Can Surgeons Identify Appendicitis Macroscopically? Results From a Multicentre Prospective Study
Conclusion: Macroscopic identification intraoperatively is inaccurate with a FN rate of 22%.
Authors: Madl P, De Filippis A, Tedeschi A Abstract Skin aging is primarily associated with the alterations in dermal extracellular matrix, in particular a decrease in collagen type-1 content. Recent studies have shown that collagen-degrading matrix metalloproteinase (MMP-1) is produced by fibroblasts in response to chronoaging, which in human dermal fibroblasts leads to the release of proinflammatory cytokines. Past studies showed that anti-inflammatory capabilities could be induced via non-chemical means. One of these methods makes use of ultra-weak fractal electromagnetic (uwf-EM) signals. Such ultra-/very-low f...
Eur J Pediatr Surg DOI: 10.1055/s-0040-1710534 Introduction The rate of misdiagnosis of appendicitis in children is a challenge and clinical prediction scores could be part of the solution. However, the pediatric appendicitis score (PAS) and the Alvarado score have shown disappointing diagnostic accuracy in pediatric validation studies, while the appendicitis inflammatory response (AIR) score and the novel pediatric appendicitis risk calculator (pARC) have not yet been validated thoroughly. Therefore, the aim of the present study was to evaluate these four prediction scores prospectively in children with suspected ...
This study represents one of the largest cohorts and with a long follow-up. For tumors smaller than 10 mm appendicectomy was sufficient as a curative procedure, as revealed by the good outcome. This series presented a 100% disease-free survival. The indolent phenotype of appendix NENs is supported by the expression of markers that point towards a strong inhibition of cell replication and growth inhibition.
Conclusion: We conclude that acute, short-term SHS exposure had a statistically significant effect on spirometry in female asthma patients but did not significantly modify spirometric indices 24 h later in COPD patients. PMID: 32441557 [PubMed - as supplied by publisher]
The number of geriatric patients is expected to grow 3-fold over the next 30 years, and as many as 50% of the surgeries done in the United States may occur in geriatric patients. Geriatric patients often have increased comorbidities and more often present in a delayed manner for acute appendicitis. The aim of this study was to evaluate outcomes between geriatric patients and younger patients undergoing appendectomy, hypothesizing that geriatric patients will have a higher risk of abscess and/or perforation, conversion to open surgery, postoperative intra-abdominal abscess, and 30-day readmission.
Conclusions: At 5 years of follow-up 46% of children treated with antibiotics for acute nonperforated appendicitis had undergone an appendectomy, although acute appendicitis was only histologically confirmed in 4/24 (17%). Treatment with antibiotics seems to be safe in the intermediate-term; none of the children previously treated nonoperatively re-presented with complicated appendicitis.
Rectal examinations of adults have fallen into less and less use, with some claiming of a reduced role in suspected appendicitis, to evaluate gastrointestinal bleeding, and in screening for prostate cancer1, 2. Many authors lament the reduction in rectal examinations. Why does it matter? Efficacy and cost-efficiency are universally acknowledged. But there is another reason: relationship-building, as the patient realizes that no part of the body is off-limits or repugnant to a concerned examiner. Even in palliative care, where one might wonder if the intrusion and discomfiture are warranted, there is compelling rationale for selective use3.
CONCLUSIONS: This Cochrane review has indicated that there are no RCTs to compare management options in this vital area, therefore trials should be undertaken as a matter of urgency. The problems with such randomised methods are standardising surgery and endotherapies in all sites, standardising histopathology in all centres, assessing which patients are fit or unfit for surgery and making sure there are relevant outcomes for the study (i.e. long-term survival (over five or more years)) and no progression of HGD. PMID: 32442322 [PubMed - as supplied by publisher]
Update in this version (21st May) - amends to the PDF of complete guidance (added text in the appendix, and a corrected link to evidence review). Corrected link to evidence review also added to the PPE page.
Update in 20th May version - added Appendix 2: Covid-19: infection prevention and control guidance Appendix 2 Update in 19th May version - Added new PDF version of complete guidance; updated'Introduction and organisational preparedness','Transmission characteristics and principles of infection prevention and control','COVID-19 personal protective equipment (PPE)','Explanation of the updates to infection prevention and control guidance'' Reducing the risk of transmission of COVID-19 in the hospital setting'.