Acute perforated appendicitis with leukopenic presentation

Most patients with appendicitis had elevated white blood cell count. It is rarely seen with leukopenic presentation in acute appendicitis. Physicians in the emergency department easily miss these cases that had normal white blood cell count and leukopenic presentation. We presented a case of a 38-year-old man who had right lower quadrant abdominal pain with fever. White blood cell count was only 1800/microL. Computed tomography showed thickening with fluid contained in the lumen of distended appendix, and emergent appendectomy was done. Accurate diagnosis of acute appendicitis is still based on the clinical history and physical examination adjuvant with imaging studies.     

腹腔镜下阑尾切除术治疗儿童阑尾炎的手术方法及策略

目的探讨腹腔镜阑尾切除术治疗儿童阑尾炎的手术方法及治疗经验。方法对35例儿童阑尾炎行腹腔镜下阑尾切除术,回顾性分析其临床特点和手术情况。结果 34例患儿顺利完成手术,1例患儿因盲肠后位阑尾、一般情况较差,中转开腹;术中无严重并发症发生;手术时间（38.38±4.78）min,住院天数（4.29±0.84）d,术中出血量（7.12±2.53）ml。结论腹腔镜阑尾切除术治疗儿童阑尾炎安全可行,且手术创伤更小,切口更为隐蔽,患儿恢复时间更短。     

早期作业治疗对全面性发育迟缓患儿认知发育的影响

目的:探讨早期作业疗法对全面性发育迟缓患儿智力发育的影响。方法:将62例全面性发育迟缓患儿分为观察组38例和对照组24例,对照组患儿接受运动训练、慢性小脑电刺激、水疗等康复训练治疗,观察组在此基础上进行早期作业治疗。2组治疗前和治疗12周后分别进行Gesell智力测试评估检查(GDS)和Peabody运动发育量表(PDMS)测试。结果:治疗12周后,2组GDS及PDMS各项评分均较治疗前明显提高(P0.05),且观察组更高于对照组(P0.05)。在不同年龄段,治疗前后观察组患儿的GDS各项评分差值有统计学差异(P0.05),1岁以内的患儿治疗前后发育商差值最大。结论:早期作业训练治疗可有效的提高全面性发育迟缓患儿的智力各能区的发育水平,越早干预效果越好,值得临床推广。     

老年人急性阑尾炎穿孔的原因及诊治

目的：探讨老年人急性阑尾炎穿孔率较高的原因是诊治经验。方法：回顾性总结分析经手术治疗的118例70岁以上老年人急性阑尾炎穿孔的临床表现及诊治过程。结果：首诊时明确诊断56例，疑及急性阑尾炎28例，手术前至少误诊其他疾病一次者34例，治愈117例，死亡1例，术后出现并发症38例，结论：老年人阑尾的病理特点，就诊不及时，诊断延误，手术延误是造成老年急性阑尾炎穿孔的主要原因，早期就诊，早期诊断，早期手术，正确进行围手术处理，是提高老年人急性阑尾炎治疗效果的关键。     

人性化护理干预对小儿阑尾炎手术预后的影响

目的 分析在小儿阑尾炎手术护理中应用人性化护理干预的价值。方法 选取 2019 年 5 月至 2021 年 5 月期间本院收治的 阑尾炎患儿 90 例作为研究对象。随机分为对照组和研究组,每组各 45 例。对照组行常规护理干预,研究组行人性化护理干预。 对比两组的不良情绪、护理依从性、疼痛情况和并发症发生率。结果 护理前,两组的 SAS、SDS 评分以及 VAS 评分均无显著 差异（P>0.05）。护理后,两组患儿的 SAS、SDS 评分以及 VAS 均显著降低（P<0.05）;并且研究组的上述评分均显著低于对 照组（P<0.05）。研究组的护理依从性显著高于对照组（P<0.05）;研究组的并发症发生率显著低于对照组（P<0.05）。结论 在 小儿阑尾炎手术护理中,人性化护理干预能改善患儿的不良情绪和疼痛情况,提升护理依从性,降低并发症发生率。     

腹腔镜治疗小儿阑尾炎穿孔的临床效果分析

目的探讨小儿阑尾炎穿孔采用腹腔镜手术治疗的临床效果及安全性。方法回顾2011年9月至2013年12月收治的137例阑尾炎穿孔患儿的临床资料。根据手术方式分为腹腔镜组(腹腔镜手术)73例和传统组(传统开腹手术)64例。比较两组患儿手术指标,入院时、术后24 h、术后48 h的血清降钙素原(PCT)、C反应蛋白(CRP)水平和手术并发症的发生情况。结果两组患儿的手术均全部成功,腹腔镜组无患儿中转开腹;腹腔镜组的手术时间、术中出血量、术后排气时间、下床活动时间、住院时间均显著的低于传统组患儿(P0.05)。腹腔镜组和传统组在入院时的PCT、CRP检查值比较差异均无统计学意义(P0.05);两组患儿术后24 h时PCT、CRP检测值较术前均有不同程度的升高(P0.05)、术后第48 h均显著的回落(P0.05);术后24 h、48 h腹腔镜组患儿的PCT、CRP检查值低于传统组(P0.05)。腹腔镜组患儿的并发症发生率和术后镇痛药使用率均显著低于传统组,差异具有统计学意义(P0.05)。结论采用腹腔镜手术治疗小儿阑尾炎穿孔较传统开腹手术具有创伤小、恢复快、术后并发症发生率低的优点。     

Sonography of acute appendicitis in childhood: perforation versus nonperforation.

We evaluated the sonographic findings in 133 consecutive children referred for suspected appendicitis. Fifty-eight of these patients (44%) ultimately underwent surgery, with 54 of these proved to have acute appendicitis. Thirty-one (58%) of the 54 had nonperforated appendicitis, and 23 (43%) had evidence of perforation. Previously described sonographic findings that have been employed in the diagnosis of appendicitis were evaluated, with the presence or absence of these findings being compared in patients with non-perforated and perforated appendicitis. In those patients who did not undergo surgery, the following findings were documented and compared to the findings in patients with proved appendicitis: (1) an identifiable appendix and its sonographic characteristics, (2) fluid localized to the right peritoneal reflection or periappendiceal region, or both, (3) free pelvic fluid, and (4) right lower quadrant adenopathy. Our results suggest that high-resolution, real-time sonography, using graded compression, is very sensitive in the identification of acute nonperforated appendicitis. Perforated appendicitis, however, can be a more difficult diagnosis because the appendix frequently decompresses with perforation and yet may not "wall off" or form a well-defined abscess. As a result, the appendix can be very difficult to identify.     

Imaging of acute appendicitis in children

Acute appendicitis is the most common acute abdominal condition that results in surgical intervention in childhood. The clinical diagnosis of acute appendicitis in children can be challenging. Approximately one-third of children with the condition have atypical clinical findings and are initially managed nonoperatively. Complications associated with delayed diagnosis of this condition include perforation, abscess formation, peritonitis, sepsis, bowel obstruction, infertility, and death. The use of cross sectional imaging has proven useful for the evaluation of suspected acute appendicitis in children. Both graded compression sonography and CT have been widely utilized in the imaging assessment of the condition. The principal advantages of sonography are its lower cost, lack of ionizing radiation, and ability to assess ovarian pathology that can often mimic acute appendicitis in female patients. The principal advantages of CT include less operator dependency than sonography as reflected by a higher diagnostic accuracy, and enhanced delineation of disease extent in perforated appendicitis.     

超声诊断儿童阑尾腔内鱼刺异物致阑尾炎伴穿孔一例

<正>患儿男性,4岁,因腹痛6d余,发热2d,加重1d于成都市妇女儿童中心医院夜间急诊就诊。患儿1周前食鱼,当时无不适。6d前出现无明显诱因间断性腹痛,可忍受,无呕吐,无腹泻,于当地诊所就诊,予以推拿、口服大山楂丸等处理后腹痛仍反复。2d前患儿发热,体温最高为38.5,家长予物理降温处理,体温可降至正常。1d前腹痛加重,到本院急诊就诊。体格检查:腹壁紧张,右下腹固定压     

小儿阑尾炎的腹腔镜阑尾切除术115例临床体会

目的 探讨小儿阑尾炎的腹腔镜阑尾切除术的应用及技巧.方法 分析 2003年2月～2008年9月115例小儿阑尾炎患者采用腹腔镜阑尾切除术治疗的临床资料.结果 115例均成功完成手术.满意恢复出院.结论 腹腔镜阑尾切除术是目前小儿阑尾炎治疗的一种较好术式选择,在应用熟练及掌握技巧基础上,提倡用于小儿阑尾炎.     

Different urinalysis appearances in children with simple and perforated appendicitis

PurposeThis study aimed to determine whether routine urinalysis may serve as a tool in discriminating between acute appendicitis and perforated appendicitis in children.Basic proceduresWe prospectively collected 357 patients with clinically suspected acute appendicitis. Urinalysis was performed in patients with clinically suspected acute appendicitis before surgical intervention. Routine urinalysis is composed of 2 examinations: chemical tests for abnormal chemical constituents and microscopic tests for abnormal insoluble constituents. Receiver operating characteristic curves for urine white blood cell (WBC) counts and urine red blood cell (RBC) counts in distinguishing between patients with simple appendicitis and patients with perforated appendicitis were also analyzed.Main findingsUrine ketone bodies, leukocyte esterase, specific gravity, pH, WBC, and RBC counts were all significant parameters among patients with normal appendices, simple appendicitis, and perforated appendicitis (all P < .05). Based on multivariate logistic regression analysis, positive urine ketone bodies and nitrate were significant parameters in predicting perforated appendicitis (P = .002 and P = .008, respectively). According to the results of receiver operating characteristic curves, the appropriate cutoff values were 2.0/high-power field for urine RBC counts and 4.0/high-power field for urine WBC counts in predicting perforated appendicitis in children.Principal conclusionsRoutine urinalysis may serve to aid in discriminating between simple and perforated appendicitis. Clinically, we believe that these urine parameters may aid primary emergency physicians with decision making in patients with clinically suspected appendicitis.     

International comparison of factors associated with delay in presentation for AMI treatment.

BACKGROUND: Prehospital delay in response to acute myocardial infarction (AMI) symptoms is well documented in the US and Europe, but little is known about it in Asian countries where cardiovascular disease is increasing. AIMS: We conducted an observational study of delay times and factors associated with hospital presentation times in 595 patients with AMI from the US, England, Japan and South Korea. METHODS: Patients were interviewed about responses to symptoms within 72 h of hospital admission and the medical records were reviewed. RESULTS: The proportions of patients with delay times of 1 h or less were: US--23%, Korea--18%, England--15% and Japan--8%. In the US and England when others present at symptom onset called an ambulance patients presented two to three times sooner. Independent predictors of presentation within an hour of symptom onset were attribution of symptoms to the heart and not waiting for symptoms to go away. CONCLUSION: Similar education about the need to seek treatment early in response to AMI symptoms may be applicable in Western and Eastern industrialised populations.