Forty patients undergoing clean-contaminated, contaminated, and dirty surgical procedures were studied to determine whether daily C-reactive protein (CRP) measurements for 10 days following surgery could predict the occurrence of septic complications before clinical recognition. Diagnostic criteria for septic complications and positive CRP response were defined in advance of the study. The CRP measurements were carried out using semiquantitative latex agglutination after the patients discharge from the hospital. Fifteen complications were diagnosed in fourteen patients. These complications consisted of wound infections (3), urinary tract infection (4), and pneumonia (3). The CRP examination was found to have a positive predictive value of 77% and a negative predictive value of 85%. We conclude that serial CRP determinations may be valuable as part of the armamentarium to surgical care in patients at considerable risk of post-operative septic complications. (Author)

Human ; Male ; Female ; Middle Aged ; Adult ; C-reactive Protein ; Latex ; Urinary Tract Infections ; Patient Discharge ; Postoperative Complications ; Pneumonia ; Wound Infection ; Agglutination

The study retrospectively reviewed 1,029 general surgery operations performed from September 1, 1991 to May 31, 1993 to find out the association between the occurrence of surgical site infection (SSI) and the Centers for Disease Control-National Nosocomial Infection Surveillance (CDC-AWS) surgical patient risk index scores. The index assigned 1 point for each of 3 risk factors: 1) American Society of Anesthesiologists (ASA) preoperative assessment class 3, 4 or 5; 2) an operational classified as either contaminated or dirty-infected; 3) an operation with a duration longer than a specified increased with increasing contamination (p=0.000) as well as increasing index scores (p=0.000). Looking at operations within the same category of contamination, SSI rates also increased with increasing scores among clean operations (p=0.944), clean-contaminated operations (p=0.000), contaminated operations (p=0.559), and dirty operations. SSI rates in this hospital series were compared to the 44-hospital CDC-NNIS report.

Human ; Male ; Female ; Surgical Wound Infection ; Cross Infection ; Anesthesiologists

A total of 38 patients with frozen section slides who underwent parotidectomy from January 1980 to December 1993 were retrieved from the Department of Pathology. The permanent section slides of the resected specimens were used as the gold standard. The frozen section and permanent section slides were reviewed by two independent pathologists and were labeled either as benign or malignant. If malignant, the tumor grade was determined as either high grade or low grade. Kappas correlation of agreement was used to determine inter-observer variability. Of the 38 slides, 16 were correctly labeled as malignant and 20 as benign. One slide was incorrectly labeled as malignant and 1 as benign. Sensitivity was 94.1 and specificity was 95.2 percent. The prevalence of malignant parotid tumors was 44.7 per cent, with a positive predictive value of 94.1 per cent and a negative predictive value of 95.2 per cent. Kappa statistic for the permanent section was 100 per cent, and 85 per cent for the frozen section. Tumor grading revealed that only 35.2 per cent were labeled correctly as high grade or low grade. This study showed that frozen section could reliably diagnose a malignant parotid tumor but could not reliably determine tumor grade. (Author)

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Frozen Sections ; Pathologists ; Prevalence ; Observer Variation ; Neoplasm Grading ; Parotid Neoplasms ; Sensitivity And Specificity

It has been suggested in a number of studies that penetrating abdominal stab wounds may be managed conservatively although only a few local studies support this claim. This study reviews experience based on 483 patients, who underwent celiotomy for a single penetrating abdominal stab wound inflicted by a single bladed knife from Jan. 1989 to June 1991. The cases were divided into two (2) groups, those who underwent celiotomy with indications and those who underwent celiotomy without indications. Tabulation of operative findings according to the location of the stab wound in the nine (9) regions of the anterior abdomen showed that 89% of all patients with indications for surgery had significant injury. In the group who underwent celiotomy without indications, 78% had positive findings. The data for groups A and B stratified into the nine regions did not show any significant difference in the frequency of abdominal injury except in the right lumbar, left lumbar, left iliac and umbilical region. In these last four regions, the frequency of abdominal injury in the group with indications is statistically higher than in the group without indications. Therefore, a trial of observation in these regions is therefore acceptable in the absence of indications for celiotomy.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Adolescent ; Wounds ; Stab ; Abdomen

A retrospective study was undertaken on 103 diabetic patients with foot ulcers who were confined at the UERM Memorial Medical Center from January 1988 to June 1991 with the aim of determining clinical and laboratory criteria which are useful in predicting the need for amputation. Patients were divided into two groups according to treatment modality: Group A, debridement (58 patients) and Group B, amputation (45 patients). Nineteen variables chosen from the patients demographic characteristics, clinical histories and evaluation, and laboratory work-up were reviewed, evaluated, and processed using the normal approximation statistics and logistic regression to obtain a resulting set of predictors. Osteomyelitis, leukocytosis, decreased or absent peripheral pulses, systolic hypertension and smoking history were the five variables found to be significantly associated with the need for an ablative surgical procedure. These quantitated variables are entered into the computed logistic equation to obtain a score which will enable us to determine the appropriate therapeutic intervention tailored to the individuals risk status. If the computed value is greater than or equal to 7, amputation should be the course of action. If the computed value is less than or equal to 3, conservative treatment is advocated. If the value obtained is between 3 and 7, the patient is considered a borderline case and proper management will have to depend on the judgment of the surgeon. With this scoring system as a guide, a definitive operation can be performed at an early stage to prevent the burden of multiple operations and the accompanying high morbidity and post-operative mortality rates.

Human ; Male ; Female ; Foot ; Diabetes Mellitus ; Diabetic Foot ; Amputation

An open, prostective, randomized multicenter clinical trial randomly allocated successive patient who were scheduled for a surgical procedure for serious intra-abdominal infections to receive either treatment CM (ceftazidine plus metronidazole) or monotherapy with treatment IC (imipenem/cilastatin). Out of 90 eligible patients, 87 were clinically evaluable of which 71 were clinically and bacteriologically evaluable (CBE). Cases allocated to each treatment group were comparable as to age, sex, diagnostic group distribution, mean APACHE II scores, and bacteriologic evaluability. Among the 87 clinically evaluable patients, there were 4 (9.1%) and 2 (4.7%) treatment failures among those who received treatments CM and IC respectively (p=0.486). For all eligible patients, the mean fever days was 2.07, mean treatment days was 6.01, and mean hospital days was 11.57, and was not significantly different between the two treatment groups. Among clinically evaluable cases, the mean APACHE II scores of patients with succesful outcomes (5.8) was very significantly lower (p=0.000) than that of patients whose treatment failed (13.8). This was also true for CBE cases. Logistic regression analysis showed that among six variables (diagnostic group, APACHE II score, antibiotic used, fever days, hospital days and treatment days) only the APACHE II score signficantly contributed to treatment failure (p=0.001).

Human ; Cilastatin ; Imipenem ; Metronidazole ; Drug Combinations ; Sex Distribution ; Age Distribution ; Intraabdominal Infections ; Anti-bacterial Agents