SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Vermiform appendix is an unusual site of diverticulosis. We present 3 examples of this entity and briefly review its pathogenesis and clinical significance. As a general rule, appendiceal diverticula are multiple, acquired naturally, and rarely associated with complications.
The existence of chronic appendicitis is controversial. In this prospective study, we investigated possible changes in the innervation of the appendix under different pathological conditions and correlated histological findings with clinical observation. Thirty appendectomy specimens and 14 appendices obtained from organ donors or patients who underwent right hemicolectomy were immediately fixed in Bouin's solution and processed for immunocytochemistry using an antiserum directed against the panneuronal marker protein gene product 9.5 (PGP 9.5). The density of PGP 9.5 immunostaining was evaluated by digitized morphometry. Significant differences in the density of the PGP 9.5-immunoreactive area were detected in the mucosal layer. In the nonacute appendicitis group, PGP 9.5 was increased (10.99 +/- 3.15%) as compared to acute appendicitis (3.89 +/- 1.77%) and controls (4.98 +/- 1.25%). The significant increase of PGP 9.5 in nonacute appendicitis may suggest axonal sprouting leading to hyperinnervation of the mucosa. This may be a neuronal factor in the pathophysiology of the disease and pain symptoms.
The appendix was used as an efferent limb of the ileocolonic pouch (Mainz pouch) in two patients who underwent radical cystectomy for invasive bladder cancer. The pouch has a low pressure character and sufficient capacity as well as complete continence. This procedure is relatively simple to perform and considered to be a useful modification of ileocolonic pouch.
A case of hepatomegalia due to multiple metastases of unknown origin to the liver is described. At autopsy the primary tumor, an adenocarcinoid tumor of the appendix, was identified along with multiple metastases to the lymph nodes and widespread peritoneal carcinoidosis. Hepatic metastases from an appendiceal adenocarcinoid tumor has not been described previously. In the liver and lymph nodes the tumor had an insular growth pattern and was composed predominantly of cells of carcinoid type, whereas the carcinoidosis was composed almost entirely of signet-ring cells. It is suggested that differentiation of the metastases of appendiceal adenocarcinoids is modulated by factors in the recipient organ.
We report the case of a 29-year-old man in whom isolated involvement of the appendix with granulomatous colitis or Crohn's disease manifested as a cecal mass. Appendectomy was performed. At operation the terminal ileum did not appear to be grossly involved. Careful long-term follow-up is essential in these patients to detect recurrent disease.
Cystadenomas of the appendix are an unusual clinical entity. Despite a recognized constellation of findings, the diagnosis is not usually made prior to surgical exploration. A 65-year-old man is reported in whom preoperative evaluation, including sonography and angiography, resulted in the correct diagnosis confirmed at surgery. The appropriate use of newer diagnostic modalities will establish the preoperative diagnosis and facilitate surgical intervention. Appendectomy is curative for this condition, as neither regional nor distant lymph node metastases or hematogenous spread have been reported. When symptoms due to pseudomyxoma peritoneai occur, a continued aggressive surgical approach is justified.
An analysis of 101 tumors of the appendix is presented. During the period under study (from 1949 to 1972), 8,699 appendectomies had been performed. Only 17 of the 101 tumors were malignant. In this group, there were two primary carcinomas, 12 metastatic carcinomas, and three lymphomas. Most of the tumors (84) were benign, including 43 carcinoids, 32 mucoceles, five neuromas, two leiomyomas, and two villous adenomas, Some of the clinical and pathologic features of carcinoids, adenocarcinoma, and mucoceles are discussed. The most significant observation in this study is the statistically significant evidence that, even without associated acute appendicitis, mucoceles 2 cm or more in diameter probably do cause clinical symptoms, which may be alleivated by appendectomy.
Sixty-five patients who had the documented histologic diagnosis of chronic ulcerative colitis were selected in order to study appendiceal involvement in this disease. There were 28 males and 37 female patients with an average age of 30 years. The incidence of appendiceal involvement involving the right colon was found to be 47 per cent. In all of these cases the appendiceal involvement occurred in association with the disease process in the cecum or the right colon. In seven patients a classic picture of ulcerative appendicitis in active phase was found. In 78 per cent of patients a similarity between the disease stages in the colon and in the appendix was observed.
Primary adenocarcinoma of the appendix is the rarest form of malignant tumor of the appendiceal stump is described. As with other malignancies, surgical treatment is described. As with other malignancies, surgical treatment is most effective during the early stages of disease. In our series most of the patients who had metastatic disease had fairly rapid downhill courses. The choice of right hemicolectomy with node dissection in all cases is suported.
Antiperistaltic appendiceal conduit based on its vascular pedicle was used as hepaticoporto-appendico-jejunostomy (HAJ) in 9 infants with advanced stage of biliary atresia. Operative procedure was simple and less time consuming. The postoperative cholangitis was conspicuously absent, possibly due to the role played by the presence of lymphoid follicles in the wall of the appendix. Our early experience with this technique shows that antiperistaltic appendiceal conduit works quite satisfactorily. The procedure has been successfully utilised to reduce the problems contributing post-operative morbidity and mortality in cases with the advanced disease. The HAJ procedure provides a conduit for bilioenteric drainage, that closely resembles to normal anatomy.
Deciduosis of the appendix is a rare cause of acute appendicitis in pregnancy. Ectopic decidual cells localized in the submesothelial stroma may represent a physiologic reaction of the pluripotent stromal cells to progestational hormonal stimulation. Less frequently, deciduosis is based on a preexisting extragenital endometriosis, visible in a localization other than strictly submesothelial, in residuals of cyclic proliferation and bleeding, and in endometrial glandular formations embedded in the decidual cells.
A 23-year-old woman presented with acute appendicitis. At laparoscopy the appendix appeared to be strangulating itself. The pathologic evaluation demonstrated mucosal coagulation necrosis, confirming the early ischemic changes of the infarctive process visualized laparoscopically.
We report a very rare case of spontaneous ilioappendicial fistula with right common iliac aneurysm. After the aneurysm was opened, afferent and efferent vessels were closed following extraanatomical femorofemoral bypass, and the appendectomy was performed. The wall of the aneurysm showed the atherosclerotic change and histologic study of the appendix confirmed the diagnosis of acute appendicitis. Enhanced computed tomography was useful for the diagnosis and the extraanatomical bypass was deemed the most effective operative strategy. The pathogenesis of the fistula was surmised to be related to the appendicitis.
Spigelian hernia is a rare lateral ventral abdominal hernia. These clinically elusive hernias are treacherous and have a real risk of strangulation. We present a patient with a strangulation of the small bowel and appendix in a right spigelian hernia, which was accurately demonstrated by spiral computerised tomography preoperatively and successfully treated with primary suturing reinforced with polypropylene mesh. With a high index of suspicion and the use of modern radiological technique, these "bewildering" hernias can be diagnosed and repaired relatively safely.
The three-dimensional organization of the lymphatics in the rabbit appendix was demonstrated by scanning electron microscopy of lymphatic corrosion casts and intact tissues. In the glandular mucosa a polygonal network of lymphatics led into perpendicularly oriented lymphatics continuous with the lymphatics in the thymus-dependent area. In the thymus-dependent area a plexus consisting of anastomosing tubular lymphatics led into the upper ends of the perifollicular sinuses. Each follicle was surrounded by a well-developed perifollicular sinus. From the bottoms of the sinuses thin lymphatics descended into the submucosal lymphatics. The cast of submucosal lymphatics showed notches corresponding to the locations of bicuspid valves. Lymphocytes migrating through the lymphatics and high-endothelial venules were only observed in the thymus-dependent area. The results indicate that the potential capacity of the perifollicular sinuses as a reservoir and as a drainage route for fluid and lymphocytes is great, but that the lymphatics in the thymus-dependent area are sites for lymphocyte migration from the follicles into the lymphatics. The well-developed lymphatic network in the glandular layer suggests great participation in fluid flux.
The spontaneous formation of multinucleated giant cells was observed in the appendix of clinically healthy adult rabbits that were free of infection with intestinal viruses, pathogenic bacteria, fungi and parasites. Giant cells occurred singly and in aggregates. They were of the foreign body and of the Langhans' type, but intermediate forms were also noticed. Ultrastructurally, the hallmark of these appendiceal polykaryons were large phagolysomal fields harbouring amorphous debris and remains of cytoplasmic organelles and bacteria. The bacteria in the appendiceal tissues were neither of a special type nor acid-fast. The aetiology and significance of appendiceal giant cells remains to be clarified.
A 4-year-old boy with symptoms of lead intoxication and confirmatory serum lead levels was eventually found to have a pellet lodged in his appendix. Because laxatives and cathartics did not dislodge the pellet, appendectomy was performed. Arguments for and against this decision are explored.
Yersinia pseudotuberculosis is an uncommon cause of abdominal pain. It has a much lower incidence than Yersinia enterocolitica, and most reports have emanated from Europe or North America. This report is about a patient with Yersiniosis affecting the appendix alone, in contrast to the usual picture of mesenteric adenitis or septicemia associated with this organism.