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Asada Y, Kanesaka T, Michida T, Satomi H, Honma K, Ishihara R. Endoscopic submucosal dissection for a large cecal adenoma covering an appendiceal orifice after appendectomy. Endoscopy 2024; 56:E27-E28. [PMID: 38194988 PMCID: PMC10776282 DOI: 10.1055/a-2218-2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Yuya Asada
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hidetoshi Satomi
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Keiichiro Honma
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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Iresjö BM, Blomström S, Engström C, Johnsson E, Lundholm K. Acute appendicitis: A block-randomized study on active observation with or without antibiotic treatment. Surgery 2024; 175:929-935. [PMID: 38218686 DOI: 10.1016/j.surg.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Antibiotic treatment of unselected patients with acute appendicitis is safe and effective. However, it is unknown to what extent early provision of antibiotic treatment may represent overtreatment due to spontaneous healing of appendix inflammation. The aim of the present study was to evaluate the role of antibiotic treatment versus active in-hospital observation on spontaneous regression of acute appendicitis. METHOD Patients who sought acute medical care at Sahlgrenska University Hospital were block-randomized according to age (18-60 years) and systemic inflammation (C-reactive protein <60 mg/L, white blood cell <13,000/μL), in combination with clinical and abdominal characteristics of acute appendicitis. Study patients received antibiotic treatment and active observation, while control patients were allocated to classic active "wait and see observation" for either disease regression or the need for surgical exploration. According to our standard surgical care, certified surgeons in charge decided whether and when appendectomy was necessary. In total, 1,019 patients were screened for eligibility; 203 patients met inclusion criteria, 126 were accepted to participate, 29 declined, and 48 were missed for inclusion. RESULTS The antibiotic group (n = 69) and the control group (n = 57) were comparable at inclusion. Appendectomy at first hospital stay was 28% and 53% for study and control patients (χ2, P < .004). Life table analysis indicated a time-dependent difference in the need for appendectomy during follow-up (P < .03). Antibiotics prevented surgical exploration and appendectomy by 72% to 50% compared to 47% to 37% in the control group across the time course follow-ups between 5 and 1,200 days. CONCLUSION Early antibiotic treatment is superior to traditional "wait and see observation" to avoid surgical exploration and appendectomy.
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Affiliation(s)
- Britt-Marie Iresjö
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Sara Blomström
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Cecilia Engström
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Erik Johnsson
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Kent Lundholm
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Coronas-Soucheiron M, Martín-Solé O, Massaguer C, Tarrado X. Is Being Overweight a Risk Factor for Torsion of the Appendix Testis in Children?: A Paired Case-Control Study. Pediatr Emerg Care 2024; 40:279-282. [PMID: 37276066 DOI: 10.1097/pec.0000000000002994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study aimed to determine whether being overweight during childhood is a risk factor for torsion of the appendix testis (TAT). METHODS We conducted a paired case-control study with all boys surgically treated for TAT, paired by age and sex with patients who were seen in the emergency department for a reason other than acute scrotum. Age and weight were registered, and weight percentile (WP) by age was calculated and compared between groups. Weight percentile was classified into 4 groups (<25, 25-50, 50-75, >75), and a conditional logistic regression analysis was performed to establish the risk of TAT related to the WP. RESULTS A total of 980 patients were diagnosed as having TAT in our institution, of which 118 patients (12%) were surgically treated and randomly paired with 118 controls. Mean age was the same in both groups (11.2 years, P = 0.908). Patients with TAT had a higher median of WP (79; interquartile range, 49-94) than the control group (49; interquartile range, 20-79; P < 0.0001). For each WP point increase, risk of TAT raised by 2.2% (odds ratio [OR], 1.022; 95% confidence interval [CI], 1.011-1.032; P < 0.001). Weight percentile >75 increased the risk of TAT: 6-fold compared with WP <25 (OR, 5.9; 95% CI, 2.5-14; P < 0.001), 4-fold compared with WP of 25 to 50 (OR, 4.3; 95% CI, 1.8-10.5; P = 0.001), and 3-fold compared with WP of 50 to 75 (OR, 3.3; 95% CI, 1.5-7.6; P = 0.004). CONCLUSIONS Overweight increases the risk of being operated on because of TAT. Because obesity is a rising problem, a greater incidence of TAT remains to be proved.
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Affiliation(s)
- Maria Coronas-Soucheiron
- From the Pediatric Surgery Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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Fennell J, Territo HM, Telt N, Wrotniak BH, Kozielski R, Pape E, Penque M. The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children. J Emerg Med 2024; 66:e508-e515. [PMID: 38429214 DOI: 10.1016/j.jemermed.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Acute appendicitis is a common cause of abdominal pain leading to emergent abdominal surgery in children. C-reactive protein (CRP), an inflammatory marker typically elevated in acute appendicitis, and Pediatric Appendicitis Score (PAS), a clinical scoring system used for the diagnosis of appendicitis, have the potential to predict the severity of inflammation of the appendix. This may be useful in helping the physician make a treatment plan prior to surgery. OBJECTIVE The purpose of this study was to assess whether CRP value and PAS differ with the extent of inflammation of the appendix seen on histologic examination. METHODS This was a prospective observational study of patients diagnosed with acute appendicitis via computed tomography or ultrasound. Enrolled patients had CRP levels drawn, PAS calculated, and appendix pathology reviewed. Appendix pathology was categorized by the pathologist on the basis of the level of inflammation: simple, suppurative, gangrenous, and perforated. RESULTS One hundred sixty-three patients were enrolled. CRP levels and PAS were statistically different (p < 0.002) among the four pathology classifications. Patients with simple appendicitis (n = 3) had a mean CRP of 2.95 mg/L and PAS of 3.9, patients with suppurative appendicitis (n = 99) had a mean CRP of 26.89 mg/L and PAS of 6.5, patients with gangrenous appendicitis (n = 56) had a mean CRP of 91.11 mg/L and PAS of 7.5, and patients with perforated appendicitis (n = 6) had a mean CRP of 154.17 mg/L and PAS of 7. The results remained statistically significant (p < 0.002) after adjusting for age, race, and sex. When combined-PAS ≥ 8 and CRP level > 40 mg/L-the specificity of complicated appendicitis was 91.2% and positive predictive value was 72.7%. CONCLUSIONS Higher CRP levels and PAS were associated with increased histologic inflammation of the appendix. This study provides preliminary evidence that CRP and PAS could potentially assist in treatment decisions for appendicitis.
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Affiliation(s)
- Jill Fennell
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
| | - Heather M Territo
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
| | - Nadya Telt
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
| | - Brian H Wrotniak
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York; Masters of Public Health Program, D'Youville College, Buffalo, New York
| | - Rafal Kozielski
- Department of Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
| | - Earl Pape
- Department of Pathology and Anatomical Sciences, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
| | - Michelle Penque
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UBMD Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children's Hospital, Buffalo, New York
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Miles EL, Spellar K, Williams D. Mycobacterium bovis infection of the appendix: a case of appendiceal tuberculosis in rural England. BMJ Case Rep 2024; 17:e258798. [PMID: 38442977 DOI: 10.1136/bcr-2023-258798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Appendiceal tuberculosis is a rare mimic of acute appendicitis, demonstrated by several case reports of patients from tuberculosis endemic countries. On literature review, there are few cases reported of appendiceal tuberculosis in urban England, and no reports from rural England. This case describes a patient with primary appendiceal tuberculosis from a remote district hospital in England who underwent a diagnostic laparoscopy for suspected acute appendicitis. Intraoperatively, an abnormal appearance with extensive intra-abdominal adhesions was seen in addition to appendicitis, making the diagnosis dubious. Histology of the appendix was positive for acid-fast bacilli and culture of the intra-abdominal fluid revealed a diagnosis of Mycobacterium bovis infection. The mode of infection was thought to be reactivation of latent bovine tuberculosis from drinking unpasteurised milk in adolescence. Taking a focused history, particularly in those with a farming background, and intraoperative sampling for histology and culture are vital in the diagnosis of appendiceal tuberculosis.
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Affiliation(s)
- Esther Lucy Miles
- Obstetrics and Gynaecology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Kayleigh Spellar
- General Surgery, Royal Devon and Exeter NHS Foundation Trust, Barnstaple, UK
| | - David Williams
- General Surgery, Royal Devon and Exeter NHS Foundation Trust, Barnstaple, UK
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Dong J, Liu J, Tian Y. A neurofibromatosis patient with a large appendix and multiple small intestine masses. Dig Liver Dis 2024; 56:528-529. [PMID: 38160103 DOI: 10.1016/j.dld.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Jinpei Dong
- Departments of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Jing Liu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yu Tian
- Departments of Gastroenterology, Peking University First Hospital, Beijing, China.
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Kartal B, Tutan MB, Alkurt EG, Sahiner IT, Turhan VB. Diagnostic Accuracy of Ileocolic Artery and Vein Diameter for Acute Appendicitis. Med Sci Monit 2024; 30:e943846. [PMID: 38425035 PMCID: PMC10913285 DOI: 10.12659/msm.943846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Regional inflammation-induced local vasodilation may exist in cases of appendicitis. In this study, the diameters of the ileocolic artery (ICA) and ileocolic vein (ICV) were measured using contrast-enhanced abdominal computed tomography (CT) scans in acute appendicitis cases. The study aimed to measure the diagnostic value of these measurements in the diagnosis of acute appendicitis. MATERIAL AND METHODS A total of 508 patients, including those with a diagnosis of acute appendicitis and a control group without appendicitis, were systematically evaluated. In all cases, the appendix was analyzed simultaneously on axial and coronal CT sections, and all measurement procedures were conducted with an electronic ruler after the actual images were magnified. Measurements of the ICA and ICV diameters were taken from the proximal 2-cm segments of the superior mesenteric artery and superior mesenteric vein in the axial plane. Demographic information, sex distribution, and ICA and ICV diameters were collected. RESULTS Of the 508 patients, 53.74% were men, and 46.26% were women. ICA and ICV diameters were significantly increased in the appendicitis group (P<0.001). Binomial logistic regression confirmed the independent predictive value of ICA and ICV diameters. Receiver operating characteristic curve analysis determined optimal cut-off values for distinguishing between the non-appendicitis and appendicitis groups (ICA: 2.475 mm, ICV: 3.885 mm) with high sensitivity and specificity. CONCLUSIONS ICA and ICV diameter measurements, in conjunction with major radiological findings, can enhance diagnostic accuracy in acute appendicitis cases. The use of ICA and ICV diameter measurements in diagnosing acute appendicitis offers a novel perspective in clinical practice.
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Getzlaff JM, Fulghum GH. Enterobius vermicularis (Pinworm) Appendicitis: The Real Vermiform Appendix. Mil Med 2024; 189:e894-e896. [PMID: 37674268 DOI: 10.1093/milmed/usad357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
Enterobius vermicularis is the most common helminthic infection in the United States, infecting an estimated 40 million persons. A rare complication of E. vermicularis infestation is appendicitis. The diagnosis must be considered during pathologic examination to ensure appropriate treatment with anti-helminthic therapy.
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Affiliation(s)
- Jared M Getzlaff
- General Surgery Residency Program, Keesler AFB Medical Center, Biloxi, MS 39534, USA
| | - George H Fulghum
- General Surgery Residency Program, Keesler AFB Medical Center, Biloxi, MS 39534, USA
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You F, Pan G, Lv C. The "Hand as Foot" teaching method for the anatomical location of the appendix. Asian J Surg 2024; 47:1287-1288. [PMID: 38008619 DOI: 10.1016/j.asjsur.2023.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/10/2023] [Indexed: 11/28/2023] Open
Affiliation(s)
- Faping You
- Department of Hepatobiliary Surgery, Shengli Oilfield Central Hospital, China
| | - Guozheng Pan
- Department of Hepatobiliary Surgery, Shengli Oilfield Central Hospital, China
| | - Chongqing Lv
- Department of Hepatobiliary Surgery, Shengli Oilfield Central Hospital, China.
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10
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Becker G, Fuhrer AE, Kremer K, Hochschild A, Kammar H, Sukhotnik I. Age as an Exclusion Criterion for Nonoperative Management in Simple Acute Appendicitis in Children. Eur J Pediatr Surg 2024; 34:102-106. [PMID: 37591255 DOI: 10.1055/a-2155-7642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Nonoperative management (NOM) for simple acute appendicitis (SAA) is an acceptable mode of treatment in healthy children. Previous studies of NOM routinely excluded young children (< 5 years); however, the effect of age on NOM failure has not been directly assessed. Efficiency of NOM in young adults is questionable. Therefore, adolescents may also be at greater risk of NOM failure. Our aim was to investigate the effect of age on NOM failure. METHODS This is a retrospective analysis of children with SAA who received NOM between January 1, 2019, and June 30, 2021, at our institution. NOM failure was defined by subsequent appendectomy. Age was assessed as a continuous variable, and we also compared different age subgroups. RESULTS In this study, 151 children were included (60% male), mean age 11.2 ± 3.2 years (range: 5-17). Overall, 66 children (44%) failed NOM, 90% of them within the first year (median 7 weeks). Ten percent of the cohort were younger than 6 years of age and 33% of them failed NOM (p = 0.39). Per 1 year increase in age, the odds of NOM failure increased by 12% (p = 0.027). Children over 14 years of age had 2.46 times higher odds to fail NOM (p = 0.03). These higher odds remained after adjusting for appendiceal diameter and appendicolith. Linear regression showed a decrease by a factor of 12 at the time of NOM failure with every 1-year increase in age (β = -12, p = 0.09). CONCLUSION The risk of NOM failure in children increases with age; therefore, age should be considered when deciding on the optimal management of SAA, especially in adolescents. Effectiveness of NOM in children younger than 6 years is noninferior to older children and therefore should not be excluded.
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Affiliation(s)
- Gal Becker
- Department of Pediatric Surgery, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Audelia Eshel Fuhrer
- Department of Pediatric Surgery, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Keren Kremer
- Department of Pediatric Surgery, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Annabella Hochschild
- Department of Pediatric Surgery, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Haguy Kammar
- Department of Pediatric Surgery, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Igor Sukhotnik
- Department of Pediatric Surgery, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Wong NA. Is it necessary to block an entire appendix to exclude acute appendicitis? Histopathology 2024; 84:569-570. [PMID: 37828870 DOI: 10.1111/his.15072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Newton Acs Wong
- Department of Cellular Pathology, Southmead Hospital, Bristol, UK
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12
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Zhao Y, Wang X, Zhang Y, Liu T, Zuo S, Sun L, Zhang J, Wang K, Liu J. Combination of clinical information and radiomics models for the differentiation of acute simple appendicitis and non simple appendicitis on CT images. Sci Rep 2024; 14:1854. [PMID: 38253872 PMCID: PMC10803326 DOI: 10.1038/s41598-024-52390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024] Open
Abstract
To investigate the radiomics models for the differentiation of simple and non-simple acute appendicitis. This study retrospectively included 334 appendectomy cases (76 simple and 258 non-simple cases) for acute appendicitis. These cases were divided into training (n = 106) and test cohorts (n = 228). A radiomics model was developed using the radiomic features of the appendix area on CT images as the input variables. A CT model was developed using the clinical and CT features as the input variables. A combined model was developed by combining the radiomics model and clinical information. These models were tested, and their performance was evaluated by receiver operating characteristic curves and decision curve analysis (DCA). The variables independently associated with non-simple appendicitis in the combined model were body temperature, age, percentage of neutrophils and Rad-score. The AUC of the combined model was significantly higher than that of the CT model (P = 0.041). The AUC of the radiomics model was also higher than that of the CT model but did not reach a level of statistical significance (P = 0.053). DCA showed that all three models had a higher net benefit (NB) than the default strategies, and the combined model presented the highest NB. A nomogram of the combined model was developed as the graphical representation of the final model. It is feasible to use the combined information of clinical and CT radiomics models for the differentiation of simple and non-simple acute appendicitis.
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Affiliation(s)
- Yinming Zhao
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, China
| | - Xin Wang
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, China
| | - Yaofeng Zhang
- Beijing Smart Tree Medical Technology Co. Ltd., Beijing, China
| | - Tao Liu
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, China
| | - Shuai Zuo
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, China
| | - Lie Sun
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, China
| | - Junling Zhang
- Department of Gastrointestinal Surgery, Peking University First Hospital, Beijing, China.
| | - Kexin Wang
- School of Basic Medical Sciences, Capital Medical University Beijing, Beijing, China.
| | - Jing Liu
- Department of Radiology, Peking University First Hospital, Beijing, China.
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She JJ, Liu WX, Ding XM, Guo G, Han J, Shi FY, Lau HCH, Ding CG, Xue WJ, Shi W, Liu GX, Zhang Z, Hu CH, Chen Y, Wong CC, Yu J. Defining the biogeographical map and potential bacterial translocation of microbiome in human 'surface organs'. Nat Commun 2024; 15:427. [PMID: 38199995 PMCID: PMC10781665 DOI: 10.1038/s41467-024-44720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
The microbiome in a specific human organ has been well-studied, but few reports have investigated the multi-organ microbiome as a whole. Here, we aim to analyse the intra-individual inter-organ and intra-organ microbiome in deceased humans. We collected 1608 samples from 53 sites of 7 surface organs (oral cavity, esophagus, stomach, small intestine, appendix, large intestine and skin; n = 33 subjects) and performed microbiome profiling, including 16S full-length sequencing. Microbial diversity varied dramatically among organs, and core microbial species co-existed in different intra-individual organs. We deciphered microbial changes across distinct intra-organ sites, and identified signature microbes, their functional traits, and interactions specific to each site. We revealed significant microbial heterogeneity between paired mucosa-lumen samples of stomach, small intestine, and large intestine. Finally, we established the landscape of inter-organ relationships of microbes along the digestive tract. Therefore, we generate a catalogue of bacterial composition, diversity, interaction, functional traits, and bacterial translocation in human at inter-organ and intra-organ levels.
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Affiliation(s)
- Jun-Jun She
- Department of General Surgery, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China.
- Center for Gut Microbiome Research, Med-X Institute Centre, First Affiliated Hospital of Xi'an Jiao Tong University, Xian, China.
- Department of Talent Highland, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China.
- Yulin Hospital, First Affiliated Hospital of Xi'an Jiao Tong University, Yulin, China.
| | - Wei-Xin Liu
- Institute of Digestive Disease and The Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiao-Ming Ding
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
- Institute of Organ Transplantation, Xi'an Jiao Tong University, Xi'an, China
| | - Gang Guo
- Center for Gut Microbiome Research, Med-X Institute Centre, First Affiliated Hospital of Xi'an Jiao Tong University, Xian, China
- Department of Talent Highland, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Jing Han
- Center for Gut Microbiome Research, Med-X Institute Centre, First Affiliated Hospital of Xi'an Jiao Tong University, Xian, China
- Department of Talent Highland, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Fei-Yu Shi
- Department of General Surgery, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
- Center for Gut Microbiome Research, Med-X Institute Centre, First Affiliated Hospital of Xi'an Jiao Tong University, Xian, China
- Department of Talent Highland, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Harry Cheuk-Hay Lau
- Institute of Digestive Disease and The Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chen-Guang Ding
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
- Institute of Organ Transplantation, Xi'an Jiao Tong University, Xi'an, China
| | - Wu-Jun Xue
- Department of Kidney Transplantation, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
- Institute of Organ Transplantation, Xi'an Jiao Tong University, Xi'an, China
| | - Wen Shi
- Center for Gut Microbiome Research, Med-X Institute Centre, First Affiliated Hospital of Xi'an Jiao Tong University, Xian, China
- Department of Talent Highland, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Gai-Xia Liu
- Department of General Surgery, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
- Center for Gut Microbiome Research, Med-X Institute Centre, First Affiliated Hospital of Xi'an Jiao Tong University, Xian, China
- Department of Talent Highland, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Zhe Zhang
- Department of General Surgery, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
- Center for Gut Microbiome Research, Med-X Institute Centre, First Affiliated Hospital of Xi'an Jiao Tong University, Xian, China
- Department of Talent Highland, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Chen-Hao Hu
- Department of General Surgery, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
- Center for Gut Microbiome Research, Med-X Institute Centre, First Affiliated Hospital of Xi'an Jiao Tong University, Xian, China
- Department of Talent Highland, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Yinnan Chen
- Center for Gut Microbiome Research, Med-X Institute Centre, First Affiliated Hospital of Xi'an Jiao Tong University, Xian, China
- Department of Talent Highland, First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, China
| | - Chi Chun Wong
- Institute of Digestive Disease and The Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jun Yu
- Center for Gut Microbiome Research, Med-X Institute Centre, First Affiliated Hospital of Xi'an Jiao Tong University, Xian, China.
- Institute of Digestive Disease and The Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China.
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The SMML, Schreurs RRCE, Drewniak A, Bakx R, de Meij TGJ, Budding AE, Poort L, Cense HA, Heij HA, van Heurn LWE, Gorter RR, Bunders MJ. Enhanced Th17 responses in the appendix of children with complex compared to simple appendicitis are associated with microbial dysbiosis. Front Immunol 2024; 14:1258363. [PMID: 38239362 PMCID: PMC10794624 DOI: 10.3389/fimmu.2023.1258363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/17/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Appendicitis is one of the most common causes of acute abdominal surgery in children. The clinical course of appendicitis ranges from simple to complex appendicitis. The mechanisms underlying the heterogeneity of appendicitis in children remain largely unclear. Dysregulated T cell responses play an important role in several inflammatory diseases of the intestine, but the extend of T cell dysregulation in appendicitis in children is less well known. Methods To characterize appendiceal T cells in simple and complex appendicitis we performed in-depth immunophenotyping of appendiceal-derived T cells by flow cytometry and correlated this to appendiceal-derived microbiota analyses of the same patient. Results Appendix samples of twenty children with appendicitis (n = 8 simple, n = 12 complex) were collected. T cells in complex appendicitis displayed an increased differentiated phenotype compared to simple appendicitis, including a loss of both CD27 and CD28 by CD4+ T cells and to a lesser extent by CD8+ T cells. Frequencies of phenotypic tissue-resident memory CD69+CD4+ T cells and CD69+CD8+ T cells were decreased in children with complex compared to simple appendicitis, indicating disruption of local tissue-resident immune responses. In line with the increased differentiated phenotype, cytokine production of in particular IL-17A by CD4+ T cells was increased in children with complex compared to simple appendicitis. Furthermore, frequencies of IL-17A+ CD4+ T cells correlated with a dysregulation of the appendiceal microbiota in children with complex appendicitis. Conclusion In conclusion, disruption of local T cell responses, and enhanced pro-inflammatory Th17 responses correlating to changes in the appendiceal microbiota were observed in children with complex compared to simple appendicitis. Further studies are needed to decipher the role of a dysregulated network of microbiota and Th17 cells in the development of complex appendicitis in children.
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Affiliation(s)
- Sarah-May M. L. The
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Renée R. C. E. Schreurs
- Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Agata Drewniak
- Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Roel Bakx
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, Netherlands
| | - Tim G. J. de Meij
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, Netherlands
- Department of Paediatric Gastroenterology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Huib A. Cense
- Department of Surgery, Red Cross Hospital, Beverwijk, Netherlands
| | - Hugo A. Heij
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - L. W. Ernest van Heurn
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, Netherlands
| | - Ramon R. Gorter
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Center (UMC), University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, Netherlands
| | - Madeleine J. Bunders
- Leibniz Institute of Virology, Hamburg, Germany
- Third Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Fan C, Ma J, Fan Y, Jia H, Li J. Noninvasive endoscopic therapy of gourd-shaped appendix stenosis: an easier and effective path to follow. Gastrointest Endosc 2024; 99:128-129. [PMID: 37423531 DOI: 10.1016/j.gie.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/22/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Caixia Fan
- Division of Gastroenterology, Linfen Central Hospital, Linfen, China
| | - Jinping Ma
- Division of Gastroenterology, Linfen Central Hospital, Linfen, China
| | - Yanming Fan
- Division of Gastroenterology, Linfen Central Hospital, Linfen, China
| | - Hui Jia
- Division of Gastroenterology, Linfen Central Hospital, Linfen, China
| | - Jianyi Li
- Division of Gastroenterology, Linfen Central Hospital, Linfen, China
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16
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Misanik M, Grajciar M, Smolár M, Miklusica J, Cmarkova K. An unusual case of gastrointestinal tract occlusion, Ladd's syndrome and neuroendocrine tumour of the appendix in a 19-year-old female patient. Rozhl Chir 2024; 102:251-256. [PMID: 38286654 DOI: 10.33699/pis.2023.102.6.251-256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Ladd's syndrome is a complex gastrointestinal anomaly that occurs based on congenital intestinal malrotation and leads to midgut volvulus and intestinal obstruction. It is mostly discovered in paediatric patients and presents itself in 90% of cases within the first year of life. It is a rare diagnosis in adult patients. We present the case report of a 19-year-old female patient with chronic abdominal pain and upper-type dyspeptic syndrome. MRI examination of the abdomen showed an abnormal location of the loops of the small intestine predominantly in the right part of the abdomen, caecum and c. ascendens in the epigastrium, duodenojejunal transition compressed and stenotized between upper mesenteric vessels and the aorta, with prestenotic dilatation of the duodenum and stomach and the "whirlpool sign" in mesentery. The patient was indicated for operational procedure and Ladd's operation was successfully performed laparoscopically, where "Ladd's bands" were divided; the procedure also included adhesiolysis, mobilization of the duodenum with its straightening, widening of the base of the mesentery, appendectomy and removal of an incidental solitary mesothelial cyst. A highly differentiated incidental neuroendocrine tumour of the apex of appendix was confirmed by histology. In the discussion, we focus on the rarity of intestinal malrotation in adulthood, clinical manifestation of the disease, diagnostic options and surgical treatment.
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17
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Fukuzawa H, Minoda N, Okamoto M, Tsuruno Y, Watanabe A. Contrast-enhanced ultrasonographic findings in torsion of the appendix testis or epididymis in children: a case series. J Med Ultrason (2001) 2024; 51:125-131. [PMID: 37864611 DOI: 10.1007/s10396-023-01377-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/30/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE Torsion of the appendix testis or epididymis is a cause of acute scrotum in children. Ultrasonography with color Doppler is the first-choice modality for diagnosis. However, this method requires skill and experience to make a diagnosis with confidence. Recently, contrast-enhanced ultrasonography for diagnosis in various fields has been reported. However, to our knowledge, there has been no report of this method being used to diagnose torsion of the appendix testis or epididymis. The purpose of this study was to retrospectively examine contrast-enhanced ultrasonographic findings in torsion of the appendix testis or epididymis. METHODS Patients who underwent contrast-enhanced ultrasonography for torsion of the appendix testis or epididymis at our institution between April 2010 and April 2023 were enrolled in this study (n = 12). Contrast-enhanced ultrasonography findings of the affected appendage and the testis parenchyma were examined retrospectively. RESULTS The parenchyma of the testes was notably enhanced in all the cases. However, 9 of the 12 cases showed that the appendage with torsion was not enhanced at all. In the remaining three cases, only slight enhancement was seen. Nevertheless, it was notably less than that of the parenchyma of the testis. CONCLUSION Our findings indicated that contrast-enhanced ultrasonography may be an easy and reliable method for diagnosing torsion of the appendix testis or epididymis.
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Affiliation(s)
- Hiroaki Fukuzawa
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Shimoteno 1-12-1, Himeji, Hyogo, 670-8540, Japan.
| | - Naoki Minoda
- Department of Clinical Laboratory, Japanese Red Cross Society Himeji Hospital, Shimoteno 1-12-1, Himeji, Hyogo, 670-8540, Japan
| | - Mitsumasa Okamoto
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Shimoteno 1-12-1, Himeji, Hyogo, 670-8540, Japan
| | - Yudai Tsuruno
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Shimoteno 1-12-1, Himeji, Hyogo, 670-8540, Japan
| | - Aya Watanabe
- Department of Pediatric Surgery, Japanese Red Cross Society Himeji Hospital, Shimoteno 1-12-1, Himeji, Hyogo, 670-8540, Japan
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18
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Oguchi H. [5. Standard Dosimetry of Absorbed Dose to Water in External Beam Radiotherapy for Electron Beams -Focusing on Appendix]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:104-111. [PMID: 38246632 DOI: 10.6009/jjrt.2024-2301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
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Stoll M, Michel O. [The (forgotten) "Stoll table" from 2010 for the appendix to § 2 of the German statutory insurance system (VersMedV)]. HNO 2024; 72:41-43. [PMID: 38051312 DOI: 10.1007/s00106-023-01391-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 12/07/2023]
Affiliation(s)
| | - O Michel
- Institut für HNO-Begutachtung, HNO-Klinik, St. Franziskus-Hospital, Schönsteinstr. 63, 50825, Köln-Ehrenfeld, Deutschland.
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Bai M, Chen J, Xu Y, Feng J, Ma R, Jia H, Xu H, Liang G, Wei H. Bland-Altman agreement analysis between CT predicted and surgical peritoneal cancer index in pseudomyxoma peritonei of appendiceal origin. Sci Rep 2023; 13:21520. [PMID: 38057378 PMCID: PMC10700599 DOI: 10.1038/s41598-023-48975-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/02/2023] [Indexed: 12/08/2023] Open
Abstract
Peritoneal cancer index (PCI) is the surgical variable most commonly used to quantify the extent of peritoneal metastases for pseudomyxoma peritonei (PMP) patients. The present study aimed to investigate the agreement between CT predicted and surgical PCI by the Bland-Altman method for PMP of appendiceal origin. A total of 167 PMP patients of appendiceal origin were included between 2016 and 2021. Bland-Altman analysis was performed for both total PCI and selected PCI (regions 2 + 9-12). After the Bland-Altman plot was drawn, the mean bias and its 95% limit of agreements (LoAs) was quantified. Besides, the correlation coefficients between CT-PCI and surgical PCI were also been calculated. The Bland-Altman plot showed the mean bias ± SD between total CT-PCI and surgical PCI as 0.431 ± 3.005, with the LoAs from - 5.459 to 6.321. There were nine points of difference in total PCI exceeded the 95% LoAs, with the rate of 5.39% (9/167). As for selected CT-PCI, Bland-Altman plot showed the mean bias ± SD between selected CT-PCI and surgical PCI as - 0.287 ± 1.955, with the LoAs from - 4.118 to 3.544. There were ten points of difference in selected PCI exceeded the 95% LoAs, with the rate of 5.99% (10/167). The Spearman's rank correlation coefficient between total CT-PCI and surgical PCI was 0.911, P < 0.001, as for selected CT-PCI and surgical PCI, the coefficient was 0.909, P < 0.001. Although there was a strong correlation for both total and selected CT-PCI with surgical PCI, however, the agreement is still not good in Bland-Altman analysis, which suggested that CT-PCI cannot predict surgical PCI accurately even in professional PMP treatment centers. In brief explanation, CT makes it difficult to distinguish the borderline between tumor tissue and mucus and to detect tumor lesions in the small intestine regions, which caused overestimation or underestimation by CT-PCI. In the future, a multiple linear regression model based on CT-PCI might accurately predict surgical PCI preoperatively.
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Affiliation(s)
- Mingjian Bai
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, 100049, People's Republic of China
| | - Jingliang Chen
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, 100049, People's Republic of China
| | - Yueming Xu
- Department of Literature and Science, University of Wisconsin-Madison, Madison, WI, 50155, USA
| | - Jing Feng
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, 100049, People's Republic of China
| | - Ruiqing Ma
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Hongmin Jia
- Department of Radiology, Aerospace Center Hospital, Beijing, 100049, People's Republic of China
| | - Hongbin Xu
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Guowei Liang
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, 100049, People's Republic of China.
| | - Hongjiang Wei
- Department of Radiology, Aerospace Center Hospital, Beijing, 100049, People's Republic of China.
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Kusano S, Otsubo I, Miyazaki H, Kikuchi T, Fukuda Y, Mizuta N, Ashitani H, Tsunemi K, Toyokawa A. [Goblet Cell Carcinoid of the Appendix with Complicated Appendicitis-A Case Report]. Gan To Kagaku Ryoho 2023; 50:1965-1967. [PMID: 38303266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
A 50-year-old male was referred to our hospital for the further evaluation and treatment of abdominal pain. He was diagnosed with complicated appendicitis using computed tomography. After conservative treatment, he underwent an interval appendectomy. A histopathological examination revealed a goblet cell carcinoid(GCC)of the appendix with subserosal invasion. He underwent laparoscopic ileocecal resection with D3 lymph node dissection. Histopathological findings showed neither residual tumor nor lymph node metastasis. The patients is currently followed as an outpatient without recurrence. Here we report our experience with GCC, a rare disease.
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Affiliation(s)
- Shunsuke Kusano
- Dept. of Surgery, AIJINKAI Health Care Corporation Akashi Medical Center
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22
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Inagaki T, Tajima Y, Shimada Y, Nakano M, Nakano M, Abe K, Yamai D, Ozeki H, Muneoka Y, Ishikawa H, Kano Y, Ichikawa H, Takizawa K, Sakata J, Wakai T. [A Case of Appendiceal Carcinoma with BRAF V600E Mutation and Microsatellite Instability-High]. Gan To Kagaku Ryoho 2023; 50:1584-1586. [PMID: 38303349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
A 75-year-old woman presented to our hospital with abdominal pain and melena. Colonoscopy revealed an ulcer at the appendiceal orifice. Histopathological examination of biopsy specimens revealed adenocarcinoma. Computed tomography showed an appendiceal mass of 11.8×6.7 cm in size involving the cecum and terminal ileum without any distant metastatic findings. Ileocecal resection with regional lymph node dissection to the root of the ileocolonic artery was performed. Histopathological examination of the specimen revealed appendiceal adenocarcinoma. Molecular subtype of the tumor was BRAF V600E mutation and microsatellite instability-high(MSI-H). The pathological stage was pT4bpN1bcM0, pStage ⅢC. She received 8 courses of CapeOX as adjuvant chemotherapy and no recurrence was noted 12 months following the surgery. The establishment of standard treatment strategies including surgery, chemotherapy, and immunotherapy for carcinoma of the appendix with BRAF V600E mutation and/or MSI-H is needed.
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Affiliation(s)
- Tatsuki Inagaki
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
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Hoshino H, Ota H, Yamashita S, Ikushima H, Mizuno H. [A Case of Appendiceal Metastasis from Hilar Cholangiocarcinoma with Acute Perforated Appendicitis and Cholecystitis]. Gan To Kagaku Ryoho 2023; 50:1609-1611. [PMID: 38303357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
An 88-year-old woman had been diagnosed with hilar cholangiocarcinoma for 3 years since she received metallic stents for malignant biliary obstruction, and observed without any aggressive medical treatment. She was admitted to our hospital for further investigation of her abdominal pain. Abdominal CT showed an enlarged gallbladder, fluid collection in the right paracolic gutter, and swollen appendix. Laboratory tests showed high-grade inflammation. She was diagnosed with acute perforated appendicitis with acute cholecystitis. Laparoscopic cholecystectomy and appendectomy were performed. Perforation was confirmed intraoperatively in the appendix wall and accumulation of pus was found in the right paracolic gutter. There were no macroscopic findings of metastasis and peritoneal dissemination. Microscopic examination of the resected appendix showed adenocarcinoma cells positive for CK7 and negative for CK20 and CDX2, and were predominantly infiltrated from the muscular layer to the serosa of the appendix wall, with a diagnosis of appendiceal metastasis from hilar cholangiocarcinoma. Metastatic appendiceal carcinoma is rare, and appendiceal metastasis from hilar cholangiocarcinoma is extremely rare. Herein, we report a rare case of metastatic appendiceal carcinoma from hilar bile duct cancer with acute perforated appendicitis and cholecystitis along with findings of previous literature.
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Chen HY, Lee CY, Hsu CW, Yeh JH, Chen TH, Tsai KF, Chou CK. Double-endoscope endoscopic submucosal dissection with snare traction and loop stabilization for adenoma involving appendiceal orifice. Endoscopy 2023; 55:E1203-E1204. [PMID: 37989238 PMCID: PMC10762688 DOI: 10.1055/a-2197-8828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Hsin-Yu Chen
- School of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Cathay General Hospital, Taipei, Taiwan
| | - Chung-Ying Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chao-Wen Hsu
- Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Hao Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA DaChang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Tsung-Hsien Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Kun-Feng Tsai
- Department of Internal Medicine, Gastroenterology and Hepatology Section, An Nan Hospital, China Medical University, Tainan, Taiwan
- Department of Medical Sciences Industry, Chang Jung Christian University, Tainan, Taiwan
| | - Chu-Kuang Chou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Obesity center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
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Zeng Q, Tao Z, Liu J, Tao K, Shan X, Chen YL. Successful appendiceal incision by endoscopic submucosal dissection to allow endoscopic removal of an encapsulated fecalith. Endoscopy 2023; 55:E1156-E1157. [PMID: 37984398 PMCID: PMC10659826 DOI: 10.1055/a-2191-2475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Qingyu Zeng
- Department of Gastroenterology, Southwest Medical University, Luzhou, China
- Department of Gastroenterology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Zhang Tao
- Department of Gastroenterology, Southwest Medical University, Luzhou, China
- Department of Gastroenterology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Jie Liu
- Department of Gastroenterology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Kong Tao
- Department of Gastroenterology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Xu Shan
- Department of Gastroenterology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Ya Lan Chen
- Department of Gastroenterology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
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Narula N, Gibbs KE, Kong F, Mukherjee I. Appendiceal Intussusception, Diverticula, and Fecalith Associated With Appendicitis. Am Surg 2023; 89:6257-6259. [PMID: 36074037 DOI: 10.1177/00031348221126954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nisha Narula
- Department of Surgery, Staten Island University Hospital
| | - Karen E Gibbs
- Department of Surgery, Yale New Haven Health, Bridgeport, CT, USA
| | - Fanyi Kong
- Department of Pathology, Staten Island University Hospital, Staten Island, NY, USA
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Litchinko A, Botti P, Meurette G, Ris F, Dupuis A. A Unique Case of Perforated Appendicitis in a Giant Incarcerated Right-Sided Inguinal Hernia: Challenges and Surgical Management. Am J Case Rep 2023; 24:e941649. [PMID: 38018032 PMCID: PMC10697529 DOI: 10.12659/ajcr.941649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/25/2023] [Accepted: 09/25/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Amyand hernia is a rare condition described as the presence of the appendix within an inguinal hernia. The clinical presentation of can be atypical, depending on the length of the defect's history and the size of the hernia. As inguinal hernia repair is considered a routine surgical procedure, giant hernias are mostly encountered in countries with limited medical care or with patient rejection of surgical management. CASE REPORT We report a case of a 56-year-old patient with a history of a chronic giant inguinal-scrotal hernia for more than 10 years who presented himself to the Emergency Department with acute pain in the scrotum and fever. Computed tomography revealed a perforated appendicitis located in the inferior part of the scrotum. The patient underwent a surgical procedure with an inguinal and middle laparotomy approach, revealing a full incarceration of the right and traverse colon, terminal ileal loop, and omentum, along with evidence of a perforated appendicitis. Standard appendectomy and direct hernia repair were successfully performed. CONCLUSIONS To the best of our knowledge, this is the first case of a perforated appendicitis within a right giant inguinal hernia described in the modern English-language literature. Rare in our daily practice, giant hernias are a real challenge regarding their surgical management during and after surgery, making this case with a perforated appendicitis even more arduous.
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Affiliation(s)
- Alexis Litchinko
- Department of Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Paul Botti
- Department of Radiology, Geneva University Hospital, Geneva, Switzerland
| | - Guillaume Meurette
- Department of Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Frédéric Ris
- Department of Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Arnaud Dupuis
- Department of Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
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Xing XC, Yang JL, Xiao X. Clinical features, treatments and prognosis of appendiceal bleeding: a case series study. BMC Gastroenterol 2023; 23:377. [PMID: 37924017 PMCID: PMC10625278 DOI: 10.1186/s12876-023-03025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/01/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Appendiceal bleeding is a rare cause of lower gastrointestinal bleeding, could be overlooked and diagnosed as obscure gastrointestinal bleeding. Due to limited real-world cases, the optimized management of appendiceal bleeding is unclear. We here shared our experiences in the past 20 years. METHODS A retrospective study was conducted at West China Hospital of Sichuan University. We reviewed data of 28,175 colonoscopies from 43,095 gastrointestinal bleeding patients between June 2003 and June 2023. Six patients diagnosed as appendiceal bleeding were included. Data including symptoms, laboratory tests, imaging results, endoscopic findings, treatment and prognosis were collected and analyzed. RESULTS Appendiceal bleeding accounts for 0.014% in gastrointestinal bleeding patients. Of the six patients, five were male, with a mean age of 48.5 years. Hematochezia was the most common symptom. The etiology included appendiceal angiodysplasia, appendicitis and appendectomy associated bleeding. Hemostasis was achieved by appendectomy, endoscopic therapy or medication according to different cases. One patient did not receive any treatment because of self-limiting bleeding. CONCLUSIONS The diagnosis of appendiceal bleeding is challenging, repeated flushing during endoscopy is helpful. Appendectomy is the priority option for treatment as well as the etiology clarification, therapeutic endoscopy and medication could be considered case by case.
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Affiliation(s)
- Xiao-Cun Xing
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer, Chengdu, China
| | - Jin-Lin Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer, Chengdu, China
| | - Xue Xiao
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer, Chengdu, China.
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Zhao B, Wang J, Ye H, Cheng X, Meng K, Yang T. Mixed adenoneuroendocrine carcinoma originating from the appendix and colorectum: a comparative analysis of a large population-based database. Tech Coloproctol 2023; 27:1017-1024. [PMID: 36995458 DOI: 10.1007/s10151-023-02786-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE As a rare gastrointestinal neoplasm, the demographic, clinicopathological, and prognostic characteristics of mixed adenoneuroendocrine carcinoma (MANEC) remain unclear. The purpose of this study was to evaluate its biological features, survival outcome, and prognostic factors. METHODS From the Surveillance, Epidemiology, and End Results (SEER) database, we retrospectively reviewed clinicopathological and survival data of 513 patients who were histopathologically diagnosed with MANEC of the appendix and colorectum bettween 2004 and 2015. The clinicopathological features and survival outcomes of MANEC located at different anatomical locations were compared, and predictive factors for cancer-specific survival (CSS) and overall survival (OS) were assessed. RESULTS In terms of anatomical distribution of MANEC, the appendix (64.5%, 331/513) was more frequently involved, followed by colon (28.1%, 144/513) and rectum (7.4%, 38/513). The MANEC at different anatomical locations had a distinct clinicopathological characteristic, and colorectal MANEC was significantly associated with more aggressive biological features. The survival outcomes of appendiceal MANEC were significantly better than that of colorectal MANEC (3-year CSS rate 73.8% vs 59.4%, P = 0.010; 3-year OS 69.2% vs 48.3%, P < 0.001). In addition, hemicolectomy had a better survival benefit than appendicectomy for patients with appendiceal MANEC, regardless of lymph node metastasis (P < 0.05). Tumor location, histology grade III, tumor size > 2 cm, T3-T4 stage, lymph node metastasis, and distant metastasis were independent prognostic factors for patients with MANEC. CONCLUSIONS Tumor location had an important prognostic significance for MANEC. As an uncommon clinical entity, colorectal MANEC had more aggressive biological features and worse prognosis than its appendiceal counterpart. The standard surgical procedure and clinical management strategy for MANEC need to be established.
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Affiliation(s)
- Bochao Zhao
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China.
| | - Jingchao Wang
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China
| | - Haikun Ye
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China
| | - Xinghao Cheng
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China
| | - Kewei Meng
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China
| | - Tao Yang
- Department of Gastrointestinal Surgery, Tianjin First Central Hospital, No.24 Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China.
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Appendix 1: Macro Policy Data Collection Template. Healthc Policy 2023; 19:1-4. [PMID: 37850700 DOI: 10.12927/hcpol.2023.27186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
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Appendix 3: Program Implementation Data Collection Tool. Healthc Policy 2023; 19:1-6. [PMID: 37850699 DOI: 10.12927/hcpol.2023.27185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
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Badri D, Cooper S, Matheson D, Dissanayake T. Appendicular deciduosis: an alternate cause for the acute abdomen in pregnancy. ANZ J Surg 2023; 93:2515-2516. [PMID: 37443457 DOI: 10.1111/ans.18591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Danniel Badri
- Department of Surgery, Sunshine Coast University Hospital, Kawana Waters, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Scott Cooper
- Department of Surgery, Sunshine Coast University Hospital, Kawana Waters, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Matheson
- Department of Pathology, Sunshine Coast University Hospital, Kawana Waters, Queensland, Australia
| | - Thushara Dissanayake
- Department of Surgery, Sunshine Coast University Hospital, Kawana Waters, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Kurt E, Turanli S. How to manage localized low-grade appendiceal mucinous neoplasm? Cir Esp 2023; 101:729-731. [PMID: 36410643 DOI: 10.1016/j.cireng.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Emine Kurt
- SBU, Ankara Oncology Education and Research Hospital, Department of General Surgery, Ankara, Turkey
| | - Sevim Turanli
- SBU, Ankara Oncology Education and Research Hospital, Department of Surgical Oncology, Ankara Turkey.
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Figueiredo M, Yzet C, Wallenhorst T, Rivory J, Rostain F, Schaefer M, Chevaux JB, Leblanc S, Lépilliez V, Corre F, Rahmi G, Jacques J, Albouys J, Pioche M. Endoscopic submucosal dissection of appendicular lesions is feasible and safe: a retrospective multicenter study (with video). Gastrointest Endosc 2023; 98:634-638. [PMID: 37380005 DOI: 10.1016/j.gie.2023.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/01/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is challenging for appendicular lesions. We report the outcomes of ESD in this context. METHODS We collected data of ESD procedures for appendiceal neoplasia in a multicenter prospective registry. Main study endpoints were R0, en-bloc, and curative resection rates and adverse event rate. RESULTS One hundred twelve patients were included, 47 (42%) with previous appendectomy. Fifty-six (50%) were Toyonaga type 3 lesions (15 [13.4%] postappendectomy). En-bloc and R0 resection rates were 86.6% and 80.4%, respectively, with no significant difference associated with different grades of appendiceal invasion (P = .9 and P = .4, respectively) or previous appendectomy (P = .3 for both). The curative resection rate was 78.6%. Additional surgery was performed in 16 cases (14.3%), including 10 (62.5%) Toyonaga type 3 lesions (P = .04). This included the treatment of 5 cases (4.5%) of delayed perforation and 1 acute appendicitis. CONCLUSIONS ESD for appendicular lesions is a potentially safer and effective alternative to surgery for a significant proportion of patients.
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Affiliation(s)
- Mariana Figueiredo
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Clara Yzet
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Timothée Wallenhorst
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Florian Rostain
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Marion Schaefer
- Endoscopy and Gastroenterology Unit, Nancy University Hospital, Nancy, France
| | | | - Sarah Leblanc
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Vincent Lépilliez
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Felix Corre
- Endoscopy and Gastroenterology Unit, Hôpital Cochin, Paris, France
| | - Gabriel Rahmi
- Gastroenterology and Endoscopy Unit, Hôpital Européen Georges Pompidou, Paris, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Jérémie Albouys
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Kingdom J, Ashwal E, Lausman A, Liauw J, Soliman N, Figueiro-Filho E, Nash C, Bujold E, Melamed N. Guideline No. 442: Fetal Growth Restriction: Screening, Diagnosis, and Management in Singleton Pregnancies. J Obstet Gynaecol Can 2023; 45:102154. [PMID: 37730302 DOI: 10.1016/j.jogc.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Fetal growth restriction is a common obstetrical complication that affects up to 10% of pregnancies in the general population and is most commonly due to underlying placental diseases. The purpose of this guideline is to provide summary statements and recommendations to support a clinical framework for effective screening, diagnosis, and management of pregnancies that are either at risk of or affected by fetal growth restriction. TARGET POPULATION All pregnant patients with a singleton pregnancy. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in this guideline should increase clinician competency to detect fetal growth restriction and provide appropriate interventions. EVIDENCE Published literature in English was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library through to September 2022 using appropriate controlled vocabulary via MeSH terms (fetal growth retardation and small for gestational age) and key words (fetal growth, restriction, growth retardation, IUGR, FGR, low birth weight, small for gestational age, Doppler, placenta, pathology). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Grey literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Table A1 for definitions and Table A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Obstetricians, family physicians, nurses, midwives, maternal-fetal medicine specialists, radiologists, and other health care providers who care for pregnant patients. TWEETABLE ABSTRACT Updated guidelines on screening, diagnosis, and management of pregnancies at risk of or affected by FGR. SUMMARY STATEMENTS RECOMMENDATIONS: Prediction of FGR Prevention of FGR Detection of FGR Investigations in Pregnancies with Suspected Fetal Growth Restriction Management of Early-Onset Fetal Growth Restriction Management of Late-Onset FGR Postpartum management and preconception counselling.
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Adams S, Swift K, Brunott N. Appendiceal fistula causing massive abdominal wall abscess. ANZ J Surg 2023; 93:2513-2514. [PMID: 37314052 DOI: 10.1111/ans.18571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/07/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Stephanie Adams
- Division of Surgery, Cairns Hospital, Cairns, Queensland, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Swift
- Division of Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Nathan Brunott
- Division of Surgery, Cairns Hospital, Cairns, Queensland, Australia
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Appendix 4. Program Integration Rating Tool. Healthc Policy 2023; 19:1-4. [PMID: 37850698 DOI: 10.12927/hcpol.2023.27184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
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Arredondo Montero J, Torres López A, Hurtado Ilzarbe G, Antona G, Ros Briones R, López-Andrés N, Martín-Calvo N. Flow cytometric characterization of cecal appendix lymphocyte subpopulations in children: a pilot study. Pediatr Surg Int 2023; 39:274. [PMID: 37736768 PMCID: PMC10516785 DOI: 10.1007/s00383-023-05558-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Scientific literature regarding the characterization of lymphocyte subpopulations of the cecal appendix is sparse, with few precedents limited to immunohistochemical techniques. METHODS We conducted a prospective pilot study to characterize lymphocyte subpopulations of the cecal appendix in children. Participants were divided into three groups: (1) patients without histological acute appendiceal inflammation, (2) patients with histological uncomplicated acute appendicitis, and (3) patients with histological complicated acute appendicitis (gangrenous, perforated). A fresh sample of the base of the appendix was taken from all patients and a flow cytometric study was performed. Quantitative variables were compared using Kruskal-Wallis test and Mann-Whitney U test. RESULTS This study included 57 patients divided into Group 1 (n = 5), Group 2 (n = 37), and Group 3 (n = 15). Median values (IQR) of the percentage of B-lymphocytes were 67.8 [66.8-68.1] in group 1, 61.15 [53.74-66.4] in group 2, and 52.1 [33-62.02] in group 3 (p = 0.02). Median values (IQR) of the percentage of NK-lymphocytes were 0.26 [0.2-0.3] in group 1, 0.55 [0.37-0.66] in group 2, and 0.84 [0.35-1.45] in group 3 (p = 0.008). Median values (IQR) of the percentage of T-lymphocytes were 31.9 [31.7-33.1] in group 1, 37.68 [32.15-45.69] in group 2, and 46.9 [37.03-67] in group 3 (p = 0.02). Pair comparisons of groups 2 and 3 also showed significant differences in the percentage of B lymphocytes (p = 0.03) and NK-lymphocytes (p = 0.02). CONCLUSIONS Significant differences in lymphocyte subpopulations were identified according to the histologic grade of the cecal appendix. More specifically, a lower percentage of B-lymphocytes and a higher percentage of T- and NK-lymphocytes were observed in cases of acute appendicitis. These findings must be confirmed and their etiopathogenic, diagnostic, and prognostic implications elucidated in future studies with larger sample sizes.
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Affiliation(s)
- Javier Arredondo Montero
- Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain.
- Preventive Medicine and Public Health Department, School of Medicine, University of Navarra, Pamplona, Navarra, Spain.
| | - Andrea Torres López
- Hematology and Haemotherapy Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | | | - Giuseppa Antona
- Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Raquel Ros Briones
- Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Natalia López-Andrés
- Cardiovascular Translational Research, NavarraBiomed (Miguel Servet Foundation), Hospital Universitario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain
| | - Nerea Martín-Calvo
- Preventive Medicine and Public Health Department, School of Medicine, University of Navarra, Pamplona, Navarra, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Health Institute Carlos III, Madrid, Spain
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Süleyman M, Senlikci A, Durhan A, Kosmaz K. Incidental presentation of appendix neuroendocrine tumor: Long-term results from a single institution. ULUS TRAVMA ACIL CER 2023; 29:972-977. [PMID: 37681719 PMCID: PMC10560821 DOI: 10.14744/tjtes.2023.78038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/24/2023] [Accepted: 05/01/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Appendix neuroendocrine tumors (NETs) are the most common tumors of the appendix and are most often diagnosed incidentally. The aim of this study was to retrospectively evaluate appendix NETs diagnosed incidentally in our clinic. METHODS Of 8304 patients who underwent appendectomy with the diagnosis of acute appendicitis in Ankara Training and Re-search Hospital, General Surgery Clinic between January 2009 and January 2022, 33 had histopathology results evaluated as appendix NET, and a retrospective analysis was made of these cases. The patients were evaluated in terms of age, gender, tumor infiltration, tumor location, tumor size, surgical margin, tumor World Health Organization grade, surgery performed, lymph node metastasis, Ki67 index, number of mitosis, follow-up time, and survival. RESULTS The rate of appendix NET was found to be 0.4%. The 33 cases comprised 15 (45.5%) males and 18 (54.5%) females with a mean age of 35.48 years (range: 16-84 years). Positive surgical margin was determined in 1 (3.03%) case, in which right hemicolectomy was performed. All other cases were followed up after appendectomy. The median follow-up was 89 (7-145) months. No recurrence was observed in any case. Mortality developed during follow-up in one case due to non-tumoral causes. CONCLUSION Appendix NETs are generally asymptomatic and appear incidentally after appendectomy due to acute appendicitis. Appendix NETs diagnosed incidentally are generally below 2 cm and have a good prognosis.
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Affiliation(s)
- Marlen Süleyman
- Department of General Surgery, Ankara Training and Research Hospital, Ankara-Türkiye
| | - Abdullah Senlikci
- Department of General Surgery, Ankara Training and Research Hospital, Ankara-Türkiye
| | - Abdullah Durhan
- Department of General Surgery, Ankara Training and Research Hospital, Ankara-Türkiye
| | - Koray Kosmaz
- Department of General Surgery, Ankara Training and Research Hospital, Ankara-Türkiye
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He K, Cramm SL, Rangel SJ. Contemporary Epidemiology of and Risk Factors Associated with Removal of a Pathologically Normal Appendix in Children with Suspected Appendicitis. J Pediatr Surg 2023; 58:1613-1617. [PMID: 37130766 DOI: 10.1016/j.jpedsurg.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/20/2023] [Accepted: 04/04/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND The goal of this study was to characterize contemporary performance benchmarks and risk factors associated with negative appendectomy (NA) in children with suspected appendicitis. METHODS A multicenter retrospective cohort analysis of children undergoing appendectomy for suspected appendicitis was performed using data from the 2016-2021 NSQIP-Pediatric Appendectomy Targeted Public Use Files. Multivariable regression was used to evaluate the influence of year, age, sex, and WBC count on NA rate, and to generate rate estimates for NA based on different combinations of demographic characteristics and WBC profiles. RESULTS 100,322 patients were included from 140 hospitals. The overall NA rate was 2.4%, and rates decreased significantly during the study period (2016: 3.1% vs. 2021: 2.3%, p < 0.001). In adjusted analyses, the highest risk for NA was associated with a normal WBC (<9000/mm3; OR 5.31 [95% CI: 4.87-5.80]), followed by female sex (OR 1.55 [95% CI: 1.42-1.68]) and age <5 years (OR 1.64 [95% CI 1.39, 1.94]). Model-estimated risk for NA varied significantly across demographic and WBC strata, with a 14.4-fold range in rates between subgroups with the lowest and highest predicted risk (males 13-17 years with elevated WBC [1.1%] vs. females 3-4 years with normal WBC [15.8%]). CONCLUSIONS Contemporary NA rates have decreased over time, however NA risk remains high in children without a leukocytosis, particularly for girls and children <5 years of age. These data provide contemporary performance benchmarks for NA in children with suspected appendicitis and identify high-risk populations where further efforts to mitigate NA risk should be targeted. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Katherine He
- Boston Children's Hospital, Department of Surgery, United States
| | - Shannon L Cramm
- Boston Children's Hospital, Department of Surgery, United States
| | - Shawn J Rangel
- Boston Children's Hospital, Department of Surgery, United States.
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Niles KM, Jain V, Chan C, Choo S, Dore S, Kiely DJ, Lim K, Roy Lacroix ME, Sharma S, Waterman E. Guideline No. 441: Antenatal Fetal Health Surveillance. J Obstet Gynaecol Can 2023; 45:665-677.e3. [PMID: 37661122 DOI: 10.1016/j.jogc.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To summarize the current evidence and to make recommendations for antenatal fetal health surveillance (FHS) to detect perinatal risk factors and potential fetal decompensation in the antenatal period and to allow for timely intervention to prevent perinatal morbidity and/or mortality. TARGET POPULATION Pregnant individuals with or without maternal, fetal, or pregnancy-associated perinatal risk factors for antenatal fetal decompensation. OPTIONS To use basic and/or advanced antenatal testing modalities, based on risk factors for potential fetal decompensation. OUTCOMES Early identification of potential fetal decompensation allows for interventions that may support fetal adaptation to maintain well-being or expedite delivery. BENEFITS, HARMS, AND COSTS Antenatal FHS in pregnant individuals with identified perinatal risk factors may reduce the chance of adverse outcomes. Given the high false-positive rate, FHS may increase unnecessary interventions, which may result in harm, including parental anxiety, premature or operative birth, and increased use of health care resources. Optimization of surveillance protocols based on evidence-informed practice may improve perinatal outcomes and reduce harm. EVIDENCE Medline, PubMed, Embase, and the Cochrane Library were searched from inception to January 2022, using medical subject headings (MeSH) and key words related to pregnancy, fetal monitoring, fetal movement, stillbirth, pregnancy complications, and fetal sonography. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All health care team members who provide care for or education to obstetrical patients, including maternal fetal medicine specialists, obstetricians, family physicians, midwives, nurses, nurse practitioners, and radiologists. SUMMARY STATEMENTS RECOMMENDATIONS.
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Nomura T, Sugimoto S, Ito K. Colorectal endoscopic submucosal dissection with a calibrated, small-caliber tip, transparent hood for tumors in the appendiceal orifice. Dig Endosc 2023; 35:e123-e124. [PMID: 37526072 DOI: 10.1111/den.14638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023]
Abstract
Watch a video of this article.
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Affiliation(s)
- Tatsuma Nomura
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
- Department of Gastroenterology, Mie Prefectural Shima Hospital, Mie, Japan
| | - Shinya Sugimoto
- Department of Gastroenterology, Ise Red Cross Hospital, Mie, Japan
| | - Keiichi Ito
- Department of Gastroenterology, Mie Prefectural Shima Hospital, Mie, Japan
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Tal A, Grinstein A, Kleijnen M. Weighing heavy: Heavy serving dishes increase food serving. PLoS One 2023; 18:e0288956. [PMID: 37624814 PMCID: PMC10456203 DOI: 10.1371/journal.pone.0288956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/10/2023] [Indexed: 08/27/2023] Open
Abstract
The current work demonstrates that people serve themselves greater amounts of food when carrying heavier serving dishes. This effect occurs because increases in carried weight lower consumers' sensitivity to the weight of the food served. Decreased sensitivity to weight of food served in turn leads people to continue serving past the point where they would normally stop. The paper demonstrates this effect across two lab studies involving actual food serving (with a third lab study extending the outcomes to unhealthy food choices reported in the S1 Appendix). The studies also demonstrate liking for the food moderates the effect, such that carrying greater weight leads people to serve an increased amount of liked, but not of less well liked, foods. The findings extend prior research regarding the effects of dish weight on food judgment to provide a first demonstration of effects of weight not only on judgment but on behavior. In this, they help expand our understanding of the ways in which elements in the eating environment effects food consumption. In addition, the studies provide initial evidence for the mechanism behind the phenomenon: reduced sensitivity to weight. The research carries important implications for public well being, given that increases in serving sizes may contribute to obesity.
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Affiliation(s)
- Aner Tal
- College of Law and Business, Ramat-Gan, Israel
| | - Amir Grinstein
- Northeastern University, Boston, Massachusetts, United States of America
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Köhler F, Matthes N, Rosenfeldt M, Kunzmann V, Germer CT, Wiegering A. Neoplasms of the Appendix. Dtsch Arztebl Int 2023; 120:519-525. [PMID: 37282595 PMCID: PMC10534129 DOI: 10.3238/arztebl.m2023.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Neoplasms of the vermiform appendix are rare. They comprise a heterogeneous group of entities requiring differentkinds of treatment. METHODS This review is based on publications retrieved by a selective literature search in the PubMed, Embase, and Cochranedatabases. RESULTS 0.5% of all tumors of the gastrointestinal tract arise in the appendix. Their treatment depends on their histopathologicalclassification and tumor stage. The mucosal epithelium gives rise to adenomas, sessile serrated lesions, adenocarcinomas,goblet-cell adenocarcinomas, and mucinous neoplasms. Neuroendocrine neoplasms originate in neuroectodermal tissue. Adenomasof the appendix can usually be definitively treated by appendectomy. Mucinous neoplasms, depending on their tumorstage, may require additional cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC). Adeno -carcinomas and goblet-cell adenocarcinomas can metastasize via the lymphatic vessels and the bloodstream and should thereforebe treated by oncological right hemicolectomy. Approximately 80% of neuroendocrine tumors are less than 1 cm in diameterwhen diagnosed and can therefore be adequately treated by appendectomy; right hemicolectomy is recommended if the patienthas risk factors for metastasis via the lymphatic vessels. Systemic chemotherapy has not been shown to be beneficial forappendiceal neoplasms in prospective, randomized trials; it is recommended for adenocarcinomas and goblet-cell adenocarcinomasof stage III or higher, in analogy to the treatment of colorectal carcinoma.
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Affiliation(s)
- Franziska Köhler
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Germany
| | - Niels Matthes
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Germany
| | - Mathias Rosenfeldt
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Germany
- Institute of Pathology, University of Würzburg, Germany
| | - Volker Kunzmann
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Germany
- Medical Clinic and Polyclinic II, University Hospital of Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Würzburg, Germany
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Sánchez NG, Estrada-Ortíz FA, Peñarrieta-Daher AA, Padilla-Rodríguez AL. Tri-luminal septate appendix: A morphologic variant of septa with muscularis propria. Rev Gastroenterol Mex (Engl Ed) 2023; 88:289-290. [PMID: 37117132 DOI: 10.1016/j.rgmxen.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/08/2022] [Indexed: 04/30/2023]
Affiliation(s)
- N G Sánchez
- DIGIPATH: Digital Pathology Laboratory, Instituto Tecnológico y de Estudios Superiores de Monterrey Campus Ciudad de México, Mexico City, Mexico
| | - F A Estrada-Ortíz
- Instituto Tecnológico y de Estudios Superiores de Monterrey Campus Ciudad de México, Mexico City, Mexico
| | - A A Peñarrieta-Daher
- Hospital Infantil de México Federico Gómez, Star Médica Hospital Infantil Privado, Mexico City, Mexico
| | - A L Padilla-Rodríguez
- DIGIPATH: Digital Pathology Laboratory, Escuela de Medicina Universidad Panamericana Campus Ciudad de México, Escuela de Medicina Instituto Tecnológico y de Estudios Superiores de Monterrey Campus Ciudad de México, Mexico City, Mexico.
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Panteli D, Polin K, Webb E, Allin S, Barnes A, Degelsegger-Márquez A, Ghafur S, Jamieson M, Kim Y, Litvinova Y, Nimptsch U, Parkkinen M, Rasmussen TA, Reichebner C, Röttger J, Rumball-Smith J, Scarpetti G, Seidler AL, Seppänen J, Smith M, Snell M, Stanimirovic D, Verheij R, Zaletel M, Busse R. Health and Care Data: Approaches to data linkage for evidence-informed policy. Health Syst Transit 2023; 25:1-248. [PMID: 37489953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
An indispensable prerequisite for answering research questions in health services research is the availability and accessibility of comprehensive, high-quality data. It can be assumed that health services research in the coming years will be increasingly based on data linkage, i.e., the linking, or connecting, of several data sources based on suitable common key variables. A range of approaches to data collection, storage, linkage and availability exists across countries, particularly for secondary research purposes (i.e., the use of data initially collected for other purposes), such as health systems research. The main goal of this review is to develop an overview of, and gain insights into, current approaches to linking data sources in the context of health services research, with the view to inform policy, based on existing practices in high-income countries in Europe and beyond. In doing so, another objective is to provide lessons for countries looking for possible or alternative approaches to data linkage. Thirteen country case studies of data linkage approaches were selected and analysed. Rather than being comprehensive, this review aimed to identify varied and potentially useful case studies to showcase different approaches to data linkage worldwide. A conceptual framework was developed to guide the selection and description of case studies. Information was first identified and collected from publicly available sources and a profile was then created for each country and each case study; these profiles were forwarded to appropriate country experts for validation and completion. The report presents an overview of the included countries and their case studies (Chapter 2), with key data per country and case study in the appendices. This is followed by a closer look at the possibilities of using routine data (Chapter 3); the different approaches to linkage (Chapter 4); the different access routes for researchers (Chapter 5); the use of data for research from electronic patient or health records (Chapter 6); foundational considerations related to data safety, privacy and governance (Chapter 7); recent developments in cross-border data sharing and the European Health Data Space (Chapter 8); and considerations of changes and responses catalysed by the COVID-19 pandemic as related to the generation and secondary use of data (Chapter 9). The review ends with overall conclusions on the necessary characteristics of data to inform research relevant for policy and highlights some insights to inspire possible future solutions - less or more disruptive - for countries looking to expand their use of data (Chapter 10). It emphasises that investing in data linkage for secondary use will not only contribute to the strengthening of national health systems, but also promote international cooperation and contribute to the international visibility of scientific excellence.
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Affiliation(s)
| | | | - Erin Webb
- European Observatory on Health Systems and Policies
| | | | | | | | | | | | - Yoon Kim
- Seoul National University College of Medicine
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Xie F, Wang L, Chen L, Li S, Shen Q, Li X, Liu T, Chen Y, Wang D. Clinical Characteristics of Pediatric Patients With Septic Shock Caused by Acute Appendicitis: A Case Series. Pediatr Emerg Care 2023; 39:511-515. [PMID: 37083643 PMCID: PMC10317293 DOI: 10.1097/pec.0000000000002946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVES This study aimed to explore the clinical characteristics of septic shock in pediatric patients caused by acute appendicitis. METHODS This case series included patients with septic shock caused by acute appendicitis in Beijing Children's Hospital between January 2015 and December 2020. RESULTS Six patients with septic shock caused by acute appendicitis were enrolled. One patient was an infant with extremely low weight; 2 patients were obese. The diagnosis was delayed in 4 patients (the time from onset to diagnosis was 5 days in 3 children and 4 days in 1 child). All patients had abnormally raised inflammatory markers (C-reactive protein 119.17 ± 48.36 mg/L, procalcitonin 129.95 ± 86.09 ng/mL). Severe abdominal infection was found in all patients. There was appendix perforation in 4 patients and diffused peritonitis in 3 patients. Two patients had metabolic diseases (Wilson disease and decreased biotinase activity, respectively). Five patients had an appendectomy and 1 patient received conservative treatment. Five patients were discharged in stable condition, while 1 patient died. CONCLUSIONS Children with delayed diagnosis, abnormal body weight, significant elevation in inflammatory markers, and underlying metabolic disease may be at greater risk of complicated appendicitis and septic shock. EVIDENCEBASED MEDICINE Level of Evidence: IV.
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Affiliation(s)
| | - Li Wang
- From the Departments of Emergency Surgery
| | - Long Chen
- From the Departments of Emergency Surgery
| | | | | | | | | | - Yongwei Chen
- Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Gabrielson A, Li O, Cohen AJ. Robotic-Assisted Augmented Roof Ureteroplasty With Appendiceal Onlay Flap. Urology 2023; 176:243-245. [PMID: 36894030 DOI: 10.1016/j.urology.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/29/2023] [Accepted: 02/05/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Mid-to-proximal ureteral strictures pose a surgical challenge that historically required ileal ureter substitution, downward nephropexy, or renal autotransplantation. Ureteral reconstruction techniques involving buccal mucosa or appendix have gained traction with success rates approaching 90%. OBJECTIVES In this video we describe surgical technique for a robotic-assisted augmented roof ureteroplasty using an appendiceal onlay flap. MATERIALS AND METHODS Our patient is a 45-year-old male with recurrent impacted ureteral stones requiring multiple right-sided interventions including ureteroscopy with laser lithotripsy, ureteral dilation, and laser incision of ureteral stricture. Despite adequate treatment of his stone disease, he had deterioration of his renal split function with worsening right hydroureteronephrosis to the level of the mid-to-proximal ureter consistent with failed endoscopic management of his stricture. We proceeded with simultaneous endoscopic evaluation and robotic repair with plan for either ureteroureterostomy or augmented roof ureteroplasty using buccal mucosa or an appendiceal flap. RESULTS Reteroscopy and retrograde pyelogram revealed a 2-3 cm near-obliterative stricture in the mid-to-proximal ureter. The ureteroscope was left in situ and the patient was placed in the modified flank position to allow concurrent endoscopic access during reconstruction. The right colon was reflected revealing significant scar tissue overlying the ureter. With the ureteroscope in situ, we utilized firefly imaging to aid in our dissection. The ureter was spatulated and mucosa of the diseased segment of ureter excised in a nontransecting manner. The mucosal edges of the posterior ureter were re-approximated with the ureteral backing left in place. Intraoperatively, we identified a healthy, robust appearing appendix and thus planned for an appendiceal onlay flap. If an atretic or diseased appendix was encountered, a buccal mucosa graft with omental wrap would be utilized. The appendix was harvested on its mesentery, spatulated, and interposed in a pro-peristaltic fashion. A tension-free anastomosis was performed between ureteral mucosa and the open appendix flap. A double-J stent was placed under direct vision and Indocyanine Green (ICG) green was used to evaluate blood supply to the margins of the ureter and the appendix flap. The stent was removed 6 weeks postoperatively, and on 3-month follow-up imaging he had resolution of his right hydroureteronephrosis and has had no further episodes of stone formation, infections, or flank pain with 8-month follow-up. CONCLUSION Augmented roof ureteroplasty with appendiceal onlay is a valuable tool in the urologists arsenal of reconstructive techniques. Use of intraoperative ureteroscopy with firefly imaging can aid in delineating anatomy during difficult ureteral dissections.
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Affiliation(s)
- Andrew Gabrielson
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins, University School of Medicine, Baltimore, MD
| | - Oscar Li
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins, University School of Medicine, Baltimore, MD
| | - Andrew J Cohen
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins, University School of Medicine, Baltimore, MD.
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Arredondo Montero J, Bardají Pascual C, Antona G, Ros Briones R, López-Andrés N, Martín-Calvo N. The BIDIAP index: a clinical, analytical and ultrasonographic score for the diagnosis of acute appendicitis in children. Pediatr Surg Int 2023; 39:175. [PMID: 37038002 PMCID: PMC10085908 DOI: 10.1007/s00383-023-05463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Pediatric acute appendicitis (PAA) continues to be a diagnostic challenge today. The diagnostic performance of classical indices is only moderate, especially in pediatric population. This study aimed to define a clinical, radiological and analytical index for the diagnosis of PAA. MATERIALS AND METHODS This prospective study included 151 patients divided into two groups: (1) 53 patients with non-surgical abdominal pain (NSAP) and (2) 98 patients with a confirmed PAA. Sociodemographic and clinical characteristics were compared between groups using the Mann-Whitney U test and the Fisher exact test. To identify the predictors of PAA, we performed a multivariable logistic regression using a forward stepwise analysis and we assigned multiples of integer values to the selected variables. The diagnostic performance of the index was assessed by calculating the area under the receiver operating characteristic curve. Intra-cohort calibration was assessed with the Hosmer-Lemeshow test. RESULTS We developed the BIDIAP index (BIomarkers for the DIagnosis of Appendicitis in Pediatrics), which included three variables that independently predicted higher odds of PAA: appendiceal caliber (≥ 6.9 mm), systemic immune-inflammation index (≥ 890) and peritoneal irritation, which scored 4, 3 and 2 points, respectively. Mean (SD) score of the participants was 2.38 (2.06) in group 1 and 7.89 (1.50) in group 2. The area under the ROC was 0.97 (95% CI 0.95-0.99). The cut-off point was established at 4 points, resulting in a sensitivity of 98.98% and a specificity of 77.78%. CONCLUSIONS The BIDIAP index has an exceptional diagnostic performance in PAA. The importance of these results lies in its novelty and in the simplicity of the index. Although external validation will be necessary, initial results look promising.
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Affiliation(s)
- Javier Arredondo Montero
- Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain.
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Navarra, Spain.
| | - Carlos Bardají Pascual
- Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Giuseppa Antona
- Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Raquel Ros Briones
- Pediatric Surgery Department, Hospital Universitario de Navarra, Calle Irunlarrea 3, 31008, Pamplona, Navarra, Spain
| | - Natalia López-Andrés
- Cardiovascular Translational Research, NavarraBiomed (Miguel Servet Foundation), Hospital Universitario de Navarra, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain
| | - Nerea Martín-Calvo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Navarra, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
- CIBER de Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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Lin HA, Lin LT, Lin SF. Application of Artificial Neural Network Models to Differentiate Between Complicated and Uncomplicated Acute Appendicitis. J Med Syst 2023; 47:38. [PMID: 36952043 DOI: 10.1007/s10916-023-01932-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/27/2023] [Indexed: 03/24/2023]
Abstract
Preoperative prediction of complicated appendicitis is challenging, and many clinical tools are developed to predict complicated appendicitis. This study evaluated whether a supervised learning method can recognize complicated appendicitis in emergency department (ED). Consecutive patients with acute appendicitis presenting to the ED were enrolled and included into training and testing datasets at a ratio of 70:30. The multilayer perceptron artificial neural network (ANN) models were trained to perform binary outcome classification between uncomplicated and complicated acute appendicitis. Measures of sensitivity, specificity, positive and negative likelihood ratio (LR + and LR-), and a c statistic of a receiver of operating characteristic curve were used to evaluate an ANN model. The simplest ANN model by Bröker et al. including the C-reactive protein (CRP) and symptom duration as variables achieved a c statistic value of 0.894. The ANN models developed by Avanesov et al. including symptom duration, appendiceal diameter, periappendiceal fluid, extraluminal air, and abscess as variables attained a high diagnostic performance (a c statistic value of 0.949) and good efficiency (sensitivity of 78.6%, specificity of 94.5%, LR + of 14.29, LR- of 0.23 in the testing dataset); and our own model by H.A. Lin et al. including the CRP level, neutrophil-to-lymphocyte ratio, fat-stranding sign, appendicolith, and ascites exhibited high accuracy (c statistic of 0.950) and outstanding efficiency (sensitivity of 85.7%, specificity of 91.7%, LR + of 10.36, LR- of 0.16 in the testing dataset). The ANN models developed by Avanesov et al. and H.A. Lin et al. developed model exhibited a high diagnostic performance.
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Affiliation(s)
- Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, 250 Wu-Hsing Street, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine , Taipei Medical University, Taipei, Taiwan
| | - Li-Tsung Lin
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sheng-Feng Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, 250 Wu-Hsing Street, Taipei, Taiwan.
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei, Taiwan.
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, Taiwan.
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