A prospective, randomized, blinded study was performed to determine whether prophylactic antibiotics would reduce the incidence of infection in peripheral vascular surgery and whether the route of antibiotic administration was important. Patients undergoing a vascular procedure with a groin incision were allocated to one of four groups with respect to prophylactic antibiotics. Group I received no antibiotic. Group II had topical cephradine instilled in their incisions prior to closure. Group III received a 24-hour perioperative course of intravenous cephradine, and Group IV received both topical and intravenous cephradine. Groin and abdominal incisional infections were significantly reduced (p < 0.01) among patients who received prophylactic antibiotics by either the topical, systemic, or combined routes of administration. No significant differences were noted among the three antibiotic groups. Profundoplasty, femoral embolectomy, and femoral aneurysm repair were each associated with an increased incidence of infection (p < 0.01). Other risk factors were only important in patients not receiving antibiotics. Either intraoperative topical antibiotics or perioperative systemic antibiotics prevent infection in peripheral vascular surgery, but antibiotic administration by both routes is unnecessary.

The records of 59 immunocompromised patients with fever and pulmonary infiltrates who underwent open lung biopsy, were reviewed. A specific diagnosis was made by lung biopsy in 49 (83%) patients, and in 32 instances (54%) the diagnosis was a treatable infection. Only two (3.4%) false‐negative biopsies occurred. Transplant recipients were more likely to have a specific, treatable pneumonia (74%) than patients with a reticuloendothelial malignancy (42%, P < 0.05). This was due to a greater frequency of bacterial pneumonias, primarily due to Legionella, in transplant recipients (P < 0.01). However, obtaining a specific diagnosis by lung biopsy did not appear to improve outcome. Seventeen of 32 (53%) patients with treatable infections survived, compared to 8 of 16 (50%) with specific, but untreatable, diagnosis and 6 of 11 (55%) with nondiagnostic biopsies. Advanced age and a low platelet count were predictive of death in both transplant recipients and patients with leukemia and lymphoma (P < 0.05); a high serum creatinine was an additional predictor in renal transplant recipients.

INTRODUCTION:The indications for CT scan to evaluate complications of minimally invasive surgery have not been well established. The objective of this study was to identify patient characteristics and clinical findings that correlated with postoperative complications diagnosed on CT scan. METHODS:A retrospective cohort study was conducted with patients who underwent laparoscopic or robotic hysterectomy, from 2011 to 2013, and had a CT scan to evaluate postoperative complications. Patient characteristics and clinical findings were analyzed for association with 1) a CT being ordered 2) abnormal CT findings. RESULTS: 784 patients underwent minimally invasive hysterectomy. 74 (9.4%) had a CT scan. Patients who underwent CT scan were demographically similar to those who did not except for a lower BMI (P5.025) and a trend toward younger age (P5.543). Chronic pain and history of prior abdominal surgery were associated with the CT scan group. There were no significant differences between patients with abnormal versus normal CT scan. In the CT scan group, subgroup analysis of CT findings (primary abnormal, incidental abnormal, normal) demonstrated a significant difference in WBC count (P5.017).CONCLUSION: Patients with smaller BMI, chronic pain, and history of abdominal surgery were more likely to undergo CT scan for workup of postoperative complication, but not more likely to have abnormalities on CT scan. There were no associations between patient characteristics or indications for CT and abnormal CTs. A larger study with more CT scans and abnormal findings may show associations not found in this study. INTRODUCTION:To determine whether preoperative uterine artery embolization (UAE) decreases blood loss during abdominal hysterectomy for fibroid uterus. METHODS: Patients who underwent same day UAE and abdominal hysterectomy at a single institution were identified based on ICD-9 codes. Data collected included blood loss, operating room time, hospital length of stay, and complication rates. This data was then compared with historical data from a study on patients with fibroid uteri .1000 g who just underwent hysterectomy.RESULTS: During 2006-2014, a total of 59 women underwent preoperative UAE prior to hysterectomy for fibroid uterus. Historical data included 47 women as controls. The average uterine size was comparable between cases and controls (153761285 g vs. 16586793.5 g). The estimated blood loss was significantly reduced in the preoperative UAE group when compared to controls, 360.66288.2 mL versus 555.86386.5 mL (P5.004) respectively. Furthermore, women who had preoperative UAE had lower complication rates (21.7%) when compared to controls (61.7%), P,.001. Cases had higher length of stay 3.761.1 days and OR time 217.8656.9 min when compared to controls 2.960.8 days and 124630.6 min (P,.001).CONCLUSION: Preoperative uterine artery embolization decreases blood loss and complication rates for women undergoing abdominal hysterectomy for fibroid uterus.