Acute perforated appendicitis: An analysis of risk factors to guide surgical decision making.

Introduction: Acute perforated appendicitis is associated with increased post-operative morbidity and mortality. Avoiding delays in surgery in these patients may play a role in reducing observed morbidity. Objective: To analyze the clinico-pathological profile and outcomes in a cohort of patients undergoing emergency appendicectomies for suspected acute appendicitis and to determine factors influencing the risk of perforated appendicitis in order to aid better identification of such patients and develop protocols for improved management of this subset of patients. Materials and Methods: A retrospective analysis of patients undergoing emergency appendicectomies following presentation with acute appendicitis to the Modbury hospital, South Australia from March 2007 to April 2011 was conducted. Statistical analyses were performed in SAS 9.2. Results and Discussion: 506 patients underwent emergency appendectomy for acute appendicitis which included equal number of male and female patients with a median age of 25 years. Perforated appendicitis was found in 102 (20%) patients. Post-operative morbidity was significantly higher in patients with perforated appendicitis (28.4% vs 4.7%; P<0.0001). Male sex, patients older than 60 years, along with raised neutrophil counts and C-reactive protein levels were found to be significantly associated with the risk of perforation (P<0.05). Conclusions: Acute perforated appendicitis is associated with high morbidity. The increased risk of perforation in males and elderly patients appears unrelated to delays in presentation, diagnosis, or surgery. Patients with clinically diagnosed acute appendicitis and an elevation in neutrophil count and CRP level must be considered candidates for early surgery as they are likely to have an appendicular perforation.

effect of the most common intravenous anaesthetic on some functions of human neutrophils

Anaesthetics may compromise host defence mechanisms by adversely affecting the specific or non specific components of the normal immune response. Adverse effects of general anaesthetic agents on neutrophil functions in vitro are important as theoretically they could imply compromised function in vivo. The inhibitory effects of some anaesthetic, including intravenous [I.V.] anaesthetics, on neutrophil functions have been well documented, the use of these anaesthetics may result not only in peri -operative immunosuppression, but if used to sedate critically ill patients in the intensive care unit [ICU], may potentially further compromise an already depressed host defense mechanism. We study the effects of the most commonly used intravenous anaesthetic agents [thiopentone, ketamine, propofol and midazolam] on some functions of human neutrophils [PMNLS] [Phagocytosis, phagocytic index [P.I.], phagocytic percentage P% and respiratory burst activity] in vitro at clinical plasma concentration and 100 times. Sample of 3mL peripheral venous blood was drawn from forty healthy volunteers free from diseases not taking medication, incubated with the corresponding I.V. anaesthetic agents, using different concentrations of I.V. anaesthetic agents. The results showed that at 100 times the clinical plasma concentration, thiopentone, ketamine produced highly significant depression of neutrophil phagocytosis and non significant depression of neutrophil phagocytosis was seen with propofol and midazolam. At clinical concentration thiopentone ketamine propofol and midazolam had minimal effects on neutrophil phagocytosis. As regard to respiratory burst activity of neutrophil, there were no significant depression at both concentrations for all durgs used

Enhancement of neurophil chemiluminescence after elective gastrointestinal surgery

The aim of the study was to test the hypothesis that elective surgery as a form of injury has no prolonged deleterious effect on neutrophil activity in nonseptic patients. In the first 9 days after elective gastrointestinal surgery, a biphasic neutrophilia occurs and the metabolic response of neutrophils to an opsonized particle is not impaired. Major elective surgery has no deleterious effects on neutrophil activity, and indeed neutrophil activity may be enhanced

Antineutrophil cytoplasmic autoantibodies[ANCA] in active systemic lupus erythematosus

To test the presence of Antineutrophil cytoplasmic Autoantibodies [ANCA] in active SLE cases and its relationship to disease activity, 20 patients with active SLE [mean age=25 +/- 9.1 years] and 10 healthy controls [mean age=29 +/- 1.5 years] were studied. All were subjected to the following investigations: C.B.C, E.S.R, C.R.P., blood urea, serum creatinine, L.E, cell test, detection of DNA by agglutination method, cDNA and ANCA by indirect immunofluorescent technique. Four cases [20%] were found to have c-ANCA, one [5%] was found to have P-ANCA and 15 cases [75%] were negative to ANCA. A statistically significant decrease was found in ANCA-negative cases when compared with ANCA-positive cases as regard; renal function test, T.L.C., absolute neutrophil count, ESR and total score of the disease activity. It may be concluded that ANCA may have a significant value as a marker of SLE activity and may be of pathogenic significance in SLE cases

study of the intracellular killing of the peripheral blood neutrophils in B-thalassemia major patients

52 Beta- thalassemia major patients were studied. Their ages ranged from two to 20 years. The group consisted of 22 girls and 30 boys. Candida intracellular killing and NBT [nitroblue tetrazolium] tests were performed on the peripheral blood neutrophils of these patients. Average results of the intracellular killing test was within normal range for the patients, but showed an appreciable decrease in comparison with the results of the normal control tests [50 normal persons of the same age group were tested as normal controls. This decrease was more pronounced in those patients who had undergone splenectomy. A converse relationship was observed between the results of the patients' intracellular killing and their serum ferritin level and age. Average results of the patients' NBT tests showed an increase in comparison with those of the control group. The average results for the patients who had their spleens removed due to hypersplenism was the same as in those who had normal spleens and had no relation to the serum ferritin level but did show a moderate relationship with the age of the patients. A suggestion that can be put forth is the likelihood that intracellular killing of peripheral blood neutrophils in the Beta- thalassemia patients is conductive to the determination of those with greater susceptibility to infection

Neutrophil phagocytic activity in lymphoma

A study of the phagocytic activity of neutrophils using the modified Wilkinson method was made in 21 lymphoma and leukemia patients as well as 15 control subjects. The results indicate a marginal reduction of the percentage of phagocytic cells but a very highly significant depression of the phagocytic index. These two parameters could however be correlated [r - 0.95]. No significant differences could be obtained between the various subgroups. Whether the cases are fresh or under therapy seems to be of little bearing but advanced cases had on the whole the lowest figures. The results were discussed in the light of some of the known facts about cancer immunology