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PubMed2003

Histological and immunological features of appendix in patients with ulcerative colitis.

Patients with ulcerative colitis (UC) have a less frequent prior history of appendectomy than the general population. The aim of the present investigation was to elucidate histological and immunological characteristics of the appendix in UC and to assess the effect of appendectomy on the disease. Nine subjects with mildly active UC were treated by surgical appendectomy. In four subjects, the histological findings of the appendix were compatible with ulcerative appendicitis. CD3+CD4+CD25+, CD3+CD4+CD45RO+, and CD3+CD8+CD45RO+ appendiceal mononuclear cells were significantly higher in UC than in acute appendicitis and in normal appendix. There was a trend towards higher mRNA transcripts of IFN-gamma in the appendix of UC than those in other two groups. Clinical activity index decreased significantly four weeks after the appendectomy, although the effect was transient. The appendix is a site of involvement in UC, where mononuclear cells are presumed to be at a state of basal activation.

Adult↗
PubMed2001

Conservative management of appendix mass in children.

BACKGROUND: The management of an appendix mass in children is controversial. An experience of conservative management of appendix masses in a paediatric population over the last 19 years is reviewed. METHODS: The medical records of all children who presented with an appendix mass to one of three children's hospitals between 1982 and 2000 were reviewed. In that interval 427 children with a mean age of 7.3 years (range from 2 months to 18 years) presented with an appendix mass. Sixteen children had an immediate appendicectomy. The remaining 411 children were treated conservatively by close observation and antibiotics, with intravenous fluids and nasogastric suction if required. Once the child was well enough for discharge home, elective appendicectomy was booked for 4-6 weeks later. RESULTS: Three hundred and forty-six (84.2 per cent) of the children responded to initial conservative management and were discharged after a median stay of 6 (range 3-24) days. The children returned 4-6 weeks later for elective appendicectomy. The complication rate for elective appendicectomy was 2.3 per cent (eight patients). Those who had an uncomplicated elective appendicectomy had a median hospital stay of 3 (range 1-6) days. Histological examination demonstrated acute or subacute inflammation in 50.8 per cent of appendices removed at elective appendicectomy. CONCLUSION: Non-operative management of an appendix mass followed by elective appendicectomy is a safe and effective method of management.

Adolescent↗
PubMed2000

Primary T-cell non-Hodgkin's malignant lymphoma of the appendix.

A case of primary T-cell lymphoma of the appendix in an 84-year-old female was reported. Appendectomy was performed as a result of the clinical diagnosis of acute appendicitis, due to the rebound tenderness of McBurney's point and thickness of the appendix wall as determined from ultra echo sonograph. Grossly, the surgical resected appendix did not have a dominant inflammatory appearance, therefore a tumor was suspected. Microscopic examination showed diffused proliferation of large and medium size lymphoma cells. Immunohistochemical examination further revealed that the lymphoma cells were positive for T-cell markers. To ensure this was a T-cell lymphoma, molecular examination was performed using paraffin-embedded tissue sections, since T-cell lymphoma of the appendix is extremely rare. Polymerase chain reaction (PCR) single-strand conformation polymorphism (SSCP) analysis demonstrated monoclonal T-cell receptor gene rearrangement. T-cell-rich B-cell lymphoma was excluded. To our knowledge, this is the first reported case of primary T-cell lymphoma of the appendix. PCR-SSCP analysis in paraffin-embedded tissue section was very useful in the diagnosis of lymphoma cell monoclonality.

Aged↗
PubMed2002

Neutrophil count in the normal appendix and early appendicitis: diagnostic index of real acute inflammation.

It is generally accepted that the uninflammed appendix does not contain neutrophils. In view of that, we searched for the presence of neutrophils in 60 uninflammed appendectomies and compared the findings with the neutrophil count in 20 cases of early appendicitis. In the uninflammed appendix, the upper third of the mucosa showed a mean of 0.75 neutrophils (N) per 5 high power fields (HPF), 4.71 N/5 HPF in the middle third, and 2.70 N/5 HPF in the deep third. At the suberosa, a mean of 3.41 and 3.32 N per 10 post-capillary venules in respectively longitudinal and transverse sections of the organ were present. The number of neutrophils in the mucosa showed a positive correlation with the number in the subserosa. In the early appendicitis we observed a mean of 12.53 N/5 HPF in the upper third, 11.33 N/5 HPF in the middle third, and 13.0 N/5 HPF in the deep third; at the subserosa, a mean of 4.95 N/10 post-capillary venules in transverse sections and 4.45 N/10 post-capillary venules in longitudinal sections was observed. No positive correlation between N in the mucosa and subserosa was observed. The count of N in the mucosa of normal appendix and early appendicitis showed a significant difference (P <.005). We conclude that, although present, not more than 10 neutrophils/5 HPF are found in the mucosa of uninflammed appendixes. Neutrophil count in the lamina propria should support the diagnosis of "normal" appendix and could be an indicator for suspecting early appendicitis, preventing underdiagnosis.

Adolescent↗
PubMed2001

Unusual duplication of appendix and cecum: extension of the Cave-Wallbridge classification.

Duplicated appendix has, to date, been classified into 3 types. The authors present a type of duplicated appendix not previously described. Surgical exploration was done in a 14-year-old girl who had an acute abdomen. Surgical exploration showed a duplicated appendix that arose from the normal appendix and ended in a thick-walled, inflamed, perforated muscular pouch. Duplicated appendix is a treatable condition that rarely occurs with colonic duplication and which should be considered in the differential diagnosis of lower abdominal pain.

Abdomen, Acute↗
PubMed1995

Preferential expansion and survival of B lymphocytes based on VH framework 1 and framework 3 expression: "positive" selection in appendix of normal and VH-mutant rabbits.

B cells with a rearranged heavy-chain variable region VHa allotype-encoding VH1 gene segment predominate throughout the life of normal rabbits and appear to be the source of the majority of serum immunoglobulins, which thus bear VHa allotypes. The functional role(s) of these VH framework region (FR) allotypic structures has not been defined. We show here that B cells expressing surface immunoglobulin with VHa2 allotypic specificities are preferentially expanded and positively selected in the appendix of young rabbits. By flow cytometry, a higher proportion of a2+ B cells were progressing through the cell cycle (S/G2/M) compared to a2- B cells, most of which were in the G1/G0 phase of the cell cycle. The majority of appendix B cells in dark zones of germinal centers of normal 6-week-old rabbits were proliferating and very little apoptosis were observed. In contrast, in 6-week-old VH-mutant ali/ali rabbits, little cell proliferation and extensive apoptosis were observed. Nonetheless even in the absence of VH1, B cells with a2-like surface immunoglobulin had developed and expanded in the appendix of 11-week-old mutants. The numbers and tissue localization of B cells undergoing apoptosis then appeared similar to those found in 6-week-old normal appendix. Thus, B cells with immunoglobulin receptors lacking the VHa2 allotypic structures were less likely to undergo clonal expansion and maturation. These data suggest that "positive" selection of B lymphocytes through FR1 and FR3 VHa allotypic structures occurs during their development in the appendix.

Animals↗
PubMed2002

Prediction of inflammation of the appendix at open and laparoscopic appendicectomy: findings and consequences.

OBJECTIVE: To evaluate the accuracy of operative assessment of the condition of the appendix during laparoscopic and open appendicectomy, and to assess whether a normal-looking appendix should be excised routinely during a laparoscopic operation. DESIGN: Prospective study. SETTING: District general hospital, UK. SUBJECTS: 387 patients who presented with signs and symptoms of appendicitis and underwent appendicectomy. INTERVENTION: 63 patients (16%) were operated on laparoscopically, of whom 48 were female. MAIN OUTCOME MEASURES: Correlation of operative with histological findings. RESULTS: The positive predictive value of operative assessment was increased during the laparoscopic procedure in both male (94.4% to 100%) and female (78% to 88%) patients. Of 21 female patients whose appendixes looked normal at laparoscopy, 5 had other conditions (appendixes normal on histological examination) and 4 were inflamed. CONCLUSION: In women of childbearing age a normal-looking appendix should be resected during laparoscopic appendicectomy unless another condition is obviously the cause of the signs and symptoms.

Adult↗
PubMed1999

Elemental mercury in the appendix: an unusual complication of a Mexican-American folk remedy.

BACKGROUND: Ingestion of small amounts of elemental mercury is generally thought to be harmless. However, in 4 previously reported cases, ingested mercury became sequestered in the appendix, causing appendicitis in one. We present a case in which elemental mercury was administered as a Mexican-American folk remedy for abdominal pain and became sequestered in the appendix. CASE REPORT: A 10-year-old Hispanic male presented with 3 days of right-sided abdominal pain, diarrhea, fever, and malaise. On admission, his temperature was 41.5 degrees C and he had right abdominal tenderness. Urinalysis showed 3 WBCs, 9 RBCs, occasional bacteria, and 1+ protein. An abdominal CT scan suggested right focal pyelonephritis, but also showed multiple intraabdominal metallic densities. On further questioning, the family admitted giving him elemental mercury as a remedy for "empacho." He was treated with intravenous ampicillin/sulbactam and gentamicin for a focal pyelonephritis. Because of mercury remaining in the gastrointestinal tract, activated charcoal and sorbitol were given. By hospital day 3, mercury filled the appendix as shown by abdominal radiograph. He was placed in the left lateral decubitus position overnight, and by the next morning, the mercury partially emptied from the appendix. By hospital day 8, his symptoms had resolved and mercury was no longer seen in the appendix. There were only minimal increases in urine mercury levels (18 mg/L). At 5-month follow-up, he has remained asymptomatic.

Abdominal Pain↗
PubMed1996

Outcome analysis of Mitrofanoff principle applications using appendix and ureter to umbilical and lower quadrant stomal sites.

PURPOSE: We compared the indications for and results of application of the Mitrofanoff principle using appendix and ureter to umbilical and lower quadrant stomal sites. MATERIAL AND METHODS: We created continent catheterizable conduits in 60 patients 3 days to 20 years old (mean age 8.8 years). The primary indication was refractory urinary incontinence associated with bladder or cloacal exstrophy, or anomalies in 31 cases. We constructed 38 umbilical (all appendix) and 22 lower quadrant (10 appendix and 12 ureter) stomas. Mean followup was 3 years. RESULTS: We preferred the umbilicus as a stomal site for its cosmetic value. The most common indication for a lower quadrant stomal site was preservation of the retroperitoneal course of the ureter. The stomal stenosis rate was 13 and 4% in patients with umbilical and lower quadrant stomas, respectively. We preferred the appendix as a conduit due to availability. Indications for the ureter as a catheterizable conduit were absence of an adequate appendix or presence of a healthy ureter after nephrectomy. The appendiceal and ureteral conduits were catheterizable in 94 and 84% of patients, respectively, and continence was achieved in 97%. CONCLUSIONS: In a complex group of patients with incontinence application of the Mitrofanoff principle yielded good results for either combination of stomal site or catheterizable conduit. Appendicovesicostomy to the umbilicus remains our preferred procedure.

Adolescent↗
PubMedDate not supplied

Visualization rate and pattern of normal appendix on multidetector computed tomography by using multiplanar reformation display.

OBJECTIVE: To evaluate the visualization rate and describe the morphologic pattern of the normal appendix on multidetector CT (MDCT) by using multiplanar reformation display. METHODS: We conducted a retrospective evaluation of the normal appendix with MDCT in 108 consecutive patients. A radiologist blinded to patient surgery history reviewed multiplanar reformation images at the workstation. The coronal and sagittal reformation images were reviewed in addition to the axial images. The visualization rate and morphologic pattern (including location, diameter, and lumen content) of normal appendices were recorded. RESULTS: The prevalence of appendectomy was 9% (10 of 108 patients). The appendix was recorded as definitely visualized in 91 of 98 patients who denied a history of appendectomy, definitely not visualized in 13 patients, and unsure in 4 patients. For statistical analysis, the definitely not visualized and unsure cases were summed and categorized as not visualized. The sensitivity, specificity, positive and negative predictive values, and accuracy of visualization of the normal appendix by MDCT were 93%, 100%, 100%, 59%, and 94%, respectively. All the patients in the unsure group had ascites or inadequate pericecal fat, or both. The mean outer diameter of the appendix was 5.6 +/- 1.3 mm (SD) (range: 3.0-11.0 mm). CONCLUSION: We verify a high visualization rate (93%) of normal appendices on MDCT by using multiplanar reformation display.

Adolescent↗
PubMed1998

Ulcerative colitis with skip lesions at the mouth of the appendix: a clinical study.

OBJECTIVE: We examined the clinical characteristics of ulcerative colitis patients who demonstrated endoscopically discontinuous lesions at the mouth of the appendix. METHODS: Of patients with initial or recurrent active ulcerative colitis who underwent total colonoscopy during the past 3 yr at Osaka City General Hospital, we selected those who had skip lesions in the mouth of the appendix before treatment, and examined their gender, age, disease type, sites of lesions, inflammatory reaction, severity of disease, effects of treatment, and posttreatment course. RESULTS: Discontinuous lesions at the mouth of the appendix were found in 10 patients, who had the following common clinical features: the major lesion was usually present in the lower part of the large bowel including the rectum, many of the patients had suffered an initial attack only, all patients had mild disease, and many of the patients responded quite satisfactorily to treatment with salicylazosulfapyridine. CONCLUSION: Numerous patients with ulcerative colitis with discontinuous lesions at the mouth of the appendix were observed and their clinical characteristics were examined. Determination of the clinical significance of skip lesions in the appendix will contribute to elucidation of the pathogenesis of ulcerative colitis.

Adult↗
PubMed1977

Responsiveness of rabbit spleen and appendix cells to bacterial mitogens.

Rabbit spleen and appendix cells were used to test the mitogenic activity of a commercial lipopolysaccharide (LPS) preparation from Salmonella typhimurium (Difco), a preparation extracted from it, and cell wall preparations from smooth (45/0) and rough (45/20) strains of Brucella abortus. On the basis of [3H]thymidine incorporation ratios (E/C), that is, the incorporation rate among cells treated with the mitogen relative to that of untreated cells, the extracted LPS and both Brucella cell wall preparations, but not the commercial LPS were potent mitogens for rabbit spleen cells. By the same criterion, only the Brucella cell wall preparation produced a significant, but minimally so, response among appendix cells. The weak responsiveness of appendix cells may be more apparent than real, however, and may not imply a difference in intrinsic susceptibility to mitogens by these two populations, because unstimulated appendix cells incorporated thymidine at 10 times the rate of unstimulated spleen cells. Appendix cells, then, may not be susceptible to further stimulation, even by active mitogens. Therefore, the significance of E/C ratios may be equivocal when materials are assayed for mitogenic activity on lymphoid populations whose basal activity is relatively high.

Animals↗
PubMed2004

Serrated adenomas of the appendix.

AIMS: A review of the literature indicated that only one case of serrated adenoma of the appendix has been recorded. The aim was to explore the possible occurrence of serrated adenomas of the appendix at the department of pathology, Karolinska Institute and University Hospital, Stockholm, Sweden. METHODS: Between January 1993 and December 2003, 38 non-carcinoid, non-neoplastic, or neoplastic polyps or tumours of the appendix were surgically removed at this hospital. All filed histological sections (haematoxylin and eosin stained) were reviewed. RESULTS: Of the 38 lesions, four were hyperplastic polyps, 10 serrated adenomas, six villous adenomas, and the remaining eight mucinous adenocarcinomas without a remnant adenoma. Serrated adenomas accounted for six of the 11 adenomas without invasion, and four of the 15 adenomas with invasive carcinoma. At the time of surgical resection, four of the 10 serrated adenomas had evolved into invasive carcinomas, in addition to 11 of the 16 villous adenomas. CONCLUSIONS: Serrated and villous adenomas of the appendix appear to be highly aggressive lesions, more aggressive than similar adenomas in the colon and rectum. Of the seven cases with a hyperplastic polyp, one concurred with a serrated adenoma, two with a serrated adenoma having an invasive carcinoma, and one with invasive carcinoma without a remnant adenomatous structure. At present, there is an increased awareness that some hyperplastic polyps of the colon and rectum may evolve into serrated adenomas. Whether this pathway is also valid for the appendix vermiformis should be investigated in a larger number of cases.

Acute Disease↗
PubMed1992

Sonographic detection of the normal and abnormal appendix.

A prospective study of 170 patients with suspected appendicitis was performed to assess the value of sonography in detecting the normal and abnormal appendix. The wall thickness (normal, less than or equal to 3 mm), compressibility of the appendix, and echogenicity of surrounding fat were the primary criteria used to determine the status of the appendix. Of 60 patients who underwent surgery, appendicitis was proved in 45. The remaining 110 patients who did not have surgery, contacted by telephone at the end of the study, had no clinical follow-up evidence of acute appendicitis. A normal appendix was clearly identified in 102 (82%) of 125 patients without acute appendicitis. The sensitivity of sonographic examination in detecting appendicitis was 93%, the specificity was 94%, and the accuracy was 94%. The predictive value of a positive test was 86%; that of a negative test was 98%. Ruptured appendicitis was predicted in all cases (11/11). Sonography is useful in detecting acute appendicitis and can clearly show the normal appendix more frequently than previously reported.

Acute Disease↗
PubMed1991

Granulomas of the appendix: is it Crohn's disease?

An epidemiologic study was performed 1) to estimate the occurrence of epithelioid granulomas in the appendix wall among patients in whom an appendectomy had been performed, 2) to identify patients with granulomas in the appendix who had symptoms and history compatible with Crohn's disease, and 3) to estimate the long-term prognosis. Within a 5-year period 6051 patients in Copenhagen County underwent appendectomy. Six patients (0.1%) had epithelioid granulomas of the appendix (0.2 per 10(5) inhabitants per year). Follow-up of the six patients for 9-11 years (median, 9.5 years) showed that all had been free of gastrointestinal symptoms since the operation. Among the 373 patients diagnosed as having Crohn's disease in Copenhagen County between 1962 and 1987, 3 patients had their disease initially confined to the appendix. Follow-up in these patients showed no recurrence within a median of 6 years (range, 4-7 years). Patients with epithelioid granulomas of the appendix have an excellent long-term prognosis, which could be explained by the fact that the condition seems to be unrelated to Crohn's disease.

Adolescent↗
PubMedDate not supplied

Study of the unaltered in situ appendix as a native continence mechanism: cadaveric and clinical correlation.

The past decade has seen intense efforts to develop the ideal pouch for use in continent diversion and bladder substitution. The aspect that has been singularly the most difficult to perfect has been the continence mechanism. In recent years much has been reported on the use of the vermiform appendix as a continence mechanism following one or more surgical manipulations. It was the aim of this study to determine whether the in situ appendix, without any surgical manipulation, could provide a native continence mechanism. Studies were carried out using (1) five cadaver subjects and (2) eight patients undergoing cystoprostatectomy in whom the distal tip of the appendix was removed and an ileocecal pouch was filled with irrigant until leakage was noted from the appendix. The pressure within the pouch at the time of leakage was defined as the appendiceal leak pressure. Mean appendiceal leak pressure was 50.6 cm H2O with a range from 21 to 86 cm H2O. These studies indicate that at the pressure being maintained in most continent pouches as constructed today, the in situ unmanipulated appendix would, in some cases, provide adequate continence. In others only minimal reinforcement is required to maintain continence.

Appendix↗
PubMed1989

[Mainz pouch using the appendix as the efferent limb].

Mainz pouch procedure requires intussuscepted ileum only at the efferent limb because ureters are tunneled into the colon wall in stead of the intussuscepted ileum as done in the Kock pouch procedure. We modified the Mainz pouch procedure using the tunneled appendix as the efferent limb in which intussuscepted ileum was no longer required. Four patients, three with bladder cancer and one with prostatic cancer, underwent this procedure. After total cystectomy and pelvic lymph-adenectomy the pedicled ileocecal segment was isolated. The appendix with the intact vascular supply was separated from the ileocecal segment. After the pouch was constructed, both the ureters and the appendix were tunneled into it. The pouch was then drained by a 24 Fr nephrostomy catheter. The ureters were splinted. The pouch was closed in one layer with locked running sutures. Three patients had ureteral strictures, 2 of which were corrected by percutaneous dilatation. The third one required persistent nephrostomy drainage. The appendix of all 4 cases functioned well as the efferent limb, preventing urinary leakage and allowing easy catheterization. Three of the 4 patients satisfied with this type of urinary diversion. The modified Mainz pouch procedure may be very useful because it does not require any staples to fix the intussuscepted ileum nor a long intestinal segment. Patients whose appendix can not be utilized may be candidates for the original Mainz pouch procedure.

Aged↗
PubMed2000

[Mucinous adenocarcinoma of the appendix associated with ovarian tumors and pseudomyxoma peritonei. The difficulty in differential diagnosis].

Mucinous adenocarcinoma of the appendix is rare. If there is a concomitant ovarian tumor to determine the primary might be difficult. Histological features are not always determinant, but there are some macroscopic findings that may suggest an origin in the appendix. We report a case of synchronous tumors in appendix and ovaries with pseudomyxoma peritonei. The patient presented with mass sensation in the right lower quadrant, asthenia, anorexia and weight loss. Abdominal ultrasound and CT scan showed a tumor involving cecum, appendix, terminal ileum and pelvis. Findings on colonoscopy and biopsies were inconclusive. At laparotomy, the tumor compressed appendix, cecum and ascendant colon, terminal ileum, ovaries and peritoneum. Histopathological analysis demonstrated a well-differentiated mucinous adenocarcinoma of appendiceal origin with metastasis in ovaries and peritoneum (pseudomyxoma peritonei).

Adenocarcinoma, Mucinous↗