This multicentric, randomized, double-blind trial compared the efficacy and safety of netilmicin, 4.5 mg/kg od and 1.5 mg/kg tid, in patients with intra-abdominal infections. Of 114 patients enrolled, 57 patients (mean age 40.3 years) in the od group and 55 (mean age 36.8 years) in the tid group were evaluated for efficacy; 58 and 56 patients in corresponding groups were evaluated for safety. Among those evaluated for efficacy were 12 od-treated and 11 tid-treated patients with documented septicaemia, and 32 and 30 patients of respective groups with polymicrobial infections. Initially, 86 and 81 netilmicin-susceptible causative microorganisms were isolated in corresponding groups. Of these pathogens, 55% in the od group and 62% in the tid group were Escherichia coli. Daily dosage of netilmicin ranged from 3.70 to 4.71 mg/kg (mean 4.50) for the od group and from 3.06 to 4.76 mg/kg (mean 4.46) for the tid group. Duration of netilmicin therapy ranged from six to 13 days (mean 8.7 days) for od-treated patients and from seven to 16 days (mean 8.8 days) for tid-treated patients. Concomitant metronidazole was administered to 41 patients of the od group and 34 of the tid group; one patient in the tid group received clindamycin. Clinical and bacteriological responses were assessed, and peak and trough serum netilmicin levels were measured periodically, during therapy. Laboratory tests, including determinations of serum creatinine and blood urea nitrogen values, were performed throughout the trial. A clinical cure was achieved in 57/57 od-treated patients and 54/55 tid-treated patients; treatment failed in one tid-treated patient (1/55). In od and tid groups, 86/86 and 80/81 netilmicin-susceptible pathogens initially isolated were considered to be eliminated, respectively; one isolate (Esch. coli) persisted in the tid group. Mean peak serum netilmicin concentration in the od group was approximately two-fold greater than that in the tid group; mean trough serum netilmicin concentrations were similar for the two groups. Adverse reactions were limited to mild pain at the site of netilmicin administration in several patients in each treatment group. Netilmicin od and tid (alone or in combination with metronidazole) were similarly efficacious in the treatment of patients with appendicitis and other intra-abdominal infections caused by netilmicin-susceptible pathogens. Both dosage regimens of netilmicin were safe and well tolerated.

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Postoperative fistulas of the small intestine are a daunting and distressing complication in abdominal surgery. On the basis of a series of 54 observations and a review of the literature, the writers evaluated various factors, concluding that the following have a significantly unfavorable effect on prognosis: existence of an intraperitoneal septic focus, diseased fistulized intestine, a fistula exposed in an evisceration, complex fistulas, and the patient's age. The aim of treatment is to find solutions to 3 problems: sometimes that of peritonitis, frequently that of the loss of parietal substance, and invariably that of the fistula. If early surgery must be carried out, it will be regarded as a rescue operation, involving notably an enterostolny and sometimes a laparotomy. Otherwise, surgery will be deferred as long as possible (beyond the second month) and will be based on a single-stage operation (resection-anastomosis) or, more frequently, phased operations, precedence being given to treatment of the intestinal fistula rather than that of parietal dehiscence.

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Three important aspects of the surgical therapy of acute pancreatitis are discussed: the time at which operation appears to be indicated, the procedure to be chosen (in accord with operative findings), and the results. After initial medical treatment, the timing of intervention should be based on clinical and biological information. Classification of acute pancreatitis in 3 degrees of severity may facilitate the decision. When edematous pancreatitis is found, irrigation and drainage are indicated. For distal necrosis, a left or subtotal pancreatectomy should be carried out. Necrotic lesions of the isthmus should be excised locally; if necessary, local isthmus excisions may be combined with left pancreatic resection. Resections of the head of the pancreas have been abandoned because of their high mortality rate; intervention is now limited to local excision of necrotic tissue (necrosectomy), with drainage and irrigation. In all cases, complementary biliary drainage by choledochostomy or at least cholecystostomy, drainage of areas of necrosis, and gastric suction are also mandatory. Forty‐nine patients who were operated upon according to these principles with a mortality rate of 36.7 % are discussed.

A Panel on Pancreatic SurgeryThis is the first of a series of symposia to appear in Langenbecks Archiv. It is modelled on the "panels by correspondence" in anglo-american journals. 3 recognized experts in the field of pancreatic surgery were asked to answer 7 questions and to comment on 3 problem cases. Since direct discussion amongst the participants was not possible, the moderator has attempted to summarise the various viewpoints and to show up any differences of opinion. The editors of Langenbecks Archly thank the 3 distinguished surgeons for their valuable contributions.

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