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Forty patients with 63 Echinococcus granulosus cysts affecting different sites were treated with albendazole and have been followed up for at least 24 months from completion of therapy. Twenty-one patients (53%) with 37 cysts (59%) showed evidence of healing. The criteria and pattern of healing are outlined. The most serious complication of albendazole therapy was hepatoxic jaundice, which occurred in 5% of patients. Recurrence during the observation period was encountered in 9.5% of patients with a positive response. It is suggested that patients suffering from uncomplicated hydatid disease should be given the benefit of a trial course of albendazole therapy, before surgery is undertaken.

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We have reviewed a series of 124 consecutive cases of hepatic hydatid cysts in 102 patients treated surgically in Benghazi, Libya, over a period of five years. Overall mortality was 3.9%. The rate of post-operative complications was 37.5%. Cysts already complicated with infection, intrabiliary communication or intra-peritoneal rupture accounted for 30.6% of the cases. They were all treated by means of removing the endocyst and external tube drainage of the residual cavity. In this subgroup, the post-operative complications' rate was 89%. In the 74 uncomplicated cysts, removal of the parasite was followed by omentoplasty in 25 cases and external tube drainage in 49 cases. Postoperative complications occurred in 16% of the omentoplasty group and 8.2% of the drainage group. It is concluded that omentoplasty for the obliteration of the residual cavity may be used in uninfected and relatively inaccessible cysts. In the majority of cases, however, external tube drainage retains its value as a simple and safe procedure.

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This paper reports the results of a prospective randomized study of antibiotic prophylaxis in 200 patients over the age of 12 years undergoing emergency appendicectomy at Al-Jala Hospital for Trauma and Emergency Surgery, Benghazi. We have compared the efficacy of ceftriaxone, a long-acting broad-spectrum cephalosporin with that of our routine regimen consisting of metronidazole, gentamicin and ampicillin, given together. Ceftriaxone was administered as a single pre-operative dose of 2 g (to be continued as a daily injection for 5 days in patients with perforated appendicitis). The triple combination was given on an 8-hourly basis for 3 days, extended to 5-7 days in cases of perforation. Patients receiving ceftriaxone did as well as or slightly better than those on the triple-antimicrobial regimen, in terms of wound infection rate (3 vs. 5%), incidence of transient post-operative pyrexia and duration of hospital stay (on average 4.5 vs. 5.9 days). More importantly, administering ceftriaxone as 1 injection per day led to a dramatic saving in terms of nursing effort and time (1 injection instead of 9 per 24 h) and of the daily financial cost of therapy per patient. It is concluded that the clinical results and economic implications seem to justify the use of ceftriaxone as a routine prophylactic antibiotic for patients undergoing emergency appendicectomy.

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A prospective study was carried out in 200 consecutive patients undergoing biliary surgery to compare the prophylactic effectiveness of ceftriaxone and clavulanate-potentiated (CP-) amoxycillin. Patients were assigned in a randomized fashion to two groups and received ceftriaxone (2 g intravenously pre-operatively), or CP-amoxycillin (1200 mg, to be repeated for 2 more doses in the case of patients undergoing procedures other than elective cholecystectomy). Post-operative wound infection occurred in 4% of patients in each group. Administration of ceftriaxone was associated with a lower incidence of post-operative pyrexia and chest infection as well as with a shorter hospital stay.

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A prospective randomized study was carried out to evaluate the efficacy of clavulanate-potentiated amoxycillin with that of cefotaxime as prophylactic agents for the prevention of sepsis following elective cholecystectomy. One hundred patients were randomized into two treatment groups. In the first group, each patient received a single intravenous dose (1200 mg) of clavulanate-potentiated amoxycillin 2 h before surgery. In the second group, patients were given intravenous cefotaxime, in three doses (2 g each) during surgery, and 6 and 12 h after their operation. No case of serious post-operative sepsis occurred in either group. Superficial wound infection occurred in 2% of patients receiving a single pre-operative dose of clavulanate-potentiated amoxycillin and in 6% of those given cefotaxime according to the three-dose regimen.

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