[Peritoneal biofilms: microscopic features]. / Biofilme peritoneale: caracteristici microscopice.

Antibiotherapy remains one of the basic clinical tools, which can influence the evolution of severe peritonitis. Peritoneal biofilm formation may minimize the antibiotic effects due to dramatic growth of Minimum Inhibitory Concentrations (MIC) and Minimum Bactericidal Concentrations (MBC) for matrix-enclosed bacteria. In this paper we demonstrate the presence and evolution of bacterial biofilms on the peritoneal surface during the course of severe secondary peritonitis using an experimental model and clinical material. Cecal Ligation Puncture was performed in 20 mice Swiss Webster. Peritoneal samples were studied at optic and electronic microscope at 10, 24, 48 and 72 hours postoperative. Clinical samples were taken from 10 patients with diffuse peritonitis. At 24 hours after the onset of the peritonitis bacterial colonies were detected on the peritoneal surface. The formation of mature multilayer polymicrobial biofilms with deep penetration in abdominal wall by 48-72 hours was documented. The bacterial biofilms appear in first 24 hours in the course of experimental generalized peritonitis. Our experimental and clinical data demonstrate formation of the mature polymicrobial biofilm in 48-72 hours after the onset of peritonitis. The possibility of resistant biofilm formation in secondary diffuse peritonitis should be taken into consideration in elaboration of treatment schemes.

[Surgical treatment of patients with ulcerative pyloroduodenal stenosis]. / Khirurgicheskoe lechenie bolnykh s iazvennym piloroduodenalnym stenozom.

The article discusses the results of surgical treatment of 342 patients with ulcerative pyloroduodenal stenosis. Selective proximal vagotomy (SPV) and truncal vagotomy (TV) with various operations were conducted in 202 patients, resection of the stomach--in 149 patients. To preserve the pylorus in the presence of anatomical conditions the authors combined SPV with duodenoplasty or pyloroduodenolysis (25 patients). The immediate results were best after vagotomy (0.4% fatal outcomes). Among 140 patients who underwent resection 5 (3.6%) died. Postoperative gastrostasis was encountered most frequently after vagotomy in patients with decompensated stenosis (17%). Bearing in mind marked and stable (up to 3 years) inhibition of gastric bioelectric activity occurring, according to the results of electrogastrography, after SPV, the authors consider decompensated stenosis too be a contraindication for any type of vagotomy. In the late-term period current peptic ulcers were revealed after SPV in 6.2%, after TV in 6.1%, and after resection in 2% of cases. Intraoperative pH measurement is recommended to improve the late-term results after vagotomy; it reduced the incidence of recurrences to 1.6%.

[Effect of proteolytic enzymes on the antimicrobial activity of antibiotics]. / K voprosu o vliianii proteoliticheskikh fermentov na antimikrobnuiu aktivnost' antibiotikov

The results of the studies on the effect of chemotripsin on the antimicrobial activity of monomycin against laboratory cultures, such as Staph. aureus 209 P, E. coli M38 and Streptococcus zymogenes and 20 clinical strains isolated from patients with purulent peritonitis are presented. The studies were performed with the method of two-fold serial dilutions. It was found that chemotripsin decreased 3.2.10-2.6.10(5) times the MIC (minimum inhibitory concentration) and the bactericidal concentration of monomycin. The presence of fibrin in the medium inhibited 4-128 times the antibacterial effect of monomycin. The potentiating effect of chemotripsin on monomycin could be explained by both a better "contact" of the antibiotic with the microbes and an direct increase in the antibiotic sensitivity of the microbial cells. Combination of monomycin with chemotripsin provided the use of decreased doses of the antibiotic. It is an effective means of overcoming the antibiotic resistance in pathogenic microbes.