Noxythiolin is a simple chemical compound which undergoes slow decomposition to liberate free formaldehyde. It is relatively non-toxic when given intraperitoneally to animals and has a high therapeutic ratio. When a lethal Gram-negative peritonitis has been induced in guinea-pigs with Proteus and coliform organisms, intraperitoneal injection of noxythiolin offers significant protection. In humans with faecal peritonitis, the use of noxythiolin intraperitoneally reduces the morbidity and mortality of the condition. In this reported series of 23 cases, only 3 deaths occurred, 2 of which were from pulmonary embolism. It is suggested that this simple substance is a useful addition to our therapeutic armamentarium in all cases of peritonitis.

The cystic duct and gallbladder were ablated in eight patients with acute gallbladder disease who had been treated with minicholecystostomy instead of cholecystectomy because of multiple risk factors. First, endoluminal transcatheter radio-frequency electrocoagulation of the cystic duct was performed under fluoroscopic control, which resulted in complete occlusion in all eight patients. Next, the mucosa of the isolated gallbladder was sclerosed with 95% ethanol and 3% sodium tetradecyl sulfate in one to four sessions; no analgesics were required. The gallbladder volumes of all patients, estimated by means of ultrasound, were 1.5-22 cm3 (average, less than 10 cm3) after a mean follow-up period of 5 months. One patient died of a cerebrovascular accident 15 months after sclerotherapy. In all surviving patients, the gallbladder fistulas are dry and obliterated. These early clinical data indicate that electrocoagulation permits reliable, safe obliteration of the human cystic duct. The authors believe that sclerotherapy of the isolated gallbladder is feasible without toxic effects but that their treatment needs adjustment to achieve complete ablation of the gallbladder mucosa in a shorter period and in all patients.

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