Duration Of Postoperative Fever Research Articles

Anterior cruciate ligament reconstruction with BPTB autograft, irradiated versus non-irradiated allograft: a prospective randomized clinical study

The effect of using gamma irradiation to sterilize bone-patellar tendon-bone (BPTB) allograft on the clinical outcomes of anterior cruciate ligament (ACL) reconstruction with irradiated allograft remains controversial. Our study was aimed to analyze the clinical outcomes of arthroscopic ACL reconstruction with irradiated BPTB allograft compared with non-irradiated allograft and autograft. All BPTB allografts were obtained from a single tissue bank and the irradiated allografts were sterilized with 2.5 Mrad of irradiation prior to distribution. A total of 102 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into three groups. The same surgical technique was used in all operations done by the same senior surgeon. Before surgery and at the average of 31 months follow-up (range 24-47 months) patients were evaluated by the same observer according to objective and subjective clinical evaluations. Of these patients, 99 (autograft 33, non-irradiated allograft 34, irradiated allograft 32) were available for full evaluation. When compared the irradiated allograft group to non-irradiated allograft group or autograft group at 31 months follow-up by the Lachman test, ADT, pivot shift test and KT-2000 arthrometer testing, statistically significant differences were found. Most importantly, 87.8% of patients in the Auto group, 85.3% in the Non-Ir-Auto group and just only 31.3% in the Ir-Allo group had a side-to-side difference of less than 3 mm according to KT-2000. The failure rate of the ACL reconstruction with irradiated allograft (34.4%) was higher than that with autograft (6.1%) and non-irradiated allograft (8.8%). The anterior and rotational stability decreased significantly in the irradiated allograft group. According to the overall IKDC, functional, subjective evaluations and activity level testing, no statistically significant differences were found between the three groups. However, there was a trend that the functional and activity level decreased and the patients felt uncomfortable more often in the irradiated allograft group. The statistical analysis showed no significant difference between the non-irradiated allograft group and the autograft group according to the aforementioned evaluations, except that patients in the allograft group had a shorter operation time and a longer duration of postoperative fever. When comparing the postoperative duration of fever of the two allograft groups, there was also a trend that the irradiated allograft group was longer than the non-irradiated allograft group, but no significant difference was found. When the patients had a fever, the laboratory examinations of all patients were almost normal (Blood routine was normal, the values of ESR were 5 - 16 mm/h, CRP were 3 - 10 mg/l). On the basis of our study, we concluded that patients undergoing ACL reconstruction with BPTB non-irradiated allograft or autograft had similar clinical outcomes. Non-irradiated BPTB allograft is a reasonable alternative to autograft for ACL reconstruction. While the short term clinical outcomes of the ACL reconstruction with irradiated BPTB allograft were adversely affected with an increased failure rate. The less than satisfactory results led the senior authors to discontinue the use of irradiated BPTB allograft in ACL surgery and not to advocate that gamma irradiation be used as a secondary sterilizing method. Further research into alternatives to gamma irradiation is needed.

Does VATS provide optimal treatment of empyema in children? a systematic review

Purpose The surgical literature is replete with studies describing methods of treatment for pediatric empyema. The purpose of this report was to perform an evidence-based review of the literature to determine the most effective and appropriate treatment for empyema in infants and children. Methods The MEDLINE database was searched for English- and Spanish-language articles published from 1987 through 2002 on the treatment of thoracic empyema in children. Additional unpublished data were obtained by contacting individual study authors. There were no multiinstitutional prospective studies; all were retrospective, institutional series. A true meta-analysis could not be performed because of inherent institutional bias and variability in outcome measures among studies. A Kruskal-Wallis nonparametric test was used to compare methods detailed in the individual studies. Results Forty-four retrospective studies with a total of 1,369 patients were available for analysis. Four treatment strategies were compared: chest tube drainage alone (16 studies, 611 patients), chest tube drainage with fibrinolytic instillation (10 studies, 83 patients), thoracotomy (13 studies, 226 patients), and video-assisted thoracoscopic decortication (VATS; 22 studies, 449 patients). Outcome measures common to the majority of studies included length of stay, fever duration, l of antibiotic therapy duration, and duration of chest tube drainage. Patients undergoing early VATS or thoracotomy had shorter length of stay ( P = .003). There was a trend for shorter duration of postoperative fever compared with chest tube alone or with fibrinolytic therapy, but this did not reach statistical significance ( P = .055). There was no statistical difference in chest tube duration between methods. There was no trend correlating antibiotic use with treatment methods, length of hospital stay, duration of fever, or length of chest tube requirement. Conclusions Early VATS or thoracotomy leads to shorter hospitalization. The duration of chest tube placement and antibiotic use is variable and does not correlate with treatment method. A carefully designed, multiinstitutional, randomized study would lead to the development of evidence-based standards that may optimize the treatment of thoracic empyema in children.

Ｆｕｒｌｏｗ法による口蓋形成術 第１報 術中，術後経過について

Cleft palate repair using Furlow double opposing Z-plasty was performed in 31 patients between 1990 and 1994. To determine the advantages and disadvantages of this technique, Furlow palatoplasty was compared with the pushback procedure. Twenty-seven patients undergoing palatal closure with the pushback technique, performed by the same surgeon during the same period, served as controls. Nineteen of the 31 patients in the Furlow group had cleft palate, nine had submucosal cleft palate, and three had cleft lip and palate. Mean age at Furlow palatoplasty was 2.4 years. In the pushback group, 17 of the 27 patients had cleft palate, three had submucosal cleft palate, and seven had cleft lip and palate. Mean age at pushback palatoplasty was 2.1 years. Operating time and blood loss in the Furlow group were 83.9±14.9 minutes and 28.3±28.8ml, respectively, while the corresponding values in the pushback group were 66.3±17.2 minutes and 39.9±38.5ml. Although operating time in the Furlow group was longer than in the pushback group, blood loss was significantly less. Intraoperative results were favorable, with acceptable operating time and blood loss. No postoperative complications occurred in the Furlow group, and adequate oral intake was achieved immediately after palatoplasty. The maximum body temperature and duration of postoperative fever in the Furlow group were 37.8±0.4°C and 37.0±21.0 hours, respectively, while the corresponding values in the pushback group were 38.3±0.5°C and 76.1±29.7 hours. The rise in body temperature in the Furlow group was significantly lower, and the postoperative course was satisfactory. Oronasal fistulas did not develop.

Should the temperature chart influence management in cardiac operations?: Result of a prospective study in 314 patients

The body temperature is measured routinely and carefully charted in our own and presumably all units. Pyrexia is normal after bypass and is discounted on the basis of clinical experience in the first few days. If this pyrexia persists, a search for infection may be instigated and discharge from the hospital may be delayed. A clinical trial of antibiotic prophylaxis provided the opportunity to collect and collate 6-hourly temperature observations for 314 patients for 1 week after operation. The length of bypass and the presence of lower respiratory tract infection were positively correlated with the duration of postoperative fever. However, neither surgical sepsis nor urinary tract infection had any consistent effect on the duration or magnitude of postoperative fever in the first week.

Surgical management of perforated diverticulitis

The surgical management of perforated diverticulitis remains a subject of controversy, with some workers advocating initial drainage with decompressive colostomy and others favoring primary resection of the perforated colon. To evaluate this problem, we reviewed our experience from January 1, 1960 through December 31, 1978. This retrospective study included 25 patients treated by primary resection and 32 patients treated by staged resection. The duration of postoperative fever and ileus and the incidence and type of postoperative complications were similar in the two groups. Hospital stay and the period of disability were significantly shortened when primary resection with primary anastomosis was carried out initially. Overall, the total cumulative hospital stay was longer (p < 0.05) for staged resection (48 days) than for primary resection (39 days). The period of disability was also longer (p < 0.001) for staged (134 days) than for primary resection (75 days). Finally, all patients in the primary resection group left the hospital cured, that is, restored to their premorbid condition, while in the staged resection group only 75 percent were cured; 16 percent were finally discharged with colostomies and 9 percent died. These data suggest that whenever technically feasible, primary resection is the treatment of choice for perforated colonic diverticulitis.