cefamandole and Emergencies

In previous published work we described 57 patients undergoing emergency abdominal surgery, prospectively randomised to receive either cefotaxime or cephamandole as a single-antibiotic, three-dose, peri-operative prophylaxis against post-operative infective complications. This earlier work suggested that cefotaxime might be more effective than cephamandole in preventing wound sepsis in emergency abdominal surgery. We describe here our findings in a further 63 patients undergoing emergency abdominal surgery who were similarly allocated into either a cefotaxime or cephamandole antibiotic group. Infective complications occurred in 12/32 (37 per cent) of the cefotaxime group and 15/31 (48 per cent) of the cephamandole group. Wound infections occurred in 5/32 (16 per cent) of the cefotaxime group and 9/31 (29 per cent) of the cephamandole group. The organisms cultured and their sensitivities are discussed in detail. The total of 120 patients studied in the two series showed wound infection to occur in 13 per cent of the 62 patients receiving cefotaxime and 30 per cent of the 58 patients receiving cephamandole. This difference reaches statistical significance (p less than 0.05). Possible mechanisms to explain this finding are discussed. Again we found the regime of 4 g of cefotaxime given peri-operatively to be a simple, safe and effective single agent as prophylaxis for emergency abdominal surgery.

Topics: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Cefamandole; Cefotaxime; Emergencies; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies; Randomized Controlled Trials as Topic; Surgical Wound Infection

A prospective randomized trial comparing prophylaxis with a single dose of cefamandole given intravenously and preincisionally with no antibiotics in patients who underwent elective and emergency operations upon the gastrointestinal tract has shown a significant reduction in the frequency of wound infections in patients receiving preincisional antibiotics over both control and intravenous groups. Fewer postoperative infections of the chest occurred in patients receiving antibiotics by either route, with hospital stay also being significantly reduced for patients who received prophylactic antibiotics before emergency operations. Preincisional cefamandole is effective in reducing postoperative sepsis after operations upon the gastrointestinal tract.

Topics: Adult; Appendectomy; Cefamandole; Clinical Trials as Topic; Digestive System Surgical Procedures; Emergencies; Female; Humans; Injections, Intravenous; Length of Stay; Male; Middle Aged; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection

Intrahepatic foreign bodies are extremely rare before 6 months of age. We reported a case of a 5-month-old boy with a needle-like foreign body in the liver. The foreign body was incidentally found in the right hepatic lobe on the x-ray image. He was asymptomatic, with neither a history of swallowing a needle nor an abdominal cutaneous scar. Three-dimensional reconstruction of spiral computed tomographic scan showed an intrahepatic needle, close to the base of the heart, with its proximal end close to the gallbladder fossae. Because of the localization of the needle and subsequent risks of complications, surgical removal was recommended. At laparotomy, a tiny scar was recognized in the upper surface of the right lobe of the liver, confirming the migration route. Postoperative course was uneventful, and the child was discharged on postoperative day 10 and is thriving perfectly 2 months after surgery. We reviewed the clinical issues of intrahepatic foreign bodies and briefly discussed its approach and implications.

Topics: Abdominal Injuries; Anti-Bacterial Agents; Asymptomatic Diseases; Cefamandole; Emergencies; Foreign Bodies; Foreign-Body Migration; Humans; Image Processing, Computer-Assisted; Incidental Findings; Infant; Laparotomy; Liver; Liver Function Tests; Male; Needles; Respiratory Tract Infections; Tomography, Spiral Computed; Wound Infection