ABSTRACT
The efficacy of a relatively cheap regimen of selective decontamination (SDD) was evaluated in a diverse population of ICU patients. Patients requiring prolonged ICU stay (greater than 5 days) were randomly allocated to a treatment group or control group. Control patients (n = 52) received perioperative antimicrobial prophylaxis and antibiotic treatment was instituted only on sound clinical and bacteriological criteria. Treated patients (n = 48) received gastro-intestinal and oro-pharyngeal decontamination with polymyxin E, norfloxacin, amphotericin B and systemic antibiotic prophylaxis with trimethoprim until decontamination was achieved. The rate of gram-positive infections was not altered by SDD. The incidence of gram-negative respiratory tract, urinary tract and line infections was significantly reduced from 44%, 27% and 15% respectively in the control group to 6%, 4% and 0% in the treatment group. Mortality from nosocomial sepsis and overall mortality were also significantly reduced from 15% and 54% to 0% and 31% respectively. The ICU stay was not reduced by SDD, nor was time on the ventilator or use of therapeutic antibiotics. The reduction in morbidity and mortality was achieved at a relatively low cost.
Subject(s)
Bacterial Infections/prevention & control , Cross Infection/prevention & control , Digestive System , Intensive Care Units , Norfloxacin/therapeutic use , Respiratory System , Bacterial Infections/drug therapy , Bacterial Infections/epidemiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Female , Gram-Negative Bacteria , Humans , Incidence , Male , Middle Aged , Norfloxacin/standards , Premedication , Prospective Studies , Randomized Controlled Trials as TopicABSTRACT
The short-term results of the Foerster-Dandy operation in 9 patients with spasmodic torticollis had been studied retrospectively. A good result was obtained for dyskinetic movement, but less for head tilt. Neck pains improved in 4 patients, but developed in 2 other patients postoperatively. Limitation of neck motility and abduction of the arms was seen in all patients. One patient died following a cerebral sinus thrombosis. Other surgical procedures are discussed and the results of studies of anterior rhizotomy are compared. The Foerster-Dandy procedure is indicated for severe disability or pain of more than 2 years duration not responding to other treatments.
