A case report of Pseudomonas citronellolis and Escherichia coli isolated from acute suppurative appendicitis: reveals the potential intestinal colonization and pathogenicity of Pseudomonas citronellolis.

Human infections caused by Pseudomonas citronellolis, an environmental bacterium, are infrequent, with only two cases related to uncommon urinary tract infections and bacteremia reported in recent years. All these cases typically occurred in elderly patients with compromised or decreased immune function. Simultaneously, the epithelial barrier disruption induced by invasive biopsy procedures or gastrointestinal disorders such as gastroenteritis provided a pathway for Pseudomonas citronellolis to infiltrate the organism. In this study, we present the first report of a case where Pseudomonas citronellolis and Escherichia coli were isolated from the inflamed appendix of a patient without underlying conditions. Compared to the Escherichia coli, Pseudomonas citronellolis has never been isolated in patients with appendicitis. We identified the species using MALDI-TOF MS and genetic sequencing. Based on our findings, we highlight the perspective that Pseudomonas citronellolis can colonize the intestines of healthy individuals and may trigger infections like appendicitis.

Diagnostic value of ultrasound-based hemodynamic examination of superior mesenteric artery for acute suppurative appendicitis / 医疗卫生装备

Objective To investigate the characteristics of hemodynamic changes in superior mesenteric artery(SMA)of patients with acute suppurative appendicitis(ASA)to facilitate the diagnosis of ASA.Methods Ninety-three ASA patients diagnosed by ultrasound and confirmed by pathology in some hospital from January 2015 to December 2022 were enrolled into an ASA group,and 88 soldiers without abnormalities in the annual physical examination at the hospital in 2021 were divided into a control group,and the two groups were compared in terms of SMA hemodynamic indexes including peak systolic velocity(PSV),end diastolic velocity(EDV),resistance index(RI)and systolic/diastolic ratio(S/D).The statistically significant data of the above indexes were selected to draw the ROC curve and obtain the cut-off values.SPSS 22.0 software was used for statistical analysis.Results The PSV was(212±69)cm/s in the ASA group and(118±26)cm/s in the control group,with statistically significant differences(P＜0.05),and the two groups had the differences in EDV,RI,and S/D not statistically significant(P＞0.05).The ROC curve was plotted based on the PSV data,and a cutoff value of 238 cm/s was obtained with an AUC of 0.714.Conclusion Ultrasound examination of SMA hemodynamic changes in suspected ASA patients facilitates a definitive diagnosis and is of guidance for clinical treatment.[Chinese Medical Equipment Journal,2023,44(10):64-67]

The effect of acute complicated appendicitis on liver function test.

OBJECTIVES: To determine the diagnostic role of hyperbilirubinemia in acute appendicitis like suppurative and gangrenous appendicitis. METHODS: This observational study was conducted at Ward-3, Jinnah Postgraduate Medical Center (JPMC), Karachi from 1st June 2019 to 1st June 2020. Males and females above 12 years of age were included. Serum liver function tests and leukocyte counts were carried out. Appendectomies were done, the operative findings and histopathology reports were noted. Hyperbilirubinemia was related with the stages of appendicitis. Results were analyzed by SPSS version 25. RESULTS: There were one hundred twenty patients. Thirty-eight (31.66%) were females and eighty-two (68.33%) were males. Age range was 13 to 60 years. Ten patients (8.33%) were between 13 - 20 years, sixty five (54.16%) were 21 to 30 years, thirty (25%) were 31 - 40 years, ten (8.33%) were 41 - 50 years and five patients (4.17%) were above 50 years of age. Sixty-two (51.66%) patients had simple appendicitis and fifty-four (45%) had complicated appendicitis like suppurative (26.66%) and (16.66%) gangrenous appendicitis. Negative appendectomy was found in four (3.33%). Hyperbilirubinemia was found (100%) in gangrenous, (94.12%) in suppurative and (12.3%) in catarrhal appendicitis. Enzymes like Alanine transaminase and Aspartate transaminase were raised (50%) in gangrenous, (50%) in suppurative and (9.67%) in catarrhal appendicitis. TLC was raised in 112 (96.55%) out of 116 patients and total leukocyte count was normal in negative appendectomies. CONCLUSIONS: It is concluded that hyperbilirubinemia is strong diagnostic predictor for complicated appendicitis.

Effect of flurbiprofen administration on postoperative inflammatory factors in patients undergoing laparoscopic acute suppurative appendicitis / 中国生化药物杂志

Objective To investigate the effect of flurbiprofen administration time on inflammatory factors in patients with acute suppurative appendicitis after laparoscopic resection. Methods 60 patients with acute suppurative appendicitis resection treated in our hospital from January 2015 to March 2017 were divided into two groups according to the different administration time. The control group received flurbiprofen at the time of operation, and the observation group received flurbiprofen before operation induction; The changes of the indexes of operation and inflammatory factors before and after the operation were compared between the two groups. Results There were no significant differences between the two groups in each operation index; The level of inflammatory factors in the observation group was better than that in the control group 24 hours after the operation, the difference was statistically significant (P<0.05). Conclusion The effect of flurbiprofen is significant before the induction of anesthesia, and the control effect of inflammatory factors is good after the operation, and the time will not affect the postoperative analgesia.

Preventive effect of octreotide combined with netilmicin sulfate on postoperative infection in suppurative appendicitis and its effect on Th17/Treg imbalance / 中国生化药物杂志

Objective To investigate the preventive effect of octreotide combined with netilmicin sulfate on postoperative infection in suppurative appendicitis and its effect on helper T cell 17(Th17)/regulatory T cells(Treg)imbalance.Methods 148 patients with acute suppurative appendicitis in Xiangshan Hospital of Traditional Chinese Medicine from August 2014 to May 2016 were randomly divided into observation group(n=74)and control group(n=74).All were underwent laparoscopic appendectomy surgery,the control group took netilmicin sulfate combined with ornidazole for anti-infection after operative,while the observation group added octreotide acetate subcutaneously.The levels of serum interleukin(IL)-4,IL-6,IL-10,IL-17,IL-23,transforming growth factor β(TGF-β),interferon γ(IFN-γ)and Th17,Treg cell ratio and expression levels of related transcription factorbefore and after treatment were detected,Th17/Treg change were analyzed.Results The levels of IL-4,IL-6,IL-10,IL-17,TGF-β were decreased,IFN-γ were increased after treatment(P<0.01),the improvement of those indicators in the observation group were supior than control group(P<0.05).Th17,Treg cell ratio and expression levels of related transcription factor orphan nuclear receptorγt(RORγt),Forkhead box protein P3(Foxp3)were decrease,Th17/Treg was reduced after treatment(P<0.01),those indexes in observation group were lower than those in control group(P<0.05).The wound infection,intra-abdominal infections and other adverse events had no significant difference in two groups.Conclusions Octreotide combined with netilmicin sulfate can prevent postoperative infection in suppurative appendicitis,regulate Th17/Treg imbalance,restore immune function,and no significant adverse reactions.

Effect on NO、IL-10、CRP and bacterial translocation rate by glutamine enriched parenteral nutrition solution in purulent appendicitis in children / 中国生化药物杂志

Objective To investigate the effect on NO、IL-10、CRP and bacterial translocation rate by glutamine enriched parenteral nutrition solution in purulent appendicitis in children.Methods72 cases of acute suppurative appendicitis complicated with peritonitis were selected and randomLy divided into control and treatment groups.Patients (36 cases) in the control group were given antibiotics and parenteral nutrition support for 7 days, 36 cases in the experiment group were given glutamine enriched parenteral nutrition solution for 7 days.NO、IL-10、 CRP and bacterial translocation rate were compared after the treatment.ResultsCompared with before treatment, two groups of patients with content of FT3, FT4 was higher(P<0.05), CRP, NO and IL-10、 content in serum was lower (P<0.05), 16Sr and BG positive rate was lower (P<0.05).Compared with the control group, the serum FT3, FT4 was higher(P<0.05), CRP, IL-8 and IL-6 content in serum was lower (P<0.05), 16Sr and BG positive rate was lower (P<0.05).ConclusionGlutamine enriched parenteral nutrition solution can significantly improve thyroid hormone levels,reduce serum CRP, bacterial translocation rate, and adverse reactions were mild.

Postoperative antibiotic use and the incidence of intra-abdominal abscess in the setting of suppurative appendicitis: a retrospective analysis.

BACKGROUND: Although guidelines exist for postoperative antibiotic use in acute appendicitis that is perforated, gangrenous, or simple/uncomplicated, there are less data about its use in suppurative appendicitis. Here, we targeted this subgroup of patients to determine whether postoperative antibiotic administration affects incidence of intra-abdominal abscess formation. METHODS: We retrospectively examined 1,192 patients who underwent laparoscopic appendectomy for acute appendicitis at Kaiser Permanente Fontana Hospital between August 2010 and August 2013. Suppurative appendicitis was described for 143 (12%) patients. Fifty-two patients received postoperative antibiotics for at least 1 week on discharge home, 91 did not. RESULTS: Of 143 patients with suppurative appendicitis, 1 (1.9%) who received postoperative antibiotics came back with an intra-abdominal abscess within 1 month. Of the 91 patients in the no antibiotic group, 1 (1.1%) came back with an intra-abdominal abscess. CONCLUSIONS: The administration of postoperative antibiotic in the setting of suppurative appendicitis has no effect on the rate of intra-abdominal abscess formation. Routine postoperative antibiotics may not be necessary in this patient population, and more evidence is needed to justify its use.

Irrigation versus suction alone during laparoscopic appendectomy; A randomized controlled equivalence trial.

INTRODUCTION: The objective of this study was to compare operative peritoneal irrigation versus suction alone during laparoscopic appendectomy in adult patients; our hypothesis was that the two methods are equivalent in terms of rate of post-operative intra-abdominal abscess. There has been only one prospective, randomized, superiority trial in children, that showed non-significant difference in the rate of intra-abdominal abscess comparing irrigation to suction alone during laparoscopic appendectomy for perforated appendicitis. Non-significant difference in a superiority trial does not imply equivalence. METHODS: This was a single-institution, prospective, randomized controlled equivalence study based on a null-hypothesis of non-equivalence between irrigation and suction alone. Adult patients with intra-operative findings of an acutely inflamed appendix, with suppuration or perforation localized to the right iliac fossa, paracolic gutter or pelvis were randomized to irrigation or suction alone. The primary endpoint was the rate of intra-abdominal abscess. An unconditional exact test of equivalence was used to test the null-hypothesis. RESULTS: Eighty-one patients were included for analysis. Two (5%) of 40 patients in the irrigation group and two (4.9%) of 41 in the suction-only group developed postoperative intra-abdominal abscess. The 95% confidence interval for the difference between the two groups was -0.1200 to 0.1244, captured within the pre-defined δ limits (-0.15, 0.15). With reference to the rate of intra-abdominal abscess, equivalence was demonstrated between irrigation and suction-only techniques. CONCLUSIONS: In patients with suppurative or perforated appendicitis, the rate of intra-abdominal abscess is equivalent between groups treated with peritoneal irrigation and suction alone.

Effect of octreotide combined with compound coenzyme on Th17/CD4+CD25+Foxp3+ Treg imbalance in patients with purulent appendicitis / 中国生化药物杂志

Objective To analyse the effect of octreotide combined with compound coenzyme on Th17/CD4 +CD25 +Foxp3 + regulatory T cells imbalance in patients with purulent appendicitis.Methods 150 patients with acute suppurative appendicitis were randomly divided into experimental group and control group, 75 cases in each group.Patients of two groups underwent appendicitis laparoscopic resection, then the control group were given conventional treatment and experimental group were given subcutaneous injection of octreotide on the basis of conventional treatment.Th17, CD4 +CD25 +Foxp3 +regulation T cells ( Treg) , and Th17 /Treg balance were analyzed.ResuIts Compared with control group, Th17/Treg imbalance of experimental group recovered better: the proportion of Th17, Treg, and Th17/Treg ratio decreased (P<0.05); the expression levels of related transcription factor, RORγt and Foxp3 mRNA decreased (P<0.05); serum cytokine (IL-4, IL-6, IL-10, IL-17, IL-23 and TGF beta) and C-reactive protein (CRP) content decreased (P<0.05);serum interferon gamma (IFN-gamma) content increased (P<0.05).ConcIusion Octreotide combined with compound coenzyme could correct Th17/Treg imbalance in suppurative appendicitis patients, improve the immune function of patients and affect the prognosis of patients.

Feasibility analysis of surgery on maintenance hemodialysis patients com-plicated with suppurative appendicitis / 中国现代医生

Objective To identify the feasibility of suppurative appendicitis operations in maintenance hemodialysis patients. Methods The medical records of 8 maintenance hemodialysis patients who experienced suppurative appen-dicitis operation were retrospectively evaluated. Results After surgery, inflammation related indicators (blood leuko cytes, c-reactive protein, calcitonin original) were significantly decreased (P<0.05). All of the patients' operations were successful,with no complications,such as bleeding and infection,no death. The average hospitalization time was 9.2 days, and half a year follow-up without adhesion sex intestinal obstruction, there is no long-term complications after six months follow-up. Conclusion Given good perioperative management in patients with MHD, appendicitis op-eration is safe and feasible.

Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study.

BACKGROUND: THE AIMS OF THE STUDY WERE: 1) to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis; and 2) to compare other variables such as age, duration of symptoms, clinical profile, white blood cell count, C-reactive protein and ultrasound in a similar role. METHODS: This is a prospective study conducted on 50 consecutive cases of acute appendicitis admitted to the emergency ward. These were subjected to investigations to support the diagnosis. These cases were also subjected to liver function tests and clinical diagnosis was confirmed perioperatively and post-operatively by histopathological examination. Their clinical and investigative data were compiled and analyzed. Statistical analysis was performed using either chi square test or fisher's exact test. The level of significance was set at P< 0.05. RESULTS: Total serum bilirubin including both direct and indirect was found to be significantly increased in case of acute suppurative appendicitis. Serum bilirubin was much higher (P <0.000) in cases of gangrenous/perforated appendicitis. CONCLUSION: Serum bilirubin is an important adjunct in diagnosing the presence of gangrenous/perforated appendicitis.

Influence on Healing Courses of Suppurative Appendicitis Incision by Positioning Drainage Tube under Fatty Layer of Incision / 中华医院感染学杂志

OBJECTIVE To investigate the infection rate and observe the healing courses of the incision after the open procedures of the suppurative appendicitis,which was managed by positioning drainage tube under the fatty layer of the incision.METHODS The infection rate,manifestation of the incision,and the mean time in hospital were observed after the drainage tube in the incision was employed.RESULTS The infection rate(9.30%) and the mean time in hospital(6.63?1.95days)dropped significantly(P