Follicular Rupture Research Articles

P–638 Status of insulin resistance in infertile women and its effect on ovulation induction

Abstract Study question Is insulin resistance ( IR) a confounding variable in infertile women, other than those those having polycystic ovarian syndrome (PCOS) Summary answer IR was identified in 20.5% of infertile women. The presence of IR did not affect response to ovulation induction but reduced chances of conception What is known already Obesity is strongly correlated with insulin resistance. Obesity also has an adverse effect on fertility. In 2008 Steeg et al reported 5% reduction in chances of spontaneous conception with each unit increase in body mass index (BMI). Tetsurou Sakumoto et al (2010) reported hyperinsulinemia to affect granulose cells in small follicles inducing early response to luteinising hormone and anovulation. Adverse effect on endometrial function and implantation was also postulated. Insulin resistance has been studied in cases of PCOS but has not been studied in infertile women not fulfilling criteria for diagnosis of PCOS . So the present study was planned Study design, size, duration A prospective cohort study was conducted in infertility unit, King George Medical University, Lucknow, India over a period of one year from August 2018 to July 2019. Total 102 women with unexplained infertility were enrolled. Ethical clearance was obtained from institutional ethical committee Participants/materials, setting, methods Women with PCOS; diminished ovarian reserve documented by antral follicle count <7 and anti Mullerian hormone < 1.1ng/ml; bilateral tubal block; abnormal semen analysis; untreated hypothyroidism, hyperprolactinaemia; known diabetes were excluded. All women underwent ovulation induction with clomiphene citrate followed by single intrauterine insemination. Homeostasis model assessment insulin resistance index (HOMA IR) was calculated HOMA-IR = Fasting S. Glucose (mg/dl) x Fasting insulin (µlU) / 405. Value ≥ 2 denoted insulin resistance Main results and the role of chance : IR was identified in 21/102 (20.5%) cases. Fasting insulin levels were in the range of 5 – 9.9 mIU/ml in 53/102 women; <5mIU/ml in 29 and >10mIU/ml in 20. Fasting insulin > 9.45mIU/ml was found to have 90.5% sensitivity and 96.3% specificity in predicting insulin resistance. None of the cases had abnormal fasting and post prandial plasma glucose levels. IR was seen to be significantly correlated with BMI > 25kg/m2 (p = 0.0018) and waist hip ratio of > 0.85 (p = 0.0024).All women had follicular development and follicle rupture irrespective of presence of IR. Women with IR were more likely to have monofollicular development (17/21 IR cases). Correlation of endometrial thickness with IR was not seen. Mean endometrial thickness was 8.9mm. There were 6 pregnancies among the 102 women studied. None of the women with IR conceived. So IR was found to be affecting one fifth of women with unexplained infertility. Failure of any woman with IR to conceive was significant but the finding needs to be further studied. Limitations, reasons for caution : It was a small study with only 102 cases and the women were followed for only one cycle of ovulation induction and intrauterine insemination so results need to be validated in a larger study with a longer follow up. Wider implications of the findings: If further larger studies corroborate the role of IR in women with unexplained infertility it could elucidate the possibility of using insulin sensitisers in management of such cases. IR may emerge as an important gamechanger in management of unexplained infertility. Trial registration number Not applicable

Serous tubal intraepithelial carcinoma: Emerging trend in ovarian neoplasm: A must know for a pathologist

Among all gynecological malignancies, ovarian cancer is associated with the highest rate of mortality. Most ovarian carcinomas have been suggested to originate from the ovarian surface epithelium or postovulatory inclusion cysts formed after follicular rupture and repair. Over the past decade, a new model has emerged to explain the origin of epithelial tumors of the ovary and the fallopian tube now appears to play a central role; however, there is now compelling evidence that many epithelial pelvic cancers, especially high-grade serous carcinomas of the ovary/peritoneum, begin in the mucosa of the fallopian tube as serous tubal intraepithelial carcinoma.

The Expression Pattern of Prostaglandin-Endoperoxide Synthase-2 in Immature Oocytes and Surrounding Cumulus Cells May Explain A Disrupted Oocyte Maturation Process

Objective: To evaluate the correlation between the gene expression of prostaglandin-endoperoxide synthase-2 in the cumulus-oocyte complex with the level of prostaglandin-endoperoxide synthase-2 in follicular fluid and follicle diameter, oocyte maturation, and fertilization capacity.Study Design: As the study group, 26 cumulus-oocyte complexes and 26 follicular fluids obtained from immature (n=10) or unfertilized mature oocytes (n=16) and as the control group, 26 cumulus complexes and 26 follicular fluids surrounding mature and fertilized oocytes were retrieved one by one totally from 32 patients in 32 intracytoplasmic sperm injection cycles. Results: There was no significant efficacy of prostaglandin-endoperoxide synthase-2 gene expressions in cumulus complexes and the level of prostaglandin-endoperoxide synthase-2 in follicular fluids in terms of oocyte maturation stage. The level of prostaglandin-endoperoxide synthase-2 in follicular fluids and follicle diameters showed a significantly positive correlation in the mature and fertilized oocyte group (r=0.414; p=0.035). Conclusions: Although the prostaglandin-endoperoxide synthase-2 gene expressions in immature oocytes and their cumulus cells were similar to those in oocytes that have completed their nuclear and cytoplasmic maturation, the level of prostaglandin-endoperoxide synthases-2 in the follicular fluid and follicle diameter correlation may lead to new clinical approaches in cases of premature follicular rupture before oocyte maturation is completed.

Sustained ERK1/2 signaling is necessary for follicular rupture during ovulation in mice.

Abolition of the LH-induced ERK1/2 pathway leads to dramatic changes in gene expression in granulosa cells, subsequently abrogating ovulation. Here we explored whether sustained ERK1/2 signaling beyond immediate-early hours of the LH surge is important for ovulation in mice. First, we examined the effect of inhibition of ERK1/2 activity at 4 h after hCG stimulation on ovulation in superovulated immature mice. Treatment with the ERK1/2 pathway inhibitor PD0325901 at 4 h post-hCG disrupted follicular rupture without altering cumulus expansion, oocyte meiotic maturation and luteinization. Profiling the expression pattern of genes of the RSK family of ERK1/2 signal mediators revealed that RSK3, but not other isoforms, was induced by hCG treatment. Further, RSK3-knockout mice were sub-fertile with reduced ovulation rate and smaller litter size compared to WT mice. Given that PD0325901 inhibits all mediators of ERK1/2 signaling, we chose to evaluate the gene expression underlying deficient follicular rupture in ERK1/2 inhibited mice. We found that inhibition of ERK1/2 signaling at 4 h post-hCG resulted in an imbalance in the expression of genes involved in extracellular matrix degradation and leukocyte infiltration necessary for follicular rupture. In conclusion, our data demonstrate that sustained ERK1/2 signaling during ovulation is not required for cumulus expansion, oocyte meiotic maturation and luteinization, but is required for follicular rupture.

Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that severely impairs patients' quality of life. It is characterized by recurrent painful nodules, abscesses and draining sinus tracts in primarily intertriginous areas. We aimed to review the most up-to-date information regarding the epidemiology, clinical presentation, diagnostic studies, pathogenesis, comorbidities and quality of life of patients with hidradenitis suppurativa. We performed a systematic search of Medline, Embase database (from inception to September 2019) and review of bibliographies without restrictions on year or language. HS has an estimated global prevalence of 0.00033-4.1% (but most likely 0.7-1.2% in the European-US population). Patients still experience a significant diagnostic delay, up to several years. In the absence of pathognomonic tests, the diagnosis of HS is made from clinical observation and the disease narrative. Phenotypic variation renders diagnosis and severity assessment difficult. Ultrasound imaging is an emerging assessment tool for deep-seated lesions. The Hurley Staging System is still widely used in severity rating. Follicular hyperkeratosis and dilatation, follicular rupture and chronic inflammation with architectural tissue changes have been implicated in the pathogenesis of HS. HS has been associated with metabolic syndrome and other risk factors for cardiovascular disease, diabetes mellitus type II, polycystic ovarian syndrome, depression, suicide and substance use disorders. It has been linked to other immune-mediated diseases such as inflammatory bowel disease and spondyloarthropathy. Pain, pruritus, malodour, low self-esteem, sleep and sexual dysfunctions, and poor mental health are chronic symptoms or consequences of uncontrolled disease. HS is an under-diagnosed and under-treated disease with a profound negative impact on patients' quality of life. In the light of its associated comorbidities, an interdisciplinary management approach may be needed to ensure the best outcomes.

Proteomic analysis of follicular fluid during human ovulation.

Human ovulation is a biologically complex process that involves several biochemical factors, promoting follicular rupture and release of a fertilizable oocyte. Proteins which are present in follicular fluid at high concentrations during ovulation are likely to be active participants in the biochemical pathways of ovulation. The aim of the study was to identify, by use of a modern proteomic technique, proteins of human follicular fluid which are differentially regulated during ovulation of the natural menstrual cycle. This prospective experimental study over 3years included women planned for laparoscopic sterilization. During surgery, retrieval of the dominant follicle was performed either at the preovulatory stage or during ovulation. Four women of preovulatory phase and four women of ovulatory phase met the predetermined criteria of hormone levels for respective phases, and samples of these were finally included out of the 15 women operated. Follicular fluid was aspirated from the excised follicle and subjected to mass spectrometry with the isobaric tags for relative and absolute quantification (iTRAQ) technology for isobaric tagging of peptides. This enables simultaneous identification and quantification of proteins. The protein profiles of the follicular fluid of the preovulatory phase and the ovulatory phase were analyzed, and proteins that were present were identified. A total of 502 proteins were identified, several of which previously have not been identified in human follicular fluid. Of the 115 proteins that were found in all samples, 20 proteins were at higher levels during ovulation. These were inflammatory-related proteins, coagulation factors, proteins in lipid metabolism, complement factors and antioxidants. Five proteins were present in lower levels during ovulation, with three being enzymes and the other two proteins of lipid metabolism and iron transport. Twenty-five follicular fluid proteins, with differential regulation during ovulation, were identified in human follicular fluid of the natural menstrual cycle. These proteins may have essential roles in the ovulatory cascade.

Mechanisms involved in the contraceptive effects of ulipristal acetate.

The use of emergency contraception (EC) methods is increasing worldwide as it constitutes an effective way to prevent unplanned pregnancy after unprotected sexual intercourse. During the last decade, ulipristal acetate (UPA), a selective progesterone receptor modulator, has emerged as the most effective EC pill, and it is now recommended as first-line hormonal treatment for EC in several countries. Its principal mechanism of action involves inhibition or delay of follicular rupture, but only when administered during the follicular phase before the luteinizing hormone (LH) peak. However, considering the high efficacy of UPA, it is possible that it also exerts contraceptive effects besides ovulation. In the present review, we summarize and discuss the existing evidence obtained on the effect of UPA on sperm function and post-ovulatory events as potential additional mechanisms to prevent pregnancy. The bulk of evidence collected so far indicates that UPA would not affect gamete function; however, it could impair embryo-uterine interaction. Thus, besides the described effects on ovarian function, UPA contraceptive effectiveness might also be attributed to post-ovulatory effects, depending on the moment of the female cycle in which the drug is administered.

Lesional Inflammatory Profile in Hidradenitis Suppurativa Is Not Solely Driven by IL-1

Lesional Inflammatory Profile in Hidradenitis Suppurativa Is Not Solely Driven by IL-1

Effects of nitric oxide on reproductive organs and related physiological processes

Nitric oxide (NO), a member of the reactive nitrogen species family, plays a role in several physiologic processes, including vasculogenesis and angiogenesis, growth and puberty, and senescence and apoptosis. NO plays an important role in the production of ovarian steroids, ovulation, and follicular apoptosis. In other words, increased activity of nitric oxide synthase (NOS) leads to an increased amount of NO, which triggers production of prostaglandins and inflammatory cascades which facilitate follicular rupture and atresia. NO concentration elevation inhibits steroid synthesis in luteal and granulosa cells. Since NO is a major paracrine mediator of various biological processes, as well as a key factor in both the reproductive cycle and embryo implantation, oversynthesis of NO in the uterus results in toxicity and inflammation in epithelial cells and immunorejection of implantation. In the male physiological system, NO synthesized by NOS plays a major role in erectile function and androgen secretion, as well as semen parameters, and oocyte junction to the sperm. Furthermore, this supposedly simple molecule is involved in a number of other functions, such as germ cell evolution, connections between sertoli cells and germ cells in the blood-testis barrier, homodynamic contraction, and germ cell apoptosis. Moreover, NO is considered a key factor in male fertility due to its widespread distribution in both normal and diseased testis tissue. The difference of expression level of NOS in normal and pathological states is a probable cause of fertility destructive processes.

In Vitro Reconstruction of Xenopus Oocyte Ovulation.

Progesterone is widely used to induce maturation of isolated fully grown oocytes of the African clawed frog, Xenopus laevis. However, the hormone fails to release oocytes from the layer of surrounding follicle cells. Here, we report that maturation and follicle rupture can be recapitulated in vitro by treating isolated follicular oocytes with progesterone and low doses of the matrix metalloproteinase (MMP), collagenase, which are ineffective in the absence of the steroid. Using this in vitro ovulation model, we demonstrate that germinal vesicle breakdown (GVBD) and oocyte liberation from ovarian follicles occur synchronously during ovulation. Inhibition of the MAPK pathway in these experimental settings suppresses both GVBD and follicular rupture, whereas inhibition of MMP activity delays follicular rupture without affecting GVBD. These results highlight importance of MAPK and MMP activities in the ovulation process and provide the first evidence for their involvement in the release of oocytes from ovarian follicles in frogs. The in vitro ovulation model developed in our study can be employed for further dissection of ovulation.

Managing Hidradenitis Suppurativa

Hidradenitis suppurativa is a debilitating chronic skin disease often failure to recognise by healthcare professionals with an average of diagnostic delay of seven years, that has resulted in misdiagnosis and mismanagement of many patients. Knowledge of the pathogenesis is limited, although it seems to be associated with follicular obstruction, follicular rupture and an associated immune response.

Expression of the plasminogen system in the physiological mouse ovary and in the pathological polycystic ovary syndrome (PCOS) state

BackgroundThe fibrinolytic system and its inhibitors play a number of roles, apart from their function in blood haemostasis and thrombosis, namely in ovarian folliculogenesis and in ovulation. Plasminogen is converted to active plasmin at the time of follicular rupture through a decrease in plasminogen activator inhibitor-1 (PAI-1) and an increase in plasminogen activators. Oligo−/anovulation and follicle arrest are key characteristics of PCOS, but studies evaluating fibrinolytic/proteolytic markers within human or animal PCOS ovaries are lacking. We aimed to investigate and compare the expression and distribution of the plasminogen system markers in PCOS and control ovaries.MethodsA hyperandrogenised PCOS mouse model was used that mimics the ovarian, endocrine and metabolic features of the human condition. Immunohistochemistry and digital image analysis were used to investigate and compare fibrinolytic/proteolytic markers plasminogen, plasminogen/plasmin, tissue plasminogen activator, urokinase plasminogen activator and inhibitor PAI-1 in PCOS and control ovaries. Student’s t-test was used to compare data sets for normally distributed data and Wilcoxon-Mann Whitney test for non-normally distributed data.ResultsWe noted differences in the ovarian distribution of PAI-1 that was expressed throughout the PCOS ovary, unlike the peripheral distribution observed in control ovaries. Plasminogen was present in small follicles only in PCOS ovaries but not in small follicles of control ovaries. When we assessed and compared PAI-1 expression within follicles of different developmental stages we also noted significant differences for both the PCOS and control ovaries. While we noted differences in distribution and expression within specific ovarian structures, no differences were noted in the overall ovarian expression of markers assessed between acyclical PCOS mice and control mice at the diestrus stage of the estrous cycle.ConclusionsOur novel study, that comprehensively assessed the fibrinolytic/proteolytic system in the mouse ovary, showed the expression, differential localisation and a potential role for the plasminogen system in the physiological mouse ovary and in PCOS. Androgens may be involved in regulating expression of the ovarian plasminogen system. Further studies evaluating these markers at different time-points of ovulation may help to further clarify both physiological and potential pathological actions these markers play in ovulatory processes distorted in PCOS.

Effect of single-dose ibuprofen on follicular fluid levels of interleukins in poor responders undergoing in vitro fertilization

ABSTRACTPremature follicular rupture during in vitro fertilization (IVF) is a well-known culprit for cycle cancellation. We sought to evaluate whether a single oral dose of ibuprofen will have an effect on the follicular fluid (FF) levels of inflammatory markers involved in ovulation. This is a prospective within-subjects study following nine patients undergoing IVF. Every patient underwent a first cycle of minimal stimulation IVF followed by a second cycle using the same stimulation protocol, except one oral dose of ibuprofen 800 mg was administered 15–18 h post-trigger injection. FF was obtained during oocyte retrievals of both cycles and analyzed for levels of selected inflammatory markers. A total of 27 cytokines and 9 matrix metalloproteinases (MMPs) were tested. Results demonstrate significantly decreased levels of interleukin (IL)-6, IL-8, granulocyte-colony stimulating factor (G-CSF), eotaxin, MMP3, MMP7, MMP12, and MMP13 in FF of cycles where ibuprofen was administered. However, other cytokines levels, such IL-1 and vascular endothelial growth factor (VEGF), were similar with or without ibuprofen. Levels of MMPs described to be involved in ovulation, namely MMP-2 and MMP-9, were either undetectable or unchanged by ibuprofen, respectively. In conclusion, our data show that one dose of ibuprofen administered orally the day after trigger injection revealed a significant impact on the FF inflammatory milieu.Abbreviations: IVF: in vitro fertilization; MMP: matrix metalloproteinase; IL: interleukins; FF: follicular fluid; VEGF: vascular endothelial growth factor; NSAIDS: non-steroidal anti-inflammatories; POR: poor ovarian response; AMH: anti-Mullerian hormone; TAFC: total antral follicle count; HMG: human menopausal gonadotropin; hCG: human chorionic gonadotropin; COX: cyclooxygenase enzymes; PGH2: prostaglandin H2; RANTES: regulated on activation, normal T expressed and secreted; NF-κb: nuclear factor kappa-light-chain-enhancer of activated B cells

Ovulation: Parallels With Inflammatory Processes.

The midcycle surge of LH sets in motion interconnected networks of signaling cascades to bring about rupture of the follicle and release of the oocyte during ovulation. Many mediators of these LH-induced signaling cascades are associated with inflammation, leading to the postulate that ovulation is similar to an inflammatory response. First responders to the LH surge are granulosa and theca cells, which produce steroids, prostaglandins, chemokines, and cytokines, which are also mediators of inflammatory processes. These mediators, in turn, activate both nonimmune ovarian cells as well as resident immune cells within the ovary; additional immune cells are also attracted to the ovary. Collectively, these cells regulate proteolytic pathways to reorganize the follicular stroma, disrupt the granulosa cell basal lamina, and facilitate invasion of vascular endothelial cells. LH-induced mediators initiate cumulus expansion and cumulus oocyte complex detachment, whereas the follicular apex undergoes extensive extracellular matrix remodeling and a loss of the surface epithelium. The remainder of the follicle undergoes rapid angiogenesis and functional differentiation of granulosa and theca cells. Ultimately, these functional and structural changes culminate in follicular rupture and oocyte release. Throughout the ovulatory process, the importance of inflammatory responses is highlighted by the commonalities and similarities between many of these events associated with ovulation and inflammation. However, ovulation includes processes that are distinct from inflammation, such as regulation of steroid action, oocyte maturation, and the eventual release of the oocyte. This review focuses on the commonalities between inflammatory responses and the process of ovulation.

Systematic Review of Ovarian Activity and Potential for Embryo Formation and Loss during the Use of Hormonal Contraception.

For this study, the authors looked at English-language research articles that focused on how hormonal birth control, such as the birth control pill, may affect very early human embryos. The authors found that abnormal ovulation, or release of an egg followed by abnormal hormone levels, may often occur in women using hormonal birth control. This may increase the number of very early human embryos who are lost before a pregnancy test becomes positive. For women who are thinking about using hormonal birth control, this is important information to consider.

Update on pathogenesis of hidradenitis suppurativa.

The exact pathogenesis of hidradenitis suppurativa (HS) is still unproven. In the last few years numerous studies hypothesized that the disease is triggered by genetic and environmental factors. Follicular occlusion seems to be central to its development followed by follicular rupture, and immune responses finally leading to the development of clinical HS lesions. Data to date suggest that there is immune dysregulation in both the cutaneous and systemic immune system in patients with HS, but relative contributions from the innate and adaptive immune systems have not been fully elucidated. Furthermore, it can be further assumed that endocrine disorders related to follicular diseases can be implicated in the pathophysiologic pathways of HS. This review focuses on the key role of the immune system and endocrine disorders in the pathogenesis of HS.

Plaque with asymptomatic verrucous surface on the right leg: Dermatofibroma

Dermatofibroma is a benign fibrohistiocytic neoplasia. The etiology of dermatofibroma remains uncertain but it is considered to have a traumatic origin such as an insect bite or follicular rupture. Dermatofibroma clinically presents as smooth-surface nodular lesions. We report a patient with a plaque with asymptomatic verrucous surface on the right leg.

Coordination of Ovulation and Oocyte Maturation: A Good Egg at the Right Time.

Ovulation is the appropriately timed release of a mature, developmentally competent oocyte from the ovary into the oviduct, where fertilization occurs. Importantly, ovulation is tightly linked with oocyte maturation, demonstrating the interdependency of these two parallel processes, both essential for female fertility. Initiated by pituitary gonadotropins, the ovulatory process is mediated by intrafollicular paracrine factors from the theca, mural, and cumulus granulosa cells, as well as the oocyte itself. The result is the induction of cumulus expansion, proteolysis, angiogenesis, inflammation, and smooth muscle contraction, which are each required for follicular rupture. These complex intercellular communication networks and the essential ovulatory genes have been well defined in mouse models and are highly conserved in primates, including humans. Importantly, recent discoveries in regulation of ovulation highlight new areas of investigation.

Non-steroidal anti-inflammatory drug induces luteinized unruptured follicle syndrome in young female juvenile idiopathic arthritis patients.

To assess prospectively luteinized unruptured follicle (LUF) syndrome in juvenile idiopathic arthritis (JIA) patients with and without non-steroidal anti-inflammatory drugs (NSAIDs) and healthy controls. Twenty-three adolescent and young adult female JIA patients (ILAR criteria) and 11 female healthy subjects were studied by pelvic ultrasound monitoring for follicular development and ovulation in one menstrual cycle. LUF syndrome was prospectively investigated by pelvic ultrasound with a dominant ovarian follicle without signs of follicular rupture, with elevation of serum progesterone in the luteal phase of the menstrual cycle and luteinizing hormone (LH) detected in the urine. Comparison between JIA patients with (n = 8) vs. without NSAIDs (n = 15) and healthy controls (n = 11) revealed that LUF syndrome was significantly higher in the former group (2 (25%) vs. 0% vs. 0%, p = 0.049). These two patients with LUF syndrome had normal menstrual cycles without reduced ovarian reserve, and they were under naproxen 500mg bid during the menstrual cycle. Disease duration was comparable in JIA with and without NSAIDs [19.8 (4.4-25) vs. 13 (3.1-33) years, p = 0.232]. Further comparison between JIA patients with and without NSAIDs and healthy controls showed similar mean anti-Müllerian hormone levels (p = 0.909), estradiol (p = 0.436), FSH (p = 0.662), LH (p = 0.686), and mean antral follicle count (p = 0.240) and ovarian volume (p = 0.363). No differences were evidenced in three groups regarding Caucasian race, body mass index, duration, and length of menstrual cycles (p > 0.05). This is the first study to identify that JIA patients have a high frequency of LUF without impaired ovarian reserve. Future prospective studies are necessary to determine if chronic/continuous use of NSAIDs in JIA will have an impact in these patients' fertility.

Apendicectomía no terapéutica: Revisión de 1 año en el Centro Hospitalario Pereira Rossell, Montevideo, Uruguay

Objetivos: A apendicite aguda e uma das patologias cirurgicas mais frequentes em pediatria e apendicectomia, um procedimento historicamente comprovado para seu tratamento. Entretanto, a atencao e a morbidade e os custos envolvidos em casos de apendicectomias nao terapeuticas (ANT) chamaram a atencao. Realizamos um estudo para determinar a proporcao de ANT em nosso hospital, analisamos suas caracteristicas e propomos hipoteses de trabalho que nos permitem reduzir sua incidencia.Metodos: Realizamos uma analise retrospectiva, incluindo todos os pacientes submetidos a cirurgia de 1/1/13 a 12/31/13 com diagnostico clinico presumivel de apendicite aguda no Hospital Pediatrico do Centro Hospitalar Pereira Rossell. Analisamos a idade, sexo, abordagem, achados intra-operatorios, diagnostico anatomopatologico e o uso e resultados de hemograma e ultra-som.Resultados: no periodo mencionado, foram realizadas 287 apendicectomias em pacientes com apendicite aguda, dos quais 146 (50,87%) foram operados por abordagem convencional e 141 (49,13%) por abordagem laparoscopica. O indice ANT foi de 10,1% com taxas semelhantes para ambas as abordagens (10,27% versus 9,92% laparoscopicas). Por outro lado, houve maior incidencia de ANT no sexo feminino (16,6% vs 5,8%). Em relacao a faixa etaria, a taxa de ANT foi maior entre os pacientes com idades entre 11-15 anos (12,19%), enquanto que para as idades 6-10 anos foi de 8,08% e para pacientes de 0 -5 anos foi de 4,16%. Dos 29 pacientes com apendice saudavel, 12 apresentavam adenite mesenterica, um paciente apresentava ruptura folicular e um paciente apresentava peritonite de grau medico. Nao foram encontradas outras alteracoes em 15 pacientes.Conclusoes: A taxa de apendicectomias nao terapeuticas em nosso hospital foi de 10,10% no ano de 2013. A experiencia internacional e alguns estudos nacionais mostram que esse resultado pode ser melhorado. O uso de algoritmos clinicos para melhorar a presuncao diagnostica e fazer o melhor uso dos recursos diagnosticos disponiveis, bem como o estabelecimento de um sistema de registro e analise prospectiva dos resultados clinicos em apendicite aguda.