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Prophylaxis of infection after appendicectomy: a survey of current surgical practice. 阑尾切除术后感染的预防:目前手术实践的调查。
1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1597
W B Campbell

Two hundred and eighty questionnaires were sent to junior surgical staff throughout England inquiring about their use of systemic antibiotic prophylaxis, topical antibacterial agents, and surgical drainage in appendicectomy. One hundred and seventy-five (63%) replies were received from 81 of the 87 hospitals included in the survey. Prophylactic systemic antibiotics were used by 78 surgeons (46%) when operating on a normal appendix but by 168 (99%) when the organ had perforated. Most surgeons started antibiotics before operation, but proportionately fewer did so when the appendix was gangrenous or perforated. Patients with severe contamination tended to receive longer courses of antibiotics, although the duration of administration varied considerably. Metronidazole was included in over 95% of all the prophylactic regimens and was often combined with other drugs when the appendix was gangrenous and perforated. Topical antibacterial agents were applied to the wound routinely by only 45 surgeons (26%), although 106 (61%) used them sometimes. Povidone-iodine was the agent most commonly used. Only 98 surgeons (56%) ever drained appendicectomy wounds, while 135 (77%) sometimes drained the peritoneal cavity. Evidence suggests that present methods of giving systemic antibiotic prophylaxis should continue, but that topical agents and surgical drainage are perhaps unnecessary when surgeons are confident of the efficacy of the systemic treatment used.

向全英格兰的初级外科医生发送了280份调查问卷,询问他们在阑尾切除术中使用全身性抗生素预防、局部抗菌药物和手术引流的情况。在参与调查的87家医院中,有81家医院回复了175份(63%)。78名外科医生(46%)在对正常阑尾进行手术时使用预防性全身抗生素,而168名(99%)在阑尾穿孔时使用预防性全身抗生素。大多数外科医生在手术前开始使用抗生素,但当阑尾坏疽或穿孔时,使用抗生素的比例更低。严重污染的患者往往接受较长的抗生素疗程,尽管给药时间差异很大。甲硝唑在所有预防方案中占95%以上,当阑尾出现坏疽和穿孔时,甲硝唑常与其他药物联合使用。只有45名外科医生(26%)在创面常规使用局部抗菌药物,106名外科医生(61%)有时使用。聚维酮碘是最常用的药剂。只有98名外科医生(56%)曾对阑尾切除伤口进行引流,而135名外科医生(77%)有时对腹腔进行引流。有证据表明,目前给予全身抗生素预防的方法应该继续,但当外科医生对所使用的全身治疗的疗效有信心时,局部药物和手术引流可能是不必要的。
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引用次数: 27
Acute renal failure precipitated by radiographic contrast medium in a patient with rhabdomyolysis. 横纹肌溶解患者的造影造影剂诱发急性肾功能衰竭。
1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1603
C G Winearls, J G Ledingham, A J Dixon
Myoglobinuria is an uncommon but important cause of acute tubular necrosis.' It was originally described in association with trauma but also occurs in cases of non-traumatic rhabdomyolysis, when diagnosis may be more difficult.2 'Infusion intravenous urography is a standard investigation for acute renal impairment of obscure cause1; we report a case of acute renal failure precipitated by administration of radiographic contrast medium in a patient with undiagnosed rhabdomyolysis and renal impairment.
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引用次数: 10
Menopausal oestrogen use and breast cancer. 绝经期雌激素的使用与乳腺癌。
1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1638-b
V Beral
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引用次数: 1
Heart rate variations in the Guillain-Barré syndrome. 格林-巴罗综合征的心率变化。
1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1641-c
J C Frisón
seven kidneys (5 %), however, showed severe arterial beading of the type previously reported in rejectionl 2; and in another nine kidneys (7 %) there were irregularities in the small renal arteries ranging from minor variations in vessel calibre and course to obvious segments of constriction or dilatation with abrupt terminations to the vessels. All the transplanted kidneys demonstrating these vascular abnormalities were undergoing rejection. One of the patients in whom aneurysms were demonstrated had arteriography of the transplanted kidney performed on two occasions; the first arteriogram showed normal intrarenal vessels, the second study one year later showed multiple small aneurysms which had developed during the course of rejection of the kidney. There was considerable overlap between the different types of arteriographic abnormality seen in rejecting transplant kidneys; the 20 kidneys comprising the three groups described above demonstrated a spectrum of vascular changes ranging from mild variations in vessel calibre at one extreme to multiple aneurysms at the other. In summary, multiple intrarenal aneurysms or severe preaneurysmal beading were demonstrated in 8 % of 136 arteriograms performed on malfunctioning transplanted kidneys. In a total series of 918 renal arteriograms rejection of a transplant was second only to polyarteritis nodosa as a cause of this type of aneurysm. Many causes of renal aneurysm are known,3 but the aneurysms seen in transplant rejection are most similar in their arteriographic appearance to those occurring in polyarteritis nodosa3 or drug abuse.4
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引用次数: 0
Effects of electric convulsion therapy. 电痉挛疗法的效果。
1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 1980-12-13
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引用次数: 0
Coeliac plexus block for control of pain in chronic pancreatitis. 腹腔神经丛阻滞对慢性胰腺炎疼痛的控制。
1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1604
S N Bell, R Cole, I C Roberts-Thomson
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引用次数: 0
Medical audit in neonatal care. 新生儿护理中的医疗审计。
1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1618
T H Williams, D P Davies

A system of medical audit on a neonatal unit based on the primary reason for admission may be used alongside the more conventional type of audit of mortality and morbidity by birthweight and gestation using a diagnostic classification of disease. The method provides a more accurate description of all babies admitted to a neonatal unit and thus a more comprehensive measure of work undertaken.

基于入院主要原因的新生儿病房医疗审计系统可与使用疾病诊断分类的按出生体重和妊娠期对死亡率和发病率进行更传统类型的审计一起使用。该方法提供了一个更准确的所有婴儿入住新生儿单位的描述,从而更全面的措施所开展的工作。
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引用次数: 6
Prevention of mumps. 预防腮腺炎。
1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1637-a
J Desmyter
the Birmingham findings. The overall pneumonia rate in Birmingham was higher (400h) than in Glasgow (26%°), where pneumonia was taken to mean either consolidation on chest radiograph or a chest infection which in the judgment of the attending physician required antibiotics. It would be interesting to know -what "confirmation" by chest radiography means in the Birminghamstudy, since the difference may be explained by differing definitions. We have been reluctant to draw definite conclusions from the complication rate in those children immunised against pertussis compared with those not immunised, since the numbers are small, and this may also apply to the Birmingham study. However, overall findings are similar, confirming that whooping cough still causes substantial numbers of hospital. admissions for a prolonged and unpleasant illness and that immunisation appears to protect children from being -admitted to hospital with the disease, either by preventing it altogether or by preventing serious complicatioris.
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引用次数: 5
Elemental diets in treatment of acute Crohn's disease. 元素饮食治疗急性克罗恩病
1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1641
M J Hall
seven kidneys (5 %), however, showed severe arterial beading of the type previously reported in rejectionl 2; and in another nine kidneys (7 %) there were irregularities in the small renal arteries ranging from minor variations in vessel calibre and course to obvious segments of constriction or dilatation with abrupt terminations to the vessels. All the transplanted kidneys demonstrating these vascular abnormalities were undergoing rejection. One of the patients in whom aneurysms were demonstrated had arteriography of the transplanted kidney performed on two occasions; the first arteriogram showed normal intrarenal vessels, the second study one year later showed multiple small aneurysms which had developed during the course of rejection of the kidney. There was considerable overlap between the different types of arteriographic abnormality seen in rejecting transplant kidneys; the 20 kidneys comprising the three groups described above demonstrated a spectrum of vascular changes ranging from mild variations in vessel calibre at one extreme to multiple aneurysms at the other. In summary, multiple intrarenal aneurysms or severe preaneurysmal beading were demonstrated in 8 % of 136 arteriograms performed on malfunctioning transplanted kidneys. In a total series of 918 renal arteriograms rejection of a transplant was second only to polyarteritis nodosa as a cause of this type of aneurysm. Many causes of renal aneurysm are known,3 but the aneurysms seen in transplant rejection are most similar in their arteriographic appearance to those occurring in polyarteritis nodosa3 or drug abuse.4
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引用次数: 36
Papillary carcinoma of the thyroid in two brothers after chest fluoroscopy in childhood. 儿童胸部透视后兄弟二人甲状腺乳头状癌。
1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 1980-12-13 DOI: 10.1136/bmj.281.6255.1600
C Fisher, C J Edmonds
perhaps be added, and a number of doses given after operation. This practice was followed by nearly a third of surgeons, although a similar proportion began antibiotic treatment only at the time of operation for a gangrenous or perforated appendix. Applying povidone-iodine to the wound is a simple measure that confers some protection against wound infection and was used occasionally by nearly half of the surgeons in the survey. The available evidence is against peritoneal drainage (which was used by 77%), but a wound drain may be advantageous, although only 56% of the surgeons ever inserted one. It is possible that topical agents and surgical drainage may be largely abandoned by those who are confident of the efficacy of the systemic antibiotic prophylaxis used.
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引用次数: 15
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British Medical Journal
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