Course Of Acute Appendicitis Research Articles

Appendicolith classification: physical and chemical properties of appendicoliths in patients with CT diagnosed acute appendicitis – a prospective cohort study

ObjectiveAppendicoliths are associated with a more complicated course of acute appendicitis and failure of non-operative treatment. We aimed to update the appendicolith classification originally described in 1966 and to assess...

NETworking for Health and in Disease: Neutrophil Extracellular Traps in Pediatric Surgical Care.

This comprehensive review examines the role of Neutrophil Extracellular Traps (NETs) in pediatric surgery. Focusing on NET formation, functions, and implications, this study highlights their dual impact in infection control and contribution to tissue damage after surgery. It covers the role of NET formation in a range of pediatric conditions including immunothrombosis, formation of peritoneal adhesions, appendicitis, burns, gallstones, tumors, and necrotizing enterocolitis (NEC). The results underscore the significance of NETs in fighting infections and their association with complications like sepsis and delayed wound healing. The breakdown products of NETs as a diagnostic tool of the clinical course of acute appendicitis will also be discussed. Understanding NET formation in the pathophysiology can potentially help to find new therapeutic approaches such as the application of DNase and elastase inhibitors to change the clinical course of various diseases in pediatric surgery such as improvement of wound healing, adhesion formation, NEC, and many more.

The Pattern of Nutritional and Inflammatory Parameters in Children with Acute Appendicitis

AbstractBackground Surgical procedures in children with overweight and obesity have many difficulties due to the high incidence of postoperative complications. This impact on comorbidity has a great interest in various surgical pathologies, such as acute appendicitis, since it is the most frequent surgical emergency in all age and sex groups. However, there are few studies assessing the effect of body mass index (BMI) and other parameters like the Glasgow Prognostic Score (GPS) and C-reactive protein (CRP)/albumin ratio on the course of acute appendicitis in children.Objectives Identify the impact of BMI and other biomarkers like CRP/albumin ratio and GPS on the clinical course of acute appendicitis in children.Patients (Materials) and Methods This is a prospective study conducted on 90 pediatric patients of acute appendicitis (30 high BMI and 60 non-high BMI) admitted at Pediatric Surgery Department, Children Hospital Cairo University (CHCU) during the period from March 2022 to September 2022. All patients had preoperative laboratory tests, intraoperative assessment regarding the type of surgery, duration of surgery, and type of appendicitis, then the postoperative assessment.Results Among the 90 patients, the mean age of participants was 8.74 (2.23) years and there was a male predominance. Frequencies of open surgeries were higher in overweight and obese children (children with high BMI). There was a significant positive correlation between the preoperative CRP/albumin ratio and GPS, and an inverse significant correlation of preoperative albumin with the postoperative hospital length of stay, duration of surgery (operation time), and duration of postoperative fever.Conclusion There is a significant relationship between the preoperative inflammatory and nutritional markers and postoperative hospital length of stay, duration of surgery (operation time), and duration of postoperative fever.

Effects of COVID-19 Pandemic on the Frequency of Complicated Appendicitis in Pediatric Populations

Background: The clinical course of acute appendicitis, one of the most common diseases needing surgical intervention in children, was affected by the coronavirus disease 2019 (COVID-19) pandemic. The global fear and panic about the outbreak and governmental decisions on lockdowns and restrictions led to an increasing number of complicated forms of appendicitis. Objectives: This study aimed to compare different aspects of appendicitis and its complications between the pre-pandemic and pandemic periods. Methods: In a retrospective cross-sectional analytical study, we enrolled all patients with a diagnosis of acute appendicitis for two consecutive years. Only children under 14 years of age were included in the study. The patients were divided into two groups based on the time of disease presentation, the pre-pandemic and pandemic periods. Demographic features, as well as clinical, laboratory, and imaging findings, were compared between the two groups. Results: Out of 369 patients included in the study, 173 were placed in the pre-pandemic group. There was no significant change in the incidence of appendicitis between the two periods (P = 0.232). However, the incidence of complicated appendicitis increased remarkably during the pandemic (27% vs. 11%, P < 0.001). No substantial differences were found in parameters like age, sex, laboratory findings, and the length of hospital stay between the two groups (P > 0.005). The patients who tested positive for COVID-19 had a significantly higher hospitalization duration (P < 0.001). Conclusions: Our results suggested that the rate of complicated appendicitis was substantially higher during the pandemic compared to the pre-pandemic time. Also, the proportion of midline laparotomy was significantly higher after the outbreak. These findings suggested that delays in care provision during the COVID-19 outbreak could have probably contributed to the rise in the incidence of complicated appendicitis in children.

Modified Frailty Index and Brief Geriatric Assessment does not predict prolonged hospitalization in elderly patients undergoing appendectomy due to Acute Appendicitis

Epidemiology and the outcomes of acute appendicitis in elderly people are very different from the younger patients. Aim of this study was to investigate the significance of frailty syndrome in the course of acute appendicitis. All patients over 65 years old who underwent laparoscopic appendectomy between 2013 and 2021 in 2nd Department of General Surgery were included in the study. In our assessment Modified Frailty Index and Brief Geriatric Assessment were performed. In the analyzed period 106 appendectomies were performed in patients over 65 years old. Postoperative complications occurred in 13 patients (12.3%). Prolonged hospitalization (over 3 days) was observed in 48 patients (45.3%). Multivariate analysis showed that every ASA class (OR=2.406; 95% CI 1.089-5.316; p=0.030) and postoperative complication (OR=5.692; 95% CI 1.077-30.073; p=0.041) are risk factors for prolonged hospitalization. Our study identified diabetes (OR=5.956; 95% CI 1.391-25.510; p=0.016) as a risk factor for postoperative complications. According to our study Modified Frailty Index and Brief Geriatric Assessment does not correlate with prolonged hospitalization or higher risk for postoperative complication after appendectomy in elderly people.

Features of diagnosis and course of acute appendicitis during the COVID-19 pandemic

This article provides a brief description of acute appendicitis, methods of its diagnosis, discusses typical clinical cases, examples of tactics for managing patients with acute appendicitis. The sequence of management of a patient with acute appendicitis, steps to a speedy recovery of the patient, including surgical interventions, his discharge with positive dynamics are summarized. Special attention is paid to the course and further development of complications of acute appendicitis during the COVID-19 pandemic. The need for timely treatment of the population for medical care is emphasized in order to avoid the development of complications (in particular, from acute conditions), for a qualitatively better prognosis and a speedy recovery in the postoperative period. Aim of the research : to identify possible complications and course of appendicitis in a pandemic coronavirus infection. Objectives : to study and analyze clinical cases in patients with appendicitis during a pandemic coronavirus infection. Materials and methods : clinical cases, case histories, educational literature. Conclusions : the course of acute appendicitis was accompanied by various complications that developed due to untimely medical care, due to the huge burden on the sphere of health protection of the Russian Federation. There was a tendency for the transition of acute appendicitis to peritonitis, abscess of the stump of the appendix, pilefl ebitis, due to coronavirus infection. Pathological activity of the immune system was also revealed in patients with appendicitis (lymphatic infi ltration of appendix tissues).

The Clinical Course of Acute Appendicitis During Pregnancy: Comparison of Reproductive Age Patients and Pregnant Patients

The Clinical Course of Acute Appendicitis During Pregnancy: Comparison of Reproductive Age Patients and Pregnant Patients

Impact of the COVID-19 pandemic and the restrictions on pediatric appendicitis in Turkey: A single-center experience.

ABSTRACTBackgroundIn this study, we investigated how the incidence and course of acute appendicitis (AA) changed in children, during the pandemic.MethodsChildren diagnosed with AA during the one‐year pandemic period after the first COVID‐19 case in Turkey and the previous one year were included in the study. Children were divided into two groups: those hospitalised during the pandemic (group A) and hospitalized in the previous year of the pandemic (group B). Furthermore, we compared the findings obtained for COVID‐19‐positive and COVID‐19‐negative children in the whole study group and within group A.ResultsIn our study, a significant difference was found between the two groups in terms of gender, the rate of vomiting and number of days of vomiting. Complicated AA findings were found more frequently from the results of patients in group B than in group A. In addition, the hospital stay was longer, and the mean number of days with fever, and mean body temperature were higher in COVID‐19 positive patients in the whole study group and within group A.ConclusionsContrary to most studies in the literature, in our study patients were admitted to hospital later in the pre‐pandemic period, and therefore the frequency of complicated AA might have been more common in these patients. In conclusion, the arrangements and warnings of health authorities during the pandemic, might have reduced the anxiety and the hesitancy of the families to go to the hospital and relatively the rate of complicated acute appendicitis.

WAYS TO IMPROVE THE RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH ATYPICAL FORMS OF ACUTE APPENDICITIS.

The aim: To search for new and improvement of known methods of diagnosis and surgical treatment of atypical forms of acute appendicitis. Materials and methods: There were analyzed the results of diagnosis and surgical treatment of 852 patients with atypical course of acute appendicitis, which amounted to 25.3% of the total number of patients in this category. Depending on the chosen diagnostic and treatment tactics, patients with acute atypical appendicitis were divided into two groups: control (n=423) and main (n=429). Results: It was found that among atypical forms of acute appendicitis retrocecal location of the appendix is 61.2% of cases, pelvic - 24.3%, medial - 11.2%, subhepatic - 3.4%. Destructive forms of atypical acute appendicitis occurred in a total of 92.5% of cases, 77.7% of patients had various types of peritonitis. Conclusions: Authors improved and tested a number of diagnostic (rectal thermometry, ethanol test) and operative methods for destructive forms of acute appendicitis complicated by typhoid (including laparoscopic). The proposed diagnostic and treatment algorithm allowed to optimize the treatment tactics of this category of patients and reduce the incidence of complications in the early postoperative period from 9.9% to 3.5% (p<0.001).

What has changed in children's appendicitis during the COVID-19 pandemic?

The present study aimed to investigate the changes in the course of acute appendicitis during the pandemic period by comparing the cases treated during the coronavirus disease 2019 (COVID-19) pandemic with those in the pre-pandemic period. The study was conducted with 601 children aged 1-18 years who were operated for acute appendicitis between May 1, 2019, and February 29, 2020 (Group I) and between March 1 and December 31, 2020 (Group II). The demographic and disease characteristics as well as the treatment processes were compared between the groups. It was found that 59.1% (n=355) of the cases included in the study were in Group I and 40.9% (n=246) were in Group II. During the pandemic period; due to the concerns of families about contracting a contagious disease for both themselves and their children, and warnings by health professionals and government officials that they should not leave their homes and not come to the hospital unless there is an emergency, the time to apply to the hospital has been extended. Before the pandemic, 20.3% of the patients presented to the hospital on the 1st day of their complaints, where during the pandemic, only 2% of the patients reported to the hospital on the 1st day, and 15% presented after 4 days or more. As a result, the rate of perforated appendicitis, which was formerly 10.4%, increased to 24.8% during the pandemic period (p<0.01). During the pandemic, we operated on four patients with positive COVID-19 test results. There were no complications related to COVID-19 and surgery in our patients. Concern of the current pandemic resulted in late presentation to the hospital, increase in the number of perforated appendicitis, and prolonged hospital stay.

Features of Diagnostics and Treatment of Acute Appendicitis in Patients &#x0D; of Infectious Hospital

Introduction. Acute appendicitis occupies one of the leading positions in terms of incidence among urgent surgical diseases of the abdominal organs in Russia and in the world. Despite the accumulated experience in the diagnosis and treatment of the disease, a number of challenges still remain, leading to delayed diagnosis and, as a consequence, the development of destructive and complicated forms and deterioration of treatment outcomes. One of these "stumbling blocks" is the differential diagnosis of acute appendicitis and infectious diseases. In addition, acute appendicitis frequently develops together with existing acute and chronic infectious diseases, and appears to be also their complication. In our opinion, the absence of a specific algorithm of actions when dealing with this category of patients may be one of the reasons for unsatisfactory results. In this regard, there is a need to develop such an algorithm.Aim. Improvement of the therapeutic and diagnostic algorithm in relation to patients with OA admitted to infectious diseases hospitals, as well as evaluation of the results of its application.Materials and methods. The article presents diagnostics and treatment results of patients with acute appendicitis hospitalized in an infectious disease hospital, and compares their outcomes before and after implementation of the developed diagnostic and treatment algorithm. The study included 102 patients. The retrospective group included 55 patients with acute appendicitis, which developed together with acute or chronic infectious diseases, treated before implementation of the algorithm. The prospective group consisted of 47 patients treated using the developed algorithm.Results. . Gangrenous forms developed in 25 (45,5%) patients of the retrospective group, and in 8 (17%) patients of the prospective group. Peritonitis complicated the course of acute appendicitis in 53 (96,4%) patients of the retrospective group, while in patients of the prospective group this complication was noted in 25 (53,5%) cases. Purulent forms of peritonitis were noted in 20 (36,4%) patients of the retrospective group, and only in 3 (6,4%) patients of the prospective group. There was also a significant difference in the incidence of appendicular infiltration / abscess. This complication was registered in 11 (20%) patients of the retrospective group, in the prospective group it was noted in 2 (4,3%) patients. Postoperative complications were recorded in 8 (14.5 %) patients of the retrospective group. There were no postoperative complications in patients of the prospective group.Conclusion. The data obtained allow assuming that use of the proposed treatment and diagnostic algorithm in patients with acute appendicitis admitted to an infectious diseases hospital can positively affect timeliness of diagnosis and treatment and, as a consequence, improve treatment outcomes for this category of patients.

ARROSIVE BLEEDING FROM THE APPENDICULAR ARTERY IN ACUTE DESTRUCTIVE APPENDICITIS

Summary. Objective of the study: to present to the surgical community a rather rare complication of severe destructive appendicitis – arrosive bleeding and the cause of its development.&#x0D; Material and methods. Published a rare clinical case from prac-tice — the development of perforation of the appendix and arrosive bleeding from the appendicular artery in a patient with acute gangrenous appendicitis.&#x0D; Results and its discussion. The atypical course of acute appendicitis of undulating nature under the mask of acute adnexitis and antibacterial therapy has led to a prolonged delay with surgery in the surgical department. Only the appendicular abscess, which spontaneously opened into the abdominal cavity, made it possible to diagnose acute appendicitis and determine indications for emergency surgery, during which arrosive bleeding was diagnosed. The favorable outcome of the disease is due to the local purulent-necrotic process and small hemoperitoneum.&#x0D; Findings. Timely diagnosis of acute appendicitis, with the involvement of additional research methods in unclear cases, and subsequent appendectomy, are the prevention of a rather rare complication — arrosive bleeding from the appendicular artery in the development of severe complicated forms of acute destructive appendicitis.

Possibilities of diagnostic scales in patients with acute appendicitis in the conditions of an infectious hospital

Currently, diagnostic scales are being actively developed to help doctors diagnose and make decisions regarding the treatment tactics of certain diseases. In particular, there are diagnostic scales for acute appendicitis. However, we found no publications describing the results of assessing the sensitivity of diagnostic scales for acute appendicitis in relation to patients admitted to infectious diseases hospitals, as well as the results of comparing the sensitivity of these scales in patients in general surgery and infectious diseases hospitals. Thus, based on the sufficient clinical material, we have analyzed the results of comparing the sensitivity of some diagnostic scales of acute appendicitis in relation to patients in general surgical hospitals and patients being treated in hospitals with an infectious profile. The results of the study show that the sensitivity of diagnostic scales in relation to acute appendicitis in patients treated in infectious diseases wards is lower than in patients in surgical departments of the general profile. The following result may be explained by masked course of acute appendicitis (when simulating the symptoms of acute intestinal infection), as well as the blurred clinical picture of acute appendicitis in patients with acute and chronic infectious diseases.

Impact of COVID-19 on the presentation and course of acute appendicitis in paediatrics

IntroductionAcute appendicitis (AA) is the most frequent urgent surgical pathology in paediatrics. The COVID-19 pandemic has led to a decrease in emergency department (ED) visits, which can lead to a delay in health care and an increase in the severity of the pathologies. The objective is to analyze the rate of complicated AA during the pandemic, compared to the same period of the previous year. Materials and methodsRetrospective unicenter observational cohort study that included patients under 14 years of age seen in the ED with a diagnosis of AA during the months of March to May 2019 (non-pandemic) and 2020 (pandemic). Results90 patients were included (41 in non-pandemic and 49 in pandemic). No difference was found between the two periods in the time from the clinic onset until the visit to the ED (37h vs. 38h, P=.881), but there was a difference in the time from arrival at the ED until the surgery (7:00h vs. 10:30h, P=.004). The difference was accentuated when comparing the month of March with April–May 2020 (6h vs. 12h; P=.001). No significant differences were observed in the rate of complicated AA in intraoperative diagnosis (35% vs. 33%; P=.870) or anatomopathology (35% vs. 48%; P=.222), nor in the number of postoperative complications, length of hospitalization and readmissions. An increase in the anatomopathological diagnosis of AA with periapendicitis was observed (47% vs. 81%; P=.001). ConclusionDuring the pandemic, a delay from arrival at the ED until the surgery was observed in children diagnosed with AA. This delay resulted in an increase in the diagnosis of histologically evolved AA, but without an increase in the clinical complications of the disease.

Impact of COVID-19 on the presentation and course of acute appendicitis in paediatrics

IntroducciónLa apendicitis aguda (AA) es la patología quirúrgica urgente más frecuente en pediatría. La pandemia por la COVID-19 ha generado un descenso en las consultas a urgencias, pudiendo conllevar un retraso en la atención sanitaria y un aumento en la gravedad de las patologías. El objetivo es analizar la tasa de AA complicadas durante la pandemia, en comparación con el mismo periodo del año anterior.Material y métodosEstudio retrospectivo observacional de cohortes unicéntrico que incluyó a pacientes menores de 14 años atendidos en urgencias con diagnóstico de AA durante los meses de marzo a mayo de 2019 (no pandemia) y 2020 (pandemia).ResultadosSe incluyeron 90 pacientes (41 en no pandemia y 49 en pandemia). No se encontraron diferencias en el tiempo desde el inicio de la clínica hasta la consulta en urgencias entre los dos periodos (37 h vs. 38 h, p = 0,881), pero sí en el tiempo desde la llegada a urgencias hasta la intervención quirúrgica (7:00 h vs. 10:30 h; p = 0,004). La diferencia se acentuó al comparar el mes de marzo con abril-mayo de 2020 (6 h vs. 12 h; p = 0,001). No se observaron diferencias significativas en la tasa de AA complicadas en el diagnóstico intraoperatorio (35% vs. 33%; p = 0,870) ni anatomopatológico (35% vs. 48%; p = 0,222), ni tampoco en el número de complicaciones postoperatorias, duración de ingreso y reingresos. Se objetivó un aumento del diagnóstico anatomopatológico de AA con periapendicitis (47% vs. 81%; p = 0,001).ConclusiónDurante la pandemia se observó una demora desde la llegada a urgencias hasta la intervención quirúrgica en niños diagnosticados de AA. Esta demora se tradujo en un incremento del diagnóstico de AA evolucionadas histológicamente, pero sin objetivarse un aumento de las complicaciones de la enfermedad.

Differences in the Clinical Course of Acute Appendicitis in Geriatric Patient Groups.

Objective:To compare the differences in the clinical course of acute appendicitis between early elderly (60-79 years) and late elderly patients (≥80 years).Method:The sample consisted of 177 patients aged over 60 that underwent surgery at the emergency service with the diagnosis of acute appendicitis between January 2010 and May 2018. Patients’ data were retrospectively obtained from electronic records. Patients that had undergone appendectomy or negative appendectomy or had an appendix tumor were excluded from the study. The patients were divided into two groups by age; early elderly (60-79 years) and late elderly (≥80 years).Results:Of the 177 patients included in the study, 162(91%) were 60-79 years old and 15 (9%) were over 80. A statistically significant difference was found between the early and late elderly groups in terms of perforation, requirement for intensive care (p =0.001), red cell distribution width (p =0.025), the Clavien-Dindo classification (p =0.020), and the Charlson comorbidity index (p =0.005). The mean hospital stay was four and 11 days for early and late elderly groups, respectively. Multivariate analysis revealed that age alone was an independent factor with a statistically significant effect on mortality (OR=Odds Ratio: 53, 95% CI: 16.91-166.08; (p<0.001)).Conclusion:In particular, in the elderly patients over 80 years old, the clinical manifestation of acute appendicitis at hospital admission is in the form of perforation. Therefore, in this age group, a careful, precise and prompt diagnosis is crucial.

Immunohistochemical evaluation of cellular composition of the immune system of lymph nodes in acute appendicitis

Introduction. There is not much data about the composition of populations of the immune system in acute appendicitis. The basic histopathological criterion for the diagnosis of acute appendicitis is neutrophil infiltration of the muscle membrane. Aim. The subject of this publication is a semi-quantitative evaluation of B lymphocytes (CD20+), T lymphocytes (CD3+) and macrophages (CD68+), and the determination of the number of active lymph nodes during the course of inflammation.Material and Methods. The study material was obtained from 79 patients who had an appendectomy due to acute appendicitis. In this group, the tissue was obtained from: 34 women (aged 20 to 91) and 45 men (aged 20 to 72).Results. In the course of acute appendicitis, there is involvement of lymph node B lymphocytes, T lymphocytes and macrophages. Independent of the type of inflammation, the cellular make-up of the nodes is similar. The number of lymph nodes decreases with age and is gender dependent.Conclusions. In the course of acute appendicitis, there is involvement of lymph node B lymphocytes, T lymphocytes and macrophages. The number of lymph nodes decreases with age and is gender dependent. A statistically significant number of the examined cells of the immunological system in the lymph nodes changed due to inflammation (p&lt;0.001). B and T lymphocytes in the lymph nodes and in the mucous membrane of the appendix differed depending on the sex, and the presence of B lymphocytes in the mucous membrane was significantly higher in the group of 20-40 years of age. T lymphocytes were predominant in the centres of the lymph nodes in groups 20-40 and 61-91 years of age, and in the peripheral zones in the group of 41-60 years of age.

2171 EUS-Guided Transrectal Drainage and Stent Placement for Large Presacral Abscess Secondary to Acute Appendicitis

INTRODUCTION: A presacral abscess is one of the most difficult abscesses to be drained. It is very challenging to drain it through the transabdominal route due to overlying pelvic structures. We present a patient with sizeable presacral abscess secondary to acute appendicitis that was drained transrectal under an endoscopic-ultrasound (EUS) guidance with stent placement. CASE DESCRIPTION/METHODS: A 23-year old male presented with worsening pelvic pain, fever, and chills for four weeks. He denies any change in the bowel movement, dysuria, recent trauma, or bladder or bowel incontinence. Past medical history was unremarkable and had no surgeries. Vital signs were normal except for the temperature of 101.2 F. Abdomen was soft, non-tender, with audible bowel sound. The rectal and genital exam was normal. Labs revealed Hgb 11.2 g/dl, WBC 17.9k/mm3, platelets 545k/mm3, creatinine 0.7 mg/dl, CRP 18.8 mg/dl, negative HIV, and negative urine and blood cultures. CT scan of the abdomen and pelvis revealed large presacral abscess and possibly ruptured acute appendicitis. Magnetic resonance enterography (MRE) showed 9.6 × 2.6 × 6.1 cm presacral abscess with acute ruptured appendicitis (Figure 1). Interventional Radiologist was consulted for drainage, but abscess was not amenable to be drained percutaneously. Despite being on intravenous antibiotics, the patient continued to be spiking febrile and having persistent pelvic pain. So, rectal endoscopic ultrasound (EUS) was performed and showed 5 cm × 3.5 cm abscess in the pre-rectal space (Figure 2). Aspiration was done with the 19-gauge needle using a transrectal approach. A 7Fr x 5 cm double pigtail plastic stent and a 10Fr x 5 cm double pigtail plastic stent were placed into the abscess (Figure 3). Good drainage from the stent was visualized into the rectum. Patient’s symptoms improved. Fluid cultures remained negative, Leukocytosis resolved, and he was discharged in a stable condition. He will follow up with a repeated CT pelvis in 2 weeks to assess for resolution of abscess and interval appendectomy. DISCUSSION: The presacral abscess is a complication with difficult management in the course of acute appendicitis. It is challenging to drain with the transabdominal route because of the overlying pelvic structures. EUS-guided transrectal drainage is safer and effective in these cases. The clinician should be aware of this treatment modality and considered as the first-line option.

Mathematical modeling for prediction of complicated acute appendicitis in children

Endogenous intoxication, which accompanies the complicated course of acute appendicitis in children, is one of the serious conditions, which are the main cause of complications in the postoperative period. Diverse clinical observations done by clinicians suggest that despite the use of modern technologies in operating equipment, anesthetic support, the number of complications in the postoperative period has no tendency to decrease, and the main cause of lethal outcomes with appendicular peritonitis is lightning development of severe degree of endotoxicosis, which develops as a result of resorbing toxic substances formed of many components, including pathogenic microflora and destruction metabolism.&#x0D; Purpose. Creation of a mathematical model for prediction of complicated acute appendicitis in children using the functions of regression analysis of EXCEL spreadsheet by approximating experimental data.&#x0D; Materials and methods. In the work, there is information about 59 patients with acute appendicitis treated at the clinic of pediatric surgery at the National Pirogov Memorial Medical University. The data on patients were divided into two groups: patients with not complicated course of pathology – 24 patients, and patients with complicated course of acute appendicitis – 35 children. The control group served the data of 37 healthy children. In each of the three groups, the following parameters were studied: gender, age, bed day, duration of the disease, presence of symptoms of peritoneal irritation, the nature of exudate in the abdominal cavity, the number of red blood cells, hemoglobin, leukocytosis, quantitative characteristics of white blood formula, ESR, cellogenic endogenous intoxication: leukocyte index of intoxication and hematological index of intoxication. All the data were determined directly at the time of hospitalization of a patient to the hospital.&#x0D; Results. Discussion. Based on multiple correlation x = f (x1 , x2 ) a two-factor mathematical model of probability of the complicated course of acute appendicitis in children was created. According to the obtained results of the study of the system of three equations with three unknowns, it was established that if the indicator of the form of the disease is y = 2.67 and above, when, in numerical terms, the result falls into the zone of complicated flow of acute appendicitis and completely coincides with data analysis of the three groups of patients.&#x0D; Conclusions. The components that determine the uncomplicated course of acute appendicitis in children, according to the developed two-factor model, include LII and GPI, which exceed the values intoxication of certain intervals studied at the time of hospitalization. The analyzed indices were determined by the degree of severity of the pathological process, duration of disease, virulence of microflora and age of patients against the background of the formed endogenous intoxication syndrome.

The meteorological influence on seasonal alterations in the course of acute appendicitis

BackgroundSeveral diseases, including acute appendicitis (AA), have been known to undergo seasonal variations. Changes in the incidence and course of AA are attributed to seasonal weather differences, but this connection remains unproven. MethodsIn this retrospective, single-center analysis, we analyzed daily meteorological data over an 8-year period. A connection of day-by-day meteorological data with 680 consecutive appendectomies was performed. Patients' characteristics, intraoperative findings, and outcome parameters were analyzed. Seasons were classified meteorologically as 3-month periods (winter, spring, summer, and autumn). ResultsNonambient temperature (unusual warm or cold weather) is correlated with a higher rate of complicated (gangrenous or perforated) AA (P = 0.018). In summer and winter, days with nonambient temperatures were more frequent (P < 0.0001). A higher rate of complicated AA was seen during summer and winter (P = 0.009). In addition, patients operated on in summer and accordingly after warm days suffer more complications (P < 0.0001), especially more superficial surgical site infections (P < 0.048). ConclusionsThe concordant observation of more complicated AA and complications after AA with meteorological data and calendric seasonal variations makes it most likely that temperature is a cofactor in complicated AA and contributes to the seasonal variations in AA. Although an increase in the microbiome of the skin during warm seasons might explain the increase in surgical site infection, the functional connection between warmer temperatures and AA complications remains unclear.