Cholecystoduodenal fistula with impending gallstone ileus.
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Biomedical subjects
Publications and source records attributed to P D Clarke.
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In vitro studies carried out in this Department confirmed the high activity of mecillinam against Salmonella spp. As a result we set up a study to investigate the efficacy of mecillinam in patients suffering from enteric fever. To date 13 out of 15 patients with typhoid or paratyphoid fever have been successfully treated with this new amidinopenicillanic acid antibiotic.
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A case of histiocytic medullary reticulosis in a 45-year-old man is described. The presentation with a swinging pyrexia is typical. Associated features were very low levels of all immunoglobulins and proved disseminated intravascular coagulation. Heparin therapy was given and the difficulties of controlling such treatment are demonstrated. It is concluded that an increased awareness of the condition as a cause of pyrexia might lead to an improvement in prognosis.
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Mecillinam is a new antibiotic related to the penicillins but more active than ampicillin against salmonellae, including Salmonella typhi. Mecillinam must be administered parenterally, but the ester, pivmecillinam, is absorbed from the gut. Eight patients suffering from typhoid fever and one suffering from paratyphoid fever were treated with the antibiotic, and seven responded satisfactorily. One patient could not tolerate pivmecillinam because of vomiting but there were no other adverse reactions. Serum and bile levels of mecillinam were many times the minimum inhibitory concentrations for most salmonellae. The antibiotic is a promising addition to the agents available for treating typhoid.
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In a case of gangrene, CT demonstrated a thin-walled appendix, dilated with gas. Such a presentation has not previously been described in the CT literature.
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