Comparison of Concentrations of Sulbactam-Ampicillin Administered by Bolus Injections or Bolus plus Continuous Infusion in Tissues of Patients Undergoing Colorectal Surgery

The concentrations of sulbactam and ampicillin were determined in sera and different abdominal tissues of 16 patients who underwent elective colorectal surgery. Patients were randomly allocated to two groups. At the time of induction of anesthesia, patients in group 1 (eight patients) were given 1,000 mg of sulbactam with 2,000 mg of ampicillin by intravenous bolus injection (3 min). This dose was administered again after 2 h by bolus injection by the same route. Patients in group 2 (eight patients) were given the same initial dose of sulbactam-ampicillin by bolus injection (3 min). Then, a continuous infusion of 1,000 mg of sulbactam with 2,000 mg of ampicillin in normal saline was immediately started and was administered over a 4-h period. Blood samples were collected to determine peak (10 min) and trough (end of surgery) antibiotic levels. Serial blood samples were also collected at predetermined periods (at the time of opening and closing of the abdominal cavity and at the time of surgical anastomosis). Abdominal wall fat, epiploic fat, and colonic wall tissue samples were collected simultaneously. Antibiotic concentrations were determined by high-performance liquid chromatography. Similar levels of the drugs in serum were observed for the two regimens of administration, with trough sulbactam levels of 33 ± 16 and 37 ± 22 μg/ml in groups 1 and 2, respectively, and trough ampicillin levels of 72 ± 55 and 79 ± 47 μg/ml in groups 1 and 2, respectively. Similar sulbactam concentrations were observed in abdominal tissues whichever regimen of administration was used; in fatty tissues the sulbactam concentrations ranged from 2.7 to 3.8 μg/g for group 1 and from 1.7 to 4.0 μg/g for group 2, and sulbactam concentrations in the colonic wall were 5.6 ± 7.7 and 6.8 ± 3.2 μg/g in groups 1 and 2, respectively (not significant). Again, no influence of the regimen of administration was observed on tissue ampicillin concentrations; in fatty tissues ampicillin concentrations ranged from 4.1 to 5.4 μg/g for group 1 and from 3.2 to 5.8 μg/g for group 2, and sulbactam concentrations in the colonic wall were 7.0 ± 2.8 and 11.0 ± 4.7 μg/g for groups 1 and 2, respectively (not significant). In most patients, the concentrations of ampicillin-sulbactam were greater than the MIC at which 50% of isolates are inhibited (MIC₅₀) for Bacteroides fragilis in the fatty tissues. In the colonic wall, for most patients the concentrations of ampicillin-sulbactam were greater than the MIC₉₀ for B. fragilis. No influence of the regimen of administration was observed on the ratio of the two components in the tissues investigated and in sera. In conclusion, a second intraoperative bolus injection or a continuous infusion were equally effective in maintaining sulbactam-ampicillin concentrations in abdominal tissues. The first method of administration can be recommended since it is easier to handle.     

Reliability of patient self‐evaluation of swollen and tender joints in rheumatoid arthritis: A comparison study with ultrasonography,physician, and nurse assessments

Objective

Swollen and tender joints, important in assessing rheumatoid arthritis (RA) activity, have traditionally been evaluated by health professionals. Whether patients can accurately evaluate joints is uncertain. This study evaluated 1) the reliability of patient‐assessed swollen joint counts (SJCs) and tender joint counts (TJCs) versus those assessed by a physician, nurse, and B‐mode ultrasonography (US) and 2) patient‐derived Disease Activity Score in 28 joints (DAS28) compared with physician‐, nurse‐, and US‐derived DAS28.

Methods

Fifty RA patients self‐assessed 28 joints (shoulders, elbows, wrists, metacarpophalangeal, proximal interphalangeal, and knees) for swelling and tenderness. They were then assessed separately by a physician, a nurse, and an ultrasonographer. Nine patients were tested twice (intraobserver reliability), and reliability was assessed at the patient level (28 joints) by intraclass correlation coefficients (ICCs) and at the joint level by prevalence‐adjusted bias‐adjusted kappa.

Results

TJC reliability was good for patient versus physician (ICC 0.85 [95% confidence interval (95% CI) 0.65, 0.94]) and patient versus nurse (ICC 0.76 [95% CI 0.47, 0.90]). However, SJC reliability was poor for patient versus physician (ICC 0.41 [95% CI ?0.05, 0.72]) and patient versus nurse (ICC 0.44 [95% CI ?0.005, 0.74]). SJC reliability was poor in all assessors compared with B‐mode US, particularly patient‐assessed SJC (ICC 0.22 [95% CI ?0.25, 0.61]). However, patient‐derived DAS28 correlated well with US‐derived DAS28 (ICC 0.95 [95% CI 0.87, 0.98]). Intraobserver reliability was good for all assessors for TJC, but was lower for SJC.

Conclusion

Patient‐derived DAS28 is at least as reliable as physician‐, nurse‐, or US‐derived DAS28, despite poor reliability in patient‐assessed SJC.

     

Four hundred and twenty‐three consecutive adults piggy‐back liver transplantations with the three suprahepatic veins: Was the portal systemic shunt required?

Background and Aims: The aim of this study is to analyze a single‐center experience in orthotopic liver transplantation with the piggy‐back technique (PB) realized with a cuff of three veins without temporary portacaval shunt. Outcome parameters were graft and patient survival and the surgical complications. Methods: The records of 423 liver transplantation in 396 adult recipients were reviewed. PB was performed in all cases also in patients with transjugular intrahepatic portosystemic shunts and redo transplants without temporary portacaval shunt. No hemodynamic instability was observed during venous reconstruction. Results: Operation time, cold ischemia time and anhepatic phase were, respectively, 316, 606 and 82 min, respectively. The mean intraoperative transfusion of packed red blood cells was 3.2 (range 1–48). Surgical complications were observed in 25% of the orthotopic liver transplantation and 2% of these was related to caval anastomosis. No case of caval thrombosis was observed; a stenosis was noted in seven patients, always treated with an endovascular approach. A postoperative ascites was observed in seven cases. Retransplantation was required in 6.3% patients. Overall in‐hospital mortality was 5.3%, but no patient died through technical problems or complications related to PB procedure. One‐, 3‐ and 5‐year grafts and patients were 94%, 83% and 75%, and 92%, 86% and 79%, respectively. Conclusion: This experience indicates that our approach is feasible with a low specific risk and can be performed without portacaval shunt, with minimal outflow venous complications.     

Clinical trial of a leucotriene B4 receptor antagonist, BIIL 284, in patients with rheumatoid arthritis

BACKGROUND: Several clinical and experimental lines of evidence suggest that leucotriene B4 (LTB4), an arachidonic acid derivative with potent proinflammatory properties, plays a key role in the pathophysiology of rheumatoid arthritis (RA). OBJECTIVE: To evaluate the efficacy and safety of BIIL 284, an oral long-acting LTB4 receptor antagonist, as monotherapy for the treatment of patients with active RA. METHODS: This was a multi-centre, randomised, double-blind, placebo-controlled trial of patients with active RA of 3 months' duration. A total of 342 patients were randomised to receive 5 mg, 25 mg or 75 mg of BIIL 284 or placebo. The primary end point was the percentage of patients achieving an American College of Rheumatology (ACR) 20. RESULTS: Although a higher percentage of ACR 20 responders was observed in the groups treated with 25 mg and 75 mg of BIIL 284 compared with those treated with placebo, no statistically significant differences were found between any of the three active treatment groups compared with the placebo group with regard to the primary or secondary end points. All trial treatments were safe and well tolerated. CONCLUSIONS: This clinical trial demonstrates that treatment of patients with active RA with a potent oral long-acting LTB4 receptor antagonist produced only modest improvements in disease activity. The results of this trial support the conclusion that LTB4 is not a major contributor to the inflammatory process in RA.     

Anterior cranial fossa dural arteriovenous fistula: Transarterial embolization from the ophthalmic artery as first-line treatment

ObjectiveTo retrospectively review the outcome of patients with dural arteriovenous fistula of the anterior cranial fossa (afDAVF) treated by transarterial embolization.Material and methodsSix consecutive patients were referred to our hospital for afDAVF treatment. After a multidisciplinary discussion, they underwent endovascular embolization with Onyx injection through the ophthalmic artery. Their clinical presentation, management and outcomes were retrospectively assessed.ResultsAll interventions were performed with the liquid embolic agent Onyx through the transarterial route from the ophthalmic artery to access the fistulous point. All patients showed a good outcome with complete afDAVF obliteration.ConclusionThis study demonstrates that afDAVFs can be safely and completely obliterated by transarterial embolization via the ophthalmic artery.     

Synthesis and Evaluation of 1,ω‐Bis(1,2,3,5‐thiatriazol‐5‐yl)alkanes as In Vitro and In Vivo α‐Amylase and Lipase Inhibitors

Thionyl chloride reacts with 1,ω‐bis‐(1‐tosylamidrazone)alkanes 1 to give a series of 1,ω‐bis‐(4‐alkyl‐2‐tosyl‐1,2,3,5‐thiatriazol‐5‐yl)alkanes 2 . All the newly synthesized compounds were characterized by IR, ¹H NMR, ¹³C NMR, elemental analysis, and ESI–MS spectral data. All the new compounds were screened for their inhibitory effect on key enzymes related to diabetes and obesity, such as α‐amylase and lipase. In vitro and in vivo studies revealed that these thiatriazole derivatives exert an inhibitory action against these key enzymes. Moreover the administration of these compounds to surviving diabetic rats induced a significant decrease in plasma glucose level. Additively 2d significantly protected the liver–kidney functions and modulated lipid metabolism, which were evidenced by the decrease in aspartate transaminase (AST), alanine transaminase (ALT), and gamma‐glutamyl transpeptidase (GGT) activities and creatinine, urea albumin, LDL‐cholesterol and triglycerides levels as well as an increase in the HDL‐cholesterol level in surviving diabetic rats. Overall, the findings of the current study indicate that 2d exhibits attractive properties and can, therefore, be considered for future application in the development of anti‐diabetic and hypolipidemic drugs.     

Coronary artery bypass in myocardial ischemia of the young due to hydatid cyst

Abstract   Cardiac hydatid cyst is an uncommon disease, especially in France. It is rarely responsible for myocardial ischemia, and even more rarely in the young. We report the clinical features and imaging of a 24-year-old Tunisian woman with hydatid cyst of the free wall of the left ventricle responsible for myocardial ischemia, associated with a hepatic hydatid cyst. Management consisted of a combination of surgery with cystopericystectomy and coronary artery bypass graft and prolonged medical treatment as for treatment of hepatic hydatid cyst. Three-year follow-up revealed no recurrence. This case illustrates two interesting points: the rare clinical presentation of cardiac hydatid cyst with a coronary syndrome in a young 24-year-old woman related to compression of the left anterior descending artery by the cyst with a need for coronary artery bypass graft after resection of the cyst, and the value of medical treatment of hydatid disease, even for cardiac localization.