Asunto(s)
Apendicectomía , Apendicitis/cirugía , Absceso Abdominal/cirugía , Humanos , Laparoscopía , Estudios RetrospectivosRESUMEN
BACKGROUND: The approach to complicated appendicitis is unclear. We have sought to determine factors which may persuade surgeons to non-operative management and whether such treatment affects outcome. METHODS: All adult patients admitted over a five-year period 2009-2014 with a diagnosis of appendicitis were reviewed. Patients were grouped into uncomplicated and complicated presentations and stratified by age, gender, ethnicity, socio-economic status, and time to presentation. Mortality, morbidity, length of hospital stay (LOS), readmission, and hospital charges were used as outcome measures. RESULTS: 611 adult patients were admitted with the diagnosis of appendicitis. Of those 306 patients presented in an uncomplicated manner, and 305 patients were complicated presentations. Selection for non-operative management was significantly correlated with older age and a longer time to presentation. For outcome patients who underwent early surgery experienced a longer LOS (5.8 ± 4.4 days versus 3.4 ± 4.5 days, p < 0.0001), and more readmissions. CONCLUSION: Surgical treatment of patients presenting with complicated appendicitis is preferable to non-operative, antibiotic oriented treatment in reduction of LOS and need for readmissions.
Asunto(s)
Apendicitis/complicaciones , Apendicitis/terapia , Adulto , Apendicectomía , Apendicitis/mortalidad , Femenino , Precios de Hospital/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Readmisión del Paciente/estadística & datos numéricos , Resultado del TratamientoRESUMEN
The pathophysiology of hepatic ischemia/reperfusion injury (IRI) includes a number of complex and diverse mechanisms involving interactions between hepatocytes, Kupffer cells, neutrophils, macrophages, sinusoidal endothelial cells, and platelets. Tumor Necrosis Factor-α (TNF-α), a cytokine produced by numerous cell types in response to inflammatory stimuli, is a well-known mediator during ischemia/reperfusion (IR) that plays a central role in injury to hepatocytes. TNF-α has a multifactorial effect in hepatic IRI because of the many interactions between TNF-α and reactive oxygen species, nitric oxide, adhesion molecules, and various cytokines and chemokines. The intracellular cascades that TNF-α triggers and their downstream effects are clearly presented throughout this manuscript. With these mechanisms in mind, ischemic preconditioning and pharmacological interventions with potential clinical application to prevent or attenuate IRI will be emphasized.