1.

1.               Garfield JL, Birkhahn RH, Gaeta TJ, Briggs WM. Diagnostic pathways and delays on route to operative intervention in acute appendicitis. Am Surg. 2004 Nov; 70(11):1010-3. 

Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, New York 11215, USA.

The purpose of this study was to determine the elements associated with delay in the evaluation of acute appendicitis at a community teaching hospital. We performed a retrospective chart review of patients undergoing operative exploration for presumed appendicitis in a 12-month period. Cases were categorized by the presence or absence of advanced radiographic imaging. Demographic information and time intervals from triage to operative incision were compared. One hundred twenty-four patients underwent operative exploration for presumed appendicitis. Forty-one patients had no advanced imaging, 67 had a CT scan, 8 had a sonogram, and 8 had both CT/sonogram. Patients using advanced radiographic imaging prior to operative exploration were no less likely to have a normal appendix at surgery. Diagnostic imaging significantly increased the preoperative emergency department length of stay. Two-thirds of patients with presumed acute appendicitis were imaged before operative exploration. The use of abdominal CT and sonogram resulted in significantly increased preoperative emergency department length of stay with no apparent improvement in diagnostic accuracy.

2.

Kenyon S, Boulvain M, Neilson J. Antibiotics for preterm rupture of the membranes: a systematic review. Obstet Gynecol. 2004 Nov;104(5 Pt 1):1051-7. Review.

Department of Obstetrics and Gynaecology, University of Leicester, United Kingdom.

OBJECTIVE: We sought to evaluate the administration of antibiotics to pregnant women with preterm rupture of membranes (PROM). DATA SOURCES: We collected data by using the Cochrane Controlled Trials Register and MEDLINE. METHODS OF STUDY SELECTION: We included randomized controlled comparisons of antibiotic versus placebo (14 trials, 6,559 women). TABULATION, INTEGRATION, AND RESULTS: Antibiotics were associated with a statistically significant reduction in maternal infection and chorioamnionitis. There also was a reduction in the number of infants born within 48 hours and 7 days and with the following morbidities: neonatal infection (relative risk [RR] 0.67, 95% confidence interval [CI] 0.52-0.85), positive blood culture (RR 0.75, 95% CI 0.60-0.93), use of surfactant (RR 0.83 95% CI 0.72-0.96), oxygen therapy (RR 0.88, 95% CI 0.81-0.96), and abnormal cerebral ultrasound scan before discharge from hospital (RR 0.82, 95% CI 0.68-0.99). Perinatal mortality was not significantly reduced (RR 0.91, 95% CI 0.75-1.11). A benefit was present both in trials where penicillins and erythromycin were used. Amoxicillin/clavulanate was associated with a highly significant increase in the risk of necrotizing enterocolitis (RR 4.60, 95% CI 1.98-10.72). CONCLUSION: The administration of antibiotics after PROM is associated with a delay in delivery and a reduction in maternal and neonatal morbidity. These data support the routine use of antibiotics for women with PROM. Penicillins and erythromycin were associated with similar benefits, but erythromycin was used in larger trials and, thus, the results are more robust. Amoxicillin/clavulanate should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotizing enterocolitis. Antibiotic administration after PROM is beneficial for both women and neonates.

3.

Shmuely H, Samra Z, Ashkenazi S, Dinari G, Chodick G, Yahav J. Association of Helicobacter pylori infection with Shigella gastroenteritis in young children. Am J Gastroenterol. 2004 Oct;99(10):2041-5. 

Helicobacter Research Institute and Microbiology Laboratory, Rabin Medical Center, Beilinson Campus, Petah Tiqvl 49100, Israel.

OBJECTIVE: Helicobacter pylori infection is acquired mainly in early childhood. Much is unknown about the mode of transmission. The organism can be cultivated from cathartic stools and vomitus and is potentially transmissible during episodes of gastrointestinal tract illness. Because Shigella and Salmonella are common pathogens in enteric infections in children, we examined the association of H. pylori with Shigella and Salmonella infections in pediatric patients. METHODS: The study population included consecutive children aged 2-72 months hospitalized with acute gastroenteritis who had culture-proven shigellosis (N = 78) or salmonellosis (N = 76). Sixty-five healthy similarly aged children with culture-negative stools served as controls. Parents of cases were queried for personal and family characteristics and socioeconomic indicators. The stool specimens from all participants were tested for H. pylori antigen. RESULTS: On univariate analysis, Shigella gastroenteritis was significantly associated with H. pylori positivity (odds ratio, OR: 3.5, 95% confidence interval (CI): 1.5-8.8, p= 0.004) compared to controls. This association remained significant even after adjusting for living conditions, father's occupation, and father's education (OR = 3.38, 95% CI: 1.39-8.22, p= 0.007). Salmonella gastroenteritis was not associated with H. pylori positivity (OR = 1.1; 95% CI: 0.4-3.0, p= 0.8). CONCLUSION: H. pylori infection in young children is associated with Shigella gastroenteritis. This association warrants further investigation.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:  

11422.   Daniels NH, Callen JP. Mycophenolate mofetil is an effective treatment for peristomal pyoderma gangrenosum. Arch Dermatol. 2004 Dec;140(12):1427-9.

11423.   Garfield JL, Birkhahn RH, Gaeta TJ, Briggs WM. Diagnostic pathways and delays on route to operative intervention in acute appendicitis.Am Surg. 2004 Nov;70(11):1010-3.

11424.   Gray HC, Foy TM, Becker BA, Knutsen AP. Rice-induced enterocolitis in an infant: TH1/TH2 cellular hypersensitivity and absent IgE reactivity. Ann Allergy Asthma Immunol. 2004 Dec;93(6):601-5.

11425.     in't Hof KH, van Lankeren W, Krestin GP, Bonjer HJ, Lange JF, Becking WB, Kazemier G. Surgical validation of unenhanced helical computed tomography in acute appendicitis.Br J Surg. 2004 Dec;91(12):1641-5.

11426.   Kenyon S, Boulvain M, Neilson J.Antibiotics for preterm rupture of the membranes: a systematic review. Obstet Gynecol. 2004 Nov;104(5 Pt 1):1051-7. Review.

11427.   Lien WC, Lai TI, Lin GS, Wang HP, Chen WJ, Cheng TY. Epiploic appendagitis mimicking acute cholecystitis. Am J Emerg Med. 2004 Oct;22(6):507-8.

11428.   Moreno-Espinosa S, Farkas T, Jiang X.  Human caliciviruses and pediatric gastroenteritis. Semin Pediatr Infect Dis. 2004 Oct;15(4):237-45. Review.

11429.   Nielsen OH, Vainer B, Schaffalitzky de Muckadell OB. Microscopic colitis: a missed diagnosis? Lancet. 2004 Dec 4;364(9450):2055-7. Review.

11430.  Nikolaidis P, Hwang CM, Miller FH, Papanicolaou N. The nonvisualized appendix: incidence of acute appendicitis when secondary inflammatory changes are absent. AJR Am J Roentgenol. 2004 Oct;183(4):889-92.

11431. Sandborn WJ, Pardi DS. Clinical management of pouchitis. Gastroenterology. 2004 Dec;127(6):1809-14.

Pathogenesis:

11432.     Ashkenazi S.  Shigella infections in children: new insights. Semin Pediatr Infect Dis. 2004 Oct;15(4):246-52. Review.

11433. Shmuely H, Samra Z, Ashkenazi S, Dinari G, Chodick G, Yahav J.  Association of Helicobacter pylori infection with Shigella gastroenteritis in young children. Am J Gastroenterol. 2004 Oct;99(10):2041-5.