scale. Regional disparity in fund distribution might be partially rectified. KJ. KAico, MD Department of physiology Eacuity of medicine University of Ottawa Ottawa, Ont.
Gangrene caused by woollen mitten To the editor: I bring your attention to
an unusual accident that occurred in our community. A 6-week-old girl was brought in for medical attention because her mother had been unable to remove a woollen mitten from the baby's left hand. The mother had put the mittens on the baby 3 days previously because the infant was scratching and the mother was wary of cutting the long fingernails. A thread of wool from the mitten had encircled the index finger, resulting in gangrene (Fig. 1).
therapy with antibiotics in the preoperative preparation of the colon for elective surgical procedures. The literature now contains reports on good prospective, randomized, controlled studies of this practice.14 As these studies indicate, the aminoglycosides neomycin and kanamycin are very effective in reducing the incidence of wound infection and anastomotic breakdown and the total morbidity following colonic operations. These drugs, as used by Nichols and colleagues,1 are given for four doses only on the day prior to operation; this regimen has not resulted in the development of resistant microorganisms or overgrowth by other enteric pathogens, as Perry and Guyatt suggested. The use of erythromycin in bowel preparation is not "unorthodox", as Perry and Guyatt believe: against anaerobes the aminoglycosides are not effective but erythromycin is. Metronidazole also has been shown by Goidring and associates3 to be effective against anaerobes. Certainly the nonabsorbed sulfa drugs succinylsulfathiazole and phthalylsulfathiazole are not effective and therefore not indicated in the preoperative preparation of the colon. Their extensive use, as in one of the hospitals studied by Perry and Guyatt, appears not to be justified. R.M. BAIRD Ste. 42. 1144 Burrard St. Vancouver, BC
References 1. NICHOLs RL, Biomo P. CONDON RE, Ct al: Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg 178: 453, 1973 2. WASHINGTON JA u, DEAlING WH, JUDD ES, et al: Effect of preoperative antibiotic regimen on development of infection after intestinal surgery: prospective, randomized, doubleblind study. Ann Surg 180: 567, 1974 3. GOLDRING J, Scorr A, MCNAUGHT W, et al: Prophylactic oral antimicrobial agents in elective colonic surgery. Lance: 2: 997, 1975
FIG 1-Gangrene of index finger caused by thread of wool from mitten Treatment was conservative
The
gangrenous portion had sloughed by day 10 and the wound had healed by day 18 Radiographic examination confirmed that the distal phalanx was removed completely T VANDOR. MD Wrinch Memorial Doctors Services Hazeiton. BC
Antimicrobial drug use in hospitals To the editor Studies on the overuse of antimicrobial drugs such as that of Perry and Guyatt (Can Med Assoc J 116 253 1977) are welcome for there is probably no group of drugs more poorly used by the practising medical profession But I take exception to the authors comments on the use of oral
To the editor: At the end of the interesting paper by Perry and Guyatt is a third-hand quotation about the abuse of a broad-spectrum antibiotic by a family doctor. It is a pity that such an excellent article should be rendered unscientific by an unverified third-hand quotation. Such a statement could well have been laid on the doorstep of any medical specialist and I have to react to the suggestion of Perry and Guyatt that family doctors are the only ones remiss in this problem. A. BOGGlE, BA, MD, CcFP
Head, department of family medicine Vancouver General Hospital Vancouver, BC
To the editor: Although some clinical trials provide evidence for the effectiveness of preoperative antibiotic therapy in preventing wound infection and other complications following colonic operations, others do not. The usefulness claimed for such chemoprophylaxis is still highly controversial. The latest edition of Goodman and Gilman's textbook1 and The Medical Letter,2 for instance, do not recommend routine oral use of antibiotics before elective surgical procedures on the bowel. I agree with Dr. Baird that careful prospective controlled studies of the possible usefulness of various antimicrobial drugs in preventing the complications of bowel operations are worth conducting. Chemoprophylaxis limited to less than 24 hours prior to surgery, as was the case in the first reference he cites, seems more likely to prove effective than does prophylaxis of longer duration. However, none of the three references he gives supports his contention strongly. The numbers of patients studied prospectively in the first and third studies were small, and the lack of placebo administration in the third study casts some doubt on its blindness.
CMA ANNUAL MEETING (Quebec City, June 19-24) Hurry up and register for the CMA Annual Meeting (more details on pages 931-934) and you can save $25.00 If you plan on bringing your children to Quebec City or wish to participate in the social optional events (excursions to Murray Bay, lie d'Orl.ans, St-Jean-Port-JoIi, just to name a few) we need your cooperation. Please complete your request for tickets and mail it JUST AS SOON AS POSSIBLE to the: ANNUAL MEETING COORDINATOR CMA House, POB 8650 Ottawa KIG 0GB, Ontario Do it todoyl CMA JOURNAL/APRIL 23, 1977/VOL. 116 843
Gangrene caused by woollen mitten To the editor: I bring your attention to
an unusual accident that occurred in our community. A 6-week-old girl was brought in for medical attention because her mother had been unable to remove a woollen mitten from the baby's left hand. The mother had put the mittens on the baby 3 days previously because the infant was scratching and the mother was wary of cutting the long fingernails. A thread of wool from the mitten had encircled the index finger, resulting in gangrene (Fig. 1).
therapy with antibiotics in the preoperative preparation of the colon for elective surgical procedures. The literature now contains reports on good prospective, randomized, controlled studies of this practice.14 As these studies indicate, the aminoglycosides neomycin and kanamycin are very effective in reducing the incidence of wound infection and anastomotic breakdown and the total morbidity following colonic operations. These drugs, as used by Nichols and colleagues,1 are given for four doses only on the day prior to operation; this regimen has not resulted in the development of resistant microorganisms or overgrowth by other enteric pathogens, as Perry and Guyatt suggested. The use of erythromycin in bowel preparation is not "unorthodox", as Perry and Guyatt believe: against anaerobes the aminoglycosides are not effective but erythromycin is. Metronidazole also has been shown by Goidring and associates3 to be effective against anaerobes. Certainly the nonabsorbed sulfa drugs succinylsulfathiazole and phthalylsulfathiazole are not effective and therefore not indicated in the preoperative preparation of the colon. Their extensive use, as in one of the hospitals studied by Perry and Guyatt, appears not to be justified. R.M. BAIRD Ste. 42. 1144 Burrard St. Vancouver, BC
References 1. NICHOLs RL, Biomo P. CONDON RE, Ct al: Effect of preoperative neomycin-erythromycin intestinal preparation on the incidence of infectious complications following colon surgery. Ann Surg 178: 453, 1973 2. WASHINGTON JA u, DEAlING WH, JUDD ES, et al: Effect of preoperative antibiotic regimen on development of infection after intestinal surgery: prospective, randomized, doubleblind study. Ann Surg 180: 567, 1974 3. GOLDRING J, Scorr A, MCNAUGHT W, et al: Prophylactic oral antimicrobial agents in elective colonic surgery. Lance: 2: 997, 1975
FIG 1-Gangrene of index finger caused by thread of wool from mitten Treatment was conservative
The
gangrenous portion had sloughed by day 10 and the wound had healed by day 18 Radiographic examination confirmed that the distal phalanx was removed completely T VANDOR. MD Wrinch Memorial Doctors Services Hazeiton. BC
Antimicrobial drug use in hospitals To the editor Studies on the overuse of antimicrobial drugs such as that of Perry and Guyatt (Can Med Assoc J 116 253 1977) are welcome for there is probably no group of drugs more poorly used by the practising medical profession But I take exception to the authors comments on the use of oral
To the editor: At the end of the interesting paper by Perry and Guyatt is a third-hand quotation about the abuse of a broad-spectrum antibiotic by a family doctor. It is a pity that such an excellent article should be rendered unscientific by an unverified third-hand quotation. Such a statement could well have been laid on the doorstep of any medical specialist and I have to react to the suggestion of Perry and Guyatt that family doctors are the only ones remiss in this problem. A. BOGGlE, BA, MD, CcFP
Head, department of family medicine Vancouver General Hospital Vancouver, BC
To the editor: Although some clinical trials provide evidence for the effectiveness of preoperative antibiotic therapy in preventing wound infection and other complications following colonic operations, others do not. The usefulness claimed for such chemoprophylaxis is still highly controversial. The latest edition of Goodman and Gilman's textbook1 and The Medical Letter,2 for instance, do not recommend routine oral use of antibiotics before elective surgical procedures on the bowel. I agree with Dr. Baird that careful prospective controlled studies of the possible usefulness of various antimicrobial drugs in preventing the complications of bowel operations are worth conducting. Chemoprophylaxis limited to less than 24 hours prior to surgery, as was the case in the first reference he cites, seems more likely to prove effective than does prophylaxis of longer duration. However, none of the three references he gives supports his contention strongly. The numbers of patients studied prospectively in the first and third studies were small, and the lack of placebo administration in the third study casts some doubt on its blindness.
CMA ANNUAL MEETING (Quebec City, June 19-24) Hurry up and register for the CMA Annual Meeting (more details on pages 931-934) and you can save $25.00 If you plan on bringing your children to Quebec City or wish to participate in the social optional events (excursions to Murray Bay, lie d'Orl.ans, St-Jean-Port-JoIi, just to name a few) we need your cooperation. Please complete your request for tickets and mail it JUST AS SOON AS POSSIBLE to the: ANNUAL MEETING COORDINATOR CMA House, POB 8650 Ottawa KIG 0GB, Ontario Do it todoyl CMA JOURNAL/APRIL 23, 1977/VOL. 116 843
