Appendicitis in acute leukemia.

The cases of five children with acute leukemia complicated by appendicitis were reviewed. All but one child had typical signs and symptoms of acute appendicitis, though four children were receiving prednisone. All five children underwent appendectomy, and all survived the immediate postoperative period. One child had a spontaneous remission following appendectomy. Two of three children in relapse suffered serious postoperative complications. Our experience supports the surgical management of appendicitis in acute leukemia.     

Appendicitis in external herniae.

Seven patients are reported with acute appendicitis occurring in an external hernial sac. The average age was 69 years. In 4 cases the site was a right femoral hernia and in 3 a right indirect inguinal hernia. In no case was the correct diagnosis made before operation. Recovery was uneventful apart from wound infection in 3 cases.     

Appendicitis in acquired immunodeficiency syndrome.

Reports in the surgical literature are few regarding common intra-abdominal disease processes, such as gallstone disease or appendicitis, in patients with AIDS and instead have focused on AIDS-related intra-abdominal diseases that infrequently require surgical intervention unless complicated by bleeding, obstruction, or perforation. A literature review for appendicitis in AIDS patients revealed only 30 well-documented cases drawn from 13 studies, with a 40% perforation rate and frequent delays and errors in diagnosis. A 7-year experience with 28 patients with appendicitis and AIDS from 4 urban San Francisco hospitals is reviewed. There were no perioperative deaths and an 18% postoperative complication rate. Five patients (18%) were found to have normal appendices with other intra-abdominal pathology, and an AIDS-related etiology for appendicitis was discovered in 7 of 23 patients with appendicitis (30%). With the exception of diffuse versus localized abdominal pain, no preoperative symptom or sign was useful in differentiating AIDS-related and non-AIDS-related disease. Aggressive use of ultrasound and abdominal computed tomographic scanning, along with early surgical intervention, is recommended.     

Appendicitis in patients with previous spinal cord injury

BACKGROUND: Acute abdominal emergencies are particularly dangerous in patients with impaired sensation. METHODS: Thirty patients with spinal cord injury who later developed appendicitis were identified in Department of Veterans Affairs computer files over a 5-year period; 26 were evaluable. RESULTS: The mean age was 55 years (range 27 to 79); all were males. Abdominal distention or discomfort was present in 16 of 26 (62%), while 2 of 26 (8%) presented in shock. A palpable right lower quadrant mass was present in 6 of 26 (23%). The mean initial white blood cell count was 18,000/mm3. Only 9 of 26 (35%) had the diagnosis of appendicitis made on admission. In 12 of 26, computed tomography was done; all correctly diagnosed appendicitis. The mean delay in diagnosis after hospitalization was 2 days (range 0 to 5). Perforated appendicitis was found at surgery in 24 of 26 (92%). Twenty-three of 26 (88%) underwent appendectomy; 3 of 26 (12%) underwent right colectomy. The 30-day mortality rate was 4%. Six of 26 (23%) developed a postoperative complication. The mean length of stay was 16 days. CONCLUSIONS: Acute appendicitis in spinal-cord-injured patients frequently presents late and complications are common. Computed tomography appears to be an excellent diagnostic modality. Some of the adverse outcomes which are related to preexisting spinal cord injury may be preventable with early intervention.     

32. Die chronische Appendicitis

Zusammenfassung Aus klinischer Sicht gibt es als Erstbefund die chronische Appendicitis nicht. Bei Zweidrittel der Patienten, die wegen einer sog. chronischen Appendicitis operiert wurden, fanden sich andere Ursachen für die rechtsseitigen Unterbauchbeschwerden. Am Wurmfortsatz wurde nicht das zu den klinischen Beschwerden passende entsprechende pathologische Substrat gefunden. Bei einem Teil der Patienten bestehen nach erfolgter Appendektomie die Beschwerden weiter. Dies mahnt zu einer strengen Operations-Indikation.     

Appendicitis near its centenary.

In an analysis of the first 72 cases treated after the formulation of the appendicitis syndrome in 1886 compared with the experience from 1929-1959 and with 307 randomly selected recent cases, the major therapeutic trend has been an emphasis on appendectomy before perforation and abscess formation occur. The rate of infection nonetheless remains approximately 17%. Although the overall mortality rate has declined from 26% overall (40% for surgery) to 0.8%, the current rate of perforation is 28%, with a diagnostic accuracy of 82%. Among 13,848 patients from several reports the perforation rate increases linearly with diagnostic accuracy; therefore, a balance must be sought. Delay awaiting a diagnosis is a major determinant of perforation, but diagnostic aids are of limited help. Clinical acuity and prudent decisiveness are the keys to proper action.     

117. Appendicitis im Kindesalter

Zusammenfassung Die kindliche Appendicitis ist durch besondere diagnostische Schwierigkeiten gekennzeichnet, die um so größer sind, je jünger das Kind ist. Leukocytenzählung, Untersuchung des Harnsedimentes und oft auch die Registrierung der Körpertemperatur lassen bei der Diagnosefindung im Stich.Die Zahl der Appendicitisfälle im Kindesalter, die mit einer Perforation einhergehen, ist seit Jahren in allen Ländern fast gleich hoch und beträgt etwa 30%, die Mortalität liegt übereinstimmend unter 1%.Verfasser drainiert bei einer diffusen Peritonitis nach perforierter Appendicitis nicht und strebt beim perityphlitischen Absceß die primäre Appendektomie ohne Drainage an. Die Komplikationsraten sind bei diesem Vorgehen geringer.

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Appendicitis in childhood

Summary The diagnosis of appendicitis in childhood is particularly difficult, and increases in difficulty with declining age of the patient. The leukocyte count, examination of urinary sediment, and often even the body temperature are no help at all in making the diagnosis.The proportion of cases of appendicitis in childhood in which perforation occurs has been approximately the same, 30%, in all countries for some years, and the mortality is uniformly less than 1%.The author does not institute drainage in cases of diffuse peritonitis following a perforated appendix, and aims at primary appendectomy without drainage in cases with a perityphlic abscess, as the incidence of complications is lower with this method.

     

Appendicitis. Improvements in diagnosis and treatment

The results of therapy in cases of suspected acute appendicitis were reviewed in 844 consecutive cases of appendicitis occurring over a 3-year period. A diagnostic accuracy of 87.4 per cent was found as well as a perforation rate of 18.4 per cent. Complication rates varied with the clinical state of the appendix: 16 per cent in perforated, 5.6 per cent in nonperforated, and 11.3 per cent in normal appendices. Excellent results were routinely obtainable employing early operative intervention, perioperative antibiotics, and a systematic surgical approach.     

Plasma levels of mature form of adrenomedullin in patients with haemodialysis.

BACKGROUND: Adrenomedullin (AM) is a potent vasodilator and natriuretic peptide with hypotensive effects. Immunoreactive AM in human plasma consists of the biologically active mature form, AM (1-52)-CONH2 (mAM) and the intermediate form, AM-gly-COOH (iAM). However, the different effects of mAM and iAM in patients on haemodialysis (HD) have remained unclear. METHODS: Thirty-nine patients on HD and 10 controls were included in this study. We determined plasma levels of mAM and iAM using an immunoradiometric assay that recognizes total AM (tAM) and another that is specific for only mAM. RESULTS: The plasma concentrations of mAM and iAM in patients before HD were significantly higher than those in the controls (n=10) (4.76+/-0.28 vs 1.28+/-0.22 fmol/ml, P<0.001, 25.99+/-1.47 vs 8.52+/- 0.91 fmol/ml, P<0.001 respectively). The plasma levels of mAM and iAM before HD significantly and negatively correlated with systolic blood pressure (SBP) (r=-0.46, P<0.01, and r=-0.32, P<0.05 respectively) and diastolic blood pressure (DBP) (r=-0.32, P<0.05, and r=-0.35, P<0.05 respectively). After HD, plasma mAM and iAM levels as well as SBP and DBP were significantly lower than before HD. Plasma levels of mAM and iAM correlated significantly (r=0.73, P<0.001). CONCLUSIONS: These data suggest that mAM and/or iAM are involved in blood pressure regulation in patients undergoing HD, and further work is needed to understand the precise role of adrenomedullin in this regulation.