Introduction The lifetime risk to develop acute appendicitis is estimated to 7-8%. Even if the condition iscommon and tools for diagnosis are existing, it is challenging to obtain a confident preoperativediagnosis which can explain differences in outcomes and complications. Aim The aim of this study was to analyze and compare differences in management and outcomesbetween patients with acute appendicitis at Karlstad Central Hospital. Methods The study was a retrospective cohort analysis comparing management between pediatric andadult patients and outcomes between patients who developed complications and patients who didnot at Karlstad central hospital between 2020-11-01 and 2021-05-31. Results Ultrasound was more often used in children than adults, 66.7% versus 10.5% (p=0.001), whereascomputed tomography (CT) was more used diagnosing adults, 73.5% versus 0% (p=<0.001). Inyounger adults (17-39) 69% had CT performed versus 96% in patients above 40 (p=<0.00005).Open appendectomy was more common among children, 25% versus 4.6% (p=<0.01) whilstlaparoscopic appendectomy was more common in adults, 90% versus 75% (p=<0.001). A longertime to intervention was seen in the adult complication group (p=0.004). Laparoscopicappendectomy was more common in the adult non-complication group 93.3% versus 78.10%(p=0.037). Conclusion There was a longer duration between admission and surgery and a higher initial CRP amongpatients that developed complications. Furthermore, in younger adults a high percentage of CTswhere performed compared to international guidelines. This indicates that there might be roomfor improvement in the management of appendicitis at CSK.

<p>Uvod: Akutni apendicitis predstavlja jedno od najče&scaron;ćih abdominalnih hirur&scaron;kih oboljenja u dečjem uzrastu. Lečenje je operativno, primenom otvorene hirurgije ili primenom minimalno invazivne hirurgije tj. laparoskopske apendektomije. Iako je laparoskopska apendektomija, zbog svojih prednosti, stekla popularnost kod mnogih hirurga, jo&scaron; uvek nije &scaron;iroko primenjena metoda na na&scaron;im prostorima. Prednost izvođenja laparoskopske apendektomije u odnosu na otvorenu metodu u dečjem uzrastu je i dalje nedovoljno definisana i predmet je mnogih istraživanja. Cilj istraživanja je da se utvrdi da li je dužina hospitalizacije kod dece operisane laparoskopski zbog akutnog apendicitisa kraća u odnosu na otvorenu metodu, kao i da se utvrdi da li postoji razlika u pojavi postoperativnih komplikacija između ove dve hirur&scaron;ke metode. Pored toga, cilj istraživanja je i da se utvrdi uticaj obe metode lečenja na kvalitet života i brzinu uspostavljanja svakodnevnih aktivnosti. Metodologija: Na Klinici za dečju hirurgiju, Instituta za zdravstvenu za&scaron;titu dece i omladine Vojvodine, sprovedena je prospektivna, kontrolisana randomizirana studija, u trajanju od deset meseci, u koju su bili uključeni svi pacijenti sa akutnim apendicitisom, kod kojih je planirana apendektomija, a čiji roditelji su dali pismeni pristanak za uče&scaron;će u istraživanju. Svi ispitanici su podeljeni u dve osnovne grupe u odnosu na operativnu tehniku: otvorena i laparoskopska apendektomija. Potom su svi ispitanici podeljeni u tri podgrupe, u zavisnosti od stepena upaljenosti crvuljka (negativni, nekomplikovani i komplikovani apendicitis). Svaki ispitanik je imao svoj individualni protokol istraživanja gde su preoperativno zabeleženi: uzrast, pol, simptomi (vrsta i dužina), fizikalni pregled, laboratorijske analize (broj leukocita, hematokrit), ultrazvučni nalaz, procena op&scaron;teg stanja, udružena oboljenja, vreme od prijema do operacije, preoperativna antibiotska terapija. Intraoperativno je analizirano: vrsta hirurgije, nalaz na apendiksu, prisustvo peritonitisa, udružena patologija, dužina operacije i trajanje pneumoperitoneuma (kod laparoskopske apendektomije), patohistolo&scaron;ki nalaz apendiksa, bakteriolo&scaron;ki bris abdomena. Postoperativno su analizirani: antibiotska terapija (vrsta i dužina), započinjanje peroralnog unosa, utvrđivanje postoperativnog bola, febrilnost, uspostavljanje peristaltike creva, izgled rane, postoperativne komplikacije (infekcija rane, intraabdominalni apscesi, ileus) i dužina hospitalizacije. Posebno su analizirani kvalitet života pacijenata nakon operacije pomoću modifikovanog upitnika SF 10 za dečji uzrast, kao i uspostavljanje svakodnevnih aktivnosti pomoću Activity Assessment Scale (AAS), modifikovane za dečji uzrast, nakon svakog postoperativnog dana, prvih sedam dana, nakon mesec dana, tri i &scaron;est meseci od operacije. Svi pacijenti su operisani u uslovima op&scaron;te anestezije. Klasična, otvorena apendektomija je vr&scaron;ena kroz naizmenični rez u desnoj ilijačnoj jami. Po otvaranju peritoneuma, cekum je izvučen i načinjena je klasična apendektomija. Laparoskopska apendektomija je vr&scaron;ena kroz tri 5 mm porta. Pneumoperitoneum je kreiran otvorenom metodom po Hasson-u, kroz infraumbilikalnu inciziju, a preostala dva porta su postavljena desno i levo ilijačno. Mezenteriolum je zbrinut pomoću ultrazvučnih makaza. Postavljene su intrakorporalne ligature i apendiks je odstranjen kroz desni port. Rezultati: Tokom perioda od deset meseci operisano je ukupno 125 pacijenata uzrasta od 2 do 18 godina, zbog akutnog apendicitisa. Laparoskopskom tehnikom je operisano 60 pacijenata (48%), a otvorenom metodom 61 (48,8%). Kod 4 pacijenta je načinjena konverzija, tj. promena operativne tehnike iz laparoskopske u otvorenu metodu. Nije bilo statistički značajne razlike između terapijskih grupa u odnosu na stepen upaljenosti apendiksa, vrstu i dužinu trajanja simptoma, u dijagnostičkim procedurama, kao ni u vremenu proteklom od prijema u bolnicu do operacije. Srednje operativno vreme je iznosilo 65 minuta (25-185 min) za laparoskopsku grupu i 45,49 minuta (25-90 min) za otvorene apendektomije (razlika je statistički značajna, p&lt;0,001). Crevna peristaltika, kao i započinjanje peroralnog unosa, se statistički značajno ranije uspostavljaju u grupi laparoskopsko operisanih. U grupi laparoskopskih apendektomija, postoperativne komplikacije (infekcija rana i formiranje intraabdominalnih apscesa) su se javile kod 8,33% ispitanika (5/60), a u otvorenoj grupi kod 4.91%, (3/61), &scaron;to nije bilo statistički značajno (c2 = 0,152; df = 1; p = 0,696). Dužina hospitalizacije kod dece operisane laparoskopski je iznosila 5,95 } 1,21 dana, a otvoreno 6,43 } 1,09 dana, &scaron;to je statistički značajna razlika (t = -2,206; p = 0,029). Rezultati Man-Vitnijevog U testa su pokazali statistički značajno bolji ukupni skor svakodnevnih aktivnosti za grupu laparoskopskih apendektomija (Z = -7,608; p = 0,000). U svim ispitivanim indikatorima kvaliteta života, deca laparoskopske grupe su imala veći skor. Deca sa akutnim apendicitisom operisana laparoskopski značajno ranije postižu visok stepen kvaliteta života (t = 2,407; p = 0,018). Zaključak: Prednost minimalno invazivne hirurgije u terapiji akutnog apendicitisa u dečjem uzrastu ogleda se u bržem uspostavljanju ponovnog funkcionisanja gastrointestinalnog trakta, kraćoj hospitalizaciji, a samim tim i bržem sveukupnom oporavku, vraćanju svakodnevnim aktivnostima i dobrom kvalitetu života. Postoperativne komplikacije se podjednako javljaju, kako kod otvorene, tako i kod laparoskopske operativne tehnike.</p> / <p>Introduction: Acute appendicitis is one of the most common abdominal surgical diseases in children. Operative treatment means open surgery or minimally invasive surgery (laparoscopic appendectomy). Although laparoscopic appendectomy, gained popularity among many surgeons, it is still not widely accepted in our region. The advantage of laparoscopic appendectomy compared to the open method in children is still not sufficiently defined and is the subject of further research. The aim of the research was to determine whether the length of hospital stay after laparoscopic surgery in children with acute appendicitis is shorter compared to the open method, as well as to determine whether there is a difference in the occurrence of postoperative complications after these two operative techniques. In addition, the aim of the research was to determine the effect of both methods of treatment on quality of life and everyday functioning. Methodology: This prospective, randomized controlled study was performed at the Clinic for Pediatric Surgery, Institute of Children and Youth Healthcare of Vojvodina, during a period of ten months. All patients with acute appendicitis, whose parents have given written consent, were included in research. All patients were divided into two basic groups, in relation to the surgical technique: open or laparoscopic appendectomy. Then, all of them were divided into three groups, depending on the degree of appendicitis (negative, uncomplicated and complicated appendicitis). Each participant had their own individual research protocol where we recorded preoperatively: age, sex, symptoms (type and length), physical examination, laboratory tests (white blood cell count, hematocrit), ultrasound finding, general state (ASA classification), associated diseases, time from admission to surgery, preoperative antibiotic therapy. During the operation we analyzed: type of surgery, degree of the appendicitis, the presence of peritonitis, associated pathology, length of surgery and duration of pneumoperitoneum (in laparoscopic appendectomy), hystopathologic findings of the appendix, a bacteriology. Postoperatively we analyzed: antibiotic therapy (type and length), oral intake, postoperative pain, fever, establishing peristalsis, the appearance of postoperative complications (wound infections, intra-abdominal abscesses, ileus) and length of hospitalization. Especially, we analyzed the quality of life of patients after surgery using the modified questionnaire SF 10 for children; and the establishment of daily activities using Activity Assessment Scale (AAS), modified for children; after each postoperative day, the first seven days, one month, three and six months after surgery. All patients were operated under general anesthesia. Open appendectomy was performed through incision in the right iliac fossa. Peritoneum was opened, the cecum was pulled out and classic appendectomy was made. Laparoscopic appendectomy is performed through three 5 mm ports. Pneumoperitoneum was created by the Hasson techique, through the infraumbilical incision, and the remaining two ports are set at right and left iliac region. Mezenteriolum was ligated by ultrasonic scissors. After putting intracorporal ligature, appendix was removed through the right port. Results: Over a period of ten months we operated 125 patients , aged 2 to 18 years, due to acute appendicitis. Laparoscopic technique was performed in 60 patients (48%), and the open method in 61 (48,8%). In 4 patients the conversion was made (operative technique changed from laparoscopic to open method). There were no statistically significant differences between the treatment groups with respect to the degree of appendix inflammation, the type and duration of symptoms, the diagnostic procedures, as well as the time from hospital admission to the surgery. Medium operative time was 65 minutes (25-185 min.) for laparoscopic group and 45,49 minutes (25-90 min.) for open appendectomy (the difference is statistically significant, p&lt;0,001). Intestinal peristalsis, as well as the initiation of oral intake was significantly sooner established in the laparoscopic group. Postoperative complications (wound infections and intra-abdominal abscess formation In laparoscopic appendectomy) occurred after laparoscopy in 8,33% of patients (5/60), and in the open group in 4,91% (3/61), which was not statistically significant (c2 = 0,152, df = 1; p = 0,696). Length of hospital stay in children operated by laparoscopy was 5,95 } 1,21 days and by open technique 6,43 } 1,09 days, which is significantly longer (t = -2,206; p = 0,029). Results of the Mann-Whitney U test showed significantly better overall record of daily activities for a group of laparoscopic appendectomy (Z = -7,608; p = 0,000). In all tested indicators of quality of life, children from laparoscopic group had a higher score. Children with acute appendicitis treated by laparoscopic surgery achieved a high level of quality of life, significantly earlier (t = 2,407; p = 0,018). Conclusion: The advantage of minimally invasive surgery in the treatment of acute appendicitis in children is reflected in the faster re-establishment of functioning of the gastrointestinal tract, shorter hospitalization and therefore, a faster overall recovery, resuming normal activities and a good quality of life. Postoperative complications occur equally in both, open as well as in laparoscopic operative techniques.</p>

<p>Uvod:Apendicitis je oboljenje, koje se najče&scaron;će javlja u dečjem uzrastu. Poslednjih godina se laparoskopska apendektomija sprovodi sve če&scaron;će u ovom uzrastu, međutim ne postoji jasan konsenzus o optimalnom izboru anestetika za održavanje op&scaron;te anestezije u toku ove hirur&scaron;ke metode u dečjem uzrastu. Cilj istraživanja: Utvrditi uticaj vrste anestezije i vrste hirur&scaron;ke procedure na odgovor organizma na hirur&scaron;ki stres tokom operacije crvuljka. Metodologija: Klinički prospektivno istraživanje je sprovedeno na Klinici za dečiju hirurgiju, na Institutu za zdravstvenu za&scaron;titu dece i omladine Vojvodine. Istraživanjem je obuhvaćeno 120 dece, uzrasta od 7 do 17 godina, bez postojećih komorbiditeta, koji su operisani zbog zapaljenja crvuljka. U zavisnosti od vrste operativnog zahvata i vrste primenjene anestezije deca su podeljena u četiri grupe bolesnika. Kod sve četiri ispitivane grupe uzimana je venska i kapilarna krv, nekoliko minuta nakon uvoda u anesteziju, u momentu vađenja crvuljka iz trbuha i 12 časova nakon kraja hirur&scaron;ke intervencije. Laboratorijski su određeni markeri oksidativnog stresa (TBARS), metaboličkog odgovora na hirur&scaron;ki stres (laktat, glikemija), inflamatornog odgovora organizma (IL-6, leukociti), gasne analize, parametri oksigenacije i ventilacije, i hemodinamski parametri ispitanika. Rezultati:U istraživanju je dobijen rezultat da je zapaljenje crvuljka oboljenje koje se če&scaron;će javlja kod dečaka. Tokom apendektomije u dečjem uzrastu, sevofluran je bolje kontrolisao arterijsku tenziju, dok na srčanu frekvencu vrsta anestezije nije imala uticaja. Sevofluran je anestetik tokom čije primene je manji inflamatorni odgovor tokom laparoskospske apendektomije. Propofol deluje suprimirajuće na oksidativni stres, ali nije nađena statistička značajnost u odnosu na vrednosti dobijene analizom uticaja sevoflurana na parametre oksidativnog stresa. Zaključak: Laparoskopska apendektomija u odnosu na laparotomiju nije praćena većim stepenom hirur&scaron;kog stresa, a sevofluran je anestetik koji tokom anestezije za laparoskopsku apendektomiju u dečijem uzrastu daje bolju kontrolu kliničkog, metaboličkog i inflamatornog odgovora.</p> / <p>Introduction: Appendicitis is a disease which appears most commonly in children. In recent years appendectomy in children is performed by laparoscopy, but there is no consensus yet on the optimal choice of anesthetics during general anesthesia for this procedure. Aim: To determine the influence of type of anesthesia and type of surgical procedure for appendectomy, on surgical stress in children. Methodology: A prospective clinical trial in Clinic of pediatric surgery in Novi Sad, Vojvodina. The study included 120 children aged from 7 to 17 years, with no commorbidities, who underwent appendectomy. Children were divided in four groups based on the type of anesthesia and type of surgery they received. In all participants, venous and capillary blood was sampled for analyzis 10 minutes after induction of anesthesia, at the moment of appendix removal and 12 hours after the procedure. The laboratory analysis included markers of oxidative stress (TBARS), metabolic response to surgical stress (lactate, blood glucose), inflammatory response (IL-6, leucocites), bloodgas analyses, parameters of oxygentation and ventilation and haemodynamic parameters of the participants. Results: In the study appendicitis was more common in boys. During laparoscopic appendectomy sevoflurane controlled better the blood pressure, but not the heart rate. Sevoflurane maintained a better control of parameters of the inflammatory response. Propofol decreased the oxidative stress, but there was no statistical difference compared to the effects of sevoflurane on oxidative stress. Conclusion: Laparoscopic appendectomy shoved no difference in the level of surgical stress compared to laparotomy, and sevoflurane appeared as an anaesthetic which had a better control of the metabolic, clinical and inflammatory response.</p>

Σκοπός της παρούσας διπλωματικής εργασίας είναι η ταξινόμηση κλινικών περιπτώσεων κοιλιακών αλγών και συγκεκριμένα περιπτώσεων σκωληκοειδίτιδας σε παιδιά ηλικίας μέχρι 14 ετών μέσω ενός εργαλείου που υλοποιούμε. Βασικός λόγος για τη κατασκευή αυτού του εργαλείου αποτέλεσε η δυσκολία στη πρόβλεψη της ασθένειας από τους ειδικούς (κατά μέσο όρο γίνονται 20% - 30% αχρείαστες εγχειρήσεις), η συχνή σύγχυσή της με άλλες περιπτώσεις κοιλιακών αλγών ενώ το ποσοστό θνησιμότητας στα παιδιά με σκωληκοειδίτιδα ποικίλλει από 0,1% - 1%. Βασισμένοι σε ένα σύνολο δεδομένων από τη Παιδοχειρουργική Κλινική του Πανεπιστημιακού Νοσοκομείου της Αλεξανδρούπολης, διεξάγουμε αναζήτηση των καλύτερων παραμέτρων για τη κατασκευή μοντέλων ταξινομητών βασισμένων στις τρεις παρακάτω τεχνικές Υπολογιστικής Νοημοσύνης: α) τα Τεχνητά Νευρωνικά Δίκτυα, β) τις Μηχανές Διανυσμάτων Υποστήριξης και γ) τα Τυχαία Δάση. Χρησιμοποιώντας ένα σύνολο 14 κλινικών και εργαστηριακών παραγόντων, υλοποιούμε μοντέλα ταξινομητών. Η βασική ιδέα για την υλοποίηση τους είναι η αντιμετώπιση των παρακάτω προβλημάτων: : α) έχει το παιδί σκωληκοειδίτιδα ή όχι; β) Αν έχει σκωληκοειδίτιδα, ποιος τρόπος αντιμετώπισής της ενδείκνυται: χειρουργική επέμβαση ή συντηρητική αγωγή; Μετά την εύρεση των βέλτιστων μοντέλων από κάθε μία από τις μεθόδους Υπολογιστικής Νοημοσύνης που χρησιμοποιήθηκαν, υλοποιήθηκε ένα εργαλείο εύχρηστης διεπαφής χρήστη στο προγραμματιστικό περιβάλλον της Matlab 2012a το οποίο ευελπιστούμε ότι θα υποβοηθήσει τους ειδικούς στη λήψη απόφασης για τη πορεία ενός νεαρού ασθενούς που εισέρχεται στο νοσοκομείο παραπονούμενος για σκωληκοειδίτιδα. Το εργαλείο αυτό ελέγχθηκε με καινούργια πραγματικά κλινικά δεδομένα από το Καραμανδάνειο Νοσοκομείο Παίδων Πατρών και η απόδοσή του ήταν ενθαρρυντική. / The purpose of this paper is the classification of clinical cases of abdominal pain and, to be more precise, the prediction of cases with acute appendicitis at children aged up to 14 years old through a tool that we implement. The main reasons for the construction of this tool are: a) the difficulty in the prediction of the appendicitis since the 20%-30% of the operations made from the experts for this disease are gratuitous, b) the frequent confusion that there is with other diseases that cause abdominal pain and c) the mortality rate at children with appendicitis varies from 0,1% to 1%. Based on a data set from the Department of the Child Surgery of the Hospital of the University of Alexandroupolis, we conduct a search of the best parameters for the construction of model classifiers based on the three following techniques of the Computational Intelligence: a) the Artificial Neural Networks, b) the Support Vector Machines and c) the Random Forests. The basic idea for the implementation of these models is, based on a sum of 14 clinical and laboratory factors, facing the following questions: a) if a child has appendicitis or not?, b) and if it does have appendicitis, which way should we follow to cure it: operational surgery or medication? After finding these best models, we implement a tool which is actually a Graphical User Interface of Matlab 2012a which we hope that will assist the experts in making the correct decision about a young patient that goes to the hospital complaining for appendicitis. This tool was tested on new real clinical data of patients of the Child Hospital of Patras and its performance was found really encouraging.

In der kontroversen Diskussion um die unklare Ätiologie der Appendizits wird oft eine Motilitätsstörungen angeführt. Die Interstitial cells of Cajal sind bedeutend für die Motilität und die Entstehung der Peristaltik im menschlichen Kolon. Bei einigen Motilitätsstörungen des Darmes wurde eine Rarifizierung dieser Zellen beobachtet. Die ICC wuden noch nie in der Appendix vermiformis beschrieben.In dieser Arbeit wurden erstmals die ICC in der Appendix mittels einer immunhistochemischen Färbung durch einen maus-monoklonalen Antikörper ( NCL- cKit) nachgewiesen sowie analysiert. Es konnten keine Subgruppen IC-SMP und IC-MP in der Appendix nachgewiesen werden. Die IC-LM zeigten sich reduziert im Vergleich zum Kolon. Die IC-CM konnten zahlreich und regelmäßig dargestellt werden. Eine unterschiedliche Verteilung bzw. Dichte der ICC in der normalen Appendix, der akut und chronisch entzündeten Appendizits konnte nicht nachgewiesen werden.Schlussfolgernd und in Übereinstimmung mit den Beobachtungen anderer Autoren besitzt die Appendix eine reduzierte Motilität und eine physiologische Koprosthase, die aber allein nicht zu einer Entzündung führt. Erst unter dem Einfluss der aus der Literatur bekannten Kofaktoren wird die Koprosthase verstärkt. Erst dies führt zu einer Alteration der Schleimhaut und zur Appendizitis. / The aetiology of the childlike appendicitis is not generally known, but a motility disorder is discussed. The Interstitial cells of Cajal (ICC) are important for the motility and the development of the peristalsis of the colon. In some motility disorders the ICC are abnormaly distributed. The ICC of the human vermiform appendix has never been examined before. We proved and analysed the ICC of the appendix with the mous-monoclonal antibody against c-kit, (NCL-cKit). We could not identify subtypes of ICC, as IC-SMP or IC-MP in the appendix. The IC-LM were reduced compared to the colon. The IC-CM were numerously and regularly distributed. There were no differences in the reduced incidence of ICC between normal vermiform appendix, acute inflamed and chronic inflamed appendicitis.In conclusion and conformance with other observations the appendix has a physiological motility disorder and koprosthasis. Only if some influences of presumably additional cofactors (e.g. inflamation, lymphoid hyperplasia, obstruction), the koprosthasis is intensified, the mucosa is irritated and the appendicitis is developed.

Most intra-abdominal infections such as acute appendicitis require surgical intervention. The use of antimicrobials, however, is essential in the treatment complementation and reduction of surgical site infection (SSI). The present study aims to make a critical analysis of the use of antimicrobials use, anatomopathological stage and surgical site infection after appendectomy. It were analyzed the demographic data, antimicrobial scheme chosen, the beginning of antimicrobial, usage time and evolution as the SSI associated with the anatomopathological stage of resected appendices. 233 patients were evaluated between 14 years and 78 years with male predominance (135 / 57.94%) and in the third decade of life (72 / 30.90%). In 139 patients (59.65%) surgical time was up to two hours with a predominance of Phlegmonous Acute Appendicitis (91 / 39.05%) and Necrotizing Acute Appendicitis (88 / 37.76%). The antimicrobial scheme most used was a combination of Ampicillin/Sulbactam totalizing 127 (54.50%) patients. Most patients had the start of the antimicrobial scheme in anesthetic induction (212 /90.94%). Regarding the usage time of antimicrobials, the prevalence was of less than 24 hours of use (122 / 52.36%) and 16 (6.87%) presented SSI. Based on the anatomopathological classification on nonnecrotic appendices, 145 (62.23%) patients should have used a single antimicrobial dose or at maximum for 24 hours. Of patients with non-necrotic appendix, only 60 (41.37%) used one dose; 15 (10.34%) used 2 to 4 doses and 70 (48.29%) used more than four doses of antimicrobial. In 16 (6.87%) patients considered with normal appendix were used more than four doses of antimicrobials. In the analysis of the SIRI SSI in perspective, no patient presented with SIRI 0 SSI (4 / 5.79%) patients presented with an SIRI SSI (9 / 5.88%) patients had 2 SIRI SSI and (1 / 12.5) 3 SIRI SSI presented. Based on anatomopathological association (necrotic and non-necrotic) of resected appendices for clinical suspicion of acute appendicitis and the use of antimicrobials, we can conclude: there was unnecessary use of more than one dose of antimicrobials in patients with uncomplicated appendicitis. / A maioria das infecções intra-abdominais, como apendicite aguda, necessita de intervenção cirúrgica. O uso de antimicrobianos, entretanto, é fundamental na complementação do tratamento e redução de infecção do sítio cirúrgico (ISC). O presente estudo tem como objetivo fazer uma análise crítica entre o uso de antimicrobianos, o estádio anátomo-patológico e infecção do sítio cirúrgico após apendicectomia. Foram analisados os dados demográficos, esquema de antimicrobiano escolhido, início do antimicrobiano, tempo de uso e evolução quanto a ISC associada com o estádio anátomo-patológico dos apêndices ressecados. Foram avaliados 233 pacientes entre 14 anos e 78 anos, com predominância do sexo masculino (135 / 57,94%) e na terceira década de vida (72 / 30,90%). Em 139 pacientes (59,63%) o tempo cirúrgico foi de uma a duas horas, com predominância da Apendicite Aguda Flegmonosa (91 / 39,05%) e Apendicite Aguda Necrosante, (88 / 37,76%). O esquema antimicrobiano mais utilizado foi a associação de Ampicilina /Sulbactam, totalizando 127 (54,50%) pacientes. A maioria dos pacientes teve o início do esquema antimicrobiano à indução anestésica, (212 / 90,94%). Em relação ao tempo de uso do antimicrobiano, a prevalência foi de menos de 24 horas de uso, (122 / 52,36%) e 14 (6,01%) apresentaram ISC. Baseado na classificação anátomo-patológica em apêndices não-necrosados, 145 (62,24%) pacientes deveriam ter usado antimicrobiano em dose única ou no máximo por 24 horas. Dos pacientes com apêndice não-necrosados apenas 60 (41,37%) usaram uma dose; 15 (10,34%) usaram de 2 a 4 doses e 70 (48,29%) usaram mais de 4 doses de antimicrobianos. Em 16 (6,87%) pacientes considerados com o apêndice normal foram usadas mais de 4 doses de antimicrobianos. Na análise das ISC sob perspectiva do Índice de Risco de Infecção Cirúrgica (IRIC), nenhum paciente com IRIC 0 apresentou ISC; (4 /5,79%) dos pacientes com IRIC 1 apresentaram ISC;( 9 / 5,88%) dos pacientes IRIC 2 apresentaram ISC e (1/ 12,5%) IRIC 3 apresentaram ISC. Baseado na associação entre o anátomo-patológico (necrosados e não necrosados) dos apêndices ressecados por suspeita clínica de apendicite aguda e o uso de antimicrobianos, podemos concluir que: houve uso desnecessário de mais de uma dose de antimicrobianos nos pacientes com apendicite não complicada. / Mestre em Ciências da Saúde

Le but de notre travail a été d’évaluer l’effet de la réduction de la dose d’irradiation en TDM multibarrette quant à la performance diagnostique, la confiance de l’observateur dans le diagnostic proposé, la capacité à suggérer un diagnostic alternatif dans quelques pathologies courantes et/ou caractérisées par des situations de faibles contrastes entre les structures anatomiques normales ou pathologiques. Nous avons donc comparé ces paramètres entre des TDM à doses réduites et à doses standard telles que couramment rapportées dans la littérature dans les circonstances suivantes :<p><p>•\ / Doctorat en sciences médicales / info:eu-repo/semantics/nonPublished

Background: In addition to patient-related systemic factors directing the immune response, the pathomechanisms of appendicitis (AP) might also include insufficient drainage leading to inflammation caused by decreased peristalsis. Genetic predisposition accounts for 30%–50% of AP. M. Hirschsprung (HSCR), also characterized by disturbed peristalsis, is associated with variants in the RET proto-oncogene. We thus hypothesized that RET variants contribute to the etiology of AP. Methods: DNA from paraffin-embedded appendices and clinical data of 264 children were analyzed for the RET c.135A>G variant (rs1800858, NC_000010.11:g.43100520A>G). In 46 patients with gangrenous or perforated AP (GAP), peripheral blood DNA was used for RET sequencing. Results: Germline mutations were found in 13% of GAP, whereas no RET mutations were found in controls besides the benign variant p.Tyr791Phe (NC_000010.11:g.43118460A>T). In GAP, the polymorphic G-allele in rs2435352 (NC_000010.11:g.43105241A>G) in intron 4 was underrepresented (p = 0.0317). Conclusion: Our results suggest an impact of the RET proto-oncogene in the etiology of AP. Mutations were similar to patients with HSCR but no clinical features of HSCR were observed. The pathological phenotypes in both populations might thus represent a multigenic etiology including RET germline mutations with phenotypic heterogeneity and incomplete penetrance.