Role of intrahepatic protein binding in the hepatobiliary extraction profile of cefixime in humans.

The hepatobiliary extraction profile of cefixime, a dianionic cephalosporin antibiotic, was studied in 10 patients, each of whom was provided with T-tube drainage of his or her common bile duct after cholecystectomy. After a single 200 mg oral dose, cefixime biliary clearance proved to be nonlinear, mostly in its initial phase, which is consistent with a concentrative uptake and intracellular protein binding for the drug. The latter process appears to be saturable and to operate at a rate that correlates with the total amount of cefixime recovered in the 24-hour bile drainage. Such findings seem to confirm the significant role played in vivo by hepatic ligandin in the hepatobiliary extraction of organic anions. The data also show that a single 200 mg oral dose of cefixime yields drug levels in bile substantially higher than the minimal inhibitory concentrations for the most frequent Enterobacteriaceae in biliary tract infections. Accordingly, this cephalosporin could be an interesting alternative in both prophylaxis and treatment of biliary tract infections.

Stapled vs sutured colorectal anastomosis.

Performance of low, anterior colorectal anastomosis by means of stapled end-to-end anastomoses and hand sutures was achieved in 51 patients. Among the 26 stapled anastomoses, leakage and external fistula were observed in two cases, but subsequent surgery has never been necessary. Conversely, hand sutures were associated with external fistula again in two cases, but leakage and peritonitis were observed in two other cases. It is suggested that stapled anastomoses are at least as reliable as sutured, colorectal anastomoses. Moreover, the stapling device enables the surgeon not only to extend the range of anterior resection to lower tumors but also to extend the level of resection below the tumor.

A prospective study of current diagnostic procedures for assessment of hepatic metastases in colorectal cancers.

In a prospective study of 305 patients with colorectal cancers, we assessed the diagnostic value of ultrasonography and laboratory tests. In each case laparotomy was carried out and the presence of liver metastases was established in 47 patients. The results show that the laboratory tests alone are not sufficiently accurate to detect liver metastases. Additional accuracy can be obtained by the combined use of a single liver imaging test (echography) and selected laboratory tests (C.E.A., gamma GT, Alkaline Phosphatase).

Regulatory role of enteric kappa opioid receptors in human colonic motility.

The effects of different kappa opioid agonists and antagonists on spontaneous mechanical activities and responses to electrical transmural nerve stimulation of both longitudinal and circular muscle strips from the human sigmoid colon were studied. A superfusion apparatus was used to record isometric contractions. Exogenously added kappa agonists did not modify spontaneous contractile activities on either type of strip. Nerve stimulation induced a triphasic response composed of a first contraction (C1) followed by a relaxation (C2) and an off-contraction (C3); this response was mediated by cholinergic excitatory nerves and non-adrenergic, non-cholinergic excitatory and inhibitory nerves. Dynorphin 1-13 and the synthetic kappa agonist trans-3,4-dichloro-N-methyl-N-(2- [1pyrolidinyl]-cyclohexyl) dramatically decreased the amplitude of the excitatory components C1 and C3. The effects of both kappa agonists were blocked in presence of the kappa antagonist Nor-Binaltorphimine. The delta antagonist ICI 174864 did not prevent the inhibition of the contractions C1 and C3 induced by dynorphin. Therefore, these data suggest that kappa receptors are involved in the neuroregulation of smooth muscle of human colon and mediate inhibition of cholinergic and non-cholinergic excitatory transmission within myenteric plexus.

Primary carcinoma of the gallbladder: review of 25 cases.

The records of 25 patients with carcinoma of the gallbladder occurring during a 5 year period were reviewed. The frequent relation of the disease with cholelithiasis and benign tumors has been widely recognized. Stones were present in the gallbladder in 92 per cent of the patients. In the majority of cases, a diagnosis of carcinoma of the gallbladder was not made clinically. The most common preoperative diagnosis was benign biliary tract disease. The mean survival time after operation was 7 months, and only five patients had a curative resection. The best hope for reducing the mortality from this disease lies in earlier cholecystectomy in patients with benign gallbladder disease.

Facilitating low colorectal anastomosis. Preliminary results.

Low anterior resection with a stapled anastomosis is the operation of choice for almost all rectal lesions in which the sphincter can be safely preserved. We have reported the results of a new technique using the EEA stapler. This method is easy and safe, it eliminates the use of a low pursestring suture, avoids spillage, and keeps contamination to a minimum. It also allows the joining of bowel segments of disparate sizes. The results of this technique used in 16 patients with colorectal anastomoses are encouraging.

Synchronous carcinoma of the colon and rectum: prognostic and therapeutic implications.

In a series of 1,037 patients with colorectal carcinoma diagnosed at one hospital during a 9-year period, synchronous cancers of the colon and rectum occurred in 2 percent. Patient characteristics and presenting symptoms were similar in single and synchronous carcinomas. The frequency of patients with associated benign neoplasms was significantly higher than that in the parent series. An examination of the modified Dukes' classification stage of the lesion in each patient revealed a higher incidence of lymph node involvement and a greater frequency of mucinous adenocarcinoma in patients with synchronous carcinomas. The 5-year survival of patients with synchronous growths did not differ from that of patients with single lesions, even when classified by Dukes' stage. Preoperative diagnosis was difficult, being achieved in no more than 30 percent of patients. Because of the poor accuracy of barium studies, total colonoscopy is the method of choice for this evaluation. We adopted a conservative surgical policy backed by life-long follow-up.

Critical evaluation of prosthetic materials in repair of abdominal wall hernias: new criteria of tolerance and resistance.

Six different materials (3 mesh and 3 cloth) commonly used for the repair of abdominal wall hernias were evaluated in 180 rats after implantation through musculature and peritoneum. Serial macroscopic and bacteriologic investigations were done, and bursting strength of the wound was determined in all groups at intervals with an original device. Histologic criteria were used to characterize the resistance of the wound and the tolerance of the host to the foreign material. Statistical analysis of the results demonstrated: (1) after postoperative day 15, the resistance of the wound was similar for each material tested; (2) during this early period mesh materials exhibited more resistance to bursting pressures than cloth materials; (3) the incorporation of mesh material was constant, whereas encystment or extrusion was always observed after implantation of cloth material; (4) no infection occurred with mesh material, but significant bacteria were found in 18 per cent of cloth material implantations; (5) the extent of the cellular reaction, the enumeration of giant, inflammatory, and fibroblastic cells showed the superiority of mesh materials; and (6) the ratio of fibroblasts to inflammatory cells reflected closely the mechanical resistance and tolerance of the foreign material.

Effect of obstructive jaundice on wound healing. An experimental study in rats.

The effect of obstructive jaundice on wound healing was investigated in an experimental study of gastric and abdominal wounds in rats after ligation and division of the common bile duct. The healing of a parietal defect in these animals showed histologic evidence of delayed healing compared with controls. The bursting strength of the abdominal incision was also decreased, but not that of the stomach. These findings suggest that the biochemical changes in the wounds of jaundiced animals interfere with wound repair. The possible causes of this delay in healing and its clinical implications require further investigation.

The posterior approach for villous tumors of the rectum. Report of eleven cases.

Use of the posterior surgical approach for the management of villous adenoma of the rectum below the peritoneal reflection has been evaluated in eleven patients. There has been no mortality and no recurrence. The Kraske approach was also suitable in four patients with noninvasive adenocarcinoma arising within villous adenomas, although there is no place for this procedure in the treatment of invasive carcinoma.

Does the histologic appearance at the margin of resection affect the postoperative recurrence rate in Crohn's disease?

Is there a role for radical surgery in the management of Crohn's disease or is it feasable to perform limited resections without increasing the risk of recurrence? Fifty eight patients with Crohn's disease underwent resection with subsequent anastomosis. A follow-up of at least 3 years (range, 3-15 years) was undertaken in all cases. All resected specimens at primary surgery were reviewed by one gastrointestinal pathologist to evaluate, retrospectively, the influence of residual microscopic disease at resectional margins on recurrence rate. No statistically significant difference was reported between patients with involved margins and those without such findings as to recurrence rate, interval between primary surgery and reoperation at site of recurrent disease. This review does not provide evidence for adverse influence of residual microscopic disease at the margins of resection. Therefore, limited resection of macroscopically diseased bowel is recommended. One must bear in mind the high rate of recurrence with the necessity of reresection.

Randomized trial of 5-fluorouracil, leucovorin and cisplatin in advanced pancreatic cancer.

BACKGROUND/AIMS: Phase II trials of combined 5 fluorouracil, leucovorin and cisplatin have demonstrated an 18-28% response rate in advanced pancreatic carcinomas. We investigated the effect of this chemotherapy regime on patients' survival. METHODOLOGY: Patients included gave informed consent. They had an advanced and proven pancreatic adenocarcinoma. The trial was multicentric, prospective and randomized. It compared a 5-day course of leucovorin (200 mg/m2/day), 5-fluorouracil (375 mg/m2/day) and cisplatin (15 mg/m2/day) repeated every 21 days (23 patients) with a control group (22 patients). The main end points were survival time (Kaplan-Meier and log-rank methods) a[not readable: see text]side effects of chemotherapy. RESULTS: Association of leucovorin, 5-fluorouracil and cisplatin failed to demonstrate any advantage of this regimen compared with supported care alone. Median survival times were 8.6 months (SD +/- 1.8) and 7.0 months (SD +/- 0.6), respectively. The modulation of 5-fluorouracil by leucovorin and cisplatin was well tolerated with moderate toxic effects. CONCLUSIONS: This multicentric trial failed to demonstrate any advantage of the evaluated chemotherapy regime in the palliative treatment of cancer of the exocrine pancreas. Other trials including gemcitabine and/or radiotherapy are needed in advanced pancreatic adenocarcinoma.

Prosthetic materials and wound healing. Critical evaluation of six different materials.

Six different materials (three mesh and three cloth) commonly used for the repair of abdominal wall hernias were evaluated in 180 rats. Macroscopic, bacteriologic, mechanical and histologic criteria were used to investigate tolerance and resistance of the foreign material. Findings demonstrate the superiority of mesh over cloth materials.

Hepatic resection for isolated tumor-like nodules in the liver.

We have reported two cases of focal nodular hyperplasia of the liver in adults. One case is the first in which the regenerative process that occurred nine months after localized hepatic necrosis was implicated in the development of focal nodular hyperplasia. The other case concerned an idiopathic isolated liver nodule that occurred in a woman who never had taken oral contraceptives. These tumor-like lesions were removed by a right and a partial hepatectomy respectively. The two patients remained asymptomatic during the first 13 postoperative months with no additional therapy.

[Congenital cystic dilatation of the common bile duct, anomaly of the biliopancreatic junction and cancer of the bile ducts]. / Dilatation kystique congénitale du cholédoque, anomalie de la jonction bilio-pancréatique et cancer des voies biliaires.

The choledochus and pancreatic duct ordinarily enter the duodenum either separately or via a common channel located in the duodenal wall. The usual maximal length of the common channel is approximately 0.5 cm. An anomalous junction of the pancreaticobiliary tract is defined by the presence of an unusually long common channel whose length is 1 cm or longer. During the last 8 years, we studied 9 cases of congenital dilatation of the bile duct. Besides the choledochal cyst, all patients had a common channel which measured 1.5 cm or longer. The mean age of patients (6 females, 3 males) was 36.5 years. Three patients had extrahepatic bile tract carcinoma. One patient, a 51-year old man, had gallbladder carcinoma without stones while the two other patients, a 43-year old woman and a 32-year old man, had carcinoma arising from the wall of the cystic dilatation. These two patients had undergone a simple internal drainage procedure 16 and 8 years before, respectively. Our study suggests that the anomalous junction of the pancreaticobiliary tract, an embryonic anomaly which allows the reflux of pancreatic juice into the bile duct and gallbladder, may be responsible for congenital bile duct dilatation and biliary tract carcinoma. Total excision of the cystic dilatation and the gallbladder with hepaticojejunostomy is the appropriate surgical treatment.

Ciprofloxacin biliary disposition in cholecystectomised patients with special references to HPLC and bioassay data.

The biliary disposition of ciprofloxacin was studied in 12 recently cholecystectomised patients during 24 hours following a single oral administration of 500 mg of the drug. Ciprofloxacin was measured in serum, urine, bile and faeces by both high performance liquid chromatography (HPLC) and bioassay. The results were found to be comparable for the concentrations in serum (mean Cmax = 0.97 +/- 0.17 microgram/ml by HPLC and 1.08 +/- 0.19 microgram/ml by bioassay) and in urine (0.6 h: 267 +/- 74 micrograms/ml and 241 +/- 58 micrograms/ml respectively). Higher concentrations were found in bile when measured by bioassay compared with HPLC (peak concentration = 10.3 +/- 3.4 micrograms/ml and 7.5 +/- 2.8 micrograms/ml respectively; p less than 0.02). The total biliary elimination was also significantly higher according to bioassay data (2167 +/- 288 micrograms/ml versus 1587 +/- 222 micrograms/ml; p less than 0.01). This suggests a first pass effect and hepatic biotransformation of ciprofloxacin to one or more active metabolite (s).

Pancreatic localization of a Castleman's tumour.

Castleman's tumour is a rare anatomo-clinical entity. Most cases of Castleman's tumour occur in the mediastinum. The histopathology demonstrates benign angiofollicular lymph node hyperplasia. The pancreatic localization is uncommon and has only been reported once. We describe a new case with literature review.

[Is wound healing modified by the use of diathermy incision (author's transl)]. / La cicatrisation est-elle modifiée par l'utilisation du bistouri électrique?

Many surgeons are hesitant to use the electrocautery on the gastrointestinal tract. The aim of the present study is to compare, with mechanical and histological criteria, wound healing following abdominal and gastric incisions made by scalpel and diathermy, in the rat. This study revealed no difference in bursting pressure between scalpel and diathermy incisions. Histologically there is not a delay in healing in the gastrointestinal tract following electroincision. It is concluded that in abdominal surgery the diathermy can be used without detriment to the strength of any suture line and with no difference in its final healing.

[Can we define "histological tolerance" of the abdominal wall after the implantation of various prosthetic materials?]. / Peut-on définir une "tolérance histologique" de la paroi abdominale après implantation de différents matériaux prothtiques?

This experimental work is a comparative trial in the rat of 6 inert prostheses (3 permeable and 3 non-permeable) that are regularly used in man for the repair of large abdominal wall defects. This is performed in both aseptic and septic conditions. Serial macroscopic and bacteriological observations were done. Quantitative histological criteria were defined to characterize the resistance and biological tolerance to the material. This shows that: 1. the width of the cellular reaction, the number of giant, inflammatory, fibroblastic cells confirms the superiority of meshes whatever the implantation conditions; 2. the proportion of fibroblasts to inflammatory cells is a histological expression of the solidity of the repair and of the biological tolerance to the material (Acta chir. belg., 1977, 76, 575-582).

[Pancreatic metastases of nephro-epitheliomas. Apropos of 2 cases]. / Les métastases pancréatiques des néphro-épithéliomes. A propos de deux observations.

Pancreatic metastasis from clear cell carcinoma of the kidney are exceptional (1 to 3 per cent). Twelve cases have been found in the literature, to which our two observations must be add. Intestinal haemorrhage rule the clinical signs. The complementary arteriography is a very good investigation. Surgery with excision may be effect when a solitary metastasis to the pancreas exist. We can argue about chemotherapy when there is a metastatic dissemination.