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Antibiotic prophylaxis of clean surgical procedures (e.g., elective operations on skin and soft tissue) is controversial based on a single randomized trial that showed benefit in breast and groin hernia surgery. The controversy persists because the incidence of superficial surgical site infection was so high (4%, versus an expected incidence of about 1%) in the placebo group. Evidence that antibiotic prophylaxis is indicated for soft tissue procedures of other types is lacking entirely, and prophylaxis cannot be recommended. If administered, antibiotic prophylaxis should be given before the skin incision is made, and only as a single dose. Additional doses are not beneficial because surgical hemostasis renders wound edges ischemic by definition until neovascularization occurs, and antibiotics cannot reach the edges of the incision for at least the first 24 hours. Not only is there lack of benefit, prolonged antibiotic prophylaxis actually increases the risk of postoperative infection. Increasingly in the practice of plastic surgery, there is a tendency to leave closed-suction drains in place for prolonged periods in the erroneous belief that the incidence of wound complications is reduced by prolonged drainage. Nothing could be further from the truth. Data indicate that the presence of a drain for more than 24 hours increases the risk of postoperative surgical site infection with MRSA. Closed suction drains must be removed as soon as possible, ideally within 24 hours. Prolonged antibiotic prophylaxis is often administered to “cover” a drain left in place for a prolonged period. This is a prime example of error compounding error, and is a practice that must be abandoned.
Explore new options and offers, including a brand new Candela laser and other non-surgical procedures.
Fibromyalgia is a common health problem that causes widespread pain and tenderness (sensitive to touch). The pain and tenderness tend to come and go, and move about the body. Most often, people with this chronic (long-term) illness are fatigued (very tired) and have sleep problems. It can be hard to diagnose fibromyalgia.
Fibromyalgia affects two to four percent of people, mostly women. Doctors diagnose fibromyalgia based on all the patient’s relevant symptoms (what you feel), no longer just on the number of tender points.
There is no test to detect this disease, but you may need lab tests or X-rays to rule out other health problems. Though there is no cure, medications can relieve symptoms. Patients also may feel better with proper self-care, such as exercise and getting enough sleep.
Fibromyalgia is a chronic health problem that causes pain all over the body and other symptoms. Other symptoms that patients most often have are:
- Tenderness to touch or pressure affecting joints and muscles
- Sleep problems (waking up unrefreshed)
- Problems with memory or thinking clearly
Some patients also may have:
- Depression or anxiety
- Migraine or tension headaches
- Digestive problems: irritable bowel syndrome (commonly called IBS) or gastroesophageal reflux disease (often referred to as GERD)
- Irritable or overactive bladder
- Pelvic pain
- Temporomandibular disorder—often called TMJ (a set of symptoms including face or jaw pain, jaw clicking and ringing in the ears).
What causes fibromyalgia?
There is most often some triggering factor that sets off fibromyalgia. It may be spine problems, arthritis, injury, or other type of physical stress. Emotional stress also may trigger this illness. The result is a change in the way the body “talks” with the spinal cord and brain. Levels of brain chemicals and proteins may change. For the person with fibromyalgia, it is as though the “volume control” is turned up too high in the brain’s pain processing centers.
Criteria Needed for a Fibromyalgia Diagnosis
- Pain and symptoms over the past week, based on the total of:
- Number of painful areas out of 19 parts of the body
- Plus level of severity of these symptoms:
- a. Fatigue
- b. Waking unrefreshed
- c. Cognitive (memory or thought) problems
Plus number of other general physical symptoms
- Symptoms lasting at least three months at a similar level
- No other health problem that would explain the pain and other symptoms
(Source: American College of Rheumatology)