The effect of antiseptic solution in central venous catheter care.

AIM: Intravenous catheters have become one of the essential tools of modern medicine. Preventive measures taken while the catheter is being inserted or in place can provide a significant reduction in catheter-related infections and bacteremia/sepsis.This study aims to evaluate whether the patient's age and gender, the presence of malignancy and coexisting diseases, catheter duration, use of total parenteral nutrition solution, blood products, and antibiotics as well as antiseptics applied while attaching the central venous catheter (chlorhexidine and povidone-iodine) affect the development of catheter colonization and catheter-related bloodstream infections in patients with central venous catheters. MATERIALS AND METHODS: Our study includes 50 cases which were admitted to Izmir Atatürk Training and Research Hospital, I. Surgical Clinic, hospitalized due to various reasons between the dates of January‒December 2010 and required catheter use. Patients were randomly assigned to one of the two operating rooms, in one of which the insertion site was disinfected with Poviiodeks® (10 % povidone-iodine) while in the other, (latter) Savlosol® (15 % cetrimide, 1.5 % Chlorhexidine-gluconate, ethanol) was used. RESULTS: Among many factors examined in our study, only the use of clorhexidine versus iodine povidon in skin antisepsis was found to be statistically significant in the reduction of CRBSI and CC (for CRBSI p=0.022 and for CC p=0.047). CONCLUSIONS: Our study concludes that skin antisepsis is the only determining factor in the prevention of blood infection and colonization due to central venous catheter application and the use of clorhexidine vs. povidon is proven to be statistically significant (Tab. 1, Ref. 27).

Preoperative diagnostic role of hyperbilirubinaemia as a marker of appendix perforation.

This retrospective study investigated preoperative markers of appendix perforation in 351 acute appendicitis cases: group 1, appendicitis not histologically confirmed; group 2, appendicitis without perforation or gangrenous changes; and group 3, histologically confirmed perforated appendicitis with gangrenous changes. In group 3, symptom duration was significantly longer, and white blood cell (WBC) and bilirubin values significantly higher, than for the other groups. Symptom duration, gender, bilirubin and elevated WBC were significantly associated with early diagnosis of acute appendicitis in univariate analysis. Multivariate analysis identified increased WBC counts and male gender as independent variables for the early diagnosis of acute suppurative appendicitis, and symptom duration, total bilirubin and elevated WBC as independent variables for identifying appendix perforation amongst acute suppurative appendicitis patients. Receiver operating characteristic curve analysis showed good discrimination of bilirubin and moderate discrimination of WBC as markers of appendix perforation. It is concluded that assessment of preoperative total bilirubin is useful for the differential diagnosis of perforated versus acute suppurative appendicitis, whereas WBC assessment is effective for diagnosing the presence versus absence of appendicitis. Symptom duration, WBC and total bilirubin should be used as independent parameters in the early diagnosis of appendix perforation.

Hyperosmolar water-soluble contrast medium in the management of adhesive small-intestine obstruction.

This prospective study investigated the value of the hyperosmolar water-soluble contrast medium Urografin(®) in choosing which patients with small-intestine obstruction, caused by post-operative adhesions, to treat conservatively. Thirty-seven patients with adhesive intestinal obstruction received Urografin(®) via a nasogastric tube. Direct abdominal radiographs were taken after 2, 4 and 8 h. Twenty-four patients (64.9%) had Urografin(®) in the right colon within 8 h and were considered to have partial obstruction. These patients commenced oral feeding even though abdominal radiographs revealed gas-fluid levels. In the remaining 13 patients (35.1%), Urografin(®) was not observed in the right colon within 8 h: three of the 13 patients (23.1%) were successfully treated conservatively; 10 of the 13 patients (76.9%) developed toxic signs and underwent surgery, with obstruction resulting from adhesive bands being confirmed at operation. Conservative treatment can be recommended for patients in whom contrast medium is observed in the right colon within 8 h following administration, regardless of the presence of obstruction signs. Absence of contrast medium in the right colon within 8 h cannot, however, be considered an indication for surgery.

Laparoscopic repair of Morgagni hernia.

BACKGROUND: Foramen of Morgagni hernias are rare diaphragmatic hernias. They account for 3-5% of all diaphragmatic hernias and the majority of the cases are asymptomatic. They are caused by trauma, obesity or pregnancy. With the advancements of laparoscopic surgery, laparoscopic repair has become an excellent alternative to open repair for Morgagni hernias. We report five cases of Morgagni hernia repaired with the laparoscopic approach in conjunction with a review of the literature. PATIENTS: A retrospective review comprised five patients who had a Morgagni hernia repaired with a laparoscopic approach. Data from these patients were collected for the period between February 2001 and May 2005. RESULTS: The average age at operation was 61. The anatomic pathology was detected preoperatively using X-rays and computerized tomography (CT) scans in four of our patients. Hernia was detected incidentally in one patient during an elective cholecysectomy. Three hernias were right-sided and two were left-sided. The contents of the hernias were omentum and transverse colon in the majority of the patients. The hernia was repaired with a laparoscopic approach in all patients. Four patients had composite mesh repair and one patient had primary closure with nonabsorbable sutures. There were no postoperative complications and all patients tolerated laparoscopic repair. There were also no recurrences during follow-up. CONCLUSIONS: Laparoscopic repair is a candidate to be a standard treatment for Morgagni-type hernias. It is an effective and safe technique and can be performed by all compotent general surgeons with a certain learning curve. It has several advantages relative to the open operation.

Laparoscopic repair of Morgagni hernia and paraesophageal hernia on the same patient.

Morgagni hernias have been recognized with increasing frequency as a source of abdominal pain and dyspnea in adults. Morgagni hernias are rarely accompanied by paraesophageal hernias. We report a case of Morgagni hernia associated with paraosephageal hernia, both repaired laparoscopically. On the 65-year-old woman patient, diaphragmatic defect and paraesophageal hernia were closed with primary sutures, and Hill-type gastropexy was performed successfully. The procedure lasted 115 min. The patient was discharged 5 days after surgical treatment and there were no complications following the operation. Primary closure with direct sutures is rapid, simple, and effective and can be combined with other laparoscopic procedures, as in our case. It can be performed by surgeons trained in intracorporeal suturing and knotting in all kinds of hospitals. The laparoscopic approach to Morgagni hernias minimizes trauma and shortens postoperative hospital stay, and patients have a comfortable postoperative period.