ABSTRACT
BACKGROUND/PURPOSE: The routine use of interval appendectomy for the treatment of perforated appendicitis, with or without abscess, remains controversial. The purpose of this study is to confirm the efficacy of this approach and to identify factors associated with failures and complications. METHODS: All patients (n = 101) with their clinical diagnosis of perforated appendicitis confirmed with imaging were treated prospectively with fluids and intravenous antibiotics (clindamycin, ceftazidime) and were discharged home on oral fluids and analgesics regardless of fever. Intravenous antibiotics were continued at home until the patients were afebrile for 48 hours, and their white blood cell and differential counts were normal. Patients were readmitted at 8 to 12 weeks for an interval appendectomy. Failure to improve by 72 hours of antibiotic therapy mandated an early appendectomy. P values were determined by chi(2) analysis and Student's t test. RESULTS: The 79 patients (78%) successfully treated with interval appendectomy had an overall 6.3% complication rate, and total hospitalization averaged 5.2 days. The treatment in 21 of 22 patients (22%) requiring early appendectomy failed because of a clinical picture suggesting small bowel obstruction. The patients with the failed procedures had a complication rate of 50% and were hospitalized an average of 12.8 days. The overall complication rate for the 101 patients was 15.8%, and the overall total hospitalization was 6.9 days. Patients requiring early appendectomy had a more frequent finding resembling a small bowel obstruction on their initial x-ray (50% v 13%, P = .004) and a higher percent band count on their initial differential blood cell count (22.6% v 7.6%, P<0.0001) than did those successfully treated with interval appendectomy. An initial band count <15% was predictive of an uncomplicated course (84% positive predictive value). CONCLUSIONS: Interval appendectomy without complications is successful in the majority of patients with perforated appendicitis. An elevated initial band count > or =15% is associated with an increased likelihood of failure and complications.
Subject(s)
Appendectomy/methods , Appendicitis/surgery , Intestinal Perforation/surgery , Leukocyte Count , Adolescent , Anti-Bacterial Agents/therapeutic use , Appendicitis/blood , Appendicitis/complications , Chi-Square Distribution , Child , Child, Preschool , Female , Fluid Therapy , Humans , Infant , Intestinal Perforation/blood , Intestinal Perforation/etiology , Length of Stay/statistics & numerical data , Male , Postoperative Complications , Predictive Value of Tests , Prospective Studies , Treatment FailureABSTRACT
The technique for thoracoscopic in children is described. The average operating time is under 2 hours, and the procedure appears to be safe and effective.
Subject(s)
Myasthenia Gravis/surgery , Thoracoscopy/methods , Thymectomy/methods , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Myasthenia Gravis/diagnosis , Sensitivity and Specificity , Treatment OutcomeABSTRACT
Lymphoscintigraphy and sentinel lymph node biopsy techniques can be applied successfully to young children with melanoma to detect nodal disease. The authors describe their methods of lymphoscintigraphy and sentinel node biopsy and its application in 2 young children with malignant melanoma of the head and neck.
Subject(s)
Biopsy , Lymph Nodes/pathology , Melanoma/secondary , Skin Neoplasms/pathology , Child , Child, Preschool , Head , Humans , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis , Male , Neck , Radionuclide ImagingSubject(s)
Pleural Effusion/etiology , Pneumonia/complications , Urokinase-Type Plasminogen Activator/therapeutic use , Child , Child, Preschool , Female , Humans , Male , Plasminogen Activators/therapeutic use , Pleural Effusion/diagnosis , Pleural Effusion/drug therapy , Thoracoscopy , Urokinase-Type Plasminogen Activator/administration & dosageABSTRACT
BACKGROUND: After major hepatectomy, the remaining liver compensates for its reduced mass and maintains euglycemia through increased hepatic glucose output. The mechanism of this compensation may be a diminished hepatic extraction of portal insulin, which thereby decreases the suppressive effects of insulin on gluconeogenesis. METHODS: Extraction of insulin by the liver was measured using the isolated perfused rat liver model. Fasted Sprague-Dawley rats were studied at 1, 2, 3, 4, 6, and 14 days after 70% hepatectomy. Control rats had no operation, and sham rats were studied 1 day after a sham laparotomy. The difference between portal and caval insulin concentrations was determined and reported as micromoles of insulin extracted per gram liver per minute. RESULTS: Insulin extraction decreased from 191 +/- 22 microU/gm liver/min in control rats to 87 +/- 13.2 microU/gm liver/min at postoperative day 1 (p = 0.0001). Extraction normalized by postoperative day 6. Extraction rates in rats recovering from sham laparotomy were similar to control rats (p = 0.088), suggesting that decreased extraction in hepatectomized rats was not due to postoperative stress. CONCLUSIONS: After 70% hepatectomy, the remaining liver extracts less insulin per gram. This may explain the ability of the reduced liver mass to maintain euglycemia after major hepatectomy.
Subject(s)
Hepatectomy , Insulin/metabolism , Liver Glycogen/metabolism , Liver Regeneration/physiology , Liver/physiology , Analysis of Variance , Animals , Blood Glucose/metabolism , In Vitro Techniques , Insulin/blood , Insulin/isolation & purification , Liver/blood supply , Male , Organ Size , Perfusion , Portal System , Rats , Rats, Sprague-Dawley , Time Factors , Vena Cava, InferiorABSTRACT
We have measured the pH dependence of kcat and kcat/Km for CO2 hydration catalyzed by both native Zn2+-and metallo-substituted Co2+-bovine carbonic anhydrase II in the absence of inhibitory ions. For the Zn2+-enzyme, the pKa values controlling kcat and kcat/Km profiles are similar, but for the Co2+-enzyme the values are about 0.6 pH units apart. Computer simulations of a metal-hydroxide mechanism of carbonic anhydrase suggest that the data for both native and Co2+-carbonic anhydrase can be accounted for by the same mechanism of action, if we postulate that the substitution of Co2+ for Zn2+ in the active site causes a separation of about 0.6 pH units in the pKa values of His-64 and the metal-bound water molecule. We have also measured the activation parameters for kcat and kcat/Km for Co2+-substituted carbonic anhydrase II-catalyzed CO2 hydration and have compared these values to those obtained previously for the native Zn2+-enzyme. For kcat and kcat/Km we obtain an enthalpy of activation of 4.4 +/- 0.6 and approximately 0 kcal mol-1, respectively. The corresponding entropies of activation are -18 +/- 2 and -27 +/- 2 cal mol-1 K-1.
Subject(s)
Carbon Dioxide/metabolism , Carbonic Anhydrases/metabolism , Cobalt/metabolism , Animals , Cattle , Computer Simulation , Hydrogen-Ion Concentration , Mathematics , Temperature , Zinc/metabolismABSTRACT
The specific activity and the activity per fly of four mitochondrial enzymes did not change with ageing in male Drosophila melanogaster (Oregon R). The enzymes assayed were rotenone-insensitive NADH-cytochrome c reductase, adenylate kinase, succinate cytochrome c reductase, and malate dehydrogenase, located in the outer membrane, inner membrane space, inner membrane and matrix, respectively. The specific activity of malate dehydrogenase showed no significant change for young and old head, thorax and abdomen. We conclude that there is no specific site for ageing damage in the mitochondrion, when the enzyme activities in this study are used as an indicator. It should be noted, however, that these enzymes represent only a small percentage of the total enzymes present in mitochondria.
