The tissue penetration of intravenous piperacillin (4 g) into the colonic structures was investigated in 18 patients (7 men, 11 women, 61 +/- 16 years old) undergoing colorectal surgery for a lieberkuhnian adenocarcinoma. In the peri-colonic ganglions, mean piperacillin concentrations were 25.6 +/- 21.5 and 18.0 +/- 21.5 mu g/g respectively 41.9 +/- 13.7 and 91.1 +/- 26.1 minutes after administration. In the colonic wall, concentrations were 26.9 +/- 24.5 and 11.9 +/- 12.6 mu g/g respectively 91.1 +/- 26.1 and 171.6 +/- 26.7 minutes after administration. These concentrations are clearly above the MICs90 of piperacillin against pathogens targeted by the antibioprophylaxis in colorectal surgery, i.e. Enterobacteriaceae, Enterococcus spp and Bacteroides fragilis.

Two cases are reported of cardiac herniation complicating intrapericardial pneumonectomy in the early postoperative period. Both patients had a radical pneumonectomy for right-sided bronchial carcinoma invading, in one patient, the carina and the superior vena cava. The pericardial defect, made necessary by the surgical procedure, had not been closed in either patient. About two hours after the end of surgery, both patients, lying supine, developed a state of shock, with tachycardia and arterial hypotension. The diagnosis of cardiac herniation was made in both cases on the chest film. Placing the patient on his left side was only partly efficient in one patient, slowing the heart rate from 160 b.min-1 to 120 b.min-1 and increasing the systolic blood pressure (from 60 mmHg to 80 mmHg). Both patients therefore required to be operated on again. In one patient, the heart had completely herniated through the pericardial defect, and had turned to the right side about the vena caval axis; in the other patient, partly improved by being turned to his left, the heart had returned to its normal position. The pericardial defects were closed in both cases with a strip of dura mater previously treated with 2 (ethyl-mercurithiol-5-benzoxazol) carboxylic acid. The immediate postoperative course was uneventful. Unexpected symptoms and signs occurring in the early postoperative period after intrapericardial pneumonectomy must imperatively lead to carrying out a chest X-ray.

Two cases are reported of cardiac herniation complicating intrapericardial pneumonectomy in the early postoperative period. Both patients had a radical pneumonectomy for right-sided bronchial carcinoma invading, in one patient, the carina and the superior vena cava. The pericardial defect, made necessary by the surgical procedure, had not been closed in either patient. About two hours after the end of surgery, both patients, lying supine, developed a state of shock, with tachycardia and arterial hypotension. The diagnosis of cardiac herniation was made in both cases on the chest film. Placing the patient on his left side was only partly efficient in one patient, slowing the heart rate from 160 b.min-1 to 120 b.min-1 and increasing the systolic blood pressure (from 60 mmHg to 80 mmHg). Both patients therefore required to be operated on again. In one patient, the heart had completely herniated through the pericardial defect, and had turned to the right side about the vena caval axis; in the other patient, partly improved by being turned to his left, the heart had returned to its normal position. The pericardial defects were closed in both cases with a strip of dura mater previously treated with 2 (ethyl-mercurithiol-5-benzoxazol) carboxylic acid. The immediate postoperative course was uneventful. Unexpected symptoms and sign occurring in the early postoperative period after intrapericardial pneumonectomy must imperatively lead to carrying out a chest X-ray.

In a bacteriology laboratory where automated and non-automated procedures co-existed during the study period (1 year), patients were randomly assigned to each type of procedure and we observed the physicians behaviour as well as patients well-being in a surgical service using the results from the laboratory. Contrary to our expectations, the reduction in the time delay necessary to obtain information did not alter either the prescribing behaviour of physicians nor the welfare of patients. Besides, the gain in time was significantly lower than expected. We also discuss in detail the meaning and relevance of the results.

With automated analysers, bacterial identification and susceptibility testing can be performed in 4-5 hours instead of 12-18 hours with conventional methods. A controlled trial was carried out in the surgical ward of a university hospital to evaluate the clinical repercussions of these rapid methods. The automated analyser reduced delays in the laboratory by about 25%, and optimizing information transfer from laboratory to ward brought the reduction up to 50%. It was found that earlier results of susceptibility testing modified prescriptions and this may be expected to result in a more rational use of antibiotics.

An accurate, quick, and reproducible method to assay serum lipase activity allowed a parallel study of lipase and amylase in 147 patients. Lipase appeared very specific of pancreatic distress. In acute pancreatitis its increase was constant, frank, quick and lasting. It brought a diagnostic argument superior to the dosages of amylase activities in serum and/or urine. But its value as an evolutive and pronostic test was as much limited. Its interest as a negative argument for differential diagnosis was not superior either. In chronic pancreatic diseases, it gave evidence of massive spread or complications.