[From nobody Tue Aug 1 03:09:33 2006 Return-Path: <siddsidd@comcast.net> Received: from rly-xb01.mx.aol.com (rly-xb01.mail.aol.com [172.20.64.47]) by air-xb02.mail.aol.com (v110.15) with ESMTP id MAILINXB24-8344cec654120; Mon, 31 Jul 2006 23:11:33 -0400 Received: from alnrmhc11.comcast.net (alnrmhc11.comcast.net [204.127.225.91]) by rly-xb01.mx.aol.com (v110.15) with ESMTP id MAILRELAYINXB11-8344cec654120; Mon, 31 Jul 2006 23:11:16 -0400 Received: from brian (c-68-62-27-123.hsd1.mi.comcast.net[68.62.27.123]) by comcast.net (alnrmhc11) with SMTP id <20060801031114b1100nsgvde>; Tue, 1 Aug 2006 03:11:14 +0000 Message-ID: <004d01c6b518$26492c10$0501a8c0@Brian> From: "Brian Shapiro" <siddsidd@comcast.net> To: <KMATTOX@aol.com> References: <26c.d24014e.320014f9@aol.com> Subject: Re: ccml Re: Appendicitis/ CT Date: Mon, 31 Jul 2006 23:11:14 -0400 MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="----=_NextPart_000_004A_01C6B4F6.9EEB40D0" X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 6.00.2900.2869 Disposition-Notification-To: "Brian Shapiro" <siddsidd@comcast.net> X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.2869 X-AOL-IP: 204.127.225.91 ------=_NextPart_000_004A_01C6B4F6.9EEB40D0 Content-Type: text/plain; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable I think there is little reason to perform an appendectomy in the middle of t= he night. I perform most appendectomies laprascopically as an outpatient the= next morning (if I get the consult after about 9pm), 6am is a great time to= do an appendix.I start antibiotics once diagnosis is made. For the last sev= eral months I have been using the 36 hour rule (see last reference) declarin= g an emergency when that time is approached (day or night). Now I am on cal= l at least every other night (for the last 13 years without residents). I th= ink the literature supports this approach. CT scanning has decreased negativ= e appendectomy rate (at my hospital from almost 20% to 5%). 1. J Pediatr Surg. 2005 Dec;40(12):1912-5. Emergent vs urgent appendectomy in children: a study of outcomes. 2.: World J Surg. 2006 Jun;30(6):1033-7. Appendectomy versus antibiotic trea= tment in acute appendicitis. a prospective multicenter randomized controlled= trial. J Am Coll Surg. 2006 Mar;202(3):401-6. Epub 2006 Jan 18.=20 How time affects the risk of rupture in appendicitis Brian Shapiro MD FACS Trauma Director Chief of Surgery Genesys Health System Grand Blanc Michigan ----- Original Message -----=20 From: KMATTOX@aol.com=20 To: kirkmahon@hotmail.com ; ccm-l@ccm-l.org=20 Sent: Monday, July 31, 2006 10:22 PM Subject: ccml Re: Appendicitis/ CT In a message dated 7/31/2006 5:11:40 P.M. Central Standard Time, kirkmahon= @hotmail.com writes: Otherwise, they ALL get CT. It is an innordinate=20 drain on ER resources. Frankly, I feel it is often a maneuver to avoid=20 coming in to examine the patient until the last possible moment. I woul= d=20 love Dr. Mattox to train more of the guys/gals from the Tub to actually=20 practice that way in real life (sans CT dependency.) Ex Baylor Med Student and Grad from the Tub.....practicing in Dallas, TX= , I fear, I really do fear that the request for the CT scan by surgeons in p= atients with suspected appendicitis is a temporizing move to get more tests=20= during the night, so they dont have to come into the hospital to operate unt= il daylight hours giving the appendix a greater chance to rupture, due to ph= ysician (surgeon) delay. Even in the current days of some physicians at= the Ben Taub General Hospital (county hospital in Houston), some persons, a= nd yes even at times some of our junior surgical residents who have recently= rotated in the private hospital order CT scans. The attitude adjustment= capabilities of our educational offerings in the M&M conference are not the= same reinforcement and discipline producing as former years. =20 k=20 ------=_NextPart_000_004A_01C6B4F6.9EEB40D0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD> <META http-equiv=3DContent-Type content=3D"text/html; charset=3Diso-8859-1"> <META content=3D"MSHTML 6.00.2900.2912" name=3DGENERATOR> <STYLE></STYLE> </HEAD> <BODY id=3Drole_body style=3D"FONT-SIZE: 10pt; COLOR: #000000; FONT-FAMILY:=20= Arial" bottomMargin=3D7 bgColor=3D#ffffff leftMargin=3D7 topMargin=3D7 rig= htMargin=3D7> <DIV>I think there is little reason to perform an appendectomy in the middle= of=20 the night. I perform most appendectomies laprascopically as an outpatient th= e=20 next morning (if I get the consult after about 9pm),&nbsp;6am is a great=20 time&nbsp;to do an appendix.I&nbsp;start antibiotics once diagnosis is made.= For=20 the last several months I have been using the 36 hour rule (see last referen= ce)=20 declaring an emergency&nbsp;when that time is approached (day or=20 night).&nbsp;&nbsp;Now I am on call at least every other night (for the last= 13=20 years without residents). I think the literature supports this approach. CT=20 scanning has decreased negative appendectomy rate (at my hospital from almos= t=20 20% to 5%).</DIV> <DIV>&nbsp;</DIV> <DIV>&nbsp;</DIV> <DIV>1.<STRONG>&nbsp;</STRONG><SPAN title=3D"Journal of pediatric surgery.">= <A href=3D"javascript:AL_get(this, 'jour', 'J Pediatr Surg.');">J Pediatr=20 Surg.</A></SPAN> 2005 Dec;40(12):1912-5.<SPAN class=3Dlinkbar><SPAN> <DD class=3Dabstract id=3Dabstract16338317></SPAN></SPAN><FONT size=3D3><FON= T size=3D2>Emergent vs urgent appendectomy in children: a study of=20 outcomes</FONT>.</FONT></DD></DIV> <DIV>&nbsp;</DIV> <DIV>&nbsp;</DIV> <DIV>2.<STRONG>: </STRONG><SPAN title=3D"World journal of surgery."><A hre= f=3D"javascript:AL_get(this, 'jour', 'World J Surg.');">World J=20 Surg.</A></SPAN> 2006 Jun;30(6):1033-7. <FONT size=3D2>Appendectomy versus=20 antibiotic treatment in acute appendicitis. a prospective multicenter random= ized=20 controlled trial.</FONT></DIV> <DIV>&nbsp;</DIV> <DIV>&nbsp;</DIV> <DIV> <TABLE cellSpacing=3D0 cellPadding=3D0 width=3D"100%"> <TBODY> <TR> <TD> <DIV><B>&nbsp;</B><SPAN title=3D"Journal of the American Colle= ge of Surgeons."><A href=3D"javascript:AL_get(this, 'jour', 'J Am Co= ll Surg.');">J Am Coll=20 Surg.</A></SPAN> 2006 Mar;202(3):401-6. Epub 2006 Jan=20 18.</DIV></TD></TR></TBODY></TABLE>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb= sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20 How time affects the risk of rupture in appendicitis</DIV> <DIV>&nbsp;</DIV> <DIV>&nbsp;</DIV> <DIV>&nbsp;</DIV> <DIV>&nbsp;</DIV> <DIV>Brian Shapiro MD FACS<BR>Trauma Director</DIV> <DIV>Chief of Surgery<BR>Genesys Health System<BR>Grand Blanc Michigan</DIV> <BLOCKQUOTE dir=3Dltr style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARG= IN-LEFT: 5px; BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px"> <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV> <DIV style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black= "><B>From:</B>=20 <A title=3DKMATTOX@aol.com href=3D"mailto:KMATTOX@aol.com">KMATTOX@aol.com= </A>=20 </DIV> <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A title=3Dkirkmahon@hotmail.co= m href=3D"mailto:kirkmahon@hotmail.com">kirkmahon@hotmail.com</A> ; <A =20= title=3Dccm-l@ccm-l.org href=3D"mailto:ccm-l@ccm-l.org">ccm-l@ccm-l.org</= A> </DIV> <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Monday, July 31, 2006 10:22=20 PM</DIV> <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> ccml Re: Appendicitis/ CT<= /DIV> <DIV><BR></DIV><FONT id=3Drole_document face=3DArial color=3D#000000> <DIV> <DIV>In a message dated 7/31/2006 5:11:40 P.M. Central Standard Time, <A =20= href=3D"mailto:kirkmahon@hotmail.com">kirkmahon@hotmail.com</A> writes:</= DIV> <BLOCKQUOTE style=3D"PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT:= blue 2px solid"><FONT style=3D"BACKGROUND-COLOR: transparent" face= =3DArial color=3D#000000>Otherwise,=20 they ALL get CT.&nbsp; It is an innordinate <BR>drain on ER resources.=20 Frankly, I feel it is often a maneuver to avoid <BR>coming in to examine= the=20 patient until the last possible moment.&nbsp; I would <BR>love Dr. Matto= x to=20 train more of the guys/gals from the Tub to actually <BR>practice that w= ay=20 in real life (sans CT dependency.)<BR><BR>Ex Baylor Med Student and Grad= =20 from the Tub.....practicing in Dallas, TX,<BR></FONT></BLOCKQUOTE></DIV> <DIV></DIV> <DIV>I fear, I really do fear that the request for the CT scan by surgeons= in=20 patients with suspected appendicitis is a temporizing move to get more tes= ts=20 during the night, so they&nbsp;dont have to come into the&nbsp;hospital to= =20 operate until daylight hours giving the appendix a greater chance to ruptu= re,=20 due to physician (surgeon) delay.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Even in th= e=20 current days of some physicians at the Ben Taub General Hospital (county=20 hospital in&nbsp;Houston), some persons, and yes even at times some of our= =20 junior surgical residents who have recently rotated in the private hospita= l=20 order CT scans.&nbsp;&nbsp;&nbsp;&nbsp; The attitude adjustment capabiliti= es=20 of our educational offerings in the M&amp;M conference are not&nbsp;the sa= me=20 reinforcement and discipline producing as former=20 years.&nbsp;&nbsp;&nbsp;&nbsp; </DIV> <DIV>&nbsp;</DIV> <DIV>k&nbsp;</DIV></BLOCKQUOTE></FONT></BODY></HTML> ------=_NextPart_000_004A_01C6B4F6.9EEB40D0-- ]