Factors leading to long-term hospitalization after laparoscopic appendectomy.

BACKGROUND: Randomized studies demonstrate that laparoscopic appendectomy yields better results compared with open techniques. We sought to identify factors that determine an extended hospital stay among patients undergoing laparoscopic appendectomy. METHODS: This was a prospective study including 669 patients undergoing laparoscopic appendectomy. We analyzed variables that can predict the length of hospital stay. RESULTS: Of 669 patients undergoing laparoscopic appendectomy, 141 stayed in the hospital for > or = 5 days (Group 1), and 97 stayed in the hospital for < or = 1 day after surgery (Group 2). The univariate analysis demonstrated that fever (P<0.0001), nausea and vomiting (P=0.060), leukocytosis (P<0.0001), gangrened or perforated intraoperative appearance of the appendix (P<0.0001), and appendix position behind the ileocecal junction (P<0.001) were related to a longer hospital stay. The multivariate analysis through logistical regression showed that the factors independently and significantly associated with an extended hospital stay were presurgical fever, appendix position behind the ileocecal junction, and intraoperative gangrened or perforated appearance of the appendix. CONCLUSION: Fever, appearance, and position of the appendix are factors related to an extended hospital stay.     

Behavior of cryopreserved endothelial cells in different phases: Their application in the seeding of vascular prostheses

Various methods of cryopreservation of human endothelial cells (EC) were studied to determine their viability and behavior when seeded onto vascular prostheses made of polytetrafluoroethylene (PTFE). Three different protocols were used: (1) cyropreservation of whole umbilical vein, (2) cyropreservation of freshly extracted umbilical EC in suspension, and (3) cryopreservation of EC derived from a first subculture. Fresh EC and EC from a first subculture were used as controls. The viability and growth of these cells in culture media were studied, and basal prostacyclin levels were determined. The cells were assessed morphologically after they were seeded onto PTFE discs. Our results showed that the cryopreservation method that maintained the greatest viability was that in which previously cultured EC were used. Basal prostacyclin levels were significantly different following cyropreservation. However, when these cells were seeded onto PTFE discs their behavior was similar to that of fresh EC.We thank W. L. Gore & Associates for supplying the prostheses used in this study.Supported by a grant from the Comision Interministerial de Cieucia y Tecnologia SAF 92/0875.     

Effect of Zinc or S-Adenosyl-l-methionine on Long Term Administration of Low Doses of Lead to Rats

Two alternatives for the treatment of lead intoxication, administration of zinc or a thiol donor, S-adenosyl-L-methionine (SAM), were analysed. Rats were exposed to lead (Pb)-acetate (60 mg/1) in drinking water during 90 days; one group also received SO₄Zn in water (40 mg/l), while another received both Pb and SAM (5 mg/24 hr intraperitoneally. Erythrocytic δ-aminolaevulinic dehydratase (ALA-D) activity was significantly reduced (P<0.001) both in rats receiving Pb alone and in rats receiving Pb and each of the other two treatments. The high erythrocytic uroporphyrinogen synthetase (URO-S) activity noticed in Pb administered rats, was significantly (P< 0.001) reduced in animals treated either with zinc or with SAM. Hepatic ALA-D activity tended to decrease while renal enzyme activity was not modified by the low level Pb exposure used in this work. Interestingly, SAM treated rats in both tissues exhibited significantly (P<0.01) higher activities of the enzyme. It is argued that SAM treatment causes a surplus of thiols that allows the full expression of ALA-D catalytic activity.     

Embolization of nonvariceal portosystemic collaterals in transjugular intrahepatic portosystemic shunts

Percutaneous embolization of large portosystemic collaterals was performed in three patients following placement of a transjugular intrahepatic portosystemic shunt in order to improve hepatopetal portal flow. Improved hepatic portal perfusion was achieved in these cases, thereby theoretically reducing the risk of chronic hepatic encephalopathy.     

Severe Necrosis Due to Paclitaxel Extravasation

Paclitaxel is an antineoplastic agent derived from the bark of the Pacific yew tree that has activity against many tumors including breast and ovarian carcinomas. In the past, its extravasation quality has been considered to be a local irritant; however, recent reports suggest that the agent may be a vesicant. A patient experienced a delayed vesicant reaction to a paclitaxel extravasation that resulted in severe necrosis. No acute symptoms were reported at the time of extravasation from the 24-hour peripheral paclitaxel infusion. However, on day 11 the patient complained of severe and progressive pain at the site of extravasation. The site was erythematous and had areas of central necrosis requiring debridement and closure by a plastic surgeon. Because paclitaxel possesses vesicant characteristics, health care professionals should be aware of its potential extravasation hazard. Prolonged peripheral infusions should be avoided or administered with extreme caution.     

中风后癫痫59例分析

对641例中风患者追踪观察1～3年,结果59例出现癫痫发作,中风后癫痫发生率为9.20％;脑出血与脑梗塞癫痫发生率间比较无已著差异(P>0.05);皮层损害者癫痫发生率显著高于皮层下损害者(P<0.01);脑出血继发癫痫发作多属早期发作(8/11),而脑梗塞多属迟发性癫痫发作(40/48)(P<0.01);早期癫痫发作需长期服抗癫痫药控制者显著低于迟发性癫痫发作(P<0.01)。提示:病损波及皮层是重要的致痫因素;早期发作与迟发性癫痫发作的发病机理不同,故表现出治疗与转归不同;迟发性癫痫尤其病灶波及皮层者长期规则服抗癫痫药是必要的。     

巨噬细胞杀伤白色念珠菌作用的探讨

本研究经杀菌试验和免疫后保护力试验探讨小鼠巨噬细胞在抗白色念珠菌感染中的作用,结果表明白色念珠菌酵母形体对巨噬细胞杀伤作用的抵抗力及对小鼠的毒力均较菌丝形体强。小鼠体内不同部位巨噬细胞杀伤白色念珠菌的作用不同,脾脏巨噬细胞作用大于腹腔残存巨噬细胞。经白色念珠菌活菌静脉免疫后脾巨噬细胞杀白色念珠菌作用增强,但其对再感染的抵抗力不增强。     

脐血CD34~+细胞体外短期培养扩增研究

为寻找更有效的体外扩增脐血CD34 + 细胞的造血细胞因子组合 ,采集健康产妇脐带血 ,用免疫磁珠法分选CD34 + 细胞。采用SCF、FLT3 L、TPO和IL 34种具有早期作用的细胞因子的不同组合进行脐血CD34 + 细胞短期无血清液体培养 ,观察培养前后有核细胞、CD34 + 细胞、CD34 + /CD38- 细胞、CFU GEMM、CFU GM和BFU E数量的变化。结果在 3种不同的细胞因子组合中 ,同时应用SCF、FLT3 L、TPO和IL 34种细胞因子培养 7d的扩增效果最好。突出的发现是在这种条件下CD34 + /CD38- 细胞亚群达到平均 1 97.9倍的扩增效果。提示 :SCF、FLT3 L、TPO和IL 34种细胞因子是脐血CD34 + 细胞体外扩增理想的细胞因子组合     

Single-Agent versus Combination Antibiotic Therapy in the Management of Intraabdominal Infections

For the treatment of intraabdominal infection, single-agent antimicrobial regimens such as β-lactams with good antianaerobic activity are frequent alternatives to combination regimens such as aminoglycosides or aztreonam plus an antianaerobic agent such as clindamycin or metronidazole. The major issues in selecting a regimen are relative efficacy, potential for adverse drug effects, and cost. Single agents are clearly equivalent to combinations in preventing infectious complications after penetrating abdominal trauma and in treating established intraabdominal infections of mild to moderate severity or in relatively low-risk patients. A few trials demonstrated their equivalency in patients at high risk of mortality, although experience is limited. Single-agent regimens may reduce the risks of adverse drug effects compared with combination regimens, but they are not always less expensive.