Accurate estimations of hepatitis B virus transmission risk for any region in Bosnia and Herzegov... more Accurate estimations of hepatitis B virus transmission risk for any region in Bosnia and Herzegovina are not clearly established. We aimed to determine levels of risk associated with intrafamilial transmission of hepatitis B infection within families in our region. Family members of 81 chronic carriers of hepatitis B surface antigen (>6 months positive and considered as index case) were tested for hepatitis B markers. For family members, we recorded their age, sex, and family relationship to the index case, and vaccination status. The proportion of HBsAg positive family members was 25/207 (12.1%), while the proportion of family members with evidence of exposure to HBV was 80/207 (38.6%). Only 17/207 (8.2%) family members had evidence of past HBV vaccination. Age was found to be a significant predictor of HBV exposure of family members (odds ratio 1.05, 95% CI 1.03-1.07, P<.001). In a multivariate analysis, HBsAg positivity was associated with a female index case (odds ratio 11.31, 95% CI 3.73-34.32, P<.001), HBeAg positivity in the index case (odds ratio 5.56, 95% CI 1.80-17.23, P<.005) and being a mother of the index case (odds ratio 9.82, 95% CI 2.43-39.68, P<.005). A female index case (odds ratio 4.87, 95% CI 2.21-10.72, P<.001), HBeAg positivity in the index case (odds ratio 3.22, 95% CI 1.15-9.00, P<.05) and being a mother of the index case (odds ratio 3.72, 95% CI 1.19-11.64, P<.05) were also risk factors for HBV exposure among family members. The combination of HBeAg positivity and female index case was a significant predictor for HBsAg positivity of family members (odds ratio 70.39, 95% CI 8.20-604.61, P<.001). Children of HBeAg positive mothers are at highest risk for becoming chronic carriers themselves and generally, the combination of female sex and HBeAg positivity dramatically increases the chances of HBV transmission within the family.
European Journal of Gastroenterology & Hepatology, 2007
To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) ... more To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) possible routes of transmission and risk factors for the intrafamilial transmission, (iii) vaccination rate among family members of chronic carriers and (iv) family members with highest risk for infection. A total of 172 family members of 67 hepatitis B surface antigen chronic carriers were tested for hepatitis B markers; 716 first-time blood donors from the same area were used as controls. Prevalence of hepatitis B surface antigen was higher (P<0.001) among family members of index cases (12.2%; 21/172) than among controls (3.6%; 26/716) with relative risk of 3.3 (95% confidence Intervals=1.9-5.8; P<0.05). Rate of exposure among family members was 37.8% (65/172); only 8.7% (15/172) had been vaccinated for hepatitis B virus. Difference (P<0.001) in exposure existed among family members; exposure increased with age (rhos=0.34; P<0.001). Prevalences of hepatitis B surface antigen positivity and hepatitis B virus exposure were higher among parents of index cases (P<0.005) and among offspring of female index cases (P<0.001). There were more (P<0.001) hepatitis B surface antigen-positive family members among those with mother-children relationship with index case (13/31; 41.9%) than among those with father-children (19/85; 22.4%) and horizontal (siblings and spouses) relationship (2/56; 3.6%). Significantly more (P<0.001) hepatitis B surface antigen-positive and hepatitis B virus-exposed offspring were found in families where only mother was hepatitis B surface antigen positive. Among family members of HBeAg-positive cases more hepatitis B surface antigen-positive cases and hepatitis B virus-exposed cases have been found (P<0.001). Combination of HBeAg positivity and female sex of index case significantly increased risk for chronic carriage among family members (relative risk=24.06; 95% confidence interval=8.88-65.21; P<0.05). In the area studied, both horizontal and vertical transmission exists, but maternal route is predominant. Female sex, HBeAg positivity of index carrier and presence of hepatitis B surface antigen-positive mother inside family increased risk for hepatitis B surface antigen positivity and exposure among family members. Vaccination rate of family members of index cases is alarmingly low.
Background There is a great need for a simple activity assessment tool that can reliably predict ... more Background There is a great need for a simple activity assessment tool that can reliably predict activity in patients with Crohn’s disease (CD). Aim To investigate the relationship between serum cytokines and endoscopic activity of CD using Crohn’s Disease Endoscopic Index of Severity (CDEIS) as a gold standard. Methods We prospectively evaluated 32 firmly established CD patients using ileocolonoscopy, CDEIS score, and Crohn’s Disease Activity Index (CDAI) score. Blood samples for cytokine analysis were obtained 1 day prior to procedure. Results The correlation between CDEIS and CDAI was moderate (r = 0.43; P = 0.01); however, the correlation between CDEIS and inflammatory cytokines was excellent, with the highest coefficients for tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6) (r = 0.96 and r = 0.96, respectively; P < 0.001). CDEIS and anti-inflammatory cytokines were correlated nonlinearly (power function). We identified two separate models for predicting CDEIS value, based on the best performing pro-inflammatory [CDEIS = 0.445 × (IL-6) − 5,143] and anti-inflammatory [CDEIS = 27.478 × (IL-10)−0.71] cytokines. Both IL-6 and IL-10 models had high adjusted R 2 values (0.916 and 0.954, respectively). IL-6 had excellent diagnostic accuracy for detecting patients with CDEIS >7 (active disease), with area under the receiver operating characteristic (ROC) curve of 1.0 [95% confidence interval (CI) = 0.89–1.0; P < 0.001]. Conclusion Serum cytokine levels are excellent predictors of endoscopic activity in patients with CD.
Background Bosnia and Herzegovina (B&H) is one of the Eastern European countries with lacking dat... more Background Bosnia and Herzegovina (B&H) is one of the Eastern European countries with lacking data on Crohn’s disease (CD) epidemiology. Goal We aimed to assess incidence of CD in Tuzla Canton of B&H during a 12-year period (1995–2006). Methods We retrospectively evaluated hospital records of both CD inpatients and outpatients residing in Tuzla Canton of B&H (total of 496,280 inhabitants) between 1995 and 2006. Patient that satisfied previously described criteria were included in the study. Incidence rates were calculated with age standardisation using European standard population. Trends in incidence were evaluated as moving 3-year averages. Results During the observed period, 140 patients met the diagnostic criteria for CD. Mean annual incidence was found to be 2.3/105 (95% CI = 1.6–3.0) inhabitants ranging from 0.20 to 6.45 per 105. Mean annual crude incidence during the last 5 years of study (2002–2006) was 4.15/105 (95% CI = 3.35–4.95). The prevalence of CD, at the end of the observed period was found to be 28.2/105 (95% CI = 23.5–32.9). CD incidence increased dramatically from 0.27/105 in 1995–1997 to 4.84/105 in 2004–2006, as well as did the number of colonoscopies performed; from 29 in 1995 to 850 in 2006. We observed almost constant trend of around three new cases of CD per 100 colonoscopies performed. Conclusions (1)Our area is the region of moderate incidence of CD with the trend that remains toward continuing increase in the rates of CD, which is most likely a direct consequence of the growing number of performed colonoscopies. (2) We believe that in the future years, CD incidence in our region will probably further increase and stabilise at a level of around five cases per 105 inhabitants.
Surgical Endoscopy and Other Interventional Techniques, 2007
Background The present study was designed to compare the therapeutic effectiveness of percutaneou... more Background The present study was designed to compare the therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of appendicitis complicated by periappendiceal abscess. Methods In a prospective study, 50 patients with acute appendicitis complicated by periappendiceal abscess ≥ 3 cm in size were randomly assigned to two groups. The first group received treatment with ultrasound guided-percutaneous drainage and i.v. antibiotics (ampicillin, cefuroxime, and metronidazole), and the other group received antibiotics only. Patient’s baseline characteristics, duration of hospital stay, and treatment outcome and complications were analyzed. Results Appendectomy was avoided in 16/25 patients in the drainage group and 2/25 patients in the non-drainage group during follow-up with RR of 0.39 (95% CI = 0.22–0.62; p < 0.05). One patient in the drainage group and 8 patients in the non-drainage group underwent surgery in the first month after the beginning of treatment. Eight patients in the drainage group and 15 in the non-drainage group underwent interval appendectomy. There was no statistically significant difference between the two groups regarding patient demographics, abscess size, and pretreatment clinical symptoms. Hospital stay up to the subsidence of clinical and sonographic signs was significantly shorter (p < 0.001) in the drainage group, with a mean difference of 6.4 days (95% CI = 5.0–7.9; p < 0.05). Conclusions Percutaneous drainage with antibiotics is a safe and effective way of treating acute perforated appendicitis. The recurrence rate for these patients is relatively low, and very often interval appendectomy is not required. For patients with periappendiceal abscess ≥ 3 cm in diameter, antibiotic therapy alone is insufficient and the recurrence rate is high.
Dear Editor,We read with great interest the article by El Malk HO et al.1 published in issue 7 of... more Dear Editor,We read with great interest the article by El Malk HO et al.1 published in issue 7 of the Journal Gastrointestinal Surgery 2010, in which the authors presented a substantial experience in surgical treatment of liver hydatid cyst (LHC). They retrospectively analyzed 672 consecutive patients that underwent surgery due to LHC during a 15-year period and also evaluated predictive factors associated with hepatic recurrence of LHC after surgery.The authors specified that:“surgery remains the basic treatment for liver hydatid cyst (LHC). The intended goals of this surgical treatment are to ensure complete elimination of the parasite and prevention of recurrent disease with lower morbidity and mortality. Recurrences can occur after all therapeutic methods including percutaneous treatment, chemotherapy with benzimidazole compounds, or surgery...Surgery for recurrence of LHC is technically more difficult due to adhesions arising from previous surgeries, which increase considerably th
Surgical Endoscopy and Other Interventional Techniques, 2007
Background The present study was designed to compare the therapeutic effectiveness of percutaneou... more Background The present study was designed to compare the therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of appendicitis complicated by periappendiceal abscess. Methods In a prospective study, 50 patients with acute appendicitis complicated by periappendiceal abscess ≥ 3 cm in size were randomly assigned to two groups. The first group received treatment with ultrasound guided-percutaneous drainage and i.v. antibiotics (ampicillin, cefuroxime, and metronidazole), and the other group received antibiotics only. Patient’s baseline characteristics, duration of hospital stay, and treatment outcome and complications were analyzed. Results Appendectomy was avoided in 16/25 patients in the drainage group and 2/25 patients in the non-drainage group during follow-up with RR of 0.39 (95% CI = 0.22–0.62; p < 0.05). One patient in the drainage group and 8 patients in the non-drainage group underwent surgery in the first month after the beginning of treatment. Eight patients in the drainage group and 15 in the non-drainage group underwent interval appendectomy. There was no statistically significant difference between the two groups regarding patient demographics, abscess size, and pretreatment clinical symptoms. Hospital stay up to the subsidence of clinical and sonographic signs was significantly shorter (p < 0.001) in the drainage group, with a mean difference of 6.4 days (95% CI = 5.0–7.9; p < 0.05). Conclusions Percutaneous drainage with antibiotics is a safe and effective way of treating acute perforated appendicitis. The recurrence rate for these patients is relatively low, and very often interval appendectomy is not required. For patients with periappendiceal abscess ≥ 3 cm in diameter, antibiotic therapy alone is insufficient and the recurrence rate is high.
Dear Editor,We read with great interest the article by El Malk HO et al.1 published in issue 7 of... more Dear Editor,We read with great interest the article by El Malk HO et al.1 published in issue 7 of the Journal Gastrointestinal Surgery 2010, in which the authors presented a substantial experience in surgical treatment of liver hydatid cyst (LHC). They retrospectively analyzed 672 consecutive patients that underwent surgery due to LHC during a 15-year period and also evaluated predictive factors associated with hepatic recurrence of LHC after surgery.The authors specified that:“surgery remains the basic treatment for liver hydatid cyst (LHC). The intended goals of this surgical treatment are to ensure complete elimination of the parasite and prevention of recurrent disease with lower morbidity and mortality. Recurrences can occur after all therapeutic methods including percutaneous treatment, chemotherapy with benzimidazole compounds, or surgery...Surgery for recurrence of LHC is technically more difficult due to adhesions arising from previous surgeries, which increase considerably th
Accurate estimations of hepatitis B virus transmission risk for any region in Bosnia and Herzegov... more Accurate estimations of hepatitis B virus transmission risk for any region in Bosnia and Herzegovina are not clearly established. We aimed to determine levels of risk associated with intrafamilial transmission of hepatitis B infection within families in our region. Family members of 81 chronic carriers of hepatitis B surface antigen (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;6 months positive and considered as index case) were tested for hepatitis B markers. For family members, we recorded their age, sex, and family relationship to the index case, and vaccination status. The proportion of HBsAg positive family members was 25/207 (12.1%), while the proportion of family members with evidence of exposure to HBV was 80/207 (38.6%). Only 17/207 (8.2%) family members had evidence of past HBV vaccination. Age was found to be a significant predictor of HBV exposure of family members (odds ratio 1.05, 95% CI 1.03-1.07, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). In a multivariate analysis, HBsAg positivity was associated with a female index case (odds ratio 11.31, 95% CI 3.73-34.32, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001), HBeAg positivity in the index case (odds ratio 5.56, 95% CI 1.80-17.23, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.005) and being a mother of the index case (odds ratio 9.82, 95% CI 2.43-39.68, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.005). A female index case (odds ratio 4.87, 95% CI 2.21-10.72, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001), HBeAg positivity in the index case (odds ratio 3.22, 95% CI 1.15-9.00, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05) and being a mother of the index case (odds ratio 3.72, 95% CI 1.19-11.64, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05) were also risk factors for HBV exposure among family members. The combination of HBeAg positivity and female index case was a significant predictor for HBsAg positivity of family members (odds ratio 70.39, 95% CI 8.20-604.61, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). Children of HBeAg positive mothers are at highest risk for becoming chronic carriers themselves and generally, the combination of female sex and HBeAg positivity dramatically increases the chances of HBV transmission within the family.
European Journal of Gastroenterology & Hepatology, 2007
To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) ... more To determine (i) the prevalence of HBV infection in families of confirmed chronic carriers, (ii) possible routes of transmission and risk factors for the intrafamilial transmission, (iii) vaccination rate among family members of chronic carriers and (iv) family members with highest risk for infection. A total of 172 family members of 67 hepatitis B surface antigen chronic carriers were tested for hepatitis B markers; 716 first-time blood donors from the same area were used as controls. Prevalence of hepatitis B surface antigen was higher (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) among family members of index cases (12.2%; 21/172) than among controls (3.6%; 26/716) with relative risk of 3.3 (95% confidence Intervals=1.9-5.8; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Rate of exposure among family members was 37.8% (65/172); only 8.7% (15/172) had been vaccinated for hepatitis B virus. Difference (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) in exposure existed among family members; exposure increased with age (rhos=0.34; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Prevalences of hepatitis B surface antigen positivity and hepatitis B virus exposure were higher among parents of index cases (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.005) and among offspring of female index cases (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). There were more (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) hepatitis B surface antigen-positive family members among those with mother-children relationship with index case (13/31; 41.9%) than among those with father-children (19/85; 22.4%) and horizontal (siblings and spouses) relationship (2/56; 3.6%). Significantly more (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) hepatitis B surface antigen-positive and hepatitis B virus-exposed offspring were found in families where only mother was hepatitis B surface antigen positive. Among family members of HBeAg-positive cases more hepatitis B surface antigen-positive cases and hepatitis B virus-exposed cases have been found (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Combination of HBeAg positivity and female sex of index case significantly increased risk for chronic carriage among family members (relative risk=24.06; 95% confidence interval=8.88-65.21; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). In the area studied, both horizontal and vertical transmission exists, but maternal route is predominant. Female sex, HBeAg positivity of index carrier and presence of hepatitis B surface antigen-positive mother inside family increased risk for hepatitis B surface antigen positivity and exposure among family members. Vaccination rate of family members of index cases is alarmingly low.
Background There is a great need for a simple activity assessment tool that can reliably predict ... more Background There is a great need for a simple activity assessment tool that can reliably predict activity in patients with Crohn’s disease (CD). Aim To investigate the relationship between serum cytokines and endoscopic activity of CD using Crohn’s Disease Endoscopic Index of Severity (CDEIS) as a gold standard. Methods We prospectively evaluated 32 firmly established CD patients using ileocolonoscopy, CDEIS score, and Crohn’s Disease Activity Index (CDAI) score. Blood samples for cytokine analysis were obtained 1 day prior to procedure. Results The correlation between CDEIS and CDAI was moderate (r = 0.43; P = 0.01); however, the correlation between CDEIS and inflammatory cytokines was excellent, with the highest coefficients for tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6) (r = 0.96 and r = 0.96, respectively; P < 0.001). CDEIS and anti-inflammatory cytokines were correlated nonlinearly (power function). We identified two separate models for predicting CDEIS value, based on the best performing pro-inflammatory [CDEIS = 0.445 × (IL-6) − 5,143] and anti-inflammatory [CDEIS = 27.478 × (IL-10)−0.71] cytokines. Both IL-6 and IL-10 models had high adjusted R 2 values (0.916 and 0.954, respectively). IL-6 had excellent diagnostic accuracy for detecting patients with CDEIS >7 (active disease), with area under the receiver operating characteristic (ROC) curve of 1.0 [95% confidence interval (CI) = 0.89–1.0; P < 0.001]. Conclusion Serum cytokine levels are excellent predictors of endoscopic activity in patients with CD.
Background Bosnia and Herzegovina (B&H) is one of the Eastern European countries with lacking dat... more Background Bosnia and Herzegovina (B&H) is one of the Eastern European countries with lacking data on Crohn’s disease (CD) epidemiology. Goal We aimed to assess incidence of CD in Tuzla Canton of B&H during a 12-year period (1995–2006). Methods We retrospectively evaluated hospital records of both CD inpatients and outpatients residing in Tuzla Canton of B&H (total of 496,280 inhabitants) between 1995 and 2006. Patient that satisfied previously described criteria were included in the study. Incidence rates were calculated with age standardisation using European standard population. Trends in incidence were evaluated as moving 3-year averages. Results During the observed period, 140 patients met the diagnostic criteria for CD. Mean annual incidence was found to be 2.3/105 (95% CI = 1.6–3.0) inhabitants ranging from 0.20 to 6.45 per 105. Mean annual crude incidence during the last 5 years of study (2002–2006) was 4.15/105 (95% CI = 3.35–4.95). The prevalence of CD, at the end of the observed period was found to be 28.2/105 (95% CI = 23.5–32.9). CD incidence increased dramatically from 0.27/105 in 1995–1997 to 4.84/105 in 2004–2006, as well as did the number of colonoscopies performed; from 29 in 1995 to 850 in 2006. We observed almost constant trend of around three new cases of CD per 100 colonoscopies performed. Conclusions (1)Our area is the region of moderate incidence of CD with the trend that remains toward continuing increase in the rates of CD, which is most likely a direct consequence of the growing number of performed colonoscopies. (2) We believe that in the future years, CD incidence in our region will probably further increase and stabilise at a level of around five cases per 105 inhabitants.
Surgical Endoscopy and Other Interventional Techniques, 2007
Background The present study was designed to compare the therapeutic effectiveness of percutaneou... more Background The present study was designed to compare the therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of appendicitis complicated by periappendiceal abscess. Methods In a prospective study, 50 patients with acute appendicitis complicated by periappendiceal abscess ≥ 3 cm in size were randomly assigned to two groups. The first group received treatment with ultrasound guided-percutaneous drainage and i.v. antibiotics (ampicillin, cefuroxime, and metronidazole), and the other group received antibiotics only. Patient’s baseline characteristics, duration of hospital stay, and treatment outcome and complications were analyzed. Results Appendectomy was avoided in 16/25 patients in the drainage group and 2/25 patients in the non-drainage group during follow-up with RR of 0.39 (95% CI = 0.22–0.62; p < 0.05). One patient in the drainage group and 8 patients in the non-drainage group underwent surgery in the first month after the beginning of treatment. Eight patients in the drainage group and 15 in the non-drainage group underwent interval appendectomy. There was no statistically significant difference between the two groups regarding patient demographics, abscess size, and pretreatment clinical symptoms. Hospital stay up to the subsidence of clinical and sonographic signs was significantly shorter (p < 0.001) in the drainage group, with a mean difference of 6.4 days (95% CI = 5.0–7.9; p < 0.05). Conclusions Percutaneous drainage with antibiotics is a safe and effective way of treating acute perforated appendicitis. The recurrence rate for these patients is relatively low, and very often interval appendectomy is not required. For patients with periappendiceal abscess ≥ 3 cm in diameter, antibiotic therapy alone is insufficient and the recurrence rate is high.
Dear Editor,We read with great interest the article by El Malk HO et al.1 published in issue 7 of... more Dear Editor,We read with great interest the article by El Malk HO et al.1 published in issue 7 of the Journal Gastrointestinal Surgery 2010, in which the authors presented a substantial experience in surgical treatment of liver hydatid cyst (LHC). They retrospectively analyzed 672 consecutive patients that underwent surgery due to LHC during a 15-year period and also evaluated predictive factors associated with hepatic recurrence of LHC after surgery.The authors specified that:“surgery remains the basic treatment for liver hydatid cyst (LHC). The intended goals of this surgical treatment are to ensure complete elimination of the parasite and prevention of recurrent disease with lower morbidity and mortality. Recurrences can occur after all therapeutic methods including percutaneous treatment, chemotherapy with benzimidazole compounds, or surgery...Surgery for recurrence of LHC is technically more difficult due to adhesions arising from previous surgeries, which increase considerably th
Surgical Endoscopy and Other Interventional Techniques, 2007
Background The present study was designed to compare the therapeutic effectiveness of percutaneou... more Background The present study was designed to compare the therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of appendicitis complicated by periappendiceal abscess. Methods In a prospective study, 50 patients with acute appendicitis complicated by periappendiceal abscess ≥ 3 cm in size were randomly assigned to two groups. The first group received treatment with ultrasound guided-percutaneous drainage and i.v. antibiotics (ampicillin, cefuroxime, and metronidazole), and the other group received antibiotics only. Patient’s baseline characteristics, duration of hospital stay, and treatment outcome and complications were analyzed. Results Appendectomy was avoided in 16/25 patients in the drainage group and 2/25 patients in the non-drainage group during follow-up with RR of 0.39 (95% CI = 0.22–0.62; p < 0.05). One patient in the drainage group and 8 patients in the non-drainage group underwent surgery in the first month after the beginning of treatment. Eight patients in the drainage group and 15 in the non-drainage group underwent interval appendectomy. There was no statistically significant difference between the two groups regarding patient demographics, abscess size, and pretreatment clinical symptoms. Hospital stay up to the subsidence of clinical and sonographic signs was significantly shorter (p < 0.001) in the drainage group, with a mean difference of 6.4 days (95% CI = 5.0–7.9; p < 0.05). Conclusions Percutaneous drainage with antibiotics is a safe and effective way of treating acute perforated appendicitis. The recurrence rate for these patients is relatively low, and very often interval appendectomy is not required. For patients with periappendiceal abscess ≥ 3 cm in diameter, antibiotic therapy alone is insufficient and the recurrence rate is high.
Dear Editor,We read with great interest the article by El Malk HO et al.1 published in issue 7 of... more Dear Editor,We read with great interest the article by El Malk HO et al.1 published in issue 7 of the Journal Gastrointestinal Surgery 2010, in which the authors presented a substantial experience in surgical treatment of liver hydatid cyst (LHC). They retrospectively analyzed 672 consecutive patients that underwent surgery due to LHC during a 15-year period and also evaluated predictive factors associated with hepatic recurrence of LHC after surgery.The authors specified that:“surgery remains the basic treatment for liver hydatid cyst (LHC). The intended goals of this surgical treatment are to ensure complete elimination of the parasite and prevention of recurrent disease with lower morbidity and mortality. Recurrences can occur after all therapeutic methods including percutaneous treatment, chemotherapy with benzimidazole compounds, or surgery...Surgery for recurrence of LHC is technically more difficult due to adhesions arising from previous surgeries, which increase considerably th
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Papers by Nermin Salkic