Appendicular Origin Research Articles

New specimens of Bunaia woodwardi Clarke, 1919 (Euchelicerata): a new member of Offacolidae providing insight supporting the Arachnomorpha.

The rapid early diversification of arthropods has made understanding internal relationships within the group fiendish. Particularly unresolved is the origin of Euchelicerata, a clade consisting of the Prosomapoda (comprising the extant Xiphosura and Arachnida and the extinct Chasmataspidida, Eurypterida and synziphosurines) and the extinct Offacolidae. Here we describe new material of the Silurian 'synziphosurine' Bunaia woodwardi Clarke, 1919 that reveals previously unknown features of its ventral anatomy: a pair of elongated chelicerae in the prosoma, followed posteriorly by five pairs of biramous appendages, a first pre-abdomen somite bearing a pair of paddle-like uniramous appendages (exopods) and a ventral pretelsonic process. Phylogenetic analyses retrieve B. woodwardi as a member of Offacolidae closely related to Setapedites abundantis from the Early Ordovician Fezouata Biota. An anatomical comparison of the pretelsonic process of B. woodwardi, also present in Setapedites, with the posterior trunk morphologies of other Offacolidae, Habeliida and Vicissicaudata, suggests a possible homologous appendicular origin. This proposed apomorphic character supports a monophyletic Arachnomorpha, formed of Vicissicaudata, Habeliida and Euchelicerata. The establishment of this new homology could help to clarify the highly enigmatic phylogeny at the base of the euchelicerates as well as the sequence of character acquisition during their early evolution.

Generalized peritonitis of appendicular origin with intraoperative finding of situs inversus abdominalis

El situs inversus es una enfermedad congénita muy rara que afecta a una de cada 10 000 personas. La revelación desitus inversuspor un síndrome peritoneal es un evento extremadamente raro. Los pacientes con situs inversus tienen una incidencia de 0,016-0,024 % de sufrir apendicitis aguda y generalmente se presentan con alguna complicación. Se presenta el caso de una paciente con peritonitis generalizada de origen apendicular con hallazgo intraoperatorio casual de situs inversus abdominalis.

Repeat cytoreduction with Hyperthermic Intraperitoneal chemotherapy in patients with peritoneal disease: A 5-year retrospective analysis

BackgroundCytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (CR-HIPEC) is a locorregional surgical therapy applied in patients with peritoneal-only metastatic disease of primary abdominal malignancies. Integrated in a multimodal treatment, CR-HIPEC is associated with increased overall survival. In cases of peritoneal-site only relapse, it may be carried out more than once. MethodsPatients who received a CR-HIPEC between January 2016 and December 2020 at Instituto Português de Oncologia do Porto, Portugal were included in a unicentric, retrospective, observational study. Short- and long-term outcomes after surgery were analyzed. ResultsIn this period, 259 CR-HIPEC were performed on 248 patients. Of these, 31 were CR-HIPEC repeats, with 6 being the third HIPEC in the same patient. Of the 31 cases, 15 (48.4 %) had an appendicular origin. Mean PCI in re-HIPEC group was 10.6 (SD ± 7.1). No significant differences in baseline characteristics between the first and re-HIPEC groups were found, except for mean PCI, higher in the 1st HIPEC group (p = 0.047). In re-HIPEC group, major complications rate (CT-CAE 3–4) was 12.9 % (n = 4), without postoperative mortality. The 1st and re-HIPEC group had similar morbidity rates and hospitalization time. With a median follow-up time of 44 months, relapse rate after repeat CR-HIPEC was 45.2 % (n = 14), with a mean overall survival (OS) of 68.7 months and 5-year OS of 78 %. ConclusionsRepeat CR-HIPEC is a safe approach with an acceptable complication rate for its complexity, associated with a survival benefit in selected patients. It should be presented as a valid therapeutic option in recurrent peritoneal disease.

PRISE EN CHARGE DES URGENCES CHIRURGICALES DIGESTIVES : ETUDE PROSPECTIVE A PROPOS DE 118 CAS

INTRODUCTION Abdominal emergencies are any acute abdominal conditions requiring a quick surgical response. The abdominal emergencies require accurate diagnosis and treatment within a particular time limit to prevent mortality. They constitute a major part of the visceralist surgeon's activity in sub-Saharan Africa. They are still burdened with significant morbidity and mortality. The purpose of this study was to determine the prognostic factors of morbi mortality during the management of non-traumatic abdominal emergencies of the adult. MATERIALS AND METHODS We made a prospective, descriptive and analytical study over 1 year from May 1, 2017 to April 31, 2018 carried out at Saint-Louis regional hospital. All patients, aged at least 16 years old and received in an acute abdominal surgical nontraumatic table were included. Results were analyzed with Epi-Info 7; focused on sociodemographic, clinical, paraclinical, therapeutic and evolutionary data. Findings were significant if the p-value was less than 0,05 RESULTS 118 patients were included in our study, representing 39.5% of digestive surgery procedures. The average age of our patients was 35.9 years with extremes of 16 and 90 years and a standard deviation of 18.1. The sex ratio was 3.9. The average consultation time was 3.5 days. The delay of surgery was 18 hours with extremes of 05h to 10 days. There were 15.3% (n = 18) of comorbidity. Abdominal pain was the most common clinical sign (96.6%). Plain abdominal xray was the most prescribed imaging test (50%) followed by ultrasound (30.8%) and CT (19.2%). Acute bowel obstruction was the most common diagnosis 51 (43.2%) followed by acute peritonitis 33 (28%), appendicitis 23 (19.5%) and strangulated hernias 11 (9.3%). The initial diagnosis tallied at 97.4% with per operative diagnosis. Sigmoid volvulus represented 55% of occlusions, 54.5% of peritonitis was of appendicular origin, and 45.5% of strangulated hernias were inguinal. There were 23 (19.5%) cases of anesthetic incidents. There were 22 hemodynamic instabilities, 4 of which required the use of amines. There were 19 cases of surgical complications, 20.9% of operated patients, dominated by parietal suppuration (15 cases) and postoperative peritonitis (4 cases). Factors influencing this morbidity were: consultation delay (p = 0.02), comorbidity (p = 0.0006), and duration of surgery (p = 0.02). In addition, there was no significant relationship between the delay of intervention and morbidity. The mortality rate was 8.5% (10 cases including 7 occlusions) usually related to septic shock (90%). Mortality was significantly related to age (p = 0.01), consultation delay (p = 0.01), comorbidity (p = 0.00004), diagnosis of acute intestinal obstruction (p = 0.04) and perioperative hemodynamic instability (p = 0.04). CONCLUSION The management of surgical acute abdomens in Saint-Louis remains still intact. Morbidity and mortality factors are dominated by delayed consultation and comorbidity. However, improving the prognosis during adult non-traumatic abdominal emergencies requires consciousness-raising and multidisciplinary. KEYWORDS: morbidity, mortality, acute abdomen, Saint-Louis

Imaging Matrix-Assisted Laser Desorption/Ionization Fourier Transform Ion Cyclotron Resonance Mass Spectrometry of oxaliplatin derivatives in human tissue sections

Mass Spectrometry Imaging is an effective technology that allows to determine the in-situ distribution of endogen and/or exogen small molecules. It is a rapidly emerging approach for visualizing drugs and their metabolites within biological tissues. Matrix-Assisted Laser Desorption Ionization (MALDI) Mass Spectrometry Imaging (MSI) coupled to high resolving power analyzer (e.g. TOF) was already investigated for metallodrug localization and metabolization studies, but was proved to suffer from a lack of sensitivity and resolution, leading to poor coverage and assignment. To counter these technological limitations, the use of ultra-high resolving power analyzer such as Fourier Transform Ion Cyclotron Resonance (FTICR) could be revealed as a technique of choice. The high field FTICR MS provides ultra-high resolving power and mass accuracy that allows exhaustive molecule coverage and non-ambiguous molecular formula assignments. Platinum derivatives, such as oxaliplatin, are widely used as therapeutic agents for cancer treatment. The assessment of their intake, distribution and metabolism within the organs is important to know the risks associated with their use. In this study, MALDI FTICR MSI analyses were performed to better understand the penetration and metabolization of platinum derivatives in ovaries of women treated by Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for peritoneal metastasis of colorectal or appendicular origin. Twelve ovary sections, from six ovary samples in six women donors, before and after treatment, were analyzed with 120 μm spatial resolution. For the first time, the high resolving power (220,000 at m/z 457) and sub-ppm accuracy (<1 ppm) of the FTICR combined with an Isotopic Fine Structure study enabled to distinguish two Pt-isobaric species derived from oxaliplatin in biological tissues. One of these, which is unknown, was specifically localized at the contour of the ovary.

Primary peritoneal hydatid cyst in a child discovered during appendicular peritonitis

Morocco is considered an endemic country for hydatidosis. Peritoneal localization is frequent in its secondary form, however, primary peritoneal hydatidosis is exceptional, especially in children. We report the observation of a 14-year-old child admitted for generalized abdominal pain with fever; the radiological assessment objectified two pelvic collections. Surgical exploration revealed a huge peritoneal hydatid cyst incidentally discovered associated with peritonitis of appendicular origin. The cyst was completely removed combined with appendectomy and peritoneal lavage. The post-operative evolution was simple.

Acute generalized peritonitis of appendicular origin: Epidemiological, clinical and therapeutic aspects at the Sino-Guinean Friendship Hospital

Acute generalized peritonitis of appendicular origin: Epidemiological, clinical and therapeutic aspects at the Sino-Guinean Friendship Hospital

Acute generalized peritonitis of appendicular origin: Epidemiological, clinical and therapeutic aspects at the Sino-Guinean Friendship Hospital

Introduction: The aim of this study is to investigate, the etiologies, the results of management of acute generalized peritonitis of appendicular origin. Acute generalized peritonitis of appendicular origin is defined as acute inflammation of the peritoneum resulting from either perforation of the appendix or spread of a peri-appendicular abscess. Methodology: The visceral surgery department of the Sino-Guinean Friendship Hospital served as the framework for this work. All patients admitted and operated on for acute generalized peritonitis of appendicular origin whose records were complete were included in this study. Results: During our study we recorded 23 cases of appendicular peritonitis, the sex ratio of nearly 3.6 reflected a clear male predominance of the condition. We noted 15 cases of appendicular perforation, 8 cases of appendicular gangrene, 2 cases of surgical site infection, 2 cases of evisceration and 2 cases of death. Conclusion: Appendicular peritonitis is a frequent disease, the management is medico-surgical.

Ehlers-Danlos Syndrome (EDS) : A Common and often Disregarded Cause of Serious Gastrointestinal Complications in Children and Adults

Ehlers-Danlos is a hereditary disease of the whole connective tissue initially described by dermatologists (Tscherchnogobov Moscow 1892, Ehlers, Copenhagen, 1900, Danlos, Paris, 1908). They emphasized the joint hyperlaxity and stretchiness of the skin which has long summed up the clinical expression of this entity. In recent decades, many other manifestations have been described and gradually identified, mainly by rheumatologists (Grahame, London, 1960). Several of them concern the digestive tract, mainly gastric reflux and constipation. They can be the cause of serious accidents: bronchial flooding by gastric reflux or aspiration, intestinal obstruction, hernial constriction, eventration, intestinal rupture, peritonitis of vesicular or appendicular origin, hemorrhages. It is important that gastroenterologists know how to link these manifestations to their etiology in order to adapt treatments, prevent iatrogenic accidents and direct the patients towards the treatment of other manifestations of Ehlers-Danlos disease. Nine clinical signs, including digestive manifestations, allow diagnosis by their significant grouping. The proof of hereditary origin is based on the identification of other identical cases in the family,, even if they are paucisymptomatic. A person affected by the disease systematically transmits the disease to all his children. We have verified this in all our patients.

Ultrastructural Changes of Blood Cells in Children with Generalized Purulent Peritonitis: A Cross-Sectional and Prospective Study.

In conditions of abdominal sepsis with indications of first- or second-stage shock, blood cells undergo significant ultrastructural changes that cause impaired gas exchange, changes in reactivity, and decompensation of organs and systems functions. This paper presents a cross-sectional prospective study aimed at researching the ultrastructure of blood cells in children experiencing abdominal septic shock against the background of generalized purulent peritonitis of appendicular origin. This study was conducted with 15 children aged 6–12 who were undergoing treatment for generalized appendicular purulent peritonitis, with first- or second-stage abdominal septic shock, in emergency care. The changes in the ultrastructure of erythrocytes did not correspond to changes characteristic of eryptosis, which confirms their occurrence under the influence of such pathogenic factors as intoxication, metabolic, water–electrolyte balance, and acid–base disorders. Ultrastructural changes of granulocytes indicate their hyperactivation, which leads to the exhaustion of membrane synthetic resources, membrane destruction, ineffective expenditure of bactericidal factors on substrates that are not subject to destruction. In lymphocytes, disorganization of the nuclear membrane and intracellular membranes, uneven distribution of chromatin, the hypertrophied Golgi apparatus, and a large number of young mitochondria, lysosomes, ribosomes, vesicles manifesting the disruption of metabolism, stress and decompensation of energy supply and protein synthesis systems, have been demonstrated. In conditions of abdominal sepsis with indications of first- or second-stage shock, blood cells undergo substantial ultrastructural changes causing gas exchange disruption, changes in reactivity, as well as decompensation of organs and system functioning.

S2189 Appendicular Ulcer- A Rare Cause of Lower GI Bleed

INTRODUCTION: Although lower gastrointestinal bleeding (LGIB) is not uncommon, appendicular ulcer as cause is extremely rare. Here, we present a case of young male who presented with LGIB due to appendicular ulcer. CASE DESCRIPTION/METHODS: 30-year-old healthy Asian male presented with loss of consciousness following 3 episodes of painless massive LGIB. On arrival, he was hemodynamically unstable which improved following immediate resuscitation with a bolus of fluids and 2 units of packed red blood cells. On examination, he was very pale, tachycardic and obtunded while abdominal examination was benign. Rectal examination showed bright red blood with no evidence of external hemorrhoids. Initial labs showed hemoglobin of 10 mg/dL. He underwent an urgent upper endoscopy and colonoscopy which showed gastric erosions and diffuse blood in the entire colon with poor visualization of the source of bleed, respectively. He underwent Meckel's scan as well as CT abdomen with negative results. Repeat colonoscopy was done on the following day which showed 7 mm ulcer at appendiceal orifice that was thought to be the source of LGIB due to increased vascularity around the orifice. He was discharged the very next day with recommendation to follow up with outpatient surgery. Due to the concern for malignancy, patient underwent partial Cecectomy and the biopsy of the surgical specimen showed an early appendicular abscess with no evidence of granulomatous findings or malignancy. DISCUSSION: Diverticulosis, angiodysplasia, inflammatory disease are the most common causes for LGIB. LGIB due to appendicular ulcer is an extremely rare cause with only few cases reported so far. Urgent colonoscopy needs to be considered in the hemodynamically unstable patient as it will offer a therapeutic intervention as well. Although it is very efficient and a safe tool for evaluation of LGIB, the chances of finding an appendicular origin bleeding is rare. Treatment needs to be individualized. Although colonoscopy hemostasis can be considered, surgical treatment plays an important role in the management of appendicular bleeding. Open or laparoscopic appendectomy can be considered for local appendicular bleeding but cecectomy , ileo-cecectomy and right hemicolectomy also needs to be considered based on the operative findings. With this case, we would like to educate about the possibility of appendicular ulcer bleedings to be considered as part of differential diagnosis of LGIB, especially in young male patients.

Evaluation of appendicitis inflammatory response score in suspected cases of acute appendicitis

Background: Acute appendicitis is a common surgical disease with varied clinical presentation, diagnosis of which, can be at times a clinical challenge. In order to aid in the clinical diagnosis various scoring system have been designed one of which is the appendicitis inflammatory response score (AIR score). The present study is designed to validate the diagnostic accuracy of AIR score in patient with suspected acute appendicitis. Method: The present study included consecutive patient presenting to the emergency department of KIMS hospital Hubli, between Dec2015 to Sept 2017 with acute pain abdomen in the right iliac fossa of suspected appendicular origin. All the clinical data and laboratory investigation necessary for the evaluation of AIR score were collected. The AIR score was then compared with the histopathological report of the resected specimen. Results: In the present study 107 patient, with 70 male and 37 female where included. The AIR score was calculated and was compared with the histopathological report of the resected specimen. AIR score had a good statistical discriminatory property for the diagnosis of acute appendicitis in patients with acute pain in the right iliac fossa, with a sensitivity of 90% and specificity of 88% when the cutoff for diagnosing acute appendicitis was placed at less than 8, with p value of

Pancreatic heterotopia in mesentery

The pancreatic heterotopia of fortuitous operational discovery remains rare because of the medical imagery progress. We report a mesenteric localisation of aberrant pancreas identified during the assumption of responsibility of an abdominal emergency. A 26-year-old man was allowed with the urgencies for an acute obstruction of the small bowel. Surgical exploration revealed a distal support an ileo-parietal adherence near to an inflammatory hearth of appendicular origin. We noted, in addition to the mesentery of the first jejunal loop, a bilobate mass of glandular-like tissue with a pancreatic aspect. The adjacent jejunal handles were macroscopically healthy. The Pathological examination of the mass confirmed the existence of a mixed glandular exocrine and endocrine origin of pancreatic tissue, type I of the Heinrich's classification. This rare topographic entity of fortuitous discovery underlines the need for a meticulous surgical exploration of the abdominal cavity particularly in urgency when a summarized radiological assessment does not permit a complete morphological study.

HALLAZGOS MICROBIOLÓGICOS Y SUSCEPTIBILIDAD ANTIMICROBIANA EN CIRUGÍA ABDOMINAL DE URGENCIA.

Introducción: Es importante mantener programas de vigilancia bacteriana para disminuir resistencia y definir esquemas farmacológicos adecuados. Los pacientes con abdomen agudo representan un grupo microbiológico especial.Objetivos: Hacer una revisión de agentes patógenos en pacientes adultos operados en nuestro Servicio de Urgencia por patología abdominal con líquido libre y analizar los resultados obtenidos de cultivos respecto a las cepas y la suceptibilidad a los antibióticos. Materiales y Método: Estudio de cohorte prospectiva con estadística descriptiva. Se incluyen pacientes consecutivos, mayores de 18 años, operados por abdomen agudo que presentan liquido libre intraperitoneal entre noviembre de 2017 y abril de 2018.Se excluyen casos con terapia antimicrobiana, hospitalización y/o cirugía en los 3 meses previos. Se registran los cultivos positivos, cepas aisladas, susceptibilidad antimicrobiana, datos demográficos y evolución clínica.Resultados: De 63 pacientes 55% fueron hombres y la edad promedio 52,2 años. Las patologías más frecuentes fueron de origen apendicular (62%) y de causa entérica (30%). En un 44% el cultivo fue positivo y en 36% con más de un germen. Escherichia coli fue el patógeno más frecuente (64,2%) seguidos de Enterococo faecium y Estreptococo anginosus (7,1%). De los otros patógenos cultivados sólo se observó resistencia múltiple en un caso aislado de Morganella Morganii.Conclusiones: Estos datos constituyen la realidad microbiológica local en abdomen agudo. La Escherichia Coli sigue siendo el germen más frecuente, debe enfrentarse con profilaxis y tratamiento antibiótico adecuado. Es necesario mantener vigilancia microbiología local para un manejo acorde.

The bacteriophages in the treatment of peritonitis of appendicular origin

The bacteriophages in the treatment of peritonitis of appendicular origin

Mammary Osteosarcoma with Neoplastic Emboli in Cerebellum

Background: The mammary neoplasms are highly frequent in female dogs. It is characterized by the proliferation of epithelial or mesenchymal cells. The mammary osteosarcoma is a example of the proliferation of the last group and its main feature is production of osteoid matrix production and areas of mature bone tissue formation. Metastases to the lungs and regional lymph nodes are frequent, however some other metastasis sites have been reported. The aim of this study is to report a mammary osteosarcoma in a mixed-breed female dog of 12 years old with multiple metastases and neoplastic emboli to the central nervous system.Case: The animal was brought to the Veterinary Hospital of the Uberlândia Federal University (HV/UFU) with the complaint of increase in the volume of the mammary glands. The cytopathological exams was performed in the mass that measured 15 cm of diameter and covering a large region of the mammary gland, from the right cranial thoracic to the right cranial abdominal mammary gland. The cytological diagnostic was inconclusive because of the lack of material for diagnosis. Therefore, total unilateral mastectomy was performed for histopathology analysis. The material was then sent to the Animal Pathology Laboratory of the HV/UFU where routine processing was performed. The microscopy showed proliferation of mesenchymal cells arranged in bundles with intense pleomorfism and producing osteoid matrix, leading to the diagnosis of mammary osteosarcoma. Around 15 days after the diagnostic the animal died and was sent the Animal Pathology Laboratory of the HV/UFU for necropsy. During the external exam there was a mass at the same site of the primary mass previously extracted. Besides it, there were masses affecting lungs, intestine and kidneys. The histopathological exam showed sites of metastasis of osteosarcoma in the organs described, as well as neoplastic emboli in the cerebellum, fortifying the metastatic potential of this neoplasm. Discussion: Mammary osteosarcomas are classified mainly based on the appearance of osteoid matrix produced by osteoblast-like cells or presence of mature bone formation. In the mammary gland it is important to highlight that the neoplasia should not show tubular epithelial cells proliferation, otherwise a better classification of the disease would be carcinosarcoma. The origin of the osteoid cells in this neoplasia is still in discussion. Some authors believe that, like in other regions as thyroid gland, the osseous metaplasia in this region can lead to malignant differentiation of the metaplastic tissue originating the osteosarcoma. The gross appearance, age and breed of the animal are frequently associated with this neoplasia, and it is in agreement of other cases reported previously by different authors. Although metastases are common in this neoplasia, the involvement of the central nervous system is rare and the reports of this condition are usually associated to osteosarcoma of the appendicular skeleton origin. Even though the dog did not show any neurological clinical sign or macroscopic lesion in the central nervous system, this report highlights the importance of complementing these exams with histopathology. In this case we show a microscopic finding made only with an accurate exam of serial transversal cuts of the brain. In conclusion, more descriptive studies of mammary osteosarcoma must be made to a better interpretation of this neoplasm behavior.

The role of mucin cell-free DNA detection as a new marker for the study of acellular pseudomyxoma peritonei of appendicular origin by liquid biopsy.

Background:Acellular pseudomyxoma peritonei (aPMP) is a rare peritoneal malignancy characterized by the accumulation of large amounts of mucin (lacking tumor cells) in the peritoneum. Many cases account for several kilograms of mucin to be screened by the pathologist. This is a comprehensive study of three patients with aPMP, whose tumors showed KRAS mutation, allowing for the tracking of this marker by liquid biopsy.Methods:Pre and post-surgery plasma, and mucin removed during cytoreductive surgery were collected from the patients. KRAS mutations were analyzed using droplet digital polymerase chain reaction (ddPCR). Mucin was injected in mice. KRAS and cytokine levels were measured in plasma of the mice using ddPCR and a magnetic bead-based assay. Mucin microbiome was analyzed by 16S rRNA sequencing.Results:KRAS mutations were detected in mucin cell-free DNA (cfDNA) from the three patients but not in the pre or post-surgery plasma. Electron microscopy detected microparticles (diameter <0.4 µm) in mucin. Mucin from one patient grew up inside the peritoneal cavity of mice and human KRAS was identified in mucin cfDNA, but not in plasma. All mucins showed the same bacterial profile. Cytokine levels were slightly altered in mice.Conclusions:The three aPMP patients included in this study shared some common aspects: the absence of tumor cells in mucin, the presence of KRAS mutated cfDNA in mucin, and the absence of this tumor-derived mutation in the bloodstream, providing additional information to the routine pathological examinations and suggesting that mucin cfDNA could potentially play a role in aPMP recurrence and prognosis.

Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p&lt;0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

Clinicopathological evaluation of acute appendicitis and the role of ultrasound in diagnosis: a prospective study

Background: Acute appendicitis is the most common acute surgical condition of the abdomen. Delay in treatment of acute appendicitis causes lot of complication. Study was done with the objective to study the clinical and pathological presentations of acute appendicitis, to evaluate the role of ultrasound in early diagnosis of acute appendicitis and to reduce negative appendicectomy in patients.Methods: This is a prospective study done on 100 patients with acute right lower abdominal pain clinically presumed to be of appendicular origin. A thorough history, clinical examination and ultrasound scan, was done for all cases. All ultrasound positive cases were subjected to surgery and some negative cases were also taken for surgery based on clinical suspicion. The ultrasound diagnosis was compared with clinical findings, operative findings and histopathological examination reports.Results: The overall accuracy of clinical diagnosis (Alvarado scoring system) with histopathology findings was 72%. The overall sensitivity and specificity was 70.3% and 81.3% respectively and positive predictive value of was 95.2% whereas the negative predictive value was 34.2%. The overall accuracy of ultrasound with histopathology report was 93%, with a sensitivity of 96.4%, specificity of 75%, and a positive predictive value of 95% and a negative predictive value of 80%. Negative appendicectomy rate was 8.82% in females and 3.63% in males.Conclusions: The Alvarado scoring system combined with ultrasound can therefore be used as a cheap and inexpensive way of confirming acute appendicitis thus reducing negative appendicectomy rate.

Analysis of Clinical Outcomes of Pseudomyxoma Peritonei from Appendicular Origin Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy-A Retrospective Study from INDEPSO.

To evaluate the clinical outcomes of patients of pseudomyxoma peritonei of appendiceal origin undergoing cytoreductive surgery and HIPEC. Data collected from members, an independent collaborative group of Indian surgeons specializing in the management of peritoneal surface malignancy (INDEPSO), was analyzed retrospectively. Clinicopathological and perioperative outcomes of patients treated for pseudomyxoma peritonei (PMP) of appendicular origin were evaluated. Ninety-one patients were diagnosed with pseudomyxoma peritonei of appendicular origin between March 2013 and December 2017. The median age was 53years and 60% were females. The median PCI was 27 [range 3-39] and a CC-0/1 resection was achieved in 83.5% patients. The most common histological grade was low-grade PMP, seen in 71.4% cases. The overall rate of grades 3-4 morbidity was 33% (30/91) and the 90-day mortality rate reported was 6.5%. Pulmonary complications and systemic sepsis emerged as the most significant factors affecting morbidity, mortality, and failure to rescue. At a median follow-up of 24months, the median OS was not reached and the median PFS was 53months. On univariate and multivariate analysis, high-grade histology, prior chemotherapy, debulking surgery alone without HIPEC, and high PCI > 10 were predictors of poor progression-free survival. The survival and morbidity results of pseudomyxoma peritonei from appendicular origin following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are encouraging. With further awareness and understanding of the disease, and improvement in surgical expertise and learning curve, there is scope for further reduction in morbidity and better improvement in survival.