An unusual presentation of perforated appendicitis in epigastric region

INTRODUCTION

Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation.

PRESENTATION OF CASE

A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver.

DISCUSSION

While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality.

CONCLUSION

Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia.     

Analysis of YKL‐40 Acute‐Phase Protein and Interleukin‐6 Levels in Periodontal Disease

Background: YKL‐40, a new acute‐phase protein, is shown to be elevated in inflammatory diseases, such as rheumatoid arthritis, type 2 diabetes mellitus, and coronary artery diseases. However, there is no data indicating a relationship between YKL‐40 and periodontal disease. Interleukin‐6 (IL‐6) is the major regulator of acute‐phase protein synthesis and one of the most studied inflammatory markers in periodontal disease. The purpose of the present study is to evaluate YKL‐40 and IL‐6 levels in gingival crevicular fluid (GCF) and serum of patients with periodontal disease and healthy individuals. Methods: Periodontally healthy individuals (n = 15), patients with gingivitis (n = 15), and patients with severe chronic periodontitis (CP) (n = 15) without any systemic disease were included in the study. Clinical measurements were recorded; GCF and blood samples were obtained from each participant. GCF and serum YKL‐40 and IL‐6 levels were analyzed by enzyme‐linked immunosorbent assay. Statistical analysis was performed by parametric and non‐parametric tests. Results: Total amounts of YKL‐40 and IL‐6 in GCF as well as serum YKL‐40 and IL‐6 levels were significantly higher in patients with gingivitis and CP compared with healthy controls (P <0.01). YKL‐40 levels in GCF and serum as well as serum IL‐6 levels were significantly higher in patients with CP compared with patients with gingivitis (P <0.01). Conclusions: YKL‐40 levels in GCF as well as serum YKL‐40 and IL‐6 levels increased from gingivitis to periodontitis. Within the limits of the present study, the YKL‐40 molecule might be a potential novel inflammatory marker of periodontal disease.     

One-step synthesis,characterization and properties of novel hybrid electromagnetic nanomaterials based on polydiphenylamine and Co–Fe particles in the absence and presence of single-walled carbon nanotubes

A one-step preparation method for hybrid electromagnetic nanomaterials based on polydiphenylamine (PDPA) and bimetallic Co–Fe particles in the absence and presence of single-walled carbon nanotubes (SWCNT) was proposed. During IR heating of PDPA in the presence of Co(ii) and Fe(iii) salts in an inert atmosphere at T = 450–600 °C, the polycondensation of diphenylamine (DPA) oligomers and dehydrogenation of phenyleneamine units of the polymer with the formation of C N bonds and reduction of metals by evolved hydrogen with the formation of bimetallic Co–Fe particles dispersed in a polymer matrix occur simultaneously. When carbon nanotubes are introduced into the reaction system, a nanocomposite material is formed, in which bimetallic Co–Fe particles immobilized on SWCNT are distributed in the matrix of the polymer. According to XRD data, reflection peaks of bimetallic Co–Fe particles at diffraction scattering angles 2θ = 69.04° and 106.5° correspond to a solid solution based on the fcc-Co crystal lattice. According to SEM and TEM data, a mixture of particles with sizes of 8–30 nm and 400–800 nm (Co–Fe/PDPA) and 23–50 nm and 400–1100 nm (Co–Fe/SWCNT/PDPA) is formed in the nanocomposites. The obtained multifunctional Co–Fe/PDPA and Co–Fe/SWCNT/PDPA nanomaterials demonstrate good thermal, electrical and magnetic properties. The saturation magnetization of the nanomaterials is M_S = 14.99–31.32 emu g⁻¹ (Co–Fe/PDPA) and M_S = 29.48–48.84 emu g⁻¹ (Co–Fe/SWCNT/PDPA). The electrical conductivity of the nanomaterials reaches 3.5 × 10⁻³ S cm⁻¹ (Co–Fe/PDPA) and 1.3 S cm⁻¹ (Co–Fe/SWCNT/PDPA). In an inert medium, at 1000 °C the residue is 71–77%.

In a self-organizing system within one stage under IR heating conditions, hybrid nanomaterials are formed with a structure that contains bimetallic Co–Fe particles, free or immobilized on the SWCNT surface, dispersed in the polymer PDPA matrix.     

Polygenic analysis suggests the involvement of calcium signaling in executive function in schizophrenia patients

European Archives of Psychiatry and Clinical Neuroscience - Cognitive deficits are increasingly recognized as a core dimension rather than a consequence of schizophrenia (SCZ). The previous...     

Contemporary treatment approaches for metastatic colorectal cancer driven by BRAF V600 mutations

The treatment of metastatic colorectal cancer (mCRC) harboring BRAF V600 mutations is challenging. These tumors are often refractory to standard treatment. Therefore, the patients may exhibit rapid clinical deterioration, depriving them of the chance to receive salvage therapy. In newly diagnosed patients with good performance status, the administration of an intensive chemotherapy regimen like FOLFOXIRI (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) along with the antiangiogenic agent bevacizumab can modify this aggressive behavior of the disease and improve patient clinical outcomes. The recently published results of the BEACON (Binimetinib, Encorafenib, and Cetuximab Combined to Treat BRAF-Mutant Colorectal Cancer) study demonstrated that a combination therapy consisting of BRAF, epidermal growth factor receptor, and mitogen-activated protein kinase kinase inhibitors could be a useful second-or third-line alternative. This review summarizes the current treatment strategies for BRAF-mutant mCRC.