ABSTRACT
STUDY OBJECTIVE: To determine whether a postoperative 5-day treatment schedule with vaginal metronidazole added to conventional antibiotic prophylaxis with 2 g cefazolin modifies the risk of pelvic cellulitis (PC) and pelvic abscess (PA) after total laparoscopic hysterectomy (TLH). DESIGN: A randomized, controlled, triple-blind, multicenter clinical trial. SETTING: Two centers dedicated to minimally invasive gynecologic surgery in Colombia. PATIENTS: A total of 574 patients were taken to TLH because of benign diseases. INTERVENTION: Patients taken to TLH were divided into 2 groups (treatment group, cefazolin 2 g intravenous single dose before surgery + metronidazole vaginal ovules for 5 days postoperatively, control group: cefazolin 2 g intravenous single dose + placebo vaginal ovules for 5 days postoperatively). MEASUREMENTS AND MAIN RESULTS: The absolute frequency (AF) of PC and PA and their relationship with the presence of bacterial vaginosis (BV) were measured. There was no difference in AF of PC (AF, 2/285 [0.7%] vs 5/284 [1.7%] in the treatment and placebo groups, respectively; risk ratio, 1.75; 95% confidence interval, 0.54-5.65; p = .261), nor for PA (AF, 0/285 [0%] vs 2/289 [0.7%]; p = .159, in the treatment and placebo groups, respectively). The incidence of BV was higher in the metronidazole group than the placebo group (42.5% vs 33.4%, p = .026). CONCLUSION: The use of vaginal metronidazole ovules during the first 5 days in postoperative TLH added to conventional cefazolin prophylaxis does not prevent the development of PC or PA, regardless of the patient's diagnosis of BV.
Subject(s)
Laparoscopy , Parametritis , Vaginosis, Bacterial , Humans , Female , Metronidazole/therapeutic use , Abscess/etiology , Abscess/prevention & control , Cefazolin/therapeutic use , Parametritis/drug therapy , Hysterectomy/adverse effects , Vaginosis, Bacterial/diagnosis , Vaginosis, Bacterial/drug therapy , Laparoscopy/adverse effects , Double-Blind Method , Anti-Bacterial Agents/therapeutic useABSTRACT
La estimulación cerebral profunda del núcleo subtalámico es una terapia efectiva en el tratamientode los síntomas motores de la Enfermedad de Parkinson; sin embargo, el éxito de la terapia depende delprotocolo de selección de pacientes, de la exactitud en la implantación de los electrodos y de la programaciónde los mismos.Objetivo. Describir los resultados de un programa de cirugía funcional en Colombia.Materiales y Métodos: Estudio observacional de corte transversal, en el que se describen los resultados deestimulación cerebral profunda realizada en una cohorte de 38 pacientes utilizando la escala UPDRS-III, loscambios en medicamentos y complicaciones luego de un año de seguimiento.Resultados: Se obtuvo disminución significativa del 51% en la severidad de la escala motora UPDRS-IIIdespués de cirugía en el estado On estimulación Off medicación un año después del procedimiento en comparaciónal estado Off medicación prequirúrgico. También hubo disminución significativa de las subescalasde temblor (-84%), rigidez (-70%), bradicinesia (-44%), marcha (-49%) y estabilidad postural (-73%). Huboempeoramiento leve no significativo del habla (8%). La dosis equivalente de levodopa se redujo en 64%, laprincipal complicación fue la confusión post-operatoria que se presentó en el 5,3%, dos pacientes.Conclusión: Los resultados obtenidos, aplicando un protocolo estructurado en la selección de pacientes,cirugía y programación, están de acuerdo a los resultados descritos en la literatura médica, siendo estos factoresdeterminantes en la implementación de la terapia y en su justificación bajo el paradigma costo-efectividad...
Introduction: Deep brain stimulation of the subthalamic nucleus is an effective therapy in the treatment ofParkinsons diseases motor symptoms. However, the success of the therapy depends on whether the patientfulfills the programs protocol, on the accuracy in the implantation of the electrodes, and the programmingof the electrodes.Objective. To describe the results of a functional Neurosurgery program in Colombia.Materials and Methods: This is a observational cross-sectional study, where the results of deep brain stimulationperformed in a cohort of 38 patients using the UPDRS -III scale are described, as well as changesof levodopa equivalent doses and surgical complications after one year of follow up.Results: A 51% decrease in the severity of the UPDRS-III motor scale after surgery was obtained in the Onstimulation Off medication status one year after the procedure compared to the preoperative Off medicationstatus. There was also significant reduction in the subscales of tremor (-84%), stiffness (-70%), bradykinesia(-44%), gait (-49%) and balance (-73%). There was no significant speech worsening (8%)...
