Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 8 de 8
Filtrar
1.
N Engl J Med ; 383(20): 1907-1919, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33017106

RESUMO

BACKGROUND: Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis. METHODS: We conducted a pragmatic, nonblinded, noninferiority, randomized trial comparing antibiotic therapy (10-day course) with appendectomy in patients with appendicitis at 25 U.S. centers. The primary outcome was 30-day health status, as assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire (scores range from 0 to 1, with higher scores indicating better health status; noninferiority margin, 0.05 points). Secondary outcomes included appendectomy in the antibiotics group and complications through 90 days; analyses were prespecified in subgroups defined according to the presence or absence of an appendicolith. RESULTS: In total, 1552 adults (414 with an appendicolith) underwent randomization; 776 were assigned to receive antibiotics (47% of whom were not hospitalized for the index treatment) and 776 to undergo appendectomy (96% of whom underwent a laparoscopic procedure). Antibiotics were noninferior to appendectomy on the basis of 30-day EQ-5D scores (mean difference, 0.01 points; 95% confidence interval [CI], -0.001 to 0.03). In the antibiotics group, 29% had undergone appendectomy by 90 days, including 41% of those with an appendicolith and 25% of those without an appendicolith. Complications were more common in the antibiotics group than in the appendectomy group (8.1 vs. 3.5 per 100 participants; rate ratio, 2.28; 95% CI, 1.30 to 3.98); the higher rate in the antibiotics group could be attributed to those with an appendicolith (20.2 vs. 3.6 per 100 participants; rate ratio, 5.69; 95% CI, 2.11 to 15.38) and not to those without an appendicolith (3.7 vs. 3.5 per 100 participants; rate ratio, 1.05; 95% CI, 0.45 to 2.43). The rate of serious adverse events was 4.0 per 100 participants in the antibiotics group and 3.0 per 100 participants in the appendectomy group (rate ratio, 1.29; 95% CI, 0.67 to 2.50). CONCLUSIONS: For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith. (Funded by the Patient-Centered Outcomes Research Institute; CODA ClinicalTrials.gov number, NCT02800785.).


Assuntos
Antibacterianos/uso terapêutico , Apendicectomia , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Apêndice/cirurgia , Absenteísmo , Administração Intravenosa , Adulto , Antibacterianos/efeitos adversos , Apendicectomia/estatística & dados numéricos , Apendicite/complicações , Apêndice/patologia , Impacção Fecal , Feminino , Nível de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
2.
Medicine (Baltimore) ; 97(52): e13700, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30593140

RESUMO

The purpose of this study is to confirm and complement previous data regarding an association between gastroesophageal reflux disease and appendectomy.The Korean National Health Insurance Service-National Sample Cohort includes data from people ≥ 20 years old collected from 2002 to 2013. A total of 13,484 participants who received an appendectomy were matched with 53,936 controls at a 1:4 ratio. We analyzed the previous histories of gastroesophageal reflux disease (GERD) in the appendectomy and control groups. Appendectomies were identified using operation codes (Q2860-Q2863) exclusive for appendicitis (International Classification of Disease-10 (ICD-10): K35). GERD was defined using the ICD-10 (K21), and patients who were treated ≥ 2 times and were prescribed a proton pump inhibitor (PPI) for ≥ 2 weeks were included. Crude (simple) and adjusted odds ratios (ORs) for GERD and appendectomy were analyzed using conditional logistic regression analyses.A higher GERD rate was detected in the appendectomy group (11.4% [1,713/15,062]) than in the control group (8.2% [4,947/60,248], P < .001). Adjusted ORs for GERD were 1.37 (95% confidence interval [CI] = 1.30-1.45) (P < .001). Subgroup analyses stratified according to age and sex revealed consistent findings. The adjusted OR for GERD in participants prescribed PPIs for ≥ 30 days was 1.31 (95% CI = 1.20-1.43), and the adjusted OR for GERD in participants prescribed PPIs for ≥ 60 days was 1.30 (95% CI = 1.15-1.48).The Odds for GERD were higher in the appendectomy group than in the control group.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Refluxo Gastroesofágico/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/epidemiologia , Apendicite/etiologia , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Razão de Chances , Inibidores da Bomba de Prótons/uso terapêutico , República da Coreia/epidemiologia , Fatores de Risco , Adulto Jovem
3.
Cir Cir ; 82(2): 142-9, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-25312312

RESUMO

BACKGROUND: Appendiceal tumors are found in about 1% of appendectomies performed and 0.5% of intestinal neoplasias. Appendiceal carcinoids are the predominant histology in this group and are usually casual after appendectomy for other reasons. The prognosis is excellent and survival is 95% at 5 years after surgery. METHODS: Retrospective analysis of all patients with appendiceal carcinoid surgery in our hospital for 20 years (1990-2010) and survival at 5 years. We also discuss the need for additional treatment and testing for follow-up visits. RESULTS: 42 patients underwent surgery for appendiceal carcinoid tumor. 38 of them were operated on urgently, mostly for suspected acute appendicitis, without having reached the carcinoid tumor diagnosed preoperatively in any of them. The predominant symptomatology at admission was abdominal pain. Surgical treatment was appendectomy in 34 patients (12 laparoscopic), 7 patients required colon resections over intraoperatively by colonic involvement; only one patient required reoperation to complete right hemicolectomy. 2 patients had disseminated disease at diagnosis (liver metastases). The 5-year survival is over 95%, with no recurrence. CONCLUSIONS: The appendiceal carcinoid tumor is difficult to diagnose preoperatively. Appendectomy surgical treatment is usually sufficient, although colonic resections may be needed for dissemination. The 5-year survival is over 95%.


Antecedentes: los tumores apendiculares se encuentran en cerca de 1% de las apendicectomías y representan 0.5% de las neoplasias intestinales. El tipo de tumor más frecuente es el carcinoide apendicular, que casi siempre es un hallazgo durante la apendicectomía por otro motivo. Su pronóstico es excelente y la supervivencia es mayor de 95% a cinco años de la intervención. Objetivo: reportar una serie de casos y analizar la supervivencia media a cinco años posteriores a la identificación el tumor. Material y métodos: análisis retrospectivo (1990-2010) de pacientes con tumor carcinoide apendicular intervenidos en el servicio de Cirugía General y del Aparato Digestivo del Hospital Universitario Virgen del Rocío, Sevilla, España. Se analizaron: la supervivencia a cinco años, la necesidad de tratamiento complementario y las pruebas para seguimiento en la consulta. Resultados: se encontraron 42 pacientes intervenidos por tener un tumor carcinoide apendicular. En 38 pacientes la operación fue de urgencia, la mayoría por sospecha de apendicitis aguda, sin que en ninguno se hubiera establecido el diagnóstico de tumor carcinoide antes de la operación. El síntoma predominante al ingreso fue el dolor abdominal. El tratamiento quirúrgico fue: apendicectomía en 34 pacientes (12 por laparoscopia), en el intraoperatorio siete pacientes requirieron resecciones colónicas mayores debido a la afectación del colon; sólo uno requirió la reintervención para completar la hemicolectomía derecha. Al momento del diagnóstico dos pacientes tenían enfermedad diseminada (metástasis hepáticas). La supervivencia a cinco años fue superior a 95%, sin recidivas o tratamiento posterior de la enfermedad. Conclusiones: el tumor carcinoide apendicular difícilmente se diagnostica antes del procedimiento quirúrgico. La apendicectomía suele ser suficiente aunque en algunos pacientes las resecciones colónicas son necesarias por diseminación. La supervivencia a 5 años es superior a 95%.


Assuntos
Apendicectomia/estatística & dados numéricos , Neoplasias do Apêndice/cirurgia , Tumor Carcinoide/cirurgia , Colectomia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/mortalidade , Neoplasias do Apêndice/patologia , Apendicite/diagnóstico , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/mortalidade , Tumor Carcinoide/patologia , Tumor Carcinoide/secundário , Criança , Colectomia/estatística & dados numéricos , Diagnóstico Diferencial , Emergências , Feminino , Humanos , Laparoscopia/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Retrospectivos , Espanha/epidemiologia , Taxa de Sobrevida , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
4.
BMC Health Serv Res ; 10: 250, 2010 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-20735857

RESUMO

BACKGROUND: The annual number of pediatric appendectomies in Ontario was stable throughout the study period, but with a significant level of regional variations across regions. The objective of this study is to use population-based data to measure the associations and to explain the variations of appendectomy rates with population socio-demographic indicators. METHODS: Appendectomy rates in children aged less than 19 years were calculated from Ontario hospital discharge data from 1993 to 2000. Small area variations in appendectomy and correlations between socio-demographic indicators were studied. Multiple logistic regression was used to measure the risk of negative appendectomy and perforation while adjusting for socio-demographic factors. RESULTS: The rate of positive primary appendectomy has been stable since 1993 with an average rate of 93.2 per 100,000 children. The negative appendectomy rates showed a significant decline over time from a high of 16.0 in 1994 to 10.2 per 100,000 in 2000 (p < 0.0001). There was a 4-fold regional variation in negative appendectomy with the highest rate of 26.0 per 100,000 in the northern regions of Ontario. After adjusting for socio-economic status, areas of higher percentages of rural living remained a single significant factor associated with a higher chance of negative and perforated appendectomy (OR = 1.28, 95% CI: 1.01, 1.61, p < 0.01 and OR = 1.11, 95% CI: 0.96, 1.28, p = 1.682 respectively). Areas with higher ultrasound use were associated with a lower risk of perforated appendectomy (OR = 0.83, 95% CI: 0.72, 0.95, p < 0.05). CONCLUSION: The higher rates of negative and perforated appendectomy in rural populations underpin the influence of access to preventive and primary health care in modifying the odds of appendicitis resulting in surgery.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Acessibilidade aos Serviços de Saúde , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Apendicite/epidemiologia , Apendicite/fisiopatologia , Criança , Estudos de Coortes , Humanos , Modelos Logísticos , Programas Nacionais de Saúde , Ontário/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Classe Social
5.
Sante ; 11(2): 117-25, 2001.
Artigo em Francês | MEDLINE | ID: mdl-11440889

RESUMO

We carried out a retrospective study to analyse clinical, paraclinical and therapeutic aspects of acute appendicitis cases as the National University Hospital (CNHU) at Bangui in the Central African Republic. We compared our findings with those for other African countries and for industrialized countries. From September 15 1990 to February 15 1992, 285 patients underwent laparotomy to treat acute appendicitis. We carried out a study of clinical, paraclinical and therapeutic aspects on 57 patients with complete case histories (20% of the patients undergoing surgery). The appendices of these patients were sent to the Laboratory of Pathological Anatomy of the Faculty of Medicine at Marseille, France, for analysis. The frequency of appendectomy among patients undergoing visceral surgery by laparotomy with no acute traumatic abdominal syndrome was 42.3%. The incidence of appendectomy for the city of Bangui in 1991 was 36.5 per 100,000 inhabitants. These cases of appendicitis were diagnosed essentially on clinical grounds. Leukocyte counts exceeded 10,000 per mm3 in 30% of the patients. Histological examination revealed the presence of parasites in 10 cases : Schistosoma mansoni eggs (seven cases) and Ascaris lumbricoides eggs (one case) in patients with acute appendicitis and one case each of Schistosoma mansoni eggs and Ascaris lumbricoides eggs at the time of diagnosis but normal histological results for the removed appendix. Most of the patients consulted late, a mean of four days after the onset of symptoms. The frequency of appendectomy on principle was 12.7% and parenteral antibiotic treatment was prescribed systematically follow- ing surgery. The mean duration of hospital stay after surgery was 7.6 days. No early postoperative complications were noted. However, two late postoperative complications resulting in the death of the patient were observed, giving a mortality rate of 3.5%. These complications were one case of peritonitis after appendectomy involving intestinal resection and one case of occlusive syndrome with septic shock. The frequency of acute appendicitis at the CNHU at Bangui was similar to that reported in another tropical African country (~ 1%). However, the incidence of appendectomies at Bangui is lower than generally reported for western countries (15 to 40%). Positive diagnosis was made on classic data obtained on clinical examination and on associated biological data, if available. Parasites were identified on histological examination in some cases of acute appendicitis, but it is unclear whether these parasites were actually responsible for the appendicitis. Efficient examinations for the exploration of acute nonspecific abdominal pain, such as the measurement of inflammation indicators, particularly serum activated protein C levels, graded-compression ultrasound scans and celioscopy, should be made available in the hospitals of African countries to increase the precision of diagnosis and to decrease the still too high frequency of appendectomies performed on principle. The postoperative mortality rate at the CNHU of Bangui is higher than the low rates (0.1 to 0.25%) reported for industrialized countries but is close to those reported for African countries. This high rate of mortality results partly from the lateness of consultations, because patients in tropical Africa often consult a traditional healer before resorting to modern medicine, and partly from misdiagnoses.


Assuntos
Apendicite , Saúde da População Urbana/estatística & dados numéricos , Doença Aguda , Adolescente , Adulto , Distribuição por Idade , Idoso , Antibacterianos/uso terapêutico , Apendicectomia/estatística & dados numéricos , Apendicectomia/tendências , Apendicite/diagnóstico , Apendicite/epidemiologia , Apendicite/etiologia , Apendicite/terapia , República Centro-Africana/epidemiologia , Criança , Pré-Escolar , Terapia Combinada , Hospitais Universitários , Humanos , Incidência , Lactente , Tempo de Internação , Pessoa de Meia-Idade , Doenças Parasitárias/complicações , Vigilância da População , Estudos Retrospectivos , Estações do Ano
6.
Swiss Surg ; 6(3): 101-7, 2000.
Artigo em Alemão | MEDLINE | ID: mdl-10894009

RESUMO

Scientific publications and provoking criticism from the lay press have recently pointed out, that appendices may be surgically removed too frequent and without indisputable necessity. In an attempt to verify these questionable statements, the Swiss Society for General Surgery (SGAC) initiated a prospective controlled multi center trial. From September 1997 to December 1998, hundred and twenty-five institutions documented 4603 appendectomies performed due to a suspected appendicitis. Histological investigation of all specimens revealed a 7% rate of normal appendices, 7.2% for patients with national health service (NHS) and 5.9% for patients with private insurances respectively. Compared to the results of the literature, where a frequency of normal appendices around 15% is judged as standard, these results are excellent. In 17.2% of the patients (15.9% NHS and 23.6% privately insured patients) an "appendicitis perforata" was observed. This percentage remains in the range reported by other authors. The analysis of time of admission (i.e. day or night) and the delay from admission to surgery shows a distribution independent to the insurance of the patients. Therefore, the planned appendectomy for patients with private insurances does not exist. A different choice of the surgical technique could be observed depending on the insurance status. In 30.4% of the private insured patients a laparoscopic appendectomy was performed as compared to 22.6% of patients with NHS. Surprisingly, an identical median hospitalization time can be observed for both groups (laparoscopic 5.5 days, open surgery 5.5 days).


Assuntos
Apendicectomia/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Estudos Prospectivos , Suíça
7.
Rev. gastroenterol. Méx ; 61(4): 366-70, oct.-dic. 1996. ilus
Artigo em Espanhol | LILACS | ID: lil-192329

RESUMO

Antecedentes: El mucocele es una dilatación quística del apéndice vermiforme que contiene material mucoso y que es originado por diversas enfermedades. objetivo: Informar y discutir cuatro casos de mucocele apendicular. Informe de los casos: Las manifestaciones clínicas principales fueron dolor abdominal y cambios en el hábito intestinal. En dos casos, el mucocele fue un hallazgo incidental ante la coexistencia de diverticulitis aguda y colecistitis aguda, respectivamente, El abordaje diagnóstico incluyó colon por enema y tomografía computada del abdomen. El mococele fue secundario a cistademona mucinoso en tres casos; en dos de ellos se realizó hemicolectomía derecha con preparación colónica preoperatoria, y en un caso se realizó apendicectomía. En el paciente restante, se realizó apendicectomía y se encontró un cistadenocarcinoma mucinoso, por lo que se realizó hemicolectomía derecha es una segunda operación. La evolución postoperatoria en todos los casos fue satisfactoria. Conclusión: el mucocele apendicular es una entidad poco frecuente. La apendicectomía es tratamiento suficiente para enfermedad benigna. En los casos en que se documente malignidad, es recomendable la realización de hemicolectomía derecha.


Assuntos
Humanos , Masculino , Feminino , Idoso , Apendicectomia/estatística & dados numéricos , Colecistite/diagnóstico , Colectomia , Colo/patologia , Diverticulite/diagnóstico , Mucocele/patologia , Tomografia
8.
Praxis (Bern 1994) ; 84(33-34): 886-92, 1995 Aug 15.
Artigo em Alemão | MEDLINE | ID: mdl-7676111

RESUMO

Psychosomatic thinking leads a shadowy existence in surgery. That this is not justified is shown here by using the example of erroneous indications for appendectomies. Historical analysis revealed that the idea of 'chronic recurrent' appendicitis was erroneous from the very beginning. It can only be understood in the context of the particular medico-scientific conditions in the early 20th century. Statistical analysis identifies primarily girls and young women as the group predominantly affected by this erroneous diagnosis: mostly women have been and are operated, whereas true (= acute) appendicitis is a disease predominating in males. By means of a psychodynamically oriented look at stereotypically occurring individual cases in a heuristic manner, links to statistic results were found, permitting a restrictive concept for indications which was new for our hospital but had already been realized for a long time in the Anglo-American countries. Within three years daily surgical practice could be modeled, so that the number of appendectomies decreased to one fourth of the original number, while the frequency of acute appendicitis and of cases with perforated appendix remained unchanged. For the first time more male than female patients have been appendectomized, in accordance with the epidemiology of the disease. Altogether, this qualitative success was only possible, because the psychosomatic way of thinking by the involved physicians has been accepted for daily surgical routine on all hierarchic levels. It is therefore stressed that surgeons, too, should participate regularly in Balint groups, above all during specialization.


Assuntos
Apendicite/diagnóstico , Medicina Psicossomática , Adolescente , Apendicectomia/estatística & dados numéricos , Apendicite/psicologia , Apendicite/cirurgia , Atitude do Pessoal de Saúde , Erros de Diagnóstico , Feminino , Humanos , Masculino , Fatores Sexuais
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA