GASTROENTERITIS
Some Selected Abstracts: | |
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. |