Alex Dinbar

Single dose prophylaxis in elective cholecystectomy: A prospective, double-blind randomized study

We tested the effectiveness of a single dose of prophylactic antibiotic (gentamicin) in elective cholecystectomy in a double-blind, controlled randomized study. All patients recognized preoperatively as being at risk were excluded. The treatment group comprised of 102 patients received a single dose of gentamicin and the 74 patients in the control group received a placebo. Of the patients who received gentamicin, wound infection developed in 4.9 percent versus 13.5 percent in the control group. Among 45 patients who had positive bile cultures, the wound infection rate for those in the treatment group was 14 percent versus 44 percent for those in the control group. Of 17 patients who underwent unexpected exploration of the choledochus, none of those in the treatment group had development of wound infection. The rate of wound infection in the control group was 50 percent. As 30 percent of the patients undergoing elective cholecystectomy were found to have risk factors for the development of wound infection which could not be identified preoperatively, we recommend single dose prophylaxis for all patients undergoing cholecystectomy.

Definitive management of acute pilonidal abscess by loop diathermy excision

A simple technique of definitive management of acute pilonidal abscess is described. The procedure consists of incision with drainage of pus followed by controlled excision of diseased tissue and lateral sinuses, using a loop diathermy. It allows one-stage definitive management of both acute pilonidal abscess and chronic pilonidal sinuses.

The hepatic response to endotoxin shock; Hemodynamic and enzymatic observations

Abstract In order to evaluate the role of the liver in endotoxin shock, purified endotoxin was injected into the portal vein or into the systemic circulation in dogs. Systemic administration of endotoxin produces a more severe hypotension than does injection into the portal vein, which suggests that endotoxin may be removed from the circulation and detoxified by the hepatic RE system. When the liver was excluded from the circulation, profound hypoglycemia followed administration of endotoxin and death soon occurred. Circulating SGOT, SGPT, and alkaline phosphatase levels increased greatly after administration of endotoxin in dogs with normal hepatic circulation, but the blood LDH levels were higher in dogs in which the hepatic inflow was excluded, which suggests an extrahepatic origin of the LDH isoenzymes. Although the present studies suggest that the liver exerts a protective effect during the initial phase of endotoxin shock, it is believed that with progression of shock the liver deteriorates and hepatic intracellular metabolites may be released into the circulation to accelerate the irreversibility of shock.

Resection of rectal mucosa without proctectomy as an adjunct to abdominoperineal resection for nonmalignant conditions

Summary An operative procedure consisting of excision of the rectal pouch and sigmoid end colostomy was performed in each of ten dogs to evaluate the fate of the rectal pouch. In each of the chronic survivors the lumen of the rectal pouch became obliterated within six to eight weeks, and abscess did not occur. Because of the frequent morbidity associated with abdominoperineal resection, it is believed that the described operation may warrant clinical trial in selected patients with ulcerative colitis and certain other nonmalignant conditions involving the rectum.

Avoiding colostomy soiling during immediate maturation after Hartmann's procedure

A simple maneuver that avoids soiling of the field during immediate maturation of colostomy performed for large bowel obstruction is presented. This maneuver involves inflating a large Foley catheter in the lumen of the obstructed large bowel just before maturation is performed.