Is acute appendicitis in the weather forecast?

A Th2 Cytokine Profile in Appendicular Lavage Fluid Suggests Allergy as a Possible Etiology for Acute Appendicitis

Acute appendicitis is the most frequent surgical abdominal emergency, but its etiology remains poorly understood. Histological examination of the appendix, following its removal due to acute appendicitis, consistently shows features in common with bronchial asthma, suggesting an allergic reaction as a candidate etiologic factor. Here, we propose the concept of appendicular lavage and use it to study the levels of the Th2 cytokines IL-4, IL-5, and IL-9 in patients with a clinical diagnosis of acute appendicitis. The study group included 20 patients with a histological diagnosis of phlegmonous appendicitis, 13 patients with gangrenous appendicitis, and a control group of 8 patients with a clinical diagnosis of appendicitis but with normal histology. Cytokine levels were higher in acute appendicitis. The difference was more pronounced when comparing phlegmonous appendicitis with nonpathological appendicitis (p = 0.01) for IL-4 (48.3 vs. 21.3 pg/mL), IL-5 (29.2 vs. 8.0 pg/mL), and IL-9 (34.1 vs. 16.6 pg/mL). This Th2 cytokine profile is compatible with the hypothesis of allergy as an etiologic factor for acute appendicitis and may have important implications for the diagnosis, prevention, and treatment of this condition.

[Seasonal variation in surgical diseases : Is an economic resource management necessary?]

BACKGROUND

The registration of diagnoses and diagnose-related groups (DRG) allows conclusions to be drawn about the distribution over the course of the year. Seasonal variations can be recognized and used to plan further resource management.

METHODS

From 2006 to 2016 a total of 30,999 main diagnoses and DRGs were registered at the hospital for visceral surgery of the University Medical Hospital in Leipzig. The data were sorted on a monthly and seasonal basis and compared to meteorological data received from the German Meteorological Service. Furthermore, epidemiological information about the patients was recorded.

RESULTS

The most frequently registered main diagnosis was malignant neoplasms of the liver and intrahepatic bile ducts with 1589 cases (C22), followed by acute appendicitis with 1557 cases (K35). There was a significant seasonal and monthly variation for cholelithiasis (K80) with 1013 cases (p = 0.002⁺⁺), inguinal hernia (K40), 887 cases (p = 0.002⁺⁺), ventral hernia (K43), 696 cases (p < 0.001⁺⁺) and varices of the lower limbs (I83), 352 cases (p < 0.001⁺⁺). A similar correlation could be shown for daily sunshine hours and case numbers for patients with the main diagnosis groups I83 (r = -0.12, p = 0.036⁺) and K43 (r = -0.08, p = 0.041⁺). Another significant correlation was observed between patients' epidemiological information and medical data: patient-related clinical severity (PCCL) ~ age (r = 0.27, p < 0.001⁺⁺), length of hospital stay ~ age (r = 0.25, p < 0.001⁺⁺), duration of ventilation ~ age (r = 0.07, p < 0.001⁺⁺) and mortality ~ age (r = 0.09, p < 0.001⁺⁺).

CONCLUSION

A seasonal variation in case numbers for individual main diagnoses could be registered and elective and therefore plannable surgeries were mostly affected. An adequate resource management can reveal economic benefits. Older patients consume a high amount of resources and should be given a higher priority.