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PubMed1981

Hospital medical staff organization and quality of care: results for myocardial infarction and appendectomy.

This article examines the relationships among hospital structural characteristics, individual physician characteristics, medical staff organization characteristics and quality of care for two conditions: acute myocardial infarction and appendicitis. Using data obtained from the Commission on Professional and Hospital Activities (CPHA), approximately 50,000 acute myocardial infarction cases and 8,183 appendectomy cases collected from 96 hospitals in the East North Central Region of the country (Illinois, Indiana, Michigan, Ohio and Wisconsin) were examined. These data were merged with medical staff organization and related data on hospital characteristics obtained from the American Hospital Association. The results indicate that such medical staff organization factors as involvement of the medical staff president with the hospital governing board, overall physician participation in hospital decision making, frequency of medical staff committee meetings and percentage of active staff physicians on contract are positively associated with higher quality-of-care outcomes, independent of the effects of hospital and physician characteristics. Further, the medical staff organization factors appear to be somewhat more strongly associated with higher quality-of-care outcomes than the hospital and physician characteristics. For acute myocardial infarction, higher volume of patients treated per family practitioner and internist and presence of a coronary care unit were also associated with better outcomes. Given the restricted number of conditions studied, the geographically limited sample and the fact that specific variables were not consistently related to quality of care for both conditions, the results area viewed as preliminary. However, they are consistent with and extend other developing findings in this area. They also suggest that more attention needs to be given to the organization of the hospital medical staff and its articulation with the overall hospital decision-making structure and process in attempts to improve outcomes of hospitalization.

Adolescent↗
PubMed1990

Laparoscopic techniques in appendectomy with argon laser.

We used laparoscopic techniques to do appendectomies with the argon laser on 32 patients. The first two patients were hospitalized overnight, and the other 30 patients were treated as outpatients. All patients resumed normal activity within 7 days. All recoveries were uneventful and no complications developed. Diagnostic laparoscopy enables the surgeon to diagnose and treat abdominal pain more definitively and much earlier.

Adolescent↗
PubMed1997

Pneumoappendix after an inversion appendectomy: an unreported radiologic finding.

Radiographically detectable gas only occasionally fills the lumen of the vermiform appendix (pneumoappendix), and the diagnostic significance of this gas remains unresolved in the radiologic literature. The following case report is a previously unreported finding of a postoperative plain abdominal radiograph showing a dilated pneumoappendix after an inversion-ligation appendectomy. A brief review of the surgical technique is included to help explain these radiographic findings.

Adult↗
PubMed2002

Mechanical small bowel obstruction from a loose linear cutter staple after laparoscopic appendectomy.

Laparoscopic linear cutting staplers are commonplace in advanced laparoscopic techniques. Most of the loose staples are probably inert, but we present a case of a mechanical small bowel obstruction after a laparoscopic appendectomy. The etiology of the bowel obstruction was a loose linear cutter staple from the load that fired across the appendiceal stump. We recommend retrieving as many loose staples as possible with the laparoscopic grasper or suction at the termination of the laparoscopy.

Adult↗
PubMed2003

Laparoscopic appendectomy: a gynecological approach.

The removal of surgical specimen at operative laparoscopy through an incision of the posterior fornix is frequently performed for the removal of pelvic masses of the internal genital tract. We present a technique for the removal of the appendix through a laparoscopic colpotomy. Eight patients who underwent laparoscopy for a suspected pelvic or adnexal disease and intraoperatively found to be affected by an appendicular disease were included in the present series. After intrabdominal dissection, the appendix was removed from the abdomen transvaginally through a laparoscopic colpotomy. The median range of the operation was 45 minutes (range 25-95). There were no intraoperative complications. The postoperative hospitalization period ranged from 2 to 7 days. Vaginal spotting was present in one case and lasted 24 hours. At follow-up visit, no patients complained of pelvic pain or dyspareunia. Vaginal wall induration was not found in any of the patients at pelvic examination. The removal of the appendix through a posterior colpotomy after laparoscopic appendectomy is simple, safe, feasible, well tolerated, and can be considered a valid alternative to other methods.

Adnexal Diseases↗
PubMed1994

Comparative audit between hospitals: the example of appendectomy.

How useful are routine, comparative audit systems? To attempt to answer this question, data from a system in North West Thames were used. A common procedure was selected (appendectomy) and data supplied by 17 surgeons between January and June 1990 were analysed. Aspects of the case-mix, clinical management, diagnostic accuracy and patient outcomes for the surgeons were compared. A total of 401 patients had been treated. All aspects of care varied between surgeons: mean age of patients (19-36 years), proportion of female patients (30-75 per cent), mean length of stay (2.1-7.1 days), prophylactic antibiotic use (0-85 per cent), diagnostic accuracy (40-100 per cent) and incidence of wound infections (0-4 per cent). As a result of the small sample sizes (mean number of cases per surgeon was 23.6) few of these differences were statistically significant. In addition, there were some doubts about the accuracy of some of the data. If such methodological difficulties can be overcome, comparative audit systems offer a practical and useful way of uncovering unusual clinical practices and generating hypotheses for evaluative research.

Adult↗
PubMed1995

99mTechnetium labelled leucocyte scanning in acute lower abdominal pain: can it reduce the negative appendectomy rate?

While the incidence of 'negative' appendectomy has long been justified as a necessary evil in the management of acute appendicitis, attempts to improve diagnostic accuracy have met with mixed results. In a prospective study of 34 selected patients who presented with acute lower abdominal pain the potential role of 99mTechnetium labelled leucocyte scanning in the diagnosis of acute appendicitis has been evaluated. Patient management was not based on the result of the nuclear scan. The clinical outcome was correlated with the scan diagnosis. There was one false positive and one false negative scan result with respect to the clinical diagnosis of appendicitis yielding a sensitivity of 90% and a specificity of 96%. 99mTechnetium labelled leucocyte scanning may have an important role in the assessment of selected patients presenting with acute lower abdominal pain.

Abdomen, Acute↗
PubMed1981

Risk factors in multiple sclerosis: tuberculin reactivity, age at measles infection, tonsillectomy and appendectomy.

The purpose of the present study was to investigate whether risk of multiple sclerosis (MS) is associated with the occurrence of viral or bacterial diseases, with vaccinations, or with operative events during childhood. Our reference population was 198,000 persons recorded in the register of school health records from the Copenhagen council. We compared 92 MS patients contained in the register with matched controls from the register, three for each patients. Risk of MS was inversely associated with a positive tuberculin skin test at age 7 years, i.e. with exposure to tuberculosis before the age of 7, possibly also with the occurrence of measles infection before age 7 (not statistically significant). Disease risk was not significantly related to other viral or bacterial infections of childhood, nor to routine vaccinations, tonsillectomy, adenoidectomy or appendectomy. Our findings suggest a difference between MS patients and controls with respect to environment before school age, the former being less exposed to air-borne infections.

Adenoidectomy↗
PubMed1984

Concentrations of cefmetazole in plasma and tissue resulting from peri-incisional administration before appendectomy.

The levels of cefmetazole in plasma and tissue were determined after injection of a dose of 30 mg/kg into the zone of the wound of each of 15 patients undergoing appendectomy. The mean plasma levels of cefmetazole at the start and end of surgery (8.9 +/- 2.4 and 31.7 +/- 6.4 min after dosage) were 21.1 and 59.0 micrograms/ml, respectively; concentrations of the drug were 14.6 and 4,486.9 micrograms/g in skin, 9,165.0 and 1,756.4 micrograms/g in subcutaneous tissue, and 8,669.6 and 2,022.9 micrograms/g in muscle.

Administration, Topical↗
PubMed1996

Contribution of ANP to plasma protein escape during VE: effects of thiorphan and atrial appendectomy.

The effects of endopeptidase inhibition and right atrial appendectomy (AA) on plasma immunoreactive atrial natriuretic peptide (irANP) concentrations and extravascular accumulation of 131I-labeled bovine serum albumin (CBSA) during volume expansion (VE) were examined in pentobarbital sodium-anesthetized rats (n = 5 per group). Compared with controls, infusion of isoncotic albumin (30 ml/kg) increased central venous pressure (CVP) by 5.5 mmHg, plasma irANP by 7-fold, and CBSA in multiple tissues by 1.6- to 4-fold (P < or = 0.05). Inhibition of ANP metabolism with thiorphan (40 mg/kg) had no effect in control animals but increased plasma irANP (+118%) and CBSA (+30-100%) compared with VE alone (P < or = 0.05). Likewise, interference with ANP release by AA reduced plasma irANP (-80%) and CBSA (-30 to -80%) response to VE in parallel (P < or = 0.05). The peak increase in CVP during VE was not affected by either of these manipulations. It is concluded that endogenous ANP increases plasma protein extravasation independent of volume and pressure disturbances during acute intravascular expansion.

Animals↗
PubMed1999

Pain, analgesic use, and morbidity in appendectomy patients.

Pain has immunosuppressive effects among the critically and chronically ill, and opioids may immunomodulate pain's deleterious effects. However, little is known about the relations between acute pain, acute illness, and morbidity among previously healthy surgical patients. This study retrospectively examined these relations in appendectomy patients (N = 61). Eleven patients (18%) had morbidity, with atelectasis (11.5%) the most frequent complication. There were no differences between those patients with and without morbidity and pain intensity, method of opioid administration, and total opioid dose. Patients who received nonopioid analgesics received fewer opioids, less preemptive analgesia, and had less morbidity, whereas patients whose appendixes perforated received higher opioid doses and received more preemptive analgesia. Although the relations between acute pain, opioid use, and morbidity among previously healthy surgical patients are unclear, findings infer that clinical practice does not follow guidelines advocated by analgesic experts.

Adolescent↗
PubMed1993

Laparoscopic appendectomy.

Laparoscopy offers the surgeon better visibility for performing an appendectomy, which is to the advantage of the child. When the appendix is normal, the offending etiology usually can be managed through the same cannulas. With proper judgment and training, the laparoscopic technique can be used on almost any patient suspected of appendicitis. The ease of the technique, coupled with the decreased postoperative morbidity and shorter hospitalization, make the laparoscopic operation an important addition to the surgical armamentarium for managing acute appendicitis.

Acute Disease↗
PubMed2006

Comparing presentation and diagnostic accuracy for conscripts and nonconscripts who have already been selected for appendectomy.

BACKGROUND: The evaluation of acute appendicitis (AA), the most common cause of acute abdomen, in conscripts is important, specifically when it seems that the probability of malingering for secondary gains (such as exemption) is high, and surgeons may lose some cases of AA through this assumption. METHODS: In this analytic cross-sectional study, 455 male conscripts with suspected AA were compared with 142 male individuals between 14 and 26 years of age who had already been selected for appendectomy. RESULTS: The mean age (+/-SE) was 20.4+/-0.08 years. There were no statistically significant differences between the case and control groups in terms of age, rates of different symptoms and signs, quality and duration of pain, vital signs, and laboratory findings. CONCLUSIONS: There was no significant difference between conscripts and others in terms of the presentation of AA and its accurate diagnosis. Therefore, it is recommended that military physicians approach conscripts with suspected AA like other patients.

Abdominal Pain↗
PubMed1999

[The justification for laparoscopic appendectomy].

Laparoscopic appendicectomy (LA), in contrast to open appendicectomy (OA), is not generally accepted as the treatment of choice for suspected appendicitis because it is technically difficult, not readily available everywhere, takes longer to perform, is expensive, and is associated with an increased incidence of intra-abdominal abscesses. However, LA has shown a superior outcome compared to an OA in terms of less postoperative pain, earlier hospital discharge, quicker return to normal activity and work and decreased incidence of wound infection. Furthermore, a diagnostic laparoscopy is valuable in case of an equivocal diagnosis of appendicitis especially in premenopausal women and obese individuals because it allows a thorough examination of the whole abdomen under direct vision. It, therefore, permits accurate diagnosis and hence reduces the negative appendectomy rate. Nevertheless, before endorsing routine and widespread use of LA, it is essential that this technique is critically evaluated in well designed, controlled, randomised, prospective trials clearly showing major benefits to the patient in terms of quicker hospital discharge, reduced postoperative pain, decreased wound infection and early return to full activities.

Appendectomy↗
PubMedDate not supplied

[Videolaparoscopic appendectomy with linear stapler].

It is presented the experience of 126 cases of acute appendicitis treated by a videolaparoscopic appendectomy using a 12 mm endostapler with 4 lines of staples and a linear cutting device in the middle. It has been used two trocars (5 mm) at the left side and one other (12 mm) trocar at the umbilicus. In the first cases other dispositions were used but this one seemed to be better. Through the left trocars, a dissection is promoted, isolating the appendix, its base and its mesentery, in which a small hole is made, close to the base. Through this hole, it is passed one of the sides of the 12 mm stapler. The device promotes the bilateral stapling and cuts the appendix at its base. The stapler is reloaded with vascular staples and then the mesentery is stapled and cut by the same way. It is a very fast method. Besides, the laparoscopic option gives the opportunity to equally treat appendicitis at unusual positions, to examine other pelvic organs (eventually treating diseases) and to aspirate secretions under direct view, anywhere in the cavity. The specimen is taken out of the cavity inside a plastic bag and we had no case of infection at the trocar sites. Only in 3 cases there were conversion to open surgery, due to difficult dissection and identification of structures, in all of them with very advanced disease and necrosis. It is concluded that this method is fast, safe, easy (although more expensive) and can be utilized routinely, at least in the first approach of the treatment of acute appendicitis.

Adult↗
PubMed1999

Wound infection in open versus laparoscopic appendectomy. A meta-analysis.

The authors performed a meta-analysis to determine whether open or laparoscopic appendectomy would reduce wound infection incidence in adult patients with acute appendicitis. The meta-analysis included nine of seven patients from eight randomized controlled trials. Data were analyzed using the fixed effect-model method of Mantel-Haenszel. Wound infection incidence was lower in the laparoscopic group.

Acute Disease↗