Efficacy of lomefloxacin and ofloxacin in complex therapy of infections in patients with burns]

The experience with lomefloxacin and ofloxacin respectively in the complex therapy of 26 and 40 patients with burns is described. The drugs were shown to be highly active in the treatment of burn wound infections and infectious complications of burn disease. The clinical efficacy of lomefloxacin and ofloxacin amounted to 88 and 77.5 per cent and the bacteriological efficacy amounted to 81 and 80 per cent respectively.     

Stepwise therapy of community-acquired pneumonia. Results of cefuroxime and cefuroxime axetil study

The efficacy of a 7-day switch therapy with parenteral cefuroxime in a dose of 750 mg for 3-5 days followed by the use of oral cefuroxime axetil in a dose of 500 mg every 12 hours was compared with that of a 7-day therapy with parenteral cefuroxime in a dose of 750 mg every 8 hours in hospitalized patients with community-acquired pneumonia. The clinical and bacteriological efficacies and pharmacokinetic properties of both the dosage forms were estimated. It was shown that the clinical and bacteriological effects did not significantly differ in the patients under the parenteral regimen with cefuroxime and under the parenteral-to-oral regimen with cefuroxime and cefuroxime axetil: the cure in 75 and 83 per cent of the patients and the bacteriological response in 100 and 86 per cent of the cases respectively. The results indicated that the cost of the switch therapy was much lower while the efficacy did not decrease.     

Effectiveness of cefpirome in the treatment of complicated infections of the upper and lower urinary tracts

Two hundred and two isolates of gram-positive and gram-negative pathogens of urinary tract infection were tested for their susceptibility to cefpirome. In 64 to 97 per cent of the cases the susceptibility was high and exceeded that of other cephalosporins used in the treatment of urological patients. Cefpirome was used in the treatment of 26 patients with signs of urinary tract infection: 19 patients with pyelonephritis and 7 patients with prostatitis. The antibiotic was administered intravenously in a dose of 1 g twice a day for the treatment course of 5-7-10 days. The clinical and bacteriological efficacies amounted to 92 and 87 per cent respectively. The drug tolerance was good. The results demonstrated that cefpirome was useful in the empirical therapy of urinary tract infection.     

In vivo efficacies of quinolones and clindamycin for treatment of infections with Bacteroides fragilis and/or Escherichia coli in mice: correlation with in vitro susceptibilities

Therapy with ofloxacin, ciprofloxacin, and lomefloxacin (alone or in combination with clindamycin) and therapy with sparfloxacin, clinafloxacin, and temafloxacin alone were given to mice with subcutaneous abscesses. The abscesses were caused by two Bacteroides fragilis isolates, one of which was susceptible and one of which was resistant to ofloxacin, ciprofloxacin, and lomefloxacin, alone or in combination with Escherichia coli. The abscesses were examined 5 days after inoculation. Numbers of B. fragilis organisms reached log10 10.2 to 11.8 per abscess, and numbers of E. coli organisms reached log10 10.6 to 11.8 per abscess. All of the quinolones reduced the number of susceptible B. fragilis isolates (log10 3.6 to 6.9) and E. coli isolates (log10 5.7 to 6.8). However, ciprofloxacin and lomefloxacin failed to reduce the number of resistant B. fragilis organisms in single-organism or mixed infections. The addition of clindamycin to either ofloxacin, ciprofloxacin, or lomefloxacin reduced the numbers of both susceptible and resistant B. fragilis organisms (log10 3.8 to 7.8). In contrast, sparfloxacin, clinafloxacin, and temafloxacin were effective as single therapy in eradicating B. fragilis resistant to ofloxacin, ciprofloxacin, and lomefloxacin. These in vivo data confirm the in vitro activity of these quinolones and suggest that although ofloxacin, ciprofloxacin, and lomefloxacin are occasionally effective as single agents in eradicating mixed infection by susceptible strains of B. fragilis and E. coli, addition of an agent with activity against anaerobic organisms will ensure their efficacy. Quinolones with good efficacy against B. fragilis may be effective as single-agent therapy of mixed infections.     

The hygienic requirements for the construction, operation and water quality of swimming pools

Data concerning operative treatment of 227 patients with lithiasis of the extrahepatic biliary ducts, covering an eleven-year period (1985 to 1995 inclusive), are presented. In all cases diagnosis and operation are done in the Second Surgical Clinic at the Medical University--State University Hospital "Alexandrovska"--Sofia. By type the surgical interventions are distributed as follows: external drainage of hepaticocholedochus--122 cases (53.74 per cent), choledochoduodenostomy 69 (30.39 per cent) and transduodenal papillosphincterotomy 36 (15.85 per cent). Fifteen patients develop postoperative complications (6.60 per cent), and in five patients the outcome is fatal with postoperative lethality amounting to 2.20 per cent. The basic indications for the various types of surgical interventions are established.     

Prophylaxis for venous thromboembolism in head and neck surgery: the practice of otolaryngologists

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are an important cause of morbidity and mortality in the surgical patient. The first guideline produced by the Scottish Intercollegiate Guidelines Network was for the prophylaxis of venous thromboembolism. Patients undergoing major head and neck cancer surgery commonly exhibit risk factors for venous thromboembolism. Currently, however, there are no data on its incidence in these patients. A questionnaire survey was performed to assess the current practice of consultant otolaryngologists regarding DVT prophylaxis in patients undergoing head and neck cancer surgery. Of those respondents who managed these patients, 57 per cent did not use routine DVT prophylaxis while 43 per cent did. A wide variety of techniques were employed among those practising DVT prophylaxis. A consensus is needed concerning the use of thromboembolism prophylaxis in head and neck surgery patients.     

Low molecular weight heparin and unfractionated heparin in thrombosis prophylaxis after major surgical intervention: update of previous meta-analyses

BACKGROUND: Previous meta-analyses comparing low molecular weight heparin (LMWH) and unfractionated heparin for thrombosis prophylaxis after surgical interventions need updating. METHODS: This is a publication-based meta-analysis of 36 double-blind studies including 16583 patients. Main outcome measures are incidence of deep vein thrombosis (efficacy) and wound haematoma (safety). RESULTS: In general surgery there is no increased efficacy in favour of LMWH (odds ratio (OR) 0.88, 95 per cent confidence interval (c.i.) 0.60-1.30) but there exists a higher incidence of bleeding complications (OR 1.47, 95 per cent c.i. 1.07-2.01). Low-dose LMWH is equally efficacious (OR 1.03, 95 per cent c.i. 0.85-1.26) but safer than unfractionated heparin (OR 0.68, 95 per cent c.i. 0.56-0.82). In orthopaedic surgery there is a trend towards an increased efficacy for LMWH (OR 0.83, 95 per cent c.i. 0.68-1.02) with equivalent safety (OR 0.96, 95 per cent c.i. 0.68-1.36). CONCLUSION: A superiority of LMWH is suggested but heterogeneity might make generalizability to future patients questionable. A meta-analysis on individual patient data should be the next step before randomizing additional patients in future trials.     

Analysis of the etiologic structure of urinary tract infection and antibiotic-resistance of its pathogens

The main pathogens of inflammatory diseases of the kidneys and upper urinary tracts in inpatients of an urological unit were gramnegative organisms of the family Enterobacteriaceae while the pathogens of the infection of the lower urinary tracts (nonspecific urethritis) and male genitalia were grampositive cocci. Pseudomonas aeruginosa, Enterobacter agglomerans and Proteus spp. (indole positive) were the chief causative agents of the hospital infections. The analysis of the materials revealed a tendency towards an increase in the microflora resistance to the most widely used antibiotics: aminoglycosides, cephalosporins and fluoroquinolones. This especially applied to the "problem" pathogen P.aeruginosa. Thus, in 1987 the portion of the P.aeruginosa gentamicin susceptible strains amounted to 52 per cent whereas in 1996 it was 13 per cent. The strains susceptible to ofloxacin equaled 79 per cent in 1988 and 44 per cent in 1995. At present the drugs of choice in the treatment of urinary tract infections due to P.aeruginosa are ceftazidime, cefpirome and amikacin (65, 64 and 62 per cent of the susceptible strains respectively). The importance of permanent microbiological monitoring and the respective correction of the therapy are indicated.     

The factors determining survivorship in patients with colorectal carcinoma complicated by obstructive ileus of the large intestine

A total of 232 patients with obturation ileus, caused by locally advanced colorectal carcinoma, are operated over a 12-year period (1979-1990). In 160 patients (68.97 per cent) the tumor is located in the colon, and in 72 (31.03 per cent)-in the rectum. The operative interventions performed are distributed as follows: 122 (52.58 per cent) radical, and 110 (47.42 per cent) palliative. There are 84 patients (36.03 per cent) in IV clinical stage. Postoperative lethality among those subjected to radical operation amounts to 25.41 per cent, with leading underlying causes-peritonitis (35.08 per cent) and serious ileus intoxication (21.05 per cent). The survival over 1, 3 and 5-year periods among those radically operated is 74.59, 48.37 and 34.06 per cent, respectively. Histologically differentiated adenocarcinoma is demonstrated in 69.38 per cent, undifferentiated-in 17.50 per cent, and mucinous adenocarcinoma-in 13.12 per cent. The factors with a high prognostic value include: stage of primary tumor development, lymph involvement, type of operative intervention and histological variant of the neoplasm.     

Urologic manifestations of hyperparathyroidism in childhood

Among renal stone-forming children 6 per cent suffer from primary hyperparathyroidism. Urologic complications were noted in 7 of 9 children (78 per cent) with surgically proved hyperparathyroidism seen in a 24-year period. These included nephrolithiasis and nephrocalcinosis (6), defective urinary concentration or acidification (5) and mild impairment of renal function (3). All children responded favorably to parathyroidectomy, which should be performed before treatment of stone disease is undertaken. The nature of urologic manifestations of hyperparathyroidism and their management are discussed.     

Current management of acute leg ischaemia: results of an audit by the Vascular Surgical Society of Great Britain and Ireland

BACKGROUND: Management of acute leg ischaemia has changed in recent years. This study aimed to elucidate current practice throughout the UK and Ireland. METHODS: Surgeons and audit departments were asked to return a questionnaire about every episode of acute leg ischaemia seen in the hospital between 1 January and 31 March 1996. RESULTS: A total of 539 episodes were reported in 474 patients (248 men) aged 19-96 (median 73) years. Common causes were thrombosis in situ (41 per cent), embolism (38 per cent) and graft or angioplasty occlusion (15 per cent). Vascular surgical advice was requested in 95 per cent of cases. Initial management was: immediate embolectomy in 21 per cent, anticoagulants in 13 per cent and no vascular intervention in 10 per cent. Arteriography was done in 56 per cent, followed by 186 endovascular and 165 surgical interventions. At 30 days, 70 per cent of limbs were definitely viable and 16 per cent had been amputated. The mortality rate was 22 per cent. Cases were reported by 86 of 182 hospitals contacted, but some referred no patients, and a supplementary audit of 54 cases (10 per cent size of the original sample) from non-contributing hospitals showed no important differences. CONCLUSION: Patients with acute leg ischaemia are generally treated by vascular specialists, with modern methods and acceptable results. This is being achieved despite insufficient vascular surgeons and radiologists for formal emergency rotas in most hospitals.     

Prevention of thromboembolic phenomena

The leading cause of death from total hip replacement is pulmonary embolism. Prophylactic anticoagulation has been effective in decreasing thromboembolic phenomena but has been associated with a high rate of complications. A low dose warfarin prophylaxis combined with anti-embolic hose, elevation of the legs and early ambulation was employed in 415 total hip replacements. Clinical thrombosis occurred in 2.4 per cent and there was 1.45 per cent pulmonary emboli but none resulted in death. Two deaths from non-embolic causes occurred for a mortality rate of 0.49 per cent. Systemic complications of the warfarin were few with 5 mild gastroentestinal hemorrhages but no deaths related to the medication. Wound hemorrhage occurred in 4.6 per cent of patients and it is recommended that severe, deep superficial hematomas be treated with early surgical evacuation. The management program appeared to be safe and effective in preventing postoperative mortality from pulmonary emboli but close monitoring is essential.     

Antimicrobial prophylaxis in colorectal surgery: a systematic review of randomized controlled trials

BACKGROUND: A systematic review was carried out to assess the relative efficacy of antimicrobial prophylaxis for the prevention of postoperative wound infection in patients undergoing colorectal surgery. METHODS: MEDLINE, EMBASE, the Cochrane Trials Register and the references cited in retrieved studies were searched to identify relevant trials published between 1984 and 1995. RESULTS: Some 147 relevant trials were identified. The quality of trials has improved over the past 12 years. The results confirm that the use of antimicrobial prophylaxis is effective for the prevention of surgical wound infection after colorectal surgery. There was no significant difference in the rate of surgical wound infections between many different regimens. However, certain regimens appear to be inadequate (e.g. metronidazole alone, doxycycline alone, piperacillin alone, oral neomycin plus erythromycin on the day before operation). A single dose administered immediately before the operation (or short-term use) is as effective as long-term postoperative antimicrobial prophylaxis (odds ratio 1.17 (95 per cent confidence interval (c.i.) 0.90-1.53)). There is no convincing evidence to suggest that the new-generation cephalosporins are more effective than first-generation cephalosporins (odds ratio 1.07 (95 per cent c.i. 0.54-2.12)). CONCLUSION: Antibiotics selected for prophylaxis in colorectal surgery should be active against both aerobic and anaerobic bacteria. Administration should be timed to make sure that the tissue concentration of antibiotics around the wound area is sufficiently high when bacterial contamination occurs. Guidelines should be developed locally in order to achieve a more cost-effective use of antimicrobial prophylaxis in colorectal surgery.     

Free tissue transfer in the management of burns

Although the majority of burn wounds undergoing surgical treatment require only excision with split-skin grafting, the introduction of free microvascular tissue transfer has allowed for the preservation of otherwise unsalvageable deep burn injuries and the resurfacing of burn scars in areas with no available local tissue. A total of 1699 patients with burn injuries were admitted to the Burns Unit in Newcastle upon Tyne in the 5 years 1989-1993. During this period 604 patients (35.5 per cent) required surgical treatment of their burns. Of these patients 582 (96.4 per cent) underwent excision of their burns with split-skin grafting, 13 (2.1 per cent) of the patients required local flap cover and nine patients (1.5 per cent) had free tissue transfer. Free flap loss in this study was 22 per cent in burns patients as compared to only 3 per cent in patients undergoing microsurgical reconstruction for other reasons.     

Outcome of palliative biliary and gastric bypass surgery for pancreatic head carcinoma in 126 patients

BACKGROUND: Recent reports of decreased morbidity and mortality following palliative surgery for patients with irresectable pancreatic head carcinoma prompted a review of the results in 126 patients (median age 64 (range 39-90) years) who had undergone palliative biliary and gastric bypass surgery. METHODS: The indication for surgical palliation was the finding of an irresectable tumour at laparotomy (n = 44), failure of endoscopic treatment (n = 43), clinical symptoms of gastric outlet obstruction (n = 28) and miscellaneous (n = 11). Biliary and gastric bypass was performed in 118 patients, biliary bypass alone in six and gastrojejunostomy alone in two. The indication for gastrojejunostomy was symptoms in 28 patients (23 per cent) and prophylaxis in 92 patients (77 per cent). RESULTS: Postoperative local complications occurred in 17 per cent of patients, general complications in 10 per cent and delayed gastric emptying in 14 per cent of patients. The 30-day mortality rate was 1 per cent and overall hospital mortality rate 2 per cent. Median hospital stay was 17 (range 5-80) days. Median overall postoperative survival was 190 (range 14-830) days. Late obstructive gastrointestinal symptoms occurred in 14 patients (11 per cent) after a median of 141 (range 21-356) days. CONCLUSION: Roux-en-Y hepaticojejunostomy combined with gastrojejunostomy offers effective palliation for irresectable pancreatic head cancer and can be performed with low mortality and acceptable morbidity rates.     

Activity of morantel citrate against strains of benzimidazole-resistant nematodes of sheep in the United Kingdom

The activity of morantel citrate (5.94 mg/kg base) was determined in laboratory tests against field isolates of benzimidazole-resistant nematodes. Its efficacies against adult and seven-day-old worms were 100 per cent and 100 per cent for Cooperia curticei, 95.1 per cent and 69.8 per cent for Haemonchus contortus and 100 per cent and 82 per cent for Ostertagia circumcincta. Morantel citrate was 100 per cent effective against benzimidazole-susceptible Nematodirus battus and Trichostrongylus vitrinus, and it reduced faecal egg counts by 97.9 per cent in sheep infected naturally with benzimidazole-resistant H contortus and O circumcincta.     

Inflammation of the tail in swine. Slaughter-house findings during 1972, 1973, and 1974 (author's transl)

In the Public Salughter-House of Utrecht, a percentage increase in the number of pigs with inflammation of the tail, which had or had not healed, was observed during the period from 1972 to 1974 inclusive. The most common secondary symptoms of inflammation consisted in embolic pneumonia, osteomyelitis of the vertebrae and abscess formation in other parts of the body, particularly the semimebranosus muscles. Osteomyelitis was found to be the most common complication in pigs in which the inflammation of the tail had healed, whereas this usually consisted in embolic pneumonia in those cases in which the inflammation of the tail had not healed. The bacteriological examination carried out in accordance with the Meat Inspection Regulations was positive in 21.7 per cent, 13.5 per cent of the cases respectively in 1972, 1973 and 1974. Micro-organisms were isolated much more frequently from the kidney than they were from the spleen and meat. There was no relationship between the presence of inflammation of the tail and climatological conditions during the fattening period. The losses at slaughter from inflammation of the tail in the Netherlands are estimated at 3-4 million guilders per annum.     

Review of a home-based palliative care program for children with malignant and non-malignant diseases

The study of the incidence and etiological pattern of infectious complications included 376 patients operated for acquired valvular disease. 40,280 bacteriological tests of the materials from the patients obtained during the operations and during the postoperative period as well as 30,113 sanitary bacteriological tests of the specimens from the cardiological operation unit were conducted. The possible use of the results of bacteriological monitoring for prediction of septic complications and optimization of antibiotic prophylaxis and therapy as well as for development and operation of a system of sanitary and hygienic measures for infection prevention was shown and statistically confirmed.     

Hygienic evaluation of the electromagnetic field created by high-voltage electric power transmission lines

The authors propose a definitely-arranged system for organization of reanimation and intensive therapy of children. It includes 5 component elements, viz. rooms and posts of reanimation aid at kindergartens and creches, polyclinics and sanatoria; intensive therapy wards at maternity homes and pediatric hospitals; anesthesiological, reanimation and intensive therapy departments of multispecialized pediatric inpatient departments; reanimation and anesthesiological centers; a consultative travelling reanimation pediatric team. The structural form of the patients' hospitalization at pediatric reanimation departments is analyzed. Of their total number 48 per cent are surgical patients after serious operative interventions on the organs of thoracic and abdominal cavities with multiple injuries and malformations; 27.1 per cent are infectious patients, 11.9 per cent - those suffering from poisonings and 10.7 per cent patients with somatic illnesses.     

Primary carcinoma of the gallbladder. The role of adjunctive therapy in its treatment

Of forty-three patients with carcinoma of the gallbladder discovered ih a twenty-five year period (during which 10,349 patients were diagnosed as having cholelithiasis), eighteen patients (42 per cent) had no obvious tumor outside of the gallbladder at the time of operation, nineteen patients (44 per cent) had local spread of the disease, and six patients (14 per cent) had abdominal carcinomatosis or distant metastasis. In the twenty-one patients who underwent surgical therapy for cure of their disease, the five year survival rate was 33 per cent. The more extensive surgical procedures (other than cholecystectomy alone) did not significantly increase survival. Neither the duration of the symptoms nor the pathologic type of the tumor altered the eventual outcome. No patients with tumor outside the gallbladder at the time of operation survived longer than two years. Compared to those who did not receive it, the fifteen patients treated postoperatively with adjunctive therapy (radiation therapy or chemotherapy or both) lived longer and also were significantly better palliated when tumor outside of the gallbladder was found at the time of operation. From these findings, the routine use of adjunctive therapy is recommended in all patients with disease outside of the gallbladder and serious consideration should be given to its use in all patients found to have carcinoma of the gallbladder.