ABSTRACT
We analyzed 276 patients operated on for acute appendicitis between January 1995 and June 1997. In 26 patients intraoperative assessment revealed a pathological finding other than appendicitis. Fifty-nine patients (24%) had a perforated appendix, 116 acute appendicitis verified by histological examination, 75 (30%) chronic fibroplastic appendicitis or no signs of appendicitis. Patients with histologically acute inflammation fulfilled more clinical criteria of appendicitis than those without (5.1 vs. 3.7). Negative histological findings were most common in younger females admitted on Mondays and Tuesdays. Clinical observation rather than immediate operation and laparoscopy rather than laparotomy appear appropriate for the latter group and may lower the rate of negative appendectomy.
Subject(s)
Appendectomy/statistics & numerical data , Appendicitis/surgery , Acute Disease , Adolescent , Adult , Aged , Appendicitis/diagnosis , Appendicitis/pathology , Appendix/pathology , Diagnostic Errors , Female , Humans , Male , Middle Aged , Prospective Studies , Unnecessary Procedures/statistics & numerical dataABSTRACT
Chart review of our patients who were operated for acute appendicitis was performed to characterize the appendicitis in the elder patients. Celiotomy revealed perforation of the appendix in almost 40%, frequently in patients with unspecific symptoms and no leucocytosis. While mortality was 9.2% in the ninteeneighties, non of our patients died during the last 5.5 years. This might be attributed to emergency operation, improved anaesthesia and intensive medical care.
Subject(s)
Appendectomy , Appendicitis/surgery , Aged , Aged, 80 and over , Appendicitis/diagnosis , Appendicitis/mortality , Diagnosis, Differential , Female , Germany , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/mortality , Intestinal Perforation/surgery , Male , Rupture, Spontaneous , Survival RateABSTRACT
Intestinal barrier failure and subsequent translocation of bacteria from the gut play a decisive role in the development of systemic infections in severe acute pancreatitis. Glutamine (GLN) has been shown to stabilize gut barrier function and to reduce bacterial translocation in various experimental settings. The aim of this study was to evaluate whether GLN reduces gut permeability and bacterial infection in a model of acute necrotizing pancreatitis. Acute necrotizing pancreatitis was induced in 50 rats under sterile conditions by intraductal infusion of glycodeoxycholic acid and intravenous infusion of cerulein. Six hours after the induction of pancreatitis, animals were randomly assigned to one of two groups: standard total parental nutrition (TPN) or TPN combined with GLN (0.5 g/kg(-1)/day(-1)). After 96 hours, the animals were killed. The pancreas was prepared for bacteriologic examination, and the ascending colon was mounted in a Ussing chamber for determination of transmucosal resistance and mannitol flux as indicators of intestinal permeability. Transmucosal resistance was 31% higher in the animals treated with GLN- supplemented TPN compared to the animals given standard TPN. Mannitol flux through the epithelium was decreased by 40%. The prevalence of pancreatic infections was 33% in animals given GLN-enriched TPN as compared to 86% in animals receiving standard TPN (P < 0.05). Adding GLN to standard TPN not only reduces the permeability of the colon but decreases pancreatic infections in acute necrotizing pancreatitis in the rat. This confirms previous reports that GLN decreases bacterial translocation by stabilizing the intestinal mucosal barrier. The present findings provide the first evidence suggesting that stabilizing the intestinal barrier can reduce the prevalence of pancreatic infection in acute pancreatitis and that GLN may be useful in preventing septic complications in clinical pancreatitis.
