients undergoing elective colectomy. Fifty-nine patients completed the study, with all receiving mechanical preparation of the colon and oral neomycin and erythromycin base. Thirty-one of these patients also received a preoperative and postoperative intravenous dose of gentamicin and clindamycin, while 28 received placebos. ⋯ The incidence of infectious complications related to colectomy was 1% (three of 28) in the placebo group and 7% (two of 31) in the group receiving intravenous gentamicin and clindamycin. There were no wound infections directly related to colectomy in either group. There was no statistically significant reduction of infectious complications with the addition of intravenous gentamicin and clindamycin to oral neomycin and erythromycin-base bowel preparation.
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The incidence of aspiration, the causative esophageal pathophysiology, and the results of surgical therapy were evaluated in 100 patients with abnormal gastroesophageal reflux documented by 24-hour esophageal pH monitoring. Based on historical evidence, 48 patients were suspected to be aspirators. Eight patients had documented episodes of aspiration (drop on esophagela pH, followed by acid taste in mouth and onset of cough or wheezing spell) during the monitoring period. ⋯ An antireflux procedure in five aspirators raised the DES pressure significantly and returned the reflux status to normal by 24-hour pH-monitoring standards. The incidence of aspiration appears to be less than that suspected by history and is due to a motor disorder that interferes with the ability of the esophagus to clear reflex acid. Abnormal pulmonary symptoms can induce or result from gastroesophageal reflux and, when the latter occurs, an antireflex procedure stops both reflux and aspiration.