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One hundred and fifty severely injured patients requiring long-term artificial ventilation were evaluated in a prospective, randomized, double blind study comparing the prophylactic effect of an intravenous immunoglobulin (Sandoglobulin; IGIV) against nosocomial infections with a placebo preparation. The groups were comparable in age, sex, injury pattern, and severity of the trauma. Seventy-six patients received 12 g of Sandoglobulin as a 3% solution on day 0, day 5 and day 12, i.e. a total of 36 g. Sandoglobulin significantly reduced the incidence of pneumonia (28 cases in the IGIV group, 43 cases in the placebo group, p = 0.0111). This resulted in a reduced therapeutic use of antibiotics. For the occurrence of sepsis (IGIV: 14 cases; placebo 19 cases) and other infections (IGIV: 11 cases; placebo: 10 cases) no significant differences were found. No side effects of the administration of IGIV were observed. IGIV prophylaxis neither reduced the overall death rate nor those deaths caused by infection. On day 5 after administration of the first 12 g of IGIV, the IgG serum concentrations were significantly higher in the Sandoglobulin group (8.41 +/- 1.96 mg/ml and 7.42 +/- 2.25 mg/ml respectively, p less than 0.001) whereas later serum samples showed no significant differences.

No abstract

This review is drawn from a total of 3,714 knee arthroscopies carried out on patients from six clinics. The diagnostic value of arthroscopy at this site is established for it can improve prognostication, prevention and treatment of derangements of the knee. The complications of the procedure, both theoretical and in practice, have been considered by subdividing them into four groups. Firstly, the infection rate following arthroscopy alone was nil. Secondly, minor articular cartilage damage attributable to the instrument occurred in just over 2% of cases. This complication is more common when the technique is first being learned and is usually avoidable when experience has been gained. Thirdly, complications of a general nature included four cases of subcutaneous emphysema produced by the insufflation of gas, and 22 instances of an allergic skin reaction to the disinfectant preparation. Finally, failures in the technique itself resulted from the instrument bending or breaking when negotiating the condyles. This occurred on 26 occasions. In a further seven instances the fat pad was entered and distended in error, thus preventing examination of the joint. Overall, the complication rate was acceptable low and confirmed that arthroscopy can be safely applied clinically.

No abstract