[Postoperative infection of an epigastric hematoma caused by Aeromonas veronii biovar sobria]. / Postoperative Infektion eines epigastrischen Hämatoms mit Aeromonas veronii biovar sobria.

HISTORY: A 52-year-old man with a gastric signet-ring cell carcinoma but without acute symptoms was admitted for reconstructive surgery of the gastrointestinal tract. INVESTIGATIONS: Before the present surgery all functional and radiological tests merely confirmed the previously known disease. Except for mild anemia and abnormal electrolytes all laboratory tests were within normal limits. COURSE, DIAGNOSIS AND TREATMENT: The patient underwent reconstructive surgery of the gastrointestinal tract, namely an ascending sigmoidostomy and resection of an enterocutaneous fistula. For a few days the postoperative development was as expected and the drain, placed during surgery, was removed at the expected time. 9 days postoperatively the patient developed signs of an infection (fever up to 38.8 degrees C, increased WBC and raised C-reactive protein levels). Computed tomography (CT) of the abdomen revealed an epigastric tumor measuring 6 x 5 cm. CT-guided needle aspiration of this lesion showed macroscopic signs of an infected hematoma. A pigtail catheter was successfully implanted for continuous drainage. Both the fluids obtained from CT-guided aspiration and the pigtail drain grew Aeromonas veronii biovar sobria when cultured on standard blood agar. Administration of both cefotaxim and metronidazole for 10 days produced a decrease in the inflammatory parameters. The abdominal CT at that time showed a noticeable regression of the epigastric mass so that the patient was discharged from hospital 3 weeks after surgery. CONCLUSION: This case emphasizes the importance of adequately dosed antibiotic therapy, also for unusual bacteria such as species of Aeromonas.

Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer.

This study aimed to evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy intensified with irinotecan in patients with locally advanced rectal cancer. Eligible patients had nonmetastatic disease at a locally advanced stage that made R0 resection and sphincter preservation uncertain. They received preoperative radiation over 6 weeks to 45 Gy and boost of 5.4 Gy and concurrent continuous infusion 5-fluorouracil 250 mg m(-2) day(-1) and weekly irinotecan 40 mg m(-2). In all, 37 patients entered the study. T stage at baseline as determined by ultrasound was T2/T3/T4 in 2/19/16 patients; 31 patients had lymph node involvement. The predominant toxicity was diarrhoea (grade 3/4 in 10/2 patients). Haematologic toxicity and surgical complications were moderate. Among 36 patients undergoing surgery, 32 (89%) had R0 resection and 23 (64%) sphincter preservation. Pathologic complete response (pCR) was achieved in eight (22%) of 36 patients, and 10 patients (28%) had only microscopic residual disease. At 4 years, overall survival was 66%, disease-free survival 73%, local relapse rate 7%, and distant failure rate 24%. Extent of resection and postoperative nodal status were significant predictors of overall and disease-free survival. Intensified neoadjuvant chemoradiotherapy with irinotecan can be safely administered and results in a high pCR rate.