Piperacillin compared with cefuroxime plus metronidazole in diffuse peritonitis.

Eighty-five patients were randomly allocated to receive either piperacillin (n = 38) or cefuroxime plus metronidazole (n = 45) after surgical treatment of diffuse peritonitis; 78 were evaluable. A mean of 1.5 (piperacillin group) and 1.7 (cefuroxime/metronidazole group) pathogens/patient were identified. Twenty-seven patients (71%) were successfully treated in the piperacillin group compared with 29 (64%) in the cefuroxime/metronidazole group. These data suggest that piperacillin was neither better nor worse than cefuroxime/metronidazole in diffuse, secondary peritonitis.

Comparisons of dental maturity between the rural community of Kuhmo in northeastern Finland and the city of Helsinki.

The aim of the study was to check whether dental maturity charts made in southern Finland can be used without modifications in other parts of the country. For this reason the dental maturity of 90 children living in the sparsely populated areas of Kuhmo in northeastern Finland was compared with that of a larger sample of Helsinki children. Most of the Kuhmo children were 7.0-8.5 and 10.5-12.5 yr of age. The method of Demirjian and associates was used to estimate dental maturity. The means of dental maturity scores were greater in Kuhmo in most half-year groups in both sexes. The median dental maturity scores of Kuhmo children were between the 50th and 84th percentile curves of Helsinki children. A referent of the same age and sex was chosen for each Kuhmo child from the Helsinki children. The paired t-test was based on the difference in dental age. The dental age of the Kuhmo children was higher (P less than 0.05). These findings suggest differences in dental maturity within a fairly homogeneous population, which should be considered when national charts are used.

Comparison of cefuroxime and gentamicin in combination with metronidazole in the treatment of peritonitis due to perforation of the appendix.

A study on 42 surgical patients was carried out to find out whether cefuroxime may be substituted for gentamicin in combination with metronidazole in the treatment of peritonitis secondary to perforation of appendix. All patients recovered and there were four wound infections in each group. Both aerobic and anaerobic bacteria were cultured in the peritoneal fluid in 69% of cases and anaerobes only in 19% of the patients. Postoperatively the patients were followed up for one month. The mean length of the hospital stay and convalescence did not differ significantly. There was also no difference in the time to the removal of gastric suction, laboratory measurements and the incidence of pyrexia between the study groups. Although the number of patients was limited the present study indicates that gentamicin may be replaced by less toxic cefuroxime. This is especially the case if there are several risk factors in the use of gentamicin and if there is not a possibility for monitoring the serum levels of gentamicin.

Serum levels of doxycycline during and after thoracic operation.

20 patients who underwent thoracotomy and lung operations mainly for lung cancer, were given oral doxycycline (DC) 100-4-- mg the previous evening. Blood samples were taken for the fluorometric assay of DC before the anaesthetic, during the operation, and 2-3 hours postoperatively. Serum DC levels during the operation correlated approximately with the dose of DC, and they were parallel to the DC concentrations measured in pulmonary or/and bronchial tissue, 11 out of 20 patients showed elevated serum DC levels during recovery, non-specific fluorescence being excluded. This phenomenon was ot seen in experiments with rabbits in which the decline of the blood DC levels was assessed after the intravenous injection of DC. Possible causes for elevated serum DC are discussed.

Metronidazole prophylaxis against wound infection in patients undergoing appendicectomy.

The effect of a preoperative single intravenous dose of metronidazole was studied in a prospective trial of 203 patients. 17.5% of the patients in the control group developed a wound infection compared with 3.4% of those receiving metronidazole (p less than 0.001). The average length of hospitalization and convalescence was significantly reduced in the metronidazole group. The use of metronidazole in prevention of wound infection is recommended.

[Doxycycline levels in serum and pulmonary tissue. Intravenous application of doxycycline in pulmonary surgery (author's transl)]. / Doxycyclin-Konzentrationen in Serum und Lungengewebe. Die intravenöse Anwendung von Doxycyclin in der Pulmonalchirurgie

Doxycycline levels were measured fluorimetrically in the serum and pulmonary tissue of 36 patients undergoing a pulmonary operation. Doxycycline 200 mg was given intravenously 20 hours before operation. The doxycycline concentration in pulmonary tissue (1.03 to 12.30 mug/g) were as high or higher than the serum doxycycline levels (0.94 to 7.82 mug/ml) in the majority of cases. This is possible as the lung has an ample blood supply and doxycycline is a lipophilic drug. There were large variations in the results, which was probably related to the underlying illness and to an altered blood circulation. The side effects were minimal. The daily infusions of doxycycline were continued over 5 days, no conclusions could be drawn about its possible prophylactic effect on postoperative infections.

Traumatic rupture of the pericardium with luxation of the heart. Case report and review of the literature.

A report is made of a case of left diaphragmatic and pericardial rupture with luxation of the heart from the pericardial sac, resulting from a steering wheel injury. The patient was successfully treated surgically. In the treatment of this injury, correcting the hemodynamic derangement caused by incarceration and torsion of the heart is stressed. A review of the literature on pericardial ruptures is presented.