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PubMed1984

A comparative study of cefamandole versus gentamicin plus clindamycin in the treatment of documented or suspected bacterial peritonitis.

Our data support the premise that antimicrobial therapy for peritonitis must be individualized. In the patient with minimal and moderate contamination who is not suppressed and who will undergo prompt and correct surgical therapy, then a single antimicrobial agent, such as cefamandole or perhaps even a first generation cephalosporin, such as cefazolin, will be adequate therapy even in instances of polymicrobial peritonitis when anticipated resistant organisms are present. In this situation, a single drug will be just as effective and safer when compared with the combination of an aminoglycoside and a specific antianaerobic agent. On the other hand, in the patient with immunosuppression, who is late to come to treatment or who has hospital acquired sepsis with probably a large contamination of resistant organisms, either a third generation cephalosporin with extended coverage or triple drug therapy, including a broad spectrum penicillin, an aminoglycoside and an anaerobic effective agent, should be the treatment of choice. Also, for infections with a culture proved overwhelming anaerobic flora, an antimicrobial specific for these pathogens should be used. The dictum, however, that all instances of peritonitis mandate double or triple drug therapy is a clinical impression based upon experimental models which do not correctly simulate the clinical situation.

Adolescent↗
PubMed1984

Decreased sensitivity of early imaging with In-111 oxine-labeled leukocytes in detection of occult infection: concise communication.

Imaging with leukocytes labeled with indium-111 oxine is a sensitive technique for detecting sites of occult infection. Traditionally, imaging is performed 24 hr after injection. We undertook a prospective study of 35 patients (40 studies) with possible occult infection to see whether a 24-hr delay in imaging is really necessary. Patients were imaged at 1-4 hr and again at 24 hr after injection. The early images had a sensitivity of only 33%, compared with 95% for the 24-hr images. Of the seven studies that were positive on both early and delayed images, 71% had more intense uptake at 24 hr. There were no false-positive early images. We conclude that imaging 1-4 hr after injection with In-111 oxine-labeled leukocytes has a low sensitivity for detecting occult infection. However, a positive early image is specific for a site of infection.

Adult↗
PubMed1980

[Nephrosonography. Possibilities of echographic diagnosis and treatment in the renal and pararenal regions (author's transl)].

Because of the retroperitoneal situation of the kidneys, dorsoanterior echography suggests itself. The rapid B-picture process is particularly suitable for urology because the movements of the kidney due to respiration can be followed. "Silent kidney" can be explained. Space-occupying processes can be differentiated. Pararenal processes can be recognised through sonography. Further indications are postoperative monitoring after plastic operations on the efferent urinary passages. The kidney can be visualized without radiation load in allergy to contrast media or in pregnancy. Cyst puncture under echographic observation can contribute to differential diagnosis. Percutaneous nephrostomy under ultrasonic observation can avoid operative intervention.

Adult↗
PubMed1978

[Choice of procedure in the surgical treatment of liver injuries].

We give an analysis of liver-rupture cases among our own patients and discuss the problems of diagnosis and surgical therapy. Total lethality is 29%; this is dependent on quick diagnostic procedure, the number and severity of accompanying traumas, and the type of liver rupture. The main diagnostic feature seems to be peritoneal lavage, Operative procedure depends on the type and severity of the liver rupture. We therefore propose a classification of the types of liver ruptures, together with their adequate surgical therapy. Some postoperative complications can also be avoided.

Accidents, Traffic↗