A prospective, double-blind, multicenter, randomized trial comparing ertapenem 3 vs >or=5 days in community-acquired intraabdominal infection.

Severe secondary peritonitis is diagnosed in only 20-30% of all patients, but studies to date have persisted in using a standard fixed duration of antibiotic therapy. This prospective, double-blind, multicenter, randomized clinical study compared the clinical and bacteriological efficacy and tolerability of ertapenem (1 g/day) 3 days (group I) vs >or=5 days (group II) in 111 patients with localized peritonitis (appendicitis vs non-appendicitis) of mild to moderate severity, requiring surgical intervention. In evaluable patients, the clinical response as primary efficacy outcome were assessed at the test-of-cure 2 and 4 weeks after discontinuation of antibacterial therapy. Ninety patients were evaluable. In groups I and II, 92.9 and 89.6% of patients were cured, respectively; 95.3% in group I and 93.7% in group II showed eradication. These differences were not statistically significant. The most frequent bacteria recovered were Escherichia coli and Bacteroides fragilis. A wound infection developed in seven patients (7.7%) and an intraabdominal infection in one patient (1.1%). There was a low frequency of drug-related clinical or laboratory adverse effects in both groups. Our study demonstrated that, in patients with localized community-acquired intraabdominal infection, a 3-day course of ertapenem had the same clinical and bacteriological efficacy as a standard duration.

Small bowel obstruction by mesh migration after umbilical hernia repair.

A case of intestinal obstruction due to mesh migration is described. A 61 year old patient affected by BPCO and chronic atrial fibrillation is admitted for mechanical intestinal obstruction. He underwent a umbilical hernia repair with mesh and omphalectomy 6 years before. Laparotomy revealed the obstruction due to an inflammatory block including polypropylene mesh penetrating an ileal loop. Intestinal resection and mechanical isoperistaltic L-L anastomosis is performed. The post-operative period is complicated by cardiorespiratory problems and the patient comes discharged in XVII day. The prosthesis migration after umbilical hernia repair is an event never described in the literature; instead rare cases of migration after inguinal hernia repair are reported. The pathophysiological mechanisms of this complication are not still cleared and that makes necessary a careful technique in the use of the hernia mesh.

[Inferior vena cava gunshot injury: case report and a review of the literature]. / Lesione cavale inferiore da ferita d'arma da fuoco. Caso clinico e revisione della letteratura.

Inferior vena-cava (IVC) injuries are uncommon but mortality is high, despite the improved organization and technical skills. The most important prognostic factors are the grade of hemorragic shock, the anatomical level of caval injury and the associated vascular lesions. Supra and retro-hepatic lacerations have the worst prognosis and their management is more difficult, as it's sometimes necessary performing complicated and high mortality related procedures, such as atrio-caval shunt and total vascular occlusion. Still controversial is the management of retroperitoneal hematomas due to suspect caval laceration. Non-operative treatment can represent a good option in non-pulsatile hematomas, while packing can be performed in case of very poor hemodynamic condition, delaying definitive surgical treatment. Vascular repair by primary venorrhaphy can usually be performed, sometimes a patch is to be used. Infrarenal cava ligation can be an acceptable, significant complication free option. Caval thrombosis and pulmonary embolism represent the most important but uncommon complications. US and CT-scan are used in non-invasive follow-up of injuried IVC but timing is still controversial.