Recurrent appendicitis of vermiform appendix after a prior appendectomy: A case report and review of the literature.

Introduction: Acute appendicitis is one of the leading causes of acute abdominal pain and surgical emergency. Stump appendicitis is a known complication of appendectomy whereby a retained appendiceal tip serves as a nidus for recurrent bouts of inflammation. Nevertheless, full-blown appendicitis of the vermiform appendix after a prior appendectomy remains a diagnostic conundrum. Case presentation: A 45-year-old woman presented with a six-month history of right iliac fossa pain. Pertinently, she had undergone a prior open appendectomy twelve years ago. Further investigative workup revealed full-blown appendicitis, which was not attributable to a retained appendiceal stump. A subsequent laparoscopic appendectomy was performed, and the resultant specimen was sent for further evaluation, confirming the diagnosis of recurrent appendicitis. Clinical discussion: Acute appendicitis is one of the most common life-threatening abdominal surgical emergencies worldwide, with 300000 appendectomies performed annually in the United States alone. Stump and chronic appendicitis are two separate and exceedingly rare clinical entities that may present simultaneously and develop serious complications unless promptly recognized and appropriately managed. The present paper prompts the clinicians to distinguish amongst the two at the initial surgery in order to thwart further exacerbations. Conclusion: While stump appendicitis is a rare but well-characterized complication of a prior appendectomy, full-blown appendicitis of vermiform appendix remains elusive. It is therefore imperative to distinguish between a duplicated and a recurrent appendix at the initial operative procedure to facilitate optimal patient management.

Management of phrenic nerve injury post-cardiac surgery in the paediatric patient.

BACKGROUND: Phrenic nerve injury is a common complication of cardiac and thoracic surgical procedures, with potentially severe effects on the health of a child. This review aims to summarise the available literature on the diagnosis and management of PNI post-cardiac surgery in paediatric patients with CHD. MAIN BODY: The presence of injury post-surgery can be difficult to detect and may present with non-specific symptoms, emphasising the importance of an effective diagnostic strategy. Chest X-ray is usually the first investigation for a suspected diagnosis of PNI, which is usually confirmed using fluoroscopy, ultrasound scan, or phrenic nerve stimulation (gold standard). Management options include supportive ventilation and/or invasive diaphragmatic plication surgery. While the optimal timing of plication surgery remains controversial, it is now the most widely accepted treatment for PNI in children post-CHD surgery, especially for very young patients who cannot be weaned off supportive ventilation. Further research is needed to determine the optimal timing of surgical intervention for positive outcomes and to explore the benefits of using minimally invasive surgical techniques in children. CONCLUSION: PNI is a common and serious complication of CHD surgery, therefore, its diagnosis and management in the paediatric population are of major importance. Further research is needed to determine the optimal timing of surgical intervention for positive outcomes and to explore the benefits of using minimally invasive surgical techniques in children.

Perioperative and long-term management of Fontan patients.

A Fontan circulation requires a series of three-staged operations aimed to palliate patients with single-ventricle CHD. Currently, the most frequent technique is the extracardiac total cavopulmonary connection, an external conduit connecting the IVC and right pulmonary artery, bypassing the right side of the heart. Fontan candidates must meet strict criteria; they are assessed utilising both cardiac catheterisation and cardiac magnetic resonance. Postoperatively, treatment protocols prioritise antibiotic prophylaxis, diuretics, angiotensin-converting enzyme inhibitors, anticoagulation, and oxygen therapy with fluid restriction and a low-fat diet. These measures aim to reduce length of stay in the ICU and hospital by preventing acute complications such as infection, venous thromboembolism, low cardiac output, pleural effusion, and acute kidney injury. Late complications of a Fontan procedure include circulation failure, protein-losing enteropathy, plastic bronchitis, and Fontan-associated liver disease. The definitive management is cardiac transplantation, with promising innovations in selective embolisation of lymphatic vessels and Fontan-specific ventricular assist devices. Further research assessing current protocols in the perioperative management of Fontan patients would be beneficial for standardising current practice and improving outcomes.

Occlusal Concepts and Considerations in Fixed Prosthodontics.

The UK has an increasingly ageing population, many of whom are retaining more of their own teeth. This has led to an increase in the prevalence of tooth wear and the need to replace pre-existing failing restorations. In many cases this will be achieved by fixed prosthodontics. This paper provides a brief overview of important occlusal concepts that should be considered when providing non-implant fixed prosthodontics using either a conformative or reorganised approach. The aim is to give general dental practitioners the confidence to provide these types of restorations in primary care. Clinical cases demonstrate how the occlusion can be controlled to optimise clinical outcomes.

Interocclusal Records in Fixed Prosthodontics.

An accurate interocclusal record is essential for the successful delivery of fixed prosthodontic restorations. There are various materials and techniques used to obtain an interocclusal record in order to facilitate mounting of the dental casts on an articulator. The interocclusal record describes the vertical and horizontal relationship of the maxillary and mandibular teeth. In circumstances where the vertical relationship is not supported through a tripod of widely spaced opposing contacts, the interocclusal record will be needed to restore this vertical support to prevent inaccurate mounting. The clinician should understand when an interocclusal record is required and have an awareness of the different materials and techniques available to record an interocclusal registration.

A pilot study of the sensitivity and specificity analysis of the standard-Spanish version of the Culture-Fair Assessment of Neurocognitive Abilities and the Examen Cognoscitivo Mini-Mental in the Dominican Republic.

This pilot study purports to address the need for culturally validated, evidence-based assessments and to serve as a springboard for future culturally sensitive research. This study was conducted in the Dominican Republic. It entailed counterbalanced administration of a standard Spanish translation of the Culture-Fair Assessment of Neurocognitive Abilities (S-S CANA) and the standard Spanish translation of the Mini-Mental State Examination (Examen Cognoscitivo Mini-Mental; ECM-M). The sample was composed of 30 Spanish-speaking Dominican adults who met the inclusion criteria for the normative and clinical groups. In an effort to initiate the validation process for the S-S CANA, as well as norm it to the given population, the efficacy of the S-S CANA in determining neuropathology was then compared to that of the ECM-M. Analyses of variance and covariance and t-tests were conducted, and a receiver-operating characteristic curve was computed. Results indicated significantly greater sensitivity and specificity of the S-S CANA relative to the ECM-M.