A comparison of pefloxacin/metronidazole and doxycycline/metronidazole in the treatment of laparoscopically confirmed acute pelvic inflammatory disease.

A double-blind, randomised study was conducted to compare the efficacy and safety of a combination of pefloxacin and metronidazole versus doxycycline and metronidazole in patients with pelvic inflammatory disease (PID). The clinical diagnosis had to be confirmed by laparoscopy before patients were included. Of the 74 patients who fulfilled the clinical criteria for PID, laparoscopy confirmed the diagnosis in only 40 patients (54%). The microorganism most frequently found as causative pathogen was Chlamydia trachomatis. Both treatment groups showed a good response to the study-medication. At discharge 9 patients in the pefloxacin group (45%) were cured and 10 patients (50%) had improved. In the doxycycline group 7 patients (35%) were cured and 10 patients (50%) had improved. Obviously pefloxacin/metronidazole and doxycycline/metronidazole are equally effective in the treatment of PID.

A randomized clinical trial comparing two methods of fascia closure following midline laparotomy.

Three hundred forty women undergoing midline laparotomy were randomized into an interrupted suture (polyglactin 910, size 1) or a continuous suture (polyglyconate, size 0) closure group. The two groups were well balanced with respect to various risk factors for postoperative wound complications. Early evaluation revealed no differences between the continuous and interrupted suture groups with respect to wound infection (3% vs 1%), superficial wound dehiscence (2% vs 4%), and deep wound dehiscence (0.6% vs 0%). Late evaluation showed no differences between the two groups either. Continuous polyglyconate and interrupted polyglactin 910 sutures had a similar incidence of suture fistula (0% vs 2%), wound pain (1% vs 2%), and incisional hernia (3% vs 4%). Continuous closure was done faster and resulted in less foreign-body suture material. Despite its smaller diameter, the polyglyconate suture also retains a higher tensile strength after surgery than does the quicker-degrading polyglactin 910 suture. Results of this study lead to the conclusion that a running polyglyconate suture is the better choice for closure of the abdominal-wall fascia following midline laparotomy.

Tissue reaction to suture materials revisited: is there argument to change our views?

Tissue reactivity to ten different suture materials (silk, plain catgut, chrome catgut, tevdek, ticron, ethibond, vicryl, dexon, maxon and prolene) was evaluated on the basis of conventional microscopic assessment of eight histologic parameters at 7 days following surgery in the rat. Each suture material was placed at different localizations in the abdominal facial layer of 6 rats, thus a total of 60 rats were operated on. A completely standardized and reproducible system of microscopic assessment was used. Weighed discriminant sum values of these parameters showed no systematic differences between tissue reaction to these sutures. The computed addition of all possible magnitudes of weighing factors to the tissue reactivity parameters did not change this negative result. Discriminant analysis showed that it is unlikely that conventional histologic parameters of tissue reaction constitute a single concept like 'tissue reactivity'. It is concluded that at 7 days after surgery the effect of surgical trauma still nullifies the possible differences between suture materials with respect to tissue reaction. Minimizing surgical trauma should, therefore, be reappraised as more important for physiologic wound healing than the use of biocompatible sutures.