Acute appendicitis during pregnancy

W latach 2000–2006 w II Klinice Chirurgii Ogólnej CMUJ w Krakowie leczono z powodu ostrego zapalenia wyrostka robaczkowego 4 ciężarne — wszystkie metodą laparoskopową. Omówiono trudności diagnostyczne oraz wynikające z tego różnice w poszczególnych trymestrach ciąży. Przedstawiono własne doświadczenia i możliwości zastosowania appendektomii laparoskopowej. Oceniono również wpływ leczenia operacyjnego na dalszy przebieg ciąży oraz rozwój płodu. Nie stwierdzono powikłań wynikających z zastosowanej metody leczenia. Wszystkie ciąże zostały zakończone o czasie: 3 siłami natury, 1 przez cięcie cesarskie z przyczyny położniczej. Wycięcie zmienionego zapalnie wyrostka robaczkowego metodą laparoskopową u kobiet w każdym trymestrze ciąży jest metodą bezpieczną zarówno dla matki, jak i dla płodu.Between 2000–2006, in the 2nd Department of Surgery at the Medical College of the Jagiellonian University, we performed 4 laparoscopic appendectomies in pregnant patients with acute appendicitis. Diagnostic difficulties in relation to the progression of pregnancy are discussed. Our own experience and the use of laparoscopic technique are also presented. We have evaluated the possible influence of operative management on the further development of the fetus. There were no complications related to the operative procedure. All pregnancies developed normally until delivery, which were either natural (3 patients) or cesarean (1 patient, due to obstetrical indications). We conclude, therefore, that laparoscopic appendectomy seems to be a safe approach both for mother and baby during any trimester of pregnancy

Mortality Following Clostridioides difficile Infection in Europe : A Retrospective Multicenter Case-Control Study

We aimed to describe the clinical presentation, treatment, outcome and report on factors associated with mortality over a 90-day period in Clostridioides difficile infection (CDI). Descriptive, univariate, and multivariate regression analyses were performed on data collected in a retrospective case-control study conducted in nine hospitals from seven European countries. A total of 624 patients were included, of which 415 were deceased (cases) and 209 were still alive 90 days after a CDI diagnosis (controls). The most common antibiotics used previously in both groups were β-lactams; previous exposure to fluoroquinolones was significantly (p = 0.0004) greater in deceased patients. Multivariate logistic regression showed that the factors independently related with death during CDI were older age, inadequate CDI therapy, cachexia, malignancy, Charlson Index, long-term care, elevated white blood cell count (WBC), C-reactive protein (CRP), bacteraemia, complications, and cognitive impairment. In addition, older age, higher levels of WBC, neutrophil, CRP or creatinine, the presence of malignancy, cognitive impairment, and complications were strongly correlated with shortening the time from CDI diagnosis to death. CDI prevention should be primarily focused on hospitalised elderly people receiving antibiotics. WBC, neutrophil count, CRP, creatinine, albumin and lactate levels should be tested in every hospitalised patient treated for CDI to assess the risk of a fatal outcome