human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Given the perceived technical dem and s of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess , initial percutaneous drainage has become an attractive option in this patient population . This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon . However , the medical burden on the patient and on the quality of patient outcomes has not been described in the literature . Therefore , we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospect i ve trial . METHODS After institutional review board approval , a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006 . Continuous variables are listed with st and ard deviation . RESULTS There were 52 patients with a mean age of 9.0 + /- 3.9 years and weight of 34.4 + /- 18.8 kg . The  mean duration of symptoms at presentation was 8.4 + /- 7.6 days . Percutaneous aspiration only was performed in 2 patients . The mean volume of fluid on initial aspiration/drain placement was 76.3 + /- 81.1 mL. The mean time to appendectomy was 61.9 + /- 25.2 days . The laparoscopic approach was used in 49 patients ( 94.2 % ) , of which one was converted to an open operation . The mean length of hospitalization after interval appendectomy was 1.4 + /- 1.4 days . A recurrent abscess developed in 17.3 % of the patients . Six patients ( 11.5 % ) required another drainage procedure . The mean total charge to the patients was $ 40,414.02 . There were 4 significant drain complications ( ileal perforation , colon perforation , bladder perforation , and buttock/thigh necrotizing abscess ) . The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy . CONCLUSIONS The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach . However , this management poses complication risks and uses considerable re sources . Therefore , this strategy should be compared with early operation in a prospect i ve trial AIM This prospect i ve study was done to evaluate the feasibility and safety of immediate appendicectomy in the presence of appendicular mass . METHODS A prospect i ve , nonr and omized study was conducted over 46 consecutive patients ( mean age : 24 ± 8.76 years ) presenting with an appendicular mass over a 4-year period . They were subjected for immediate appendicectomy within 24 h of admission . RESULTS The appendix was identified and removed in all 46 patients at operation . Peri-appendiceal abscesses were present in 25 % ( 11 of 46 ) . There was difficulty with adhesolysis and localization of the appendix in 10%(4 ) of patients . Superficial wound infection had occurred in 8(17 % ) while deep wound infection had occurred in 9%(4 ) patients . The mean hospital stay was 3 ± 0.25 day . No major complications had occurred . CONCLUSIONS Early surgical intervention in patients with an appendicular mass  is feasible , safe and avoids the consequences of the misdiagnosis and mistreatment of other surgical pathologies PURPOSE The aim of of this study was to evaluate prospect ively the long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon . METHODS Between October 1986 and October 1997 , a total of 465 patients urgently admitted to our hospital with a suspected diagnosis of acute left-sided colonic diverticulitis had a CT scan .  Of 76 patients ( 17 percent ) who had an associated mesocolic or pelvic abscess , 3 were lost to follow-up . The remaining 73 patients ( 45 with a mesocolic abscess and 28 with a pelvic abscess ) were followed for a median of 43 months . RESULTS of the 45 patients with a mesocolic abscess , 7 ( 15 percent ) required surgery during their first hospitalization versus 11 ( 39 percent ) of the 28 patients with a pelvic abscess ( P = 0.04 ) . At the end of follow-up , 22 ( 58 percent ) of the 38 patients with a mesocolic abscess who had successful conservative treatment during their first hospitalization did not need surgical treatment vs. 8 ( 47 percent ) of the 17 who had a pelvic abscess . Altogether , 51 percent of the patients with a mesocolic abscess had surgical treatment versus 71 percent of those with a pelvic abscess ( P = 0.09 ) . CONCLUSIONS Considering the poor outcome of pelvic abscess associated with acute left-sided colonic diverticulitis , percutaneous drainage followed by secondary colectomy seems justified . Mesocolic abscess by itself is not an absolute indication for colectomy PURPOSE Prospect i ve evaluation was undertaken of surgical findings , complications , morbidity , and hospital stay between initial nonsurgical management versus early surgical intervention of an appendicular mass . METHODS A prospect i ve , nonr and omized study was conducted of 82 consecutive patients ( mean age , 6.9 + /- 3.3 years ) presenting with an appendicular mass over a 5-year period . They were categorized as group 1 , 58.5 % ( 48 of 82 ) nonsurgically managed and an interval appendectomy performed at a mean period of 8.6 + /- 4.6 weeks and group 2 , 41.5 % ( 34 of 82 ) appendectomy at presentation . RESULTS An appendix was identified in all 82 patients in both groups at operation . In-group 1 , recurrent episodes of abdominal pain necessitated interval appendectomy in 39.6 % ( 19 of 48 ) patients at a mean 4.3 + /- 0.8 versus 11.5 + /- 3.7 weeks in 60.4 % ( 29 of 48 ) who underwent scheduled interval appendectomy .  Periappendiceal abscesses present at interval appendectomy in group 1 was ( 38 of 48 ) 79.2 % versus 100 % ( 34 of 34 ) at appendectomy in group 2 . Adhesions at interval appendectomy  in group 1 was 81.3 % ( 39 of 48 ) versus 100 % ( 34 of 34 ) at appendectomy in group 2 . In-group 1 , superficial wound infection was observed in 0 versus 4 wound infections in group 2 . Overall morbidity rate between group 1 and group 2 was statistically significant ( P < .05 ) . Total mean hospital stay in group 1 was 13.2 + /- 1.5 versus 4.8 + /- 0.4 days in group 2 . Of the 48-interval appendectomy specimens , 37 of 48 ( 77 % ) appendices had a patent lumen , and 11 of 48 ( 23 % ) showed fibrosis and obliteration of appendicular lumen . There was no correlation ( r = 0.22 ) between the histopathologic findings and the interval between abscess treatment and interval appendectomy . CONCLUSIONS Early surgical intervention was beneficial over nonoperative management in this cohort of patients . Interval appendectomy is recommended after nonsurgical management of an appendicular mass BACKGROUND Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial . We studied the results of initial conservative treatment ( antibiotics and percutaneous drainage if necessary , with or without interval appendectomy ) compared with immediate surgery . METHODS We undertook an observational , retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon , treated in our hospital between January 1997 and March 2009 . Patients younger than 14 , with severe sepsis or with diffuse peritonitis were excluded . A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment . A control group was composed of the other patients , who all underwent  urgent appendectomy  , matched for age and later r and omized 1:1 . The infectious risk stratification was established with the National Nosocomial Infections Surveillance System ( NNIS ) index . Dependent variables were hospital stay and surgical site infection . Analysis was with SPSS , with p < 0.05 considered significant . RESULTS Interval appendectomy  was performed in 7 study group patients . Surgical site infection episodes were more frequent in the control group ( 6 vs. 0 , p < 0.001 ) . A greater percentage of high risk patients ( NNIS ≥ 2 ) was identified in the control group ( 80 vs. 28.7 % , p < 0.03 ) , mostly related with contaminated or dirty procedures in this group ( p < 0.001 ) . No significant difference between groups was found in hospital stay . CONCLUSION Initial conservative treatment should be considered the best therapeutic choice for acute appendicitis with abscess or phlegmon BACKGROUND : Ileocecal resection is the most commonly performed operation in patients with Crohn ’s disease . Anastomotic-associated complications , with their associated morbidity , are the most feared risks of surgery . OBJECTIVE : This study aim ed to assess the influence of a variety of putative risk factors in a homogenous group of patients undergoing first or subsequent surgery for Crohn ’s disease to quantify the cumulative risk for anastomotic-associated complications . DESIGN AND PATIENTS : All patients undergoing ileocecal or ileocolic resections for Crohn ’s disease from 2000 to 2010 were studied with the use of a prospect i ve data base . Demographics , operative details , possible risk factors , and anastomotic-associated complications were recorded . Patients having strictureplasties , multiple resections , or subtotal colonic resections were excluded from analysis . Statistical analysis was by univariate analysis ( Mann-Whitney U test ) and binary logistic regression . OUTCOMES : An anastomotic-associated complication was defined as a proven anastomotic leak , postoperative fistulation , or intra-abdominal abscess formation . RESULTS : Two hundred seven patients ( 109 female ) with a median age of 35 years ( range , 13 - 75 years ) were identified . One hundred seventy-three underwent primary anastomosis , 94 as an emergency procedure . Fifty-three had laparoscopic ( 5 converted ) procedures . Nineteen of 173 anastomotic complication events ( 11 % ) were recorded . Steroid usage ( OR 2.67 , 95 % CI 1.0 - 7.2 ) and the presence of preoperative abscess formation ( OR 3.4 , 95 % CI 1.2 - 9.8 ) were identified as independent predictors of anastomotic-associated complications . In the absence of both steroids and intra-abdominal abscess , the risk of anastomotic complications was 6 % , which increased to 14 % if either risk factor was present . When both risk factors were present , complication rates reached 40 % . CONCLUSION : Steroid usage and preoperative abscess were associated with higher rates of anastomotic complications following ileocolic resection for Cohn ’s disease . When both risk factors are present , it is best to avoid primary anastomosis Background The present study was design ed to compare the therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of appendicitis complicated by periappendiceal abscess . Methods In a prospect i ve study , 50 patients with acute appendicitis complicated by periappendiceal abscess ≥ 3 cm in size were r and omly assigned to two groups . The first group received treatment with ultrasound guided-percutaneous drainage and i.v . antibiotics ( ampicillin , cefuroxime , and metronidazole ) , and the other group received antibiotics only .  Patient ’s baseline characteristics , duration of hospital stay , and treatment outcome and complications were analyzed . Results Appendectomy was avoided in 16/25 patients in the drainage group and 2/25 patients in the non-drainage group during follow-up with RR of 0.39 ( 95 % CI = 0.22–0.62 ; p < 0.05 ) . One patient in the drainage group and 8 patients in the non-drainage group underwent surgery in the first month after the beginning of treatment . Eight patients in the drainage group and 15 in the non-drainage group underwent interval appendectomy . There was no statistically significant difference between the two groups regarding patient demographics , abscess size , and pretreatment clinical symptoms . Hospital stay up to the subsidence of clinical and sonographic signs was significantly shorter ( p < 0.001 ) in the drainage group , with a mean difference of 6.4 days ( 95 % CI = 5.0–7.9 ; p < 0.05 ) . Conclusions Percutaneous drainage with antibiotics is a safe and effective way of treating acute perforated appendicitis . The recurrence rate for these patients is relatively low , and very often interval appendectomy is not required . For patients 
    Output:
    
agent
Operation with appendectomy for appendiceal mass carries a high risk of complications compared with conservative treatment or drainage .
Drainage may lower the risk of treatment failure but entails a risk of complications .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Given the perceived technical dem and s of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess , initial percutaneous drainage has become an attractive option in this patient population . This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon . However , the medical burden on the patient and on the quality of patient outcomes has not been described in the literature . Therefore , we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospect i ve trial . METHODS After institutional review board approval , a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006 . Continuous variables are listed with st and ard deviation . RESULTS There were 52 patients with a mean age of 9.0 + /- 3.9 years and weight of 34.4 + /- 18.8 kg . The  mean duration of symptoms at presentation was 8.4 + /- 7.6 days . Percutaneous aspiration only was performed in 2 patients . The mean volume of fluid on initial aspiration/drain placement was 76.3 + /- 81.1 mL. The mean time to appendectomy was 61.9 + /- 25.2 days . The laparoscopic approach was used in 49 patients ( 94.2 % ) , of which one was converted to an open operation . The mean length of hospitalization after interval appendectomy was 1.4 + /- 1.4 days . A recurrent abscess developed in 17.3 % of the patients . Six patients ( 11.5 % ) required another drainage procedure . The mean total charge to the patients was $ 40,414.02 . There were 4 significant drain complications ( ileal perforation , colon perforation , bladder perforation , and buttock/thigh necrotizing abscess ) . The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy . CONCLUSIONS The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach . However , this management poses complication risks and uses considerable re sources . Therefore , this strategy should be compared with early operation in a prospect i ve trial AIM This prospect i ve study was done to evaluate the feasibility and safety of immediate appendicectomy in the presence of appendicular mass . METHODS A prospect i ve , nonr and omized study was conducted over 46 consecutive patients ( mean age : 24 ± 8.76 years ) presenting with an appendicular mass over a 4-year period . They were subjected for immediate appendicectomy within 24 h of admission . RESULTS The appendix was identified and removed in all 46 patients at operation . Peri-appendiceal abscesses were present in 25 % ( 11 of 46 ) . There was difficulty with adhesolysis and localization of the appendix in 10%(4 ) of patients . Superficial wound infection had occurred in 8(17 % ) while deep wound infection had occurred in 9%(4 ) patients . The mean hospital stay was 3 ± 0.25 day . No major complications had occurred . CONCLUSIONS Early surgical intervention in patients with an appendicular mass  is feasible , safe and avoids the consequences of the misdiagnosis and mistreatment of other surgical pathologies PURPOSE The aim of of this study was to evaluate prospect ively the long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon . METHODS Between October 1986 and October 1997 , a total of 465 patients urgently admitted to our hospital with a suspected diagnosis of acute left-sided colonic diverticulitis had a CT scan .  Of 76 patients ( 17 percent ) who had an associated mesocolic or pelvic abscess , 3 were lost to follow-up . The remaining 73 patients ( 45 with a mesocolic abscess and 28 with a pelvic abscess ) were followed for a median of 43 months . RESULTS of the 45 patients with a mesocolic abscess , 7 ( 15 percent ) required surgery during their first hospitalization versus 11 ( 39 percent ) of the 28 patients with a pelvic abscess ( P = 0.04 ) . At the end of follow-up , 22 ( 58 percent ) of the 38 patients with a mesocolic abscess who had successful conservative treatment during their first hospitalization did not need surgical treatment vs. 8 ( 47 percent ) of the 17 who had a pelvic abscess . Altogether , 51 percent of the patients with a mesocolic abscess had surgical treatment versus 71 percent of those with a pelvic abscess ( P = 0.09 ) . CONCLUSIONS Considering the poor outcome of pelvic abscess associated with acute left-sided colonic diverticulitis , percutaneous drainage followed by secondary colectomy seems justified . Mesocolic abscess by itself is not an absolute indication for colectomy PURPOSE Prospect i ve evaluation was undertaken of surgical findings , complications , morbidity , and hospital stay between initial nonsurgical management versus early surgical intervention of an appendicular mass . METHODS A prospect i ve , nonr and omized study was conducted of 82 consecutive patients ( mean age , 6.9 + /- 3.3 years ) presenting with an appendicular mass over a 5-year period . They were categorized as group 1 , 58.5 % ( 48 of 82 ) nonsurgically managed and an interval appendectomy performed at a mean period of 8.6 + /- 4.6 weeks and group 2 , 41.5 % ( 34 of 82 ) appendectomy at presentation . RESULTS An appendix was identified in all 82 patients in both groups at operation . In-group 1 , recurrent episodes of abdominal pain necessitated interval appendectomy in 39.6 % ( 19 of 48 ) patients at a mean 4.3 + /- 0.8 versus 11.5 + /- 3.7 weeks in 60.4 % ( 29 of 48 ) who underwent scheduled interval appendectomy .  Periappendiceal abscesses present at interval appendectomy in group 1 was ( 38 of 48 ) 79.2 % versus 100 % ( 34 of 34 ) at appendectomy in group 2 . Adhesions at interval appendectomy  in group 1 was 81.3 % ( 39 of 48 ) versus 100 % ( 34 of 34 ) at appendectomy in group 2 . In-group 1 , superficial wound infection was observed in 0 versus 4 wound infections in group 2 . Overall morbidity rate between group 1 and group 2 was statistically significant ( P < .05 ) . Total mean hospital stay in group 1 was 13.2 + /- 1.5 versus 4.8 + /- 0.4 days in group 2 . Of the 48-interval appendectomy specimens , 37 of 48 ( 77 % ) appendices had a patent lumen , and 11 of 48 ( 23 % ) showed fibrosis and obliteration of appendicular lumen . There was no correlation ( r = 0.22 ) between the histopathologic findings and the interval between abscess treatment and interval appendectomy . CONCLUSIONS Early surgical intervention was beneficial over nonoperative management in this cohort of patients . Interval appendectomy is recommended after nonsurgical management of an appendicular mass BACKGROUND Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial . We studied the results of initial conservative treatment ( antibiotics and percutaneous drainage if necessary , with or without interval appendectomy ) compared with immediate surgery . METHODS We undertook an observational , retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon , treated in our hospital between January 1997 and March 2009 . Patients younger than 14 , with severe sepsis or with diffuse peritonitis were excluded . A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment . A control group was composed of the other patients , who all underwent  urgent appendectomy  , matched for age and later r and omized 1:1 . The infectious risk stratification was established with the National Nosocomial Infections Surveillance System ( NNIS ) index . Dependent variables were hospital stay and surgical site infection . Analysis was with SPSS , with p < 0.05 considered significant . RESULTS Interval appendectomy  was performed in 7 study group patients . Surgical site infection episodes were more frequent in the control group ( 6 vs. 0 , p < 0.001 ) . A greater percentage of high risk patients ( NNIS ≥ 2 ) was identified in the control group ( 80 vs. 28.7 % , p < 0.03 ) , mostly related with contaminated or dirty procedures in this group ( p < 0.001 ) . No significant difference between groups was found in hospital stay . CONCLUSION Initial conservative treatment should be considered the best therapeutic choice for acute appendicitis with abscess or phlegmon BACKGROUND : Ileocecal resection is the most commonly performed operation in patients with Crohn ’s disease . Anastomotic-associated complications , with their associated morbidity , are the most feared risks of surgery . OBJECTIVE : This study aim ed to assess the influence of a variety of putative risk factors in a homogenous group of patients undergoing first or subsequent surgery for Crohn ’s disease to quantify the cumulative risk for anastomotic-associated complications . DESIGN AND PATIENTS : All patients undergoing ileocecal or ileocolic resections for Crohn ’s disease from 2000 to 2010 were studied with the use of a prospect i ve data base . Demographics , operative details , possible risk factors , and anastomotic-associated complications were recorded . Patients having strictureplasties , multiple resections , or subtotal colonic resections were excluded from analysis . Statistical analysis was by univariate analysis ( Mann-Whitney U test ) and binary logistic regression . OUTCOMES : An anastomotic-associated complication was defined as a proven anastomotic leak , postoperative fistulation , or intra-abdominal abscess formation . RESULTS : Two hundred seven patients ( 109 female ) with a median age of 35 years ( range , 13 - 75 years ) were identified . One hundred seventy-three underwent primary anastomosis , 94 as an emergency procedure . Fifty-three had laparoscopic ( 5 converted ) procedures . Nineteen of 173 anastomotic complication events ( 11 % ) were recorded . Steroid usage ( OR 2.67 , 95 % CI 1.0 - 7.2 ) and the presence of preoperative abscess formation ( OR 3.4 , 95 % CI 1.2 - 9.8 ) were identified as independent predictors of anastomotic-associated complications . In the absence of both steroids and intra-abdominal abscess , the risk of anastomotic complications was 6 % , which increased to 14 % if either risk factor was present . When both risk factors were present , complication rates reached 40 % . CONCLUSION : Steroid usage and preoperative abscess were associated with higher rates of anastomotic complications following ileocolic resection for Cohn ’s disease . When both risk factors are present , it is best to avoid primary anastomosis Background The present study was design ed to compare the therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of appendicitis complicated by periappendiceal abscess . Methods In a prospect i ve study , 50 patients with acute appendicitis complicated by periappendiceal abscess ≥ 3 cm in size were r and omly assigned to two groups . The first group received treatment with ultrasound guided-percutaneous drainage and i.v . antibiotics ( ampicillin , cefuroxime , and metronidazole ) , and the other group received antibiotics only .  Patient ’s baseline characteristics , duration of hospital stay , and treatment outcome and complications were analyzed . Results Appendectomy was avoided in 16/25 patients in the drainage group and 2/25 patients in the non-drainage group during follow-up with RR of 0.39 ( 95 % CI = 0.22–0.62 ; p < 0.05 ) . One patient in the drainage group and 8 patients in the non-drainage group underwent surgery in the first month after the beginning of treatment . Eight patients in the drainage group and 15 in the non-drainage group underwent interval appendectomy . There was no statistically significant difference between the two groups regarding patient demographics , abscess size , and pretreatment clinical symptoms . Hospital stay up to the subsidence of clinical and sonographic signs was significantly shorter ( p < 0.001 ) in the drainage group , with a mean difference of 6.4 days ( 95 % CI = 5.0–7.9 ; p < 0.05 ) . Conclusions Percutaneous drainage with antibiotics is a safe and effective way of treating acute perforated appendicitis . The recurrence rate for these patients is relatively low , and very often interval appendectomy is not required . For patients 
    Output:
    