Acute appendicitis in patients with AIDS/HIV infection
Article Abstract:
Patients with compromised immune function, including patients with AIDS and human immunodeficiency virus (HIV) infection, the cause of AIDS, are at increased risk of death and complications of surgery. It has been recommended that abdominal and rectal operations be postponed until improvement in the immune status of HIV-infected patients with or without AIDS. This approach can not be maintained when emergency surgical conditions occur, such as acute appendicitis. In addition, immune status is not generally expected to improve in patients with AIDS or HIV infection. The surgeon must determine the best time to operate. A report is presented of nine patients with AIDS or HIV infection who had signs of acute appendicitis and underwent surgery. An elevated white blood cell count is a typical finding in appendicitis; six of the nine patients did not have increased white blood cell counts prior to surgery. Two patients had laparoscopic examinations to confirm the diagnosis prior to surgery. Four patients had a perforated or ruptured appendix; previously, three of these patients were incorrectly diagnosed, thus delaying surgery. Following surgery seven patients had elevated temperatures; none of the nine patients had elevated white blood cell counts. Only one patient (who had a perforated appendix) developed a superficial wound infection; this responded well to treatment. Although most patients with signs and symptoms of appendicitis are operated on within six hours, HIV-infected patients with or without AIDS experience a delay in surgery. This delay probably occurs so that a more accurate diagnosis can be established before operating. The results of this survey indicate that this group of patients differed little from other patients with acute appendicitis. In three of the nine patients, efforts to confirm the diagnosis resulted in delays in surgery. Diagnostic laparoscopy was found to be helpful in making an earlier, more accurate diagnosis, and providing surgical intervention before the development of complications, such as perforation of the appendix. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Surgery
Subject: Health
ISSN: 0002-9610
Year: 1991
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Antimicrobial prophylaxis in colorectal surgery
Article Abstract:
A review of 152 clinical trials involving antibiotic prophylaxis to prevent wound infection in colorectal surgery reveals that this is usually an effective procedure. The review did not indicate any preferred regimens, but use of a single antibiotic is generally inadequate, and single-dose regimens are as effective as multiple-dose regimens. Users should select antibiotics according to the local presence of antibiotic-resistant bacteria, but antimicrobial prophylaxis can prevent bacterial resistance development through the reduced requirement for long-term antibiotic administration.
Publication Name: Nursing Times
Subject: Health
ISSN: 0954-7762
Year: 1998
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