Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers: a pragmatic noncommercial multicentre randomized open-label parallel-group medical device trial.

BACKGROUND: Silicone adhesive multilayer foam dressings are used as adjuvant therapy to prevent hospital-acquired pressure ulcers (PUs). OBJECTIVES: To determine whether silicone foam dressings in addition to standard prevention reduce the incidence of PUs of category 2 or worse compared with standard prevention alone. METHODS: This was a multicentre, randomized controlled medical device trial conducted in eight Belgian hospitals. At-risk adult patients were centrally randomized (n = 1633) to study groups based on a 1 : 1 : 1 allocation: experimental groups 1 (n = 542) and 2 (n = 545) - pooled as the treatment group - and the control group (n = 546). The experimental groups received PU prevention according to hospital protocol, and a silicone foam dressing on the relevant body sites. The control group received standard of care. The primary endpoint was the incidence of a new PU of category 2 or worse at the studied body sites. RESULTS: In the intention-to-treat population (n = 1605), PUs of category 2 or worse occurred in 4·0% of patients in the treatment group and 6·3% in the control group [relative risk (RR) 0·64, 95% confidence interval (CI) 0·41-0·99, P = 0·04]. Sacral PUs were observed in 2·8% and 4·8% of the patients in the treatment group and the control group, respectively (RR 0·59, 95% CI 0·35-0·98, P = 0·04). Heel PUs occurred in 1·4% and 1·9% of patients in the treatment and control groups, respectively (RR 0·76, 95% CI 0·34-1·68, P = 0·49). CONCLUSIONS: Silicone foam dressings reduce the incidence of PUs of category 2 or worse in hospitalized at-risk patients when used in addition to standard of care. The results show a decrease for the sacrum, but no statistical difference for the heel and trochanter areas.

Peritoneal lavage after abdominal trauma: indications, technique, results.

This study represents our experience with 1461 patients who were seen in the Emergency Room of the University Hospital in Ghent with multiple traumatic lesions, between 1978 and 1982. In 43% of these polytraumata, we did an explorative peritoneal lavage in order to obtain a quick evaluation of intrabdominal haemorrhage. In 65% of the patients, the lavage was negative; 221 positive lavages (35%) underwent abdominal exploration; in 85% of these there were evident positive findings. The remaining 15% showed either no lesions, or minor lesions not involving risk of life. The overall accuracy-rate of the technique described above is at least 93%.

Surgical repair of acute postinfarction cardiac rupture.

Acute myocardial infarction is complicated by cardiac rupture in 4% to 24% of all infarction deaths, and approximately 10% of hospital infarction deaths. There are no reliable indices to determine which patients run an increased risk of cardiac rupture. This report describes the surgical treatment and outcome of a patient who sustained a rupture of the left ventricular free wall, nine days after extensive anterior myocardial infarction.

[Treatment of resectable cancer of the stomach]. / Traitement du cancer gastrique réséquable.

The results of 631 cancers of the stomach treated by gastrectomy between 1970 and 1983 were closely reviewed in six departments of surgery. This review showed that the prognostic factors determined by resectability, extension of the tumor and lymph node involvement are considered to be reliable following the various pre- and postoperative examinations. In addition, it was shown that most of the gastrectomies were performed following conventional procedures and that the widespread lymph node dissections are not applied in a systematic manner. The postoperative mortality is very low (4.4%) for all the gastrectomies and even lower for the radical gastrectomies (3%). The 5 year survival rate for all the gastrectomies is 15%; this rate amounts to 36% for the gastrectomies performed with a curative aim. In the discussion, the adjuvant radiotherapy and chemotherapy are discussed and their timeliness is shown.

[Truncal vagotomy with pyloroplasty as a routine procedure in perforated duodenal ulcer]. / Trunculaire vagotomie met pyloroplastie als routine ingreep voor het geperforeerd ulcus bulbi.

Truncal vagotomy and pyloroplasty for perforated duodenal ulcer. A retrospective study of 220 patients operated upon between 1959 and 1982 for perforated duodenal ulcer by truncal vagotomy and pyloroplasty shows that this operation can be performed as safely as suture plication, even in the critically ill patient. The advantages of this procedure as the routine treatment of perforated duodenal ulcer are discussed.

[Our experience in the treatment of imperforate anus. Anterior (Mollard's technic) versus posterior approach (Stephens' technic)]. / Onze ervaring met de behandeling van anus imperforatus. Anterieure (techniek volgens Mollard) versus posterieure toegangsweg (techniek volgens Stephens).

The present series concerns the method of treatment for anus imperforatus as it was performed at the Academic Hospital Ghent (Belgium) between 1971 and 1980. Two different technics are confronted one with the other: the anterior perineal approach according to Mollard and the posterior transsacral approach according to Stephens. In agreement with the recent literature the anterior way of acceding to the puborectalissling has undeniable advantage. Even with a very short follow-up period the number of children with supralevatoric localization of anus imperforatus treated by the technic of Mollard and showing a proven continence is now already outnumber.