Antibiotic prophylaxis in Wertheim-Meigs surgery. A single dose vs three doses.

A prospective, randomized study to compare the prophylactic efficacy of a single dose of piperacillin with that of a three doses, was carried out with patients undergoing Wertheim-Meigs surgery. The results demonstrate that in this case three doses of piperacillin have a higher efficacy than one dose in the prevention of febrile complications and post-operative infections.

[Antibiotic prophylaxis with piperacillin in vaginal hysterectomy. Study of 1 dose versus 3 doses]. / Profilaxis antibiótica con piperacilina en la histerectomiá vaginal. Estudio de una dosis frente a tres.

A homogeneous and consecutive series of 93 patients treated with vaginal hysterectomy is studied in a controlled, randomized clinical essay. The patients were divided in two groups. One of the groups received one single dose of 49 of piperacillin 30 minutes before surgery; the other, three doses of 4 g of the same antibiotic 30 minutes before surgery and 6 & 12 hours after it. No significant difference was found between both groups and therefore it is fair to suppose that one single preoperative dose of piperacillin shows similar efficacy to the usually used three doses, one preoperative and two postoperative.

The colposcopy and the cone biopsy in the diagnosis, treatment and follow-up of 81 cases of cervical intraepithelial neoplasia.

A conization was performed on 81 patients with histological diagnosis of cervical intraepitelial neoplasia (CIN), whom and previously a rigorous colposcopic examination. 64 patients were younger than 35 years. The previous strict colposcopic examination determined that in none of the cases were the surgical margins of the cone biopsy affected: In 26 cases there was no correlation between the previous biopsy and the histological diagnosis of the cone biopsy. The latter was--higher in degree in 9 cases and, in addition to this, in the 23 histerectomies that were performed after the conization, 7 surgical specimens showed CIN in their histological study. The non-involved surgical margins--that could be obtained in those cases with a careful previous colposcopy,--can not guarantee the exeresis of all the CIN zones. The biopsy of an atypical zone, in a colposcopic extensive lesion, cannot be representative of the whole lesion. In the follow-up--5 years maximum and 1 year minimum--3 relapses had appeared and 9 pregnancies had been diagnosed, that had not showed an increase in the number of premature labours, nor in the cesareas-rate.

Ovarian pure leiomyosarcoma: case report.

We report a case of a pure ovarian leiomyosarcoma, a rare tumor that comprises less than 0.1% out of all the ovarian malignant tumors.

Second tumor in gynecological cancer.

We have searched the second tumor in a series of 695 women with gynecological cancer. We have determined with precision when the second tumor was diagnosed: during the first tumor staging (7 cases), during its treatment (3 cases) or in its follow-up (9 cases). We comment the clinical, diagnostic, histologic and prognostic circumstances of this women with multiple cancer.

Gynecologic cytology at the Catholic Hospital St. John of God, Lunsar Sierra Leone.

The authors refer their experience in cervical cancer screening in a subdeveloped population of Sierra Leone. On this basis they define some etiopatogenetic aspect of nature history of cervical cancer. In particular they emphasize the role of vaginal infections diseases as a very important epidemiological datum.

Repair of sinus of Valsalva aneurysm associated with aortoventricular discontinuity.

The case of patient with unruptured sinus of Valsalva aneurysm with absence of the intervalvular lamina fibrosa is presented. The association of Valsalva aneurysm and aortic subvalvular defects has been explained as a deficiency of elastic tissue at the aortic root or maldevelopment of the fibrous trigone. Valvular aortic insufficiency with histological evidence of myxoid changes required prosthetic replacement. Myxomatous changes in the fibrous trigone and aortic annulus can explain this unusual, complex anomaly. Accurate preoperative diagnosis may require special views and simultaneous left and right injections at cineangiography. Techniques of repair that have been successful are reviewed, and the essential features of adequate correction are outlined.

Chylothorax after myocardial revascularization with internal mammary graft.

Chylothorax following an intrapericardial cardiac operation is rare, and we are aware of only 12 reported cases. Nine followed median sternotomy for treatment of congenital heart disorders or acquired valvular disease; more than expected were reoperations (23%). This report documents that this complication may also occur following myocardial revascularization with internal mammary graft and describes the anatomy that makes this possible. This rare complication is important because of the high morbidity of prolonged tube drainage and the fact that nearly half of the affected patients underwent reoperation (5 of 13). Dilated lymphatics exuding chyle have been found at operations undertaken to control lymph fistulas and were located in anterior thymic tissue previously divided by electrocautery. Awareness of the significance of lymph encountered during cardiac operations, particularly during reoperation and near the origin of the internal mammary artery, may alert the surgeon that the stage is set for a disabling complication. Electrocautery may be an unreliable means of control as lymph contains little coagulable material; suture is recommended instead.

Improved oxygen delivery to the myocardium during hypothermia by perfusion with 2,3 DPG-enriched red blood cells.

The oxygen affinity of red cells increases stepwise with temperature reductions below 37 degrees C. In vitro studies demonstrated that biochemically modified red cells with increased 2,3 diphosphoglycerate (2,3 DPG) (150% and 250% of normal) exhibited significantly less oxygen affinity at 24 degrees C than did unmodified cells. At 15 degrees C, significant attenuation of affinity was observed with 250%, but not 150%, of normal 2,3 DPG cells. Measurements made of isolated fibrillating dog hearts during perfusion at 24 degrees C alternately with unmodified (80% of normal 2,3 DPG) and modified (300% of normal 2,3 DPG) red cells demonstrated significantly greater oxygen consumption, higher coronary sinus partial pressures of oxygen and carbon dioxide, higher in vitro P50 values, and lower arterial and coronary sinus lactate levels during perfusion with modified as compared with unmodified cells. This evidence, indicating improved oxygen delivery to hypothermic dog hearts by red cells with 300% of normal 2,3 DPG activity, suggests that high 2,3 DPG cells might protect myocardial tissue in patients undergoing hypothermic cardiac operation.

Coronary bypass with Gore-Tex graft.

The case is presented of a 68-year-old man who previously had undergone aorta-coronary bypass. During a 3 year interval the coronary disease progressed, so that a once insignification lesion necessitated reoperation. A Gore-Tex vascular graft was chosen as a substitute because of the lack of saphenous vein. Three months posoperatively the patient's recatheterization study showed patency of the Gore-Tex graft placed in the distal righ coronary artery, and there was a satisfactory clinical result. No anticoagulants have been given to the patient after the operation.

Management of penetrating heart wounds.

The records of ninety-two patients treated between 1965 and 1976 at the Boston City Hospital for penetrating wounds of the heart were reviewed and the results were compared with a previous series of twenty-five patients admitted to the same institution between 1956 and 1964. The annual incidence rose from 2.8 cases during the first period to 8.0 during the more recent years. Gunshot wounds increased in frequency in the second period. The overall mortality was similar in the two series. However, there were more complex wounds and agonal patients subjected to immediate emergency room thoracotomy during the second phase of this experience. The salvage rate in the latter group of patients gradually improved and averaged 24% between 1965 and 1976. These data indicate that an aggressive approach, including the use of immediate thoracotomy, to the agonal patient with a heart wound will be rewarded with salvage of some patients.