Clinical features of amoebic appendicitis in children: A study of 23 cases

Aim of the Study: To describe the clinical, surgical, and pathological features of children with acute appendicitis and amebiasis.Materials and methods: The medical records of children diagnosed with appendicitis and amebiasis treated at Fundación Hospital la Misericordia were retrospectively reviewed. Patients were classified into two groups according to the location of the amoebas: the amoebic appendicitis (AA) group (when the amoebic infection involved the appendiceal wall), and the appendicitis with incidental amoebiasis (IA) group (when amoebas were only found in the appendiceal lumen). We compared demographics and outcomes.Results: We identified 23 children with appendicitis and amoebiasis. The mean age was 9 (3–15) years, and 52% were male. The main duration of the pain at the time of presentation was 1.8 (1–4) days. Fever and diarrhea were observed in 64% and 43% of the patients, respectively. Four patients had perforated appendicitis, all of them within the AA group. Anti-parasitic therapy was used only in 2 subjects (all other patients were diagnosed after discharge and were asymptomatic on follow up). AA was diagnosed in 11 patients and IA in 12. AA and IA patients shared similar characteristics regarding age, clinical findings, radiologic features, and preoperative laboratory results. Appendiceal necrosis and perforation were only found within the AA group (4 patients).Conclusions: AA is a rare condition in children. It seems to have a greater risk of perforation than cases of appendicitis with IA, which is in agreement with the more severe histological findings in our series. Anti-parasitic treatment is not necessary in cases of AA or IA.     

Pitfalls of anesthesiologic management in paediatric strabismus surgery

Strabismus surgery is one of the most common paediatric operation procedures. As associated with congenital syndrome, congenital heart disease and neuromuscular disorder, the anesthesiologic management has to be planned carefully. Considering high incidences of oculocardiac reflex (OCR) and postoperative nausea and vomiting (PONV) anesthesia can be performed to decrease both. Induction of anesthesia with ketamine or midzolam reduces risk of oculocardiac reflex, whereas propofol or remifentanil lead to higher incidences of OCR. A combination anti-emetic therapy from different drug classes is recommend to patients at high risk for nausea and vomiting like patients undergoing strabismus surgery. A combination therapy of ondansetron and dexamethasone lead to a risk reduction of PONV to at least 10 %. Further, the incidence of OCR and PONV is significantly reduced in children receiving peribulbar block on top of general anaesthesia.     

Central neurocytoma: clinical features of 8 cases

The authors report 8 cases of central neurocytoma with a minimum follow-up of 3 years. Five patients were males and 3 females with average age of 21 years. All patients underwent surgical removal of tumor, and radiotherapy was delivered to 2 of the 3 patients in whom removal had been partial. At an average follow-up of 5 years, all patients are alive and none of them has presented signs of recurrence or progression of the disease. Some typical clinical and histological features of this tumor are pointed out.     

Role of clinical judgment and tissue harmonic imaging ultrasonography in diagnosis of paediatric acute appendicitis

Background

Appendicitis is the most common surgical emergency in children; yet, diagnosis of equivocal presentations continues to challenge clinicians.

Aim

The objective of this study was to investigate the hypothesis that the use of a modified clinical practice and harmonic ultrasonographic grading scores (MCPGS) may improve the accuracy in diagnosing acute appendicitis in the pediatric population.

Patients &; Methods

Main outcome measures

Sensitivity, specificity, and accuracy of the modified scoring system. Five hundred and thirty patients presented with suspected diagnosis of acute appendicitis during the period from December 2000 to December 2009 were enrolled in this study. Children's data that have already been published of those who presented with suspected diagnosis of acute appendicitis- to whom a special clinical practice grading scores (CPGS) incorporating clinical judgment and results of gray scale ultrasonography (US) was applied- were reviewed and compared to the data of 265 pediatric patients with equivocal diagnosis of acute appendicitis (AA), to whom a modified clinical practice grading scores (MCPGS) was applied. Statistical analyses were carried out using Z test for comparing 2 sample proportions and student's t-test to compare the quantitative data in both groups. Sensitivity and specificity for the 2 scoring systems were calculated using Epi-Info software.

Results

The Number of appendectomies declined from 200 (75.5%) in our previous CPGS to 187 (70.6%) in the MCPGS (P > 0.05). Specificity was significantly higher when applying MCPGS (90.7%) in this study compared to 70.47% in our previous work when CPGS was applied (P < 0.01). Furthermore, the positive predictive value (PPV) was significantly higher (95.72%) than in our previous study (82.88%), (P < 0.01). Overall agreement (accuracy) of MCPGS was 96.98%. Kappa = 0.929 (P < 0.001). Negative predictive power was 100%. And the Overall agreement (accuracy) was 96.98%.

Conclusions

MCPGS tends to help in reduce the numbers of avoidable and unnecessary appendectomies in suspected cases of pediatric acute appendicitis that may help in saving hospital resources.     

腹腔镜胆囊切除术中遗漏并存的消化道肿瘤15例临床分析

笔者所在医院自1993年1月至2008年6月共行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)10 320例,其中发现有15例(0.15%)在LC术中遗漏并存的消化道肿瘤,现报告如下.     

Postpartum appendicitis: Report of two cases

The literature of postpartum appendicitis is reviewed and two cases occurring in the early puerperium are presented.The outstanding features of these cases are discussed in relation to the differential diagnosis of some of the common complications of the early postpartum period, namely, pyelitis, early puerperal sepsis and salpingitis.It is suggested that the cathartic given to both patients shortly before their onset of symptoms may have been an etiological factor.The treatment recommended is surgery as soon as the diagnosis is made.     

Bilateral adrenal tumor: causes and clinical features in eighteen cases

Bilateral adrenal neoplasms are very rare. Studies have shown that most are metastatic tumors, and clinical presentation varies with tumor type. We retrospectively reviewed medical records of 18 cases of bilateral adrenal tumor in our hospital between 2002 and 2007. The etiology was pheochromocytoma in six, primary lymphoma in four, nonfunctioning cortical adenoma in four, metastatic tumors in two, primary aldosteronism in one, and Cushing syndrome in one. Patients with lymphoma had largest average tumor size. Our findings suggest that pheochromocytoma, primary lymphoma, and nonfunctioning cortical adenoma are common causes of bilateral adrenal tumor.     

Unexpected, unsuspected and missed injuries in a paediatric trauma unit

In a newly established trauma unit 12 282 patients were seen in 1 year, of whom 1 557 were admitted. Out of the total there was 0.3% of missed, unexpected or unsuspected injuries; this was 2.5% of ward admissions. These injuries are classified and analysed, highlighting the need for constant vigilance. Although the majority were orthopaedic injuries, the abdominal injury cases show that these can be more severe than clinically suspected.     

Takayasu arteritis: clinical features and management: report of 272 cases

BACKGROUND: Takayasu's arteritis is a condition of unknown aetiology with an unpredictable natural history. Most of the literature available has originated from Asia, with a few contributions from Africa where the pattern of the disease may be different. This is a single institution's experience review. METHODS: Data were obtained retrospectively from the angiographic and medical records of patients treated at Groote Schuur Hospital over the period 1952-2002. The criteria for inclusion were those proposed by the Aortitis Syndrome Research Committee of Japan and the American College of Rheumatology. RESULTS: Two hundred and seventy-two patients were identified. The mean age at presentation was 25 years (range 14-66 years) and 75% were female. Only 8% were Caucasian. Hypertension was the most common presentation (77%) and was usually a consequence of renal artery stenosis or aortic coarctation. Cardiac failure was the most common problem. Cerebrovascular symptoms were recorded in 20%. Convincing evidence of tuberculosis was present in 20%. The entire aorta was involved in 70% of cases. Thirty per cent had aortic bifurcation involvement. Occlusions were noted in 93% and aneurysms in 46%. Vascular reconstruction was performed on 115 occasions in 99 patients, with an operative mortality of 4%. Cardiac failure was the usual cause of death. One hundred and six patients (39%) were followed for a minimum of 5 years. No further progression of disease was noted in 70 patients. CONCLUSION: The natural history and prognosis of Takayasu's arteritis still remain poorly defined.     

Survey of common duct stones in clinical and necropsy cases

1.

1. A statistical review is presented of fifty-nine cases of clinical common duct stones and thirty-three cases of common duct stones found at necropsy with and without symptoms.     

Larsen syndrome: clinical features and treatment--a report of two cases

The literature on reported clinical and radiographic findings of Larsen syndrome is reviewed in detail. Two patients with Larsen syndrome who exhibited previously unreported skeletal deformities and such characteristic features as flattened facies, palate defects, and multiple joint dislocations are reported. Persistent difficulties in wound healing are discussed.     

Composition and morphologic and clinical features of common duct stones

No systematic study of the composition of common duct stones has been carried out to date. In this study, we assessed the chemical composition and morphologic characteristics of common duct stones from 115 patients, and compared them with gallbladder stones in 67 patients who had both. Visually and chemically, common duct stones could be divided into two groups: cholesterol stones and pigment stones. Cholesterol common duct stones contained 83 ± 1 percent cholesterol, 2.3 ± 0.4 percent bilirubin, and 5.5 ± 1 percent insoluble pigment residue. Pigment common duct stones contained 7 ± 1 percent cholesterol, 24 ± 2 percent bilirubin, and 38 ± 3 percent pigment residue. There were two subgroups of pigment stones: one with large amounts of bilirubin and one with large amounts of pigment residue. A high proportion (46 percent) of common duct stones were composed of pigment. Patients with pigment common duct stones were more likely to have cholangitis and pancreatitis than were patients with cholesterol stones. It was not possible to distinguish primary from secondary stones on morphologic grounds.In 65 of 67 patients (97 percent), gallbladder stones and common duct stones were of the same chemical type. Morphologically, cholesterol common duct stones were very similar (3.6+ on a scale of 0 to 4+) to their counterparts. Pigment common duct stones and gallbladder stones were less similar (2.4+). Chemically, cholesterol common duct stones were identical to their gallbladder counterparts. Pigment common duct stones regularly contained a greater fraction of bilirubin and less pigment residue than associated gallbladder stones (p < 0.05). Earthy common duct stones were associated with earthy gallbladder stones, and were chemically indistinguishable from other pigment stones.These data suggest that all cholesterol common duct stones, and when the gallbladder is present, most pigment common duct stones, are secondary. The latter stones, however, probably grow after entering the duct, adding pigment with a high proportion of bilirubin relative to pigment residue.