BACKRGOUND: Appendicitis is the condition in which the appendix, a finger-length appendage located in the right lower quadrant (RLQ) of the abdomen, becomes inflamed due to a bacterial infection. Every year, nearly 300,000 cases of appendicitis are diagnosed at hospitals and clinics throughout the United States. In the U.S., the current standard of care for appendicitis is an appendectomy; surgery that completely removes the appendix from the body. Numerous studies in Europe, however, have demonstrated that antibiotics can be an equally safe and effective treatment for treating appendicitis. This clinical research study hypothesizes that antibiotics for intra-abdominal infections like appendicitis can be an effective treatment. METHODS: Patients that met eligibility were randomized to either antibiotic treatment or appendectomy treatment. If patients decided not to randomize, they had the option to join the Electronic Medical Record (EMR) cohort in which they could choose the treatment that they received. Patients in both cohorts were followed along via EMRs for the span of two years after initial treatment. Individuals who consented to the randomization group also received follow-up phone calls at specified points in time. RESULTS: A total of 374 patients were approached between March 2016 – March 2018. 100 patients consented to the randomization group and 118 patients elected into the EMR group. In the randomization group, 49 patients were randomized to appendectomy and 51 were randomized to antibiotic treatment. 21 patients in the antibiotic treatment group (41.1%) returned back to the hospital within two years of their index visit for an appendectomy. From the EMR cohort, 109 patients chose to receive appendectomies, and 9 patients received antibiotics. CONCLUSION: Treatment with antibiotics can serve as an alternative to surgery. However, due to the recurrence rate of 41% after two years, antibiotics should only be used as a means to delay permanent treatment. If a patient’s current situation is not immediately life-threatening, they should be granted the option to decide whether they would prefer to take antibiotics or elect into surgery. / 2021-06-14T00:00:00Z

M.Tech. / Iridology is defined as a science that identifies pathological and functional changes within organs via assessing the iris for aberrant lines, spots, and discolourations (Medow, 2000). According to iridology, the iris does not reflect changes during anaesthesia, due to its inhibitory effect on nerves impulses, and in cases of organ removal, it reflects the pre-surgical condition (Jensen, 1986). The Homoeopathic profession is frequently associated with iridology and in a recent survey by Rostovsky et al. (2009) investigating the perceptions of Masters of Technology graduates in Homoeopathy on the existing programme offered by the University of Johannesburg, iridology was highly regarded as a potential additional skill requirement for assessing the health status of the patient. This was a randomized and controlled quantitative study. The study aimed to assess the reliability of iridology in the diagnosis of previous acute appendicitis, as evidenced by appendectomy. A total of 60 participants took part in the study. Of the 60 participants, 30 had had an appendectomy due to acute appendicitis, and 30 with their appendix intact with no prior history of appendicitis. All participants were recruited on the premises of Rita Frank Optometrists. Each participant signed a Participant Information and Consent Form (Appendix E) and a Consent Form to Photograph the iris (Appendix F). Thereafter the researcher obtained the information required in a private setting (Appendix G). Afterwards each participant’s right iris was documented by photograph with the use of a specialist non-mydriatic retinal camera (Canon EOS-20D), reset for the iris, by the researcher. The photographs were then randomized by an external person and no identifying data made available to the three raters. The raters included the researcher and two practising iridologists. Data was obtained from the analyses of the photographs wherein the presence or absence of lesions (implying acute appendicitis) was indicated by the raters. All the data was captured into an Excel spreadsheet (Appendix H) and sent for statistical analysis. vi None of the three raters showed a significant success rate in determining correctly who had had acute appendicitis and resultant appendectomies and who had not. The outcome of this study indicated an outcome that was subject to chance. The null hypothesis that states that appendectomy due to acute appendicitis does not manifest in a corresponding lesion in the typical organ area of the eye, is supported. It is in the opinion of the researcher that the association of iridology with homoeopathic practice may harm the credibility of the profession and that further research on iridology is needed to disprove this conviction.

Abstract Background and Objectives: Since 1894, open appendectomy (OA) has been the treatment of choice for acute appendicitis. In 1981 Semm performed the first laparoscopic appendectomy (LA). More than 2 decades later, the benefits of LA are still controversial. The goal of the present investigation was to compare the effectiveness of LA and OA based on a large administrative (The Bureau of National Health Insurance, BNHI) Research Database. The source of data analyzed was the administrative claims data from the BNHI Research Database. Methods: The objective of this retrospective study was based on the ICD-9-CM procedure code of 4701 (Laparoscopic appendectomy, LA) and 4709 (Open appendectomy, OA) respectively from a database of 20 million insurance population, Separate analyses were performed for uncomplicated (ICD-9-CM, 540.9) and complicated (presence of appendiceal perforation or abscess; ICD-9-CM 540.0 and 540.1) appendicitis. Exclusive criteria were: (1) Average length of stay exceeds 3 S.D. (n=1,262). (2) Gender unmentioned (n=243). All these data will analyze in multiple dimensions including length of hospital stay, in-hospital complications, in-hospital mortality, and rate of routine discharge between laparoscopic (LA) and open appendectomy (OA) based on The Bureau of National Health Insurance (BNHI) database. Results: We enrolled 11,118 patients underwent LA and 47,725 patients underwent OA during 2004 to 2007. The prevalence of LA increases gradually from 6.97 per 100,000 populations in 2004 to 21 per 100,000 populations in 2007. The prevalence of OA decreases gradually from 57.5 per 100,000 populations in 2004 to 44.86 per 100,000 populations in 2007. Patients underwent LA (3.25¡Ó1.51day) have significant lower length of hospital stay than OA (3.57¡Ó1.49 day) (p<0.001). We also found the trend that the annual medical expenditure of LA increases gradually but OA decreases gradually. In general, LA spends higher medical expenditure than OA. With respect to medical expenditure, higher length of hospital stay and co-morbidity are associated with more medical expenditure significantly. Conclusions: LA is the current developing trend of surgical treatments for appendicitis. LA can reduce length of hospital stay significantly. OA can reduce the medical expenditure in Taiwan. In our opinion, the results represent the native data in Taiwan and are very important for a good administration of public resources distribution.

Objective: To retrospectively evaluate antibiotic use in pediatric appendectomy procedures following an educational intervention in December 2001. Methodology: Demographic, clinical, and prescribing data was collected for all the patients <18 years old who have had undergone non-perforated appendectomy procedures at Princess Margaret Hospital for Children, WA. Data collection and analysis were divided into three groups. Group-I involved patients from May 2002 to April 2004 (which followed the post-intervention follow-up conducted from December 2001-April 2002 by Mallik et al.1). In May 2004, the Western Australian Therapeutic Advisory Group (WATAG) sent an advisory note which recommended a change from the use of cefotetan for surgical prophylaxis to cephazolin plus metronidazole. Group-II of the study involved patients between May 2004 (when the WATAG note was released) and June 2004; while Group-III involved patients from July 2004 to April 2005 (when the hospital issued the new guidelines and withdrawn cefotetan).Patient records were randomly selected for Group I & III and all the records were evaluated for Group III. Results: Records for 408 patients were evaluated across the three groups of the study. There no significant difference (p>0.05) between gender and age across the three groups. An appropriate prophylactic drug regimen was prescribed in 68.5%, 66.7% and 39.8% of patients in Groups I, II and III respectively, with a significant difference in appropriate drug choice between Groups I and III (p <0.05). There was no significant difference between the groups with respect to appropriate prophylactic drug dose (p>0.05). Appropriateness rates for antibiotic choices for ward treatment were high at 91.0%, 92.0% and 92.7%, with no significant differences (p>0.05). / There was a significant difference (p<0.05) between the three groups regarding the number of doses for ward treatment, with inappropriateness rates of 29.9%, 40% and 16.4%. The total appropriateness rates (drug choice plus dose in theatre and ward) across the study were 54.7%, 54.2% and 31.5%, with a significant difference (p <0.05) between Groups I and III. Conclusion: This study has identified deficiencies related to the prescribing of antibiotics for prophylaxis. There was a varied level of prescribing appropriateness in terms of antibiotic choice for prophylaxis with an increasing trend for inappropriateness towards the end of the study period. This would indicate that issuing of changed guidelines and withdrawal of the drug being replaced did not positively influence appropriate prescribing. Further interventions are required to improve compliance with hospital prescribing guidelines.

No description available.

gcpriale@hotmail.com / Objective: Identify the frequency of negative appendectomy (NA) and associated factors associated in a private hospital in Lima. Methods: Retrospective study of all appendectomies performed between 2012 and 2013 at a private hospital of Lima-Peru. We reviewed the medical records of patients who underwent appendectomy and had a medical report of emergency. We excluded the ones without pathology reports. Adjusted ORs were calculated with a logistic regression model to identify factors associated with AN. Results: Three hundred seventy-six appendectomies were performed for suspected appendicitis 55.9% in women). The average patient age was 33.4 ± 17.6 years. We identified 28 AN cases of 363 patients (7.7%). We found that pain in right flank (aOR: 5.4; 95%CI: 1.4-20.8), negative Mc Burney (aOR: 3.6; 95%CI: 1.3- 10.5), pain in hypogastrium (aOR: 3.1; 95%CI: 1.1-8.4) and no leucocitosis (aOR: 2.9; 95%CI: 1.2-6.7) were associated factors to AN. Gynecologic conditions (53.6%) and complicated diverticular disease (14.3%) are the most common diagnosis in AN cases. Conclusion: The obtained results indicate that the presence of pain in the right flank, negative Mc Burney, pain in hypogastrium and no leukocytosis are factors that can be taken into account to prevent negative appendectomy. / Objetivo: Identificar la frecuencia de apendicectomías negativas (AN) y los factores asociados en una clínica privada de Lima. Métodos: Estudio retrospectivo de todas las apendicectomías realizadas entre los años 2012 y 2013 en una clínica privada de Lima-Perú. Se revisó las historias clínicas de pacientes apendicectomizados que contaron con historia clínica de emergencia e informe quirúrgico. Se excluyó a aquellos que no contaban con informe anatomopatológico del apéndice. Se calculó los OR ajustados con un modelo de regresión logística para identificar los factores asociados con AN. Resultados: Se realizaron 376 apendicectomías durante el periodo 2012-2013. Se excluyó 13 casos por no contar con registro de historia clínica. La población femenina fue de 55.9%. La media de edad del paciente fue 33.4 ± 17.6 años. En 28 de 363 pacientes (7.7%) se registró una AN. Se encontró que el dolor en flanco derecho (ORa: 5.4; IC95%: 1.4-20.8), Mc Burney negativo (ORa: 3.6; IC95%: 1.3-10.5), dolor en hipogastrio (ORa: 3.1; IC95%: 1.1-8.4), y no leucocitosis (ORa: 2.9; IC95%: 1.2-6.7) son factores asociados a una AN. Las patologías más frecuentemente implicadas en el caso de una AN fueron las de causa ginecológica (53.6%) seguida de enfermedad diverticular complicada (14.3%). Conclusión: Los resultados obtenidos indican que la presencia de dolor en hipogastrio, dolor en flanco derecho, Mc Burney negativo y no leucocitosis son factores que se pueden tener en cuenta para prevenir apendicectomías negativas.

Acute appendicitis is a common cause of abdominal surgery in children, and is the result of appendiceal luminal obstruction and subsequent inflammation. The clinical presentation is often variable, allowing imaging to play a central role in disease identification and characterization. Ultrasound is often the modality of choice for diagnosis of appendicitis in children. Ready availability and lack of ionizing radiation are attractive features of sonography, though operator dependence is a potential barrier. Computed tomography (CT) was historically the preferred modality in children, as in adults, but recent awareness of the risks of radiation has reduced its usage. The purpose of this article is to detail the imaging findings of appendicitis in children. The discussion will focus on typical signs of appendicitis seen on ultrasound, CT, and magnetic resonance imaging. Considerations for percutaneous drainage by interventional radiology will also be presented. Finally, the evolution of imaging algorithms for appendicitis will be discussed.

Objetivo: Una tasa de apendicectomía negativa (AN) entre 10-15% es considerada aceptable. Sin embargo, a nivel internacional el rango va entre 2-9%. El presente estudio busca identificar la TAN y los factores asociados a esta. Métodos: Estudio retrospectivo de todas las apendicectomías realizadas entre los años 2012 y 2013 en una clínica privada de Lima-Perú. Se revisó las historias clínicas de pacientes apendicectomizados que contaron con historia clínica de emergencia e informe quirúrgico. Se excluyó a aquellos que no contaban con informe anatomopatológico del apéndice. Se calculó los OR ajustados con un modelo de regresión logística para identificar los factores asociados con AN. Resultados: Se realizaron 376 apendicectomías durante el periodo 2012-2013. Se excluyeron 13 casos por no contar con registro de historia clínica. La población femenina fue de 55,9%. La media de edad del paciente fue 33,4 años ± 17,6. En 28 de 363 pacientes (7,7%) se registró una AN. Se encontró que el dolor en flanco derecho (OR: 5,44 P=0,013), Mc Burney negativo (OR: 3,63 P=0,017), dolor en hipogastrio (OR: 3,05 P=0,030),) y no leucocitosis (OR: 2,85 P=0,015) son factores asociados a una AN. Las patologías más frecuentemente implicadas en el caso de una AN fueron las de causa ginecológica (53,6%) seguida de enfermedad diverticular complicada (14,3%). Conclusión: Los resultados obtenidos indican que la presencia de dolor en hipogastrio, dolor en flanco derecho, Mc Burney negativo y no leucocitosis son factores diagnósticos que se pueden tener en cuenta para prevenir apendicectomías negativas. / Background: A negative appendectomy rate (NAR) between 10-15% is considered acceptable. Nevertheless, internationally the range is between 2-9%. This study seeks to find factors associated with a negative appendectomy (NA) and the NAR. Methods: Retrospective study of all appendectomies performed between 2012 and 2013 at a private hospital of Lima-Perú. We reviewed the medical records of patients who underwent appendectomy and had a medical report of emergency. We excluded the ones whithout pathology reports. Adjusted ORs were calculated with a logistic regression model to identify factors associated with AN. Results: Three hundred seventy-six appendectomies were performed for suspected appendicitis 55.9% in women). The average patient age was 33.4 ± 17.6 years. A NA was found in 28 of 363 patients (7,7%). We found that pain in right flank (OR: 5,44 P=0,013), negative Mc Burney (OR: 3,63 P=0,017), pain in hypogastrium (OR: 3,05 P=0,030),) and no leucocitosis (OR: 2,85 P=0,015) were associated factors to AN. Gynecologic conditions (53,6%) and intestinal diseases (14.3%) are the most common to be misdiagnosed as appendiceal disease. Conclusion: The obtained results indicate that the presence of pain in the right flank, negative Mc Burney, pain in hypogastrium and no leukocytosis are diagnostic factors that can be taken into account to prevent negative appendectomy. / Tesis

El adenocarcinoma mucinoso de apéndice es una neoplasia poco frecuente con una tasa de incidencia de 0,08% de todas las neoplasias. El diagnóstico suele hacerse por biopsia ya que por su presentación clínica puede simular otras patologías de estructuras localizadas en cuadrante abdominal inferior derecho. Actualmente el tratamiento aún es controversial siendo la cirugía la mejor opción. El presente reporte describe un paciente con antecedentes de apendicectomía hace 27 años que actualmente acude con una tumoración dolorosa en fosa ilíaca derecha asociada a un antígeno carcinoembrionario de 138 ng/dl. / Mucinous adenocarcinoma of the appendix is a rare neoplasm with an incidence rate of 0.08% of all malignancies. The diagnosis is usually made by biopsy because its clinical presentation may mimic other diseases of structures located in the right lower quadrant. Currently, the treatment is still controversial, being surgery the best option. This report describes a patient with a history of appendectomy 27 years ago that is hospitalized for a painful mass in the lower abdomen associated with carcinoembryonic antigen of 138 ng/dl.

Abstract Epidemiological and clinical data suggest that acute appendicitis might have two different forms with different disease severities. Uncomplicated and complicated acute appendicitis appear to be distinct entities instead of consecutive events. Appendicitis does not always inevitably progress to perforation and most cases are uncomplicated by nature. This supports the importance of an accurate differential diagnosis between uncomplicated and complicated acute appendicitis enabling treatment optimization. This thesis consists of three studies. The first study evaluated the possibility to differentiate between uncomplicated and complicated appendicitis using only clinical symptoms and laboratory markers with a special focus on predicting the presence of an appendicolith without the use of modern imaging. We found neither sufficiently reliable to accurately estimate the severity of acute appendicitis or to determine the presence of an appendicolith, supporting the use of computed tomography imaging to assess the disease. The second study focused on clarifying the histopathological differences between uncomplicated acute appendicitis and acute appendicitis presenting with an appendicolith; a calcified deposit of faecal material in the appendiceal lumen. It’s presence has been shown to predict perforation and failure of conservative treatment. This study evaluated the histopathological findings of computed tomography diagnosed uncomplicated acute appendicitis and appendicolith appendicitis without perforation. Acute appendicitis presenting with an appendicolith was histopathologically different from uncomplicated acute appendicitis on all the assessed histological parameters, indicating the potentially complicated nature of appendicolith appendicitis. The third study was a randomized, multicentre clinical trial comparing interval appendectomy with follow-up with magnetic resonance imaging after successful initial non-operative treatment of complicated acute appendicitis presenting with a periappendicular abscess. The study hypothesis was that an interval appendectomy might not be necessary based on the previously reported low appendicitis recurrence rate after a periappendicular abscess. The original study hypothesis was left unresolved, as an unexpectedly high rate of appendiceal neoplasms was detected in the study population and the study was prematurely terminated. The neoplasm rate after a periappendicular abscess in this prematurely terminated study was high (20%). All the neoplasms were detected in patients over 40 years of age, strongly supporting an interval appendectomy for all patients over 40 years of age if this rate of neoplasms is validated in future studies. / Tiivistelmä Aiemmat tutkimukset viittaavat siihen, että on olemassa kaksi erillistä akuutin umpilisäkkeen tulehduksen muotoa: komplisoitumaton ja komplisoitunut. Nämä muodot eivät ole toistensa jatkumo: umpilisäkkeen tulehdus ei aina johda umpilisäkkeen puhkeamiseen, vaan valtaosa umpilisäkkeen tulehdustapauksista on komplisoitumattomia. Oikean hoitotavan valinta edellyttää tarkkaa erotusdiagnostiikkaa tautimuotojen välillä Tämä väitöskirjatyö koostuu kolmesta osatyöstä. Ensimmäisen osatyö selvitti, onko komplisoitumaton ja komplisoitunut umpilisäkkeen tulehdus mahdollista erottaa ilman kuvantamista kliinisin löydöksin ja laboratoriokokein painottaen ulostekiven olemassaolon ennustamista. Umpilisäkkeen tulehduksen vaikeusasteen tai ulostekiven olemassaolon ennustaminen ei ollut mahdollista pelkästään kliinisten löydösten tai laboratoriokokeiden perusteella. Tämä korostaa tietokonetomografian merkitystä taudin vaikeusasteen arvioinnissa. Toinen osatyö selvitti histologisia eroja komplisoitumattoman umpilisäkkeen tulehduksen ja ulostekiven sisältävän äkillisen umpilisäkkeen tulehduksen välillä. Ulostekiven tiedetään ennustavan umpilisäkkeen puhkeamaa ja konservatiivisen hoidon epäonnistumista. Tutkimuksessa selvitettiin histologisia löydöksiä potilailla, joilla oli tietokonetomografiatutkimuksella varmistettu komplisoitumaton äkillinen umpilisäkkeen tulehdus tai ulostekiven sisältävä äkillinen umpilisäkkeen tulehdus ilman puhkeamaa. Tutkimuksessa todettiin, että ulostekiven sisältävät tulehtuneet umpilisäkkeet poikkeavat kaikkien tutkittujen parametrien osalta komplisoitumattomasta umpilisäkkeen tulehduksesta. Tämä tukee käsitystä ulostekiven sisältävän umpilisäkkeen tulehduksen komplisoituneesta luonteesta. Kolmas osatyö oli randomoitu monikeskustutkimus, jossa verrattiin toisiinsa rauhallisessa vaiheessa tehtyä umpilisäkkeen poistoa ja seurantaa magneettiresonanssikuvauksella potilailla, joilla oli onnistuneesti hoidettu konservatiivisesti umpilisäkkeen ympäryskudoksen paise. Hypoteesina oli, että myöhempi umpilisäkkeen poisto ei ole tarpeen, koska tulehduksen uusiutumisen riski umpilisäkkeen vieruskudoksen paiseen hoidon jälkeen on aiemmin raportoitu matalaksi. Tutkimushypoteesi jäi avoimeksi, koska tutkimuksen aikana havaittiin runsaasti umpilisäkkeen kasvaimia, mikä johti tutkimuksen ennenaikaiseen keskeyttämiseen. Umpilisäkkeen kasvainten ilmaantuvuus oli 20 %, kaikki yli 40-vuotiailla potilailla. Mikäli tutkimuksen tulokset vahvistuvat tulevissa tutkimuksissa, kaikille yli 40-vuotiaille potilaille tulisi suositella umpilisäkkeen poistoa sairastetun umpilisäkkeen vieruskudoksen paiseen jälkeen.