ABSTRACT
A prospective study of wound infections following major head and neck cancer surgery was undertaken to define a rational approach to trials of antibiotic prophylaxis and initial therapy of these infections. Preoperative aerobic cultures were taken from the planned site of skin incision and from the oropharynx. Both aerobic and anaerobic cultures were obtained from all wound infections. Patients receiving prophylactic antibiotics were excluded from the study. The data indicate that preoperative cultures are not usually predictive of the bacteriology of subsequent wound infection. Mixed aerobic and anaerobic flora were cultured from most wound infections and usually reflected normal anaerobic oropharyngeal flora and/or exogenously acquired Staphylococcus aureus. Bacteroides fragilis was not cultured in this series. Antibiotics selected for trials of prophylaxis or initial treatment of these infections should cover both the resident oral aerobic and anaerobic flora and S aureus. Coverage for B fragilis does not appear necessary. Antibiotic choices might include (1) penicillin G agents plus a penicillinase-resistant penicillin or (2) a parenteral cephalosporin.
Subject(s)
Head and Neck Neoplasms/surgery , Surgical Wound Infection/microbiology , Head and Neck Neoplasms/microbiology , Humans , Nasopharynx/microbiology , Prospective Studies , Skin/microbiologyABSTRACT
Pseudocaloric nystagmus (PCN) is an appropriately beating nystagmus induced by cold caloric irrigation of an ear with abolished vestibular function. The nystagmus is not the result of endolymph flow but probably represents unmasking a latent nystagmus by altering the patient in this case, through tactile (caloric) stimulation. Pseudocaloric nystagmus has the following characteristics: (1) mild intensity (eyes closed-slow phase velocity usually less than 8 degrees/sec), it has not been observed with the eyes open, (2) always beats away from the diseased ear; therefore, any nystagmus induced by cold irrigation will be appropriately (contralateral) beating while that induced by warm irrigation will be inappropriately (contralateral beating; 3) the induced nystagmus will not reverse direction after inverting the ampulla. Establishing bidirectional sensitivity of the cupula by demonstrating appropriately beating nystagmus to ampullopetal and ampullofugal flow of endolymph not only assures that the lateral semicircular canal (SCC) is functionally intact to caloric stimulation but will avoid errors in electronystagmorgraphic (ENG) interpretation.
