ABSTRACT
PURPOSE: Laparoscopic appendectomy has recently been performed more frequently than open appendectomy because of its advantages. Yet laparoscopic appendectomy has the risk of converting to open appendectomy. We evaluated the preoperative evaluation factors that can influence the rate of conversion to open appendectomy. METHODS: For the 255 patients admitted to our hospital, we reviewed their medical history, their clinical and laboratory examination etc. and the final diagnosis was made by CT scan. The preoperative characteristics of the patients who underwent laparoscopic appendectomy and the patients who were converted to open appendectomy were compared using univariate and multivariate analysis. RESULTS: Out of 255 patients who underwent laparoscopic appendectomy, 15 patients (5.8%) were converted to open appendectomy. The main reasons were adhesion and periappendiceal abscess formation. Periappendiceal fat infiltration (p=0.030) seen in the CT scan and perforation (p=0.019) were significant risk factors associated with converting to open appendectomy. CONCLUSION: Periappendiceal fat infiltration and perforation seen on preoperative CT scanning are important when considering performing laparoscopic appendectomy. Identifying the potential preoperative factors for conversion may assist surgeons when making decisions concerning the management of patients with appendicitis and for the judicious use of LA.
Subject(s)
Humans , Abscess , Appendectomy , Appendicitis , Risk FactorsABSTRACT
The internal stipe necrosis of cultivated mushrooms (Agaricus bisporus) is caused by the bacterium Ewingella americana, a species of the Enterobacteriaceae. Recently, Ewingella americana was isolated from cultivated white button mushrooms in Korea evidencing symptoms of internal stipe browning. Its symptoms are visible only at harvest, and appear as a variable browning reaction in the center of the stipes. From these lesions, we isolated one bacterial strain (designated CH4). Inoculation of the bacterial isolate into mushroom sporocarps yielded the characteristic browning symptoms that were distinguishable from those of the bacterial soft rot that is well known to mushroom growers. The results of Gram stain, flagellal staining, and biochemical tests identified these isolates as E. americana. This was verified by pathogenicity, physiological and biochemical characteristics, and the results of an analysis of the 16S rRNA gene sequences and the fatty acids profile. This is the first report of the isolation of E. americana from cultivated white button mushrooms in Korea.