Infection of a malignant appendiceal mucocele masquerading as an appendiceal abscess: Role of preoperative sonography and CT

We report the case of a 71‐year‐old lady with a suspected appendiceal abscess in whom preoperative sonography and CT demonstrated an infected appendiceal mucocele. The lesion was surgically removed and final pathologic examination revealed malignancy. Correct recognition of the mucocele prevented a potentially disastrous percutaneous drainage. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009     

Adult intussusception caused by an appendiceal mucocele and reduced by colonoscopy

Appendiceal intussusception is a very rare disease that is found in only 0.01% of patients who have undergone an appendectomy. Clinical symptoms vary but include acute appendicitis symptoms such as right lower quadrant abdominal pain or repetitive right lower quadrant crampy pain. Some patients are asymptomatic. Operative treatment is necessary to reduce an appendiceal intussusception in adults, but there is a debate about how to perform the reduction. Successful colonoscopic reductions have been recently reported for some cases. We report a case of appendiceal intussusception that was diagnosed, reduced by colonoscopy, and histologically confirmed as a mucinous cystadenoma after the operation.     

Appendiceal Crohn’s disease clinically presenting as acute appendicitis

AIM: To determine the incidence of appendiceal Crohn’s disease (CD) and to summarize the characteristic histologic features of appendiceal CD.METHODS: We reviewed the pathology files of 2179 appendectomy specimens from January 2007 to May 2013. The computer-assisted retrieval search facility was utilized to collect specimens. We selected those cases that were diagnosed as CD or chronic granulomatous inflammation and defined the final diagnosis according to the histologic findings of CD, including transmural lymphocytic inflammation, non-caseating epithelioid granulomas, thickening of the appendiceal wall secondary to hypertrophy of muscularis mucosa, mucosal ulceration with crypt abscesses, mucosal fissures, and fistula formation.RESULTS: We found 12 cases (7 male and 5 female patients, with an average age of 29.8 years) of appendiceal CD. The incidence of appendiceal CD was 0.55%. The chief complaints were right lower quadrant pain, abdominal pain, lower abdominal pain, and diarrhea. The duration of symptom varied from 2 d to 5 mo. The histologic review revealed appendiceal wall thickening in 11 cases (92%), transmural inflammation in all cases (100%), lymphoid aggregates in all cases (100%), epithelioid granulomas in all cases (100%), mucosal ulceration in 11 cases (92%), crypt abscesses in 5 cases (42%), perforation in 2 cases (17%), muscular hypertrophy in 1 case (8%), neural hyperplasia in 5 cases (42%), and perpendicular serosal fibrosis in 8 cases (67%).CONCLUSION: A typical and protracted clinical course, unusual gross features of the appendix and the characteristic histologic features are a clue in the diagnosis of appendiceal CD.     

Endoscopic diagnosis and treatment of an appendiceal mucocele: A case report

BACKGROUNDAppendiceal mucocele is a rare disease that causes obstructive dilatation of the appendix due to the intraluminal accumulation of mucin. We report a case of endoscopic diagnosis and treatment of an appendiceal mucocele.CASE SUMMARYA 47-year-old man presented with a protrusion around the orifice of the appendix discovered by colonoscopy incidentally. He was admitted to our hospital for a routine checkup without any symptoms. Abdominal computed tomography showed a cystic mass approximately 3 cm in diameter with fat stranding. The preoperative diagnosis was non-neoplastic appendiceal mucocele, and endoscopic treatment was performed. The endoscopic findings and pathological results supported our preoperative diagnosis. The endoscopic treatment of appendiceal mucocele was feasible and effective, which was confirmed by repeated endoscopy and post-operative computed tomography after 7 mo. CONCLUSIONEndoscopic therapy provides a new method for the treatment of appendiceal mucocele.     

临界外径的阑尾炎与正常阑尾的超声鉴别诊断

目的 分析临界外径范围内急性阑尾炎与正常阑尾声像图差异,探讨其对超声诊断儿童急性阑尾炎的意义。方法 于2019年1月~2023年5月我院疑诊急性阑尾炎并行超声检查的患儿中连续收集阑尾外径0.6cm~0.7cm的病例,并根据临床最终诊断结果分为确诊阑尾炎、排除阑尾炎组。比较两组病例声像图差异,找出在临界外径范围内有助于鉴别诊断急性阑尾炎与正常阑尾的声像图特征。结果 两组病例“阑尾周围系膜网膜增厚”、“阑尾腔内粪石”及“阑尾周围积液”的声像图差异比较具有统计学意义(p<0.05),其中“阑尾周围系膜网膜增厚”对于临界外径范围内急性阑尾炎与正常阑尾的鉴别诊断具有较高且稳定的诊断效能(AUC=0.906, 95% CI 0.855—0.957),敏感度为100%(95%CI 96.4S%—100%),特异度为81%(95%CI 71.9S%—88.2%)。结论 超声能有效应用于临界外径范围内急性阑尾炎与正常阑尾的鉴别诊断,其中“阑尾周围系膜网膜增厚”的声像图特征具有重要鉴别诊断价值。     

Analysis of biparietal diameter as an accurate indicator of gestational age

To date, there have been 25 studies attempting to correlate biparietal diameter and gestational age; of these, 17 meet specific criteria and thus are included in this evaluation. Although all studies have shown an increase in biparietal diameter with advancing gestational age, between 17 wk and term there is a discrepancy of approximately 3 wk. In this evaluation the charts are compared and the variations analyzed. An ideal table is constructed by combining the mean gestational age, calculated from a statistical analysis, and the variation at each millimeter point, determined by comparison of all the studies. It is hoped that this new 90% composite table, which consists of a range of gestational ages in weeks for each biparietal diameter, will not only provide more realistic indications of fetal age but also will serve as a reminder to sonographers, obstetricians, and patients of the relative accuracy and variations of biparietal diameter measurements.     

Evaluation of whether the ultrasonographic onion skin sign is specific for the diagnosis of an appendiceal mucocele

Purpose

To evaluate whether the onion skin sign on ultrasonography (US) of the lower abdomen is specific for the diagnosis of an appendiceal mucocele.

Methods

Our study included 231 lesions from 229 patients in whom transabdominal US detected lesions in the lower abdomen and who had definitive pathological diagnoses in the small bowel, ileocecal valve, cecum, appendix, mesentery, adnexa uteri or pelvic cavity outside the major organs. Patients with metastatic tumors were excluded. We reviewed the reports and images from transabdominal US and checked for the presence of the onion skin sign. The sensitivity, specificity, and accuracy of the sign for the diagnosis of an appendiceal mucocele were calculated.

Results

Five (2.2 %) of the 231 lesions showed the onion skin sign on US and all were diagnosed with an appendiceal mucocele. The sensitivity, specificity, and accuracy of the sign for the diagnosis of an appendiceal mucocele were 63, 100, and 99 %, respectively.

Conclusions

The onion skin sign in the lower abdomen appears to be specific for the diagnosis of an appendiceal mucocele. In cases where the onion skin sign is obviously present in the lower abdomen on US, an appendiceal mucocele should be considered as the leading diagnosis.     

Single-incision laparoscopic partial cecectomy for appendiceal mucocele in a patient with porphyria photosensitivity

Erythropoietic protoporphyria (EPP) is a rare hereditary subtype of cutaneous porphyria characterized by photosensitivity. Increased exposure to light irradiation may precipitate acute liver failure, and surgical light-induced intestinal burns and perforations are known to occur. We report a case of EPP in a patient who underwent laparoscopic partial cecectomy for appendiceal mucocele. A 55-year-old man with EPP was presented for treatment of appendiceal mucocele. A light test using two types of laparoscopes (Companies O and S) was performed preoperatively. Light from the laparoscope manufactured by Company O caused photosensitivity; this effect was not observed with light from the laparoscope manufactured by Company S. Therefore, we performed laparoscopic partial cecectomy through a single umbilical incision using the laparoscope from Company S. Except for the incision site, the patient's skin was completely covered using surgical drapes. No intra- or postoperative complications were observed. Histopathological examination of the resected specimen revealed a low-grade appendiceal mucinous neoplasm.     

阑尾粪石征在急性阑尾炎CT诊断中的价值

目的探讨阑尾粪石征在多层螺旋CT(MSCT)诊断急性阑尾炎中的价值。方法回顾性分析60例经手术和病理证实的急性阑尾炎患者的CT表现。结果 60例急性阑尾炎患者中主要的CT征象有:阑尾粪石征36例(60.0%),阑尾肿胀伴阑尾周围炎(无阑尾粪石征)15例(25.0%),回盲部周围炎6例(10.0%),阑尾炎伴盲肠周围脓肿形成3例(5.0%),提示穿孔1例。所有患者均行急诊阑尾切除术,术后病理诊断为急性阑尾炎。结论阑尾粪石征在MSCT对急性阑尾炎的影像诊断中有着十分重要的意义。     

C-reactive protein as an indicator of sepsis

Objective: To determine the use of plasma C-reactive protein (CRP) concentrations, body temperature (BT) and white blood cell count (WBC) in the detection of sepsis in critically ill patients. Design: All patients admitted for more than 24 h in the intensive care unit (ICU) were prospectively included. Patients were followed up to ICU discharge and each patient-day was classified in one of four categories according to the infectious status: 1) Negative, patient-day without systemic inflammatory response syndrome (SIRS); 2) Definite, patient-day with SIRS and a positive culture; 3) SIRS, patient-day with SIRS and negative or no cultures. The last group was subdivided according to the following criteria: a) new, or persistence of, pulmonary infiltrates, b) the presence of pus in a place known to be sterile. Patient-days without these criteria were classified as SIRS with improbable sepsis (Unlikely), and with one criteria or more as SIRS with probable sepsis (Probable). Setting: Medical/surgical intensive care unit. Patients: Twenty-three patients were followed. Measurements and results: A total of 306 patient-days were analysed: 20 Negative, 15 Definite, 63 Unlikely and 208 Probable. The median (range) CRP values for Negative, Unlikely, Probable and Definite groups were as follows: 24.5 (7–86), 34 (5–107), 143 (39–544), and 148 (52–320) mg/l. The plasma CRP levels were significantly related to the infectious status (Negative, Unlikely, Probable or Definite) of the patient-day classification (p < 0.05). Concentrations of CRP in the Negative and Unlikely groups were significantly lower than in the Probable and Definite ones (p < 0.05). A plasma CRP of 50 mg/l or more was highly suggestive of sepsis (sensitivity 98.5 %, specificity 75 %). Conclusions: Daily measurement of CRP is useful in the detection of sepsis and it is more sensitive than the currently used markers, such as BT and WBC. Received: 22 December 1997 Accepted: 8 July 1998     

用于组织工程医疗产品海藻酸钠主要性能指标的测定

背景：海藻酸钠的平均分子质量及其分子质量分布,以及化学组成和序列结构的不同将会导致海藻酸钠最终用途的不同。目的：测定用于组织工程医疗产品海藻酸钠的平均分子质量及分子质量分布,以及化学组成和序列结构。方法：采用高效液相凝胶渗透色谱联合多角度激光散射测定仪法测定海藻酸钠的平均分子质量及分子质量分布,并通过高分辨1H-核磁共振光谱法测定其化学组成和序列结构。结果与结论：组织工程医疗产品海藻酸钠样品的数均分子质量为7.360×104,重均分子质量为1.031×105,分子质量分布为1.401,G单体含量为0.405,M单体含量为0.595,M/G为1.47,连续M单体的平均数量为2.78,连续G单体的平均数量为1.89,连续G单体数量大于1的数值为2.72。     

Bone marrow dose as an indicator for the effective dose equivalent

The effective dose equivalent HE is used for comparing methods in radiation protection. There are problems in its definition, so its determination from the average organ doses that are easily calculated with a computer program seems desirable. Under the aspect of accuracy the average bone marrow dose of the trunk given by HE = k (Ho X WKM) for k = 3 with an error of +/- 10% seems to be adequate for diagnostic radiology.     

Investigating early readmission as an indicator for quality of care studies

Readmission to a hospital shortly following a previous discharge may be viewed as an adverse outcome of care. Consequently, early readmission represents a potentially useful indicator for monitoring quality. While a number of recent research studies have focused on this issue, several important questions concerning appropriate use of early readmission as a quality of care indicator remain to be addressed. In this article, using data on all discharges for 1 year from 18 hospitals, several of these questions are investigated. Specifically, whether the significant predictors of readmission risk are different for different types of cases (defined using DRGs), whether case severity is an important predictor of readmission risk, whether readmission risks differ systematically with hospital size and other characteristics, whether readmission risk is a function of patients' lengths-of-stay, and whether readmission risk is influenced by whether or not patients are discharged home or into organized care environments are explored. For this study, the focus is on patients who experienced unplanned readmissions to acute care hospitals within 31 days of a prior discharge. The Patient Management Category classification system and ICD-9-CM diagnosis and procedure codes are used to identify, and then exclude from consideration, those readmissions that occurred as part of an appropriately planned sequence of care. In each of 22 sets of related DRGs, analysis of unplanned readmissions indicates that severity/complexity is an important risk factor for early readmission and that clinical and other risk factors differ for different DRG groups. Thus, in future studies of early readmissions, researchers will need to control for both the type (e.g., DRG) and severity/complexity of individual cases. In examining relationships between early readmission and hospital characteristics, no consistent patterns suggestive of quality of care problems were detected.     

Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies

Postoperative hemorrhage in patients undergoing open-heart surgery is a major cause of morbidity and mortality. Monitoring of coagulation in these patients has routinely involved the activated clotting time. Thromboelastography is currently used as a monitor of coagulation during liver transplantation. The thromboelastogram, by providing information on the interaction of all the coagulation precursors, gives more clinically useful information on coagulation than that available from the coagulation profile or the activated clotting time alone. This study was done to assess the usefulness of thromboelastography in open-heart surgery. Thirty-eight patients (29 undergoing coronary artery bypass grafting and 9 undergoing valve replacement) were studied with activated clotting time, thromboelastography, and coagulation profiles during three periods: before bypass, during bypass, and after protamine administration. Thromboelastography was a significantly better predictor (87% accuracy) of postoperative hemorrhage and need for reoperation than was the activated clotting time (30%) or coagulation profile (51%). Thromboelastography is easy to use and provides diagnostic data within 30 minutes of blood sampling.