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Biomedical subjects

R Germiniani

Publications and source records attributed to R Germiniani.

At least 19 recordsLinked to original sources

[Frequency of surgical wound infections in patients treated with a barrier procedure. Multicentric study].

In 3088 patients submitted to various surgical procedures an open clinical trial was carried out to evaluate the rare of surgical wound infections (SWI). All of them were treated, before and after surgery, with a foam emulsion (Bioshield) considered, from a theoretical point of view, to be able decrease the bacterial contamination of the surgical wounds. The SWI rate was really low (congruent to 2.3%) and a favorable role played by Bioshield cannot be excluded, both minimizing the skin lesions of the surgeon's hands and reducing wound contamination by exogenous flora.

Adolescent

[Evolution of the bacteria responsible for surgical infection. n 8-year study in our department].

Since 1981 we monitored all the bacteria strains isolated from patients bearing a surgical infection and hospitalized in our department. We also tested the susceptibility of the isolated strains to different antibiotics. The observed results at three different intervals (1981, 1984, 1987-1988) reveal an increase in Gram+strains. Among the tested antibiotics Imipenem and Amikacin showed the highest antibacterial activity in recent years (1987-1988).

Amikacin

[Sulbactam-ampicillin in surgery. Our experience].

The bacterial infections constitute a serious problem for the surgeon: the choice of antibiotic drugs is really important and, as often as possible, should be guided by antibiotic sensitivity tests. In this study we used sulbactam-ampicillin (Unasyn) who is an antibiotic combination between sulbactam, inhibitor of beta lactam and ampicillin. The preliminary results were as follows: Unasyn was administered to 21 hospitalized selected patients, 16 women and 5 man, who had clinical signs of intraabdominal infection, wound infection and subphrenic abscess after digestive surgery. In these patients were isolated the following organisms: Staphylococcus epidermidis (8), Staphylococcus aureus (11), serratia (1), streptococcus (3), E. coli (3). The daily dosage of Unasyn was 3-12 g/die administered in three to four divided doses, and was determined by the severity of infection, the antibiotic susceptibility of the causative organism(s) and the condition of the patient. Each dose was given by slow i.v. infusion in 15-30 minutes. Our success rate was 100%, and neither systemic nor local side effects were recorded.

Adult

Prevention and control of surgical infections.

Surveillance and control of hospital infections are two particularly important aspects of the surgical ward, and great activity is necessary in the identification and the elimination of the risk factors whenever possible. Today the rational use of antibiotics, in both the prevention and treatment of infections, should be used to avoid or limit nosocomial infections, and it is as important as the use of disinfectants. Cefotetan has been studied in different surgical specialties in prophylaxis and treatment of postoperative infections for its particularly broad spectrum of activity, covering both aerobic and anaerobic organisms, and for the very low incidence of side-effects. In general surgery, Cefotetan has proved able to reduce not only the occurrence of surgical wound infections, but also that of postoperative infections of the genitourinary system.

Cefotetan

Adjuvant chemotherapy with fluorouracil and CCNU in colon cancer. Results of a multicentric randomized study.

To establish the effectiveness of adjuvant chemotherapy in patients with colon cancer after radical surgery, from 1980 to December 1983, 263 patients were randomized in a multicentric study to no further treatment (131 patients) or to a combination of fluorouracil (5-FU) (400 mg/m2 i.v., days 1-5) and lomustine (CCNU) (100 mg/m2 per os on day 5) every 6 weeks for 9 cycles (132 patients). The two groups were well balanced for age, sex, histology, tumor and nodal extent. Chemotherapy was not given to 30 of the 132 randomized patients, and of 98 treated patients only 38 completed the entire protocol. Analysis, as intention to treat, at 54 months did not show any significant difference between the two treatment groups in terms of relapse-free survival (surgery alone, 74.5%; surgery + adjuvant chemotherapy, 70.9%; p = 0.91). In contrast, a significant difference was observed in overall survival (surgery alone, 78.8%; surgery + adjuvant chemotherapy, 60.8%; p = 0.04). The sites of relapse were identical in the two treatment arms. In conclusion, from this study it appears that adjuvant chemotherapy with 5-FU and CCNU seems to have no efficacy in the cure rate of colon cancer patients.

Aged

Treatment of postoperative infections with a single daily dose of ceftriaxone: analysis of international issues.

The results of 13 clinical trials were analysed in order to define the efficacy of ceftriaxone (Rocephin) when given alone and in a single daily dose in the treatment of postoperative infections. In a total of 306 evaluable patients, many of whom were suffering from severe infections, the global clinical success rate was about 90%. The drug was very well tolerated. Minor transient effects occurred only in a few patients. In 8 out of the 13 trials, ceftriaxone was compared with other standard antibiotics. In these comparative studies, the global clinical success rate with ceftriaxone (93.8%) was higher than with other drugs (81%). The microbiological response to ceftriaxone was extremely satisfactory for almost all pathogenes.

Anti-Bacterial Agents

Effect of bile salts on carbonic anhydrase from rat and human gastric mucosa.

Gastric carbonic anhydrase (CA) is believed to play an important role related to cytoprotection, and duodenogastric reflux of bile salts (BS) is suspected of having a causal role in many pathologic conditions. Thus, we decided to investigate the effect of free and conjugated BS on human and rat gastric CA activity. Cholate exerted the most potent inhibitory activity on both human (I50 = 2.24 mM) and rat (I50 = 1.68 mM) gastric CA, followed by glycochenodeoxycholate and taurocholate (I50 = 6.90 mM and 13.67 mM on rat gastric CA). Human and rat whole bile produced 10-90% and 20-40% inhibition of gastric CA of the same species. Since the concentrations of free and conjugated BS tested in this study can be found in the postgastrectomized stomach, our data suggest that inhibition of gastric CA might be one mechanism contributing to the gastric mucosa damage caused by BS refluxing into the stomach after gastric surgery.

Animals

Effectiveness of defibrotide for prophylaxis of deep venous thrombosis after general surgery: a double-blind, placebo-controlled clinical trial.

The prophylactic activity of defibrotide, a new extractive antithrombotic-thrombolytic agent of mammalian origin, was assessed by detection of deep venous thrombosis (DVT) in patients who underwent general elective surgery. 120 patients (aged 25-85 years, mean 55.6) were randomly assigned to defibrotide (60 patients) or to placebo (60 patients). The two groups were homogeneous for age, sex and risk factors for DVT. The active drug was given intravenously 200 mg four times a day, starting the day before the operation and then for the following 7 days. To detect DVT, 125I-fibrinogen was used, by conventional methods. Defibrotide reduced the frequency of DVT to 4/60 (7%) from 16/60 (27%) in the placebo group. The difference was highly significant (p less than 0.01). Neither side effects nor anticoagulant activity were observed. On the basis of this evidence, defibrotide may be considered an effective and well-tolerated drug for prevention of DVT.

Adult

Effects of buflomedil in a group of patients with chronic peripheral arterial diseases. Clinical and hemorheological evaluation.

Fifty-three patients suffering from chronic arterial diseases of the lower limbs were treated with buflomedil, a vasoactive drug with vasodilating and hemorheological action on the microcirculation. The patients suffered from pain on walking or pain at rest; they were given 300 mg buflomedil orally twice a day for a period of about 2 months. The walking distance before pain onset was checked in all patients before and after the trial. Blood and plasma viscosity, haematocrit and fibrinogen and a Doppler velocimetry were also recorded. A significant improvement of the walking distance before pain onset was observed in nearly all patients, and in most patients the morphology of the velocity waves improved, too. No clear correlation between the positive clinical results and the hemorheological parameters studied could be observed.

Aged