A prospective, randomised comparison of single- vs. multiple-dose antibiotic prophylaxis in penetrating trauma.

UNLABELLED: This study was designed to compare the clinical efficacy of a single dose of ceftriaxone with cefoxitin given 3 times a day for 3 days. METHODS: Patients had to have a penetrating injury to only one part of the body, reach the hospital within 2 h and be operated on within 16 h after the trauma. Patients were excluded if it appeared likely that they would require mechanical ventilation for more than 24 h. The same applies to open or grade II/III craniocerebral trauma. The end point was the occurrence of infections within 10 days. The costs of antibiotic treatment were also calculated. RESULTS: 96% of the ceftriaxone patients (n = 97) and 95% of the cefoxitin group (n = 98) remained infection-free. In neither treatment group was deep infection, abscess, phlegmon or sepsis seen. No additional surgery or intensive care due to infection was required. At $41.83 vs. $172.16, the average total cost of delivering antibiotic treatment was significantly lower in the ceftriaxone group (p < 0.001). CONCLUSION: Prophylaxis in penetrating trauma with a single dose of ceftriaxone is safe and has considerable practical and economic advantages.

[Relative mortality risk in malignant tumors. 1969-1987]. / Das relative Sterberisiko durch bösartige Geschwülste. 1969-1987.

As a part of mortality risk study from 1969 to 1987 the relative mortality risk (odds ratio) by malignancies, stratified to age groups is calculated for the eastern countries of the Federal Republic of Germany. With a twofold higher common mortality risk of males in this period, the relative mortality risk exceeds the value of 2.0 only in the female age groups between 25 to 65 years with increasing tendency. Possible reasons for this development are discussed.

[Postoperative wound infections and perioperative preventive antibiotic administration]. / Postoperative Wundinfektionen und perioperative Antibiotikaprophylaxe.

Nearly 200 clinical studies concerning perioperative antibiotic prophylaxis are compiled and evaluated by biometric methods, however without fulfilling the criteria of meta-analysis. Derived from its results it can be concluded, that this prophylaxis is indicated for the wound categories "clean" and "clean-contaminated". An effective level of antibiotics is necessary only for the period of operation. No benefits could be demonstrated by prolongation of the prophylaxis or by combination of two or more antibiotics. Regarding the limited power of this compilation a reduction of postoperative wound infections is to be expected in "clean-contaminated" procedures to a quart, in "clean" procedures to a half in comparison with procedures without prophylaxis.

[Surgical risk in old age. Prospective evaluation of a prognosis index]. / Zum Operationsrisiko im Senium. Prospektive Validierung eines Prognose-Index.

A prognostic index of octogenarians was calculated by a critical retrospective analysis of our results of the outcome after operations. In the years 1986-1988 this index was prospective validated at 381 patients over 80 years old. The accuracy was 85%. The other quality parameter (sensitivity, specificity, negative and positive predictive values) of the decision point of our prognostic model reached good or very good values too. This results showed the possibility of application for the recommended prognostic index. In the last three years the postoperative mortality has fallen essential in general surgery. At present the mortality estimate 20% for emergency and elective operations for the whole hospital stay of the patients. The direct clinical utility of risk analyses to work out prognostically statements was proved by this study.

[Perforated gastroduodenal ulcer. I. postoperative mortality and late results following simple suturing]. / Das perforierte Gastroduodenalulkus. I. Postoperative Letalität und Spätergebnisse nach Ubernähung.

Following the introduction of H2-blockers in the treatment of gastroduodenal ulcer disease, there has not been a change in the incidence of perforated peptic ulcer. By the diagnosis of perforated peptic ulcer the indication for an emergency operation is shown in generally. The postoperative mortality amount now as before 10% and the ulcer relapse rate behave less or more high, dependent on operative procedures, which optical choice is open. Therefore the perforated gastroduodenal ulcer has not lost any actuality. The following paper takes into account the informations of 245 patients from 1970 to 1988, which perforation of peptic ulcer were treated only with simple suture. The collection of data was retrospective till 1985 and since then prospective. Beside analysis of postoperative mortality, reasons of death, complications during healing and preoperative false diagnosis we have done a follow up of operated patients till 1987 (n = 232). On the basis of the results a statement was given for the therapeutical management of ulcer perforations.

[Perforated gastroduodenal ulcer. II. Risk analysis in the prognostic evaluation of the postoperative course]. / Das perforierte Gastroduodenalulkus. II. Risikoanalyse zur prognostischen Beurteilung des postoperativen Verlaufes.

The data of 245 patients of our clinic, which perforation was treated with simple suture, were analysed by uni- and multivariate statistics to estimate risk factors. The aim was to predict the postoperative outcome. In a first step univariate test methods gave some orientation of the relevance of the factors. There was a highly significant correlation of age, preoperative shock, medical illnesses, time interval perforation-operation and clinical diagnosis to postoperative mortality. In a second step a multivariate decision model was used to calculate a prognostic index of the outcome after operation of perforated peptic ulcer. The index was tested in a cohort study. The results of validation were good for all quality parameters, so that the index allows a relatively safer statement about the so-called risk patients.--The prognostic problems of perforated gastroduodenal ulcer, including diagnosis, are also represented with graphic figures in the form of decision trees.

[Life expectancy and "premature mortality" in the Democratic Republic of Germany. An analysis from the surgical viewpoint]. / Lebenserwartung und "vorzeitige Sterblichkeit" in der DDR. Eine analyse aus chirurgischer Sicht,

An analysis was made of medical statistics on life and death, over the past decades, with reference being made to some key data of the national economy. The period under review had largely been a phase of stagnation, though progress was recordable by substantial criteria in some important areas of surgery, despite restrictions on finding, equipment, and personnel. This analysis, hopefully, will be helpful in proper appraisal of public health performance in the period under review. An additional analysis will have to show, if life expectancy and premature mortality, the two parameters analysed in this study, can be improved, in the future, solely by amendments to the organisational setup, financing, and strategy of the national health system.

[Surgical risk in the elderly]. / Zum Operationsrisiko im Senium.

Analyses in the context of risk research prove to be clearly relevant to clinical practice, when it comes to diseases with increased postoperative morbidity and lethality. Results of surgical therapy are not in all cases satisfactory, if patients in advanced age are involved. A critical appraisal of this problem has continued to be necessary. Univariate and multivariate statistical techniques were used for an analysis of the data recorded from 481 patients above 80 years of age (1979 through 1985). A prognostic index is proposed as a result of the analysis.

[Sigmoid diverticulitis]. / Die Sigmadivertikulitis.

Colonic diverticulitis has become a relatively frequent disease, with the sigma being affected by up to 95 per cent of all cases. Its clinical relevance has proved to depend on the prognosis of life-threatening diverticulitis complications. Sixty patients who had received surgical treatment at the Surgical Department of Potsdam District Hospital were analysed. That analysis together with evaluation of literature has been used for therapeutic recommendations. For cases of sigmoid diverticulitis early elective intervention is advised. The method of Henri Hartmann is considered an effective approach to diffuse peritonitis.

[Endometriosis of the large intestine]. / Die Dickdarmendometriose.

Extragenitally localized endometriosis with necessity of treatment is very rare. By means of case reports topical problems of symptomatology, diagnostics and therapy of endometriosis intestini have been discussed from surgical point of view.

[Obstructive jaundice and bilirubin level]. / Verschlussikterus und Bilirubinspiegel.

A brief comparative description of normal and pathological bilirubin levels is followed in this paper by an account of findings recorded from 301 patients with obstructive jaundice. Particular reference is made to laws underlying preoperative rise, in the form of a logistic function, and postoperative decline of bilirubin, in the form of an exponential function. Average half-life, t/2, amounted to 7.5 days after successful surgery. Half-life was found to be affected by preoperative albumin levels but not by duration of obstructive jaundice, primary disease, surgical technique or other parameters.

[Performance evaluation (validation) of diagnosis]. / Zur Leistungsbewertung (Validierung) der Diagnostik.

A theoretical account is given of methods for validation of diagnostic procedures, with reference being made to literature quoted in surgical journals. Wider use of those methods is recommended to ensure more economy, effectiveness, and higher scientific standards in every-day routine.

[Clinically silent suture insufficiency in colorectal surgery]. / Die klinisch stumme Nahtinsuffizienz in der kolorektalen Chirurgie.

The courses of 140 colorectal resections were evaluated from among the authors' own patients. Regular postoperative radiological control and follow-up of anastomoses have shown that nearly half of all suture insufficiencies remain without any clinical symptoms. No direct relationship appeared to exist between expansion of suturing leaks and their clinical relevance. This seems to underline the importance of contrast media to follow up colorectal resections.