21 research outputs found
[Outpatient parenteral antibiotic therapy (OPAT) of diabetic foot infections with piperacillin/tazobactam]
No full textTreatment of diabetic foot infections (DFIs) represents an important challenge for surgeons, especially in light of the poor results achieved by traditional therapeutic approaches. In this study, the clinical and bacteriological efficacy of TZP for treatment of DFIs in 38 outpatients was evaluated. All patients (median age 63 yrs) were affected by DFIs to different degrees of severity according to Wagner's classification: degree 0, 7 pts; degree 1, 17 pts; degree 2, 10 pts; degree 3, 4 pts. Degree 0-1 infections underwent a 10-18 day course with TZP given i.m. (2.25 g bid); degree 2-3 infections were initially treated with TZP i.v. (4.5 g bid or tid). Some patients began treatment in hospital and after early discharge continued parenteral therapy at home; others were treated exclusively at home. Some pts, after a 5-7-day course of i.v. therapy switched to i.m. route. The average duration of antibiotic therapy was 28 days. At the end of treatment with TZP, some patients underwent a new treatment with oral coamoxi-clav for 10-15 days. A bacteriological examination was done for all patients: ulcus (degree 1) and deep tissue (degree 2-3) swabs at the first surgical toilette. Clinical controls, medications, surgical toilettes and microbiological cultures were performed according to the degree of severity, extension of the lesion and response to treatment. All cultures were positive for polymicrobial infections (Staphylococcus spp, Enterococcus spp, Enterobacteriaceae, Pseudomonas spp). In 30/38 pts (79%) a complete resolution was observed; in 4 pts (10%) an improvement. DFIs require long term parenteral treatment, with wide spectrum antibiotics including Gram +, Gram - and anaerobes. OPAT represents a valid alternative to hospitalisation when the general conditions of the patient are stable, the infection is not too severe and complications are not present. TZP proved to be a good choice for treatment of diabetic foot infections that, due to its high safety, can be successfully utilized also in OPAT programme
Biliopancreatic Limb Length in One Anastomosis Gastric Bypass: Which Is the Best?
No full textThe use of one anastomosis gastric bypass (OAGB) is rapidly spreading. Concerns about biliary reflux and malabsorption with consequent nutritional deficits exist, so studies on biliopancreatic limb (BPL) adequate length in OAGB are required to balance excess weight loss in percentage (% EWL), resolution of comorbidities, and nutritional deficit. The purpose was to evaluate, at 2 years after OAGB, the effects of BPL length on weight loss, resolution of comorbidity, and nutritional deficiencies in patients
Minimal invasive surgery in treatment of liver metastases from colorectal carcinomas: case studies and survival rates
No full textBackground: Liver represents the main organ subject to metastases from colorectal tumors. Resections of liver
metastases from colorectal cancer have a well-considered therapeutic role underlined by survival of 5 years by
approximately 50-60% of surgical cases as is deduced from an analysis of the most recent literature. The objective
of surgery is to eradicate the metastases present and obtain a margin free from neoplastic impact of amplitude of
approximately 1 cm with residual liver quantity at the end of the intervention that allows the patient to survive.
Currently the dimensions and the number of colorectal liver metastases (CRLM) do not limit the hepatectomy.
Purpose of this work is to evaluate the survival, according to our case studies of patients treated only with the
wedge resection (atypical resection) approximately 1 cm from the margins of metastases.
Methods: In “A. Rizzoli” Lacco Ameno Hospital (Ischia), from 2005 to 2010, 12 liver resections were performed for
metastases from colorectal carcinoma with atypical resection. Synchronous surgical treatment with resection of the
colorectal carcinoma and metastases was performed in 6 patients, 2 female and 4 male (Group 1). Surgical liver
metastasectomy post-colectomy was performed on 6 patients, 3 female and 3 male (Group 2).
Results: No patient was treated with chemotherapy. The mortality rate of intraoperative and perioperative
infection was in both cases of 0%. Survival:11 patients treated surgically from 2005-2010 with synchronous surgery
resection (Group 1) and liver metastasectomy (Group 2) are currently living. One 77-years-old patient died three
years after surgery for BPCO.
Conclusions: This result was able to be obtained due to the wedge resection technique routinely used in our
Hospital, associated with the indispensable use of intraoperatory ultrasound (IOUS). Significant differences between
the synchronous and non-synchronous intervention emerged only regarding the number of days of hospital stay,
higher in the first case
Multicentre survey of post-surgical infections in Campania (Italy)
No full textThe aim of the study was to evaluate the incidence of post-surgical infections and to assess the way of managing antibiotic surgical prophylaxis. The survey was carried out by means of a questionnaire in order to obtain diverse information such as demographics, length of pre- and post-operative hospitalization, type of surgery, intervention duration, possible antibiotic prophylaxis and onset of post-surgical infections also monitored by post-discharge ambulatory controls. Four General Surgery and five Obstetrics and Gynaecology Departments in Campania (southern Italy) participated in the study, which was carried out in the period December 2001-January 2002. Overall, 410 questionnaires were collected referring to as many patients; antibiotic prophylaxis was performed in 385 (93.9%) patients. Antibiotic prophylaxis was generally managed not according to the general principles suggested by the international guidelines either for timing or for its duration or for the route of administration. Substantial differences were also noted in patient selection and antibiotic choice. Surgical site infections were recorded in 0.6% of patients undergoing clean surgery, in 5.3% of patients undergoing clean-contaminated surgery and in 3.2% of those undergoing contaminated surgery. Distant infections occurred in 1.8% and 6.5% in clean-contaminated and contaminated surgery, respectively. The results of the present study suggest the need of a continuous and accurate monitoring of post-surgical infections and the need to adopt appropriate guidelines to improve the management of surgical prophylaxis
Chirurgia Ambulatoriale - I Corso di Perfezionamento - a cura di A. Agresti e A. Gubitosi
No full text
Surveillance of post-operative infections and management of antibiotic surgical prophylaxis in an Italian region
No full textThe aim of the study was to evaluate the incidence of post-surgical infections and to assess management of antibiotic surgical prophylaxis. The survey was carried out by means of a questionnaire in order to obtain diverse information such as demographics, length of pre- and post-operative hospitalization, type of surgery, intervention duration, possible antibiotic prophylaxis and onset of post-surgical infections also monitored by post-discharge ambulatory controls. Four General Surgery and five Obstetrics and Gynecology Departments in Campania (southern Italy) participated in the study, which was carried out from December 2001-January 2002. Overall, 410 questionnaires were collected, referring to as many patients; antibiotic prophylaxis was performed in 385 (93.9%) patients. Antibiotic prophylaxis was generally managed not according to the general principles suggested by the international guidelines either for timing, for its duration or for the route of administration. Substantial differences were also noted in patient selection and antibiotic choice. Surgical site infections were recorded in 0.9% of patients undergoing clean surgery and in 3.6% of patients undergoing clean-contaminated surgery. Distant infections occurred in 1.5% in clean-contaminated surgery. The results of the present study suggest the need for continuous and accurate monitoring of post-surgical infections and the need to adopt appropriate guidelines to improve the management of surgical prophylaxis
Safety and efficacy of prophylactic resorbable biosynthetic mesh in loop-ileostomy reversal: a case–control study
No full text
