The management of primary adenocarcinoma of the vermiform appendix.
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Primary adenocarcinoma of the appendix is not of low grade malignancy as has been previously supposed and a right hemicolectomy is the proper procedure, offering a much better prognosis than simple appendicectomy. (+info)
CARCINOID TUMOR OF THE VERMIFORM APPENDIX WITH DISTANT METASTASIS.
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Metastatic carcinoid tumors of the appendix are probably not as rare as is commonly thought. In five of thirteen cases diagnosed at the Stanford-Palo Alto Hospital, there was microscopic evidence of lymphatic invasion. Metastasis to regional nodes was demonstrated in two of the five. These two cases bring the total number reported in the medical literature to 31. One of the patients was a 14-year-old girl. The youngest patient previously cited with metastasis from carcinoid tumor of the appendix was 16 years of age. We believe that all carcinoid tumors, regardless of location, are malignant lesions and urge careful pathologic study for evidence of lymphatic invasion. When such invasion is present, removal of regional nodes by right hemicolectomy seems indicated. (+info)
A simple scoring system to reduce the negative appendicectomy rate.
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In a controlled, prospective study the following five criteria were used for the diagnosis and management of acute appendicitis: abdominal pain; vomiting; right lower quadrant tenderness; low grade fever (< or = 38.8 degrees C); and polymorphonuclear leucocytosis (TC > or = 10,000 with polymorphs > or = 75%). The aim of the study was to reduce the negative appendicectomy rate. If four out of five or five out of five criteria were present on admission, appendicectomy was carried out. On the other hand, if three out of five criteria were present on admission, the patient was subjected to active inpatient observation until either the development of the fourth criterion, when appendicectomy was performed, or until the patient recovered and the condition did not progress beyond the third criterion. Generalised peritonitis due to a perforated appendix was excluded from the study. Over a 1-year period, 58 patients (M:F = 45:13) were entered into the study. Appendicectomy was carried out in 46 (80%) of patients; of these, 32 patients (70%) were operated on soon after admission. The remaining 14 (30%) were operated on after a period of inpatient observation decided the development of the fourth criterion. A total of 12 patients (12/58 = 20%) did not undergo operation. The control group consisted of 59 patients upon whom appendicectomy was carried out by another surgical unit over the same 1-year period. The negative appendicectomy rate in the trial group was 6.5% (3/46), whereas in the control group it was 17% (10/59) (P < 0.05). We conclude that the use of a simple scoring system can significantly reduce the negative appendicectomy rate. (+info)
REGIONAL ENTERITIS: DISEASE PATTERENS AND MEDICAL MANAGEMENT.
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The clinical picture of regional enteritis was reviewed in 98 cases collected from five hospitals in the City of Edmonton. There was no apparent racial prevalence, although only one case was reported among Indians and Eskimos. More than one-half had their onset between the ages of 11 and 30 years. Men were more commonly affected than women. The onset in 44 patients was acute and closely mimicked acute appendicitis. Twenty-eight patients had had abdominal surgery prior to the onset of symptoms. Major symptoms were abdominal pain, diarrhea and weight loss. Abdominal tenderness, fever and abdominal mass were the most consistent physical signs. The most valuable diagnostic procedure was radiological examination of the bowel. Complications were largely confined to the gastrointestinal tract. In the majority of cases, surgery was the ultimate form of therapy. (+info)
SURGICAL MANAGEMENT OF REGIONAL ENTERITIS.
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The present-day concepts concerning the surgical management of regional enteritis are reviewed and the multitude of problems that may arise in surgical treatment are discussed. The primary treatment of regional enteritis remains medical. Surgical intervention is necessary only for the complications of intractability, obstruction, fistula, abscess formation, anal and rectal complications, massive hemorrhage and perforation. To ensure the best possible results, medical treatment should continue after surgery. A perfect operation for this disease does not exist. Operations for regional enteritis can now be performed with a mortality rate of less than 2%, and although the recurrence rate following surgery averages approximately 30%, the disease is well controlled in the majority of patients with medical and/or surgical treatment. (+info)
POSITIVE NITROGEN BALANCE AND THE PREVENTION OF ILEUS IN THE IMMEDIATE POSTOPERATIVE PERIOD.
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A solution to the problems of nitrogen balance and ileus in the postoperative period is presented. A new three-lumen nasogastric tube (Moss decompression tube) was used in three patients on whom aortic grafts were carried out and in five who underwent cholecystectomy, and these patients are compared to control groups. The use of this tube prevents postoperative ileus and permits the feeding of patients, by the enteral route, as early as two hours after operation in some instances. A positive nitrogen balance was achieved as early as four hours after operation. In control groups, positive nitrogen balance could not be obtained until six to 10 days postoperatively. Weight loss was prevented and hospital stay considerably reduced. The use of the Moss decompression tube prevents postoperative ileus and permits early enteral feeding obtaining, in a matter of hours, a positive nitrogen balance. (+info)
Appendicitis following blunt abdominal trauma.
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A young boy presented with history of abdominal trauma. History and initial clinical findings suggested a soft tissue injury. Due to increasing abdominal pain and fever, we proceeded with an exploratory laparotomy with a diagnosis of intra-abdominal injury, at which we found a perforated appendix. Appendicitis following blunt abdominal trauma needs high index of suspicion. (+info)
Laparoscopic surgery in children.
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A review of laparoscopy as used in paediatric surgery with special reference to cholecystectomy, appendicectomy, fundoplication, the undescended testicle, inguinal hernia and hydroceles. (+info)