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991.
Mohammad Mohammadi Huan Song Yang Cao Ingrid Glimelius Anders Ekbom Weimin Ye 《Scandinavian journal of gastroenterology》2016,51(5):583-589
Objective Appendectomy remains one of the most common surgical procedures, but possible long-term consequences for health and disease are incompletely investigated. The appendix forms part of the secondary lymphoid system and appendectomy has been associated with increased risks of hematolymphoproliferative malignancies in some studies. Materials and methods We examined the risk of lymphoid neoplasms in a large cohort of 337,437 appendectomised patients <60 years of age in Sweden 1975–2009. We estimated relative risks of non-Hodgkin lymphoma (NHL) and major subtypes, Hodgkin lymphoma (HL), chronic lymphocytic leukaemia (CLL), myeloma, and acute lymphoblastic leukaemia (ALL) versus the general population using standardised incidence ratios (SIRs) with 95% confidence intervals (CIs). Results There was no increased risk of NHL (SIR?=?0.97, 95%CI 0.88–1.06), major NHL subtypes, CLL (SIR?=?0.87, 95%CI 0.70–1.06), myeloma (SIR?=?1.14, 95%CI 0.96–1.33) or ALL (SIR?=?1.10, 95%CI 0.80–1.47) following appendectomy. An increased risk of HL was observed among patients diagnosed with appendicitis (SIR?=?1.29, 95%CI 1.07–1.54, p=0.007), especially individuals aged?<20 years at surgery (SIR?=?1.43, 95%CI 1.11–1.82), and for the nodular sclerosis subtype of HL (SIR?=?1.55, 95%CI 1.01–2.27). A marginally increased risk of myeloma was noted among men, but the association was limited to the first few years of follow-up. Conclusion Appendectomy is not associated with any notable increase in risk of lymphoid neoplasms. A small increased risk of HL following appendicitis (rather than appendectomy per se) could reflect a true association, or shared susceptibility to infection/inflammation among individuals prone to develop HL. The association observed for myeloma may be explained by chance or surveillance bias. 相似文献
992.
Mihajlo Gjeorgjievski Mitual B Amin Mitchell S Cappell 《World journal of gastroenterology : WJG》2015,21(44):12713-12721
This work aims to facilitate diagnosing Aspergillus appendicitis, which can be missed clinically due to its rarity, by proposing a clinical pentad for Aspergillus appendicitis based on literature review and one new case. The currently reported case of pathologically-proven Aspergillus appendicitis was identified by computerized search of pathology database at William Beaumont Hospital, 1999-2014. Prior cases were identified by computerized literature search. Among 10980 pathology reports of pathologically-proven appendicitis, one case of Aspergillus appendicitis was identified (rate = 0.01%). A young boy with profound neutropenia, recent chemotherapy, and acute myelogenous leukemia presented with right lower quadrant pain, pyrexia, and generalized malaise. Abdominal computed tomography scan showed a thickened appendiceal wall and periappendiceal inflammation, suggesting appendicitis. Emergent laparotomy showed an inflamed, thickened appendix, which was resected. The patient did poorly postoperatively with low-grade-fevers while receiving antibacterial therapy, but rapidly improved after initiating amphotericin therapy. Microscopic examination of a silver stain of the appendectomy specimen revealed fungi with characteristic Aspergillus morphology, findings confirmed by immunohistochemistry. Primary Aspergillus appendicitis is exceptionally rare, with only 3 previously reported cases. All three cases presented with (1)-neutropenia, (2)-recent chemotherapy, (3)-acute leukemia, and (4)-suspected appendicitis; (5)-the two prior cases initially treated with antibacterial therapy, fared poorly before instituting anti-Aspergillus therapy. The current patient satisfied all these five criteria. Based on these four cases, a clinical pentad is proposed for Aspergillus appendicitis: clinically-suspected appendicitis, neutropenia, recent chemotherapy, acute leukemia, and poor clinical response if treated solely by antibacterial/anti-candidial therapy. Patients presenting with this proposed pentad may benefit from testing for Aspergillus infection by silver-stains/immunohistochemistry and considering empirical anti-Aspergillus therapy pending a tissue diagnosis. 相似文献
993.
Daisuke Ito Kenji Miki Shimizu Seiichiro Shojiro Hata Kaoru Kobayashi Masanori Teruya Michio Kaminishi 《World journal of gastroenterology : WJG》2015,21(13):3921-3927
AIM: To study the clinical features and computed tomography(CT) findings of appendiceal diverticulitis vs acute appendicitis.METHODS: We retrospectively reviewed the records of 451 patients who had undergone appendectomy inour in stitution from January 2007 to September 2012. Patient demographics, clinical features, pathological findings, and surgical outcomes were analyzed. We also compared preoperative CT images of 25 patients with appendiceal diverticulitis with those of 25 patients with acute appendicitis.RESULTS: Among 451 patients, 44(9.7%) were diagnosed to have appendiceal diverticulitis and 398(86.9%) to have acute appendicitis. Patients with appendiceal diverticulitis were older(59 vs 37 years, P < 0.001) and had a longer duration of the illness(4.0 d vs 1.0 d, P < 0.001). Perforation rates in patients with appendiceal diverticulitis were higher(68% vs 27%, P < 0.001). The appendix could be visualized in only 13 patients(52%) among the appendiceal diverticulitis cases, but in all acute appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix(84% vs 12%, P < 0.001), absence of appendicolith(92% vs 52%, P = 0.005), and formation of abscess(68% vs 16%, P < 0.001). Appendiceal diverticula were identified in 6 patients(24%).CONCLUSION: Among patients who had undergone appendectomy, 9.7% had appendiceal diverticulitis. Patients with appendiceal diverticulitis had different clinical features and CT findings from patients with acute appendicitis. 相似文献
994.
急性阑尾炎是外科最常见的急腹症,腹腔镜阑尾切除术已成为阑尾切除的首选方法。阑尾系膜与残端的处理是腹腔镜阑尾切除术中的关键环节。对于穿孔性阑尾炎,腹腔脓液的处理及引流问题仍存在争论。随着微创观念提高及手术器械的进步,单孔腹腔镜阑尾切除术临床应用将更加广泛。 相似文献
995.
Dhruba Kadel Sabin Chaulagain Bikash Raj Thapa Angela Basnet Shashinda Bhuju 《Clinical Case Reports》2021,9(9)
Hypertriglyceridemia led acute pancreatitis secreted exudative fluid tacked to the right iliac fossa may cause irritation of retroperitoneum leading to acute periappendicular inflammation and acute appendicitis. 相似文献
996.
997.
Isolated granulomatous inflammation of the appendix is extremely rare, and its etiology is still unknown. We describe a 12-year-old boy with isolated granulomatous appendicitis where the etiology could not be clarified despite infectious criteria such as high fever and gastroenteritis. Children with epithelioid granulomatous appendicitis have a good prognosis following appendectomy. 相似文献
998.
Lee SL Islam S Cassidy LD Abdullah F Arca MJ; American Pediatric Surgical Association Outcomes Clinical Trials Committee 《Journal of pediatric surgery》2010,45(11):2181-2185
Objective
The aim of the study was to review evidence-based data regarding the use of antibiotics for the treatment of appendicitis in children.Data Source
Data were obtained from PubMed, MEDLINE, and citation review.Study Selection
We conducted a literature search using “appendicitis” combined with “antibiotics” with children as the target patient population. Studies were selected based on relevance for the following questions:- (1)
- What perioperative antibiotics should be used for pediatric patients with nonperforated appendicitis?
- (2)
- For patients with perforated appendicitis treated with appendectomy:
- a.
- What perioperative intravenous antibiotics should be used?
- b.
- How long should perioperative intravenous antibiotics be used?
- c.
- Should oral antibiotics be used?
- (3)
- For patients with perforated appendicitis treated with initial nonoperative management, what antibiotics should be used in the initial management?
Results
Children with nonperforated appendicitis should receive preoperative, broad-spectrum antibiotics. In children with perforated appendicitis who had undergone appendectomy, intravenous antibiotic duration should be based on clinical criteria. Furthermore, broad-spectrum, single, or double agent therapy is as equally efficacious as but is more cost-effective than triple agent therapy. If intravenous antibiotics are administered for less than 5 days, oral antibiotics should be administered for a total antibiotic course of 7 days. For children with perforated appendicitis who did not initially undergo an appendectomy, the duration of broad-spectrum, intravenous antibiotics should be based on clinical symptoms.Conclusions
Current evidence supports the use of guidelines as described above for antibiotic therapy in children with acute and perforated appendicitis. 相似文献999.
1000.
目的:总结小儿阑尾炎的临床诊疗,及时做出临床诊断与手术治疗,减少术后并发症的发生.方法:对本院6年来外科手术治疗的56例小儿急性化脓穿孔性阑尾炎临床资料进行回顾性分析.结果:56例均行手术治疗,其中化脓性阑尾炎22例,坏疽、穿孔性阑尾炎28例,阑尾周围脓肿6例,首发症状以腹泻为主8例,以感冒发热为主7例,以肠梗阻为主5例,术前诊断与术后诊断均为阑尾炎者40例,符合率为71.4%.术前诊断与术后诊断不相符16例,误诊率28.6%.并发症有切口感染7例,肺部感染5例,腹腔残余感染4例,肠梗阻3例,粪瘘1例,腹膜裂开2例.结论:详细了解病史、仔细体格检查、合理运用辅助诊断及综合分析可避免延误诊断及治疗,减少术后并发症的发生. 相似文献