[Pefloxacin + metronidazole versus netilmicin + metronidazole in the prevention of nosocomial infections in contaminated surgery. Pefloxacin Study Group]. / Pefloxacina + metronidazolo versus netilmicina + metronidazolo nella prevenzione delle infezioni nosocomiali in chirurgia contaminata. Gruppo Di Studio Pefloxacina.

Pefloxacin plus metronidazole versus netilmicin plus metronidazole in the prevention of nosocomial infections during contaminated surgery. Surgical prophylaxis is widely used in contaminated surgery, especially colorectal surgery. In this clinical trial the efficacy of pefloxacin 800 mg i.v. slow infusion associated to metronidazole 500 mg i.v. 1-2 hours before surgery and then metronidazole alone after 6 and 12 hours versus netilmicin 200 mg i.m. associated to metronidazole 500 mg i.v. 1-2 hours before surgery and then both after 6 and 12 hours were evaluated in 97 patients suffering by colorectal surgery. Efficacy of prophylaxis in patients was evaluated in terms of appearance of post-surgical infections (abdominal, urinary, respiratory and wound infections). In pefloxacin + metronidazole group (53 patients), two cases of wound infections (3.8%) and three cases of respiratory infections (5.8%) were observed. In netilmicin + metronidazole group (44 patients), two cases of wound infections (4.9%), three cases of urinary infections (7%), three cases of respiratory infections (7.5%) and one case of intra-abdominal infection were observed. Our data confirmed that in colorectal surgery, the association pefloxacin, drug with microbiological and pharmacokinetics characteristics suitable for prophylaxis + metronidazole, active against anaerobes pathogens, prevents post-surgical infections as well as a reference association (netilmicin + metronidazole), with the advantage of a single administration.

[The natural history of breast cancer. The impact of prevention and therapy]. / La storia naturale del cancro della mammella. L'impatto della prevenzione e della terapia.

Four periods are recognizable in breast carcinoma treatment: the first period can be called as "era of the incurable disease". It begins at the arising of the mankind and lasts up to the end of the 19th century. During this period the disease was usually diagnosed in far advanced stage and any therapeutical attempt was unable to cure a significant percentage of patients. The second period begins with Halsted and ends in the late 60's. It should be considered as the "eve of the surgical treatment of the breast cancer". In these years an increasing number of patients was diagnosed in earlier, curable stage and about half of them was definitively cured. In the early 70's several multimodality treatments of breast cancer were proposed by different Cancer Centers worldwide. Usually a local treatment (surgery+radiotherapy) was adopted combined with a systemic treatment (chemotherapy or monotherapy), commonly in N+ patients. Such approach cured a further 25% of patients that the local treatment alone could not cure. Moreover conservative surgical procedures were extensively carried up. In the last ten years the increasing amount of clinical data leads us to adopt a tailored therapeutical plan for nearly every patient. Numerous subgroups of patients with different level of risk were identified (patients with inflammatory carcinoma, young women at high risk, elderly patients etc.). The early data show that some further advantages in survival rates, in cost saving policy and in cosmetic outcome can be achieved.

[Pefloxacin versus ceftriaxone in single-dose antibiotic prophylaxis in general clean-contaminated surgery. The Pefloxacin Study Group]. / Pefloxacina versus ceftriaxone nella profilassi antibiotica in monodose in chirurgia generale pulita-contaminata. Gruppo di Studio Pefloxacina.

Single-shot surgical prophylaxis is today used in all clean-contaminated surgery, because it is able to reduce the incidence of post-surgical infections. The aim of this clinical trial is to evaluate the efficacy of Pefloxacin 800 mg i.v. slow infusion in single administration 1-2 hours before surgery versus ceftriaxone 2 g i.v. 1-2 hours before surgery in 297 patients suffering from clean-contaminated surgery, especially biliary surgery and gastrectomy. Efficacy of prophylaxis in 259 patients, evaluable according to the protocol, was evaluated in terms of appearance of post-surgical infections (urinary, respiratory and wound infections). In the Pefloxacin group (128 patients), no cases of wound infections were observed, except one case of wound sterile secretion, without dehiscence, (0.81%), one case of urinary infection (0.81%) and three cases of respiratory infections (2.34%). In the ceftriaxone group (131 patients), three cases of wound sterile secretion without dehiscence (2.36%), one case of urinary infections (0.76%) and four cases of respiratory infections (3.05%) were observed. From this study we can conclude that single-shot surgical prophylaxis with pefloxacin, drug with microbiological and pharmacokinetics characteristics suitable for prophylaxis, is able to prevent postsurgical nosocomial infections as well as ceftriaxone, considered a reference drug largely used in this indication.

[Frequency of surgical wound infections in patients treated with a barrier procedure. Multicentric study]. / Analisi della frequenza di infezioni della ferita chirurgica in pazienti trattati con un provvedimento ad effetto barriera. Ricerca multicentrica.

In 3088 patients submitted to various surgical procedures an open clinical trial was carried out to evaluate the rare of surgical wound infections (SWI). All of them were treated, before and after surgery, with a foam emulsion (Bioshield) considered, from a theoretical point of view, to be able decrease the bacterial contamination of the surgical wounds. The SWI rate was really low (congruent to 2.3%) and a favorable role played by Bioshield cannot be excluded, both minimizing the skin lesions of the surgeon's hands and reducing wound contamination by exogenous flora.

[Evolution of the bacteria responsible for surgical infection. n 8-year study in our department]. / Evoluzione dei batteri responsabili della sepsi chirurgica. Un'indagine di 8 anni nel nostro reparto.

Since 1981 we monitored all the bacteria strains isolated from patients bearing a surgical infection and hospitalized in our department. We also tested the susceptibility of the isolated strains to different antibiotics. The observed results at three different intervals (1981, 1984, 1987-1988) reveal an increase in Gram+strains. Among the tested antibiotics Imipenem and Amikacin showed the highest antibacterial activity in recent years (1987-1988).

[Sulbactam-ampicillin in surgery. Our experience]. / Sulbactam-ampicillina in chirurgia. La nostra esperienza.

The bacterial infections constitute a serious problem for the surgeon: the choice of antibiotic drugs is really important and, as often as possible, should be guided by antibiotic sensitivity tests. In this study we used sulbactam-ampicillin (Unasyn) who is an antibiotic combination between sulbactam, inhibitor of beta lactam and ampicillin. The preliminary results were as follows: Unasyn was administered to 21 hospitalized selected patients, 16 women and 5 man, who had clinical signs of intraabdominal infection, wound infection and subphrenic abscess after digestive surgery. In these patients were isolated the following organisms: Staphylococcus epidermidis (8), Staphylococcus aureus (11), serratia (1), streptococcus (3), E. coli (3). The daily dosage of Unasyn was 3-12 g/die administered in three to four divided doses, and was determined by the severity of infection, the antibiotic susceptibility of the causative organism(s) and the condition of the patient. Each dose was given by slow i.v. infusion in 15-30 minutes. Our success rate was 100%, and neither systemic nor local side effects were recorded.

Prevention and control of surgical infections.

Surveillance and control of hospital infections are two particularly important aspects of the surgical ward, and great activity is necessary in the identification and the elimination of the risk factors whenever possible. Today the rational use of antibiotics, in both the prevention and treatment of infections, should be used to avoid or limit nosocomial infections, and it is as important as the use of disinfectants. Cefotetan has been studied in different surgical specialties in prophylaxis and treatment of postoperative infections for its particularly broad spectrum of activity, covering both aerobic and anaerobic organisms, and for the very low incidence of side-effects. In general surgery, Cefotetan has proved able to reduce not only the occurrence of surgical wound infections, but also that of postoperative infections of the genitourinary system.

Adjuvant chemotherapy with fluorouracil and CCNU in colon cancer. Results of a multicentric randomized study.

To establish the effectiveness of adjuvant chemotherapy in patients with colon cancer after radical surgery, from 1980 to December 1983, 263 patients were randomized in a multicentric study to no further treatment (131 patients) or to a combination of fluorouracil (5-FU) (400 mg/m2 i.v., days 1-5) and lomustine (CCNU) (100 mg/m2 per os on day 5) every 6 weeks for 9 cycles (132 patients). The two groups were well balanced for age, sex, histology, tumor and nodal extent. Chemotherapy was not given to 30 of the 132 randomized patients, and of 98 treated patients only 38 completed the entire protocol. Analysis, as intention to treat, at 54 months did not show any significant difference between the two treatment groups in terms of relapse-free survival (surgery alone, 74.5%; surgery + adjuvant chemotherapy, 70.9%; p = 0.91). In contrast, a significant difference was observed in overall survival (surgery alone, 78.8%; surgery + adjuvant chemotherapy, 60.8%; p = 0.04). The sites of relapse were identical in the two treatment arms. In conclusion, from this study it appears that adjuvant chemotherapy with 5-FU and CCNU seems to have no efficacy in the cure rate of colon cancer patients.

Treatment of postoperative infections with a single daily dose of ceftriaxone: analysis of international issues.

The results of 13 clinical trials were analysed in order to define the efficacy of ceftriaxone (Rocephin) when given alone and in a single daily dose in the treatment of postoperative infections. In a total of 306 evaluable patients, many of whom were suffering from severe infections, the global clinical success rate was about 90%. The drug was very well tolerated. Minor transient effects occurred only in a few patients. In 8 out of the 13 trials, ceftriaxone was compared with other standard antibiotics. In these comparative studies, the global clinical success rate with ceftriaxone (93.8%) was higher than with other drugs (81%). The microbiological response to ceftriaxone was extremely satisfactory for almost all pathogenes.

Effect of bile salts on carbonic anhydrase from rat and human gastric mucosa.

Gastric carbonic anhydrase (CA) is believed to play an important role related to cytoprotection, and duodenogastric reflux of bile salts (BS) is suspected of having a causal role in many pathologic conditions. Thus, we decided to investigate the effect of free and conjugated BS on human and rat gastric CA activity. Cholate exerted the most potent inhibitory activity on both human (I50 = 2.24 mM) and rat (I50 = 1.68 mM) gastric CA, followed by glycochenodeoxycholate and taurocholate (I50 = 6.90 mM and 13.67 mM on rat gastric CA). Human and rat whole bile produced 10-90% and 20-40% inhibition of gastric CA of the same species. Since the concentrations of free and conjugated BS tested in this study can be found in the postgastrectomized stomach, our data suggest that inhibition of gastric CA might be one mechanism contributing to the gastric mucosa damage caused by BS refluxing into the stomach after gastric surgery.