Infección intraabdominal y nuevas quinolonas. / [Intra-abdominal infection and new quinolones]

Intra-abdominal infection is defined as the presence of an infectious process within the peritoneal cavity. It may be local or have a systemic consequence generating multiple organic disfunction. Most of the studies report a mortality of 30

in severe intra-abdominal infection. Secondary peritonitis is caused by the loss of integrity of the gastrointestinal apparatus, which contaminates with pathogens the peritoneal cavity. Invariably they are polymicrobial infections, mostly due to facultative anaerobic and anaerobic Gram negative bacilli. Prognosis of peritonitis depends on the struggle between two forces: local and systemic immunity of the host and the volume, nature and length of the contamination. Microorganisms and their products estimulate cellular defenses in the host and activate numerous inflammatory mediators responsible for sepsis. Antibiotic treatment of secondary peritonitis must act mainly against Escherichia coli and Bacteroides fragilis. The adequate and early empirical administration of antibiotics against these bacteria is well established. It is necessary to consider if the infection is localized or generalized and if it is accompanied or not by organic disfunction. It also has to be taken into account if peritonitis is community or hospital-acquired when choosing the antibiotic scheme. In community-acquired peritonitis with low to moderate infections a combination of metronidazole-ceftriaxone, metronidazole-gentamycin or a monodrug like ampicillin-sulbactam may be used. In severe hospital-acquired peritonitis imipenem or the combination piperacillin-tazobactam are effective. New quinolones such as trovafloxacin or clinafloxacin, with excellent activity against aerobes and anaerobes producing intra-abdominal infections, may be effective. Future clinical trials are needed to determine their utility. Tertiary peritonitis represent a systemic inflammatory response with multiorganic failure due to the uncontrolled activation of the inflammatory cascade. It is considered a persistent, systemic peritoneal inflammation. Antibiotics and new surgery do not seem to be useful in this situation.

Tromboflebitis séptica de la vena porta asociada a hipertension portal reversible. / [Septic thrombophlebitis of the portal vein associated with reversible portal hypertension]

Septic thrombophlebitis of the portal vein is an unusual and serious complication of abdominal infection. We present a patient with thrombophlebitis of the portal vein of unknown origin, suffering from fever, abdominal pain, jaundice, abnormal liver test function and bacteremia related to Bacteroides fragilis. Ultrasonography, with doppler of the portal vein, was performed which showed thrombosis of the portal vein together with signs of portal hypertension. The patient underwent six weeks of antibiotic treatment. The evolution was favourable, the infection was overcome and the portal vein was de-obstructed as a consequence of which the signs of portal hypertension disappeared.

Profilaxis antimicrobiana sistemica y oral en cirugia colorrectal electiva.Comparacion. / Antimicrobial systemic and oral prophylaxis in elective colorectal surgery

En el presente estudio se ha evaluado la incidencia de infeccion postoperatoria en 68 pacientes sometidos a cirugia colorrectal electiva, comparando en forma prospectiva y al azar dos tipos diferentes de antibioticos profilacticos. Un regimen incluia neomicina-eritromicina por via oral y el otro clindamicina fosfato-lobramicina por via parenteral.Los 2 grupos de pacientes fueron similares en terminos de sexo, edad, enfermedad y tipos de operaciones.Se realizaron cultivos de la flora colonica o de los sitios de infeccion postoperatoria. Los niveles sericos de clindamicina fosfato y tobramicina fueron determinados por metodos microbiologicos. La incidencia de infeccion postoperatoria significativas entre los 2 regimenes con respecto a la frecuencia e importancia de infecciones parietales, peritoneales, septicemia y mortalidad y promedio de dias de internacion. Complicaciones toxicas significativas no se observaron. Se concluye que cualquiera de estas dos preparaciones pueden ser recomendadas indistintamente para la prevencion de infecciones post-operatorias en la cirugia colorrectal electiva

Restablecimiento de la continuidad intestinal luego de la operacion de Hartmann con el aparato E.E.A. de sutura mecanica. / Restoration of intestinal continuity after Hartmanns operation with EEA stapler

Se presentan 12 casos de reconstruccion de operacion de Hartmann con sutura mecanica E.E.A. Se describen la tactica y tecnica operatorias, preferindo los autores la anastomosis terminolateral. En 6 casos se efectuo colostomia transversa contemporanea. No se observaron dehiscencias anastomoticas, ni se registro mortalidad