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1.
Mymensingh Med J ; 29(1): 92-96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915342

RESUMO

A cross sectional descriptive study was performed on 40 postmortem vermiform appendix (male 24 and female 16) to find out the diameter of lymphoid follicle of vermiform appendix of Bangladeshi people. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique and were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). For this purpose, about 3mm long of whole thickness transverse section was taken from the middle of the vermiform appendix and thus the permanent slides were made for microscopic examination. To measure the diameter of the lymphoid follicle two measurements were taken. One was taken at the maximum diameter and another was perpendicular to it by ocular micrometer. Diameter of one largest and one smallest lymphoid follicles were measured and find out the mean diameter of lymphoid follicle between them. Diameter of lymphoid follicle = (Maximum transverse diameter + perpendicular diameter) /2. All data were recorded in the predesigned data sheet, analyzed by SPSS program (version 21, 2012) and compared with the findings of other national and international studies and standard text books. It was observed that diameter of lymphoid follicle of vermiform appendix gradually decreased as age advanced. The mean±SD diameter of lymphoid follicle was 580.31±37.07, 545.58±38.37, 485.68±40.20 and 428.12±68.41µm in Group A, B, C and D respectively. Statistical analysis shows that the mean differences of diameter of lymphoid follicle between A&B, C&D were statistically non significant at p= or >0.05 level, difference between Group B&C was statistically moderately significant at p<0.01 level and differences between Group A&C, B&D, A&D were statistically highly significant at p<0.001 level. Mean diameter of lymphoid follicle of vermiform appendix in male was higher (584.30±12.65µm in Group A, 549.42±38.36µm in Group B, 487.38±39.91µm in Group C, 430.68±70.30µm in Group D) than in female (576.31±53.77µm in Group A, 536.61±45.14µm in Group B, 483.14±46.68µm in Group C, 424.28±75.95µm in Group D) but mean difference between sexes in the different groups was statistically non significant at p=or >0.05 level. The present study will help to increase the information pool on the diameter of lymphoid follicle of vermiform appendix of Bangladeshi people.


Assuntos
Apêndice , Autopsia/métodos , Tecido Linfoide , Adulto , Fatores Etários , Idoso , Apêndice/anatomia & histologia , Apêndice/patologia , Grupo com Ancestrais do Continente Asiático , Bangladesh , Cadáver , Estudos Transversais , Grupos Étnicos , Feminino , Humanos , Tecido Linfoide/anatomia & histologia , Tecido Linfoide/patologia , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
2.
J. coloproctol. (Rio J., Impr.) ; 39(3): 279-287, June-Sept. 2019. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1040330

RESUMO

ABSTRACT Aim: The purpose of this review was to present and discuss the anatomical variations and congenital abnormalities of the vermiform appendix and mesoappendix reported in recent years, and their associations with acute appendicitis and other associated pathologies. Methods: The search was carried out in the following databases: PubMed, Science Direct, and SciELO. Results: Thirty-seven studies were included in this review. Among the abnormalities of the vermiform appendix identified are agenesis and duplicity, and anatomical variations were related to length and positioning. Appendicular duplicity was a more frequent abnormality, mainly Type B2, associated with acute appendicitis, followed by agenesis, Type III. The first case of agenesis associated with acute appendicitis and volvulus-type duplicity of the appendix was identified. The most frequent position was retrocecal in adults and pelvic in children. In the mesoappendix, anatomical variations in its positioning, shape, absence, and length were identified. Conclusion: This review sought to present and discuss the anatomical variations and congenital abnormalities of the vermiform appendix and mesoappendix reported in recent years, and their associations with acute appendicitis and other associated pathologies, contributing to aid in clinical diagnosis and surgical interventions in patients with suspected acute appendicitis.


RESUMO Objetivo: O objetivo desta revisão foi apresentar e discutir as variações anatômicas e anomalias congênitas do apêndice vermiforme e mesoapêndice relatados nos últimos anos e suas associações com apendicite aguda e outras patologias associadas. Métodos: A busca foi realizada nas seguintes bases de dados: Pubmed, Science Direct e Scielo. Resultados: Trinta e sete estudos foram incluídos nesta revisão. Entre as anormalidades do apêndice vermiforme identificada estão agenesia e duplicidade e, variações anatômicas relacionadas ao comprimento e posicionamento. A duplicidade apendicular foi a anormalidade mais incidente, principalmente do Tipo B2, associada à apendicite aguda, seguida de agenesia do Tipo III. O primeiro caso de agenesia associada à apendicite aguda e à duplicidade de apêndice do tipo vólvulo foi identificado. A posição mais frequente foi a retrocecal em adultos e a pélvica em crianças. No mesoapêndice, foram identificadas variações anatômicas em seu posicionamento, formato, ausência e comprimento. Conclusão: Esta revisão procurou apresentar e discutir as variações anatômicas e anomalias congênitas do apêndice vermiforme e mesoapêndice relatados nos últimos anos e suas associações com apendicite aguda e outras patologias associadas contribuindo para o auxílio no diagnóstico clínico e intervenções cirúrgicas em pacientes com suspeita apendicite aguda.


Assuntos
Humanos , Masculino , Feminino , Apêndice/anatomia & histologia , Apêndice/anormalidades , Apendicite , Anormalidades Congênitas , Variação Anatômica
3.
Mymensingh Med J ; 28(1): 54-59, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30755551

RESUMO

This cross sectional descriptive study was performed on 70 postmortem vermiform appendices (male 34 and female 36) to find out the various positions of vermiform appendix of Bangladeshi people. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique from October 2016 to March 2017. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy technique. During postmortem examination abdominal cavity was routinely exposed by classical midline incision from xiphoid process to the symphysis pubis and a semicircular incision around the umbilicus and the flaps were reflected to give a good view of the abdominal cavity along with its contents and then the taeniae coli of the caecum were identified. The three taeniae coli of the caecum converge at the base of the appendix and become its longitudinal muscle coat. The anterior caecal taeniae coli acts as the best guide for identification of the vermiform appendix. The relation of the base of the appendix to the caecum is constant but the position of the vermiform appendix, which is variable, was studied in relation to caecum and the terminal part of the ileum. Accordingly the position of the vermiform appendix was noted either retrocaecal, pelvic, preileal or postileal, subcaecal. All data were recorded in the predesigned data sheet, analyzed by SPSS program (version 21, 2012) and compared with the findings of other national and international studies and standard text books. Among 70 specimens, 44(62.9%) vermiform appendices were retrocaecal in position. The next common position was pelvic which was in 22(31.4%) specimen followed by postileal in 3(4.3%) specimen and subcaecal was observed only in 1(1.4%) specimen. In this study in all age groups incidence of retrocaecal vermiform appendix was highest and it was about 67.6%, 50%, 69.2% and 72.7% in Group A, B, C, D respectively. Pelvic position was 7.1%, 46.9%, 23.1% and 27.3% in Group A, B, C, D respectively. Subcaecal vermiform appendix was absent in Group A, B and Group D. On the other hand postileal vermiform appendix was absent in Group C and Group D. The findings of this study may help the physician and the surgeons for proper diagnosis, management and treatment of disease of vermiform appendix.


Assuntos
Apêndice/anatomia & histologia , Autopsia , Bangladesh , Cadáver , Estudos Transversais , Grupos Étnicos , Feminino , Humanos , Masculino
4.
Ann Ital Chir ; 90: 72-77, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30467271

RESUMO

AIM: Although still debatable, appendicectomy during laparoscopy in patients with abdominal pain is often performed even if the appendix seems normal. The study's aim is to compare the postoperative outcomes of laparoscopic appendicectomies with appendix proven to be histologically normal to those with proven appendicitis, adding evidence on whether a normal appendix should be removed. METHODS: All consecutive patients who underwent laparoscopic appendicectomy in a one-year period in a single centre were retrospectively studied. Comparison was attempted between patients with negative and positive histology with regards to their postoperative outcomes (length of stay and postoperative complications). RESULTS: Out of 134 patients included in the study, ten patients developed postoperative complications (7.5%), 42 patients had negative histology (31.3%), 92 patients had positive histology (68.7%) and six (14.3%) and four patients (4.3%) respectively from each group developed post-operative complications. No statistically significant difference was found regarding morbidity, length of stay and Clavien-Dindo grading of complications between the two groups. DISCUSSION: Morbidity and length of stay in laparoscopic appendicectomy with normal appendix are not inferior to those with histologically confirmed appendicitis and thus should not be disregarded when considering a routine appendicectomy. CONCLUSION: The final decision to remove a normal appendix in laparoscopy for abdominal pain should be based on the individual clinical scenario and surgeon's experience. KEY WORDS: Acute appendicitis, Histology, Length of Stay, Morbidity.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Apêndice/anatomia & histologia , Laparoscopia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Radiol Technol ; 89(6): 571-590, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30420527

RESUMO

Near the ileocecal valve, at the junction of the small intestine and large intestine, lies a blind-ended tube and possible homeostatic regulator called the vermiform appendix. The organ can cause several abdominal maladies that, if left untreated, can result in a complicated recovery or death. Imaging professionals should understand the structure and function of the entire gastrointestinal tract to provide optimal care for patients undergoing diagnostic imaging. This article provides a brief overview of gastrointestinal anatomy, appendix physiology and function, clinical evaluation, appendix imaging, and treatment of appendicitis.


Assuntos
Apendicite/diagnóstico por imagem , Apêndice/diagnóstico por imagem , Tecnologia Radiológica , Apendicite/terapia , Apêndice/anatomia & histologia , Apêndice/fisiologia , Diagnóstico Diferencial , Humanos
8.
J Surg Res ; 230: 143-147, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30100031

RESUMO

BACKGROUND: The standard of care for treatment of lymphedema is manual lymphatic drainage and compression therapy, which is time intensive and requires a life-long commitment. Autologous lymph node transfer is a microsurgical treatment in which a vascularized lymph node flap is harvested with its blood supply and transferred to the lymphedematous region to assist with lymph fluid clearance. An ideal donor lymph node site minimizes the risk of iatrogenic lymphedema and other donor site morbidity. To address this, we have used jejunal mesentery lymph nodes and omental flaps and hypothesize that the mesoappendix, as a "spare part," may be an ideal autologous lymph node transfer donor site. METHODS: In this Institutional Review Board-approved study, 25 mesoappendix pathology specimens resected for benign disease underwent gross pathologic examination for the presence of lymph nodes and measurement of the appendicular artery and vein caliber and length. RESULTS: A single lymph node was present in two of 25 specimens (8%). Mean arterial and vein calibers at the point of ligation were 0.87 ± 0.44 mm and 0.86 ± 0.48 mm (range 0.30-2.2 mm and 0.25-2.2 mm), respectively. Mean arterial and vein length was 1.70 ± 1.06 cm and 1.84 ± 1.09 cm (range 0.8-4.5 cm for each), respectively. CONCLUSIONS: The mesoappendix rarely contains a lymph node. The artery and vein calibers of 46% of the specimens were greater than 0.8 mm, the minimum caliber preferred for microsurgical anastomosis. If transplantation of a vascularized lymph node for the treatment of lymphedema is desired, the mesoappendix is inconsistent in providing adequate lymph nodes.


Assuntos
Apêndice/anatomia & histologia , Retalhos de Tecido Biológico/transplante , Linfonodos/transplante , Linfedema/cirurgia , Mesentério/anatomia & histologia , Adulto , Idoso , Apêndice/transplante , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Humanos , Linfonodos/anatomia & histologia , Masculino , Mesentério/transplante , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Pessoa de Meia-Idade , Sítio Doador de Transplante/patologia , Sítio Doador de Transplante/cirurgia , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Adulto Jovem
9.
Mymensingh Med J ; 27(3): 487-495, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30141436

RESUMO

This cross sectional descriptive study was performed on 70 postmortem vermiform appendix (male 34 and female 36) to find out the external diameter of vermiform appendix of Bangladeshi people in different age and sex. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from October 2016 to March 2017 by purposive sampling technique. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy techniques. The vermiform appendix was collected and preserved in 10% formol-saline solution. The external diameter of vermiform appendix was measured with the help of digital slide calipers. Three measurements were taken at its base, middle and near the tip (1cm away from the tip) and expressed in mm. The data were analyzed by using student unpaired 't' test and compaired with the findings of other national and international studies and standard text books. It was observed that external diameter of vermiform appendix gradually decreased as age advanced. The mean±SD external diameter of vermiform appendix at base was 6.50±0.82 mm, 6.22±0.60 mm, 6.00±0.51 mm and 5.51±0.57 mm in Group A, B, C & D respectively. The mean±SD external diameter of vermiform appendix at middle was 6.09±0.89 mm, 5.67±0.65 mm, 5.38±0.59 mm and 4.95±0.76 mm in Group A, B, C and D respectively. The mean±SD external diameter of vermiform appendix near the tip (1 cm away from the tip) was 5.73±0.88 mm, 5.21±0.72 mm, 4.81±0.74 mm and 4.34±0.74 mm in Group A, B, C and D respectively. Statistical analysis shows that the mean differences of external diameter of vermiform appendix at its base between Group A&D, B&D were statistically moderately significant at p<0.01 level. Between Group C&D was statistically significant at p<0.05 level and between Group A&B, B&C, A&C were statistically non significant at p = or >0.05 level. Mean differences of external diameter of vermiform appendix at its middle between Group A&D, B&D were statistically moderately significant at p<0.01 level. Between Group A&C was statistically significant at p<0.05 level and between Group A&B, B&C, C&D were statistically non significant at p = or >0.05 level. Mean differences of external diameter of vermiform appendix near its tip (1 cm away from the tip) between Group A&D was statistically highly significant at p<0.001 and mean differences between Group B&D, A&C were statistically moderately significant at p<0.01 level. Between Group A&B was statistically significant at p<0.05 level and between Group B&C, C&D were statistically non significant at p = or >0.05 level. Mean external diameter of vermiform appendix in male was higher than that of female in all age group at its base, middle and near the tip (1cm away from the tip) but mean difference between sexes in the different study groups was statistically non significant at p = or >0.05 level. The present study will help to increase the information pool on the external diameter of vermiform appendix of Bangladeshi people.


Assuntos
Apêndice , Adolescente , Adulto , Idoso , Apêndice/anatomia & histologia , Autopsia , Bangladesh , Cadáver , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
Mymensingh Med J ; 27(2): 257-262, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29769487

RESUMO

A cross sectional descriptive study was performed on 70 postmortem vermiform appendix (male 34 and female 36) to find out the length of vermiform appendix of Bangladeshi people in different age and sex. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh from October 2016 to March 2017 by purposive sampling technique. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy techniques. The vermiform appendix was collected and preserved in 10% formol-saline solution. The length of the vermiform appendix was determined by measuring the distance from its base to tip with the help of a flexible thread. Then the thread was placed on measuring scale graduated in centimeter which represents the length of vermiform appendix. The data were analyzed by using student unpaired 't' test and compared with the findings of other national and international studies and standard text books. It was observed that length of vermiform appendix gradually decreased as age advanced. The mean±SD length of vermiform appendix was 9.41±1.26cm, 8.63±1.32cm, 7.96±1.20cm and 6.81±0.75cm in Group A, B, C and D respectively. Mean length of vermiform appendix in male was 9.92±1.55cm in Group A, 9.09±1.19cm in Group B, 8.04±1.10cm in Group C, 6.88±0.86cm in Group D and in female mean length of vermiform appendix was 9.12±1.06cm in Group A, 8.31±1.34cm in Group B, 7.79±1.60cm in Group C, 6.69±0.63cm in Group D. Statistical analysis shows that the mean differences of the length of vermiform appendix between A & D, B & D were statistically highly significant. The mean difference between Group A & C was moderately significant. Between Group C & D the difference was statistically significant and between Group A & B, B & C were statistically non significant. No significance difference of length of vermiform appendix between male and female was observed. The present study will help to increase the information pool on the length of vermiform appendix of Bangladeshi people.


Assuntos
Apêndice , Adolescente , Adulto , Idoso , Apêndice/anatomia & histologia , Autopsia , Bangladesh , Cadáver , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Pediatr Radiol ; 47(9): 1091-1100, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28779198

RESUMO

Appendicitis is the most common pediatric surgical emergency. Ultrasound (US) receives the highest appropriate rating scale in children with right lower quadrant pain suspected to have appendicitis. The US exam of the appendix has improved since Puylaert pioneered the technique of graded compression in 1986. In this article, we review ultrasonography of the pediatric appendix as it pertains to the normal appendix, acute appendicitis and the different sonographic manifestations. We also briefly describe technical optimization of image acquisition, common pitfalls and differential diagnoses.


Assuntos
Dor Abdominal/diagnóstico por imagem , Apendicite/diagnóstico por imagem , Ultrassonografia/métodos , Apêndice/anatomia & histologia , Apêndice/diagnóstico por imagem , Criança , Pré-Escolar , Diagnóstico Diferencial , Humanos , Lactente , Recém-Nascido
12.
AJR Am J Roentgenol ; 209(3): W128-W138, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28829172

RESUMO

OBJECTIVE: The purpose of this study is to identify the anatomic locations of appendixes on CT when graded compression sonography fails to visualize the appendix. MATERIALS AND METHODS: The study included 197 patients with suspected appendicitis whose appendixes were not visualized on graded compression sonography performed with typically used transducers of at least 10 MHz, who underwent CT within 48 hours following graded compression sonography, and who had available either pathologic examination following surgery or 6-week follow-up if surgery was not performed. Appendixes were retrospectively localized using four transverse quadrants (including the posteromedial quadrant) centered on the ileocecal valve and projected vertically, the craniocaudal level relative to the iliac crests, and the depth of the appendix as measured from the surface of the skin. Data were assessed using the Fisher exact test, t test, multinomial test, binomial distribution, ANOVA, and linear regression. RESULTS: Appendixes were most frequently located in the posteromedial quadrant (123 of 197 patients [62.4%]; 95% CI, 55.3-69.2%) at a statistically significantly greater frequency than that expected by chance (p < 0.00001). Appendixes were located above the iliac crests in 19.8% of patients (39/197; 95% CI, 14.5-26.1%) and at depths exceeding the penetration of typical transducers of at least 10 MHz in 19.3% of patients (38/197; 95% CI, 14.0-25.5%). All appendixes (95% CI, 98.1-100.0%) were located within the range of 6-MHz transducers. CONCLUSION: Appendixes that are not visualized on graded compression sonography are most frequently located in the posteromedial quadrant and are often located above the iliac crests or at depths too great for visualization with typically used transducers of at least 10 MHz. Accordingly, when the appendix is not visualized on graded compression sonography, targeted scanning of the posteromedial quadrant and the region above the iliac crests, and scanning with 6-MHz transducers, may enable visualization of the appendix and are recommended additions to scanning protocols.


Assuntos
Apendicite/diagnóstico por imagem , Apêndice/anatomia & histologia , Apêndice/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Criança , Pré-Escolar , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Iohexol , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
BMJ Case Rep ; 20172017 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-28827432

RESUMO

The vermiform appendix (whether inflamed or not) within a hernia is very rare occurrence. We present the unprecedented case of a normal appendix found within a Pfannenstiel incisional hernia. A diagnostic laparoscopy was performed as appendicitis was suspected. However, the tip of a normal appendix was visualised within a previous Pfannenstiel incision. Laparoscopic appendicectomy was carried successfully and the patient was discharged. The patient later returned for a successful elective laparoscopic incisional hernia repair.


Assuntos
Apendicite/cirurgia , Apêndice/cirurgia , Hérnia Incisional/cirurgia , Apendicectomia/métodos , Apendicite/diagnóstico , Apêndice/anatomia & histologia , Apêndice/patologia , Diagnóstico Diferencial , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Hérnia Incisional/complicações , Hérnia Incisional/patologia , Laparoscopia/métodos , Pessoa de Meia-Idade , Resultado do Tratamento
14.
Medicine (Baltimore) ; 96(21): e6447, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28538362

RESUMO

Organ weight is one important indicator to discern normal from abnormal condition in forensic pathology as well as in clinical medicine. The present study aimed to investigate morphometric parameters and organ weights of southern Iranian adults, which can be fundamental sources to be compared to abnormal cases.Morphometric parameters and weights of 6 organs (heart, liver, kidney, spleen, appendix, and brain), which were harvested from 501 southern Iranian adults (385 males and 116 females) during ordinary postmortem examination, were measured.All the organs were heavier in males than in females. Heart, brain, spleen, and right kidney were significantly heavier in males compared to females, but no significant difference was observed between the 2 sexes regarding the weights of the rest of the organs. Moreover, brain and heart became heavier as one got older and most organs were heavier in middle-aged individuals compared to other age groups. Furthermore, various types of correlations were observed between different organs' weights and body parameters.These results can be useful anatomical data for autopsy investigations, clinical practices, and research in southern Iran.


Assuntos
Autopsia , Tamanho do Órgão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Análise de Variância , Apêndice/anatomia & histologia , Encéfalo/anatomia & histologia , Feminino , Coração/anatomia & histologia , Humanos , Irã (Geográfico) , Rim/anatomia & histologia , Fígado/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Caracteres Sexuais , Baço/anatomia & histologia , Adulto Jovem
15.
Pediatr Radiol ; 47(3): 301-305, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28091700

RESUMO

BACKGROUND: Computed tomography (CT) is commonly used to evaluate suspected acute appendicitis. Although very effective, CT uses ionizing radiation, exposing patients to an increased risk of cancer. OBJECTIVE: This study assessed the potential for decreasing the field of view of the CT (and therefore the dose to the patient) in the evaluation of suspected acute appendicitis in children. MATERIALS AND METHODS: This study was a retrospective review of prospectively collected data from 212 consecutive patients who underwent CT for suspected acute appendicitis. The most superior aspect of the appendix with respect to vertebral bodies was recorded. Age, gender and diagnosis (negative, acute appendicitis or alternative diagnosis) were noted. RESULTS: The appendix was visualized in 190 of 212 subjects (89.6%). Overall, all visualized appendixes were located at or below the level of L1. Sixty-three of the subjects (29.7%) were diagnosed with acute appendicitis via CT imaging. All appendixes in patients with acute appendicitis were located at or below the level of the L3 vertebral body, predominating at the level of L5. Six subjects (3.1%) received alternative diagnoses, including pneumonia, pyelonephritis, small bowel obstruction and infected urachal cyst. There were no differences in appendix location with regard to diagnosis, gender, or age (P=0.664, 0.748 and 0.705, respectively). CONCLUSION: CT field of view may be decreased to the level of L1 or L3 superiorly, decreasing radiation dose without affecting the rate of appendix visualization.


Assuntos
Apendicite/diagnóstico por imagem , Apêndice/anatomia & histologia , Vértebras Lombares/anatomia & histologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Pontos de Referência Anatômicos , Criança , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Iopamidol , Masculino , Exposição à Radiação , Estudos Retrospectivos
16.
Pediatr Radiol ; 47(3): 294-300, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28062934

RESUMO

BACKGROUND: Confirmation of appendicitis in children often requires CT. A focused CT scan that is limited to the lower abdomen/pelvis might help to reduce radiation exposure. OBJECTIVE: To determine the position of the appendix relative to the umbilicus and derive a height-adjusted threshold for a focused CT that would identify most appendices. MATERIALS AND METHODS: We conducted a retrospective study of children younger than 18 years who underwent a CT scan for suspected appendicitis. A pediatric radiologist determined the distance from the most cephalad portion of the appendix to the center of the umbilicus. This distance was divided by the child's height to create a ratio for each child. We then assessed the largest of these distance/height ratios ("height constants") as potential height-adjusted thresholds that, when multiplied by any patient's height, would yield the superior threshold for the focused CT scan. Radiation reduction was calculated as percentage decrease in scan length compared to a complete abdominopelvic CT. RESULTS: Of 270 patients whose entire appendix was identified on CT, all were identified within 10.5 cm above the umbilicus. A focused CT using a height constant of 0.07 identified 100% of the appendices visualized on the complete CT scan and resulted in an estimated mean percentage radiation reduction of 27% (standard deviation [SD] +/-4.7). If a height constant of 0.03 was used, 97% of appendices were identified and the estimated radiation reduction was 43% (SD +/-4.3). CONCLUSION: A height-adjusted focused abdominopelvic CT scan might reduce radiation exposure without sacrificing the diagnostic accuracy of the complete CT scan.


Assuntos
Apendicite/diagnóstico por imagem , Apêndice/anatomia & histologia , Tomografia Computadorizada por Raios X/métodos , Umbigo/anatomia & histologia , Adolescente , Pontos de Referência Anatômicos , Estatura , Criança , Pré-Escolar , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Exposição à Radiação , Estudos Retrospectivos
17.
World J Surg ; 40(10): 2342-7, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27198997

RESUMO

BACKGROUND: Closure of the appendiceal stump is the most critical part of laparoscopic appendectomy. Establishing the average diameter of the inflamed appendix, and forming the appropriate size of clip, endoloop or stapler length, would make this critical phase of laparoscopic appendectomy easier. METHODS: One hundred and fifty consecutive patients, with the diagnosis of acute appendicitis, were included in this study and divided into three groups according to the histological verification of the status of the infection, as follows: phlegmonous, gangrenous and perforated forms of acute appendicitis. The external diameter of the appendiceal base was measured, and the widest part of the appendix with the mesoappendix and the tip, with the help of Vernier callipers, and the measurement was expressed in millimetres. RESULTS: The average size of the appendiceal base in the phlegmonous form was 10.29 ± 3.13, in the gangrenous form 12.41 ± 3.56, and in the perforated form 12.42 ± 3.64. The maximal size of base was observed in the perforated form, 23.13 mm. The dimensions of the appendiceal base, the central part and the tip in the phlegmonous form were statistically significantly smaller than in the gangrenous and perforated forms of acute appendicitis. The size of the appendix did not differ statistically significantly in the gangrenous and perforated forms of acute appendicitis. CONCLUSION: In view of the price, the size of the opening, radiological advantage and biocompatibility, the Hem-o-lok clip is the most effective, although its internal diameter should be increased. The DS clip is also effective, but the size of the opening sometimes makes application difficult, and possibly increasing the length of the legs and the opening would make this clip ideal. Staplers have the best characteristics, but their price means they are an option only for forms where it is not possible to close the stump using other methods.


Assuntos
Apendicectomia/métodos , Apêndice/anatomia & histologia , Laparoscopia/métodos , Doença Aguda , Apendicite/cirurgia , Gangrena/cirurgia , Humanos
18.
Eur Radiol ; 26(2): 532-8, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26518583

RESUMO

OBJECTIVE: To determine superior-inferior anatomic borders for CT following inconclusive/nondiagnostic US for possible appendicitis. METHODS: Ninety-nine patients with possible appendicitis and inconclusive/nondiagnostic US followed by CT were included in this retrospective study. Two radiologists reviewed CT images and determined superior-inferior anatomic borders required to diagnose or exclude appendicitis and diagnose alternative causes. This "targeted" coverage was used to estimate potential reduction in anatomic coverage compared to standard abdominal/pelvic CT. RESULTS: The study group included 83 women and 16 men; mean age 32 (median, 29; range 18-73) years. Final diagnoses were: nonspecific abdominal pain 50/99 (51%), appendicitis 26/99 (26%), gynaecological 12/99 (12%), gastrointestinal 9/99 (10%), and musculoskeletal 2/99 (2%). Median dose-length product for standard CT was 890.0 (range, 306.3 - 2493.9) mGy.cm. To confidently diagnose/exclude appendicitis or identify alternative diagnoses, maximum superior-inferior anatomic CT coverage was the superior border of L2-superior border of pubic symphysis, for both reviewers. Targeted CT would reduce anatomic coverage by 30-55% (mean 39%, median 40%) compared to standard CT. CONCLUSIONS: When CT is performed for appendicitis following inconclusive/nondiagnostic US, targeted CT from the superior border of L2-superior border of pubic symphysis can be used resulting in significant reduction in exposure to ionizing radiation compared to standard CT. KEY POINTS: • When CT is used following inconclusive/ nondiagnostic ultrasound, anatomic coverage can be reduced. • CT from L2 to pubic symphysis can be used to diagnose/exclude appendicitis. • Reduced anatomic coverage for CT results in reduced exposure to ionizing radiation.


Assuntos
Apendicite/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Abdome/anatomia & histologia , Abdome/diagnóstico por imagem , Adolescente , Adulto , Idoso , Apêndice/anatomia & histologia , Apêndice/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Pelve/anatomia & histologia , Pelve/diagnóstico por imagem , Radiografia Abdominal , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia , Adulto Jovem
19.
Kathmandu Univ Med J (KUMJ) ; 14(56): 357-361, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29336425

RESUMO

Background Appendix is a blind-ended tubular structure arising from caecum, with variable intraluminal contents and position. Acute appendicitis is one of the common indications for emergency radiological investigation. Objective To assess visualization rate, size and position of normal appendix by Computed Tomography (CT). Method This cross-sectional observational study was done in 198 individuals undergoing abdominal CT without suspicion of acute appendicitis and without any pathology localized within right iliac fossa. Axial and coronal reformatted images of nonenhanced and contrast enhanced CT of abdomen were evaluated for visualization of appendix. Visualized appendices arising from caecum were traced and tip localized. Contents within the appendicular lumen were also evaluated and maximum transverse diameter of appendix measured. The relationship between appendicular diameter, intraluminal content and position with different age groups & gender were also derived. Result Visualization rates of appendix were 90% (93% male and 87% female) in nonenhanced CT and 97% (99.8% male and 95.4% female) in enhanced CT. The mean diameter of the appendix was 6.2 ± 1.16 mm. Most common location of the tip of appendix was pelvic position, followed by retrocaecal position. Most of the appendices showed intraluminal air. Conclusion Multi-Detector Computed Tomography is superior over ultrasonography (USG) in detection of appendix. Modifications of CT protocol reduce limitations of CT over ultrasound in evaluation of appendix. Ultrasound size criteria for appendicitis (>6 mm) is not applicable in CT as normal appendix can measure >6 mm in CT.


Assuntos
Apêndice/anatomia & histologia , Apêndice/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Meios de Contraste , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto Jovem
20.
J Obstet Gynaecol ; 35(7): 688-90, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25693051

RESUMO

The aim of this study was to determine the location of the appendix at the third trimester of pregnancy as there are conflicting results in literature. Distances from the base of the appendix were measured intra-operatively to the anterior iliac spine (A), symphysis pubis (B) and the xyphoid process (C). The same measurements were taken from McBurney's point on the abdominal wall (A1, B1 and C1). In the allocated 21 pregnant and 18 non-pregnant women, distance A and B were 10.3 ± 0.9 cm and 18.3 ± 3.2 cm in pregnant and 6.7 ± 0.9 cm and 13.2 ± 0.9 cm in non-pregnant women (p < 0.001), respectively. Distance C was shorter in pregnant women (14.7 ± 2.5 cm vs. 23.8 ± 1.9, p < 0.001). Conversely, distance C1 was longer in pregnant women (30.3 ± 3.0 vs. 24.8 ± 5.1 cm, p = 0.004). This study provides evidence that the appendix moves cranially late in the course of the pregnancy. Therefore, McBurney's point cannot be used as a reference point to localise the appendix at the third trimester of pregnancy.


Assuntos
Apêndice/anatomia & histologia , Terceiro Trimestre da Gravidez , Gravidez , Pontos de Referência Anatômicos , Cesárea , Feminino , Humanos
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