[Etiologic diagnosis of non-tumoral organic diseases of the right ceco-colon].
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Red grouse infected with the caecal threadworm Trichostrongylus tenuis developed a mild anaemia. Haemoglobin and albumin levels in the blood fell but there were no significant changes in the number of red blood cells or their size. In infected birds the numbers of circulating eosinophils and heterophils increase, as did the concentration of alpha, beta and gamma globulin. Body weights did not change but muscle masses shrank. Birds that subsequently died had the lowest concentration of haemoglobin and packed cell volumes and the highest counts of eosinophils. The survivors were affected little by worms and their haematology showed small deviations from normal.
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The authors present a case of a 36 year old male, admitted with a 3 year history of cramping abdominal pain, fever, and transient finding of a right lower quadrant mass. The abdominal roentgenogram revealed a large opacity located on the right side of the fifth lumbar segment. The patient underwent laparotomy: an enlarged appendix was removed. The specimen had 4 calculi completely obstructing the lumen of the appendix. The diameter of calculi were 0.5 (in 3 instances) and 3 cm. The case herein described is rather uncommon, due to: 1) the rarity of multiple appendiceal calculi; 2) the size of the larger stone; 3) the inconstant finding of right lower quadrant mass; 4) the non development of acute appendicitis. Differential diagnosis involved several diseases presenting with palpable mass of the lower quadrant of the abdomen and/or laminated densities at the plain abdominal roentgenogram.
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One thousand fourteen consecutive large intestines were removed at autopsy from persons over the age of 14 years and examined for diverticular disease. Diverticulosis was encountered in 194 patients (19 percent). The lesion appeared early in life, after the second decade. Men were affected more frequently than women before the age of 60 years. Chinese men had significantly more diverticular disease than Malayan men (P less than 0.01) and Indian men (P less than 0.02). Chinese men also had significantly more diverticular disease than Chinese women. There was a predominance of right colon involvement, with the disease affecting especially the ascending colon and cecum. This pattern was observed in all three major ethnic groups, and in both the Singapore-born and foreign-born Singaporeans. The cause of right-sided diverticulosis is unknown. It appears that, while adoption of the western diet may influence the prevalence of diverticular disease, the site of predilection is determined more by racial or genetic predisposition. All diverticula examined histologically were false, including 39 (20 percent) solitary diverticula. The distribution of solitary diverticula was similar to that of multiple diverticulosis. It is suggested that solitary and multiple diverticulosis are part of the spectrum of the same disease.
Mucocele of the appendix is a nonspecific term that is used to describe an appendix abnormally distended with mucus. This may be the result of either neoplastic or non-neopleastic causes and may present like most appendiceal pathology with either mild abdominal pain or life-threatening peritonitis. Urologic manifestations of mucocele of the appendix have rarely been reported. Laparoscopy can be used as a diagnostic tool in equivocal cases. Conversion to laparotomy may be indicated if there is a special concern for the ability to remove the appendix intact or if more extensive resection is warranted, as in malignancy. We here report our experience with a woman presenting with hematuria whose ultimate diagnosis was mucocele of the appendix, and we review the appropriate literature. This case highlights the mucocele as a consideration in the differential diagnosis of appendiceal pathology and serves to remind the surgeon of the importance for careful intact removal of the diseased appendix.
The authors report a new case of caecal perforation complicating acute dilatation of the colon without organic obstruction (Ogilvie's syndrome). They recall the two characteristics of this syndrome : abdominal distension due to colonic ileus, without any organic cause, and the constant coexistence of an associated pathological condition (traumatic, post-operative, infective, cardio-vascular, respiratory or neurological). The major complication is caecal perforation, announced by a clinical and radiological preperforative syndrome. The pathogenesis of Ogilvie's syndrome remains mysterious. Two facts are worth attention : the role of the sympathetic nerve in intestinal paralysis and the direct intervention of an extra-intestinal pathological factor in the onset of this syndrome. Hence two therapeutic consequences : the favourable effect of splanchnic infiltrations on intestinal motility, and the parallel course of acute colonic dilatation and the extra-intestinal disease.
The authors treated for intestinal invagination 726 children: conservatively--528, surgically--198. In conservative treatment, 0.96% of the patients developed complications, there were no lethal outcomes. After the operation, the complications were noted in 19.69% of the children, who were mainly operated 2 days after onset of the disease and later.
Two cases of simultaneous typhoid perforation of terminal ileum and appendix are reported from Harare Central Hospital. These findings have not been reported before. Perforations were associated with schistosomiasis and HIV/AIDS. Definitive diagnosis was made only after laparotomy, serology and histopathology. With early diagnosis, effective resuscitation and timely intervention, this life-threatening condition is not necessarily fatal. Septic shock is however, an ominous sign of poor prognosis. In the tropics, bradycardia, leukopaenia and perforation in a febrile patient with right iliac fossa tenderness should arouse suspicion. Perforations may occur in patients with underlying diseases.