A guy walks into a post office one day to see a middle-aged, balding man standing at the counter methodically placing "Love" stamps on pink envelopes with hearts all over them. He then takes out a perfume bottle and starts spraying scent all over them. His curiosity getting the better of him, he goes up to the balding man and asks him what he is doing. The man says, "I'm sending out one thousand Valentine cards signed, "Guess who?" "But why?" asks the man. "I'm a divorce lawyer", the man replies.

One Condition

Phil, a smart and handsome young man, dressed in the latest fashion, walked into this local pub. He noticed a woman gazing at him without blinking her big eyes. Phil felt flattered so he walked up to the woman and said in his deepest voice, "I'll do anything you wish, beautiful lady, for just $10 but on one condition." The woman appeared to be trapped in the moment and asked as if in a trance, "What's your condition?" Phil answered, "Tell me your wish in three words." There was a long pause, the woman opened her purse, counted out the money and handed it to the man along with her address. She then looked deeply into his eyes and whispered, "Clean my house".

I Just Had a Dream About It

A young woman was taking an afternoon nap. After she woke up, she told her husband, "I just dreamed that you gave me a pearl necklace for Valentine's Day. What do you think it means?" "You'll know tonight", he said. That evening the man came home with a small package and gave it to his wife. Delighted, she opened it-only to find a book entitled " The Meaning of Dreams".

Each year in the United States over 30million operative procedures are performed and surgical-site infection occurs in 300-500,000 cases each year. Two recent well controlled randomized studies in the New England Journal of Medicine offer some valuable insights into controlling these infections.

The first by Darouiche randomly assigned adults undergoing clean-contaminated surgery to skin preparation with either chlorhexidine-alcohol scrub or povidone-iodine scrub and paint. The overall rate of surgical site infection was significantly lower in the chlorhexidine-alcohol group than in the povidone-iodine group (9.5 vs 16.1) a greater than 40% reduction. The rate of staph aureus surgical site infections was reduced by approximately 50% in the chlorhexadine-alcohol group. This scrub has previously been recommended by the CDC as the antiseptic of choice to reduce vascular catheter associated blood stream infections.The evidence suggests that chlorhexidine-alcohol scrub should replace povidone- iodine as a standard pre-operative surgical scrub.

The second study looked at preventing surgical infections in nasal carriers of staph aureus. They screened a total of 6771 patients with nasal swabs for staph aureus. This was done with rapid identification of the staph through a PCR assay. All of the strains in this study were susceptible to methicillin and mupirocin. Patients were randomly assigned to either active treatment with mupirocin ointment 2% in combination with chlorhexidine soap for at least four days. A sub-group of surgical site infection caused by staph aureus was reduced by 60% among those in the active treatment group vs those treated with placebo nasal ointment and placebo soap.

An accompanying editorial suggests that real time PCR assays pre-operatively be reserved primarily for patients who are undergoing cardiac surgery, receiving an implant or any immuno-compromised surgical candidate. (N Engl J Med January 7, 2010:362;1)

John J. Mohr, M.D.