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Query: UMLS:C0085693 (acute appendicitis)
 3,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Laparoscopic appendicectomy for acute appendicitis has been promulgated in many European countries during the 1980s. The introduction of the microchip camera and visual assistance on a monitor has increased the appeal of laparoscopic appendiceal resection. It carries a unique appeal in that the extent of inflammation and the presence of other pathological conditions are readily identified. This approach does not prevent the surgeon proceeding to open surgery if appropriate, and will aid in defining the site of incision. Prospective analyses (McAnena et al, 1992; Attwood et al, 1992) have shown that this approach shortens hospital stay, decreases wound infection rates and provides excellent cosmetic results. It also hastens return to full activity. It requires experience and, as with cholecystectomy, the option of converting to an open procedure should not be considered a failure of the approach. Details of approaches to the inflamed appendix are described. Caution in the use of diathermy is needed (particularly at the base of the appendix), as it may cause necrosis of the caecum or dissolution of the ties at the appendix base. Control of the appendicular artery by clip ligation is preferable to diathermy. The training of surgical residents will be enhanced rather than diminished if, under close, experienced supervision, they are taught to perform appendicectomy laparoscopically, as the essentials of anatomic dissection of the appendix are perhaps better appreciated on a video screen than at open surgery through a small incision.
Baillieres Clin Gastroenterol 1993 Dec
PMID:Laparoscopic appendicectomy: diagnosis and resection of acute and perforated appendices. 811 77

Aetiologic factors (gallstones, hyperlipidemia I-IV, hypertriglyceridaemia) make their occurrence, mainly, in the third trimester of gestation. Two cases of acute pancreatitis in pregnancy are described; in both cases patients referred healthy diet, no habit to smoke and no previous episode of pancreatitis. An obstructive pathology of biliary tract was the aetiologic factor. Vomiting, upper abdominal pain are aspecific symptoms that impose a differential diagnosis with acute appendicitis, cholecystitis and obstructive intestinal pathology. Laboratory data (elevated serum amylase and lipase levels) and ultrasonography carry out an accurate diagnosis. The management of acute pancreatitis is based on the use of symptomatic drugs, a low fat diet alternated to the parenteral nutrition when triglycerides levels are more than 28 mmol/L. Surgical therapy, used only in case of obstructive pathology of biliary tract, is optimally collected in the third trimester or immediately after postpartum. Our patients, treated only medically, delivered respectively at 38th and 40th week of gestation. Tempestivity of diagnosis and appropriate therapy permit to improve prognosis of a pathology that, although really associated with pregnancy, presents high maternal mortality (37%) cause of complications (shock, coagulopathy, acute respiratory insufficiency) and fetal (37.9%) by occurrence of preterm delivery.
Minerva Ginecol 1993 Dec
PMID:[Acute pancreatitis and pregnancy]. 813 93

Acute appendicitis is usually diagnosed on the basis of signs, symptoms, and results of simple laboratory tests. However, in patients with atypical clinical features, imaging studies play a significant role in preoperative diagnosis and determination of proper treatment. In this pictorial essay, we present a spectrum of imaging findings in patients whose clinical features were unusual because of the abnormal position of the appendix, the presence of other illnesses, or the presence of complications in children. Appendicitis was not initially considered on clinical presentation in any of our cases. In most cases, the correct diagnosis of appendicitis was made or, at least in retrospect, could have been made on the basis of imaging findings.
AJR Am J Roentgenol 1993 Dec
PMID:Diagnosis of appendicitis: imaging findings in patients with atypical clinical features. 797 21

Appendicitis remains a common and morbid illness in children. The history, epidemiology, pathophysiology, clinical presentation, diagnostic evaluation, and management of acute appendicitis are discussed in this article.
Pediatr Clin North Am 1993 Dec
PMID:The right lower quadrant "revisited". 825 22

Antimicrobial resistance of operative site flora was correlated with postoperative infection in 175 patients undergoing operation for intra-abdominal sepsis: Diagnoses for study patients were acute or gangrenous appendicitis in 48 (27%), complicated appendicitis in 98 (56%), perforated viscus other than appendix in 21 (12%), and eight (5%) had other intra-abdominal infections. One hundred thirty-six (78%) patients were males. The average age was 33 +/- 14 years, average number of hospital days was 11.6 +/- 13.5, and average number of days on antibiotics was 6.9 +/- 2.5. Overall recovery without infection was 75 per cent (131/175). Analysis of susceptibility of 939 intraoperative isolates indicated a significant relationship (P = 0.0002) between resistance to the empiric antimicrobials received and postoperative infection. Of 131 patients with resolution of the intra-abdominal infection, 57 (44%) had resistant isolates while 36 (82%) of 44 patients with postoperative infectious complications had resistant isolates. Streptococcus Group D, Escherichia coli, and Bacteroides fragilis were the most prevalent resistant organisms isolated from both intra- and postoperative cultures. Other variables that were significantly different between those without complications and those who had complications were, respectively: average age 31 versus 38; admission WBC 14.5 versus 16.7; and diagnosis, acute appendicitis 28 per cent versus 2 per cent. A stepwise logistic regression analysis confirmed the predictive value of intraoperative isolate resistance, age, and admission WBC, in that order, on outcome.
Am Surg 1993 Dec
PMID:Susceptibility of intra-abdominal isolates at operation: a predictor of postoperative infection. 825 30

The purpose of this study was to determine the etiology of elevated alanine aminotransferase (ALT) in a population of asymptomatic volunteer blood donors. Subjects with an ALT value > 2.25 sd above norm (> 55 IU/liter) from the donated unit, were prospectively evaluated over a six-week interval. The subjects consisted of blood donors (78% male, 22% female) beginning basic military training at Lackland Air Force Base. Of 44,160 individuals screened, 19,877 (45%) voluntarily donated blood, 99 (0.5%) of which had confirmed ALT elevation. Of these (90 male/9 female), an associated condition or explanation was made in 12%: four with acute hepatitis B, four positive for anti-HCV, two with autoimmune disease, one with cholelithiasis and one associated with acute appendicitis. In 87 the ALT elevation could not be explained using available testing methods but may represent individual variation from a non-Gaussian distribution, be of nonhepatic origin (muscle), or of hepatic disease not detected by the diagnostic algorithm used. To increase the diagnostic yield, it is suggested that at least two elevated ALT values be established in this population over a period of time (yet undefined), before an extensive hepatic investigation is pursued.
Dig Dis Sci 1993 Dec
PMID:Serum alanine aminotransferase (ALT) elevation in asymptomatic US Air Force basic trainee blood donors. 826 13

The case records of 71 patients (31 women and 40 men aged 5-76 years, median age 18) who were registered under the diagnosis of perforated acute appendicitis at the Department of Surgery, Frederikssund Hospital between 1 January 1983 to 31 December 1988 have been reviewed in order to examine the relevance of culturing peritoneal swabs for the antibiotic treatment given. Four antibiotic regimens were used. In 65% of the cases, the cultured bacteria were completely sensitive to gentamycin and metronidazole (82% when cultures where there was no growth are included), the corresponding figure for the treatment given was 48% (65%). Thirty-one percent developed postoperative infections, 20% in the form of abscesses. In four percent of the cases where bacterial resistance to the given antibiotic treatment was found did this result have a consequence in relation to further treatment. The result of culture was on average available 2.1 days after antibiotic treatment had been terminated. The cultures could have greater relevance if 1) the results were communicated to the ward within one to two days 2) bacterial type and pattern of antibiotic sensitivity were registered in such a manner that the effectivity of the standard antibiotic regime could be controlled and 3) if demonstration of possible exogenous contamination were used as a parameter in the department's quality control.
Ugeskr Laeger 1993 Dec 20
PMID:[Relevance of cultures for the antibiotic treatment in acute perforated appendicitis]. 827 42

The diagnosis of acute appendicitis is usually made from the history and physical examination. Recently, abdominal ultrasonography (US), laparoscopy, computerized tomography (CT), and barium enema (BE) have been used in the preoperative evaluation of patients with presumed appendicitis in order to improve the diagnostic accuracy. However, the usefulness of these tests in verifying the diagnosis of appendicitis has not been established. We reviewed the medical records of 203 patients who underwent appendectomy. One hundred patients were surgically treated before 1984 (group I) and 103 patients underwent surgery after 1988 (group II). Patients in group II were more likely to have preoperative US, laparoscopy, CT, or BE (24 in group II versus 3 in group I, p < 0.05). When groups I and II were compared, the rates of perforation (27% versus 20%), normal appendectomy (8% versus 11%), and the interval between admission and operation (12.2 hours versus 10.7 hours) and length of hospitalization (5.0 days versus 5.1 days) were not significantly different. We concluded that although adjunctive testing may be beneficial in selected patients, its routine use in patients suspected of having appendicitis cannot be advocated at present.
Am J Surg 1993 Dec
PMID:Impact of adjunctive testing on the diagnosis and clinical course of patients with acute appendicitis. 827 45

Ninety surgical cases of cecal diverticulitis at the University of Hawaii hospitals were reviewed from 1980 to 1991. Seventy-eight percent of the study group were of Asian descent, with a mean age of 41.7 years. Right lower quadrant pain and tenderness were the only constant findings, occurring in 86 and 87 of the 90 patients, respectively. The most common preoperative diagnosis was acute appendicitis, occurring in 73% of patients. A right colectomy or cecectomy was performed in 49 patients, an appendectomy in 29, and a diverticulectomy in 10. Seventeen complications occurred, only 1 of which was in the appendectomy group. Follow-up of up to 10 years was successful in 27 of 29 appendectomy patients, only 4 of whom had recurrent pain. There were no instances of a missed cecal carcinoma. We concluded that in those patients in whom carcinoma can be ruled out and in whom there is no evidence of abscess formation, appendectomy combined with postoperative antibiotics is a safe and effective method for the treatment of cecal diverticulitis.
Am J Surg 1993 Dec
PMID:Surgical management of cecal diverticulitis. 827 46

A study was carried out of 137 patients with a diagnosis of acute appendicitis who were randomized to either laparoscopic or open appendicectomy. Patients found to have perforated or normal appendices at histological examination were excluded. Fifty-two patients undergoing laparoscopic appendicectomy and those receiving 57 open procedures were analysed. Laparoscopic appendicectomy took no longer than the open procedure (mean 43 versus 40 min). The number of doses of pethidine (1 mg per kg body-weight) required in the immediate postoperative period did not differ between the two groups but the mean number of doses of oral analgesic (naproxen sodium 550 mg twice daily) required was less in patients undergoing laparoscopic appendicectomy (2.8 versus 5.0, P < 0.05). There was no significant difference between time to resumption of fluid and diet intake and length of hospital stay. There were five (9 per cent) wound infections after open appendicectomy compared with none after the laparoscopic operation (P < 0.01). Patients who underwent laparoscopy returned to full home (17 versus 30 days, P < 0.01) and social (19 versus 32 days, P < 0.05) activities earlier than those who underwent open operation. Laparoscopic appendicectomy may allow reduction in the number of wound infections and earlier return to normal activities.
Br J Surg 1993 Dec
PMID:Randomized controlled trial comparing laparoscopic and open appendicectomy. 829 36


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