Peritonitis postoperatorias / Postoperative peritonitis

Las infecciones postoperatorias de la cavidad abdominal son infecciones graves con alta morbilidad y mortalidad que pueden producirse por contaminación masiva de la cavidad peritoneal durante la intervención quirúrgica o por fallo de la anastomosis. Desde un punto de vista microbiológico, diferentes tipos de gérmenes aerobios grampositivos y negativos, así como microorganismos anaerobios, pueden ser aislados como causantes de las mismas. Habitualmente se trata de infecciones polimicrobianas. Durante los últimos años se ha incrementado de manera notoria el aislamiento de Enterococcus y hongos, especialmente del género Candida, en este tipo de infecciones. El principio fundamental para su tratamiento es realizar una eliminación correcta del foco causante de la contaminación bacteriana bien sea por vía quirúrgica o por drenaje percutáneo. Paralelamente, es imprescindible para el cirujano utilizar un tratamiento antibiótico adecuado, que tenga un amplio espectro antibacteriano para cubrir tanto las bacterias aerobias grampositivas y negativas como las anaerobias. En el momento actual, se dispone de diversas alternativas antibióticas, varias de ellas incluyen la posibilidad de realizar una monoterapia altamente eficaz (AU)

Tumor adrenal. Una manifestación extracolónica infrecuente en la poliposis adenomatosa familiar / Adrenal tumour. An infrequent extracolonic manifestation of the familial adenomatous polyposis

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Botulinum toxin for the treatment of anal fissure.

BACKGROUND: The classic treatment for uncomplicated anal fissure is surgical sphincterotomy, i.e. cutting of the internal anal sphincter, thus eliminating spasm of this muscle and breaking the vicious circle of pain, spasm and inflammation. Recently, however, botulinum toxin has become available for the treatment of muscular dystonias, and thus for anal fissure. In the present study, we investigated the effectiveness of treatment with botulinum toxin in 76 patients with uncomplicated anal fissure. MATERIAL AND METHOD: The 76 patients received an injection of 40 U of botulinum toxin on each side of the fissure. Response was monitored 7, 30 and 90 days later. All patients who did not show clear improvement after 30 days received a second dose of 40 U on each side. RESULTS: After 90 days, 51 patients (67%) showed complete recovery, 19 patients (25%) substantial improvement though not complete recovery, and 6 patients (8%) no significant improvement. Transitory gas incontinence was reported by 2 patients (2.6%), and 1 patient presented hemorrhoidal thrombosis. DISCUSSION: Botulinum toxin enables chemical denervation of the internal sphincter, facilitating healing of the anal fissure. Its principal advantages with respect to surgical sphincterotomy are the absence of the general risks of surgery, and reduced incidence of incontinence, which even if it occurs tends to be transitory. The technique does not require hospitalization and is well tolerated. It appears suitable for the initial treatment of uncomplicated anal fissure, reserving surgical treatment for those cases which fail to response adequately.

[Meropenem in the treatment of surgical intra-abdominal infections]. / Meropenem en el tratamiento de la infección intraabdominal quirúrgica.

Intraabdominal infections are severe with a high morbidity and mortality which may be produced by multiple causes: perforation of the empty viscera, intestinal inflammatory processes, vascular pictures, abdominal traumatisms as a consequence of surgery. From a microbiologic point of view, different types of gram positive and gram negative aerobes such as anaerobe microorganisms or fungi may be isolated as causes. Polymicrobial infections are usually observed. The main treatment policy is to correctly eliminate the causing foci of the bacterial contamination whether surgically of by percutaneous drainage. Parallelly, it is essential for the surgeon to use appropriate antibiotic treatment. Meropenem, a carbapenem, has a wide spectrum antibacterial activity which cover gram positive and gram negative aerobes in addition to anaerobes leading to scarce adverse reactions. All the above leads meropenem to be a very effective alternative in both the treatment of these infections as monotherapy and for initiating empiric therapy.