Retrospective analysis of operative time and time to discharge for laparoscopic vs robotic approaches to appendectomy and cholecystectomy.

Robotic-assisted appendectomies and cholecystectomies are believed to increase cost compared to the gold standard laparoscopic approach. Two equally qualified surgeons performed both approaches over 2 years to evaluate intraoperative duration, time to discharge, conversion to open procedure, and readmission within 30 days. 110 laparoscopic, 81 robotic-assisted appendectomies; and 105 laparoscopic and 165 robotic-assisted cholecystectomies were performed. Intraoperative time; laparoscopic appendectomy was 1.402 vs 1.3615 h for robotic-assisted (P value = 0.304); laparoscopic cholecystectomy was 1.692 vs 1.634 h for robotic-assisted (P value = 0.196). Time to discharge, was 38.26 for laparoscopic vs 28.349 h for robotic-assisted appendectomy (P value = 0.010), and 35.95 for laparoscopic vs 28.46 h for robotic-assisted cholecystectomy (P value = 0.002). Intraoperative conversion to open; only laparoscopic procedures were converted, one appendectomy and nine cholecystectomies. None in the robotic-assisted procedures. Readmissions, none in the appendectomy group and three in the cholecystectomy group. One laparoscopic and two robotic-assisted cholecystectomy patients were readmitted. Intraoperative times for robotic appendectomy and cholecystectomy were not longer than laparoscopic approach. Robotic approach shortened the time to discharge and the likelihood for conversion to open procedure.

Edwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Factors.

BACKGROUND Edwardsiella tarda is a facultative anaerobic bacterium that is rarely pathogenic to humans, but, in patients with certain risk factors, it can lead to severe, disseminated infections. Humans are inoculated through the gastrointestinal tract while consuming undercooked or raw seafood or through skin penetration. E. tarda has been isolated from marine environments, including lakes, rivers, wells, and sewage water. Although the bacterium has not been directly isolated from seawater, it has been cultured from animals inhabiting seawater environments. In the United States, E. tarda is predominantly localized along the coastline of the Gulf of Mexico. Complications from this bacterium usually arise in patients with liver disease, iron overload, or cirrhosis or in those who are immunocompromised or on immunosuppressive therapy. CASE REPORT Our patient was a 59-year-old woman with a history of advanced lung cancer, pulmonary hypertension, liver cirrhosis, hepatitis C, and alcoholism. She initially presented to the Emergency Department in the Florida Panhandle on June 16 with colitis, which then progressed to fulminant sepsis with septic shock. Despite aggressive interventions, including intravenous hydration, broad-spectrum antibiotics, and vasopressor support, our patient succumbed to her illness approximately 34 h after initial presentation. CONCLUSIONS Although severe cases of E. tarda have been reported in patients with liver dysfunction, we believe this is the first reported case potentially complicated by concomitant lung cancer. The rise in sea water temperature, increased human consumption of raw seafood, and increased prevalence of nonalcoholic steatohepatitis may increase the incidence and mortality of E. tarda in the near future.

Probable Clostridium septicum pneumocephalus in a user of natural remedies with newly diagnosed diabetes mellitus type 1.

Clostridium septicum encephalitis is a rare cause of spontaneous, non-traumatic pneumocephalus. Systemic infections with this organism have a fulminant course, likely leading to death within 48 hours, and are commonly associated with hematological or colonic malignancies. The effectiveness of an antibacterial regimen is unknown because of a lack of studies. The best prognosis is observed in patients undergoing early surgical intervention for localized intracranial processes. Here we describe a case of rapidly developing C. septicum sepsis as a result of bacteremia and hematogenous spread, resulting in encephalitis and pneumocephalus in a patient without a diagnosed malignancy. The patient presented to the emergency department with diabetic ketoacidosis, which led to the diagnosis of new-onset type 1 diabetes mellitus. There are currently 19 reported cases of C. septicum central nervous system infections in the literature, with 12 of them having pneumocephalus. Natural remedies, such as drinking kombucha tea and performing coffee enemas, that were used by our patient may have played a role in the dissemination of C. septicum. In survivors of this fulminant illness, colonic and hematologic malignancies should be excluded because of their association with such infections. Type 1 diabetes mellitus, drinking kombucha tea, and performing coffee enemas may be newly recognized risk factors associated with the dissemination of C. septicum.