[Importance of mycoses in intra-abdominal infections]. / Stellenwert der Mykosen bei intraabdominalen Infektionen.

Although there is a 20% yeast colonization in the gastrointestinal tract of the population, fungal infections appear only rarely in secondary peritonitis. The risk of severe mycosis increases after a major operation and when a patient is taking broad-spectrum antibiotics, is on total parenteral nutrition, is catheterized, and/or is immune-suppressed. In the past years the incidence of nosocomial fungal infections (usually Candida spp.) has risen significantly. Five percent of CAPD-related peritonitis is caused by fungi. In enteral anastomosis breakdown, invasive mycosis occurs more often, with an accompanying lethality of up to 80%. In severe pancreatitis, up to 5% of peripancreatic necrosis is infected with fungi. The clinical course of severe mycosis, like the septic syndrome, is associated with fungemia in up to 50% of cases. As most of the facultative pathogenic fungi are part of the physiological flora, it is difficult to interpret mycological cultures. In order to diagnose invasive fungal infections, histopathological techniques and serologic tests for antigens and antibodies are available. Three antifungal agents (amphotericin B, flucytosine, fluconazole) are available for intravenous administration. Amphotericin B is given at doses of up to 1 mg/kg per day, in liposomal galenism up to 3 mg/kg per day. Combining amphotericin B with flucytosine (150-200 mg/kg per day) a synergistic effect is reached. Fluconazole at a dosage of 200-800 mg per day represents an alternative with similar antifungal activity and lower side effects.

[Changes in therapy of severe acute pancreatitis]. / Wandel in der Therapie der schweren akuten Pankreatitis.

Report about the treatment of necrotizing pancreatitis in the years 1988 until 1991. A rigorous conservative therapy was preferred, so that only 8.6% of the 140 patients underwent surgery. In 11 cases a continuous venous-venous hemofiltration (CVVH) was applied to patients with most serious clinical course and multi-system failure. The overall lethality rate of all treated patients was 7.9%. The present results show, that, eliminating mediators by hemofiltration, system failure in connection with sterile necrosis can be treated with a good success rate. Therefore toxic organ failure should no longer be regarded as an imperative indication for operation. We recommend strict intensive care including CVVH and antibiotical prophylaxis for treatment of sterile necrosis, while surgical therapy should only be applied to patients with bacterial contamination of pancreatic necrosis.