In vitro activity of azthreonam, a monobactam antibiotic

We studied the activity of azthreonam (SQ 26,776), a novel monocyclic beta-lactam compound, against a variety of clinical isolates. It was more potent than moxalactam, cefoperazone, cefamandole, cefoxitin, ticarcillin, tobramycin, or amikacin against strains of Klebsiella spp., Serratia spp., and the Proteus group. It was highly effective against Escherichia coli and strains of Salmonella spp. The median minimal inhibitory concentration for all species of Enterobacteriaceae was less than or equal to 2 micrograms/ml. Azthreonam was moderately active against Pseudomonas aeruginosa, including tobramycin-resistant strains, and against Pseudomonas cepacia (median minimal inhibitory concentration, 16 to 32 micrograms/ml), but was weakly active against Pseudomonas maltophilia and strains of Acinetobacter spp. and Achromobacter spp. The drug showed little activity against Staphylococcus aureus, enterococci, and anaerobic bacteria, including Bacteroides fragilis, Clostridium spp., and gram-positive cocci. Like moxalactam and cefoperazone, azthreonam exhibited a considerable inoculum effect with strains of Enterobacter spp. and Pseudomonas spp. Combination with clavulanic acid did not increase the activity of azthreonam against S. aureus but was synergistic for 5 of 15 strains of B. fragilis. Azthreonam is about 50% bound to human serum protein. The selective range of activity of this compound could be of clinical benefit.

Rectal atresia: treatment through a single sacral approach

Rectal atresia (with a normal anus) is a rare abnormality. A boy was operated upon successfully by using a single stage sacral approach, when he was 1 yr old. In the neonatal period he had a colostomy done for decompression. This colostomy was later useful in demonstrating the distance between the two blind pouches of the anal canal and the rectosigmoid segment. He is now perfectly continent without stenosis, 3 yr after the operation. If this procedure could be done in the neonatal period before the colon becomes very dilated, a long term colostomy might be obviated.

Free flaps for reconstruction of the lower extremity

Experience with the use of free flaps for lower extremity reconstruction during the period 1973 to 1980 is reviewed. From 1973 to 1977, 12 groin and 2 deltopectoral flaps were used, with 8 successes and 6 failures. From 1978 to 1980, 19 myocutaneous flaps (15 latissimus dorsi, 3 tensor fascia lata, and 1 osteocutaneous groin flap based on the deep circumflex vessels) were performed, 17 successfully and 2 unsuccessfully. The reasons for the improved results seem to be the longer and bigger vascular pedicle, the use of more end-to-side arterial anastomoses, and the choice of arterial trunks that are more distal and easier to work with. For these reasons, myocutaneous free flaps are the flap of choice for microsurgical soft tissue reconstruction of the lower limb.

Thermophilic Campylobacter-associated diarrhoea in Rio de Janeiro

Thermophilic Campylobacter is reported as the agent associated with chronic and acute diarrhoea in Rio de Janeiro. Nine strains were isolated from 186 children with gastroenteritis. To our knowledge this is the first report of human Campylobacteriosis in Latin-America.

[Microsurgical cerebral revascularization]

Techniques of microsurgical revascularization are reviewed. A series of 5 cases, submitted to 6 anastomosis of the superficial temporal artery is presented.