Early versus delayed operative management of appendicular mass

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hassan sayed Tantawy ◽  
Amr Mohamed El Hefny ◽  
Ahmed Yasser Abd El Halim ◽  
Mohammed Ali Abdel Ghaffar Nasr
Keyword(s):  
Retrospective Study ◽  
Acute Abdomen ◽  
Defense Mechanisms ◽  
Operative Management ◽  
University Hospital ◽  
Greater Omentum ◽  
Abdominal Ultrasonography ◽  
Military Hospitals ◽  
Group I ◽  
Appendicular Mass

Abstract Background Acute appendicitis is one of the most common causes of acute abdomen. It may be either complicated or uncomplicated. Sometimes the acute inflammation of the appendix may be enclosed by the patient’s own defense mechanisms to form inflammatory phlegmon. Complicated appendicitis is a palpable appendiceal mass, phlegmon, or a localized abscess. A phlegmon is an inflammatory tumor consisting of the inflamed appendix, with the greater omentum and adjacent viscera. Aim of the Work To determine the preferred approach taken to the management of the appendicular mass, to compare between acute appendectomy and delayed surgical intervention for appendicular mass, and to determine patient outcome following appendectomy for appendicular mass. Material and Methods: Study A retrospective study. Study Setting The study has been conducted in Ain Shams University Hospital (El-Demerdash) and military hospitals in Cairo and Alexandria under supervision of thesis supervisors. Study Period The study retrospectively analyze data of patients diagnosed as appendicular mass between January 2017 and December 2017. Study Population: Inclusion Criteria Patients with acute abdomen, diagnosed as appendicular mass by clinical examination and imaging (US and CT). Exclusion Criteria Females with right ovarian problems. Cases with right ureteric stones. Cases of recurrence. Abdominal ultrasonography and CT did not confirm the mass. Results The present study was a descriptive, retrospective, study that included 20 patients diagnosed with appendicular mass attended to surgery clinics at El-Demerdash and Military hospitals between January 2017 and December 2017. The patients were divided into two groups: Group I including 10 patients started conservative treatment then received delayed appendectomy. Group II including 10 patients received early appendectomy. Conclusion In conclusion, early appendicectomy is a safe and superior option in patients with appendicular mass compared to delayed appendicectomy. The results indicate that early appendicectomy leads to shorter hospital stay and return to normal activities than delayed appendicectomy. Moreover, postoperative difficulties and complications were less following early appendicectomy. The early appendectomy appears to achieve more favorable outcomes in patients with more severe symptoms, high fever, and high inflammatory markers. Nonetheless, more studies are necessary to confirm our findings.

Major Kinds of Drug Targets in Chagas Disease or American Trypanosomiasis

2019 ◽  
Vol 20 (11) ◽  
pp. 1203-1216 ◽  
Author(s):  
Vilma G. Duschak
Keyword(s):  
Chagas Disease ◽  
Latin American ◽  
Drug Targets ◽  
Defense Mechanisms ◽  
Cysteine Proteinase ◽  
Parasitic Infection ◽  
Etiologic Agent ◽  
World Health ◽  
American Trypanosomiasis ◽  
Group I

American Trypanosomiasis, a parasitic infection commonly named Chagas disease, affects millions of people all over Latin American countries. Presently, the World Health Organization (WHO) predicts that the number of international infected individuals extends to 7 to 8 million, assuming that more than 10,000 deaths occur annually. The transmission of the etiologic agent, Trypanosoma cruzi, through people migrating to non-endemic world nations makes it an emergent disease. The best promising targets for trypanocidal drugs may be classified into three main groups: Group I includes the main molecular targets that are considered among specific enzymes involved in the essential processes for parasite survival, principally Cruzipain, the major antigenic parasite cysteine proteinase. Group II involves biological pathways and their key specific enzymes, such as Sterol biosynthesis pathway, among others, specific antioxidant defense mechanisms, and bioenergetics ones. Group III includes the atypical organelles /structures present in the parasite relevant clinical forms, which are absent or considerably different from those present in mammals and biological processes related to them. These can be considered potential targets to develop drugs with extra effectiveness and fewer secondary effects than the currently used therapeutics. An improved distinction between the host and the parasite targets will help fight against this neglected disease.

scholarly journals Peri-Implant Behavior of Tissue Level Dental Implants with a Convergent Neck

2021 ◽  
Vol 18 (10) ◽  
pp. 5232
Author(s):  
Rubén Agustín-Panadero ◽  
Irene Bermúdez-Mulet ◽  
Lucía Fernández-Estevan ◽  
María Fernanda Solá-Ruíz ◽  
Rocío Marco-Pitarch ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Statistical Analysis ◽  
Bone Loss ◽  
Tissue Level ◽  
Functional Load ◽  
Implant Placement ◽  
Group I ◽  
Bone Level ◽  
Single Crowns ◽  
Functional Loading

Introduction: The aim of this retrospective study was to analyze the radiographic peri-implant bone loss of bone level implants and tissue level implants with a convergent neck in screw-retained single crowns and in screw-retained fixed partial prostheses, after two years of functional loading. Materials and methods: The sample was divided into two groups according to their type: Group I: supracrestal implants with convergent transmucosal neck; Group II: crestal implants. In each group we distinguish two subgroups according to the type of prosthetic restoration: single crowns and a three-piece fixed partial prosthesis on two implants. To quantify bone loss, parallelized periapical radiographs were analyzed at the time of implant placement and after two years of functional load. Results: A total of 120 implants were placed in 53 patients. After statistical analysis it was observed that for each type of implant bone loss was 0.97 ± 0.91 mm for bone level and 0.31 ± 0.48 mm for tissue level. No significant differences were found regarding the type of prosthesis and the location (maxilla or mandible) of the implants. Conclusions: Tissue level implants with a convergent transepithelial neck exhibit less peri-implant bone loss than bone level implants regardless of the type of prosthesis.

The Role of Nutritional Access in Malnourished Elderly Undergoing Major Surgery for Acute Abdomen: A Propensity Score-Matched Analysis

2020 ◽  
pp. 000313482097371
Author(s):  
Shekhar Gogna ◽  
David Samson ◽  
James Choi ◽  
Jorge Con ◽  
Kartik Prabhakaran ◽  
...  
Keyword(s):  
Propensity Score ◽  
Abdominal Surgery ◽  
Acute Abdomen ◽  
Anastomotic Dehiscence ◽  
The Elderly ◽  
Major Surgery ◽  
P Value ◽  
Gastrointestinal Complications ◽  
Group I

Background About 50% of the elderly undergoing emergency abdominal surgery are malnourished. The role of timely surgical nutritional access in this group of patients is unknown. Methods We analyzed the National Inpatient Sample database from 2009 through the first three-quarters of 2015 of patients aged ≥65 years who were malnourished and underwent major abdominal surgery for the acute abdomen within the first 2 days of hospital admission. Results Of 3 246 721 patients analyzed, 4311 patients met inclusion criteria. Of these, only 507 (11.8%) patients had surgical nutritional access (gastrostomy or jejunostomy) (group I), while 3804 patients (88.2%) did not (group II). In the propensity score-matched population, there were 482 patients in each group. The patients in group I had lower odds of mortality and postoperative gastrointestinal complications (paralytic ileus, anastomotic dehiscence, and intestinal fistulae) ( P-value <.01, respectively). Discussion Elderly who receive surgical nutritional access have lower rates of gastrointestinal complications and mortality.

scholarly journals Long term clinical result of implant induced injury on the adjacent tooth

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yang-Jin Yi ◽  
In-Woo Park ◽  
Jeong-Kui Ku ◽  
Deuk-Won Jo ◽  
Jung-Suk Han ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Root Surface ◽  
Chi Square ◽  
Group Iii ◽  
Direct Invasion ◽  
Adjacent Tooth ◽  
Group I ◽  
Long Term Result ◽  
Root Group

AbstractThe purpose of the retrospective study was to investigate the long-term result of implant-induced injury on the adjacent tooth. The subjects of this retrospective study were patients who had received implants and had tooth injury; direct invasion of root (group I), root surface contact (group II), or < 1 mm distance of the implant from the root (group III). Clinical and pathological changes were periodically examined using radiographs and intra-oral examinations. Paired t-tests and chi-square tests were used to evaluate the implant stability quotient (ISQ) of implant and tooth complications, respectively (α = 0.05). A total of 32 implants and teeth in 28 patients were observed for average 122.7 (± 31.7, minimum 86) months. Seven teeth, three of which were subsequently extracted, needed root canal treatment. Finally, 90.6% of the injured teeth remained functional. Complications were significant and varied according to the group, with group I showing higher events than the others. The ISQs increased significantly. One implant in group I resulted in osseointegration failure. The implant survival rate was 96.9%. In conclusion, it was found even when a tooth is injured by an implant, immediate extraction is unnecessary, and the osseointegration of the invading implant is also predictable.

Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients

2001 ◽  
Vol 115 (2) ◽  
pp. 112-118 ◽  
Author(s):  
A. Escribano Uzcudun ◽  
P. Bravo Fernández ◽  
J. J. Sánchez ◽  
A. García Grande ◽  
I. Rabanal Retolaza ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Head And Neck ◽  
Clinical Features ◽  
Medical Records ◽  
Performance Status ◽  
Nasopharyngeal Cancer ◽  
University Hospital ◽  
Premalignant Lesions ◽  
Pharyngeal Cancer ◽  
Presenting Symptoms

Pharyngeal cancer still presents an unsatisfactory mortality (30-40 per cent in most series, with a slightly better prognosis for nasopharyngeal cancer relative to both oropharyngeal and hypophyarngeal cancers) despite advances in treatment. Therefore, it is critical to know the clinical features of pharyngeal cancer. The purpose of this study was to investigate the most relevant clinical features of pharyngeal cancer (oropharyngeal, hypopharyngeal, and nasopharyngeal) in order to improve knowledge of this malignancy with the aim of ameliorating diagnosis and treatment.The retrospective study was based on a review of medical records from 258 consecutive patients with pharyngeal cancer (oropharyngeal, hypopharyngeal and nasopharyngeal) diagnosed at La Paz University Hospital, Madrid, Spain, between January 1 1991 and and December 31 1995. Medical records were provided by the Departments of Otorhinolaryngology, Head and Neck Surgery, Radiation Oncology, and Medical Oncology.All medical records were analysed for the following clinical variables: 1) incidence, 2) sociodemographics, 3) sites (oropharynx, hypopharynx, nasopharynx) and subsites, 4) clinical and histological staging, 5) pathlogy, 6) presenting symptoms, 7) time to diagnosis, 8) patients’ general performance status at diagnosis, 9) personal cancer history and synchronous head and neck tumours, 10) premalignant lesions, and 11) paediatric cases.Our most outstanding finding was the excessively long time that elapsed between first clinical manifestation appearance and conclusive diagnosis of pharyngeal cancer (4.7 months for pharynx, 4.5 for oropharynx, 4.4 for hypopharynx and 6.5 for nasopharynx cancers). It was found that nasopharyngeal cancer was quite different from both oropharyngeal and hypopharyngeal cancers with respect to its potential aetiology, risk factors and clinical presentation. In addition it has a better prognosis.

Craniofacial Morphology in Children with Complete Bilateral Cleft Lip and Palate: Does Infantile Size of the Premaxilla Predetermine Outcome?

2004 ◽  
Vol 41 (4) ◽  
pp. 410-415 ◽  
Author(s):  
Yu-Fang Liao ◽  
Chiung-Shing Huang ◽  
Ya-Yu Tsai ◽  
M. Samuel Noordhoff
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Craniofacial Morphology ◽  
University Hospital ◽  
Cephalometric Analysis ◽  
Bilateral Cleft Lip ◽  
Dental Cast ◽  
Craniofacial Characteristics

Objective To evaluate the possible association between the size of the premaxilla in infants and craniofacial morphology in children with complete bilateral cleft lip and palate (CBCLP) and identify the characteristics of craniofacial morphology in children with CBCLP with median facial dysplasia (MFD). Design Retrospective study. Setting A university hospital craniofacial center. Subjects Thirty-four patients with nonsyndromic CBCLP, 24 boys and 10 girls, had large premaxilla (LP group). Thirty-six patients with nonsyndromic CBCLP, 16 boys and 20 girls, had small premaxilla (SP group). Thirteen CBCLP patients with MFD, five boys and eight girls (MFD group). Main Outcome Measures Infant maxillary dental cast at the age of 1 year was used to measure the size of the premaxilla. Cephalometric analysis was used to determine craniofacial morphology in children at the age of 5 years. Results The size of the premaxilla in infants with CBCLP varied greatly. The LP group tended to have a longer maxilla and a more protruded maxilla, producing a better interjaw relation. The opposite phenomena were observed in the MFD group; the SP group yielded results between those of the LP and the MFD groups. Conclusion The size of the premaxilla in infants with CBCLP can be used to predetermine subsequent craniofacial morphology at the age of 5 years. Children with nonsyndromic CBCLP had craniofacial characteristics that differed significantly from those of children with CBCLP with median facial dysplasia.

scholarly journals Comparison of isoflurane and propofol sedation in critically ill COVID-19 patients—a retrospective chart review

2021 ◽  
Author(s):  
Azzeddine Kermad ◽  
Jacques Speltz ◽  
Guy Danziger ◽  
Thilo Mertke ◽  
Robert Bals ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Retrospective Study ◽  
Linear Regression ◽  
Chart Review ◽  
Distress Syndrome ◽  
Minute Ventilation ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
High Doses ◽  
End Tidal

Abstract Purpose In this retrospective study, we compared inhaled sedation with isoflurane to intravenous propofol in invasively ventilated COVID-19 patients with ARDS (Acute Respiratory Distress Syndrome). Methods Charts of all 20 patients with COVID-19 ARDS admitted to the ICU of a German University Hospital during the first wave of the pandemic between 22/03/2020 and 21/04/2020 were reviewed. Among screened 333 days, isoflurane was used in 97 days, while in 187 days, propofol was used for 12 h or more. The effect and dose of these two sedatives were compared. Mixed sedation days were excluded. Results Patients’ age (median [interquartile range]) was 64 (60–68) years. They were invasively ventilated for 36 [21–50] days. End-tidal isoflurane concentrations were high (0.96 ± 0.41 Vol %); multiple linear regression yielded the ratio (isoflurane infusion rate)/(minute ventilation) as the single best predictor. Infusion rates were decreased under ECMO (3.5 ± 1.4 versus 7.1 ± 3.2 ml∙h−1; p < 0.001). In five patients, the maximum recommended dose of propofol of 4 mg∙hour−1∙kg−1ABW was exceeded on several days. On isoflurane compared to propofol days, neuro-muscular blocking agents (NMBAs) were used less frequently (11% versus 21%; p < 0.05), as were co-sedatives (7% versus 31%, p < 0.001); daily opioid doses were lower (720 [720–960] versus 1080 [720–1620] mg morphine equivalents, p < 0.001); and RASS scores indicated deeper levels of sedation (− 4.0 [− 4.0 to − 3.0] versus − 3.0 [− 3.6 to − 2.5]; p < 0.01). Conclusion Isoflurane provided sufficient sedation with less NMBAs, less polypharmacy and lower opioid doses compared to propofol. High doses of both drugs were needed in severely ill COVID-19 patients.

Sign in / Sign up

Export Citation Format

Share Document