Aaron Prigot

Enzymatic debridement with activated whole pancreas.

Abstract Our experience in 125 cases of infected wounds, amputation stumps, stasis and decubitus ulcers, and second and third degree burns indicated the clinical effectiveness of pancreatic enzymes for debridement in the local management of these conditions. In animal experiments the preparation did not interfere with wound healing and its activity is maintained in the presence of water and human exudates. As packaged in a squeeze bottle spraying a powder, it is easily applied, is effective in the open treatment of wounds and facilitates the management of patients on an ambulatory basis. Morbidity in these cases was reduced considerably and enzymatic debridement could be undertaken when the patients condition did not warrant formidable surgical debridement. Although the pancreatic enzymes have no bactericidal properties, bacterial flora were controlled by denial of a suitable substrate for proliferation. Many organisms were thus eliminated. The foul odor characteristic of infected wounds disappeared almost completely. Necrosis and purulent exudates were eliminated. The wounds became clean, with healthy granulation tissue, and the areas thus revitalized were closed through progressive healing or by surgical resurfacing.

Evaluation of a chemical depilatory for preoperative preparation of five hundred fifteen surgical patients

Abstract A hair removing cream was employed in the preoperative preparation of 515 patients. The surgical procedures necessitated depilation which involved all regions of the body. The superiority of the cream over shaving technics was established in 470 of 526 applications, the body surfaces were left clean and smooth with no scratching nor excoriation of the skin. In appearance and odor the cream is acceptable to patients. Nurses report that its consistency and ease of application and removal facilitated the preparation of surgical patients, hair was removed from body crevices, inflamed or sensitive areas, and around lacerations with rapidity and without discomfort. Although the bacterial inhibitory properties are limited, the compound is sterile. In animal studies, it effectively removed hair and cellular debris, was nonirritating and non-toxic and did not interfere with the healing of experimental wounds. Histologic comparison of dermal sections from the same patient, one operative site shaved and the other prepared with the depilatory, revealed no tissue reaction to the chemical compound. In plastic surgery and autografts of the skin, there was no interference with the “take” of the graft. A low order of allergenicity was found in patch tests in 100 patients. Side reactions in preoperative hair removal are reported thirty-seven times in 526 applications. The majority of these manifestations were mild in character and of short duration. Three case histories detail other factors accountable for adverse reactions and emphasize precautions in the topical application of any chemical substance.

Intraperitoneal use of kanamycin as an adjunct in the therapy of established peritonitis and peritoneal contamination.

Although the broad spectrum antibiotics, employed systemically, have reduced morbidity and mortality associated with peritonitis and peritoneal contamination, uncontrolled infection still results in a small percentage of cases which terminate in death.1-5 In an effort to reduce this group to a minimum, numerous methods of procedure have been employed by various investigators, including peritoneal toilet with copious quantities of saline and the use of sulfonamides in powdered form. In recent years the intraperitoneal instillation of appropriate antibiotics at surgery has afforded a technique of combatting bacterial invasion in these emergency situations. Prigot et al. and ~thersO-~ have reported impressive results with the instillation of 1 gm. of neomycin sulfate into the peritoneal cavity at surgery involving established peritonitis and peritoneal contamination. The present study was undertaken to determine if the antimicrobial potential and safety margin of kanamycin would make this new antibiotic a suitable adjunct to surgery in these critical cases. Kanamycin sulfate, recently introduced from Japan,l0 is produced from Streptomyces kanamyceticus. As prepared for clinical use, the kanamycin sulfate occurs as kanamycin-A, 95 per cent, and kanamycin-B, 5 per cent, the “A” being biologically active. The chemical structure is known, and it contains radicals similar to those in neomycin and streptomycin. Two amino sugars appear in the molecule. The antibiotic is water-soluble and highly stable at room temperature. In vitro and animal studies11-12 have indicated that kanamycin has a wide range of activity against both Gram-positive and Gram-negative organisms. It is especially potent against the Micrococcus pyogenes var. aureus and less effective against the Streptococcus and Diplococcus pneumoniae. Resistance to kanamycin appears to develop in a slow stepwise fashion. This antibiotic is relatively nontoxic a t therapeutic levels in both animals and man. In humans, after 5 days of oral medication at 1 gm. daily, hyaline casts appear in the urine. Kidney function tests and the nonprotein nitrogen remain normal. No case of eighth nerve damage has been reported. No adhesions developed when kanamycin was injected into the peritoneal cavity of guinea pigs at a level of 20 mg./kg. of body weight. There was no evidence that these animals suffered any nephrotoxic effect, nonprotein nitrogen and urine continuing normal during the observation period to the time the animals were sacrificed for examination of the peritoneum. Kana* This study was supported in part by a grant from Bristol Laboratories Inc., Syracuse, N. Y . This firm furnished the medication employed.

Aureomycin in soft tissue infections

Abstract Aureomycin was used in eighty-two surgical infections of the soft tissues which have been divided into the following groups: cellulitis, perirectal infections, peripheral ulcers, lymphadenitis, traumatic cases, gas gangrene infections and a miscellaneous group. Infections caused by a variety of grampositive and gram-negative bacilli were successfully treated. Most of these infections were caused by staphylococci or beta hemolytic streptococci. The miscellaneous group includes a case of bacteremia by the paracolon bacillus and one by S. minus. The age of the patients and medical complications have not hampered the activity of the drug. Aureomycin was used effectively by the oral, intramuscular and intravenous routes. Blood level studies and in vitro sensitivity tests have been performed and have confirmed the clinical results. No resistance to the drug has developed in any organism in cases in which prolonged administration was necessary. No serious clinical signs of toxicity have been seen as a result of drug administration. A chemical phlebitis developed in approximately 15 per cent of the patients receiving the drug intravenously if its administration extended two days or longer. In our hands aureomycin has yielded satisfactory results in the treatment of the reported infections whether used alone or as an adjunct to indicated surgery. It has appreciably shortened the clinical course of some infections, for example the lymphadenitis cases. In other infections such as cellulitis the usual rate of surgical intervention was markedly reduced during its use. In perirectal infections the use of the drug made early definitive surgery possible by reducing the local infection. Further use of aureomycin in the field of soft tissue infections seems definitely indicated.

The clinical trial of streptomycin pantothenate in the treatment of soft tissue infections

Abstract Didrothenate was the antibiotic employed in the treatment of 116 patients with soft tissue infections, some of whom were managed on an ambulatory basis. Surgical intervention was required in fewer instances and was usually of lesser magnitude than ordinarily employed in similar cases. The intramuscular administration of the antibiotic was acceptable to the patients and the therapeutic response to this medication was excellent. In susceptibility tests on the microorganisms recovered in this study more strains were found sensitive to the didrothenate than to streptomycin, indicating that the possibility of the emergence of resistant bacterial strains is decreased. None of the organisms recovered proved more sensitive to streptomycin sulfate than to the streptomycin pantothenate preparation.

An iodophor, alkyl aryl polyether alcohol ester iodine complex used as an antiseptic scrub in surgical practice

Abstract Despite its antibacterial efficiency, the use of tincture of iodine for preoperative preparation of body surfaces and other surgical purposes is disadvantageous because of topical and systemic reactions, often of a serious nature. In bacteriological studies, animal experiments and extensive clinical trial, an iodophor, iodine in a stable organic complex, demonstrated prolonged germicidal action without the danger of cutaneous burns, irritation and allergic manifestations, and there was no interference with wound healing. Its use on the surgical service included the cleansing of lacerations prior to suturing in 100 operations, the preparation of the body surface for surgery, 127 operations, and as a preoperative scrub for the hands of the surgeons in 2,568 operations. We found the alkyl aryl polyether alcohol ester iodine complex an excellent and safe antiseptic for surgical practice.

Aureomycin packing as an adjunct to the surgical treatment of localized infections

Abstract Aureomycin packing was found to be a valuable adjunct to the surgical therapy of certain localized infections. It has been shown to make available high concentrations of aureomycin over a long period of time and not to interfere with wound healing. No significant local or systemic toxic effects were noted nor was allergy or local skin irritation in evidence. Odor from infected wounds has been considerably reduced.