Incidence of occult appendiceal neoplasm in patients over 40 years with acute appendicitis: A single-institution review.

OBJECTIVE: To investigate the incidence of occult appendiceal neoplasm in patients aged 40 years and over who underwent appendicectomy for appendicitis. METHODS: The clinical coding electronic database was used to identify patients aged 40 years and over who were diagnosed with appendicitis from September 2010 to September 2022. Patients were included if they were managed operatively. DESIGN: Retrospective cohort study. SETTING: Modified Monash category 3 (large rural town). PARTICIPANTS: Patients aged 40 years and over undergoing appendicectomy for appendicitis. MAIN OUTCOME MEASURES: Incidence of appendiceal neoplasm within appendicectomy specimen. RESULTS: A total of 279 patients aged 40 years and over underwent appendicectomy, with a median age of 53 years (range 40-95). Nineteen patients (7%) were found to have a primary neoplastic lesion within the appendix: seven neuroendocrine neoplasms (37%), six sessile serrated lesions (32%), two colonic-type adenocarcinoma (11%), two goblet cell adenocarcinoma (11%) and two appendiceal mucinous neoplasms (11%). Additionally, one patient had a metastatic adenocarcinoma of pancreaticobiliary aetiology. CONCLUSIONS: Occult appendiceal neoplasm was higher than reported in the literature in our cohort. This would support appendicectomy as the treatment of choice for patients aged 40 years and over with acute appendicitis and caution against nonoperative management in this demographic.

Surface Electromyography of the Internal and External Oblique Muscles During Isometric Tasks Targeting the Lateral Trunk.

CONTEXT: Tasks that activate the lateral trunk muscles are clinically relevant in athletic and rehabilitation programs. However, no electromyography studies have compared tasks aimed at lateral trunk muscle activation. OBJECTIVE: To compare the activation magnitudes of the internal and external obliques between 4 tasks targeting recruitment of the lateral trunk muscles, including the proposal of a novel assessment. DESIGN: Comparative laboratory study. SETTING: University-based biomechanics laboratory. PARTICIPANTS: Sixty-three participants (35 females, age = 23.6 [2.0] y, height = 1.72 [0.10] m, mass = 70.7 [14.4] kg, body mass index = 23.6 [2.86] kg/m2). INTERVENTION(S): Surface electromyography data were recorded bilaterally from the internal and external obliques while the participants performed 2 maximum voluntary contraction tasks followed by 4 isometric tasks. The isometric tasks included feet-elevated side-supported, trunk-elevated side-unsupported, lateral plank, and side-lying hip abduction. MAIN OUTCOME MEASURES: Maximum voluntary contraction-normalized and integrated muscle activities were calculated for targeted and nontargeted muscles in each task. A side-by-task analysis of variance with Bonferroni correction was conducted. RESULTS: The trunk-elevated side-unsupported task strongly activated the internal (199% maximum voluntary contraction) and external (103%) oblique muscles. The feet-elevated side-supported task strongly activated the internal obliques (205%) but not the external obliques (55%). The lateral plank task successfully activated the internal (107%) and external (72%) obliques, but not at the highest levels of the tested tasks. The side-lying hip abduction task was the least effective at activating either the internal (48%) or external (20%) obliques. CONCLUSIONS: We recommend the novel trunk-elevated side-unsupported task for assessing lateral trunk muscle performance. For independent exercise, we recommend the lateral plank task, unless arm or shoulder pathologies are present, whereby the feet-elevated side-supported task may be favorable.

The role of screening colonoscopy after appendicitis in patients over 40 years of age.

BACKGROUND: There is some evidence of the association between acute appendicitis and colorectal neoplasm in patients over the age of 40 years. Despite this, few centres routinely evaluate the colon endoscopically following an episode of appendicitis in these patients. Our aim was to investigate the incidence of colorectal neoplasm in patients aged 40 years and over who underwent screening colonoscopy following acute appendicitis. METHODS: Retrospective cohort study of patients aged 40 years and over who were diagnosed with acute appendicitis via imaging or histology between January 2015 and May 2022. Findings on subsequent screening colonoscopy were evaluated and classified according to adenomatous and non-adenomatous lesions. RESULTS: A total of 176 patients met inclusion criteria, with a median age of 54 years (range 40-92) and female to male ratio of 1:1.3. One hundred patients (56%) had a colonoscopy following their admission, at a mean duration of 3.5 months post discharge. 15% of patients had an adenomatous polyp detected (10 adenomas, 4 advanced adenomas, and 1 sessile serrated adenoma), and 9% had a non-adenomatous lesion detected (8 hyperplastic polyps and 1 lipoma). CONCLUSION: Adenoma detection rate in patients aged 40 years and over undergoing colonoscopy after acute appendicitis was 15% in our cohort. This high adenoma detection rate supports the view of appendicitis as an indication for screening faecal immunochemical testing or colonoscopy in patients above 40 years.

Outcomes of laparoscopic colorectal cancer surgery in a non-metropolitan Australian hospital: audit of 120 patients with long-term follow-up results.

BACKGROUND: Laparoscopic colorectal cancer surgery has been shown to produce comparable oncological long-term results as well as improved short-term outcomes compared to open surgery in multicentre trials. Limited information is available whether these results are reproduced in non-metropolitan surgery. METHODS: Audit of prospectively collected follow-up data in a rural surgical centre in South Australia. Short- and long-term results of colorectal cancer patients undergoing elective laparoscopic surgery for cure. Outcomes are compared with results of open surgery. RESULTS: Survival and clinical data of 120 patients after laparoscopic resection were analysed and then benchmarked against results of 157 open resections. Conversion rate was 10.8% (N = 13). Mean patient age was 69.9 years. Mean number of lymph nodes analysed was 15.5. Mean follow-up is 53.0 months. Thirty-day mortality was 0.36% (n = 1) and 90-day mortality was 0.72% (n = 2). No differences in complications rates, long term survival or procedures performed were observed. This is a single centre audit of clinical and oncological outcomes and a number of exclusion criteria were applied. Patient gender, cancer stages as well as number of patients undergoing neoadjuvant radio-chemotherapy differ significantly between the study and the benchmarking group. Patients were not randomized and the benchmarking group is in part a historical control. CONCLUSIONS: This audit of clinical outcomes and survival after laparoscopic CRC resection for cure indicates that minimal invasive surgery may be suitable for adequately staffed and equipped rural centres.