Unhappy after an appendectomy. Gastric ulcer.
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METHODS: From January 1991 to July 1995, 260 patients with acute appendicitis were operated on. After excluding 21 patients, the remaining 239 cases were randomly divided into two groups. Group A was given the treatment and group B was the control group. Precisely 0.915 g metronidazole disodium phosphate injection (Tongzhen Pharmaceutical Co., Shan Xi Province, P. R. China) or 25% metronidazole glucose solution was added to 100 mL 0.9% normal saline. After anesthetizing the patients in group A, 60 to 80 mL of the solution was injected into the subcutaneous tissue and muscle. The control group B was given intravenous injection of metronidazole disodium phosphate and cephazolin postoperatively. RESULTS: In the 119 cases in group A, the rate of incision infection was 0.8%. By contrast, the rate of infection among the 120 cases in group B was 11.6%. The statistical analysis (chi square) was significant, with P < 0.001 showing that preincisional or intraincisional infiltration with metronidazole was effective.
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A child with cystic fibrosis developed the meconium ileus equivalent in the postappendectomy period. This problem has not been emphasized in patients with cystic fibrosis. Operative evacuation only partially relieved the obstruction. Transient upper gastrointestinal bleeding fortuitously produced beneficial effect, which completely resolved the persisting ileus.
In 1980 Mitrofanoff described the use of the isolated appendix as an intermittent catheterization route to empty a continent urinary reservoir. The procedure was popularized and numerous variations on the same principle were reported. Presence of histopathological abnormalities in the appendix may limit its suitability for reconstructive purposes. We studied the frequency of incidental histopathological abnormalities in appendixes removed electively in 122 urological patients during a radical pelvic operation. The implications for incorporation of the appendix in urinary tract reconstruction are evaluated. A total of 38 patients (31.1%) had notable histological abnormalities of the appendix: 35 had fibrous obliteration of the lumen, 2 had carcinoid tumor and 1 had a mucocele of the appendix. The rate of abnormal appendixes was significantly higher in elderly patients (more than 70 years old). Incidental pathology of the appendix is a frequent finding that may affect the immediate results and the late outcome of urinary tract reconstruction using the appendix. When such strategy of urinary tract reconstruction is considered, potential histopathological abnormalities should be anticipated. The patients should be informed and aware of possible unexpected changes in the preplanned procedure, while the surgeon must be familiar with these alternative reconstructive methods.
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