Pharmacokinetics and pharmacodynamics of ciprofloxacin in critically ill patients after the first intravenous administration of 400 mg.

PURPOSE: To investigate the pharmacokinetics and pharmacodynamics of ciprofloxacin in critically ill patients after the first intravenous administration of 400 mg. MATERIAL/METHODS: Plasma concentrations were measured in 20 critically ill patients (mean [SD]; age, 55.5 [16.5] years; weight, 80.3 [16.9] kg; and creatinine clearance, 110.0 [71.5] mL/min). Four blood samples were drawn at the following time points 0, 0.5, 6 , 8 hours after infusion. Ciprofloxacin concentrations were determined by high-performance liquid chromatography. RESULTS: In the cases where ciprofloxacin was applied in targeted antibiotic therapy the minimum inhibitory concentrations (MIC) were ≤0.5 mg/l. The maximum and minimum plasma concentrations of ciprofloxacin were 1.74 (0.58-7.90) and 0.45 (0.16-2.96) mg/l, respectively. The main pharmacokinetic parameters for ciprofloxacin in the analyzed patients were as follows: k(el), 0.21 h-1; t(1/2kel), 3.37 h; AUC(0-inf), 10.10 mg×h/l; AUMC(0-last), 15.36 mg×h(2)/l; MRT, 1.71 h; V(d), 214.8 l; Cl, 39.70 l/h. Considering the maximum value of MIC (0.5 mg/l) only 30% and 25% of analyzed patients had desired values of the PK/PD indexes AUIC>125 and C(max) /MIC>10, respectively. CONCLUSIONS: The target plasma concentrations after the first dose of ciprofloxacin were reached only in a few critically ill patients. Considerable inter-subject variability for PK/PD parameters in ICU patients requires systematic monitoring.

Influence of long-term used herbicides on resistance development in Apera spica-venti L. to sulfonylureas.

Sulfonylurea herbicides are widely used for grass and broadleaf weed control in winter cereals in Poland developed resistance, especially in Silky bent grass (Apera spica-venti). The aim of the study was to evaluate the possibility of resistance increase after six years used of some herbicide for control of A. spica-venti in winter cereals monoculture. The field experiments were conducted in Agricultural Experimental Station at Winna Gora. During six years the herbicides: chlorsulfuron, sulfosulfuron, iodosulfuron and isoproturon were applied. In fourth, fifth and sixth years A. spica-venti seed from the experiment was collected and used in greenhouse experiment. The obtained results indicated that after six years usage of the herbicides resistance of A. spica-venti to sulfonylurea herbicides were found. Results obtained in field condition were confirmed in greenhouse experiment. Resistance process was found also on untreated plots. It was indicated that resistance is transferred also by pollen.

[45 years of experience in surgical treatment for cancer of the large intestine]. / 45 lat doswiadczen w chirurgicznym leczeniu raka jelita grubego.

The aim of the study was to evaluate the results of surgical treatment of colorectal cancer during 45 years of existence of the Department. In this time 1478 cases of rectal cancer and 1008 cases of colon cancer were operated on. Most commonly the diseases occurred between the sixth and seventh decade of live (32.8%). Histology revealed tubular adenocarcinoma in 83.3% of the cases, mucinous adenocarcinoma in 13.5% and other types in 3.2%. The choice of the surgical procedure was based on the individual characteristics of each case, including: localisation of the tumor, histological type, clinical staging, sex of the patient, obesity and overall operative risk. The tumor was localised less then 10 cm above the anal verge in 70% of the patients with rectal cancer. Well differentiated carcinomas (G1) were seen in 32% of the patients, moderately differentiated carcinomas (G2) in 57% and poorly differentiated (G3) in 11%. Curative resections were performed in 64.7% of the patients (1608 cases) and palliative procedures in 35.3% of the patients (878 cases). The mortality rate after curative surgery was 6% and after palliative procedures 5%. The use of combined therapy consisting of surgical treatment and chemo- or radiotherapy allowed for obtaining five years survival rate of 57.4%, local recurrences were seen in 21% of patients. Analysing our own material we evaluated the radicality of different types of operations and the possibility of preserving the sphincter apparatus.

[Surgical procedure in fulminant colitis and toxic megacolon]. / Postepowanie chirurgiczne w colitis fulminant oraz toxic megacolon.

Both fulminant colitis and toxic megacolon are regarded as the sequelae of colitis in which irreversible changes in the whole thickness of colonic wall have occurred. These condition both call for an immediate, emergent surgical intervention. Until recently the procedure of choice in this acute phase of the disease was colectomy with Brooke ileostomy and Hartmann type closure of the distal rectum. Colectomy with ileal pouch anal anastomosis was reserved only for elective surgery. The improvement in surgical technique, but first of all widespread of stapling devices, have shortened the time of operation and simplified the procedure, so that creation of an ileal reservoir is currently more often performed as a one step procedure and without an increased risk. Between 1985 and 1997 in our Department, 120 patients had ileal pouches created for various conditions. There were 72 patients with ulcerative colitis in this series and 10 of them had-one-step procedure involving pouch formation in the acute phase of the disease. Multi-step procedures, including Hartmann's colectomies were performed in 16 patients. One-step operations involving ileal pouch creation in the acute phase of the ulcerative colitis are feasible in selected cases and in experienced centres. Such an approach shortens the time of treatment.