Forms Of Appendicitis Research Articles

Species Characteristics of Causative Agents of Acute Appendicitis in Children and Determination of Their Susceptibility to Antibiotics

In pediatric surgery, acute appendicitis is considered one of the most common problems requiring surgical intervention. Among the causes of this disease, microorganisms are of primary importance. The specificity of postoperative treatment depends both on the degree of virulence of the pathogen and on the microbial load that caused the inflammatory process. The increase in the use of antimicrobial agents is of great concern because of the emergence of antibiotic-resistant bacteria. Therefore, the issue of rational postoperative antibiotic therapy remains relevant, as excessive, often unjustified use and incorrect dosage of drugs have become the cause of many medical problems. The aim of the research was to determine the species structure and analyze antibiotic resistance of microorganisms in biomaterial obtained from children after appendectomy for acute appendicitis. Methods. We studied biomaterial obtained from 74 patients aged 2—18 years who were treated at the MNCE Ternopil Regional Children Clinical Hospital TRC in the period from September 2021 to March 2022. After appendectomy, the samples were placed in a transport medium for further laboratory research, which involved staining smears according to the Gram method, sowing microorganisms on nutrient media such as blood agar, salt agar, sugar broth and serum agar, and Endo medium for enterobacteria as well as for anaerobic pathogens — thioglycolic medium and Kitta-Tarozzi medium, and identifying by morphological, tinctorial, cultural and biochemical properties. The sensitivity of selected pathogenic microorganisms to antibiotics was determined using the Kirby-Bauer method. Statistical processing of digital data was carried out using Excel software (Microsoft, USA) and the Statistica 10.0 program. Results. 74 children aged from 2 to 18 years were involved in the study. E. coli (28.4% of all examined), S. aureus (21.6%), and P. aeruginosa (14.9%) were found during the laboratory study of biomaterial. E. faecalis, Klebsiella spp., S. epidermidis, and S. viridans occurred much less often (from 9.4% to 4.5%). The study of antibiotic resistance showed that the isolated microorganisms differed significantly in their sensitivity both to different groups of antimicrobial agents and to generations of drugs within the same group. Ceftriaxone was the most effective inhibitor of all detected microorganisms. E. coli, S. aureus, P. aeruginosa, and S. epidermidis showed 100% sensitivity to it, and the others — within 75—50%. Bacteria Klebsiella spp. and S. epidermidis were sensitive to amikacin, strains of E. coli — 90.5%, P. aeruginosa and S. aureus — 81.8% and 81.2%, respectively. Amoxiclav and ampisulbin had weak inhibitory activity, except for 100% of Klebsiella spp. and 75% of E. faecalis, which were inhibited only by amoxiclav. However, almost all studied microorganisms were partially sensitive to azithromycin. The activity of this antibiotic ranged from 100—81.8% (S. epidermidis, S. aureus) to 36.4% (P. aeruginosa). Conclusions. The most common causative agents of acute appendicitis among children are the following microorganisms: E. coli, S. aureus, P. aeruginosa, and sporadically — S. saprophiticus, Micrococus spp., S. viridans, and Candida spp. Among the antibiotics used for the treatment of postoperative complications in various forms of appendicitis, the most effective were ceftriaxone — cephalosporins of the III generation — 100—66.7%, amikacin — aminoglycosides — 100—57.1%, and furagin — nitrofuran derivatives — 100—60%. The studied microorganisms were the least sensitive to penicillins and antibiotics of the II generation of the fluoroquinolone group. Resistance of microorganisms to certain antibiotics was also found, in particular: P. aeruginosa and E. faecalis — to cefuroxime and cefazolin; E. coli and S. aureus — to tobramycin, S. epidermidis — to ofloxacin and amoxiclav.

CONSERVATIVE MANAGEMENT OF ACUTE APPENDICITIS IN BHUJ, KUTCH: A PROSPECTIVE STUDY

Objective: The current research was performed to know the outcome of conservative treatment in acute appendicitis using antibiotic therapy. Methods: The present and prospective research performed at Department of Surgery, Gujarat Adani Institute of Medical Science, Bhuj, Kutch for a duration of 2 years. All subjects diagnosed as acute appendicitis radiologically were enrolled into the research considering inclusion and exclusion criteria. Modified Alvarado score (MAS) was calculated based on clinical symptoms, signs, and laboratory investigations. Injection ceftriaxone and injection metronidazole were given for 48–72 h. Subjects who responded for i.v. antibiotics were switched to tablet ciprofloxacin and tablet metronidazole for 7 days and followed for 6 months. Subjects who did not respond to conservative treatment or had recurrence were classified as treatment failure/recurrence. Results: In the present research, total of 300 subjects were incorporated that comprise of 140 males and 160 females. Tenderness in the right inguinal fossa was observed in all the Subjects. MAS were in between 4 and 6 in 84 subjects and were 7–9 in 216 subjects with an average of 7.30. Thirty-six subjects had complicated acute appendicitis and 264 had uncomplicated acute appendicitis. Conclusion: In general, achievement rate of conservative management according to the present research was 82%. On the other hand, there were 12% failures and 6% recurrences in the current research. One of the major future goals will be to recover diagnosis of appendicitis, particularly the diagnostic capability to distinguish among the various forms of appendicitis.

How doest the retrocecal anatomic localization of the appendix vermiformis affect the prognosis of acute appendicitis today? A comparative prospective study

Appendix vermiformis is found in various anatomical localizations. Localization of the appendix vermiformis has been suggested to affect the clinical findings and outcomes of acute appendicitis. Aimed at investigating the effect of retrocecal localization of appendix vermiformis on the prognosis of acute appendicitis today. This study was started in August 2018 and finished in August 2021. Adult patients of both sexes who were operated in general surgery clinic with a pre-diagnosis of acute appendicitis were included in the study. Anatomic localization of appendix vermiformis were divided into two parts as retrocecal localizations and non-retrocecal localizations. The forms of appendicitis, postoperative complications, and length of hospitalization obtained from retrocecal and non-retrocecal localizations were compared and evaluated. A total of 776 patients were included in the study. Retrocecal localization was found in 15%, and non-retrocecal in 84.9% of the patients. The rate of acute appendicitis was 65.8% in retrocecal localization, 83.1% in non-retrocecal localization, perforated appendicitis at 31.6% in retrocecal localization and 11.2% in non-retrocecal localization. The perforated appendicitis rate was significantly higher in retrocecal localizations (p=.0001). Although postoperative complications were 5.1% in retrocecal appendicitis and 2.4% in non-retrocecal appendicitis, there was no significant difference between them in terms of postoperative complications (p=.105). The mean length of hospital stay was 2.4 days for appendicitis with retrocecal localization and 1.7 days for non-retrocecal localizations. The mean length of hospital stay was also significantly higher in retrocecal localizations (p=.0001). In conclusion, both perforated appendicitis rates and the mean length of hospital stay were higher in appendicitis with retrocecal localization. Therefore, appendicitis with retrocecal localization still negatively affects the prognosis of acute appendicitis today.

Techniques of Laparoscopic Appendectomy for Pediatric Appendicitis: How I Do It.

Background: Appendicitis is the most common operative emergency in children. As a result of accumulating evidence from randomized trials, observational studies, database work, and meta-analyses, the management of appendicitis in children has been shifting the past 15 years with many new debates emerging. In this article, we review our current management schemes. Methods: We reviewed the current and critical literature relevant to the rationale for our current management. Results: Clinical pathways appear to reduce variation and cost while improving the ability to diagnose and treat the disease. Minimally invasive approaches can be used to treat all forms of appendicitis. Conclusions: The future role of non-operative management deserves ongoing exploration. Refining diagnostic treatment algorithms and enhancing antibiotic stewardship are important moving forward.

Аналіз ефективності відеолапароскопії при гострому апендициті у вагітних

Diagnosis and treatment of acute surgical abdominal pathology in pregnant women is still complex and not fully resolved issue. The most frequent reason of urgent surgery in pregnant is acute appendicitis. This pathology remains an urgent problem nowadays. Still there is no consensus on the choice of appendectomy method depending on gestational term. The introduction of endoscopic surgery into widespread clinical practice significantly changed the views on the possibility of using it in pregnant women. But possibility of performing laparoscopy in pregnant women still causes some caution. Moreover, laparoscopic techniques at different stages of pregnancy are far from being improved. Material and methods. The study involved 73 pregnant women with acute appendicitis (group I) and 43 non-pregnant women (group II), who were hospitalized to the clinic. The informativeness of laparoscopic method was studied according to the following criteria: sensitivity (Se), specificity (Sp), accuracy (Ac) and efficiency (De). For each of these criteria was calculated a 95% confidence interval (CI). Results and discussion. Research did not reveal correlation of frequency direct and indirect laparoscopic signs from gestational terms. The frequency of these signs was almost the same in the groups of pregnant and non-pregnant women. The most difficult laparoscopic diagnosis was with catarrhal changes in the wall of appendix, since morphological changes in this form of inflammation extended only to the mucous and submucosal membranes, and macroscopic changes were minimal. Such symptom as the imposition of fibrin in catarrhal appendicitis was absent in all cases. The rest of the signs were observed in all women studied, while macroscopic changes in destructive forms of appendicitis, indicating inflammation, were frequent compared with catarrhal ones. Attention drawn to high parameters of informativeness diagnostic laparoscopy in pregnant women in the first trimester. This is due to the coincidence of clinical and histological diagnoses in this trimester. Considering the number of truly negative results of the study in the II and III trimesters of pregnancy, the indicators of informativeness of laparoscopy did not differ much from the gestational age. Conclusion. Thus, laparoscopy as a diagnostic method for acute appendicitis turned out to be quite informative in both pregnant and non-pregnant women: it allowed confirming or excluding diagnosis of acute appendicitis, it also accurately determined the localization of appendix, choosing correct treatment tactics and safely perform an adequate low-traumatic surgery

Correlation of clinico – histopathological findings in different forms of appendicitis

Background: Appendicitis even though being the most common cause of surgical abdomen, its diagnosis remains an enigmatic challenge. Aim: This study aims to prove whether the clinical, investigative and operative findings correlate with histopathological findings of both acute and chronic forms of appendicitis.Materials and Methods: The study was conducted on 64 patients admitted in P K Das Institute of Medical Sciences, diagnosed of having appendicitis and underwent appendectomy during period of 18 months from July 2018 to December 2019.Results . 64% of cases were seen in age group 10-30 years . Rate of appendicular perforation was 7.8% . Significant association was found between clinical findings (previous history of pain abdomen) and histopathological findings of chronic inflammation of appendix. . Sensitivity of clinical judgment and ultrasonogram to diagnose appendicitis was found to be 93.6% and 80.9% respectively. . Sensitivity of operative findings to detect appendicitis was only 58.7%. . Negative predictive value of operative findings to identify appendicitis was only 3.7%. Conclusion: The diagnostic accuracy of the surgeon is directly dependent on the surgeon's expertise and there is no substitution for an experienced surgeon's judgment. Ultrasonography is a useful tool in avoiding negative appendectomy rates particularly in females and should be used in cases with equivocal clinical findings. Ultrasonography has limitation of variable reliability and operator dependency. If surgeon encounters a normal looking appendix per-operatively in a clinically diagnosed case of appendicitis still appendectomy should be done.

Sonographic differentiation of complicated from uncomplicated appendicitis.

This study aims to differentiate acute uncomplicated and complicated appendicitis, by investigating the correlation between sonographic findings and histological results in different types of paediatric appendicitis. This is a retrospective study of 1017 paediatric patients (age < 18 years) who underwent ultrasound by paediatric radiologists before appendicectomy at our institution between 2006 and 2016. Histologically, uncomplicated appendicitis was primarily associated with transmural infiltration of neutrophil granulocytes, while complicated appendicitis was characterised by transmural myonecrosis. Logistic regression analyses were used to investigate the association between sonographic and histological findings. Out of 566 (56%) male and 451 (44%) female patients with a mean age of 10.7 years, uncomplicated appendicitis was histologically diagnosed in 446 (44%) children and complicated appendicitis was diagnosed in 348 (34%) cases. The following ultrasound findings were significantly associated with complicated appendicitis in multivariate regression: an increased appendiceal diameter (OR = 1.3, p < .001), periappendiceal fat inflammation (OR = 1.5, p = 0.02), the presence of an appendicolith (OR = 1.7, p = 0.01) and a suspected perforation (OR = 6.0, p < .001) by the pediatric radiologist. For complicated appendicitis, an appendiceal diameter of more than 6 mm had the highest sensitivity (98%), while a sonographically suspected perforation showed the highest specificity (94%). Abdominal sonography by paediatric radiologists can differentiate between uncomplicated and complicated appendicitis in paediatric patients by using an increased appendiceal diameter, periappendiceal fat inflammation, the presence of an appendicolith and a suspected perforation as discriminatory markers. This paper demonstrates expanded information on ultrasound, which is not only an essential tool for diagnosing appendicitis, but also a key method for distinguishing between different forms of appendicitis when performed by paediatric radiologists. Compared with previous studies, the crucial distinction features in our analysis are 1) the definition of gangrene and not primarily perforation as an acute complicated appendicitis enabling early decision-making by sonography and 2) a large number of patients in a particularly affected age group.

Patient Classification Model of Appendicitis Severity Based on Bayesian Stepwise Discriminant Analysis

To emphasize distinctions in diagnosis and provide valuable guidance for treatment based on patient heterogeneity, it is useful to classify the various forms of appendicitis into three groups. A bayesian stepwise discriminant model was proposed to predict the patient’s severity of Appendicitis. The age, BMI index, diabetes status, perforation status, other complications, WBC and hemoglobin index were discriminant factors for patient classification according to a bayesian stepwise discriminant analysis. The classification accuracies for severe appendicitis and mild appendicitis were 96% and 97% respectively. The results showed that the presented method was verified effective and practically applicable.

Phlegmonous appendicitis in children is characterized by eosinophilia in white blood cell counts

Phlegmonous and complicated appendicitis represent independent entities depending on hereditary immunological mechanisms. However, clinically there are no means to distinguish uncomplicated phlegmonous from complicated appendicitis. The ability to distinguish these two forms of appendicitis is relevant as current attempts are to treat both forms of the disease differently. The aim of the present study was to investigate differences in white blood cell counts (WBCs) in these conditions to identify areas of interest for future molecular studies. White blood cell counts of patients aged between 7 and 14years who underwent appendectomy from January 2008 to June 2016 were investigated with special reference to particular cellular subpopulations. A total of647 children were included in the study. Within distinct inflammatory patterns, significant eosinophilia and basophilia were found in phlegmonous inflammation compared with complicated inflammation (0.11 ± 0.19 × 109/L vs. 0.046 ± 0.104 × 109/L, P < 0.0001, and 0.033 ± 0.031 × 109/L vs. 0.028 ± 0.024 × 109/L, P < 0.001). Compared with complicated disease, phlegmonous appendicitis seems to depend primarily on eosinophil inflammation. This observation is stable over time and indicates a direction for investigation of underlying genetic prerequisites.

Distinguishing fecal appendicular peritonitis from purulent appendicular peritonitis

IntroductionFecal appendicular peritonitis (FAP) is a poorly studied, rare form of acute appendicitis, corresponding to peritoneal inflammation with the presence of feces secondary to ruptured appendix. The purpose of this study was to describe FAP and to compare FAP with purulent appendicular peritonitis (PAP). Patients and methodsThis single-center, retrospective study was conducted in consecutive patients to compare the FAP group and the PAP group. The primary endpoint was the 30-day postoperative morbidity and mortality according to the Clavien-Dindo classification. The secondary endpoints were description and comparison of intraoperative data (laparoscopy rate, conversion rate, type of procedure and the mean operating time), and short-term outcomes (types of complications, length of stay, readmission rate, and reoperation rate), comparison of intraoperative bacteriological samples of FAP and PAP as well as the rate of resistance to amoxicillin and clavulanic acid, used as routine postoperative antibiotic therapy. ResultsBetween January 2006 and January 2016, 2.2% of appendectomies were performed for FAP. Patients of the FAP group reported a longer history of pain than patients of the PAP group (mean: 58 h [range: 24–120] vs 24 h [range: 6–504], p = 0.0001) and hyperthermia was more frequent in the FAP group than in the PAP group (72% vs 26%, p = 0.0001). Mean preoperative CRP was also higher in the FAP group than in the PAP group (110 mg/L [range: 67–468] vs 37.5 mg/L [range: 3.1–560], p = 0.007). Significantly less patients were operated by laparoscopy in the FAP group (89.7% vs 96.6%, p < 0.0001). Mean length of stay was significantly longer in the FAP group than in the PAP group (10 days [range: 3–24] vs 5 days [range: 1–32], p = 0.001). The overall 30-day complication rate was significantly higher in the FAP group than in the PAP group (62.1% vs 24.7%, p = 0.0005). The readmission rate was not significantly different between the two groups (14% vs 11.2%, p = 0.2), but the reoperation rate was higher in the FAP group than in the PAP group (31% vs 11%, p = 0.01). No significant difference was observed between the FAP and PAP groups in terms of the positive culture rate (75.9% vs 65.6%, p = 0.3). No significant difference was observed between the two groups in terms of resistance to amoxicillin and clavulanic acid (18.2% vs 20.5%, p = 0.8). ConclusionFAP is associated with significantly more severe morbidity compared to PAP. Clinicians must be familiar with this form of appendicitis in order to adequately inform their patients.

ПАТОМОРФОЛОГИЧЕСКАЯ ДИАГНОСТИКА ХРОНИЧЕСКОГО АППЕНДИЦИТА (ОБЗОР ЛИТЕРАТУРЫ)

The review is devoted to the problem of diagnostics and differential diagnostics of chronic appendicitis. As it is commonly&#x0D; known, the very existence of chronic appendicitis is still considered controversial. The article describes the current ideas&#x0D; on chronic appendicitis (primary, secondary, residual and recurrent), presents the list of morphological manifestations&#x0D; in the vermiform appendix at chronic inflammation, discovered at routine histological examination: dystrophic changes&#x0D; in the form of atrophy of all layers of appendix with sclerosis or hypotrophy of various degree, up to appendiclausis&#x0D; and disappearance of mucous membrane, and lipomatosis of submucosa. The authors discuss the complexity of diag-&#x0D; nostics predetermined by lack of precise criteria of the disease; show the possibility of evaluation of the expression of&#x0D; cytoadherence molecules for diagnostics of the disease, in particular of VCAM-1 and ICAM-1 for differential diagnostics&#x0D; of chronic appendicitis. The role of suppressor of signal cytokine proteins SOCS3 in chronic inflammation is discussed.&#x0D; The data demonstrate the increase of T-lymphocytes and neurons in chronic appendicitis as an increase of PGP 9.5&#x0D; (panneuronal marker protein gene product 9.5) level. It has been shown, that immunohistochemical staining on p44&#x0D; MAPK has an advantage in differential diagnostics of chronic appendicitis – specific staining of subserous and muscle&#x0D; layer of the wall is observed only at the discussed pathology of the appendix.&#x0D; In spite of multiple studies and acknowledgment of the fact that chronic form of appendicitis is a separate disease,&#x0D; the diagnostics of this pathology still presents quite a problem especially when only routine methods of examination&#x0D; are used. Thus, we found it necessary to introduce additional immunomorphologic methods into the clinical practice.

Videolaparoscopic and morphological parallels in diagnosis of different forms of acute appendicitis

To compare results of macroscopic assessment and materials of histological examination of 1635 appendices removed using videolaparoscopy in patients with acute appendicitis. All patients have been treated in N.V.Sklifosovsky Research Institute of Emergency Care for the period from 2002 to 2014. Intraoperative macroscopic assessment of appendix's inflammatory changes was performed using some conventional signs. Сatarrhal, phlegmonous and gangrenous changes were suspected in 77 (4.7%), 1432 (87.5%) and 126 (7.7%) cases respectively. Histological examination revealed catarrhal, phlegmonous and gangrenous changes in 86 (5.3%), 1338 (81.8%) and 115 (7.0%) cases respectively. In 65 (4.0%) patients changes were estimated as chronic, 31 (1.9%) patients had not inflammation. Intraoperatively suspected diagnosis of different forms of appendicitis was confirmed by histological survey in 94.1%. Most cases of matched intraoperative and histological diagnosis were observed in case of phlegmonous appendicitis (88.2%). Only 5.9% of patients had not acute inflammation of appendix that may be explained by overdiagnosis and excess of indications for appendectomy.

Appendicitis and Infectious Diseases.

The pre-eminently local character of appendicitis and its successful surgical treatment have undoubtedly served to distract the attention from its possible relations to infectious diseases in general. In the large majority of the cases local conditions appear to explain satisfactorily the development of appendicitis and its consequences, but there are also forms of appendicitis in which the etiology is not quite so simple, and it is to these forms that Finney and Hamburger¹direct attention. "Propagated appendicitis" is the term applied by M. Reclus to appendicitis developing from extension of enterocolitis. The nature of the appendix favors stagnation and increased bacterial virulence, which result in greater intensity of the resulting lesions of this part of the intestine. Then there are cases in which appendicitis seems to be a "local expression of a general infection." Finney and Hamburger cite three cases associated with rheumatic polyarthritis, and they also refer to

A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis.

Catarrhal appendicitis (CA) could be treated effectively with antibiotics in some patients because of the milder inflammation associated with this form of appendicitis. Although several trials have compared surgery with antibiotic therapy for acute appendicitis (AA), the indications for antibiotic therapy remain controversial. The subjects of this study were 342 patients who underwent appendectomy at our hospital between January, 2000 and March, 2013. The patients were divided into two groups based on the severity of their appendicitis: Group A comprised patients with severe appendicitis and Group B comprised patients with CA. Statistical analyses were performed to assess the clinical features associated with CA. Multivariate analysis of the eight clinical features correlated with CA according to univariate analysis revealed that the neutrophil to lymphocyte ratio (NLR) (<5/>5), age (<38/>38years), fever (<38/>38°C), white blood cell count (<11.5/>11.5×103/mm3) and serum level of C-reactive protein (<110/>110mg/L) were significantly associated with CA. The NLR (<5/>5) (OR 0.421; 95% CI 0.218-0.811; P=0.010) was the most useful predictor of CA, because the area under the ROC curve of NLR was the lowest of all these features. The preoperative NLR in patients undergoing appendectomy is closely associated with CA.

Schistosomiasis of the Appendix in a Tertiary Hospital in Northern Nigeria: A 22-Year Review

Background:Schistosomiasis is one of the neglected tropical diseases caused by a trematode, Schistosoma spp, and affects many systems in the body including the gastrointestinal tract. Schistosomiasis of the appendix is a well-recognized disease and presents as a chronic granulomatous inflammation. This study aims to document the frequency and pattern of distribution of schistosomal appendicitis in our environment.Materials and Methods:This is a retrospective histopathological review of schistosomiasis of the appendix in the Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria - Nigeria, between January 1, 1991 to December 31, 2012.Results:Within the study period, there were 1,464 appendectomy specimens histologically examined in the Pathology Laboratory. Thirty of these, representing 2.1%, were diagnosed as schistosomiasis of the appendix. The male:female ratio was 6.5:1 and peak age incidence was in the 20-29 years age group. Abdominal pains, vomiting and fever were seen in 23 (76.7%) and altered bowel motion in seven (23.3%) patients.Conclusion:This study showed that schistosomiasis of the appendix is not rare and that its presentation is similar to other forms of appendicitis. There is a need to focus on the prevention of schistosomiasis in order to reduce morbidity among these economically viable age groups.

Pediatric Anxiety Disorder after Operation for Carcinoid: A Case Report

One of the most common abdominal emergency situations which requires operation is acute apendicitis. The obstruction of the lumen is the primary cause of acute appendicitis and some unusual factors such as a carcinoid tumor may be involved in the pathogenesis. This rare tumor describes a 16-year-old girl presented with an abdominal pain which had a clinical presentation that was not different compared with the usual form of appendicitis and was diagnosed via the investigation of the appendectomy specimen histopathologically. During the follow-up, no oncologic adjuvant therapy was needed. However, at routine pediatric surgery examinations, child cardiology and psychiatry consultations were requested since the patient reported tachycardia, sweating, and difficulty of breathing, which were not present before. The postoperative period was surgically free of complications in the child surgery clinic controls and there was no metastasis. However, the pediatric anxiety disorder treatment of the patient is ongoing. This type of clinical postoperative manifestation is not found in the literature and a multi-disciplinary approach may be needed in appendix carcinoid tumor cases even after an unproblematic surgical intervention.

Screening for biomarkers in plasma from patients with gangrenous and phlegmonous appendicitis using CE and CEC in combination with MS

Today a high degree of "false" appendicitis diagnoses are occurring. In this study, a screening experiment of biomarkers of two different kinds of appendicitis, gangrenous and phlegmonous, were conducted with CE and CEC coupled to MS. Plasma samples were obtained from patients pre- and post-surgery. A large amount of data was generated to be able to compare them, and chemometrics tools were utilized to visualize the differences. Indicative patterns were found for both pre- and post-surgery of the two types of inflammation as well as between them. The divergences were traced back to the MS peaks obtained in the CE- and CEC-MS setups as possible biomarkers for the two forms of appendicitis.

Laparoscopic stapler appendectomy. A prospective study of 267 consecutive cases.

The value of laparoscopic appendectomy remains controversial. Therefore, we investigated the accuracy of diagnostic laparoscopy in detecting acute appendicitis and tested the applicability and safety of stapling appendectomy as a routine procedure. Data from 267 consecutive patients with suspicion of acute appendicitis were recorded prospectively. Histopathological examination revealed nonperforated and perforated appendicitis in 63.3% and 13.1%, respectively, and no inflammation in 10.8%. Other pathological findings were observed in 12.7%. Diagnostic laparoscopy detected appendicitis with a sensitivity and specificity of 95.6% and 96.6%, respectively; the positive and negative predictive value were 99.5% and 74.3%, respectively. Morbidity was 10.2% in total and 40% for perforated appendicitis. Planned laparoscopic reexploration reduced morbidity by 23.4% in patients with perforated appendicitis and substantial peritonitis. Mortality was 0.4%. Laparoscopy improves diagnostic accuracy for acute appendicitis and laparoscopic stapling appendectomy is a safe and efficient procedure for all forms of appendicitis.

Comparative characteristics of complications after appendectomy under local anesthesia and anesthesia

Complications arising after surgical interventions are still a very urgent problem. So, after appendectomies, their frequency ranges from 7.2 to 37.3%. In 6-10% of patients who underwent appendectomy, wound suppuration and other wound complications are observed in the postoperative period. The frequency (30-40%) of infectious complications of the wound during operations performed for destructive forms of appendicitis is especially high.

On the tactics for catarrhal appendicitis

The issues of diagnostics and treatment of acute appendicitis are systematically covered in the periodical press, but insufficient attention is paid to the tactics of non-destructive (catarrhal) form of appendicitis, the causes of rather frequent removal of morphologically unchanged processes in patients with the clinical picture of acute appendicitis and measures to reduce the number of needless appendectomies.&#x0D; Some authors consider appendectomy mandatory in all cases of pain syndrome in the right iliac region. Thus, according to S.D. Lebedev, appendectomy is performed in 84.4% of patients admitted with suspected appendicitis. The unchanged appendectomies, which, in the author's opinion, contribute to the reduction of appendicitis morbidity.