Pefloxacin in the treatment of 24 suppurative infections.
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Biomedical subjects
Publications and source records attributed to R Houdart.
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The authors describe three cases of perityphlitis secondary to Chlamydia trachomatis infection and revealed at laparotomy. Clinically, the symptoms invariably mimicked acute appendicitis. The pathogen was identified by a direct immunofluorescent assay with specific monoclonal antibodies (Microtrak). Prompt cure was achieved by doxycycline therapy. Thus, peroperatively, the discovery of an isolated perityphlitis with a normal appendix should raise the possibility of a C. trachomatis infection, even if there is no salpingitis.
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An experimental study was carried out to analyze the reaction of polydioxanone suture. Two hundred ten single layer colonic anastomoses were performed in rats and histopathologically studied at nine different times between the 2nd and 180th postoperative days. Eighteen of 105 abdominal wound closures were studied in the same way between the 7th and 90th days. Polydioxanone was resorbed slowly in approximately 6 months with minimum inflammation. We believe that polydioxanone is actually the suture material of choice for all biliary and biliodigestive sutures.
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One hundred eighty left colonic single-layer end-on anastomoses performed on 90 rats by microsurgical techniques, using polydioxanone monofilament absorbable sutures, were examined histopathologically and microangiographically at nine different times, from two to 180 days. There was no anastomotic leakage. The vascular state after suturing and the evolution of the neovascularization are described. The neovascularization appeared to follow the same process of evolution as tissue restoration. It began early, was greatest on the seventh day, and diminished thereafter. When granulation tissue was narrow, the anastomoses were barely hypervascular, the neovascularization assured by submucosal plexus. A voluminous granulation tissue was hypervascular, had a slower evolution, and neovascularization was then assured above all by the peritoneal formations adherent to the suture.
This article reviews 11 cases of distal revascularization of the extracranial vertebral artery above C2. Revascularization was indicated in 7 cases of extensive atheromatous stenotic or occlusive lesions, 3 cases of dissecting aneurysm, and one case of cervical malformation of the vertebral artery. The procedure of choice was a venous graft - in the C1/C2 space in 10 cases and above C1 in the eleventh. Doppler tests, ultrasound and arteriography demonstrated the patency of all the bypasses, and this was confirmed, 6 months to 3 years postoperatively, by Doppler and ultrasound. No neurological anomalies were observed either during the postoperative course or subsequently. The satisfactory results obtained would seem to justify extension of indications to include the treatment of atheromatous lesions of the supra-aortic trunks, and also adjacent vascular tumors (vertebral bone tumors, or complex cervical malformations of the vertebral artery).
Two hundred and ten left colonic single-layer end-to-end anastomoses (105 by extramucosal continuous suture, 53 by extramucosal interrupted sutures, 52 by total continuous suture) performed on 105 rats with microsurgical techniques using a slowly resorbed suturing material were examined histologically at nine different times between the 2nd and the 180th days. The histopathological evolution of the inflammatory granuloma, the granulation tissue, the reepithelialization process and the restoration of the smooth muscle layers are described. The rate and the amount of inflammation were found to differ between animals and three different types of evolution could be schematized. The differences could not be due to the suturing techniques since continuous and interrupted sutures gave the same results, but rather to the manner of treating the intestinal cut edges before and during suturing. The amount of inflammation was found to decrease with the operator's training.
Changes in diagnosis and management of intracranial infections have been studied on a continuous series of 102 cases 1968 through 1980. Use of CT scan has not increased the number of patients diagnosed in acute phase (before the fifteenth day) but has increased the rate of case observed before the second day (37 p. cent with and 27 p. cent without the CT scan). However the neurological status and specially the state of consciousness has not changed. Four specific data of abscess diagnosis have been defined on 56 cases suspected to have an intracranial infection; 16 out of these cases have proven by surgery not to be infectious lesion. Evolution under treatment is best followed by CT. Final aspect on CT are not different after puncture or after excision. Average delay of disappearance of edema is 20 days and of abscess is 44 days. Importance of bacteriological study in the choice of antibiotics is underlined by comparison of bacteriological and clinical results. Since the introduction of a laboratory of bacteriology in the hospital in 1976, we observed a decrease of sterile cultures (11.5 p. cent and 56 p. cent before 1976), an increase of the number of germs identified in each case and specially anaerobic germs (40 p. cent after and 10 p. cent before 1976) and a decrease in mortality and sequelae (respectively 8,3 p. cent and 19.4 p. cent before 1976 and 11,5 p. cent and 33 p. cent before 1976). Use of CT scan and progress in bacteriological study have led us to simplify our surgical attitude in case of intracranial abscess: puncture as soon as the diagnosis is done on CT; antibiotics according to the bacteriological study and survey by CT in neurosurgical unit.
Three cases of acute interhemispheric subdural hematomas, one of which bilateral, are reported. These are secondary to cranial traumatism and/or to treatment by anticoagulants and have stereotyped clinical signs. Following a lucid period, intracranial hypertension appears, then a sudden predominantly crural hemiparesis or even paraplegia. The aspects shown by computerized tomography are characteristic. The literature and our experience suggest that the best treatment is complete evacuation of the hematoma by craniotomy performed before alteration of consciousness.
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