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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Bien qu'un seul antibiotique avec un large spectre couvrant les germes aérobies et anaérobies soit reconnu comme efficace dans l'appendicite, beaucoup de chirurgiens continuent d'utiliser une polyantibiothérapie. Dans un essai contrôlé en double aveugle, nous avons testé la corrélation clinique avec la sensibilité in vitro d'une association de plusieurs antibiotiques comme traitement complémentaire chez 114 patients ayant eu une appendicite compliquée. Quatre-vingt pour-cent (36/40) des patients ayant eu du céfotétan et 86% (31/36) des patients ayant eu l'association clindamycine/amikacíne n'ont pas eu de complications infectieuses postopératoires (p=0.11). II a été nécessaire de changer les antibiotiques en raison d'une complication postopératoire plus souvent chez les patients ayant eu l'association clindamycine/amikacine, 5 (12%) comparé à 1 (2%) dans le groupe céfotétan (p=0.07). On a identifié des organismes Bacteroides fragilis résistants au céfotétane mais aucun n'était responsable d'infection postopératoire. II y a eu des effets secondaires non désirables, essentiellement une perturbation des tests de la fonction hépatique, chez 28% et chez 26% des patients ayant pris respectivement du céfotétane et l'assocíation clindamycine/amikacine, respectivement. Une monothérapie avec une céphalosporine de deuxième génération du type céfotétan, donnée deux fois par jour, est ffficace et économique dans le traitement de l'appendicite compliquée mais opéréc. Les aminosides et les autres antibiotiques plus puissants doivent être réservés pour les germes résistants ou les infections nosocomiales.
    Abstract: Resumen Aunque los antibióticos únicos de amplio espectro de cobertura aeróbica y anaeróbica son eficaces en la apendicitis, muchos cirujanos continúan utilizando agentes múltiples. Se diseñó un ensayo clínico prospectivo, doble ciego y aleatorizado con el fin de correlacionar la susceptibilidad in vitro de agentes antimicrobianos múltiples como terapia adyuvante en el manejo de 114 pacientes sometidos a operación por apendicitis complicada. 90% (36/40) de los pacientes en el Grupo de cefotetan y 86% (31/36) en el Grupo que recibió clindamicina/amikacina tuvieron resolución clínica de sus infecciones intraabdominales sin recurrencia de complicaciones sépticas postoperatorias (P=0.11). El número de pacientes que tuvieron cambio en la terapia antibiótica por complicaciones postoperatorias fue más alto en el Grupo clindamicina/amikacina, 5 (12%) comparados con 1 (2%) en el Grupo cefotetan (P=0.07). Aunque se identifícaron microorganismos del Grupo de los Bacteroides fragilis resistentes a cefotetan, ninguno fue responsable de infecciones postoperatorias. Se presentaron reacciones farmacológicas adversas en 28% del Grupo cefotetan y en 26% del Grupo clindamicina/amikacina, las cuales consistieron primordialmente en elevaciones pasajeras de los valores de las pruebas de función hepática. La monoterapia con una cefalosporina de amplio espectro de segunda generación, tal como el cefotetan, administrado en dos dosis diarias constituye un régimen económico y eficaz en la apendicitis complicada en la cual la cirugía representa el tratamiento definitivo. Los aminoglucósidos y otros agentes antimicrobianos más potentes deben ser reservados para el tratamiento de infecciones nosocomiales por microorganismos resistentes.
    Notes: Abstract Although single antimicrobials with broad-spectrum aerobic and anaerobic coverage are effective in patients with appendicitis, many general surgeons continue to use multiple agents. A prospective, doubleblind, randomized trial was designed to detect any clinical correlate of in vitro susceptibility advantage of multiple antimicrobials as adjunctive therapy for 114 patients undergoing operation for complicated appendicitis. There was clinical resolution of intraabdominal infections with no occurrence of postoperative infectious complications in 90% (36 of 40) of the cefotetan group and 86% (31 of 36) of the clindamycin/amikacin group (p=0.11). The number of patients who had changes in antibiotic therapy due to postoperative complications was higher in the clindamycin/amikacin group: five (12.5%), compared to one (2.8%) in the cefotetan group (p=0.07). Although Bacteroides fragilis group organisms resistant to cefotetan were identified, none was responsible for the postoperative infections. Adverse drug events in 28% of the cefotetan group and 26% of the clindamycin/amikacin group consisted primarily of transient elevations of liver function tests. Monotherapy with a second-generation, broad-spectrum cephalosporin, such as cefotetan, given twice a day is an economical and effective adjunctive regimen in patients with complicated appendicitis for which operation is the definitive treatment. Aminoglycosides and other, more potent antimicrobials should be reserved for resistant organisms or nosocomial infections.
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  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'article rapporte 3 cas de nécrose duodénale insoupÇonnée avec perforation, survenant de 2 à 4 semaines après traitement initialement efficace de pancréatite aigue hémorragique. L'exploration chirurgicale fut rendue nécessaire par l'apparition de fièvre, masse abdominale et signes radiologiques d'abcès d'intra-abdominaux. Le traitement chirurgical consista en drainage des abcès pancréatiques et rétroduodénaux, et fermeture de la fistule duodénale. Le'duodénum fut décomprimé à l'aide d'un tube endoluminal introduit par gastrostomie. En période post-opératoire les patients furent traités par hyperalimentation parentérale totale, antibiothérapie spécifique et radiographie répétées pour localiser la formation de nouveaux abcès intra-abdominaux. Tous les patients durent Être réopérés de une à quatre reprises à cause de nécrose pancréatique persistante et abcédation. La pancréatite nécrosante avec infection rétropéritonéale persistante et fistulisation s'accompagne d'une morbidité grave, d'une période d'hospitalisation de plusieurs mois et est actuellement la principale cause de décès chez les patients porteurs de pancréatite. La survie de ces 3 patients est attribuable au drainage précoce des abcès péritonéaux, et aux progrès réalisés dans le traitement des fistules duodénales.
    Notes: Abstract Acute necrotizing pancreatitis associated with occult duodenal necrosis and perforation developed in 3 patients 2 to 4 weeks after initially successful treatment of hemorrhagic pancreatitis. Exploration was required for fever, abdominal mass, or X-ray findings of an intra-abdominal abscess. At operation all pancreatic and retroperitoneal abscesses were drained with sump tubes, and the duodenal fistula was closed. An intraluminal tube, placed via a gastrostomy, was used for decompression of the duodenum. Postoperative management included total parenteral nutrition, antibiotics specific for aerobic and anaerobic flora, and frequent X-rays to locate new intra-abdominal abscesses. One to 4 reoperations were necessary because of continuing pancreatic necrosis and abscess formation in each patient. Necrotizing pancreatitis with unrelenting retroperitoneal sepsis and fistula formation results in serious morbidity, hospital stays of several months, and is now the major cause of death in patients with pancreatitis. Survival of all 3 patients resulted from drainage of evolving retroperitoneal abscesses and improvement in our technique for management of large duodenal fistulas.
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  • 3
    ISSN: 1432-0509
    Keywords: Appendix-mucocele ; Colon-intussusception
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Intussusception by an appendiceal mucocele into the colon is illustrated and the literature reviewed.
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  • 4
    ISSN: 1432-0509
    Keywords: Abdominal ultrasound ; Intussusception ; Infiltrating carcinoma of pyloric antrum ; Bowel loops
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gray scale ultrasound examination of two patients with abdominal space-occupying lesions demonstrated characteristic ring shadows on longitudinal scans. In one case a multiple concentric ring shadow resulted from an ileocolic intussusception, and in the other a “bull's eye” image was due to an infiltrating carcinoma of the pyloric antrum. A study of these patients confirms the suspicion [1] that there is a characteristic ultrasonic appearance of intussusception in bowel loops.
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  • 5
    ISSN: 1619-7089
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Sprague-Dawley rats were treated with varying quantities of parathyroid hormone for 1–3 days, then sacrificed at periods ranging from 1–6h after administration of 99mTc-pyrophosphate. Very little increase in bone accumulation of tracer occurred with this treatment. A small, but obvious decrease occurred in the blood levels of 99mTc-pyrophosphate and a smaller and less consistent decrease was affected in the muscle levels of the radiopharmaceutical. The overall result was an improvement in the bone/blood and bone/muscle ratios. It is suggested that the basis of the “supernormal” bone scan of hyperparathyroidism is achieved by this mechanism and that the increased bone uptake of other ions in response to parathyroid hormone is not shared by 99mTc-pyrophosphate.
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  • 6
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 7
    ISSN: 1615-5947
    Keywords: Percutaneous balloon angioplasty ; combined iliac angioplasty and distal bypass ; Veterans Administration Cooperative Study No. 199
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Multiple sites of atherosclerotic occlusion in high risk patients may be treated by angioplasty of the iliac obstruction and distal reconstruction. We report 18 male patients with symptomatic peripheral vascular disease in whom proximal iliac percutaneous transluminal angioplasty was combined with femoropopliteal bypass (11), femorotibial bypass (2), or femorofemoral bypass (5). There were no operative deaths. The pretreatment ankle brachial index of 0.40 ± 0.04 was increased to 0.64 ± 0.04 by discharge (p=0.0001), and remained significantly increased through 27 months (0.65 ± 0.07) (p=0.0001). During the follow-up period of 2–57 (mean 27 months) one dilated iliac artery required repeated percutaneous transluminal angioplasty and revision of the femoropopliteal bypass at three months. Two late amputations of study limbs occurred at two years and three years due to progression of distal disease in the infrapopliteal segment. Four patients died during the follow-up period of ischemic heart disease (3) and lung carcinoma (1). Life table analysis shows a 76% success rate for the combined procedures at two years. In selected, high risk patients, proximal iliac dilatation and distal bypass is an acceptable alternative reconstruction for multilevel occlusion.
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  • 8
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 9
    ISSN: 1615-5947
    Keywords: Chylous ascites ; ascites ; abdominal aortic operations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Three patients, two women, one man (mean age 74 years), who had abdominal aortic aneurysms (2) or aortobifemoral surgery (1), developed chylous ascites postoperatively. They were studied to determine their clinical course and develop a plan for management of this complication. In each patient, the ascites was not manifest until abdominal swelling developed two weeks after operation, and the problem was confirmed by the finding of milky fluid on paracentesis. A low serum albumin (mean 2.6 gm) was also characteristic. The ascites was not altered by parenteral nutrition or reduction of dietary fat and ingestion of medium chain triglycerides. In one patient (man, age 93) the ascites resolved spontaneously two months after abdominal aortic aneurysm surgery. Another (woman, age 70) was cured following operative ligation of a lymphatic fistula identified at operation five weeks after abdominal aortic aneurysm repair. In the third (woman, age 60), the ascites resolved immediately following placement of a peritoneal venous shunt six weeks after an aortobifemoral bypass. Chylous ascites is rare after aortic surgery and manifests itself about two weeks after operation, at times after discharge from hospital. It has an indolent course, but may resolve spontaneously up to two months after operation. Its course appears not to be foreshortened by diet, including omission of fat, but can be successfully treated surgically with a shunt or fistula ligation. If done early a protracted hospital course may be avoided.
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  • 10
    ISSN: 1617-4623
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Summary The ilv-662 allele was previously identified as a mutation that caused acetohydroxy acid synthase activity to be resistant to feedback inhibition by valine (Davis et al. 1977). This allele was mapped between thr and leu by cotransduction analysis and labeled ilvJ. This report describes the mapping of ilvJ relative to genes that lie between thr and leu (ara, carA and pdxA) by three factor reciprocal cross analyses. We find that the probable gene order is thr-carA-pdxA-ilvJ-ara-leu. Although the phenotypic properties of ilvJ662 appear to be quite distinct from brnS, a gene reported to involve branched chain amino acid transport (Guardiola et al. 1974), we do not rule out possible allelism because of the uncertainty of the map position of brnS.
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