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PubMed1986

Neuromas of the appendix. A light-microscopic, immunohistochemical and electron-microscopic study of 20 cases.

The neural origin and even the existence of appendiceal neuromas have been questioned. We have studied 20 examples, 7 discovered during a prospective examination of 26 consecutive routine appendectomy specimens (for an incidence of 27%), 2 selected from random cases, and 11 discovered in a retrospective review of 11 randomly selected cases of appendices diagnosed as "fibrous obliteration." By light-microscopy, appendiceal neuromas appear as a loose proliferation of spindle cells usually in a myxoid background, frequently with entrapped fat and connective tissue and infiltrated by eosinophils. Seventeen were located centrally in the appendix without nodule formation. One was central with nodularity and two were confined to the mucosa. The spindle cells were positive for S-100 protein and neuron-specific enolase in all cases. In 12, serotonin positive cells entrapped in the proliferation were present. In 5 of 11 cases with apparent uninvolved appendix present in the specimen, the number of serotonin cells in the crypts was greater than in normal appendix controls. Two appendiceal neuromas contained somatostatin positive cells. Stains for vasoactive intestinal polypeptide, substance P, neurotensin, bombesin and gastrin were negative. Ultrastructural examination of one case confirmed the presence of a mixture of Schwann cells and cells containing neurosecretory granules. We conclude that appendiceal neuroma is a rather common entity, and that most cases of so-called fibrous obliteration actually represent appendiceal neuroma.

Adolescent↗
PubMedDate not supplied

The position of the vermiform appendix in Nigerians with a review of the literature.

This is a study of the positions of the appendix in 548 Nigerians 447 of whom were autopsies or cadavers while the rest (101) were appendicectomy patients. Overall, the retrocaecal appendix was the commonest because of its very high frequency in the surgical material. The pelvic appendix as distinct from the retrocaecal or retrocolic was the commonest in the nonsurgical cases and it also had an increasing frequency with age. When previous reports were reviewed, the retrocaecal position was moderately infrequent in blacks compared to causasians.

Adolescent↗
PubMed1989

["Cecal appendix with pellets"].

A case is presented of caecal appendix with birdshots, in a 38 years-old male patient, with a clinical picture of biliary pathology. An elongated and "heavy" caecal appendix was palpated during cholecystectomy and removed. The pathological study showed the presence of 99 ammunitions or lead birdshots in the appendicular lumen, with a diameter of 1-5 mm, without histologic evidence of active appendicitis. The patient was fond of hunting wild animals and is used to eat them pickled. Pertinent literature is revised and works are commented in relation to the incidence of different foreign bodies in the appendix lumen, clinical picture and complications.

Adult↗
PubMedDate not supplied

Blood lead levels in patients with lead shot retained in the appendix.

Seven patients with one or two lead shots retained in the appendix were identified by radiography. For each case, two sex- and age-matched control patients without lead shot in the appendix were found. None of the 7 patients with lead shot in the appendix had blood lead levels (median 0.55 mumol/l) approaching the toxic levels, but they averaged almost twice the levels of the controls (median 0.29 mumol/l). Thus, lead shots may add to individual lead exposures, and blood lead analysis should be performed, at least when more than a few lead shots are present.

Appendix↗
PubMed1988

[Endocrinocytes of the appendix in the human fetus].

At light and electron microscopic level endocrine cells of the human embryos (9-31-week-old) appendices have been studied. They appear in the human embryo appendix on the 11th week of development for the first time. Amount of the endocrine cells in the field of vision increases significantly on the 17th-24th and does not change on the 25th-31st weeks. Basing on certain morphological criteria, presence of EC-cells and those resembling S- or I-cells is demonstrated in the human embryo appendix. Thus, already during the embryonal period there are cells in the appendix, main function of which is to produce biogenic amines and peptide hormones, participating in local regulation of homeostasis.

Appendix↗
PubMed1985

Transient gas-filled appendix developing during excretory urography.

Gas-filled appendix is well recognized in association with appendicitis, and in acute abdominal conditions associated with bowel distension. 3 patients who developed gas-filled appendix in the course of excretory urography are reported. The phenomenom is thought to result from the reported property of ionic contrast materials to produce anticholinesterase activity and histamine release, either or both of which could produce increased bowel tone and consequent displacement of cecal gas into the appendix.

Adolescent↗
PubMed1979

Crohn's disease of the appendix, manifested as acute appendicitis with postoperative fistula.

Two cases are reported of Crohn's disease localized to the appendix and manifested as acute appendicitis; after appendectomy a fistula developed. In none of 18 patients with Crohn's disease reported by other authors, where the appendix was the primary site, did a fistula develop postoperatively. When the appendix is the primary site of Crohn's disease the presence of mild inflammation of adjacent organs such as the terminal ileum may be mistakenly attributed to ordinary appendicitis. If, at exploratory laparotomy performed on a tentative diagnosis of appendicitis, Crohn's disease is suspected in the adjacent intestine, it is proposed that appendectomy should be followed by at least 10 days of total parenteral nutrition to minimize the risk of a fistula developing.

Acute Disease↗
PubMed1976

[Histochemical characteristics of the secretory elements of the vermiform appendix following surgical trauma, circulatory hypoxia and immunization].

Histochemical methods were applied to determination of salomycin, dermatansulfate, keratosulfate and neutral mucopolysaccharides in the goblet cells of rabbit appendix. Sialomycin and neutral mucopolysaccharides were found in the glands. Immunization with human gamma globulin was followed in the productive phase of immunogenesis by a rise of the secretory activity of the mucosa of the appendix. An increase of the mucus formation in the appendix occurred after laparatomy and during the initial period of experimental appendicitis. However, surgical trauma caused an opposite effect against the background of increased functional activity of the secretory elements of the immunized animals, and during experimental appendicitis no activation of mucus formation was seen. The influence of the abovementioned factors on the secretory activity of the mucous membrane was accompanied by qualitative changes in the synthesized mucus.

Animals↗
PubMed1984

[Development of the mucosa and differentiation of the lymphocytes of the vermiform appendix of the human fetus].

One hundred and twenty-two appendices have been obtained from 12-30-week-old human fetuses and studied histologically (90) and immune-morphologically (32). Lymphoid follicles in the organ appear on the 17th week. Character of the epithelial and the reticular tissue structure in the area of the cupola including the lymphoid follicle have been studied. T- and B-lymphocytes have been stated to be present in the appendix of a 17-week-old fetus. As the fetus is further developing, the number of lymphocytes in the appendix increases: the amount of T-lymphocytes is practically constant, and that of B-lymphocytes increases. Direction of the lymphocytes migration out of the follicle is demonstrated. The lymphoid formations of the appendix are necessary for certain local protective reactions and already in the fetus they begin to participate in the general system of the organism's immunogenesis.

Appendix↗
PubMed1983

The position, length and arterial supply of vermiform appendix.

The arterial blood supply, position and length of appendix were studied in 100 Indian (Uttar Pradesh region) cadavers. In 39% more than one appendicular artery was demonstrated. The retrocaecal and retrocolic positions of the appendix were by far the commonest (58%). Incidence of postilial position was also fairly common (10%). The average length of the appendix was found to be 9.5 cm in the male and 8.7 cm in the female. The prevalence of the retrocaecal and retrocolic positions may partly explain the incidences of appendicitis.

Adolescent↗
PubMed1982

Endoscopic removal of an intussuscepted appendix mimicking a polyp--an endoscopic hazard.

A 55-yr-old white woman with a polypoid filling defect in the caput cecum, on barium enema examination, had endoscopic removal of this mass. This was immediately recognized macroscopically to be an intussuscepted appendix. This case is only the second naturally inverting appendix to be removed endoscopically, and it was complicated 18 h later by local peritonitis which was heralded by acute right lower quadrant pain. Laparotomy revealed a cleanly transected base of appendix and cecal adhesions representing previous chronic inflammatory disease. Endoscopists should consider this diagnosis in all cases of mass lesions of the caput cecum. It is imperative to retrieve such lesions if polypectomy is performed, as the macroscopic diagnosis is then evident. Once the diagnosis is established, immediate surgery is advised rather than watchful waiting.

Appendix↗
PubMed1982

Participation of follicle associated epithelium (fae), macrophages, and plasma cells in the function of appendix.

Rabbit appendix was studied by correlated scanning and transmission electron microscopy and light microscopy, taking advantage of luminal bacteria as naturally occurring markers for following antigen uptake. The three-dimensional relationship of lymphoid follicles to other structures was revealed clearly. The smooth luminal surface of the appendix is interrupted by stomata each leading to a recessed interval between the dome epithelium covering the apical pole of each follicle and the goblet cell-rich epithelium forming a cupola on the opposing surface. Bacteria abound in this recess. They are taken up by follicle associated epithelial (FAE) cells which comprise part of the dome epithelium. Intraepithelial macrophages phagocytize the bacteria. Bacteria-laden macrophages are numerous in the dome area of the follicle and in the germinal center. Large lymphatic sinuses surrounding the follicles are well visualized following stimulation of fluid movement. Plasma cells are located within the dome epithelial layer and immediately beneath it. Plasma cells may be concentrated along the base of epithelial cells, with the absence of a basal lamina indicating an absence of the molecular selection which it would normally provide. The appendix, like Peyer's patches, takes up antigens, processes them, and gives evidence of reaction to them locally, with the secretions from plasma cells possibly modulating antigen entry.

Animals↗
PubMed1995

Lectin-binding sites in the epithelium of normal human appendix vermiformis and in acute appendicitis.

By using histochemical methods, the binding pattern of various lectins in the epithelium of normal human appendix vermiformis was assessed. In addition to plant and invertebrate sugar receptors with nominal monosaccharide specificity for alpha-L-Fuc (UEA-I), alpha-D-Man and alpha-D-Gluc (Con A), alpha-D-GalNAc (DBA), D-GalNAc (SBA, HPA) beta-D-Gal (RCA-I) and D-Gal (VAA), a mammalian beta-galactoside-specific lectin (MW, 14 kDa) was included in the applied panel. The apical surface of enterocytes presented binding sites for RCA-I on all cells, binding sites of UEA-I, DBA, SBA, HPA and VAA heterogeneously and no binding sites of Con A and 14 kDa. Binding sites of DBA, SBA, HPA, VAA and RCA-I within enterocytes were located primarily focally in a supranuclear position, whereas Con A and 14 kDa bound to the cytoplasm both in apical and basal cell parts. In the follicle-associated epithelium more enterocytes expressed SBA- and VAA-binding sites than in the crypt epithelium. No differences between the lectin-binding pattern of M-cells and enterocytes were found in the follicle-associated epithelium. Intraepithelial macrophages were heterogeneously positive for the full panel of applied lectins. In contrast, intraepithelial lymphatic cells expressed binding sites only for RCA-I and less prominently for Con A, VAA and 14 kDa. Goblet cell mucus contained lectin-binding sites in a heterogeneous manner: binding sites for Con A were not detected in goblet cells for DBA, SBA, VAA and 14 kDa in less than 20%, for UEA-I in 20-40%, for HPA in 40-60% and for RCA-I in 60-100% of the goblet cells. Secreted mucus differed in its lectin-binding capacity from intracellular goblet cell mucus selectively by an increase of UEA-I, SBA- and RCA-I-binding sites and a lack of 14 kDa-binding sites. Comparative study of lectin binding to goblet cell mucin in another region of the large intestine, namely the rectosigmoid, demonstrated that DBA, SBA and 14 kDa bound mainly to the distal colon, while UEA-I and VAA labelling was selectively found in appendiceal goblet cell mucin. Comparing the lectin-binding pattern in normal appendix epithelium and in appendicitis, the percentage of goblet cells expressing DBA- and SBA-binding sites in mucus globules was found to be about 4 times higher in appendicitis than in normal appendix.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1995

Case of vesico-appendiceal fistula secondary to mucinous adenocarcinoma of the appendix.

We present a rare case of vesico-appendiceal fistula secondary to mucinous adenocarcinoma of the appendix. Transurethral biopsy of the bladder revealed a mucinous adenocarcinoma of probable colonic origin. Adenocarcinoma of the appendix that directly invaded the bladder was diagnosed preoperatively by air-contrast barium enema, colonoscopy and magnetic resonance imaging. When one encounters a case of adenocarcinoma of the bladder suspected to be of colonic origin, one should examine the colon and rectum as well as the appendix and cecum.

Adenocarcinoma, Mucinous↗
PubMed1995

[Idiopathic granulomatous appendicitis or Crohn's disease confined to the appendix?].

Crohn's disease limited to the appendix is uncommon. When Crohn's disease affects the appendix it typically has a longer clinical course than most cases of acute appendicitis. The diagnosis is histological. Appendiceal Crohn's disease has a benign course after surgery, and that's why some authors believe that it could be a different entity which should be better addressed to as "Idiopathic Granulomatosus Appendicitis". We present three new cases of Crohn's disease limited to the appendix.

Adolescent↗
PubMed1997

[Diverticular disease of the appendix].

The incidence of appendiceal diverticulosis in pathologic specimens is 0.004-2.1%. Diverticular disease of the appendix is classified as congenital (true) or acquired (false). The clinical presentation differs from that of acute appendicitis. The average age is older, the pain is often intermittent, and while localized in the right lower abdominal quadrant, is of longer duration. No further treatment besides appendectomy is needed. Since a high rate of perforations, peritonitis and lower gastrointestinal bleeding have been reported as complications, it is recommended that in those with an incidental finding of diverticula of the appendix during surgery, that appendectomy be performed. It is not recommended to perform prophylactic appendectomy when diverticula of the appendix are found on barium enema.

Appendectomy↗
PubMed1997

[Ureteral replacement with appendix].

OBJECTIVE: The scant references in the literature on the use of the appendix in ureteral substitution prompted us to describe the present case in whom this technique was utilized. METHODS: The surgical technique of appendiceal interposition to repair a defect approximately 10 cm long in the right ureter is described. Following excision of a mass arising from the adnexa that entrapped the ureter at the level of the pelvis, the defect was repaired with the appendix. RESULTS: At two years follow-up, the patient is well and right excretory system function is normal. CONCLUSION: Ureteral repair with the appendix is simple and easy to perform. However, the indications for appendiceal interposition are more limited than those of the classical surgical techniques.

Appendix↗
PubMed1998

Continent ileocecal diversion with an unaltered in situ appendix conduit.

PURPOSE: We performed continent urinary diversion using an unaltered, in situ appendix to decrease the risk of appendicocolic manipulation. MATERIALS AND METHODS: Since September 1994, 19 patients a mean of 46.5 years old underwent continent urinary diversion with an ileocecal segment and an unaltered, in situ appendiceal conduit. In 1 case of a permanent colostomy we performed simple transposition of the appendix on the ileal pouch as a conduit, which to our knowledge is the first reported case. RESULTS: During the 4 to 24-month followup (mean 12) 17 patients were continent day and night, defined as being completely dry for 3 to 5 hours. Two patients were occasionally incontinent at night. One patient with a history of multiple operations who was completely incontinent achieved complete continence with endoscopic polytetrafluoroethylene (Teflon) injection at the appendicocecal junction. CONCLUSIONS: This unaltered in situ appendix technique is timesaving, safe, effective and comparable with other methods that provide urinary continence.

Adolescent↗