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A prospective double-blind study on the effects of doxycycline as a prophylactic antimicrobial in elective colonic surgery is presented. One hundred-eighteen patients were evaluated. Fifty-eight were treated and 60 were controls. Two hundred milligrams, doxycycline or placebo (two capsules) were given orally four to six hours prior to surgery and 100 mg or placebo (one capsule) for five days postoperatively. Doxycycline levels in serum and tissues were determined and related to the MICvalues of the contaminants of the operative field. A significantly lower incidence of abdominal wound sepsis, intra-abdominal complications, and septicemia was recorded in the doxycycline group compared to the control group, 12.1 and 45% respectively. The prophylactic effect was most pronounced in patients with a negative wound culture upon closure. Macroscopical peritoneal contamination was associated with less severe consequencies in the doxycycline group. Infections in the perineal field, 3/15 vs 8/17, appeared alone in the doxycycline group, whereas they were combined with abdominal sepsis in 6/8 among the controls. Treatment also reduced the incidence of repeat laparotomy due to septic complications, 0 vs 8. Thus systemic per and postoperative prophylaxis with doxycycline significantly reduced both the incidence and the severity of postoperative sepsis in potentially contaminated elective colorectal surgery without any adverse reactions.

Nine local recurrences have been diagnosed in 38 patients with carcinoma of the rectum operated on with anterior resection using the EEA-stapling instrument. The characteristics of these recurrences have been compared with those of other authors, currently a total of 27 recurrences. The presence of a locally advanced growth with extramural spread, a distal location and a short margin of clearance seems to increase the risk of local recurrence, with often distressing symptoms. It is proposed that even if the EEA-stapler offers technical possibilities for anterior resection in these growths, this operation should be restricted to less advanced tumours.

Preoperative nutritional status and muscle energy metabolism were studied in 26 patients with gastric carcinoma. Fat stores were reduced in 30% and visceral proteins in 25% to 90% of the patients. According to the nutritional assessment, the patients were divided into well-nourished (group I, n = 8) with no or minor signs of malnutrition and malnourished (group II, n = 13) with signs of pronounced malnutrition. Group I had normal content of muscle energy metabolites despite their malignant disease. In group II, adenine nucleotides (p less than 0.001), phosphorylcreatine (p less than 0.01), creatine (p less than 0.05) and also glycogen (p less than 0.01) were markedly decreased. Weight loss, albumin, and fibronectin levels correlated significantly with adenosine-triphosphate, total adenine nucleotides, and glycogen levels. The most malnourished patients also had the poorest energy metabolite status in the muscle. These findings revive the interest in nutritional assessment.