RESUMO
OBJECTIVE: To see if a eutectic mixture of local anaesthetics (EMLA) could be used effectively for the release of preputial adhesions as a day case procedure. PATIENTS AND METHODS: A total of 36 consecutive symptomatic children had their preputial adhesions separated under local anaesthetic with EMLA. RESULTS: The procedure was successful in 27 children. Of these, 16 remained symptom free at 9 to 12 months follow up although five children had slight recurrence of adhesions. The other 11 children were listed for circumcision at 2 weeks following the procedure because of marked recurrence of adhesions. CONCLUSION: EMLA cream is a good alternative to general anaesthetics in the separation of preputial adhesions. The technique is operator-dependent and better results were obtained when one person was using it regularly. Separation of adhesions is a worthwhile procedure in boys with symptomatic non-retractile foreskins.
Assuntos
Anestésicos Locais , Lidocaína , Doenças do Pênis/cirurgia , Pênis/cirurgia , Prilocaína , Criança , Pré-Escolar , Circuncisão Masculina , Combinação de Medicamentos , Seguimentos , Humanos , Combinação Lidocaína e Prilocaína , Masculino , Pomadas , Recidiva , Reoperação , Aderências Teciduais/cirurgiaRESUMO
Blood pressure and pulse rate measurements were recorded in 35 patients undergoing endotracheal intubation during general anaesthesia (Group A), and 35 patients who had an awake fibreoptic intubation under local anaesthesia (Group B). The mean arterial pressure in Group A rose by a mean of 35 mmHg immediately after intubation, compared with a mean fall of 9 mmHg in Group B. The mean pulse rate in Group A rose by 24 beats per minute (b.p.m.) immediately after intubation, compared with a rise of 3 b.p.m. in Group B. Both these differences were statistically significant (P less than 0.0001 and P less than 0.001 respectively, Mann Whitney U test). Postoperative discomfort was assessed 24 h later by means of linear analogue scales. There was a statistically higher mean score in relation to nose discomfort in Group B (P less than 0.002). Awake fibreoptic intubation successfully reduces the pressor response to endotracheal intubation in normotensive adults. It is suitable for use in those patients who are at risk from the pressor response.
Assuntos
Anestesia Local , Pressão Sanguínea/fisiologia , Intubação Intratraqueal/métodos , Laringoscopia , Anestesia Geral , Broncoscopia , Deglutição , Feminino , Tecnologia de Fibra Óptica , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nariz , Dor/etiologia , Faringe , Estudos Prospectivos , Pulso Arterial/fisiologiaRESUMO
We have evaluated a new agglutination test for serum immunoreactive lipase in 24 patients with abdominal pain and hyperamylasaemia. On admission all 20 patients with acute pancreatitis had a positive lipase test, 3 of the 4 patients who did not have pancreatitis had a negative lipase test. The sensitivity of the lipase test on day 1 is 100%, the specificity 96% and predictive value of a positive test is 95.2% compared to 83% for amylase. A negative test excludes pancreatitis. In addition, the test stays positive longer than hyperamylasaemia.
Assuntos
Ensaios Enzimáticos Clínicos , Lipase/sangue , Pancreatite/diagnóstico , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Testes de Fixação do Látex , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Kit de Reagentes para DiagnósticoRESUMO
Between February 1983 and September 1985, an outbreak of methicillin-resistant Staphylococcus aureus involving 151 patients and staff occurred in a district general hospital. At its peak, 43 cases occurred in 3 months. Sixty-two patients suffered morbidity and two died. Conventional isolation techniques and once-daily whole body washing of affected patients with triclosan successfully controlled the outbreak.
Assuntos
Antissepsia/métodos , Surtos de Doenças/prevenção & controle , Meticilina , Infecções Estafilocócicas/epidemiologia , Banhos , Inglaterra , Hospitais com mais de 500 Leitos , Hospitais Gerais , Humanos , Resistência às Penicilinas , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/isolamento & purificação , Triclosan/uso terapêuticoRESUMO
Fifty-six patients undergoing abdomino-perineal excision of the rectum for carcinoma were randomized to receive twice daily irrigation of the perineal wound with either 1% povidone-iodine (PVP-I) or normal saline for 5 days following surgery. The incidence of perineal wound infection, primary and delayed wound healing and persistent sinus formation was recorded. There was a highly significant reduction in perineal wound infection in the PVP-I group (P less than 0.01) and this was true even if perineal wound contamination had occurred during operation (P less than 0.05). Primary wound healing was significantly improved in the treatment group (P less than 0.02) and this was found also in the presence of contamination (P less than 0.005). There was no significant difference between the treated and control group in the incidence of delayed wound healing and persistent sinus formation.
Assuntos
Anti-Infecciosos Locais/administração & dosagem , Períneo/cirurgia , Povidona-Iodo/administração & dosagem , Povidona/análogos & derivados , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso , Anti-Infecciosos Locais/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Neoplasias Retais/cirurgia , Irrigação Terapêutica , Cicatrização/efeitos dos fármacosAssuntos
Infecção Hospitalar/prevenção & controle , Unidades Hospitalares , Meticilina/farmacologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/efeitos dos fármacos , Procedimentos Cirúrgicos Vasculares , Anti-Infecciosos Locais/uso terapêutico , Tipagem de Bacteriófagos , Portador Sadio/tratamento farmacológico , Portador Sadio/microbiologia , Descontaminação/métodos , Surtos de Doenças/prevenção & controle , Inglaterra , Hospitais com mais de 500 Leitos , Humanos , Métodos , Resistência às Penicilinas , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificaçãoRESUMO
Patients undergoing biliary surgery received either 750 mg cefuroxime i.m. with the premedication and then 8 hourly for 3 days ((group A) or 1.5 g cefuroxime i.v. at the time of induction of anaesthesia (group B) or not treatment (group C). Wound infections occurred in 3 out of 35 patients in group A, 1 out of 40 patients in group B and 11 out of 39 patients in group C (group B significantly different than group C, P less than 0.05). Eight patients (23%) in group C had chest complications. Cefuroxime was effective in the reduction of wound sepsis following biliary surgery and 1.5 g i.v. administered during induction of anaesthesia is the dosage of choice. The incidence of chest infection tended to be lower in patients receiving cefuroxime but many more patients would have to be studied for a conclusive result.
Assuntos
Infecções Bacterianas/prevenção & controle , Cefuroxima/uso terapêutico , Cefalosporinas/uso terapêutico , Pré-Medicação , Infecções Respiratórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Idoso , Procedimentos Cirúrgicos do Sistema Biliar , Cefuroxima/administração & dosagem , Esquema de Medicação , Avaliação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controleRESUMO
Serial measurements of serum amylase, lipase and ionized calcium were made in a prospective study of 17 patients with acute pancreatitis. The mean serum ionized calcium was significantly below the normal range for the first 24 h and had returned to normal after 48 h. There was no correlation between serum ionized calcium and paired calcium corrected for albumin during the first 36 h of the study, but they were correlated for the remainder of the investigation. Serum lipase and ionized calcium levels were just significantly correlated over the first 3 days (r = -0.44; t = 2.3; P less than 0.05; d.f. 22), but failed to reach correlation over the whole period of study (r = -0.34; t = 2.0; d.f. 31). These data establish a significant drop in directly measured ionized calcium early in an attack of pancreatitis, which is not seen in the paired corrected calcium values. Furthermore, the drop is correlated with serum lipase, although this is weak and other factors must be involved in the hypocalcaemia.