AIM: To examine if fulminant Clostridium difficile infections(CDI) resulting in colectomy was associated with a prior appendectomy and whether any association affected the severity of the disease.METHODS: A retrospect...AIM: To examine if fulminant Clostridium difficile infections(CDI) resulting in colectomy was associated with a prior appendectomy and whether any association affected the severity of the disease.METHODS: A retrospective chart review was performed on patients who underwent colectomy for CDI between 2001 and 2011.The appendectomy rate was calculated based on the absence of an appendix on the surgical pathology report.This was compared to an established lifetime risk of appendectomy in the general population.A chart review was performed for mortality and traditional markers of CDI disease severity.Fisher’s exact test was used to calculate the likelihood of association between prior appendectomy,mortality,and clinical markers of severity of infection.RESULTS: Fifty-five specimens were identified with pseudomembranous colitis consistent with CDI.All patients had a clinical history consistent with CDI and 45 of 55(81.8%) specimens also had microbiological confirmation of CDI.Appendectomy was observed in 24 of 55 specimens(0.436,99%CI: 0.280-0.606).This was compared to the lifetime incidence of appendectomy of 17.6%.The rate of appendectomy in our sample was significantly higher than would be expected in the general population(43.6% vs 17.6%,P 【 0.01).Disease severity did not differ based on presence or absence of an appendix and no association was detected between prior appendectomy and mortality(OR = 0.588,95%CI: 0.174-1.970).CONCLUSION: The rate of appendectomy in the patients whose CDI led to colectomy,was significantly higher than the calculated lifetime risk,suggesting an association of appendectomy and severe CDI resulting in colectomy.Larger prospective studies are needed to assess any potential causal relationships affecting fulminant CDI.展开更多
Over the years there has been substantial advanced in the diagnosis and surgical management of complex thoracic aortic disease and complex endocarditis.As these therapies are being offered to a growing segment of pati...Over the years there has been substantial advanced in the diagnosis and surgical management of complex thoracic aortic disease and complex endocarditis.As these therapies are being offered to a growing segment of patients-and more and more patients are felt to potentially benefit from such therapies,the longterm consequences of these interventions is sometimes poorly understood.While traditional medical complications,such as stroke,renal failure,respiratory failure,and even death are often the focus of outcomes studies,little is known on the impact of these diseases and therapies on mental health.This commentary emphasizes the importance of better understanding the psychologic impact of endocarditis and thoracic aortic pathology as reviewed by Dr.Bagnasco.展开更多
文摘AIM: To examine if fulminant Clostridium difficile infections(CDI) resulting in colectomy was associated with a prior appendectomy and whether any association affected the severity of the disease.METHODS: A retrospective chart review was performed on patients who underwent colectomy for CDI between 2001 and 2011.The appendectomy rate was calculated based on the absence of an appendix on the surgical pathology report.This was compared to an established lifetime risk of appendectomy in the general population.A chart review was performed for mortality and traditional markers of CDI disease severity.Fisher’s exact test was used to calculate the likelihood of association between prior appendectomy,mortality,and clinical markers of severity of infection.RESULTS: Fifty-five specimens were identified with pseudomembranous colitis consistent with CDI.All patients had a clinical history consistent with CDI and 45 of 55(81.8%) specimens also had microbiological confirmation of CDI.Appendectomy was observed in 24 of 55 specimens(0.436,99%CI: 0.280-0.606).This was compared to the lifetime incidence of appendectomy of 17.6%.The rate of appendectomy in our sample was significantly higher than would be expected in the general population(43.6% vs 17.6%,P 【 0.01).Disease severity did not differ based on presence or absence of an appendix and no association was detected between prior appendectomy and mortality(OR = 0.588,95%CI: 0.174-1.970).CONCLUSION: The rate of appendectomy in the patients whose CDI led to colectomy,was significantly higher than the calculated lifetime risk,suggesting an association of appendectomy and severe CDI resulting in colectomy.Larger prospective studies are needed to assess any potential causal relationships affecting fulminant CDI.
文摘Over the years there has been substantial advanced in the diagnosis and surgical management of complex thoracic aortic disease and complex endocarditis.As these therapies are being offered to a growing segment of patients-and more and more patients are felt to potentially benefit from such therapies,the longterm consequences of these interventions is sometimes poorly understood.While traditional medical complications,such as stroke,renal failure,respiratory failure,and even death are often the focus of outcomes studies,little is known on the impact of these diseases and therapies on mental health.This commentary emphasizes the importance of better understanding the psychologic impact of endocarditis and thoracic aortic pathology as reviewed by Dr.Bagnasco.
