Antibiotic prophylaxis in cardiac surgery.

BACKGROUND: A prospective, randomised study was conducted among 1009 cardiac surgery patients in order to compare the prophylactic efficacy of a second generation cephalosporin (cefuroxime) given as single shot, versus a broad spectrum double regimen (amoxycillin-netilmicin). METHODS: Cefuroxime received 501 patients (Group A), while a 4-day combination of amoxycillin-netilimicin 508 patients (Group B). RESULTS: There were found no statistically significant differences either in infection rate or the kind of infection between the two groups. Single shot cefuroxime prophylaxis was just as effective, as a 4-day combination of amoxycillin and netilmicin. Total infection rate was 5.6% (n=28) in Group A and 5.7% (n=29) in Group B. Respiratory tract infection was the most frequently registered in both groups; 2.6% in Group A and 2.9% in Group B. Sternal wound and catheter-related infection rates were 0.6% and 1% in both groups, respectively. There were no side effects due to the given antibiotics. CONCLUSIONS: A single shot of cefuroxime prophylaxis is equally effective and safe as a 4-day regimen with amoxycillin and netilmicin.

Pedicled pericardial fat pad: a useful hemostatic supplement.

Control of bleeding in areas difficult to suture because of tissue friability, edema, or calcification poses a serious problem in cardiac surgery patients. We report the use of a pedicled pericardial fat pad as an adjunct to the control of bleeding in these difficult-to-suture areas. This technique was used in 9 patients who were bleeding from different areas (the atria, coronary sinus, aorta, and myocardium), and the bleeding was completely and easily controlled. We consider the pedicled pericardial fat pad to be a useful supplement when suturing alone cannot effectively bring the bleeding under control.

Hypothermic circulatory arrest and the management of giant and large cerebral aneurysms.

The surgical adjuncts of hypothermic circulatory arrest, exsanguination, and barbiturate cerebral protection were evaluated in nine cases of cerebral aneurysms felt unapproachable by conventional surgery. These techniques were used in seven posterior circulation aneurysms, two of which were giant and two giant anterior circulation aneurysms originating at the middle cerebral artery bifurcation. Four patients had excellent outcomes, two had a fair result, one had a poor result, and two died. The outcome of surgery reflected that of the management of patients with unruptured or ruptured aneurysms. Three of the four patients who did well had unruptured aneurysms, and all three of the cases in which death or a poor outcome resulted occurred in patients presenting with subarachnoid hemorrhage. The rationale for the use of hypothermic circulatory arrest is discussed, and the surgical indications, techniques, and anesthetic considerations are also reviewed.

Carcinoid tumors of the thymus.

Carcinoid tumors arising in the thymus are rare. Since Rosai and Higa in 1972 distinguished these neoplasms from thymomas, fewer than 100 cases have been reported in the world literature. In a 38-year review (1950 to 1988) of surgically treated thymic tumors at Henry Ford Hospital, only 7 cases of thymic carcinoids were identified. These 6 men and 1 woman ranged in age from 27 to 70 years (mean, 48 years) at diagnosis. Follow-up was available in all patients with the longest survival being 12 years in 2 patients, and the shortest, 1 year, in 1. Recurrences and/or metastases developed in 4 of 7 patients between 1 and 9 years after initial resection. Recurrences were treated by reexcision in addition to radiation treatment and chemotherapy in 3 patients and reexcision with radiation treatment alone in 1 patient. A review of the literature along with our experience suggests that thymic carcinoids have a biological behavior distinct from thymoma in terms of cell origin, associated syndromes, neoplastic behavior, and prognosis. An aggressive surgical approach with complete initial excision of the tumor and of subsequent recurrences, along with radiation and probably chemotherapy, is the best available treatment today.