BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and ...BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and an ideal postoperative antiinfective approach for PPA management has yet to be established.AIM To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem(CBP)and cephalosporin(CPS)antibiotics.METHODS We retrospectively analyzed medical records of 65 children(43 boys,22 girls;mean age 6.92±3.41 years)with PPA who underwent surgery at our hospital between December 2019 and August 2022.Data were collected in September 2023.Based on postoperative antibiotic selection,patients were divided into CBP(32 cases)and CPS(33 cases)groups.Chi-square and T-tests compared recovery outcomes,while univariate and multivariate regression models identified independent factors affecting postoperative recovery.RESULTS There were no significant differences between the two groups in gender,age,weight,height,body mass index,baseline ear temperature,or heart rate(P>0.05).Escherichia coli(40.00%)and Pseudomonas aeruginosa(24.62%)were the most common pathogens in PPA.Postoperative analysis showed significantly shorter C-reactive protein(CRP)recovery times in the CPS group than in the CBP group[(6.18±1.84)vs(8.12±3.48)days,P=0.009].Univariate logistic regression indicated CPS selection(OR=0.32,95%CI:0.10-0.97,P=0.044)was significantly associated with a higher CRP recovery rate within 7 days.Multivariate analysis confirmed CPS selection(OR=3.49,95%CI:1.19-10.24,P=0.023)as an independent factor affecting CRP recovery within 7 days postoperatively.CONCLUSION The choice of CBP or CPS independently affects CRP recovery within 7 days.CBP offers no advantage over CPS in treating PPA,with CPS also demonstrating favorable clinical outcomes.展开更多
Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons.Sometimes too much reliance is put on investigations that can lead to a misdiagnosis.This case ...Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons.Sometimes too much reliance is put on investigations that can lead to a misdiagnosis.This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase,which led to an assumed diagnosis of pancreatitis.She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis,with no evidence of pancreatitis.Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.展开更多
BACKGROUND Coronavirus disease 19(COVID-19)is a global pandemic and has had a profound impact on our routine surgical activities.Acute appendicitis is the most common abdominal emergency worldwide.Therefore,it is high...BACKGROUND Coronavirus disease 19(COVID-19)is a global pandemic and has had a profound impact on our routine surgical activities.Acute appendicitis is the most common abdominal emergency worldwide.Therefore,it is highly essential to assess the influence the pandemic has on acute appendicitis.AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing,China.Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019.Preoperative management,intraoperative protective measures,and postoperative management were conducted.RESULTS After screening,six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group.The results of the nucleic acid test were negative.Of the 76 patients enrolled in the simple group,nine patients received medication therapy,and all others underwent surgery.From this same group,66 patients were diagnosed with suppurative appendicitis,and one patient was diagnosed with perforated appendicitis after surgery.There were 14 patients in the complex group,for which the postoperative diagnosis indicated perforated appendicitis.The proportion of men with perforated appendicitis was higher than that in 2019(P<0.05).The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019(P<0.05).The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019(P<0.05).The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019(P<0.05).Online consultation after discharge was selected in 59 cases(65.6%).No perioperative infection with COVID-19 or long-term postoperative complications were found.CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.展开更多
BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandem...BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIM To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODS The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) periods.RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period.PreCOVID-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital stay increased.On the other hand,negative appendectomy rate decreased.There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.展开更多
基金Supported by Jiaxing Science and Technology Plan Project,No.2024AD30035.
文摘BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and an ideal postoperative antiinfective approach for PPA management has yet to be established.AIM To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem(CBP)and cephalosporin(CPS)antibiotics.METHODS We retrospectively analyzed medical records of 65 children(43 boys,22 girls;mean age 6.92±3.41 years)with PPA who underwent surgery at our hospital between December 2019 and August 2022.Data were collected in September 2023.Based on postoperative antibiotic selection,patients were divided into CBP(32 cases)and CPS(33 cases)groups.Chi-square and T-tests compared recovery outcomes,while univariate and multivariate regression models identified independent factors affecting postoperative recovery.RESULTS There were no significant differences between the two groups in gender,age,weight,height,body mass index,baseline ear temperature,or heart rate(P>0.05).Escherichia coli(40.00%)and Pseudomonas aeruginosa(24.62%)were the most common pathogens in PPA.Postoperative analysis showed significantly shorter C-reactive protein(CRP)recovery times in the CPS group than in the CBP group[(6.18±1.84)vs(8.12±3.48)days,P=0.009].Univariate logistic regression indicated CPS selection(OR=0.32,95%CI:0.10-0.97,P=0.044)was significantly associated with a higher CRP recovery rate within 7 days.Multivariate analysis confirmed CPS selection(OR=3.49,95%CI:1.19-10.24,P=0.023)as an independent factor affecting CRP recovery within 7 days postoperatively.CONCLUSION The choice of CBP or CPS independently affects CRP recovery within 7 days.CBP offers no advantage over CPS in treating PPA,with CPS also demonstrating favorable clinical outcomes.
文摘Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons.Sometimes too much reliance is put on investigations that can lead to a misdiagnosis.This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase,which led to an assumed diagnosis of pancreatitis.She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis,with no evidence of pancreatitis.Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.
基金Jiaxing Key Discipline of Medicine-Oncology(Supporting Subject),No.2019-zc-11.
文摘BACKGROUND Coronavirus disease 19(COVID-19)is a global pandemic and has had a profound impact on our routine surgical activities.Acute appendicitis is the most common abdominal emergency worldwide.Therefore,it is highly essential to assess the influence the pandemic has on acute appendicitis.AIM To assess the efficacy of the management of acute appendicitis during the COVID-19 pandemic.METHODS We retrospectively analyzed 90 patients who presented with acute appendicitis during the outbreak of COVID-19 in Jiaxing,China.Clinical data regarding appendectomies patients were also collected for the corresponding time frame from 2019.Preoperative management,intraoperative protective measures,and postoperative management were conducted.RESULTS After screening,six patients were identified as unqualified due to fever and were then referred to the COVID-19 expert group.The results of the nucleic acid test were negative.Of the 76 patients enrolled in the simple group,nine patients received medication therapy,and all others underwent surgery.From this same group,66 patients were diagnosed with suppurative appendicitis,and one patient was diagnosed with perforated appendicitis after surgery.There were 14 patients in the complex group,for which the postoperative diagnosis indicated perforated appendicitis.The proportion of men with perforated appendicitis was higher than that in 2019(P<0.05).The chief complaint duration for perforated appendicitis patients in 2020 was longer than that in 2019(P<0.05).The routine blood test showed that white blood cell counts and neutrophil ratios were higher in perforated appendicitis patients in 2020 than in 2019(P<0.05).The ratio of open appendectomies to the amount of mean blood loss during surgery was greater in 2020 than in 2019(P<0.05).Online consultation after discharge was selected in 59 cases(65.6%).No perioperative infection with COVID-19 or long-term postoperative complications were found.CONCLUSION The management of acute appendicitis from Jiaxing effectively reduced the influence of the pandemic and minimized the risk of nosocomial infection.
文摘BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIM To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODS The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) periods.RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period.PreCOVID-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital stay increased.On the other hand,negative appendectomy rate decreased.There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.
