Historical aspects of appendicitis in children.

Evidence of appendicitis exists from ancient Egyptian mummies but the appendix was not discovered as an anatomical entity until the renaissance in Western European literature. Much confusion reigned over the cause of right iliac fossa inflammatory disease until the late 19th century, when the appendix was recognized as the cause of the great majority of cases. Coining the term 'appendicitis' and making the case for early surgery, Fitz in 1886 set the scene for recovery from appendicitis through operative intervention.

Physiological function of insoluble dietary fiber prepared from exploded oak wood (Quercus mongolica).

This study investigated the production of insoluble dietary fiber using exploded and chemically treated oak wood (Quercus mongolica) and the physiological functions of prepared insoluble dietary fiber in laboratory animals. To produce high quality insoluble dietary fiber, the steam explosion treatment was performed at 25 kgf/cm2 pressure for 6 minutes. In the chemical analysis of insoluble dietary fiber, exploded oak wood was pretreated by 1% sodium hydroxide solution. The insoluble dietary fiber contained 7.6% residual lignin and 61.7% of alpha-cellulose. In order to compare the physiological functions of prepared insoluble dietary fiber with those of commercial insoluble dietary fiber, Sprague-Dawley male rats weighing 100 +/- 10 g were randomly assigned to one normal diet and five high cholesterol diets, containing 1% cholesterol. The high cholesterol diet groups were classified as the fiber-free diet (FF group), 5% commercial alpha-cellulose diet group (5C group), 10% commercial alpha-cellulose group (10C group), 5% insoluble dietary fiber group (5M group) and 10% insoluble dietary fiber group (10M group). Food intake, weight gain and food efficiency ratio in high cholesterol groups were significantly higher than those of the normal group, but there were no significant differences among the high cholesterol diet groups. In addition, there were no significant differences in the weights of liver, kidney and small intestine in insoluble dietary fiber-supplemented groups. Cecum weights in all insoluble dietary fiber groups were significantly higher than those of the FF group. There were no significant differences in the activities of the glutamic pyruvic transaminase (GPT) and glutamic oxaloacetic transaminase (GOT) among the insoluble dietary fiber-supplemented groups. In conclusion, the prepared insoluble dietary fiber and the commercially available insoluble fiber showed the same physiological effects. Moreover, the preparation method for the insoluble dietary fiber from the exploded oak wood was successful.

Apendicitis aguda horas de evolución y diagnóstico histopatológico: Hospital Patrocinio Peñuela Ruíz: período 1999-2000 / Appendicitis sharp hours of evolution and diagnose histopathological: Hospital Patrocinio Peñuela Ruíz: period 1999-2000

Se estudiaron 149 casos de pacientes operados con diagnóstico histológico de apendicitis aguda, en el HPPR durante el período 1999-2000. El objetivo del mismo fue determinar la existencia o no de una correlación entre las horas de evolución y el diagnóstico histopatológico. Se recolectaron los siguientes datos de las historias clínicas: horas de evolución del dolor abdominal y diagnóstico histológico. Se clasificaron los pacientes en cuatro grupos según el tiempo de evolución del dolor (12 horas o menos, 12 a 24 horas, 24 a 48 horas). La mayor parte de los pacientes (47 por ciento) consultaron entre las 24 y 48 horas de iniciado el dolor. Para los cuatro grupos el hallazgo histológico más frecuente fue apendicitis flegmonosa y hemorrágica (46,51 por ciento, 65,51 por ciento, 55,32 por ciento y 40 por ciento respectivamente). Se concluye que no hay relación directa entre las horas de evolución del dolor y la fase histológica.

McBurney's point: are we missing it?

A prospective study of 100 post-evacuation barium enemas was done. Films were centered at McBurney's point, with an opaque skin marker at that point. Analysis of these revealed that in only one case (1%) was the base of the appendix at McBurney's point. In 67% it was cephalic and in 32% it was caudal to this point. The limitations of McBurney's point as an anatomical landmark should be recognized. This needs to be highlighted in teaching anatomy, especially to surgical trainees. Planning and choice of surgical incisions should be based on an understanding of these anatomical variations since McBurney's original description was clinical rather than anatomical.

Apendicitis aguda: revisión casuística y bibliográfica / Acute appendicitis: clinical series and bibliographic review

Se analiza el cuadro de apendicitis aguda, se establecen los factores involucrados en su etiopatogenia y se determina la importancia del diagnóstico clínico. Como elementos de apoyo destacamos la importancia de exámenes como la Proteína C Reactiva y la ecotomografía abdominal. Se establece la conducta a seguir ante un paciente con sospecha de apendicitis aguda y se realiza un análisis respecto a la técnica quirúrgica. Damos gran valor al análisis histopatológico de la pieza quirúrgica, porque permite el diagnóstico incidental de tumores apendiculares; y permite también, realizar una autoevaluación respecto a la impresión clínica del proceso apendicular. Se presentan 305 casos de pacientes con diagnóstico de apendicitis aguda operados analizando datos de la clínica, laboratorio, hallazgos operatorios, técnica quirúrgica, evolución postoperatoria y estudio histopatológico de la pieza quirúrgica

Is the appendix where you think it is--and if not does it matter?

For over 100 years the recognized surface marking for the appendix has been McBurney's point (the junction of the lateral and middle thirds of a line joining the umbilicus with the right anterior superior iliac spine (ASIS)). In order to test its validity, the relationship between McBurney's point and the appendix was determined on 275 double contrast barium enemas (DCBE). A wide spread of distribution of the site of the appendix base was seen. Only 35% of appendix bases were found to lie within 5 cm of McBurney's point, and 15% were more than 10 cm distant. Seventy-five per cent of appendix bases were below and medial to a line joining the umbilicus with the right ASIS. These findings are in agreement with world-wide studies conducted by the World Organisation of Gastroenterology which showed that less than half of all patients with appendicitis have tenderness maximal over McBurney's point. A record was also made in 93 cases of the position of the appendix in relation to the caecum. The importance of these results in the diagnosis and management of patients with suspected appendicitis is discussed.

McBurney's point--fact or fiction?

Anthropometric measurements were performed on 51 normal, supine, barium enema examinations to determine the position of the lower pole of the caecum and the base of the appendix relative to palpable bony landmarks (the anterior superior iliac spine and the symphysis pubis). Four quadrants were defined (iliac, umbilical, inguinal and pelvic) by the intersection of the right lateral line and the interspinous line (the line joining the left and right anterior superior iliac spines). The position of the lower pole of the caecum was iliac in 12%, inguinal in 37%, and pelvic in 51%. The appendix or appendix stump was visualised on 53% of the barium examinations. The position of the appendix was iliac in 15%, umbilical in 15%, inguinal in 11%, and pelvic in 59%. The positions of the lower pole of the caecum and base of the appendix are lower and more medial than previously described. 70% of appendices were found to lie inferior to the interspinous line, contrary to established surgical teaching, which assumes McBurney's point to be the surface landmark for the appendix.