IMPACT OF ENDEMICITY OF ASCARIASIS ON DIAGNOSIS OF ACUTE APPENDICITIS

Objective: To determine the impact of endemicity of ascariasis in the manifestation of acute appendicitis. Study Design: Prospective observational study. Place and Duration of Study: General Surgery Department, Combined Military Hospital Skardu, from May 2012 to Apr 2015. Methodology: Patients presenting with symptoms of acute appendicitis were included in the study. Patients were diagnosed after taking detailed history, clinical examination and blood chemistry. All the patients underwent open appendectomy under general anesthesia. Per-operatively presence of worms was assessed in terminal ileum and after that in the lumen of the appendix initially by palpation and then by opening its lumen after it was removed. Histopathologic diagnosis could not be confirmed due to its non-availability as the surgeries were performed in a remote and resource constraint area of the country. Results: A total of 224 patients were included in the study. Out of these, 143 (63.8%) were male and 81 (36.1%) female patients. The mean age of patients was 22 ± 6 years. Per-operatively, 21 (9.3%) patients had worms in both ileum and appendicular lumen while 22 (9.8%) patients had worms only in the terminal ileum and there were no worms seen in either ileum or appendix in 181 (80.8%) patients. Conclusion: There is a relation of parasitic infestation especially Ascaris lumbricoides in the manifestation of acute appendicitis in endemic areas.

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LIVER BIOPSY

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.04.2684 ◽

2011 ◽

Vol 18 (04) ◽

pp. 709-714

Author(s):

FUAD AHMAD SIDDIQI ◽

RIZWANA KITCHLEW ◽

ASIF HASHMI

Keyword(s):

Liver Biopsy ◽

Liver Tissue ◽

Blood Donors ◽

Carrier State ◽

Military Hospital ◽

Histopathologic Diagnosis ◽

Right Lobe ◽

The Mean ◽

One Year ◽

Made In

Objective: To study the safety and efficacy of Surecut needle in obtaining the liver tissue by percutaneous liver biopsy. Design: Single centered prospective hospital based study. Place and duration of study: Department of Internal medicine (Unit-1) & Family ward, Combined military hospital Lahore for more than one year from August 2002 to March 2004. Materials and Methods: One hundred and fifty patients of either gender having asymptomatic hepatitis C carrier state, healthy blood donors, with positive HCV-PCR were included in study. The patients liver biopsy was done with Surecut needle 16G with patient breath suspended in expiration from the periphery of right lobe of liver. Result: Majority of patients, 135 ( 90% ) were male and 15 (10%) were female. The mean age was 30.3 years with range of 25-55years. In 146(97.31%)patients successful biopsy was done while the biopsy was non-diagnostic in 4(2.69%) patients. Mean core length of liver tissue obtained was Mean+sd(1.2+0.42cm) and histopathologic diagnosis was made in 97.31% cases. Total number of attempts were 1-2. In 99% single attempt was done. No major complications related to procedure was seen. Conclusions: liver biopsy with Surecut needle is safe and effective in establishing the diagnosis of Chronic hepatitis.

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Perforated Appendicitis: An Unintended Consequence During the Coronavirus-19 Pandemic

Military Medicine ◽

10.1093/milmed/usaa527 ◽

2020 ◽

Author(s):

Andrew W Wang ◽

James Prieto ◽

Daniel S Ikeda ◽

Paul R Lewis ◽

Emily M Benzer ◽

...

Keyword(s):

Acute Appendicitis ◽

Disease Process ◽

Perforated Appendicitis ◽

The United States ◽

Military Hospital ◽

Symptom Duration ◽

Delayed Presentation ◽

Historical Cohort ◽

Surgical Conditions ◽

The Impact

ABSTRACT Background The coronavirus disease 2019 (COVID-19) pandemic has had major clinical impact across the globe. Delayed presentation for medical emergencies has been noted by the medical community. There has been limited reporting on the impact for the care for emergent surgical conditions. We sought to describe the effect of the global pandemic on the presentation and outcomes for the most common urgent general surgery disease process, acute appendicitis. Methods We performed a retrospective review of patients admitted to the United States Naval Hospital Okinawa during the COVID-19 pandemic, from January 2020 to May 2020 (COVID cohort), and compared them to a historical cohort (pre-COVID cohort) over the prior 2 years. Demographics, clinical presentation data, and interventions were collected. Results Of the 80 patients with appendicitis, 20% presented perforated. Most patients were male (71%), presented with 1 day of symptoms and had a length of stay of 1 to 2 days. Comparing groups, 13% of the pre-COVID group vs. 31% of the COVID cohort presented perforated (P = .04), with a symptom duration of 1.6 vs. 2.7 days before presentation (P = .075), respectively. Conclusions The COVID-19 pandemic and the global systematic response has impacted unrelated medical and surgical conditions. At our overseas military hospital with minimal disease burden, we observed a delay in presentation for acute appendicitis with a higher incidence of perforation. Patients should be empowered to continue to seek care for urgent and emergent medical and surgical conditions so that they are not harmed by fear of COVID-19 rather than by COVID-19 itself.

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Evaluation of outcome of early appendectomy in appendicular lump

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20205501 ◽

2020 ◽

Vol 8 (1) ◽

pp. 7

Author(s):

A. S. M. Rezbanul Haque ◽

Bablu Kumar Saha ◽

M. Mahfuzul Haque ◽

M. Abdus Sattar ◽

Upendra Nath Ray ◽

...

Keyword(s):

Acute Appendicitis ◽

Recovery Period ◽

Medical College ◽

Group I ◽

Perforated Appendix ◽

Early Exploration ◽

The Mean ◽

Group Ii ◽

Surgery Department ◽

The Cost

Background: Appendicular lump is a well-known sequalae of acute appendicitis encountered in 2-6% of patients. Successful management of appendicular lump is controversial with different approaches. This study aims to evaluate the outcome of early appendectomy in an appendicular lump.Methods: A total of 210 patients were admitted in surgery and pediatric surgery department of Rangpur medical college and hospital with the diagnosis of acute appendicitis and its sequalae over two years.Results: In this study, sixty patients were included who were presented with an appendicular lump. Maximum patients (50%) were found in the age group of 21-30 years. Males (66.67%) were more affected. Eighty percent of patients were coming from below-average socio-economic conditions. In group I, early appendicectomy had done and outcomes were satisfactory and favorable. In group II, eighteen patients were operated who were admitted at 6 to 8 days after an attack of acute appendicitis, and twelve patients were continued the conservative treatment. In group II, who had done surgery, among them, fourteen patients (77.78%) were found an appendicular abscess, and four patients (22.22%) were found perforated appendix per-operatively. In group I, the mean recovery period was less and they had minimum complications. In group II, the mean recovery period was more and they had more complications.Conclusions: Based on these findings, it can be concluded that early exploration in appendicular lump patients confirm the diagnosis, cures the problem, reduces the cost of management, and shortens the convalescence period and hospital stay with reasonably satisfactory outcomes.

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Management and Outcomes of Acute Appendicitis in the Presence of Cirrhosis: A Nationwide Analysis

The American Surgeon ◽

10.1177/000313481908501011 ◽

2019 ◽

Vol 85 (10) ◽

pp. 1129-1133 ◽

Cited By ~ 1

Author(s):

Monika Garcia ◽

Ari Gerber ◽

Bishoy Zakhary ◽

Tiago Finco ◽

Albert Kazi ◽

...

Keyword(s):

Acute Appendicitis ◽

Nonoperative Management ◽

Open Appendectomy ◽

Hospital Length Of Stay ◽

Treatment Modalities ◽

Decompensated Cirrhosis ◽

Best Management ◽

Nationwide Inpatient Sample Database ◽

Treatment Type ◽

The Impact

Best management for acute appendicitis (AA) in adults with liver cirrhosis is controversial and needs more investigation. We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was queried to identify AA patients with no cirrhosis, compensated cirrhosis (CC), and decompensated cirrhosis (DC). Each cohort was further stratified according to the treatment type: nonoperative management, open appendectomy, and laparoscopic appendectomy (LA). Chisquare, ANOVA, and binary regression analyses were used to determine differences between groups and risk factors for mortality and complications, with P < 0.05 considered statistically significant. A total of 108,289 AA patients were analyzed; of those, 304 with CC and 134 with DC were identified. Compared with CC and no cirrhosis, DC patients had significantly higher mortality, higher cost, and longer hospital length of stay. LA is accompanied by higher survival, lower cost, shorter duration of hospitalization, and lower incidence of complications across all groups. We conclude that LA is the best management strategy for AA in cirrhotic patients. Even in decompensated cirrhotics, which are associated with worse clinical outcomes, LA is still a favorable option over open appendectomy and nonoperative management.

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Return-To-Practice Roadmap In Orthopedic Surgery Of A Spanish Military Hospital After Covid-19 Pandemic

10.21203/rs.3.rs-29088/v1 ◽

2020 ◽

Author(s):

Diana Crego Vita ◽

Carlos Rodríguez-Moro ◽

José Adolfo Orelana Gómez-Rico ◽

Rafael García-Cañas ◽

Monica Huecas Martínez ◽

...

Keyword(s):

Orthopedic Surgery ◽

Emergency Situation ◽

Military Hospital ◽

Protection Measures ◽

Group 4 ◽

Orthopedic Surgeons ◽

Individual Protection ◽

The Moment ◽

Surgery Department ◽

The Impact

Abstract Background The impact of the COVID-19 pandemic In Spain, especially in Madrid, suddenly affected all the activity of the hospital including the suspension of all non-urgent surgical procedures. What´s more crucial, the urgent procedures were seriously obstructed by to factors: the mandatory protection measures (individual protection clothes, facemasks, and their initial stockout, etc), the redesigned flow of the patients in and out the operation room specially because the advisable diagnosis study of severe acute respiratory syndrome related Coronavirus 2 in each patient.Methods We review the patients treated in our orthopedic department during the outbreak of Coronavirus disease 19. Based in our early experience and the emergency situation with high contagious rate in Madrid, Spain, we have built a list of considerations and recommendations to guide orthopaedic units in their resumption of their regular activity, focusing at the moment of reintroduce elective surgeries, during the contained epidemic phases.Results The mortality rate in Coronavirus disease 19 patients was 3/9 and in the non Coronavirus disease group 4/23 developed pneumonia by Coronavirus2 (1 dead). There are no guidelines in literature for orthopedic surgeons in the postpandemic phase.Conclusion Coronavirus disease 19 patients have an elevated morbidity and mortality, surgery during this pandemia can facilitate pneumonia by Coronavirus2. The return-to-practice measures in the orthopedic units must take into account this fact. We recommend for each orthopedic surgery department to create a flowchart, as ours, in order to restart surgical activity.

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Pediatric Equestrian Injuries: Assessing The Impact of Helmet Use

PEDIATRICS ◽

10.1542/peds.95.4.487 ◽

1995 ◽

Vol 95 (4) ◽

pp. 487-489

Author(s):

G. Randall Bond ◽

Richard A. Christoph ◽

Bradley M. Rodgers

Keyword(s):

Emergency Department ◽

Prospective Observational Study ◽

Injury Severity ◽

Head Injuries ◽

University Of Virginia ◽

Severity Scale ◽

Helmet Use ◽

The Mean ◽

The University ◽

The Impact

Objective. To assess the impact of helmet use on the pattern, and severity of pediatric equestrian injuries. Design. A prospective observational study of all children less than 15 years of age who were brought to the University of Virginia children's Emergency Department with horse-related injuries. Results. During the two-year period of the study, 32 children were evaluated. Two children were injured when a horse stepped on them. Thirty children fell from or were thrown from a horse. Of these, 20 were wearing a helmet. Head injuries were more frequent in those patients not wearing helmets. The mean Modified Injury Severity Scale (MISS) score for riders without a helmet (12.9) was significantly higher (more severe) than that for helmeted riders (2.8). All three patients with a Glascow Coma Score <15 on arrival were not wearing a helmet at the time of injury. The frequency of hospitalization was significantly higher for those not wearing a helmet. Compared with other common mechanisms of childhood injury the mean Modified Injury Severity Scale score of injured riders was exceeded only by that of pedestrians struck by a car. Conclusion. Equestrian injuries are more severe than those suffered from other common pediatric mechanisms. Helmet use is associated with decreased frequency and severity of central nervous system injury.

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Evaluating the impact of an international short-term medical mission through diabetic glycemic control

Journal of Public Health ◽

10.1093/pubmed/fdy182 ◽

2018 ◽

Vol 41 (4) ◽

pp. 815-820

Author(s):

John C Mach ◽

Hope Barone ◽

Christopher Boni ◽

Humberto Jimenez ◽

Michael Tinglin

Keyword(s):

Disease Burden ◽

Prospective Observational Study ◽

Glucose Monitoring ◽

Phone Call ◽

Short Term ◽

Education Medical ◽

The Mean ◽

The Impact ◽

Diabetic Care

AbstractBackgroundThis prospective observational study evaluated the impact of a primary care-based, international, short-term medical mission’s (STMM) impact on diabetes disease burden as represented through reductions in hemoglobin A1C (HbA1c).MethodsFrom November 2016 to May 2017, we tracked the HbA1c’s of diabetic individuals in Dajabon, Dominican Republic through care provided by Waves of Health (WOH). Participants were provided counseling, glucose monitoring equipment, a 6-month supply of anti-diabetic medications, and received a ‘check-in’ phone call at 3 months. HbA1c’s were re-measured at 6-month follow up. We hypothesized WOH diabetic care would have a modest impact of reducing mean HbA1c by 0.5%.ResultsIn total, 75% (n = 76) of 101 participants presented for follow-up care. Mean and median HbA1c decreased from 8.71 (SD 2.0) and 8.5% to 8.36 (SD 2.1) and 7.7%, respectively (P = 0.07). The percentage of individuals with HbA1c ≤7.5 increased by 10.4% at follow-up. The mean HbA1c decrease was 1.1%.ConclusionsThough limited by sample size, our results suggest that medical STMM’s may have a clinically meaningful impact in chronic disease management when utilizing a systematic combination of education, medical therapy, clearly documented medication instructions and regular trip intervals.

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575 Management of Acute Appendicitis During the COVID-19 Pandemic. Our Experience at The General Surgery Department in Queen Elizabeth Hospital, London

British Journal of Surgery ◽

10.1093/bjs/znab134.068 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Chatzikonstantinou ◽

A Pouncey ◽

M l David ◽

F Aljarad ◽

P Sorelli

Keyword(s):

Acute Appendicitis ◽

General Surgery ◽

Emergency Services ◽

Surgical Patients ◽

Queen Elizabeth Hospital ◽

Single Centre ◽

Open Procedure ◽

Negative Appendicectomy ◽

Surgery Department ◽

The Impact

Abstract Introduction The pandemic of CoViD-19 had a major impact on provision of emergency services. National (CoViD-19) Guidelines (NG) were issued by the Colleges of Surgeons for the management of surgical patients. Aim To assess the impact of CoViD-19 in the management of patients with acute appendicitis (AA) and review patients’ characteristics and compliance with NG. Method A single-centre retrospective analysis of prospectively collected data on surgical admissions with suspected AA between March and May 2020. Main outcomes of interest were the pre-operative investigation, the type of operation and the negative appendicectomy rate (NAR) comparing to 2019. Results A total of 109 patients were referred for suspected AA. Out of 39 patients who had surgery 21 (53.8%) were investigated with a CT and 13 (33%) with an ultrasound. There was a 31.6% reduction in appendicectomies compared to 2019. 30 patients (76.9%) had an open procedure vs 9 laparoscopic (23.1%) in alignment with the NG2. Histology showed AA in 37 out of 39 of the cases. The NAR was 5.12 vs 12.2 for 2019. Conclusions There was a 31.6% reduction in appendicectomies during CoViD-19. Most patients were investigated with a CT and underwent an open procedure. Pre-operative investigation with a CT led in reduction of NAR.

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Mucocele of the appendix: a rare case report

International Surgery Journal ◽

10.18203/2349-2902.isj20170233 ◽

2017 ◽

Vol 4 (2) ◽

pp. 789

Author(s):

Sudarshan P. B. ◽

Reshma S.

Keyword(s):

Acute Appendicitis ◽

Histopathological Examination ◽

Correct Diagnosis ◽

Open Appendectomy ◽

Cystic Mass ◽

Free Fluid ◽

Histopathologic Diagnosis ◽

Rare Case Report ◽

Mucocele Of The Appendix ◽

Mucous Cyst

Appendiceal mucocele is a rare disease. Sometimes it is discovered accidentally and sometimes it resembles acute appendicitis. Correct diagnosis before surgery is important for the selection of adequate surgical treatment to avoid intraoperative and postoperative complications. Ultrasonography, and particularly computed tomography, should be used extensively for this purpose. If mucocele is treated incorrectly, pseudomyxoma peritonei may develop. We present a case of 22 year old man who was admitted to the emergency department with the signs of acute appendicitis. Emergency open appendectomy was performed. At the time of surgery, a cystic mass was found at the tip of the inflammed appendix. No free fluid was found in the peritoneal cavity. Diagnosis of Mucocele of appendix was suspected. Appendectomy was done and specimen sent for histopathological examination. No lymphadenopathy. Histopathologic diagnosis was subacute appendicitis, mucocele of appendix with simple mucous cyst. Patient is on regular follow-up.

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Transumbilical Laparoscopic-Assisted Appendectomy in the Treatment of Acute Uncomplicated Appendicitis in Children

Gastroenterology Research and Practice ◽

10.1155/2015/949162 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Carmine Noviello ◽

Mercedes Romano ◽

Ascanio Martino ◽

Giovanni Cobellis

Keyword(s):

Acute Appendicitis ◽

Operative Time ◽

Open Appendectomy ◽

Laparoscopic Technique ◽

Diffuse Peritonitis ◽

Histopathologic Examination ◽

Appendiceal Mass ◽

Uncomplicated Appendicitis ◽

The Mean ◽

Laparoscopic Assisted

Transumbilical laparoscopic-assisted appendectomy (TULAA) is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis) and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA). All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA) was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males) with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years). Primary OA was performed in 144 cases. In 300 patients a transumbilical laparoscopic-assisted approach was performed. TULAA was completed in 252 patients. Conversion to OA was performed in 45 patients and to LA in 3. Conversion was related to the impossibility to adequately expose the appendix in 47 patients and bleeding in 1. The mean operative time for TULAA was 42 minutes. Histopathologic examination of the appendix removed by TULAA showed a phlegmonous/gangrenous type in 92.8% of cases. Among the 252 TULAA there were 11 cases of umbilical wound infection. TULAA is a feasible and effective procedure for uncomplicated appendicitis in children. It combines the advantages of open and laparoscopic technique (low operative time, low complications rate, and excellent cosmetic results).

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