scholarly journals Management of wound infection after appendectomy: are parenteral antibiotics useful?

2021 ◽  
Vol 8 (4-5) ◽  
pp. 638-644
Author(s):  
B. Harahsheh ◽  
B. Hiyasat ◽  
A. Abulail ◽  
M. Al Basheer
Keyword(s):  
Povidone Iodine ◽  
Perforated Appendicitis ◽  
Length Of Hospital Stay ◽  
District General Hospital ◽  
Antibiotic Use ◽  
Wound Infections ◽  
Perforated Appendix ◽  
The Mean ◽  
To Receive ◽  
Single Blind

This study investigated the use of antibiotics in the treatment of wound infections after appendectomy. The subjects were 72 patients with post-operative wound infections at a district general hospital in Jordan. All patients received daily antiseptic dressings with povidone-iodine 10% in alcohol. The patients were randomized in a single-blind trial to receive either no antibiotics or parenteral antibiotics metronidazole and cefoxitin. There was no significant effect of antibiotic use in patients with early inflamed or severely inflamed appendicitis. However, for patients with perforated appendicitis the mean length of hospital stay and the mean frequency of change of dressings were significantly reduced. We conclude that antibiotics do not offer any advantage in post-appendectomy wound infections except for cases of perforated appendix

Association of Wound Infection with Various Surgical Technique Applied for Appendectomy in Diabetic and Hypertensive Patients

2021 ◽  
Vol 15 (8) ◽  
pp. 2163-2165
Author(s):  
Muhammad Armughan ◽  
Imran Sadiq ◽  
Shafqat Mukhtar ◽  
Hafiz Ahmad Altaf
Keyword(s):  
Wound Infection ◽  
Laparoscopic Appendectomy ◽  
Surgical Procedure ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
Diabetic Patients ◽  
Wound Infections ◽  
Hypertensive Patients ◽  
Duration Of Surgery ◽  
Perforated Appendix

Background: Perforated appendix in diabetic as well as hypertensive patients is associated with elevated risks of postoperative infectious complications such as wound infection and intra-abdominal abscess. Objective: To identify better appendectomy procedure for diabetic and hypertensive patients. Study Design: Randomized Controlled Trial Place and Duration of Study: Department of Surgery, Unit l, Bahawal Victoria Hospital Bahawalpur from 10th October 2020 to 9th April 2021. Methodology: Ninety eight patients meeting the criteria of perforated appendix were divided in two groups; one group consisted of 49 patients who were managed by open surgical procedure. Second group was consisted of 49 patients who were managed by laparoscopic surgical procedure. Patient outcomes in-terms of wound infections, operative time and duration of surgery was assessed. Results: Mean age of patients was 25.49±6.03 years. There were 17 hypertensive while 15 diabetic patients. Wound infection was seen in 21% and 28% open surgery diabetic and hypertensive patients respectively in comparison to 10%and 8% in laparoscopic appendectomy diabetic and hypertensive patients respectively (p<0.001). Conclusion: Laparoscopic appendectomy (LA) is associated with significantly lower rates of post-operative wound infections and shorter hospital stay in comparison to open appendectomy in diabetic and hypertensive patients of perforated appendicitis. Key Words: Perforated appendix, laparoscopic, open appendectomy

scholarly journals Pyoderma Gangrenosum: A Review of Clinical Features and Outcomes of 23 Cases Requiring Inpatient Management

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Mingwei Joel Ye ◽  
Joshua Mingsheng Ye
Keyword(s):  
Pyoderma Gangrenosum ◽  
Length Of Hospital Stay ◽  
Rapid Progression ◽  
High Morbidity ◽  
Systemic Diseases ◽  
Wound Infections ◽  
Inpatient Management ◽  
The Mean ◽  
Topical Treatments ◽  
Systemic Therapies

Pyoderma gangrenosum (PG) is a rare dermatological disorder characterised by the rapid progression of a painful, necrolytic ulcer. This study retrospectively identified patients who were admitted and treated for PG during a 10-year period (2003–2013). Twenty-three patients were included in this study, 16 women and seven men. The mean age at initial admission was 62.8 years (range 30 to 89 years). Lesions were localised to lower limb in 13 patients, peristomal region in four, breast in three, and upper limb in one, and two patients had PG at multiple sites. The variants of PG noted were ulcerative (18), bullous (2), vegetative (2), and pustular (1). Associated systemic diseases were observed in 11 patients (47.8%). Systemic therapies were initiated in 21 patients while two patients received topical treatments. The mean length of hospital stay was 47 days (range 5 to 243 days) and five patients died during their admissions. Seven patients required readmissions for exacerbations of their PG. Our study showed that patients admitted for treatment of PG had high morbidity and mortality. This study also highlights the importance of early and aggressive treatment of patients admitted with PG as well as treating associated systemic diseases and wound infections.

Clinical impact of febrile neutropenia (FN) increase among patients receiving adjuvant docetaxel/cyclophosphamide (TC) chemotherapy compared to TC plus pegfilgrastim for breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1076-1076 ◽  
Author(s):  
Erika Paige Hamilton ◽  
Donna L. Topping ◽  
Jeffrey M. Peppercorn ◽  
P. Kelly Marcom ◽  
Gretchen Genevieve Kimmick ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Routine Care ◽  
Breast Cancer Patients ◽  
Retrospective Reports ◽  
Baseline Characteristics ◽  
The Cost ◽  
To Receive

1076 Background: The FN rate for the approved regimen of TC is 5% in pivotal studies. Other small retrospective reports have reported FN rates as high as 20-35%. We report the incidence of FN from a large retrospective series of breast cancer patients receiving TC with or without pegfilgrastim (PF) for adjuvant therapy. Methods: We reviewed records of 240 sequential patients who had received adjuvant TC (75 and 600 mg/m2) between Mar ’07 and Nov ’12 for FN, upfront PF use, and adverse events by treatment cohort. FN was defined as T> 100.4°F and ANC <500, while upfront PF was defined as PF given at physician discretion 24-48h after 1stcycle of TC administration. Comparisons between two proportions used exact binomial methods; effect of PF on FN after adjusting for baseline characteristics was tested using multivariate logistic regression. Results: 153 (63.7%) patients received upfront PF, while 87 (36.3%) did not (Table). Patients receiving upfront PF were older (57 vs. 52 yrs, p=0.02). Other baseline characteristics (size of primary tumor, hormone receptor status, and nodal status) were no different between groups. FN, fever, antibiotic use, hospitalization, and dose delay were significantly higher when upfront PF was not used (Table). The average length of hospital stay was 2.9 days for TC + PF, and 3.8 days for TC pts. 31/87 (35.6%) of patients without upfront PF went on to receive PF after the 1st cycle. Conclusions: FN for adjuvant TC meets clinical practice threshold and ASCO guidelines for upfront use of PF. FN-related outcomes such as fever, antibiotic use, dose delays, and number of hospitalizations, and were significantly increased without upfront PF. The cost-effectiveness of these findings will be presented and have major clinical implications for routine care. [Table: see text]

scholarly journals Fournier's Gangrene: Conventional Dressings versus Dressings with Dakin's Solution

ISRN Urology ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Bülent Altunoluk ◽  
Sefa Resim ◽  
Erkan Efe ◽  
Mustafa Eren ◽  
Can Benlioglu ◽  
...  
Keyword(s):  
Povidone Iodine ◽  
Length Of Hospital Stay ◽  
Fournier’S Gangrene ◽  
Morbidity And Mortality ◽  
Wound Management ◽  
Fournier's Gangrene ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Destructive Inflammation

Purpose. Fournier’s gangrene is a fulminant and destructive inflammation of the scrotum, penis, and perineum. The objective of this study was to compare 2 different approaches to wound management after aggressive surgical debridement. Methods. Data from 14 patients with Fournier’s gangrene were retrospectively collected (2005–2011). Once the patients were stabilized following surgery, they were treated with either daily antiseptic (povidone iodine) dressings (group I, n=6) or dressings with dakin’s solution (sodium hypochloride) (group II, n=8). Results. The mean age of the patients was 68.2 ± 7.8 (55–75) years in group I and 66.9 ± 10.2 (51–79) years in group II. Length of hospital stay was 13 ± 3.5 (7–16) days in group I and 8.9 ± 3.0 (4–12) days in group II (P<0.05). The number and rate of mortality was 1/6 (16.7%) in group I, and 1/8 (12.5%) in group II. Conclusions. The hospitalization time can be reduced with the use of dakin’s solution for the dressings in the treatment of FG. Also, dressings with dakin’s solution seems to have favorable effects on morbidity and mortality. Consequently dakin’s solution may alter the treatment of this disastrous disease by reducing cost, morbidity and mortality.

Ep.We.1001Name That Tune - Acccuracy of Interpreting Hand-Held Doppler Audio Signals in the Assessment of Peripheral Arterial Circulation

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mohamad Kamarizan ◽  
Anthony Da Silva
Keyword(s):  
District General Hospital ◽  
Wave Form ◽  
Audio Signals ◽  
Single Centre ◽  
Arterial Circulation ◽  
Doppler Signals ◽  
Improve Accuracy ◽  
The Mean ◽  
Peripheral Arterial ◽  
Single Blind

Abstract Aims Interpretation of Doppler audio signals among non-podiatrist has not been thoroughly investigated. This study analyses the accuracy of interpretation of Doppler audio signals among clinicians. Methods A single-centre prospective single blind study was used. Clinicians in the vascular department and with prior vascular experience in a district general hospital participated in interpreting 15 12-second Doppler audio signals (5 monophasic, 5 biphasic and 5 triphasic) into either ‘monophasic’, ‘biphasic’ and ‘triphasic’ using a Huntleigh’s Dopplex DMXTM digital hand-held Doppler ultrasound with visual waveform display covered. After all the audio signals were graded, the waveforms of each doppler signals are shown on the hand-held doppler display to reveal the correct responds. Results 8 clinicians were involved; 5 had less than 6 months of vascular experience. Out of 15 audio signals, the mean number correct grading of signals was 10.1. There is no difference in number of correct grading of the 3 waveforms (monophasic 3.5 out of 5, biphasic 3.25 out of 5, triphasic 3.5 out of 5). There is also no difference in responses between clinicians with less than 6 months and more than 6 months of vascular experience (p = 0.82). Conclusions There is a need for further ongoing education among clinicians in the use of hand held Doppler and interpretation of its audio signals. Reliability of Doppler examination in vascular assessment is also in contention, and further studies are required. The use of digital hand-held Doppler with visual wave form display will significantly improve accuracy of interpretation

scholarly journals Comparison of efficacy and safety of ketoprofen patch versus diclofenac patch as post-operative analgesic in hysterectomy patients

2019 ◽  
Vol 8 (11) ◽  
pp. 2445 ◽  
Author(s):  
Seema Rani ◽  
Meenakshi Savant ◽  
Rajiv Mahendru ◽  
Pranav Bansal
Keyword(s):  
Rating Scale ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Efficacy And Safety ◽  
Serious Adverse Events ◽  
The Mean ◽  
Student’S T ◽  
To Receive ◽  
Single Blind

Background: The objective of the study was to compare the efficacy and safety of ketoprofen patch versus diclofenac patch as post-operative analgesic in hysterectomy patients.Methods: The study was a prospective, single blind, randomized, comparative interventional clinical study conducted in a tertiary care hospital. Sixty female patients were randomly allocated to receive either ketoprofen or diclofenac patch 1 hour prior to the hysterectomy. Pain was assessed postoperatively after an interval of every four hours for 24 hours using visual analogue scale (VAS) and verbal rating scale (VRS).Results: In ketoprofen group, mean VAS was (2.92±0.11) significantly low as compared to diclofenac group (3.25±0.14). The mean VRS score in group ketoprofen (1.62±0.22) was low as compared to group diclofenac (1.83±0.16). Safety analysis revealed no apparent serious adverse events. Inj. Paracetamol 1 gm i.v was given as rescue analgesic to the patients in whom VRS >2 and VAS >5 was noted. Data were analysed using unpaired student’s t-test.Conclusions: Transdermal patches are very convenient to use and causes less discomfort as compared to traditional routes of drug delivery. Ketoprofen patch was found better in providing analgesia after hysterectomy as compared to diclofenac patch with lesser side effects. 

scholarly journals Diagnostic value of serum hyperbilirubinemia in acute appendicitis and its complications

2017 ◽  
Vol 4 (5) ◽  
pp. 1710
Author(s):  
Farooq A. Mir ◽  
Shaugfta Aara ◽  
Masrat Jan ◽  
Nisar A. Wani
Keyword(s):  
Acute Appendicitis ◽  
Bilirubin Level ◽  
Predictive Factor ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
Significant Difference ◽  
Perforated Appendix ◽  
The Mean ◽  
Appendiceal Perforation

Background: To increase diagnostic accuracy and to decrease complication rates secondary to acute appendicitis, a variety of different approaches have been described, including predictive scoring systems. To prevent the catastrophic effects of perforated appendix, a surgeon needs diagnostic tools which may signal perforation of appendix at earliest, as a result of which the delay in the management of perforated appendix will not be witnessed. Keeping in view the above facts, the diagnostic value of serum bilirubin in acute appendicitis and its complications has been evaluated.Methods: This prospective study was conducted on 100 patients who presented with clinical diagnosis of Acute Appendicitis. Role of serum bilirubin as a diagnostic tool in acute appendicitis and diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation was evaluated. . Estimation of serum bilirubin was done by Jendrassik and Gorf method using Hitachi – 912 automatic biochemistry analyzer. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the investigations in the diagnosis of the acute appendicitis were calculated.Results: Serum bilirubin levels had a sensitivity of 84.1% and specificity of 83.3% in the diagnosis of acute appendicitis. The mean bilirubin level of patients with gangrenous appendicitis (2.1±1.2mg/dl) was significantly higher than the mean bilirubin level of patients with simple acute appendicitis (1.5 ±0.6)   (p1=0.030 sig). A statistically significant difference was also observed in the mean bilirubin level of patients with perforated appendicitis (mean=2.9±1.6mg/dl) and mean bilirubin level of patients with simple acute appendicitis (p2=<0.0001 sig). However statistically non-significant difference was observed between the mean bilirubin level of patients with gangrenous and perforated appendicitis (p3=0.056 non- sig).Conclusions:Pre-operative assessment of serum bilirubin not only helps in acute appendicitis but also serves as a predictive factor for appendiceal perforation. 

Dual versus Triple Antibiotics Regimen in Children with Perforated Acute Appendicitis

2017 ◽  
Vol 28 (06) ◽  
pp. 491-494 ◽  
Author(s):  
Elad Feigin ◽  
Inbal Samuk ◽  
Dragan Kravarusic ◽  
Artur Baazov ◽  
Itzhak Levy ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Perforated Appendicitis ◽  
Cost Effective ◽  
Dual Therapy ◽  
Wound Infections ◽  
Perforated Appendix ◽  
Group A ◽  
Group B

Introduction Acute appendicitis is the most common emergency condition in pediatric surgery. Historically, a triple-antibiotic therapy consisted of ampicillin, gentamicin, and clindamycin has been used postoperatively for perforated appendicitis. According to recently published trials, dual therapy consists of ceftriaxone and metronidazole only, offers a more efficient and cost-effective antibiotic management compared with triple therapy. Based on these results, our department applied dual antibiotic therapy for children with perforated appendicitis that underwent appendectomy from 2009 and forth. Aim The aim of our study was to compare postoperative outcomes between patients treated with triple therapy (ampicillin, gentamicin, and metronidazole) (group A) versus dual therapy (ceftriaxone and metronidazole) (group B). Methods Clinical and laboratory data were retrospectively collected by review of the medical records for all children who underwent appendectomy for the perforated appendix at the Schneider Children's Medical Center of Israel, a tertiary pediatric care center between 2007 and 2011. Children with perforated appendicitis received antibiotic therapy in accordance with the hospital's guidelines that were valid at the time the surgery took place. In the first period (years 2007–2009) (group A) a triad of ampicillin, gentamicin, and metronidazole and the second period (2009–2011) (group B) dual therapy consists of ceftriaxone and metronidazole. The two groups were compared for outcome and complications, such as wound infections, changing of antibiotic therapy, and length of stay. Results During the study period 1,203 patients underwent an appendectomy. Of these, 175 patients were diagnosed with perforated appendix and were treated with postoperative antibiotic's regimen. Group A and group B consisted of 89 and 86 patients, respectively. The two groups were not different significantly in terms of demographic data, length of stay, or readmission rates. However, more rates of wound infection and changing of antibiotic therapy were seen in group B, although not statistically significant (p = 0.064). Conclusion Dual antibiotic therapy for perforated appendicitis is a cost-effective and efficient mode of therapy compared with triple-antibiotic's regimen. However, prospective studies are required to determine whether this policy is associated with higher rates of wound infections and change in antibiotic therapy.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

The Antiaggressive Action of Combined Haloperidol-Propranolol Treatment in Schizophrenia

2000 ◽  
Vol 5 (4) ◽  
pp. 312-325 ◽  
Author(s):  
Gadi Maoz ◽  
Daniel Stein ◽  
Sorin Meged ◽  
Larisa Kurzman ◽  
Joseph Levine ◽  
...  
Keyword(s):  
Rating Scales ◽  
Double Blind ◽  
Propranolol Group ◽  
Schizophrenic Patients ◽  
Propranolol Treatment ◽  
Simultaneous Decrease ◽  
The Mean ◽  
Haloperidol Treatment ◽  
To Receive ◽  
Drug Free

Psychopharmacological interventions for managing aggression in schizophrenia have thus far yielded inconsistent results. This study evaluates the antiaggressive efficacy of combined haloperidol-propranolol treatment. Thirty-four newly admitted schizophrenic patients were studied in a controlled double-blind trial. Following a 3-day drug-free period and 7 days of haloperidol treatment, patients were randomly assigned to receive either haloperidol-propranolol or haloperidol-placebo for eight consecutive weeks. Doses of medications were adjusted as necessary; biperiden was administered if required. Rating scales were applied to assess aggression, anger, psychosis, depression, anxiety and extrapyramidal symptoms. The mean daily dose of haloperidol was 21 mg (SD = 6.4) in the research group and 29 mg (SD = 6.9) in the controls. Mean and maximal daily doses of propranolol were 159 mg (SD = 61) and 192 mg (SD = 83), and of placebo, 145 mg (SD = 50) and 180 mg (SD = 70), respectively. Compared with the controls, the scores for the research patients decreased significantly from baseline, particularly after 4 weeks of treatment, for some dimensions of anger, psychosis, anxiety, and neuroleptic-induced parkinsonism. A tendency for reduced aggression was shown in the combined haloperidol-propranolol group for some dimensions but not others. These patients also required significantly less biperiden. The tendency toward elevated antiaggressive effect of combined haloperidol-propranolol treatment compared to haloperidol alone may be explained by a simultaneous decrease in aggression, psychotic symptomatology, and anxiety.

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