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An unusual case of a malignant carcinoid of the appendix is reported, together with a brief review of the pertinent literature. The case exhibited mesenteric invasion, peritoneal seeding, terminal ileal ischemia and features of the carcinoid syndrome. The radiographic and angiographic documentation are unique in the literature.
Retrospective study of patients who underwent as an emergency, a peritoneal drainage during laparotomy for peritonitis with perforated appendix (147 cases), or operation for lage bowel (68 cases) or small bowel (46 cases) pathology. The technique of drainage number of drains, duration of drainage, and length of stay in hospital are examined, as well as antibiotherapy. The conclusions do not allow us to attribute a harmful influence to peritoneal drainage, except perhaps that the duration of stay in hospital can be longer. The absence of a comparison group does not allow us to prove the utility of peritoneal drainage. The literature at our disposal is discussed, the majority of which is opposed to peritoneal drainage.
A woman, 32 years of age, was admitted with classical symptoms of acute appendicitis. Peroperative findings were typical of the condition. Histology revealed a colloid adenocarcinoma of colon-type, penetrating all layers. A secondary hemicolectomy was performed. One month previously the patient had undergone a conization of the uterine cervix on account of a cancer in situ. The age, sex, and the histological findings, altogether, make this case an extremely rare one. The literature has been perused, and it is concluded that hemicolectomy should still be considered the correct treatment for carcinoma of the appendix. The necessity of all specimens removed by surgery being sent for histological examination is emphasized.
A study on 42 surgical patients was carried out to find out whether cefuroxime may be substituted for gentamicin in combination with metronidazole in the treatment of peritonitis secondary to perforation of appendix. All patients recovered and there were four wound infections in each group. Both aerobic and anaerobic bacteria were cultured in the peritoneal fluid in 69% of cases and anaerobes only in 19% of the patients. Postoperatively the patients were followed up for one month. The mean length of the hospital stay and convalescence did not differ significantly. There was also no difference in the time to the removal of gastric suction, laboratory measurements and the incidence of pyrexia between the study groups. Although the number of patients was limited the present study indicates that gentamicin may be replaced by less toxic cefuroxime. This is especially the case if there are several risk factors in the use of gentamicin and if there is not a possibility for monitoring the serum levels of gentamicin.
A simple, fully-automated, continuous-flow system suitable for radioimmunoassay, enzyme immunoassay, and fluoro-immunoassay is described. The system is versatile, inexpensive, and requires only equipment and skills that already are available in most clinical chemistry laboratories. In this system, the antibody is covalently linked to solid-phase, porous particles of agarose (Sepharose, size 40-70 micrometer in the dry form). After sampling and mixing the assay reactants, the assay "cocktail" containing the solid-phase-bound antigen and the unbound fraction is directed to the separation block. Separation is achieved by use of a highly porous membrane (pore size, about 10 micrometer) and by controlling the volume of inflow and outflow a fixed and precise amount of fluid is filtered through the membrane containing only the free (unbound fraction), which can then be quantitated. The percentage of unbound fraction misclassified is negligible (less than 1.0%). Application of these principles to the assay of serum thyroxine is described in an appendix.
Diverticulosis of the vermiform appendix is not a common entity. Due to possible complications resulting from this lesion the discovery of an appendiceal diverticulum on barium studies should not be overlooked and may be an indication for appendectomy.
The physical and chemical requirements of today's modern inhalation anaesthetic agents have resulted in the production of compounds that closely approach those of the ideal agent. As medical science develops and defines the need for better drug characteristics, the complexity of the research problems for the organic chemist is intensified. Many of the inhalation anaesthetic agents in use 30 yr ago would not pass a clinical investigator screen today, and would be rejected as inhalation anaesthetic agents. An outline of the manufacture of isoflurane is given as an Appendix to this paper.
Regarding the event of an adenocarcinoma of the colic type of the cecal appendix, operated on at the ABC Medical College Hospital, the authors summarize the subject stating that, among the appendiceal carcinoma, this particular one tends to spread, by the veins or lymphatics, besides spreading by contiguity. This carcinoma hardly presents a symptomology of its own. It appears fairly often as acute appendicitis. The authors also state the difficulty for a macroscopic diagnosis. Thus, its real nature is determined, in general, only after the histologic exam of the removed part. The right hemicolectomy is the most indicated surgery and best results are obtained in the first surgery or 30 days afterwards. About the reported case the patient was operated on with the pre and intra operatory diagnosis of appendicitis and the histologic exam, on top of confirming it, pointed out the presence of neoplasm. After the indication for reoperation, the prompt spreading of the neoplastic disease offered no means to perform any other surgery disclosing its malignant potential.
A 44-year-old man developed anuria 8 days after an operation for a perforated appendix. An intravenous pyelography showed delayed excretion on both sides with hydronephrosis, a right dilated ureter and no contrast passing to the bladder. On neither sides a ureter-catheter could be passed through the obstructions from below. By surgical intervention no ureter-catheter could be passed through the obstructions from above, and both ureters were drained with a T-tube. The benign obstruction was caused by a periappendicular abscess with inflammation and oedema of the ureteral and periureteral tissues. The condition was normalized within 7 days.
Carcinoid tumors of the appendix are common incidental findings, but appendiceal tumors with histologic features of both carcinoids and adenocarcinomas are rare, and their biologic behavior is still unclear. We studied 10 such cases among 45 appendiceal tumors seen at Yale-New Haven Hospital between 1960 and 1982. The patients, ranging in age from 23 to 65 yr, were all clinically symptomatic [acute appendicitis (5); abdominal mass (5)]. Right colectomy was performed in 5 patients; the other 5 underwent appendectomy only. In 1 case, metastasis to a lymph node was detected; 2 patients had ovarian metastases, and 4 patients had cecal invasion. One of the 10 patients died of widely disseminated tumor, 2 are living with persistent disease, and 5 remained free of disease from 1 to 5 yr after initial surgery. Two cases were lost to follow-up. We conclude that the histology of these lesions is distinctive, enabling their differentiation from ordinary carcinoids. Because these lesions behave in a clinically more aggressive fashion than the usual appendiceal carcinoids, but are less virulent than adenocarcinoma, we support their classification as adenocarcinoids.
A child with a "tumor"--like lesion of the appendix, diagnosed as an inflammatory pseudotumor is being reported. Awareness of this entity to avoid overtreatment is emphasized.
Following the recent finding of seven malignant or potentially malignant tumors of the appendix, all appendicular tumors encountered in our practice in the past ten years were reviewed. Right hemicolectomy seems to be the treatment of choice for proven malignancy.
The experience in Hamilton, Ontario, with adenocarcinoma of the appendix, between 1974 and 1980, is reviewed and the findings are compared with those of a previous report from Hamilton. There were seven patients (five men and two women) in the current series. The average age was 55.6 years. The unusual presenting signs and symptoms of this tumour are noted; the diagnosis is rarely made preoperatively. This tumor often cannot be distinguished from cecal or ileal malignant tumours. Detailed histologic examination of all specimens is essential to identify epithelial types and to plan treatment. While appendectomy alone may suffice for tumours confined to the appendiceal mucosa, radical right hemicolectomy is still the standard therapy. The authors' study shows no improvement in preoperative diagnosis, or in prognosis, over the earlier report. The authors recommend (a) that this condition be considered in the diagnosis of any appendiceal mass that is not obviously inflammatory, and (b) the frequent use of frozen-section examination to confirm the diagnosis.
A 62-year-old female presented with bilateral ovarian tumors. These proved to be metastatic from a primary appendiceal lesion which showed histochemical and ultrastructural evidence of differentiation along two cell lines with features of both carcinoid and mucinous tumor. This case illustrates the malignant potential of so-called mucinous carcinoid or adenocarcinoid of the appendix.
The authors report one case of perforated appendix associated with an inflammatory ileo-coecal pseudotumour due to malacoplakia. Right hemicolectomy resulted in uneventful and complete recovery. This case, together with a survey of available published data, enables the authors to briefly review the pathological, pathogenic and therapeutic aspects of this rare, if not exceptional, localisation of malacoplakia.
64 patients under forty years of age with appendical carcinoid tumor in Denmark 1943-67 have been followed 10-33 years after the operation. Recurrence is found in one patient with a tumor larger than 2 cm and local metastases. Appendectomy alone is generally a sufficient treatment. Right hemicolectomy is indicated in tumors larger than 2 cm, in cases with local metastases or if the resected appendix-base is not free of tumor in cases with tumor localized near the base. Invasion in the mesoappendix does not increase the frequency of recurrence.
The atrial myocardium has been barely visible with thallium-201 myocardial scintigraphy. This is probably related to the difference in size, distance from anterior chest wall, and small coronary blood flow of the atrium, compared with the ventricle. We have encountered eight cases of visualization of the right atrial appendix (RAA). All had disease involving the right side of the heart, such as mitral stenosis (four cases), congenital heart disease (two), cor pulmonale (one), and primary myocardial disease (one). The RAA was identified from multiple projections in all cases and sometimes confirmed by radionuclide angiocardiography. The RAA was seen at the right upper aspect of the ventricles and was distinguishable from them. Evidence derived from ECG, chest radiographs, and cardiac catheterization, indicated that the most important factor in the visualization might be the displacement of the RAA to a more anterior position.
Based on a group of six patients with carcinoid of the appendix treated at the Surgical Clinic of Dérer's Hospital in Bratislava in 1988/93, the authors discuss the diagnosis and treatment of clinically silent carcinoids (< 2 cm). Appendectomy was performed and the mesoappendix was removed. The prognosis of these patients is good, after five years 100% of the patients survive. The carcinoid syndrome is a symptom of an advanced tumour or secondaries in the liver where comprehensive treatment (surgery + metastasectomy + chemotherapy) is indicated. One third of the patients survive after five years.