Primary Wound Infection Research Articles

A ten year experience with cadaver kidney preservation using cryoprecipitated plasma

Between August 1967 and January 1977, 699 cadaver kidneys were preserved and transplanted in our hospital after continuous perfusion with cryoprecipitated plasma. Overall graft survival of primary transplants was 55 ± 2 per cent at one year and 41 ± 2 per cent at four years. The results with ninety-six second transplants were similar. The number of HLA antigens shared and the duration of preservation did not influence graft survival. Patient survival among 426 cadaver graft recipients since September 1972, when lower dose immunosuppression was started, was 91 ± 1 per cent at one year and 84 ± 2 per cent at four years, significantly better than survival before then. Survival of fifty-two recipients of cadaver retransplants since September 1972 was 86 ± 5 per cent at one year and 86 ± 5 per cent at four years, which was better than before. The incidence of posttransplantation dialysis was 30 per cent and did not correlate with the length of preservation. Primary wound infections, primary ureteral extravasation, and vascular complications each occurred with an incidence of 1.1 per cent or less in patients treated with lower dose immunosuppression. Only four kidneys were lost because of complications, and in no instance was the need for transplant nephrectomy directly related to the method of preservation. Perfusion preservation with cryoprecipitated plasma gives excellent results compared with alternative methods.

THE BRIDGING OF BONE DEFECTS

Bone-grafting operations, for defects and non-union of the bones of the extremities, were performed on 105 patients at Deer Lodge Hospital between April 15, 1944, and April 15, 1946. Union has occurred in ninety-three cases. Penicillin was used routinely after every operation, and no graft was lost or failed to unite because of primary wound infection. In eighty-four cases, or 80 per cent., the first graft was successful. The cortical onlay graft was use twenty-nine times for twenty-seven patients, and resulted in union in twenty-three, or 79 per cent, of the cases. The cortical inlay graft was used twenty-seven times for twenty-five patients, and was successful in twenty-two, or 81 per cent. Cancellous bone alone was used to fill gaps, or to promote union in ununited fractures, twenty-three times for twenty-three cases; union occurred in twenty, or 87 per cent. Combined with a metal plate, it was used thirteen times on thirteen patients, with union in nine, or 69 per cent. It was used nine times in incomplete defects of the shaft of the long bones, and fused with the shaft in seven, or 78 per cent. Cancellous bone alone was used to fill infected bone cavities, with discharging sinuses, in twelve cases. Wound healing occurred in nine cases.

LOCAL SULFONAMIDE THERAPY IN ACUTE MASTOIDITIS

The local use of sulfanilamide and its related compounds is increasing rapidly, as indicated by numerous reports in the recent literature. Jensen, Johnsrud and Nelson¹implanted sulfanilamide crystals in 39 cases of compound fracture and 2 compound dislocations after careful débridement and hemostasis, followed by primary closure of the skin, with no primary wound infection. In 94 similarly treated cases, but without sulfanilamide, 27 per cent showed infection. Key and Burford²had a similar experience with compound fractures. They noted also that experimentally produced fractures in rabbits treated locally with sulfanilamide showed as rapid wound and bone healing as those in which the drug was not used. Campbell and Smith³treated 54 compound fractures, using sulfanilamide both locally and by mouth. Mueller⁴used it in the peritoneal cavity in 55 cases of abscess and peritonitis following ruptured appendixes, with no mortality. Many other reports have appeared