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PubMed2005

[Grouping of the International Classification of Diseases for analysis of hospital readmissions].

ICD chapters and three-digit categories are not always appropriate for epidemiological analysis; the former are too generic and the latter too numerous. When the epidemiological focus is not on a specific clinical diagnosis, an intermediate grouping proposal between these two possibilities becomes necessary. Such proposals are not frequent in the literature. We used a two-stage grouping proposal based on hospital admissions volume, internal clinical coherence in each group, and the results of a Cox multivariate model for real data. As a result, we obtained 26 groups for adults and 19 groups for children, among which we chose hernia as the reference category for adults and appendiceal disease for children. The grouping proved adequate for the analysis of readmissions in a large Brazilian general hospital. Procedures similar to those described in this research report can be used to analyze other health problems.

Adult↗
PubMed1995

[Gelatinous peritoneal disease].

Gelatinous degeneration of the peritoin is an unusual disorder which inevitably takes the surgeon by surprise during laparotomy. Three cases are reported. The diagnosis, pathogenesis, prognosis and possible therapies are discussed. The tumoral pathogenesis usually appears to be non-malignant and to originate in the ovaries or appendix. However, gelatinous degeneration of the peritoin must be viewed as a disease with attenuated malignancy. The pattern of development is slow, with repeated peritoneal recurrences. The survival time is long. Treatment is essentially surgical even when recurrences occur.

Adenocarcinoma, Mucinous↗
PubMed2000

Prolonged ambulatory recording of antroduodenal motility in slow-transit constipation.

BACKGROUND: Slow-transit constipation may be part of a pan-enteric motor disorder. To test this hypothesis 24-h ambulatory antroduodenal manometry was performed and orocaecal transit time determined in patients with slow-transit constipation and in healthy controls. METHODS: Antroduodenal motility was recorded with a five-channel solid-state catheter. Postprandial motility was recorded after consumption of two standardized test meals and interdigestive motility was recorded nocturnally. Manometry tracings were analysed for quantitative and qualitative abnormalities. Orocaecal transit time was determined by means of the lactulose hydrogen breath test. RESULTS: Postprandial motility was no different between patients and controls. However, some minor changes of interdigestive motility were observed. The proportion of phase II activity of the nocturnal cycles of the interdigestive migrating motor complex was increased in patients while phase I activity was decreased. The total number of observed phase III fronts was no different in patients and controls, although the number of phase III fronts with antral onset was decreased. Furthermore, the amplitude of phase III activity of duodenal onset was also decreased. Specific motor abnormalities such as retrograde propagation of phase III fronts were more frequent in patients. Orocaecal transit time was delayed in patients. CONCLUSION: In patients with slow-transit constipation, orocaecal transit time is delayed but antro- duodenal motility is generally well preserved with only minor alterations. Presented as a poster to the Digestive Disease Week meeting in New Orleans, Louisiana, USA, May 1998, and published in abstract form as Gastroenterology 1998; 114: A820

Adolescent↗
PubMed1998

Inflammatory bowel disease-like enteritis and caecitis in a senescence accelerated mouse P1/Yit strain.

BACKGROUND: A new subline of the senescence accelerated mouse (SAM) P1/Yit strain has been established which shows spontaneous enteric inflammation under specific pathogen free (SPF) conditions. AIMS: To elucidate the pathogenesis of enteric inflammation in this new subline. METHODS: The SPF and germ free (GF) SAMP1/Yit strains were used. Histological, immunological, and microbiological characterisation of the mice with enteric inflammation was performed. RESULTS: Histologically, enteritic inflammation developed as a discontinuous lesion in the terminal ileum and caecum with the infiltration of many inflammatory cells after 10 weeks of age. the activity of myeloperoxidase, and both immunolocalisation and mRNA expression of inducible nitric oxide synthase increased in the lesion. CD3-epsilon positive T cells, neutrophils, and macrophages were more numerous in the inflamed mucosa of the SAMP1/Yit strain. The GF SAMP1/Yit strain did not show any inflammation in the intestinal wall, by the age of 30 weeks, and the enteritis and caecitis developed 10 weeks after the conventionalisation of the GF SAMP1/Yit strain. CONCLUSION: Enteric inflammation in the ileum and caecum developed in the SAMP1/Yit strain. The pathophysiological characteristics of the disease in this mouse have some similarities to those of human inflammatory bowel disease (IBD). This mouse strain should be a useful model system for elucidating the interaction between the pathogenesis of IBD and the gut microflora.

Aging↗
PubMed2000

'Silent' surgical disease presenting with severe dysuria.

We report a case of long-standing dysuria due to silent surgical abscess disease. The cause of our patient's complaint was not expected because we focused on dysfunctional voiding and not dysfunction as result of pathology close to the bladder neck since the history given by the patient was unremarkable.

Abscess↗
PubMed1990

Crohn's disease of the appendix.

Crohn's disease limited to the appendix is uncommon. The disease may mimic acute appendicitis with fever, leukocytosis, right lower quadrant pain, and occasionally a palpable mass. When Crohn's disease affects the appendix, it typically has a longer clinical period in which the patient has symptoms than do most cases of acute appendicitis. The most common preoperative diagnoses are acute appendicitis and appendiceal abscess. A review of the literature is presented along with our experience in three additional cases of Crohn's disease limited to the appendix. We suggest that Crohn's disease be included in the preoperative differential diagnosis and that extensive intraoperative examination of the gastrointestinal tract be made in any case of suspected appendicitis that has had a protracted preoperative course.

Adolescent↗
PubMed2004

[Isolated Crohn's disease of the appendix as a source of enterorrhagia].

BACKGROUND: Crohn's disease confined to the appendix is relatively rare as a sole primary manifestation of the disease. Young people are more affected. The medical history and the physical examination are similar to the findings in acute appendicitis, but the manifestations are protracted. On physical examination there are signs of peritoneal irritation and an abdominal mass is palpable in the right iliac fossa. AIMS: To report a case of Crohn's disease confined to the appendix and presenting with enterorrhagia. The source of the bleeding was localized by colonoscopy. PATIENT: A 16-year old caucasian male without past history of gastrointestinal symptoms, presented with two episodes of enterorrhagia within a period of one year. In the second episode colonoscopy identified the appendicular ostium as the source of bleeding. RESULTS: At operation the cecum and terminal ileum were normal in thickness and texture, and an inflammatory appendix adherent to the omentum was removed. Microscopically there were non-caseating granulomas, intense infiltration of the wall with plasma cells, lymphocytes and macrophages. The patient has not suffered recurrence, and a colonoscopy realized 2 years after the operation did not show signs of Crohn's disease. CONCLUSION: This case, like others in the literature, appendectomy is curative, but a 5-year follow-up is mandatory. When a young patient presents with enterorrhagia, this diagnosis has to be considered.

Adolescent↗
PubMed1990

[Early adhesive ileus after appendicectomy].

For the period 1980-1988 a total of 5363 patients have been operated at the surgical clinics in the town of Pazardzhik. Early adhesive ileus developed in 13 (0.2 per cent). Intestinal obstruction occurred most frequently after destructive appendicitis (84,6 per cent). In 53.8 per cent of the patients it occurred during the first week after the operation. Conservative treatment was effective in only 2 patients. The other 11 were operated. The case fatality rate was 9.09 per cent. Acute appendicitis usually requires operative treatment both in children and in adults. It keeps on being one of the most important problems of modern surgery, agitating the surgeons all over the world. Appendicitis is called an insidious disease, not only because of the manifold clinical picture, but also because it has a leading position among the causes of the grave surgical complication peritonitis and occupies first place as cause of the severe pathology in the peritoneal cavity--the adhesive disease. Early intestinal obstruction is one of the severe complications following appendicectomy. According to available data in the literature, its incidence is between 0.06 and 0.8 per cent. Most authors consider intestinal obstruction as being early, when developing within three weeks after the operation.

Adult↗
PubMed1994

[Diagnosis and treatment of intestinal tuberculosis].

Primary tuberculosis of the intestines was revealed in four patients. The process was localized in the cecum in three and in the descending colon in one patient. The true diagnosis was suspected before the operation in one patient, determined during the operation in two patients and after pathohistological study in one patient. The course of the disease was complicated by intestinal obstruction in three cases by anemia in one case. The differential diagnosis was made with intestinal tumors. Three patients underwent right hemicolectomy and one patient left hemicolectomy. Specific therapy was prescribed after recognition of the tuberculous process. All patients recovered.

Adult↗
PubMed2006

Pathology of the appendix in children: an institutional experience and review of the literature.

BACKGROUND: The appendix can be affected by a variety of congenital and acquired diseases, but acute appendicitis is the most common pathology found in the pediatric population. OBJECTIVE: This is a retrospective review of all appendectomies performed during a 2-year period at a major children's hospital with a review of the literature regarding the most common pathologic findings. MATERIALS AND METHODS: The pathology database was reviewed for appendectomy specimens, and patient medical records were evaluated to determine the age, gender, race and operative diagnosis. All slides were reviewed and the histologic findings were recorded. RESULTS: A total of 392 appendectomies were performed, including 68 incidental appendectomies and 324 performed for clinical suspicion of acute appendicitis. In 247 of the latter, acute appendicitis was confirmed histologically, and of the remainder 14 were interval appendectomies, 2 had findings suspicious for Crohn disease, 1 confirmed diverticulitis and 60 were histologically negative for appendicitis. CONCLUSION: Acute appendicitis is the most common pathologic cause of appendectomy, but various other pathologic entities are found in children. Examination of the appendix is warranted even when it appears normal on exploration.

Abdomen, Acute↗
PubMed1985

Protection of hamsters against Clostridium difficile ileocaecitis by prior colonisation with non-pathogenic strains.

Prior colonisation of clindamycin-treated hamsters with non-toxigenic strains of C. difficile protected them from subsequent colonisation with a toxigenic pathogenic strain. In total, 13 of 18 'protected' hamsters survived for up to 27 days whereas all 27 animals challenged with the toxigenic strain alone died within 48 h. Protection was not evident if a heat-killed suspension was used or if the colonising non-toxigenic strain was first removed with vancomycin. No antitoxic activity could be detected in the faeces of animals colonised with the non-toxigenic strains. Other species of clostridia did not protect against the lethal effects of subsequent exposure to the toxigenic strain. Conversely, non-toxigenic strains would not protect the animals from the lethal effects of a different clostridial pathogen, C. spiroforme. In most cases, even in the protected animals, the toxigenic strain eventually became dominant and caused disease, with translocation across the gut wall occurring early in the disease process. It was also shown that a non-toxigenic strain of C. difficile can adhere to gut mucosa. It is proposed that the protection afforded by the non-toxigenic strains may be due to competition for ecological niches.

Adult↗
PubMedDate not supplied

[Mucocele of the vermiform appendix].

BACKGROUND: Mucocele is a cystic dilatation of the vermiform appendix that contains mucous material. It may be caused by benign or malignant diseases. AIM: To report and discuss four cases with mucocele. REPORT OF CASES: The main clinical manifestations were abdominal pain and changes in the bowel habits. In two cases, appendiceal mucocele was an incidental finding in the diagnostic work-up or operation for acute diverticulitis and acute cholecystitis, respectively. The diagnostic approach included barium enema and CT scan of the abdomen. In three cases, the mucocele was secondary to mucinous cystadenoma; two of them had a preoperative diagnosis of mucocele and underwent colonic preparation and right hemicolectomy, one patient underwent appendectomy alone. The remaining case underwent appendectomy alone, was found to have mucinous adenocarcinoma, and underwent a right hemicolectomy in a second operation. Postoperative outcome was adequate in all cases. CONCLUSION: Mucocele of the vermiform appendix is a rare disease. An appendectomy is an adequate treatment for benign disease. If malignant disease is demonstrated, a right hemicolectomy should be performed.

Adult↗
PubMed1989

Recurrent typhlitis. A disease resulting from aggressive chemotherapy.

Neutropenic typhlitis is a frequently fatal disease most commonly reported in leukemics. The authors have treated eight such patients over the last 18 months. All patients had abdominal pain and sepsis during chemotherapy-induced neutropenia. CT scanning was diagnostic in six patients thought to have typhlitis. Two patients were not diagnosed before exploratory laparotomy. The authors have found nonoperative treatment highly effective in patients who do not manifest signs of peritonitis, perforation, gastrointestinal hemorrhage, or clinical deterioration. Recurrent typhlitis was frequent after conservative therapy (recurrence rate, 67 percent), however. One patient underwent an elective right hemicolectomy after a second episode, and typhlitis did not recur despite neutropenia associated with a subsequent course of chemotherapy. It is concluded that successful treatment of this disease hinges on: 1) early diagnosis provided by a high index of suspicion and the use of CT scanning, 2) nonoperative treatment for uncomplicated cases, and 3) elective right hemicolectomy to prevent recurrence.

Adolescent↗
PubMedDate not supplied

Rare benign and malignant appendiceal lesions: spectrum of computed tomography findings with pathologic correlation.

Although acute appendicitis is the most common disease of the appendix, the appendix can be involved by a wide range of diseases. Diseases other than acute appendicitis may produce signs and symptoms indistinguishable from those of acute appendicitis. Computed tomography (CT) can provide important information for diagnosis and evaluation of appendiceal diseases. The various CT and histologic features of appendiceal benign and neoplastic diseases are discussed, illustrated, and correlated in this article. Radiologists need to understand the full spectrum of appendiceal abnormalities, their underlying pathologic changes, and associated CT imaging findings.

Adult↗
PubMed1989

Caecal diverticulitis.

Ten cases of caecal diverticulitis are reviewed. Caecal diverticulitis is frequently diagnosed as appendicitis pre-operatively and is difficult to distinguish from carcinoma or inflammatory bowel disease intra-operatively. The average age of presentation is younger than that of left-sided colonic diverticulitis. Most of the diverticula are narrow-neck false diverticula. When diagnosed intra-operatively hemicolectomy can often be avoided.

Adult↗
PubMed1990

[Crohn's disease limited to the appendix. Apropos of a case].

A rare case of Crohn's disease limited to the appendix is reported in an 18 years old adolescent, hospitalised as having acute appendicitis. Appendectomy was performed. There were no postoperative complication and no recurrence after 3 years follow-up. Surgical indications are discussed and literature reviewed.

Abscess↗
PubMed2006

[6 years V.A.C. in general surgery -- clinical data from 128 patients].

Since the introduction of vacuum assisted closure therapy (V.A.C.) at the Department of Surgery/St. Anna-Hospital Herne has taken place in 2000 there was a rapid increase of indications to use this therapy. We present data from 128 patients who were treated with this method from 2000-2005 for different kinds of diseases. We report the management of a 78-year-old male patient who developed a Fournier's gangrene after an acute appendicitis with retroperitoneal perforation and an enterocutaneous fistula of the cecum. Using V.A.C. in surgery, a quick and safe treatment of infection and healing could be achieved.

Aged↗