Page 28 - AT

A28 SCIENCE
Thursday 27 sepTember 2018
Antibiotics for appendicitis? Surgery often not needed

By LINDSEY TANNER offering antibiotics instead ish study all had conven-
CHICAGO (AP) — When of surgery and Salminen tional incisions rather than
emergency tests showed says she occasionally does the less invasive "keyhole"
the telltale right-sided pain too. The journal editorial surgeries that are more
in Heather VanDusen's ab- says appropriate patients common for appendix re-
domen was appendicitis, should be given that op- moval in the United States.
she figured she'd be quick- tion. The non-surgery patients
ly wheeled into surgery. But The study involved about received three days of IV
doctors offered her the op- 500 Finnish adults who had antibiotics in the hospital,
tion of antibiotics instead. CT scans to rule out severe followed by seven days of
A new study from Fin- cases. pills at home.
land shows her choice is Half were treated with an- Dr. Giana Davidson, a Uni-
a reasonable alternative tibiotics; the others had sur- versity of Washington sur-
for most patients with ap- gery. geon, is involved in a simi-
pendicitis. Five years after Among the antibiotics pa- larly designed multicenter
treatment with antibiotics, tients, 100 ended up hav- U.S. study that may answer
almost two-thirds of pa- ing surgery within five years whether similar benefits
tients hadn't had another of treatment — most for would be seen for antibiot-
attack. a suspected recurrence ics versus "keyhole" surgery.
It's a substantial change of appendicitis in the first Davidson called the Finn-
in thinking about how to year. Seven of them did ish study "a critical piece to
treat an inflamed appen- not have appendicitis and the puzzle but I don't think
dix. For decades, appen- likely could have avoided it answers all of the ques-
dicitis has been considered surgery. The results suggest tions."
a medical emergency re- In this 2016 photo provided by the University of Washington, Dr. the success rate for antibi- Heather VanDusen was
quiring immediate surgery Linda Vorvick examines Heather VanDusen at UW Neighbor- otic treatment was almost treated at the University of
to remove the appendix hood Clinic in Seattle. 64 percent, the authors Washington in 2016. She
because of fears it could Associated Press said. said she chose antibiotic
burst, which can be life- About 1 in 4 surgery patients treatment partly to avoid
threatening. lead author and a surgeon Journal of the American had complications, includ- surgery scars, and now of-
But advances in imaging at Turku University Hospital Medical Association. ing infections around the fers advice to patients for
tests, mainly CT scans, have in Finland. A journal editorial says "it's incision, abdominal pain Davidson's study.
made it easier to determine Her study in adults is the a new era of appendicitis and hernias, compared "I knew the worst case sce-
if an appendix might burst, longest follow-up to date treatment." with only 7 percent of an- nario was ending up back
or if patients could be safe- of patients treated with Appendix removal is the tibiotics patients. Antibiotic in the hospital so why not
ly treated without surgery. drugs instead of surgery for most common emergency patients had 11 fewer sick try antibiotics first," said
The results suggest that appendicitis and the results surgery worldwide, with days on average than the VanDusen, who works in
nearly two-thirds of appen- confirm one-year findings about 300,000 performed surgery group. In the first university communications.
dicitis patients don't face reported three years ago. each year in the United year, their treatment costs She said she has done well
that risk and may be good Research has also shown States alone, said Salmin- were about 60 percent since her treatment, but
candidates for antibiotics antibiotics may work for en. She said the results from lower. A cost analysis for that the biggest drawback
instead. some children with appen- her study suggest many of the full five years wasn't in- "is wondering, with every
"It's a feasible, viable and a dicitis. those surgeries could be cluded in the published re- episode of stomach or
safe option," said Dr. Pau- The Finnish results were avoided. sults. bad gas, if it could happen
lina Salminen, the study's published Tuesday in the U.S. doctors have started Surgery patients in the Finn- again."q

Big changes about small fish are in store for fishermen

By PATRICK WHITTLE Atlantic herring is a small, Oceanic and Atmospheric mid-sized trawlers from sen- Debate over the proposed
Associated Press schooling fish that is the Administration has said a sitive spawning, feeding changes has prompted a
Fisheries managers are target of an industry that recent assessment of the and nursery habitat. The clash between herring fish-
adopting a host of poten- collects more than 100 herring stock shows a de- buffer extends 12 miles (19 ermen, harvesters of other
tially major changes for At- million pounds (45 million cline. kilometers) from the coast species, conservationists
lantic herring, an economi- kilograms) of catch every On Tuesday, the New Eng- in most areas but will ex- and stakeholders. The her-
cally important fish that year. The fish is also the sub- land Fishery Management tend to nearly 20 miles (32 ring fishery wants to make
serves as a key part of the ject of concern from envi- Council adopted a new kilometers) around Cape sure it isn't unfairly penal-
ocean ecosystem in New ronmentalists and fishery formula that will help guide Cod in Massachusetts. ized for the decline of the
England. managers, as the National how it sets catch limits in Peter Baker, director of species, said Jeff Kaelin,
the future. Catch limits U.S. Ocean Conservation- who works in government
will change based on the Northeast for the Pew relations for herring harvest-
health of the fishery, which Charitable Trusts, praised er Lund's Fisheries of Cape
is updated through stock the council's actions. May, New Jersey.
assessments. "Protecting these sensitive "Environment plays a big-
The council aims to further areas from intensive fish- ger part than the level of
reduce catch limits to pre- ing and rebuilding the her- fishing pressure that has
vent overfishing of herring. ring population will directly been allowed," Kaelin said.
But there were no projec- benefit marine wildlife and Herring are important eco-
tions available Tuesday. the coastal businesses that nomically because they
It also approved a coastal depend on them," Baker serve as key bait for the lob-
buffer zone to keep out said in a statement. ster and tuna industries.q