tag:blogger.com,1999:blog-4968787219619380438.post9006370548287155009..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: In 22% of kids with appendicitis, antibiotics do not prevent perforationSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-4968787219619380438.post-38706893244678565602015-09-05T11:56:24.921-04:002015-09-05T11:56:24.921-04:00Unless a fecalith is present, there is no reliable...Unless a fecalith is present, there is no reliable way to tell if the appendix is obstructed or what the cause is. I don't know how one could study this. CT scans that don't show fecaliths would be of no value.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-46767223118710544802015-09-04T14:34:28.816-04:002015-09-04T14:34:28.816-04:00In some of these cases, we must ask is it truly ap...In some of these cases, we must ask is it truly appendicitis and if so what is the cause? If it is blocked by stool, a foreign body, or cancer, then surgery is the only option. <br /><br />If the blockage is from infection (since the appendix swells in response to any infection in the body,) one can see why antibiotics work. Infection goes away, swelling goes down, appendix is unblocked. (That is a overly-simplistic explanation.)<br /><br />I think that if we were to study the cause of the blockage, have a way to determine it, then we would probably see that there are only certain types that respond to antibiotics. <br /><br />Failure to investigate this more and simply rely on surgery does just as much an injustice to the patient as always preforming surgery. There is obviously potential here, just not enough of the right research yet.<br /><br />Remember that I’m medicine it is not what we know, but what we think that we know…A. Banteringshttps://www.blogger.com/profile/05026455474056909739noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-25982229009271423302015-08-29T13:47:44.251-04:002015-08-29T13:47:44.251-04:00I'm not sure. :-)I'm not sure. :-)Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-26221812544540647862015-08-27T08:30:42.693-04:002015-08-27T08:30:42.693-04:00Scalpel, isn't that what I said?Scalpel, isn't that what I said? artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-35144297686618708222015-08-27T07:13:50.294-04:002015-08-27T07:13:50.294-04:00Artiger, I don't agree. If you really feel a t...Artiger, I don't agree. If you really feel a treatment is inferior, you should tell the patient. I would tell the patient about the recent Finnish study but point out its flaws. I would then say I recommend surgery and would not want any member of my family to be treated only with antibiotics. Then if the patient wants the antibiotics, that's fine with me.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-27310158275493150802015-08-26T21:41:18.970-04:002015-08-26T21:41:18.970-04:00Don't worry, there will always be some gambler...Don't worry, there will always be some gamblers out there who are willing to risk recurrence and treatment failure for minimal (if any) gain. These "volunteers" will help provide further evidence for what actually works. Let's not discourage them. <br /><br />Seriously, we should always include data as mentioned above in all discussions with patients, prior to operative intervention. If the patient wants to make a bad decision, that is his/her choice, but our charge is to provide them with understandable information, which is easier in some locations than others. artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-66866506210347625822015-08-26T09:52:52.070-04:002015-08-26T09:52:52.070-04:00Lou, thanks for commenting. I agree with you.Lou, thanks for commenting. I agree with you.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-57646450233502333962015-08-25T19:08:58.072-04:002015-08-25T19:08:58.072-04:00Hope a lot of processing docs see this and realiz...Hope a lot of processing docs see this and realize how dumb he recent stuff about treatment without surgery is. Of course, a lot of patients with be ok. Some would get well without any treatment. But why risk the ones who won't? L Browning M.D. ( long retired, so no personal gain involved! )<br /><br />tLouishttps://www.blogger.com/profile/10586732957981400166noreply@blogger.com