Prospective Randomized Open Labeled Study Comparing Prophylactic Efficacy of Parenteral Single Dose Cefuroxime vs Ampicillin-Sulbactam in Patients undergoing elective cholecystectomy.

The present study was carried to compare the prophylactic efficacy of parenteral single dose Cefuroxime (C) in comparison to parenteral single dose Ampicillin-Sulbactam (A+S) in patients undergoing elective cholecystectomy. Two hundred patients were randomly allocated to single dose parenterally (intra-venous) of either of the regimen before the induction of anaesthesia. Two groups were compared on the basis of American Society of Anesthesiologists (ASA) score, rate of development of wound infection, duration of surgery and hospital stay. Patients were followed up for 30 days and inspected for the development of wound infection. Frequency of bile infection and the sensitivity of the organisms to study drugs and the corelation between bile infection and risk of wound infection were also recorded. Peri-operative prophylactic antimicrobials seem to play a significant role. Both A+S and C when given prophylactically play a significant role in prevention of surgical site infections. However, A+S seems to be more effective than C in doing so in case of high risk groups. Risk of wound infection significantly increases with co existing morbidity. Bile infection does not significantly increase the risk of surgical site infection. Duration of surgery does not significantly increase the risk of wound infection. A+S and C were equally effective in preventing surgical site infections undergoing elective cholecystectomy, but A+S favored better than C in prevention of surgical site infections in high risk patients.

Appendiceal ascariasis in children

The propensity of Ascaris lumbricoides to wander leads to varied surgical complications in the abdomen. Wandering A lumbricoides may sometimes reach the vermiform appendix and its presence there may remain silent or incite pathology. Our aim was to study ascariadial appendicitis. Over a period of 3 years, we identified children who were found to have appendiceal ascariasis during surgery for different intestinal complications due to ascariasis. We studied the relationship between ascariasis and its lodgement inside the vermiform appendix in these patients. No preoperative diagnosis was made in this series. We found 11 patients with appendiceal ascariasis. It was incidentally found that 8/11 [72.7%] patients had worms inside their vermiform appendix but not appendicitis, whereas the remaining three patients [27.2%] were found to have Ascaris-associated appendicitis. The characteristic finding in Ascaris-infested vermiform appendix was that the worm is positioned with its head at the base and its tail at the tip of the appendix. Migration of A lumbrocoides inside the vermiform appendix is an incidental finding and tends to pursue a silent course in most patients. Only rarely does the presence of Ascaris inside the vermiform appendix cause appendicitis