Antibiotic treatment: an alternative to appendicectomy/Appendectomy surgeries for acute appendicitis!

Every year millions of people with appendicitis are rushed into emergency surgery---this is about to change!

 Most think that if the appendix is not immediately removed, it will burst — with potentially fatal consequences.

Now some doctors say there may be another option: antibiotics.

Five small studies from Europe, involving a total of 1,000 patients, indicate that antibiotics can cure some patients with appendicitis(Click here for the research article); about 70 percent of those who took the pills did not require surgery (appendicectomy).

Of these patients, even those who later had to go for surgery had no increased complications.

 Many emergency specialist surgeons are optimistic about it:

“These studies seem to indicate that antibiotics can cure appendicitis in many patients; you at least have the chance of avoiding surgery altogether.”

Dr. David Flum and others want to compare the results of antibiotics and surgery.

By suggesting an antibiotic alternative, the researchers are bucking longstanding medical tradition.

Little Background:

Surgical treatment for appendicitis began in the 1880s, when surgery itself was new. Doctors struggled to figure out which patients to operate on, because the procedure was dangerous and they knew some patients would get better without it.

As surgery and anesthesia improved, however, the appendectomy became the treatment of choice.

A little Science:
It made sense; for years, doctors thought the appendix — a tiny worm-shaped tube that hangs off the right side of the colon — became inflamed because it was blocked by a small piece of hardened feces. As it turns out, though, the vast majority of people with appendicitis do not have such a blockage.

“No one knows what causes appendicitis,” said Dr. James Barone, a retired chairman of surgery at Stamford Hospital in Connecticut and Lincoln Hospital in the Bronx.

An inflamed appendix is not a ticking time bomb, as people like to believe. While perforation occurs in 15 percent to 25 percent of patients, researchers hypothesize that those who get perforations may have a predisposing immune response or infection with certain kinds of bacteria. In others, appendicitis goes away on its own. Interestingly enough even the time that an appendix is inflamed is not necessarily linked to the risk of perforation. Most people with a ruptured appendix already have it when they show up in the emergency room.

Role of Antibiotics:
Surprisingly enough, this is not even the first time they are being considered as possible alternative to an appendectomy.

When antibiotics became available in the 1940s, doctors in England began giving them to patients with appendicitis and reported excellent results. During the Cold War, when American sailors spent six months or more on nuclear submarines prohibited from surfacing, those who developed appendicitis were given antibiotics.

“Those submariners did great, and no deaths or complications were reported,” Dr. Flum said.

 But that did not put a dint in the perception that surgery was the treatment of choice. 

In 1961 a Russian doctor stationed in Antarctica, Leonid Rogozov, went so far as to cut out his own appendix when it became inflamed.

There is already a debate in the medical field over whether to tell patients about the antibiotic option, and if so, which patients to tell.

Interesting Little Story:

Richard Redelfs, a 40-year-old man (in washington), woke up with abdominal pain a few years ago. An emergency room doctor told him that he needed immediate surgery for appendicitis.

But Mr. Redelfs was uninsured, and he told the surgeon that he had read online that antibiotics might be a viable alternative.

“Once he found out I didn’t have insurance, it was easy to talk him into prescribing me antibiotics,” Mr. Redelfs said.

He felt better almost immediately. But six months later, Mr. Redelfs felt a twinge in his abdomen and returned to the hospital. This time, he had insurance ;)

He was told that he had appendicitis again, he opted for surgery. “I wanted the peace of mind,” he said.

Important related link: http://www.medscape.com/viewarticle/781798_4

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Genes or the Enviroment (Age-old nature nurture debate almost finalizes)

How much our genes or environment takes part in our development has been calculated by a meta analysis of 5 decades of twin studies. 
 

In a study published recently, an international team of researchers shows an almost 50-50 split in the influence of genes or the environment on the development of various human traits.
The finding, published in Nature Genetics, is based on a review of 2748 studies involving 14 million twin pairs from across 39 countries.
The twins involved in the various studies ranged in age from 18 to 64 years.

Co-first author Dr Beben Benyamin (in photo above) says:
"there was some controversy and differences in terms of how much of the variation [in traits] is due to genetics and how much is due to environment,"

He says the team, including Dutch and American researchers, looked at all published twin studies to answer this puzzle.
Benyamin says while identical twins are genetically the same, non-identical twins share 50 per cent of their DNA.
The researchers were able to determine the contribution of genetics and the environment on the trait by measuring how similar various traits are between identical twins and non-identical twins.

"If the trait is genetic then you would expect identical twins will be more similar than the non-identical twin. The more similar an identical twin to a non-identical twin then we can infer the trait is largely due to the genetic factor,"  says Benyamin.

For all traits, the average genetic influence was 49 per cent while the environment accounted for 51 per cent.

"We were amazed the number was so close to half," admits Benyamin.

However, he says, this is an average figure and some traits are more or less influenced by genes.
For example:
*schizophrenia is 70 per cent the result of genetic influences and 30 per cent environmental.
 *social values are shaped by around 30 per cent genetics, and 70 per cent socio-economic factors.


The researchers also found almost 70 per cent of the effect of genes on a trait is additive.
This means that where hundreds of genes are involved in a trait, such as height, each gene has a tiny cumulative impact.

"So for example in height one gene might add one centimetre, the next gene a half a centimetre," Benyamin says.

This finding has implications on the design of gene mapping studies, says Benyamin, as it enables researchers to adopt the correct modelling.

"We comprehensively reviewed everything in the literature of twin studies — and we found everything is inherited, but the degree to how much the genetics contributed varies between traits and phenotype."

Since the birth of psychology, the psychologists have been fighting over the share of nature or nurture in the development, as illustrated below showing different psychological models and their viewpoint.

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