Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection?

BACKGROUND: The role of laparoscopy in the setting of perforated appendicitis remains controversial. A retrospective study was conducted to evaluate the early postoperative outcomes of laparoscopic appendectomy (LA) compared to open appendectomy (OA) in patients with perforated appendicitis. METHODS: A total of 1,032 patients required an appendectomy between January 2005 and December 2009. Among these patients, 169 presented with perforated appendicitis. Operation times, length of hospital stay, overall complication rates within 30 days, and surgical site infection (SSI) rates were analyzed. RESULTS: Out of the 169 evaluated patients, 106 required LA and 63 OA. Although operation times were similar in both groups (92 ± 31 min for LA vs. 98 ± 45 for OA, p = 0.338), length of hospital stay was shorter in the LA group (6.9 ± 3.8 days vs. 11.5 ± 9.2, p < 0.001). Overall complication rates were significantly lower in the LA group (32.1 vs. 52.4 %, p < 0.001), as were incisional SSI (1.9 vs. 22.2 %, p < 0.001). Organ/space SSI rates were similar in both groups (23.6 % after LA vs. 20.6 % after OA, p = 0.657). CONCLUSIONS: For perforated appendicitis, LA results in a significantly shorter hospital stay, fewer overall postoperative complications, and fewer wound infections compared to OA. Organ/space SSI rates were similar for both procedures. LA provides a safe option for treating patients with perforated appendicitis.

A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance

PURPOSES Geriatric problems frequently go undetected in older patients in emergency departments (EDs), thus increasing their risk of adverse outcomes. We evaluated a novel emergency geriatric screening (EGS) tool designed to detect geriatric problems. BASIC PROCEDURES The EGS tool consisted of short validated instruments used to screen 4 domains (cognition, falls, mobility, and activities of daily living). Emergency geriatric screening was introduced for ED patients 75 years or older throughout a 4-month period. We analyzed the prevalence of abnormal EGS and whether EGS increased the number of EGS-related diagnoses in the ED during the screening, as compared with a preceding control period. MAIN FINDINGS Emergency geriatric screening was performed on 338 (42.5%) of 795 patients presenting during screening. Emergency geriatric screening was unfeasible in 175 patients (22.0%) because of life-threatening conditions and was not performed in 282 (35.5%) for logistical reasons. Emergency geriatric screening took less than 5 minutes to perform in most (85.8%) cases. Among screened patients, 285 (84.3%) had at least 1 abnormal EGS finding. In 270 of these patients, at least 1 abnormal EGS finding did not result in a diagnosis in the ED and was reported for further workup to subsequent care. During screening, 142 patients (42.0%) had at least 1 diagnosis listed within the 4 EGS domains, significantly more than the 29.3% in the control period (odds ratio 1.75; 95% confidence interval, 1.34-2.29; P<.001). Emergency geriatric screening predicted nursing home admission after the in-hospital stay (odds ratio for ≥3 vs <3 abnormal domains 12.13; 95% confidence interval, 2.79-52.72; P=.001). PRINCIPAL CONCLUSIONS The novel EGS is feasible, identifies previously undetected geriatric problems, and predicts determinants of subsequent care.

Ms. hebr. oct. 52 - Agadot ve-ḥidushim

Vorbesitzer: Moses Simon Sivitz

Ms. Barth. 52 - Summa Decreti

Vorbesitzer: Bartholomaeusstift Frankfurt am Main;

Probe einer freien Überseetzung des Isais Kap. 52

M.J. L-u.

Zu S. 35-52: Der Prophet Jesaia und der Baum

Bernhard Heller

Zu S. 456-463 [Nachricht] : (Magnet in der jüdischen Literatur) ; zugleich zur Ergänzung meiner Ausführungen über den schwebenden Sarg (MGWJ 1925, 50-52 ; 1926, 271-276)

Bernhard Heller

Ms. Praed. 52 - Quaestiones longae in libros Physicorum Aristotelis

Vorbesitzer: Jodocus Sayler de Eßlinga; Dominikanerkloster Frankfurt am Main

Na 1 Nachlass Max Horkheimer, 80 - Korrespondenzen u.a. mit Marjorie Fiske Lissance (p. II 11, 1-52)

4 Briefe zwischen Frederick Lilge und Max Horkheimer, 1948; 15 Briefe zwischen Marjorie Fiske Lissance und Max Horkheimer, 1947-1948; 2 Brief und Beilage von Max Horkheimer an Harvey J. Locke, 1948; 3 Briefe zwischen Walter Lichtblau-Lohner und Max Horkheimer, 1940-1944; 2 Briefe zwischen Anton Lourie und Max Horkheimer, 17.08.1945, 1.09.1945 sowie 1 Memorandum von Max Horkheimer über ein Gespräch mit Anton Lourie 26.09.1945; 1 Brief von G. L. an George A. Lundberg, 1948; 6 Briefe zwischen Zvi Lurie und Max Horkheimer, 1949; 3 Briefe zwischen Georg Lukács und Max Horkheimer, 07.07.1948, 1948-1949; 1 Brief von Helen Lynd an Max Horkheimer, 1945;

Na 50 Nachlass Arthur Schopenhauer - 'Schopenhauer-Archiv', 52 - Grußschreiben des evangelischen Pfarrers Karl Candidus anlässlich der Übersetzung der "Welt als Wille und Vorstellung" ins Französische

u.a.: Gründe für die Bewunderung Schopenhauers; "Allgemeine Zeitung"; Immanuel Kant, Charles Secretan; S. Hirzel; Alexandre Weill;

Na 50 Nachlass Arthur Schopenhauer - 'Schopenhauer-Archiv', 338 - Postkarte an Professor Hugo von Meltzl mit der Mitteilung des Streites mit Professor Siebenlist

u.a.: Ferdinand Laban; Prof. Siebenlist;

Ms.Ff.F.Stoltze 3. 52 - Brief von Franz Fabricius an Friedrich Stoltze

Bitte um humoristischen Text, Weber: Familie, silberne Hochzeit