Surveillance for postoperative infections in outpatient gynecologic surgery.

Postoperative infection rates were determined for gynecologic outpatient surgical procedures performed in a traditional operating room environment and a separate, recently opened, surgicenter within the same hospital. Infections were self-reported by attending surgeons responding to computer-generated line listings of their recent surgical procedures. Responses were obtained on 97.9% (612/625) of women having surgery in the operating room and 99.5% (629/632) of women with surgicenter procedures. The overall infection rate for reported women was 0.9% (11/1,241). The difference between operating room and surgicenter rates was not statistically significant. Postoperative infections occurred in 2.5% (3/118) of diagnostic laparoscopies with tubal lavage and 1.4% (3/214) of voluntary abortions by dilatation and evacuation and curettage (D&E&C). The five other infections were scattered among the remaining 25 procedure categories. Ten of the 11 infections were limited to the "clean-contaminated" wounds. No serious or life-threatening infections were encountered. The computer-assisted surveillance system worked well and was easily incorporated into the existing infection surveillance system. The degree of ascertainment of postoperative wound infections is unknown due to reliance on physician self-reporting. However, no patients requiring readmission for infection went unreported by the attending surgeons.

Septic dermatitis of the neonatal scalp and maternal endomyometritis with intrapartum internal fetal monitoring.

During a 3-month period, 1,062 mother-infant pairs were studied for infections following internal fetal monitoring during labor. Six infants (0.56%) developed septic scalp dermatitis at the site of the spiral electrode application. Factors associated with septic scalp dermatitis included the number of vaginal examinations, the use of an intrauterine pressure catheter or of more than one spiral electrode, and fetal scalp blood sampling. Maternal diabetes and endomyometritis were also associated with an increased risk of scalp infection. The duration of spiral electrode use and duration of ruptured membranes were not significant risk factors. Endomyometritis was documented in 41 mothers, an overall incidence of 3.9%. In women whose babies were delivered by cesarean section, the incidence of endomyometritis was 28/117 (23.9%). Using multivariate analysis by logistic regression, endomyometritis was associated with the number of vaginal examinations during labor but not with the duration of internal monitoring, duration of labor, or duration of ruptured membranes.

Relationship between cholecystectomy and ascending colon cancer.

A retrospective study involving 706 sample cases of large bowel cancer grouped by subsite (ascending colon, transverse colon, descending colon, sigmoid colon, ana rectum), sex, and age identified during the Third National Cancer Survey (Pittsburgh SMSA, 1969--1971) was recently completed. The basic strategy of this comparative study was to determine whether the frequency distribution patterns of both demorgraphic characteristics and environmental factors differed among persons with subsite-specific cancer of the large bowel. Based on the information provided in the hospital records there was a gradient of previous cholecystectomy history from ascending colon cancer (10.5%) to rectal cancer (2.1%) in those patient records whose only gastrointestinal surgery indicated was cholecystectomy. For patient records in which the only surgical operation was cholecystectomy, or cholecystectomy plus other gastrointestinal surgery, the gradient persisted as one moved from the right to the left subsites of the large bowel. No relationship with respect to other types of gastrointestinal surgery was observed. It is clear, however, that a bias associated with the review of hospital records can account for this relationship and, therefore, the finding may be spurious. On the other hand, there is increasing evidence of a relationship between bile acid metabolism and carcinoma of the colon. It might be considered that the right side of the colon would be most likely affected by the potential carcinogenic effect of certain bile acid metabolites.

Bacteriocin (klebocin) sensitivity typing of klebsiella.

High-titer preparations of Klebsiella bacteriocins (klebocins) were obtained by using mitomycin to induce standard strains of Klebsiella. Of 296 clinical isolates of Klebsiella, 67% could be typed on the basis of their sensitivity to klebocins. The method proposed in this paper affords a standard basis for the further development of klebocin typing as a suitable procedure for hospital laboratories concerned with epidemiological investigations of hospital-associated infections. Evidence is also provided to show that high-titered klebocin typing can be used in conjunction with biochemical typing to provide a sensitive epidemiological marker for Klebsiella.

"Hippie" hepatitis: an epidemiologic investigation conducted within a population of "street-people".

An epidemiologic investigation of viral hepatitis among "street-people" was conducted in Pittsburgh, PA in 1971. Among 146 individuals, 100 admitted to parenteral drug use and 73 (50%) had evidence of acute viral hepatitis. Counterelectrophoresis (CEP) and complement-fixation (CF) were used to test for type B antigen (HBS AG). Seventeen individuals (22%) had detectable HBSAG; 13 of these were clinically ill and admitted to drug use, Type B antibody (anti-HBS) was tested for by CEP and radioimmunoprecipitation (RIP). Thirty-five persons (29%), 15 of whom admitted to drug use and were ill, had detectable antibody by RIP; none had detectable antibody by CEP. None of those tested had both HBSAB and anti-HBS Evidence to support the hypothesis of sexual transmission of type B virus was found. Use of prophylactic gamma globulin in street-people populations is recommended.