A comparison of imipenem/cilastatin with the combination of cefuroxime and metronidazole in the treatment of intra-abdominal infections.

515 patients with intra-abdominal infection participated in an open randomized comparative multicenter trial in order to compare the efficacy, safety, and tolerance of imipenem/cilastatin with cefuroxime/metronidazole. 258 patients (mean age 56 years) received imipenem/cilastatin 1.5-2.0 g/day, and 257 patients (mean age 54 years) received cefuroxime 3.0-4.5 g/day plus metronidazole 1.0-1.5 g/day for at least 3 days. 130/161 evaluable patients (80.8%) receiving imipenem/cilastatin and 124/145 evaluable patients (85.5%) receiving cefuroxime/metronidazole were clinically cured. The microbiological response was favorable in 86.9% in the imipenem/cilastatin group and in 90.8% in the cefuroxime/metronidazole group. The two treatment groups were similar with respect to median time to defervescence which was 4 days. The median duration of treatment was 6 days and the median time to discharge from hospital was 9 days in both groups. Drug-related adverse reactions were observed in 14 patients receiving iminpenem/cilastatin and in 8 patients receiving cefuroxime/metronidazole. 19 patients in the imipenen/cilastatin group and 12 patients in the cefuroxime/metronidazole group died. No correlation was found between the deaths and the study drugs. The present study shows that intra-abdominal infections can be treated successfully with imipenem/cilastatin as well as with cefuroxime/metronidazole.

[Partial or total stripping of the great saphenous vein. 5-year recurrence frequency and 3-year frequency of neural complications after partial and total stripping of the great saphenous vein]. / Partiel eller total stripping af vena saphena magna, Femårs recidivfrekvens og treårs nervekomplikationsfrekvens efter partiel og total stripping of vena saphena magna.

One hundred and sixty-three patients with primary long saphenous vein varices were randomized to either classical (total) stripping of the long saphenous vein (n = 84) or partial stripping, i.e. only of the femoral part of the vein (n = 79). Permanent nerve lesions were evaluated clinically three years and recurrence of varicosities evaluated five years postoperatively. It was found that 24 patients (29%) who had total stripping performed had permanent lesions of the saphenous nerve, whereas only four of the patients (5%) who had partial stripping of the vein had lasting nerve lesions (p < 0.01). Ten percent of patients in both groups had recurrence of varicosities. The present - one and only - long-term, randomized study of different stripping procedures shows that stripping the long saphenous vein below the knee increases the permanent nervedamage six-fold without reducing long-term recurrency. Total stripping of the long saphenous vein should be abandoned as a routine in varicose vein surgery.

Comparison of one dose versus three doses of prophylactic antibiotics, and the influence of blood transfusion, on infectious complications in acute and elective colorectal surgery.

In a randomized prospective controlled trial involving 311 patients undergoing acute or elective colorectal surgery, the efficacy and safety of two different single dose and one triple dose regimen of antibiotic prophylaxis, as well as the influence of blood transfusion on postoperative infectious complications, were studied. Postoperative infectious complications occurred in a total of 59 patients (19.0 per cent). There were no major differences between the three treatment groups. Thirty-four patients (10.9 per cent) developed abdominal wound infection, 17 patients (5.5 per cent) intra-abdominal abscess and 16 patients (5.1 per cent) anastomotic leakage. Of 202 patients (65.0 per cent) requiring blood transfusion during hospitalization 57 (28.2 per cent; 95 per cent confidence limits of 23-36 per cent) developed infectious complications, whereas two non-transfused patients (1.8 per cent; 95 per cent confidence limits of 0.2 to 6 per cent; P less than 0.001) developed infectious complications. It is concluded that one single dose of antibiotic prophylaxis in acute and elective colorectal surgery is as protective as a triple dose regimen. The development of infectious complications despite antibiotic prophylaxis is strongly related to blood transfusion.

Incidence of lesions of the saphenous nerve after partial or complete stripping of the long saphenous vein.

To find out whether the usual total stripping of the long saphenous vein in operations for varicose veins could be replaced by a less traumatic removal of only the femoral part of the vein, a randomised prospective study was carried out in 163 consecutive patients, of whom 157 were evaluable. Group A (n = 80) had total stripping and group B (n = 77) had partial stripping (extraction of the long saphenous vein from the groin to immediately below the knee). The two groups, which were comparable, were assessed three months after operation when 75 in group A (94%) and 75 in group B (97%) had excellent or good relief of symptoms and comparable absence of residual varicosities. Lesions of the saphenous nerve were found in 31 in group A (39%) and 5 in group B (7%) (p less than 0.001). There were few other complications. We conclude that preservation of the distal long saphenous vein not only reduces nerve damage, but also retains enough vein for use should coronary artery bypass or peripheral vascular grafting be necessary in future.

The anatomic relationship between the long saphenous vein and the saphenous nerve. Relevance for radical varicose vein surgery.

Radical surgery for varicose veins often includes total stripping of the long saphenous vein. Some surgeons now claim, however, that stripping of the distal part of that vein can be avoided, thereby reducing the risk of damage to the saphenous nerve. Dissection of 60 cadaver legs to demonstrate the relationship between the long saphenous vein and the saphenous nerve indicated that stripping performed from the groin to immediately below the knee would minimize the risk of nerve damage.