Culture-based bacterial evaluation of the appendix lumen in patients with and without acute appendicitis

PurposeControversy exists over whether bacterial flora within the appendix differs between patients with and without appendicitis. To examine these potential differences, we cultured the appendiceal luminal microbiota of patients with and without acute appendicitis, and identified the bacterial species therein.MethodsFifty-seven patients with acute appendicitis and 37 patients without acute appendicitis who underwent curative resection of colorectal cancer and prophylactic appendectomies (control group) were included. Appendicitis patients were classified into the phlegmonous group or the gangrenous appendicitis group histopathologically. There was no patient with perforated appendicitis. Aerobic isolates were identified using standard identification schemata, and anaerobic isolates were identified according to the Japanese guidelines.ResultsThere were no significant differences among the three groups in the median number aerobe species present per patient. However, the median number anaerobe species in the gangrenous appendicitis group was significantly higher than that of the control group and the phlegmonous appendicitis group. In addition, the incidence of patients with Bacillus species, Fusobacterium nucleatum, and Bilophila wadsworthia increased as the disease progressed from phlegmonous to gangrenous appendicitis.ConclusionThe present results suggest that increased diversity of anaerobes and the translocation of Bacillus species, F. nucleatum, and B. wadsworthia are associated with the progression of acute appendicitis.     

C反应蛋白检测在急性阑尾炎手术时机选择中的作用探讨

目的：探讨C反应蛋白对急性阑尾炎手术时机的指导作用。方法选择我院2012年7月至12月行阑尾切除术并同时检测了白细胞、中性粒细胞比例和C反应蛋白的患者101例,并对这些检测指标进行Logistic回归分析及ROC分析并绘制ROC曲线,分析白细胞计数、中性粒细胞比例和C反应蛋白在三种不同病理类型阑尾炎中的分布特点,并探讨三种检测指标对坏疽性阑尾炎的预测价值,从而指导是否采用手术治疗。结果 Logistic回归分析结果显示C反应蛋白是坏疽性阑尾炎患者进行手术的惟一独立危险因素,从箱状图中可以看出白细胞计数和中性粒细胞比例的分布范围在三种不同病理类型的阑尾炎中无明显界限,而在单纯性阑尾炎的C反应蛋白均在50 mg/L以下,约有75%的蜂窝织炎性阑尾炎的C反应蛋白水平在50 mg/L以下,ROC曲线也提示C反应蛋白对判断坏疽性阑尾炎的敏感性优于白细胞及中性粒细胞分类（曲线下面积分别为0.788、0.688和0.604）,其截断值为51.22 mg/L。结论C反应蛋白的水平与急性阑尾炎的病理类型相关,可以作为选择是否手术的一个参考指标。     

阑尾炎手术患者围手术期预防性应用抗菌药物情况及合理性

目的 调查分析阑尾炎手术患者围手术期预防性应用抗菌药物情况,探讨其用药的合理性.方法 随机选取2018年4月至2020年1月在我院实施手术治疗的106例阑尾炎患者作为研究对象.统计患者围手术期预防性应用抗菌药物的情况,并了解其用药时间及联合用药情况,分析用药合理性.结果 106例阑尾炎手术患者中,97例为预防性用药,占...     

Botulinum toxin type A in the prophylactic treatment of chronic migraine

Since the second edition of the International classification of headache disorders (ICDH-II 2004), chronic migraine has been listed amongst migraine complications. Compared to episodic migraine the prevalence of chronic migraine is low, its impact, however, significant. Until recently no prophylactic drug had been approved for chronic migraine prophylaxis. After case reports had stated an effect of botulinum toxin type A on migraine, several randomized placebo-controlled studies were conducted in episodic headache; the results, however, were disappointing. Only when botulinum toxin type A was used in chronic migraine in the PREEMPT (phase 3 research evaluating migraine prophylaxis therapy) trials, its superiority compared to placebo was established. Thus, for the first time a prophylactic drug against chronic migraine is available which is both effective and well tolerated. Botox? has been licensed in England for the prophylaxis of headaches in adults with chronic migraine in 2010. Approval for its use in Germany has been applied for.     

Prophylaxe der chronischen Migr?ne mit Botulinumtoxin Typ A

Since the second edition of the International classification of headache disorders (ICDH-II 2004), chronic migraine has been listed amongst migraine complications. Compared to episodic migraine the prevalence of chronic migraine is low, its impact, however, significant. Until recently no prophylactic drug had been approved for chronic migraine prophylaxis. After case reports had stated an effect of botulinum toxin type?A on migraine, several randomized placebo-controlled studies were conducted in episodic headache; the results, however, were disappointing. Only when botulinum toxin type?A was used in chronic migraine in the PREEMPT (phase 3 research evaluating migraine prophylaxis therapy) trials, its superiority compared to placebo was established. Thus, for the first time a prophylactic drug against chronic migraine is available which is both effective and well tolerated. Botox? has been licensed in England for the prophylaxis of headaches in adults with chronic migraine in 2010. Approval for its use in Germany has been applied for.     

Klion infusion for controlling surgical and other bacterial gynaecological febrile complications

The incidence of febrile infectious postoperative complications following Caesarean sections and gynaecological major operations during 2 two-year periods has been retrospectively analysed. In the operated group receiving Klion infusion as an adjuvant to postoperative therapy infectious febrile complication occurred only in 2.63% of the cases versus the 6.73% of the control period without Klion therapy. The acute period of febrile acute pelvic inflammations decreased to 1-2 days in women treated with Klion infusion as well, versus the 3-4 days of the control cases. The study proved that prevention and therapy with metronidazole infusion decrease the incidence of complications and inflammations in which anaerobic pathogens play an important to about 50%.     

A migraine prophylaxis educational intervention in a Medicaid population

OBJECTIVES: To assess migraine prophylactic drug utilization in the Idaho Medicaid population and to evaluate responsiveness of practitioners to an educational intervention from the Idaho Medicaid Drug Utilization Review (DUR) Program. BACKGROUND: While established guidelines recommend migraine prophylactic therapies for defined patient populations and several drugs have demonstrated efficacy, their actual utilization is reportedly low. METHODS: Profiles for Idaho Medicaid patients were reviewed retrospectively to identify candidates for migraine prophylactic therapy based on excessive triptan utilization. Use of a prophylactic agent was then characterized for these patients, and an educational mailing was sent to practitioners directly involved in the care of patients who did not appear to be using prophylaxis. Patient profiles were again assessed 6 months following the mailing to determine if a trial of a prophylactic drug had been attempted. RESULTS: A total of 1909 patients were identified as having at least one claim for a triptan drug in the year studied. Of these patients, 360 appeared to be candidates for prophylaxis, but 154 had no record of prophylactic drug use. In the 6 months following the intervention mailing, 27 of the 91 non-prophylaxis patients (30%) who were still active clients of Idaho Medicaid and who had seen their physician during that time, appeared to have been given a trial of a migraine prophylactic drug. CONCLUSIONS: Following an educational intervention for Idaho Medicaid patients identified through retrospective DUR, a trial of a migraine prophylactic drug was initiated for approximately one-third of potential candidates.     

New ways of treating and preventing malaria: mefloquine (Lariam)

Mefloquine--a quinolinemethanol--opens new aspects in the therapy and prophylaxis of malaria. Since this drug will be soon available in Austria, a review of the pharmacological and clinical data is given. Preliminary results of studies dealing with resistance induction against mefloquine showed that Plasmodium falciparum can develop resistance to this substance in vivo as well as in vitro. Hence, some guidelines are given, in particular with regard to the use of mefloquine as a prophylactic drug. It should be used only in malaria endemic zones in which highly chloroquine resistant Plasmodium falciparum is prevalent and the duration of prophylactic administration should be limited to 3 months in order to prevent the development of resistance. However, mefloquine has proved to be a valuable new drug, well tolerated in clinical trials and with pharmacological properties that make its use simple and safe.     

Regional prophylaxis with teicoplanin in monolateral or bilateral total knee replacement: an open study

From January 1991 to June 1997, patients undergoing primary elective monolateral or bilateral total knee replacement (TKR) were consecutively enrolled in a prospective, open clinical study on the efficacy and safety of regional prophylaxis with teicoplanin (TEC). Those scheduled for monolateral TKR (115 patients) received 400 mg of TEC in 100 ml of saline as a 5-min infusion into a foot vein of the leg to be operated on immediately after the tourniquet was inflated to 400 mm Hg (ca. 50 kPa). For patients undergoing bilateral surgery (45 patients), regional administration of TEC was also repeated for the second knee operation. Follow-up ranged from a minimum of 2 years to 8 years. None of the patients experienced local or systemic adverse effects following regional administration of TEC. In the immediate postoperative and 2-year follow-up periods, only one superficial infection of the primary site attributable to intraoperative contamination (prophylaxis failure) out of the 205 prostheses implanted was observed. Deep infections involving the prosthesis did not occur. Infectious complications at distant sites were observed in nine cases (urinary tract infection due to Escherichia coli in eight cases, and Salmonella enteritidis gastroenteritis in one case) in the immediate postoperative period; they all were rapidly cured after antibiotic treatment. A delayed prosthetic infection, related to hematogenous spread of the etiological agent and therefore not considered a prophylactic failure, was observed in a patient who had undergone TKR 5 years before. Regional administration of TEC in monolateral and bilateral TKR appears to be a safe and valuable prophylactic technique.     

Toward a prophylaxis against fetal and neonatal alloimmune thrombocytopenia: induction of antibody-mediated immune suppression and prevention of severe clinical complications in a murine model

BACKGROUND: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a severe bleeding disorder caused by maternal antibody–mediated destruction of fetal or neonatal platelets (PLTs). Results from our recent large screening study suggest that the pathophysiology of FNAIT is more similar to hemolytic disease of the fetus and newborn (HDFN) than previously thought. Immunization against HPA‐1a might therefore be preventable by a prophylactic regimen of inducing antibody‐mediated immune suppression (AMIS), which has been documented to be a useful prophylaxis against HDFN. This preclinical proof‐of‐concept study investigated whether passive administration of anti‐β3 integrin could induce AMIS and thereby prevent clinical complications of FNAIT. STUDY DESIGN AND METHODS: A murine model of FNAIT using β3 integrin (GPIIIa)‐deficient (β3?/?) mice was employed for this study. AMIS in β3?/? mice was induced by intravenous administration of human anti‐HPA‐1a immunoglobulin G or murine anti‐β3 antisera given as prophylaxis after transfusion of HPA‐1a–positive human PLTs or murine wild‐type PLTs, respectively. RESULTS: AMIS against both human and murine PLT antigens was induced using this prophylactic approach, reducing the amount of maternal PLT antibodies by up to 90%. Neonatal PLT counts were significantly increased and pregnancy outcome was improved in a dose‐dependent manner. The incidence of intracranial hemorrhage, miscarriage, and dead‐born pups in mice receiving high‐dose prophylaxis was reduced to that of normal controls. We also observed that the severity of thrombocytopenia inversely correlated with birth weight. CONCLUSION: This work conceptually proves that prophylactic administration of PLT antibodies induces AMIS and prevents poor pregnancy outcome in FNAIT.     

Flunarizine-pizotifen single-dose double-blind cross-over trial in migraine prophylaxis

The results of a double-blind cross-over clinical trial involving 27 patients with classical or common migraine are described to compare the prophylactic effect of the calcium entry blocker flunarizine with that of pizotifen. Duration of the treatment was two months, with an evening single-dose administration of both drugs. For most parameters, there was no definite difference between flunarizine and pizotifen in migraine prophylaxis. It has been demonstrated previously that pizotifen is an effective drug in migraine prophylaxis, and these results suggest that flunarizine is effective, too. Weight gain as a side effect was less frequent and less severe with flunarizine than with pizotifen; other side effects showed the same incidence with both drugs.     

Comparison of 1-day, 2-day,and 3-day administration of antimicrobial prophylaxis in radical prostatectomy

An adequate protocol for antimicrobial prophylaxis (AMP) in radical prostatectomy has not been established. We retrospectively compared the incidence and severity of infectious complications after radical prostatectomy with three different protocols for AMP. The study cohort consisted of 67 patients with prostate cancer who underwent radical prostatectomy at Hakodate Goryoukaku Hospital between January 2003 and December 2005. As a prophylactic antimicrobial agent, one of the cephalosporins or penicillins was administered intravenously to all patients. The analyzed protocols were for: (1) a 3-day group: administration of AMP until the second postoperative day (POD 2), (2) a 2-day group: administration of AMP until POD 1, and (3) a 1-day group: administration of AMP only on the operative day. The incidence and severity of infectious complications were retrospectively investigated. Three patients in the 3-day group (9.4%), 2 patients in the 2-day group (12.5%), and 2 patients in the 1-day group (10.5%) developed some infectious complications. The incidence of infectious complications was not significantly different among the three groups. No patients developed severe infectious complications such as sepsis. We conclude that single-day AMP is sufficient in patients with radical prostatectomy.     

The value of laboratory tests in patients suspected of acute appendicitis.

The clinical usefulness of laboratory tests was examined in 258 patients admitted to the emergency room with the general practitioner's tentative diagnosis, acute appendicitis. Acute appendectomy was performed on 91 patients. Histological examination of the appendix confirmed the diagnosis in 69 cases (acute appendicitis 20, phlegmonous appendicitis 36, perforation 13). Seven patients with appendicular infiltrate were not subjected to operation but the diagnosis was clear from clinical examination. On close examination/operation by the surgical team, 96 admitted patients were excluded from the primary diagnosis, acute appendicitis, and served as a control group. Receiver Operation Characteristic curves (ROC-curves) showed that the sensitivity and specificity and hence diagnostic efficiency for total white blood cell count, number of segmented leukocytes and C-reactive protein concentration for the detection of acute appendicitis were higher than for erythrocyte sedimentation rate, alpha 1-antiproteinase concentration and body temperature. We observed that when all three parameters, C-reactive protein, white blood cell count and segmented leukocytes, are within the normal range the diagnosis, acute appendicitis is highly unlikely. The diagnostic value of the different laboratory parameters appears, moreover, to be highly dependent on the degree of inflammation/perforation and the development of appendicular infiltration. However, diagnostic efficiency can be improved, and unnecessary surgery prevented, by performance of an appropriately selected combination of laboratory tests combined with evaluation of clinical symptoms.     

Tolerance to the beneficial effects of prophylactic migraine drugs: a systematic review of causes and mechanisms

Loss of benefit of a previously effective treatment regimen, also known as tolerance, can be an important barrier to the successful preventive treatment of migraine. We undertook a systematic review of the literature to identify the prevalence and possible mechanisms of drug tolerance in migraine prophylaxis. Results demonstrate that the frequency of tolerance to prophylactic migraine treatment is unknown, but available data support an estimate that it occurs in 1-8% of patients receiving prophylaxis. Four broad types of tolerance were identified that are likely to be relevant to migraine prophylaxis. These are pharmacokinetic, pharmacodynamic, behavioral, and cross tolerance. The mechanisms that underlie these types of tolerance determine whether their effects can be overcome or minimized. For example, certain forms of tolerance may be affected by manipulation of environmental cues associated with drug administration, by the order in which drugs are used, and by the concomitant use of other medications. Many medications used for migraine prophylaxis exert their effects through the endogenous opioid system. The implications of this finding are explored, particularly the parallels between medication overuse headache and tolerance to migraine prophylaxis. Given the many ways in which tolerance to migraine medications may develop, in some ways it is not surprising that migraine-preventive drugs stop working; it is more surprising that in many cases they do not.     

小儿急性阑尾炎误诊149例

目的探讨小儿急性阑尾炎术前误诊原因及其防范措施,以提高小儿急性阑尾炎术前确诊率。方法对我院收治的小儿急性阑尾炎149例误诊病例的临床资料进行回顾性分析。结果本组术前误诊率为37.7%(149/395),误诊为肠梗阻69例、急性胃肠炎23例、上呼吸道感染34例、肠系膜淋巴结炎17例、脑炎2例、细菌性痢疾3例、消化道穿孔1例。149例均经术后病理检查确诊阑尾炎,其中化脓性阑尾炎135例,坏疽性阑尾炎14例。术后一期愈合124例,延期愈合23例,死亡2例。结论小儿急性阑尾炎术前误诊率高,仔细询问病史及查体,及时行特异性医技检查,认真进行鉴别诊断可提高其诊断准确率,减少术后并发症。     

Langzeitwirksamkeit und Nebenwirkungen verschiedener Migräneprophylaktika—eine retrospektive Analyse

Introduction

Drug therapy for the prevention of migraine attacks is becoming more and attacks is becoming more and more important. The aims of such prophylactic treatment are to reach a lower frequency, shorter duration and milder intensity of migraine attacks, and to reduce the intake of anti-migraine medication, to improve the quality of life and working ability. The question of efficacy and tolerance of established migraine prophylactics [1] has been thoroughly investigated in many studies. So far the question of sustained efficacy after a successful prophylactic treatment completion has not been a research priority, but it is nonetheless of great importance. Researchers at the neurologic scientific research institute of the university of Naples have followed up migraine out-patients after successful prophylactic treatment and observed that prophylactic agents differ not only in their immediate efficacy and safety, but also in long-term efficacy. Therefore, an open pilot study was performed with the prophylactic agents propranolol, flunarizine, pizotifen, DHE retard, methysergide and cyclandelate in the recommended dossages (Tabe 1).

Objective and methods

The aim of this study was to determine whether the various prophylactic agents available differ in active and long-term efficacy (at the end of a period after a successful prophylaxis=follow-up) and in the distribution of long-term responders at the end of the follow-up. The side effects of all prophylactic agents during active prophylaxis were also compared. Initially, 387 outpatients who had successfully completed a period of prophylactic treatment were recruited, and 208 were included in the study. At the time of follow-up a further period of prophylactic treatment was recommended if the efficacy rate was lower than 40% of the baseline at the end of the active prophylaxis period. The patients kept migraine headache daries (MHD) during the active prophylaxis and the follow-up, recording the following migraine objectives: number of attacks, pain total index (PTI), frequency of awakening with headache, and use of analgesics.

Results

The results showed that cyclandelate—actually a drug that is not yet officially accepted—had especially good results from the aspects of immediate efficacy, long-term efficacy and tolerance, compared with all other prophylactic agents. Significant differences were found in the duration of active prophylaxis. The mean monthly duration for patients treated with pizotifen (4.2), cyclandelate (3.9), and DHE retard (3.8) was longer than for those treated with flunarizine (2.8), and for patients treated with pizotifen it was longer than for those receiving propranolol (3.4). The mean duration (in months) of the postprophylactic period was distinctly longer for patients treated with cyclandelate (18.2) than for patients treated with DHE retard (12.9), flunarizine (13.1), propranolol (13.3) or pizotifen (13.8), but comparable with that after methysergide (17.2). Among the 208 patients, 85 were long-term responders (with no indication for repeated prophylaxis). No significant differences were found between the various groups, but the group of patients treated with cyclandelate was the only one with more than 50% long-term responders (18 vs 14). In general, the side effects of pizotifen, flunarizine and DHE retard seemed to be most pronounced. For cyclandelate, propranolol and methysergide fewer side effects were reported.

Conclusion

In spite of the uncontrolled pilot design, it can be said in summary that all prophylactic drugs were effective. Cyclandelate had a good safety profile, and in efficacy it was at least comparable to the other prophylactic drugs. Patients treated with cyclandelate had a longer duration of active treatment and likewise a longer period of follow up. In addition, the proportion of patients with “no indication for repeated prophylaxis” at follow up was higher than for any of the other drugs. The results are interesting for medical practice and suggest replication in a randomized blind study. If the results yielded by the present study are confirmed, cyclandelate should be classified as a drug of first choice for migraine prophylaxis.     

B型超声在小儿晚期阑尾炎诊断治疗上的应用

为了对小儿晚期阑尾炎的正确诊断，本文对177例小儿晚期阑尾炎进行了B超观察与分析。根据晚期阑尾炎的病理变化，显示出的各种声像图特征分为以下四型，其各有不同的治疗方法。（1）炎性浸润型；（2）部分液化浸润型；（3）完全液化脓肿型；（4）粪石穿孔阑尾周围炎型。其中Ⅰ型和Ⅱ型以保守药物治疗为主；Ⅲ型以穿刺抽脓治疗为主；Ⅳ型则行手术切除治疗。由于小儿不能与医生合作，常给诊断及治疗造成困难。本文资料表明B超对小儿晚期阑尾炎的诊断及指导治疗有极其重要的使用价值。     

超声对急性阑尾炎阑尾周边高回声结构的分析

目的 探讨阑尾周边高回声结构的性质，评价其在急性阑尾炎超声诊断中的临床意义。方法 对75例急性阑尾炎患者声像图进行回顾性分析，并与手术及病理结果相对照，分析阑尾周边高回声结构与阑尾炎病理及病变现象之间的相互关系。结果 75例急性阑尾炎中阑尾周边高回声结构阳性者32例，阴性者43例。阳性者中单纯性阑尾炎2例，化脓性阑尾炎18例，坏疽性阑尾炎12例，分别占各阑尾炎类型总例数的13％（2／15），39％（18／46），86％（12／14），阑尾周边高回声结构阳性率与病理类型间呈正相关关系（r=0．451，P〈0．001），阑尾炎越严重，阑尾周边高回声结构阳性率越高。病理结果显示阑尾周边高回声结构阳性病例均伴有阑尾周围炎，且阑尾发生与周围组织粘连及穿孔的比率明显高于阑尾周边高回声结构阴性病例。结论 阑尾周边高回声结构是急性阑尾炎超声征象之一，是阑尾周围组织（大网膜、肠系膜脂肪）受炎症浸润发生急性炎性反应的表现，阑尾周边高回声结构阳性提示与周围组织粘连、阑尾穿孔等严重病变可能性大。     

The effect of blunt abdominal trauma on appendix vermiformis

Objectives: Trauma and appendicitis are the most common conditions of childhood for which surgical consultation is sought in emergency departments. Occasionally, appendicitis and trauma exist together, which causes an interesting debate whether trauma has led to appendicitis. We aimed to evaluate our patients with traumatic appendicitis and to discuss their properties in the light of the literature. Methods: We retrospectively reviewed the charts of children of blunt abdominal trauma accompanied by appendicitis. Results: Of 29 cases of blunt abdominal trauma that had required surgical exploration, five were found to have gross findings of acute appendicitis and underwent appendicectomy. Appendicitis was confirmed histopathologically. Conclusion: It should be kept in mind that children managed for severe blunt abdominal trauma may develop appendicitis. If clinical outlook suggests appendicitis in cases conservatively managed for blunt abdominal trauma, physical examinations, abdominal ultrasonography and/or abdominal computed tomography should be repeated for diagnosis of traumatic appendicitis. This approach will help to protect the patients against the complications of appendicitis that are likely to develop.     

Tuberculosis exposure in a day-care center: recommended management

BACKGROUND: This article describes the contact investigation, clinical evaluation, and prophylactic treatment of the children and staff members in a day-care center after exposure to a teaching assistant with tuberculosis (TB). METHODS: The investigation included baseline and follow-up tuberculin skin testing, history and physical examinations, and chest radiographs. Directly observed prophylactic therapy with isoniazid was recommended for all exposed children with a negative evaluation and all children with positive skin test reactions and normal chest radiographs. Treatment was discontinued in children with negative skin test results at follow-up. Adult staff members were screened with baseline and follow-up skin tests and were referred for chest radiographs if skin test reactions were positive. RESULTS: In 3 of the 141 exposed children and 3 of the 41 adult staff members, tuberculin skin tests yielded positive results. No active TB disease was found. CONCLUSIONS: Isoniazid prophylaxis, administered by directly observed prophylactic therapy in the children, was effectively administered and tolerated in the day-care setting.