Trovafloxacin in the treatment of intra-abdominal infections: results of a double-blind, multicenter comparison with imipenem/cilastatin. Trovafloxacin Surgical Group.

BACKGROUND: Trovafloxacin, a new broad-spectrum fourth-generation quinolone, has in vitro activity against most gram-negative and gram-positive anaerobes and aerobes. Trovafloxacin is available as both an intravenous formulation, alatrofloxacin, and a single daily oral tablet. Excellent tissue pharmacokinetics and oral bioavailability suggest usefulness in the treatment of complicated intra-abdominal infections. Thus, the efficacy of alatrofloxacin followed by oral trovafloxacin was compared with the standard regimen of intravenous imipenem/cilastatin followed by oral amoxicillin/clavulanic acid in this prospective, multicenter, double-blind trial. METHODS: Patients were randomized to receive either 300 mg alatrofloxacin daily followed by 200 mg oral trovafloxacin daily or 1 g imipenem/cilastatin intravenously thrice daily followed by 500 mg oral amoxicillin/clavulanic acid thrice daily for up to 14 days following surgical intervention of a documented intra-abdominal infection. Efficacy was assessed at the end of therapy and at follow-up (day 30). RESULTS: At the end of the study, cure or improvement occurred in 83% (129/156) and 84% (127/152) of clinically evaluable patients in the trovafloxacin and comparative groups, respectively. Pathogen eradication rates, adverse-event profiles, and significant laboratory abnormalities were comparable between groups. CONCLUSION: Intravenous alatrofloxacin with or without oral trovafloxacin was as effective as intravenous imipenem/cilastatin followed by oral amoxicillin/clavulanic acid in complicated intra-abdominal infections.

[Diffusion of ceftriaxone in healthy and infected peritoneal tissue]. / Etude de la diffusion de la ceftriaxone dans le tissu péritonéal sain et infecté.

The authors studied the peritoneal diffusion of ceftriaxone in the four quadrants of the abdomen (right and left inguinal and right and left hypochondrium) in 50 adult patients divided into 4 groups: pre-operative IVD administration of ceftriaxone in patients with healthy peritoneum, 1 g (group I), 2 g (group II): pre-operative IVD administration of ceftriaxone in patients presenting peritonitis 1 g (group III), 2 g (group IV). After laparotomy, a fragment of peritoneal membrane was resected from each of the four quadrants, the product was extracted from the peritoneum by a crushing technique and the assayed by HPLC with concomitant blood level assay. The mean assayed concentrations in situ are respectively in groups I to IV: 27.2, 31.2, 31.36 and 43.65 micrograms/g, with a rapid time of appearance (30 minutes) and a homogeneous topographic distribution for all peritoneal sample sites. In cases of peritonitis, the concentrations are higher by a factor of 1.15 and 1.39 for the dosages of 1 and 2 g as compared to healthy peritoneum. Beyond the third hour after injection, peritoneal concentrations remained high at 9.8 micrograms/g in patients having received 1 g of ceftriaxone and very high at 22.6 micrograms/g in patients having received 2 g. These levels are therefore effective whatever the posology in antibioprophylaxis, taking into account the MIC of the product on Gram- bacilli.

[The "left-open abdomen". Technic, indication and results]. / Das "offengelassene Abdomen". Technik, Indikation und Resultate.

Critical evaluation of 22 cases with serious diffuse purulent or fecal peritonitis treated by open abdomen following surgical intervention. Seven (32%) patients died, three because of continuing sepsis and one because of acute haemorrhagic necrotizing pancreatitis. The three other died of general complications (1 coma hepaticum, 2 massive embolisms; at autopsy their abdominal cavity was entirely cleaned. The therapeutic principle of "open abdomen" in cases of severe purulent and fecal peritonitis will be recommendable.

[Effect of surgery on the level of total and free thyroid hormones, reverse T3 and TSH]. / Effet de la chirurgie sur le taux des hormones thyroïdiennes totales et libres, la T3 inverse et la TSH.

Changes in total and free thyroid hormones, reverse triiodothyronine (rT3) and TSH were followed in 64 patients undergoing surgery and divided into three groups according to nature of surgery. Group I patients underwent extraperitoneal surgery, group II mild and group III heavy intraperitoneal surgery. A significant fall in total and free triiodothyronine (T3), a rise in rT3, free thyroxine (FT4) and in TSH were noted in each group after surgery, while total T4 levels remained unchanged. There was no correlation between the change in thyroid hormones and TSH. These changes are more marked in groups II and III than in group I. The rT3/T3 ratio was more elevated after surgery in group III than in group II. Thus the severity of the stress induced by surgery may interact with the mechanism of peripheral T4 conversion. The rise in FT4 may be interpreted as a consequence of the presence of an inhibitor of thyroid-hormonal binding to serum proteins. The slight increase in TSH levels seems rather due to stress than to a feed-back adaptation. The ratio rT3/T3 appears as an index of severity and prognosis.

[Intra- and sub-peritoneal effusions of barium. A report on 16 cases (author's transl)]. / Les épanchements barytés intra et sous-péritonéaux. A propos de 16 observations.

The authors report 16 cases of intra or retro-peritoneal effusion of barium due to colorectal or gastroduodenal perforations. Possible mechanisms and the consequences of barium loss are discussed. Treatment must be directed towards repair of the visceral perforation, usually in the colon or rectum, employing exteriorization or resection but without initial anastomisis, and must treat associated peritonitis by very careful extensive cleaning of the peritoneal cavity. In certain well-defined cases, sub-peritoneal perforation can be treated conservatively. The high mortality rate of about 40% can be explained by the particular type of bacterial potentiation due to barium sulfate. Preventive measures are outlined, including the use of water soluble contrast media in some selected cases.

[The giant ulcer of the stomach. Notes concerning 30 cases (author's transl)]. / L'ulcère géant de l'estomac. Réflexions à propos d'une série de trente cas.

The giant stomach ulcer can be defined as a crater measuring more than 30 mm in diameter. This variety of stomach ulcer represents 10-15% of the whole range of gastric ulcers, but they are not quite different from the nosologic point of view. It appears effectively that no etiopathogenic clinical or evolving particular factors can distinguish this kind of ulcer from the niches of normal size. To be taken into consideration is the risk of transforming into cancer which is multiplied by 3 or 5 times when compared with normal stomach ulcers, whence the importance of the endoscopy with many biopsies. In spite of the endoscopy the percentage of error is 5%, this is the reason for which, when in doubt, the more or less extensive gastric resection of the total gastrectomy is required with even more necessity then in normal cases of ulcers.

[Should the B-I gastric resection no longer be used? Results of 228 cases (author's transl)]. / Hat die Resektion nach Billroth I beim Magengeschwür an Bedeutung verloren?

Clinical indications, operative findings, technical details and pathological studies in 228 Billroth-I-Pean gastrict resections for gastric ulcer, are represented in detail. 186 of these patients could be followed up with a maximum of 18 years: 8.6% had troubles after meals, 8.6% gastritis of the remaining stump, 5.9% a small stomach syndrome and 0.5% a reflux oesophagitis. But no one of them had to be reoperated nor for functional troubles, nor for recurrent ulceration. According to the Visick classification the following results have been obtained: V. 1:75.3%, V. 2:13.4%, V. 3:7.5% and V.4:3.7%.