Schweizerische medizinische Wochenschrift. Supplementum
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Schweiz Med Wochenschr Suppl · Jan 1996
Review[Treatment of severe infections: should one always administer an aminoglycoside?].
Until recently, aminoglycoside antibiotics were the cornerstone for the treatment of severe infections. The rationale for using combination therapy containing beta-lactams and aminoglycosides was not only to broaden the antimicrobial spectrum but also to achieve enhanced bacterial killing by synergism and to prevent the emergence of antibiotic resistance. ⋯ A review of the literature suggests that the addition of an aminoglycoside to a broad-spectrum beta-lactam does not improve the outcome in nosocomial pneumonia and severe diffuse peritonitis. However, the lack of large prospective studies in severe sepsis or septic shock makes it impossible to draw any conclusion about the addition of an aminoglycoside, and the administration of these agents must be decided on an individual basis.
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Schweiz Med Wochenschr Suppl · Jan 1996
[Endoscopic therapy of bile leakage following laparoscopic cholecystectomy].
Biliary leakages are more frequent in laparoscopic than in open cholecystectomy. The aim of our study was to evaluate the diagnostic and therapeutic value of endoscopic retrograde cholangiography (ERC) in the management of bile leakages after laparoscopic cholecystectomy. The primary management was endoscopic sphincterotomy and extraction of remaining gallstones in the common bile duct to provide a decrease of biliary pressure, allowing closure of the fistulas. ⋯ Five of these procedures were performed within 7 days of ERCP, in most cases due to persistent bile leak. We conclude that biliary leakages after laparoscopic cholecystectomy require laparotomy only exceptionally. Endoscopic sphincterotomy, combined with percutaneous drainage in the case of large collections, represents a safe and successful strategy ensuring closure of the leaks in most cases.