April 7, 2012 Clippings

Two-thirds of appendix removals 'unnecessary'

Medical dogma and 130 years of tradition mean doctors often wrongly consider surgery to be the only course of action, according to a study published in the British Medical Journal.

Academics say there is good evidence that treating uncomplicated cases of appendicitis with antibiotics tends to be better for the patient than surgery. Uncomplicated appendicitis, where an inflamed appendix has not led to other problems such as perforation of the organ or a serious infection, account for 80% of cases. The rest are complicated cases, where surgery is the only option.

Researchers wanted to see how patients with uncomplicated appendicitis fared if put on antibiotics. They examined four trials that compared the two approaches, which together contained about 900 patients. Volunteers were assigned either antibiotics or surgery on a random basis.

Among those given antibiotics, 80 per cent did not suffer another bout of appendicitis within 12 months of their course. Consequently, just under two thirds (63 per cent) of all appendectomies could be regarded as unnecessary.

The researchers, from the Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, said that while appendectomy had been the mainstay treatment since it was first reported in 1889, antibiotics had been overlooked. "The role of antibiotic treatment in acute uncomplicated appendicitis may have been overlooked mainly on the basis of tradition," they wrote.

They said routine early appendectomy was based on the dogma that appendicitis is a progressive disease, from an uncomplicated stage to one with complications of gangrene, perforation, or peritonitis, and that any delay in treatment increases the risk of complications.

They concluded: "Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis."

Professor Dileep Lobo, who worked on the study, said: "If your doctor thinks you have uncomplicated appendicitis, there's no harm in putting you on antibiotics and observing you. There's a good chance you are going to get better." Those who did not could still have an operation if things did not improve, he added.

He added that of the 20 per cent of patients who did have a recurrence of appendicitis in a year, "only about one in five patients develop complicated appendicitis" requiring surgery.

There are about 47,000 appendix removals on the NHS each year.

Source: www.dnaindia.com

07.04.2012

Man gifts life to a boy with dead son’s kidney

A brain-dead teenager saved the life of another teenager, suffering from last-stage renal failure for the past 18 months, when his father donated one of his kidneys to him.

When doctors at the MGM hospital in Vashi told Bishnu Adhikari on March 31 that they had done everything possible for his 18-year-old son Ishwar, but he was brain-dead, he decided to donate his son’s organs. That way, he felt, Ishwar would remain alive.

Sashanker Puran, chief administrator of the hospital, said Adhikari’s decision was nothing short of bravery. “In their saddest time they decided to go for cadaver transplant. They have given a new lease of life to 17-year-old US Arjun,” he said. “And not just the kidneys, their son’s cornea will give the blind a gift of vision.”

Adhikari, originally from Nepal, had migrated to Maharashtra nearly 30 years ago in search of a livelihood. Ishwar, who stayed with his mother in Nepal, often visited his father and uncle, Bambahadur Chatri, at Raigad where they used to work. This time, too, he wanted to spend his holidays with his father and uncle and visit Mumbai.

A relative said Ishwar fell from the third floor trying to hang his clothes for drying. “He suffered head injuries and doctors declared him dead in just two days,” he said.

Hospital administrator Puran said Ishwar was brought to MGM hospital on March 28 and “he was declared brain-dead on March 31”. “The formalities for cadaver transplant were completed on the same day,” he said.”

Ishwar’s was the second cadaver transplant in the hospital in the past 18 months. Apart from the kidneys, Ishwar’s corneas and liver too have been retrieved. “With the family’s consent, we informed the Zonal Transplant Coordination Centre, Mumbai. Arjun was in our waiting list of registered candidates for kidney transplant,” Puran said. “He needed a kidney immediately because he had renal failure and was undergoing dialysis for more than a year. The transplant was carried out on March 31.”

His other kidney and liver have been sent to other hospitals through the distribution system of the coordination centre. “His corneas have been sent to an eye bank,” Puran said.

Source: www.dnaindia.com

07.04.2012

It's not hard to make decisions when you know what your values are

Roy Disney